Renal Disorders, Alterations of Renal and Urinary Tract Function; Bladder and Lower Urinary Tract, Urinary Elimination (Ch 32-35; Ch. 42-45 ish)
The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which of the following statements?
"Alterations in bladder function can only occur when there is incontinence."
The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which statement?
"Alterations in bladder function can only occur when there is incontinence."
A young mother asks,"Why can my 3-year-old daughter have a bowel movement on the toilet but she wets her pants?" Which of the following is the nurse's best response?
"Bowel control occurs earlier than bladder control."
The nursing instructor who is teaching about incontinence in the elderly recognizes a need for further instruction when one of the students makes which of the following statements?
"Frequency is not a major problem for the elderly."
A client has a spastic bladder. Which comment is of most concern to the nurse?
"I feel like I have a fever"
Several of the clients on a geriatric subacute medicine unit are experiencing urinary incontinence from differing causes. Which statement suggests that the client requires further education?
"I make sure to limit how much I drink so that I don't have accidents."
A public health nurse is conducting a health promotion class for a group of older adults. Which of the participants' following statements demonstrates an accurate understanding of the risk factors for bladder cancer?
"More than ever, I guess it would worthwhile for me to quit smoking."
The client has just been diagnosed with bladder cancer and asks the nurse what causes it. Which of the following would be the nurse's best response to the client?
"The cause is unknown."
A patient has a postvoid residual (PVR) volume of 40 mL. Which of the following information would the nurse teach the patient?
"This is a normal value."
A bladder cancer client asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to do for treatments over months and months?" The best response would be:
"This is when they put the chemotherapy directly into the bladder to kill any cancer cells."
A patient has a postvoid residual (PVR) volume of 250 mL. Which of the following information would the nurse tell the patient?
"This value indicates you are having difficulty emptying your bladder."
A female client is diagnosed with a urinary tract infection (UTI) and states this is her second one in the last 6 months. In teaching the client about health promotion, the nurse would include which statement?
"Try to urinate immediately after sexual intercourse."
A client experienced asymptomatic UTIs while pregnant. The client asks the nurse if this places her at any risk for complications. Which would be the best response by the nurse?
"You are at risk for developing acute pyelonephritis."
A mother asks, "why can't my 1 year old go to the bathroom by himself?" Which of the following is the nurse's best response?
"Your child is too young to begin toilet training."
A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding CKD are correct? Select all that apply.
-Nephron destruction takes place over many months. -Signs and symptoms develop gradually. -Functioning nephrons compensate for those that are damaged. -There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed
The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply.
-Structural changes in the bladder -Structural changes in the urethra -Impairment of neurologic control of bladder function
Which statements identify bladder function? Select all that apply.
-The parasympathetic nervous system promotes emptying. -Control of function involves the autonomic and somatic nervous systems. -The sympathetic nervous system promotes bladder filling
The nurse is preparing to assess a client's postvoid residual using a bladder scanner. Arrange the following steps in the correct order.
1. Press the appropriate gender button. 2. Position scanner head with directional arrow pointing to the head. 3. Press scanner head onto the skin 1 to 1.5 inches (2.5 to 3.75 cm) above the symphysis pubis. 4. Aim scanner head toward coccyx and activate scan. 5. Verify that screen crossbars fall within bladder image. 6. Observe and record the volume measurement on the screeen
Accumulation of nitrogenous wastes such a urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately which of the following?
20 mg/dL
Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine?
24-hour specimen
A geriatric nurse is caring for several clients. Which alterations in clients' health should the nurse attribute to age-related physiologic changes?
A 78-year-old woman's GFR has been steadily declining over several years
Which of the following patients is likely at the greatest risk of developing a urinary tract infection?
A 79-year-old patient with an indwelling catheter
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:
A loss of over half the client's normal kidney function
The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as:
A streptococcal infection 7 to 12 days prior to onset
Which of the following statements correctly describes a direct end-effect of the renin-angiotensin-aldosterone system? A) Angiotensin II causes systemic vasoconstriction. B) Aldosterone promotes the excretion of sodium and water in the renal tubules. C) Renin promotes sodium and water reabsorption in the collecting tubules. D) Aldosterone increases the permeability of the collecting tubules to water only.
A) Angiotensin II causes systemic vasoconstriction.
What is the cause of rapidly progressive glomerulonephritis in Goodpasture syndrome? A) Autoimmune destruction of the glomerular membrane B) Glomerular injury from drug toxicity C) Viral infection of the glomerular membrane D) Abnormal clotting in the glomerular capillaries
A) Autoimmune destruction of the glomerular membrane
Which of the following substances are actively secreted by the renal tubules? A) Hydrogen and potassium B) Sodium and chlorine C) Bicarbonate and carbonic acid D) Phosphate and calcium
A) Hydrogen and potassium
Which of the following changes will result in a decreased glomerular filtration rate? A) Increased hydrostatic pressure in Bowman's capsule B) Decreased plasma colloid oncotic pressure C) Increased arterial blood pressure D) All of the above
A) Increased hydrostatic pressure in Bowman's capsule
Which of the following procedures uses ultrasound waves to break large renal calculi into smaller stones that can be passed through the urinary tract? A) Lithotripsy B) Pyelography C) Renal biopsy D) Enterocystoplasty
A) Lithotripsy
Which of the following disorders is characterized by a lesion of the central or peripheral nervous system that affects bladder control? A) Neurogenic bladder B) Bladder dyssynergia C) Bladder prolapse D) Cystitis
A) Neurogenic bladder
Which of the following substances does not normally get filtered in the kidneys? A) Plasma proteins B) Glucose C) Sodium D) Creatinine
A) Plasma proteins
Which of the following hormones is produced and secreted by the juxtaglomerular apparatus in response to low blood pressure? A) Renin B) Aldosterone C) Antidiuretic hormone D) Natriuretic peptide
A) Renin
Increased levels of aldosterone stimulate the reabsorption of which of the following molecules? A) Sodium and water B) Potassium and sodium C) Glucose and sodium D) Protein and water
A) Sodium and water
In addition to urinary tract infection, which of the following is a risk factor in the development of pyelonephritis? A) Urinary retention and reflux B) Nephrotic syndrome C) Respiratory disease D) Glomerulonephritis
A) Urinary retention and reflux
Acute tubular necrosis leading to acute renal failure can result from all of the following problems except: A) increased ammonia levels from liver failure. B) contrast dyes used for radiologic studies. C) ischemia occurring after major surgery. D) antibiotics that are nephrotoxic.
A) increased ammonia levels from liver failure.
After passing through the proximal convoluted tubule, the urine filtrate flows into the: A) loop of Henle. B) minor calyx. C) collecting tubule. D) distal tubule.
A) loop of Henle.
Prerenal causes of acute renal failure include: A) severe hypotension. B) glomerulonephritis. C) kidney stones. D) acute tubular necrosis.
A) severe hypotension.
Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications and autosomal recessive polycystic kidney disease (ARPKD) is accurate?
ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction
One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study?
Activity of the voluntary muscles of the perineal area
Which client is displaying manifestations of having a kidney stone?
