Urinary (UTI, Nephrolithiasis, Urinary Diversions, etc.)

Diet for Oxylate Stones

Limit intake of Oxylate- Limit foods like Spinach, Strawberries, Rhubarb, chocolate, tea, Peanuts, and wheat bran. Increase in fluids.

Symptoms for Acute Pyelonephritis

Low-grade fever, Chills, Hematuria, Abdominal discomfort, Back pain or flank, N/V, Tachycardia, Tachypnea.

What is a pyelolithotomy?

incision of the renal pelvis to remove a stone

Urolithiasis

prescence of stones in the urinary system- caused from bed rest, increased Vitamin D intake, Hyperparathyroidism, cancer, excessive secretion to uric acid.

Benign Prostatic Hypertrophy

prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems.

BPH Medication Nursing Care

terazoSIN, doxazoSIN, tamsuloSIN, alfuzoSIN (relieves obstruction and increases urine flow),finaSTERIDE, dutaSTERIDE (shrinks prostate)-change position slowly, assess BP, pregnant pt. do not handle crushed or broken tablets.

Nursing Care for Percutaneous Nephrostomy or Ureterostomy Tubes -Do not clamp or irrigate. - If bilateral tubes, record amount and color of urine output from each tube. -Ask client if they are voiding normally even with tube in.

-Do not clamp or irrigate. -If bilateral tubes, record amount and color of urine output from each tube. -Ask client if they are voiding normally even with tube in.

What is creatinine normal value?

0.6-1.5 mg/dl (high if > 4)

You're planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include? 1. "Your urine might turn bright orange." 2. "You need to take this antibiotic for 7 days." 3. "Take this drug between meals and at bedtime." 4. "Don't take this drug if you're allergic to penicillin."

1. "Your urine might turn bright orange." (The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.)

You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi? 1. Increased calcium loss from the bones 2. Decreased kidney function 3. Decreased calcium intake 4. High fluid intake

1. Increased calcium loss from the bones (Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system.)

A nurse is assessing a 68-year-old female patient who states, "I am having episodes of urinary incontinence." The nurse should recognize this statement as indicating which of the following? 1. an abnormal finding requiring further testing 2. an indication of the presence of a urinary infection 3. a normal outcome of the aging process 4. the result of having several children

1. an abnormal finding requiring further testing (Rationale: An abnormal finding requiring further testing is correct because incontinence is not a normal part of the aging process, and therefore will require further investigation to identify the cause. An indication of the presence of a urinary infection is incorrect because although frequency and urgency can be symptoms of a urinary tract infection, a culture and sensitivity test is necessary in order to determine infection. A normal outcome of the aging process and a result of having several children are incorrect because incontinence is not normal, and is it not necessarily the result of having had several children.)

Which of these assessments of an 86-year-old patient requires immediate nursing intervention? 1. reports of urinary incontinence 2. reports of urinary frequency 3. reports of urinary urgency 4. reports of nocturia

1. reports of urinary incontinence (Rationale: Urinary incontinence is not a normal part of aging and requires immediate nursing intervention. Reports of urinary frequency, urgency, and nocturia are more common in older adults than in younger people. These may represent normal changes expected with aging.)

The nurse assesses a patient admitted to the medical-surgical unit who has a diagnosis of type I diabetes mellitus. The nurse notes that the patient's urine is cloudy and foul-smelling. Which of the following diagnostic tests does the nurse anticipate will be ordered based on this finding? 1. urine culture and sensitivity (C&S) 2. blood urea nitrogen (BUN) 3. creatinine clearance 4. residual urine

1. urine culture and sensitivity (C&S) (Rationale: Urine culture and sensitivity (C&S) is correct because cloudy and foul-smelling urine indicates a urinary tract infection. The diagnostic test to identify the organism responsible is a urine C&S. Blood urea nitrogen (BUN) measures the amount of urea (end product of protein metabolism) in the blood plasma. It does not identify infection. Creatinine clearance is a 24-hour urine test used to identify renal function; it will not identify an infection. Residual urine measures the amount of urine left in the bladder after voiding, and does not identify an infection.)

normal urine specific gravity

1.015 - 1.025

You have a patient that might have a urinary tract infection (UTI). Which statement by the patient suggests that a UTI is likely? 1. "I pee a lot." 2. "It burns when I pee." 3. "I go hours without the urge to pee." 4. "My pee smells sweet."

