Ch. 46 Urinary Elimination

In which order do the events occur in the process of micturition?

1. As the bladder fills and stretches, bladder contractions are inhibited by sympathetic stimulation from the thoracic micturition center 2. A string sensation of urinary urgency is triggered 3. When in an appropriate situation to void, the CNS sends a message to the micturition centers 4. Sympathetic stimulation is stopped and begins parasympathetic stimulation from the sacral micturition center 5. urinary sphincter relaxes 6. bladder contracts

Inserting the indwelling catheter in a female patient

1. Perform hand hygiene 2. close the curtain or door 3. raise the bed to the appropriate working height 4. place a waterproof pad under the patient 5. place the patient in a dorsal recumbent position 6. drape the patient with a bath blanket to provide privacy

Application of a male condom catheter after assessing the patient's urinary elimination

1. assess the patient's mental status and knowledge about the procedure 2. prepare the condom catheter 3. apply clean gloves and assess the penis for rashes 4. apply the condom catheter 5. secure the condom according to the manufacturer's directions 6. connect the drainage tubing to the end of the condom catheter 7. dispose of contaminated supplies and remove gloves 8. inspect the penis with the condom catheter after application for any swelling

Removing an indwelling Foley catheter

1. perform hand hygiene and provide privacy 2. Position the patient with a waterproof bag under the buttocks 3. remove the catheter-securing device and free the drainage 4. if necessary, clean the genital area with soap and water 5. move the syringe plunger up and down to loosen it 6. withdraw the plunger to 0.5 mL 7. Insert the hub of the syringe into the inflation valve to drain balloon fluid by gravity 8. pull the catheter out smoothly 9. wrap the contaminated catheter in a waterproof pad and unlock the collection bag and drainage tubing from the bed

Which condition is a cause of transient urinary incontinence? A. Idiopathic bladder overactivity B. Fecal impaction C. Cognitive impairment D. Overactive bladder caused by neurologic problems

B. rationale: Transient incontinence is caused by medical conditions that in many cases are treatable and reversible. Fecal impaction is a reversible condition that can cause transient urinary incontinence.

Hematuria

Blood-tinged urine

Which hormone causes vasoconstriction and stimulates the release of aldosterone? A. Renin B. Erythropoietin C. Angiotensin II D. Antidiuretic hormone

C. rationale: Angiotensin II causes vasoconstriction and stimulates the release of aldosterone. Renin converts angiotensinogen into angiotensin I and stimulates the production of aldosterone. Erythropoietin stimulates red blood cell production. Antidiuretic hormone helps in water retention and balance in the body.

An elderly patent who has dementia is suffering from cognitive deficit and an overactive bladder. Which type of urinary incontinence is this patient likely yo suffer from? A. stress incontinence B. functional incontinence C. low risk of incontinence D. urge incontinence

D rationale: elderly patients with cognitive deficits such as dementia may have overactive bladder. These patients are at risk of developing urge incontinence as a result of involuntary bladder contraction.

Which substance secreted by the kidneys helps control blood pressure via vasodilation? A. renin B. aldosterone C. angiotensin II D. prostaglandin E2

D. rationale: Prostaglandin E2, along with prostacyclin, helps maintain renal blood flow via vasodilation and is produced by the kidneys. Renin functions as an enzyme to convert angiotensinogen into angiotensin I. Aldosterone causes retention of water, which increases the blood volume. Angiotensin II causes vasoconstriction and stimulates aldosterone release from the adrenal cortex

The cluster of capillaries in each nephron is referred to by which term? A. urethra B. trigone C. detrusor D. glomerulus

D. rationale: The cluster of capillaries in each nephron is known as the glomerulus. The urethra is the structure through which urine travels from the bladder and passes to the outside of the body. The trigone is the name given to the fixed base of the urinary bladder. The detrusor is the bladders distensible body

Antimuscarinic agents

Help prevent the involuntary contraction of the bladder muscles and prevent the passage of urine

What should the nurse include in the plan of care for a patient with urge urinary incontinence?

Helping the patient strengthen the pelvic floor muscles and learn fluid and food modifications rationale: While caring for a patient with urge urinary incontinence, the nurse should help the patient strengthen the pelvic floor muscles, learn techniques to inhibit the urinary urge, and learn fluid and food modifications.

Cystoscopy

Helps visualize the structures of the urinary tract

What hormonal change in the urinary system might a pregnant woman experience?

