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MSN Exam for Kidney Stones, Bladder Cancer, Prostate Disorders (PM)
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Question 1
A client received a kidney transplant 2 months ago. He’s admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected?
A
Elevated BUN and creatinine levels
B
Decreased WBC count
C
Normal body temperature
D
Hypotension
Question 1 Explanation:
In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. The nurse would see elevated WBC counts and fever because the body is recognizing the graft as foreign and is attempting to fight it. The client would most likely have acute hypertension.
Question 2
The client is to undergo kidney transplantation with a living donor. Which of the following preoperative assessments is important?
A
Urine output
B
Signs and symptoms of rejection
C
Signs of graft rejection
D
Client’s support system and understanding of lifestyle changes.
Question 2 Explanation:
The client undergoing a renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. The client is most likely anuric or oliguric preoperatively, but postoperatively will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important post-op will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important postoperatively due to the immunosuppressant therapy. Rejection can occur postoperatively.
Question 3
Because a client’s renal stone was found to be composed to uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications?
A
Milk, apples, tomatoes, and corn
B
Salmon, chicken, caviar, and asparagus
C
Eggs, spinach, dried peas, and gravy.
D
Grapes, corn, cereals, and liver.
Question 3 Explanation:
Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline-ash diet is also advocated, because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Food allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.
Question 4
The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply.
A
“If I limit my fluid intake I will not have to empty my ostomy pouch as often.”
B
“I can place an aspirin tablet in my pouch to decrease odor.”
C
“I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
D
“I should empty my ostomy pouch of urine when it is full.”
E
“I must use a skin barrier to protect my skin from urine.”
Question 4 Explanation:
The client with an ileal conduit must learn self-care activities related to care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 ml per day and should not limit intake. Adequate fluid intake helps to flush mucus from the ileal conduit. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight from pulling the appliance away from the skin.
Question 5
A priority nursing diagnosis for the client who is being discharged t home 3 days after a TURP would be:
A
Deficient fluid volume
B
Imbalanced Nutrition: Less than Body Requirements
C
Impaired Tissue Integrity
D
Ineffective Airway Clearance
Question 5 Explanation:
Deficient Fluid Volume is a priority diagnosis, because the client needs to drink a large amount of fluid to keep the urine clear. The urine should be almost without color. About 2 weeks after a TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the ED if at any time the urine turns bright red. The client is not specifically at risk for nutritional problems after a TURP. The client is not specifically at risk for nutritional problems after a TURP. The client is not specifically at risk for impaired tissue integrity because there is no external incision, and the client is not specifically at risk for airway problems because the procedure is done after spinal anesthesia.
Question 6
A client had a transurethral prostatectomy for benign prostatic hypertrophy. He’s currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first?
A
Stop the irrigation and call the physician
B
Check for the presence of clots, and make sure the catheter is draining properly.
C
Administer a belladonna and opium suppository as ordered by the physician.
D
Administer an oral analgesic
Question 6 Explanation:
Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn’t be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only afterassessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.
Question 7
The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms?
A
Nocturia
B
Urinary retention
C
Urge incontinence
D
Decreased force in the stream of urine
Question 7 Explanation:
Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.
Question 8
A client with BPH is being treated with terazosin (Hytrin) 2mg at bedtime. The nurse should monitor the client’s:
A
Pulse
B
White blood cell count
C
Blood pressure
D
Urinary nitrites
Question 8 Explanation:
Terazosin (Hytrin) is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or postural hypotension. The client should be instructed to change positions slowly. Urinary nitrites, white blood cell count, and pulse rate are not affected by terazosin.
Question 9
The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with what product?
A
Alcohol
B
Hydrogen peroxide
C
Soap
D
Baking soda
Question 9 Explanation:
A reusable appliance should be routinely cleaned with soap and water.
Question 10
The primary function of the prostate gland is:
A
To regulate the acidity and alkalinity of the environment for proper sperm development.
B
To store underdeveloped sperm before ejaculation
C
To produce a secretion that aids in the nourishment and passage of sperm
D
To secrete a hormone that stimulates the production and maturation of sperm
Question 10 Explanation:
The prostate gland is located below the bladder and surrounds the urethra. It serves one primary purpose: to produce a secretion that aids in the nourishment and passage of sperm.
Question 11
When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently, primarily to prevent which of the following problems?
A
Separation of the appliance from the skin
B
Interruption of urine production
C
Development of odor
D
Rupture of the ileal conduit
Question 11 Explanation:
If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin. A full appliance will not rupture the ileal conduit or interrupt urine production. Odor formation has numerous causes.
Question 12
The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to:
A
Prevent the catheter from kinking in the urethra
B
Prevent accidental catheter removal
C
Eliminate pressure at the penoscrotal angle
D
Allow the client to turn without kinking the catheter
Question 12 Explanation:
The primary reason for taping an indwelling catheter to a male client soothe penis is held in a lateral position to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula.
Question 13
The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions?
A
Avoid citrus fruits and citrus juices
B
Increase intake of meat, fish, plums, and cranberries
C
Increase intake of dairy products.
D
Avoid green, leafy vegetables such as spinach.
Question 13 Explanation:
Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
Question 14
A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client?
A
Frequent dribbling of urine
B
Loss of urine when coughing
C
Involuntary urination with minimal warning
D
Inability to empty the bladder
Question 14 Explanation:
A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urinary retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of vesicovaginal or urethrovaginal fistula.
Question 15
A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors?
A
Antibodies
B
Composition of calculus
C
Type of infection
D
Size and number of calculi
Question 15 Explanation:
The calculus should be analyzed for composition to determine appropriate interventions such as dietary restrictions. Calculi don’t result in infections. The size and number of calculi aren’t relevant, and they don’t contain antibodies.
Question 16
Which of the following symptoms indicate acute rejection of a transplanted kidney?
A
Increased WBC count, pain with voiding
B
Fever, anorexia
C
Edema, nausea
D
Weight gain, pain at graft site
Question 16 Explanation:
Pain at the graft site and weight gain indicates the transplanted kidney isn’t functioning and possibly is being rejected. Transplant clients usually have edema, anorexia, fever, and nausea before transplantation, so those symptoms may not indicate rejection.
Question 17
The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include on the client’s postoperative care?
A
Sterile irrigation of the Penrose drain
B
Weighing the dressings
C
Frequent dressing changes around the Penrose drain
D
Maintaining the client’s position on the affected side
Question 17 Explanation:
Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. A Penrose drain is not irrigated. Weighing the dressings is not necessary. Placing the client on the affected side will prevent a free flow of urine through the drain.
Question 18
Which of the following assessment data would most likely be related to a client’s current complaint of stress incontinence?
A
The client’s intake of 2 to 3 L of fluid per day.
B
The client’s age of 45 years
C
The client’s history of three full-term pregnancies
D
The client’s history of competitive swimming
Question 18 Explanation:
The history of three pregnancies is most likely the cause of the client’s current episodes of stress incontinence. The client’s fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.
Question 19
The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care?
A
No special precautions except to wear gloves if in contact with the client’s urine.
B
Save all urine in a radiation safe container for 18 hours
C
Limit contact with the client to 20 minutes per hour.
D
Place the client on radiation precautions for 18 hours
Question 19 Explanation:
No specific precautions are necessary following a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions.
Question 20
The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas?
A
Hip
B
Umbilicus
C
Costovertebral angle
D
Shoulder
Question 20 Explanation:
Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip.
Question 21
A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and postobstructive diuresis is occurring. Which of the following interventions should be done?
A
Assess for urine output every shift
B
Monitor the client’s electrolyte levels.
C
Take vital signs every 8 hours
D
Weigh the client every other day
Question 21 Explanation:
Postobstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The client’s weight should be taken daily to assess fluid status more closely.
Question 22
If a client’s prostate enlargement is caused by a malignancy, which of the following blood examinations should the nurse anticipate to assess whether metastasis has occurred?