Acute onset of colicky flank pain radiating to lower abdomen
A child is recovering from a bout with group A beta-hemolytic Streptococcus infection. The child returns to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:
Acute postinfectious glomerulonephritis
A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis?
Acute pyelonephritis
A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs?
Administration of a-adrenergic agonistic drugs as ordered
A nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations?
Albumin
A client has been given the diagnosis of diffuse glomerulonephritis. They ask the nurse what diffuse means. The nurse responds:
All glomeruli and all parts of the glomeruli are involved
Chronic kidney disease impacts many systems in the body. What is the number one hematologic disorder caused by CKD?
Anemia
Which of the following types of pharmacological therapy does the nurse anticipate administering to a patient for treatment of a spastic bladder in order to decrease bladder hyperactivity?
Anticholinergic medications
A client with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat coexisting conditions that carry a high mortality?
Antihypertensive medications
A client with chronic kidney disease reports not being able to urinate for the past 24 hours. A bladder scan shows no urine in the bladder. How does the nurse document this data?
Anuria
The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which of the following disorders?
Autosomal recessive polycystic kidney disease (ARPD)
If the posterior pituitary is damaged, which of the following hormones is affected? A) Renin B) Antidiuretic hormone C) Erythropoietin D) Aldosterone
B) Antidiuretic hormone
Which of the following sexually transmitted diseases is an infectious cause with urinary tract infections? A) Herpes simplex virus B) Candida albicans C) Human papillomavirus D) Trichomoniasis
B) Candida albicans
Which one of the following microorganisms causes the vast majority of urinary tract infections (UTIs)? A) Klebsiella B) Escherichia coli C) Herpes simplex virus D) Candida albicans
B) Escherichia coli
What is the consequence of an upper urinary tract obstruction in a single ureter? A) Renal stone formation B) Hydronephrosis C) Dilation of the urethra D) Anuria
B) Hydronephrosis
What would urinalysis show in a patient who is developing glomerular disease? A) Increased urine creatinine B) Proteinuria C) Low urine sodium D) Presence of white blood cells
B) Proteinuria
Which of the following renal structures is not a component of the nephron? A) Loop of Henle B) Renal capsule C) Proximal convoluted tubule D) Collecting duct
B) Renal capsule
Which of the following infections is most commonly associated with the development of acute poststreptococcal glomerulonephritis? A) Skin and wound infections B) Throat infections C) Endocarditis D) Urinary tract infections
B) Throat infections
Activation of the renin-angiotensin system stimulates the secretion of: A) antidiuretic hormone. B) aldosterone. C) atrial natriuretic peptide. D) cortisol.
B) aldosterone.
The most common cause of glomerulonephritis is: A) infection of the glomerular capsule secondary to a urinary tract infection. B) antigen-antibody complexes that deposit on the glomerular membrane. C) hydronephrosis from kidney stones. D) viral infection in the blood stream that migrates to the glomerulus.
B) antigen-antibody complexes that deposit on the glomerular membrane.
A major modifiable risk factor for the development of renal calculi in the general population is: A) obesity. B) dehydration. C) smoking. D) drinking alcohol.
B) dehydration.
Problems associated with a lower urinary tract obstruction include all of the following except: A) urinary retention. B) flank pain. C) increased voiding frequency. D) intermittent urinary stream.
B) flank pain.
Secondary forms of nephrotic syndrome are associated with all of the following conditions except: A) diabetes. B) hyperthyroidism. C) renal disease. D) systemic lupus erythematosus.
B) hyperthyroidism.
Loss of one kidney results in ______ of the remaining kidney. A) hyperplasia B) hypertrophy C) atrophy D) dysplasia
B) hypertrophy
The primary manifestation of acute renal failure is: A) proteinuria. B) oliguria. C) hematuria. D) diuresis.
B) oliguria.
Obstruction of the lower urinary tract in males is often caused by: A) congenital stricture of a calyx. B) prostate enlargement. C) pelvic organ prolapse. D) urinary tract infection.
B) prostate enlargement.
A significant complication of bladder infection is: A) uterine infection. B) pyelonephritis. C) polycystic kidney disease. D) bladder prolapse.
B) pyelonephritis.
The transport maximum for glucose refers to the maximum rate of glucose: A) filtration. B) reabsorption. C) secretion. D) excretion.
B) reabsorption.
The main clinical manifestation of a kidney stone obstructing the ureter is: A) pyuria. B) renal colic. C) urge incontinence. D) an abdominal mass.
B) renal colic.
Acute pyelonephritis is a result of
Bacterial infection
Acute pyelonephritis is a result of which of the following?
Bacterial infection
The nurse is caring for a patient who has had acute blood loss from ruptured esophageal varices. Which of the following does the nurse recognize is an early sign of prerenal failure?
Baseline urine output of 50 mL/hr that is now 10 mL/hr
A client has just been diagnosed with urinary incontinence. The primary nurse knows that the treatment/management of incontinence can include which measures? Select all that apply.
Behavioral measures Surgical correction Pharmacologic measures Non-catheter devices to obstruct urine flow Indwelling catheter
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is which of the following?
Bladder
When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. What could cause this variation in color of the urine?
Blood
A nurse is caring for a patient with systemic lupus erythematosis (SLE). The patient asks why a urinalysis is necessary. The best answer is that a urinalysis would determine whether which of the following factors was present in the urine?
Blood or protein
A client with a long-standing diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis?
Blood work for hemoglobin, red blood cells, and hematocrit
An adult female patient has been diagnosed with cystitis. The patient informs the nurse that this is has been occurring with some frequency and she recognized the symptoms. Which of the following symptoms reported by the patient does the nurse recognize are significant for cystitis? Select all that apply.
Burning and pain with urination Frequency of urination Lower abdominal and back discomfort
In renal failure, the kidneys will continue to adapt until renal function reaches what percent of normal? A) 75% B) 50% C) 25% D) 10%
C) 25%
Renal insufficiency refers to a decline in renal function to ____ of normal. A) 75% B) 50% C) 25% D) 5%
C) 25%
Which of the following symptoms manifests with both urinary tract infection and pyelonephritis? A) Costovertebral (CVA) tenderness B) Chills C) Dysuria D) Fever
C) Dysuria
In chronic renal failure, which of the following hormones often needs to be pharmacologically supplemented? A) Antidiuretic hormone (ADH) B) Cortisol C) Erythropoietin D) Aldosterone
C) Erythropoietin
What is the cause of the peripheral edema that often manifests with glomerulonephritis and nephrotic syndrome? A) Systemic inflammation B) Right heart failure C) Loss of plasma proteins in urine D) Sodium retention
C) Loss of plasma proteins in urine
Which of the following capillaries surround the proximal and distal convoluted tubules and are involved in reabsorbing filtered substances back into the blood? A) Glomerular capillaries B) Renal papillae C) Peritubular capillaries D) Vasa recta
C) Peritubular capillaries
Which of the following dietary nutrients must be restricted in individuals with advanced chronic renal failure? A) Fats B) Carbohydrates C) Protein D) All of the above
C) Protein
Which of the following factors has a major influence on the development of renal calculi? A) Urine sodium levels B) Serum lactate levels C) Urine pH D) Urine creatinine levels
C) Urine pH
An important cause of bacterial persistence and recurring bacterial urinary tract infections includes: A) poor hygiene. B) increased mucus secretion by the urinary tract. C) microbial resistance to antibiotics. D) acidic urine pH.