Increases urinary production rationale: Increased urinary production is observed during pregnancy because of hormonal changes and pressure of a growing fetus on the bladder

A patient with a bladder disorder is advised to get a urinary diversion. The patient wishes to have the type of urinary diversion that allows normal voiding. Which type of urinary diversion suits the patients requirements?

Orthotopic neobladder using an ideal pouch rationale:An orthotropic neobladder of the ileal pouch is the diversion procedure that allows the patient to have normal voiding.

Which type of urinary incontinence is managed with timed voiding and double voiding?

Overflow urinary incontinence rationale: Urinary incontinence associated with chronic retention of urine, also known as overflow urinary incontinence in its mild form, is managed by timed voiding and double voiding.

A nurse is caring for an elderly patient who is receiving tx for urinary incontinence. After reviewing the patient's prescription, the nurse shoes to observe the patient for cognitive impairment. Which medication is the patient most likely taking?

Oxybutynin rationale: antimuscarinic agents such as oxybutynin are used to treat different types of urinary incontinence. These drugs may cause cognitive impairment in older adults

Postvoid Residual (PVR)

PVR can be assessed using a portable noninvasive bladder ultrasound device, which helps determine the amount of urine left in the bladder after voiding

Dysuria

Pain or burning during urination

Orthotopic neobladder

Patient can control voiding through the urethra using the valsalva technique

The patients urine specific gravity is 1.05. The urine tests positive for ketone bodies. Which condition is a possible cause?

Starvation Dehydration Diabetes Mellitus Rationale: The presence of ketone bodies supports the possibility of starvation. Specific gravity is increased if the patient is dehydrated, and increased specific gravity and ketone bodies in the urine also support the possibility of diabetes mellitus. A high specific gravity and the presence of ketone bodies do not include urine dilution or over hydration

Which statement is true about the urethra?

Striated muscles are responsible for voluntary control over the flow of urine. Rationale: The external urethral sphincter, which is made up of striated muscles, contributes to voluntary control over the flow of urine.

Oliguria

The decrease in urine output in spite of normal intake. It often occurs when fluid loss through other means such as sweating, diarrhea, or vomiting increases

While caring for a female patient with altered urinary elimination, the nurse instructs the patient to assume a squatting position when voiding. Which rationale is the reason behind this recommendation?

To promote complete bladder emptying rationale: the squatting position facilitates complete bladder emptying in female patients

What can a nurse use to measure the PVR in a patient with urinary retention?

Ultrasound Bladder scanner Straight catheterization

A patient reports a strong urge to urinate when hearing running water and leaks small amount of urine on the way to the bathroom. Which type of urinary incontinence does the nurse suspect in this patient?

Urge urinary incontinence rationale: Urge urinary incontinence is caused by involuntary contractions of the bladder associated with an urge to void that causes leakage of urine. One of the symptoms of this type of incontinence is having strong urges or leaks when one hears water running, washing hands, or drinks fluids.

The nurse assess that the patient has a full bladder, and the patient states that she is having difficult voiding. Which instruction would the nurse provide the patient?

Use the Crede method rationale: With the crede method, pressure is put o the suprapubic area with each attempted void. The maneuver promotes bladder emptying by relaxing the urethral sphincter.

What is the minimum catheter insertion length in centimeters?

When inserting an intermittent bladder catheter into an adult make patient, the nurse should advance the catheter 17 - 22.5 cm (7-9 in) or until urine flows out of the catheter

Elimination changes that result from the inability of the bladder to empty properly ay cause which condition? SATA A. incontinence B. frequency C. urgency D. urinary retention E. urinary tract infection

a, b, c, d, e rationale: Urinary retention results from the inability of the bladder to empty. Chronic urinary retention has a slow, gradual onset during which patients may experience a decrease in voiding volumes, straining to void, frequency, urgency, incontinence, and sensations of incomplete emptying. Urinary retention increases the risk for a urinary tract infection

A patient has a delay in the start of the urinary stream when voiding. Which condition is the least likely cause for this? A. Anxiety B. Urethral stricture C. Prostate enlargement D. UTI

d. rationale: A UTI causes dysuria, increased frequency, nocturia, and hematuria. A UTI does not cause hesitancy or a delay in the start of a urinary stream when voiding. Anxiety, urethral stricture, and prostate enlargement may be the likely causes of hesitancy

