Quiz #3 Genitourinary System
The course of ARF is divided into phases, what are the phases? A) Oliguria B) Hematuria C) Azotemia D) Diuresis E) Recovery
A) Oliguria D) Diuresis E) Recovery
Mr. Shunter receives hemodialysis treatments through an arteriovenous (AV) shunt in the left arm. Which of the following interventions is appropriate? A) Take the blood pressure on the right arm B) Monitor input and output hourly C) Keep patient on bed rest D) Irrigate the fistula every 4 hours
A) Take the blood pressure on the right arm
Which of the following instructions is given to clients with chronic pyelonephritis? A) You may need antibiotic treatment for several weeks for the treatment of the infection B) Use narcotic on a regular basis for up to 6 months C) Stay on bedrest for up to 3 weeks D) Have a urine culture every 2 weeks for up to 6 months
A) You may need antibiotic treatment for several weeks for the treatment of the infection
One method of monitoring for signs and symptoms of fluid overload when administering diuretics is: A) record daily morning weights (same time, scale, clothes). B) record random weights throughout the day (same scale, clothes, staff member). C) eat a diet high in sodium. D) assess abdomen every shift.
A) record daily morning weights (same time, scale, clothes).
When preparing to teach a patient about continuous bladder irrigation, the nurse notes that the most frequently used irrigant is A) sterile isotonic saline. B) heparinized normal saline. C) sterile water. D) an antibiotic solution.
A) sterile isotonic saline.
A nurse has an order to collect a 24-hour urine specimen from a client. The nurse should avoid which of the following errors in technique while completing this procedure? a. Ask the client to void, save the specimen, and document the start time. b. Ask the client to save a urine voided at the end of the collection time. c. Place the specimen on ice. d. Discard a urine specimen collected at the start time.
Ask the client to void, save the specimen, and document the start time. Rationale: Because the 24-hour urine test is a timed quantitative determination, the test must be started with an empty bladder. Therefore, the first urine is discarded. Fifteen minutes prior to the end of the collection time, the client should be asked to void, and this specimen is added to the collection. The urine collection should be refrigerated or placed on ice to prevent changes in urine.
A patient has nephrotic syndrome. Which of these statements made by the patient indicates that she understands the dietary modifications? A) "Carbohydrate restriction will be difficult." B) "I will need to increase protein and decrease sodium intake." C) "I will need to drink more milk to get my calcium." D) "Potassium restriction won't be hard since I don't like fruit."
B) "I will need to increase protein and decrease sodium intake." Medical management for nephrotic syndrome depends on the extent of tissue involvement and may include the use of corticosteroids and a low-sodium, high-protein diet
A client with chronic renal failure asks the nurse why he is anemic. Which of the following responses by the nurse is best? A) "The increased metabolic waste products in your body depress the bone marrow" B) "There is a decreased production by the kidneys of the hormone erythropoietin" C) "It is most likely that you have hereditary traits for the development of anemia" D) "We will need to review your dietary intake of iron-rich foods
B) "There is a decreased production by the kidneys of the hormone erythropoietin"
Which of the following clients is at greatest risk for developing acute renal failure? A) A teenager who has an appendectomy B) A client with diabetes and who is dehydrated C) A dialysis patient receiving blood transfusion D) A pregnant woman who has a fractured femur
B) A client with diabetes and who is dehydrated
In the clients suspected of having benign prostatic hypertrophy (BPH), the most frequent signs observed are: A) Flank pain, chills B) Dysuria, nocturia, dribbling C) Hematuria, groin discomfort D) Bladder stones, malaise
B) Dysuria, nocturia, dribbling
dehydration and electrolyte imbalance. She is confused and incontinent of urine on admission. Which appropriate nursing intervention does the nurse include in developing a plan of care? A) Restrict fluids after the evening meal. B) Use protective undergarments. C) Assist the patient to the bathroom every half hour. D) Insert an indwelling catheter immediately.
B) Use protective undergarments. Use of protective undergarments may help to keep the patient and the patient's clothing dry. Confused patients are high risk for falls. Restricting fluids will only decrease incontinence during the night and will exacerbate the dehydration and electrolyte imbalance.
Urinary frequency, urgency, nocturia, retention, and incontinence are common with aging. These occur because of (Select all that apply.) A) 1,000 to 2,000 mL fluids per 24 hours. B) diminished neurologic sensation combined with decreased bladder capacity. C) weakened musculature in the bladder and urethra. D) increased hormonal changes and muscle strength. the effects of medications such as diuretics. E) the effects of medications such as diuretics.
