Urinary/Renal Function
Which of the following terms is used to refer to inflammation of the renal pelvis? a. Pyelonephritis b. Interstitial nephritis c. Urethritis d. Cystitis
Answer: A Rationale: Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.
A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation? a. Need to urinate after engaging in sexual intercourse b. Need to wear underwear made from synthetic material c. Importance of urinating every 4 to 6 hours while awake d. Suggestion to take tub baths instead of showers
Answer: A Rationale: Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear, urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.
A physician orders cystoscopy and random biopsies of the bladder for a client who reports painless hematuria. Test results reveal carcinoma in situ in several bladder regions. To treat bladder cancer, the client will have a series of intravesical instillations of bacillus Calmette-Guérin (BCG), administered 1 week apart. When teaching the client about BCG, the nurse should mention that this drug commonly causes: a. delayed ejaculation. b. hematuria. c. impotence. d. renal calculi.
Answer: B ?Rationale: Intravesical instillation of BCG commonly causes hematuria. Other common adverse effects of BCG include urinary frequency and dysuria. Less commonly, BCG causes cystitis, urinary urgency, urinary incontinence, urinary tract infection, abdominal cramps or pain, decreased bladder capacity, tissue in urine, local infection, renal toxicity, and genital pain. BCG isn't associated with renal calculi, delayed ejaculation, or impotence.
A nurse, when caring for a client, notes that the specific gravity of the client's urine is low. What could have lead to the low specific gravity of urine? a. Repeated diarrhea b. Excess fluid intake c. Frequent vomiting d. Urine retention
Answer: B Rationale: Excess fluid intake results in low specific gravity of urine. Excessive fluid intake will result in formation of dilute urine. When the urine is diluted, it results in low specific gravity of urine. Frequent vomiting, repeated diarrhea, and urine retention will result in high specific gravity of urine.
The nurse observes the color of the client's urine which appears pale blue-green. The nurse obtains a drug history from the client based on the understanding that drugs used by the client may affect which of the following? a. Size of the urinary bladder b. Urinary tract tests c. Urine specific gravity d. Amount of urine produced
Answer: B Rationale: It is important to inquire about drugs because some drugs may affect the outcome of urinary tract tests as well as the color and odor of the urine. Dietary intake may affect urine characteristics as well as urinary tract disorders and their management. Drugs do not directly affect the size of the urinary bladder or the amount of urine produced.
Which is the correct term for the ability of the kidneys to clear solutes from the plasma? a. Glomerular filtration rate (GFR) b. Renal clearance c. Specific gravity d. Tubular secretion
Answer: B Rationale: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.
Nursing management of the client with a urinary tract infection should include: a. Teaching the client to douche daily b. Discouraging caffeine intake c. Administering morphine sulfate d. Instructing the client to limit fluid intake
Answer: B Rationale: Strategies for preventing urinary tract infection include proper perineal hygiene, increased fluid intake, avoiding urinary tract irritants (including caffeine), and establishing a frequent voiding regimen.
A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant? a. History of hyperparathyroidism b. History of osteoporosis c. Recent history of streptococcal infection d. Previous episode of acute pyelonephritis
Answer: C ?Rationale: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.
A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in: a. 1 hour. b. 24 hours. c. 1 minute. d. 30 minutes.
Answer: C ?Rationale: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? a. Decreased blood urea nitrogen (BUN) b. Decreased potassium c. Increased serum albumin d. Increased serum creatinine
Answer: D Rationale: In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a. Impaired urinary elimination b. Toileting self-care deficit c. Risk for infection d. Activity intolerance
Answer: C ?Rationale: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a. Serum sodium level of 135 mEq/L b. Serum potassium level of 4.9 mEq/L c. Temperature of 99.2° F (37.3° C) d. Urine output of 20 ml/hour
Answer: D Rationale: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
The nurse is preparing an education program on risk factors for kidney disorders. Which of the following risk factors would be inappropriate for the nurse to include in the teaching program? a. Pregnancy b. Diabetes mellitus c. Neuromuscular disorders d. Hypotension
Answer: D Rationale: Hypertension, not hypotension, is a risk factor for kidney disease.
Which of the following is a characteristic of a normal stoma? a. Painful b. No bleeding when cleansing stoma c. Dry in appearance d. Pink color
Answer: D ?Rationale: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? a. Increased red blood cell count b. Decreased serum potassium level c. Increased serum calcium level d. Increased serum creatinine level
Answer: D ?Rationale: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a. Therapeutic index b. GI absorption rate c. Liver function studies d. Creatinine clearance
Answer: D ?Rationale:? The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? a. Restricting fluid intake to reduce the need to void b. Establishing a predetermined fluid intake pattern for the client c. Encouraging the client to increase the time between voidings d. Assessing present voiding patterns
Answer: D Rationale: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.
