CH57 Intro to Urinary System
A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: 1) pyelonephritis. 2) ureteral stones. 3) Urethral infection. 4) cystitis.
Correct response: ureteral stones. Explanation: The findings are constant with ureteral stones, edema or stricture, or a blood clot. The other answers do not apply.
A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? 1) glucose 2) chloride 3) creatinine 4) potassium
Correct response: glucose Explanation: Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.
A client with gross hematuria has been admitted to a surgical floor in preparation for an upper cystoscopy in the morning. What post-procedure interventions would the nurse anticipate for this client? 1) Select all that apply. 2) Sedative agent administration 3) Intermittent straight catheterization 4) Moist heat to abdomen 5) Nothing by mouth (NPO) 6) Monitor for urinary retention
Correct Response: Moist heat to abdomen Monitor for urinary retention Intermittent straight catheterization Explanation: Post-procedural management is directed at relieving any discomfort from the procedure. Moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing muscles. The client may experience urinary retention, so intermittent straight catheterization may be necessary for a few hours after the procedure. The nurse would also monitor the client for signs of urinary tract infection and obstruction. NPO and sedative agent administration is accomplished before the procedure. A cystoscope examination/procedure is used to directly visualize the urethra and bladder.
A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response? 1) "A biopsy is often ordered for clients before they have a kidney transplant." 2) "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease." 3) "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." 4) "A biopsy is routinely ordered for all clients with renal disorders."
Correct response: "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease." Explanation: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute kidney injury, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.
The nurse is giving discharge instructions to the client following a bladder ultrasound. Which statement by the client indicates the client understands the instructions? 1) "It is normal for my urine to be blood-tinged." 2) "If I have difficulty urinating, I should contact my physician." 3) "I should increase my fluid intake for the rest of the day." 4) "I can resume my usual activities without restriction."
Correct response: "I can resume my usual activities without restriction." Explanation: A bladder ultrasound is a non-invasive procedure. The client can resume usual activities without restriction.
A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult? 1) "Remember to drink frequently, even if you don't feel thirsty." 2) "Make sure you eat plenty of salt in order to stimulate thirst." 3) "Ensure that you avoid replacing water with other beverages." 4) "If possible, try to drink at least 4 liters of fluid daily."
Correct response: "Remember to drink frequently, even if you don't feel thirsty." Explanation: The nurse emphasizes the need to drink throughout the day even if the client does not feel thirsty because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive, and fluids other than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for increased fluid intake.
Which value represents a normal BUN-to-creatinine ratio? 4:1 6:1 8:1 10:1
Correct response: 10:1 Explanation: A normal BUN-to-creatinine ratio is about 10:1. The other values are incorrect.
The nurse received report on a hospitalized patient who was being evaluated for renal disease. The nurse was told that the patient had oliguria. Select the output record that would be consistent with that diagnosis. 1) 800 mL/24 hr 2) 600 mL/24 hr 3) 350 mL/24 hr 4) 2,000 mL/24 hr
Correct response: 350 mL/24 hr Explanation: Oliguria refers to an output of less than 400 mL/day.
The normal urine pH range should be: 1) 6.0 to 9.5. 2) 3.5 to 5.0. 3) 4.5 to 6.0. 4) 4.6 to 8.0.
Correct response: 4.6 to 8.0. Explanation: The normal range for urine pH is 4.6 to 8.0.
A nurse is caring for a client with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples? 1) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values 2) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process 3) A BUN and serum creatinine level on three consecutive mornings 4) A fasting serum potassium level and a random urine sample
Correct response: A 24-hour urine specimen and a serum creatinine level midway through the urine collection process Explanation: To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.
A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient? Less reabsorption of water ADH stimulation Diuresis An increase in urine volume
Correct response: ADH stimulation Explanation: Antidiuretic hormone (ADH), also known as vasopressin, is a hormone that is secreted by the posterior portion of the pituitary gland in response to changes in osmolality of the blood. With decreased water intake, blood osmolality tends to increase, stimulating ADH release.
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? 1) At 8:00 am, with or without a specimen 2) After discarding the 8:00 am specimen 3) With the first specimen voided after 8:00 am 4) 6 hours after the urine is discarded
Correct response: After discarding the 8:00 am specimen Explanation: A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to: 1) Encourage high fluid intake. 2) Apply moist heat to the flank area. 3) Monitor for hematuria. 4) Strain all urine for 48 hours.