B) diminished neurologic sensation combined with decreased bladder capacity. C) weakened musculature in the bladder and urethra. E) the effects of medications such as diuretics.
Mr. Jelly is undergoing continuous ambulatory peritoneal dialysis (CAPD). The dialysate dwell time is completed, and the clamp is opened to allow the dialysate to drain. The nurse notes that drainage has stopped and only 500ml has drained; the amount of dialysate instilled was 1500 ml. Which of the following interventions would be done first? A) Clamp the catheter and instill more dialysate at the next exchange time B) Call the physician C) Check the catheter for kinks or obstruction D) Instruct the patient to take deep breaths
C) Check the catheter for kinks or obstruction
A nurse is caring for a client who has been diagnosed as having a kidney mass. The client asks the nurse the reason for a renal biopsy, when other tests such as computerized tomography (CT) and ultrasound are available. In formulating a response, the nurse incorporates the knowledge that a renal biopsy: A) Determines if the mass is growing rapidly or slowly B) Provides an outline of the renal vascular system C) Gives specific cytological information, malignancy determination about the lesion D) Helps differentiate between a solid mass and a fluid-filled cyst
C) Gives specific cytological information, malignancy determination about the lesion
A nurse is caring for a client undergoing peritoneal dialysis. The nurse checks the client and notes that the drainage from the outflow catheter is cloudy. The nurse notifies the registered nurse and plans to take which action? A) Temporarily institute hemodialysis B) Stop the peritoneal dialysis C) Obtain a culture and sensitivity of the drainage per orders D) Add antibiotics to the next several dialysis bags
C) Obtain a culture and sensitivity of the drainage per orders
The patient is on postoperative day 1 after having undergone a TURP procedure. He has continuous bladder irrigation (CBI). Actual urine output during continuous bladder irrigation is calculated by A) measuring and recording all fluid output in the drainage bag. B) adding the total of the intravenous and irrigating solutions and then deducting the amount of output. C) measuring total output and deducting the amount of irrigating solution used. D) measuring the total output and deducting the total of the irrigating and intravenous solutions.
C) measuring total output and deducting the amount of irrigating solution used.
A nurse is performing an admission assessment on a client with a diagnosis of bladder cancer. Which of the following would the nurse most likely expect to note on data collection of this client? a. Burning on urination b. Urgency C. Hematuria D. Frequency
C. Hematuria rationale: Gross, painless hematuria is most frequently the first manifestation of bladder cancer. As the disease progresses the client may experience burning, frequency, and urgency.
A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent? A) Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand B) Absence of a bruit on auscultation of the fistula C) Presence of a radial pulse in the left wrist D) Presence of bruit and thrill over the fistula
D) Presence of bruit and thrill over the fistula
In preparing your client for an intravenous pyelogram (IVP), it is important to implement which of the following? a. Determine any history of allergies specially to iodine or shellfish b. Encourage the client to eat a full meal c. Explain to the client that he will be given an oral preparation of a radiopaque dye d. Provide client teaching about radiation problems
Determine any history of allergies specially to iodine or shellfish
Mr. S. Tony came to ED with family, complaining of low-grade fever, sudden onset of sharp, severe pain originating in the lumbar area and radiating around the side and down toward the testicle, hematuria with urinary frequency and alternating retention. Morphine for pain was ordered and the patient was further assessed to be having what, basing on the initial signs and symptoms? a. Glomerulonephritis b. Renal calculi c. Cystitis d. Hydronephrosis
Renal calculi
_____________ is a term for severe generalized edema. a. Anasarca b. Ascites C. Cirrhosis d. Presbycussis
a. Anasarca
A patient, age 69, is admitted to the hospital with gross hematuria and history of a 20-pound weight loss during the last 3 months. The physician suspects renal cancer. In obtaining a nursing history from this patient, the nurse recognizes which factor as a significant risk factor for renal cancer? a. Cigarette smoking b. Use of artificial sweeteners C.High caffeine intake D. Chronic cystitis
a. Cigarette smoking rationale: Risk factors include smoking; familial incidence; and preexisting renal disorders such as adult polycystic kidney disease and renal cystic disease secondary to renal failure.
A nurse is reviewing the client's record and notes that the physician has documented that the client has a renal disorder. On review of the laboratory results, the nurse would most likely expect to note which of the following? a. Elevated blood urea nitrogen (BUN) and creatinine level b. Decreased white blood cell (WBC) count c. Decreased hemoglobin level d. Decreased red blood cell (RBC) count
a. Elevated blood urea nitrogen (BUN) and creatinine level Rationale: BUN testing is a frequently used laboratory test to determine renal function. The BUN level starts to rise when the glomerular filtration rate falls below 40% to 60%. A decreased hemoglobin and RBC count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased WBC is most likely to be noted in renal disease.
