Chapter 50--Urinary Disorders

5. A nurse is collecting data from a client who has returned to the medical-surgical unit following a CT scan of the kidneys with IV contrast. Which of the following findings should the nurse identify as an indication the client is experiencing an allergic reaction to the contrast material? A. Bradycardia B. Pink-tinged urine C. Hyperpyrexia D. Skin hives

A. A client who has an allergic reaction to contrast media can experience tachycardia rather than bradycardia. B. A client who undergoes cystoscopic examination can have pink-tinged urine. However, this is not an indication of an allergic reaction to contrast media C. A client who develops a urinary tract infection following an invasive renal diagnostic test (cystogram, pyelogram) can develop a fever. However, hyperpyrexia is not an indication of an allergic response to contrast media D. CORRECT: A client who develops an allergic reaction to contrast media used during a CT of the renal pelvis can experience manifestations (tachycardia, dyspnea, rash, and hives).

3. A nurse is contributing to the plan of care for a client who received hemodialysis. Which of the following interventions should the nurse suggest to include in the plan of care? (Select all that apply.) A. Check BUN and blood creatinine. B. Administer medications the nurse withheld prior to dialysis. C. Observe for findings of hypovolemia. D. Monitor the access site for bleeding. E. Obtain blood pressure on the arm with AV access.

A. CORRECT: Check the BUN and blood creatinine to determine the presence and degree of uremia or waste products that remain following dialysis. B. CORRECT: Withhold medications the treatment can partially dialyze. After the treatment, administer the medications. Antihypertensive medications might need to be withheld until the next day if the client is hypotensive. C. CORRECT: A client who is post-dialysis is at risk for hypovolemia due to a rapid decease in fluid volume. D. CORRECT: Monitor the access site for bleeding because the client receives heparin during the procedure to prevent clotting of blood. E. Never measure blood pressure on the extremity that has the AV access site because it can cause collapse of the AV fistula or graft.

3. A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? (Select all that apply.) A. Identify an allergy to seafood. B. Withhold metformin for 24 hr. C. Administer an enema. D. Obtain a blood coagulation profile. E. Monitor for asthma.

A. CORRECT: Clients who have an allergy to seafood are at higher risk for an allergic reaction to the contrast media they will receive during the procedure. B. CORRECT: Clients who take metformin are at risk for lactic acidosis from the contrast media with iodine they will receive during the procedure. C. CORRECT: Clients should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization. D. A blood coagulation profile is essential for a client prior to a kidney biopsy because of the risk of hemorrhage from the procedure. E. CORRECT: Clients who have asthma have a higher risk of an exacerbation as an allergic response to the contrast media they will receive during the procedure.

5. A nurse is contributing to the plan of care for a client who will undergo peritoneal dialysis Which of the following actions should the nurse take? (Select all that apply.) A. Monitor blood glucose levels. B. Report cloudy dialysate return. C. Warm the dialysate in a microwave oven. D. Monitor for shortness of breath E. Maintain medical asepsis when accessing the catheter insertion site.

A. CORRECT: Monitor blood glucose levels because the dialysate solution contains glucose. B. CORRECT: Monitor for cloudy dialysate return, which indicates an infection. Clear, light-yellow solution is typical during the outflow process. C. Avoid warming the dialysate in a microwave oven, which causes uneven heating of the solution. D. CORRECT: Monitor for shortness of breath, which can indicate inability to tolerate a large volume of dialysate. E. Maintain surgical, not medical, asepsis when accessing the catheter insertion site to prevent infection from contamination.

2. A nurse is caring for a client who has acute kidney injury and is scheduled for hemodialysis. Which of the following actions should the nurse take? (Select all that apply.) A. Review the medications the client currently takes. B. Check the AV fistula for a bruit. C. Calculate the client's hourly urine output. D. Measure the client's weight. E. Check serum electrolytes. F. Use the access site area for venipuncture.

A. CORRECT: Reviewing the medications the client currently takes determines which medications to withhold until after dialysis. B. CORRECT: Checking the AV fistula for a bruit determines the patency of the fistula for dialysis. C. The client's hourly urine output can vary with the remaining kidney function and does not determine the need for dialysis. D. CORRECT: Measuring the client's weight before dialysis is essential for comparing it with the client's weight after dialysis E. CORRECT: Checking the serum electrolytes determines the need for dialysis and can help with evaluating effectiveness of the dialysis. F. Never use the access site area for venipuncture because compression from the tourniquet can cause loss of the vascular access.

1. A nurse is reinforcing teaching a client who will have an X-ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include? A. "You will receive contrast dye during the procedure." B. "An enema is necessary before the procedure." C. "You will need to lie in a prone position during the procedure." D. "The procedure determines whether you have a kidney stone."

