Chapter 45 Urinary Elimination Answers 3

Test Bank 45-19 41. The nurse knows that which of the following clients is most at risk for a bone fracture: 1. 44-year-old female with rheumatoid arthritis 2. 64-year-old male with Cushing’s disease 3. 53-year-old female with chronic alterations in renal function 4. 60-year-old male with cirrhosis of the liver ANS: 2 The kidneys affect calcium and phosphate regulation by producing a substance that converts vitamin D into its active form. Clients with chronic alterations in kidney function do not make sufficient amounts of the active vitamin D. They are prone to develop renal bone disease resulting from the demineralization of bone caused by impaired calcium absorption. DIF: A REF: 1132 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 42. A 33-year-old female client in her first trimester of pregnancy complains to the nurse on her prenatal visit that she is needs to urinate more frequently and is concerned about having a urinary tract infection. Which of the following statements would be most appropriate for the nurse to make? 1. Are you having any burning or pain when you urinate? 2. Your uterus is pushing up against your bladder which causes you to have to go more frequently 3. Later in your pregnancy as the baby gets bigger it will be a lot worse 4. It is normal for you to have to urinate more frequently because you are eliminating for two now ANS: 1 In a pregnant woman the developing fetus pushes against the bladder, reducing the bladder’s capacity and causing a feeling of fullness. This effect is more likely to occur in the first and third trimesters. Since the client expressed concern regarding a UTI, the nurse should make further assessments to explore that possibility. DIF: A REF: 1134 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 43. The nurse is caring for a 56-year-old female client with renal failure who regularly undergoes peritoneal dialysis. The nurse understands that this client is most at risk for: 1. Pulmonary embolism 2. Electrolyte imbalances 3. Polyuria 4. Urinary incontinence Test Bank 45-20 ANS: 2 Peritoneal dialysis is an indirect method of cleansing the blood of waste products using osmosis and diffusion with the peritoneum functioning as a semipermeable membrane. This method removes excess fluid and waste products from the bloodstream when a sterile electrolyte solution (dialysate) is instilled into the peritoneal cavity by gravity via a surgically placed catheter. The dialysate remains in the cavity for a prescribed time interval and then is drained out by gravity, taking accumulated wastes and excess fluid and electrolytes with it. This places the client at risk for electrolyte imbalances. DIF: A REF: 1138 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 44. A 46-year-old client has had kidney disease for the past 10 years. His kidneys are no longer functioning. The nurse knows that which of the following offers the client the potential for restoration of normal kidney function? 1. Lasix therapy 2. Hemodialysis 3. Peritoneal dialysis 4. Kidney transplant ANS: 4 Unlike the other treatments, successful organ transplantation offers the client the potential for restoration of normal kidney function. DIF: C REF: 1130 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 45. A 45-year-old female client has been hospitalized for severe abdominal pain. The health care provider has ordered a PCA pump for the client to help control the pain. It has been determined that the pain is due to cholelithiasis and the client is scheduled for a cholecystectomy later that day. The client returns to the unit postoperatively with a Foley catheter anchored. The nurse notes that the client’s urine output has decreased. The nurse knows that this is most likely due to: 1. Stress response 2. Preoperative NPO status 3. Kidney failure 4. Post-operative urinary retention ANS: 1 Test Bank 45-21 The stress response releases an increased amount of ADH, which increases water reabsorption. Stress also elevates the level of aldosterone, causing retention of sodium and water. Both of these substances reduce urine output in an effort to maintain circulatory fluid volume. Although the client was NPO postoperatively, she had a pain pump, which indicates that she had a running IV with fluids. It is not indicated that the client had kidney failure, and since the client had an anchored urinary catheter, she would not have urinary retention. DIF: A REF: 1131 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 46. A 73-year-old female client with Parkinson’s syndrome was prescribed levodopa when other therapies had failed. The client is alarmed that her urine has become dark brown and is concern. The nurse explains to the client that one of the side effects of this medication is that it may cause: 1. Her urine to become dark brown or black 2. Heart failure 3. Kidney failure 4. Hair loss ANS: 1 Some medications change the color of urine. Phenazopyridine (Pyridium) colors the urine a bright orange to rust; amitriptyline causes a green or blue discoloration, whereas levodopa discolors the urine to brown or black. DIF: C REF: 1134 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 47. A 34-year-old diabetic female client had a spontaneous vaginal birth of a 37-week 6.2 kg infant. The nurse caring for the client post-partum understands