Chapter 44: Assessment of the Urinary System
Which patient statements indicate an understanding of self-management techniques in reducing the incidence of overflow incontinence? Select all that apply "I'd really like to read some materials about smoking cessation programs." "Taking oxybutynin will increase my bladder tone, which will lead to fewer leaks." "Regular bowel movements and avoiding constipation will help me to dribble less." "Intermittent catheterization will increase the likelihood that I will have nocturnal enuresis." "These Kegel exercises feel funny, but I'll be glad when I can control my pelvic floor muscles." "By practicing the Valsalva maneuver, I should be able to empty my bladder more completely."
"Regular bowel movements and avoiding constipation will help me to dribble less." "These Kegel exercises feel funny, but I'll be glad when I can control my pelvic floor muscles." "By practicing the Valsalva maneuver, I should be able to empty my bladder more completely." Constipation worsens urinary leakage, so avoiding it is a proper technique for improving overflow incontinence. Strengthening pelvic floor muscles by doing Kegel exercises will also help prevent unwanted leakage. The Valsalva maneuver is the straining of abdominal muscles, thereby increasing bladder pressure to allow for more complete emptying of the bladder. Oxybutynin is an anticholinergic that works to relax the muscles in the bladder to allow for increased filling. Taking oxybutynin would not effectively treat overflow incontinence but would instead worsen the problem. Quitting smoking reduces the incidence of stress incontinence specifically, not overflow incontinence. Intermittent catheterization is beneficial for people struggling with overflow incontinence and is not related to nocturnal enuresis.
When assessing a patient with a urinary tract infection, indicate on the accompanying figure where the nurse will percuss to assess for possible pyelonephritis. 1 2 3 4
2 Costovertebral angle (CVA) tenderness with percussion suggests pyelonephritis or polycystic kidney disease.
What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a creatinine clearance result of 60 mL/min? 60 mL/min 90 mL/min 120 mL/min 180 mL/min
60 mL/min The creatinine clearance approximates the GFR. The other responses are not accurate.
Which nursing action is essential for a patient immediately after a renal (kidney) biopsy? Check blood glucose to assess for hyperglycemia or hypoglycemia. Insert a urinary catheter and test urine for gross or microscopic hematuria. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function. Apply a pressure dressing and keep the patient on the affected side for 30 minutes.
Apply a pressure dressing and keep the patient on the affected side for 30 minutes. A pressure dressing is applied and the patient is kept on the affected side for 30 to 60 minutes to put pressure on the biopsy side and decrease the risk for bleeding.
A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first? Ask about the usual urinary pattern and any measures used for bladder control. Assist the patient to the toilet at scheduled times to help ensure bladder emptying. Check the patient for urinary incontinence every 2 hours to maintain skin integrity. Use intermittent catheterization on a regular schedule to avoid the risk of infection.
Ask about the usual urinary pattern and any measures used for bladder control. Before planning any interventions, the nurse should complete the assessment and determine the patients normal bladder pattern and the usual measures used by the patient at home.
A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first? Notify the patients health care provider. Teach correct midstream urine collection. Ask the patient about current medications. Question the patient about urinary tract infection (UTI) risk factors.
Ask the patient about current medications. A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as phenazopyridine (Pyridium). The color would not be expected with urinary tract infection, is not a sign that poor technique was used in obtaining the specimen, and does not need to be communicated to the health care provider until further assessment is done.
