Urinary 105 Exam

The patient states that she "loses urine" every time she laughs or coughs. The nurse teaches the patient measures to regain urinary control. The nurse recognizes the need for further teaching when the patient states: A) "I will perform my Kegel exercises every day." B) "I joined weight watchers." C) "I drink two glasses of wine with dinner." D) "I have tried urinating every 3 hours."

"I drink two glasses of wine with dinner."

The Doctor has order an indwelling catheter inserted in a hospitalized male "PT". The nurse is aware of which of the following considerations? A)The male urethra is more vulnerable to injury during insertion B)In the hospital, a clean technique is used for catheter insertion C)The catheter is inserted 2" to 3" into the meatus D)Since it uses a closed system, the risk for urinary infection is absent

A)The male urethra is more vulnerable to injury during insertion Because of its length the male urethra is more prone to injury and requires that the catheter be inserted 6" to 8". This procedure requires surgical asepsis to prevent introducing bacterica into the urinary tract. The placement of an indwelling catheter has a risk of UTI

Which change in renal or urinary functioning as a result of the normal aging process increases the older client's risk for infection? A. Decreased glomerular filtration B. Decreased filtrate reabsorption C. Weakened sphincter muscles D. Urinary retention

ANS: D Incomplete bladder emptying for whatever reason increases the client's risk for urinary tract infections as a result of urine stasis providing an excellent culture medium that promotes the growth of microorganisms

The patient is incontinent, and a condom catheter is placed. The nurse should take which action? A) Secure the condom with adhesive tape B) Change the condom every 48 hours C) Assess the patient for skin irritation D) Use sterile technique for placement

Assess the patient for skin irritation

Which of the following terms did note a patient's inability to void even though the kidneys are producing urine that enters the bladder? A) Urgency B) Retention C)Oliguria D)Dysuria

B) Retention Urgency is a strong desire to void. Oliguria is scanty or greatly diminished amount of urine voided in a given time. Dysuria is difficulty urinating

A 70-year-old male 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. Dysuria Painful and difficult urination is characterized as dysuria. Anuria is an absence of urine production, whereas oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.

As a component of the head-to-toe assessment of a patient who has been recently transferred to the clinical unit, the nurse is preparing to palpate the patient's 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. Supine 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.

Which urinalysis result should the nurse recognize as an abnormal finding? A. pH 6.0 B. Amber yellow color C. Specific gravity 1.025 D. White blood cells (WBCs) 9/hpf

D. White blood cells (WBCs) 9/hpf Correct 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 ranges for specific gravity are 1.003 to 1.030.

The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to: A) Use the double-voiding technique. B) Perform Kegel exercises. C) Use Credé's method. D) Keep a voiding diary.

Use Credé's method.

Which urine specific gravity value would indicate to the nurse that the patient is receiving excessive IV fluid therapy? a. 1.002 b. 1.010 c. 1.025 d. 1.030

a. A urine specific gravity of 1.002 is low, indicating dilute urine and the excretion of excess fluid. Fluid overload, diuretics, or lack of ADH can cause dilute urine. Normal urine specific gravity is 1.003 to 1.030. A high urine specific gravity indicates concentrated urine that would be seen in dehydration.

A urinary diversion is the surgical rerouting of urine from the kidneys to a site other than the bladder. Which type of client would this type of procedure would benefit from this procedure? a. An abdominal trauma victim b. A renal failure client c. A client with kidney stones d. An individual suffering from a urinary tract infection

a. An abdominal trauma victim Objective: Explain the care of clients with retention catheters or urinary diversions. Rationale: The abdominal trauma victim is the only appropriate answer here. The remaining problems can be treated with less traumatic care measures

the nurse notes that the patient's Foley catheter bag has been empty for 4 hours. The priority action would be to: A) Irrigate the Foley. B) Check for kinks in the tubing. C) Notify the health care provider. D) Assess the patient's intake.

b

When assessing a client who has a diagnosis of neurogenic bladder, what would you most likely find the client to say? [Hint] a. "My bladder always feels full." b. "I am often unable to control my urination." c. "I have a nervous bladder." d. "I urinate about 5 to 7 times each 24-hour day."

b. "I am often unable to control my urination." The client with a neurogenic bladder does not perceive bladder fullness and is unable to control the urinary sphincters. There may be frequent involuntary urination.

The male patient is admitted with a diagnosis of benign prostatic hyperplasia (BPH). What urination characteristics should the nurse expect to assess in this patient? a. Oliguria b. Hesitancy c. Hematuria d. Pneumaturia

b. Hesitancy is difficulty starting the urine stream and is common with benign prostatic hyperplasia (BPH). Oliguria is scanty urine formation and output. Hematuria is blood in the urine. Pneumaturia is urine containing gas, as is caused by a fistula between the bowel and bladder.

A patient with kidney disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of a. tubular secretion b. glomerular filtration c. capillary permeability d. concentration of filtrate

b. glomerular filtration Rationale: The amount of blood filtered each minute by the glomeruli is expressed as the glomerular filtration rate (GFR). The normal GFR is about 125 mL/min.

