ALTERATIONS IN ELIMINATION ASSOCIATED WITH RENAL URINARY DISORDERS:UNIT6

A patient is one day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? A) Requires two tablets of Tylenol #3 during the night B) Complains of fatigue and claims to have minimal appetite C) Continuous bladder irrigation (CBI) infusing, but output has decreased D) Expressed anxiety about his planned discharge home the following day

C A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.

The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? A) Grilled steak, French fries, and vanilla shake B) Hamburger with cheese, pudding, and coffee C) Baked chicken, peas, apple slices, and skim milk D) Grilled cheese sandwich, onion rings, and hot tea

C A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD) admitted for pneumonia. What laboratory finding would be consistent with decreased kidney function in this patient? A) Serum uric acid of 5.2 mg/dL B) Urine specific gravity of 1.040 C) Serum creatinine 2.3 of mg/dL D) Blood urea nitrogen (BUN) of 10 mg/dL

C An expected assessment finding related to decreased kidney function in the aging process is an increased serum creatinine. Other expected assessments include an elevated BUN and inability to concentrate urine (with urine specific gravity fixed at 1.010). Uric acid is used as a screening test for disorders of purine metabolism or kidney disease; values depend on renal function, rate of purine metabolism, and dietary intake of food rich in purines. Normal reference intervals: serum creatinine, 0.6 to 1.3 mg/dL; BUN, 6 to 20 mg/dL; urine specific gravity, 1.003 to 1.030; and serum uric acid, 2.3 to 6.6 mg/dL (female) or 4.4 to 7.6 mg/dL (male).

An older male patient visits his primary care provider because of burning on urination and production of foul-smelling urine. What contributing factor should the health care provider consider? A) High-purine diet B) Sedentary lifestyle C) Benign prostatic hyperplasia (BPH) D) Recent use of broad-spectrum antibiotics

C BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, but a diet high in purines is associated with renal calculi.

The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia and symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis? A) White blood cell count is 7500 cells/μL. B) Antistreptolysin-O (ASO) titer is 106 Todd units/mL. C) Glucose, protein, and ketones are present in the urine. D) Nitrites and leukocyte esterase are present in the urine.

D A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). The presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/μL) indicates a bacterial infection. AASO titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.

The nurse obtained a urine specimen from a patient. What result should the nurse recognize as an abnormal finding? A) pH of 6.0 B) Amber yellow color C) Specific gravity of 1.025 D) White blood cells (WBCs) 9/hpf

D Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference range for specific gravity is 1.003 to 1.030.

A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created for urinary diversion. In creating a discharge teaching plan for the client, the nurse should include which instruction in the plan? A) Dietary restrictions B) Technique of catheterization C) External pouch and application care D) Proper administration of prophylactic antibiotics

B A Kock pouch is a continent internal ileal reservoir. The nurse instructs the client about the technique of catheterization. Dietary restrictions are not required. There is no external pouch. Antibiotics are not required unless an infection is present; also, antibiotics are prescribed by the health care provider.

A female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which problem? A) Rupture of the bladder B) The development of a vesicovaginal fistula C) Extreme stress because of the diagnosis of cancer D) Altered perineal sensation as a side effect of radiation therapy

B A complication of radiation therapy for bladder cancer is fistula formation. In women, this frequently is manifested as a vesicovaginal fistula, which is an opening between the bladder and the vagina. With this complication the client senses that urine is flowing out of the vagina. In men, a colovesical fistula may develop, which is an opening between the bladder and the colon. This is manifested as voiding urine that contains fecal material. The remaining options are incorrect interpretations.

The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? A) Avoid straining during defecation. B) Restrict fluids to prevent incontinence. C) Sexual functioning will not be affected. D) Prostate examinations are not needed after surgery.

A Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.