Possible causes of nocturia

diuretics overactive bladder UTI

Polyuria

excessive output of urine

A patient who has undergone urological surgery is prescribed urinary catheterization. Which diameter of catheter does the nurse anticipate will be used for this patient?

greater than 16 Fr rationale: Large catheters with diameters greater than 16 Fr should be used in patients who have undergone urological surgery. Catheters with diameters of 5 to 5 Fr are used for infants. Children use catheters with diameters of 8 to 10 Fr. Catheters with diameters of 12 Fr are used for young girls

Bacteremia

is a bloodstream infection

Possible causes of dysuria

trauma to the lower urinary tract inflammation of the prostate urethritis

Possible causes of nocturia

use of diuretics, an overactive bladder, or a UTI

Which intervention is MOST appropriate for a patient with functional urinary continence?

Provide normal fluid intake and establish a toilet schedule rationale: For physiologic health, a patient must maintain normal fluid intake. A toileting schedule based on the patient's elimination patterns can help reduce episodes of incontinence. Catheters are used as a last choice because of the potential for infection and body self-image issues. Fluid intake should be kept at normal levels; there is no need to increase it Restricting fluid intake may cause dehydration

Patients with which type of urinary incontinence can be at risk of severe elevation of BP and PR and diaphoresis?

Reflex urinary incontinence rationale: Patients with reflex urinary incontinence are likely to be at risk of autonomic dysreflexia, a life-threatening condition that causes a severe elevation of blood pressure and pulse rate and diaphoresis. Functional incontinence, stress urinary incontinence, and urge urinary incontinence are not associated with an increased risk of autonomic dysreflexia

Which type of urinary incontinence occurs as a result of spinal cord damage between C1 and S2?

Reflex urinary incontinence rationale: Reflex urinary incontinence is the involuntary loss of urine at somewhat predictable intervals when the patient reaches a specific bladder volume; it is related to spinal cord damage between c1 and S2

A patient's urinalysis shows the presence of casts. Based on this lab data, which condition would the nurse suspect?

Renal disease rationale: The increased presence of granular casts is always an abnormal finding and is usually indicative of renal disease or injury.

Nephrostomy tubes

Small tubes that are tunneled through the skin into the renal pelvis and drain the renal pelvis when the ureter is obstructed

Which paramount should be assessed in the urine sample if a patient complains of infrequent urination?

Specific gravity rationale: increased levels of antidiuretic hormone (ADH) may cause infrequent urination. Specific gravity increases with increased ADH levels, so this parameter is used to detect increased levels. Glucose, pH, and ketone levels are not associated with increased ADH levels

Which assessment question will the nurse ask when assessing the genitourinary health of a female patient with genital circumcision?

"Do you experience any loss of urine?" "Do you have a history of UTIs?" "Have you ever been treated for a pelvic infection?" rationale: Some cultures may practice genital circumcision, leaving only a small opening for urine and menses. Long-term consequences include incontinence, recurrent UTIs, and pelvic infection. A diminished sensation or bases of awareness of the bladder filling is associated with reflex urinary incontinence caused by neurological impairment. An increased frequency and volume of urine is not a pathological finding associated with genital circumcision but its a symptom of conditions such as diabetes.

Which statement by a student nurse about hormones and the kidneys indicates further teaching is needed?

"the kidneys synthesize angiotensinogen" rationale: The liver, not the kidneys, synthesizes angiotensinogen. The kidneys release prostacyclin, which plays a major role in BP control via the renin-angiotensin system. The kidneys produce erythropoietin, which stimulates red blood cell production. The kidneys produce prostaglandin E2, which helps maintain renal blood flow through vasodilation

A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. Which condition is the probable cause of these symptoms?

Cystitis Rationale: urine is cloudy in cystitis because of bacteria and white cells

In which order d the steps occur in the control of BP by the kidneys through the renin-angiotensin system?

1. the blood supply deceased in the kidneys 2. renin is released from the juxtaglomerular cells 3. angiotensinogen is converted into angiotensin I 4. Angiotensin II is formed in the lungs 5. Aldosterone release from the adrenal cortex is stimulated 6. The blood volume increases because of retention of water rationale: In times of renal ischemia or decreased blood supply to the kidneys, renin is released from the juxtaglomerular cells. Renin functions as an enzyme to convert angiotensinogen into angiotensin I. Angiotensin I is converted to angiotensin II in the lungs. Angiotensin II causes vasoconstriction and stimulates aldosterone release from the adrenal cortex. Aldosterone causes water retention, which increases blood volume. This mechanism, along with the mechanism of vasodilation through prostaglandin E2 and prostacyclin produced by the kidneys, helps control the BP through the renin-angiotensin system

A patient with diabetes has a urine test positive for glucose. The nurse would expect the patient's blood glucose to be a minimum of which level?