A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which of the following on return from the dialysis treatment? a. Headache, decreasing level of consciousness, and seizures b. Hypotension, bradycardia, and hypothermia c. Hypertension, tachycardia, and fever d. Restlessness, irritability, and generalized weakness
a. Headache, decreasing level of consciousness, and seizures Rationale: Disequilibrium syndrome occurs most often in clients who are new to dialysis. It is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. It results from rapid removal of solutes from the body during hemodialysis, with a higher residual concentration gradient in the brain because of the blood- brain barrier. Water goes into cerebral cells because of the osmotic gradient, causing brain swelling and the onset of symptoms. It is prevented by dialyzing for shorter times or at reduced blood flow rates.
A nurse has an order to obtain a sample for urinalysis from a client with an indwelling urinary catheter. The nurse would avoid which of the following, which could contaminate the specimen? a. Obtaining the specimen from the urinary drainage bag b. Clamping the tubing of the drainage bag c. Aspirating a sample from the port on the tubing attached to the drainage bag d. Wiping the port on the tubing with an alcohol swab before inserting the syringe
a. Obtaining the specimen from the urinary drainage bag Rationale: A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag and does not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. Options 2, 3, and 4 are correct actions.
A nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which of the following questions to the mother would elicit information about the cause of this disease? a. Have you noticed any rashes on your child?" b. "Did your child recently complain of a sore throat?" c. "Has your child had any diarrhea?" d. "Did your child sustain any injuries to the kidney area?"
b. "Did your child recently complain of a sore throat?"
A client has just undergone a renal biopsy. In planning care for this client, the nurse would avoid which intervention? a. Administer opioid analgesics as needed. b. Ambulate in the room and hall for short distances. c. Test urine for blood hourly. d. Encourage fluids to at least 3 L in the first 24 hours.
b. Ambulate in the room and hall for short distances.
The patient is receiving continuous bladder irrigation after a transurethral resection of the prostate (TURP). He complains of a "spasm like" pain over his lower abdomen. Which of these actions should the nurse perform first in response to this complaint? a. Inform the nurse in charge. b. Check the catheter and drainage system for obstruction or kinks. c. Administer the prescribed analgesic. d. Decrease the continuous bladder irrigation flow.
b. Check the catheter and drainage system for obstruction or kinks. The patient who has a TURP may have continuous closed bladder irrigation or intermittent irrigation to prevent occlusion of the catheter with blood clots, which would cause bladder spasms.
A nurse is providing instructions to the client regarding the complications of peritoneal dialysis. The nurse instructs the client that which manifestation is most likely associated with the onset of peritonitis? a. Clear dialysate output b. Fever c. Fatigue d. Leaking around site
b. Fever Rationale: The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. Leaking around the catheter site is not an indication of peritonitis. Fatigue may be associated with peritonitis, but fever is the most likely sign.
A 56-year-old patient with cancer of the bladder is recovering from a cystectomy with an ileal conduit. An important aspect in nursing interventions of the patient with an ileal conduit is a. limiting acid-ash foods b. maintenance of skin integrity. c. instructing the patient to void when with defecation is felt. d. prevention of tissue rejection.
b. maintenance of skin integrity. Care of the patient with an ileal conduit is a nursing challenge because of the continual drainage of urine through the stoma. Complication of this procedure is wound infection, dehiscence, and urinary leakage.
The nurse notes the amount and color of the urine of the patient with urolithiasis (presence of stones). While using standard precautions, the nurse's next action would be to: a. discard the urine. b.make sure to strain all urine c.add the urine to a 24-hour collector. d.save the urine for physician assessment.
b. make sure to strain all urine All urine should be strained. Because stones may be any size, even the smallest speck must be saved for assessment by the laboratory.
A nurse is providing information to the mother of a child with nephrotic syndrome regarding the edematous appearance of the child. Which of the following statements should the nurse make to the mother? a. "Dress the child in loose-fitting clothing to hide the extra weight." b."The fluid retention should be controlled by medication and diet." c. "The child will always have this appearance, and preparing the child for the body image change is important." d. "Children always look a little bit fat, so don't be concerned."
b."The fluid retention should be controlled by medication and diet."
