Urinary Prep U

URINARY PREP U Question 1 A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing?  “I am allergic to shrimp.” Explanation: The nurse should obtain the patient’s allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine. Chapter 47: Assessment of Kidney and Urinary Function - Page 1550 Question 2: Which of the following urine characteristics would the nurse anticipate when caring for a client whose lab work reveals a high urine specific gravity related to dehydration?  Dark amber urine Explanation: Concentrated urine (one with a high specific gravity) is a dark amber color due to the solutes in the urine. Clear or yellow urine indicates a flushing of the urinary system. Red urine indicates hematuria. A turbid urine may indicate bacteriuria. Chapter 47: Assessment of Kidney and Urinary Function - Page 1548 Question 3 Which term describes painful or difÏcult urination?  Dysuria Explanation: Dysuria refers to painful or difÏcult urination. Oliguria is urine output less than 0.5 mL/kg/hr. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Question 4 : During a routine assessment, the client states; “I wake up all night long to go the bathroom.” The nurse documents this finding as which condition?  Nocturia Explanation: Nocturia is awakening at night to urinate. Oliguria is urine output less than 0.5 mL/kg/hr Polyuria is increased urine output. Dysuria is painful or difÏcult urination. Chapter 47: Assessment of Kidney and Urinary Function - Page 1540 Question 5: The nurse is caring for a client after a cystoscopic examination. Following the procedure, the nurse informs the client that which effect may occur?  Blood-tinged urine Explanation: Postprocedural management is directed at relieving any discomfort resulting from the examination. Some burning upon voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected. Moist heat to the lower abdomen and warm Sitz baths are helpful in relieving pain and relaxing the muscles. Not eating and diarrhea are not expected following a cystoscopic examination. The client should not experience severe abdominal pain. Page 1552 Question 6: Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?  Increased serum creatinine level Explanation: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased. Chapter 48: Management of Patients with Kidney Disorders - Page 1564 Question 7: A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:  sodium polystyrene sulfonate (Kayexalate) Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the client is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells. Chapter 48: Management of Patients with Kidney Disorders - Page 1568 Question 8: The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium?  Citrus fruits Explanation: Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted. Chapter 48: Management of Patients with Kidney Disorders - Page 1569 Question 9 :A client who suffered hypovolemic shock during a cardiac incident has developed acute kidney injury. Which is the best nursing rationale for this complication?  Decrease in the blood flow through the kidneys Explanation: Acute kidney injury can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client. Chapter 48: Management of Patients with Kidney Disorders - Page 1564 Question 10: Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.  Tall, peaked T waves Explanation: Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex. Chapter 48: Management of Patients with Kidney Disorders - Page 1568 Question A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has?  Calcium Explanation: Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek’s or Trousseau’s sign, tingling of fingers and around mouth, and ECG changes. Chapter 48: Management of Patients with Kidney Disorders - Page 1556 Question 12 See full question The client with polycystic kidney disease asks the nurse, “Will my kidneys ever function normally again?” The best response by the nurse is:  “As the disease progresses, you will most likely require renal replacement therapy.” Explanation: There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail. Reference:  Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 48: Management of Patients with Kidney Disorders, Polycystic Kidney Disease, p. 1562. Chapter 48: Management of Patients with Kidney Disorders - Page 1562 13. The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? You Selected:  Administration of sodium polystyrene sulfonate [Kayexalate]) Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Chapter 48: Management of Patients with Kidney Disorders - Page 1568 Question 14 See full question The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement?  Void immediately after sexual intercourse. Explanation: Voiding flushes the urethra, expelling contaminants. Showers are encouraged, rather than tub baths, because bacteria in the bath water may enter the urethra. Coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants should be avoided. The client should be encouraged to void every 2 to 3 hours during the day and completely empty the bladder. Question 15: A female client is undergoing a bladder training program as treatment for urinary incontinence. Which technique would be the most appropriate for the nurse to suggest?  Performing Kegel exercises Explanation: Instructing the client on Kegel exercises will help the client achieve continence. These exercises improve muscle tone and voluntary control. Reducing fluids will not change continence or aid in muscle strength. Holding the urine until the sensation is felt will not aid in muscle strength. Warm sitz baths may be suggested to a client in the event of urethra inflammation. Chapter 49: Management of Patients with Urinary Disorders - Page 1614 Question 16: A client is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function?  