Unit P-Genitourinary Flashcards
A nurse reviews the urinalysis of a client and notes the presence of glucose. What action
would the nurse take?
a. Document findings and continue to monitor the client.
b. Contact the primary health care provider and recommend a 24-hour urine test.
c. Review the client’s recent dietary selections over 3 days.
d. Perform a finger stick blood glucose assessment.
ANS: D
Glucose normally is not found in the urine. The normal renal threshold for glucose is about
220 mg/dL (12.2 mmol/L), which means that a person whose blood glucose is less than 220
mg/dL (12.2 mmol/L) will not have glucose in the urine. A positive finding for glucose on
urinalysis indicates high blood sugar. The most appropriate action would be to perform a
blood glucose assessment. The client needs further evaluation for this abnormal result;
therefore, documenting and continuing to monitor are not appropriate. Requesting a 24-hour
urine test or reviewing the client’s dietary selections will not assist the nurse to make a
clinical decision related to this abnormality.
A nurse reviews the health history of a client with an oversecretion of renin. Which disorder
would the nurse correlate with this assessment finding?
a. Alzheimer disease
b. Hypertension
c. Diabetes mellitus
d. Viral hepatitis
ANS: B
Renin is secreted when special cells in the distal convoluted tubule, called the macula densa,
sense changes in blood volume and pressure. When the macula densa cells sense that blood
volume, blood pressure, or blood sodium levels are low, renin is secreted. Renin then converts
angiotensinogen into angiotensin I. This leads to a series of reactions that cause secretion of
the hormone aldosterone. This hormone increases kidney reabsorption of sodium and water,
increasing blood pressure, blood volume, and blood sodium levels. Inappropriate or excessive
renin secretion is a major cause of persistent hypertension. Renin has no impact on Alzheimer
disease, diabetes mellitus, or viral hepatitis.
A nurse reviews the urinalysis results of a client and notes a urine osmolality of 1200
mOsm/kg (1200 mmol/kg). Which action would the nurse take?
a. Contact the primary health care provider to recommend a low-sodium diet.
b. Prepare to administer an intravenous diuretic.
c. Encourage the client to drink more fluids.
d. Obtain a suction device and implement seizure precautions
ANS: C
Normal urine osmolality ranges from 300 to 900 mOsm/kg (300 to 900 mmol/kg). This
client’s urine is more concentrated, indicating dehydration. The nurse would encourage the
client to drink more water. Dehydration can be associated with elevated serum sodium levels.
Although a low-sodium diet may be appropriate for this client, this diet change will not have a
significant impact on urine osmolality. A diuretic would increase urine output and decrease
urine osmolality further. Low serum sodium levels, not elevated serum levels, place the client
at risk for seizure activity. These options would further contribute to the client’s dehydration
or elevate the osmolality.
A nurse assesses a client with renal insufficiency and a low red blood cell count. The client
asks, “Is my anemia related to my kidney problem?” How would the nurse respond?
a. “Red blood cells produce erythropoietin, which increases blood flow to the
kidneys.”
b. “Your anemia and kidney problem are related to inadequate vitamin D and a loss
of bone density.”
c. “Erythropoietin is usually released from the kidneys and stimulates red blood cell
production in the bone marrow.”
d. “Kidney insufficiency inhibits active transportation of red blood cells throughout
the blood.”
ANS: C
Erythropoietin is produced in the kidney and is released in response to decreased oxygen
tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the
bone marrow. Anemia and renal insufficiency are not manifestations of vitamin D deficiency.
The kidneys do not play a role in the transportation of red blood cells or any other cells in the
blood.
A nurse contacts the primary health care provider after reviewing a client’s laboratory results
and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a serum creatinine of
1.0 mg/dL (88.4 mcmol/L). What collaborative care measure would the nurse recommend?
a. Intravenous fluids
b. Hemodialysis
c. Fluid restriction
d. Urine culture and sensitivity
ANS:A
Normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Normal creatinine is 0.6 to 1.2 mg/dL
(53.0 to 106.1 mcmol/L) (males) or 0.5 to 1.1 mg/dL (44.2 to 97.2 mcmol/L) (females).
