Deck 10: Care of the Patient With a Urinary Disorder

Question 1

The patient is on postoperative day 1 after having undergone a TURP procedure. He has continuous bladder irrigation (CBI). Actual urine output during continuous bladder irrigation is calculated by

A) measuring and recording all fluid output in the drainage bag.
B) measuring the total output and deducting the total of the irrigating and intravenous solutions.
C) adding the total of the intravenous and irrigating solutions and then deducting the amount of output.
D) measuring total output and deducting the amount of irrigating solution used.

Answer 1

measuring total output and deducting the amount of irrigating solution used.

Question 2

The amount of water that is eliminated with the urine is regulated by a complex mechanism within the nephron and influenced by a hormone from the posterior pituitary gland called

A) pitocin.
B) rennin hormone.
C) antidiuretic hormone.
D) ACTH.

Answer 2

antidiuretic hormone.

Question 3

The patient is scheduled for a cystogram via a cystoscope. Which is the best explanation of this procedure by the nurse?

A) "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 film."
B) "Your doctor will inject a dye into a vein in your arm that is carried to the urinary system. Then a lighted tube in your bladder is used to see when the dye appears."
C) "Your doctor will insert a lighted tube into the bladder and inject a dye into your kidneys through little catheters inserted into the ureters."
D) "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."

Answer 3

"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 film."

Question 4

It is 2 days after a difficult patient's urinary diversion surgery. He continues to be critical of the hospital and the nursing care, even though the staff has spent time explaining the care to him. The most likely explanation for his behavior is that he

A) is used to having things done his way.
B) has an obsessive-compulsive disorder.
C) has no other responsibilities to keep him occupied.
D) is having problems accepting the urinary diversion.

Question 5

A nursing intervention to assist the patient with chronic renal failure (CRF) in learning about available community resources would be a consultation with

A) a chaplain.
B) social services.
C) the physician's office.
D) administrative services.

Question 6

In teaching a patient how to decrease the chance of further problems with urolithiasis, barring any other contraindication, the nurse would encourage him to

A) increase his fluid intake.
B) avoid contact sports.
C) restrict his protein intake.
D) take one baby aspirin daily.

Question 7

The patient is receiving continuous bladder irrigation after a transurethral resection of the prostate (TURP). He complains of a "spasmlike" pain over his lower abdomen. Which of these actions should the nurse perform first in response to this complaint?

A) Inform the nurse in charge.
B) Decrease the continuous bladder irrigation flow.
C) Administer the prescribed analgesic.
D) Check the catheter and drainage system for obstruction.

Question 8

The physician orders a urinalysis and urine culture. To obtain the urine specimen, the nurse would first instruct the patient about

A) collecting the urine for a 24 hour period.
B) obtaining a clean-catch specimen.
C) bringing in an early morning specimen.
D) limiting fluid intake to concentrate the urine.

Question 9

A patient, age 69, is admitted to the hospital with gross hematuria and history of a 20-pound weight loss during the last 3 months. The physician suspects renal cancer. In obtaining a nursing history from this patient, the nurse recognizes which factor as a significant risk factor for renal cancer?

A) High caffeine intake
B) Cigarette smoking
C) Use of artificial sweeteners
D) Chronic cystitis

Question 10

A patient, age 71, has benign prostatic hypertrophy. He is recovering from a transurethral prostatic resection. The physician orders removal of the indwelling catheter 2 days after the TURP procedure. The patient should be instructed that at first he might experience

A) an intolerance to acidic fluids.
B) normal voiding patterns.
C) dribbling of urine.
D) no urine output for 6-8 hours.

Question 11

When preparing to teach a patient about continuous bladder irrigation, the nurse notes that the most frequently used irrigant is

A) sterile isotonic saline.
B) an antibiotic solution.
C) sterile water.
D) heparinized normal saline.

Question 12

Chronic renal failure (CRF) affects both patients and their families because of the financial predicament and facing the death of a loved one. Which would be an appropriate nursing intervention to address these concerns?