The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply. a. Vitamin D synthesis b. Secretion of prostaglandins c. Vitamin B production d. Secretion of insulin e. Regulation of blood pressure
Answers: A, B, E ?Rationale: Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? a. "This medication will prevent re-infection." b. "This medication should be taken at bedtime." c. "This medication will relieve your pain." d. "This will kill the organism causing the infection."
Answer: C Rationale: Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.
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
Answer: B Rationale: 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.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a. "Be aware that your urine will be cherry-red for 5 to 7 days." b. "Increase your fluid intake to 2 to 3 L per day." c. "Apply an antibacterial dressing to the incision daily." d. "Take your temperature every 4 hours."
Answer: B Rationale: The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.
During physical assessment of the urinary system, the nurse: a. Auscultates the lower abdominal quadrants for fluid sounds b. Palpates an empty bladder at the level of the symphysis pubis c. Percusses the kidney with a firm blow at the posterior costovertebral angle d. Positions the patient prone to palpate the kidneys with a posterior approach
Answer: C Rationale: To assess for kidney tenderness, the nurse strikes the fist of one hand over the dorsum of the other hand at the posterior costovertebral angle. The upper abdominal quadrants and costovertebral angles are auscultated for vascular bruits in the renal vessels and aorta, and an empty bladder is not palpable. The kidneys are palpated through the abdomen, with the patient supine.
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3-, 24 mEq/L. What do these values indicate? a. Metabolic alkalosis b. Metabolic acidosis c. Respiratory alkalosis d. Respiratory acidosis
Answer: C Rationale: A client with pneumonia may hyperventilate in an effort to increase oxygen intake. Hyperventilation leads to excess carbon dioxide (CO2) loss, which causes alkalosis — indicated by this client's elevated pH value. With respiratory alkalosis, the kidneys' bicarbonate (HCO3-) response is delayed, so the client's HCO3- level remains normal. The below-normal value for the partial pressure of arterial carbon dioxide (PaCO2) indicates CO2 loss and signals a respiratory component. Because the HCO3- level is normal, this imbalance has no metabolic component. Therefore, the client is experiencing respiratory alkalosis.
Which type of incontinency refers to the involuntary loss of urine due to medications? a. Overflow b. Urge c. Reflex d. Iatrogenic
Answer: D Rationale: Iatrogenic incontinence is the involuntary loss of urine due to medications. Reflex incontinence is the involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.
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
Answer: D Rationale: 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.
You are caring for a client with severe hypokalemia. The physician has ordered IV potassium to be administered at 10 mEq/hr. The client complains of burning along their vein. What should you do? a. Change the electrolyte. b. Switch to an oral formulation. c. Increase the speed of transfusion. d. Dilute the infusion.
Answer: D Rationale: Treatment of severe hypokalemia requires treatment with IV infusion of potassium. Clients may experience burning along the vein with IV infusion of potassium in proportion to the infusion's concentration. If the client can tolerate the fluid, consult with the physician about diluting the potassium in a larger volume of IV solution. Oral potassium may not be enough in severe cases hypokalemia. Hypokalemia requires treatment with potassium and not any other electrolyte.
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."
Answer: D Rationale:?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.
When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? a. Check for thrill or bruit over the access site. b. Warm the solution to body temperature. c. Inspect the catheter insertion site for infection. d. Add the prescribed drug to the dialysate.
Answer: A ?Rationale: When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.
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.
Answer: A Rationale: 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 nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? a. Catheterize the client immediately after the client voids. b. Check for residual after the client reports the urge to void. c. Set up a routine schedule of every 4 hours to check for residual urine. d. Record the volume of urine obtained.
Answer: A Rationale: To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.
Which of the following is a factor contributing to UTI in older adults? a. Low incidence of chronic illness b. Sporadic use of antimicrobial agents c. Immunocompromise d. Active lifestyle
Answer: C Rationale: Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, and frequent use of antimicrobial agents.
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a. Perform deep-breathing exercises vigorously. b. Avoid carrying heavy items. c. Auscultate the lungs frequently. d. Wear a mask when performing exchanges.