C) microbial resistance to antibiotics.
Several of the clients on a geriatric subacute medicine unit are experiencing urinary incontinence from differing cause. Which statement suggests that the client requires further education? A). Ive made a point of scheduling when I drink water instead of waiting until I am thirsty B). I know it is hard to get there, but I want to try and use the commode instead of wearing an adult diaper C). I make sure to limit how much I drink so that I do not have accidents D). At home, I take my water pill in the morning so that I do not have to use the bathroom as much during the night
C). I make sure to limit how much I drink so that I do not have accidents
While providing care, the client states that she has a "burning sensation when urinating." After further questioning, the nurse inspects the client's perineal area. Which would the nurse document as an abnormal finding? A). Absence of discharge B). Moist perineal skin C). Reddened perineal skin D). Presence of smegma
C). Reddened perineal skin
Which catheter would the nurse use to drain a client's bladder for short period (5-10 minutes) A). Suprapubic catheter B). Foley catheter C). Straight catheter D). Indwelling urethral catheter
C). Straight Catheter
The nurse is caring for a client with a Foley catheter in place who has a prescription for a sterile urine specimen for culture and sensitivity. The nurse implements which techniques to obtain the prescribed urine specimen? (Select all that apply.) a) The nurse disconnects the catheter and allows the urine to drip into the specimen container. b) The nurse clamps the tube below the access port for 40 minutes to allow urine to accumulate. c) The nurse dons clean gloves and cleanses the port with aseptic solution. d) The nurse uses a syringe to withdraw urine from the port. e) The nurse allows the urine to flow from the collection bag into the specimen container.
C). The nurse dons clean gloves and cleanses the port with aseptic solution. D). The nurse uses a syringe to withdraw urine from the port.
A woman is reporting bladder urgency. It is most important to assess:
Caffeine Intake
A patient who has had an intestinal bypass has developed a kidney stone. Which of the following types of kidney stone does the nurse recognize that this patient will most likely be treated for?
Calcium
Select the body systems most commonly affected by chronic kidney disease in the elderly. Select all that apply.
Cardiovascular Cerebrovascular systems Skeletal
Hospitalized patients are at the greatest risk of developing septicemia related to which procedure?
Catheter-associated bacteriuria
Which is true regarding the normal urination?
Catheterized clients should drain a minimum of 30 mL of urine per hour.
When preparing to irrigate a Foley catheter, which is the appropriate initial nursing action?
Check health record for provider's order
A client could experience increased urination when using which classification of medication?
Cholinergic agents
A client is diagnosed with decreased gomerular filtration rate but has no renal damage. The nurse recognizes that this can occur with which of the following? Select all that apply.
Cirrhosis Heart failure Removal of one kidney Dehydration
The nurse is preparing to insert an indwelling urinary catheter into a female client's bladder. The nurse has opened the sterile catheterization tray using sterile technique, donned sterile gloves and has opened all sterile supplies. Arrange the following steps in the correct order.
Clean each labial fold, then the area directly over the meatus. Insert the lubricated catheter into the urethra. Advance the catheter until there is a return of urine. Inflate the balloon with the correct amount of sterile saline. Discard used supplies.
A nurse is caring for an older adult client with a urinary tract infection (UTI). The nurse understands which information about UTI's in the older adult population? Select all that apply.
Client may have no symptoms. The UTI may be reflected in a change in the client's mental state. UTI is relatively common in older adults.
Diet may affect urinary elimination. Which foods contain diuretics that can increase urine output when they are ingested in large amounts? Select all that apply. a) Pretzels b) Coffee c) Alcohol d) Tea e) Potato chips f) Chocolate
Coffee Alcohol Tea Chocolate
The UAP reports that a client on furosemide has voided 4000 mL in a 24-hour period. What is the appropriate nursing action?
Contact the health care provider to decrease furosemide.
A client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen?
Continue taking antibiotics for 10 to 14 days even if symptoms of infection disappear.
What percentage of filtered creatinine is excreted in the urine? A) 0% B) 20% C) 50% D) 100%
D) 100%
Which of the following are risk factors for the development of renal cell carcinoma? A) Male gender B) Tobacco use C) Obesity D) All of the above
D) All of the above
Which of the following are symptoms of uremia and azotemia? A) Pruritus B) Fatigue C) Nausea D) All of the above
D) All of the above
Which of the following systems are affected by uremia in renal failure? A) Skin B) Central nervous system C) Reproductive system D) All of the above
D) All of the above
Which of the following is not a known cause of chronic renal failure? A) Hypertension B) Systemic lupus erythematosus C) Diabetes D) Cortical necrosis
D) Cortical necrosis Angiotensin converting enzyme inhibitors
Which of the following hormones stimulates the production of red blood cells in the bone marrow? A) Aldosterone B) Renin C) Creatinine D) Erythropoietin
D) Erythropoietin
Which of the following complications associated with renal failure creates the greatest need for immediate dialysis? A) Uremia B) Increased creatinine C) Hypertension D) Hyperkalemia
D) Hyperkalemia
What is a primary laboratory finding in chronic renal failure? A) Decreased blood urea nitrogen (BUN) B) Decreased serum sodium C) Metabolic alkalosis D) Increased serum creatinine
D) Increased serum creatinine
Which of the following diseases is a glomerular disorder? A) Pyelonephritis B) Obstructive uropathy C) Interstitial cystitis D) Nephrotic syndrome
D) Nephrotic syndrome
Renal calculi are formed from all of the following substances except: A) Struvite B) Calcium oxalate C) Uric acid D) Urobilirubin
D) Urobilirubin
Individuals with chronic renal failure are at risk for osteomalacia and spontaneous bone fractures because: A) excess potassium leaches calcium from the bone. B) erythropoietin secretion is impaired. C) urea causes demineralization of the bone tissue. D) of a vitamin D deficiency.
D) of a vitamin D deficiency.
Nephrotic syndrome occurs when damage to the glomeruli result in loss of _____ in the urine. A) red blood cells B) sodium C) glucose D) protein
D) protein
The renal structure that drains urine directly into the ureter is the: A) major calyx. B) urethra. C) collecting duct. D) renal pelvis.
D) renal pelvis.
A major risk factor for developing bladder cancer is: A) exposure to asbestos. B) urethral obstruction. C) cystitis. D) smoking.
D) smoking.
Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine? A). clean-catch specimen B). Random specimen C). Intermittent specimen D). 24-hr specimen
D). 24-hr specimen
The nurse is reviewing the chart of an elderly client who exhibits signs of confusion. Which laboratory value would indicate to the nurse that intervention is needed? a) Hemoglobin - 40% b) Blood urea nitrogen (BUN) - 7 mg c) Magnesium - 2.5 mEq/L d) Urine culture & sensitivity - 100,000/mL
D). Urine culture and sensitivity- 100,000/mL
A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and best way to remember the transient and treatable causes of urinary incontinence is to use which of the following acronyms?