The nurse is caring for a patient after a right kidney biopsy. Which position would be the most appropriate for this patient immediately after the procedure? A) Right lateral side-lying position B) Reverse Trendelenburg position C) Supine with lower extremities elevated D) High Fowler's position with arms supported

A After a renal biopsy, a pressure dressing should be applied. The patient should be kept on the affected side for 30 to 60 minutes to apply additional pressure from the patient's own body weight and then on bed rest for 24 hours. High Fowler's position with arms supported is a position for a patient in respiratory distress. Reverse Trendelenburg position is used to maintain circulation to the legs in peripheral artery insufficiency. Supine with legs elevated puts excessive pressure on the diaphragm and should generally be avoided.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? A) Fish B) Plum juice C) Fruit juice D) Cranberries

A Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.

A patient was admitted 2 weeks ago after multiple traumatic injuries in a motor vehicle collision. The patient now has a serum creatinine at 3.9 mg/dL and blood urea nitrogen (BUN) of 100 mg/dL. Which medication, if ordered by the health care provider, should the nurse question? A) Gentamicin B) Nitrofurantoin C) Acetaminophen D) Morphine sulfate

A Elevated serum creatinine and BUN indicate renal insufficiency or acute kidney injury. Medications (e.g., prescribed, over-the-counter, and herbs) should be evaluated for nephrotoxic potential. Many drugs are known to be nephrotoxic (see Table 44-3); gentamicin is a potential nephrotoxic agent.

The nurse counsels a 64-yr-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? A) Venison, crab, and liver B) Spinach, cabbage, and tea C) Milk, yogurt, and dried fruit D) Asparagus, lentils, and chocolate

A Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation (see Table 45-12).

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? A) Pale pink urine B) Dark pink urine C) Tea-colored urine D) Bright red blood with small clots in the urine

A If the bladder irrigation is infusing at a sufficient rate, the urinary drainage through the Foley tubing should be pale pink. Dark pink urine indicates that the rate of the irrigation solution should be increased. Tea-colored urine is not seen after TURP but may be noted in a client with other renal disorders such as renal failure. Bright red bleeding and clots could indicate a complication, and if this is noted, it should be reported to the health care provider.

A patient underwent a surgical procedure has a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What is the nurse's first action to assess for urinary retention? A) Bladder scan B) Cystometrogram C) Residual urine test D) Kidneys, ureters, bladder (KUB) x-ray

A If the patient is unable to void, the bladder may be palpated for distention or percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicoureteral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder, so this assessment would not be helpful for this patient.

The nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that education was effective if the client chooses which selections from a diet menu? A) Spinach salad, milk, and a banana B) Chicken, potatoes, and cranberries C) Peanut butter sandwich, milk, and prunes D) Linguini with shrimp, tossed salad, and a plum

A In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. Options, 2, 3 and 4 represent an acid residue diet.

The nurse is preparing a patient for an intravenous pyelogram (IVP). What is a priority action by the nurse? A) Administer a cathartic or enema. B) Assess patient for allergies to penicillin. C) Keep the patient NPO for 4 hours preprocedure. D) Advise the patient that a metallic taste may occur during procedure.

A Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity; keep the patient NPO for 8 hours before the procedure; and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure? A) "You might have pink-tinged urine and burning after your cystoscopy." B) "You'll need to refrain from eating or drinking after midnight the day before the test." C) "The morning of the test, you will drink some water that contains a contrast solution." D) "You'll require a urinary catheter inserted before the cystoscopy, and it will be in place for a few days."

A Pink-tinged urine, burning, and frequency are common after a cystoscopy. The patient does not need to be NPO before the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.

A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention? A) Resumption of normal urinary drainage B) Maintenance of normal sexual functioning C) Prevention of acute or chronic renal failure D) Prevention of fluid and electrolyte imbalances

A The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, impaired sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

What is the nurse's priority when changing the appliance for a patient with an ileal conduit? A) Keep the skin free of urine. B) Inspect the peristomal area. C) Cleanse and dry the area gently. D) Affix the appliance to the faceplate.

A The nurse's priority is to keep the skin free of urine because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed; the area will be gently cleaned and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.