When reading the lab reports of your assigned clients, you find that one of your clients has a urine pH of 6. You determine that this urine pH is: [Hint] a. strongly alkalinic. b. slightly acidic. c. abnormal. d. neutral.

b. slightly acidic

During the shift report, you learn that your assigned client has "nocturia." Which of the following questions should you ask this client? [Hint] a. "How often do you wet the bed at night?" b. "Are you eating salty snacks in the evening?" c. "How many times do you get up to void at night?" d. "When did these bladder spasms at night begin?"

c. "How many times do you get up to void at night?"

Which diagnostic study would include assessing for iodine sensitivity, teaching the patient to take a cathartic the night before the procedure, and telling the patient that a salty taste may occur during the procedure? a. Cystometrogram b. Renal arteriogram c. Intravenous pyelogram (IVP) d. Kidneys, ureters, bladder (KUB)

c. A cathartic the evening before the procedure and sensitivity to iodine are important for both intravenous pyelogram (IVP) and renal arteriogram but the salty taste is only a possibility with IVP. The cystometrogram involves filling the bladder with water or saline to measure tone and stability. The kidneys, ureters, and bladder (KUB) is an x-ray that may have bowel preparation.

The physician has written an order for your assigned client to have a 24-hour urine collection sent to the laboratory for specific testing. You realize that you must: a. inform the client that they must save all urine for 24 hours beginning at 12:01 a.m. b. start the urine collection at either 12:01 a.m. or 12:01 p.m. c. at the start of the collection period, have the client void and discard this urine. d. provide enough sterile receptacles for the urine collection.

c. At the start of the collection period, have the client void and discard this urine

Which test is most specific for renal function? a. Renal scan b. Serum creatinine c. Creatinine clearance d. Blood urea nitrogen (BUN)

c. The rate at which creatinine is cleared from the blood and eliminated in the urine approximates the GFR and is the most specific test of renal function. The renal scan is useful in showing the location, size, and shape of the kidney and general blood perfusion.

The goal of nursing care of the client with an indwelling catheter and continuous drainage is largely directed at preventing infection of the urinary tract and encouraging urinary flow through the drainage system. Which of the following interventions encouraged by nurses working with these clients would not be appropriate in meeting this goal? a. Having the client drink up to 3000mL per day b. Encouraging the client to eat foods that increase the acid in the urine c. Routine hygienic care d. Changing indwelling catheters every 72 hours.

d. Changing indwelling catheters every 72 hours. Objective: Explain the care of clients with retention catheters or urinary diversions. Rationale: Retention catheters are removed after their purpose is achieved; routine changing of the catheter or drainage system is not recommended. Large amounts of fluid ensure a large urine output, which keeps the bladder flushed out and decreases the likelihood of urinary stasis and subsequent infection. Eating foods that increase the acid in urine helps to reduce the risk of urinary tract infections and stone formation. Hygiene care related to catheters is set by hospital policy.

Urinary incontinence is not a normal part of aging. An intervention used by nurses to assist clients to regain or maintain continence with individuals suffering from this problem would not include: a. Bladder training b. Habit training c. Prompted voiding d. Fluid restriction

d. Fluid restriction Objective: Develop nursing diagnoses, desired outcomes, and interventions related to urinary elimination. Rationale: Fluids would be encouraged, to allow the kidneys to be flushed and urine to be formed. Bladder training requires that the client postpone voiding, resist or inhinbit the sensation of urgency, and void according to a timetable, rather than according to an urge. Habit training is also referred to timed or scheduled voiding. There is no attempt to motivate the client to delay voiding if the urge occurs. Prompted voiding supplements habit training by encouraging the client to try to use the toilet and reminding the client when to void.

11. A patient has has a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shred are seen in the drainage bag. The nurse should. a. notify the physician b.notify the charge nurse c. irrigate the drainage tube d. chart it as a normal observation

d. chart it as a normal observation

A 72-year-old who has benign prostatic hyperplasia is admitted to the hospital with chills, fever, and vomiting. Which finding by the nurse will be most helpful in determining whether the patient has an upper urinary tract infection (UTI)? a. Suprapubic pain b. Bladder distention c. Foul-smelling urine d. Costovertebral tenderness

ANS: D Costovertebral tenderness is characteristic of pyelonephritis. The other symptoms are characteristic of lower UTI and are likely to be present if the patient also has an upper UTI. DIF: Cognitive Level: Application REF: 1128

A 62-year-old asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is most appropriate to include in the care plan? a. Assist the patient to the bathroom q3hr. b. Place a commode at the patient's bedside. c. Demonstrate how to perform the Credé maneuver. d. Teach the patient how to perform Kegel exercises.

ANS: D Exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The Credé maneuver is used to help empty the bladder for patients with overflow incontinence. Placing the commode close to the bedside and assisting the patient to the bathroom are helpful for functional incontinence. DIF: Cognitive Level: Application REF: 1148

Which of the following is a nursing priority when caring for a male patient with a condom catheter? A) Preventing the tubing from kinking to maintain free urinary drainage B) Not removing the catheter for any reason C) Fastening the condom tightly to prevent the possible ability of leakage D) Maintaining bed rest at all times to prevent the catheter from slipping off

A) Preventing the tubing from kinking to maintain free urinary drainage The catheter should be allowed to drain freely through toothing that is not king. It also should be removed daily to prevent skin excoriation And should not be fastened to tightly or restriction of blood vessels in the area is likely. Confining a patient to bed rest increases the risk for other hazards related to immobility

Which nursing diagnosis is a priority in the care of a patient with renal calculi? A. Acute pain B. Risk for constipation C. Deficient fluid volume D. Risk for powerlessness

A. Acute pain Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas 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.