A
Serum creatinine level
B
Endogenous creatinine clearance time
C
Serum acid phosphatase level
D
Total nonprotein nitrogen level
Question 22 Explanation:
The most specific examination to determine whether a malignancy extends outside of the prostatic capsule is a study of the serum acid phosphatase level. The level increases when a malignancy has metastasized. The prostate specific antigen (PSA) determination and a digital rectal examination are done when screening for prostate cancer. Serum creatinine level, total nonprotein nitrogen level, and endogenous creatinine clearance time give information about kidney function, not prostate malignancy.
Question 23
The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client’s VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician?
A
Blood pressure of 100/50 and pulse 130.
B
Urinary output of 200 ml greater than intake
C
Pain related to bladder spasms.
D
Red bloody urine
Question 23 Explanation:
Frank bleeding (arterial or venous) may occur during the first few days after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 ml of greater than intake is adequate. Bladder spasms are expected to occur after surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The physician should be notified.
Question 24
Steroids, if used following kidney transplantation would cause which of the following side effects?
A
Orthostatic Hypotension
B
Increase Blood Glucose Level
C
Increase Cholesterol Level
D
Alopecia
Question 25
A 27-year old client, who became paraplegic after a swimming accident, is experiencing autonomic dysreflexia. Which condition is the most common cause of autonomic dysrelexia?
A
Bladder distention
B
Incontinence
C
Upper respiratory infection
D
Diarrhea
Question 25 Explanation:
Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. Incontinence and diarrhea don’t result in obstruction of the urinary system or bowel, respectively. An URI could obstruct the respiratory system, but not the urinary or bowel system.
Question 26
A client is diagnosed with prostate cancer. Which test is used to monitor progression of this disease?
A
Prostate specific antigen (PSA)
B
Serum potassium
C
Complete blood cell count (CBC)
D
Serum creatinine
Question 26 Explanation:
The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Serum creatinine levels may suggest blockage from an enlarged prostate. CBC is used to diagnose anemia and polycythemia. Serum potassium levels identify hypokalemia and hyperkalemia.
Question 27
The client has a clinic appointment scheduled 10 days after discharge. Which laboratory finding at that time would indicate that allopurinol (Zyloprim) has had a therapeutic effect?
A
Decreased serum uric acid level
B
Increased urinary calcium excretion
C
Decreased urinary alkaline phosphatase level
D
Increased serum calcium level
Question 27 Explanation:
By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drug’s effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, not does it affect urinary calcium excretion or the serum calcium level.
Question 28
Adverse reactions of prednisone therapy include which of the following conditions?
A
Sodium retention and constipation
B
Increased blood glucose levels and decreased wound healing.
C
Acne and bleeding gums
D
Mood swings and increased temperature
Question 28 Explanation:
Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood swings, and sodium and water retention. Steroids don’t affect thermoregulation, bleeding tendencies, or constipation.
Question 29
A client is receiving a radiation implant for the treatment of bladder cancer. Which of the following interventions is appropriate?
A
Restrict the client’s fluid intake
B
Monitor the client for signs and symptoms of cystitis
C
Place the client in a semi-private room
D
Flush all urine down the toilet
Question 29 Explanation:
Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Clients with radiation implants require a private room. Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes lab for monitoring. It is recommended that fluid intake be increased.
Question 30
The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria?
A
Restricting fluids
B
Irrigation of foley catheter
C
Administration of diuretics
D
Encourage fluid intake
Question 30 Explanation:
To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the foley catheter will not assist in allievating this oliguria.
Question 31
When developing a plan of care for the client with stress incontinence, the nurse should take into consideration that stress incontinence is best defined as the involuntary loss of urine associated with:
A
A strong urge to urinate
B
Overdistention of the bladder
C
Obstruction of the urethra
D
Activities that increase abdominal pressure
Question 31 Explanation:
Stress incontinence is the involuntary loss of urine during such activities as coughing, sneezing, laughing, or physical exertion. These activities increase abdominal and detruser pressure. A strong urge to urinate is associated with urge incontinence. Overdistention of the bladder can lead to overflow incontinence. Obstruction of the urethra can lead to urinary retention.
Question 32
Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication?
A
Retinopathy
B
Dizziness
C
Nasal congestion
D
Maculopapular rash
Question 32 Explanation:
Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiess, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not side effects of allopurinol.
Question 33
The nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis?
A
High urine specific gravity
B
Normal to low urine specific gravity
C
High urine osmolarity
D
Elevated urine pH
Question 33 Explanation:
Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. High specific gravity indicates dehydration. Hypernatremia signals acidosis and shock. Elevated urine pH can result from potassium deficiency, a high-protein diet, or uncontrolled diabetes.
Question 34
The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome?
A
Bradycardia and confusion
B
Decreased urinary output and bladder spasms
C
Tachycardia and diarrhea
D
Increased urinary output and anemia
Question 34 Explanation:
Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.
Question 35
The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones?
A
Calcium oxalate
B
Cystine
C
Struvite
D
Uric acid
Question 35 Explanation:
Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect that results in decreased renal absorption of the amino acid cystine.
Question 36
The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on the assessment data, which of the following nursing interventions would be most appropriate at this time?
A
Notify the physician
B
Change the appliance bag
C
Obtain a urine specimen for culture
D
Encourage a high fluid intake
Question 36 Explanation:
Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.
Question 37
The client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client’s problem is related to bacterial prostatitis, the nurse would look at the results of the prostate examination, which should reveal that the prostate gland is:
A
Reddened, swollen, and boggy.
B
Tender and edematous with ecchymosis
C
Soft and swollen
D
Tender, indurated, and warm to the touch
Question 37 Explanation:
The client with prostatitis has a prostate gland that is swollen and tender but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder).
Question 38
The nurse is receiving in transfer from the postanesthesia care unit a client who has had a percutaneous ultrasonic lithrotripsy for calculuses in the renal pelvis. The nurse anticipates that the client’s care will involve monitoring which of the following?
A
Urethral stent
B
Nephrostomy tube
C
Jackson-Pratt drain
D
Suprapubic tube
Question 38 Explanation:
A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculus fragments.
Question 39
The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician?
A
Temperature, 99.8
B
A 2×2 inch area of serous sanguineous drainage on the flank dressing.
C
Absence of bowel sounds
D
Urine output, 20 ml/hour
Question 39 Explanation:
The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serous sanguineous drainage is to be expected.
Question 40
A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time?
A
Apply warm compresses to the flank area
B
Strain the urine carefully
C
Report hematuria to the physician
D
Administer meperidine (Demerol) every 3 hours
Question 40 Explanation:
Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessoned.
Question 41
A client is scheduled to undergo a transurethral resection of the prostate gland (TURP). The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should be particularly alert for early signs of:
A
Renal shutdown
B
Cardiac arrest
C
Convulsions
D
Respiratory paralysis
Question 41 Explanation:
If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Convulsions, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.
Question 42
During a client’s urinary bladder catherization, the bladder is emptied gradually. The best rationale for the nurse’s action is that completely emptying an overdistended bladder at one time tends to cause:
A
Abdominal cramping
B
Possible shock
C
Renal failure
D
Atrophy of bladder musculature
Question 42 Explanation:
Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 ml at one time was the standard of practice, but this is no longer thought to be necessary as long as the overdistended bladder is emptied slowly.
Question 43
A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for:
A
Dullness in the lower left quadrant
B
Urine discharge from the urethral meatus
C
A rounded swelling above the pubis.
D
Rebound tenderness below the symphysis
Question 43 Explanation:
The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.
Question 44
A client underwent a TURP, and a large three way catheter was inserted in the bladder with continuous bladder irrigation. In which of the following circumstances would the nurse increase the flow rate of the continuous bladder irrigation?
A
When the drainage appears cloudy and dark yellow
B
When the drainage becomes bright red
C
When there is no drainage of urine and irrigating solution
D
When the drainage is continuous but slow
Question 44 Explanation:
The decision made by the surgeon to insert a catheter after a TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.
Question 45
A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. Which of the following conditions is a major complication of this drug therapy?