DIAPPERS
A client with a history of advanced liver disease comes to the emergency department (ED) with dehydration. White blood cell count shows elevation in bands and neutrophils. When preparing to catheterize the client, what color urine does the nurse anticipate will drain?
Dark brown, cloudy
Anemia frequently occurs in clients with chronic kidney disease (CKD). The nurse will monitor these clients for which of the following contributors to anemia? Select all that apply.
Decreased erythropoietin production Anorexia Bone marrow suppression Chronic blood loss
The nurse is inserting a urinary catheter into a female client and has begun to inflate the balloon, an action that has caused the client to wince and cry out in pain. Consequently, the nurse should:
Deflate the balloon, insert the catheter further, and slowly attempt reinflation
The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate?
Dehydration
The nurse is conducting a staff development program on urinary disorders. The nurse evaluates that the participants are understanding the information when they identify that disruption of which muscle's contraction can lead to the inability to expel urine from the bladder.
Detrusor
While studying about the process of urination, the nursing student learns that which of the following is known as the "muscle of micturition"?
Detrusor muscle
When caring for a client with autosomal dominant polycystic kidney disease (ADPD), which sign/symptom is associated with a complication that requires immediate treatment?
Develops an excruciating headache; the client needs to get to the emergency department right away because of the possibility of an aneurysm that is bleeding.
A 57-year-old man is suffering from polyuria. What can cause polyuria?
Diabetes insipidus
A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. What treatment should the nurse anticipate?
Dialysis
The nurse is instructing a patient with advanced kidney disease (AKD) about a dietary regimen. Which of the following restrictions should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?
Dietary protein
The nurse has an order to obtain a 24-hour urine from a client. Which of the following instructions would be accurate for collection of the specimen?
Discard your first urine and begin the collection after that
Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which of the following types of drugs?
Diuretics
The nurse is caring for a client with urinary incontinence who has a prescription for a postvoid residual (PVR) collection. 45 mL of amber urine is returned via PVR. Which appropriate action would the nurse take with this data collection?
Document the finding
The nursing assistant reports that a client on furosemide has voided 2000 mL in a 24-hour period. What is the appropriate nursing action?
Document the finding as normal.
A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is which of the following?
Dorsiflexion of hands and feet
The nurse is caring for a client with recurring urinary tract infections (UTIs). The client asks, "Other than taking antibiotics, what else can I do?" Which response by the nurse is most accurate?
Drink lots of fluids to help relieve the signs/symptoms of UTIs.
Which of the following integumentary problems most often accompanies chronic kidney disease?
Dry skin and pruritus
Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome?
Elevated urine protein and hypoalbuminemia
Which laboratory findings would the nurse anticipate in a client diagnosed with nephritic syndrome?
Elevated urine protein level (>3.5 g/day) and hypoalbuminemia
An older male comes to the clinic with the chief complaint of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. Which of the following should the nurse suspect to be the most frequent cause of this client's problem?
Enlargement of the prostate gland
Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra.
Escherichia coli
What is the most common cause of a lower urinary tract infection?
Escherichia coli
Which reserve urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure?
External sphincter
Which of the following is a nonsurgical method of treatment for renal calculi (kidney stones)?
Extracorporeal shock wave lithotripsy (ESWL)
a urinalysis has been ordered for a client. When is the best time for the client to provide a sample?
First thing in the morning
The nurse is caring for a patient with cystitis. Which of the following is most characteristic of the urine associated with cystitis?
Foul smell
A client reports that he is often unable to retain urine until he locates a toilet because his mobility is decreased. The nurse should recognize the characteristics of what type of incontinence?
Functional
A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer?
Gross hematuria
Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis?
Group A Β-hemolytic streptococci
Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?
Hematuria
Which of the following client clinical manifestations most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?
Hematuria
Which signs and symptoms would you expect to see in a patient diagnosed with acute nephritic syndrome?
Hematuria and azotemia
Which signs and symptoms would you expect to see in a client diagnosed with acute nephritic syndrome?
Hematuria and proteinuria
A nurse is caring for a patient who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this patient?
Hydration
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
Hypertension
A male patient is being transferred to the hospital from a long-term care facility with a diagnosis of dehydration and urinary bladder infection. His skin is also excoriated from urinary incontinence. Which nursing diagnosis is most appropriate for this patient?
Impaired skin integrity related to urinary bladder infection and dehydration
The patient who has been admitted with a problem with his bladder has a postvoid residual (PVR) of 250 ml. The nurse understands that this indicates which of the following?
Inadequate bladder emptying
Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction?
Incontinence
Which of the following assessments indicates to the nurse that a patient may have a spastic bladder dysfunction?
Incontinence
A nurse advises a client with recurring UTIs to drink large amounts of water. What normal protective action is the nurse telling the client to utilize?
Increase washout of urine
The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?
Increased blood pressure
The nurse is planning care for a patient with a urinary tract obstruction. The nurse includes assessment for which of the following possible complications?
Increased blood pressure
Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which of the following?
Increased blood pressure
A patient is to receive a radiocontrast media as part of a diagnostic scan. Which of the following is intended to reduce the nephrotoxic effects of the radiocontrast media?
Increasing the normal saline intravenous infusion rate to 125 mL/hour
A patient sustained acute tubular injury approximately 2 hours ago. Which of the following phases of this disorder does the nurse recognize that the patient is in at this time?
Initiating phase
A nurse drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance?
Intermittent urethral catheter
A 45-year-old man is being treated for bladder cancer. Which therapy would have the least complications?
Intravesical chemotherapy
What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence?
It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.
A nurse is giving discharge instructions for a patient who was diagnosed with acute pyelonephritis 3 days previously. Which of the following is important for the nurse to discuss when instructing the patient?
It is important that the patient take the prescribed antibiotic for the duration of the prescription
The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises will the nurse include?
Keep muscles contracted for at least 10 seconds
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which of the following statements regarding vitamin D is correct?
Kidneys convert inactive vitamin D to its active form, calcitriol
The nurse is attempting to insert a urinary catheter into a female client's bladder and realize the catheter has been inserted into the vagina. Which action is most appropriate?
Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.
An older adult presents to the primary health care provider's office with a report of bladder leakage. Which assessment correlates with a diagnosis of stress incontinence?
Loss of small amounts of urine when laughing or sneezing
If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?
Lower extremeties
The nurse should assess which of the following when assessing for the initial presence of edema in a patient with nephrotic syndrome?
Lower extremities
After reviewing the 24-hour intake and output of a hospital client, the nurse suspects that the client may be experiencing flaccid bladder dysfunction. Which of the following diagnostic methods is most likely to confirm or rule out whether the client is retaining urine?
Measurement of postvoid residual (PVR) by ultrasound
Dietary restrictions placed on clients with chronic kidney disease (CKD) include limiting protein in their diet. The recommended sources of protein for clients with CKD include what source of protein?
Milk
A client is suspected of having a disease process affecting the functional unit of the kidney. Which structure is most likely involved?
Nephron
The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:
Nephrotoxic acute tubular necrosis
A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a:
Neurogenic bladder
Which statement should be included in the nurse's education plan for older adults regarding urinary elimination?
