Test 4 GU, GI

UTI clinical manifestations *

1. Urgency, frequency, burning. 2. Nocturia. 3. Abdominal discomfort, perineal or back pain. 4. Cloudy or blood tinged urine. 5. Asthenia aka general tired feeling.

Pathophysiology- calculi form in 3 situations

- Decreased fluid volume - Deficiency of inhibitor substance that prevent crystallization (citrate, magnesium) - Concentration of substances which form stones(calcium oxalate, calcium phosphate, uric acid increase)

predisposition factors of renal calculi

- dehydration - past history - diet high in purine, calcium supplements, animal proteins - UTI - prolonged indwelling catheter - neurogenic bladder - people who live in hot areas

A client scheduled to have a vasectomy in a few weeks is at the health care provider (HCP)'s office and asked the nurse what complications may occur post vasectomy? What is the nurse's best response? Select all that apply. A. "Bleeding or a scrotal hematoma." B. "Your semen may have blood in it." C. "Scrotal bruising may occur." D. "Infection at the surgical site." E. "Penile swelling and drainage."

A. "Bleeding or a scrotal hematoma." B. "Your semen may have blood in it." C. "Scrotal bruising may occur." D. "Infection at the surgical site (A. bleeding or a scrotal hematoma are minor complications that may result post vasectomy. Hematomas may cause a moderate amount of bleeding into the scrotum. Both usually resolve without intervention. Most clients post vasectomy have few complications experienced. The milder side effects of the surgery may include discomfort and pain at the surgical site, discomfort the first time engaging in sexual intercourse, and some edema and bruising at the surgical site. B. the client's semen may have blood in it. Post vasectomy, a client is not immediately sterile. It can take up to 6-8 weeks for sperm to leave the tube of the body. It is normal for the client to have blood in his semen for up to two months post vasectomy. The milder side effects of the surgery may include discomfort and pain at the surgical site, discomfort the first time engaging in

A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The X-ray results show the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following? A. Acute rejection B. Chronic rejection C. Kidney infection D. Kidney obstruction

A. Acute rejection (Acute rejection most often occurs in the first two (2) weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. It is related to preexisting circulating antibodies in the recipient's blood against the donor antigen (usually ABO blood group or HLA antigen), which is present at the time of transplantation. These antibodies attack and destroy the transplanted organ as soon as or within a few hours after allograft is revascularized. Option B: Chronic rejection occurs gradually during a period of months to years. Chronic rejection is related to both immune and nonimmune mediated factors. The primary risk factor for chronic rejection is non-compliance with immunosuppressive medication. It can be either chronic antibody-mediated rejection, which is mainly related to the presence of donor HLA-antigens donor Specific Antibody (DSA) or Chronic cellular rejection, which is uncommon. Option C: Kidney infection (pyelonephritis) is a type of urinary tract infection (UTI) that generally begins in the urethra or bladder and travels to one or both of the kidneys. A kidney infection requires prompt medical attention. If not treated properly, a kidney infection can permanently damage the kidneys or the bacteria can spread to the bloodstream and cause a life-threatening infection.

A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The X-ray results show the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following? A. Acute rejection B. Chronic rejection C. Kidney infection D. Kidney obstruction

A. Acute rejection (Acute rejection most often occurs in the first two (2) weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. It is related to preexisting circulating antibodies in the recipient's blood against the donor antigen (usually ABO blood group or HLA antigen), which is present at the time of transplantation. These antibodies attack and destroy the transplanted organ as soon as or within a few hours after allograft is revascularized.)

The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome? A. Bradycardia and confusion B. Tachycardia and diarrhea C. Decreased urinary output and bladder spasms D. Increased urinary output and anemia

A. Bradycardia and confusion (Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.)

A priority nursing diagnosis for the client who is being discharged home 3 days after a TURP would be: A. Deficient fluid volume B. Imbalanced Nutrition: Less than Body Requirements C. Impaired Tissue Integrity D. Ineffective Airway Clearance

A. Deficient fluid volume (Deficient Fluid Volume is a priority diagnosis because the client needs to drink a large amount of fluid to keep the urine clear. The urine should be almost without color. About two (2) weeks after a TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client should be instructed to call the surgeon or go to the ED if at any time the urine turns bright red.)

The primary reason for taping an indwelling catheter laterally to the thigh of a male client is to: A. Eliminate pressure at the penoscrotal angle. B. Prevent the catheter from kinking in the urethra. C. Prevent accidental catheter removal. D. Allow the client to turn without kinking the catheter.

A. Eliminate pressure at the penoscrotal angle. (The primary reason for taping an indwelling catheter to a male client is so the penis is held in a lateral position to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a urethrocutaneous fistula.)

Which of the following interventions would be most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery? A. Encourage the client to ambulate every 2 to 4 hours. B. Offer 3 to 4 ounces of a carbonated beverage periodically. C. Encourage use of a stool softener. D. Continue intravenous fluid therapy.

A. Encourage the client to ambulate every 2 to 4 hours. (Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until peristalsis returns. Encouraging ambulation very early in the postoperative period is a simple but very important prevention and treatment measure. Regular and serial clinical assessments should be exerted with open eyes and mind for worsening complications or a missed diagnosis.)

A client with a newborn who is diagnosed with PKU asks how the disease can cause mental retardation. Which statement by the nurse is most appropriate? A. PKU is a deficit in amino acid metabolism resulting in the unconverted amino acids building up in the body causing brain damage. B. PKU is a deficit in protein metabolism and causes respiratory distress in unborn babies and lack of oxygen to the brain causing mental retardation. C. PKU is a deficit in amino acid metabolism and results in low ox

A. PKU is a deficit in amino acid metabolism resulting in the unconverted amino acids building up in the body causing brain damage. (PKU is a deficit in amino acid metabolism resulting in the unconverted amino acids building up in the body causing brain damage. PKU is a deficit in amino acid metabolism resulting in the unconverted amino acids building up in the body causing brain damage. Amino acids are found in high protein foods.)

A new mother on the maternity floor is having trouble voiding due to urinary retention after just giving birth to a large-for-gestational age (LGA) newborn. Which intervention is most appropriate for this client? A. Pouring warm water over the perineum. B. Obtain an order to catheterize the client. C. Administer oxybutynin to the client. D. Limit the client's fluid intake.

A. Pouring warm water over the perineum (it is the least invasive method to encourage voiding. Pouring warm water over the perineum will promote urination. Warm water creates vasodilation, which in turn, assists the muscarinic receptors to stimulate the bladder and relax the sphincter in order to promote micturition. Warm water also creates the sensation to urinate through sensory stimulation.)