185 mg/100 mL rationale: Urine will be positive for glucose when the glucose level is above the normal reabsorptive capacity of the kidneys, which corresponds to 180mg/100 mL. Therefore, the urine will be positive for blood glucose above a concentration of 180 mg/100 mL. Concentrations of 155 mg, 165 mg, 175 mg are within the normal absorptive capacity of the kidney. Hence the urine will be negative for glucose in these situations

Which amount of space allowed between the tip of the penis and the end of the catheter while placing a condom catheter on a patient is correct?

2,5 to 5 cm rationale: While placing a condom catheter on a patient, the nurse should allow a space of 2,5 to 5 c (1 to 2 in) between the tip of the penis and the end of the catheter

A patient with normal renal function who does not have heart disease or alteration that require fluid restriction should have approx. --- mL her 24-hour period

2300 mL per 24-hour period

An adult patient who has undergone a radical retropubic prostatectomy and will need an indwelling catheter. Which balloon size is most appropriate for this patient?

30 mL rationale: Patients who have undergone a surgical prostatectomy require a catheter balloon size of 30 mL ti provide hemostatic of the prostatic bed. A catheter balloon size of 3 mL is used in pediatric patients. A catheter balloon size of 5 mL is appropriate for optimal drainage in adults. There are no urinary catheters with a balloon size of 75 mL

What is the minimum value of urinary output per hour that is considered normal before a nurse should immediately assess for signs of blood loss?

30 mL/h rationale: if the urinary output falls below 30 mL/h the nurse should immediately assess for signs of blood loss and notify yer HCP. A change in urine volume can be a significant indicator of fluid imbalance, kidney dysfunction, or decreased blood volume

Which measurement is in the normal range for the length os an adult female urethra?

4 cm rationale: The average adult female urethra is approximately 3-4 cm; therefore, a length of 2 cm is shorter than average, and lengths of 15 cm and 19 cm are too long. The male urethra is about 18-20 cm long

What is the minimum length of an intermittent catheter that should be inserted through the ureteral meatus in a female patient?

5 cm (2 in)

Autonomic dysreflexia

A life-threatening condition that causes severe elevation of the BP and PR as well as diaphoresis. Patients with reflex urinary incontinence are at an increased risk of this condition

A student nurse is learning about the structure and function of the urinary system. Which statement by the student nurse indicates effective knowledge about the ureters? A. "A kidney stone can result in hydroureter" B. "The distensible body of the ureter is called the detrusor" C. "Urine enters the urinary bladder through the ureter in a steady flow." D. "Compression of the upper part of the ureters prevents backflow of urine during micturition

A. rationale: A kidney stone can obstruct the flow of urine through the ureters, causing a back flow of urine into the ureters and kidney. This can cause distention, such as hydroureter or hydronephrosis

Which hormone causes retention of water, resulting in an increase in blood volume? A. Aldosterone B. Erythropoietin C. Angiotensin II D. Antidiuretic hormone

A. rationale: Aldosterone causes retention of water, thereby increasing blood volume. Erythropoietin stimulates the production and maturation of red blood cells. Angiotensin II helps with vasoconstriction and stimulates the production of aldosterone. Antidiuretic hormone helps regulate and balance water in the body.

The nurse is reviewing the lab report of a patient. The urine report shows the presence of large proteins in the urine. Which condition is the MOST probably cause of proteinuria? A. glomerular injury B. infection of the urinary tract C. excessive aspirin ingestion D. starvation

A. rationale: The glomerular capillaries filter water, glucose, amino acids, urea, creatinine, and major electrolytes from the blood. Large proteins do not normally get filtered because of the size of protein molecules. However, if the glomeruli are injured, the large proteins may pass into the urine.

Which type of incontinence is MOST likely to be associated with a urinary tract infection? A. transient incontinence B. Functional incontinence C. Stress urinary incontinence D. Overflow urinary incontinence

A. rationale: Transient incontinence is caused by medical conditions that in many cases are treatable and reversible. Inflammation caused by a UTI or urethritis is a common cause of this type of incontinence

Which statement regarding hormonal function and the renal system is true?