A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethreal resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the HCP? 1. red bloody urine 2. pain rated as 2 on a 0-10 pain scale 3. urinary output of 200 mL higher than intake 4. BP 100/50, pulse 130 bpm
BP 100/50, pulse 130 bpm Rationale: Frank bleeding (arterial or venous) may occur during the first day after surgery. A urinary output of 200 mL more than intake is adequate. A client pain rating of 2 on a 0-10 scale indicates adequate pain control. A rapid pulse with a low BP is a potential sign of excessive blood loss. The HCP should be notified Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate. An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra)
Which diagnostic studies would the health care provider prescribe to determine loss of kidney function secondary to fibrosis from significant anatomic abnormalities or recurrent upper urinary tract infections? Select all that apply. Biopsy Urine sediment microscopy CT scan MRI Voiding cystourethrogram (VCUG)
Biopsy CT scan The kidneys become small, atrophic, and lose function due to scarring from chronic pyelonephritis, which is commonly caused by significant anatomic abnormalities, such as vesicoureteral reflux or recurring infections involving the upper urinary tract. Biopsy and CT scan results indicate the loss of functioning of the nephrons; infiltration of the parenchyma with inflammatory cells, fibrosis, visualization of the kidney size; and tumors, as observed in chronic pyelonephritis. Urine sediment microscopy reveals erythrocytes in significant numbers. VCUG is used to confirm the diagnosis of urethral diverticula. MRI is used to determine the size of the diverticulum in relation to the urethral lumen.
A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for Renal failure. Kidney stones. Pyelonephritis. Bladder cancer.
Bladder cancer Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.
Which prescribed diagnostic test would the nurse associate with a patient's report of voiding large amounts of urine five to six times each night? Cholesterol levels Amino acid level Blood glucose level Blood urea nitrogen level
Blood glucose level Nocturia is a high frequency of urination in the night, and polyuria is the passage of a large volume of urine in a given time. Together, these clinical manifestations reflect diabetes mellitus, and the health care provider may suggest that the patient undergo diagnostic tests for glucose levels.
Which prescribed diagnostic test would the nurse associate with a patient's report of voiding large amounts of urine five to six times each night? Cholesterol levels Amino acid level Blood glucose level Blood urea nitrogen level
Blood glucose level Nocturia is a high frequency of urination in the night, and polyuria is the passage of a large volume of urine in a given time. Together, these clinical manifestations reflect diabetes mellitus, and the health care provider may suggest that the patient undergo diagnostic tests for glucose levels. Alteration in amino acid levels may indicate malnutrition in the patient. The prescriber may order a cholesterol level test for an obese patient. The patient who is dehydrated may have the blood urea nitrogen (BUN) test prescribed.
When collecting a urine sample for analysis and a culture with sensitivity (C&S) from a patient admitted with suprapubic pain and dysuria, which instruction would the nurse provide the patient? After drinking 1 liter of water, wash your hands and collect the urine sample. When you complete your breakfast, immediately collect the next voided urine. Clean your periurethral area, begin voiding, and then catch a sample of your urine. Use the antiseptic cloth to clean your periurethral area before collecting the sample.
Clean your periurethral area, begin voiding, and then catch a sample of your urine. A clean-catch, or midstream, sample should be collected to prevent contamination of urine with bacteria present in the vagina or penis. Clean the periurethral area, begin to void, and catch a midstream sample of urine. The periurethral area should be cleaned, but the use of antiseptic should be avoided because it can contaminate the sample and provide a false positive. A sample should not be collected directly after a meal or after drinking a liter of water because food and water can affect the normal chemical composition of a patient's urine.
When prescribed an angiotensin-converting enzyme (ACE) inhibitor, which potential side effect would affect the patient's lower urinary tract function? Polyuria Bladder irritation Urinary retention in males Cough triggering stress urinary incontinence (UI)
Cough triggering stress urinary incontinence (UI) ACE inhibitors result in chronic dry cough leading to stress UI. Alcohol and diuretics cause polyuria. Methylxanthines cause bladder irritation. α-adrenergic receptor agonists cause urinary retention in males.
Aging has which effect on the patient's urinary system and affects the action of bumetanide (Bumex)?
Decreased function of the loop of Henle
To assess whether there is any improvement in a patients dysuria, which question will the nurse ask? Do you have to urinate at night? Do you have blood in your urine? Do you have to urinate frequently? Do you have pain when you urinate?
Do you have pain when you urinate? Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.