A) Encourage open discussion with social services.
B) Allow family privacy to resolve their issues.
C) Refer the family to a support group.
D) Have the physician speak to the family.

Question 13

The nurse notes the amount and color of the urine of the patient with urolithiasis. While using standard precautions, the nurse's next action would be to

A) discard the urine.
B) add the urine to a 24-hour collector.
C) save the urine for physician assessment.
D) strain the urine.

Question 14

As the nurse and the dietitian review a patient's diet plan with her, she becomes very angry, shouting that with her diabetes and now the kidney failure, there is just nothing she can eat. She says she might as well eat what she wants, because these diseases will kill her anyway. Based on the patient's response, which nursing diagnosis does the nurse identify?

A) Noncompliance, risk for, related to feelings of anger
B) Risk for ineffective health maintenance, related to complexity of therapeutic regimen
C) Anticipatory grieving, related to actual and perceived losses
D) Ineffective coping, related to emotional liability

Question 15

A patient with chronic renal failure (CRF) has a nursing diagnosis of Disturbed sensory perceptions related to central nervous system changes induced by uremic toxins. Which nursing intervention is appropriate for this problem?

A) Ensure restricted protein intake to prevent nitrogenous product accumulation.
B) Provide an opportunity for the patient to discuss concerns about his condition.
C) Convey a caring attitude and foster the nurse-patient relationship.
D) Discourage eating fruits and vegetables as sources of high potassium in the diet.

Question 16

The patient is scheduled for a transurethral resection of the prostate. During preoperative teaching, it is important to emphasize that after surgery he should expect

A) red drainage from the catheter.
B) limited intake of fluids.
C) a sodium-restricted diet.
D) incisional drainage.

Question 17

When a patient on Lasix, a loop diuretic, complains of weakness and irregular pulse, there may be an electrolyte deficiency of

A) magnesium.
B) sodium.
C) potassium.
D) calcium.

Question 18

A 56-year-old patient with cancer of the bladder is recovering from a cystectomy with an ileal conduit. An important aspect in nursing interventions of the patient with an ileal conduit is

A) instructing the patient to void when the urge is felt.
B) maintenance of skin integrity.
C) prevention of tissue rejection.
D) limiting acid-ash foods.

Question 19

As the body breaks down protein, nitrogen wastes are broken down into urea, ammonia, and

A) nitrogen.
B) uric acid.
C) nitrates.
D) creatinine.

Question 20

Because the kidneys are located in proximity to the vertebrae and are protected by the ribs, their location in documentation is referred to as

A) retroperitoneal.
B) diaphragm-vertebral.
C) costovertebral.
D) urachal-peritoneal.

Question 21

The patient has end-stage renal disease (ESRD) and is admitted with a blood urea nitrogen (BUN) level of 93 mg/dL. An excessive elevation of BUN could result in

A) dehydration.
B) disorientation.
C) edema.
D) catabolism.

Question 22

A 69-year-old patient is admitted with severe diarrhea. His urinalysis report indicates an increased level of ketone bodies. This occurs with

A) kidney disease.
B) starvation or carbohydrate-restricted diets.
C) infection.
D) urolithiasis.

Question 23

A patient, age 78, has been admitted to the hospital with dehydration and electrolyte imbalance. She is confused and incontinent of urine on admission. Which nursing intervention does the nurse include in developing a plan of care?

A) Restrict fluids after the evening meal.
B) Insert an indwelling catheter.
C) Assist the patient to the bathroom every 2 hours.
D) Apply absorbent incontinence pads.

Question 24

_____________ is a term for severe generalized edema.

Question 25

Urinary frequency, urgency, nocturia, retention, and incontinence are common with aging. These occur because of (Select all that apply.)

A) weakened musculature in the bladder and urethra.
B) 1,000 to 2,000 mL fluids per 24 hours.
C) diminished neurologic sensation combined with decreased bladder capacity.
D) increased hormonal changes and muscle strength.
E) the effects of medications such as diuretics.

