Question 1

The nurse is caring for a confused patient who requires bladder training.Which component of the bladder training program can the nurse safely delegate to the nursing assistant?

Accepted Answer

In planning and implementing a bladder training program for your confused patient,there are several ways in which the UAP can provide help.The nurse appropriately delegates reporting and recording any fluids offered and consumed,along with frequency of linen changes.The nurse should perform patient teaching about the diary,especially since the patient is confused; the nurse is responsible for determining the patient's level of comprehension.The nurse should create the schedule for voiding and fluids,and once the schedule is established,the nursing assistant can help the patient to follow the schedule.

Question 2

A patient has just returned to the nursing unit after having a renal biopsy.Which intervention is most important to include in the patient's nursing care plan?

Accepted Answer

Postprocedure care for the patient who has undergone a renal biopsy will include monitoring for bleeding,avoiding activities that could increase abdominal pressure,and keeping the patient flat for 6 to 24 hours.Laughing and sneezing increase abdominal pressure and should be avoided; splinting when sneezing will help to decrease abdominal pressure.Oral intake is encouraged.Bloody urine is expected for the first 24 hours after the biopsy.The patient should increase fluid intake unless otherwise contraindicated and drink at least 3000 mL of fluid to flush the urinary system.

Question 3

When the patient asks why he has so many urinary tract infections (UTIs),the nurse informs the patient that his recurrent UTIs most likely result from which causative factor?

Accepted Answer

The urinary tract is very vulnerable to bacterial infection.In the high volume of blood that is filtered by the kidney,there are some bacteria that can colonize in the kidney,causing an infection.Also,bacteria can easily enter the urinary tract through the urethra,and then the infection may spread up into the kidneys.Viral infections do not generate bladder debris.Recurrent UTIs are not likely the result of poor hand hygiene.Spicy foods do not irritate the bladder wall or lead to UTIs.

Question 4

The nurse is caring for a patient with deteriorating kidney function.Laboratory work indicates 900 mg of uric acid in 24 hours.In addition to administering prescribed medication,which dietary modification should the nurse address?

Accepted Answer

Uric acid is an end product of protein metabolism,and levels may be elevated in renal failure and associated with increased dietary intake of purine-containing foods.Normal findings are 250 to 750 mg/24 hr (normal diet).A value of 900 mg/24 hr indicates an elevated uric acid level.Sources of purines include beef,liver,and sardines.Purine-rich foods like beef should be limited to small portions or eliminated completely from the patient's diet.Additionally,fatty foods like avocados aid the kidneys in retaining uric acid.Skim milk,yogurt,potatoes,and pasta are low-purine food choices that the patient can eat.

Question 5

When the nurse is caring for a patient who reports he has blood that begins when he initiates the urine stream and then abates.Based on underlying pathophysiology,the nurse concludes that the hematuria is occurring in which location?

Accepted Answer

Gross hematuria indicates bleeding from some point in the urinary tract.If the blood is noticed as soon as voiding starts,it is likely that the blood is from somewhere in the urethra.Blood that appears at the end of urination probably comes from near the neck of the bladder.Bleeding throughout voiding indicates that the blood is coming from a site above the neck of the bladder because the blood has been well mixed with the urine in the bladder.

Question 6

A patient is scheduled to undergo a cystogram.Which statement indicates that the patient accurately understands the nurse's teaching about prevention of potential complications of the test?

Accepted Answer

A radionuclide cystogram utilizes a sodium iodine solution to obtain images of the bladder.The patient should increase intake postprocedure to flush the solution out of the body quickly to limit potential for damage from the hypertonic solution.While the patient is allowed to have a clear breakfast the morning prior to the test and will require a Foley catheter during the procedure,neither of these actions prevent complications from the test.An understanding of the purpose of the test does not prevent potential complications from the procedure.

Question 7

The nurse is caring for a patient who has been taking a sulfa drug for a urinary tract infection (UTI).Which intervention is most important for the nurse to add to the patient's care plan?

Accepted Answer

With sulfa drugs,it is most important for the patient to maintain a fluid intake of at least 3000 mL (1.5 L)in order to prevent crystalluria and stone formation.Ambulation does not directly correlate to the sulfa drug in any way.Investigating an allergy is an assessment,not an intervention,and this action should occur prior to administering the first dose.Daily weights are important for tracking inputs and outputs,but it is not the priority intervention.

Question 8

The nurse reviewing laboratory reports for a patient admitted for acute pyelenophritis.Which finding is most concerning to the nurse?

Accepted Answer

A creatinine of 2.0 is abnormally high and indicates that kidney function negatively affected.The BUN,sodium,and potassium values are within normal limits.(Laboratory ranges include: BUN 10 to 20 mg/dL,creatinine 0.6 to 1.2 mg/dL,sodium 135 to 145 mEq/L,and potassium 3.5 to 5.5 mEq/L.)

Question 9

The nurse is instructing a patient about use of vaginal weight training.Which technique indicates that the patient accurately understands the nurse's teaching?

Accepted Answer

Vaginal weight training is done with a set of five small,cone-shaped weights that are used along with pelvic muscle exercise as a therapeutic option for incontinence.The lightest cone,which has a string attached,is inserted into the vagina and held in place by muscle tightening for 15 minutes twice a day.When there is no problem holding this cone in place,the next heaviest cone is used.This continues until the heaviest cone can be held in place for the 15-minute period.