A
Hemorrhage
B
Infection
C
Depression
D
Peptic ulcer disease
Question 45 Explanation:
Infections is the major complication to watch for in clients on cyclosporine therapy because it’s an immunosuppressive drug. Depression may occur posttransplantation but not because of cyclosporine. Hemorrhage is a complication associated with anticoagulant therapy. Peptic ulcer disease is a complication of steroid therapy.
Question 46
The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications?
A
Decongestants
B
Diuretics
C
Antibiotics
D
Antitussives
Question 46 Explanation:
In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.
Question 47
The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent:
A
Urine leakage
B
The need to restrict fluids
C
Appliance separation
D
Urine reflux into the stoma
Question 47 Explanation:
The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent reflux into the stoma and ureters, which can result in infection. Use of a standard collection bag also keeps the appliance from separating from the skin and helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. A client with a urinary diversion should drink 2000-3000 ml of fluid each day; it would be inappropriate to suggest decreasing fluid intake.
Question 48
When providing discharge teaching for a client with uric acid calculi, the nurse should an instruction to avoid which type of diet?
A
Low-calcium
B
High-purine
C
High-oxalate
D
Low-oxalate
Question 48 Explanation:
To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. A low-calcium diet decreases the risk for oxalate renal calculi. Oxalate is an essential amino acid and must be included in the diet. A low-oxalate diet is used to control calcium or oxalate calculi.
Question 49
A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to:
A
Ensure that the catheter is draining freely
B
Clamp the catheter every 2 hours for 30 minutes.
C
Irrigate the catheter with 30 ml of normal saline every 8 hours
D
Ensure that the catheter drains at least 30 ml an hour
Question 49 Explanation:
The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client’s total urine output (ureteral catheter plus voiding or foley catheter output) should be 30 ml/hour.
Question 50
Mr. Roberto was readmitted to the hospital with acute graft rejection. Which of the following assessment finding would be expected?
A
Normal Body Temperature
B
Hypotension
C
Elevated BUN and Creatinine
D
Decreased WBC
Question 51
The nurse teaches the client with an ileal conduit measures to prevent a UTI. Which of the following measures would be most effective?
A
Maintain a daily fluid intake of 2,000 to 3,000 ml
B
Irrigate the stoma daily.
C
Avoid people with respiratory tract infections
D
Use sterile technique to change the appliance
Question 51 Explanation:
Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be effective in preventing UTI. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.
Question 52
The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included?
A
Avoid activities that are stressful and upsetting
B
Limit physical exertion
C
Do not wear a girdle
D
Avoid caffeine and alcohol
Question 52 Explanation:
Client’s with stress incontinence are encouraged to avoid substances such as caffeine and alcohol which are bladder irritants. Emotional stressors do not cause stress incontinence. It is caused most commonly be relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may be inclined to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.
Question 53
A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The x-ray results the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following?
A
Kidney obstruction
B
Acute rejection
C
Kidney infection
D
Chronic rejection
Question 53 Explanation:
Acute rejection most often occurs in the first 2 weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Chronic rejection occurs gradually during a period of months to years. Although kidney infection or obstruction can occur, the symptoms presented in the question do not relate specifically to these disorders.
Question 54
After surgery for an ileal conduit, the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery?
A
Ascites
B
Inguinal hernia
C
Peritonitis
D
Thrombophlebitis
Question 54 Explanation:
After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal surgery.
Question 55
A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important?
A
Strain all urine
B
Limit fluid intake
C
Encourage a high calcium diet
D
Enforce strict bed rest
Question 55 Explanation:
Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary tract and prevent further calculi formation. A low-calcium diet is recommended to help prevent the formation of calcium calculi. Ambulation is encouraged to help pass the calculi through gravity.
Question 56
A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client’s understanding of the surgical procedure by explaining that an ileal conduit:
A
Is a temporary procedure that can be reversed later.
B
Conveys urine from the ureters to a stoma opening in the abdomen.
C
Creates an opening in the bladder that allows urine to drain into an external pouch.
D
Diverts urine into the sigmoid colon, where it is expelled through the rectum.
Question 56 Explanation:
An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible. Diversion of the urine to the sigmoid colon is called a ureteroileosigmoidostomy. An opening in the bladder that allows urine to drain externally is called a cystostomy.
Question 57
Which of the following interventions would be most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
A
Encourage the client to ambulate every 2 to 4 hours
B
Offer 3 to 4 ounces of a carbonated beverage periodically.
C
Encourage use of a stool softener
D
Continue intravenous fluid therapy
Question 57 Explanation:
Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until peristalsis returns. Intravenous fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus. A stool softener will not stimulate peristalsis.
Question 58
A female client with a urinary diversion tells the nurse, “This urinary pouch is embarrassing. Everyone will know that I’m not normal. I don’t see how I can go out in public anymore.” The most appropriate nursing diagnosis for this patient is:
A
Deficient Knowledge about how to care for the urinary diversion.
B
Low Self-Esteem related to feelings of worthlessness
C
Disturbed Body Image related to creation of a urinary diversion.
D
Anxiety related to the presence of urinary diversion.
Question 58 Explanation:
It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggest that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner. Although the client may be anxious about this situation and self-esteem may be diminished, the underlying problem is disturbance in body image. There are no data to support a diagnosis of Deficient Knowledge.
Question 59
Which of the following symptoms is the most common clinical finding associated with bladder cancer?
A
Urinary retention
B
Dysuria
C
Suprapubic pain
D
Painless hematuria
Question 59 Explanation:
Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency, dysuria, and urgency, but these are not as common as the hematuria. Suprapubic pain and urinary retention do not occur in bladder cancer.
Question 60
The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH?
A
Inhaled ipratropium (Atrovent)
B
Buspirone (BuSpar)
C
Ophthalmic timolol (Timoptic)
D
Metformin (Glucophage)
Question 60 Explanation:
Atrovent is a bronchodilator, and its anticholinergic effects can aggravate urinary retention. Glucophage and BuSpar do not affect the urinary system; timolol does not have a systemic effect.
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MSN Exam for Kidney Stones, Bladder Cancer, Prostate Disorders (EM)
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Question 1
The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on the assessment data, which of the following nursing interventions would be most appropriate at this time?
A
Encourage a high fluid intake
B
Change the appliance bag
C
Notify the physician
D
Obtain a urine specimen for culture
Question 1 Explanation:
Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.
Question 2
A client is scheduled to undergo a transurethral resection of the prostate gland (TURP). The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should be particularly alert for early signs of:
A
Renal shutdown
B
Respiratory paralysis
C
Convulsions
D
Cardiac arrest
Question 2 Explanation:
If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Convulsions, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.
Question 3
A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client?
A
Involuntary urination with minimal warning
B
Inability to empty the bladder
C
Frequent dribbling of urine
D
Loss of urine when coughing
Question 3 Explanation:
A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urinary retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of vesicovaginal or urethrovaginal fistula.
Question 4
The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include on the client’s postoperative care?
A
Weighing the dressings
B
Maintaining the client’s position on the affected side
C
Sterile irrigation of the Penrose drain
D
Frequent dressing changes around the Penrose drain
Question 4 Explanation:
Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. A Penrose drain is not irrigated. Weighing the dressings is not necessary. Placing the client on the affected side will prevent a free flow of urine through the drain.
Question 5
The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client’s VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician?
A
Pain related to bladder spasms.
B
Blood pressure of 100/50 and pulse 130.
C
Urinary output of 200 ml greater than intake
D
Red bloody urine
Question 5 Explanation:
Frank bleeding (arterial or venous) may occur during the first few days after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 ml of greater than intake is adequate. Bladder spasms are expected to occur after surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The physician should be notified.