Nocturia and urinary retention are more common in older adults
A drug abuser was found unconscious after shooting up heroin 2 days prior. Because of the pressure placed on the hip and arm, the client has developed rhabdomyolysis. The nurse knows this can:
Obstruct the renal tubules with myoglobin and damage tubular cells
Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)?
Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month
A 55-year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. Which is the most likely diagnosis and possible underlying pathophysiologic problem?
Overactive bladder that may result from both neurogenic and myogenic sources
A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse?
Painless hematuria
What is the most common sign of epithelial cell bladder cancer?
Painless hematuria
A patient is concerned about the possibility of having bladder cancer after his brother was diagnosed with it 2 years ago. Which of the following assessment data obtained by the nurse would indicate that the patient should be screened for this disease?
Patient reports that he occasionally has blood in his urine but has no pain with it
The nurse is evaluating her patient's risk for an urinary tract infection. Which of the following patients has the highest risk?
Patient with obstructed urinary outflow from the kidney
A nurse is caring for a patient in spinal shock. Which of the following interventions is appropriate in relation to the patient's urinary status?
Perform intermittent catheterization
Three days post-surgery for breast reconstruction, the nurse assesses that the client is ambulating several times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action? Select all that apply.
Perform, or allow client to perform, perineal hygiene at least once daily Contact the health care provider to ask for an order for catheter discontinuation
While assessing a peritoneal dialysis client in his or her home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:
Peritonitis
The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?
Plasma proteins
A patient diagnosed with Goodpasture's syndrome would require which of the therapies to remove proteins and autoantibodies from the system?
Plasmapheresis
Which one of the following would the nurse see as being liable to cause the most serious long-term problems?
Polycystic kidney disease
The nurse knows that one of the earliest manifestations of acute renal failure (ARF) is which of the following?
Polyuria
An 86-year-old female patient is admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patient's most recent laboratory results are suggestive of acute renal failure. The nurse recognizes that this patient has which type of failure?
Prerenal
A patient in renal failure has marked decrease in renal blood flow caused by hypovolemia, caused by gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which of the following forms of acute renal injury does this patient have?
Prerenal failure
A nurse is caring for a client who is catheterized following a surgery of the prostate. When caring for the client, the nurse performs a continuous irrigation of the catheter. Which of the following interventions should the nurse perform when providing continuous irrigation?
Prime the tubing with the solution
The nurse is reviewing the diagnosis of four male clients. Select the diagnosis that places the clients at risk for developing postrenal kidney failure.
Prostatic hyperplasia
Which of the following substances would not be found in glomerular filtrate?
Protein
Which substance would not be found in glomerular filtrate?
Protein
When acute tubular necrosis (ATN) is suspected, the nurse will likely see which of the following laboratory findings on the urinalysis report? Select all that apply.
Protein Red blood cells Cast cells
Phosphate excretion is impaired in chronic kidney disease (CKD), resulting in high serum phosphate levels and the development of phosphate crystals. The nurse knows that which of the following symptoms may occur?
Pruritus
The nurse recognizes that acute renal injury is characterized by which of the following?
Rapid decline in renal function
While providing care to a client admitted to the health care facility, the client states that she has "a burning sensation when urinating." After further questioning, the nurse inspects the client's perineal area. Which of the following would the nurse document as an abnormal finding?
Reddened perineal skin
The nurse reviews the lab results for a patient who has advanced autosomal dominant polycystic kidney disease (ADPKD). The patient 's hemoglobin is 8.8 g/dL. The nurse suspects this lab value is related to which of the following causes?
Reduced production of erythropoietin
What is the most common cancer of the kidney?
Renal cell carcinoma
Which of the following is the most common cancer of the kidney?
Renal cell carcinoma
A client who had an open hysterectomy 2 days ago is ambulating around the unit four times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action?
Request an order for catheter discontinuation from the health care provider.
Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy?
Restless legs syndrome
A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which would be the best instruction for the nurse to provide?
Restrict intake of dietary protein
A nurse is caring for an elderly client who has been prescribed a condom catheter. What potential problems related to the use of condom catheter should the nurse monitor in the client? Select all that apply.
Restricted blood flow to the glans tissue Excoriation of the skin in the glans area
The parents of a child who has been diagnosed with CKD ask the nurse about manifestations of the disease. Which is the most appropriate information for the nurse to provide? Select all that apply.
Secondary hyperparathyroidism Developmental delay Delayed cognitive development Growth impairment
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?
Serum creatinine
The nurse knows that a child with chronic kidney disease (CKD) may experience which of these manifestations? Select all that apply.
Severe growth deficit High bone turnover
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which of the following early signs of prerenal injury?
Sharp decrease in urine output
The nurse is assessing a patient with diabetic nephropathy whose blood pressure is 124/80. The patient smokes two packs of cigarettes a day and consumes a diet high in saturated fats and sodium. The nurse's plan of care should focus on which of the following to decrease the patient's risk for progression of the diabetic nephropathy?
Smoking cessation program
Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)?
Straight catheter
A 56-year-old client complains of urinary incontinence when she laughs. The nurse documents this as which type of incontinence?
Stress
A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence?
Stress incontinence
A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises, because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence?
Stress incontinence
A client who has a problem with incontinence loses a small amount of urine every time she coughs or sneezes. This type of incontinence is known as which of the following?
Stress incontinence
A patient is describing difficulty with urinating and informs the nurse that every time she coughs or laughs, she urinates and has begun to wear a thin pad. Which of the following types of urinary incontinence is the patient describing?
Stress incontinence
The nurse is caring for a client who has been experiencing nausea, vomiting, and diarrhea for 3 days. Which urine characteristics does the nurse anticipate?
Strongly aromatic, dark amber
The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply.
Structural changes in the urethra Impairment of neurologic control of bladder function Structural changes in the bladder
What is the micturition reflex?
The act of bladder contraction and perceived need to void.
Which is not true of urine color?
The appearance of urine streaked with blood is always abnormal
The nurse is caring for a client who has been experiencing difficulty voiding since her vaginal birth. The client voices concern to the nurse. What information should be provided to the client?
The birth can cause perineal swelling
The nurse is providing education to a client who is being discharged to home with an indwelling urinary catheter in place. What information is important for the nurse to discuss with the client?
The catheter can be connected to a smaller leg bag for ambulation.
The nurse is inserting a urinary catheter into a 63-year-old male client and encounters resistance. What is the most likely cause of the resistance?
The client has an enlarged prostate.
A client's BUN test results are significantly elevated. When reviewing the client's history, which finding is consistent with BUN elevation other than renal compromise?
The client is dehydrated.
The doctor has ordered the collection of a fresh urine sample for a particular examination. Which urine sample would the nurse discard?
The first voiding of the day
Which of the following patients should have a feeling of bladder fullness?
The patient with 200 mL of urine in their bladder
A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason?
The patient's urine contains material from the degradation of red blood cells
A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe?
There is possible obstruction in the urinary tract
The nurse is teaching a client how to perform pelvic floor muscle exercises (Kegel exercises). Which teaching will the nurse include?