The nurse completing a physical assessment for a newly admitted male patient is unable to feel either kidney on palpation. Which action should the nurse take next? Obtain a urine specimen to check for hematuria. Document the information on the assessment form. Ask the patient about any history of recent sore throat. Ask the health care provider about scheduling a renal ultrasound
Document the information on the assessment form The kidneys are protected by the abdominal organs, ribs, and muscles of the back, and may not be palpable under normal circumstances, so no action except to document the assessment information is needed.
With the release of aldosterone, which reaction occurs within the distal convoluted tubules of the kidney?
Excretion of potassium into urine increases.
A patient has elevated blood urea nitrogen (BUN) and serum creatinine levels. Which bowel preparation order would the nurse question for this patient who is scheduled for a renal arteriogram? Fleet enema Tap-water enema Senna/docusate (Senokot-S) Bisacodyl (Dulcolax) tablets
Fleet enema High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure
Which medication taken at home by a 47-year-old patient with decreased renal function will be of most concern to the nurse? Ibuprofen (Motrin) Warfarin (Coumadin) Folic acid (vitamin B9) Penicillin (Bicillin LA)
Ibuprofen (Motrin) The nonsteroidal antiinflammatory medications (NSAIDs) are nephrotoxic and should be avoided in patients with impaired renal function. The nurse also should ask about reasons the patient is taking the other medications, but the medication of most concern is the ibuprofen.
The nurse assessing the urinary system of a 45-year-old female would use auscultation to determine kidney position identify renal artery bruits. check for ureteral peristalsis. assess for bladder distention.
Identify renal artery bruits. The presence of a bruit (abnormal sound) may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract information.
When a patients urine dipstick test indicates a small amount of protein, the nurses next action should be to Send a urine specimen to the laboratory to test for ketones. Obtain a clean-catch urine for culture and sensitivity testing. Inquire about which medications the patient is currently taking. Ask the patient about any family history of chronic renal failure
Inquire about which medications the patient is currently taking Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false- positive readings. The other actions by the nurse may be appropriate, but checking for medications that may affect the dipstick accuracy should be done first.
Which disorder would the nurse associate with a patient's clinical manifestations of urgency, urinating approximately 10 times within a 24-hour period, and eliminating 150 mL per void?
Interstitial cystitis
A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain? Urinary catheter Cleaning towelettes Large container for urine Sterile urine specimen cup
Large container for urine Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test
A 79-year-old man has been admitted with benign prostatic hyperplasia (prostate enlargement) . What is most appropriate to include in the nursing plan of care? Limit fluid intake to no more than 1000 mL/day. Leave a light on in the bathroom during the night. Ask the patient to use a urinal so that urine can be measured. Pad the patients bed to accommodate overflow incontinence
Leave a light on in the bathroom during the night. The patients age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients.
The nurse is caring for a 68-year-old hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care? Monitor the urine output after the procedure. Assist with monitored anesthesia care (MAC). Give oral contrast solution before the procedure. Insert a large size urinary catheter before the IVP.
Monitor the urine output after the procedure. Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patients urine output
Which statement by a patient who had a cystoscopy the previous day should be reported immediately to the health care provider? My urine looks pink. My IV site is bruised. My sleep was restless. My temperature is 101.
My temperature is 101 The patients elevated temperature may indicate a bladder infection, a possible complication of cystoscopy. The health care provider should be notified so that antibiotic therapy can be started. Pink-tinged urine is expected after a cystoscopy.
Which clinical manifestations would the nurse use to determine the location of the urinary tract infection (UTI) when the male patient's urinalysis reported a high microorganism count? Select all that apply. Pain location Fever and chills Mental confusion Urinary hesitancy Urethral discharge Postvoid dribbling
Pain location Urethral discharge Although all the listed manifestations are evident with UTIs, pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis (upper UTI), but dysuria is characteristic of cystitis and urethritis (lower UTI). Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.