The nurse has a prescription to obtain a urinalysis specimen from a client with an indwelling urinary catheter. Which actions should the nurse include in performing this procedure? Select all that apply. A) Explaining the procedure to the client B) Clamping the tubing of the drainage bag C) Aspirating a sample from the port on the drainage tubing D) Obtaining the specimen from the urinary drainage bag E) Wiping the port with an alcohol swab before inserting the syringe

A,B,C,E A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag, so its properties do not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. The remaining options are correct interventions for obtaining the specimen.

A patient with suspected renal insufficiency is scheduled for a creatinine clearance diagnostic test. Which instructions would be appropriate for the nurse to provide to the patient? A) "Empty your bladder and discard the urine; then save all urine for 24 hours." B) "Your blood creatinine level will be tested after you eat a high-protein meal." C) "This test should not be performed if you have allergies to iodine or shellfish." D) "A sterile container must be used to store the urine during the collection period.

A The patient should discard the first urination when this test is started. Urine should be saved from all subsequent urinations for 24 hours. Creatinine clearance testing does not involve the injection of contrast dye. A serum creatinine is determined during the 24-hour period and used in the calculation to determine creatinine clearance. Consumption of a high-protein meal is not indicated. Sterile containers would be indicated if cultures are performed to determine the presence of microorganisms.

A patient with type 2 diabetes is reporting a second urinary tract infections(UTI)within the past month. Which medication should the nurse expect to be ordered for the recurrent infection? A) Ciprofloxacin B) Fosfomycin C) Nitrofurantoin D) Trimethoprim-sulfamethoxazole

A This UTI is a complicated UTI because the patient has type 2 diabetes, and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin , and trimethoprim-sulfamethoxazole should be used for uncomplicated UTIs.

Which nursing diagnosis is priority when caring for a patient with renal calculi? A) Acute pain B) Risk for constipation C) Deficient fluid volume D) Risk for powerlessness

A Urinary stones are associated with severe abdominal or flank pain. Whereas deficient fluid volume is unlikely to result from urinary stones, constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder? A) Diabetes mellitus B) Orthostatic hypotension C) Coronary artery disease D) Intravenous (IV) contrast medium

A most commonly caused by entry of bacteria, obstruction, or reflux. Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, overuse of analgesics, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply. A) Nocturia B) Incontinence C) Enlarged prostate D)Nocturnal emissions E) Decreased desire for sexual intercourse

A,B,C These need to be assessed for in all male clients over 50 years of age. Nocturnal emissions are commonly associated with prepubescent males. Low testosterone levels (not BPH) may be associated with a decreased desire for sexual intercourse.

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys (select all that apply.)? Select all that apply. A)Production of renin B) Activation of vitamin D C) Carbohydrate metabolism D) Erythropoietin production E) Hemolysis of old red blood cells (RBCs)

A,B,D In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.

The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply. A) Proteinuria B) Hematuria C) Positive ketones D) A low specific gravity E) A dark and smoky appearance of the urine

A,B,E characteristic findings in the urinalysis report are gross proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark and smoky. Positive ketones are not associated with this condition but may indicate a secondary problem.

The urinalysis of a patient reveals a high microorganism count. What data should the nurse use to determine which part of the urinary tract is infected (select all that apply.)? Select all that apply. A) Pain location B) Fever and chills C) Mental confusion D) Urinary hesitancy E) Urethral discharge F) Postvoid dribbling

A,D,E Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. 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.

A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? A) E. coli bacteria in his urine B) A very tender prostate gland C) Complaints of chills and rectal pain D) Complaints of urgency and frequency

B A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatitis.

The client diagnosed with benign prostatic hyperplasia (BPH) is scheduled for a transrectal ultrasound examination and a test to measure the level of prostate-specific antigen (PSA). The client says to the nurse, "I can't remember . . . can you tell me again why I need these tests to be done?" The nurse responds, knowing that these tests are done for which purpose? A) Specifically to predict the course of BPH B) Help to rule out the possibility of cancer C) Pinpoint the likelihood of developing urinary obstruction D) Give an indication of whether intermittent self-catheterization is needed

B A transrectal ultrasound examination and PSA level determination help to rule out the possibility of prostate cancer. They do not specifically predict the course of BPH or the development of complications such as urinary obstruction. These tests have nothing to do with determining need for self-catheterization.

A 73-yr-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance regarding what condition? A) A tumor of the prostate B) Benign prostatic hyperplasia C) Bladder atony because of age D) Age-related altered innervation of the bladder

B Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men older than age 50 years and 80% of men older than age 80 years. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.

The nurse is providing instructions to a client who is scheduled for cystoscopy and possible biopsy under general anesthesia. Which information should the nurse include? A) The procedure will take about 4 hours. B) Intravenous fluids may be started on the day of the procedure. C) Preprocedure sedatives are never administered with general anesthesia. D) Only a full liquid breakfast may be allowed on the day of the procedure.

B Client preparation for cystoscopy and possible biopsy includes informing the client that intravenous fluids will be started the day of the procedure to ensure adequate hydration and flow of urine. The procedure will take approximately 30 minutes to 1 hour. An informed consent is obtained from the client, and preprocedure sedatives are administered as prescribed. If a general anesthetic is to be used, the client is told that fasting is necessary after midnight before the procedure.

The nurse is caring for a 62-yr-old woman taking tolterodine (Detrol), a antispasmodic, to treat urinary urgency and incontinence. Which instruction should be included in the discharge plan? A) "Stop smoking for 2 to 3 weeks before starting to take this medication." B) "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." C) "Have your vision checked every 6 months because this drug can cause cataracts." D) "Ask your physician to prescribe an extended-release form if you have loose stools."

B Dry mouth is a common side effect of tolterodine. Patients can suck on hard candy or ice chips or chew gum if dry mouth occurs. Tobacco use does not affect the initiation of this medication. Visual changes (but not cataracts) can occur while taking this medication. Constipation may occur as a side effect of this medication.

The nursing student is caring for a client with benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs further teaching if the student states that which finding is an early symptom of BPH? A) Nocturia B) Hematuria C) Decreased force of urine stream D) Difficulty initiating urine stream

B Hematuria is not an early sign of BPH. Nocturia, decreased force of urine stream, and difficulty initiating urine stream are all early signs of BPH.

A patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding? A) Anuria B) Dysuria C) Oliguria D) Enuresis

B Painful and difficult urination is characterized as dysuria. Whereas anuria is an absence of urine production, oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder? A) Hypoglycemia B) Diabetes mellitus C) Coronary artery disease D) Orthostatic hypotension

B Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.

The nurse is performing an assessment on a client after a cystoscopy. Which assessment finding indicates a need to notify the health care provider (HCP)? A) A temperature of 99.4°F (37.4°C) B) Grossly bloody urine with clots C) A bluish or green tinge to the urine D) A blood pressure of 120/82 mm Hg

B The client may have clear or blood-tinged urine after cystoscopy. If a contrast agent such as methylene blue is used, the urine may have an unusual bluish or green tinge. A blood pressure of 120/82 mm Hg and a temperature of 99.4°F (37.4°C) are not abnormal findings at this time.

The nurse caring for a client immediately after transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. Which is the priority nursing action for this client? A) Reorient the client. B) Notify the health care provider (HCP). C) Ensure that a clock and calendar are in the room. D) Increase the flow rate of the intravenous infusion.

B The client who suddenly becomes disoriented and confused after TURP could be experiencing early signs of hyponatremia. This may occur because the flushing solution used during the operative procedure is hypotonic. If the solution is absorbed through the prostate veins during surgery, the client experiences increased circulating volume and dilutional hyponatremia. The nurse should notify the HCP of these symptoms. Reorienting the client and ensuring that a clock and calendar are visible may be helpful but do not correct the problem. The nurse does not increase the flow rate of an intravenous infusion without a prescription from the HCP. In addition, speeding up the flow rate could potentially worsen the problem, depending on the solution that is infusing.