Monitor the client's intake and output. Explanation: Monitoring and recording the client's intake and output provides information about the kidneys' function. It also helps identify any arising complications such as hydronephrosis. Chapter 49: Management of Patients with Urinary Disorders - Page 1616 Question 17: The clinic nurse is preparing a plan of care for a client with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach?  Teach the client to perform pelvic floor muscle exercises. Explanation: Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions have a behavioral approach. Question 18: A client has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the client's discharge education accordingly. What preventive measure should the nurse encourage the client to adopt?  Increasing fluid intake Explanation: Increased fluid intake is encouraged to prevent the recurrence of kidney stones. Protein intake from all sources should be limited. Most clients do not require a low-calcium diet, but increased calcium intake would be contraindicated for all clients. Eating small, frequent meals does not influence the risk for recurrence. Question 19: A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include? Yo Notify the physician if urinary urgency, burning, frequency, or difÏculty occurs. Explanation: Urgency, burning, frequency, and difÏculty urinating are all common symptoms of a UTI. The client should notify the physician so that a microscopic urinalysis can be done and appropriate treatment can be initiated. The client should be instructed to drink 2 to 3 L of fluid per day to dilute the urine and reduce irritation of the bladder mucosa. To prevent UTI recurrence, the full amount of antibiotics ordered must be taken despite the fact that the symptoms may have subsided. Women are told to avoid scented toilet tissue and bubble baths and to wear cotton underwear, not nylon, to reduce the chance of irritation. Question 20: The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do?  Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. Explanation: A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hrs. Question 21: A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing?  Stress incontinence Explanation: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing Question 22: Which of the following is the most common site of a nosocomial infection?  Urinary tract Explanation: The urinary tract is the most common site of nosocomial infection, accounting for greater than 3% of the total number reported by hospitals each year. Question 23: Examination of a client’s bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?  Low purine Explanation: A low-purine diet is used for uric acid stones; the benefits, however, are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels. Chapter 49: Management of Patients with Urinary Disorders - Page 1622 Question 24: A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?  "Increase your fluid intake to 2 to 3 L per day." Explanation: The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear. Chapter 49: Management of Patients with Urinary Disorders - Page 1622 Question 25: The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which item should the nurse include?  Implement a 2- to 3-hour voiding schedule Explanation: Immediately after the removal of the indwelling catheter, the client is placed on a voiding schedule, usually 2 to 3 hours. At the given time, the client is instructed to void. Immediate voiding is not usually encouraged. Chapter 49: Management of Patients with Urinary Disorders - Page 1619 Question 26: 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?  Urge Explanation: Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an over distended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet. Chapter 49: Management of Patients with Urinary Disorders - Page 1612 Question 27: A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, “I can even feel the pain at the tip of my penis.” Which of the following would the nurse suspect? Correct response:  Urinary calculi Explanation: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages. Chapter 49: Management of Patients with Urinary Disorders - Page 1624 Question 28: A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic?  The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy Explanation: Yeast vaginitis occurs in many clients treated with antimicrobial agents that affect vaginal flora. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.. Chapter 49: Management of Patients with Urinary Disorders - Page 1607 Question 29: The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply. Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care. Explanation: In institutionalized older patients, such as those in long-term care facilities, infecting pathogens are often resistant to many antibiotics. Diligent hand hygiene, careful perineal care, and frequent toileting may decrease the incidence of UTIs. Chapter 49: Management of Patients with Urinary Disorders - Page 1607 Question 30: Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis?  Risk for infection Explanation: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection. Chapter 49: Management of Patients with Urinary Disorders - Page 1622 Question Which of the following is a cause of a calcium renal stone?  Excessive intake of vitamin D Explanation: Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies. Chapter 49: Management of Patients with Urinary Disorders - Page 1621 Question 32: The nurse advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances?  