The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas? A. Shoulder B. Umbilicus C. Costovertebral angle D. Hip

A. Shoulder (Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip. Aside from iatrogenic injuries, patients with signs and symptoms of bladder injury will likely relay a history typical for pelvic trauma. Option B: Most patients with bladder rupture complain of suprapubic or abdominal pain but many can still void. The ability to urinate does not exclude bladder injury or perforation, however. Option C: An abdominal examination may reveal distention, guarding, or rebound tenderness. Absent bowel sounds and signs of peritoneal irritation indicate possible intraperitoneal bladder rupture. Option D: Bladder injury pain does not radiate to the hip. If the prostate is "high riding" or elevated, proximal urethral disruption should be suspected. In the setting of motor vehicle collision or crush injury, bilateral palpation of the bony pelvis may reveal abnormal l

The client is admitted to the ER following a MVA. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To determine further whether the pain is due to bladder trauma, the nurse asks the client if the pain is referred to which of the following areas? A. Shoulder B. Umbilicus C. Costovertebral angle D. Hip

A. Shoulder (Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, CV angle, or hip. Aside from iatrogenic injuries, patients with signs and symptoms of bladder injury will likely relay a history typical for pelvic trauma.)

A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important? A. Strain all urine. B. Limit fluid intake. C. Enforce strict bed rest. D. Encourage a high calcium diet.

A. Strain all urine. (Urine should be strained for calculi and sent to the lab for analysis. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of type of stone and influences choice of therapy.)

A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important? A. Strain all urine. B. Limit fluid intake. C. Enforce strict bed rest. D. Encourage a high calcium diet.

A. Strain all urine. (Urine should be strained for calculi and sent to the lab for analysis. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of type of stone and influences choice of therapy.)

The client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse would look at the results of the prostate examination, which should reveal that the prostate gland is: A. Tender, indurated, and warm to the touch B. Soft and swollen C. Tender and edematous with ecchymosis D. Reddened, swollen, and boggy

A. Tender, indurated, and warm to the touch (The client with prostatitis has a prostate gland that is swollen and tender, but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder). Option B: Patients with ABP typically complain of fever, malaise, myalgias, dysuria, urinary frequency/hesitancy, and pelvic pain. On physical exam, the prostate is often enlarged and exquisitely tender to palpation. Option C: Vigorous manipulation of the prostate gland should not be performed in ABP as this may acutely exacerbate the patient's condition. The patient should also be evaluated for signs and symptoms of urinary retention, which may present with suprapubic tenderness and suprapubic fullness. Option D: Patients suspected of having ABP should also be assessed for CVA tenderness, as pyelonephritis is an important differential. The prostate is not acute

The client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse would look at the results of the prostate examination, which should reveal that the prostate gland is: A. Tender, indurated, and warm to the touch B. Soft and swollen C. Tender and edematous with ecchymosis D. Reddened, swollen, and boggy

A. Tender, indurated, and warm to the touch (The client with prostatitis has a prostate gland that is swollen and tender, but that is also warm to the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back pain, and signs of urinary tract infection (which often accompany the disorder).)

An adolescent boy is brought to the emergency department because of an injury to his scrotum during a baseball game. The scrotum is swollen with fluid collection noted surrounding one of his testicles. Which of these tests will be implemented to diagnose the client with a hydrocele? A. Transillumination of the scrotum. B. X-ray of the scrotal sac. C. Ultrasound of the scrotal sac. D. CT scan of the scrotal sac.

A. Transillumination of the scrotum. (a collection of fluid within the scrotum is tested by transillumination where a light is shone behind the scrotal sac to assess if the sac is illuminated or light moves through it or the mass is solid. Hydroceles are common in older boys, adult men, and newborns. Hydroceles are not painful but can be large and disruptive.)

A client diagnosed with benign prostatic hyperplasia (BPH) one year ago presents with worsening symptoms. He is compliant with his medication for management of symptoms yet he is still experiencing problems with BPH. What would the health care provider (HCP) recommend next? A. Transurethral resection of the prostate B. Total removal of the prostate (prostatectomy) C. Antibiotics to relieve worsening symptoms D. Decrease the dose of his medication

A. Transurethral resection of the prostate (a transurethral resection of the prostate is the alternative to treatment for BPH when drug therapy does not resolve symptoms of the diagnosis. A TURP is anticipated when BPH has been refractory with treatment. Some clients do require a prostatectomy, which is more invasive with longer recovery times than a TURP.)

The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The most important reason for doing this is to prevent: A. Urine reflux into the stoma. B. Appliance separation C. Urine leakage D. The need to restrict fluids.

A. Urine reflux into the stoma. (The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent reflux into the stoma and ureters, which can result in infection. Unlike the Indiana pouch, the ileal conduit is not continent because of its small size. Urine is not collected and held in the pouch but continuously flows out of the stoma. An ileal conduit requires you to wear an external urostomy bag that adheres to the skin around the stoma and collects urine. Option B: The use of a standard collection bag also keeps the appliance from separating from the skin. Closely monitor the stoma's color, size, discharge, and the skin around it. Know what is normal and what is not. The client should've been thoroughly educated by the ostomy nurse. Option C: The use of a standard collection bag helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. Washing around the stoma with water is enough, but the client can use mild unscented soap if he wants. If he is wearing a pouch, rinse well because soap can affect the adhesiveness of the skin barrier. Option D: A client with a urinary diversion should drink 2000-3000 ml of fluid each day; it would be inappropriate to suggest decreasing fluid intake. Cleaning the stoma and skin with water is enough. If the client wishes to use soap, rinse well as soap might affect the adhesiveness of the skin barrier. Pat the skin dry before putting on the skin barrier and pouch.)