Alcohol decreases the release of antidiuretic hormone (ADH); thus increasing urine production Erythropoietin stimulates bone marrow to produce red blood cells (RBSc) Under the influence of hormones, kidneys act as a filter to regulate fluids and electrolytes

Which hormonal release does the renin-angiotensin system stimulate?

Aldosterone rationale: The renin-angiotensin system helps blood pressure control and stimulates the production of aldosterone, leading to retention of water during the filtration of urine

pyelonephritis

An upper UTI

Which condition might a patient with chronic kidney disease and decreased production erythropoietin experience?

Anemia rationale: The kidneys secrete erythropoietin, which stimulates red blood cell production and maturation in bone marrow. Chronic kidney disease causes insufficient production of this hormone, resulting in anemia

Which increased hormonal secretion leads to oliguria?

Antidiuretic hormone (ADH) rationale: Increased secretion of ADH diminishes urinary output in relation to fluid intake, a condition called oliguria

While the nurse is performing closed catheter irrigation, the patient experiences pain. Which action is the nurse least likely to take?

Assess for hypovolemic shock rationale: A nurse assesses the patient for hypovolemic shock if there is bright red bleeding during irrigation This assessment is not necessary for a patient who experiences pain but no bleeding. If the patient experiences pain while performing closed catheter irrigation, the nurse needs to evaluate for a distended bladder. Also, the nurse needs to examine the drainage tubing for clots, sediments, or kinks. There is also a need to evaluate the urine for the presence of, or increase in, blood clots and sediment

Which statement is true about a ureterostomy?

B. rationale: A ureterostomy or ill conduit is created by transplanting the ureters into a closed-off part of the intestinal ileum and bringing the other end out onto the abdominal wall to form a stoma. A ureterostomy is a permanent continent urinary division

Which factor may increase urine production? A. use of anticholinergics B. Excessive alcohol intake C. Enlargement of the prostate gland D. occurrence of local trauma during pelvic surgery

B. rationale: Excessive alcohol intake decreases the release of antidiuretic hormone, leading to increased urine production. Anticholinergics increase the risk of urinary retention by inhibiting bladder contractility. Prostatic enlargement causes obstruction of the bladder outlet, causing urinary retention. Local trauma during pelvic surgery may sometimes obstruct urine flow

Which statement made by a nursing student regarding glomerular filtrate indicates a need for further education? A. "one percent of the glomerular filtrate is excreted as urine" B. "the glomerulus always filters large protein and blood cells" C. "Each nephron contains a cluster of capillaries called the glomerulus" D. "The glomerulus filters water, amino acids, urea, and uric acid"

B. rationale: The presence of large proteins (proteinuria) or blood cells (hematuria) in the urine indicated glomerular injury. The glomerulus does not usually filter large proteins and blood cells. Only 1% of glomerular filtrate is excreted in urine. The glomerulus is a cluster of capillaries contained in each nephron. Water, glucose, amino acids, urea, uric acid, creatinine, and major electrolytes are filtered by the glomerulus

A nurse is caring for a patient who is receiving treatment for urinary urgency. After a few days of taking the prescribed medications, the patient reports a dry mouth, constipation, and blurred vision. Which medication is the most likely cause of the patient's symptoms? A. nitrofurantoin B. bethanechol C. oxybutynin D. phenazopyridine

C. rationale: Antimuscarinic agents, such as oxybutynin, are used to treat different types of urinary problems, including urinary urgency. These medications may cause dry mouth, constipation, and blurred vision. Antibiotics such as nitrofurantoin are used to treat UTIs Bethanechol is issued to treat urinary retention and may have side effects of nausea, vomiting, diarrhea, and increased salivation. Patients with painful urination associated with UTIs may be prescribed urinary analgesics such as phenazopyridine, which will turn the urine orange

A patient is scheduled for a cystoscopy. Which instruction would the nurse give to this patient about cystoscopy? A. The patient should limit the intake of fluids before the test B. Urine output will increase after the test C. The patient may have difficulty voiding after the test D. Urine will be straw-colored after the test

C. rationale: Cystoscopy involves the visualization of urinary structures through a scope inserted into the urinary tract. It may cause tissue edema and, as a result, the patient may have difficulty voiding after the test. Because of the edema, the urine output may decrease, not increase. The urine may be red or pink in color after the test because of local injury