Creatinine is more specific for kidney function than BUN, because BUN can be affected by
several factors (dehydration, high-protein diet, and catabolism). This client’s creatinine is
normal, which suggests a nonrenal cause for the elevated BUN. A common cause of increased
BUN is dehydration, so the nurse would recommend giving the client more fluids, not placing
the client on fluid restrictions. Hemodialysis is not an appropriate treatment for dehydration.
The lab results do not indicate an infection; therefore, a urine culture and sensitivity are not
appropriate.
The nurse is assessing a group of clients for their risk of kidney disease. Which racial/ethnic
group is at the greatest risk as they age?
a. Latino Americans
b. African Americans
c. Jewish Americans
d. Asian Americans
ANS: B
Older African Americans have a greater age-related decrease in glomerular filtration rate
when compared to other racial-ethnic groups. In addition, blood flow decreases and sodium
excretion is less effective in older hypertensive African Americans. These changes make this
group most at risk for kidney disease.
A nurse cares for a client with a urine specific gravity of 1.040. What action would the nurse
take?
a. Obtain a urine culture and sensitivity.
b. Place the client on restricted fluids.
c. Assess the client’s creatinine level.
d. Increase the client’s fluid intake.
ANS: D
Normal specific gravity for urine is 1.005 to 1.030. A high specific gravity can occur with
dehydration, decreased kidney blood flow (often because of dehydration), and presence of
antidiuretic hormone. Increasing the client’s fluid intake would be a beneficial intervention.
Assessing the creatinine or obtaining a urine culture would not provide data necessary for the
nurse to make a clinical decision.
A nurse reviews a client’s laboratory results. Which results from the client’s urinalysis would the nurse recognize as abnormal? a. pH of 5.6 b. Ketone bodies present c. Specific gravity of 1.020 d. Clear and yellow color
ANS: B
Ketone bodies are by-products of incomplete metabolism of fatty acids. Normally, no ketones
are present in urine. Ketone bodies are produced when fat sources are used instead of glucose
to provide cellular energy. A pH between 4.6 and 8, specific gravity between 1.005 and 1.030,
and clear yellow urine are normal findings in a urinalysis.
A nurse cares for a client who is recovering from a closed percutaneous kidney biopsy. The
client states, “My pain has suddenly increased from a 3 to a 10 on a scale of 0-10.” Which
action would the nurse take first?
a. Reposition the client on the operative side.
b. Administer the prescribed opioid analgesic.
c. Assess the client’s pulse rate and blood pressure.
d. Examine the color of the client’s urine.
ANS: C
An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of
possible internal hemorrhage. A change in vital signs (elevated pulse and decreased blood
pressure) can indicate that hemorrhage is occurring.
The nurse delegates completing a bladder scan to assistive personnel (AP). Which action by
the AP indicates that the nurse must provide additional instructions when delegating this task?
a. Selecting the female icon for all female patients and male icon for all male patients
b. Telling the client, “This test measures the amount of urine in your bladder.”
c. Applying ultrasound gel to the scanning head and removing it when finished
d. Taking at least two readings using the aiming icon to place the scanning head
ANS: A
The AP should use the female icon for women who have not had a hysterectomy. This allows
the scanner to subtract the volume of the uterus from readings. If a woman has had a
hysterectomy, the AP should choose the male icon. The AP should explain the procedure to
the client, apply gel to the scanning head and clean it after use, and take at least two readings.
A nurse reviews a client’s laboratory results. Which results from the client’s urinalysis would the nurse identify as normal? (Select all that apply.) a. pH: 6 b. Specific gravity: 1.015 c. Protein: 1.2 mg/dL d. Glucose: negative e. Nitrate: small f. Leukocyte esterase: positive
ANS: A, B, D
The pH, specific gravity, and glucose are all within normal ranges. The other values are
abnormal.