Tighten the internal muscles used to prevent or interrupt urination
The school nurse is caring for a student who experienced a seizure in the classroom. The student was noted to lose a large amount of urine during the seizure. Which type of incontinence does the nurse anticipate the client may have experienced?
Total
A patient with chronic kidney disease (CKD) will be managed with peritoneal dialysis. The nurse will give the patient which of the following descriptions of this type of dialysis?
Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time
Bruising of the skin is a manifestation of bleeding disorders in patients with CKD.
True
One of the complications of asymptomatic urinary tract infection (UTI) during pregnancy is the risk of preterm birth.
True
Use of an indwelling urinary catheter leads to the loss of bladder tone.
True
The family members of a client who has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD) asks the nurse what they should do to find out if they have this disease. The nurse will respond that they should visit with their healthcare provider and ask about having which lab/diagnostic test to screen for the disease?
Ultrasound of the kidney
A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as:
Urge incontinence
The nurse understands that medications although very beneficial to clients can also have harmful effects. When working with elderly clients the nurse should recognize which of the following is a common result of potent, fast-acting diuretics?
Urge incontinence
The nurse understands that medications, although very beneficial to clients, can have harmful effects. When working with older adult clients the nurse should recognize that which outcome is a common result of potent, fast-acting diuretics?
Urge incontinence
The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice?
Urinal
A patient is admitted with lower urinary tract obstruction and stasis. Which of the following is the primary intervention?
Urinary catheterization
One of the most damaging effects of urinary obstruction on kidney structures is which effect?
Urinary stasis
The nurse caring for an older adult notes a marked decrease in mental acuity over a 24-hour period. What assessment indicates the most likely cause of this change?
Urine cloudy with strong odor
Which of the following clinical manifestations would tell a nurse that a patient is having progressive decompensation related to obstruction of urinary outflow?
When tested for residual urine volume, 1400 mL of urine is obtained when patient is catheterized
Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client:
Will not undergo an acute kidney injury by decreasing renal blood flow
A sterile urine specimen for culture and sensitivity has been ordered for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen?
Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle.
A nurse is working primarily with adult and older adult clients. Which lifespan considerations should the nurse keep in the mind when working with these populations? Select all that apply. a) Because of decreased arterial perfusion, kidney function progressively decreases later in life. b) Men have a higher risk of developing urinary incontinence than women. c) Urinary incontinence is a normal part of aging. d) Older adults may try to manage incontinence by restricting intake of fluids. e) Older men may experience urinary hesitancy and difficulty starting the urinary stream. f) Symptoms of a urinary tract infection in an older adult include painful urination and a high fever.
a) Because of decreased arterial perfusion, kidney function progressively decreases later in life. d) Older adults may try to manage incontinence by restricting intake of fluids. e) Older men may experience urinary hesitancy and difficulty starting the urinary stream.
When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. What could cause this variation in color of the urine? a) Blood b) Infection c) Stasis d) Dehydration
a) Blood
Which is true regarding the normal urination? a) Catheterized clients should drain a minimum of 30 mL of urine per hour. b) Urinary output does not vary all that much between adults and children. c) In adults, the average amount of urine per void is 500 mL. d) In adults, the amount of urine voided typically does not depend on fluid intake and losses.
a) Catheterized clients should drain a minimum of 30 mL of urine per hour.
A 57-year-old man is suffering from polyuria. What can cause polyuria? a) Diabetes insipidus b) Renal disease c) Renal calculi d) Urinary tract infection
a) Diabetes insipidus
The nurse is caring for a client with a history of renal insufficiency and Type II diabetes mellitus. Which prescription, if noted in the client's chart, would alert the nurse to discuss with the health care practitioner? a) Gentamicin (Garamycin) 70 mg intramuscular (IM) every 8 hours b) Urine dipstick four times a day c) Blueberry juice 10 ounces by mouth (PO) daily d) Encourage fluids intake - 2 to 3 liters per day
a) Gentamicin (Garamycin) 70 mg intramuscular (IM) every 8 hours
The nurse is changing a stoma appliance on an ileal conduit. Which nursing action is recommended procedure? Select all that apply. a) Gently remove the appliance, starting at the top and keeping the abdominal skin taut. b) Make sure skin around stoma is thoroughly dry by patting it dry. c) Apply faceplate by using firm, even pressure for approximately 60 seconds. d) Apply a silicone-based adhesive remover by spraying or wiping as needed. e) Remove appliance faceplate by pulling appliance from skin rather than pushing. f) Clean skin around stoma with alcohol on a gauze pad.
a) Gently remove the appliance, starting at the top and keeping the abdominal skin taut. b) Make sure skin around stoma is thoroughly dry by patting it dry. d) Apply a silicone-based adhesive remover by spraying or wiping as needed.
The nurse is preparing a patient for an intravenous pyelogram. Which nursing actions are performed correctly? (Select all that apply.) a) Give a laxative the evening before the examination. b) Tell the patient not to void before the test. c) Give an enema the day of the examination. d) Restrict fluids and foods immediately after the examination. e) Obtain patient's allergy history. f) Withhold or limit foods before testing.
a) Give a laxative the evening before the examination. c) Give an enema the day of the examination. e) Obtain patient's allergy history. f) Withhold or limit foods before testing.
The nurse is preparing a client for a cystoscopy procedure. Which intervention would be part of the preparation for this? a) Having the client sign a consent form for the procedure b) Maintaining the client without liquids before the procedure c) Explaining to the client that the procedure will be painful d) Inserting a Foley catheter the morning of the procedure
a) Having the client sign a consent form for the procedure
Which is not true of urine color? a) The appearance of urine streaked with blood is always abnormal. b) Medications can alter urine's color. c) Someone's state of hydration affects the color. d) The color of urine ranges from light yellow to amber.
a) The appearance of urine streaked with blood is always abnormal.
A nurse is collecting a routine urinalysis on a client presenting to the emergency room with abdominal pain. Which of the following is true regarding this specimen? a) The nurse will obtain a nonsterile specimen and send it to the lab. b) The nurse will obtain a nonsterile specimen, allow it to settle at room temperature for two hours, and then send it to the lab. c) The nurse will obtain a sterile specimen and allow it to settle at room temperature for two hours. d) The nurse will obtain a sterile specimen and send it to the lab.
a) The nurse will obtain a nonsterile specimen and send it to the lab.
The nursing student who is learning skills during campus lab identifies which of the following statements about bedpans to be true? a) The rounded shelf of a regular bedpan should be placed under the client's buttocks. b) A fracture bedpan should used only for clients who have fractures of the femur or lower spine. c) A regular bedpan is generally more comfortable for clients than a fracture bedpan. d) A fracture pan is preferred for urination and a regular bedpan is preferred for defecation.
a) The rounded shelf of a regular bedpan should be placed under the client's buttocks.
Use of an indwelling urinary catheter leads to the loss of bladder tone. a) True b) False
a) True
A nurse is inserting a catheter into a female urinary bladder. Which nursing action is performed correctly? a) Use dominant hand to inflate the catheter balloon, and inject entire volume of sterile water supplied in prefilled syringe. b) Using dominant hand, hold the catheter 12 inches from the tip and insert slowly into the urethra. c) Clean the perineal area with a gauze pad and alcohol using a different corner of the gauze with each stroke. d) Assist the client to a prone position with knees flexed, feet about 2 feet apart, with legs abducted.
a) Use dominant hand to inflate the catheter balloon, and inject entire volume of sterile water supplied in prefilled syringe.