When working in the urology/nephrology clinic, which patient could the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? Patient who is scheduled for a renal biopsy after a recent kidney transplant Patient who will need monitoring for several hours after a renal arteriogram Patient who requires teaching about possible post-cystoscopy complications Patient who will have catheterization to check for residual urine after voiding
Patient who will have catheterization to check for residual urine after voiding LPN/LVN education includes common procedures such as catheterization of stable patients. The other patients require more complex assessments and/or patient teaching that are included in registered nurse (RN) education and scope of practice.
Which medication is the only oral agent approved for the treatment of interstitial cystitis?
Pentosan (Elmiron) Pentosan is the only oral agent used in the treatment of interstitial cystitis. Penicillin is used in the treatment of streptococcal infection as seen in acute poststreptococcal glomerulonephritis. Nortriptyline and amitriptyline are tricyclic antidepressants that may be used to reduce burning pain and urinary frequency.
Which prescribed medication would the nurse expect to administer to a patient reporting painful urination secondary to bladder tumors? Ciprofloxacin (Cipro) Fluconazole (Diflucan) Phenazopyridine (Pyridium) Nitrofurantoin (Macrodantin)
Phenazopyridine (Pyridium) A patient with bladder tumors usually experiences increased frequency and dysuria. A urinary analgesic such as phenazopyridine relieves discomfort caused by pain during urination (dysuria) by exerting an analgesic effect on the urinary tract mucosa. Fluconazole is the preferred therapy in patients with urinary tract calculi secondary to fungi. Ciprofloxacin is an antibiotic used to treat complicated urinary tract infection (UTI). Nitrofurantoin is a first-line drug that is used to treat initial uncomplicated UTI.
A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? (Select all that apply). 1. Place the client on a cardiac monitor. 2. Notify the health care provider (HCP). 3. Put the client on NPO (nothing by mouth)status except for ice chips. 4. Review the client's medications to determineif any contain or retain potassium. 5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.
Place the client on a cardiac monitor. Notify the health care provider (HCP). Review the client's medications to determineif any contain or retain potassium. Rationale: the normal potassium level is 3.5-5.0 mEq/L. A potassium level of 7.0 is elevated. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review medications to determine if any contain potassium or are potassium retaining. The client does not need to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly
Which surgical procedure would the nurse associate as treatment for a patient who has frequent urination, accidental loss of urine, and dyspareunia (painful intercourse)? Cystoscopy Cystolitholapaxy Spence procedure Electrohydraulic lithotripsy
Spence procedure Frequent urination, accidental loss of urine, and pain during sexual intercourse are the clinical manifestations of urethral diverticula. A Spence procedure is performed for marsupialization (creation of permanent opening) of the diverticular sac into the vagina in patients with urethral diverticula. Cystoscopy is a procedure used to remove small stones from the kidneys. Cystolitholapaxy is a procedure that is used to break up large stones. Electrohydraulic lithotripsy is used in conjunction with an ureteroscope to pulverize a stone.
Which type of urinary incontinence would the nurse suspect when preparing a patient for a procedure to increase the closing pressure of the urethra and increase the periurethral electromyography activity? Stress incontinence Reflex incontinence Overflow incontinence Incontinence after trauma or surgery
Stress incontinence Injection of a bulking agent under the urethra mucosa helps to correct stress incontinence. Agents include glutaraldehyde cross-linked bovine collagen (GAX cologne), autologous fat, carbon beads, etc. Injecting autologous stem cells into the rhabdosphincter and urethral submucosa is a recent surgical technique performed for stress urinary incontinence (UI) to increase the closure pressure and periurethral electromyography activity. Surgical sphincterotomy cures reflex incontinence. Urinary or intermittent catheterization can cure overflow incontinence. Treatment of incontinence after trauma or surgery includes by placing an artificial implantable sphincter.
