Chapter 36 Urinary System Function, Assessment, and Therapeutic Measures

Answers CHAPTER 36 URINARY SYSTEM FUNCTION, ASSESSMENT, AND THERAPEUTIC MEASURES AUDIO CASE STUDY Adam: Kidney Stones, Cystoscopy, and Pyelogram 1. Colicky, wavelike pain pattern when he needed to urinate. 2. A test using high-frequency sound waves to image the kidneys, ureters, and bladder. It can show congenital disorders of the kidney, abscesses, hydronephrosis, kidney stones or tumors, kidney enlargement, or structural changes that occur with chronic renal infections. 3. Passing the stone on his own. 4. Signing an informed consent, consuming nothing by mouth (NPO) after midnight, administering continuous intravenous (IV) fluids, and completing pre-op checklist. 5. Urine output, fluid intake, pain (especially on urination for about 24 hours), blood in his urine. VOCABULARY 1. (3) 2. (1) 3. (4) 4. (2) 5. (7) 6. (6) 7. (8) 8. (5) ANATOMY Renal medulla Papilla Renal pelvis Renal cortex Calyx Renal artery Renal vein Ureter 1 2 Chapter 36 Answers Proximal convoluted tubule Glomerulus Bowman’s capsule (inner) Bowman’s capsule (outer) Distal convoluted tubule Peritubular capillaries Efferent arteriole Afferent arteriole Blood flow Loop of Henle Collecting tubule SAMPLE URINALYSIS RESULTS Patient A: urinary tract infection Patient B: dehydration, deficient fluid volume Patient C: liver disease RENAL DIAGNOSTIC TESTS 1. False. It is an intravenous (IV) pyelogram. 2. False. It is a renal ultrasound. 3. False. It is a urine culture and sensitivity. 4. True 5. False. Allergic reactions are possible; It can be nephrotoxic and cause contrast induced nephropathy. CRITICAL THINKING 1. These are classic symptoms of stress incontinence. 2. Mrs. Bohke should be taught how to perform Kegel exercises. She also should be referred to a health care provider such as a urologist or a clinic specializing in incontinence. She may benefit from medications or surgery. 3. Functional incontinence. Mrs. Simmon would have been continent if she had been able to call the nurse for assistance within enough time. 4. The patient should receive a call light that she can feel and that is secured where she can reach it at all times. It would also be helpful to have the nurse make hourly rounds and identify the need to toilet. A regular toileting schedule could be helpful. A roommate, if present, might be able to turn on the call light for her, if needed. 5. Fluids should not be restricted. Fluid restriction can result in concentrated urine, which is more irritating to the urinary tract and can contribute to incontinence. Some people become continent only by increasing their fluid intake and setting a regular pattern of voiding. Chapter 36 REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (1) is correct. (2, 3, 4) are incorrect. 2. (2) is correct. (1, 3, 4) are incorrect. 3. (3) is correct. (1, 2, 4) are incorrect. 4. (2) is correct. (1, 3, 4) are incorrect. 5. (4) is correct. (1, 2, 3) are incorrect. 6. (1) is correct. (2, 3, 4) are incorrect. 7. (1, 2, 3, 4, 6) are correct. (5) is incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 8. (1, 5) are correct. The perineum should be washed before collecting a urine sample from a female and the labia held open to decrease contamination of the specimen. (2, 3, 4) are not necessary for a routine urine specimen. 9. (1) is correct. The elevated specific gravity is seen with dehydration because the urine is more concentrated. When a patient is dehydrated, the amount of urine that the patient makes is decreased, which makes the urine more concentrated. A small amount of bacteria is normally found in the urinalysis. (2, 3) are incorrect. A small amount of bacteria does not indicate infection. (4) is incorrect. No blood was noted on the results. 10. (4, 5) are correct. The elevated serum creatinine level and blood urea nitrogen (BUN) level reflect reduced kidney function. (1, 2, 3, 6) are incorrect. 11. (2) is correct. The patient should be nil per os (NPO; nothing by mouth) before undergoing an intravenous pyelogram so the dye is more concentrated for better visualization of renal structures. After the intravenous pyelogram, the nurse should encourage fluids to help clear the dye from the kidneys. (1, 3, 4) are not restricted. 12. (1) is correct. It is important that the nurse determine whether the patient is able to urinate. There may be edema of the urethra after a cystoscopy, which can result in urinary retention. (2, 3, 4) are not postcystoscopy interventions. 13. (1) is correct. Urge incontinence is associated with difficulty retaining urine once the urge to urinate is sensed. (2) is stress incontinence. (3) is functional incontinence. (4) is total incontinence. Answers 3 14. (3, 5) is correct. It is important to keep the catheter taped to prevent its movement, which increases the chance of introducing bacteria into the urine and trauma to the urethra. The exit spout must be handled with care to prevent contamination when it is open for emptying the urinary catheter bag. (1) increases risk of infection, and (2) is not necessary. (4) is incorrect. A full bag increases risk of backflow and contamination. 15. (4) is correct. With total incontinence, the patient is unable to control urination, and an adult incontinence brief is appropriate. (1) is incorrect. Cranberry juice would be helpful to decrease onset of a urinary tract infection, but the patient will still be incontinent of urine. (2) is incorrect. A urinal will not help if the patient has continuous, unpredictable urine flow. (3) is incorrect. Kegel exercises will not help total incontinence. 16. (1, 3, 6) are correct, as smoking and leather making exposes the bladder to nephrotoxic chemicals, and hematuria is a symptom of bladder cancer. (2) is incorrect. Weight loss is common with cancer, not weight gain. (4, 5) are not correct. 17. (2) is correct. Hyperkalemia can cause cardiac arrhythmias. (1, 3, 4) are not affected by hyperkalemia. 18. The area where the nurse would observe the insertion site of a peritoneal dialysis catheter.