Ch 89 Urinary Disorder

Question 1

______ refers to the procedure of crushing the kidney stones.

Answer 1

Lithotripsy

Question 2

_____ are epithelial, fatty, or waxy tissue abnormally forced out of the renal tubules.

Answer 2

Casts

Question 3

A ______ is performed to measure bladder pressure during filling.

Answer 3

Cystometrogram

Question 4

A primary cancer of the kidney is referred to as a/an _____

Answer 4

Hypernephroma

Question 5

A _____ pouch is a type of continent diversion in which the middle portion of the ileum is folded and opened onto itself to create a pouch.

Answer 5

Kock

Question 6

Almost continuous; commonly caused by prostatectomy

Answer 6

True Incontinence

Question 7

A sudden increase in intraabdominal pressure

Answer 7

Stress incontinence

Question 8

Irritation of the bladder wall by urine components

Answer 8

Urge incontinence

Question 9

Bladder instability as a result of upper motor lesions

Answer 9

Reflex incontinence

Question 10

Write the correct sequence of the steps performed during a cystoscopy.

1. Instill Xylocaine jelly into the urethra.
2. Encourage the client to drink fluids.
3. Obtain a urinalysis and a urine culture.
4. Pass the cystoscope into the client’s bladder.

Answer 10

Obtain a urinalysis and a urine culture.

Instill Xylocaine jelly into the urethra.

Pass the cystoscope into the client’s bladder.

Encourage the client to drink fluids.

Question 11

What are the specialized imaging studies used to study the urinary tract?

Answer 11

The specialized imaging studies used to study the urinary tract include the following: intravenous
pyelogram, radioactive renogram, bone scan, nephrotomogram, renal arteriogram, cystogram and voiding cystourethrogram, and retrograde pyelogram.

Question 12

What are urodynamic tests?

Answer 12

Urodynamic testing is a series of tests that determine the actual function of the detrusor muscle of
the bladder, which pushes the urine out; the external sphincter muscle; and the pelvic (pubococcygeal) muscles.

Question 13

What are the factors that cause transient incontinence?

Answer 13

Factors that cause transient incontinence include reversible contributing factors such as changes in
mental status, infections, medications, fluid intake, mobility problems, and stool impaction.

Question 14

Which factors make a person more susceptible to urinary tract infection (UTI)?

Answer 14

Factors that may make a person more susceptible to UTI include catheterization, which can advance
bacteria into the bladder; systemic diseases, such as diabetes; and changes in the vaginal pH in women.

Question 15

What is glomerulonephritis?

Answer 15

Glomerulonephritis is a group of diseases in which the kidneys are damaged and partly destroyed by inflammation of the glomeruli. It may be a result of an acute infection, as with poststreptococcal glomerulonephritis. This type of inflammation may result in an antigen and antibody reaction.

Question 16

Who is considered a good candidate for kidney donation?

Answer 16

The client’s living relatives who have compatible tissue matches are considered good candidates as
kidney donors. The donor must have two well functioning kidneys and no underlying disease.

Question 17

A client comes to the healthcare facility with complaints of increased urinary frequency, especially during the night, for about the past week. The client also reports a painful, burning sensation felt when passing urine.

a. Which nursing diagnoses may be established for a client with a urinary disorder?

Answer 17

• Risk for infection related to dehydration, excess wastes in the body, or tissue breakdown
and damage.
• Risk for deficient or excess fluid volume related to the kidney’s inability to effectively concentrate urine, fluid restrictions, or electrolyte imbalance.
• Stress urinary incontinence, reflex urinary incontinence, functional urinary incontinence related to sphincter incompetence, neurologic disorders, impaired mental status, medications, fistula, cancer, surgery, trauma, or obstruction.
• Urinary retention related to obstruction, sphincter incompetence, cancer, or trauma.
• Impaired tissue integrity related to dehydration, mucous membrane friability and break-down, or general malaise.
• Social isolation related to incontinence, presence of ureterostomy, or presence of a
urinary diversion appliance.
• Ineffective sexuality patterns related to indwelling catheter, dialysis, or urinary diversion.
• Pain related to surgery, invasive diagnostic tests, urinary tract infections, pyelonephritis, or calculi.

Question 18

A client comes to the healthcare facility with complaints of increased urinary frequency, especially during the night, for about the past week. The client also reports a painful, burning sensation felt when passing urine.

Answer 18

• Obtaining frequent vital signs, especially blood pressure.
• Managing related symptoms such as diarrhea, nausea, vomiting, headache, anemia, and pain.
• Administering prescribed diuretics, mineral supplements, and antibiotics.
• Providing skin and mouth care.
• Observing and documenting skin condition, tissue turgor, and presence of edema or dehydration.
• Measuring and recording fluid intake and output (I&O), color and clarity of urine, and urine specific gravity.
• Taking daily weights and encouraging fluid intake.
• Assisting with voiding and continence training.
• Providing medications and emotional support for dysuria and painful intercourse.
• Managing and caring for an indwelling catheter or suprapubic Cystocath.
• Giving sitz baths and warm moist packs to offset pain.
• Assisting with movement and activity to prevent disorders of immobility, such as deep-vein thrombosis, pneumonia, and urinary tract infections

Question 19

What are the general nursing considerations undertaken when caring for clients with urinary disorders?

