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QUESTIONS (PART2)

1.    After having transurethral resection of the prostate (TURP), a Mr. Locke returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client’s catheter is occluded?

a.    The urine in the drainage bag appears red to pink.

b.    The client reports bladder spasms and the urge to void.

c.    The normal saline irrigant is infusing at a rate of 50 drops/minute.

d.    About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned.

2.    Nurse Myrna is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:

a.    initiate a stream of urine.

b.    breathe deeply.

c.    turn to the side.

d.    hold the labia or shaft of penis.

3.    A female adult client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

a.    Blood urea nitrogen (BUN) level of 22 mg/dl

b.    Serum creatinine level of 1.2 mg/dl

c.    Serum creatinine level of 1.2 mg/dl

d.    Urine output of 400 ml/24 hours

4.    A 55-year old client with benign prostatic hyperplasia doesn’t respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, nurse Gail asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?

a.    Transurethral resection of the prostate (TURP)

b.    Suprapubic prostatectomy

c.    Retropubic prostatectomy

d.    Transurethral laser incision of the prostate

5.    A female client with suspected renal dysfunction is scheduled for excretory urography. Nurse July reviews the history for conditions that may warrant changes in client preparation. Normally, a client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding would call for the client to be well hydrated instead?

a.    Cystic fibrosis

b.    Multiple myeloma

c.    Gout

d.    Myasthenia gravis

6.    Nurse Kim  is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence?

a.    Encouraging intake of at least 2 L of fluid daily

b.    Giving the client a glass of soda before bedtime

c.    Taking the client to the bathroom twice per day

d.    Consulting with a dietitian

7.    When examining a female client’s genitourinary system, nurse Sally  assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist. Normally, this percussion technique produces which sound?

a.    A flat sound

b.    A dull sound

c.    Hyperresonance

d.    Tympany

8.    A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should nurse Olivia assess first?

a.    Blood pressure

b.    Respirations

c.    Temperature

d.    Pulse

9.    Nurse Hazel is ware that the following is an appropriate nursing diagnosis for a client with renal calculi?

a.    Ineffective tissue perfusion

b.    Functional urinary incontinence

c.    Risk for infection

d.    Decreased cardiac output

10.    A male client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client’s 24-hour urine output totals 240 ml, nurse Andy suspects that the client is at risk for:

a.    cardiac arrhythmia.

b.    paresthesia.

c.    dehydration.

d.    pruritus.

11.    After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a male client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should nurse Andrew do first?

a.    Increase the I.V. flow rate.

b.    Notify the physician immediately.

c.    Assess the irrigation catheter for patency and drainage.

d.    Administer meperidine (Demerol), 50 mg I.M., as prescribed.

12.    When performing a scrotal examination, nurse Paul finds a nodule. What should the nurse do next?

a.    Notify the physician.

b.    Change the client’s position and repeat the examination.

c.    Perform a rectal examination.

d.    Transilluminate the scrotum.

13.    A male client who has been treated for chronic renal failure (CRF) is ready for discharge. Nurse Bea should reinforce which dietary instruction?

a.    “Be sure to eat meat at every meal.”

b.    “Monitor your fruit intake, and eat plenty of bananas.”

c.    “Increase your carbohydrate intake.”

d.    “Drink plenty of fluids, and use a salt substitute.”

14.    Nurse Wayne is aware that the following statements describing urinary incontinence in the elderly is true?

a.    Urinary incontinence is a normal part of aging.

b.    Urinary incontinence isn’t a disease.

c.    Urinary incontinence in the elderly can’t be treated.

d.    Urinary incontinence is a disease.

15.    The client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Nurse Yoly is aware that the following nursing interventions is appropriate?

a.    Tell the client to try to urinate around the catheter to remove blood clots.

b.    Restrict fluids to prevent the client’s bladder from becoming distended.

c.    Prepare to remove the catheter.

d.    Use aseptic technique when irrigating the catheter.

16.    A female client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole). Nurse Don should provide which medication instruction?

a.    “Take the medication with food.”

b.    “Drink at least eight 8-oz glasses of fluid daily.”

c.    “Avoid taking antacids during co-trimoxazole therapy.”

d.    “Don’t be afraid to go out in the sun.”

17.    A male client is admitted for treatment of glomerulonephritis. On initial assessment, Nurse Rose detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

a.    generalized edema, especially of the face and periorbital area.

b.    green-tinged urine.

c.    moderate to severe hypotension.

d.    polyuria.

18.    A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?

a.    Cottage cheese–like discharge

b.    Yellow-green discharge

c.    Gray-white discharge

d.    Discharge with a fishy odor

19.    A 24-year old female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

a.    This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

b.    The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.

c.    The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.

d.    The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex.

20.    Nurse Vic is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)?

a.    Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg

b.    Limiting fluid intake to 1 L/day

c.    Encouraging the client to use a feminine deodorant after bathing

d.    Encouraging the client to douche once a day after removal of the indwelling urinary catheter

21.    Nurse Eve is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence?

a.    Encouraging intake of at least 2 L of fluid daily

b.    Giving the client a glass of soda before bedtime

c.    Taking the client to the bathroom twice per day

d.    Consulting with a dietitian

22.    A female client with an indwelling urinary catheter is suspected of having a urinary tract infection. Nurse Angel should collect a urine specimen for culture and sensitivity by:

a.    disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container.

b.    wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle.

c.    draining urine from the drainage bag into a sterile container.

d.    clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine.

