urine
A creatinine clearance test is ordered for a hospitalized patient with possible renal insufficiency. Which equipment will the nurse need to obtain? a.Sterile specimen cup b.Large container for urine c.Foley catheter and drainage bag d.Towelettes for perineal
cleaningANS: B Since creatinine clearance testing involves a 24-hour urine specimen, the nurse should obtain a large container for the urine collection. Catheterization, cleaning of the perineum with antiseptic towelettes, and a sterile specimen cup are not needed for this test
A hospitalized patient with renal insufficiency is scheduled to have an IVP. Which nursing action will be needed during this procedure? a. Assist with monitoring for conscious sedation. b. Insert a large size urinary catheter prior to the IVP. c. Monitor the urine output after the procedure. d. Give oral contrast solution before the procedure.
ANS:C Rationale: Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient's urine output. Conscious sedation and retention catheterization are not required for the procedure. The contrast medium is given intravenously, not orally.
Pediatric patients, especially girls, are susceptible to urinary tract infections because A. Genetically females have a weaker immune system B.females have a short and proximal urethra in relation to the vagina C. girls are more sexually active then males D. girls have a weakened musculature and sphincter tone
ANS B females have a short and proximal urethra in relation to the vagina
the nurse reassures the patient recovering from acute glomerulonephritis that after all other signs abd symptoms of the diease subside, it is normal to have some residual (select all that apply) a. proteinuria b. oliguria c. hematuria d. anasarca e. ologuria
ANS. A,C PROTEINURIA AND HEMATURIA MAY EXIST MICROSCOPICALLY EVEN WHEN OTHER SYMPTOMS SUBSIDE.
which foods should the home ealth nurse counsel hypokalemic patien to include in their deit? a. Bananas, oranges, cantaloupe b. carrots, summer squash green beans c. apples, pineapple, watermelon d. winter squash, cauliflower, lettuce
ANS: A Bananas, oranges, cantaloupe
a client in renal failure is receiving epoetin alfa. The nurse should monitor thin client for which adverse reaction to this medication? a. Hypotension b. hypertension c. Depression d. Bracycardia
ANS: A Epotein alfa is an erythropoietin growth factor and is generally well tolerated, although hypertension can occur and is the most significant adverse effect. Occasionally, tachycardia may also cures as a side effect and may cause an improved sense of well being.
What portion of the nephron is involved with filtration? a.Glomerulus of the Bowman capsule b.Henle loop c.Proximal convoluted tubule d.Distal convoluted tubule
ANS: A Filtration of water and blood products occurs in the glomerulus of the Bowman capsule
The health care provider orders a clean-catch urine specimen for culture and sensitivity testing for a patient with a suspected urinary tract infection (UTI). To obtain the specimen, the nurse will plan to a. teach the patient to clean the urethral area, void a small amount into the toilet, then void into a sterile specimen cup. b. insert a short, small "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen. c. clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container. d. have the patient empty the bladder completely, and then obtain the next urine specimen that the patient is able to void.
ANS: A Rationale: This answer describes the technique for obtaining a clean-catch specimen. The answer beginning, "insert a short, small, 'mini' catheter attached to a collecting container" describes a technique that would result in a sterile specimen, but a health care provider's order for a catheterized specimen would be required. Using Betadine before obtaining the specimen is not necessary and might result in suppressing the growth of some bacteria. And the technique described in the answer beginning "have the patient empty the bladder completely" would not result in a sterile specimen.
which of the following are sign of fluid overloaded in the patient with nephrosis? select all the apply? a. increased in pulse rate b. increase in daily weight c. clear lung sounds d. edema e. labored respirations
ANS: A,B,D,E S/SX of fluid overload changes in pulse rate respiration , cardia sounds, and lung fields increased in daily morning weights
why are urinary tract infections common in older adults ? a. older adults have weakened musculature in the bladder and urethra. b. older adults have urinary stasis c. older adults have increased bladder capacity d. older adults have diminished neurologic sensation e. the effects of medication such as diuretic that many older adults take.