The nurse is preparing to administer erythropoietin to a patient who present with a deficiency. The nurse knows that the patient needs this medication because of dysfunction in which organ? A. Liver B. Bone C. Kidney D. Spleen

C. rationale: The kidneys produce erythropoietin. Patients with chronic renal failure require exogenous erythropoietin supplementation for red blood cell production. The liver, bones, and spleen are not involved in the synthesis of erythropoietin

Which patient is MOST likely to exhibit symptoms such as dysuria, urgency, frequency, and nocturia? A. a patient with kidney failure B. a patient receiving diuretic therapy C. a patient with a urinary tract infection D. a patient with uncontrolled diabetes mellitus

C. rationale: dysuria, urgency, frequency, and nocturne are symptoms that may be exhibited by patient's with urinary tract infections. A patient with kidney failure may experience oliguria. Patients receiving diuretic therapy and those with uncontrolled diabetes mellitus may exhibit polyuria

which statement is true regarding the use of a bladder scanner to measure residual bladder volume? A. the patient is placed in the dorsal recumbent position B. the scan measurement should be performed within 20 min of voiding C. women who have had a hysterectomy should be designated as male D. Ultrasound gel is applies to the midline about 2.5-4 cm below the symphysis pubis

C. rationale: women who have had a hysterectomy should be designated as male when setting the gender designation according to the manufacturer's guidelines. The patient is placed in a supine position, not dorsal recumbent. The scan measurement is conducted within 10 minutes of voiding not 20. Ultrasound gel is applied to the midline about 2.5-4 cm above, not below, the symphysis pubis

Oliguria

Caused by increased secretion of ADH, which results in diminished urinary output

Since removal of the patient's indwelling catheter, the patient has voided 50-100 mL every 2-3 hours. Which action would the nurse take first?

Check for bladder distention rationale: The patient may experience urinary retention after catheter removal. If amounts voided are small, checking for bladder distention is necessary. The nurse would not encourage fluid intake first before checking for bladder distention because of possible urinary retention. The nurse would not obtain a prescription to recatheterize the patient before assessing for bladder distention because the patient is able to void. The nurse would not document the amount of voiding for 24 hours before checking for bladder distention because urinary retention after urinary catheter removal needs to be addressed first

The nurse notes that the patient's indwelling catheter bag has been empty for 4 hours. Which action is priority?

Check for kinks in the tubing Rationale: Kinks in the tubing prevent the flow of urine. To keep the drainage system patent, check for kinks or bends in the tubing.

Which disorder may lead to a decrease in erythropoietin production?

Chronic kidney diseases rationale: Kidneys produce erythropoietin, so its production is decreased in chronic kidney diseases

A nurse is assisting the HCP in assessing a patient with altered urinary elimination. After assessment, the HCP suspects that the patient has an obstruction of the ureters. Which diagnostic test does the nurse expect the patient to undergo?

Computed axial tomography (CAT) scan rationale: a CAT scan is commonly used to identify anatomical abnormalities, renal tumors and cysts, calculi, and obstruction of the ureters

Which statement by a student nurse indicates appropriate knowledge about the urinary bladder? A. "the fixed base of the urinary bladder is called the detrusor" B. "the urinary bladder lies behind the pelvic floor muscles" C. "the urinary bladder rests against the rectum inn both men and women" D. "the low pressure in the bladder during filling prevents the backward flow of urine into the ureters

D. rationale: The urinary bladder is a hollow, distensible, muscular organ that expands as it fills with urine. The pressure in the bladder normally remains low during filling, which prevents the backward flow of urine into the ureters and kidney.

What are double-lumen catheters used for? A. intermittent bladder irrigation B. intermittent catheterization C. continuous bladder irrigation D. indwelling catheterization

D. rationale: double-lumen catheters are designed specifically for indwelling catheters, in which one lumen provides urinary drainage and the other inflates the balloon that keeps the catheter in place. Single lumen catheters are used for intermittent catheterization. Triple lumen catheters are used for intermittent and continuous bladder irrigation

Which term describes leakage of urine despite voluntary control of urination?

Dribbling rationale: Dribbling is the leakage of urine despite voluntary control of urination. Urgency is the feeling of the need to void immediately. Hesitancy is difficulty initiating urination. Incontinence is the involuntary loss of urine

Which nursing step during closed continuous bladder irrigation is MOST appropriate for flushing clots out of the bladder ?

