Question 1

Chin is scheduled for a voiding cystogram. Which nursing intervention would be essential to carry out several hours before the test?
A)Maintaining NPO status
B)Medicating with urinary antiseptics
C)Administering bowel preparations
D)Forcing fluids

Accepted Answer

Forcing fluids ensures a continuous flow of urine to provide adequate urine output for specimen collection. High fluid intake also prevents multiplication of bacteria that may have been introduced during the procedure.

Question 2

Rodriguez is to undergo a vasectomy the next day. The nurse discussed with him important points after the operation is done. Which of the following instructions should the nurse include in her health teaching?
A)No sexual activity for 2 weeks
B)Application of ice for pain or swelling
C)Bed rest for several days
D)Returning for suture removal in 1 week

Accepted Answer

If the client has pain or swelling, application of ice will help reduce symptoms. Sexual activity can be resumed, but the client will not be clear of sperm from the ductus for 4 to 6 weeks. Bed rest is not indicated and sutures are absorbable.

Question 3

The physician has ordered a 24-hour urine specimen collection. After explaining the procedure to the client, the nurse collects the first specimen. She is doing the right thing if she ________.
A)Discards the first specimen, and then starts the collection
B)Saves this specimen as part of the 24-hour collection
C)Tests the specimen, and then discards it
D)Places this specimen in a separate container and later adds to the collection

Accepted Answer

The first specimen is discarded because it is considered "old urine" or urine that was in the bladder before the test began. After the first discarded specimen, urine is collected for 24 hours.

Question 4

Drake, a 22-year-old male, has just developed chickenpox. The nurse will monitor him for acute glomerulonephritis for _________.
A)3 days
B)7 days
C)2 weeks
D)2 months

Accepted Answer

2 weeks. Circulating immune complexes may become trapped in the glomerular membrane and cause an inflammatory response 10 to 14 days after the initial infection.

Question 5

Faye, a nurse in a urology clinic, conducts a community education program about benign prostatic hypertrophy. When asked to explain the condition, Faye should respond that BPH is:
A)Associated with multiple factors, including frequent UTIs
B)Thought to occur because of declining testosterone levels
C)Rare until the seventh decade of life
D)Responsible for the symptoms such as weak urinary stream and that the size of the prostate gland directly correlates to the severity of the symptoms.

Accepted Answer

The only known risk factor for BPH is aging. It is estimated that over 50% of men over the age of 50 will develop BPH, with the incidence increasing in age. Prostate size correlates poorly with symptoms.

Question 6

Paolo, a 37-year-old freelance writer, is scheduled for an intravenous pyelogram (IVP) to evaluate possible obstruction in the urinary tract. To prepare the client, the nurse will:
(Select all that apply.)
A)Give a laxative and/or enemas starting the night before the procedure.
B)Force fluids orally or by IV at least 4 hours before the test.
C)Verify that an informed consent has been signed.
D)Explain that there might be a salty taste in the mouth from the dye.
E)Drape a lead apron over the pelvic area for radiation protection.

Accepted Answer

(A) the bowel must be cleansed because stool could obscure the movement of the dye through the kidneys and bladder; (C) there are risks associated with the procedure and the nurse should always verify that the physician informed the client; (D) metallic taste, as well as flushing and burning can occur when the dye is injected; (F) hydration is important if the kidney is going to be able to excrete the dye. Choice B is incorrect because the client is NPO several hours before the test. Choice E is incorrect because a lead apron would prevent visualization of the area of interest.

Question 7

John, 15 years old, developed acute glomerulonephritis after a bout of complicated upper respiratory infection. The nurse is planning to teach about dietary restrictions. Which of the following dietary changes should be included in the plan?
A)Limit fluid intake to 500ml per day
B)Restrict protein intake by limiting meats and other high-protein foods
C)Increase intake of high-fiber foods, such as bran cereal
D)Increase intake of potassium-rich foods such as bananas or cantaloupe

Accepted Answer

A client with glomerulonephritis should eat a diet that is high in calories, but low in protein to inhibit protein catabolism and allow the kidneys to rest by diet (since they have fewer nitrogenous wastes to clear). It is important to protect the kidneys while they are recovering their function. The other responses are incorrect.

