Prep-U Urinary disorders
The nurse recognizes that which laboratory test is a key diagnostic indicator of heart failure? Blood urea nitrogen (BUN) Creatinine Brain natriuretic peptide (BNP) Complete blood count (CBC)
Brain natriuretic peptide (BNP)
Which information is important when teaching a client how to perform self-catheterization? Peroxide is recommended for cleaning the urinary catheter. Catheterization should occur every 4 to 6 hours and before bedtime. The nurse uses nonsterile technique in the hospital setting. The catheter is rinsed with sterile normal saline after being soaked in a cleaning solution.
Catheterization should occur every 4 to 6 hours and before bedtime.
Sympathomimetics have which of the following effects on the body? Relaxation of bladder wall Decrease of heart rate Constriction of bronchioles Constriction of pupils
Relaxation of bladder wall
A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding? Pulmonary congestion Cough Dyspnea Jugular venous distention
Jugular venous distention
A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason? Preparation for likely nephrectomy Increases the effectiveness of dialysis Hypervolemia Lack of erythropoietin
Lack of erythropoietin The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.
A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care? Turn the patient every 2 hours around the clock. Administer pain medication every 2 hours. Monitor urine output hourly and report output less than 30 mL/hr. Clean the stoma with soap and water after the patient voids.
Monitor urine output hourly and report output less than 30 mL/hr.
Which nursing diagnosis is appropriate for a client with renal calculi? Ineffective tissue perfusion (renal) Functional urinary incontinence Risk for infection Decreased cardiac output
Risk for infection
A nurse is reviewing a patient's laboratory test results. Which serum albumin level would lead the nurse to suspect that the patient is at risk for pressure ulcers? 2.5 g/mL 3.1 g/mL 3.5 g/mL 4.0 g/mL
Serum albumin is a sensitive indicator of protein deficiency. Levels below 3 g/mL are associated with hypoalbuminemic tissue edema and increased risk of pressure ulcers.
A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? Stress Urge Overflow Functional
Urge
A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds: "Albumin will stay in your blood vessels a long time so that you will not seep out more fluid in your belly for at least a few weeks." "Albumin works like your diuretics to help you get rid of excess fluid through your kidneys. It's just more potent than your home water pills." "After the albumin, your potassium level will stay steady and you should keep excess water weight off for several weeks." "Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."
"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."
A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patient's ileostomy output has been unexpectedly high in the 2 days since surgery, and the patient's most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations? Confusion and decreased level of consciousness Shortness of breath, rales, and peripheral edema Dysphagia, tetany, and emotional lability Fatigue, cramps, and weakness
Fatigue, cramps, and weakness
During a routine checkup, a nurse observes the client's skin to be tight and shiny. Which of the following is the correct indication of this sign? Sebum deficiency Fluid retention Dehydration Protein deficiency
Fluid retention
When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply. Hypercalcemia Hyperkalemia Hyperuricemia Hyperphosphatemia
Hyperkalemia Hyperuricemia Hyperphosphatemia
After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an IV infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output? It's a normal finding caused by blood loss during surgery. It's a normal finding associated with the client's nothing-by-mouth status. It's an abnormal finding that requires further assessment. It's an abnormal finding that will correct itself when the client ambulates.
It's an abnormal finding that requires further assessment.
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? "This medication will relieve your pain." "This medication should be taken at bedtime." "This medication will prevent re-infection." "This will kill the organism causing the infection."
"This medication will relieve your pain."
In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the client's residual urine must be less than which amount? 30 mL 50 mL 100 mL 400 mL
100 mL
The nurse is planning the care of a patient with a major thermal burn. What outcome will the nurse understand will be optimal during fluid replacement? A urinary output of 10 mL/hr A urinary output of 30 mL/hr A urinary output of 80 mL/hr A urinary output of 100 mL/hr
A urinary output of 30 mL/hr
The clinic nurse is teaching a young woman about preventing recurrent urinary tract infections. What information should the nurse include? Bathe daily. Avoid voiding immediately after sexual intercourse. Drink liberal amounts of fluids. Void every 6 to 8 hours.