What should the nurse expect to do to prepare a patient for an intravenous pyelogram (IVP)? 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. Administer a cathartic or enema. 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 preprocedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur

The patient had surgery and a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What should the nurse do first to assess for urinary retention? A. Bladder scan B.Cystometrogram C. Residual urine test D. Kidneys, ureters, bladder (KUB) x-ray

A.Bladder scan If the patient is unable to void, the bladder may be palpated for distention, 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 client is experiencing urinary retention, and the health care provider is contacted. The nurse anticipates a medication that will be ordered to promote emptying of the bladder is: 1. Oxybutynin chloride (Ditropan) 2. Bethanechol (Urecholine) 3. Propantheline (Pro-Banthine) 4. Nystatin (Mycostatin)

ANS: 2 Cholinergic drugs, such as bethanechol (Urecholine), increase contraction of the bladder and improve emptying. Bethanechol stimulates parasympathetic nerves to increase bladder wall contraction and relax the sphincter. Oxybutynin chloride (Ditropan) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder), and thus reduces incontinence. Propantheline (Pro-Banthine) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder), and thus reduces incontinence. Nystatin (Mycostatin) is an antifungal agent.

Which of the following statements made by a client with benign prostatic hypertrophy (BPH) during an admissions interview reflects the best understanding of the long-term effects of this condition? 1. "I usually get up 3 to 4 times a night to urinate." 2. "My health care provider prescribed some medication that has helped." 3. "At least I can usually empty my bladder; I really hate that feeling of being full." 4. "The prostate specific antigen (PSA) results have stayed stable for the last 3 tests."

ANS: 3 If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time the micturition reflex changes, causing bladder overactivity, and can cause the bladder to not completely empty. The remaining options focus on the impact the condition has on daily living and the monitoring of the client for prostate cancer.

In an assessment of a client with reflex incontinence the nurse expects to find that the client has: 1. A constant dribbling of urine 2. An uncontrollable loss of urine when coughing or sneezing 3. No urge to void and an unawareness of bladder filling 4. An immediate urge to void but not enough time to reach the bathroom

ANS: 3 The nurse expects to find the client with reflex incontinence to have no urge to void and an unawareness of bladder filling. A constant dribbling of urine may be seen with overflow incontinence. With stress incontinence the client is unable to control loss of urine when coughing or sneezing. Functional incontinence is seen when there is an immediate urge to void but not enough time to get to the bathroom.

Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes. Which nursing action is most appropriate? a. Use an ultrasound scanner to check the postvoiding residual. b. Monitor the patient's intake and output over the next few hours. c. Have the patient take small amounts of fluid frequently throughout the day. d. Reassure the patient that this is normal after rectal surgery because of anesthesia.

ANS: A An ultrasound scanner can be used to check for residual urine after the patient voids. Because the patient's history and clinical manifestations are consistent with overflow incontinence, it is not appropriate to have the patient drink small amounts. Although overflow incontinence is not unusual after surgery, the nurse should intervene to correct the physiologic problem, not just reassure the patient. The patient may develop reflux into the renal pelvis as well as discomfort from a full bladder if the nurse waits to address the problem for several hours. DIF: Cognitive Level: Application REF: 1146-1147 | 1154

A female patient being admitted with pneumonia has a history of neurogenic bladder as a result of a spinal cord injury. Which action will the nurse plan to take first? a. Ask about the usual urinary pattern and any measures used for bladder control. b. Assist the patient to the toilet at scheduled times to help ensure bladder emptying. c. Check the patient for urinary incontinence every 2 hours to maintain skin integrity. d. Use intermittent catheterization on a regular schedule to avoid the risk of infection.

ANS: A Before planning any interventions, the nurse should complete the assessment and determine the patient's normal bladder pattern and the usual measures used by the patient at home. All the other responses may be appropriate, but until the assessment is complete, an individualized plan for the patient cannot be developed.

A patient has elevated blood urea nitrogen (BUN) and serum creatinine levels. Which bowel preparation order would the nurse question for this patient who is scheduled for a renal arteriogram? a. Fleet enema b. Tap-water enema c. Senna/docusate (Senokot-S) d. Bisacodyl (Dulcolax) tablets

ANS: A High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure. The other medications for bowel evacuation are more appropriate.

A patient in the hospital has a history of functional urinary incontinence. Which nursing action will be included in the plan of care? a. Place a bedside commode near the patient's bed. b. Demonstrate the use of the Credé maneuver to the patient. c. Use an ultrasound scanner to check postvoiding residuals. d. Teach the use of Kegel exercises to strengthen the pelvic floor.

ANS: A Modifications in the environment make it easier to avoid functional incontinence. Checking for residual urine and performing the Credé maneuver are interventions for overflow incontinence. Kegel exercises are useful for stress incontinence. DIF: Cognitive Level: Application REF: 1148

When reviewing laboratory results, the nurse should immediately notify the health care provider about which finding? a.Glomerular filtration rate of 20 mL/min b.Urine output of 80 mL/hr c.pH of 6.4 d. Protein level of 2 mg/100 mL

ANS: A Normal glomerular filtration rate should be around 125 mL/min; a severe decrease in renal perfusion could indicate a life-threatening problem such as shock or dehydration. Normal urine output is 1000 to 2000 mL/day; an output of 30 mL/hr or less for 2 or more hours would be cause for concern. The normal pH of urine is between 4.6 and 8.0. Protein up to 8 mg/100 mL is acceptable; however, values in excess of this could indicate renal disease.

The nurse is caring for a 68-year-old hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care? a. Monitor the urine output after the procedure. b. Assist with monitored anesthesia care (MAC). c. Give oral contrast solution before the procedure. d. Insert a large size urinary catheter before the IVP.

ANS: A Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient's urine output. MAC sedation and retention catheterization are not required for the procedure. The contrast medium is given IV, not orally.

What glomerular filtration rate (GFR) would the nurse estimate for a 30-year-old patient with a creatinine clearance result of 60 mL/min? a. 60 mL/min b. 90 mL/min c. 120 mL/min d. 180 mL/min

ANS: A The creatinine clearance approximates the GFR. The other responses are not accurate.

The nurse would anticipate an order for which diagnostic test for a patient who has severe flank pain and calcium phosphate crystals revealed on urinalysis? a.Renal ultrasound b.Bladder scan c.KUB x-ray d.Intravenous pyelogram

ANS: D Flank pain and calcium phosphate crystals are associated with renal calculi. An intravenous pyelogram allows the provider to observe pathological problems such as obstruction of the ureter. A renal ultrasound is performed to identify gross structures. A bladder scan measures the amount of urine in the bladder. A KUB x-ray shows size, shape, symmetry, and location of the kidneys.

An 88-year-old with benign prostatic hyperplasia (BPH) has a markedly distended bladder and is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first? a. Insert a urinary retention catheter. b. Schedule an intravenous pyelogram. c. Administer lorazepam (Ativan) 0.5 mg PO. d. Draw blood for blood urea nitrogen (BUN) and creatinine testing.

ANS: A The patient's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test, but does not need to be done urgently. DIF: Cognitive Level: Application REF: 1135-1136

The client scheduled for intravenous urography informs the nurse of the following allergies. Which one should the nurse report to the physician immediately? A. Seafood B. Penicillin C. Bee stings D. Red food dye

ANS: A Clients with seafood allergies often have severe allergic reactions to the standard dyes used during intravenous urography.

11. Which of the following is the primary function of the kidney? a. Metabolizing and excreting medications b. Maintaining fluid and electrolyte balance c. Storing and excreting urine d. Filtering blood cells and proteins

ANS: B The main purpose of the kidney is to maintain fluid and electrolyte balance by filtering waste products and regulating pressures. The kidneys filter the byproducts of medication metabolism. The bladder stores and excretes urine. The kidneys help to maintain red blood cell volume by producing erythropoietin.

A patient gives the nurse health information before a scheduled intravenous pyelogram (IVP). Which item has the most immediate implications for the patient's care? a. The patient has not had food or drink for 8 hours. b. The patient lists allergies to shellfish and penicillin. c. The patient complains of costovertebral angle (CVA) tenderness. d. The patient used a bisacodyl (Dulcolax) tablet the previous night

ANS: B Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started. The other information is also important to note and document but does not have immediate implications for the patient's care during the procedures

After the home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying, which patient statement indicates that the teaching has been effective? a. "I will use a sterile catheter and gloves for each time I self-catheterize." b. "I will clean the catheter carefully before and after each catheterization." c. "I will need to buy seven new catheters weekly and use a new one every day." d. "I will need to take prophylactic antibiotics to prevent any urinary tract infections."

ANS: B Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days. There is no need to use a new catheter every day, to use sterile catheters, or to take prophylactic antibiotics. DIF: Cognitive Level: Application REF: 1154

The nurse caring for a patient after cystoscopy plans that the patient a. learns to request narcotics for pain. b. understands to expect blood-tinged urine. c. restricts activity to bed rest for a 4 to 6 hours. d. remains NPO for 8 hours to prevent vomiting.

ANS: B Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires opioids for relief is not expected. A good fluid intake is encouraged after this procedure. Bed rest is not required following cystoscopy.

The nurse completing a physical assessment for a newly admitted male patient is unable to feel either kidney on palpation. Which action should the nurse take next? a. Obtain a urine specimen to check for hematuria. b. Document the information on the assessment form. c. Ask the patient about any history of recent sore throat. d. Ask the health care provider about scheduling a renal ultrasound.

ANS: B The kidneys are protected by the abdominal organs, ribs, and muscles of the back, and may not be palpable under normal circumstances, so no action except to document the assessment information is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound may be appropriate when assessing for renal problems for some patients, but there is nothing in the question stem to indicate that they are appropriate for this patient.

A 79-year-old man has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care? a. Limit fluid intake to no more than 1000 mL/day. b. Leave a light on in the bathroom during the night. c. Ask the patient to use a urinal so that urine can be measured. d. Pad the patient's bed to accommodate overflow incontinence.

ANS: B The patient's age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patient's output is necessary or that the patient has overflow incontinence.

The nurse assessing the urinary system of a 45-year-old female would use auscultation to a. determine kidney position. b. identify renal artery bruits. c. check for ureteral peristalsis. d. assess for bladder distention.

ANS: B The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract information.