23.    Nurse Grace is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

a.    Rashes on the palms of the hands and soles of the feet

b.    Cauliflower-like warts on the penis

c.    Painful red papules on the shaft of the penis

d.    Foul-smelling discharge from the penis

24.    Nurse Ethel is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client:

a.    retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea.

b.    retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea.

c.    retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn’t necessary to reduce the potassium level.

d.    retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn’t necessary to reduce the potassium level.

25.    When caring for a male client with acute renal failure (ARF), Nurse Fatima expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment?

a.    acetaminophen (Tylenol)

b.    gentamicin sulfate (Garamycin)

c.    cyclosporine (Sandimmune)

d.    ticarcillin disodium (Ticar)

ANSWERS (PART2)

1.    Answer B. Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client’s urine output (1,000 ml + 200 ml), which reflects catheter patency.

2.    Answer B. When inserting a urinary catheter, facilitate insertion by asking the client to breathe deeply. Doing this will relax the urinary sphincter. Initiating a stream of urine isn’t recommended during catheter insertion. Turning to the side or holding the labia or penis won’t ease insertion, and doing so may contaminate the sterile field.

3.    Answer D. ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn’t diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn’t result from this disorder.

4.    Answer A. TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; they all require an incision.

5.    Answer B. Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don’t necessitate changes in client preparation for excretory urography.

6.    Answer A. By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client’s bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn’t give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won’t address the problem of urinary incontinence.

7.    Answer B. Percussion over the costovertebral angle normally produces a dull, thudding sound, which is soft to moderately loud with a moderate pitch and duration. This sound occurs over less dense, mostly fluid-filled matter, such as the kidneys, liver, and spleen. In contrast, a flat sound occurs over highly dense matter such as muscle; hyperresonance occurs over the air-filled, overinflated lungs of a client with pulmonary emphysema or the lungs of a child (because of a thin chest wall); and tympany occurs over enclosed structures containing air, such as the stomach and bowel.

8.    Answer D. An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. The client’s blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also can delay assessing respirations and temperature because these aren’t affected by the serum potassium level.

9.    Answer C. Infection can occur with renal calculi from urine stasis caused by obstruction. Options A and D aren’t appropriate for this diagnosis, and retention of urine usually occurs, rather than incontinence.

10.    Answer A. As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn’t cause paresthesia (sensations of numbness and tingling). Dehydration doesn’t occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In a client with ARF, pruritus results from increased phosphates and isn’t associated with hyperkalemia.

11.    Answer C. Although postoperative pain is expected, the nurse should make sure that other factors, such as an obstructed irrigation catheter, aren’t the cause of the pain. After assessing catheter patency, the nurse should administer an analgesic, such as meperidine, as prescribed. Increasing the I.V. flow rate may worsen the pain. Notifying the physician isn’t necessary unless the pain is severe or unrelieved by the prescribed medication.

12.    Answer D. A nurse who discovers a nodule, swelling, or other abnormal finding during a scrotal examination should transilluminate the scrotum by darkening the room and shining a flashlight through the scrotum behind the mass. A scrotum filled with serous fluid transilluminates as a red glow; a more solid lesion, such as a hematoma or mass, doesn’t transilluminate and may appear as a dark shadow. Although the nurse should notify the physician of the abnormal finding, performing transillumination first provides additional information. The nurse can’t uncover more information about a scrotal mass by changing the client’s position and repeating the examination or by performing a rectal examination.

13.    Answer C. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can’t secrete adequate urine. Salt substitutes are high in potassium and should be avoided. Extra carbohydrates are needed to prevent protein catabolism.

14.    Answer B. Urinary incontinence isn’t a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

15.    Answer D. If the catheter is blocked by blood clots, it may be irrigated according to physician’s orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. Encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is only removed with a physician’s order.

16.    Answer B. When receiving a sulfonamide such as co-trimoxazole, the client should drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.

17.    Answer A. Generalized edema, especially of the face and periorbital area, is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria (not green-tinged urine), proteinuria, fever, chills, weakness, pallor, anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension), oliguria or anuria (not polyuria), headache, reduced visual acuity, and abdominal or flank pain.

18.    Answer A. The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.

19.    Answer A. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won’t protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

20.    Answer A. Maintaining a closed indwelling urinary catheter system helps prevent introduction of bacteria; securing the catheter to the client’s leg also decreases the risk of infection by helping to prevent urethral trauma. To flush bacteria from the urinary tract, the nurse should encourage the client to drink at least 10 glasses of fluid daily, if possible. Douching and feminine deodorants may irritate the urinary tract and should be discouraged.

21.    Answer A. By encouraging a daily fluid intake of at least 2 L, the nurse helps fill the client’s bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn’t give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won’t address the problem of urinary incontinence.

22.    Answer B. Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn’t be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. When there is no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.

23.    Answer D. Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

24.    Answer A. Kayexalate is a sodium exchange resin. Thus the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.

25.    Answer A. Because acetaminophen is metabolized in the liver, its dosage and dosing schedule need not be adjusted for a client with ARF. In contrast, the dosages and schedules for gentamicin and ticarcillin, which are metabolized and excreted by the kidney, should be adjusted. Because cyclosporine may cause nephrotoxicity, the nurse must monitor both the dosage and blood drug level in a client receiving this drug.

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