ANS: A,B,D,E urinnary frequency , urgency, nocturne, retention and incontinence are common with aging. These occur because of weakened musculature in the bladder and breath, diminished neuralgic sensation combined with decreased bladder capacity, and the effects of medication such as diuretics. older women are at risk for stress incontinence because of homaonl changes and weakened pelvic musculature. inadequeate fluid intake less than 1000 to 2000 ml per 24 hours can lead to urinary stasis.
Because the kidneys are located in proximity to the vertebrae and are protected by the ribs, their location in charting is referred to as A. retroperitoneal B. diaphragm-vertebral C. costovertebral D. urachal-peritoneal
ANS: A. Because the kidneys are located in proximity to the vertebrae and are protected by the ribs, their location in documentation is referred to as retroperitoneal
It is most important that the nurse ask a patient admitted with acute glomerulonephritis about a. history of kidney stones. b. recent sore throat and fever. c. history of high blood pressure. d. frequency of bladder infections.
ANS: B Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection (UTI).
A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs? A.Vitamin K B.Atropine sulfate C.Protamine sulfate D.Acetylcysteine (Mucomyst)
ANS: B Atropine sulfate should be readily available for use if overdose occurs. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for Warfarin.
A 58-year-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma due to a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon? a. Blood pressure is 102/58. b. Urine output is 20 mL/hr for 2 hours. c. Incisional pain level is reported as 9/10. d. Crackles are heard at bilateral lung bases.
ANS: B Because the urine output should be at least 0.5 mL/kg/hr, a 40 mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life threatening as decreased renal perfusion. In addition, the nurse can medicate the patient for pain.
The nurse will plan to teach a 27-year-old female who smokes 2 packs of cigarettes daily about the increased risk for a. kidney stones. b. bladder cancer. c. bladder infection. d. interstitial cystitis.
ANS: B Cigarette smoking is a risk factor for bladder cancer. The patient's risk for developing interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by quitting smoking.
A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician? a. Teach the patient about fluid restrictions. b. Check blood pressure before starting dialysis. c. Assess for causes of an increase in predialysis weight. d. Determine the ultrafiltration rate for the hemodialysis.
ANS: B Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.
A client has been given a prescription for trimethoprim (Proloprim). The nurse determines that the client understands how to use the medication properly if the client states an intention to: A.Restrict fluids while taking the medication. B.Drink extra fluids while taking the medication. C.Discontinue the medication once symptoms subside. D.Call the health care provider if the urine becomes brown.
ANS: B Drink extra fluids while taking the medication.
To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. b. sardines, liver and organ meats. c. legumes and dried fruit. d. spinach, chocolate, and tea.
ANS: B Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.
Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine (Pyridium)? a. Pyridium may cause photosensitivity b. Pyridium may change the urine color.(reddish-orange color) c. Take the Pyridium for at least 7 days. d. Take Pyridium before sexual intercourse.
ANS: B Patients should be taught that Pyridium will color the urine deep orange. Urinary analgesics should only be needed for a few days until the prescribed antibiotics decrease the bacterial count. Pyridium does not cause photosensitivity. Taking Pyridium before intercourse will not be helpful in reducing the risk for UTI.
A patient with cystitis is receiving phenazopyridine (Pyridium) for pain and is voiding a brightred-orange urine. What should the nurse do? a.Report this immediately b.Explain to the patient that this is normal c.Increase fluid intake d.Collect a specimen
ANS: B Pyridium will turn the urine reddish-orange
The result of a patient's creatinine clearance test is 60 ml/min. The nurse equates this finding to a glomerular filtration rate (GFR) of _____ ml/min. a. 30 b. 60 c. 120 d. 240
ANS: B Rationale: The creatinine clearance approximates the GFR. The other responses are not accurate.
A 56-year-old female patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect? a. Poor skin turgor b. Recent weight gain c. Elevated urine ketones d. Decreased blood pressure
ANS: B The patient with a nephrotic syndrome will have weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high.
