Lewis Ch 45/46

Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur? a. The only treatment modalities for the disease are palliative. b. Diagnostic tests are not available to detect tumors before they metastasize. c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced. d. Early metastasis to the brain impairs the patient's ability to recognize the seriousness of symptoms.

c. There are no early characteristic symptoms of cancer of the kidney and gross hematuria, flank pain, and a palpable mass do not occur until the disease is advanced. The treatment of choice is a partial or radical nephrectomy, which can be successful in early disease. Many kidney cancers are diagnosed as incidental imaging findings. Targeted therapy is the preferred treatment for metastatic kidney cancer. Radiation is palliative. The most common sites of metastases are the lungs, liver, and long bones.

A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity b. No treatment with medication unless she develops fever, chills, and flank pain c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests

c. Unless a patient has a history of recurrent UTIs or a complicated UTI, trimethoprim-sulfamethoxazole (TMPSMX) or nitrofurantoin (Macrodantin) is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment but symptomatic UTIs should always be treated.

2. While caring for a 77 y/o woman who has a urinary catheter, the nurse monitors the pt for the development of a UTI. What clinical manifestations is the patient most likely to experience? a. Cloudy urine and fever b. Urethral burning and bloody urine c. Vague abdominal discomfort and disorientation d. Suprapubic pain and slight decline in body temperature

c. Vague abdominal discomfort and disorientation

3. A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Empty the bladder at least 4 times a day. b. Drink at least 2 quarts of water every day. c. Wait to urinate until the urge is very intense d. Clean the urinary meatus with an antiinfective agent after voiding

c. Wait to urinate until the urge is very intense

10. Glomerulonephritis is characterized by glomerular damage caused by a. growth of m/os in the glomeruli b. release of bacterial substances toxic to the glomeruli c. accumulation of immune complexes in the glomeruli d. hemolysis of RBCs circulating int he glomeruli

c. accumulation of immune complexes in the glomeruli

Which characteristics are associated with urge incontinence (select all that apply)? a. Treated with Kegel exercises b. Found following prostatectomy c. Common in postmenopausal women d. Involuntary urination preceded by urgency e. Caused by overactivity of the detrusor muscle f. Bladder contracts by reflex, overriding central inhibition

d, e, f. Urge incontinence is involuntary urination preceded by urgency caused by overactivity of the detrusor muscle when the bladder contracts by reflex, which overrides central inhibition. Treatment includes treating the underlying cause and retraining the bladder with urge suppression, anticholinergic drugs, or containment devices. The other options are characteristic of stress incontinence. Patients may have a combination of urge and stress incontinence.

Which test is required for a diagnosis of pyelonephritis? a. Renal biopsy b. Blood culture c. Intravenous pyelogram (IVP) d. Urine for culture and sensitivity

d. A urine specimen specifically obtained for culture and sensitivity is required to diagnose pyelonephritis because it will show pyuria, the specific bacteriuria, and what drug the bacteria is sensitive to for treatment. The renal biopsy is used to diagnose chronic pyelonephritis or cancer. Blood cultures would be done if bacteremia is suspected. Intravenous pyelogram (IVP) would increase renal irritation, but CT urograms may be used to assess for signs of infection in the kidney and complications of pyelonephritis.

What manifestation in the patient will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)? a. Hematuria b. Proteinuria c. Hypertension d. Elevated blood urea nitrogen (BUN)

d. An elevated blood urea nitrogen (BUN) indicates that the kidneys are not clearing nitrogenous wastes from the blood and protein may be restricted until the kidney recovers. Proteinuria indicates loss of protein from the blood and possibly a need for increased protein intake. Hypertension is treated with sodium and fluid restriction, diuretics, and antihypertensive drugs. The hematuria is not specifically treated.

When caring for the patient with interstitial cystitis, what can the nurse teach the patient to do? a. Avoid foods that make the urine more alkaline. b. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder. c. Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia. d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.

d. Calcium glycerophosphate (Prelief) alkalinizes the urine and can help to relieve the irritation from acidic foods. A diet low in acidic foods is recommended and if a multivitamin is used, high-potency vitamins should be avoided because these products may irritate the bladder. A voiding diary is useful in diagnosis but does not need to be kept indefinitely.

11. What manifestation in the pt will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)? a. Hematuria b. Proteinuria c. HTN d. Elevated BUN

d. Elevated BUN

Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks? a. Milk and milk products b. Dried beans and dried fruits c. Liver, kidney, and sweetbreads d. Spinach, cabbage, and tomatoes

d. Oxalate-rich foods should be limited to reduce oxalate excretion. Foods high in oxalate include spinach, rhubarb, asparagus, cabbage, and tomatoes, in addition to chocolate, coffee, and cocoa. Currently, it is believed that high dietary calcium intake may actually lower the risk for renal stones by reducing the intestinal oxalate absorption and therefore the urinary excretion of oxalate. Milk, milk products, dried beans, and dried fruits are high sources of calcium. Organ meats are high in purine, which contributes to uric acid lithiasis.

26. Which disease causes connective tissue changes that cause glomerulonephritis? a. Gout b. Amyloidosis c. DM d. SLE

d. SLE

22. Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks? a. Milk and milk products b. Dried beans and dried fruits c. Liver, kidney, and sweetbreads d. Spinach, cabbage, and tomatoes

d. Spinach, cabbage, and tomatoes

Which disease causes connective tissue changes that cause glomerulonephritis? a. Gout b. Amyloidosis c. Diabetes mellitus d. Systemic lupus erythematosus

d. Systemic lupus erythematosus causes connective tissue damage that affects the glomerulus. Gout deposits uric acid crystals in the kidney. Amyloidosis deposits hyaline bodies in the kidney. Diabetes mellitus causes microvascular damage affecting the kidney.

A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis? a. Residual urine greater than 200 mL b. A large, atonic bladder on urodynamic testing c. A voiding pattern that indicates psychogenic urinary retention d. Pain with bladder filling that is transiently relieved by urination

d. The symptoms of interstitial cystitis (IC) imitate those of an infection of the bladder but the urine is free of infectious agents. Unlike a bladder infection, the pain with IC increases as urine collects in the bladder and is temporarily relieved by urination. Acidic urine is very irritating to the bladder in IC and the bladder is small but urinary retention is not common.

A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, what should the nurse plan to do? a. Measure and fit the stoma for a permanent appliance. b. Encourage high oral intake to flush mucus from the conduit. c. Teach the patient to self-catheterize the stoma every 4 to 6 hours. d. Empty the drainage bag every 2 to 3 hours and measure the urinary output.

d. Urine drains continuously from an ileal conduit and the drainage bag must be emptied every 2 to 3 hours and measured to ensure adequate urinary output. Fitting for a permanent appliance is not done until the stoma shrinks to its normal size in a few weeks. With an ileal conduit, mucus is present in the urine because it is secreted by the ileal segment as a result of the irritating effect of the urine but the surgery causes paralytic ileus and the patient will be NPO for several days postoperatively. Self-catheterization is performed when patients have formation of a continent Kock pouch.

In teaching a patient with pyelonephritis about the disorder, the nurse informs the paitent that the organisms that cause pyelonephritis most commonly reach the kidneys through* a. the bloodstream b.the lymphatic system c. a descending infection d. an ascending infection

d. an ascending infection

A patient has has a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shred are seen in the drainage bag. The nurse should.* a. notify the physician b.notify the charge nurse c. irrigate the drainage tube d. chart it as a normal observation

d. chart it as a normal observation

The nurse recommends genetic counseling for the children of a patient with* a.nephrotic syndrome b.chronic pyelonephritis c. malignant nephrosclerosis d.adult onset polycystic kidney disease

d.adult onset polycystic kidney disease

The edema that occurs in nephrotic syndrome is due to* a. increased hydrostatic pressure caused by sodium retention. b. decreased aldosterone secretion from adrenal insufficiency. c. increased fluid retention caused by decreased glomerular filtration d.decreased colloidal osmotic pressure caused by loss of serum albumin

d.decreased colloidal osmotic pressure caused by loss of serum albumin

Delegation Decision: Which nursing interventions could be delegated to unlicensed assistive personnel (UAP) (select all that apply)? a. Assess the need for catheterization. b. Use bladder scanner to estimate residual urine. c. Teach patient pelvic floor muscle (Kegel) exercises. d. Insert indwelling catheter for uncomplicated patient. e. Assist incontinent patient to commode at regular intervals. f. Provide perineal care with soap and water around a urinary catheter.

e, f. The unlicensed assistive personnel (UAP) may assist the incontinent patient to void at regular intervals and provide perineal care. An RN should perform the assessments and teaching. In long-term care and rehabilitation facilities, UAP may use bladder scanners after they are trained.

B

During physical assessment of the urinary system, the nurse: A. palpates an empty bladder as a small nodule B. auscultates over each CVA to detect impaired renal blood flow C finds a dull percussion sound when 100mL of urine is present in the bladder D. palpates above the symphysis pubis to determine the levels of urine in the bladder

A, D

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply): A. nonpalpable left kidney B. auscultation of renal artery bruit C. CVA tenderness elicited by a kidney punch D. no CVA tenderness elicited by a kidney punch E. palpable bladder to the level of the pubic symphysis

D

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find: A. a pH of 8.4 B. RBCs of 4/hpf C. color: yellow, cloudy D. specific gravity of 1.035

Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI b. Lower UTI c. Complicated UTI d. Uncomplicated UTI

a. An upper urinary tract infection (UTI) affects the renal parenchyma, renal pelvis, and ureters. A lower UTI is an infection of the bladder and/or urethra. A complicated UTI exists in the presence of obstruction, stones, or preexisting diseases. An uncomplicated UTI occurs in an otherwise normal urinary tract.

20. Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective GI and kidney absorption

a. Associated with alkaline urine

When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer? a. Smoking b. Family history of cancer c. Chronic use of phenacetin d. Chronic, recurrent nephrolithiasis

a. Both cancer of the kidney and cancer of the bladder are associated with smoking. A family history of renal cancer is a risk factor for kidney cancer and cancer of the bladder has been associated with the use of phenacetin-containing analgesics and recurrent upper UTIs.

Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective gastrointestinal (GI) and kidney absorption

a. Calcium phosphate calculi are typically mixed with struvite or oxalate stones and related to alkaline urine. Cystine calculi are associated with a genetic autosomal recessive defect and defective GI and kidney absorption of cystine. Struvite calculi are three to four times more common in women than in men.

The nurse plans care for the patient with APSGN based on what knowledge? a. Most patients with APSGN recover completely or rapidly improve with conservative management. b. Chronic glomerulonephritis leading to renal failure is a common sequela to acute glomerulonephritis. c. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane. d. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis, resulting in kidney failure.

a. Most patients recover completely from acute poststreptococcal glomerulonephritis (APSGN) with supportive treatment. Chronic glomerulonephritis that progresses insidiously over years and rapidly progressive glomerulonephritis that results in renal failure within weeks or months occur in only a few patients with APSGN. In Goodpasture syndrome, antibodies are present against both the GBM and the alveolar basement membrane of the lungs and dysfunction of both renal and pulmonary are present.

12. The nurse plans care for the pt with APSGN based on what knowledge? a. Most pts with APSGN recover completely or rapidly improve with conservative management. b. Chronic glomerulonephritis leading to renal failure is a common sequela to acute glomerulonephritis c. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane. d. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis, resulting in kidney failure

a. Most pts with APSGN recover completely or rapidly improve with conservative management.

The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing? a. Reflex incontinence b. Overflow incontinence c. Functional incontinence d. Incontinence after trauma

a. Reflex incontinence occurs with no warning, equally during the day and night, and with spinal cord lesions above S2. Overflow incontinence is when the pressure of urine in the overfull bladder overcomes sphincter control and is caused by bladder or urethral outlet obstruction. Functional incontinence is loss of urine resulting from cognitive, functional, or environmental factors. Incontinence after trauma or surgery occurs when fistulas have occurred or after a prostatectomy.

Which characteristic is more likely with acute pyelonephritis than with a lower UTI? a. Fever b. Dysuria c. Urgency d. Frequency

a. Systemic manifestations of fever and chills with leukocytosis and nausea and vomiting are more common in pyelonephritis than in a lower UTI. Dysuria, frequency, and urgency can be present with both.

Which urinary diversion is a continent diversion created by formation of an ileal pouch with a stoma for catheterization? a. Kock pouch b. Ileal conduit c. Orthotopic neobladder d. Cutaneous ureterostomy

a. The Kock pouch is a continent diversion created by formation of an ileal pouch with an external stoma requiring catheterization. Ileal conduit is the most common incontinent diversion using a stoma of resected ileum with implanted ureters. Orthotopic neobladder is a new bladder from a reshaped segment of intestine in the anatomic position of the bladder with urine discharged through the urethra. A cutaneous ureterostomy diverts the ureter from the bladder to the abdominal skin but there is frequent scarring and strictures of the ureters, so ileal conduits are used more often.

1. Which classification of UTI is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI b. Lower UTI c. Complicated UTI d. Uncomplicated UTI

a. Upper UTI

A patient is admitted to the hospital with severe renal colic. The nurse's first priority in management of the patient is to* a. administer opioids as prescribed. b. obtain supplies for straining all urine c. encourage fluid intake of 3-4L/day d. keep the patient NPO in preparation for surgery

a. administer opioids as prescribed.

One of the nurse's most important roles in relation to acute poststreptococcal golmerulonephritis is to* a. promote early diagnosis and treatment of sore throats and skin lesions b.encourage patients to obtain antibiotic therapy for upper respiratory tract infections c.teach patients with APSGN that long term prophylactic antibiotic therapy is necessary to prevent recurrence d.monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane

a. promote early diagnosis and treatment of sore throats and skin lesions

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes:* a. teaching the patient to use Kegel exercises b.clamping and releasing a catheter to increase bladder tone c.teaching the patient biofeedback mechanisms to suppress the urge to void d.counseling the patient concerning choices of incontinence containment devices

a. teaching the patient to use Kegel exercises

The male patient is Jewish, has a history of gout, and has been diagnosed with renal calculi. Which treatment will be used with this patient (select all that apply)? a. Reduce dietary oxalate b. Administer allopurinol c. Administer α-penicillamine d. Administer thiazide diuretics e. Reduce animal protein intake f. Reduce intake of milk products

b, e. This patient is most likely to have uric acid calculi, which have a high incidence in Jewish men, and gout is a predisposing factor. The treatment will include allopurinol and reducing animal protein intake to reduce purine, as uric acid is a waste product from purine metabolism. Reducing oxalate and using thiazide diuretics help to treat calcium oxalate calculi. Administration of α-penicillamine and tiopronin prevent cystine crystallization for cystine calculi. Reducing intake of milk products to reduce calcium intake may be used with calcium calculi.

Priority Decision: Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria. b. Encourage fluid intake of 3 L/day. c. Apply moist heat to the flank area. d. Strain all urine through gauze or a special strainer.

b. A high fluid intake maintains dilute urine, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals. Moist heat to the flank may be helpful to relieve muscle spasms during renal colic and all urine should be strained in patients with renal stones to collect and identify stone composition but these are not related to infection.

During assessment of the patient who has a nephrectomy, what should the nurse expect to find? a. Shallow, slow respirations b. Clear breath sounds in all lung fields c. Decreased breath sounds in the lower left lobe d. Decreased breath sounds in the right and left lower lobes

b. A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breathe deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.

19. The male patient is Jewish, has a history of gout, and has been diagnosed with renal calculi. Which treatment will be used with this pt? (select all that apply) a. Reduce dietary oxalate b. Administer allopurinol c. Administer alpha-penicillamine d. Administer thiazide diuretics e. Reduce animal protein intake f. Reduce intake of milk products

b. Administer allopurinol e. Reduce animal protein intake

In providing care for the patient with adult-onset polycystic kidney disease, what should the nurse do? a. Help the patient to cope with the rapid progression of the disease b. Suggest genetic counseling resources for the children of the patient c. Expect the patient to have polyuria and poor concentration ability of the kidneys d. Implement measures for the patient's deafness and blindness in addition to the renal problems

b. Adult-onset polycystic kidney disease is an inherited autosomal dominant disorder that often manifests after the patient has children but the children should receive genetic counseling regarding their life choices. The disease progresses slowly, eventually causing progressive renal failure. Hereditary medullary cystic disease causes poor concentration ability of the kidneys and classic Alport syndrome is a hereditary nephritis that is associated with deafness and deformities of the optic lens.

A teaching plan developed by the nurse for the patient with a new ileal conduit includes instructions to do what? a. Clean the skin around the stoma with alcohol every day. b. Use a wick to keep the skin dry during appliance changes. c. Use sterile supplies and technique during care of the stoma. d. Change the appliance every day and wash it with soap and warm water.

b. Because the stoma continuously drains urine, a wick formed of a rolled-up 4 × 4 gauze or a tampon is held against the stoma to absorb the urine while the skin is cleaned and a new appliance is attached. The skin is cleaned with warm water only because soap and other agents cause drying and irritation and clean, not sterile, technique is used. The appliance should be left in place for as long as possible before it loosens and allows leakage onto the skin, perhaps up to 14 days.

19. Which urinalysis results would most likely indicate a UTI? a. Yellow; protein 6 mg/dL; pH 6.8; 10/mL bacteria b. Cloudy, yellow; WBC >5hpf; pH 8.2; numerous casts c. Cloudy, brown; ammonia odor; specific gravity 1.030; RBC 3/hpf d. Clear; colorless; glucose: trace; ketones: trace; osmolality 500 mOsm/kg (500 mmol/kg)

b. Cloudy, yellow; WBC >5hpf; pH 8.2; numerous casts

23. Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing Dx of risk for infection r/t the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria b. Encourage fluid intake of 3 L/day c. Apply moist heat to the flank area d. Strain all urine through gauze or a special strainer

b. Encourage fluid intake of 3 L/day

34. A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the pt after the procedure, what is an appropriate nursing action? a. Milk or strip the catheter every 2 hours. b. Measure ureteral urinary drainage every 1 to 2 hours c. Irrigate the catheter with 30mL sterile saline every 4 hours d. Encourage ambulation to promote urinary peristaltic action

b. Measure ureteral urinary drainage every 1 to 2 hours

A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, what is an appropriate nursing action? a. Milk or strip the catheter every 2 hours. b. Measure ureteral urinary drainage every 1 to 2 hours. c. Irrigate the catheter with 30-mL sterile saline every 4 hours. d. Encourage ambulation to promote urinary peristaltic action.

b. Output from ureteral catheters must be monitored every 1 to 2 hours because an obstruction will cause overdistention of the renal pelvis and renal damage. The renal pelvis has a capacity of only 3 to 5 mL and if irrigation is ordered, no more than 5 mL of sterile saline is used. The patient with a ureteral catheter is usually kept on bed rest until specific orders for ambulation are given. Suprapubic tubes may be milked to prevent obstruction of the catheter by sediment and clots.

18. The female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone? a. Cystine b. Struvite c. Uric acid d. Calcium phosphate

b. Struvite

The female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone? a. Cystine b. Struvite c. Uric acid d. Calcium phosphate

b. Struvite calculi are most common in women and always occur with UTIs. They are also usually large staghorn type.

A female patient with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding prevention of recurrence. What should the nurse include in the teaching plan instructions for this patient? a. Empty the bladder at least 4 times a day. b. Drink at least 2 quarts of water every day. c. Wait to urinate until the urge is very intense. d. Clean the urinary meatus with an antiinfective agent after voiding.

b. The bladder should be emptied at least every 3 to 4hours. Fluid intake should be increased to about 2000 mL/ day without caffeine, alcohol, citrus juices, and chocolate drinks, because they are potential bladder irritants. Cleaning the urinary meatus with an antiinfective agent after voiding will irritate the meatus but the perineal area should be wiped from front to back after urination and defecation to prevent fecal contamination of the meatus.

Which infection is asymptomatic in the male patient at first and then progresses to cystitis, frequent urination, burning on voiding, and epididymitis? a. Urosepsis b. Renal tuberculosis c. Urethral diverticula d. Goodpasture syndrome

b. The manifestations of renal tuberculosis are described. Urosepsis is when the UTI has spread systemically. Urethral diverticula are localized outpouching of the urethra and occur more often in women. Goodpasture syndrome manifests with flu-like symptoms with pulmonary symptoms that include cough, shortness of breath, and pulmonary insufficiency and renal manifestations that include hematuria, weakness, pallor, anemia, and renal failure.

With which diagnosis will the patient benefit from being taught to do self-catheterization? a. Renal trauma b. Urethral stricture c. Renal artery stenosis d. Accelerated nephrosclerosis

b. The patient with urethral stricture will benefit from being taught to dilate the urethra by self-catheterization every few days. Renal trauma is treated related to the severity of the injury with bed rest, fluids, and analgesia. Renal artery stenosis includes control of hypertension with possible surgical revascularization. Accelerated nephrosclerosis is associated with malignant hypertension that must be aggressively treated as well as monitoring kidney function.

18. A urinalysis of a urine specimen that is not processed within 1 hour may result in erroneous measurement of a. glucose b. bacteria c. specific gravity d. WBCs

b. bacteria

The immunologic mechanisms involved in acute poststreptococal glomerulonephritis include:* a. tubular blocking by precipitates of bacteria and antibody reactions b. deposition of immune complexes and complement along the GBM c. thickening of the GBM from autoimmune microangiopathic changes d. destruction of glomeruli by proteolytic enzymes contained in the GBM

b. deposition of immune complexes and complement along the GBM

A patient with ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes:* a.encourage the patient to drink fruit juices and milk b.encouraging fluids of at least 2-3 L/day after nausea has subsided c. irrigating the nephrostomy tube with 10ml of NS solution as needed d. notifying the physician if nephrostomy tube drainage is more than 30ml/hr

b.encouraging fluids of at least 2-3 L/day after nausea has subsided

The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of* a.aspirin use b.tobacco use c.chronic alcohol abuse d.use of artificial sweeteners

b.tobacco use

The nurse teaches the female paitent who has frequent UTIs that she should* a. take tub baths with bubble bath b.urinate before and after sexual intercourse c.take prophylactic sufonamides for the rest of her life d. restrict fluid intake to prevent the need for frequent voiding

b.urinate before and after sexual intercourse

Number in sequence the following ascending pathologic changes that occur in the urinary tract in the presence of a bladder outlet obstruction. a. Hydronephrosis b. Reflux of urine into ureter c. Bladder detrusor muscle hypertrophy d. Ureteral dilation e. Renal atrophy f. Vesicoureteral reflux g. Large residual urine in bladder h. Chronic pyelonephritis

c g b d f a h e

Which drugs are used to treat overflow incontinence (select all that apply)? a. Baclofen (Lioresal) b. Anticholinergic drugs c. α-Adrenergic blockers d. 5α-reductase inhibitors e. Bethanechol (Urecholine)

c, d, e. α-Adrenergic blockers block the stimulation of the smooth muscle of the bladder, 5α reductase inhibitors decrease outlet resistance, and bethanechol enhances bladder contractions. Baclofen or diazepam is used to relax the external sphincter for reflex incontinence. Anticholinergics are used to relax bladder tone and increase sphincter tone with urge incontinence.

On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report? a. A history of chronic UTIs b. Dull, costovertebral flank pain c. Severe, colicky back pain radiating to the groin d. A feeling of bladder fullness with urgency and frequency

c. A classic sign of the passage of a calculus down the ureter is intense, colicky back pain that may radiate into the testicles, labia, or groin and may be accompanied by mild shock with cool, moist skin. Many patients with renal stones do not have a history of chronic UTIs. Stones obstructing a calyx or at the ureteropelvic junction may produce dull costovertebral flank pain and large bladder stones may cause bladder fullness and lower obstructive symptoms.

What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients? a. Measuring urine output every 1 to 2 hours to ensure patency b. Turning the patient frequently from side to side to promote drainage c. Using strict sterile technique during irrigation and obtaining culture specimens d. Daily cleaning of the catheter insertion site with soap and water and application of lotion

c. All urinary catheters in hospitalized patients pose a very high risk for infection, especially antibiotic-resistant, health care-associated infections, and scrupulous aseptic technique is essential in the insertion and maintenance of all catheters. Routine irrigations are not performed. Turning the patient to promote drainage is recommended only for suprapubic catheters. Cleaning the insertion site with soap and water should be performed for urethral and suprapubic catheters but lotion or powder should be avoided and site care for other catheters may require special interventions.

What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract? a. The kidney is scarred and fibrotic. b. The organism is resistant to antibiotics. c. There is a preexisting abnormality of the urinary tract. d. The patient does not take all of the antibiotics for treatment of a UTI.

c. Ascending infections from the bladder to the kidney are prevented by the normal anatomy and physiology of the urinary tract unless a preexisting condition, such as vesicoureteral reflux or lower urinary tract dysfunction (bladder tumors, prostatic hyperplasia, strictures, or stones), is present. Resistance to antibiotics and failure to take a full prescription of antibiotics for a UTI usually result in relapse or reinfection of the lower urinary tract.

What can patients at risk for renal lithiasis do to prevent the stones in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

c. Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is by drinking adequate fluids to keep the urine dilute and flowing (e.g., an output of about 2 L of urine a day). Sedentary lifestyle is a risk factor for renal stones but exercise also causes fluid loss and a need for additional fluids. Protein foods high in purine should be restricted only for the small percentage of patients with uric acid stones and although UTIs contribute to stone formation, prophylactic antibiotics are not indicated.

17. Which type of urinary tract calculi are the most common and frequently obstruct the ureter? a. Cystine b. Uric acid c. Calcium oxalate d. Calcium phosphate

c. Calcium oxalate

Which type of urinary tract calculi are the most common and frequently obstruct the ureter? a. Cystine b. Uric acid c. Calcium oxalate d. Calcium phosphate

c. Calcium oxalate calculi are most common and small enough to get trapped in the ureter.

13. What results in the edema associated with nephrotic syndrome? a. Hypercoagulability b. Hyperalbuminemia c. Decreased plasma oncotic pressure d. Decreased GFR

c. Decreased plasma oncotic pressure

16. What can patients at risk for renal lithiasis do to prevent the stones in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

c. Drink enough fluids to produce dilute urine

Glomerulonephritis is characterized by glomerular damage caused by a. growth of microorganisms in the glomeruli. b. release of bacterial substances toxic to the glomeruli. c. accumulation of immune complexes in the glomeruli. d. hemolysis of red blood cells circulating in the glomeruli.

c. Glomerulonephritis is not an infection but rather an antibody-induced injury to the glomerulus, where either autoantibodies against the glomerular basement membrane (GBM) directly damage the tissue or antibodies reacting with nonglomerular antigens are randomly deposited as immune complexes along the GBM. Prior infection by bacteria or viruses may stimulate the antibody production but is not present or active at the time of glomerular damage.

To assist the patient with stress incontinence, what is the best thing the nurse should teach the patient to do? a. Void every 2 hours to prevent leakage. b. Use absorptive perineal pads to contain urine. c. Perform pelvic floor muscle exercises 40 to 50 times per day. d. Increase intraabdominal pressure during voiding to empty the bladder completely.

c. Pelvic floor exercises (Kegel exercises) increase the tone of the urethral sphincters and should be done in sets of 10 or more contractions four to five times a day (total of 40 to 50 per day). Frequent bladder emptying is recommended for patients with urge incontinence and an increase in pressure on the bladder is recommended for patients with overflow incontinence. Absorptive perineal pads should be only a temporary measure because longterm use discourages continence and can lead to skin problems.

21. On assessment of the pt with a renal calculus passing down the ureter, what should the nurse expect the pt to report? a. A history of chronic UTIs b. Dull, costovertebral flank pain c. Severe, colicky back pain radiating to the groin d. A feeling of bladder fullness with urgency and frequency

c. Severe, colicky back pain radiating to the groin

What results in the edema associated with nephrotic syndrome? a. Hypercoagulability b. Hyperalbuminemia c. Decreased plasma oncotic pressure d. Decreased glomerular filtration rate

c. The massive proteinuria that results from increased glomerular membrane permeability in nephrotic syndrome leaves the blood without adequate proteins (hypoalbuminemia) to create an oncotic colloidal pressure to hold fluid in the vessels. Without oncotic pressure, fluid moves into the interstitium, causing severe edema. Hypercoagulability occurs in nephrotic syndrome but is not a factor in edema formation and glomerular filtration rate (GFR) is not necessarily affected in nephrotic syndrome.

While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient most likely to experience? a. Cloudy urine and fever b. Urethral burning and bloody urine c. Vague abdominal discomfort and disorientation d. Suprapubic pain and slight decline in body temperature

c. The usual classic manifestations of UTI are often absent in older adults, who tend to experience nonlocalized abdominal discomfort and cognitive impairment characterized by confusion or decreased level of consciousness rather than dysuria and suprapubic pain.

C

A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is: A. IVP B. VCUG C. renal scan D. loopogram

A 68-year-old man with suspected renal insufficiency is scheduled for a creatinine clearance diagnostic test. Which instructions would be appropriate for the nurse to provide to the patient? A) "Empty your bladder and discard the urine; then save all urine for 24 hours." B) "Your blood creatinine level will be tested after you eat a high-protein meal." C) "This test should not be performed if you have allergies to iodine or shellfish." D) "A sterile container must be used to store the urine during the collection period."

A) "Empty your bladder and discard the urine; then save all urine for 24 hours." {The patient should discard the first urination when this test is started. Urine should be saved from all subsequent urinations for 24 hours. Creatinine clearance testing does not involve the injection of contrast dye. A serum creatinine is determined during the 24-hour period and used in the calculation to determine creatinine clearance. Consumption of a high protein meal is not indicated. Sterile containers would be indicated if cultures are performed to determine the presence of microorganisms.}

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure. A) "You might have pink-tinged urine and burning after your cystoscopy." B) "You'll need to refrain from eating or drinking after midnight the day before the test." C) "You'll require a urinary catheter inserted before the cystoscopy, and it will be in place for a few days." D) "The morning of the test. the nurse will ask you to drink some water that contains a contrast solution."

A) "You might have pink-tinged urine and burning after your cystoscopy." {Pink-tinged urine, burning, and frequency are common following a cystoscopy. The patient does not need to be NPO prior to the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.}

What should the nurse expect to do to prepare a patient for an intravenous pyelogram (IVP)? A) Administer a cathartic or enema. B) Assess patient for allergies to penicillin. C) Keep the patient NPO for 4 hours preprocedure. D) Advise the patient that a metallic taste may occur during procedure

A) Administer a cathartic or enema. {Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity, keep the patient NPO for 8 hours preprocedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.}

The patient had surgery and a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What should the nurse do FIRST to assess for urinary retention? A) Bladder scan B) Cystometrogram C) Residual urine test D) Kidneys, ureters, bladder (KUB) x-ray

A) Bladder Scan {If the patient is unable to void, the bladder may be palpated for distention, 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.}

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions inportant to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys (Select all that apply)? A) Production of renin B) Activation of vitamin D C) Carbohydrate metabolism D) Erythropoietin production E) Hemolysis of old red blood cells (RBCs)

A) Production of renin B) Activation of vitamin D D) Erythropoietin production {In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.}

The nurse cares for a 55-year-old male patient after a right kidney biopsy. Which position would be the most appropriate for this patient following the procedure? A) Right lateral side-lying position B) Reverse Trendelenburg position C) Supine with lower extremities elevated D) High Fowler's position with arms supported

A) Right lateral side-lying position {After a renal biopsy, a pressure dressing should be applied. The patient should be kept on the affected side for 30 to 60 minutes to apply additional pressure from the patient's own body weight, then on bed rest for 24 hours. High Fowler's position with arms supported is a position for a patient in respiratory distress. Reverse Trendelenburg position is used to maintain circulation to the legs in peripheral artery insufficiency. Supine with legs elevated puts excessive pressure on the diaphragm and should generally be avoided.}

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply) A) nonpalpable left kidney. B) auscultation of renal artery bruit. C) CVA tenderness elicited by a kidney punch. D) no CVA tenderness elicited by a kidney punch. E) palpable bladder to the level of the pubic symphysis.

A) nonpalpable left kidney. D) no CVA tenderness elicited by a kidney punch {In the physical assessment of the urinary system, normal findings include no CVA tenderness, nonpalpable kidneys and bladder, and no palpable masses.}

A patient's urine dipstick indicates a small amount of protein in the urine. The next action by the nurse should be to A. check which medications the patient is currently taking. B. obtain a clean-catch urine for culture and sensitivity testing. C. ask the patient about any family history of chronic renal failure. D. send a urine specimen to the laboratory to test for ketones and glucose.

A. check which medications the patient is currently taking. Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings. The other actions by the nurse may be appropriate, but checking for medications that may affect the dipstick accuracy should be done first.

A patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole (Bactrim) for 3 days. Which action will the nurse plan to take? a. Remind the patient about the need to drink 1000 mL of fluids daily. b. Obtain a midstream urine specimen for culture and sensitivity testing. c. Teach the patient to take the prescribed Bactrim for at least 3 more days. d. Suggest that the patient use acetaminophen (Tylenol) to treat the symptoms.

ANS: B Since uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3 days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine appropriate antibiotic therapy. Tylenol would not be as effective as other over-the-counter (OTC) medications such as phenazopyridine (Pyridium) in treating dysuria. The fluid intake should be increased to at least 1800 mL/day. Since the UTI has persisted after treatment with Bactrim, the patient is likely to need a different antibiotic. DIF: Cognitive Level: Application REF: 1123-1125

A 70-year-old male patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding? A) Anuria B) Dysuria C) Oliguria D) Enuresis

B) Dysuria {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.}

A 26-year-old man was admitted 2 weeks ago after multiple traumatic injuries in a motor vehicle collision. Today the patient has a serum creatinine at 3.9 mg/dL and blood urea nitrogen (BUN) of 100 mg/dL. Which medication, if ordered by the health care provider, should the nurse question? A) Morphine sulfate B) Gentamicin (Garamycin) C) Acetaminophen (Tylenol) D) Notrofurantoin (Macrodantin)

B) Gentamicin (Garamycin) {Elevated serum creatinine and BUN indicate renal insufficiency or acute kidney injury. Medications (e.g., prescribed, over-the-counter, and herbs) should be evaluated for nephrotoxic potential. Many drugs are known to be nephrotoxic (Table 45-3); gentamicin is a potential nephrotoxic agent.}

As a component of the head-to-toe assessment of a patient who has been recently transferred to the clinical unit, the nurse is preparing to palpate the patient's kidneys. How should the nurse position the patient for this assessment? A) Prone B) Supine C) Seated at the edge of the bed D) Standing, facing away from the nurse

B) Supine {To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.}

During physical assessment of the urinary system, the nurse A) palpates an empty bladder as a small nodule. B) auscultates over each CVA to detect impaired renal blood flow. C) finds a dull percussion sound when 100 mL of urine is present in the bladder. D) palpates above the symphysis pubis to determine the level of urine in the bladder.

B) auscultates over each CVA to detect impaired renal blood flow. {The bell of the stethoscope may be used to auscultate over the costovertebral angle (CVA) and the upper abdominal quadrants. With this technique, the abdominal aorta and renal arteries are auscultated for a bruit (i.e., abnormal murmur), which indicates impaired blood flow to the kidneys.}

A patient with kidney disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of A) tubular secretion B) glomerular filtration C) capillary permeability D) concentration of filtrate

B) glomerular filtration {The amount of blood filtered each minute by the glomeruli is expressed as the glomerular filtration rate (GFR). The normal GFR is about 125 mL/min.}

The nurse prepares a 39-year-old woman for discharge after a cystoscopy. it is most important for the nurse to provide additional information in response to which patient statement? A) "I should drink plenty of fluids to prevent complications." B) "If my urine is cloudy, I should contact my health care provider." C) "Bright red bleeding is normal for a few days after the procedure." D) "Sitz baths and acetaminophen will help to reduce my discomfort."

C) "Bright red bleeding is normal for a few days after the procedure." {Bright red bleeding after a cystoscopy is not normal and should be reported immediately. Other complications include urinary retention, bladder infection, and perforation of the bladder. Patients should drink plenty of fluids and expect burning on urination, pink-tinged urine, and urinary frequency. Warm sitz baths, heat, and mild analgesics may be used to relieve discomfort.}

The patient called the clinic with manifestations of burning on urination, dysuria, and frequency. What is the BEST advice for the nurse to give the patient? A) "Drink less fluid so you don't have to void so often." B) "Take some acetaminophem to decrease the discomfort." C) "Come in so we can check a clean catch urine specimen." D) "Avoid caffeine and spicy food to decrease inflammation."

C) "Come in so we can check a clean catch urine specimen." {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.}

Which effect of aging on the urinary system is most likely to affect the action of bumetanide (Bumex)? A) Benign enlargement of prostatic tissues B) Decreased sensation of bladder capacity C) Decreased function of the loop of Henle D) Less absorption in the Bowman's capsule

C) Decreased function of the loop of Henle {Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.}

A nurse is caring for a 70-year-old woman with a history of chronic obstructive pulmonary disease (COPD) admitted for pneumonia. What laboratory finding would be consistent with decreased kidney function in this patient? A) Serum uric acid 5.2 mg/dL B) Urine specific gravity 1.040 C) Serum creatinine 2.3 mg/dL D) Blood urea nitrogen (BUN) 10 mg/dL

C) Serum creatinine 2.3 mg/dL {An expected assessment finding related to decreased kidney function in the aging process is an increased serum creatinine. Other expected assessments include an elevated BUN and inability to concentrate urine (with urine specific gravity fixed at 1.010). Uric acid is used as a screening test for disorders of purine metabolism or kidney disease; values depend on renal function, rate of purine metabolism, and dietary intake of food rich in purines. Normal reference intervals: serum creatinine 0.6 to 1.3 mg/dL; BUN 6 to 20 mg/dL; urine specific gravity 1.003 to 1.030; and serum uric acid: 2.3 to 6.6 mg/dL (female) or 4.4 to 7.6 mg/dL (male).}

Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to A) a decrease in bladder sensory receptors. B) a decrease in the number of functioning nephrons. C) decreased function of the loop of Henle and tubules. D) thickening of the basement membrane of Bowman's capsule.

C) decreased function of the loop of Henle and tubules. {Older adults have decreased function of the loop of Henle and tubules, which results in the loss of normal diurnal excretory pattern because of a decreased ability to concentrate urine and because of less concentrated urine.}

A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is a(n) A) IVP. B) VCUG. C) renal scan. D) loopogram.

C) renal scan. {A renal scan is used to evaluate the anatomic structures, perfusion, and function of kidneys. The scan shows the location, size, and shape of the kidneys and helps assess blood flow, glomerular filtration, tubular function, and urinary excretion.}

When reading a patient's chart, the nurse notes that the patient has dysuria. To assess whether there is any improvement, which question will the nurse ask? A. "Do you have any blood in your urine?" B. "Do you have to urinate very frequently?" C. "Do you have any pain when you urinate?" D. "Do you have to get up at night to urinate?"

C. "Do you have any pain when you urinate?" Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.

A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with A) the structural support of the kidney. B) regulation of the concentration of urine. C) the entry and exit of blood vessels at the kidney. D) collection and drainage of urine from the kidney.

D) Collection and drainage of urine from the kidney. {The outer layer of the kidney is the cortex, and the inner layer is the medulla. The medulla consists of a number of pyramids. The apices (tops) of these pyramids are called papillae, through which urine passes to enter the calyces. The minor calyces widen and merge to form major calyces, which form a funnel-shaped sac called the renal pelvis. The minor and major calyces transport urine to the renal pelvis, from which it drains through the ureter to the bladder.}

The patient in the intensive care unit is receiving gentamicin for pneumonia from Pseudomonas. What assessment results should the nurse report to the health care provider? A) Decreased weight B) Increased appetite C) Increased urinary output D) Elevated creatinine level

D) Elevated creatinine level {Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the physician as it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia.}

When the patient reports acute, sever, renal colic pain in the lower abdomen, the nurse knows that the patient is most likely to have an obstruction at which area? A) Kidney B) Urethra C) Bladder D) Ureterovesical junction

D) Ureterovesical junction {The ureterovesical junction (UVJ) is the narrowest part of the urethra and easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction (UPJ), the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones.}

Which urinalysis result should the nurse recognize as an abnormal finding? A) pH 6.0 B) Amber yellow color C) Specific gravity 1.025 D) White blood cells (WBCs) 9/hpf

D) White blood cells (WBCs) 9/hpf {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 1.003 to 1.030.}

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes A) hyperaldosteronism. B) serotonin deficiency. C) adrenal insufficiency. D) hyperparathyroidism.

D) hyperparathryodism {Excessive levels of circulating parathyroid hormone (PTH) usually lead to hypercalcemia and hypophosphatemia. In the kidneys, the excess calcium cannot be reabsorbed, and so the calcium levels in the urine increase (i.e., hypercalciuria). This excess urinary calcium, along with a large amount of urinary phosphate, can lead to calculi formation.}

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find A) a pH of 8.4. B) RBCs of 4/hpf. C) color: yellow, cloudy. D) specific gravity of 1.035.

D) specific gravity of 1.035. {Normal specific gravity of urine is 1.003 to 1.030; the concentrating ability of the kidneys is maximal in producing morning urine (1.025 to 1.030). A high urinary specific gravity value indicates dehydration.}