Drink liberal amounts of fluids.
The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which factor as contributing to UTIs in older adults? Low incidence of chronic illness Immunocompromise Sporadic use of antimicrobial agents Active lifestyle
Immunocompromise
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform? Determine the client's ability to manage stoma care Show photographs and drawings of the placement of the stoma Maintain skin and stoma integrity Suggest a visit to a local ostomy group
Maintain skin and stoma integrity
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? Urinary retention Fever Frequency Painless hematuria
Painless hematuria
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? Pulmonary congestion Pedal edema Nausea Jugular venous distention
Pulmonary congestion
Which term refers to inflammation of the renal pelvis? Pyelonephritis Cystitis Urethritis Interstitial nephritis
Pyelonephritis
Which nursing intervention should the nurse caring for the client with pyelonephritis implement? Straight catheterize the client every 4 to 6 hours. Administer acetaminophen (Tylenol). Teach client to increase fluid intake up to 3 liters per day. Restrict fluid intake to 1 liter per day.
Teach client to increase fluid intake up to 3 liters per day.
A client is prescribed amitriptyline (an antidepressant) for incontinence. The nurse understands that this drug is an effective treatment because it: increases contraction of the detrusor muscle. increases bladder neck resistance. reduces bladder spasticity. decreases involuntary bladder contractions.
increases bladder neck resistance.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: calcium and phosphorus abnormalities. chloride and magnesium abnormalities. sodium and chloride abnormalities. sodium and potassium abnormalities.
sodium and potassium abnormalities.
Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Reflex Iatrogenic Overflow Urge
Iatrogenic
The nurse is reviewing laboratory data for a client with pancreatic cancer. Which finding does the nurse prioritize as requiring notification of the health care provider? creatinine: 2.0 mg/dl (176.8 µmol/L) sodium: 136 mEq/L (136 mmol/L) glucose, fasting: 204 mg/dl (11.32 mmol/L) potassium: 2.2 mEq/L (2.2 mmol/L)
The nurse should identify potassium 2.2 mEq/L as critical because a normal potassium level is 3.8 to 5.5 mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl). The sodium level is normal (135-145 mEq/L). The creatinine is elevated (normal is 0.8 to 1.4 mg/dl), but this would not be a priority to report at this time.
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action? Determine the client's ability to manage stoma care. Show pictures and drawings of placement of the stoma. Maintain skin and stomal integrity. Suggest a visit to a local ostomy group.
Maintain skin and stomal integrity.
A client has been admitted for an outpatient cystoscopy because of a suspected interstitial cystitis. Which statement best describes the pathology of this disorder? The bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa. It is caused by infection with Chlamydia trachomatis. It is caused by bacterial infection. The surface of the bladder becomes edematous and reddened, and ulcerations may develop. The bladder can contract without warning, fail to accommodate adequate volumes of urine, or fail to empty completely.
The bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa.
The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? Anticholinergic Diuretics Anticonvulsant Cholinergic
Anticholinergic
Trousseau's sign is elicited by which of the following? Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. The patient complains of pain in the calf when his foot is dorsiflexed.
A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye.
A client is suspected of having interstitial cystitis. Which diagnostic test would the nurse anticipate as being used to confirm the diagnosis? Cystoscopy Voiding cystourethrogram Urine culture Bladder biopsy
Bladder biopsy
Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what? Voiding at given intervals Prompted voiding Interval voiding Bladder retraining
Bladder retraining
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? Polyuria Bradycardia Hypotension Warm moist skin
Hypotension
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use clean technique during insertion Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens Place the catheter bag on the client's abdomen when moving the client Perform meticulous perineal care daily with soap and water
Perform meticulous perineal care daily with soap and water
A client has been diagnosed with heart failure. What is the major nursing outcome for the client? Reduce the workload on the heart. Walk 30 minutes three times a week. Maintain a healthy diet. Sleep 8 hours per night.
Reduce the workload on the heart.
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury? Sharp decrease in urine output Excessive voiding of clear urine Acute hypertensive crisis Intermittent periods of confusion
Sharp decrease in urine output
Which diuretic medication conserves potassium? Furosemide Spironolactone Chlorothiazide Chlorthalidone
Spironolactone
Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Reflex Iatrogenic Overflow Urge
Iatrogenic
The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest? A low-sodium diet A low-purine diet A diet high in fruits and vegetables A diet high in calcium
The nurse would suggest a low-purine diet. Foods to avoid are anchovies, animal organs and sardines. The other options do not lower the uric acids levels.
The nurse is providing teaching for the parents of an 8-year-old girl who has undergone surgery. The nurse emphasizes the importance of maintaining adequate hydration. Which response by the mother would indicate a need for further teaching? "I will remind her that she will need an IV if she does not drink." "Anything that melts at body temperature is counted as a fluid." "Ice chips count as fluid intake. One cup of ice equals a half-cup of water." "I should offer her small amounts of fluid frequently."
"I will remind her that she will need an IV if she does not drink."
Which is considered an isotonic solution? 0.9% normal saline Dextran in normal saline 0.45% normal saline 3% NaCl
0.9% normal saline
In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the client's residual urine must be less than which amount on two separate occasions (morning and evening)? 30 mL 50 mL 100 mL 400 mL
100 mL
A nurse must deliver 1,000 ml of normal saline solution over 8 hours. The I.V. tubing has a drop factor of 10 gtt/ml. The nurse should set the flow rate as 20.5 gtt/minute 21 gtt/minute 25 gtt/minute 31 gtt/minute
21 gtt/minute
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use a clean technique during insertion Use a sterile technique to disconnect the catheter from the tubing to obtain urine specimens Place the catheter bag on the client's abdomen when moving the client Perform meticulous perineal care daily with soap and water
Perform meticulous perineal care daily with soap and water
A client with a severe electrical burn injury is treated in the burn unit. Which laboratory result would cause the nurse the most concern? BUN: 28 mg/dL K+: 5.0 mEq/L Na+: 145 mEq/L Ca: 9 mg/dL
The elevated BUN would cause the nurse the most concern. The nurse should report decreased urine output or increased BUN and creatinine values to the physician. These laboratory values indicate possible renal failure. In addition, myoglobinuria, associated with electrical burns, is common with muscle damage and may also cause kidney failure if not treated. The other values are within normal limits.
The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction? The nursing assistant keeps the catheter and drainage bag together when moving the client. The nursing assistant places the drainage bag on the client's abdomen for transport. The nursing assistant places the drainage bag on the lower area of the wheelchair for transport. The nursing assistant holds the drainage bag while the client moves to the wheelchair.
The nursing assistant places the drainage bag on the client's abdomen for transport.
A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction? Cystitis Bladder stones Urinary retention Urethral stricture
Urinary retention
The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) burns over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse? Pain at a 7 on a 0 to 10 scale Urine output of 15 ml per hour over the last 4 hours Refused dinner due to nausea Weight gain of 0.9 kg over the last 2 days
Urine output of 15 ml per hour over the last 4 hours
Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? drinking liquids with meals limiting intake of heavy, greasy foods increasing fluid intake limiting carbohydrate intake
limiting intake of heavy, greasy foods
The nurse is caring for a client with chronic renal failure who must begin restricting potassium intake. Which food does the nurse emphasize should be avoided? white flour seafood butter potatoes
Food high in potassium include oranges, dried fruits, bananas, and potatoes. Although bananas are typically thought of being exceptionally high in potassium, a banana contains approximately 425 mg of potassium while a baked potato contains about 925 mg.
Bladder retraining following removal of an indwelling catheter begins with encouraging the client to void immediately. advising the client to avoid urinating for at least 6 hours. performing straight catheterization after 4 hours. instructing the client to follow a 2- to 3-hour timed voiding schedule.
instructing the client to follow a 2- to 3-hour timed voiding schedule.