A nurse is caring for a patient who just underwent intravenous pyelography that revealed a renal calculus obstructing the left ureter. What is the nurse's first priority in caring for this patient? a.Turn the patient on the right side to alleviate pressure on the left kidney. b.Encourage the patient to increase fluid intake to flush the obstruction. c.Administer narcotic medications to alleviate pain. d.Monitor the patient for fever, rash, and difficulty breathing.

ANS: D Intravenous pyelography is performed by administering iodine-based dye to view functionality of the urinary system. Many individuals are allergic to shellfish; therefore, the first nursing priority is to assess the patient for an allergic reaction that could be life threatening. The nurse should then encourage the patient to drink fluids to flush dye resulting from the procedure. Narcotics can be administered but are not the first priority. Turning the patient on the side will not affect patient safety.

A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will a. have the patient empty the bladder completely, then obtain the next urine specimen that the patient is able to void. b. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup. c. insert a short sterile "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen. d. clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container.

ANS: B This answer describes the technique for obtaining a clean-catch specimen. The answer beginning, "insert a short, small, 'mini' catheter attached to a collecting container" describes a technique that would result in a sterile specimen, but a health care provider's order for a catheterized specimen would be required. Using Betadine before obtaining the specimen is not necessary, and might result in suppressing the growth of some bacteria. The technique described in the answer beginning "have the patient empty the bladder completely" would not result in a sterile specimen.

Which assessment maneuvers should the nurse perform first when assessing the renal system at the same time as the abdomen? A. Abdominal percussion B. Abdominal auscultation C. Abdominal palpation D. Renal palpation

ANS: B Auscultation precedes percussion and palpation because the nurse needs to auscultate for abdominal bruits before palpation or percussion of the abdominal and renal components of a physical assessment.

The female client's urinalysis shows all the following characteristics. Which should the nurse document as abnormal? A. pH 5.6 B. Ketone bodies present C. Specific gravity is 1.030 D. Two white blood cells per high-power field

ANS: B Ketone bodies are byproducts of incomplete metabolism of fatty acids. Normally, there are no ketones in urine. Ketone bodies are produced when fat sources are used instead of glucose to provide cellular energy.

Which of the following muscle actions results in voluntary urination? A. Detrusor contraction, external sphincter contraction B. Detrusor contraction, external sphincter relaxation C. Detrusor relaxation, external sphincter contraction D. Detrusor relaxation, external sphincter relaxation

ANS: B Voiding becomes a voluntary act as a result of learned responses controlled by the cerebral cortex that cause contraction of the bladder detrusor muscle and simultaneous relaxation of the external urethral sphincter muscle.

32. A nurse notifies the provider immediately if a patient with an indwelling catheter a. Complains of discomfort upon insertion of the catheter. b. Places the drainage bag higher than the waist while ambulating. c. Has not collected any urine in the drainage bag for 2 hours. d. Is incontinent of stool and contaminates the external portion of the catheter.

ANS: C If the patient has not produced urine in 2 hours, the physician needs to be notified immediately because this could indicate renal failure. Discomfort upon catheter insertion is unpleasant but unavoidable. The nurse is responsible for maintaining the integrity of the catheter by ensuring that the drainage bag is below the patient's bladder. Stool left on the catheter can cause infection and should be removed as soon as it is noticed. The nurse should ensure that frequent perineal care is being provided.

31. The nurse knows that which indwelling catheter procedure places the patient at greatest risk for acquiring a urinary tract infection? a. Emptying the drainage bag every 8 hours or when half full b. Kinking the catheter tubing to obtain a urine specimen c. Placing the drainage bag on the side rail of the patient's bed d. Failing to secure the catheter tubing to the patient's thigh

ANS: C Placing the drainage bag on the side rail of the bed could allow the bag to be raised above the level of the bladder and urine to flow back into the bladder. The urine in the drainage bag is a medium for bacteria; allowing it to reenter the bladder can cause infection. The drainage bag should be emptied and output recorded every 8 hours or when needed. Urine specimens are obtained by temporarily kinking the tubing; a prolonged kink could lead to bladder distention. Failure to secure the catheter to the patient's thigh places the patient at risk for tissue injury from catheter dislodgment.

18. To obtain a clean-voided urine specimen for a female patient, the nurse should teach the patient to a. Cleanse the urethral meatus from the area of most contamination to least. b. Initiate the first part of the urine stream directly into the collection cup. c. Hold the labia apart while voiding into the specimen cup. d. Drink fluids 5 minutes before collecting the urine specimen.

ANS: C The patient should hold the labia apart to reduce bacterial levels in the specimen. The urethral meatus should be cleansed from the area of least contamination to greatest contamination (or front-to-back). The initial steam flushes out microorganisms in the urethra and prevents bacterial transmission in the specimen. Drink fluids 30 to 60 minutes before giving a specimen.

The nurse would anticipate inserting a Coudé catheter for which patient? a.An 8-year-old male undergoing anesthesia for a tonsillectomy b.A 24-year-old female who is going into labor c.A 56-year-old male admitted for bladder irrigation d.An 86-year-old female admitted for a urinary tract infection

ANS: C A Coudé catheter has a curved tip that is used for patients with enlarged prostates. This would be indicated for a middle-aged male who needs bladder irrigation. Coudé catheters are not indicated for children or women.