Correct response: Encourage high fluid intake. Explanation: A voiding cystogram involves the insertion of a urinary catheter, which can result in the introduction of microorganism into the urinary tract. Fluid intake is encouraged to flush the urinary tract and promote removal of microorganisms. Monitoring for hematuria, applying heat, and straining urine do not address the nursing diagnosis of risk for infection.
Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse? 1) Distract the client's attention from the pain. 2) Assess the patient's back and shoulder areas for signs of internal bleeding. 3) Provide analgesics to the client. 4) Enable the client to sit up and ambulate.
Correct response: Assess the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the client should be on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake.
The nurse is performing a focused genitourinary and renal assessment of a client. Where should the nurse assess for pain at the costovertebral angle? 1) At the suprapubic region and the umbilicus 2) At the umbilicus and the right lower quadrant of the abdomen 3) At the 7th rib and the xiphoid process 4) At the lower border of the 12th rib and the spine
Correct response: At the lower border of the 12th rib and the spine Explanation: The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle.
The nurse is reviewing the electronic health record of a client with a history of incontinence. The nurse reads that the health care provider assessed the client's deep tendon reflexes. What condition of the urinary/renal system does this assessment address? Renal calculi Recurrent urinary tract infections (UTIs) Benign prostatic hyperplasia (BPH) Bladder dysfunction
Correct response: Bladder dysfunction Explanation: The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of testing for neurologic causes of bladder dysfunction because the sacral area, which innervates the lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic function does not directly influence the course of renal calculi, BPH or UTIs.
A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions? 1) Check the patient's urine for hematuria. 2) Place a bed board under the mattress to add support. 3) Keep the patient on bed rest for 72 hours. 4) Apply moist heat, every 4 hours for the first 48 hours to aid healing.
Correct response: Check the patient's urine for hematuria. Explanation: The kidneys are located from the 12th thoracic vertebrae to the third lumbar vertebrae. Therefore, the accident may have caused blunt force trauma damage to the kidneys. Ice is always applied for the first 24 hours, then heat, if not contraindicated. Activity will be restricted but bed rest is not necessary.
A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection? 1) Blood urea nitrogen 2) Creatinine 3) Hemoglobin 4) Osmolality
Correct response: Creatinine Explanation: To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine concentration is measured midway through the collection. The other concentrations are not measured during this test.
Which value does the nurse recognize as the best clinical measure of renal function? 1) Circulating ADH concentration 2) Volume of urine output 3) Urine-specific gravity 4) Creatinine clearance
Correct response: Creatinine clearance Explanation: Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.
A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? 1) GI absorption rate 2) Creatinine clearance 3) Therapeutic index 4) Liver function studies
Correct response: Creatinine clearance Explanation: 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.
The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? 1) Decreased fluid intake 2) Diabetes insipidus 3) Increased fluid intake 4) Glomerulonephritis
Correct response: Decreased fluid intake Explanation: When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.
Diagnostic testing of an adult client reveals renal glycosuria. The nurse should recognize the need for the client to be assessed for what health problem? 1) Diabetes insipidus 2) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 3) Diabetes mellitus 4) Renal carcinoma
Correct response: Diabetes mellitus Explanation: Renal glycosuria can occur on its own as a benign condition. It also occurs in poorly controlled diabetes, the most common condition that causes the blood glucose level to exceed the kidney's reabsorption capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.
The nurse is caring for a client suspected of having renal dysfunction. When reviewing laboratory results for this client, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? 1) Potassium and sodium 2) Creatinine and chloride 3) Glucose and protein 4) Bicarbonate and urea
Correct response: Glucose and protein Explanation: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that they are not excreted in the urine.
A client with a history of incontinence will undergo urodynamic testing in the health care provider's office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action? 1) Push fluids for several hours prior to the test. 2) Help the client to relax before and during the test. 3) Discuss possible test results as the client voids. 4) Administer diuretics as prescribed.
Correct response: Help the client to relax before and during the test. Explanation: Voiding in the presence of others can frequently cause guarding, a natural reflex that inhibits voiding due to situational anxiety. Because the outcomes of these studies determine the plan of care, the nurse must help the client relax by providing as much privacy and explanation about the procedure as possible. Diuretics and increased fluid intake would not address the client's anxiety. It would be inappropriate and anxiety-provoking to discuss test results during the performance of the test.