Increasing the rate of irrigation as prescribed by the HCP rationale: When performing continuous bladder irrigation, the nurse increases the rate of irrigation as prescribed by the HCP to flush blood clots out of the bladder. The nurse should not irrigate or instill cold solution into the bladder since it may result in bladder spasm and discomfort. When performing closed intermittent irrigation, the nurse injects fluid into the catheter and bladder slowly and every to minimize potential trauma to bladder mucosa. When performing closed continuous bladder irrigation, the nurse connects the drainage bag and tubing to the drainage port if a triple-lumen catheter to ensure that urine and irrigation solution drain from the bladder without any leakage; however, this does not flush out blood clots

The nurse received a prescription to obtain a postpaid residual for a patient via catheterization. Which method to obtain this measurement is best?

Intermittent catheterization rationale: an intermittent catheterization is used when evaluation the residual urine after urination. The investigation requires measurement of urine remaining in the bladder after voiding. Intermittent catheterization prevents the risk of infection.

The nurse is reviewing the medical record of a patient admitted with cystitis. Which condition is associated with this diagnosis?

Irritation of the bladder rationale: cystitis is associated with irritation of the urinary bladder

A patient reports a burning sensation and pain while passing urine. Which assessment would the nurse perform?

Look for presence of blood in the urine rationale: Pain and a burning sensation during urination are symptoms of a lower UTI. Irritation to the bladder mucosa by bacteria frequently causes hematuria (blood in the urine), so presence of blood in the urine is another sign of a UTI.

Intravenous pyelography (IVP)

May help determine the function of the kidneys but does not help determine postpaid residual

An X-ray exam of the abdomen

May show the condition of abdominal organs but is not helpful to determine the residual urine left in the bladder

A patient needs to undergo intravenous pyelography (IVP). Which preparation would the nurse perform before starting the procedure? SATA A. Cleanse the patient's bowels B. Assess for allergies C. Encourage the patient to drink fluids to promote dye excretion D. Restrict food and fluid intake up to 4 hours before the test E. Assess for delayed hypersensitivity to the contrast media

a, b, d rationale: During preparation of the patient who has to undergo IVP, the nurse should cleanse the patient's bowels according to agency guidelines. The nurse should also assess for allergies and restrict food and fluid for up to 4 hours before the test. The nurse should consider encouraging fluids to promote dye excretion after IVP. The nurse needs to assess for delayed hypersensitivity to the contrast media after IVP

After assessing a patient, a nurse suspects that the patient has overflow urinary incontinence. Which finding supports the nurses's conclusion? SATA A. Nocturia B. Frequency C. Distended bladder on palpation D. Leakage of urine on the way to the bathroom E. Diminished or absent awareness of bladder filling and the urge to void

a, b, d rationale: Overflow urinary incontinence may be characterized by nocturia, frequency, and a distended bladder on palpation. Leakage of urine on the way to the bathroom may occur in patients with urge urinary incontinence. A diminished or absent awareness of bladder filling and the urge to void are associated with reflex urinary incontinence

Which characteristic is associated with urge urinary incontinence? SATA A. urgency B. frequency C. leakage of urine without awareness D. diminished awareness of the urge to void E. difficulty holding urine once the urge to void occurs

a, b, e rationale: The characteristics associated with urge urinary incontinence are urgency, frequency, and difficulty holding urine once the urge to void occurs. Leakage of urine without awareness and diminished awareness of the urge to void are associated with reflex urinary incontinence

Which condition is a common cause of dysuria? A. trauma to the lower urinary tract B. uncontrolled diabetes mellitus C. inflammation of the prostate D. urethritis E. bladder outlet obstruction

a, c, d rationale: Trauma to the lower urinary tract inflammation of the prostate, and urethritis are the common causes of dysuria. Uncontrolled diabetes mellitus is a common cause of polyuria. Bladder outlet obstruction can lead to dribbling

A patient with an indwelling catheter carries the collection bag at waist level when ambulating. The patient is at risk of which condition? SATA A. infection B. retention C. stagnant urine D. reflux of urine E. hypotension

a, d rationale: urine in the bag and tubing becomes a medium for bacteria; infection is likely to develop if there is a reflux of urine into the bladder by having the urinary bad at waist level. Retention involves the patient's bladder holding urine and is not affected by the level of the urinary bag. Stagnant urine is urine that has remained in one place for a long period of time. The level of the urinary bag does not affect the stagnancy of urine. Hypotension will affect blood flow to the patient's kidneys but is not affected by the level of the urinary bag