2. "It burns when I pee." (A common symptom of a UTI is dysuria. A patient with a UTI often reports frequent voiding of small amounts and the urgency to void. Option D: Urine that smells sweet is often associated with diabetic ketoacidosis.)

Which of the following symptoms do you expect to see in a patient diagnosed with acute pyelonephritis? 1. Jaundice and flank pain 2. Costovertebral angle tenderness and chills 3. Burning sensation on urination 4. Polyuria and nocturia

2. Costovertebral angle tenderness, flank pain, and chills are symptoms of acute pyelonephritis. (Option A: Jaundice indicates gallbladder or liver obstruction. Option C: A burning sensation on urination is a sign of lower urinary tract infection.)

A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120ml. The drainage system has no obstructions. Which intervention has priority? 1. Give a 500 ml bolus of isotonic saline 2. Evaluate the patient's circulation and vital signs 3. Flush the urinary catheter with sterile water or saline 4. Place the patient in the shock position, and notify the surgeon

2. Evaluate the patient's circulation and vital signs (A total UO of 120ml is too low. Assess the patient's circulation and hemodynamic stability for signs of hypovolemia. A fluid bolus may be required, but only after further nursing assessment and a doctor's order.)

Immediately post-op after a prostatectomy, which complications requires priority assessment of your patient? 1. Pneumonia 2. Hemorrhage 3. Urine retention 4. Deep vein thrombosis

2. Hemorrhage (Hemorrhage is a potential complication. Option A: Pneumonia may occur if the patient doesn't cough and deep breathe. Option C: Urine retention isn't a problem soon after surgery because a catheter is in place. Option D: Thrombosis may occur later if the patient doesn't ambulate.)

Which action is most important during bladder training in a patient with a neurogenic bladder? 1. Encourage the use of an indwelling urinary catheter 2. Set up specific times to empty the bladder 3. Encourage Kegel exercises 4. Force fluids

2. Set up specific times to empty the bladder (Instruct the patient with neurogenic bladder to write down his voiding pattern and empty the bladder at the same times each day.)

Which patient is at greatest risk for developing a urinary tract infection (UTI)? 1. A 35 y.o. woman with a fractured wrist 2. A 20 y.o. woman with asthma 3. A 50 y.o. postmenopausal woman 4. A 28 y.o. with angina

3. A 50 y.o. postmenopausal woman (Women are more prone to UTI's after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Options B, C, and D: Angina, asthma and fractures don't increase the risk of UTI.)

The most indicative test for prostate cancer is: 1. A thorough digital rectal examination 2. Magnetic resonance imaging (MRI) 3. Biopsy of the prostate 4. Prostate-specific antigen

3. Biopsy of the prostate

Which of the following causes the majority of UTI's in hospitalized patients? 1. Lack of fluid intake 2. Inadequate perineal care 3. Invasive procedures 4. Immunosuppression

3. Invasive procedures (Invasive procedures such as catheterization can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentration of urine, but wouldn't necessarily cause infection.)

A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in this patient's diet? 1. Carbohydrates 2. Fats 3. Protein 4. Vitamin C

3. Protein (Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so this patient's protein intake must be restricted. Options A, B, and D: A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient's tissues.)

A patient is experiencing which type of incontinence if she experiences leaking urine when she coughs, sneezes, or lifts heavy objects? 1. Overflow 2. Reflex 3. Stress 4. Urge

3. Stress (Stress incontinence is an involuntary loss of a small amount of urine due to sudden increased intra-abdominal pressure, such as with coughing or sneezing.)

A nurse is caring for a patient who asks the nurse why females are more likely than males to contract bladder infections. The nurse knows teaching has been effective when the patient identifies which of the following as a female risk factor for bladder infections? 1. The pH of the female urethra is more conducive to infection. 2. The urinary meatus is farther from the anus than most males. 3. The urinary meatus is closer to the bladder than in most males. 4. Females urinate more frequently than males, increasing risk.