Upper UTI's

Acute pyelonephritis, chronic pyelonephritis, renal abscess, internal nephritis, perirenal abscess

High purine foods

Alcoholic beverages, some seafood/fish...some meats like turkey, bacon, liver

The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria? A. Encourage fluid intake B. Administration of diuretics C. Irrigation of Foley catheter D. Restricting fluids

B. Administration of diuretics (To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Given early in the oliguric phase of ARF in an effort to convert to non-oliguric phase, flush the tubular lumen of debris, reduce hyperkalemia, and promote adequate urine volume. Option A: Fluid intake would not be encouraged. Fluid management is usually calculated to replace output from all sources plus estimated insensible losses (metabolism, diaphoresis). Prerenal failure (azotemia) is treated with volume replacement and/or vasopressors. Option C: Irrigation of the Foley catheter will not assist in alleviating this oliguria. Accurately record intake and output (I&O) noting to include "hidden" fluids such as IV antibiotic additives, liquid medications, frozen treats, ice chips. Religiously measure gastrointestinal losses and estimate insensible losses (sweating), including wound drainage, nasogastric outputs, and diarrhea. Option D: The oliguric patient with adequate circulating volume or fluid overload who is unresponsive to fluid restriction and diuretics requires dialysis. Note: During the oliguric phase, "push/pull" therapy (push IV fluids and diuresis with diuretics) may be tried to stimulate kidney function.)

The nurse is caring for a client following a kidney transplant. The client develops oliguria. Which of the following would the nurse anticipate to be prescribed as the treatment of oliguria? A. Encourage fluid intake B. Administration of diuretics C. Irrigation of Foley catheter D. Restricting fluids

B. Administration of diuretics (To increase urinary output, diuretics and osmotic agents are considered. The client should be monitored closely because fluid overload can cause hypertension, congestive heart failure, and pulmonary edema. Given early in the oliguric phase of ARF in an effort to convert to non-oliguric phase, flush the tubular lumen of debris, reduce hyperkalemia, and promote adequate urine volume.)

A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to: A. Irrigate the catheter with 30 ml of normal saline every 8 hours. B. Ensure that the catheter is draining freely. C. Clamp the catheter every 2 hours for 30 minutes. D. Ensure that the catheter drains at least 30 ml an hour.

B. Ensure that the catheter is draining freely. (The ureteral catheter should drain freely without bleeding at the site. Ensure nephrostomy is secure at all times with drain fixation dressing (and secondary film dressing if required). Check drainage tubing is patent and not kinked/twisted. At night, the patient and/or carer should be taught to attach a larger-volume night drainage bag to ensure a comfortable night's sleep.)

The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include in the client's postoperative care? A. Sterile irrigation of the Penrose drain. B. Frequent dressing changes around the Penrose drain. C. Weighing the dressings. D. Maintaining the client's position on the affected side.

B. Frequent dressing changes around the Penrose drain. (Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. Change the dressing 2 times every day and anytime it's wet or loose. It's best to change it around the same time every day.)

The nurse teaches the client with an ileal conduit measure to prevent a UTI. Which of the following measures would be most effective? A. Avoid people with respiratory tract infections. B. Maintain a daily fluid intake of 2,000 to 3,000 ml. C. Use sterile technique to change the appliance. D. Irrigate the stoma daily.

B. Maintain a daily fluid intake of 2,000 to 3,000 ml. (Maintaining a fluid intake of 2,000 to 3,000 ml/day is likely to be effective in preventing UTI. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Infections can occur when urine is not drained frequently or completely. They can also occur when the catheter is contaminated by the user's hands. Watch out for foul-smelling, cloudy, or dark urine as this is a common symptom.)

A client diagnosed with prostatitis and treated with terazosin a few days ago came to the emergency department for complaints of feeling dizzy when standing, weakness, shakiness, and a headache. The nurse suspects the client has been taking which of these medications along with the terazosin? A. Naprosyn. B. Sildenafil. C. Ibuprofen. D. Aspirin.

B. Sildenafil. (sildenafil dilates blood vessels and decreases the client's blood pressure. Terazosin is an alpha-blocker used in the treatment of prostatitis because the medication relaxes the bladder and prostate. The client should not take terazosin and sildenafil at the same time due)

The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with what product? A. Baking soda B. Soap C. Hydrogen peroxide D. Alcohol

B. Soap (A reusable appliance should be routinely cleaned with soap and water. Clean with warm water and pat dry. Use soap only if the area is covered with sticky stool. If the paste has collected on the skin, let it dry, then peel it off. Maintaining a clean and dry area helps prevent skin breakdown. Option A: Baking soda may irritate the skin. Clean stoma gently by wiping it with warm water. Do not use soap. Aggressive cleaning can cause bleeding. If removing stoma adhesive paste from the skin, use a dry cloth first. Option C: Wash the skin and pat dry. Do not use alcohol or hydrogen peroxide to clean around the stoma because this can damage the tissue. Consider more frequent pouch changes if the skin is red and irritated. Option D: Do not use Benzoin on the skin around the stoma. Skin preparations should not be used under wafer-type barriers because this can result in redness and itching and can actually interfere with the integrity of the barrier.)

A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time? A. Report hematuria to the physician. B. Strain the urine carefully. C. Administer meperidine (Demerol) every 3 hours. D. Apply warm compresses to the flank area.

B. Strain the urine carefully. (Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect the passage of the stone. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of the type of stone and influences choice of therapy.)

After surgery for an ileal conduit, the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery? A. Peritonitis B. Thrombophlebitis C. Ascites D. Inguinal hernia

B. Thrombophlebitis (After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. The pathogenesis is thought to include injury to the intima of the pelvic vein caused by a spreading uterine infection, bacteremia, and endotoxins, which can also occur secondary to the trauma of delivery or surgery.)

A client who is receiving external radiation for his bladder cancer is being discharged home. He remarks to the nurse how happy he will be when he gets home and is able to see his live-in grandchildren. Which statement by the nurse is best? A. "You will be radioactive for a short time and you will want to limit your time or avoid being around people." B. "You will need to use a private bathroom and instruct your family to avoid contact with your waste." C. "I am very happy that you get to see

C. "I am very happy that you get to see your grandchildren soon and it has been a pleasure caring for you." (it promotes positivity for the client. By conveying happiness, the nurse inspires hope in the client. This can assist in an optimistic wellness outcome for the client. A. This answer is not correct because the client undergoing external radiation is never radioactive. The client nor family need to take any special precautions. B. This is a concern only with internal or systemic radiation, or with chemotherapy. D. the client who undergoes external radiation will be at risk for impaired skin integrity. During discharge planning, the client will be advised to avoid exposing the skin to sunlight and extremes in temperature.) Test Taking Tips Understand the differences between internal

The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply. A. "If I limit my fluid intake I will not have to empty my ostomy pouch as often." B. "I can place an aspirin tablet in my pouch to decrease odor." C. "I can usually keep my ostomy pouch on for 3 to 7 days before changing it." D. "I must use a skin barrier to protect my skin from urine." E. "I should empty my ostomy pouch of urine when it is full."