Answer: D Rationale: The nurse should advise the client to wear a mask while performing exchanges. This prevents contamination of the dialysis catheter and tubing, and is usually advised to clients with upper respiratory infection. Auscultation of the lungs will not prevent contamination of the catheter or tubing. The client may also be advised to perform deep-breathing exercises to promote optimal lung expansion, but this will not prevent contamination. Clients with a fistula or graft in the arm should be advised against carrying heavy items.
To assess circulating oxygen levels, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests? a. Hemoglobin b. Hematocrit c. Arterial blood gases d. Serum iron levels
Answer: A ?Rationale: Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit. Serum iron levels measure iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.
A 32-year-old flight attendant is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure. The client asks what the angiography will reveal. What is your response, as her nurse? a. Renal circulation b. Urine production c. Kidney function d. Kidney structure
Answer: A Rationale: A renal angiogram (renal arteriogram) provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries (multiple vessels to the kidney are not unusual) and the patency of each renal artery.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a. Urine output of 250 ml/24 hours b. Temperature of 100.2° F (37.8° C) c. Serum creatinine level of 1.2 mg/dl d. Blood urea nitrogen (BUN) level of 22 mg/dl
Answer: A Rationale: ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a. Acute glomerulonephritis b. Acute renal failure c. Nephrotic syndrome d. Chronic renal failure
Answer: A Rationale: Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.
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
Answer: A Rationale: 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.
A patient with an obstruction of the renal artery causing renal ischemia exhibits HTN. One factor that may contribute to HTN: a. increase renin release b. increased ADH secretion c. decreased aldosterone secretion d. increased synthesis and release of prostaglandins
Answer: A Rationale: Renin is released in resonse to decreased B/P, renal ischemia, eosinophil chemotactic factor (ECF) depletion, and other factors affecting blood suppy to the kidney. It is they catalyst of the renin-angiotensin-aldosterone system, which raises B/P when stimulated. ADH is secreted by the posterior pituitary in response to serum hyperosmolality and low blood volume. Aldosterone is secreted within the renin-angiotensin II, and kidney prostaglandins lower B/P by causing vasodilation.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? a. Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose. b. Administer furosemide (Lasix) 20 mg I.V. c. Encourage oral fluids. d. Start hemodialysis after a temporary access is obtained.
Answer: A Rationale: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a. Dehydration b. Crackles c. Hypertension d. Hyperkalemia
Answer: A Rationale: The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction? a. Urinary retention b. Cystitis c. Bladder stones d. Urethral stricture
Answer: A Rationale: Urinary retention and urinary incontinence are voiding dysfunctions, temporary or permanent alterations in the ability to urinate normally. Cystitis is an infectious disorder. Bladder stones and urethral stricture are obstructive disorders.
A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate? a. "Make sure to eat enough fiber to prevent constipation." b. "Try drinking coffee throughout the day." c. "Use scented powders to disguise any odor." d. "Limit the number of times you urinate during the day."
Answer: A Rationale:?Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying.
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? a. Urinary retention b. Painless hematuria c. Fever d. Frequency
Answer: B Rationale: The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.
You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults? a. Hypovolemia b. Dehydration c. Hypervolemia d. Fluid volume excess
Answer: B Rationale: The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.
The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? a. Clean intermittent catheterization b. Suprapubic cystostomy tube c. Permanent drainage with a urethral catheter d. Credé voiding procedure
Answer: C Rationale: Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones, renal diseases, bladder infections, and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: a. a decreased serum phosphate level secondary to kidney failure. b. an increased serum calcium level secondary to kidney failure. c. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. d. metabolic alkalosis secondary to retention of hydrogen ions.
Answer: C Rationale: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? a. "The effluent should be allowed to drain by gravity." b. "It is important to use strict aseptic technique." c. "The infusion clamp should be open during infusion." d. "It is appropriate to warm the dialysate in a microwave."
Answer: D ?Rationale: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
An age related change in the kidney that leads to nocturia in an older adult is: a. Decreased renal mass b. Decreased detrusor muscle tone c. Decreased ability to conserve sodium d. Decreased ability to concentrate urine
Answer: D Rationale: The decreased ability to concentrate urine results in an increased volume of dilute urine, which does not maintain the usual diurnal elimination pattern. A decrease in bladder capacity also contributes to nocturia, but decreased bladder muscle tone results in urinary retention. Decreased renal mass decreases renal reserve, but function is generally adequate under normal circumstances.
After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the student have understood the material when they identify which of the following as a cause of stress incontinence? a. Obstruction due to fecal impaction or enlarged prostate b. Bladder irritation related to urinary tract infections c. Increased urine production due to metabolic conditions d. Decreased pelvic muscle tone due to multiple pregnancies
Answer: D Rationale: Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.