Uric acid Explanation: Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended. Chapter 49: Management of Patients with Urinary Disorders - Page 1622 Question 33: A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?  Kidney Explanation: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation. Chapter 49: Management of Patients with Urinary Disorders - Page 1621 Question 34: The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet?  "I should limit my intake of meat and fish." Explanation: A low-purine diet is prescribed for the client with uric acid renal calculi. Organ meats, shellfish, anchovies, asparagus, and mushrooms are foods high in purine. Chapter 49: Management of Patients with Urinary Disorders - Page 1622 Question 35: A nurse catheterized an elderly client and confirmed the presence of residual urine. What residual urine volume would be considered abnormal for an elderly client?  150 mL Explanation: Residual urine volume of more than 50-100 mL is considered normal for an elderly client. Amounts of less than 100 are within a normal range for a middle-aged person. Chapter 49: Management of Patients with Urinary Disorders - Page 1616 Question 36: A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client’s post procedure care?  Strain the client's urine following the procedure. Explanation: Following ESWL, the nurse should strain the client's urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL. Chapter 49: Management of Patients with Urinary Disorders - Page 1622 Question 37: A client being treated in the hospital has been experiencing occasional urinary retention. What voiding trigger technique would help this client?  Dipping the client’s hands in warm water Explanation: Dipping the client’s hands in warm water is a urinary trigger technique that helps encourage clients to start voiding. Other trigger techniques include turning on the faucet while the client is attempting to void and stroking the abdomen or inner thighs. Using a commode instead of a bedpan is a nursing measure to encourage normal voiding patterns. Encouraging a male client to use a urinal while standing is more natural and comfortable and is also linked to voiding patterns. Bladder scanning after voiding will assess whether the client is retaining urine but is not a trigger technique. Chapter 49: Management of Patients with Urinary Disorders - Page 1616 Question 38: A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?  Pyridium Explanation: The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI. Chapter 49: Management of Patients with Urinary Disorders - Page 1608 Question : The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day?  2,000 mL Explanation: Unless contraindicated by kidney injury or hydronephrosis, clients with renal stones should drink at least eight 8-oz (250 mL) glasses of water daily or have IV fluids prescribed to keep the urine dilute. Urine output exceeding 2 L a day is advisable. Chapter 49: Management of Patients with Urinary Disorders - Page 1625 Question 40: A female client's most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse's data analysis should be informed by what principle?  Urine samples are frequently contaminated by bacteria normally present in the urethral area. Explanation: Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 10 5 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology. Chapter 49: Management of Patients with Urinary Disorders - Page 1606 Question 41: A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout?  Elevated uric acid levels Explanation: Gout is characterized by hyperuricemia (accumulation of uric acid in the blood) caused by alterations in uric acid production, excretion, or both. An elevated white blood count may be indicative of any inflammatory response and is not specific to gout. A decreased hemoglobin and hematocrit may indicate bleeding from somewhere in the body. Increased AST and ALT would indicate liver dysfunction. Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders - Page 1089 Question 42: A nurse should advise a client with gout to avoid which foods?  Organ meats and scallops Explanation: An excessive intake of foods that are high in purines (shellfish, organ meats) may result in symptoms of gout in susceptible persons. A diet low in purine is recommended. Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders - Page 1089 Question 43: Primary gout is often caused by an inherited disorder in which type of metabolism?  Purine Explanation: Primary gout is often caused by an inherited disorder in purine metabolism. Primary gout is not a disorder of altered carbohydrate, fat, or glucose metabolism. Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders - Page 1089 Question 44 :The nursing assessment findings reveal joint swelling and tenderness in the great toe of a client. What does the nurse suspect? Correct response:  gout Explanation: Joint swelling and tenderness of the great toe and tophi are classic manifestations of gout. Clients with ankylosing spondylitis have pain and stiffness in the back. Clients with osteoarthritis have general joint swelling and tenderness. Clients with rheumatoid arthritis have joint swelling; pain in the back, joints, and muscles; tenderness; and multiple other symptoms. Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders - Page 1089 Question 45: A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack?  eating organ meats and sardines Explanation: During an acute attack, high-purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops. The other listed factors do not worsen attacks. Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders - Page 1090