A male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first? a. Notify the patient's health care provider. b. Teach correct midstream urine collection. c. Ask the patient about current medications. d. Question the patient about urinary tract infection (UTI) risk factors.
ANS: C A red-orange color in the urine is normal with some over-the-counter (OTC) medications such as phenazopyridine (Pyridium). The color would not be expected with urinary tract infection, is not a sign that poor technique was used in obtaining the specimen, and does not need to be communicated to the health care provider until further assessment is done.
what is the hormone from the posterior pituitary gland that influences the amount of water that eliminated with the urine? a. Pitocin b. Renin Hormone c. Antidiuretic Hormone (ADH) d.ACTH
ANS: C Antidiuretic Hormone (ADH)
A 28-year-old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time? a. Complications of renal transplantation b. Methods for treating severe chronic pain c. Discussion of options for genetic counseling d. Differences between hemodialysis and peritoneal dialysis
ANS: C Because a 28-year-old patient may be considering having children, the nurse should include information about genetic counseling when teaching the patient. The well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There is no indication that the patient has chronic pain.
When reading a patient's chart, the nurse notes that the patient has dysuria. To assess whether there is any improvement, which question will the nurse ask? a."Do you have any blood in your urine?" b."Do you have to urinate very frequently?" c."Do you have any pain when you urinate?" d."Do you have to get up at night to urinate?"
ANS: C Dysuria is painful urination. The alternate responses are used to assess other urinary tract symptoms: hematuria, nocturia, and frequency.
The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with a. antibiotics. b. antifungals. c. anticoagulants. d. antihypertensives.
ANS: C Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Fungal pyelonephritis is uncommon and is treated with antifungals. Antihypertensives are used if the patient has high blood pressure.
How will the nurse assess the flank area with pyelonephritis for tenderness? a. Percuss the area between the iliac crest and ribs along the midaxillary line. b. Palpate along both sides of the lumbar vertebral column. c. Place one hand flat at the costovertebral angle (CVA) and strike it with the other fist. d. Push gently into the two lowest intercostal spaces.
ANS: C Rationale: Checking for flank pain is best performed by percussion of the CVA and asking about pain. The other techniques would not assess for flank pain. Cognitive Level: Comprehension Text Reference: pp. 1144-1145 Nursing Process: Assessment
A patient with a possible renal cell tumor who is scheduled for an intravenous pyelogram (IVP) and computed tomography (CT) scanning of the abdomen gives the nurse all the following data. Which information has the most immediate implications for the patient's care? a. The patient has not had anything to eat or drink for 8 hours. b. The patient used a bisacodyl (Dulcolax) tablet the previous night. c. The patient describes allergies to shellfish and penicillin. d. The patient complains of costovertebral angle (CVA) tenderness.
ANS: C Rationale: In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken. The response beginning, "Your doctor will place a catheter" describes a renal arteriogram procedure. The response beginning, "Your doctor will inject a radioactive solution" describes an IVP. And the response beginning, "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted" describes a retrograde pyelogram.
When teaching a patient scheduled for a cystogram via a cystoscope about the procedure, the nurse tells the patient, a. "Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys." b. "Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked." c. "Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray." d. "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney."
ANS: C Rationale: In a cystoscope and cystogram procedure, a cystoscope is inserted into the bladder for direct visualization, and then contrast solution is injected through the scope so that x-rays can be taken. The response beginning, "Your doctor will place a catheter" describes a renal arteriogram procedure. The response beginning, "Your doctor will inject a radioactive solution" describes an IVP. And the response beginning, "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted" describes a retrograde pyelogram.
The nurse informs the patient undergoing cystoscopy that following the procedure, the patient a. should ask for the ordered narcotics as necessary for pain. b. will be NPO for 8 hours to prevent nausea and vomiting. c. may experience blood-tinged urine and urinary frequency. d. is expected to be on strict bed rest for about 4 to 6 hours
ANS: C Rationale: Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires narcotics for relief is not expected. A good fluid intake is encouraged after this procedure. Bed rest is not required following cystoscopy.