3. The urinary meatus is closer to the bladder than in most males. (Rationale: In females, the urethra is approximately 1.5 inches (3 to 5 cm) long, and the urinary meatus is anterior to the vaginal orifice. In males, the urethra is approximately 8 inches (20 cm) long. The shorter distance of the female urethra creates a mechanism by which more females than males contract bladder infections. The female urinary meatus is closer, not farther from the anus than in most males, also increasing risk for bladder infections. The pH of the female urethra is not more conducive to infection. Frequent urination decreases the risk of bladder infection making this choice incorrect.)

Which instructions do you include in the teaching care plan for a patient with cystitis receiving phenazopyridine (Pyridium). 1. If the urine turns orange-red, call the doctor. 2. Take phenazopyridine just before urination to relieve pain. 3. Once painful urination is relieved, discontinue prescribed antibiotics. 4. After painful urination is relieved, stop taking phenazopyridine.

4. After painful urination is relieved, stop taking phenazopyridine. (Pyridium is taken to relieve dysuria because is provides an analgesic and anesthetic effect on the urinary tract mucosa. The patient can stop taking it after the dysuria is relieved. Option A: The urine may temporarily turn red or orange due to the dye in the drug. Option B: The drug isn't taken before voiding, and is usually taken 3 times a day for 2 days.)

Your patient has complaints of severe right-sided flank pain, nausea, vomiting and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi? 1. Pain radiating to the right upper quadrant 2. History of mild flu symptoms last week 3. Dark-colored coffee-ground emesis 4. Dark, scanty urine output

4. Dark, scanty urine output (Patients with renal calculi commonly have blood in the urine caused by the stone's passage through the urinary tract. The urine appears dark, tests positive for blood, and is typically scant.)

A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching? 1. Take cool baths 2. Avoid tampon use 3. Avoid sexual activity 4. Drink 8 to 10 eight-oz glasses of water daily

4. Drink 8 to 10 eight-oz glasses of water daily (Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.)

Which intervention do you plan to include with a patient who has renal calculi? 1. Maintain bed rest 2. Increase dietary purines 3. Restrict fluids 4. Strain all urine

4. Strain all urine (All urine should be strained through gauze or a urine strainer to catch stones that are passed. The stones are then analyzed for composition. Option A: Ambulation may help the movement of the stone down the urinary tract. Option C: Encourage fluid to help flush the stones out.)

Which of these laboratory results would be most important for a nurse to monitor for a patient who has lower abdominal pain and urinary urgency? 1. serum creatinine 1.20 mg/dL 2. urine Osmolality 400 mOsm/kg H2O 3. BUN 30 mg/dL 4. urine culture 150,000 organisms/mL

4. urine culture 150,000 organisms/mL (Rationale 1: BUN and serum creatinine tests are use primarily to evlauate kidney function. Rationale 2: Urine osmolality is used to evaluate increaded and decreased urine output. Rationale 3: BUN and serum creatinine tests are use primarily to evlauate kidney function.)

What is the BUN normal value?

8-25 mg/dL (high if greater than 100)

Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder? a) Anticholinergic agent b) Over-the-counter decongestant c) Tricyclic antidepressants d) Estrogen hormone

A) Anticholinergic agent (Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.)

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output? a) It's an abnormal finding that requires further assessment. b) It's a normal finding caused by blood loss during surgery. c) It's an abnormal finding that will correct itself when the client ambulates. d) It's a normal finding associated with the client's nothing-by-mouth status.

A) It's an abornmal finding that requires further assessment. (The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour.)

The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include? a) Hematuria b) Change in cognitive functioning c) Back pain d) Incontinence

B) Change in cognitive functioning (The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.)

The nurse would assess a client with urolithiasis for which of the following symptoms? Absence of urine Flank pain Headache Difficult urination

Flank pain (Urolithiasis is the development of renal calculi that cause an acute, severe pain in the flank and upper abdominal quadrant on the affected side. It is sudden in onset and may be accompanied by nausea, diaphoresis, and vomiting. Difficult or painful urination is usually associated with an infectious process in the urinary tract. Absence of urine or anuria is associated with renal failure or complete urinary obstruction. Headache may result from disequilibrium syndrome following hemodialysis or other problems not related to the renal system.)