Question 6
When developing a plan of care for the client with stress incontinence, the nurse should take into consideration that stress incontinence is best defined as the involuntary loss of urine associated with:
A
Activities that increase abdominal pressure
B
A strong urge to urinate
C
Obstruction of the urethra
D
Overdistention of the bladder
Question 6 Explanation:
Stress incontinence is the involuntary loss of urine during such activities as coughing, sneezing, laughing, or physical exertion. These activities increase abdominal and detruser pressure. A strong urge to urinate is associated with urge incontinence. Overdistention of the bladder can lead to overflow incontinence. Obstruction of the urethra can lead to urinary retention.
Question 7
After surgery for an ileal conduit, the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery?
A
Ascites
B
Inguinal hernia
C
Thrombophlebitis
D
Peritonitis
Question 7 Explanation:
After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal surgery.
Question 8
The nurse is receiving in transfer from the postanesthesia care unit a client who has had a percutaneous ultrasonic lithrotripsy for calculuses in the renal pelvis. The nurse anticipates that the client’s care will involve monitoring which of the following?
A
Suprapubic tube
B
Nephrostomy tube
C
Urethral stent
D
Jackson-Pratt drain
Question 8 Explanation:
A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculus fragments.
Question 9
If a client’s prostate enlargement is caused by a malignancy, which of the following blood examinations should the nurse anticipate to assess whether metastasis has occurred?
A
Serum creatinine level
B
Serum acid phosphatase level
C
Total nonprotein nitrogen level
D
Endogenous creatinine clearance time
Question 9 Explanation:
The most specific examination to determine whether a malignancy extends outside of the prostatic capsule is a study of the serum acid phosphatase level. The level increases when a malignancy has metastasized. The prostate specific antigen (PSA) determination and a digital rectal examination are done when screening for prostate cancer. Serum creatinine level, total nonprotein nitrogen level, and endogenous creatinine clearance time give information about kidney function, not prostate malignancy.
Question 10
Which of the following interventions would be most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
A
Offer 3 to 4 ounces of a carbonated beverage periodically.
B
Continue intravenous fluid therapy
C
Encourage use of a stool softener
D
Encourage the client to ambulate every 2 to 4 hours
Question 10 Explanation:
Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until peristalsis returns. Intravenous fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus. A stool softener will not stimulate peristalsis.
Question 11
The client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client’s problem is related to bacterial prostatitis, the nurse would look at the results of the prostate examination, which should reveal that the prostate gland is:
A
Reddened, swollen, and boggy.
B
Soft and swollen
C
Tender, indurated, and warm to the touch
D
Tender and edematous with ecchymosis
Question 11 Explanation:
The client with prostatitis has a prostate gland that is swollen and tender but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder).
Question 12
The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included?
A
Avoid caffeine and alcohol
B
Avoid activities that are stressful and upsetting
C
Do not wear a girdle
D
Limit physical exertion
Question 12 Explanation:
Client’s with stress incontinence are encouraged to avoid substances such as caffeine and alcohol which are bladder irritants. Emotional stressors do not cause stress incontinence. It is caused most commonly be relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may be inclined to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.
Question 13
A 27-year old client, who became paraplegic after a swimming accident, is experiencing autonomic dysreflexia. Which condition is the most common cause of autonomic dysrelexia?
A
Bladder distention
B
Diarrhea
C
Upper respiratory infection
D
Incontinence
Question 13 Explanation:
Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. Incontinence and diarrhea don’t result in obstruction of the urinary system or bowel, respectively. An URI could obstruct the respiratory system, but not the urinary or bowel system.
Question 14
The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms?
A
Urinary retention
B
Decreased force in the stream of urine
C
Urge incontinence
D
Nocturia
Question 14 Explanation:
Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.
Question 15
The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician?
A
Absence of bowel sounds
B
Temperature, 99.8
C
Urine output, 20 ml/hour
D
A 2×2 inch area of serous sanguineous drainage on the flank dressing.
Question 15 Explanation:
The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serous sanguineous drainage is to be expected.
Question 16
A client received a kidney transplant 2 months ago. He’s admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected?
A
Normal body temperature
B
Elevated BUN and creatinine levels
C
Decreased WBC count
D
Hypotension
Question 16 Explanation:
In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. The nurse would see elevated WBC counts and fever because the body is recognizing the graft as foreign and is attempting to fight it. The client would most likely have acute hypertension.
Question 17
The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas?
A
Shoulder
B
Costovertebral angle
C
Umbilicus
D
Hip
Question 17 Explanation:
Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip.
Question 18
Mr. Roberto was readmitted to the hospital with acute graft rejection. Which of the following assessment finding would be expected?
A
Normal Body Temperature
B
Elevated BUN and Creatinine
C
Hypotension
D
Decreased WBC
Question 19
A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors?
A
Antibodies
B
Composition of calculus
C
Size and number of calculi
D
Type of infection
Question 19 Explanation:
The calculus should be analyzed for composition to determine appropriate interventions such as dietary restrictions. Calculi don’t result in infections. The size and number of calculi aren’t relevant, and they don’t contain antibodies.
Question 20
The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with what product?
A
Hydrogen peroxide
B
Baking soda
C
Alcohol
D
Soap
Question 20 Explanation:
A reusable appliance should be routinely cleaned with soap and water.
Question 21
Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication?
A
Retinopathy
B
Dizziness
C
Nasal congestion
D
Maculopapular rash
Question 21 Explanation:
Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiess, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not side effects of allopurinol.
Question 22
When providing discharge teaching for a client with uric acid calculi, the nurse should an instruction to avoid which type of diet?
A
Low-calcium
B
Low-oxalate
C
High-purine
D
High-oxalate
Question 22 Explanation:
To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. A low-calcium diet decreases the risk for oxalate renal calculi. Oxalate is an essential amino acid and must be included in the diet. A low-oxalate diet is used to control calcium or oxalate calculi.
Question 23
When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently, primarily to prevent which of the following problems?
A
Interruption of urine production
B
Development of odor
C
Rupture of the ileal conduit
D
Separation of the appliance from the skin
Question 23 Explanation:
If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin. A full appliance will not rupture the ileal conduit or interrupt urine production. Odor formation has numerous causes.
Question 24
A client had a transurethral prostatectomy for benign prostatic hypertrophy. He’s currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first?
A
Check for the presence of clots, and make sure the catheter is draining properly.
B
Administer an oral analgesic
C
Administer a belladonna and opium suppository as ordered by the physician.
D
Stop the irrigation and call the physician
Question 24 Explanation:
Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn’t be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only afterassessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.
Question 25
A priority nursing diagnosis for the client who is being discharged t home 3 days after a TURP would be:
A
Impaired Tissue Integrity
B
Deficient fluid volume
C
Ineffective Airway Clearance
D
Imbalanced Nutrition: Less than Body Requirements
Question 25 Explanation:
Deficient Fluid Volume is a priority diagnosis, because the client needs to drink a large amount of fluid to keep the urine clear. The urine should be almost without color. About 2 weeks after a TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the ED if at any time the urine turns bright red. The client is not specifically at risk for nutritional problems after a TURP. The client is not specifically at risk for impaired tissue integrity because there is no external incision, and the client is not specifically at risk for airway problems because the procedure is done after spinal anesthesia.
Question 26
The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones?
A
Uric acid
B
Calcium oxalate
C
Cystine
D
Struvite
Question 26 Explanation:
Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect that results in decreased renal absorption of the amino acid cystine.
Question 27
The nurse teaches the client with an ileal conduit measures to prevent a UTI. Which of the following measures would be most effective?
A
Use sterile technique to change the appliance
B
Maintain a daily fluid intake of 2,000 to 3,000 ml
C
Irrigate the stoma daily.
D
Avoid people with respiratory tract infections
Question 27 Explanation:
Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be effective in preventing UTI. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.
Question 28
A client is receiving a radiation implant for the treatment of bladder cancer. Which of the following interventions is appropriate?
A
Restrict the client’s fluid intake
B
Monitor the client for signs and symptoms of cystitis
C
Place the client in a semi-private room
D
Flush all urine down the toilet
Question 28 Explanation:
Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Clients with radiation implants require a private room. Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes lab for monitoring. It is recommended that fluid intake be increased.
Question 29
Adverse reactions of prednisone therapy include which of the following conditions?