A. Clients do not receive any contrast media for this procedure, as they would for excretory urography. B. Clients do not receive an enema before this procedure, because it does not affect the gastrointestinal system. C. The client will lie supine, not prone. D. CORRECT: Explain to the client that a KUB can identify renal calculi, strictures, calcium deposits, and obstructions of the urinary system.

4. A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? A. Administer an opioid medication. B. Monitor for hypertension. C. Determine level of consciousness. D. Increase the dialysis exchange rate.

A. Do not administer an opioid medication because it could worsen the client's condition. The provider can prescribe medication to decrease seizure activity. B. Monitor for hypotension due to rapid change in fluids and electrolytes causing disequilibrium syndrome. C. CORRECT: Determine the client's level of consciousness. A change in urea levels can cause increased intracranial pressure. Subsequently, the client's level of consciousness decreases. D. Decrease the dialysis exchange rate to slow the rapid changes in fluid and electrolyte status when a client develops disequilibrium syndrome.

1. A nurse is reinforcing teaching with a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include? A. Hemodialysis restores kidney function. B. Hemodialysis replaces hormonal function of the renal system. C. Hemodialysis allows an unrestricted diet. D. Hemodialysis returns a balance to blood electrolytes.

A. Hemodialysis does not restore kidney function, but it sustains the life of a client who has kidney disease. B. Hemodialysis does not replace hormonal function of the renal system due to tissue damage causing dysfunction of the renin-angiotensin-aldosterone system C. Hemodialysis does not allow an unrestricted diet. it requires a diet high in folate and more protein than predialysis restrictions allowed, and low in sodium, potassium, and phosphorus. D. CORRECT: Explain to the client that hemodialysis restores electrolyte balance by removing excess sodium, potassium, fluids, and waste products, and also restores acid-base balance.

4. A nurse is preparing to begin a 24-hr urine collection for a client. Which of the following actions should the nurse take? A. Store collected urine in a designated container at room temperature. B. Discard the first voiding when beginning the test. C. Post a notice on the client's door regarding the testing. D. Document any urine collection that was missed during the 24 hr of the testing.

A. Store collected urine in an approved container that is kept on ice or refrigerated B. CORRECT: Begin the testing period after discarding the first voiding C. Post notices on the client's medical record and over the toilet alerting all personnel of the ongoing test. However, placing a notice on the client's door is a violation of privacy laws. D. In the event the client urinates without collecting it in the approved container, the test must be started again. A full 24 hr of urine collection is needed for accurate testing

2. A nurse is monitoring a client who had a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client? A. Infection B. Hemorrhage C. Hematuria D. Pain

A. The client is at risk for infection of the kidney because a biopsy is an invasive procedure. However, another complication is the priority. B. CORRECT: The greatest risk to the client following a kidney biopsy is hemorrhage due to a lack of clotting at the puncture site. Report this finding to the provider immediately C. The client is at risk for hematuria, which is a common complication the first 48 to 72 hr after the biopsy However, another complication is the priority. D. The client is at risk for pain after a kidney biopsy because blood in and around the kidney causes pressure on the nerves in the area; however, another complication is the priority.

What are the major functions of the kidneys? Select all that apply. 1. Glomerular filtration, tubular reabsorption, and secretion 2. Maintain correct balance of fluid and electrolytes 3. Direct excretion of hydrogen ions and forming bicarbonate 4. Direct removal of metabolic waste products 5. Control of circulating volume and renin secretion 6. Stimulate production of white blood cells

Answer 1, 2, 3, 4, 5: Kidneys form the urine by filtration, reabsorption and secretion. Fluid and electrolytes are controlled. Acid-base balance is achieved by excreting hydrogen ions and forming bicarbonate to maintain pH of blood (7.35- 7.45) at normal range. Kidneys excrete waste products. Blood pressure is regulated by blood volume control and renin secretion. Secretion of erythropoietin stimulates the production of red blood cells. See Box 50.1 for additional information.

A 49-year-old man has a prostate-specific antigen (PSA) of 9.5 ng/mL (9.5 mcg/L). Which conditions could be associated with this result? Select all that apply. 1. Had a recent prostate biopsy 2. Could be related to prostate cancer 3. Suggests UTI 4. Indicative of prostatitis 5. Within normal limits for age

Answer 1, 2, 3, 4: The normal range is less than 4 ng/mL (4 mcg/L). Elevated levels may result from prostate cancer, inflammation or infection, UTI, or recent cystoscopy or prostatic biopsy.

For a patient who is prescribed furosemide for ARF, which nursing interventions are related to the medication and ARF? Select all that apply. 1. Keep accurate intake and output (I&O) records. 2. Assess BUN and serum electrolytes. 3. Teach the patient to avoid overuse of salt. 4. Monitor for flank and abdominal pain. 5. Record and monitor daily morning weights.