The nurse is teaching a group of LVNs and LPNs about the pathogenesis of urinary infections. Which information pertaining to catheter-associated UTIS (CAUTIs) would the nurse include in the teaching? SATA A. bacteria inhabit the vagina B. CAUTIs are mostly caused by descending infection C. Colonic flora do not cause UTIs D. Bacteria inhabit the distal urethra in men and women E. E coli is the common causative organism

a, d, e rationale: A CAUTI is caused by bacteria that inhabit the vagina in women and by bacteria that inhabit the distal urethra in men and women. The most common organism responsible for a CAUTI is E. coli. The infection is ascending in nature cause bacteria cause infections as they ascend the urinary tract. Bacteria from the colon are the main causes of UTIs

Which characteristic is associated with overflow urinary incontinence? SATA A. nocturia B. fecal impaction C. altered mobility D. high postvoid residual volume E. distended bladder on palpation

a, d, e rationale: The characteristics associated with overflow urinary incontinence, or urinary incontinence associated with chronic retention of urine, are nocturne, a high post void residual volume, and a distended bladder on palpation

The patient is to have intravenous pyelography (IVP). Which action applies to this procedure? SATA a. note any allergies b. monitor intake and output c. Provide for perineal hygiene d. assess vital signs e. encourage fluids after the procedure

a, e rationale: the dye used in the procedure is iodine based. Assessing for history of any allergies ca predict an allergy to the dye used. Fluid intake dilutes ad flushed the dye from the patient. The nurse would not need to monitor intake and output for an IVP because it is a test to visualize abnormalities of the urinary structures. The nurse would not need to provide for peril hygiene for an ICP because the test involves an x-ray of the urinary structures after a dye is injected in the vein; there is no involvement with the perineal area. The nurse would not need to assess for vital signs for a patient having an IVP because neither the dye nor the x-ray has hemodynamic effects

The nurse understands that hypertension can be causes by an impaired renin-angiotensin mechanism. Which statement accurately describes the renin-angiotensin mechanism? SATA A. angiotensinogen is synthesized in the lungs B. renin is secreted by the juxtaglomerular apparatus C. angiotensin II causes peripheral vasoconstriction D. angiotensin II causes aldosterone secretion in the adrenal cortex E. converting enzyme in the liver converts angiotensin I to angiotensin II

b, c, d rationale: The juxtaglomerular apparatus of the kidneys secretes renin in response to a drop in BP. Angiotensin II has two functions. It causes peripheral vasoconstriction, which in turn increases BP. It is also involved in secreting aldosterone from the adrenal cortex of the adrenal gland. Aldosterone also raises the BP by causing water retention. Angiotensinogen is produced in the liver, not the lungs, in response to renin production. The converting enzyme responsible for conversion of angiotensin I to angiotensin II is present in the lungs, not in the liver

The nurse is reviewing lab results for a patient and notices the urine tested positive for ketones. Which underlying factor may lead to the presence of urinary ketone bodies? SATA A. epilepsy B. starvation C. dehydration D. hyperthyroidism E. uncontrolled diabetes mellitus

b, c, e rationale: Ketones are produced as a by-product when the body uses fat for energy production. When a patient is not taking adequate amounts of carbs, such as in starvation, the body uses other sources foe energy. Dehydration can also lead to ketonuria. A patient with uncontrolled diabetes mellitus breaks down fatty acids for energy. Epilepsy and hyperthyroidism are not associates with the presence of ketone bodies in urine. Epilepsy is a disease that affects the nervous system, and hyperthyroidism affects the endocrine system

Which statement is true regarding hormonal processes of the renin-angiotensin system/ SATA A. angiotensinogen is a substance that the kidney's synthesize B. Angiotensin I to angiotensin II conversion occurs in the pulmonary capillaries C. In times of renal ischemia, angiotensinogen is released from juxtaglomerular cells D. the kidneys play a major role in blood pressure control via the renin-angiotensin system E. angiotensin II causes vasoconstriction and stimulates aldosterone release from the adrenal cortex

b, d, e rationale: the angiotensin converting enzyme found in the pulmonary capillaries converts angiotensin I to angiotensin II. The kidneys play a major role in BP control via the renin-angiotensin system. Angiotensin II causes vasoconstriction and stimulates aldosterone release from the adrenal cortex. Angiotensinogen is a substance that the liver synthesizes. In times of renal ischemia (decreased blood supply), renin is released from juxtaglomerular cells