A
Mood swings and increased temperature
B
Sodium retention and constipation
C
Increased blood glucose levels and decreased wound healing.
D
Acne and bleeding gums
Question 29 Explanation:
Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood swings, and sodium and water retention. Steroids don’t affect thermoregulation, bleeding tendencies, or constipation.
Question 30
A female client with a urinary diversion tells the nurse, “This urinary pouch is embarrassing. Everyone will know that I’m not normal. I don’t see how I can go out in public anymore.” The most appropriate nursing diagnosis for this patient is:
A
Anxiety related to the presence of urinary diversion.
B
Deficient Knowledge about how to care for the urinary diversion.
C
Low Self-Esteem related to feelings of worthlessness
D
Disturbed Body Image related to creation of a urinary diversion.
Question 30 Explanation:
It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggest that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner. Although the client may be anxious about this situation and self-esteem may be diminished, the underlying problem is disturbance in body image. There are no data to support a diagnosis of Deficient Knowledge.
Question 31
A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. Which of the following conditions is a major complication of this drug therapy?
A
Depression
B
Infection
C
Peptic ulcer disease
D
Hemorrhage
Question 31 Explanation:
Infections is the major complication to watch for in clients on cyclosporine therapy because it’s an immunosuppressive drug. Depression may occur posttransplantation but not because of cyclosporine. Hemorrhage is a complication associated with anticoagulant therapy. Peptic ulcer disease is a complication of steroid therapy.
Question 32
Steroids, if used following kidney transplantation would cause which of the following side effects?
A
Increase Cholesterol Level
B
Increase Blood Glucose Level
C
Orthostatic Hypotension
D
Alopecia
Question 33
The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria?
A
Restricting fluids
B
Irrigation of foley catheter
C
Administration of diuretics
D
Encourage fluid intake
Question 33 Explanation:
To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the foley catheter will not assist in allievating this oliguria.
Question 34
A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to:
A
Ensure that the catheter is draining freely
B
Clamp the catheter every 2 hours for 30 minutes.
C
Ensure that the catheter drains at least 30 ml an hour
D
Irrigate the catheter with 30 ml of normal saline every 8 hours
Question 34 Explanation:
The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client’s total urine output (ureteral catheter plus voiding or foley catheter output) should be 30 ml/hour.
Question 35
A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time?
A
Report hematuria to the physician
B
Apply warm compresses to the flank area
C
Administer meperidine (Demerol) every 3 hours
D
Strain the urine carefully
Question 35 Explanation:
Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessoned.
Question 36
The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome?
A
Increased urinary output and anemia
B
Decreased urinary output and bladder spasms
C
Bradycardia and confusion
D
Tachycardia and diarrhea
Question 36 Explanation:
Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.
Question 37
The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to:
A
Prevent accidental catheter removal
B
Allow the client to turn without kinking the catheter
C
Prevent the catheter from kinking in the urethra
D
Eliminate pressure at the penoscrotal angle
Question 37 Explanation:
The primary reason for taping an indwelling catheter to a male client soothe penis is held in a lateral position to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula.
Question 38
The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent:
A
Appliance separation
B
Urine reflux into the stoma
C
The need to restrict fluids
D
Urine leakage
Question 38 Explanation:
The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent reflux into the stoma and ureters, which can result in infection. Use of a standard collection bag also keeps the appliance from separating from the skin and helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. A client with a urinary diversion should drink 2000-3000 ml of fluid each day; it would be inappropriate to suggest decreasing fluid intake.
Question 39
A client is diagnosed with prostate cancer. Which test is used to monitor progression of this disease?
A
Complete blood cell count (CBC)
B
Prostate specific antigen (PSA)
C
Serum potassium
D
Serum creatinine
Question 39 Explanation:
The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Serum creatinine levels may suggest blockage from an enlarged prostate. CBC is used to diagnose anemia and polycythemia. Serum potassium levels identify hypokalemia and hyperkalemia.
Question 40
The nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis?
A
Elevated urine pH
B
High urine specific gravity
C
High urine osmolarity
D
Normal to low urine specific gravity
Question 40 Explanation:
Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. High specific gravity indicates dehydration. Hypernatremia signals acidosis and shock. Elevated urine pH can result from potassium deficiency, a high-protein diet, or uncontrolled diabetes.
Question 41
The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions?
A
Increase intake of meat, fish, plums, and cranberries
B
Avoid citrus fruits and citrus juices
C
Avoid green, leafy vegetables such as spinach.
D
Increase intake of dairy products.
Question 41 Explanation:
Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
Question 42
A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The x-ray results the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following?
A
Acute rejection
B
Kidney infection
C
Chronic rejection
D
Kidney obstruction
Question 42 Explanation:
Acute rejection most often occurs in the first 2 weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Chronic rejection occurs gradually during a period of months to years. Although kidney infection or obstruction can occur, the symptoms presented in the question do not relate specifically to these disorders.
Question 43
The client has a clinic appointment scheduled 10 days after discharge. Which laboratory finding at that time would indicate that allopurinol (Zyloprim) has had a therapeutic effect?
A
Increased serum calcium level
B
Increased urinary calcium excretion
C
Decreased urinary alkaline phosphatase level
D
Decreased serum uric acid level
Question 43 Explanation:
By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drug’s effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, not does it affect urinary calcium excretion or the serum calcium level.
Question 44
The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications?
A
Diuretics
B
Antibiotics
C
Decongestants
D
Antitussives
Question 44 Explanation:
In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.
Question 45
A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important?
A
Encourage a high calcium diet
B
Strain all urine
C
Enforce strict bed rest
D
Limit fluid intake
Question 45 Explanation:
Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary tract and prevent further calculi formation. A low-calcium diet is recommended to help prevent the formation of calcium calculi. Ambulation is encouraged to help pass the calculi through gravity.
Question 46
Which of the following assessment data would most likely be related to a client’s current complaint of stress incontinence?
A
The client’s history of three full-term pregnancies
B
The client’s age of 45 years
C
The client’s history of competitive swimming
D
The client’s intake of 2 to 3 L of fluid per day.
Question 46 Explanation:
The history of three pregnancies is most likely the cause of the client’s current episodes of stress incontinence. The client’s fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.
Question 47
The primary function of the prostate gland is:
A
To store underdeveloped sperm before ejaculation
B
To secrete a hormone that stimulates the production and maturation of sperm
C
To regulate the acidity and alkalinity of the environment for proper sperm development.
D
To produce a secretion that aids in the nourishment and passage of sperm
Question 47 Explanation:
The prostate gland is located below the bladder and surrounds the urethra. It serves one primary purpose: to produce a secretion that aids in the nourishment and passage of sperm.
Question 48
Which of the following symptoms indicate acute rejection of a transplanted kidney?
A
Fever, anorexia
B
Weight gain, pain at graft site
C
Increased WBC count, pain with voiding
D
Edema, nausea
Question 48 Explanation:
Pain at the graft site and weight gain indicates the transplanted kidney isn’t functioning and possibly is being rejected. Transplant clients usually have edema, anorexia, fever, and nausea before transplantation, so those symptoms may not indicate rejection.
Question 49
A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and postobstructive diuresis is occurring. Which of the following interventions should be done?
A
Assess for urine output every shift
B
Monitor the client’s electrolyte levels.
C
Take vital signs every 8 hours
D
Weigh the client every other day
Question 49 Explanation:
Postobstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The client’s weight should be taken daily to assess fluid status more closely.
Question 50
The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care?
A
Save all urine in a radiation safe container for 18 hours
B
Limit contact with the client to 20 minutes per hour.
C
Place the client on radiation precautions for 18 hours
D
No special precautions except to wear gloves if in contact with the client’s urine.
Question 50 Explanation:
No specific precautions are necessary following a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions.
Question 51
A client underwent a TURP, and a large three way catheter was inserted in the bladder with continuous bladder irrigation. In which of the following circumstances would the nurse increase the flow rate of the continuous bladder irrigation?