Diet for Calcium Phosphate stones

Increasing Acidity of urine. Limit intake of high animal protein, Limit milk intake, increase cranberry juice.

The nurse is caring for a client diagnosed with Acute Renal Failure. Which laboratory values are most significant for diagnosing Acute Renal Failure? Potassium and sodium. BUN and creatinine. WBC and hemoglobin. Bilirubin and ammonia level.

BUN and creatinine (Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing renal failure. WBCs (white blood cells) are monitored for infection, and hemoglobin is monitored for blood loss. Potassium (intracellular) and sodium (interstitial) are electrolytes and are monitored for a variety of diseases or conditions not specific to renal function. Potassium levels will increase with renal failure, but the level is not a diagnostic indicator for renal failure. Bilirubin and ammonia levels are laboratory values determining the function of the liver, not the kidneys.)

A client seen in the Emergency Department reports painful urination, frequency, and urgency. Which of the following conditions would the nurse suspect? Polycystic kidney disease Renal calculi Cystitis Glomerulonephritis

Cystitis (Painful urination, frequency, and urgency are common signs of cystitis, or bladder infection.Renal calculi or stones present with flank pain that progresses toward the groin as the stone migrates downward. Glomerulonephritis frequently presents with hematuria. Polycystic kidney disease frequently presents with flank pain and hypertension.)

Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection? a) Drink coffee or tea to increase diuresis b) Use tub baths as opposed to showers c) Void every 4 to 6 hours d) Drink liberal amount of fluids

D) Drink liberal amounts of fluids (Patients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The patient should shower instead of bathe in a tub because bacteria in the bath water may enter the urethra.)

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective? a) "My urine will be eliminated with my feces." b) "A catheter will drain urine directly from my kidney." c) "I will not need to worry about being incontinent of urine." d) "My urine will be eliminated through a stoma."

D) My urine will be eliminated through a stoma (An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.)

Nursing Care for Cystitis

Diet: intake in acidic foods (cranberries, whole grain, meat, cheese, plums; Avoid alkalinity foods (peaches, apples, carbonated beverages. Increase fluid intake, Avoid tub bath/bubble bath, wipe front to back, wear cotton underwear, avoid tight-fitting pants. Meds: Give Cipro, Keflex, Bactrim, or Septra.

Symptoms of Cystitis

Dysuria, Urinary urgency, urinary frequency, low-grade fever, lower abdominal or pelvic pain, foul-smelling urine, hematuria. Interstitial Cystitis: negative for bacteria in urine.

Nursing Care for Urinary Incontinence

Kegal exercises, Weight reduction, avoid alcohol and caffeine, Estrogen replacement, limit fluids in evenings, bladder training, skin protection.

The nurse is caring for a client with renal calculi. Which physician order would be a PRIORITY? Continuous warm compresses to the flank area Intravenous antibiotics Push oral fluids and keep vein open Morphine sulfate as client controlled analgesia

Morphine sulfate as client controlled analgesia (Morphine sulfate as client controlled analgesia is the correct option. Administering narcotic analgesics provide prompt relief of the severe pain caused by kidney stones.)

The physician has ordered several diagnostic measures for a client with suspected renal calculi. Which diagnostic measure has the highest sensitivity for detecting renal calculi? Ultrasonography Magnetic resonance imaging Noncontrast helical computerized tomography X-ray of the kidneys, ureter, and bladder

Noncontrast helical computerized tomography (Noncontrast helical computerized tomography is the most sensitive means for diagnosing renal calculi. Magnetic resonance imaging, ultrasonography, and x-ray of the kidneys, ureters, and bladder are not as sensitive; therefore, they are incorrect.)

What are the signs of a kidney stone? And what diagnostic tests do you do?

PAIN, nausea, vomiting, WBC in urine, HEMATURIA - get a urine spec. asap and check for RBC's, pain medication immediately

Which modifiable risk factor should the nurse identify for the development of cancer of the bladder in a client? Pelvic radiation therapy. Previous exposure to chemicals. Parasitic infections of the bladder. Cigarette smoking.

