Elimination (Urinary) Flashcards
Urinary elimination depends on the effective functioning of the upper urinary tract’s ___________ and the lower urinary tract’s urinary ________.
kidneys and ureters; bladder, urethra, and pelvic floor
The paired kidneys are situated on either side of the _________, behind the ________.
spinal column; peritoneal cavity
T/F: The left kidney is slightly lower than the right due to the position of the liver.
F - right kidney is lower
They are the primary regulators of fluid and acid–base balance in the body.
Kidneys
The functional units of the kidneys, the _______, filter the blood and remove metabolic wastes.
nephrons
T/F: In the average adult 1,200 mL of blood, or about 21% of the cardiac output, passes through the kidneys every minute.
T
Each kidney contains approximately 1 million nephrons. Each nephron has a _______, a tuft of capillaries surrounded by Bowman’s capsule.
glomerulus
Which of the following statements is/are true:
- The endothelium of glomerular capillaries is porous, allowing fluid and solutes to readily move across this membrane into the capsule.
- Plasma proteins and blood cells are too large to cross the membrane normally.
- Glomerular filtrate is similar in composition to plasma, made up of water, electrolytes, glucose, amino acids, and metabolic wastes.
All of the above
Which of the following is/are true?
- From Bowman’s capsule the filtrate moves into the tubule of the nephron.
- In the distal convoluted tubule, most of the water and electrolytes are reabsorbed.
- Solutes such as glucose are reabsorbed in the loop of Henle.
- Other substances are secreted into the filtrate in the same area, resulting in concentrated urine.
- In the proximal convoluted tubule, additional water and sodium are reabsorbed under the control of hormones such as antidiuretic hormone (ADH) and aldosterone.
2nd and 5th are false - proximal; distal
Which of the following is/are true?
- This controlled reabsorption allows regulation of fluid and electrolyte balance in the body.
- When fluid intake is low or the concentration of solutes in the blood is high, ADH is released from the posterior pituitary, more water is reabsorbed in the distal tubule, and less urine is excreted.
- By contrast, when fluid intake is high or the blood solute concentration is low, ADH is suppressed.
-Without ADH, the distal tubule becomes impermeable to water, and more urine is excreted.
-When aldosterone is released from the adrenal cortex, sodium and water are reabsorbed in greater quantities, increasing the blood volume and decreasing urinary output.
All of the above
Once the urine is formed in the kidneys, it moves through the collecting ducts into the calyces of the renal pelvis and from there into the _______.
ureters
T/F:
1st Statement: The upper end of each ureter is funnel-shaped as it enters the kidney.
2nd Statement: The lower ends of the ureters enter the bladder at the posterior corners of the floor of the bladder
Both T
At the junction between the ureter and the bladder, a flaplike fold of mucous membrane acts as a valve to prevent _________ of urine up the ureters.
reflux
The ________ (vesicle) is a hollow, muscular organ that serves as a reservoir for urine and as the organ of excretion. When empty, it lies behind the symphysis pubis.
urinary bladder
In men, the bladder lies in front of the _______ and above the prostate gland. In women, it lies in front of the ________.
rectum; uterus and vagina
The wall of the bladder is made up of four layers:
(1) an inner mucous layer;
(2) a connective tissue layer;
(3) three layers of smooth muscle fibers, some of which extend lengthwise, some obliquely, and some more or less circularly;
(4) an outer serous layer.
The smooth muscle layers are collectively called the _______. It allows the bladder to expand as it fills with urine, and to contract to release urine to the outside of the body during voiding.
detrusor muscle
The ________ at the base of the bladder is a triangular area marked by the ureter openings at the posterior corners and the opening of the urethra at the anterior inferior corner.
trigone
T/F
1st Statement: The bladder is capable of considerable distention because of rugae (folds) in the mucous membrane lining and because of the elasticity of its walls.
2nd Statement: When full, the dome of the bladder may extend above the symphysis pubis; in extreme situations, it may extend as high as the umbilicus. Normal bladder capacity is between 300 and 600 mL of urine.
Both T
The urethra extends from the bladder to the _______ (opening).
urinary meatus
In the adult woman, the urethra lies directly behind the _______, anterior to the vagina, and is between 3 and 4 cm (1.5 in.) long
symphysis pubis
T/F: In women, the urethra serves only as a passageway for the elimination of urine.
T
The urinary meatus is located between the _______, in front of the vagina, and below the clitoris.
labia minora
T/F:
1st Statement: The male urethra is approximately 20 cm (8 in.) long and serves as a passageway for urine only.
2nd Statement: The meatus is located at the proximal end of the penis
Both F - serves as a passageway for semen too; distal
In both men and women, the urethra has a _________ that is continuous with the bladder and the ureters.
mucous membrane lining
T/F:
1st Statement: An infection of the urethra can extend through the urinary tract to the kidneys.
2nd Statement: Men are particularly prone to urinary tract infections (UTIs) because of their short urethra and the proximity of the urinary meatus to the anus.
1st T 2nd F - Women
The vagina, urethra, and rectum pass through the _________, which consists of sheets of muscles and ligaments that provide support to the viscera of the pelvis.
pelvic floor
These muscles and ligaments extend from the symphysis pubis to the coccyx forming a ________.
sling
T/F: Specific sphincter muscles contribute to the continence mechanism.
T
The __________ situated in the proximal urethra and the bladder neck is composed of smooth muscle under involuntary control. It provides active tension designed to close the urethral lumen.
internal sphincter muscle
The _________ is composed of skeletal muscle under voluntary control, allowing the individual to choose when urine is eliminated.
external sphincter muscle
________, _________, and _______ all refer to the process of emptying the urinary bladder.
micturition, voiding, and urination
Urine collects in the bladder until pressure stimulates special sensory nerve endings in the bladder wall called ________.
stretch receptors
You urinate when:
T/F:
1st Statement: This occurs when the adult bladder contains between 250 and 450 mL of urine.
2nd Statement: In children, a considerably smaller volume, 50 to 200 mL, stimulates these nerves.
Both T
Identify the statements that is/are true:
- The stretch receptors transmit impulses to the spinal cord, specifically to the voiding reflex center located at the level of the second to fourth sacral vertebrae, causing the internal sphincter to relax and stimulating the urge to void.
- If the time and place are appropriate for urination, the conscious portion of the brain relaxes the external urethral sphincter muscle and urination takes place.
- If the time and place are inappropriate, the micturition reflex usually subsides until the bladder becomes more filled and the reflex is stimulated again.
All of the above
Voluntary control of urination is possible only if the nerves supplying the bladder and urethra, the neural tracts of the cord and brain, and the motor area of the cerebrum are all “_______”.
intact
T/F: The individual must be able to sense that the bladder is full.
T
Injury to any of these parts of the nervous system—for example, by a ________ or ______ above the level of the sacral region—results in intermittent involuntary emptying of the bladder.
cerebral hemorrhage or spinal cord injury
T/F: Older adults whose cognition is IMPROVED may not be aware of the need to urinate or able to respond to this urge by seeking toilet facilities.
F - poor
T/F:
1st Statement: Urine output varies according to fluid intake but gradually increases to 250 to 500 mL a day during the first year.
2nd Statement: An infant may urinate as often as 20 times a day.
Both T
The urine of the neonate is colorless and odorless and has a specific gravity of _________. This is due to?
1.008; newborns and infants have immature kidneys, they are unable to concentrate urine very effectively.
T/F: Infants are born with urinary control.
F - without
T/F:
1st Statement: Infants will develop urinary control between the ages of 2 and 5 years.
2nd Statement: Control during the night-time normally precedes daytime control.
1st T 2nd F - control during the daytime normally precedes night-time control.
T/F:
1st Statement: The preschooler is able to take responsibility for independent toileting.
2nd Statement: Parents need to realize that accidents do occur and the child should be punished or disciplined for this.
1st T 2nd F - Shouldn’t be punished or disciplined
T/F: Girls should be taught to wipe from back to front to prevent contamination of the urinary tract by feces.
F - front to back
The child’s elimination system reaches maturity during this period. The kidneys double in size between ages 5 and 10 years. During this period, the child urinates six to eight times a day.
School-Age Children
Is defined as the involuntary passing of urine when control should be established (about 5 years of age), which can be a problem for some school-age children.