Which assessment of a 62-year-old patient who has just had an intravenous pyelogram (IVP) requires immediate action by the nurse? a. The heart rate is 58 beats/minute. b. The patient complains of a dry mouth. c. The respiratory rate is 38 breaths/minute. d. The urine output is 400 mL after 2 hours.
ANS: C The increased respiratory rate indicates that the patient may be experiencing an allergic reaction to the contrast medium used during the procedure. The nurse should immediately assess the patient's oxygen saturation and breath sounds. The other data are not unusual findings following an IVP.
The nurse assessing a patient who is taking furosemide (Lasix) finds an irregular pulse. This is likely a sign of: a.hypomagnesemia. b.hypernatremia. c.hypokalemia. d.hypercalcemia
ANS: C The loop diuretic prototype, furosemide (Lasix), affects electrolytes and causes hypokalemia;the deficiency of the electrolyte can cause arrhythmias and muscle weakness
A patient is receiving chlorothiazide (Diuril), a thiazide diuretic for hypertension. What nursing action is most important for prevention of complications? a.Measure output b.Increase fluid intake c.Assess for hypokalemia d.Assess for hypernatremia
ANS: C The thiazide diuretic, chlorothiazide (Diuril), affects electrolytes to cause hypokalemia (extreme potassium depletion in blood)
? is the name for hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina
ANS: CYSTOCELE
The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by a. using a filter to strain all urine. b. avoiding dietary sources of calcium. c. choosing diuretic fluids such as coffee. d. drinking 2000 to 3000 mL of fluid a day.
ANS: D A fluid intake of 2000 to 3000 mL daily is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
The nurse is preparing a client scheduled for an intravenous pyelogram (IVP). The nurse should take which important action before the test? a. administer a sedative b. encourage fluid intake c. administer an oral preparation of radiopaque dye. d. question about allergies to iodine or selfish
ANS: D question about allergies to iodine or selfish
The nurse notes the amount and color of the urine the patient with urolithiasis has voided. While using Standard Precautions, what should be the nurse's next action? a.Discard the urine b.Add the urine to a 24-hour collector c.Send the urine to the laboratory d.Strain the urine
ANS: D All urine should be strained. Because stones may be any size, even the smallest speck must besaved for assessment by the laboratory
a nurse has an order to collect a 24 hour specimen from a client. the nurse should avoid which of the following error in technique while completing this procedure? a. discard the urine specimens collected at the start time b. place the specimen on the ice c.ask the client to save a sample voided at the end of the collection time d. Ask the client to void, save the specimen, and note the start time
ANS: D Ask the client to void, save the specimen, and note the start time
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective? a. The patient denies pain with voiding. b. The urine dipstick is negative for nitrites. c. The antistreptolysin-O (ASO) titer is decreased. d. The periorbital and peripheral edema is resolved.
ANS: D Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection.
The home health nurse suggests the use of complementary and alternative therapies to preventand/or treat urinary tract infections (UTIs). Which of the following is an example of such therapies? a.Grape juice b.Caffeine c.Tea d.Cranberry juice
ANS: D Cranberry (Cranberry Plus, Ultra Cranberry) has been used to prevent urinary tract infections (UTIs), particularly in women prone to recurrent infection. It has also been used to treat acute UTI. Monitor patients for lack of therapeutic effect. Caffeine and tea will increase diuresis butnot prevent UTI.
A client is beginning to take trimethoprim-sulfamethoxazole (Bactrim) for a recurrent urinary tract infection (UTI). The nurse would give the client which instruction regarding this medication? A. Expect rashes or skin changes as a result of therapy. B. Discontinue the medication when symptoms subside. C. Take most doses early in the day when fluid intake is greatest. D. Take each dose with 8 oz of water, and drink extra water each day.
ANS: D D. Take each dose with 8 oz of water, and drink extra water each day.
A 68-year-old female patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action will be best to include in the plan of care? a. Restrict fluids between meals and after the evening meal. b. Apply absorbent incontinent pads liberally over the bed linens. c. Insert an indwelling catheter until the symptoms have resolved. d. Assist the patient to the bathroom every 2 hours during the day.