A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first? a. Notify the patient's health care provider. b. Teach correct midstream urine collection. c. Ask the patient about current medications. d. Question the patient about urinary tract infection (UTI) risk factors.

ANS: C A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as phenazopyridine (Pyridium). The color would not be expected with urinary tract infection, is not a sign that poor technique was used in obtaining the specimen, and does not need to be communicated to the health care provider until further assessment is done.

A hospitalized patient with possible renal insufficiency after coronary artery bypass surgery is scheduled for a creatinine clearance test. Which equipment will the nurse need to obtain? a. Urinary catheter b. Cleaning towelettes c. Large container for urine d. Sterile urine specimen cup

ANS: C Because creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test.

A patient passing bloody urine is scheduled for a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate? a. "Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys." b. "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney." c. "Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray." d. "Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked."

ANS: C In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken. The response beginning, "Your doctor will place a catheter" describes a renal arteriogram procedure. The response beginning, "Your doctor will inject a radioactive solution" describes a nuclear scan. The response beginning, "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted" describes a retrograde pyelogram.

Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine (Pyridium)? a. Take the medication for at least 7 days. b. Use sunscreen while taking the Pyridium. c. The urine may turn a reddish-orange color. d. Use the Pyridium before sexual intercourse.

ANS: C Patients should be taught that Pyridium will color the urine deep orange. Urinary analgesics should only be needed for a few days until the prescribed antibiotics decrease the bacterial count. Taking Pyridium before intercourse will not be helpful in reducing the risk for UTI. Pyridium does not cause photosensitivity.

Which information from a patient's urinalysis requires that the nurse notify the health care provider? a. pH 6.2 b. Trace protein c. WBC 20 to 26/hpf d. Specific gravity 1.021

ANS: C The increased number of white blood cells (WBCs) indicates the presence of urinary tract infection or inflammation. The other findings are normal

Which assessment of a 62-year-old patient who has just had an intravenous pyelogram (IVP) requires immediate action by the nurse? a. The heart rate is 58 beats/minute. b. The patient complains of a dry mouth. c. The respiratory rate is 38 breaths/minute. d. The urine output is 400 mL after 2 hours.

ANS: C The increased respiratory rate indicates that the patient may be experiencing an allergic reaction to the contrast medium used during the procedure. The nurse should immediately assess the patient's oxygen saturation and breath sounds. The other data are not unusual findings following an IVP.

Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic increase in pain. What is the nurse's best first action? A. Reposition the client on the operative side. B. Administer prescribed opioid analgesic. C. Assess pulse rate and blood pressure. D. Check the Foley catheter for kinks.

ANS: C An increase in the intensity of pain after a percutaneous kidney biopsy is a symptom of internal hemorrhage.

The client is going home after urography. Which instruction or precaution should the nurse teach this client? A. "Avoid direct contact with the urine for 24 hours until the radioisotope clears." B. "You are likely to experience some dribbling of urine for several weeks after this procedure." C. "Be sure to drink at least 3 L of fluids today to help eliminate the dye faster." D. "Your skin may become slightly yellow-tinged from the dye used in this procedure."

ANS: C Dyes used in urography are potentially nephrotoxic.

The client has an elevated blood urea nitrogen (BUN) level and an increased ratio of blood urea nitrogen to creatinine. What is the nurse's interpretation of these laboratory results? A. The client probably has a urinary tract infection. B. The client may be overhydrated. C. The kidney may be hypoperfused. D. The kidney may be damaged.

ANS: C When dehydration or renal hypoperfusion exist, the BUN level rises more rapidly than the serum creatinine level, causing the ratio to be increased, even when no renal dysfunction is present.

7. An 86-year-old patient tells the nurse that she is experiencing uncontrollable leakage of urine. Which nursing diagnosis should the nurse include in the patient's plan of care? a. Urinary retention b. Hesitancy c. Urgency d. Urinary incontinence

ANS: D Age-related changes such as loss of pelvic muscle tone can cause involuntary loss of urine known as Urinary incontinence. Urinary retention is the inability to empty the bladder. Hesitancy occurs as difficulty initiating urination. Urgency is the feeling of the need to void immediately.

25. The nurse anticipates preparing a patient who is allergic to shellfish for an arteriogram by a. Obtaining baseline vital signs after the start of the procedure. b. Monitoring the extremity for neurocirculatory function. c. Keeping the patient on bed rest for the prescribed time. d. Administering an antihistamine medication to the patient.

ANS: D Before the procedure is begun, the nurse should assess the patient for food and other allergies and should administer an antihistamine, because a contrast iodine-based dye is used for the procedure. Baseline vitals should be obtained before the start of the procedure and frequently thereafter. The procedure site is monitored and the patient kept on bed rest after the procedure is complete.

22. The nurse would anticipate an order for which diagnostic test for a patient who has severe flank pain and calcium phosphate crystals revealed on urinalysis? a. Renal ultrasound b. Bladder scan c. KUB x-ray d. Intravenous pyelogram

ANS: D Flank pain and calcium phosphate crystals are associated with renal calculi. An intravenous pyelogram allows the provider to observe pathological problems such as obstruction of the ureter. A renal ultrasound is performed to identify gross structures. A bladder scan measures the amount of urine in the bladder. A KUB x-ray shows size, shape, symmetry, and location of the kidneys.

