Elimination

The nurse is evaluating an unlicensed assistive personnel (UAP) member who is helping a patient use a bedpan. Which action by the UAP indicates a need for correction? 1 Using a cold bedpan 2 Cleaning out the bedpan after every use 3 Putting the patient in a high Fowler's position 4 Placing a small pillow under the patient's back

1 A patient who is unable to ambulate to the bathroom may use a bedpan for urination. The UAP should warm the bedpan before use because a cold bedpan contracts the perineal muscles and inhibits voiding.

Which daily urine output from a child weighing 10 kg would lead the nurse to conclude the child has oliguria? 1 100 mL 2 120 mL 3 140 mL 4 150 mL

1 100 mL Normal urine output in children is 0.5 mL/kg per hour. Therefore the normal urine output per day for a child who weighs 10 kg is 0.5 mL × 10 kg × 24 hours = 120 mL per day. The nurse finds that the child has oliguria, which indicates that the urine volume of the child is less than 120 mL per day. The urine volumes of 120 mL per day, 140 mL per day, and 150 mL per day indicate adequate urine output for a child who weighs 10 kg.

A patient's laboratory report shows presence of large proteins in the urine. Which condition is the most probable cause of proteinuria? 1 Glomerulonephritis 2 Infection of the urinary tract 3 Excessive aspirin ingestion 4 Starvation

1 Glomerulonephritis The glomerular capillaries filter water, glucose, amino acids, urea, creatinine, and major electrolytes from the blood. Large proteins do not normally get filtered because of the size of protein molecules. In conditions such as glomerulonephritis (inflammation of the glomeruli of the kidney), the cell membrane can become permeable and allow proteins to cross. The presence of white blood cells in the urine indicates infection of the urinary tract. The presence of ketones in urine may be due to excess ingestion of aspirin or starvation.

While assessing the stoma of a patient with an ostomy, the nurse notices that the stoma is dry and black with no sign of bleeding. Which patient condition does the nurse infer from this finding? 1 Necrotic stoma 2 Normal stoma 3 Fungal infection 4 Allergic reaction

1 Necrotic stoma

A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-catch urine specimen is markedly cloudy. Which factor might be the cause of these symptoms and findings? 1 Bacteria 2 Hypercalcemia 3 Liver failure 4 Uncontrolled diabetes

1 bacteria Urine normally is clear. Cloudy urine is indicative of bacteria, blood, sperm, crystals, or mucus. Patients with hypercalcemia may have blue-green urine. Those with liver failure from hepatitis and cirrhosis may have brown to tea-colored urine. In uncontrolled diabetes, the urine can have a sweet, fruity odor.

When a patient asks about the mechanism of action of an oil retention enema, which explanation would the nurse provide? Select all that apply. 1 It lubricates the rectum and colon. 2 The feces absorb oil and become softer. 3 It exerts osmotic pressure lower than the fluid in the interstitial space. 4 It irritates the intestinal mucosa and stimulates peristalsis. 5 It provides relief from gaseous distention.

1,2 The oil retention enema helps lubricate the rectum and colon. The feces absorb oil and become softer and easier to pass, thus relieving constipation. A tap-water enema exerts osmotic pressure lower than fluid in the interstitial space. A soapsuds enema acts by irritating the intestinal mucosa and stimulating peristalsis. A carminative enema provides relief from gaseous distention.

Why is a stool culture used? Select all that apply. 1To detect parasites 2 To help determine the cause of diarrhea 3 To verify that a previous pathogenic bacterial infection has been resolved 4 To detect blood in the stool 5 To identify internal hemorrhoids

1,2,3 A stool culture is used along with other tests to detect parasites in the stool and to help determine the cause of diarrhea. Stool cultures are ordered if the patient complains of diarrhea for several days or when blood or mucus is noted in loose stools. Stool culture may be performed if the history suggests that the patient may have consumed food contaminated with bacteria associated with undercooked meat or raw eggs, or the same food that has made others ill. Recent travel outside the United States may suggest possible food contamination. If the patient has had a previous pathogenic bacterial infection of the GI tract that has been treated or resolved, additional stool cultures may be performed to verify that the pathogenic bacteria are no longer detectable. Testing for the presence of blood in the feces is performed using a fecal occult blood test. A stool culture does not help identify or diagnose internal or external hemorrhoids.

Which parameters does the nurse find in a patient with constipation? Select all that apply. 1 Development of hemorrhoids 2 Changes in cardiac rhythm 3 Increase in intracranial pressure 4 Decrease in intraocular pressure 5 Decreased intrathoracic pressure

1,2,3 Due to constipation, the veins in the anus or lower rectum may swell, resulting in hemorrhoids. Cardiac rhythm changes due to use of the Valsalva maneuver. A patient with constipation also strains during defecation, which may result in increased intracranial pressure. Straining during defecation causes an increase in intraocular pressure, not a decrease. Intrathoracic pressure increases rather than decreases as a result of exhalation through a closed windpipe.