A
When the drainage is continuous but slow
B
When the drainage appears cloudy and dark yellow
C
When the drainage becomes bright red
D
When there is no drainage of urine and irrigating solution
Question 51 Explanation:
The decision made by the surgeon to insert a catheter after a TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.
Question 52
The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply.
A
“If I limit my fluid intake I will not have to empty my ostomy pouch as often.”
B
“I must use a skin barrier to protect my skin from urine.”
C
“I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
D
“I should empty my ostomy pouch of urine when it is full.”
E
“I can place an aspirin tablet in my pouch to decrease odor.”
Question 52 Explanation:
The client with an ileal conduit must learn self-care activities related to care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 ml per day and should not limit intake. Adequate fluid intake helps to flush mucus from the ileal conduit. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight from pulling the appliance away from the skin.
Question 53
A client with BPH is being treated with terazosin (Hytrin) 2mg at bedtime. The nurse should monitor the client’s:
A
Urinary nitrites
B
Blood pressure
C
Pulse
D
White blood cell count
Question 53 Explanation:
Terazosin (Hytrin) is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or postural hypotension. The client should be instructed to change positions slowly. Urinary nitrites, white blood cell count, and pulse rate are not affected by terazosin.
Question 54
During a client’s urinary bladder catherization, the bladder is emptied gradually. The best rationale for the nurse’s action is that completely emptying an overdistended bladder at one time tends to cause:
A
Renal failure
B
Abdominal cramping
C
Possible shock
D
Atrophy of bladder musculature
Question 54 Explanation:
Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 ml at one time was the standard of practice, but this is no longer thought to be necessary as long as the overdistended bladder is emptied slowly.
Question 55
A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for:
A
Dullness in the lower left quadrant
B
Rebound tenderness below the symphysis
C
A rounded swelling above the pubis.
D
Urine discharge from the urethral meatus
Question 55 Explanation:
The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.
Question 56
The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH?
A
Inhaled ipratropium (Atrovent)
B
Ophthalmic timolol (Timoptic)
C
Metformin (Glucophage)
D
Buspirone (BuSpar)
Question 56 Explanation:
Atrovent is a bronchodilator, and its anticholinergic effects can aggravate urinary retention. Glucophage and BuSpar do not affect the urinary system; timolol does not have a systemic effect.
Question 57
Because a client’s renal stone was found to be composed to uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications?
A
Eggs, spinach, dried peas, and gravy.
B
Milk, apples, tomatoes, and corn
C
Salmon, chicken, caviar, and asparagus
D
Grapes, corn, cereals, and liver.
Question 57 Explanation:
Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline-ash diet is also advocated, because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Food allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.
Question 58
Which of the following symptoms is the most common clinical finding associated with bladder cancer?
A
Urinary retention
B
Painless hematuria
C
Dysuria
D
Suprapubic pain
Question 58 Explanation:
Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency, dysuria, and urgency, but these are not as common as the hematuria. Suprapubic pain and urinary retention do not occur in bladder cancer.
Question 59
The client is to undergo kidney transplantation with a living donor. Which of the following preoperative assessments is important?
A
Client’s support system and understanding of lifestyle changes.
B
Signs and symptoms of rejection
C
Urine output
D
Signs of graft rejection
Question 59 Explanation:
The client undergoing a renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. The client is most likely anuric or oliguric preoperatively, but postoperatively will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important post-op will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important postoperatively due to the immunosuppressant therapy. Rejection can occur postoperatively.
Question 60
A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client’s understanding of the surgical procedure by explaining that an ileal conduit:
A
Diverts urine into the sigmoid colon, where it is expelled through the rectum.
B
Is a temporary procedure that can be reversed later.
C
Creates an opening in the bladder that allows urine to drain into an external pouch.
D
Conveys urine from the ureters to a stoma opening in the abdomen.
Question 60 Explanation:
An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible. Diversion of the urine to the sigmoid colon is called a ureteroileosigmoidostomy. An opening in the bladder that allows urine to drain externally is called a cystostomy.
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1. A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important?
Strain all urine
Limit fluid intake
Enforce strict bed rest
Encourage a high calcium diet
2. A client is receiving a radiation implant for the treatment of bladder cancer. Which of the following interventions is appropriate?
Flush all urine down the toilet
Restrict the client’s fluid intake
Place the client in a semi-private room
Monitor the client for signs and symptoms of cystitis
3. A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. Which of the following conditions is a major complication of this drug therapy?
Depression
Hemorrhage
Infection
Peptic ulcer disease
4. A client received a kidney transplant 2 months ago. He’s admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected?
Hypotension
Normal body temperature
Decreased WBC count
Elevated BUN and creatinine levels
5. The client is to undergo kidney transplantation with a living donor. Which of the following preoperative assessments is important?
Urine output
Signs of graft rejection
Signs and symptoms of rejection
Client’s support system and understanding of lifestyle changes.
6. A client had a transurethral prostatectomy for benign prostatic hypertrophy. He’s currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first?
Administer an oral analgesic
Stop the irrigation and call the physician
Administer a belladonna and opium suppository as ordered by the physician.
Check for the presence of clots, and make sure the catheter is draining properly.
7. A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and postobstructive diuresis is occurring. Which of the following interventions should be done?
Take vital signs every 8 hours
Weigh the client every other day
Assess for urine output every shift
Monitor the client’s electrolyte levels.
8. A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors?
Antibodies
Type of infection
Composition of calculus
Size and number of calculi
9. Which of the following symptoms indicate acute rejection of a transplanted kidney?
Edema, nausea
Fever, anorexia
Weight gain, pain at graft site
Increased WBC count, pain with voiding
10. Adverse reactions of prednisone therapy include which of the following conditions?
Acne and bleeding gums
Sodium retention and constipation
Mood swings and increased temperature
Increased blood glucose levels and decreased wound healing.
11. The nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis?
High urine specific gravity
High urine osmolarity
Normal to low urine specific gravity
Elevated urine pH
12. A client is diagnosed with prostate cancer. Which test is used to monitor progression of this disease?
Serum creatinine
Complete blood cell count (CBC)
Prostate specific antigen (PSA)
Serum potassium
13. a 27-year old client, who became paraplegic after a swimming accident, is experiencing autonomic dysreflexia. Which condition is the most common cause of autonomic dysrelexia?
Upper respiratory infection
Incontinence
Bladder distention
Diarrhea
14. When providing discharge teaching for a client with uric acid calculi, the nurse should an instruction to avoid which type of diet?
Low-calcium
Low-oxalate
High-oxalate
High-purine
15. The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones?
Calcium oxalate
Uric acid
Struvite
Cystine
16. The nurse is receiving in transfer from the postanesthesia care unit a client who has had a percutaneous ultrasonic lithrotripsy for calculuses in the renal pelvis. The nurse anticipates that the client’s care will involve monitoring which of the following?
Suprapubic tube
Urethral stent
Nephrostomy tube
Jackson-Pratt drain
17. The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas?
Shoulder
Umbilicus
Costovertebral angle
Hip
18. The client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client’s problem is related to bacterial prostatitis, the nurse would look at the results of the prostate examination, which should reveal that the prostate gland is:
Tender, indurated, and warm to the touch
Soft and swollen
Tender and edematous with ecchymosis
Reddened, swollen, and boggy.
19. The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms?
Urge incontinence
Nocturia
Decreased force in the stream of urine
Urinary retention
20. The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications?
Diuretics
Antibiotics
Antitussives
Decongestants
21. The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care?
Place the client on radiation precautions for 18 hours
Save all urine in a radiation safe container for 18 hours
Limit contact with the client to 20 minutes per hour.
No special precautions except to wear gloves if in contact with the client’s urine.
22. The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions?
Increase intake of meat, fish, plums, and cranberries
Avoid citrus fruits and citrus juices
Avoid green, leafy vegetables such as spinach.
Increase intake of dairy products.