The nurse is performing an assessment for a patient and preparing to palpate the kidneys. How should the nurse position the patient for this assessment? A) Prone B) Supine C) Seated at the edge of the bed D)Standing, facing away from the nurse

B To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome? A) Tachycardia and diarrhea B) Bradycardia and confusion C) Increased urinary output and anemia D) Decreased urinary output and bladder spasms

B Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis? A) Tea B) Water C) Coffee D) White wine

B Water helps flush bacteria out of the bladder, and an intake of 6 to 8 glasses per day is encouraged. Caffeine and alcohol can irritate the bladder. Therefore, alcohol- and caffeine-containing beverages such as coffee, tea, and wine are avoided to minimize risk.

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving orders, what should the nurse do? A) Keep the patient on bed rest. B) Use 5 mL of sterile saline to irrigate. C) Use 30 mL of water to gently irrigate. D) Have the patient turn from side to side.

B With a nephrostomy tube, if the tube is occluded and irrigation is ordered, the nurse should use 5 mL or less of sterile saline to gently irrigate it. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply. A) Milk B) Prune juice C) Apricot juice D) Cranberry juice E) Carbonated drinks

B,C,D Acidification of the urine inhibits multiplication of bacteria. Fluids that acidify the urine include prune, apricot, cranberry, and plum juice. Carbonated drinks should be avoided because they increase urine alkalinity. Two glasses of milk a day can make the urine more alkaline, which could aid in the development of kidney stones.

The nurse prepares a patient for discharge after a cystoscopy. It is most important for the nurse to provide additional information in response to which patient statement? A) "I should drink plenty of fluids to prevent complications." B) "If my urine is cloudy, I should contact my health care provider." C) "Bright red bleeding is normal for a few days after the procedure." D) "Sitz baths and acetaminophen will help to reduce my discomfort."

C Bright red bleeding after a cystoscopy is not normal and should be reported immediately. Other complications include urinary retention, bladder infection, and perforation of the bladder. Patients should drink plenty of fluids and expect burning on urination, pink-tinged urine, and urinary frequency. Warm sitz baths, heat, and mild analgesics may be used to relieve discomfort.

The nurse is caring for an older adult patient taking bumetanide. What age-related changes does the nurse inform the patient that may be experienced? A) Benign enlargement of prostatic tissues B) Decreased sensation of bladder capacity C) Decreased function of the loop of Henle D) Less absorption in the Bowman's capsule

C Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus, the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.

Which client is most at risk for developing a Candida urinary tract infection (UTI)? A) An obese woman B) A man with diabetes insipidus C) A young woman on antibiotic therapy D) A male paraplegic on intermittent catheterization

C Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug addiction

A patient has scleroderma and hypertension. The nurse knows this could be related to which renal diagnoses? A) Obstructive uropathy B) Goodpasture syndrome C) Chronic glomerulonephritis D) Calcium oxalate urinary calculi

C Hypertension occurs with chronic glomerulonephritis, which may be found in patients with scleroderma. Obstructive uropathy, Goodpasture syndrome, and calcium oxalate urinary calculi are not related to scleroderma and do not cause hypertension.

The nurse has administered a dose of meperidine hydrochloride to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side and adverse effect of this medication? A) Bradycardia B) Hypertension C) Urinary retention D) Increased respirations

C Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? A) Increase intake of dairy products. B) Avoid citrus fruits and citrus juices. C) Avoid green, leafy vegetables such as spinach. D) Increase intake of meat, fish, plums, and cranberries.

C Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea.

A client who is to have a cystectomy with creation of an ileal conduit asks the nurse why the bowel needs to be cleansed before surgery if the bladder is being removed. Which response by the nurse is the most appropriate? A) "All clients undergo bowel preparation with major surgery." B) "This will decrease the chance of postoperative paralytic ileus." C) "A portion of the bowel will be used to create the conduit for urinary diversion." D) "This will reduce the chance that the surgeon will nick the bowel during surgery."