Question 8

The indwelling Foley catheter was removed following an episode of prostatitis, but the client did not void for the next 8 hours, even when allowed to stand. The best action for the nurse to take is to:
A)Ask the physician for a prostate evaluation
B)Wait another 8 hours and encourage frequent attempts
C)Ask the physician for orders to catheterize the bladder
D)Encourage oral fluids and hot baths to relax the sphincter

Accepted Answer

Not voiding for 8 hours may result in infection, as well as more severe problems. A straight catheterization may be done or the Foley reinserted to allow for bladder reflexes to recover. Choice A is incorrect because the potential for bladder distention will not be relieved by a prostate evaluation. Choice B is incorrect because waiting can result in severe bladder distention, infection, damage to the kidneys, and even bladder rupture. Choice D is incorrect because increasing oral intake does not correct the inability to void.

Question 9

Which of the following clients would indicate that he/she is manifesting chronic renal failure?
A)A client with a total urinary output of 876 ml over 24 hours
B)A client with serum potassium level of 4.2 mEq/L
C)A client with serum creatinine level of 1.1 mg/dL
D)A client with serum blood urea nitrogen of 25 mg/dL

Accepted Answer

Chronic renal failure presents with decreased urinary output and increased serum BUN, creatinine, and potassium levels. In this case, the serum BUN level is elevated (normal range: 10-20 mg/dL) and everything else is within normal limits.

Question 10

Andrews, a 42-year-old dance instructor, returns to the unit after undergoing a right modified radical mastectomy with dissection of the axillary lymph nodes. Which measure is an appropriate intervention for the nurse to include in Ms. Andrews' postoperative care?
A)Instruct the client to watch the clock and use the PCA pump every 10 minutes
B)Insist that the client to examine the surgical incision when the surgical dressings are removed
C)Post a sign at the bedside to avoid pressure measurements or venipunctures in the right arm
D)Encourage the client to obtain a permanent breast prosthesis upon discharge from the hospital

Accepted Answer

Postoperative care of a client following a modified radical mastectomy includes not taking the blood pressure or performing venipunctures on the operative side.

Question 11

Kyle, a 28-year-old teacher, is admitted to the hospital with a diagnosis of renal calculi. The result of Kyle's blood studies shows a BUN of 20 mg/dL, serum calcium level of 4.5 mEq/L, serum phosphorus of 1.8 mEq/L, serum sodium of 138 mEq/L, and urine pH of 5.1. Calcium phosphate stone is suspected. What nursing intervention would be most effective in altering Kyle's urine pH?
A)Increasing activity
B)Forcing fluids
C)Administering allopurinol Zyloprim as ordered
D)Excluding high calcium fluids from his diet

Accepted Answer

Foods high in calcium, such as milk products, tend to alkalinize urine. Avoiding high calcium foods will help to decrease urine pH.

Question 12

Which problem should the nurse expect following uterine isotope insertion?
A)Bladder atony
B)Constipation
C)Foul-smelling vaginal discharge
D)Loss of sexual libido

Accepted Answer

During treatment (total insertion time varies from 48 to 144 hours), vaginal discharge may be foul-smelling due to tissue destruction; however, perineal care is generally not allowed due to the danger of dislodging the needles. A douche given under low pressure following removal of the applicator helps to reduce this side effect of therapy. Bladder atony (Choice A) is a rare complication; diarrhea, rather than constipation (Choice B), is more likely to occur. Sexual libido (Choice D) following this therapy seems more dependent on the relationship of the partners before therapy than on the therapy itself.

Question 13

The physician orders a combination of sulfamethoxazole and phenazopyridine hydrochloride (Pyridium) for a client with acute pyelonephritis. Which therapeutic effect should this combination drug have?
A)Pain relief and a decreased WBC count
B)Equal fluid intake and output
C)Polyuria with reddish stain
D)Increased complaints of bladder spasm after 20 minutes

Accepted Answer

Pain relief and a decreased WBC count. Sulfamethoxazole is a sulfonamide antibiotic used to treat infection. Naturally, when infection has been treated, WBC count will go down to normal. Phenazopyridine hydrochloride (Pyridium) is used to relieve pain, burning, urgency, and frequency of urination caused by irritation of the urinary tract by the infection. The medication is effective when the client indicates that he/she no longer feels difficulty or pain during urination.