The nurse is preparing a client for a percutaneous kidney biopsy. Which laboratory tests results would the nurse review prior to the procedure? (Select all that apply.) a. Hemoglobin b. Hematocrit c. Sodium d. Potassium e. Platelet count f. Prothrombin time
ANS: A, B, E, F
Kidneys are very vascular and the client is at risk for bleeding after a biopsy. Therefore, it is
essential that the nurse review preprocedure laboratory test results for anemia and coagulation
problems.
A nurse assesses a client recovering from a cystoscopy. Which assessment findings would
alert the nurse to urgently contact the primary health care provider? (Select all that apply.)
a. Decrease in urine output
b. Tolerating oral fluids
c. Prescription for metformin
d. Blood clots present in the urine
e. Burning sensation when urinating
ANS:A,D
The nurse would monitor urine output and contact the primary health care provider if urine
output decreases or becomes absent. The nurse would also assess for blood in the client’s
urine. The urine may be pink-tinged, but gross bleeding or blood clots should not be present.
If bleeding is present, the nurse would urgently contact the primary health care provider.
Tolerating oral fluids is a positive outcome and does not need intervention. Metformin would
be a concern if the patient received dye; no dye is used in a cystoscopy procedure. The client
may experience a burning sensation when urinating after this procedure; this would not
require a call to the primary health care provider.
A nurse prepares a client for a percutaneous kidney biopsy. What actions should the nurse
take prior to this procedure? (Select all that apply.)
a. Keep the client NPO for 4 to 6 hours.
b. Review coagulation study results.
c. Maintain strict bedrest in a supine position.
d. Assess for blood in the client’s urine.
e. Administer client’s antihypertensive medications.
ANS: A, B, E
Prior to a percutaneous kidney biopsy, the patient should be NPO for 4 to 6 hours.
Coagulation studies should be completed to prevent bleeding after the biopsy. Blood pressure
medications should be administered to prevent hypertension before and after the procedure.
There is no need to keep the patient on bedrest or assess for blood in the client’s urine prior to
the procedure; these interventions should be implemented after a percutaneous kidney biopsy.
A nurse plans care for an older adult patient. Which interventions should the nurse include in
this client’s plan of care to promote kidney health? (Select all that apply.)
a. Ensure adequate fluid intake.
b. Leave the bathroom light on at night.
c. Encourage use of the toilet every 6 hours.
d. Delegate bladder training instructions to the assistive personnel (AP).
e. Provide thorough perineal care after each voiding.
f. Assess for urinary retention and urinary tract infection.
ANS: A, B, E, F
The nurse should ensure that the client receives adequate fluid intake and has adequate
lighting to ambulate safely to the bathroom at night, encourage the client to use the toilet
every 2 hours, provide thorough perineal care after each voiding, and assess for urinary
retention and urinary tract infections. The nurse would not delegate any teaching to the AP,
including bladder training instructions. The AP may participate in bladder training activities,
including encouraging and assisting the client to the bathroom at specific times.
The nurse assesses a client who has possible bladder cancer. What common assessment
finding associated with this type of cancer would the nurse expect?
a. Urinary retention
b. Urinary incontinence
c. Painless hematuria
d. Difficulty urinating
ANS: C
The classic and most common finding in clients who have bladder cancer is painless and
intermittent hematuria that can be with gross or microscopic. Dysuria, frequency, and urgency
occur in clients who have bladder infection or obstruction.
A nurse reviews the laboratory findings of a client with a urinary tract infection (bacterial
cystitis). The laboratory report notes a “shift to the left” in the client’s white blood cell count.
What action would the nurse take?
a. Request that the laboratory perform a differential analysis on the white blood cells.
b. Notify the primary health care provider and start an intravenous line for parenteral
antibiotics.
c. Ask assistive personnel (AP) to strain the client’s urine for renal calculi.
d. Assess the client for a potential allergic reaction and anaphylactic shock.
ANS: B
An increase in band cells creates a “shift to the left.” A left shift most commonly occurs with
urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be
administering antibiotics, most likely via IV, so he or she would notify the primary health care
provider and prepare to give the antibiotics. The shift to the left is part of a differential white
blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are
associated with elevated eosinophil cells, not band cells.
A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in
the last 6 months. The client asks, “I never have urinary tract infections. Why is this
happening now?” How would the nurse respond?
a. “Your immune system becomes less effective as you age.”
b. “Low estrogen levels can make the tissue more susceptible to infection.”
c. “You should be more careful with your personal hygiene in this area.”
d. “It is likely that you have an untreated sexually transmitted disease.”
ANS: B
Low estrogen levels decrease moisture and secretions in the perineal area and cause other
tissue changes, predisposing it to the development of infection. Urethritis is most common in
postmenopausal women for this reason. Although immune function does decrease with aging
and sexually transmitted diseases are a known cause of urethritis, the most likely reason in
this patient is low estrogen levels. Personal hygiene usually does not contribute to this disease
process.
After teaching a client with bacterial cystitis who is prescribed phenazopyridine, the nurse
assesses the client’s understanding. Which statement made by the client indicates a correct
understanding of the teaching?
a. “I will not take this drug with food or milk.”
b. “I will have my partners tested for STIs.”
c. “An orange color in my urine should not alarm me.”
d. “I will drink two glasses of cranberry juice daily.”
ANS: C
Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients
think that they have blood in their urine when they see this. In addition, the urine can
permanently stain clothing. There are no dietary restrictions or needs while taking this
medication.
After teaching a client who has stress incontinence, the nurse assesses the client’s
understanding. Which statement made by the client indicates a need for further teaching?
a. “I will limit my total intake of fluids.”
b. “I must avoid drinking alcoholic beverages.”
c. “I must avoid drinking caffeinated beverages.”
d. “I shall try to lose about 10% of my body weight.”
ANS: A
Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence or
cystitis. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated
beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing
incontinence.
The nurse teaches a client who has stress incontinence methods to regain more urinary
continence. Which health teaching is the most important for the nurse to include for this
client?
a. What type of incontinence pads to use?
b. What types of liquids to drink and when?
c. Need to perform intermittent catheterizations.
d. How to do Kegel exercises to strengthen muscles?
ANS: D
The client who has stress incontinence needs to strengthen the muscles of the pelvic floor
using Kegel exercises. Catheterizations would not help with incontinence. Incontinence pads
may need to be used by this client but that is not the most important thing to teach, and it does
not help the client regain more control over his or her bladder.
After delegating care to assistive personnel (AP) for a client who is prescribed habit training
to manage incontinence, a nurse evaluates the AP’s understanding. Which action indicates
that the AP needs additional teaching?
a. Toileting the client after breakfast
b. Changing the client’s incontinence brief when wet
c. Encouraging the client to drink fluids
d. Recording the client’s incontinence episodes
ANS: B
Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse
should reeducate the AP on the technique of habit training. The AP should continue to toilet
the client after meals, encourage the client to drink fluids, and record incontinent episodes.
A nurse plans care for a client with overflow incontinence. Which intervention does the nurse
include in this client’s plan of care to assist with elimination?
a. Stroke the medial aspect of the thigh.
b. Use intermittent catheterization.
c. Provide digital anal stimulation.
d. Use the Valsalva maneuver.
ANS: D
In patients with overflow incontinence, the voiding reflex arc is not intact. Mechanical
pressure, such as that achieved through the Valsalva maneuver (holding the breath and
bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or
providing digital anal stimulation requires the reflex arc to be intact to initiate elimination.
Due to the high risk for infection, intermittent catheterization should only be implemented
when other interventions are not successful.
A client with pneumonia and dementia is admitted with an indwelling urinary catheter in
place. During interprofessional rounds the following day, which question would the nurse ask
the primary health care provider?
a. “Do you want daily weights on this client?”
b. “Will the client be able to return home?”
c. “May we discontinue the indwelling catheter?”
d. “Should we get another chest x-ray today?”
ANS: C
An indwelling urinary catheter dramatically increases the risks of urinary tract infection and
urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are
medically needed. The nurse would inquire about removing the catheter. All other questions
might be appropriate, but because of client safety, this question takes priority.
