EAQ 11- Elimination
Which is the maximum recommended length for enema tube insertion in an adolescent?
10 cm
Which is the recommended size of the urinary catheter that can be used in a 3 year old child?
8-10Fr; 5-6Fr generally used in infants; 14-16 Fr is recommended for most adult clients; 16-18 Fr is commonly used in adult males
A health care provider prescribed an upper GI series and a barium enema. The client asks, "Why do I need barium for these tests?" Which explanation would the nurse give?
it gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-rays
Which instruction would the nurse include in a health practices teaching plan for a female client with a history of recurrent urinary tract infections?
wear cotton underwear to lingerie
Which urine characteristic is consistent with a UTI?
cloudy- cellular debris, white blood cells, bacteria, and pus can cause the urine to become cloudy; dark, smoky urine usually suggests hematuria; orange-amber color of urine may indicate concentrated urine; yellow-brown to dark color of urine indicates excessive bilirubin
Which component of the client's nephron acts as a receptor site for the antidiuretic hormone to regulate water balance?
collecting ducts; Bowman capsule collects glomerular filtrate and funnels it into the tubule; the distal convoluted tubule acts as a site for additional water and electrolyte reabsorption; the proximal convoluted tubule is the site for reabsorption of sodium, chloride, water, and urea
Which factor would the nurse assess in a client reporting constipation?
diet, fluid intake, use of laxatives, date of last BM, and use of opioid pain medication
Which conclusion would the nurse make about the assessment finding of a client's very pale-yellow colored urine?
dilute urine
A health care provider prescribed a diuretic for a client with hypertension. Which mechanism of action explains how diuretics reduce blood pressure?
they reduce the circulating blood volume- decrease blood volume by blocking sodium reabsorption in the renal tubules, thus promoting fluid loss and reducing arterial pressure; direct relaxation of arteriolar smooth muscle is accomplished by vasodilator-they act on smooth muscles; medications that act on the nervous system inhibit sympathetic vasoconstriction
At which site would the nurse obtain a sterile urinalysis from a client with an indwelling catheter?
tubing injection port
The nurse prepares a male client with a history of recurrent UTI for discharge after uterolithotomy. Which clinical manifestations of a UTI would the nurse teach this client to recognize?
urgency or frequency of urination- occurs with UTI because of bladder irritability; burning on urination and fever are additional signs of a UTI; increased ketones indicates DM, starvation, or dehydration; pain radiating to the external genitalia is a symptom of a urinary calculus, not an infection
A client recovering from deep, partial thickness burns develops chills, fever, flank pain, and malaise. Which prescribed diagnostic test would the nurse expect to confirm a tentative urinary tract diagnosis?
urinalysis and urine culture and sensitivity- culture will identify the microorganism, and sensitivity will identify the most appropriate antibiotic; a cytoscopy is too invasive as a screening procedure; altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms; creatinine clearance reflects renal function; A/G ration reflects liver function; increased urine specific gravity may indicate red blood cells, white blood cells, or casts in the urine, which are associated with UTI, it will not identify the causative organism
Which is the recommended length of insertion of the enema tube in a child of 3 years?
5-7.5cm; for infants tube should be 2.5 to 3.7cm, for adolescents and adults the length is 7.5 to 10cm
The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis report. Which urinary finding indicates the need to notify the primary health care provider?
presence of large proteins- the glomeruli are not permeable to large proteins such as albumin or red blood cells, and findings them in the urine is abnormal; the urine can be acidic; the normal pH is 4-8; glucose and bacteria should be negative and are normal findings
What would the nurse ask the mother of a child who goes to the bathroom almost every hour at school?
"Has your child being going to the bathroom often at home?"- if this behavior persists outside school as well, the nurse may pursue a physical examination to test for possible problems such as UTI or diabetes
Which part of the kidney produces the hormone bradykinin?
juxtaglomerular cells of the arterioles- increases blood flow and vascular permeability; the kidney tissues produce prostaglandins that regulate internal blood flow by vasodilation or vasoconstriction; the kidney parenchyma produces erythropoietin that stimulates the bone marrow to make red blood cells; the renin producing granular cells produce the renin hormone that raises blood pressure as a result of angiotensin and aldosterone secretion
Which ovulation stimulant would the nurse identify as being derives from the urine of postmenopausal women?
menotropins- standardized mixture of follicle stimlating hormones and leuteinizing hormones; chomiphene is a synthetic ovulation stimulant; oxytocin and dinoprostone are synthetic uterine stimulants
A client who has been diagnosed with a myocardial infarction receives digoxin, fluoxetine, morphine, and docusate sodium. Which medication would the nurse identify as a risk factor for straining due to constipation?
morphine- opioids decrease peristalsis, straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart
Which characteristic of urine changes in the presence of UTI?
clarity- cloudy urine usually indicates drainage associated with infection; specific gravity yields information related to fluid balance
Which instruction would the nurse provide a client needing to collect a clean-catch urine specimen?
urinate a small amount, stop flow, and then fill one half of the specimen cup
The nurse receives an order to prepare the solution for administering a cleansing enema to a 3 year old child. Which is the volume of solution the nurse would prepare?
250-350mL of warmed solution for administering a cleansing enema; 150-250mL for infants; 300 to 500mL in school aged children; 500-750mL in adolescents
Which type of cytokine is used to treat anemia secondary to chronic kidney disease?
erythropoietin- cytokines are signaling cells, failing kidneys are not able to produce erythropoietin to signal bone marrow to produce red blood cells, resulting in anemia; a-interferon is used to treat hairy cell leukemia or malignant melanoma; interleukin-2 is used to treat metastatic renal carcinoma; interleukin-11 is used to prevent thrombocytopenia after chemotherapy
Which is the recommended size of the urinary catheter that can be used in a 3 year old child?
8-10Fr; 5-6Fr is for infants; 14-16Fr is for adult clients; a length of 16-18Fr is commonly used in adult males
The nurse is caring for a client who is having diarrhea. Which client data would the nurse closely monitor to prevent an adverse outcome?
fluid and electrolyte balance
Which hormone would the nurse identify as being excreted in urine during pregnancy?
human chorionic gonadotropin; estrogen, oxytocin, and progestin may induce ovulation but cannot be isolated from urine
After a cardiac catheterization, a client's urinary output is 3 times the client's fluid intake. What is the likely cause of the high urinary output?
an expected effect of the dye used with the procedure- the dye used is hypertonic and has a diuretic effect
The nurse recognizes which statement are true regarding the pharmacokinetic changes observed in infants
an infant's gastric pH is less acidic, an infant's gastric emptying is slow, and infant's first pass metabolism is slow
In which parts of the kidney are glucose and amino acids resorbed?
proximal tubule- glucose, amino acids, electrolytes, and bicarbonate are reabsorbed in the proximal tubule; in the distal tubules, water and bicarbonate are reabsorbed; sodium and chloride are reabsorbed in the ascending limb, and water in the descending loop; water is reabsorbed in the presence of antidiuretic hormone in the collecting duct
For which condition would an infant born with exstrophy of the bladder be at risk?
infection- greatest problem facing infant is infection of the bladder mucosa and excoriation of the surrounding tissue, meticulous hygiene is necessary both before and after surgery
The nurse would expect to find an increase of which substance in the urine of a client following a low carbohydrate diet?
ketones- as a result of fat metabolism, ketone bodies are formed and the kidneys attempt to decrease the excess by filtration and excretion, excessive ketones in the blood can cause metabolic acidosis
A client with irritable bowel syndrome has instructions to take psyllium for constipation. Which statement is important for the nurse to include in the teaching plan?
each dose should be taken with a full glass of water or juice- the bulk forming laxative works by absorbing water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement
Which statement indicates the nurse has a correct understanding of the kidney ultrasonography?
kidney US makes use of sound waves and has minimal risk, when reflected from internal organs of varying densities produce images of the kidneys, bladder, and associated structures on the display screen; bladder usually full when doing US; CT gives three dimensional information about the kidney and associated structures
The day after receiving instructions regarding dressing changes and care of a recently inserted nephrostomy tube, the client states, "I hope I can handle all this at home; it's a lot to remember." Which response would the nurse use?
"You seem to be nervous about going home
Which surgical procedure involves urinary diversion in which the ureters are transplanted to a resected section of the small intestines, with one end attached to the abdominal wall?
ileal conduit; cystostomy is an opening into the bladder through the abdominal wall that allows urine to flow out; in ureterosigmoidostomy the ureter is transplanted into the colon and urine is excreted through the rectum; in cutaneous ureterostomy the ureter is transplanted through the abdomen and attached to the skin
Which client statement indicates understanding of content taught about removing his or her three way indwelling catheter and continuous bladder irrigation?
I probably will experience some burning on urination- because of the trauma to the mucous membranes of the urinary tract, burning on urination is an expected response that should subside gradually
A client has a prescription for nitrofurantoin 50mg orally every evening to manage recurrent urinary tract infections. Which instruction would the nurse give to the client?
increase your intake of fluids- to prevent crystal formation should increase fluids to 1000-1500mL daily
Which goal would the nurse expect a client receiving treatment for bacterial cystitis to achieve before their discharge from the hospital?
achieve relief of clinical symptoms and maintain kidney function
The parents of a child diagnosed with hepatitis A express concern that other family members may contract hepatitis because they only have one bathroom. Which response would the nurse reply?
all family members, including your child, need to each their hands after using the bathroom- hep A is spread via the fecal oral route, transmission is prevented by proper hand washing
The nurse in the pediatric clinic is examining a toddler with a suspected pinworm (enterobius vermicularis) infestation. Which first sign of an infestation would the nurse assess the child?
anal itching- pinworm lays eggs around anal opening, producing itchy irritation; scaly patches commonly seen with eczema or dermatitis; a maculopapular rash may be seen with hookworm; a bald spot is produced by ringworm of the scalp
Wich hormonal deficiency causes diabetes insipidus in a client?
antidiuretic hormone; decreased levels of prolactin may cause decreased amounts of milk secretion after birth; decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy; luteinizing hormone deficiency causes menstrual abnormalities, decreased libido, and breast atrophy
The nurse administers vasopressin to a client and recalls that the medication is which type of hormone?
antidiuretic hormone; somatotropin is a growth hormone; gonadotropin as a luteinizing hormone; thyrotropin is a thyroid stimulating hormone
A client is scheduled for discharge after surgery. The medical record indicates that the client has not had a bowel movement since before surgery, which was four days ago. Which prescribed medication will the nurse administer to ensure a bowel movement before discharge?
bisacodyl suppository- takes effect in 15 to 60 minutes; lactulose takes about 24 hours to take effect; docusate sodium takes 1 to 3 days; psyllium takes 12 to 24 hours
Why is blood glucose self-monitoring preferred over urine glucose testing?
blood glucose monitoring is more accurate; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder
Which collecting structure is located at the end of the renal papilla?
calyx- a cuplike structure that collects urine and is located at the end of each papilla; the outer surface of the kidney consists of fibrous tissue and is called the capsule; the renal cortex is the outer tissue later; the renal columns are the cortical tissue that dip down into the interior of the kidney and separate the pyramids
Which sign and symptom is an associated complication of chronic kidney disease while undergoing peritoneal dialysis?
cloudy return dialysate- the returned dialysate should be clear, cloudy indicated infection
A client is taking fertility medications for the first time. Which adverse effect of the medication would the nurse inform the client about?
constipation; DVT adverse effect of prolonged use of fertility medications
A client arrives at a health clinic reporting a recent onset of hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse observe in the client's medical record?
cystitis- an inflammation of the bladder that cuases frequency and urgency or urination, pain on micturition, and hematuria; chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload; nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria; pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness
Which part of the kidney sense changes in blood pressure?
macula dense- part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood; calices are cuplike structures, present at the end of each papilla, that collect urine; the glomerulus is the initial part of the nephron, which filters blood to make urine; juxtaglomerular cells secrete renin; renin is produced when sensing cells in the macula dense sense changes in blood volume and pressure
Which urine specific gravity level is abnormal?
normal specific gravity of urine lies between 1.005 and 1.030
A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7mEq. Which action will the nurse take next?
notify the health care provider that the potassium level is below normal- normal range 3.5-5, clients on diuretic therapy require close monitoring of their electrolytes because some can cause hypokalemia, whereas others spare potassium, which can cause hyperkalemia
After several episodes of intermittent abdominal pain and vomiting, a 5 month old infant is admitted to the pediatric unit. Which nursing assessment helps confirm the diagnosis of intussesception?
observing the characteristics of stools- the stools are red and currant jelly like due to the mixture of stool with blood and mucus
Which physical assessment maneuver is the nurse performing when placing the nurse's left hand under on the client's right lower back between the rib cage and the iliac crest?
palpation
Which term is used for the tip of a pyramid in the kidney?
papilla- pyramids are components of renal medulla, and the tip of each pyramid is called the papilla; a calyx is a structure that collects the urine at the end of each pyramid; the renal calices joint together to form the renal pelvis; a renal column is a cortical tissue that separates the pyramids
When monitoring a client 24 to 48 hours after abdominal surgery, the nurse would assess for which problem associated with anesthetic agents?
paralytic ileus- nurse can prevent or minimize paralytic ileus by increasing movement as soon as possible after surgery through actions such as turning and early ambulation; evidence of bowel function returning to normal includes auscultation of bowel sounds and passing of flatus and stool; colitis, stomatitis, and gastrocolic reflux are not postoperative complications related to anesthetic agents
Which primary symptom would the nurse assess for in a boy who has encopresis?
passing feces either voluntary of involuntarily into inappropriate places- encopresis is the passage of feces into inappropriate places such as clothing, closets, floors, or toy boxes
Which stool finding would the nurse anticipate in a breastfed neonate?
pasty consistency; bottle fec infants typically have stool that is pale yellow to light brown in color with an offensive odor and firm consistency
Which medication turns urine reddish-orange in color?
phenazopyridine- a topical anesthetic that is used to treat pain or burning sensation associated with urination; amoxicillin is a penicillin form that could cause pseudomembranous colitis; ciprofloxacin is a quinolone antibiotic used for treating UTIs and can cause serious cardiac dysrhythmias and sunburns; nitrofurantoin in an antimicrobial medication prescribed for UTIs
The nurse is assisting the primary health care provider during renal ultrasonography. Arrange the steps involved in the procedure in the correct sequence.
place the client in prone position, apply gel over skin, move transducer across skin, wipe gel with cotton pad
Which term is sued to describe a client passing air and bubbles during urination?
pneumaturia- could result from the formation of a fistula between the bowel and urinary bladder
Which findings indicates that a client is at an increased risk for colorectal cancer?
presence of dark, tarry stools, family history of polyposis, 20 year history of ulcerative colitis, unintentional 20 pound weight loss, change in bowel pattern for 3 months
The client with a suprapubic prostatectomy for cancer of the prostate has continuous bladder irrigation (CBI) in place after surgery. Which primary goal is the nurse trying to achieve with CBI?
prevent the development of clots in the bladder- continuous flushing of the bladder dilutes the bloody urine and empties the bladder, preventing clots
Which nursing intervention would the nurse direct toward a child admitted for acute glomerulonephritis?
promoting diuresis
which nursing intervention would the nurse direct toward a child admitted for acute glomerulonephritis?
promoting diuresis- with the reduction of edema the child'd health improves, the appetite increases, and the blood pressure normalized; fluids not encouraged because the kidneys are inflamed and cannot tolerate large amounts of fluid; sodium intake is decreased, not eliminated
Which structure surrounding the male urethra would the nurse describe to a client scheduled for a dilation of the urethra?
prostate gland- prostate gland is shaped like a ring, with the urethra passing through its center; the epididymis lies along the top and sides of the testes; the seminal vesicles are on the posterior surface of the bladder; the bulbourethral gland lies below the prostate
The nurse shares the discharge instructions with a client who has prostate cancer. The client asks, "How much more blood will the need? Don't they have enough?" Which laboratory test would the nurse discuss the need to monitor throughout the course of the disease?
prostate-specific antigen (PSA)- PSA is an indication of the presence of prostate cancer, the higher the level, the greater the tumor burden; albumin is a protein and an indicator of nutritional and fluid status; creatinine and BUN levels indicate renal function and may elevate when blockage of the urethra occurs from an enlarges prostate, but the reports do not indicate metastasis or prostate cancer
Which part of the nephron secretes creatinine for elimination?
proximal tubule- secretes creatinine and hydrogen ions, also resorbs water and electrolytes; the glomerulus filters the blood selectively; ascending loop of Henle reabsorbs sodium and chloride, whereas the descending loop of Henle concentrates the filtrate; the collecting duct reabsorbs water
Which diagnostic tests are used to measure kidney size?
radiography and computed tomography (CT); cytoscopy is used to identify abnormalities of the bladder wall in clients with kidney dysfunction; a cystography and a cystourethrography are used to examine the structure of the urethra and to detect backward flow of urine
Which action is promoted by vasopressin?
reabsorption of water- also known and antidiuretic hormone, it helps in the reabsorption of water into the capillaries; aldosterone promotes sodium reabsorption; natriuretic hormones promote tubular secretions of sodium; erythropoietine stimulates bone marrow to make red blood cells
The nurse is caring for a client with a bowel obstruction. Which assessment findings indicate the possible onset of peritonitis?
rebound tenderness, diminished bowel sounds, rigid, boardlike abdomen
The nurse understands which vaccine may cause intussusception in children?
rotavirus- very rarely cause intussusception, a form of bowel obstruction in which the bowel telescopes in on itself; hepatitis vaccines can cause anaphylactic reactions; the MMR vaccine may cause thrombocytopenia; diphtheria, tetanus, and pertussis vaccine carries a small risk of causing acute encephalopathy, convulsions, and shock like state
When a parent asks about a sudden issue with bedwetting, which would the nurse document in the child's health record?
secondary enuresis- is the onset of bedwetting in a child who was previously potty trained at nighttime; primary enuresis occurs in a child who has never been trained overnight; encopresis is the involuntary passage of fecal material
Which antidepressant may be prescribed to a new mother diagnosed with depression?
sertraline- considered safe in lactating females, dosing immediately after breast feeding can reduce the risk for excretion of the medication in the breast milk by the next feeding time; fluoxetine and amphetamine are not recommended for breast feeding clients; carbamazepine is not used to treat depression
Which electrolyte deficiency triggers the secretion of renin?
sodium- low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion; decreased blood volume triggers the release of renin from the juxtaglomerular cells; deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin
A client with invasive carcinoma of the bladder is scheduled for a cystectomy and an ileal conduit. The client expresses worries about the possibility of offensive odors associated with the urinary diversion. How would the nurse respond?
tell me more about your concerns
Which statement reflects the nurse's suspicions regarding a client's cloudy urine noted on a urinalysis report?
the client has a urinary infection- urine becomes cloudy when infection present duet o presence of leukocytes; in case of biliary obstruction, the urine contains bilirubin; presence of ketones in the urine indicated diabetic ketoacidosis or prolonged starvation
A health care provider prescribes Lactobacillus granulates to a 3 month old infant to manage postantibiotic diarrhea. Which explanation would the nurse give to the infant's parents about the reason for giving lactobacilli?
the flora that inhibit a health GI tract must be recolonized- lactobacilli are part of the flora in the healthy GI tract- purpose of administering lactobacilli granules is to help recolonize the normal GI flora that were destroyed with antibiotic therapy
Which information would the nurse include when teaching about why women are more susceptible to UTIs than men?
the length of the urethra
Before client examination, the registered nurse provides education for a student nurse regarding the gross anatomy and physiology of the kidneys. Which statement made by the student nurse indicates the need for additional teaching?
the right kidney is a little longer and narrower than the left kidney- generally the left side kidney is slightly longer and narrower compared with the right side kidney; these are true- the existence of three kidney with normal kidney function is normal, the presence of a single kidney with normal kidney function is normal, the urinary bladder lies directly behind the pubic bone
A client with chronic kidney disease selects treatment using continuous ambulatory peritoneal dialysis (CAPD). Which statement indicates the client understands the purpose of this therapy?
the treatment uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion- diffusion moves particles from an area of greater concentration, osmosis moves fluid from an area of lesser concentration to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen; principle of ultrafilatration involves a pressure gradient, which is associated with hemodialysis
Why is the vomitus of an infant with pyloric stenosis withe rather than bile stained?
there is an obstruction above the opening of the common bile duct- the common bile duct enters the duodenum, the pyloric sphincter is located between the end of the stomach and the beginning of the duodenum, therefor when it is hypertrophied the tight sphincter prevents any mixing of vomited formula with bile
Identify the hypersensitivity reaction associated with systemic lupus erythematosus (SLE)
type III; anaphylaxis is an example of type 1 or immediate hypersensitive reaction; cytotoxic, or type II, hypersensitive reactions can result in conditions such as myasthenia gravis and Goodpasture syndrome; graft rejection and sarcoidosis are conditions caused by delayed or type IV hypersensitivity reactions