Question 14

Forty-eight hours after a nephrectomy, a client complains of increasing nausea and abdominal pressure. The nurse's first nursing action is to:
A)Change the client's position to relieve abdominal pressure
B)Auscultate bowel sounds
C)Insert a rectal tube to relieve flatus
D)Administer morphine SO4, 6 mg, as ordered for the relief of discomfort

Accepted Answer

Auscultate bowel sounds. Though nausea may occur following the administration of narcotics, if it is accompanied by the absence of bowel sounds and upper abdominal distention, gastric or small-intestine dilation should be suspected and the nurse's findings reported to the physician.

Question 15

The nurse caring for an adult client with polycystic kidney disease (PKD) knows that an early and commonly seen symptom of this disease process would be which of the following?
A)Steady, dull flank pain
B)Hypotension
C)Confusion
D)Sharp back pain

Accepted Answer

A common early symptom of adult PKD is abdominal or flank pain, which is steady and dull or abrupt in onset. Other clinical manifestations include hematuria, UTI, and hypertension.

Question 16

For a client with a recurrent urinary tract infection (UTI), which of the following statements describes the primary drug therapy regimen for this disease process?
A)A one- to three-day treatment regimen of antibiotic therapy
B)A three- to five-day treatment regimen of antibiotic therapy
C)Consideration of a 10-day trial of suppressive antibiotic therapy
D)Phenazopyridine (Pyridium) to relieve discomfort associated with a UTI

Accepted Answer

Recurrent UTIs are treated with a course of three to five days of antibiotics such as trimethoprim-sulfamethoxazole (Bactrim, Septra) or nitrofurantoin (Macrodantin, Furadantin). A simple, uncomplicated UTI is treated with a one to three day regimen of antibiotic therapy. In comparison, a complicated UTI will require longer treatment, lasting from 7 to 14 days, or even longer. Pyridium is an OTC drug that may be used in combination with antibiotic agents to provide a soothing effect on the urinary tract mucosa and relieve the transient acute discomfort associated with a UTI.

Question 17

A client with nephrotic syndrome is educated by the nurse on his disease and course treatment. The following statement from the client would indicate a need for further instruction:
A)"I can expect to experience swelling in my hands and feet."
B)"The protein in my blood will probably be low and my cholesterol may be high."
C)"I will need to take medication to control the swelling and high cholesterol."
D)"I may eat a diet that is not restricted in salt or protein."

Accepted Answer

"I may eat a diet that is not restricted in salt or protein." Clinical manifestations of nephrotic syndrome include peripheral edema, massive proteinuria, hyperlipidemia, and hypoalbuminemia. Blood chemistries include decreased serum albumin, decreased total serum protein, and elevated serum cholesterol. The increased glomerular membrane permeability found with this disease is responsible for the massive excretion of protein in the urine. This results in decreased serum protein and edema formation. Treatment of this disease is aimed at relieving edema (ACE inhibitors, NSAIDs) and usually entails a low-sodium (2 to 3 g per day), low-to-moderate protein diet (0.5 to 0.6 kg per day). Treatment of hyperlipidemia includes use of lipid-lowering agents such as colestipol (Colestid) and lovastatin (Mevacor).

Question 18

One potential complication of an abdominal hysterectomy is abdominal distention. Postoperative nursing measures designed to avoid abdominal distention are:
A)Auscultation of the abdomen for bowel sounds
B)Abdominal massage and bed rest
C)Insertion of nasogastric and rectal tubes and ambulation, as ordered
D)Progression of postoperative diet

Accepted Answer

Insertion of nasogastric and rectal tubes and ambulation, as ordered. Manipulation of abdominal contents during surgery produce inhibition of peristalsis for 24 to 48 hours. Measures to avoid potential distention could include insertion of a nasogastric tube before surgery and continuous postsurgical suction until peristalsis returns; rectal tubes can be inserted to remove excess air in the lower colon; and early ambulation promotes return of bowel sounds.