A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed:
acute postinfectious glomerulonephritis
An infant is born with spina bifida. She may have:
alterations in urinary elimination
A parent asks the nurse when an 18-month-old daughter will be ready for toilet training. Which statement best answers the parent's question regarding toilet training? a) "Your child will tell you when there is a sensation of bladder fullness." b) "One signal of preparedness is when your child is dry for at least 2 hours." c) "Your child should be at least 2 years old before you start toilet training." d) "Girls typically take longer than boys to be ready for toilet training."
b) "One signal of preparedness is when your child is dry for at least 2 hours."
Which scenario does not illustrate a normal lifespan variant regarding urination? a) A toddler age 3 1/2 is showing interest in being ready for toilet training by showing that he can undress himself and by being able to stay dry for 2 hours at a time. b) An 8-year-old is continent during the day but is incontinent 2 times during the night. c) A 10-year-old child has been voiding straw-colored urine 6 or 7 times a day. d) The urine of a neonate, 5 hours old, appears pink-tinged.
b) An 8-year-old is continent during the day but is incontinent 2 times during the night.
A nurse is caring for an older adult client who is incontinent. Which effects of aging might contribute to urinary alterations? Select all that apply.
b) Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine. c) Decreased bladder contractility may lead to urine retention and stasis. e) Neuromuscular problems may interfere with voluntary control of urination. f) Diminished ability of kidneys to concentrate urine may result in nocturia.
A client is suspected of having a disease process affecting the functional unit of the kidney. Which stucture is most likely involved? a) Loop of Henle b) Nephron c) Glomerulus d) Bowman's capsule
b) Nephron
The nurse is preparing to catheterize a client who is incontinent of urine following bladder surgery. What fact should the nurse keep in mind when performing catheterization? a) A normal bladder is as susceptible to infection as an injured one. b) The bladder normally is a sterile cavity. c) The external opening to the urethra should always be sterilized. d) Pathogens introduced into the bladder remain in the bladder.
b) The bladder normally is a sterile cavity.
The nurse is observing the unlicensed assistive personnel (UAP) assist the client with the bedpan. The nurse would intervene if which action, by the UAP, is noted? a) UAP places the hand closest to the client palm up, under the lower back, and assists with lifting. b) UAP positions the bedpan so the client's buttocks rest on the shallow end of the regular bedpan. c) UAP applies powder to the rim of the bedpan. d) UAP places a waterproof pad under the client's buttocks before placing bedpan.
b) UAP positions the bedpan so the client's buttocks rest on the shallow end of the regular bedpan.
The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice? a) Specimen hat b) Urinal c) Large urine collection bag d) Bedpan
b) Urinal
A sterile urine specimen for culture and sensitivity has been ordered for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen? a) Discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen. b) Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle. c) Collect a urine specimen from the collection bag first thing in the morning, or a few hours after the client receives a diuretic. d) Empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag.
b) Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle.
A nurse collects a clean-catch specimen from a client at a health care facility. Which statement describes a clean-catch urine sample? a) a sample of urine collected over a period of 24 hours b) a sample of urine that is considered sterile c) a sample of urine collected in a sterile environment d) a sample of fresh urine collected in a clean container
b) a sample of urine that is considered sterile
A nurse drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance? a) retention catheter b) intermittent urethral catheter c) indwelling urethral catheter d) Foley catheter
b) intermittent urethral catheter
A client at the health care facility has been diagnosed with total urinary incontinence. How could the nurse describe the condition of the client? a) loss of small amount of urine when intra-abdominal pressure rises b) loss of urine without any identifiable pattern or warning c) loss of urine control because a toilet is not accessible d) need to void is perceived frequently, with short-lived ability to sustain control of flow
b) loss of urine without any identifiable pattern or warning
The nurse educator is presenting a lecture on clients at risk for developing urinary tract infections (UTIs). Which response made by the staff nurse would indicate to the educator a need for further teaching? a) "A woman using an intrauterine device for contraceptive reason is at risk for developing an UTI." b) "I will make sure to teach my clients with diabetes mellitus to control their glucose level to help prevent an UTI." c) "Having sexual relationships does not put a woman at risk for developing an UTI." d) "Due to the physiological changes with aging, the elderly are at risk for developing an UTI."
c) "Having sexual relationships does not put a woman at risk for developing an UTI."
The nurse is providing instructions to a client with kidney stones on measures to help prevent urinary tract infections (UTIs). Which statement made by the client, would indicate to the nurse that further teaching is necessary? (Select all that apply.) a) "I will start wearing underwear with a cotton crotch." b) "I will notify my health care provider if my urine starts smelling again." c) "I will drink 10 ounces of cranberry juice every day." d) "I will bathe in the bath tub rather than take a shower." e) "I will drink about ten 8-ounce glasses of water a day."
c) "I will drink 10 ounces of cranberry juice every day." d) "I will bathe in the bath tub rather than take a shower."
The nurse is caring for a client with a prescription for a midstream urine specimen. The nurse would provide which information to the client? a) "You will have a catheter put in to collect the urine." b) "Save all urine for the next 24 hours." c) "Void a small amount, stop, and discard it." d) "Void into the specimen hat in the toilet bowl."
c) "Void a small amount, stop, and discard it."
A nurse is caring for a client with an external condom catheter. What is a guideline for applying and caring for this type of catheter? a) Keep the tip of the tubing 2-3 inches (5 to 7.5 cm) beyond the tip of the penis. b) Remove the catheter every 8 hours, or more often in humid weather. c) Fasten the condom securely enough to prevent leakage without constricting the blood vessels. d) Wash the penis with antimicrobial soap and dry thoroughly.
c) Fasten the condom securely enough to prevent leakage without constricting the blood vessels.