Enuresis
_________, or bed-wetting, is the involuntary passing of urine during sleep. It has many causes but basically, it occurs because the client fails to awaken when the bladder empties.
Nocturnal enuresis
T/F: Bed-wetting should not be considered a problem until after the age of 8.
F - age of 6
T/F:
1st Statement: Nocturnal enuresis may be referred to as primary when the child has never achieved night-time urinary control.
2nd Statement: The incidence of nocturnal enuresis declines as the child matures.
Both T
_________ is that which appears after the child has achieved dryness for a period of 6 consecutive months. It is often related to another problem such as constipation, stress, or illness, and may resolve when the cause is eliminated.
Secondary enuresis
The excretory function of the kidney diminishes with ________, but usually not significantly below normal levels unless a disease process intervenes.
Ex. Blood flow can be reduced by arteriosclerosis, impairing renal function.
age
T/F: With age, the number of functioning nephrons decreases to some degree, impairing the kidney’s filtering abilities.
T
Choose the statements that is/are true:
- Conditions that alter normal fluid intake and output, such as having influenza or having surgery, can compromise the kidney’s ability to filter, maintain acid–base balance, and maintain electrolyte balance in older adults.
- It also takes a much LESSER time for these processes to return to normal functioning.
- The decrease in kidney function also places the older adult at higher risk for toxicity from medications if excretion rates are longer.
1st and 3rd T 2nd F - longer
The more noticeable changes with age are those related to the _______.
bladder
T/F:
1st Statement: Complaints of urinary urgency and urinary frequency are common.
2nd Statement: In men, these changes are often due to an enlarged prostate gland, and in women, they may be due to weakened muscles supporting the bladder or weakness of the urethral sphincter.
Both T
T/F: The capacity of the bladder and its ability to completely empty doesn’t diminish with age.
F - it diminishes with age
This explains the need for older adults to arise during the night to void and the retention of residual urine, predisposing the older adult to bladder infections.
nocturnal frequency
For many people, a set of conditions helps stimulate the ________. These conditions include privacy, normal position, sufficient time, and, occasionally, running water.
micturition reflex
Circumstances that do not allow for the client’s accustomed conditions may produce anxiety and muscle tension. As a result, the person is unable to relax abdominal and perineal muscles and the external urethral sphincter; thus, ______ is inhibited.
voiding
People also may voluntarily suppress urination because of perceived time pressures; for example, nurses often ignore the urge to void until they are able to take a break. This behavior can increase the risk of _______.
UTIs
T/F: The healthy body maintains a balance between the amount of fluid ingested and the amount of fluid eliminated.
T
T/F: When the amount of fluid intake increases, therefore, the output normally increases.
T
Choose the following that increase fluid output:
- Alcohol
- Fluids that contain caffeine.
- Food and fluids high in sodium
1st and 2nd statement only - alcohol increase fluid output by inhibiting the production of antidiuretic hormone; fluids that contain caffeine (e.g., coffee, tea, and cola drinks) also increase urine production; food and fluids high in sodium can cause fluid retention because water is retained to maintain the normal concentration of electrolytes.
T/F: Some foods and fluids can change the color of urine. For example, beets can cause urine to appear red; foods containing carotene can cause the urine to appear yellower than usual.
T
Many medications, particularly those affecting the __________, interfere with the normal urination process and may cause retention.
autonomic nervous system
It increases urine formation by preventing the re-absorption of water and electrolytes from the tubules of the kidney into the bloodstream.
Ex. chlorothiazide and furosemide
Diuretics
T/F: Good muscle tone is important to maintain the stretch and contractility of the detrusor muscle so the bladder can fill adequately and empty completely.
T
Clients who require a _________ for a long period may have poor bladder muscle tone because continuous drainage of urine prevents the bladder from filling and emptying normally.
retention catheter
________ also contributes to the ability to store and empty urine.
Pelvic muscle tone
Diseases of the kidneys may affect the ability of the _______ to produce urine.
nephrons
Abnormal amounts of protein or blood cells may be present in the urine, or the kidneys may virtually stop producing urine altogether, a condition known as ________.
renal failure.