C. "I can usually keep my ostomy pouch on for 3 to 7 days before changing it." D. "I must use a skin barrier to protect my skin from urine." (The client with an ileal conduit must learn self-care activities related to the care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 ml per day and should not limit intake. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine.) (Option A: Adequate fluid intake helps to flush mucus from the ileal conduit. Monitor intake and output (I&O) carefully, measure liquid stool. Weigh regularly. Provides direct indicators of fluid balance. Greatest fluid losses occur with an ileostomy, but they generally do not exceed 500-800 mL/day. Option B: An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. Apply corticosteroid aerosol spray and prescribed antifungal powder as indicated. Assists in healing if peristomal irritation persists and/or fungal infection develops. Note: These products can have potent side effects and should be used sparingly. Option E: The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight from pulling the appliance away from the skin. Use a transparent, odor-proof drainable pouch. A transparent appliance during the first 4-6 wk allows easy observation of stoma without the necessity of removing pouch/irritating skin.)

The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions? A. Increase intake of meat, fish, plums, and cranberries. B. Avoid citrus fruits and citrus juices. C. Avoid green, leafy vegetables such as spinach. D. Increase intake of dairy products.

C. Avoid green, leafy vegetables such as spinach. (Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The more oxalate that is absorbed from the digestive tract, the more oxalate in the urine. Often a combination of calcium from foods or beverages with meals and fewer high-oxalate foods is required.)

A 27-year old client, who became paraplegic after a swimming accident, is experiencing autonomic dysreflexia. Which condition is the most common cause of autonomic dysreflexia? A. Upper respiratory infection B. Incontinence C. Bladder distention D. Diarrhea

C. Bladder distention (Rationale: Autonomic dysreflexia is a potentially life-threatening complication of spinal cord injury, occurring from obstruction of the urinary system or bowel. In about 85% of cases, this stimulus is from a urological source such as a UTI, a distended bladder, or a clogged Foley catheter. The etiology is a spinal cord injury, usually above the T6 level. It is unlikely to occur if the level is below T10. The higher the injury level, the greater the severity of the cardiovascular dysfunction.)

A client with BPH is being treated with terazosin (Hytrin) 2 mg at bedtime. The nurse should monitor the client's: A. Urinary nitrites B. White blood cell count C. Blood pressure D. Pulse

C. Blood pressure (Terazosin (Hytrin) is an antihypertensive drug that is also used in the treatment of BPH. Blood pressure must be monitored to ensure that the client does not develop hypotension, syncope, or postural hypotension. The client should be instructed to change positions slowly. Statistically significant adverse effects associated with terazosin detected in placebo-controlled trials listed in the FDA database include dizziness, headache, weakness, postural hypotension, and nasal congestion.)

The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client's VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician? A. Red bloody urine B. Urinary output of 200 ml greater than intake C. Blood pressure of 100/50 and pulse 130. D. Pain related to bladder spasms.

C. Blood pressure of 100/50 and pulse 130. (A rapid pulse with low blood pressure is a potential sign of excessive blood loss. The physician should be notified. Class III of hemorrhagic shock includes a volume loss from 30% to 40% of total blood volume, from 1500 mL to 2000 mL. A significant drop in blood pressure and changes in mental status occurs. Heart rate and respiratory rate are significantly elevated (more than 120 BPM). Urine output declines. Capillary refill is delayed.)

A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors? A. Antibodies B. Type of infection C. Composition of calculus D. Size and number of calculi

C. Composition of calculus (The calculus should be analyzed for the composition to determine appropriate interventions such as dietary restrictions. Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels or excessive urinary acidity.)

A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Preoperatively, the nurse reinforces the client's understanding of the surgical procedure by explaining that an ileal conduit: A. Is a temporary procedure that can be reversed later. B. Diverts urine into the sigmoid colon, where it is expelled through the rectum. C. Conveys urine from the ureters to a stoma opening in the abdomen. D. Creates an opening in the bladder that allows urine to drain into an external pouch.

C. Conveys urine from the ureters to a stoma opening in the abdomen. (An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure and the ileal conduit is not reversible. Option A: Commonly, a permanent urinary diversion is created after surgery to treat a bladder or pelvic malignancy, but it can be performed for other functional and anatomical abnormalities of the urinary tract. Ileal conduits are the most common form of incontinent urinary diversion, other options providing continent urinary diversion do exist, and these are more widely practiced in America, whereas in Europe, ileal conduits are preferred. Option B: Diversion of the urine to the sigmoid colon is called a ureter ileosigmoidostomy. When bladder cancer is treated with curative intent, continence-preserving orthotopic urinary bladder replacement is preferred. For heterotopic urinary bladder replacement, a reservoir is fashioned from an ileal or ileocecal segment. Urine is diverted to the rectum by way of the sigmoid colon. Option D: An opening in the bladder that allows urine to drain externally is called a cystostomy. Cystostomy is the general term for the surgical creation of an opening into the bladder; it may be a planned component of urologic surgery or an iatrogenic occurrence. Often, however, the term is used more narrowly to refer to suprapubic cystostomy or suprapubic catheterization.)

What is the priority intervention for a pregnant client with a penicillin allergy who tested positive for syphilis? A. Tell your client that she will not be able to be treated since she has an allergy to penicillin. B. Inform your client that her health care provider (HCP) will be able to order her doxycycline for treatment due to her penicillin allergy. C. Educate your client that clients with penicillin allergies will be treated with much smaller doses of penicillin needed to treat the syph

C. Educate your client that clients with penicillin allergies will be treated with much smaller doses of penicillin needed to treat the syphilis. (this is the priority intervention for the client with an allergy to penicillin with syphilis. The priority intervention for this client would be to educate the client about penicillin desensitization for the treatment of her syphilis.)

A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection. Which of the following conditions is a major complication of this drug therapy? A. Depression B. Hemorrhage C. Infection D. Peptic ulcer disease

C. Infection (Infection is the major complication to watch for in clients on cyclosporine therapy because it's an immunosuppressive drug. Urinary tract infections are common within the first 6 months. Opportunistic infections are more likely to occur 1-6 months after transplantation, reflecting the greater impact of immunosuppression during this time. Reactivation of latent pathogens such as polyomavirus BK, hepatitis C virus (HCV), and mycobacterium tuberculosis may also occur. Option A: Depression may occur posttransplantation but not because of cyclosporine. While kidney transplantation offers several advantages in terms of improved clinical outcomes and quality of life compared to dialysis modalities, depressive symptoms are still present in approximately 25% of patients, rates comparable to that of the hemodialysis population. Option B: Hemorrhage is a complication associated with anticoagulant therapy. Bleeding is the most important complication of VKAs and a major concern

The nurse is receiving in transfer from the postanesthesia care unit a client who has had percutaneous ultrasonic lithotripsy for calculuses in the renal pelvis. The nurse anticipates that the client's care will involve monitoring which of the following? A. Suprapubic tube B. Urethral stent C. Nephrostomy tube D. Jackson-Pratt drain

C. Nephrostomy tube (A nephrostomy tube is put in place after percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect the elimination of the calculus fragments. Option A: A suprapubic catheter is a hollow flexible tube that is used to drain urine from the bladder. It is inserted into the bladder through a cut in the tummy, a few inches below the navel (tummy button). This is done under a local anesthetic or a light general anesthetic. Option B: Urethral stent placement is a procedure to open a blockage or stricture (narrowing) of the urethra. The urethra is the tube that carries urine from the bladder out of the body. A stent is a small plastic or metal tube used to open the narrowed urethra. Option D: A Jackson-Pratt (JP) drain is used to remove fluids that build up in an area of the body

The nurse is receiving in transfer from the postanesthesia care unit a client who has had percutaneous ultrasonic lithotripsy for calculuses in the renal pelvis. The nurse anticipates that the client's care will involve monitoring which of the following? A. Suprapubic tube B. Urethral stent C. Nephrostomy tube D. Jackson-Pratt drain

C. Nephrostomy tube (A nephrostomy tube is put in place after percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect the elimination of the calculus fragments.)

The nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis? A. High urine specific gravity B. High urine osmolarity C. Normal to low urine specific gravity D. Elevated urine pH

C. Normal to low urine specific gravity (Rationale: Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. Water diuresis was accompanied by (i) a rapid increase in urea excretion during the phase of increasing urine flow, followed by a fall in later periods to values similar to those in non-diuresis, (ii) a slower increase in sodium output, continuing after the establishment of the constant water load, (iii) unchanged potassium excretion, but slightly increased ammonium outputs.)

The nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water diuresis? A. High urine specific gravity B. High urine osmolarity C. Normal to low urine specific gravity D. Elevated urine pH

C. Normal to low urine specific gravity (Water diuresis causes low urine specific gravity, low urine osmolarity, and a normal to elevated serum sodium level. Water diuresis was accompanied by (i) a rapid increase in urea excretion during the phase of increasing urine flow, followed by a fall in later periods to values similar to those in non-diuresis, (ii) a slower increase in sodium output, continuing after the establishment of the constant water load, (iii) unchanged potassium excretion, but slightly increased ammonium outputs.)

Which of these options is an appropriate treatment for clients diagnosed with endometriosis? A. Surgery. B. Anti-inflammatory drugs. C. Oral contraception. D. No treatment.

C. Oral contraception. (oral contraception called progestins (synthetic progesterone hormone) is prescribed to clients diagnosed with endometriosis to slow the growth of endometrial tissue. Oral contraception medication contains estrogen and progesterone which inhibit endometrial tissue growth.)

Which of the following symptoms is the most common clinical finding associated with bladder cancer? A. Suprapubic pain B. Dysuria C. Painless hematuria D. Urinary retention

C. Painless hematuria (Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include frequency, dysuria, and urgency, but these are not as common as the hematuria. Bladder carcinoma (BC) is the most common neoplasm of the urinary system. Urothelial carcinoma (UC) is the most common histologic type of BC (approximately 90%). The definition of UC is the invasion of the basement membrane or lamina propria or deeper by neoplastic cells of urothelial origin. Option A: Suprapubic pain and urinary retention do not occur in bladder cancer. The WHO has replaced the old term transitional cell carcinoma with urothelial carcinoma. Invasion is referred to as 'micro invasion' when the depth of invasion is 2 mm or less. The World Health Organization (2016) classifies bladder cancers based on differentiation as low grade (grade 1 and 2) or high grade (grade 3). Option B: Other less common symptoms include painful micturition, frequency, constitutional symptoms such as fatigue, weight loss, and a pelvic mass. In developing countries, schistosomiasis infection is an important cause of BC. Schistosoma haematobium ova embedded in the bladder wall leading to irritation, chronic inflammation, squamous metaplasia, and dysplasia, with further progression leading to squamous cell carcinoma of the urinary bladder. Option D: Complications of UC include symptoms related to the tumor and treatment of adverse effects. Complications related to the tumor include weight loss, fatigue, UTI, metastasis, and urinary obstruction leading to chronic kidney failure. The adverse effects of surgical management include UTI, urinary leak, pouch stones, urinary tract obstruction, erectile dysfunction, and vaginal narrowing.)

A client is diagnosed with prostate cancer. Which test is used to monitor the progression of this disease? A. Serum creatinine B. Complete blood cell count (CBC) C. Prostate-specific antigen (PSA) D. Serum potassium

C. Prostate-specific antigen (PSA) (The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Elevated Prostate-Specific Antigen (PSA) levels (usually greater than 4 ng/ml) in the blood is how 80% of prostate cancers initially present even though elevated PSA levels alone correctly identify prostate cancer only about 25% to 30% of the time. We recommend at least 2 abnormal PSA levels or the presence of a palpable nodule on DRE to justify a biopsy and further investigation.)

The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones? A. Calcium oxalate B. Uric acid C. Struvite D. Cystine

C. Struvite (Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Struvite stones are also known as triple-phosphate (3 cations associated with 1 anion), infection (or infection-induced), phosphatic, and urease stones. Option A: Calcium oxalate stones result from increased calcium intake or conditions that raise serum calcium concentrations. Other, less common staghorn calculi can be composed of mixtures of calcium oxalate and calcium phosphate. Option B: Uric acid stones occur in clients with gout. Uric acid stones form when the levels of uric acid in the urine is too high, and/or the urine is too acidic (pH level below 5.5) on a regular basis. Uric acid can result from a diet high in purines, which are found especially in animal proteins such as beef, poultry, pork, eggs, and fish. The highest levels of purines are found in organ meats, such as liver and fish. Option D:

The primary function of the prostate gland is: A. To store underdeveloped sperm before ejaculation. B. To regulate the acidity and alkalinity of the environment for proper sperm development. C. To produce a secretion that aids in the nourishment and passage of sperm. D. To secrete a hormone that stimulates the production and maturation of sperm.

C. To produce a secretion that aids in the nourishment and passage of sperm. (The prostate gland is located below the bladder and surrounds the urethra. It serves one primary purpose: to produce a secretion that aids in the nourishment and passage of sperm. The prostate gland is situated in the true pelvis and plays a supportive role in the male reproductive system. Its principal purpose is to secrete an alkaline solution protective for sperm in the acidic environment of the vagina.)

Which of the following symptoms indicate acute rejection of a transplanted kidney? A. Edema, Nausea B. Fever, Anorexia C. Weight gain, pain at graft site D. Increased WBC count, pain with voiding

C. Weight gain, pain at graft site (Pain at the graft site and weight gain indicates the transplanted kidney isn't functioning and possibly is being rejected. In general, when transplanting tissue or cells from a genetically different donor to the graft recipient, the alloantigen of the donor induces an immune response in the recipient against the graft. This response can destroy the graft if not controlled. The whole process is called allograft rejection. Option A: Transplant clients usually have edema, anorexia, fever, and nausea before transplantation, so those symptoms may not indicate rejection. Allograft rejection is inflammation with specific pathologic changes in the allograft, due to the recipient's immune system recognizing the non-self antigen in the allograft, with or without dysfunction of the allograft. Option B: Renal transplant rejection, as stated earlier, is an immunological response that leads to inflammation with specific pathological changes in the allograft,

Which of the following symptoms indicate acute rejection of a transplanted kidney? A. Edema, Nausea B. Fever, Anorexia C. Weight gain, pain at graft site D. Increased WBC count, pain with voiding

C. Weight gain, pain at graft site (Pain at the graft site and weight gain indicates the transplanted kidney isn't functioning and possibly is being rejected. In general, when transplanting tissue or cells from a genetically different donor to the graft recipient, the alloantigen of the donor induces an immune response in the recipient against the graft. This response can destroy the graft if not controlled. The whole process is called allograft rejection.)

A client underwent a TURP, and a large three-way catheter was inserted into the bladder with continuous bladder irrigation. In which of the following circumstances would the nurse increase the flow rate of the continuous bladder irrigation? A. When the drainage is continuous but slow. B. When the drainage appears cloudy and dark yellow. C. When the drainage becomes bright red. D. When there is no drainage of urine and irrigating solution.

C. When the drainage becomes bright red. (The decision made by the surgeon to insert a catheter after a TURP or prostatectomy depends on the amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of irrigating solution helps flush the catheter well so clots do not plug it.)

The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH? A. metformin (Glucophage) B. buspirone (BuSpar) C. inhaled ipratropium (Atrovent) D. ophthalmic timolol (Timoptic)

C. inhaled ipratropium (Atrovent) (Atrovent is a bronchodilator, and its anticholinergic effects can aggravate urinary retention. Caution is necessary for the use of intranasal/inhaled ipratropium in patients with hypertrophic prostate. Ipratropium is an acetylcholine antagonist via blockade of muscarinic cholinergic receptors. Blocking cholinergic receptors decreases the production of cyclic guanosine monophosphate (cGMP). This decrease in the lung airways will lead to decreased contraction of the smooth muscles.)

Cyclosporine side effects

CNS: Altered level of consciousness, confusion, encephalopathy, headache, intracranial hypertension, lethargy, loss of motor function, migraine, neurotoxicity, paresthesia, progressive multifocal leukoencephalopathy, posterior reversible encephalopathy syndrome (PRES), psychiatric disturbances, seizures, tremor CV: Chest pain, hypertension, MI EENT: Gingival hyperplasia, optic disc edema, oral candidiasis, sinusitis, visual impairment including blindness ENDO: Gynecomastia GI: Cholestasis, diarrhea, hepatitis, hepatotoxicity, jaundice, liver failure, nausea, pancreatitis, vomiting GU: Albuminuria, elevated serum creatinine and blood urea nitrogen levels, glomerular capillary thrombosis, hematuria, nephropathy associated with BK virus, nephrotoxicity, proteinuria, renal failure HEME: Anemia, leukopenia, thrombocytopenia MS: Lower extremity pain SKIN: Acne, cancer, flushing, hirsutism, pruritus, rash Other: Anaphylaxis; bacterial, fungal, protozoal, and viral infections

Urolithiasis and Nephrolithiasis

Calculi (stones) in the urinary tract or kidney

Lower UTI's

Cystitis, prostatitis, urethitis

A client had a transurethral prostatectomy for benign prostatic hypertrophy. He's currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first? A. Administer an oral analgesic. B. Stop the irrigation and call the physician. C. Administer a belladonna and opium suppository as ordered by the physician. D. Check for the presence of clots and make sure the catheter is draining prop

D. Check for the presence of clots and make sure the catheter is draining properly. (Blood clots and blocked outflow of urine can increase spasms. Bladder irrigation helps remove and prevent blood clots in the bladder. The blood clots stop urine from flowing through the catheter. The urine collects in the bladder and causes pain that gets worse as the bladder fills. Option A: Oral analgesics should be given if the spasms are unrelieved by the belladonna and opium suppository. Pain is a common symptom after endoscopic urologic surgery, and the need for effective pain management is obvious. Pain after TURP is due to bladder spasms and the catheter thus differs from open operations. The ideal postoperative analgesic treatment should provide rapid and effective pain relief, have a low incidence of adverse effects, and a minimal impact on organ systems or no significant interaction with other pharmacologic agents. Option B: The irrigation shouldn't be stopped as long as the catheter is

The client is to undergo kidney transplantation with a living donor. Which of the following preoperative assessments is important? A. Urine output B. Signs of graft rejection C. Signs and symptoms of infection D. Client's support system and understanding of lifestyle changes.

D. Client's support system and understanding of lifestyle changes. (The client undergoing renal transplantation will need vigilant follow-up care and must adhere to the medical regimen. For many people, getting a kidney transplant can feel like getting another chance at life. There are many great things that come with getting a kidney transplant, like having more time in the day and more freedom. There are also many things the client should consider in the life after transplant that involve taking care of the new kidney. Option A: The client is most likely anuric or oliguric preoperatively but postoperatively will require close monitoring of urine output to make sure the transplanted kidney is functioning optimally. Those patients who were followed for 6 months post-transplant were observed to have a mean urine volume of 3.20 +/- 1.24 L at the end of this period. This trend showed that urine volume steadily decreased from 24 and 48 hours to 1 month after renal transplantation Optio

The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications? A. Diuretics B. Antibiotics C. Antitussives D. Decongestants

D. Decongestants (In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.)

A female client with a urinary diversion tells the nurse, "This urinary pouch is embarrassing. Everyone will know that I'm not normal. I don't see how I can go out in public anymore." The Anxiety related to the presence of urinary diversion. appropriate nursing diagnosis for this patient is: A. Anxiety related to the presence of urinary diversion. B. Deficient Knowledge about how to care for the urinary diversion. C. Low Self-Esteem related to feelings of worthlessness D. Disturbed Body Image related to creation of a urinary diversion.

D. Disturbed Body Image related to creation of a urinary diversion. (It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggest that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner. Option A: Although the client may be anxious about this situation, it is not the underlying problem. Encourage patient/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression, and grief over a loss. Discuss daily "ups and downs" that can occur. Option B: There is no data to support a diagnosis of Deficient Knowledge. Maintain a positive approach during care activities, avoiding expressions of disdain or revulsion. Do not take angry expressions of the patient and SO personally. Option C: Self-esteem may be diminished, the underlying problem is a disturbance in body image. Provide opportunities for the patient/SO to view and touch the stoma, using the moment to point out positive signs of healing, normal appearance, and so forth. Remind the patient that it will take time to adjust, both physically and emotionally.)

A client received a kidney transplant 2 months ago. He's admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected? A. Hypotension B. Normal body temperature C. Decreased WBC count D. Elevated BUN and creatinine levels

D. Elevated BUN and creatinine levels (In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. In renal transplantation matching of MHC class II antigens are more critical than MHC class I antigen compatibility in determining graft survival. Matching of the ABO blood group system is also essential since A and B antigens can express endothelium. When there is a genetic disparity between donor and receptor, MHC class I and II can be seen as foreign by the immune system. Option A: The client would most likely have acute hypertension. After a few days or weeks of successful transplantation surgery, the patient complains about tenderness at the site of the graft, pyrexia, and abnormal function of the organ or tissue graft, for example, in renal transplantation appears anuria, an increasing serum creatinine levels, and metabolic problems including hyperkalemia. Option B: Acute rejection can associate with a high incidence of infections and other

A client received a kidney transplant 2 months ago. He's admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected? A. Hypotension B. Normal body temperature C. Decreased WBC count D. Elevated BUN and creatinine levels

D. Elevated BUN and creatinine levels (In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. In renal transplantation matching of MHC class II antigens are more critical than MHC class I antigen compatibility in determining graft survival. Matching of the ABO blood group system is also essential since A and B antigens can express endothelium. When there is a genetic disparity between donor and receptor, MHC class I and II can be seen as foreign by the immune system.)

The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on the assessment data, which of the following nursing interventions would be most appropriate at this time? A. Change the appliance bag. B. Notify the physician. C. Obtain a urine specimen for culture. D. Encourage a high fluid intake.

D. Encourage a high fluid intake. (Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Monitor intake and output (I&O) carefully, measure liquid stool. Weigh regularly. Provides direct indicators of fluid balance. Greatest fluid losses occur with an ileostomy, but they generally do not exceed 500-800 mL/day. Option A: Because mucus in the urine is expected, it is not necessary to change the appliance bag or notify the physician. Inspect stoma and peristomal skin area with each pouch change. Note irritation, bruises (dark, bluish color), rashes. Monitors the healing process and effectiveness of appliances and identifies areas of concern, need for further evaluation and intervention. Option B: It is unnecessary to inform the physician. Verify that the opening on the adhesive backing of the pouch is at least 1?16 to 1?8 in (2-3 mm) larger than the base of the stoma, with adequate adhesiveness left to apply pouch. Prevents trauma to the stoma tissue and protects the peristomal skin. Adequate adhesive area prevents the skin barrier wafer from being too tight. Note: Too tight a fit may cause stomal edema or stenosis. Option C: The mucus is not an indication of an infection, so a urine culture is not necessary. Monitor vital signs, noting postural hypotension, tachycardia. Evaluate skin turgor, capillary refill, and mucous membranes. Reflects hydration status and/or the possible need for increased fluid replacement.)

When providing discharge teaching for a client with uric acid calculi, the nurse should make an instruction to avoid which type of diet? A. Low-calcium B. Low-oxalate C. High-oxalate D. High-purine

D. High-purine (To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low-fat dairy products.)

Adverse reactions of prednisone therapy include which of the following conditions? A. Acne and bleeding gums B. Sodium retention and constipation C. Mood swings and increased temperature D. Increased blood glucose levels and decreased wound healing.

D. Increased blood glucose levels and decreased wound healing. (Steroid use tends to increase blood glucose levels, particularly in clients with diabetes and borderline diabetes. Steroids also contribute to poor wound healing and may cause acne, mood swings, and sodium and water retention. Adverse effects are common in patients receiving glucocorticoids in high doses or over a long period. Potential adverse effects include skin fragility, weight gain, increased risk of infections, and fractures. Significant cardiovascular and metabolic effects are hypertension, hyperglycemia, and dyslipidemia.)

The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care? A. Place the client on radiation precautions for 18 hours. B. Save all urine in a radiation safe container for 18 hours. C. Limit contact with the client to 20 minutes per hour. D. No special precautions except to wear gloves if in contact with the client's urine.

D. No special precautions except to wear gloves if in contact with the client's urine. (No specific precautions are necessary following a renal scan. The nurse wears gloves to maintain body secretion precautions. The client should tell his doctor about any prescription or over-the-counter medications he is taking. Discuss how to use them before and during the test.)

A client is receiving a radiation implant for the treatment of bladder cancer. Which of the following interventions is appropriate? A. Flush all urine down the toilet. B. Restrict the client's fluid intake. C. Place the client in a semi-private room. D. Monitor the client for signs and symptoms of cystitis.

D. Monitor the client for signs and symptoms of cystitis. (Cystitis is the most common adverse reaction of clients undergoing radiation therapy; symptoms include dysuria, frequency, urgency, and nocturia. Document the color of the patient's urine. Be aware that patients who complain of dysuria may require a urinalysis to rule out infection. Option A: Urine of clients with radiation implants for bladder cancer should be sent to the radioisotopes lab for monitoring. Teaching is a primary responsibility of nursing care for radiation patients. Patients and families must know what to expect, get a chance to ask questions, and have those questions answered to their satisfaction. Option B: It is recommended that fluid intake be increased. A dehydrated patient may require I.V. fluids. Teach the patient to report dehydration signs and symptoms, such as weakness, dizziness, and decreased urine output. If the patient reports diarrhea or vomiting, assess for volume depletion and check orthosta

A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and post obstructive diuresis is occurring. Which of the following interventions should be done? A. Take vital signs every 8 hours. B. Weigh the client every other day. C. Assess for urine output every shift. D. Monitor the client's electrolyte levels.

D. Monitor the client's electrolyte levels. (Post-obstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. Obstructive uropathy is a hindrance to normal urinary flow that can be caused by a variety of structural and functional etiologies. This is a common and potentially serious condition that affects people across all ages and walks of life. Option A: VS should initially be taken every 30 minutes for the first 4 hours and then every 2 hours. A complete examination should be performed, focusing on the abdomen and genitalia. The presence of a distended bladder should direct the clinician to the possibility of urinary retention. A digital rectal examination may reveal prostatic enlargement or fecal impaction. An assessment of strength, sensation, reflexes, and muscle tone can be informative. A thorough history and physical examination will often point towards the underlying etiology. Option B:

A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and post obstructive diuresis is occurring. Which of the following interventions should be done? A. Take vital signs every 8 hours. B. Weigh the client every other day. C. Assess for urine output every shift. D. Monitor the client's electrolyte levels.

D. Monitor the client's electrolyte levels. (Post-obstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. Obstructive uropathy is a hindrance to normal urinary flow that can be caused by a variety of structural and functional etiologies. This is a common and potentially serious condition that affects people across all ages and walks of life.)

The nurse is preparing to care for the client following a renal scan. Which of the following would the nurse include in the plan of care? A. Place the client on radiation precautions for 18 hours. B. Save all urine in a radiation safe container for 18 hours. C. Limit contact with the client to 20 minutes per hour. D. No special precautions except to wear gloves if in contact with the client's urine.

D. No special precautions except to wear gloves if in contact with the client's urine. (No specific precautions are necessary following a renal scan. The nurse wears gloves to maintain body secretion precautions. The client should tell his doctor about any prescription or over-the-counter medications he is taking. Discuss how to use them before and during the test. Option A: A renal scan is an outpatient, or same-day, procedure. The client won't have to stay at the hospital overnight. A nuclear medicine technician performs the scan. This is usually done either in a hospital radiology department or a medical office with special equipment. Option B: Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. If the client needs to have an empty bladder for the scan, he may need a soft tube called a catheter to maintain this condition. Option C: Depending on the reasons for the scan, testing may take between 45 minutes and 3 hour

The nurse provides care for a client experiencing a small amount of hematuria following a cystoscopy. Which is an appropriate action by the nurse? A. Contact the health care provider. B. Order an ultrasound to rule out active bleeding. C. Instruct the client to not strain while urinating. D. Reassure the client this may occur and continue to monitor.

D. Reassure the client this may occur and continue to monitor. (hematuria is an expected complication associated with cystoscopy; however, hemorrhage that necessitates intervention rarely occurs. Therefore, this is an appropriate response from the nurse to the client.)

A client is scheduled to undergo a transurethral resection of the prostate gland (TURP). The procedure is to be done under spinal anesthesia. Postoperatively, the nurse should be particularly alert for early signs of: A. Convulsions B. Cardiac arrest C. Renal shutdown D. Respiratory paralysis

D. Respiratory paralysis (If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the effects of the anesthesia subside. The patient's hemodynamics requires monitoring in the immediate post-op period until the resolution of the anesthetic. Nurses and physicians from other fields managing the patient need to be aware of the nature of anesthesia that patient underwent)

When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently, primarily to prevent which of the following problems? A. Rupture of the ileal conduit. B. Interruption of urine production. C. Development of odor. D. Separation of the appliance from the skin.

D. Separation of the appliance from the skin. (If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin. Empty, irrigate, and cleanse ostomy pouch on a routine basis, using appropriate equipment. Frequent pouch changes are irritating to the skin and should be avoided. Emptying and rinsing the pouch with the proper solution not only removes bacteria and odor-causing stool and flatus but also deodorizes the pouch.)

UTI - HARD TO VOID pnemonic

H - hormone changes (pregnancy, menopause, birth A - antibiotics R - renal stones (struvite) D - diabetes (compromised circulation, decreased immune system, glucose in urine, urinary retention T- Toiletries (perfumes, scented tampons) O - obstructive prostatic hypertrophy (males bph, urinary retention, decreased anti microbial fluid) V - vescicoreteral reflux (VUR, *Peds urine backflow) O - overextended bladder (not empty, weak) I - indwelling catheter, invasive procedures, intercourse, spermicides D - decreased immune system (viral + fungal

how do you get Urinary Obstruction (Uropathies)?

May be congenital or acquired

Cyclosporine indications

To prevent or treat organ rejection in heart, kidney, and liver allogenic transplantation

Hypnotic fluid is never used to irrigate bladder (true or false)

True

UTI diagnosed by

Urine dip (Done in ED) or Urinalysis (Specimen sent to lab to test for Nitrite, WBC and Bacteria in urine)

the most common cause of autonomic dysreflexia?

bladder distention

The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms? A. Urge incontinence B. Nocturia C. Decreased force in the stream of urine D. Urinary retention

c. Decreased force in the stream of urine (Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.)

avoid urinary tract irritants

coffee, tea, cola, alcohol, citrus, juice, spices

1. Which question should the nurse ask to assess a patient's dysuria? a. "Do you have to urinate at night?" b. "Do you have blood in your urine?" c. "Do you have to urinate frequently?" d. "Do you have pain when you urinate?"

d. "Do you have pain when you urinate?" (Dysuria is painful urination. The alternate responses can be used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.)

Post-obstructive diuresis seen in hydronephrosis can cause

electrolyte imbalances

Urinary Obstruction (Uropathies) Infection

increases of risk irreversible damage.

cystitis

inflammation of the bladder

Prostitis

inflammation of the prostate

Urethritis

inflammation of the urethra

calculi

kidney stones

Potential Sites of Urinary Calculi

kidneys, ureters, bladder

Ascites is most frequently an indication of

liver disease

Urolithiasis

presence of calculi in the urinary tract which can occur from kidney to bladder.

UTI: Nursing Goals

symptomatic relief, teaching and prevention (showers no baths)

Urinary Obstruction (Uropathies) Severity may depend on?

the location, duration of obstruction, amount of pressure or dilation, and presences of urinary stasis or infection.

Common Causes of Urinary Tract Infections

• Candida albicans #2 • Enterobacter • Enterococcus • Escherichia coli #1 • Klebsiella • Proteus • Pseudomonas • Serratia • Staphylococcus • Streptococci