Regulation of electrolyte balance is a management goal for patients suffering from renal disease. Which of the following lab results is considered the most life-threatening effect of renal failure? 1) Hyperkalemia 2) Hypocalcemia 3) Hypernatremia 4) Hyperphosphatemia
Correct response: Hyperkalemia Explanation: The kidneys are responsible for excreting more than 90% of the body's potassium. The normal level is 5 mEq/L. Mild hyperkalemia (5.1 to 6 mEq/L) may have little effect on the electrical conduction of the heart. Moderate hyperkalemia (6.1 to 7 mEq/L) can produce ECG changes, and severe hyperkalemia (>7 mEq/L) can cause cardiac arrest.
Regulation of electrolyte balance is a management goal for patients suffering from renal disease. Which of the following lab results is considered the most life-threatening effect of renal failure? 1) Hypocalcemia 2) Hypernatremia 3) Hyperkalemia 4) Hyperphosphatemia
Correct response: Hyperkalemia Explanation: The kidneys are responsible for excreting more than 90% of the body's potassium. The normal level is 5 mEq/L. Mild hyperkalemia (5.1 to 6 mEq/L) may have little effect on the electrical conduction of the heart. Moderate hyperkalemia (6.1 to 7 mEq/L) can produce ECG changes, and severe hyperkalemia (>7 mEq/L) can cause cardiac arrest.
A nurse is working with a client who will undergo invasive urologic testing. The nurse has informed the client that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria? 1) Activity limitation for the first 12 hours after the test 2) Use of an over-the-counter (OTC) diuretic after the test 3) Increased fluid intake following the test 4) Gentle massage of the lower abdomen
Correct response: Increased fluid intake following the test Explanation: Drinking fluids can help to clear hematuria. Diuretics are not used for this purpose. Activity limitation and massage are unlikely to resolve this expected consequence of testing.
The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse normally anticipate? 1) Decrease in blood urea nitrogen (BUN) 2) Decreased urine osmolality 3) Less antidiuretic hormone (ADH) released 4) Increased urine specific gravity
Correct response: Increased urine specific gravity Explanation: Urine specific gravity depends largely on hydration status. A decrease in fluid intake will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. Blood urea nitrogen (BUN) levels are usually elevated with volume deficits related to dehydration. With decreased water intake as seen in a client with fluid volume deficit, blood osmolality increases, which stimulates antidiuretic hormone (ADH) release. ADH acts on the kidney, increasing water reabsorption and returning the blood osmolality to a normal level. Normally, urine osmolality increases (urine is concentrated) with fluid volume deficits.
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? 1) Cortisol 2) Renin 3) Albumin 4) Vasopressin
Correct response: Renin Explanation: Renin is directly involved in the control of arterial blood pressure. It is also essential for the proper functioning of the glomerulus and management of the body's renin-angiotensin system (RAS).
The nurse observes that the client's urine is orange. Which additional assessment would be important for this client? 1) Bleeding 2) Infection 3) Intake of medication such as phenazopyridine hydrochloride 4) Intake of multiple vitamin preparations
Correct response: Intake of medication such as phenazopyridine hydrochloride Explanation: Urine that is orange may be caused by intake of phenazopyridine hydrochloride or other medications. Orange to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Urine that is bright yellow is an anticipated abnormal finding in the client taking a multiple vitamin preparation. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams. Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications phenazopyridine hydrochloride and nitrofurantoin. Infection would cause yellow to milky white urine. Phenytoin would cause the urine to become pink to red. Metronidazole would cause the urine to become brown to black.
Which is an effect of aging on upper and lower urinary tract function? 1) Increased blood flow to the kidneys 2) Acid-base balance 3) Increased glomerular filtration rate 4) More prone to develop hypernatremia
Correct response: More prone to develop hypernatremia Explanation: The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.
Which term best describes a total urine output less than 500 mL in 24 hours? 1) Oliguria 2) Dysuria 3) Nocturia 4) Polyuria
Correct response: Oliguria Explanation: Oliguria is a urine output less than 500 mL in 24 hours. Polyuria is increased urine output. Nocturia is awakening at night to urinate. Dysuria is painful or difficult urination.