A nurse collects a urine specimen for a urinalysis from a client recently diagnosed with polycystic disease of the kidneys. The nurse documents that the urine is dilute and that the specific gravity of the urine is low. Based on this documentation, which of the following specific gravity results was present? a. 1.010 b. 1.030 c. 1.000 d. 1.020
c. 1.000
An alkaline ash diet is prescribed for the client with renal calculi. Which of the following diet menus does the nurse advise the client to select? a. Pasta with shrimp, tossed salad, and a plum b. Peanut butter sandwich, milk, and prunes c. A spinach salad, milk, and a banana d. Chicken, rice, and cranberries
c. A spinach salad, milk, and a banana
A nurse is caring for a hospitalized client following cystoscopy and is monitoring for signs of complications associated with the procedure. Which of the following, if noted in the first few hours following the procedure, indicates the need to notify the registered nurse? a. Clear urine b. Pink-tinged urine c. Bloody urine with clots d. Yellow-colored urine
c. Bloody urine with clots Rationale: The client may have clear, yellow, or pink- tinged urine after cystoscopy. Bloody urine with clots is always an abnormal finding and should be reported immediately.
****A female client has an order for a clean-catch urine culture. After providing a sterile specimen cup to the client, the nurse would give which instruction so that the specimen is collected properly? a. Wipe the labia front to back with toilet paper and void into the sterile specimen container. b. Cleanse the labia using cleansing towels, position the container, and begin to void. c. Cleanse the labia using cleansing towels, begin to void into toilet, and then collect the specimen. d. Void into the container, saving the full amount of urine.
c. Cleanse the labia using cleansing towels, begin to void into toilet, and then collect the specimen.
A nurse is admitting a client with chronic renal failure (CRF) to the nursing unit. The nurse monitors the client for which most frequent cardiovascular sign that occurs in CRF? a. Bradycardia b. Hypotension c. Hypertension d. Tachycardia
c. Hypertension Rationale: Hypertension is the most common cardiovascular finding in the client with CRF. It is due to a number of mechanisms, including volume overload, renin- angiotensin system stimulation, vasoconstriction from sympathetic stimulation, and absence of prostaglandins. Hypertension may also be the cause of the renal failure. It is an important item to assess because hypertension can lead to heart failure in the CRF client because of increased cardiac workload in conjunction with fluid overload.
A young female client with acute pyelonephritis is scheduled for a voiding cystourethrogram. The nurse determines that this client would most likely benefit from increased support and teaching about the procedure because a. The client must lie on an x-ray table in a cold, barren room. b. Radiopaque contrast is injected into the bloodstream with a syringe. c. The client must void while the micturition process is filmed. d. Radioactive material is injected into the bladder with a syringe.
c. The client must void while the micturition process is filmed. Rationale: Having to void in the presence of others can be very embarrassing for clients and may actually interfere with the client's ability to void. The nurse teaches the client about the procedure to try to minimize stress from lack of preparation and gives the client encouragement and emotional support. Screens may be used in the radiology department to try to provide an element of privacy during this procedure.
The patient has end-stage renal disease (ESRD) and is admitted with a blood urea nitrogen (BUN) level of 93 mg/dL. An excessive elevation of BUN could result in a. edema. b. constipation c. disorientation and confusion. d. catabolism.
c. disorientation and confusion. If the BUN is elevated, preventive nursing measures should be instituted to protect the patient from possible disorientation or seizures.
It is 2 days after a difficult patient's urinary diversion surgery. He continues to be critical of the hospital and the nursing care, even though the staff has spent time explaining the care to him. The most likely explanation for his behavior is that he a. has an obsessive-compulsive disorder. b. is used to having things done his way. c. is having problems accepting the urinary diversion. d. has no other responsibilities to keep him occupied.
c. is having problems accepting the urinary diversion. Patient teaching centers on tasks of lifestyle adaptation: care of the stoma, nutrition, fluid intake, maintaining self- esteem in light of altered body image, modifying sexual activities, and early detection of complications.
A client has an arteriovenous (AV) shunt in place for hemodialysis. The nurse would take which of the following priority precautions, knowing that bleeding is a potential complication? a. Check the results of blood tests as they are ordered. b. Check the shunt for the presence of a bruit and thrill. c. Observe the site once per shift. d. Ensure that small clamps are attached to the AV shunt dressing.
d. Ensure that small clamps are attached to the AV shunt dressing. Rationale: An AV shunt is a cannula with two ends that are tunneled subcutaneously into an artery and a vein. An AV shunt is a less common form of access site but carries a risk for bleeding when it is used. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site should also be observed at least every 4 hours. Once per shift is insufficient. Checking for blood results, bruit, and thrill all apply to the care of this client but do not focus on bleeding.