23. The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include on the client’s postoperative care?
Sterile irrigation of the Penrose drain
Frequent dressing changes around the Penrose drain
Weighing the dressings
Maintaining the client’s position on the affected side
24. The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria?
Encourage fluid intake
Administration of diuretics
Irrigation of foley catheter
Restricting fluids
25. A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The x-ray results the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following?
Acute rejection
Chronic rejection
Kidney infection
Kidney obstruction
26. The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome?
Bradycardia and confusion
Tachycardia and diarrhea
Decreased urinary output and bladder spasms
Increased urinary output and anemia
27. The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client’s VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician?
Red bloody urine
Urinary output of 200 ml greater than intake
Blood pressure of 100/50 and pulse 130.
Pain related to bladder spasms.
28. Which of the following symptoms is the most common clinical finding associated with bladder cancer?
Suprapubic pain
Dysuria
Painless hematuria
Urinary retention
29. A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client’s understanding of the surgical procedure by explaining that an ileal conduit:
Is a temporary procedure that can be reversed later.
Diverts urine into the sigmoid colon, where it is expelled through the rectum.
Conveys urine from the ureters to a stoma opening in the abdomen.
Creates an opening in the bladder that allows urine to drain into an external pouch.
30. After surgery for an ileal conduit, the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery?
Peritonitis
Thrombophlebitis
Ascites
Inguinal hernia
31. The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on the assessment data, which of the following nursing interventions would be most appropriate at this time?
Change the appliance bag
Notify the physician
Obtain a urine specimen for culture
Encourage a high fluid intake
32. When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently, primarily to prevent which of the following problems?
Rupture of the ileal conduit
Interruption of urine production
Development of odor
Separation of the appliance from the skin
33. The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with what product?
Baking soda
Soap
Hydrogen peroxide
Alcohol
34. The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply.
“If I limit my fluid intake I will not have to empty my ostomy pouch as often.”
“I can place an aspirin tablet in my pouch to decrease odor.”
“I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
“I must use a skin barrier to protect my skin from urine.”
“I should empty my ostomy pouch of urine when it is full.”
35. A female client with a urinary diversion tells the nurse, “This urinary pouch is embarrassing. Everyone will know that I’m not normal. I don’t see how I can go out in public anymore.” The most appropriate nursing diagnosis for this patient is:
Anxiety related to the presence of urinary diversion.
Deficient Knowledge about how to care for the urinary diversion.
Low Self-Esteem related to feelings of worthlessness
Disturbed Body Image related to creation of a urinary diversion.
36. The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent:
Urine reflux into the stoma
Appliance separation
Urine leakage
The need to restrict fluids
37. The nurse teaches the client with an ileal conduit measures to prevent a UTI. Which of the following measures would be most effective?
Avoid people with respiratory tract infections
Maintain a daily fluid intake of 2,000 to 3,000 ml
Use sterile technique to change the appliance
Irrigate the stoma daily.
38. A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time?
Report hematuria to the physician
Strain the urine carefully
Administer meperidine (Demerol) every 3 hours
Apply warm compresses to the flank area
39. A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to:
Irrigate the catheter with 30 ml of normal saline every 8 hours
Ensure that the catheter is draining freely
Clamp the catheter every 2 hours for 30 minutes.
Ensure that the catheter drains at least 30 ml an hour
40. Which of the following interventions would be most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
Encourage the client to ambulate every 2 to 4 hours
Offer 3 to 4 ounces of a carbonated beverage periodically.
Encourage use of a stool softener
Continue intravenous fluid therapy
41. The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician?
Temperature, 99.8
Urine output, 20 ml/hour
Absence of bowel sounds
A 2×2 inch area of serous sanguineous drainage on the flank dressing.
42. Because a client’s renal stone was found to be composed to uric acid, a low-purine, alkaline-ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications?
Milk, apples, tomatoes, and corn
Eggs, spinach, dried peas, and gravy.
Salmon, chicken, caviar, and asparagus
Grapes, corn, cereals, and liver.
43. Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication?
Retinopathy
Maculopapular rash
Nasal congestion
Dizziness
44. The client has a clinic appointment scheduled 10 days after discharge. Which laboratory finding at that time would indicate that allopurinol (Zyloprim) has had a therapeutic effect?
Decreased urinary alkaline phosphatase level
Increased urinary calcium excretion
Increased serum calcium level
Decreased serum uric acid level
45. When developing a plan of care for the client with stress incontinence, the nurse should take into consideration that stress incontinence is best defined as the involuntary loss of urine associated with:
A strong urge to urinate
Overdistention of the bladder
Activities that increase abdominal pressure
Obstruction of the urethra
46. Which of the following assessment data would most likely be related to a client’s current complaint of stress incontinence?
The client’s intake of 2 to 3 L of fluid per day.
The client’s history of three full-term pregnancies
The client’s age of 45 years
The client’s history of competitive swimming
47. The nurse is developing a teaching plan for a client with stress incontinence. Which of the following instructions should be included?
Avoid activities that are stressful and upsetting
Avoid caffeine and alcohol
Do not wear a girdle
Limit physical exertion
48. A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client?
Inability to empty the bladder
Loss of urine when coughing
Involuntary urination with minimal warning
Frequent dribbling of urine
49. A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for:
A rounded swelling above the pubis.
Dullness in the lower left quadrant
Rebound tenderness below the symphysis
Urine discharge from the urethral meatus
50. During a client’s urinary bladder catherization, the bladder is emptied gradually. The best rationale for the nurse’s action is that completely emptying an overdistended bladder at one time tends to cause:
Renal failure
Abdominal cramping
Possible shock
Atrophy of bladder musculature
51. The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to:
Eliminate pressure at the penoscrotal angle
Prevent the catheter from kinking in the urethra
Prevent accidental catheter removal
Allow the client to turn without kinking the catheter
52. The primary function of the prostate gland is:
To store underdeveloped sperm before ejaculation
To regulate the acidity and alkalinity of the environment for proper sperm development.
To produce a secretion that aids in the nourishment and passage of sperm
To secrete a hormone that stimulates the production and maturation of sperm
53. The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH?
Metformin (Glucophage)
Buspirone (BuSpar)
Inhaled ipratropium (Atrovent)
Ophthalmic timolol (Timoptic)
54. A client is scheduled to undergo a transurethral resection of the prostate gland (TURP). The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should be particularly alert for early signs of:
Convulsions
Cardiac arrest
Renal shutdown
Respiratory paralysis
55. A client with BPH is being treated with terazosin (Hytrin) 2mg at bedtime. The nurse should monitor the client’s:
Urinary nitrites
White blood cell count
Blood pressure
Pulse
56. A client underwent a TURP, and a large three way catheter was inserted in the bladder with continuous bladder irrigation. In which of the following circumstances would the nurse increase the flow rate of the continuous bladder irrigation?
When the drainage is continuous but slow
When the drainage appears cloudy and dark yellow
When the drainage becomes bright red
When there is no drainage of urine and irrigating solution
57. A priority nursing diagnosis for the client who is being discharged t home 3 days after a TURP would be:
Deficient fluid volume
Imbalanced Nutrition: Less than Body Requirements
Impaired Tissue Integrity
Ineffective Airway Clearance
58. If a client’s prostate enlargement is caused by a malignancy, which of the following blood examinations should the nurse anticipate to assess whether metastasis has occurred?
Serum creatinine level
Serum acid phosphatase level
Total nonprotein nitrogen level
Endogenous creatinine clearance time
59. Steroids, if used following kidney transplantation would cause which of the following side effects?
Alopecia
Increase Cholesterol Level
Orthostatic Hypotension
Increase Blood Glucose Level
60. Mr. Roberto was readmitted to the hospital with acute graft rejection. Which of the following assessment finding would be expected?
Hypotension
Normal Body Temperature
Decreased WBC
Elevated BUN and Creatinine
Answers and Rationales
A. Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary tract and prevent further calculi formation. A low-calcium diet is recommended to help prevent the formation of calcium calculi. Ambulation is encouraged to help pass the calculi through gravity.
D. Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Clients with radiation implants require a private room. Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes lab for monitoring. It is recommended that fluid intake be increased.
C. Infections is the major complication to watch for in clients on cyclosporine therapy because it’s an immunosuppressive drug. Depression may occur posttransplantation but not because of cyclosporine. Hemorrhage is a complication associated with anticoagulant therapy. Peptic ulcer disease is a complication of steroid therapy.
D. In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. The nurse would see elevated WBC counts and fever because the body is recognizing the graft as foreign and is attempting to fight it. The client would most likely have acute hypertension.
D. The client undergoing a renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. The client is most likely anuric or oliguric preoperatively, but postoperatively will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important post-op will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. While the client will always need to be monitored for signs and symptoms of infection, it’s most important postoperatively due to the immunosuppressant therapy. Rejection can occur postoperatively.
D. Blood clots and blocked outflow if the urine can increase spasms. The irrigation shouldn’t be stopped as long as the catheter is draining because clots will form. A belladonna and opium suppository should be given to relieve spasms but only afterassessment of the drainage. Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository.
D. Postobstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. Urine output needs to be assessed hourly. The client’s weight should be taken daily to assess fluid status more closely.
C. The calculus should be analyzed for composition to determine appropriate interventions such as dietary restrictions. Calculi don’t result in infections. The size and number of calculi aren’t relevant, and they don’t contain antibodies.
C. Pain at the graft site and weight gain indicates the transplanted kidney isn’t functioning and possibly is being rejected. Transplant clients usually have edema, anorexia, fever, and nausea before transplantation, so those symptoms may not indicate rejection.
D. Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood swings, and sodium and water retention. Steroids don’t affect thermoregulation, bleeding tendencies, or constipation.
C. Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. High specific gravity indicates dehydration. Hypernatremia signals acidosis and shock. Elevated urine pH can result from potassium deficiency, a high-protein diet, or uncontrolled diabetes.
C. The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Serum creatinine levels may suggest blockage from an enlarged prostate. CBC is used to diagnose anemia and polycythemia. Serum potassium levels identify hypokalemia and hyperkalemia.
C. Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. Incontinence and diarrhea don’t result in obstruction of the urinary system or bowel, respectively. An URI could obstruct the respiratory system, but not the urinary or bowel system.
D. To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. A low-calcium diet decreases the risk for oxalate renal calculi. Oxalate is an essential amino acid and must be included in the diet. A low-oxalate diet is used to control calcium or oxalate calculi.
C. Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Uric acid stones occur in clients with gout. Cystine stones are rare and occur in clients with a genetic defect that results in decreased renal absorption of the amino acid cystine.
C. A nephrostomy tube is put in place after a percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculus fragments.
A. Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip.
A. The client with prostatitis has a prostate gland that is swollen and tender but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder).
C. Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.
D. In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.
D. No specific precautions are necessary following a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions.
C. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.
B. Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. A Penrose drain is not irrigated. Weighing the dressings is not necessary. Placing the client on the affected side will prevent a free flow of urine through the drain.
B. To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Fluid intake would not be encouraged or restricted. Irrigation of the foley catheter will not assist in allievating this oliguria.
A. Acute rejection most often occurs in the first 2 weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Chronic rejection occurs gradually during a period of months to years. Although kidney infection or obstruction can occur, the symptoms presented in the question do not relate specifically to these disorders.
A. Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.
C. Frank bleeding (arterial or venous) may occur during the first few days after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 ml of greater than intake is adequate. Bladder spasms are expected to occur after surgery. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The physician should be notified.
C. Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency, dysuria, and urgency, but these are not as common as the hematuria. Suprapubic pain and urinary retention do not occur in bladder cancer.
C. An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible. Diversion of the urine to the sigmoid colon is called a ureteroileosigmoidostomy. An opening in the bladder that allows urine to drain externally is called a cystostomy.
B. After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal surgery.
D. Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.
D. If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin. A full appliance will not rupture the ileal conduit or interrupt urine production. Odor formation has numerous causes.
B. A reusable appliance should be routinely cleaned with soap and water.
C, D. The client with an ileal conduit must learn self-care activities related to care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 ml per day and should not limit intake. Adequate fluid intake helps to flush mucus from the ileal conduit. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight from pulling the appliance away from the skin.
D. It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggest that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner. Although the client may be anxious about this situation and self-esteem may be diminished, the underlying problem is disturbance in body image. There are no data to support a diagnosis of Deficient Knowledge.
A. The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent reflux into the stoma and ureters, which can result in infection. Use of a standard collection bag also keeps the appliance from separating from the skin and helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. A client with a urinary diversion should drink 2000-3000 ml of fluid each day; it would be inappropriate to suggest decreasing fluid intake.
B. Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be effective in preventing UTI. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.
B. Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessoned.
B. The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the physician. The catheter is never clamped. The client’s total urine output (ureteral catheter plus voiding or foley catheter output) should be 30 ml/hour.
A. Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until peristalsis returns. Intravenous fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus. A stool softener will not stimulate peristalsis.
B. The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serous sanguineous drainage is to be expected.
A. Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline-ash diet is also advocated, because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Food allowed on an alkaline-ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.
B. Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiess, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not side effects of allopurinol.
D. By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drug’s effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol does not alter the level of alkaline phosphatase, not does it affect urinary calcium excretion or the serum calcium level.
C. Stress incontinence is the involuntary loss of urine during such activities as coughing, sneezing, laughing, or physical exertion. These activities increase abdominal and detruser pressure. A strong urge to urinate is associated with urge incontinence. Overdistention of the bladder can lead to overflow incontinence. Obstruction of the urethra can lead to urinary retention.
B. The history of three pregnancies is most likely the cause of the client’s current episodes of stress incontinence. The client’s fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.
B. Client’s with stress incontinence are encouraged to avoid substances such as caffeine and alcohol which are bladder irritants. Emotional stressors do not cause stress incontinence. It is caused most commonly be relaxed pelvic musculature. Wearing girdles is not contraindicated. Although clients may be inclined to limit physical exertion to avoid incontinence episodes, they should be encouraged to seek treatment instead of limiting their activities.
C. A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urinary retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of vesicovaginal or urethrovaginal fistula.
A. The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine flow is blocked by the enlarged prostate.
C. Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 ml at one time was the standard of practice, but this is no longer thought to be necessary as long as the overdistended bladder is emptied slowly.
A. The primary reason for taping an indwelling catheter to a male client soothe penis is held in a lateral position to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula.
C. The prostate gland is located below the bladder and surrounds the urethra. It serves one primary purpose: to produce a secretion that aids in the nourishment and passage of sperm.
C. Atrovent is a bronchodilator, and its anticholinergic effects can aggravate urinary retention. Glucophage and BuSpar do not affect the urinary system; timolol does not have a systemic effect.
D. If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Convulsions, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.
C. Terazosin (Hytrin) is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or postural hypotension. The client should be instructed to change positions slowly. Urinary nitrites, white blood cell count, and pulse rate are not affected by terazosin.
C. The decision made by the surgeon to insert a catheter after a TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so clots do not plug it. There would be no reason to increase the flow rate when the return is continuous or when the return appears cloudy and dark yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating solution.
A. Deficient Fluid Volume is a priority diagnosis, because the client needs to drink a large amount of fluid to keep the urine clear. The urine should be almost without color. About 2 weeks after a TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the ED if at any time the urine turns bright red. The client is not specifically at risk for nutritional problems after a TURP. The client is not specifically at risk for impaired tissue integrity because there is no external incision, and the client is not specifically at risk for airway problems because the procedure is done after spinal anesthesia.
B. The most specific examination to determine whether a malignancy extends outside of the prostatic capsule is a study of the serum acid phosphatase level. The level increases when a malignancy has metastasized. The prostate specific antigen (PSA) determination and a digital rectal examination are done when screening for prostate cancer. Serum creatinine level, total nonprotein nitrogen level, and endogenous creatinine clearance time give information about kidney function, not prostate malignancy.