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected? 1) A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. 2) When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity may vary widely. 3) On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. 4) On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity.
Correct response: On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. Explanation: Specific gravity is altered by the presence of blood, protein, and casts in the urine and is normally influenced primarily by hydration status. On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired, and the specific gravity remains relatively constant.
Retention of which electrolyte is the most life-threatening effect of renal failure? 1) Sodium 2) Phosphorous 3) Potassium 4) Calcium
Correct response: Potassium Explanation: Retention of potassium is the most life-threatening effect of renal failure.
A client with recurrent urinary tract infections has just undergone a cystoscopy and reports slight hematuria during the first void after the procedure. What is the nurse's most appropriate action? 1) Position the client supine and insert a Foley catheter, as prescribed. 2) Reassure the client that this is not unexpected and then monitor the client for further bleeding. 3) Promptly inform the health care provider of this assessment finding. 4) Administer a STAT dose of vitamin K, as prescribed.
Correct response: Reassure the client that this is not unexpected and then monitor the client for further bleeding. Explanation: Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected after cystoscopy. The nurse should explain this to the client and ensure that the bleeding resolves. No clear need exists to report this finding and it does not warrant insertion of a Foley catheter or vitamin K administration.
Which of the following is an age-related change associated with the renal system? 1) Renal arteries thicken 2) Increased bladder capacity 3) Blood flow increase 4) Kidney weight increases
Correct response: Renal arteries thicken Explanation: Age-related changes include thickening of the renal arteries, a decrease in the weight of the kidney, blood flow decrease by approximately 10% per decade, and decreased bladder capacity.
Which of the following hormones is secreted by the juxtaglomerular apparatus? 1) Renin 2) Aldosterone 3) Calcitonin 4) Antidiuretic hormone (ADH)
Correct response: Renin Explanation: Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.
The nurse is assessing a client's bladder by percussion. The nurse elicits dullness after the client has voided. How should the nurse interpret this assessment finding? 1) The client has kidney enlargement. 2) The client has a ureteral obstruction. 3) The client's bladder is not completely empty. 4) The client has a fluid volume deficit.
Correct response: The client's bladder is not completely empty. Explanation: Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.
A nurse is preparing a client diagnosed with benign prostatic hyperplasia (BPH) for a lower urinary tract cystoscopic examination. The nurse should caution the client about what common temporary complication of this procedure? 1) Nausea 2) Bladder perforation 3) Hemorrhage 4) Urinary retention
Correct response: Urinary retention Explanation: After a cystoscopic examination, the client with obstructive pathology may experience urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the client with prostatic hyperplasia for urine retention. Postprocedure, the client will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.
A client has been asked to provide a clean-catch midstream urine specimen. It is important that the instructions are clear and that things are done in the proper order. Select the proper sequence of events for obtaining a specimen from a client. 1) Wash hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands. 2) Wash hands and remove the lid from the specimen container without touching the inside of the lid. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands. Open the antiseptic towelette package and cleanse the urethral area. 3) Wash hands and remove the lid from the specimen container without touching the inside of the lid. Begin voiding into the toilet. Open the antiseptic towelette package and cleanse the urethral area. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands. 4) Wash hands and remove the lid from the specimen container without touching the inside of the lid. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Open the antiseptic towelette package and cleanse the urethral area. Carefully replace the lid, dry the container if necessary, and wash hands.
Correct response: Wash hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands. Explanation: Wash hands and remove the lid from the specimen container without touching the inside of the lid. Open the antiseptic towelette package and cleanse the urethral area. Begin voiding into the toilet. Void 30 to 50 mL of the midstream urine into the collection container, taking care not to contaminate the container. Carefully replace the lid, dry the container if necessary, and wash hands.
A client is being seen by the urologist due to an increasingly troublesome need to urinate several times through the night. After checking the client's prostate (which was within normal limits), the physician prescribes limiting fluid intake after the evening meal. What is causing the client's increased need to urinate? 1) increased age 2) increased protein intake 3) leg elevation 4) increased sodium intake
Correct response: leg elevation Explanation: Urine formation increases during the night when leg elevation promotes blood return to the heart and kidneys and may interrupt sleep patterns.
A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 mL. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of: 1) prostate irritation. 2) incorrect urine output values. 3) client discomfort. 4) microorganism transfer.
Correct response: microorganism transfer. Explanation: Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.