Which nursing action is essential for a patient immediately after a renal biopsy? a. Check blood glucose to assess for hyperglycemia or hypoglycemia. b. Insert a urinary catheter and test urine for gross or microscopic hematuria. c. Monitor the blood urea nitrogen (BUN) and creatinine to assess renal function. d. Apply a pressure dressing and keep the patient on the affected side for 30 minutes.

ANS: D A pressure dressing is applied and the patient is kept on the affected side for 30 to 60 minutes to put pressure on the biopsy side and decrease the risk for bleeding. The blood glucose and BUN/creatinine will not be affected by the biopsy. Although monitoring for hematuria is needed, there is no need for catheterization.

Which statement by a patient who had a cystoscopy the previous day should be reported immediately to the health care provider? a. "My urine looks pink." b. "My IV site is bruised." c. "My sleep was restless." d. "My temperature is 101."

ANS: D The patient's elevated temperature may indicate a bladder infection, a possible complication of cystoscopy. The health care provider should be notified so that antibiotic therapy can be started. Pink-tinged urine is expected after a cystoscopy. The insomnia and bruising should be discussed further with the patient but do not indicate a need to notify the health care provider.

The client reports the regular use of all the following medications. Which one alerts the nurse to the possibility of renal impairment when used consistently? A. Antacids B. Penicillin C. Antihistamine nasal sprays D. Nonsteroidal anti-inflammatory drug

ANS: D NSAIDs inhibit prostaglandin production and decrease blood flow to the nephrons. They can cause an interstitial nephritis and renal impairment.

The client is scheduled to have a renogram (kidney scan). She is concerned about discomfort during the procedure. What is the nurse's best response? A. "Before the test you will be given a sedative to reduce any pain." B. "A local anesthetic agent will be used, so you might feel a little pressure but no pain." C. "Although this test is very sensitive, there is no more discomfort than you would have with an ordinary x-ray." D. "The only pain associated with this procedure is a small needle stick when you are given the radioisotope

ANS: D The test involves an intravenous injection of the radioisotope and the subsequent recording of the emission by a scintillator.

A urinary diversion is the surgical rerouting of urine from the kidneys to a site other than the bladder. Which type of client would this type of procedure would benefit from this procedure? Open Hint for Question 8 in a new window. An abdominal trauma victim A renal failure client A client with kidney stones An individual suffering from a urinary tract infection

An abdominal trauma victim Rationale: The abdominal trauma victim is the only appropriate answer here. The remaining problems can be treated with less traumatic care measures.

When collecting a urine specimen for routine urinalysis from a "PT", the nurse must keep in mind which of the following? A)A sterile specimen is required for collection B)Results may be altered of a sample if left standing at room temperature for a long time C)The external meatus requires cleaning with antiseptic soap and water before voiding D)A clean-catch midstream specimen is necessary

B)Results may be altered of a sample if left standing at room temperature for a long time Urine chemistry it altered after urine stands at room temperature for a long period of time. For a routine urinalysis, a clean specimen is adequate. The external meatus does not need to be cleaned with an antiseptic, as is required for a clean-catch midstream specimen

A patient taking Phenazopyridine (pyridium, a urinary track analgesic) Should be cautioned that her year and may change to what color? A) Pale yellow B) Green C) Orange red D) Brown

C) Orange red Pyridium Is noted for turning the year and orange red, and the patient needs to be aware of this

Nursing care for a "PT" with an indwelling catheter includes which of the following A)Irrigation of the catheter with a 30mL of normal saline solution every 4hours B)Disconnecting and reconnecting the drainage system quickly to obtain a urine sample C)Encourage a generous fluid intake of not contraindicate by the "PT" conduction. D)Telling the "PT" that burning and irritation are normal, subsiding within a few days

C)Encourage a generous fluid intake of not contraindicate by the "PT" conduction. A generous fluid intake promotes healthy urinary tract function. Irrigation may introduce bacteria into the urinary tract and is not routinely ordered. The drainage system should never be disconnected to obtain a sample, this could allow bacteria to enter into the urinary tract. Burning and irritation may indicate that an infection is present and should never be disregarded.

The patient called the clinic with manifestations of burning on urination, dysuria, and frequency. What is the best advice for the nurse to give the patient? 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. "Come in so we can check a clean catch urine specimen." The patient's symptoms are typical of a urinary tract infection (UTI). 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.

An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)? A. High-purine diet B. Sedentary lifestyle C. Benign prostatic hyperplasia (BPH) D. Recent use of broad-spectrum antibiotics

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

Since removal of the patient's Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first? A) Check for bladder distention B) Encourage fluid intake C) Obtain an order to recatheterize the patient D) Document the amount of each voiding for 24 hours

Check for bladder distention

An older male patient states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this patient is to: A) Help him stand to void. B) Place a condom catheter. C) Have him practice Credé's method. D) Initiate Kegel exercises.