An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? Shows damage to the kidneys If risk for chronic pyelonephritis is likely Reveals causative microorganisms Detects calculi, cysts, or tumors
Detects calculi, cysts, or tumors
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following? Stoma ischemia Postoperative pneumonia Stoma retraction Peritonitis
Peritonitis
The nurse is caring for an infant who is retaining fluid. How will the nurse assess for urine output? weighing the child before and after feeds weighing the diaper before and after micturition measuring the formula before the child ingests it monitoring the amount of time for breast feeding
weighing the diaper before and after micturition
During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure? wheezes with wet lung sounds stridor high-pitched sounds laborious breathing
wheezes with wet lung sounds If the left side of the heart fails to pump efficiently, blood backs up into the pulmonary veins and lung tissue. For abnormal and normal breath sounds, the nurse auscultates the lungs. With left-sided congestive heart failure, auscultation reveals a crackling sound, wheezes, and gurgles. Wet lung sounds are accompanied by dyspnea and an effort to sit up to breathe. With left-sided congestive heart failure, auscultation does not reveal a high pitched sound.
A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: limit oral fluid intake for 1 to 2 weeks. report the presence of fine, sandlike particles through the nephrostomy tube. notify the physician about cloudy or foul-smelling urine. report bright pink urine within 24 hours after the procedure.
notify the physician about cloudy or foul-smelling urine. The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy.
When working with a client who has end-stage renal disease (ESRD) and is receiving peritoneal dialysis, the concept of diffusion can be explained by which statement? "If your potassium level is high, then K+ particles will move from your peritoneal cavity into the dialysis solution, where the concentration of K+ is lower." "You will need to give yourself a potent diuretic so that you can pull the potassium into your bloodstream and filter the potassium out in your kidneys." "Your potassium molecules are lipid soluble and will dissolve in the lipid matrix of your cell membranes." "If you can get very warm in a sauna, you will heat up your K+ particles, and the kinetic movement of the particles will increase and pass through the cell membranes faster."
"If your potassium level is high, then K+ particles will move from your peritoneal cavity into the dialysis solution, where the concentration of K+ is lower."
Patients with urolithiasis need to be encouraged to: Increase their fluid intake so that they can excrete up to 4 liters every day. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. Supplement their diet with calcium needed to replace losses to renal calculi. Limit their voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system.
Increase their fluid intake so that they can excrete up to 4 liters every day.
Which clinical manifestation of hemorrhage is related to carotid artery rupture? Increased pulse rate Increased blood pressure Shallow respirations Dry skin
Increased pulse rate The nurse monitors vital signs for changes, particularly increased pulse rate, decreased blood pressure, and rapid, deep respirations. Cold, clammy, pale skin may indicate active bleeding.
The nurse caring for a client with a urinary diversion notices mucus around the stents and in the client's urine. Which is the appropriate nursing intervention? Contact the physician. Document the separation of the mucocutaneous junction. Remove the urinary stents. Document presence of mucus in the urine.
The nurse should document the presence of mucus in the urine, as this is a normal finding in urinary diversions.
A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with? Syndrome of inappropriate antidiuretic hormone (SIADH) Diabetes insipidus Liver disease with ascites Hyperglycemia
The syndrome of inappropriate ADH (SIADH) results from a failure of the negative feedback system that regulates the release and inhibition of ADH. In people with this syndrome, ADH secretion continues even when serum osmolality is decreased, causing marked water retention and dilutional hyponatremia. SIADH may occur as a transient condition, as in a stress situation, or, more commonly, as a chronic condition, resulting from disorders such as lung or brain tumors. Tumors, particularly bronchogenic carcinomas and cancers of the lymphoid tissue, prostate, and pancreas, are known to produce and release ADH independent of normal hypothalamic control mechanisms. The manifestations of SIADH are those of dilutional hyponatremia. Urine osmolality is high and serum osmolality is low. Urine output decreases despite adequate or increased fluid intake. Hematocrit and the plasma sodium and blood urea nitrogen levels are all decreased because of the expansion of the extracellular fluid volume.