Pelvic radiation therapy (Cigarette smoke contains more than 400 chemicals, 17 of which are known to cause cancer. The risk is directly proportional to the amount of smoking.The client has already been exposed; this cannot be undone.Pelvic radiation is prescribed for cancer in the abdomen. It is a life-saving procedure, but one of the risks of radiation therapy is the development of a secondary cancer.Clients may be unaware of a parasitic infection of the bladder for some time prior to diagnosis, but it is not a risk factor for cancer of the bladder.HINT: The question asks for a modifiable risk factor. Modifiable factors involve lifestyle changes, weight loss, tobacco use, and eating habits.)

The nurse is collecting a 24-hour urine sampling for creatinine clearance on a client hospitalized with acute glomerulonephritis. While making rounds, the nurse learns that the client discarded the 2 a.m. voiding. The nurse should? Continue the collection as ordered by the physician Extend the collection time to replace the last voiding Discard the collected urine, obtain a new bottle, and begin the collection again Record the information in the client's chart and continue the collection

Record the information in the client's chart and continue the collection (Failure to collect all urine voided in the 24-hour period invalidates specimen results; therefore, the nurse should obtain a new collection bottle, discard the collected urine, and begin the collection again. All other options are incorrect because they are improper ways of obtaining a 24-hour urine specimen.)

A client is admitted with a distended bladder due to the inability to void. The nurse obtains an order to catheterize the client knowing that gradual emptying is preferred over complete emptying because it ________. Reduces the intensity of bladder spasms Prevents bladder atrophy Reduces the potential for renal collapse Reduces the potential for shock

Reduces the potential for shock (Complete, rapid emptying can cause shock and hypotension due to sudden changes in the abdominal cavity.)

A 74 year-old male is admitted due to inability to void. He has a history of an enlarged prostate and has not voided in 14 hours. When assessing for bladder distention, the BEST method for the nurse to use is to assess for? Rebound tenderness Rounded swelling above the pubis Urinary discharge Left lower quadrant dullness

Rounded swelling above the pubis (Rounded swelling above the pubis is the correct option. Swelling above the pubis is representative of a distended bladder in the male client.)

A client with a chronic urinary tract infection (UTI) is scheduled for a number of laboratory tests. The nurse would note which test results to best evaluate whether the kidneys are being adversely affected? Serum creatinine 2.0 mg/dL Serum potassium 3.8 mEq/L Urine culture negative Urinalysis specific gravity 1.015

Serum creatinine 2.0 mg/dl (Serum creatinine measures the amount of creatinine and indicates renal function (normal 0.8-1.6 mg/dL). Urinalysis is a gross and microscopic view of the urine that can indicate such disorders as urinary tract infection and dehydration. The specific gravity of 1.015 is within normal limits (1.010-1.025). Urine culture specifically examines the type and amount of microscopic organisms present in the urine and should be negative. Serum potassium may be increased in renal failure as well as other disorders, so it is not a definitive diagnostic test for renal function; this value is normal (range 3.5-5.1 mEq/L).)

The nurse tells a student nurse that the normal constituents of urine are the following. Select all that apply? Sodium chloride Urea Protein Water Ketones Epithelial cells

Sodium Chloride, Urea, Water (Urine is normally made up of sodium chloride, urea, and water. Protein is an abnormal constituent of urine indicating renal disease. Ketones may be found in a client who is in diabetic ketoacidosis. The presence of epithelial cells is found in a urinary tract infection.)

Explain Types of Urinary Incontinence: Stress, Urge, Overflow, Mixed, Functional

Stress: inability to tighten the Urethra (sneezing), Urge: Inability to suppress signal to prevent urination, Overflow: Over distention of the bladder, Functional: Voiding at inappropriate times.

What are kidney stones?

They are deposits in the real system commonly made from calcium deposits that can lodge causing severe pain.

Symptoms/ Treatment for BPH

Urinary frequency, Nocturia, reduced force, size of urinary stream.-Saw palmetto/Lycopene) may show false low PSA and can mask signs of cancer. TURP.