ANS: D In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling catheters increase the risk for urinary tract infection (UTI). Incontinent pads increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with dehydration.
A client with a urinary tract infection with dysuria is given a prescription for phenazopyridine hydrochloride (Pyridium) for symptom relief. Which should the nurse reinforce instructing the client about this medication? a.Take the medication at bedtime. b.Take the medication 1 hour before meals. c.Expect the urine to become reddish orange. d.Notify the health care provider if a headache occurs.
ANS: D Notify the health care provider if a headache occurs. It can cause a reddish orange discoloration of urine and tears and can stain undergarments and soft contact lenses. The medication should be taken after meal s to reduces the possibility of gastrointestinal upset. A headaches is an occasion side effect of the medication and does not warrant notifying the physician
While assessing a patient's urinary system, the nurse cannot palpate either kidney. Which action should the nurse take next? a. Ask the patient about any history of recent sore throat. b. Obtain a urine specimen to check for hematuria. c. Ask the health care provider about scheduling a renal ultrasound. d. Document the information on the assessment form.
ANS: D Rationale: The kidneys are protected by the abdominal organs, ribs, and muscles of the back and may not be palpable under normal circumstances, so no action except to document the assessment information is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound may be appropriate when assessing for renal problems for some patients, but there is nothing in the stem to indicate that they are appropriate for this patient.
The nurse uses auscultation during assessment of the urinary system to a. determine the position of the kidneys. b. assess for bladder distension. c. check for ureteral peristalsis. d. identify renal artery or aortic bruits.
ANS: D Rationale: The presence of a bruit may indicate problems such as renal artery tortuosity or abdominal aortic aneurysm. Auscultation would not be helpful in assessing for the other listed urinary tract information.
The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs) has been effective for a 22-year-old female patient with cystitis when the patient states which of the following? a. "I can use vaginal antiseptic sprays to reduce bacteria." b. "I will drink a quart of water or other fluids every day." c. "I will wash with soap and water before sexual intercourse." d. "I will empty my bladder every 3 to 4 hours during the day."
ANS: D Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal sprays is discouraged. The bladder should be emptied before and after intercourse, but cleaning with soap and water is not necessary. A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI.
a nurse is told that a client will be admitted to the hospital for a radiation implant for bladder cancer. the nurse is asked to prepare for the admission of the client and plans which of the following as a priority measure for this client a. encourage the family to visit b. place the client on reverse isolation c. place the client in a room near the nurse station d. admit the client to a private room
ANS: D admit the client to a private room
Which action can reduce the risk of skin impairment secondary to urinary incontinence a. decreasing fluid intake b. catheterization of the elderly patient c. limiting the use of medication (diuretics etc.) d. frequent toiling and meticulous skin care
ANS: D frequent toileting and meticulous skin care
A client with acute glomerulonephritis is admitted to the nursing unit. The nurse should plan to do which action immediately on admission? a. ambulate the client frequently b. encourage a diet that high in protein c. monitor the temperature every 2 hours d. remove the water pitcher from the bedside
ANS: D remove the water richer from the bedside.
Put the sequence of the blood flow in order of the flow through the nephron. a. reabsorption in loop of Henle b. efferent arteriole c. filtration in the glomerulus d. reabsorption in proximal convoluted tubule e. afferent arteriole f. secretion in the distal convoluted tubule
ANS: E,C,D,A,F,B
exercises to increase muscle tone of the pelvic floor are know as ? exercises
ANS: Kegel
the prostatectomy technique, which involves an incision through the abdomen and the bladder, is a ? prostatectomy.
ANS: Suprapubic suprapubic prostatectomy involves an incursion through the abdomen and the bladder with removal of the gland with fingers
acute glomerulonephritis is commonly a result of a preexisting infection of ?
ANS: beta-hemolytic streptococci
A patient with hypertension and stage 2 chronic kidney disease is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient's a. creatinine. b. glucose. c. phosphate. d. potassium.
Answer: D Rationale: Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention; therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not impact whether the captopril was given or not.
