EAQ Ch. 44 Urinary System Assessment
Which functional ability would the nurse anticipate for the patient who sustained a severe spinal cord injury in the sacral and thoracolumbar regions of the vertebral column? Inability to urinate CORRECT Ability to ambulate to the bathroom Need to use a urinal/bedpan to urinate Need to call for assistance when needing to void
Together, the bladder, urethra, and pelvic floor muscles form what is called the urethrovesical unit. Voluntary control of this unit is defined as continence. Stimulating and inhibiting impulses are sent from the brain through the thoracolumbar (T11 to L2) and sacral (S2 to S4) areas of the spinal cord to control voiding. Damage in this area will prevent voluntary control and lead to incontinence. Without control, the patient may not be aware of the need to go to the bathroom, to use a urinal/bedpan, or to call for assistance.
For the patient with a history of recurrent urinary tract infections, which procedural teaching point would the nurse emphasize when scheduling the patient for a cystoscopy? "You might have pink-tinged urine and burning after your cystoscopy." CORRECT "Refrain from eating or drinking after midnight the day before the test." "The morning of the test, you will drink some water containing a contrast solution." "A urinary catheter will be inserted before the cystoscopy and remain for a few days."
4 "A urinary catheter will be inserted before the cystoscopy and remain for a few days." Pink-tinged urine, burning, and frequent urinating are common following a cystoscopy. The patient does not need to be NPO before the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.
During an IV pyelogram, development of which clinical manifestation would prompt the nurse to report the patient's status to the health care provider? Flushing of the face Salty taste in the mouth Tight sensation in the throat CORRECT Feeling of warmth over the entire body
A tight feeling in the throat indicates the possible development of a severe allergic reaction to the dye used during IV pyelography, resulting in edema of the larynx and difficulty breathing. Flushing of the face, a salty taste in the mouth, and a feeling of warmth over the body are all possible and expected side effects during this procedure. They are usually transient and nondistressing.
Which instruction would the nurse provide the patient when explaining the process of collecting a urine sample at home for a prescribed urinalysis? Collect your urine sample at some point during the night, tonight. In the morning, during your first void, collect a sample of your urine. CORRECT At any time prior to the clinic's closing time, collect your urine sample. Obtain your prescribed urine sample one hour after your first morning void.
Although a specimen may be collected at any time of the day for a routine urinalysis, it is best to obtain the first specimen urinated in the morning. This concentrated specimen is more likely to contain abnormal constituents if they are present in the urine. The specimen should be examined within one hour of urinating. It is not necessary to collect the urine overnight.
Which diagnostic report would the nurse review when identifying a patient's renal function? Urinalysis Creatinine clearance CORRECT Blood urea nitrogen (BUN) Composite urine collection
Because almost all creatinine in the blood is excreted normally by the kidneys, creatinine clearance is the most accurate indicator of renal function. It is a commonly used test to analyze renal function and urinary system disorders. The result of a creatinine clearance test closely approximates that of the glomerular filtration rate. Urinalysis is a general examination of urine to establish baseline information. Composite urine collection measures specific components, such as electrolytes, glucose, protein, 17-ketosteroids, catecholamines, creatinine, and minerals. BUN is used to detect renal problems but is not as reliable as creatinine clearance.
A patient reports extreme left flank pain, training for a marathon, high-protein diet, and drinking "a lot of milk." Which potential disorder would the nurse associate with the patient's admission assessment data? Renal calculi CORRECT Muscle strain Urinary tract infection (UTI) Excessive nocturnal urination
Dehydration may contribute to UTIs, calculi formation, and kidney failure. Large intake of foods, such as dairy products or foods high in proteins, may also lead to calculi formation. Because the patient is athletic, muscle strain is probably not the primary cause of his symptoms. Caffeine, alcohol, carbonated beverages, some artificial sweeteners, or spicy foods often aggravate urinary inflammatory diseases. The patient avoids sodas, so this would not be as great a concern. Up to one episode of nocturia is considered normal in younger adults, and up to two episodes are acceptable among adults ages 65 years or older.
When all laboratory specimens are transported two hours away for analysis, which action would the nurse implement when obtaining a patient's urine specimen for a prescribed urinalysis? Refrigerate the urine specimen. CORRECT Send the patient to the laboratory. Store the specimen at 25 oC (77 oF). Send the specimen to the lab immediately.
Ideally, examination of the specimen for urinalysis occurs within one hour of urinating. If immediate analysis is not possible, refrigerate the urine sample until analyzed. If the urine sample is not refrigerated, bacteria will start multiplying. The red blood cells tend to hemolyze, casts disintegrate, and the urine becomes alkaline, as a result of urea-splitting bacteria. The nurse is able to collect the specimen, refrigerate, and transport to the laboratory instead of sending a patient on an unnecessary two-hour trip to have a fresh specimen. Storing the specimen at 25oC (77oF) would still likely cause bacteria to multiply.
Which assessment finding would the nurse report to the health care provider who prescribed gentamicin for a patient with pneumonia from Pseudomonas? Decreased weight Increased appetite Increased urinary output Elevated creatinine level CORRECT
Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the health care provider because it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have the side effect of anorexia.
Which instructions would the nurse provide the patient scheduled for a renal CT scan? Select all that apply. Begin fasting at 12 o'clock midnight before the scan. Rest for six hours prior to the scheduled test. This test does not have any activity restrictions. CORRECT Dietary restrictions are not required for this test. CORRECT Neither pain nor discomfort occurs during the test. CORRECT
When preparing the patient for a renal CT scan, the nurse should inform the patient that no dietary or activity restrictions are required. Also, no pain or discomfort should be felt during the test. The test does not require the patient to fast before the test or to restrict activities and rest.
Which patient action may contaminate the specimen when collecting a clean-catch, midstream urine sample? The patient collects the urine sample in a sterile specimen cup. The patient cleans the urinary meatus in a back-to-front motion. CORRECT The patient uses three sponges saturated with cleansing solution for cleaning. The patient starts urinating and then continues urinating in the sample container.
A clean-catch midstream urine sample is ideal for obtaining a urine culture because it is the method that is least likely to be contaminated. However, if the patient cleans the meatus in a back-to-front motion, then the urine may get contaminated with microorganisms from the anal area. Therefore the patient should be instructed to clean the meatus in a front-to-back motion. The urine sample should be collected in a sterile specimen container for accurate culture results. The patient should use at least three sponges saturated with a cleansing solution to clean the meatus because this helps to prevent contamination of the urine sample. After the cleaning, the patient starts voiding, and then continues voiding into the sample container. This midstream collection helps to ensure that the sample is without any contaminants
Which action would the nurse implement when assessing a postoperative patient who had a urinary catheter discontinued eight hours ago, is tolerating fluids, but is unable to void? Perform a bladder scan. CORRECT Schedule a cystometrogram. Obtain a residual urine test. Order a kidneys, ureters, bladder (KUB) x-ray.
If the patient is unable to void, the bladder may be palpated for distention and percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicoureteral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder, so this assessment would not be helpful for this patient.
Which urinalysis result would the nurse recognize as an abnormal finding? Urine pH 6.0 Amber yellow color Specific gravity 1.025 White blood cells (WBCs) 9/hpf CORRECT
Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average, amber yellow is normal coloration, and the reference ranges for specific gravity are 1.005 to 1.030.
At 7:00 AM, which intervention would the nurse implement when noting the patient's urine output was 1500 mL of clear yellow urine for yesterday's 12-hour day shift and 700 mL urine output on last night's 12-hour shift? Perform a straight catheterization. Restrict fluid intake to clear liquids. Continue to monitor the urine output. CORRECT Notify the patient health care provider.
Normal adult urine output is approximately 1500 mL/day, which varies with food and fluid intake. The volume of urine produced at night is less than half of that formed during the day because of hormonal influences (e.g., antidiuretic hormone [ADH]). This diurnal pattern of urination is normal. The nurse should continue to monitor urine output. There is no need to notify the patient health care provider or perform a catheterization. Fluid restriction is not warranted unless there are other conditions that require it.
Which term would the nurse utilize to document an older adult's recent difficulties with pain when establishing and maintaining a urine stream? Anuria Dysuria CORRECT Oliguria Enuresis
Painful and difficult urination is characterized as dysuria. Anuria is an absence of urine production, whereas oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.
Which explanation would the nurse associate with the patient who experienced progressive renal failure over the last 10 years, dialysis for the last 5 years, and now has a diagnosis of chronic anemia? Decreased renin production Increased vitamin D production Increased erythropoietin production Decreased erythropoietin production CORRECT
The kidneys perform vital functions through participation in red blood cell (RBC) production and BP regulation. Erythropoietin is a hormone produced in the kidneys and secreted in response to hypoxia and decreased renal blood flow. Erythropoietin stimulates RBC production in the bone marrow. A deficiency of erythropoietin occurs in kidney failure, leading to anemia. The patient with kidney failure (also called renal failure) has a deficiency of the active metabolite of vitamin D and manifests problems of altered calcium and phosphate balance. Renin is released into the bloodstream in response to decreased renal perfusion, decreased arterial BP, decreased extracellular fluid (ECF), decreased serum Na+ concentration, and increased urinary Na+ concentration. It has no direct effect on blood cell production.
Which advice would the nurse provide the patient who calls into the clinic reporting burning, frequency, and difficulty when urinating? "Drink less fluid so you don't have to void so often." "Take some acetaminophen to decrease the discomfort." "Come in so we can check a clean-catch urine specimen." CORRECT "Avoid caffeine and spicy food to decrease inflammation."
The patient's symptoms are typical of a urinary tract infection (UTI). To verify this, a clean-catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.
Identify the primary functions of the kidneys. Select all that apply. Maintaining the body's internal homeostasis CORRECT Diverting blood away from Bowman's capsule Allowing for slow filtration within the glomerulus Excreting excess blood cells and proteins in the urine Filtering and removing waste products from the body CORRECT
The primary functions of the kidneys are to filter the blood to remove waste products and maintain the body's internal homeostasis. Urine formation begins at the glomerulus, where blood filtering occurs. The hydrostatic pressure of the blood within the glomerular capillaries causes filtering of a portion of blood across the semipermeable membrane into Bowman's capsule, where the filtered portion of the blood (the glomerular filtrate) begins to pass down to the tubule. Filtration is more rapid in the glomerulus than in ordinary tissue capillaries because the glomerular membrane is porous. The ultrafiltrate is similar in composition to blood except that it lacks blood cells, platelets, and large plasma proteins. Under normal conditions, the capillary pores are too small to allow the loss of these large blood components. In many kidney diseases, capillary permeability is increased, which permits plasma proteins and blood cells to pass into the urine.
Which response would the nurse use when the patient questions the purpose of the 24-hour urine collection for determining creatinine clearance? The patient's age does not affect the serum creatinine clearance levels. The creatinine clearance closely approximates the glomerular filtration rate (GFR). CORRECT Serum creatinine clearance levels vary greatly among individuals and disorders. Protein ingestion and digestion significantly affect serum creatinine clearance levels.
The result of a creatinine clearance test closely approximates that of the GFR. Serum creatinine clearance levels remain remarkably constant for each person because they are not significantly affected by protein ingestion, muscular exercise, water intake, or rate of urine production. After age 40, the creatinine clearance rate decreases at a rate of about 1 mL/min/yr. Normal creatinine clearance values range from 70 to 135 mL/min.
Which element promotes water reabsorption by the distal convoluted tubules of the kidney to regulate fluid balance? Aldosterone availability Antidiuretic hormone (ADH) CORRECT Concentration of sodium ions Concentration of chloride ions
Two important functions of the distal convoluted tubules are the final regulation of water balance and acid-base balance. ADH is required for water reabsorption in the kidney and is important in water balance. ADH makes the distal convoluted tubules and the collecting ducts permeable to water, allowing water to be reabsorbed into the peritubular capillaries and eventually returned to the circulation. Chloride and sodium ions are reabsorbed but do not allow reabsorption. Aldosterone causes reabsorption of sodium ions and water.