The nurse is explaining to a patient with gastritis about the various physiologic functions of the stomach. Which statements pertain to the functions of the stomach? Select all that apply. 1 Storage of food 2 Reabsorption of nutrients 3 Secretion of intrinsic factor 4 Production of hydrochloric acid 5 Mucus secretion to aid protein digestion

1,3,4,5 The functions of the stomach include storage of food and liquids, and secretion of intrinsic factor, which is responsible for absorption of vitamin B12. The stomach also produces hydrochloric acid, which along with pepsin helps in protein digestion. Reabsorption of nutrients occurs in the small intestine and not in the stomach. Mucus is secreted from the stomach, but it does not aid in protein digestion. Instead, it forms a protective barrier for stomach mucosa.

The nursing mentor is explaining to nursing students about the role of the large intestine. Which information would the mentor include in the explanation about the large intestine? Select all that apply. 1 The large intestine excretes potassium. 2 The large intestine has no absorptive role. 3 The large intestine has a role in elimination function. 4 The large intestine is composed of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus. 5 The ileocecal valve prevents regurgitation (backflow) of chyme.

1,3,4,5 The large intestine excretes 4 to 9 mEq of potassium daily. It is the primary organ for bowel elimination and fluid absorption. The large intestine is composed of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus. Peristalsis, the mechanism of progressive contraction and relaxation of the walls of the intestine, forces chyme into the large intestine through the ileocecal valve, which prevents regurgitation (backflow) of chyme. The large intestine is responsible for absorption of water, sodium, and chloride from the digested food.

The nurse determines that a patient has hyperactive bowel sounds and diarrhea. Which nursing interventions are appropriate to reduce complications in this patient? Select all that apply. 1 Suggest small, bland meals. 2 Encourage the patient to drink fruit juices. 3 Instruct the patient to have milk products. 4 Have the patient drink lukewarm liquids. 5 Monitor the fluid and electrolyte balance.

1,4,5 The patient with diarrhea benefits from bland, small meals, which may be more easily tolerated. Hot and cold liquids stimulate peristalsis. Therefore the nurse should encourage the patient to have lukewarm liquids to restore fluid levels. A patient with diarrhea may have an electrolyte imbalance due to the loss of fluids; therefore monitoring the patient's fluid and electrolyte balance prevents life-threatening conditions caused by fluid deficiency. Fruit juices stimulate peristalsis and are avoided by the patient with diarrhea. A patient with diarrhea should refrain from consuming milk products.

A patient reports pink-colored urine. During the assessment, the nurse finds that the patient has abdominal distension and feels discomfort during percussion. The patient's medical reports show an increased ratio of blood urea nitrogen to creatinine, along with the presence of glucose in the urine. How would the nurse interpret these patient findings? 1 Kidney disease 2 Signs of cirrhosis of the liver 3 Indomethacin use 4 Promethazine use

1. Kidney disease The color of normal urine varies from pale yellow to amber. Pink urine indicates either the presence of blood in the urine or kidney disease. Normally, the abdomen is not distended and it is free of swelling and bruises. Abdominal distension may occur due to additional fluid retention because of the kidney disease. The patient should not feel pain or discomfort with percussion. Discomfort during percussion is a symptom of kidney disease. An increased ratio of blood urea nitrogen to creatinine is a symptom of kidney disease. Normal urine has very little to no glucose. The presence of glucose in the urine can also indicate kidney disease. A decreased ratio of blood urea nitrogen to creatinine indicates cirrhosis of the liver. Indomethacin and promethazine cause blue-green urine and do not affect the ratio of blood urea nitrogen to creatinine.

specific gravity of urine

1.003 - 1.032

A patient with constipation reports having blurred vision. The nurse assesses that the patient is straining during defecation. Which factor does the nurse suspect as the cause of these symptoms? 1 A decrease in intrathoracic pressure 2 An increase in intraocular pressure 3 An increase in arterial blood pressure 4 A decrease in intracranial pressure

2 An increase in intraocular pressure

Which complication is the nurse trying to prevent by instructing a patient to increase fluid intake after a series of lower gastrointestinal scans? 1 Diarrhea 2 Constipation 3 Flatulence 4 Incontinence

2 Constipation

A patient with acute renal failure has low blood pressure with pale, clammy, and cool skin. The nurse determines that the patient's urine volume is less than 400 mL per day and the serum potassium level is 7.5 mEq/L. Which condition does the nurse suspect in this patient? 1 Anuria 2 Oliguria 3 Dysuria 4 Nocturia

2 Oliguria Normal urine output is about 2500 mL per day. The patient's urine output is less than 400 mL per day, which indicates oliguria (a condition in which the patient has reduced urine output). Low blood pressure and pale, clammy, and cool skin occur as a result of acute renal failure and oliguria; potassium retention also may occur. Anuria is the absence of urine excretion. Dysuria is painful urination. Nocturia is excessive urination at night.