How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected pyelonephritis (upper UTI)? Palpate along both sides of the lumbar vertebral column. Strike a flat hand covering the costovertebral angle (CVA). Push fingers upward into the two lowest intercostal spaces. Percuss between the iliac crest and ribs along the midaxillary line
Strike a flat hand covering the costovertebral angle (CVA) Checking for flank pain is best performed by percussion of the CVA and asking about pain. The other techniques would not assess for flank pain.
A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP). Which item has the most immediate implications for the patients care? The patient has not had food or drink for 8 hours. The patient lists allergies to shellfish and penicillin. The patient complains of costovertebral angle (CVA) tenderness. The patient used a bisacodyl (Dulcolax) tablet the previous night.
The patient lists allergies to shellfish and penicillin. Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started.
When reviewing the medical report of patients with urinary incontinence (UI), which patient would the nurse suspect as having overflow incontinence? The patient with a herniated disc The patient with Parkinson's disease The patient with multiple pregnancies The patient with retropubic prostatectomy
The patient with a herniated disc Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. It is due to an underactive detrusor muscle, caused by myogenic or neurogenic factors such as a herniated disc. Therefore the patient with a herniated disc would have overflow incontinence. Central nervous system disorders, such as Parkinson's disease and Alzheimer's disease, lead to urge incontinence. A patient who has had multiple pregnancies experiences relaxation of the pelvic floor muscles, which can cause stress incontinence. Retropubic prostatectomy causes incontinence after trauma or surgery.
When administering a medication that inhibits atrial natriuretic peptides (ANP), which response would the nurse expect to occur?
The patient's urine will become more concentrated
Which assessment of a 62-year-old patient who has just had an intravenous pyelogram (IVP) requires immediate action by the nurse? The heart rate is 58 beats/minute. The patient complains of a dry mouth. The respiratory rate is 38 breaths/minute. The urine output is 400 mL after 2 hours.
The respiratory rate is 38 breaths/minute. The increased respiratory rate indicates that the patient may be experiencing an allergic reaction to the contrast medium used during the procedure. The nurse should immediately assess the patients oxygen saturation and breath sounds
When providing care for a patient with urinary incontinence (UI), which rationale supports the nursing intervention of inserting a urethral plug into the patient's urethra? To support the bladder neck To direct urine into the drainage bag To prevent leakage through the urethra To mechanically obstruct urine leakage
To mechanically obstruct urine leakage A urethral plug is an intraurethral occlusive device and worn in the urethra to provide mechanical obstruction to prevent urine leakage. Pessaries and bladder neck support prostheses are devices to help support the bladder neck. A drainage bag directs urine through external catheter systems. Penile compression devices prevent leakage through the urethra.
Which instructions would the nurse include when teaching self-care to an obese female patient diagnosed with stress incontinence? Select all that apply Use of urethral inserts for support Excess weight-reduction strategies Practice Kegel exercises frequently Initiate oxybutynin (Ditropan) treatment Perform bladder decompression procedure
Use of urethral inserts for support Excess weight-reduction strategies Practice Kegel exercises frequently Urethral inserts support and correct the underlying problem causing stress incontinence. Reducing excess weight can help to reduce the pressure on and relaxation of the pelvic floor muscles. Practicing pelvic floor muscle (Kegel) exercises frequently can decrease stress incontinence caused by relaxed pelvic floor muscles. Oxybutynin is an anticholinergic drug, which treats central nervous system disorders such as urge incontinence. Bladder decompression prevents ureteral reflux and hydronephrosis in the case of reflex incontinence.
Which information from a patients urinalysis requires that the nurse notify the health care provider? pH 6.2 Trace protein WBC 20 to 26/hpf Specific gravity 1.021
WBC 20 to 26/hpf The increased number of white blood cells (WBCs) indicates the presence of urinary tract infection or inflammation. The other findings are normal. Normal in urine = 0-5/hpf
A patient passing bloody urine is scheduled for a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate? Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys. Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney. Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray. Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked.
Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray. In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken. The response beginning, Your doctor will place a catheter describes a renal arteriogram procedure.
