GU Disorders

Cystine stones

A low-protein diet is prescribed, the urine is alkalinized, and fluid intake is increased

Oxylate stones

A dilute urine is maintained, and the intake of oxalate is limited. Many foods contain oxalate; however, only certain foods increase the urinary excretion of oxalate. These include spinach, strawberries, rhubarb, chocolate, tea, peanuts, and wheat bran.

A client had a lithotripsy to treat renal calculi. The client is having ureteral spasms and hematuria. What should the nurse do? Select all that apply. a) Apply a heating pad to the lower back area. b) Strain all urine. c) Assess pain level. d) Encourage fluid intake of 1,000 ml/day. e) Contact the health care provider (HCP) to report hematuria.

Strain all urine. • Apply a heating pad to the lower back area. • Assess pain level. Explanation: Following lithotripsy, the nurse strains all urine to collect and identify stone composition. Providing heat to the flank area may be helpful to relieve muscle spasms when renal colic is present; the nurse assesses the client's pain level and administers analgesics as needed. Hematuria is common after lithotripsy, and it is not necessary to notify the HCP. The nurse should promote a fluid intake of at least 2,000 ml/day to flush stones and clots through the urinary tract.

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate? a) Use sterile technique when irrigating the catheter. b) Prepare to remove the catheter. c) Restrict fluids to prevent the client's bladder from becoming distended. d) Tell the client to try to urinate around the catheter to remove blood clots.

Use sterile technique when irrigating the catheter. Explanation: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.

A client who had transurethral resection of the prostate (TURP) 2 days earlier has lower abdominal pain. The nurse should first: a) administer an oral analgesic. b) assess the patency of the urethral catheter. c) have the client use a sitz bath for 15 minutes. d) auscultate the abdomen for bowel sounds.

b The lower abdominal pain is most likely caused by bladder spasms. A common cause of bladder spasms after TURP is blood clots obstructing the catheter; therefore, the nurse's first action should be to assess the patency of the catheter. Auscultating the abdomen for bowel sounds would be appropriate after patency of the catheter has been established. The nurse should assess for bladder spasms before administering an analgesic. A sitz bath would not relieve bladder spasms that are caused by an obstructed catheter.

A client is scheduled to undergo transurethral resection of the prostate. The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should assess the client for: a) renal shutdown. b) seizures. c) cardiac arrest. d) respiratory paralysis.

respiratory paralysis. Explanation: If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. Seizures, cardiac arrest, and renal shutdown are not likely results of spinal anesthesia.

A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove renal calculi. Which nursing measure is appropriate for the postoperative care of this client? a) Limit fluid intake to 1,000 mL/day until all stone fragments have been passed. b) Instruct the client to anticipate hematuria for about 24 hours after the procedure. c) Instruct the client to anticipate a decrease in urine output. d) Maintain the client on strict bed rest for 48 hours after the procedure.

Instruct the client to anticipate hematuria for about 24 hours after the procedure. Correct Explanation: It is normal for hematuria to occur for up to 24 hours after ESWL. Hematuria that occurs for longer than 24 hours should be reported to the health care provider. ESWL is usually performed on an outpatient basis. Strict bed rest is not necessary after the procedure. Urine output should not decrease. Any difficulty urinating should be reported. Fluid intake should be increased to 2 to 3 L/day, not decreased.

A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6° F (38.1° C). Which outcome would be a priority for this client? a) maintenance of fluid and electrolyte balance b) alleviation of nausea c) prevention of urinary tract complications d) alleviation of pain

alleviation of pain Correct Explanation: The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate throughout the client's hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte imbalance.

A client with benign prostatic hypertrophy (BPH) is being treated with terazosin 2 mg at bedtime. The nurse should monitor the client's: a) urine nitrites. b) white blood cell count. c) pulse. d) blood pressure.

blood pressure. Explanation: Terazosin is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or orthostatic hypotension. The client should be instructed to change positions slowly. Urine nitrates, white blood cell count, and pulse rate are not affected by terazosin

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a) limit oral fluid intake for 1 to 2 weeks. b) report the presence of fine, sandlike particles through the nephrostomy tube. c) report bright pink urine within 24 hours after the procedure. d) notify the physician about cloudy or foul-smelling urine.

notify the physician about cloudy or foul-smelling urine. Explanation: The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis? a) Impaired urinary elimination b) Imbalanced nutrition: Less than body requirements c) Acute pain d) Risk for infection

Acute pain Correct Explanation: Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

Kidney stone patient education

Avoid protein intake; usually protein is restricted to 60 g/day to decrease urinary excretion of calcium and uric acid. • A sodium intake of 3-4 g/day is recommended. Table salt and high-sodium foods should be reduced, because sodium competes with calcium for reabsorption in the kidneys. • Low-calcium diets are not generally recommended, except for true absorptive hypercalciuria. Evidence shows that limiting calcium, especially in women, can lead to osteoporosis and does not prevent renal stones. • Avoid intake of oxalate-containing foods (e.g., spinach, strawberries, rhubarb, tea, peanuts, wheat bran). • During the day, drink fluids (ideally water) every 1-2 hours. • Drink two glasses of water at bedtime and an additional glass at each nighttime awakening to prevent urine from becoming too concentrated during the night. • Avoid activities leading to sudden increases in environmental temperatures that may cause excessive sweating and dehydration. • Contact your primary provider at the first sign of a urinary tract infection

The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which action would be most important for the nurse to include in pretest preparation? a) Prepare the client for the possibility of bladder spasms during the test. b) Determine when the client last had a bowel movement. c) Ensure adequate fluid intake on the day of the test. d) Check the client's history for allergy to iodine.

Check the client's history for allergy to iodine. Correct Explanation: A client scheduled for an IVP should be assessed for allergies to iodine and shellfish. Clients with such allergies may be allergic to the IVP dye and be at risk for an anaphylactic reaction. Adequate fluid intake is important after the examination. Bladder spasms are not common during an IVP. Bowel preparation is important before an IVP to allow visualization of the ureters and bladder, but checking for allergies is most important.

After an intravenous pyelogram (IVP), the nurse should include which measure in the client's plan of care? a) Encourage adequate fluid intake. b) Administer a laxative. c) Maintain bed rest. d) Assess for hematuria.

Encourage adequate fluid intake. Correct Explanation: After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria

A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I.V. pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow? a) Attaching the infusion set to an infusion pump b) Evaluating patency of the drainage lumen c) Collecting a urine specimen before beginning irrigation d) Counter-balancing the I.V. pole

Evaluating patency of the drainage lumen Correct Explanation: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary

Uric acid stones

For uric acid stones, the patient is placed on a low-purine diet to reduce the excretion of uric acid in the urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided, and other proteins may be limited. Allopurinol (Zyloprim) may be prescribed to reduce serum uric acid levels and urinary uric acid excretion

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? a) Ureter b) Kidney c) Bladder d) Urethra

Kidney Explanation: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.