Which dietary instructions does the nurse give to improve the bowel health of a patient with constipation? Select all that apply. 1 "Stay away from spicy foods." 2 "Include prunes or figs daily." 3 "Increase your fluid intake." 4 "Include eggs and lean meat." 5 "Eat at the same time daily." 6 "Include fiber in your diet."

2,3,5,6

Which intervention is most appropriate for a patient with functional urinary incontinence? 1 Insert an indwelling catheter. 2 Increase fluid intake to "flush" the kidneys. 3 Provide normal fluid intake and establish a toilet schedule. 4 Restrict fluid intake to decrease the episodes of incontinence.

3 For physiologic health, a patient needs to maintain normal fluid intake. A toileting schedule based on the patient's elimination patterns can help reduce episodes of incontinence. Catheters are used as a last choice because of infection potential and body self-image issues. Fluid intake should be kept at normal levels; there is no need to increase it. Restricting fluid intake may cause dehydration.

Which statement by a patient with ileostomy indicates a need for additional teaching? 1 "I'll change the pouch before it begins to leak." 2 "I can eat dairy products." 3 "I don't need to monitor my fluid intake." 4 "I won't need to buy new clothing that better accommodates the pouch."

3 "I don't need to monitor my fluid intake." A patient with an ileostomy should maintain a daily fluid intake of at least 3 L to prevent blockage.

The nurse is reviewing the urinalysis report for a patient. Which finding indicates possible glomerular injury? 1 White blood cells 2 Casts 3 Large proteins 4 Glucose

3 Large proteins The presence of large proteins in the urine is suggestive of glomerular injury, as they are not normally able to filter through the glomerulus. White blood cells and casts can indicate a urinary tract infection. Glucose in the urine may be indicative of diabetes mellitus.

The nurse assesses that a patient's urinary output is 25 mL per hour. Which nursing intervention is the priority for this patient? 1 Give the patient intravenous fluids. 2 Monitor the patient's potassium levels. 3 Notify the health care provider. 4 Have the patient increase fluid intake.

3 Notify the health care provider. Normal urine output in adults is 60 mL per hour. Urine output of less than 30 mL per hour indicates decreased renal perfusion; the nurse reports this to the health care provider immediately to identify the cause and prevent complications. Intravenous fluids help maintain the fluid and electrolyte balance if the cause of the decrease in urine output is determined to be decreased intake of fluids. Potassium levels increase during renal failure; therefore the nurse should monitor the potassium levels and start dialysis accordingly. Increased intake of fluids is useful if the cause of the patient's low urine output is decreased fluid intake.

A patient with a bladder disorder is advised to get a urinary diversion. The patient wishes to have the type of urinary diversion that allows normal voiding. Which type of urinary diversion suits the patient's requirement? 1Ileal conduit 2 Indiana pouch 3 Orthotopic neobladder 4 Mainz pouch

3 Orthotopic neobladder Orthotopic neobladder is the diversion procedure that allows the patient to have normal voiding. In the case of an ileal conduit, urine drains through a stoma into a collection bag. Incontinent urinary diversion is associated with continuous urinary drainage without the patient's voluntary control. For cutaneous continent diversions (Kock pouch, Indiana pouch, Mainz pouch), a collection reservoir is surgically created using a segment of the intestine; the patient then needs to catheterize the reservoir through a cutaneous stoma every 4 to 6 hours to drain stored urine.

Nurses discourage patients from straining on defecation primarily because it can cause which conditions? Select all that apply. 1 Pain 2 Impaction 3 Hemorrhoids 4 Dysrhythmias 5 Dry stool

3,4 The Valsalva maneuver requires the patient to hold his or her breath while straining to defecate. This maneuver increases venous pressure from straining. Over time, hemorrhoids result. In addition, this maneuver increases the risk for dysrhythmias, which are often life threatening. Straining when trying to pass stool does not result in pain. Pain is the result of issues with the anus, such as hemorrhoids, and not the actual passing of the stool. Straining does not cause impaction; the patient may strain because of the impaction. Dry stool is caused by diminished fluid in the patient's system.