A client with new-onset renal failure is having a first hemodialysis treatment. The nurse is especially careful to monitor the client for which of the following on return from the dialysis treatment (Disequilibrium syndrome)? a. Restlessness, irritability, and generalized weakness b. Hypotension, bradycardia, and hypothermia c. Hypertension, tachycardia, and fever d. Headache, decreasing level of consciousness, and seizures
d. Headache, decreasing level of consciousness, and seizures Rationale: Disequilibrium syndrome occurs most often in clients who are new to dialysis. It is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. It results from rapid removal of solutes from the body during hemodialysis, with a higher residual concentration gradient in the brain because of the blood- brain barrier. Water goes into cerebral cells because of the osmotic gradient, causing brain swelling and the onset of symptoms. It is prevented by dialyzing for shorter times or at reduced blood flow rates.
The patient, age 30, has a history of renal calculi and is admitted to the hospital with gross hematuria and severe colicky left flank pain that radiates to his left testicle. An intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal left ureter. Physician orders include morphine 1mg q4h prn, strain all urine, and encourage fluids to 4,000 mL/day. In planning care for this patient, the nurse gives the highest priority to which nursing diagnosis? a. Ineffective health maintenance related to lack of knowledge about prevention of stones b. Risk for injury related to disorientation c. Anxiety related to unclear outcome of condition d. Pain related to irritation of a stone
d. Pain related to irritation of a stone Nursing diagnoses include, but are not limited to, patient pain related to mobility of renal calculus which is the active problem of the patient (physiological needs)
A client with acute renal failure (ARF) has been treated with sodium polystyrene sulfonate (Kayexalate) by mouth. The nurse evaluates this therapy as effective if which of the following values is noted on follow-up laboratory testing? a. Phosphorus 3.9 mg/dL b. Sodium 142 mEq/L c. Calcium 9.8 mg/dL d.Potassium 4.9 mEq/L
d. Potassium 4.9 mEq/L' Rationale: Of all the electrolyte imbalances that accompany renal failure, hyperkalemia is the most dangerous because it can lead to cardiac dysrhythmias and death. If the potassium level rises too high, sodium polystyrene sulfonate may be given to cause excretion of potassium through the gastrointestinal tract. Each of the electrolyte levels noted in the question falls within the normal reference range for that electrolyte. The potassium level is measured following administration of this medication to note the extent of its effectivenes
An adult client has had serum electrolytes drawn. The nurse receiving the results by telephone from the laboratory would be most concerned with which of the following results? a. Bicarbonate 24 mEq/L b. Sodium 142 mEq/L c. Chloride 103 mEq/L d. Potassium 5.7 mEq/L
d. Potassium 5.7 mEq/L Rationale: The normal serum electrolyte ranges for adults are sodium, 136 to 145 mEq/L; potassium, 3.5 to 5.5 mEq/L; chloride, 98 to 107 mEq/L; and bicarbonate (venous), 22 to 29 mEq/L. The only abnormal value identified above is the serum potassium, which would be the one of most concern to the nurse.
A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this patient's pouch, the nurse observes that the bag was tight and the area around the stoma is red, weeping, and painful. What should the nurse conclude? a. Stoma dilation was not performed b. A skin barrier was applied properly c. The skin was not lubricated before the pouch was applied d. The pouch faceplate barrier or wafer is tight and does not fit the stoma
d. The pouch faceplate barrier or wafer is tight and does not fit the stoma Rationale: A stoma that is bigger than the faceplate will have pressure around the sides as it is being compressed and blood flow is being compromised, causing swelling and weeping because of the tightness.
Pediatric patients, especially girls, are susceptible to urinary tract infections because a. girls have a weakened musculature and sphincter tone. b. genetically females have a weaker immune system. c. girls are more sexually active than males. d. females have a short and proximal urethra in relation to the vagina.
d. females have a short and proximal urethra in relation to the vagina. Rationale: Pediatric patients, especially girls, are susceptible to urinary tract infections because of the short urethra.
****In teaching a patient how to decrease the chance of further problems with urolithiasis and other contraindications, the nurse would encourage patient to: a. restrict protein intake. b. avoid contact sports. c. take one baby aspirin daily. d. increase fluid intake.
d. increase fluid intake
The method that employs shock waves to shatter/pulverize kidney stones is: a. dialysis b. cystectomy c. cystoscopy d. lithotripsy (ESWL)
d. lithotripsy (ESWL)
The physician orders a urinalysis and urine culture. To obtain the urine specimen, the nurse would first instruct the patient about a. bringing in an early morning specimen. b. limiting fluid intake to concentrate the urine. c. collecting the urine for a 24 hour period. d. obtaining a clean-catch specimen.
d. obtaining a clean-catch specimen. Urinalysis is completed on a clean-catch or catheterized specimen.