A client reports that he is often unable to retain urine until he locates a toilet because his mobility is decreased. The nurse should recognize the characteristics of what type of incontinence? a) Stress b) Urge c) Functional d) Total
c) Functional
A 75-year-old man was admitted to the hospital for altered mental status. He had been in his usual state of good health until this morning when a nurse at the long-term care facility where he lives noticed that he was confused. Shortly after being admitted to the hospital, he became combative and had to be restrained. His bed linens have to be changed frequently because of urinary incontinence. Which nursing diagnosis best describes this client's condition? a) Urge Urinary Incontinence b) Total Urinary Incontinence c) Functional Incontinence d) Stress Incontinence
c) Functional Incontinence
The nurse is caring for a male patient who has a urinary obstruction and is not a candidate for surgery. What intervention would the nurse expect the health care provider to perform? a) Insertion of a straight catheter b) Insertion of a suprapubic catheter c) Insertion of a urologic stent d) Insertion of an indwelling urethral catheter
c) Insertion of a urologic stent
A nurse notes that the volume of the client's urinary elimination is less than 50 mL/day. Which of the following could be the possible cause for the low volume of urination by the client? a) Liver disease b) Diuretic medication c) Kidney dysfunction d) Endocrine disease
c) Kidney dysfunction
A client at a health care facility is being treated for cancer of the bladder. The physician uses a urinary diversion to help the client with urinary elimination. Which of the following describes a urinary diversion? a) Use of a catheter to collect urine in a sterile environment b) Hygiene measures used to keep meatus and adjacent area of the catheter clean. c) One or both of the ureters are surgically implanted elsewhere d) Inability to control either urinary or bowel elimination
c) One or both of the ureters are surgically implanted elsewhere
Which type of incontinence is caused by pelvic floor muscle weakness? a) Functional b) Urge c) Stress d) Overflow
c) Stress
A nurse is caring for a client who has an infant age 4 months. The client informs the nurse that she has been experiencing a sudden loss of urine whenever she laughs; this is causing embarrassment to her. Which type of urinary incontinence is this client experiencing? a) Urge incontinence b) Functional incontinence c) Stress incontinence d) Reflex incontinence
c) Stress incontinence
A nurse is caring for an older adult client at his home. The client has had a condom catheter applied. Which describes a condom catheter? a) a urine drainage tube that is left in place over a period of time b) a urine drainage tube inserted but not left in place c) a flexible sheath that is rolled around the penis d) a bag attached by adhesive backing to the skin around the genitals
c) a flexible sheath that is rolled around the penis
The nurse collects a urine sample from a client for urinalysis. What would the nurse document as a normal characteristic? a) ammonia odor b) cloudy appearance c) light yellow color d) presence of mucus shreds
c) light yellow color
A nurse is the guest speaker at a women's club. Most of the women are over the age of 40 years. The women have asked the nurse to speak on health promotion topics. In the area of urinary urgency, the nurse will instruct the women to: a) take an antispasmodic. b) limit fluid intake. c) perform Kegel exercises. d) increase caffeine daily.
c) perform Kegel exercises.
Upon assessment of the urine in a client's indwelling urinary catheter drain bag, the nurse notes the urine to be dark yellow. This assessment finding indicates: a) the client is receiving adequate fluid intake. b) the client has a urinary tract infection. c) the client is underhydrated. d) the client is overhydrated.
c) the client is underhydrated.
The primary care provider for a newly admitted hospital patient has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The patient's GFR will be extrapolated from serum levels of:
creatinine
A 65-year-old Caucasian female who smokes presents with increased urinary frequency, dysuria, and sporadic, painless hematuria. The client's follow-up will likely include:
cytoscopy
The nurse has an order to obtain a 24-hour urine from a client. Which of the following instructions would be accurate for collection of the specimen? a) "Start collecting the urine with the next time you urinate." b) "You will need to have a catheter inserted for this collection." c) "Begin the collection when you first urinate in the morning." d) "Discard your first urine and begin the collection after that."
d) "Discard your first urine and begin the collection after that."
A client is diagnosed with frequent urinary tract infections. Which of the following would be an appropriate question for the nurse to ask the client? a) "Are you on any type of special diet at home?" b) "Are you on any blood pressure medications?" c) "How often do you have a bowel movement?" d) "How frequently do you urinate each day?"
d) "How frequently do you urinate each day?"
The nurse is assessing a female client who states that she notices an involuntary loss of urine following a coughing episode. What would be the nurse's best reply? a) "You are experiencing transient incontinence. Have you been administered diuretics or IV fluids lately?" b) "You are experiencing reflex incontinence. Have you had a spinal cord injury in the past?" c) "You are experiencing total incontinence. Have you had any surgeries or trauma that may be causing this?" d) "You are experiencing stress incontinence. Do you know how to do Kegel exercises?"
d) "You are experiencing stress incontinence. Do you know how to do Kegel exercises?"
Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence? a) Boys may walk by 1 year and should be continent by 3 years. b) Incontinence after the age of 3 years is not normal. c) Daytime continence is usually not achieved by boys until age 5. d) Boys may take longer for daytime continence than girls.
d) Boys may take longer for daytime continence than girls.
The nurse is providing education to a client who is being discharged to home with an indwelling urinary catheter in place. What information is important for the nurse to discuss with the client? a) Clamp the catheter tubing daily for 2 hours and then release the clamp at night. b) Restrict daily fluid intake. c) The catheter can be connected to a smaller leg bag for ambulation. d) Empty the catheter bag every few days when it is full.
d) Empty the catheter bag every few days when it is full.
A nurse is caring for an elderly client who has been prescribed a condom catheter. What potential problems related to the use of condom catheter should the nurse monitor in the client? Select all that apply. a) Frequent urinary tract infection b) Inability to control urinary elimination c) Frequent leakage of urinary output d) Excoriation of the skin in the glans area e) Restricted blood flow to the glans tissue
d) Excoriation of the skin in the glans area e) Restricted blood flow to the glans tissue
What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence? a) A sterile urine specimen can be obtained from the drainage bag tubing. b) The client can apply it himself with minimal supervision. c) It can be left in place for a long period of time. d) It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.
d) It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.
You are attempting to insert a urinary catheter into a female patient's bladder and realize the catheter has been inserted into the vagina. Which of the following actions is most appropriate? a) Ask the patient to bear down until the catheter is expelled. b) Immediately remove the catheter from the vagina, contact the primary care provider and anticipate an order for prophylactic antibiotics. c) Remove the catheter from the vagina and attempt to insert it into the bladder. d) Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.
d) Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.
Because of the older adult's inability to concentrate urine as a physiologic change, the nurse should assess the client for which condition? a) Urinary retention b) Incontinence c) Urinary stasis d) Nocturia
d) Nocturia
A nurse is caring for a client who is catheterized following a surgery of the prostate. When caring for the client, the nurse performs continuous bladder irrigation. Which intervention should the nurse perform when providing continuous bladder irrigation? a) Empty the balloon with a syringe b) Clean the urinary meatus c) Place the sterile solution on the bed d) Purge air from the tubing
d) Purge air from the tubing
A nurse is preparing to measure a client's urine output. Which of the following interventions would be of highest priority? a) Measuring the urine container at eye level b) Using an appropriate measuring container c) Noting the color and clarity of the urine d) Wearing gloves when handling the urine
d) Wearing gloves when handling the urine
A physician orders a long-term continuous drainage system to monitor a chronically ill client. What type of catheter would best suit this client's needs? a) external catheter b) indwelling urethral catheter c) intermittent urethral catheter d) suprapubic catheter
d) suprapubic catheter
The nurse is preparing to place a Foley catheter for a female client who will soon have surgery. Into what position will the nurse place the client?
dorsal recumbent
A client with CKD has a GFR of 28 mL/min/1.73 m2. When teaching the client about dietary modifications, the nurse should recommend:
identifying and limiting phosphorus intake
A client at a health care facility is being treated for cancer of the bladder. The physician uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion?
one or both of the ureters are surgically implanted elsewhere
The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to:
plasma proteins
The doctor has ordered the collection of a fresh urine sample for a particular examination. Which urine sample would the nurse discard?
the first voiding of the day
The nurse measures a client's residual urine by catheterization after the client voids. Which condition would this test verify?
urinary retention