The postoperative patient has difficulty voiding after surgery and is feeling "uncomfortable" in the lower abdomen. Which action should the nurse implement first? 1 Encourage fluid intake. 2 Administer pain medication. 3 Catheterize the patient. 4 Turn on the bathroom faucet as the patient tries to void.

4 Turn on the bathroom faucet as the patient tries to void. The sound of running water helps many patients void through the power of suggestion. Encouraging fluid intake, administering pain medications, and catheterizing the patient are effective measures, but it may be helpful to provide sensory stimuli that will help the patient relax, as this is a less invasive approach to take initially.

A patient reports abdominal pain and the urge to pass feces. While examining the patient, the nurse finds hyperactive bowel sounds. Which medications would be involved in the patient's treatment regimen? Select all that apply. 1 Naproxen sodium 2 Ibuprofen 3 Acetaminophen 4 Loperamide 5 Diphenoxylate-atropine

4,5 The patient's symptoms indicate that the patient has diarrhea. Loperamide and diphenoxylate-atropine are medications that decrease intestinal muscle tone and control fecal incontinence. Therefore these medications are commonly used in the treatment of diarrhea. Naproxen sodium is used to relieve pain, but it is not useful for diarrhea. Ibuprofen is a nonsteroidal antiinflammatory drug used to reduce inflammation; it does not affect intestinal function. Acetaminophen is an antipyretic drug used to reduce fever and pain, but it is not useful for diarrhea.

normal pH of urine

4.5-8

normal volume of urine

750-2000ml/24 hrs

medications that slow movement in the intestines to promote absorption of excess fluid in the intestine

Antidiarrheal Medications

failure of the kidneys to excrete urine

Anuria

COMMON SYMPTOMS: FREQUENCY OF URINATION, INCREASED FREQUENCY OF URINATING AT NIGHT, DIFFICULTY STARTING URINARY FLOW, AND A WEAK URINARY STREAM

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement

Non-Pharmacological Therapy includes: Urinate at first urge Avoid caffeine and alcohol Kegal exercises Small amounts of fluid throughout day

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement

a common condition as men get older; can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems. treatment includes Transurethral resection of the prostate (TURP)

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement

caused by Growth of the prostate gland influenced by increased sensitivity to the androgen hormone that stimulates prostate growth; risk factors are age and presence of testes; the enlarged prostate compresses the urethra

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement

examination of the bladder and urethra via a cystoscope inserted into the urethra and advanced into the bladder

Cystoscopy

painful urination

Dysuria

involuntary passing of urine

Enuresis

blood in the urine

Hematuria

work to soften the stool and distend the rectum; are more effective than their oral counterparts because of their stimulant effect on the rectal mucosa; The nurse ensures that it is placed next to the mucosa and not in stool that is in the rectum.

Laxative suppositories

increased urination at night

Nocturia

reduced urine volume; <400 mL / day in adults

Oliguria

excessive production of urine

Polyuria

loss of control of urine during coughing, sneezing, laughing

Stress incontinence

incomplete emptying of the bladder

Urinary retention

a substance that accelerates defecation. Examples include magnesium citrate, magnesium sulfate, sodium sulfate, and magnesium hydroxide (Phillips Milk of Magnesia®)

cathartic

used to look for early signs of colorectal cancer and to diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.

colonoscopy

infrequent or difficult bowel movements; fewer than three bowel movements in a week; symptoms include abdominal cramping, pain, pressure, distention anorexia, and headache

constipation

urinary output less than 30 mL per hour is an indication of what? What action should the nurse take?

decreased renal perfusion, report to doctor immediatly

Causes include: -allergies or intolerance to food, drugs, or fluids -antibiotic use -cathartic or laxative use -communicable foodborne pathogens -diseases of the colon -diagnostic testing of the lower GI tract -enteral nutrition usage -medications -Psychological stress -surgery of GI tract

diarrhea

ingested materials pass too quickly through the intestine, resulting in a decrease in the amount of time for absorption of fluids and nutrients

diarrhea

symptoms include Hyperactive bowel sounds, urgency, abdominal pain, and cramping

diarrhea

Testing for the presence of blood in the feces is performed utilizing a

fecal occult blood test

a substance that eases defecation, usually by softening feces. example: Psyllium hydrophilic mucilloid (Metamucil)

laxative

should urine have ketones, nitrites, blood, or glucose?

no

is there protien in urine?

none or trace

Normal urinary output

output is approximately equal to fluid intake; in adults should equal about 0.5 ml/kg/hr

normal color and odor of urine

pale yellow to deep amber; odorless

progressive wave action causing movement of contents through the gastrointestinal system

peristalsis

consequences include: Backflow to the upper urinary tract, Dilation of the ureters and renal pelvis, Pyelonephritis and renal atrophy

urinary retention