Answer 19

• Teach the client to take ample time in the bathroom.
  • Encourage the client with “shy bladder syndrome” to find a private, quiet bathroom.
  • Encourage the client to listen to the sound of running water, which helps the bladder that
  has difficulty starting to urinate.
  • Encourage the client to start a bladder training program.
  • Tap above the pubic bone, tap the clitoris, or tickle the base of the bladder to initiate a stream.
  • Push on the belly above the pubic bone during the stream to empty the bladder completely.
  • Use the double-void technique to empty the bladder completely

Question 20

A client complains of urinary leakage when coughing or sneezing. The client has been experiencing these incidences since childbirth 6 months ago. The client is diagnosed with stress incontinence.

a. Which tips should the nurse provide the client to help empty the bladder completely?

Answer 20

Use an incontinent pad on the bed and wheel-
chair to prevent soiling.
• Teach principles of bladder retraining, including the Credé maneuver, if necessary.
• Self-catheterization may be required for long-term management.
• Wear an appliance, condom catheter, or incontinent briefs or pads.
• Wash appliances regularly.
• Ensure regular skin care to maintain good skin integrity.
• Wash hands after using the bathroom

Question 21

A client complains of urinary leakage when coughing or sneezing. The client has been experiencing these incidences since childbirth 6 months ago. The client is diagnosed with stress incontinence.

Which client education is provided for the management of stress incontinence?

Answer 21

• Use an incontinent pad on the bed and wheelchair to prevent soiling.
• Teach principles of bladder retraining, including the Credé maneuver, if necessary.
• Self-catheterization may be required for long-term management.
• Wear an appliance, condom catheter, or incontinent briefs or pads.
• Wash appliances regularly.
• Ensure regular skin care to maintain good skin integrity.
• Wash hands after using the bathroom.

Question 22

A nurse is caring for a client who is experiencing a flare-up of chronic glomerulonephritis. Which measure should the nurse employ when caring for this client?

a. Encourage the client to drink plenty of fluids.
B. Place the client in the orthopneic position.
c. Provide the client with a protein-rich diet.
d. Encourage the client to remain ambulatory.

Answer 22

B. Place the client in the orthopneic position.

Question 23

A nurse is caring for a client who is receiving peritoneal dialysis. Which measure should the nurse take after the procedure?

a. Ask the client to avoid breathing deeply.
b. Place the client flat for 24 hr.
C. Assess the client for constipation.
d. Encourage increased fluid intake for 24 hr.

Answer 23

C. Assess the client for constipation.

Question 24

A female client is required to provide a urine sample for a culture and sensitivity test. Which intervention should the nurse perform?

a. Ask the client to insert a container and start voiding.
b. Send the urine sample to the laboratory within 24 hr.
C. Instruct the client to clean the perineal area before voiding.
d. Give the client nothing by mouth (NPO) for 8-10 hr before the test.

Answer 24

C. Instruct the client to clean the perineal area before voiding.

Question 25

Which information should the nurse provide the client who is preparing to undergo a cystoscopy procedure?

a. Voiding may be uncomfortable for 1-2 weeks.
b. Salt and fluid intake should be restricted after the procedure.
c. Urine is sent for culture immediately after cystoscopy.
d. Urine may be reddish immediately after cystoscopy.

Answer 25

d. Urine may be reddish immediately after cystoscopy.

Question 26

A nurse is assisting a healthcare provider to perform a needle biopsy of a client’s kidney. Which step should the nurse perform first?

a. Place a sandbag under the client’s abdomen.
b. Apply pressure to the biopsy site.
c. Keep the client lying flat for 24 hr.
D. Give the client. Sedative as ordered

Answer 26

D. Give the client. Sedative as ordered

Question 27

6. Which measures should the nurse employ when caring for a client with end-stage renal disease (ESRD)?

a. Encourage fluid intake.
b. Provide a sodium-rich diet.
C. Weigh the client daily.
d. Keep the room cool and breezy.

Answer 27

C. Weigh the client daily.

Question 28

Which objective should the nurse include in the short-term goals for a client with renal calculi?

A. Pain that is of tolerable level
b. Urination without difficulty or pain
c. Evidence of passage of stone
d. Reduced urine output each time

Answer 28

A. Pain that is of tolerable level

Question 29

Which clinical manifestations should the nurse monitor for in a client with ESRD?
Select all that apply.
a. Increased appetite
b. Anasarca
C. Uremic frost
d. Hypotension
E. Bleeding disorders

Answer 29

b. Anasarca
C. Uremic frost
E. Bleeding disorders

Question 30

Which sign should the nurse instruct the client to observe for as the first sign of bladder cancer?

a. Loss of body weight
b. Pain in the flanks
c. Sensation of a mass in the flanks
d. Blood in the urine without any pain

Answer 30

d. Blood in the urine without any pain

Question 31

Which measurement of 24-hr urine output would the nurse document as oliguria?
a. 75 ml/day
b. 250 ml/day
c. 2.5 L/day
d. 7.5 L/day

Answer 31

b. 250 ml/day