Answer 1, 2, 3, 5: Flank or abdominal pain are not anticipated with diuretic therapy or ARF. The other interventions are correct.

Which instructions would the nurse give to the UAP about the care of a patient who has an indwelling catheter and urinary collection bag? Select all that apply. 1. Never rest the collecting bag on the floor. 2. Cleanse the perineum from front to back with mild soap and warm water, then pat dry. 3. Inspect the catheter entry site for blood, exudate, or other signs of infection. 4. Avoid kinks or compression of the drainage tubing. 5. Assist the patient to ambulate; hold drainage bag below the catheter insertion site.

Answer 1, 2, 4, 5: The nurse would assess the catheter entry site for signs of trauma or infection. The other instructions are correct and these actions can be delegated to the UAP.

Which blood test is done to evaluate for impaired renal function, which is affected very little by dehydration, malnutrition, or hepatic function? 1. Serum creatinine 2. Blood urea nitrogen (BUN) 3. Creatinine clearance 4. Prostate-specific antigen

Answer 1--The blood test done to evaluate for impaired renal function, which is affected very little by dehydration, malnutrition, or hepatic function, is known as blood creatinine, or serum creatinine. This test measures the amount of creatinine—a catabolic product of creatine, which is used in skeletal muscle contraction—in the blood. The blood urea nitrogen (BUN) is a laboratory test used to determine the kidney's ability to rid the blood of the nonprotein nitrogen (NPN) waste and urea that results from catabolism. The BUN is affected by dehydration, malnutrition, or hepatic function, however. The creatinine clearance test involves testing of blood and urine over a 24-hour period. Elevated serum levels accompanied by a decline in urine levels indicate renal disease. Prostate-specific antigen is a blood test that is performed to assess for prostate cancer, prostate hypertrophy, and prostatitis.

For patients with diabetes mellitus or starvation states, what is the underlying pathophysiology for the abnormal presences of ketones in the urine? 1. Fatty acids are rapidly catabolized. 2. Glucose is converted to ketones. 3. Insulin levels are excessive. 4. Glucose is transformed into fat.

Answer 1: Ketones appear in the urine as the body converts fats into energy because glucose is not available to use as an energy source.

When caring for a patient with hydronephrosis, which nursing intervention is appropriate? (Select all that apply.) 1. Restriction of fluids 2. Strict intake and output recording 3. Assessment and management of pain 4. Observing for signs and symptoms of infection 5. Encourage a diet high in fiber

Answer 2, 3, 4--Appropriate nursing interventions for a patient with hydronephrosis include strict intake and output recording, assessment and management of pain, and observing for signs and symptoms of infection. It is important to determine that output is adequate and proportional to fluid intake, because this disorder is caused by obstructions in the urinary tract. Severe, stabbing pain may be present in the patient with hydronephrosis. Nausea and vomiting may be caused by a reflex reaction to the pain and will usually subside once the pain is under control. Infection can cause prolonged pressure in the region, which can result in fibrosis and loss of function in affected nephrons. If the condition is left untreated, the kidney can be destroyed. Appropriate nursing interventions for a patient with hydronephrosis do not include restriction of fluids. Rather, fluids are encouraged to avoid concentrated urine. A high-fiber diet will have no impact on the diagnosis of hydronephrosis.

Which statement is correct regarding the effect of aging on the renal system? (Select all that apply.) 1. Urinary incontinence is inevitable with aging. 2. Older men are at risk for urinary retention because of prostatic hypertrophy. 3. Urinary tract infections in older adults are often associated with diabetes, neurologic disorders, and procedures (e.g., catheterization). 4. Excessive fluid intake can increase the risk of urinary tract infections in the older adult. 5. Older women are at risk for stress incontinence because of weakened pelvic musculature.

Answer 2, 3, 5--Older men are at risk for urinary retention because of prostatic hypertrophy. An enlarged prostate restricts urinary outflow by narrowing the lumen of the urethra; this contributes to urinary retention. Urinary tract infections in older adults are often associated with diabetes, neurologic disorders, and procedures (e.g., catheterization). Any time an invasive procedure is performed, there is a risk of bacteria being introduced, and the older adult is especially vulnerable to this threat because of age-related decline in immunity. Older adults with diabetes and neurologic disorders are at greater risk for infection as well. Older women are at risk for stress incontinence because of weakened pelvic musculature. This can be related to earlier childbearing. Another contributing factor for stress incontinence in the older woman is hormonal changes that occur with aging. Urinary incontinence is not inevitable with aging, although it is more common due to age-related changes of musculature, neurologic system, and renal system, and the effects of medications. Urinary incontinence is a leading reason for institutional placement of older adults. Inadequate fluid intake, immobility, and conditions that lead to urinary stasis can increase the risk of urinary tract infections in the older adult.

A transrectal ultrasound is performed to visualize which structure? 1. Rectum 2. Prostate 3. Bladder 4. Kidneys

Answer 2--A transrectal ultrasound is a diagnostic test that is done to look at the prostate. With this test, the health care provider can differentiate between prostate enlargement and prostate cancer. A biopsy also can be performed to obtain tissue samples from various areas of the prostate. A transrectal ultrasound is not done to look at the rectum, although the rectum is the area in which the ultrasound probe is inserted. A transrectal ultrasound is not done to look at the bladder. Ordinary ultrasonography, using a probe on the outside of the skin, would be better suited for visualization of the bladder. A transrectal ultrasound is not done to look at the kidneys. Ordinary ultrasonography, using a probe on the outside of the skin, would be better suited for visualization of the bladder.

Which statement is true regarding the anatomy and physiology of the renal system? 1. The functional unit of the kidney is the glomerulus. 2. The three phases of urine formation are filtration, reabsorption, and secretion. 3. The outer covering of the kidney is called the medulla. 4. Blood is delivered to the glomerulus by the efferent arteriole and exits through the afferent arteriole.

Answer 2--The three phases of urine formation are filtration, reabsorption, and secretion. Filtration occurs in the glomerulus of Bowman capsule. Reabsorption of water, glucose, and ions occurs in the proximal convoluted tubules, loop of Henle, and the distal convoluted tubules. Secretion of ions, waste products, and drugs occurs primarily in the distal convoluted tubule. The functional unit of the kidney is the nephron. Each kidney contains more than 1 million nephrons, which are responsible for filtering the blood and processing the urine. The outer covering of the kidney is called the renal capsule, a strong layer of connective tissue. Blood is delivered to the glomerulus by the afferent arteriole and exits through the efferent arteriole.

The LPN/LVN is reading over the nursing care plan for a newly admitted female patient. One patient problem written is impaired urinary elimination. Upon further reading of the care plan, the nurse discovers nursing interventions listed as including remind patient to perform Kegel exercises four times per shift and assist patient to toilet every 2 hours. Considering the care plan information, which urinary problem is the patient most likely experiencing? 1. Urinary tract infection 2. Urinary incontinence 3. Neurogenic bladder: flaccid type 4. Neurogenic bladder: spastic type

Answer 2--This patient is probably experiencing urinary incontinence (UI). UI is the involuntary loss of urine from the bladder. It may be permanent or temporary. Although it affects all age-groups, it affects older adults more frequently. Kegel exercises and scheduled toileting are two of the interventions that might help the patient achieve continence. A urinary tract infection (UTI) is the presence of microorganisms in the urinary tract structure. Whereas medical care will focus on treating the patient with the correct antibiotics, the primary focus of nursing care of the patient with a UTI is maintaining adequate hydration and hygiene. The patient with a neurogenic bladder has a lesion of the central nervous system that interferes with normal nerve conduction to the urinary bladder. In the flaccid type, caused by a lower motor neuron lesion, the bladder continues to fill and distend, with pooling of urine and incomplete emptying. Because of the loss of sensation, the patient may not even be aware that he or she has a distended bladder. The patient with a neurogenic bladder has a lesion of the central nervous system that interferes with normal nerve conduction to the urinary bladder. In the spastic type, caused by a lesion above the voiding reflex arc, there is a loss of sensation to void and a loss of motor control. There is resultant bladder wall atrophy and a diminished capacity. The bladder releases urine on reflex, with little or no conscious control.

What is an indicator of chronic glomerulonephritis? 1. Residual urine 2. Albumin in the urine 3. Ketones in the urine 4. Prostate-specific antigen

Answer 2: Albumin and blood in the urine are early indicators of chronic glomerulonephritis. Residual urine is a bladder outflow problem that is not related to actual kidney function. Retained urine in the bladder is suspected to contribute to bladder cancer. Ketones in the urine are usually associated with diabetes mellitus, although diet and medication could be factors. Prostate-specific antigen is a screening test for prostate cancer.

A young healthy patient who has no known health problems has a blood urea nitrogen (BUN) level of 26 mg/dL (9.28 mmol/L). Which question is the nurse most likely to ask to clarify this laboratory result? 1. "Have you had an exposure to a sexually transmitted infection? " 2. "When was the last time you had anything to eat or drink? " 3. "Do you have a family history of diabetes or liver problems? " 4. "Are you having any problems with starting the urine stream? "

Answer 2: Blood urea nitrogen (BUN) is a laboratory test used to determine the kidneys' ability to rid the blood of waste and urea. Serum range for BUN is 7-20 mg/dL (2.5-7.1 mmol/L). An elevated BUN can be related to renal disease, dehydration, diet high in protein, or heart disease. In a young healthy patient, the nurse would first ask about foods and fluids.

For a patient undergoing peritoneal dialysis, which finding would nurse report to the HCP as an indicator of peritonitis? 1. Weight has increased. 2. Dialysate fluid is cloudy. 3. Dialysate fluid is red-tinged. 4. Drain time is slower than expected.

Answer 2: Cloudy fluid is sign of possible infection and this would be reported to the HCP. A specimen of the fluid should be collected for diagnostic testing. An increase of weight and fluid retention would be monitored. If the patient is consistently retaining fluid, therapy would be adjusted. Red-tinged fluid is reported for possible hemorrhage. If the drain time is slower than expected, the nurse would suggest position change, ambulation, and troubleshoot the drainage system for kinks or damage.

For a patient who is being discharged with a prescription for spironolactone, which laboratory result will the nurse verify before the patient goes home? 1. Urinalysis 2. Potassium level 3. White cell count 4. Blood urea nitrogen

Answer 2: Spironolactone is a potassiumsparing diuretic, so it is contraindicated for patients who have hyperkalemia.

Which point is stressed when teaching the patient about sulfamethoxazole-trimethoprim? 1. Expect an increase in urination and try to take the medication in the morning. 2. Complete the full course of medication even if feeling better after a day or two. 3. The medication makes the urine a bright orange color, but this is harmless. 4. Drink at least 3000 mL of water every day to prevent crystal precipitation.

Answer 2: Sulfamethoxazole-trimethoprim is an antibiotic used to treat infections such as uncomplicated UTIs and urethritis. Completing antibiotics as prescribed is the most important information to prevent recurrence and resistant strains of bacteria. Drinking at least 2000 mL is also recommended. Phenazopyridine hydrochloride will turn the urine orange. Diuretics are usually taken in the morning.

Which over-the-counter (OTC) medication is likely to create additional problems for a patient with BPH? 1. Acetaminophen 2. Diphenhydramine 3. Vitamin K supplement 4. Iron supplement

Answer 2: The nurse would advise the patient that diphenhydramine can cause urinary retention. This could add problems with passing urine, because BPH can cause an obstruction of urine flow. In addition, the nurse would remind the patient that all OTC medications should be reviewed with the HCP and be on file with the local pharmacist.

For a patient who needs habit training for bladder control, which action would the nurse perform first? 1. Reduce fluids before bedtime. 2. Assess and identify voiding patterns. 3. Schedule voiding times with meals. 4. Instruct unlicensed assistive personnel (UAP) to assist patient.

Answer 2: The nurse would assess first, because the program will be more successful if existing habits and voiding patterns are incorporated. Many people will go to the bathroom before meals to wash their hands or after eating and drinking stimulates elimination. Reducing fluids before bedtime decreases nocturia, but the nurse must ensure that fluid allotment is consumed earlier in the day. The UAP is an essential team member who can assist and remind the patient about scheduled toileting.

Which older male patient is the best candidate for an external condom catheter? 1. Has a UTI and is currently taking antibiotics 2. Has urge incontinence and functional incontinence related to a hip fracture 3. Has Alzheimer's disease and recently pulled out an indwelling catheter 4. Has an enlarged prostate and occasionally has trouble starting the stream

Answer 2: The patient with urge and functional incontinence will benefit the most from having an external condom, because he is unable to get to the bathroom in time. The patient with Alzheimer's is likely to pull the external catheter off. If the patient with a UTI has problems with incontinence, antibiotic therapy should resolve the problem. An enlarged prostate prevents flow, so the external catheter does not address the underlying problem.

The patient is in the diuretic phase of acute renal failure (ARF). Which assessment findings does the nurse expect? 1. BUN is over 50 mg/dL (17.85 mmol/L), urine output is less than 30 mL/hour. 2. BUN and serum creatinine levels begin to normalize and urine output is 1 to 2 L/24 hours. 3. Glomerular filtration rate rises and kidneys are at normal or near-normal function. 4. BUN and serum creatinine levels rise and urine output is less than 400 mL/24 hours.

Answer 2: There are three phrases in ARF: 1) oliguric phase, 2) diuretic phase, and 3) recovery phase. In the diuretic phase, blood chemistry levels begin to return to normal and urinary output increases to 1-2 L/24 hours. In the oliguric phase, BUN and serum creatinine levels rise while urine output decreases to less than 400 mL/24 hours. Return to normal or nearnormal function occurs in the recovery phase. End-stage kidney disease (ESKD) is confirmed by elevated BUN of at least 50 mg/dL (17.85 mmol/L) and serum creatinine level greater than 5 mg/dL (442.1 µmmol/L).

The nurse is caring for a patient who is taking digoxin once a day for treatment of congestive heart failure. He now has a new order to begin taking spironolactone. Which nursing intervention is most appropriate for this patient? 1. Take blood pressure, pulse, and respiratory rate twice a day until he is stabilized on the new medication. 2. Obtain a prescription for potassium supplement. 3. Monitor the patient for signs and symptoms of digoxin toxicity. 4. Encourage salt supplements to modify the untoward effects of the new medication.

Answer 3--The appropriate nursing intervention would be to monitor the patient for signs and symptoms of digoxin toxicity. As a diuretic takes effect, there may be a resultant increase in the serum concentration of other medications that the patient is currently taking. Since this patient is taking digoxin, the nurse must carefully assess for development of digoxin toxicity. The appropriate nursing intervention would be to take blood pressure, pulse, and respiratory rate four times a day until the patient is stabilized on the new medication. Obtaining a prescription for a potassium supplement would be inappropriate in this situation, as spironolactone is classified as a potassium-sparing diuretic. These medications conserve potassium that is usually lost with diuretic agents. Salt should be discouraged for patients on diuretic therapy. The patient should be instructed to avoid overuse of salt in cooking or as a table additive. The health care provider might also place patients on a restricted salt diet (e.g., 2 g).

The nurse is admitting a patient to the unit who has been diagnosed with a urinary tract infection (UTI). The patient is acutely ill, with a temperature of 102.5°F and chills. the patient is grabbing the left side and reporting severe pain. The urine specimen appears concentrated with a cloudy appearance and the nurse knows that this symptom is most associated with which type of UTI? 1. Urethritis 2. Cystitis 3. Pyelonephritis 4. Prostatitis

Answer 3--This patient appears acutely ill, and is probably experiencing pyelonephritis. Pyelonephritis is an inflammation of the structures of the kidney the renal pelvis, renal tubules, and the interstitial tissue, usually caused by Escherichia coli. Pyelonephritis can lead to kidney damage because of destruction of nephrons. Urethritis is an inflammation of the urethra. Assessment findings are more localized to the area and include inflammation of the urethra with pus formation in the mucus-forming glands, discomfort, and burning on urination. Cystitis is an inflammation of the wall of the bladder, usually caused by urethrovesical reflux, introduction of a catheter or similar instrument, or contamination (e.g., from feces). It is most common in women due to the short urethra. Signs and symptoms include dysuria, urinary frequency, and pyuria. Prostatitis is an infection or inflammation of the prostate, which women do not have. It can be bacterial or nonbacterial.

Which postprocedure assessment would be considered a normal finding after a cystoscopy of the urinary bladder? 1. Increased output and low specific gravity 2. Urinary retention and bladder distention 3. Blood-tinged urine at the first void 4. Mild flank pain and low-grade fever

Answer 3: A local anesthetic is administered, and a scope is inserted into the urethra. Bloodtinged urine at the first voiding can occur because of mechanical trauma from the procedure. The other findings are not related to cystoscopy.

The nurse and UAP are aware that no tension should be placed on urinary catheters; however, the nurse would reinforce this principle for which patient? 1. Has a suprapubic catheter for long-term management 2. Has a three-way catheter for continuous bladder irrigation 3. Has an indwelling catheter after reconstruction of urethra 4. Has a catheter and urometer for hourly measurements

Answer 3: An indwelling urinary catheter is inserted to splint and support the suture line after reconstruction of the urethra; thus, tension on the catheter could result in disruption of the surgical site. The other patients have catheters primarily for drainage purposes.

During a urodynamic study, a patient is given bethanechol, a cholinergic drug. What is the expected effect of the medication? 1. Relaxes the patient 2. Reduces urine production 3. Stimulates the atonic bladder 4. Increases the uptake of dye

Answer 3: Cholinergic and anticholinergic medications may be administered during urodynamic studies to determine their effects on bladder function.

Which breakfast tray is the best example of foods that adhere to the acid-ash diet? 1. Blueberry pancakes with maple syrup and tea 2. Coffee, orange juice, and granola with raisins 3. Whole-grain toast, boiled egg, and prunes 4. Low-fat milk, banana, and peanut butter toast

Answer 3: Examples of acid-ash foods include: meat, whole grains, eggs, cheese, cranberries, prunes, and plums. Examples of alkaline-ash foods include: milk, vegetables, and fruits (except cranberries, prunes, and plums).

Which patient is most likely to benefit from patient education pamphlets about urodynamic studies and rectal electromyography? 1. Patient has renal cancer, staging yet to be determined. 2. Patient has risk for polycystic kidney disease. 3. Patient has urinary incontinence related to neurologic disorder. 4. Patient has signs/symptoms of chronic glomerulonephritis.

Answer 3: For patients with urinary incontinence secondary to neurologic disorder, urodynamic studies are used to evaluate the activity level of the urinary bladder muscle. Rectal electromyography is an associated test, which evaluates urethral pressures.

In planning care for patients who will have diagnostic testing, which procedure is going to require the most time for postprocedural care? 1. Kidney-ureter-bladder radiography 2. Intravenous pyelogram 3. Renal angiography 4. Renal ultrasonography

Answer 3: For renal angiography, the nurse must assess circulatory status of the involved extremity every 15 minutes for 1 hour, then every 2 hours for 24 hours. A kidney-ureterbladder radiography and ultrasonography do not require any special postprocedural care. For the intravenous pyelogram, the patient needs to be encouraged to drink water to flush the dye from the system, and the venipuncture site should be routinely observed.

What is an early sign of bladder cancer? 1. Change in voiding pattern 2. Dusky yellow-tan or gray skin color 3. Painless, intermittent hematuria 4. Difficult starting the stream of urine

Answer 3: Painless hematuria is an early sign. Other symptoms include changes in voiding patterns, signs of urinary obstruction, or renal failure, depending on the extent of the disease process.

Which patient condition is likely to result in the abnormal finding of urine specific gravity of 1.000 g/mL? 1. Diabetic ketoacidosis 2. Hyperemesis gravidarum 3. Diabetes insipidus 4. Febrile illness

Answer 3: The normal range of urine specific gravity is 1.003-1.030. Diabetes insipidus is an endocrine disorder in which the kidneys are unable to conserve water, so the urine is very dilute. The other three conditions will cause dehydration and the specific gravity will increase.

The nurse is caring for a patient with acute renal failure (oliguric phase). Which finding would the nurse expect to assess on a patient with this diagnosis? 1. Decreased blood urea nitrogen 2. Low levels of serum creatinine 3. Urine output in excess of 2 L/day 4. Anorexia, nausea, vomiting, and decreased urine output

Answer 4--In a patient with acute renal failure (oliguric phase), typical clinical manifestations include anorexia, nausea, vomiting, and decreased urine output. The patient may also experience lethargy, headache, dry mucous membranes, diarrhea, poor skin turgor, and anasarca. A patient who is in the oliguric phase of acute renal failure will have an elevation in the blood urea nitrogen value. A patient who is in the oliguric phase of acute renal failure will have an elevated serum creatinine. A patient who is in the oliguric phase of acute renal failure will have a decreased urine output, usually less than 400 mL in a 24-hour period.

The nurse is performing patient teaching for a patient who has urolithiasis. This patient has been determined to have calcium oxalate kidney stones. Which current research recommendation will the nurse base the answers to the patient's dietary questions? 1. Restriction of calcium 2. Sodium chloride supplementation 3. Restriction of fluid 4. Restricted animal protein

Answer 4--The newer research on the impact of diet on the development of calcium oxylate kidney stones suggests that restricted consumption of animal protein and salt in combination with normal calcium intake reduces the risk of kidney stones better than the traditional low-calcium diet. Newer research suggests that normal calcium intake, in combination with restricted consumption of animal protein and salt, reduced the risk of kidney stones better than the traditional low-calcium diet. Sodium chloride, or salt, supplementation would not be advisable for this patient. Fluids are encouraged for the patient with kidney stones. Restriction of fluid can lead to increased alkalinity of the urine, and further development of kidney stones.

The patient with acute glomerulonephritis is placed on bedrest. Which vital sign is of primary interest as an indicator of the success of the intervention? 1. Temperature 2. Pulse rate 3. Respiratory rate 4. Blood pressure

Answer 4: Excess fluid causes edema and hypertension, so the patient is placed on bedrest until those symptoms resolve. The patient is also likely to have orthopnea, so the head of the bed would be elevated.

Which procedure requires prior insertion of an indwelling urinary catheter? 1. Intravenous pyelogram for possible hydronephrosis 2. Renal venography for possible dysfunction of venous drainage 3. Renal ultrasonography for possible congenital anomaly 4. Voiding cystourethrogram for possible abnormal urethra

Answer 4: In voiding cystourethrography, an indwelling catheter is inserted into the urinary bladder, and dye is injected to outline the lower urinary tract. Radiographs are taken, and the catheter is then removed. The patient is asked to void while radiographs are being taken.

Which patient has urinary output that needs to be immediately reported to the health care provider (HCP)? 1. Is postoperative for an ileal conduit and urine output is 40 mL/hr 2. Has an indwelling urinary catheter and urine output is 60 mL/hr 3. Diagnosed with urolithiasis and urine output is 2500 mL in 24 hours 4. Has nephrotic syndrome and urine output is less than 400 mL in 24 hours

Answer 4: Oliguria is urinary output less than 500 mL in 24 hours. Decreased urine is characteristic of nephrotic syndrome; however, the HCP may decide to adjust therapy because permanent kidney damage will occur if fluid imbalance is prolonged. Postoperatively for an ileal conduit, the nurse would report output less than 30 mL/h. If the patient has an indwelling urinary catheter and urine output is below 50 mL/h, first the nurse would troubleshoot the equipment for kinks or damage. If the system is functional and output is still low, the nurse would report the abnormality to the HCP. Patients with urolithiasis are encouraged to drink extra fluids to flush the stones and to increase urine flow, so urine output of 2500 mL in 24 hours is acceptable.

For a patient with advanced end-stage kidney disease (ESKD), which type of medication would the nurse question if it were prescribed? 1. Antiemetic 2. Antipruritic 3. Vitamin supplement 4. Osmotic diuretic

Answer 4: Osmotic diuretics are used for ARF to prevent irreversible failure, but they are contraindicated in advanced ESKD.

Which instructions would the nurse give to the UAP for assisting a patient who had a renal biopsy? 1. Measure, record, and report intake and output. 2. Ask the patient about dizziness before ambulating. 3. Withhold all foods and fluids for 24 hours. 4. Remind the patient to rest for 4-6 hours.

Answer 4: Rest is advised for 4-6 hours after the procedure to decrease the chances of bleeding. Measuring intake and output is not usually required, but the UAP would be instructed to report any blood in the urine. Dizziness is not anticipated. Restriction of food and fluid is usually not necessary. Gradual resumption of activities is allowed after 12-48 hours.

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Which patient is most likely to benefit from learning about Kegel exercises? 1. Experiences loss of urine during sneezing and lifting 2. Has urinary retention secondary to chronic infection 3. Has urge incontinence due to advanced Parkinson's disease 4. Has a spastic bladder due to upper motor neuron lesion

Answer 1: Kegel exercises are recommended in prevention and treatment of stress incontinence, which is loss of urine during coughing, laughing, sneezing, or straining. Kegel exercises are recommended for all patients who are able to practice conscious motor control over the pelvic musculature to reduce present or future episodes of incontinence. Some patients who have Parkinson's or Alzheimer's may be able to learn Kegel exercises, depending on cognition and motor control.

Which staff member must be reassigned if scheduled to care for a patient who has returned from a renal scan that used a radionuclide tracer substance? 1. UAP who is in the first trimester of pregnancy 2. LPN/LVN who is taking medication for a urinary tract infection (UTI) 3. RN who is immunosuppressed secondary to a splenectomy 4. UAP who has allergies to iodine, seafood, and latex

Answer 1: Pregnant health care staff should refrain from caring for patients who received radioactive substances.

A student nurse is assessing the function of an arteriovenous fistula after a dialysis treatment. When would the supervising nurse intervene? 1. Flushes with saline using strict aseptic technique. 2. Palpates a thrill and auscultates for a bruit. 3. Assesses the distal pulses and checks for sensation. 4. Asks the patient about pain or discomfort at the site.

Answer 1: A nurse would never access the fistula to draw blood, to give fluids or to check patency, unless he/she has had special training in dialysis procedures. Auscultating the arteriovenous fistula for bruit (adventitious sound of venous or arterial origin heard on auscultation) and palpating arteriovenous fistula for thrill (abnormal tremor) are correct. Checking pulses and assessing pain are part of the assessment that is performed after the patient returns from dialysis.

Identify the renal disorders associated with an abnormal elevation in serum creatinine. Select all that apply. 1. Stress incontinence 2. Glomerulonephritis 3. Pyelonephritis 4. Acute tubular necrosis 5. Chronic renal failure (CRF)

Answer 2, 3, 4, 5: The serum creatinine test is used to diagnose impaired kidney function. With normal renal function, the serum creatinine level should remain constant and normal. Stress incontinence is related to stress or pressure on the bladder sphincter.

For patients with nephrotic syndrome, which signs/symptoms is the nurse most likely to observe? 1. Periorbital edema, pitting edema in legs, and crackles in lungs 2. Sore throat or skin infection with fever and malaise 3. Burning with urination, low back pain, hematuria, and fatigue 4. Dysuria, weak stream, and increasing pain with bladder distention

Answer 1: In nephrotic syndrome, excess fluid in the body is the most common sign. Patients who develop acute glomerulonephritis may report a preceding episode of sore throat or skin infection with fever and malaise. Burning with urination, low-back pain, hematuria, and fever are more associated with cystitis. Dysuria, weak stream, and increasing pain with bladder distention are seen in patients with urethral strictures.

Which patient condition is likely to result in casts in the urine specimen? 1. Type 1 diabetes mellitus 2. Stress incontinence 3. Acute pyelonephritis 4. Ureter structure trauma

Answer 3: White blood cell casts in the urine indicate involvement of the renal parenchyma in renal disorders, such as acute pyelonephritis or acute glomerulonephritis.