that due to the traumatic birth the client is at increased risk for: 1. Acute urinary retention 2. Hematuria 3. Kidney failure 4. Enuresis ANS: 1 Test Bank 45-22 In acute retention key signs are bladder distention and absence of urine output over several hours. The client under the influence of anesthetics or analgesics often feels only pressure, but the alert client has severe pain as the bladder distends beyond its normal capacity. In severe urinary retention the bladder holds as much as 2000 to 3000 mL of urine. Retention occurs as a result of urethral obstruction, surgical or childbirth trauma, alterations in motor and sensory innervation of the bladder, medication side effects, or anxiety. DIF: C REF: 1132 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 48. A 46-year-old male client with chronic renal problems is in the hospital for a nephrostomy. The nurse understands that this is the surgical insertion of a tube that will drain urine from the client’s: 1. Bladder 2. Urethra 3. Ureters 4. Renal pelvis ANS: 4 Some clients have a need for urinary drainage directly from one or both kidneys. In this case a tube placed directly into the renal pelvis. This procedure is called a nephrostomy. DIF: A REF: 1132 OBJ: Knowledge TOP: Nursing Process: Planning MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination MULTIPLE RESPONSE 1. Which of the following clients presents with an increased risk for urinary incontinence? (Select all that apply.) 1. The 74-year-old diagnosed with parkinsonism 5 years ago 2. The 25-year-old with Crohn’s disease diagnosed 4 years ago 3. The 62-year-old Alzheimer’s disease client diagnosed 8 years ago 4. The 34-year-old mother of two diagnosed with multiple sclerosis 8 years ago 5. The 73-year-old diagnosed with benign prostatic hyperplasia (BPH) 6 years ago 6. The 69-year-old client diagnosed with type 2 diabetes 9 years ago ANS: 1, 3, 4, 5, 6 Test Bank 45-23 Many diseases and conditions affect the ability to micturate. Diabetes mellitus and multiple sclerosis cause changes in nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions. Older men often suffer from BPH, which makes them prone to urinary retention and incontinence. Some clients with cognitive impairments, such as Alzheimer’s disease, lose the ability to sense a full bladder or are unable to recall the procedure for voiding. Diseases that slow or hinder physical activity interfere with the ability to void. Degenerative joint disease and parkinsonism are examples of conditions that make it difficult to reach and use toilet facilities. Crohn’s disease is gastrointestinal in nature and does not directly affect micturition. DIF: C REF: 1133 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 2. The nurse is caring for a client with type 1 diabetes who has been diagnosed with endstage renal disease (ESRD). The nurse regularly assesses the client for which of the following? (Select all that apply.) 1. Nausea 2. Polyuria 3. Lethargy 4. Vomiting 5. Confusion 6. Headache ANS: 1, 3, 4, 5, 6 Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease (ESRD). Eventually the client has symptoms resulting from uremic syndrome. An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, oliguria, nausea, vomiting, headache, drowsiness, coma, and convulsions characterize this syndrome. DIF: A REF: 1133 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 3. Which of the following symptomatology is reflective of a lower urinary tract infection? (Select all that apply.) 1. Chills and fever 2. Nausea and vomiting 3. Frequency or urgency 4. Cloudy or blood-tinged urine 5. Pelvic tenderness or flank pain 6. Burning or pain when voiding Test Bank 45-24 ANS: 1, 2, 3, 4, 6 Clients with lower UTIs have pain or burning during urination (dysuria) as urine flows over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the infection worsens. An irritated bladder (cystitis) causes a frequent and urgent sensation of the need to void. Irritation to bladder and urethral mucosa results in blood-tinged urine (hematuria). The urine appears concentrated and cloudy because of the presence of white blood cells (WBCs) or bacteria. If infection spreads to the upper urinary tract (kidneys— pyelonephritis, a serious renal condition), flank pain, tenderness, fever, and chills are common. DIF: A REF: 1133 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 4. The nurse is discussing a middle-age adult male client’s report of nocturia. The client has diabetes that is managed with diet and exercise as well as hypertension that is currently well-controlled with medication. The nurse should include which of the following as possible causes for his frequent urination at night? (Select all that apply.) 1. An enlarged prostate gland 2. Poorly controlled blood glucose 3. Drinking a cup of tea before bed 4. Possible side effect of his medication 5. Taking his diuretic too close to bedtime 6. Consuming too many liquids during the day ANS: 1, 2, 3, 5 Excessive fluid intake before bed (especially coffee or alcohol), renal disease, the aging process, prostate enlargement, poorly controlled diabetes, and diuretic medication therapy scheduled late in the day can cause nocturia. If taken appropriately, his medications are not likely a cause. DIF: C REF: 1135 OBJ: Analysis TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination