Elimination MASTERY ASSESSMENT

A nurse is counseling a woman who had recurrent urinary tract infections. Which factor should the nurse explain is the reason why women are at a greater risk than men for contracting a urinary tract infection? 1-Altered urinary pH 2-Hormonal secretions 3-Juxtaposition of the bladder 4-Proximity of the urethra to the anus

Proximity of the urethra to the anus--Because a woman's urethra is closer to the anus than a man's, it is at greater risk for becoming contaminated. Urinary pH is within the same range in both men and women. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in men and women.

A 24-hour urine test is prescribed for a client who has a tentative diagnosis of pheochromocytoma. What should the nurse do first? 1-Start the time of the test after discarding the first voiding. 2-Discard the last voiding in the 24-hour time period for the test. 3-Insert a urinary retention catheter to promote the collection of urine. 4-Strain the urine following each voiding before adding the urine to the container.

Start the time of the test after discarding the first voiding--The first voiding is discarded because that urine was in the bladder before the test began and should not be included. The last voiding should be placed in the specimen container because the urine was produced during the 24-hour time frame of the test. Discarding the last void in the 24-hour time period for the test is not necessary; voided specimens are acceptable. Straining the urine following each voiding before adding the urine to the container is not necessary; this is done for clients with renal calculi.

The nurse provides discharge instructions to a male client who had an ureterolithotomy. The client has a history of recurrent urinary tract infections (UTIs). For which indicators of a UTI should the nurse instruct the client to be on the alert? 1-Urgency or frequency of urination 2-An increase of ketones in the urine 3-The inability to maintain an erection 4-Pain radiating to the external genitalia

Urgency or frequency of urination--Urgency or frequency of urination occur with a urinary tract infection [1] [2] because of bladder irritability; burning on urination and fever are additional signs of a UTI. Increase of ketones is associated with diabetes mellitus, starvation, or dehydration. The inability to maintain an erection is not related to a UTI. Pain radiating to the external genitalia is a symptom of a urinary calculus, not infection.

A nurse receives an order to prepare the solution for administering a cleansing enema to a 3-year-old child. What is the volume of solution the nurse should prepare? 1-150 to 250 mL 2-250 to 350 mL 3-300 to 500 mL 4-500 to 750 mL

250 to 350 mL--The nurse should prepare 250 to 350 mL of warmed solution for administering a cleansing enema in a toddler. The nurse should prepare 150 to 250 mL of warmed solution for infants. In school-aged children, the volume of warmed solution is 300 to 500 mL. In adolescents, the volume required is 500 to 750 mL.

What is the recommended size of the urinary catheter that can be used in a 3-year-old child? 1-5 to 6 Fr 2-8 to 10 Fr 3-14 to 16 Fr 4-16 to 18 Fr

8 to 10 Fr--The recommended size of a urinary catheter that can be used in a 3-year-old child is 8 to 10 Fr. A urinary catheter of 5 to 6 Fr is generally used in infants. A length of 14 to 16 Fr is recommended for most adult clients. A length of 16 to 18 Fr is commonly used in adult males.

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe? 1-Psyllium 2-Bisacodyl 3-Loperamide 4-Docusate sodium

Loperamide--Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.

A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action should the nurse take next? 1-Hold the client's morning diuretic dose 2-Notify the healthcare provider that the potassium level is above normal 3-Notify the healthcare provider that the potassium level is below normal 4-No action is required because the potassium level is within normal limits

Notify the healthcare provider that the potassium level is below normal--The healthcare provider should be notified immediately because the client's potassium is below normal. The normal potassium level range is 3.5 mEq/L to 5.0 mEq/L (3.5 mmol/L to 5.0 mmol/L). Clients on diuretic therapy require close monitoring of their electrolytes because supplemental potassium may be needed.

A nurse observes that a client's urine has a sweet fruity odor. Which information is most important to evaluate when performing a further client assessment? 1-Vital signs 2-Fluid balance 3-Serum glucose level 4-Dietary calorie count

Serum glucose level--Sweet fruity-smelling urine is an indicator of ketoacidosis, which can result from uncontrolled diabetes. Hyperglycemia and hypoglycemia are assessed by serum glucose monitoring. Vital signs, fluid imbalance, and dietary counts have no relation to sweet fruity-smelling urine.

Which electrolyte deficiency triggers the secretion of renin? 1-Sodium 2-Calcium 3-Chloride 4-Potassium

Sodium--Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells. Deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin.

A 3-year-old preschooler has been hospitalized with nephrotic syndrome. What is the best way for the nurse to evaluate fluid retention or loss? 1-Measuring the abdominal girth daily 2-Having the child urinate in a bedpan 3-Testing the child's urine for proteinuria 4-Weighing the child at the same time each day

Weighing the child at the same time each day--Comparison of daily weights is the most accurate way to assess fluid retention or loss. Having the child urinate in a bedpan is difficult for a child of this age, and the findings will not be accurate. Measuring the abdominal girth daily is way to assess the degree of ascites; it indirectly measures fluid retention. Assessment of urine for protein gives information about the disease process, but not about the amount of fluid retention.

A client tells the nurse about recent recurrent episodes of bleeding hemorrhoids. What should the nurse advise the client to do to help prevent future hemorrhoidal episodes? 1-Exercise to improve circulation 2-Eat bland foods and avoid spices 3-Consume a high-fiber diet and drink adequate water 4-Use laxatives to avoid constipation and the Valsalva maneuver

Consume a high-fiber diet and drink adequate water--Consuming a high-fiber diet and drinking adequate water promote regular bowel function, prevents constipation, and prevent straining, which can make hemorrhoids worse; a high-fiber diet provides bulk that stimulates peristalsis, and water promotes a soft stool. Exercise is advisable, but the purpose in this instance is to increase peristalsis, not improve circulation. Bland foods and spices are unrelated to hemorrhoids; bland foods are preferred for clients with gastric or intestinal problems. Laxatives are contraindicated because they are irritating to the bowel, decrease intestinal tone, and promote dependency. The Valsalva maneuver should also be avoided.

A nurse is performing a health history and physical assessment of a client with cholelithiasis and obstructive jaundice. Which clinical finding should the nurse expect this client to exhibit? 1-Hematuria 2-Bloody stools 3-Straw-colored urine 4-Pain in the right upper quadrant

Pain in the right upper quadrant--The gallbladder is located in the right upper quadrant. Pain occurs after fatty meals and may radiate to the right back or shoulder. Hematuria occurs with nephrolithiasis, not cholelithiasis. The stool will be clay-colored, not dark brown, because of the lack of bile. When the level of bile in blood increases, bile will be present in urine, causing it to have a dark color.