A client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardia, pale, and anxious and the nurse suspects air embolism. What are the priority nursing actions? Select all that apply. 1. administer oxygen to the client 2. continue dialysis at a slower rate after checking the lines for air 3. notify the HCP and RRT 4. stop dialysis, and turn the client on the left side with head lower than feet 5. bolus the client with 500 mL of normal saline to break up the air embolus
administer oxygen to the client notify the HCP and RRT stop dialysis, and turn the client on the left side with head lower than feet Rationale: if the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, position the client so the air embolus is in the right side of the heart, notify the HCP and RRT, and administer oxygen as needed. Slowing the dialysis treatment or giving an intravenous bolus will not correct the air embolism or prevent complications
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply. 1. check the level of the drainage bag 2. reposition the client to his or her side 3. contact the HCP 4. place the client in good body alignment 5. check the peritoneal dialysis system for kinks 6. increase the flow rate of the peritoneal dialysis solution
check the level of the drainage bag reposition the client to his or her side place the client in good body alignment check the peritoneal dialysis system for kinks Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the HCP. Increasing the flow rate should not be done and also is not associated with the amount of outflow solution
The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia (prostate enlargement)? 1. nocturia 2. scrotal edema 3. occasional constipation 4. decreased force in the stream of urine
decreased force in the stream of urine Rationale: decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. 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. Constipation or scrotal edema is not associated with benign prostatic hyperplasia
The nurse is reviewing a client's record and notes that HCP has documented that the client has chronic renal disease. On review of the lab results, the nurse most likely would expect to note which finding? 1. elevated creatinine level 2. decreased hemoglobin level 3. decreased RBC count 4. increased number of WBCs in the urine
elevated creatinine level Rationale: The creatinine level is the most specific lab test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and RBC count are associated with anemia or blood loss and not specifically with decreased renal function. Increased white blood cells in the urine are noted with UTI
The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination? 1. fever, diarrhea, groin pain, and ecchymosis 2. nausea, painful scrotal edema, and ecchymosis 3. fever, nausea, vomiting, and painful scrotal edema 4. diarrhea, groin pain, testicular torsion, and scrotal edema
fever, nausea, vomiting, and painful scrotal edema Rationale: typical signs and symptoms of epididymitis include scrotal pain and edema, which often are accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by infection, although sometimes it can be caused by trauma. The remaining options do not present all of the accurate manifestations Epididymitis is an inflammation of the epididymis. The epididymis is a tube located at the back of the testicles that stores and carries sperm.
The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestation? hypertension, tachycardia, and fever hypotension, bradycardia, and hypothermia restlessness, irritability, and generalized weakness headache, deteriorating level of consciousness, and twitching
headache, deteriorating level of consciousness, and twitching Rationale: disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water does into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialusis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low BP and anemia. Restlessness and irritability are not associated with disequilibrium syndrome
The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply. 1. hemodialysis 2. peritoneal dialysis 3. kidney transplant 4. bilateral nephrectomy 5. intense immunosuppression therapy
hemodialysis kidney transplant bilateral nephrectomy Rationale: polycystic kidney disease is a genetic familial disease in which the kidney enlarge with cysts that rupture and scar the kidney, eventually resulting in end stage renal disease. Treatment options include hemodialysis or kidney transplant. Clients usually undergo bilateral nephrectomy to remove the large, painful, cyst-filled kidneys. Peritoneal dialysis is not a treatment option due to the infected cysts. The condition does not respond to immunosuppression
The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply. 1. hemodialysis 2. peritoneal dialysis 3. kidney transplant 4. bilateral nephrectomy. 5. intense immunosuppression therapy
hemodialysis kidney transplant bilateral nephrectomy Rationale: polycystic kidney disease is a genetic familial disease in which the kidney enlarge with cysts that rupture and scar the kidney, eventually resulting in end stage renal disease. Treatment options include hemodialysis or kidney transplant. Clients usually undergo bilateral nephrectomy to remove the large, painful, cyst-filled kidneys. Peritoneal dialysis is not a treatment option due to the infected cysts. The condition does not respond to immunosuppression
The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1. peritonitis 2. hyperglycemia 3. hyperphosphatemia 4. disequilibrium syndrome