Initiate Kegel exercises

The nurse is counseling a young mother who complains of having stress incontinence continuing for three months after her pregnancy. It has been recommended that she practice pelvic muscle exercises to strengthen her bladder muscles. What action would the nurse recommend to this client in order to perform this activity correctly? Open Hint for Question 10 in a new window. Stopping urination midstream Standing tall and stretching out her arms and touching her toes Emptying her bladder completely Moving her bowels

Stopping urination midstream Rationale: Stopping the flow of urination midstream focuses on the muscle used to control this activity. The remaining answers do not affect this muscle in the same manner

What is the most likely reason that the BUN would be increased in a patient? a. Has impaired renal function b. Has not eaten enough protein c. Has decreased urea in the urine d. May have nonrenal tissue destruction

a. The blood urea nitrogen (BUN) is increased in patients with renal problems. It may also be increased when there is rapid or extensive tissue damage from other causes. Low protein intake may cause a low BUN.

During physical assessment of the urinary system, the nurse a. cannot palpate the left kidney b. palpates an empty bladder as a small nodule c. finds a dull percussion sound when 100 mL of urine is present in the bladder d. palpates above the symphysis pubis to determine the level of urine in the bladder

a. cannot palpate the left kidney Rationale: The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it. Occasionally the lower pole of the right kidney is palpable. The urinary bladder is normally not palpable unless it is distended with urine. If the bladder is full, it may be felt as a smooth, round, firm organ and is sensitive to palpation.

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply) a. nonpalpable left kidney b. auscultation of renal artery bruit c. CVA tenderness elicited by a kidney punch d. no CVA tenderness elicited by a kidney punch e. palpable bladder to the level of the pubic symphysis

a. nonpalpable left kidney d. no CVA tenderness elicited by a kidney punch Rationale: In the physical assessment of the urinary system, normal findings include no CVA tenderness, non palpable kidneys and bladder, and no palpable masses.

When collecting a clean catch or midstream specimen from a client, it is most important that the nurse: [Hint] a. provide the client with a sterile specimen container and a lid. b. instruct the client to squat or stand while voiding into the container. c. have the client wear a pair of clean or sterile gloves. d. give the client an antibacterial soap to use in cleansing the urethral area.

a. provide the client with a sterile specimen container and a lid.

Priority Decision: Following a renal biopsy, what is the nurse's priority? a. Offer warm sitz baths to relieve discomfort. b. Test urine for microscopic bleeding with a dipstick. c. Expect the patient to experience burning on urination. d. Monitor the patient for symptoms of a urinary infection.

b. Bleeding from the kidney following a biopsy is the most serious complication of the procedure and urine must be examined for both gross and microscopic blood, in addition to vital signs and hematocrit levels being monitored. Following a cystoscopy the patient may have burning with urination and warm sitz baths may be used. Urinary infections are a complication of any procedure requiring instrumentation of the bladder.

Which action represents the appropriate nursing management of a client wearing a condom catheter? a. Ensure that the tip of the penis fits snugly against the end of the condom. b. Check the penis for adequate circulation 30 minutes after applying. c. Change the condom every 8 hours. d. Tape the collecting tubing to the lower abdomen.

b. Check the penis for adequate circulation 30 minutes after applying. Rationale: The penis and condom should be checked one-half hour after application to ensure that it is not too tight. A 1-in. space should be left between the penis and the end of the condom (option 1). The condom is changed every 24 hours (option 3), and the tubing is taped to the leg or attached to a leg bag (option 4). An indwelling catheter is taped to the lower abdomen or upper thigh.

Which urinalysis results most likely indicate a urinary tract infection (UTI)? a. Yellow; protein 6 mg/dL; pH 6.8; 102/mL bacteria b. Cloudy, yellow; WBC >5/hpf; pH 8.2; numerous casts c. Cloudy, brown; ammonia odor; specific gravity 1.030; RBC 3/hpf d. Clear; colorless; glucose: trace; ketones: trace; osmolality 500 mOsm/kg (500 mmol/kg)

b. Cloudiness in a fresh urine specimen, WBC count above 5 per high-power field (hpf), and the presence of casts are all indicative of urinary tract infection (UTI). The pH is usually elevated because bacteria in urine split the urea alkaline ammonia. Cloudy, brown urine usually indicates hematuria or the presence of bile. Colorless urine is usually very dilute. Option a is characteristic of normal urine.

A practice guideline for nurses to use in preventing catheter-associated urinary infection includes which of the instructions listed below? a. Maintain clean technique when inserting the catheter into the client. b. Disconnect the catheter and drainage tubing once a shift to rinse the unit in cleaning the device. c. Since you are wearing gloves, it is not necessary to wash your hands. d. Prevent contamination of the catheter with feces in the incontinent client.

d. Prevent contamination of the catheter with feces in the incontinent client. Objective: Explain the care of clients with retention catheters or urinary diversions. Rationale: Keeping the perineal area free of feces eliminates the possible spread of any bacteria that may colonize in the feces and travel up the catheter to the bladder. Sterile or aseptic technique is used when inserting Foley catheters into clients to prevent the spread of infection with the process. Catheter tubing should not be disconnected once put into use. Connections are usually taped to help secure their seal. Wearing gloves with this procedure is part of the practice of Universal Precautions utilized when health care workers come in contact with most tubes and body fluids

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find a. a pH of 8.4 b. RBCs of 4/hpf c. color: yellow, cloudy d. specific gravity of 1.035

d. specific gravity of 1.035 Rationale: Normal specific gravity of urine is 1.003 to 1.030; the concentrating ability of the kidneys is maximal in producing morning urine (1.025 to 1.030). A high urinary specific gravity value indicates dehydration.