T/F: Heart and circulatory disorders such as heart failure, shock, or hypertension can affect blood flow to the kidneys, interfering with urine production.
T
If abnormal amounts of fluid are lost through another route (e.g., vomiting or high fever), the kidneys _______ water and urinary output falls.
retain
A ________ (calculus) may obstruct a ureter, blocking urine flow from the kidney to the bladder.
urinary stone
Hypertrophy of the ________, a common condition affecting older men, may obstruct the urethra, impairing urination and bladder emptying.
prostate gland
The urethra may swell following a _______, and surgical procedures on any part of the urinary tract may result in some _________; as a result, the urine may be red or pink-tinged for a time.
cystoscopy; postoperative bleeding
Spinal anesthetics can affect the passage of urine because they decrease the client’s awareness of the need to ________.
void
Surgery on structures adjacent to the urinary tract can also affect voiding because of swelling in the _________.
lower abdomen
Although people’s patterns of urination are highly individual, most people void about _________ a day.
five to six times
T/F: People usually void when they first awaken in the morning, before they go to bed, and around mealtimes.
T
________ (or diuresis) refers to the production of abnormally large amounts of urine by the kidneys, often several liters more than the client’s usual daily output.
Polyuria
Polyuria can follow excessive fluid intake, a condition known as ________, or may be associated with diseases such as diabetes mellitus, diabetes insipidus, and chronic nephritis.
polydipsia
T/F: Polyuria can cause excessive fluid loss, leading to intense thirst, dehydration, and weight loss.
T
T/F: The terms oliguria and anuria are used to describe increased urinary output.
F - decreased
________ is low urine output, usually less than 500 mL a day or 30 mL an hour for an adult.
Oliguria
________ is low urine output, usually less than 500 mL a day or 30 mL an hour for an adult.
Oliguria
Although oliguria may occur because of abnormal fluid losses or a lack of fluid intake, it often indicates impaired blood flow to the ______ or impending ________ and should be promptly reported to the primary care provider.
kidneys; renal failure
T/F: Restoring renal blood flow and urinary output promptly can prevent renal failure and its complications.
T
________ refers to a lack of urine production.
Anuria
Should the kidneys become unable to adequately function, some mechanism of filtering the blood is necessary to prevent illness and death. This filtering is done through the use of _______, a technique by which fluids and molecules pass through a semi-permeable membrane according to the rules of osmosis.
renal dialysis
What are the two most common methods of dialysis?
hemodialysis and peritoneal dialysis
In _______, the client’s blood flows through vascular catheters, passes by the dialysis solution in an external machine, and then returns to the client.
hemodialysis
In ________, the dialysis solution is instilled into the abdominal cavity through a catheter, allowed to rest there while the fluid and molecules exchange, and then removed through the catheter.
peritoneal dialysis
T/F: Both hemodialysis and peritoneal dialysis must be performed at frequent intervals until the client’s kidneys can resume the filtering function.
T
_______,________,_______, and ______ often are manifestations of underlying conditions such as a UTI.
Frequency, nocturia, urgency, and dysuria
_______,_______,_______, and _____ may be either a manifestation or the primary problem affecting urinary elimination.
Enuresis, incontinence, retention, and neurogenic bladder
_______ is voiding at frequent intervals, that is, more than four to six times per day.
Urinary frequency
Which of the following may cause Urinary frequency:
- An increased intake of fluid
- Conditions such as UTI, stress, and pregnancy
All of the above
_______ is voiding two or more times at night. Like frequency, it is usually expressed in terms of the number of times the person gets out of bed to void.
Nocturia
_________ is the sudden, strong desire to void. There may or may not be a great deal of urine in the bladder, but the person feels a need to void immediately.
Urgency
Which of the following may cause Urgency?
- psychological stress
- irritation of the trigone and urethra.
- poor external sphincter control
- unstable bladder contractions.
All of the above
T/F: Urgency is a normal finding.
F
_______ means voiding that is either painful or difficult.
Dysuria
Choose the things Dysuria can accompany.
- a stricture (decrease in caliber) of the urethra
- urinary infections
- injury to the bladder and urethra.
- polyuria
1st-3rd statements only