hyperglycemia Rationale: An extended dwell time increases the risk of hyperglycemia in the client with DM as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique. Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. Disequilibrium syndrome is a complication associated with hemodialysis
A week after kidney transplantation, a client develops a temperature of 101 F, the BP is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? 1. antibiotic therapy 2. peritoneal dialysis 3. removal of the transplanted kidney 4. increased immunosuppression therapy
increased immunosuppression therapy Rationale: Acute rejection most often occurs within 1 week after transplantation but can occur any time post-transplantation. Clinical manifestation include fever, malaise (discomfort), elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuppressive therapy. Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly transplanted kidney due to the recent surgery. Removal of the transplanted kidney is indicated with hyper acute rejection, which occurs within 48 hours of the transplant surgery
The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1. monitor the client 2. elevate the head of the bed 3. assess the fistula site and dressing 4. notify the HCP
notify the HCP Rationale: Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the head of bed, and assessing the fistula site are correct actions, the priority action is to notify the HCP
A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 101.2 F. Which nursing action is most appropriate? 1. encourage fluid intake 2. notify the HCP 3. continue to monitor vital signs 4. monitor the site of the shunt for infection
notify the HCP Rationale: a temperature of 101.2 F is significantly elevated and may indicate infection. The nurse should notify the HCP. Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the HCP should be notified first
A client is admitted to the ED following a fall from a horse and the HCP prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1. notify the HCP before performing the catheterization 2. use a small-sized catheter and an anesthetic gel as a lubricant 3. administer parenteral pain medication before inserting the catheter 4. clean the meatus with soap and water before opening the catheterization kit
notify the HCP before performing the catheterization Rationale: the presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing.
A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1. warmth, redness, and pain in the left hand 2. ecchymosis and audible bruit over the fistula 3. edema and reddish discoloration of the left arm 4. pallor, diminished pulse, and pain in the left hand
pallor, diminished pulse, and pain in the left hand Rationale: steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal findings for a fistula
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. palpation of a thrill over the fistula 2. presence of a radial pulse in the left wrist 3. visualization of enlarged blood vessels at the fistula site 4. capillary refill less than 3 seconds in the nail beds of the fingers on the left hand
palpation of a thrill over the fistula Rationale: the nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nail beds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency
A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will have the patient empty the bladder completely, then obtain the next urine specimen that the patient is able to void. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup. insert a short sterile mini catheter attached to a collecting container into the urethra and bladder to obtain the specimen. clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container.
teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup This answer describes the technique for obtaining a clean-catch specimen. The answer beginning, insert a short, small, mini catheter attached to a collecting container describes a technique that would result in a sterile specimen, but a health care providers order for a catheterized specimen would be required.
A 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 reviews the results of the prostate examination for which characteristic of this disorder? 1. soft and swollen prostate gland 2. swollen and boggy prostate gland 3. tender and edematous prostate gland 4. tender indurated prostate gland that is warm to the touch
tender indurated prostate gland that is warm to the touch Rationale: the client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of UTI, which often accompany the disorder
A client arrives at the emergency department with complaints of low abdominal pain and hematuria (blood in urine). The client is afebrile. The nurse next assess the client to determine a history of which condition? 1. pyelonephritis 2. glomerulonephritis 3. trauma to the bladder or abdomen 4. renal cancer in the client's family
trauma to the bladder or abdomen Rationale: bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client described in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area
The nurse caring for a patient after cystoscopy plans that the patient learns to request narcotics for pain. understands to expect blood-tinged urine. restricts activity to bed rest for a 4 to 6 hours. remains NPO for 8 hours to prevent vomiting.
understands to expect blood-tinged urine. Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires opioids for relief is not expected.
