Urinary Elimination Davis

Which describes the glomerular filtration rate? 1. The amount of filtrate formed by the kidneys per minute 2. The volume of blood that passes through the kidneys in each cardiac cycle 3. The amount of waste removed by the kidney each minute 4. The amount of urine that collects in the bladder per minute

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Which health history information should be obtained before a nurse places an indwelling catheter? Select all that apply. 1. Any allergies 2. History of bladder surgery 3. History of heart disease 4. Any problems with constipation 5. Number of pregnancies

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7. What anatomical feature makes women more prone to urinary tract infections than men? 1. Increased width of the pelvic bones 2. Proximity of the urethra to the vagina and anus 3. Larger bladder 4. Decreased length of the ureters

2

A nurse is placing an indwelling catheter in an obese female client and realizes that the catheter is in the vagina rather than the urinary meatus. Which action should the nurse take? 1. Remove the catheter from the vagina and again try to place the catheter. 2. Adjust the client's position or lighting and attempt again with the same catheter. 3. Discard the catheter, adjust the client's position and lighting, and try again with a new catheter. 4. Discard the catheter and ask another nurse to try to place the catheter.

3

Which is a normal specific gravity for urine? 1. 0.12 2. 1.30 3. 1.02 4. 13.0

3 1.002-1.030

Which ion controls acid-base balance? 1. Sodium 2. Oxygen 3. Hydrogen 4. Potassium

3 more H = acidosis less H = alkalosis

A client presents to the emergency room with vomiting and diarrhea. The client is dehydrated. Which hormone does the nurse expect to be secreted by the posterior pituitary gland to reduce water loss? 1. Renin 2. Aldosterone 3. Erythropoietin 4. Antidiuretic hormone (ADH)

4

What is the term for the amount of blood that is filtered in a minute? 1. Creatinine 2. Ammonia 3. Blood urea nitrogen 4. Glomerular filtration rate Creatinine is a nitrogenous waste product that is excreted by the kidneys. Option 2: Ammonia is a waste product of protein metabolism. It is not the term for the amount of blood filtered in a minute. Option 3: Blood urea nitrogen is a nitrogenous waste product. It is not the term for the amount of blood filtered in a minute. Option 4: The glomerular filtration rate measures the amount of blood that is filtered through the glomerulus in a minute.

4

Which part of the kidney is made up of millions of functional units called nephrons? 1. Cortex 2. Calyx 3. Medulla 4. Renal pelvis Rationales Option 1: The cortex is the outer part of the kidney and contains millions of functional units called nephrons. Option 2: The calyx is the central part of the kidney and directs urine into the renal pelvis. Option 3: The medulla is the inner layer of the kidney, made up of collecting tubules. Option 4: The renal pelvis is the innermost layer of the kidney.

1

The nurse is discussing ways to treat functional incontinence with a group of older adults in a senior citizens center. Which intervention would be most appropriate for the nurse to include in the presentation? 1. Timed voiding 2. Kegel exercises 3. Straight catheterization 4. Pharmacological treatment Rationales Option 1: The nurse would instruct the clients to use the bathroom to urinate every 2 to 3 hours. This alleviates the problem of not being able to get to the bathroom in time. Option 2: The nurse would instruct clients with stress incontinence, not functional incontinence, how to perform Kegel exercises. Option 3: The nurse would encourage a client with a spinal cord injury or neuromuscular disorder, not urinary incontinence, to perform straight catheterization to prevent urinary retention. Option 4: The nurse would discuss pharmacological treatment of urge incontinence with the client and health-care provider. These medications are not appropriate for functional incontinence. [Page reference: 1083]

1 kegal for stress straight for spinal injury pharm for urge

10. Which health history information should be obtained before a nurse places an indwelling catheter? Select all that apply. 1. Any allergies 2. History of bladder surgery 3. History of heart disease 4. Any problems with constipation 5. Number of pregnancies Rationales Option 1: Allergies to iodine and latex will require alterations to normal indwelling catheter insertion procedure. Option 2: History of bladder disease may require a smaller lumen catheter or alteration in the procedure. Option 3: A history of heart disease is not relevant to catheter insertion. Option 4: Constipation is not relevant to catheter insertion. Option 5: Number of pregnancies is not usually relevant to catheter insertion.

1 (assess for iodine and latex allergy) 2 (surgery need smaller catheter)

What should the nurse include in the teaching for a client with an ileal conduit urinary diversion? Select all that apply. 1. Ensure the collection device fits snugly against skin. 2. Empty the ostomy bag frequently. 3. Apply lotion to the area if skin is excoriated. 4. Catheterize the reservoir several times a day. 5. Performing Credé's maneuver to empty the bladder. Rationales Option 1: A good snug fit prevents urine from leaking onto the skin. If this happens, it crystallizes and can cause skin irritation. Option 2: The client should be taught to empty the bag when it is about one-third full. This prevents the bag from becoming heavy and separating from the face plate. Option 3: Lotion should not be used on peristomal skin because it can irritate the skin. Option 4: A client with a continent urinary reservoir, not a urinary diversion, would catheterize the reservoir. Option 5: The nurse would instruct the client with a neobladder to perform the Credé's maneuver to empty bladder. This is not applicable for a client with a urinary diversion.

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. The parents of a 2-year-old child voice concern to the nurse that they are not able to toilet train the child yet. Which factors should the nurse explain to the parents that affect toilet training? Select all that apply. 1. The child must be able to sense the urge to void. 2. The child must be able to remove his or her clothes. 3. The child must be able to voice the need to urinate. 4. The child must be able to completely wipe from front to back. 5. The child must be able to balance himself or herself on the toilet. Rationales Option 1: In order to obtain bladder control, the toddler must be able to sense the urge to urinate. Option 2: The child must be able to remove his or her clothes in order to be toilet trained. Option 3: In order to be toilet trained, the child must be able to verbalize the need to urinate. Option 4: The child does not need to be able to wipe from front to back, as parents and caregivers can help with this. Option 5: The child can be toilet trained using a smaller potty chair until he or she is big enough to sit on a toilet.

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The nurse is educating unlicensed nursing assistive personnel (NAP) about recording output for a client. What fluids should the nurse include in the output for accuracy? Select all that apply. 1. Urine 2. Emesis 3. Diarrhea 4. Nasal drainage 5. Intravenous fluids 6. Nasogastric drainage

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Which actions occur to blood as it moves through the peritubular capillaries? Select all that apply. 1. Removes ammonia from blood 2. Hydrogen ions secreted to help maintain normal blood pH 3. Antidiuretic hormone produced 4. Aldosterone secreted 5. Removes creatinine from the blood

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Which physiological factors can place an 83-year-old client at risk for acute kidney injury? Select all that apply. 1. Decline in glomerular function 2. Loss of urinary sphincter control 3. Arteriosclerotic blood vessel changes 4. Decreased abdominal muscle control 5. Consumption of large quantities of caffeine Rationales Option 1: By the time a client is 80-years-old, only about two-thirds of the nephrons function. This places the client at risk for acute kidney injury. Option 2: Loss of urinary sphincter control leads to urinary incontinence, not acute kidney injury. Option 3: Arteriosclerosis occurs with age and this decreases blood flow to the kidneys. Option 4: Clients, especially females, are at higher risk for urinary incontinence when abdominal muscle control decreases. This does not cause acute kidney injury. Option 5: Caffeine is a diuretic and increases urine production. This does not place the client at risk for acute kidney injury.

1 3 diuretic

Which interventions should the nurse instruct the client to perform to decrease the incidence of urinary incontinence? Select all that apply. 1. Eliminate caffeine from the diet. 2. Limit the intake of fluids. 3. Stop smoking. 4. Lose weight. 5. Increase the use of artificial sweeteners.

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A nurse is assessing a urostomy on a client. She should be most concerned about which findings? Select all that apply. 1. Sloughing of skin 2. Moisture 3. Skin breakdown 4. Encrustation 5. Red in color Rationales Option 1: Sloughing of skin could be the result of severe skin irritation. Option 2: A normal urostomy site is moist and shiny. Option 3: Skin breakdown can occur if urine is left on the skin for a period of time. Option 4: Encrustation is a risk for a localized infection in a urostomy. Option 5: A normal urostomy is red in color.

1 3 4 ostomy SHOULD be Moist encrusted is infected

The nurse is providing discharge teaching for a client who will be taking a loop diuretic. What should the nurse include in the teaching? Select all that apply. 1. Change positions slowly. 2. Stay out of direct sunlight. 3. Report any muscle weakness. 4. Notify the health-care provider of any rash. 5. Signs and symptoms of high potassium levels. Rationales Option 1: Diuretics have a side effect of hypotension and dizziness. Therefore, the nurse should teach the client to change positions slowly. Option 2: The nurse would instruct the client who is taking a thiazide diuretic, not a loop diuretic, to stay out of the direct sunlight. Option 3: The nurse would instruct the client to report any muscle weakness, as this can be a major complication from diuretic use. Option 4: A rash indicates a possible allergic reaction and this should be reported. Option 5: The nurse would instruct the client about the signs and symptoms of low potassium levels as this is a side effect of loop diuretics.

1 3 4 avoid sun for HCTZ monitor for hypokalemia for loop diuretic (furosemide)

The nurse just finished inserting an indwelling urinary catheter into a client and is sitting down to document the procedure. Which information should the nurse include in the medical record? Select all that apply. 1. Catheter size 2. Provision of privacy 3. Date and time of insertion 4. Projected date of removal 5. Amount of saline in balloon 6. Color, clarity, and amount of urine return

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Which are urinary symptoms that may occur as a result of the aging process? Select all that apply. 1. Leakage of urine 2. Decreased frequency of urination 3. Decreased volume of urine 4. Nocturnal frequency of urine 5. Bladder infections Leakage of urine related to loss of pelvic muscle tone can occur. Option 2: Decreased frequency of urination is not associated with aging. Option 3: Decreased volume of urine produced is not associated with aging. Option 4: Nocturnal frequency of urine may occur as a result of incomplete bladder emptying. Option 5: Bladder infections can occur as a result of incomplete bladder emptying.

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A urine specimen is obtained by a client cleaning the exterior meatus, then beginning to void, then collecting the urine sample midstream. Which type of specimen does this describe? 1. Freshly voided specimen 2. Clean-catch specimen 3. Sterile urine specimen 4. 24-hour specimen

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A nurse is caring for an elderly client who has nearly fallen twice while getting out of bed to go to the bathroom. The nurse has instructed the client not to get up without assistance. The client tells the nurse about feeling a need to get to the bathroom when the urge to void occurs and feeling a need to rush. Which strategy should the nurse utilize to minimize the client's risk of falling? 1. Obtain an order for an indwelling catheter. 2. Check on the client every 2 hours and offer toileting assistance. 3. Require that a family member stay with the client. 4. Obtain an order for restraints to prevent injury.

2 prevent CAUTI

Which functions of the kidney are considered secondary functions? Select all that apply. 1. Acid-base balance 2. Renin production 3. Water reabsorption 4. Vitamin D activation 5. Erythropoietin secretion Acid-base balance is a primary function of the kidney. It does this by regulating hydrogen ion excretion. Option 2: Renin is excreted by the kidneys in response to hypotension. It is a secondary function of the kidneys. Option 3: Water reabsorption is a primary kidney function. Option 4: The secondary functions of the kidneys include the activation of vitamin D. Option 5: A secondary function of the kidneys is to secrete erythropoietin in response to hypoxia.

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Which piece of information is most important for the nurse to obtain prior to removing an indwelling urinary catheter? 1. Date of insertion 2. Type of catheter material 3. Amount of saline in balloon 4. Allergy to betadine or shellfish The date of insertion is not the most important aspect to know prior to the removal of an indwelling urinary catheter. The nurse may need to know this prior to changing the catheter. Option 2: The nurse would need to pay attention to the type of material used prior to insertion, especially if the client has a latex allergy. However, this is not needed prior to removal. Option 3: The nurse would need to know the amount of saline inserted into the balloon prior to removing the catheter. This allows the nurse to use the correct syringe size and to ensure the nurse removes all of the saline before pulling the catheter out. Option 4: The nurse would need to know allergies to betadine and shellfish prior to inserting the catheter as betadine is used in the prep. This is not necessary to know prior to removal.

3

Which laboratory test should be performed prior to a client undergoing a renal biopsy? 1. Urinalysis 2. Blood glucose 3. Coagulation studies 4. Hepatic function panel

3 ensure bleeding is ok.

Which is an advantage of intermittent catheterization over indwelling catheters? 1. Convenience to the client 2. Decreased risk of infection 3. Can be removed immediately and client can void normally 4. Convenient for the nurse

3 there is a risk with all ATI says otherwise.

A client reports severe pain in the pubic area and the nurse determines the client has acute urinary retention. The client reports never experiencing this before. Which new medication may be the cause? 1. Lisinopril 2. Ibuprofen 3. Fexofenadine 4. Metoprolol

3 antihistamine cause urinary retention (anticholinergic effects)

How would the nurse assess for costovertebral angle tenderness? 1. Inspect the urinary meatus. 2. Auscultate over the abdominal aorta. 3. Percuss between the 12th rib and spine. 4. Palpate in the pubic area over the bladder. The nurse would inspect the urinary meatus prior to inserting an indwelling urinary catheter. This is not done prior to determining costovertebral angle tenderness. Option 2: The nurse would auscultate over the abdominal aorta to determine the presence of a bruit. This is not assessing for costovertebral angle tenderness. Option 3: The nurse would percuss the area between the 12th rib and spine on both sides to determine the presence of costovertebral angle tenderness. Option 4: The nurse would palpate in the pubic area over the bladder to determine bladder distention; not costovertebral angle tenderness.

3 sign of Kidney infection

The nurse calculates urinary output for a client admitted with dehydration and determines the client's output is 800 mL/day. Which nursing intervention is most appropriate for the nurse to perform first? 1. Notify the health-care provider. 2. Document the finding as normal. 3. Assess the urine color and clarity. 4. Insert an indwelling urinary catheter. Rationales Option 1: The normal daily urine output should be a minimum of 1200 mL. This client is at risk for urinary dysfunction due to low output. However, the nurse needs to obtain more information prior to contacting the health-care provider. Option 2: The nurse should not document the finding as normal, as there is a problem with the urinary output. Option 3: The nurse needs more information prior to notifying the health-care provider. Therefore, the nurse should assess the color and clarity of the urine first. Option 4: The nurse would not insert an indwelling urinary catheter without first obtaining an order from the health-care provider.

3 (assess before you call MD) normal urine output is 1200 per day

A client presents to the emergency department with nausea and vomiting for 2 days. The client states he or she has not urinated at all for the past 8 hours. Which is the most likely cause of his lack of urine output? 1. Impaired renal function 2. Renal calculi 3. Dehydration 4. Prostatic hypertrophy

3 r/t vomiting

The nurse has an order to obtain a urine specimen for a culture and sensitivity test from a client with an indwelling urinary catheter. Which procedure is accurate for obtaining the specimen? 1. Obtaining the specimen from the drainage bag 2. Disconnecting the tubing and obtaining the specimen 3. Inserting a new indwelling urinary catheter to obtain a sterile urine specimen 4. Clamping the tubing and withdrawing a fresh specimen from the tubing aseptically Rationales Option 1: The nurse would not obtain the sample from the drainage bag, as it may be several hours old. Option 2: The nurse should not disconnect the seal between the drainage bag and the catheter. This opens the tubing and places the client at risk for infection. Option 3: The nurse would not need to insert a new indwelling urinary catheter because this is not needed. Option 4: The nurse would clamp the tubing and withdraw a fresh specimen from the tubing aseptically. This ensures the specimen is sterile and not contaminated.

4

The nurse is caring for a client with acute kidney injury and reviews the medical record for new orders. Which order given by the health-care provider should the nurse question? 1. Cystoscopy 2. Cystometry 3. Renal biopsy 4. Intravenous pyelogram Rationales Option 1: A cystoscopy is not contraindicated for a client with acute kidney injury. This procedure could be used to remove stones that may be causing the acute kidney injury. Option 2: Cystometry is used to measure the amount of urine in the bladder as well as the amount of pressure in the bladder. This test would be allowed for this client. Option 3: A renal biopsy is a procedure that could be used to determine the cause of acute kidney injury. It is not contraindicated. Option 4: An intravenous pyelogram is contraindicated in a client with acute kidney injury, as the intravenous dye is nephrotoxic and can worsen the kidney injury.

4 (contrast contraindicated if renal impairment)

The nurse is preparing to remove an indwelling urinary catheter from a client who underwent a prostatectomy a week ago. Which size syringe would be most appropriate for the nurse to use to deflate the retention balloon? 1. 3 mL 2. 5 mL 3. 10 mL 4. 30 mL Rationales Option 1: A 3-mL syringe is too small for removing the water from the retention balloon for an adult. It is the correct size for a child. Option 2: A 5-mL syringe would be used to remove an indwelling urinary catheter from an adult client who did not have a urological procedure performed. Option 3: Sometimes a 10-mL syringe is used to inflate a retention balloon in an adult client who uses an indwelling urinary catheter on a long-term basis. However, this is a catheter used after a urological procedure. Option 4: A urologist would insert an indwelling urinary catheter with a 30-mL retention balloon in a client who underwent prostate surgery. This would prevent the catheter from being pulled out.

4 need 30ml if had prostatectomy usually its 10 ml inflated balloon