Question 10

The nurse is caring for a patient who recently had abdominal surgery.Which assessment finding requires the nurse's immediate attention?

Accepted Answer

Urine output of 20 mL in an hour is inadequate and could indicate that the patient is not perfusing properly.Bruising is a common occurrence after surgery,from small blood vessels leaking blood under the skin after an incision is made.Constipation is normal after abdominal surgery,as anesthesia,surgery,and pain medications slow bowl motility.Abdominal pain of 4/10 may require an analgesic but does not indicate an emergent or urgent finding.

Question 11

The nurse cautions the diabetic patient that diabetes affects the blood flow through the kidney.Which statement indicates that the patient understands the nurse's teaching?

Accepted Answer

The long-term effect of diabetes is generalized vasoconstriction,which leads many diabetic patients to renal insufficiency and renal failure.Diabetes can increase a patient's risk for infection.Diabetes does not cause exposure to antibody complexes.Insulin usage does not scar the kidneys.

Question 12

In order to keep optimal flow through the urinary system,a person should have a minimum daily intake of how many mL of fluid?

Accepted Answer

Intake of a minimum of 2000 mL/day is adequate to maintain optimal flow through the urinary system.

Question 13

The student nurse is attempting to irrigate an indwelling catheter.Which action best indicates that the student nurse accurately understands the correct procedure?

Accepted Answer

When irrigating,use the correct amount of sterile solution (according to agency policy,or the amount of solution that may be determined by physician's order for nephrostomy tubes,ureteral tubes,or catheters).When irrigating,use a steady,gentle stream to irrigate.Avoid exerting pressure that may traumatize or cause discomfort.Do not pull back forcefully on an irrigating syringe attached to a urinary catheter or tube as this creates negative pressure that may damage delicate tissues.The amount of irrigation fluid is counted as intake,not output.

Question 14

The nurse is caring for a woman suspected of having a vaginal fistula.Which finding supports the potential diagnosis?

Accepted Answer

Pneumaturia,or gas in the urine,can occur if there is an abnormal passage between the bladder and vagina.A fistula would not cause hematuria,oliguria,or dysuria.

Question 15

The patient confides that sneezing makes her "wet her pants." The nurse recognizes this cardinal sign of which type of incontinence?

Accepted Answer

Stress incontinence occurs when the urethral sphincter fails and there is an increase in intra-abdominal pressure,caused by things such as sneezing,laughing,coughing,or aerobic exercise.Urge incontinence is the involuntary loss of urine when there is a strong urge to urinate (urinary urgency).Functional incontinence is caused by cognitive inability to recognize the urge to urinate or self-care deficit caused by extreme depression.Inability to reach the bathroom due to restraints,side rails,or an out-of-reach walker can also result in functional incontinence.Overflow incontinence occurs when there is poor contractility of the detrusor muscle or obstruction of the urethra,as in prostate hypertrophy in the male or genital prolapse or abnormality in the female.

Question 16

The nurse is collecting data from a patient who complains of having urinary frequency.The nurse should inquire about which dietary habit?

Accepted Answer

Caffeine and other diuretics found in foods and drinks,as well as increased fluid intake of fluid,can increase the number of times a person must urinate.

Question 17

The nurse explains that when the kidney suffers an autoimmune inflammatory reaction,the glomeruli lose their ability to function effectively.The nurse is describing the etiology of which problem?

Accepted Answer

Glomerulonephritis occurs when the inflammatory process alters the effectiveness of the semipermeable membrane in the glomeruli.Renal calculi are kidney stones; causative factions include urinary infections,inadequate fluid intake,and sluggish urine flow.Hydronephrosis results when flow of urine from the kidney is obstructed,and the kidney dilates and fills with fluid.Acute pyelonephritis an infection of the kidneys thought to occur when bacteria (such as Escherichia coli)from a bladder infection travel up the ureters to infect the kidneys.

Question 18

The nurse is caring for a frustrated patient reports that she still involuntarily voids despite two surgeries to correct incontinence.Which statement indicates that the patient accurately understands the nurse's teaching about incontinence management after surgery?

Accepted Answer

When surgical measures do not solve the problem,incontinence may be managed by a variety of measures,including intermittent catheterization,indwelling urethral catheterization,suprapubic catheters,external collection systems (such as condom catheters),protective pads and garments,or pelvic organ support devices such as a pessary.The pessary may be useful in managing this patient's stress incontinence.The patient should utilize protective pads and garments.An indwelling catheter may or may not be necessary for this patient.There is no indication that the patient will require another surgery,especially since the previous two surgeries have not eliminated episodes on incontinence.

Question 19

How can nephrotoxic drugs such as doxycycline and rifampin cause kidney damage?

Accepted Answer

Nephrotoxic drugs may chemically alter the glomeruli,which make them ineffective.

Question 20

An 85-year-old patient who has been NPO since midnight last night for diagnostic testing just completed the procedure.Which intervention is most important?

Accepted Answer

Offering small amounts of fluid every hour will rehydrate the older adult without resorting to intravenous fluids.The older adult has very little fluid reserve and has lost the ability to concentrate the urine; consequently,a long period without fluid intake can cause dehydration.The doctor should inform the patient about the test results.Weighing the patient again is unnecessary.While prevention of skin breakdown is important,there is no indication that the patient cannot reposition independently.

Quiz 33: The Urinary System