Question 26

Which are signs and symptoms of fluid overload in a patient receiving diuretics? (Select all that apply)

A) Changes in cardiac and lung sounds
B) Increase in daily weight
C) Decrease in daily weight
D) Dry skin

Question 27

The following constituent of the urinalysis test indicates possible renal disease, muscle exertion, or dehydration

A) proteinuria
B) positive glucose
C) positive bilirubin
D) bacteriuria

Question 28

Exercises to increase muscle tone of the pelvic floor are known as ____________ exercises.

Question 29

For a patient who is recovering from acute glomerulonephritis, which symptoms may exist even when other symptoms have subsided? (Select all that apply.)

A) Proteinuria
B) Oliguria
C) Hematuria
D) Anasarca

Question 30

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 than males.
D) girls have a weakened musculature and sphincter tone.

Question 31

The type and size of urinary catheter are determined by the (Select all that apply.)

A) location of the urinary tract problem.
B) urinary output.
C) cause of the urinary tract problem.
D) weight of the patient.

Question 32

Which 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 toileting and meticulous skin care

Question 33

One method of monitoring for signs and symptoms of fluid overload when administering diuretics is

A) record daily morning weights (same time, scale, clothes).
B) record random weights throughout the day (same scale, clothes, staff member).
C) assess abdomen every shift.
D) eat a diet high in sodium.

Question 34

Which complementary and alternative therapies are used to prevent and/or treat urinary tract infections (UTIs)?

A) Grape juice
B) Caffeine
C) Tea
D) Cranberry juice

Question 35

A patient is receiving a thiazide diuretic for hypertension. For prevention of complications, it is particularly important that the nurse

A) measure output.
B) increase fluid intake.
C) monitor serum potassium levels.
D) encourage emptying of the bladder.

Question 36

A patient has nephrotic syndrome. Which of these statements made by the patient indicates that she understands the dietary modifications?

A) "I will need to increase protein and decrease sodium intake."
B) "I will need to drink more milk to get my calcium."
C) "Carbohydrate restriction will be difficult."
D) "Potassium restriction won't be hard since I don't like fruit."

Question 37

The patient, age 30, has a history of renal calculi and is admitted to the hospital with gross hematuria and severe colicky left flank pain that radiates to his left testicle. An intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal left ureter. Physician orders include meperidine (Demerol) 100 mg IM q4h prn, strain all urine, and encourage fluids to 4,000 mL/day. In planning care for this patient, the nurse gives the highest priority to which nursing diagnosis?

A) Pain related to irritation of a stone
B) Anxiety related to unclear outcome of condition
C) Ineffective health maintenance related to lack of knowledge about prevention of stones
D) Risk for injury related to disorientation

Question 38

The patient, age 43, has cystitis with dysuria. She is receiving Pyridium to decrease her pain. Her urine is reddish-orange. The nurse should

A) report this immediately.
B) explain to the patient that this is normal.
C) increase fluid intake.
D) send a specimen to the laboratory for analysis.

Question 39

The patient, age 43, has cancer of the urinary bladder. He has received a cystectomy with an ileal conduit. Which characteristics would be considered normal for his urine?

A) Hematuria
B) Clear amber with mucus shreds
C) Dark bile-colored
D) Dark amber

Question 40

Patients on diuretics who become hypokalemic should make sure they include which foods in their daily diet?

A) Bananas, oranges, cantaloupe
B) Carrots, summer squash, green beans
C) Apples, pineapple, watermelon
D) Winter squash, cauliflower, lettuce

Question 41

_________ training involves developing the muscles of the perineum to improve voluntary control over voiding; bladder training may be modified for different problems.

Question 42

Acute ______________ is commonly a result of a preexisting infection.

Question 43

Bladder distention may be assessed by palpating above the ___________ _________.

Question 44

Aldactone (spironolactone) is classified as a ______________-sparing diuretic.