Question 19

During discharge teaching with a client following abdominal hysterectomy, the nurse should include the following instruction:
A)Avoid sitting for a long period of time
B)Evacuate bowels daily
C)Restrict sexual activity for 6 months after hysterectomy
D)Avoid all household chores for 2 months

Accepted Answer

Sitting for long periods of time and wearing constrictive clothing tend to increase pelvic congestion. Daily bowel movements are not necessary as long as a normal pattern is achieved. It is important to reinforce the physician's instructions that sexual activity may be resumed within a specific period of time, usually 6 to 8 weeks. Paced and gradual ambulation aids in increasing venous return and general strength. Complete avoidance of chores for 2 months is not necessary. Lifting of heavy objects, however, may injure the incision site and promote bleeding.

Question 20

After teaching breast self-examination, Ms. Ry asked why it is important to move her arms in different positions while standing in front of a mirror. The correct response of the nurse is:
A)"It is more comfortable in this manner."
B)"Change in shape or contour of the breast is easily noticed when you do this."
C)"Nipple discharge will be determined with every movement."
D)"It gives more emphasis and time to analyze the breast."

Accepted Answer

"Change in shape or contour of the breast is easily noticed when you do this." When the arms are placed in different positions, it allows the client to check for any changes in the contour of the breasts. Different positions give different orientations.

Quiz 4: Genitourinary

Chin is scheduled for a voiding cystogram. Which nursing intervention would be essential to carry out several hours before the test?

Rodriguez is to undergo a vasectomy the next day. The nurse discussed with him important points after the operation is done. Which of the following instructions should the nurse include in her health teaching?

The physician has ordered a 24-hour urine specimen collection. After explaining the procedure to the client, the nurse collects the first specimen. She is doing the right thing if she ________.

Drake, a 22-year-old male, has just developed chickenpox. The nurse will monitor him for acute glomerulonephritis for _________.

Faye, a nurse in a urology clinic, conducts a community education program about benign prostatic hypertrophy. When asked to explain the condition, Faye should respond that BPH is:

Paolo, a 37-year-old freelance writer, is scheduled for an intravenous pyelogram (IVP) to evaluate possible obstruction in the urinary tract. To prepare the client, the nurse will: (Select all that apply.)

John, 15 years old, developed acute glomerulonephritis after a bout of complicated upper respiratory infection. The nurse is planning to teach about dietary restrictions. Which of the following dietary changes should be included in the plan?

The indwelling Foley catheter was removed following an episode of prostatitis, but the client did not void for the next 8 hours, even when allowed to stand. The best action for the nurse to take is to:

Which of the following clients would indicate that he/she is manifesting chronic renal failure?

Andrews, a 42-year-old dance instructor, returns to the unit after undergoing a right modified radical mastectomy with dissection of the axillary lymph nodes. Which measure is an appropriate intervention for the nurse to include in Ms. Andrews' postoperative care?

Which problem should the nurse expect following uterine isotope insertion?

The physician orders a combination of sulfamethoxazole and phenazopyridine hydrochloride (Pyridium) for a client with acute pyelonephritis. Which therapeutic effect should this combination drug have?

Forty-eight hours after a nephrectomy, a client complains of increasing nausea and abdominal pressure. The nurse's first nursing action is to:

The nurse caring for an adult client with polycystic kidney disease (PKD) knows that an early and commonly seen symptom of this disease process would be which of the following?

For a client with a recurrent urinary tract infection (UTI) , which of the following statements describes the primary drug therapy regimen for this disease process?

A client with nephrotic syndrome is educated by the nurse on his disease and course treatment. The following statement from the client would indicate a need for further instruction:

One potential complication of an abdominal hysterectomy is abdominal distention. Postoperative nursing measures designed to avoid abdominal distention are:

During discharge teaching with a client following abdominal hysterectomy, the nurse should include the following instruction:

After teaching breast self-examination, Ms. Ry asked why it is important to move her arms in different positions while standing in front of a mirror. The correct response of the nurse is: