Renal: Elimination

A client who has a history of alcohol abuse now has recurrent exacerbations of chronic pancreatitis. The nurse asks the client to obtain a stool specimen. When the client's stool is assessed, what does the nurse expect? 1 Melena 2 Steatorrhea 3 Hard, dry stool 4 Ribbon-shaped stoo

2 Steatorrhea Decreased secretion of lipase from the pancreas limits fat breakdown in the small intestine, resulting in increased fat content in feces; steatorrhea is soft, frothy, foul-smelling feces. Melena refers to black, tarry stool containing digested blood; melena is caused by upper gastrointestinal bleeding. Hard, dry stool reflects constipation; stools associated with pancreatitis are soft and frothy. Ribbon-shaped stool is associated with obstruction of the descending or sigmoid colon.

What should the nurse do when collecting a 24-hour urine specimen? 1 Check to verify if a preservative is needed. 2 Weigh the client before starting the collection. 3 Discard the last voided specimen of the 24-hour period. 4 Assess the client's intake and output (I&O) for the previous 24-hour period.

1 Check to verify if a preservative is needed. Depending on the purpose of the collection, a preservative to prevent breakdown of the specimen may be necessary. Weighing the client is not necessary. The last specimen should be collected as close as possible to the end of the 24-hour period and added to the urine collected. Collecting urine for the next 24 hours, not checking the I&O for the previous 24 hours, is important.

How should the nurse expect the urine of a child with acute glomerulonephritis with hematuria to appear? 1 Cola-colored 2 Orange 3 Bright red 4 Straw-colored

1 Cola-colored Cola-colored urine indicates the presence of large numbers of red blood cells. Orange-colored urine usually is associated with certain foods or medications. Red indicates frank bleeding that is associated with urinary tract trauma, not glomerulonephritis. Straw-colored urine is the color of dilute urine; it is an expected finding in a healthy child.

A nurse plans to teach the signs of rejection to a client who just had a transplanted kidney. What sign of rejection should the nurse include? 1 Weight loss 2 Subnormal temperature 3 Elevated blood pressure 4 Increased urinary output

2 Subnormal temperature Hypertension results from hypervolemia because of failure of the new kidney. Weight gain will occur because of fluid retention with failure of a transplanted kidney. Body temperature will exceed 100° F if a kidney is rejected. Urine output will be decreased or absent, depending on the degree of failure.

A client has a permanent sigmoid colostomy as a result of cancer of the rectum. The primary health care provider prescribes daily colostomy irrigations. What does the nurse explain that the primary purpose of these irrigations is? 1 To prevent straining at passage of stool 2 To establish a regular elimination schedule 3 To decrease the amount of flatus in the bowel 4 To limit the amount of fluid lost from the intestine

2 To establish a regular elimination schedule Irrigations regulate the bowel to function at a specific time for the convenience of the client. Although irrigations will prevent straining, this is not the purpose of the irrigation. Irrigations will facilitate expulsion of flatus but will not decrease the amount; avoidance of gas-forming foods will accomplish this. Bowel irrigations do not limit the amount of fluid lost from the intestine; most ingested fluid already is absorbed in the large intestine by the time it reaches the sigmoid colon.

A client has a permanent sigmoid colostomy, and colostomy irrigations are prescribed. The client asks the nurse why they are needed. How should the nurse respond? 1. "Less fluid is lost from the intestine." 2. "They help establish an elimination schedule." 3. "They decrease the amount of flatus in the bowel." 4. "Straining is minimized during a bowel movement."

2. "They help establish an elimination schedule." Irrigations regulate the bowel to function at a specific time for the convenience of the client. The response "Less fluid is lost from the intestine" is not the function of the irrigation; most ingested fluid already is absorbed in the large intestine by the time it reaches the sigmoid colon. Irrigations facilitate expulsion of flatus but do not decrease the amount; avoidance of gas-forming foods will reduce the production of flatus. Although irrigations will prevent straining, this is not their purpose.

After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted with a tentative diagnosis of intussusception. What observation should the nurse document that will aid confirmation of the diagnosis? 1 Frequency of crying 2 Amount of oral intake 3 Characteristics of stools 4 Absence of bowel sounds

3 Characteristics of stools Because intussusception creates intestinal obstruction in which the intestine "telescopes" and becomes trapped, passage of intestinal contents is lessened; stools are red and look like currant jelly because of the mixing of stool with blood and mucus. Frequency of crying is a behavior is not specific to a diagnosis of intussusception. Accurate intake and output records are important, but they are not essential for confirming this diagnosis. Bowel sounds will not be affected significantly with intussusception.

A client with Parkinson disease complains about a problem with elimination. What should the nurse encourage the client to do? 1 Eat a banana daily 2 Decrease fluid intake 3 Take cathartics regularly 4 Increase residue in the diet

4 Increase residue in the diet Increasing residue in the diet produces bulk, which stimulates defecation; the muscles used in defecation are weak in clients with Parkinson disease. Bananas are binding and will intensify the problem of constipation. Decreasing fluid intake will intensify the problem; fluids need to be increased. Cathartics are irritating to the intestinal mucosa, and their regular administration promotes dependence.

A health care provider prescribes bisacodyl (Dulcolax) for a client with cardiac disease. The nurse explains to the client that this drug acts by doing what? 1 Producing bulk 2 Softening feces 3 Lubricating feces 4 Stimulating peristalsis

4Stimulating peristalsis Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. Bisacodyl is not a bulk cathartic. Bulk-forming laxatives, such as psyllium hydrophilic mucilloid (Metamucil), form soft, pliant bulk that promotes physiological peristalsis. Bisacodyl is not a stool softener. Stool softeners, such as docusate sodium, permit fat and water to penetrate feces, which softens and delays the drying of the feces. Bisacodyl is not an emollient. Emollient laxatives, such as mineral oil (Kondremul), lubricate the feces and decrease absorption of water from the intestinal tract.