C The client scheduled for surgical creation of either an ileal conduit or a reservoir undergoes bowel preparation the night before the procedure. Preparation can include intake of copious clear liquids, laxatives, enemas, and antibiotics, depending on health care provider preference. This is done primarily to prevent infection because a loop of bowel will be used to create the urinary diversion.

A patient informs the nurse that they are having burning on urination, dysuria, and frequency. What is the best response by the nurse? A) "Drink less fluid so you don't have to void so often." B) "Take some acetaminophen to decrease the discomfort." C) "Come in so we can check a clean-catch urine specimen." D) "Avoid caffeine and spicy food to decrease inflammation."

C The patient's symptoms are typical of a urinary tract infection. To verify this, a clean-catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.

The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care (select all that apply.)? Select all that apply. A) Casts in his urine B) Presence of α-fetoprotein C) Serum PSA level 10 ng/mL D) Onset of erectile dysfunction E) Nodularity of the prostate gland F) Development of a urinary tract infection

C,E The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues.

The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? A) "I should try to maintain an acid ash diet." B) "I should increase my fluid intake to 3 L per day." C) "I should take my daily dose of vitamin C to acidify the urine." D) "I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

D Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia? A) Nocturia B) Scrotal edema C) Occasional constipation D) Decreased force in the stream of urine

D 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.

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral 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 health care provider (HCP)? A) Red, bloody urine B) Pain rated as 2 on a 0-10 pain scale C) Urinary output of 200 mL higher than intake D) Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute

D Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days 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 blood pressure is a potential sign of excessive blood loss. The HCP should be notified.

A patient in the intensive care unit is receiving gentamicin for treatment of pneumonia from Pseudomonas aeruginosa. What assessment results should the nurse report to the health care provider? A) Decreased weight B)Increased appetite C) Increased urinary output D) Elevated creatinine level

D Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the physician because it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia.

A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid? A) Pasta B) Lentils C) Lettuce D) Spinach

D Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. Pasta, lentils, and lettuce are acceptable to consume.

The ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by the client indicates a need for further teaching? A) "I should increase my fluid intake." B) "I can apply heat to my lower abdomen." C) "I may have some burning on urination for the next few days." D) "If I notice any pink-tinged urine, I should contact the health care provider."

D The client is instructed that pink-tinged urine and burning on urination are expected for 1 to 2 days after the procedure. Increased fluid intake is encouraged. Application of heat to the lower abdomen, administration of mild analgesics, and the use of sitz baths may relieve discomfort. The client also is advised to avoid alcoholic beverages for 2 days after the test.

The home health nurse is planning to make a home visit to a client who has undergone surgical creation of an ileal conduit. The nurse should include which information on ostomy care in discussion with the client? A) Plan to do appliance changes in the late evening hours. B) Cut an opening that is slightly smaller than the stoma in the face plate of the appliance. C) Appliance odor from urine breakdown to ammonia can be minimized by limiting fluids. D) Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well.

D The skin around the stoma is cleansed at each appliance change using a gentle, nonresidue soap and water. The skin is rinsed and then dried thoroughly. The appliance should be changed early in the morning because urine production is slowest from no fluid intake during sleep. The appliance is cut so that the opening is not more than 3 mm larger than the stoma. An opening smaller than the stoma will prevent application of the appliance. Generous fluid intake is encouraged to dilute the urine, decreasing the intensity of odor.

When a patient reports acute, severe, renal colic pain in the lower abdomen, the nurse suspects that the patient is most likely to have an obstruction at which area? A) Kidney B) Urethra C) Bladder D) Ureterovesical junction

D The ureterovesical junction is the narrowest part of the urethra and easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction, the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones.

The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure? A) Urethra B) Nephron C) Glomerulus D) Ureterovesical junction

D The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item? A) Steak B) Shrimp C) Chicken liver D) Cottage cheese

D With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Intake of foods with moderate levels of purines, such as red and white meats and some seafood, also is limited. Avoiding the consumption of milk and dairy products is a recommended dietary change for calculi composed of calcium stones but is acceptable for the client with a uric acid stone.