URINARY

Question 1

Urethra in males…

Answer 1

is longer at 20cm ⤻ external urethral orifice opens at the tip of the penis - the male urethra transports both urine and semen and passes through the prostate gland ⤻ called the prostatic urethra.

Question 2

⇧ risk for CAUTI?

Answer 2

women
⇧ age / debilitation
malnourishment
chronic illness
immunosuppression
DM

Question 3

S/Sx of infection in a catheterized PT?

Answer 3

cloudy malodorous urine, hematuria, fever, chills, anorexia, malaise

Question 4

On a UA, what finding may indicate infection/presence of bacteria?

Answer 4

+ for nitrates/nitrites

bacteria has enzymes that would cause these to appear in urine.

Question 5

The nurse is educating a patient who will be performing self-catheterization at home. What information provided by the nurse will help reduce the incidence of infection?

1. Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion.
2. Sterilize the catheter by boiling it in water for 20 minutes.
3. Insert the catheter for urine drainage three times per day.
4. A new catheter must be used each time catheterization is required.

Answer 5

1. Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion.

Question 6

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?

1. Abnormalities in urine
2. Location of discomfort
3. Elevated calcium levels
4. Structural defects in the kidneys

Answer 6

2.Location of discomfort

Question 7

To help with odor, a patient with an ileal conduit can…

Answer 7

use deodorizer or a few drops of diluted vinegar inserted through the drainage spout of bag

Question 8

A client is learning how to perform Kegel exercises. Which statement by the client indicates a need for additional teaching?

1. “I need to sit or stand with my legs slightly apart.”
2. “I should draw in my muscles like when I’m moving my bowels.”
3. “I need to hold the position for at least 15 seconds.”
4. “I should repeat the sequence of exercises 3 to 4 times a day.”

Answer 8

3. “I need to hold the position for at least 15 seconds.”

Question 9

RN should assess PT with ileal conduit for…

Answer 9

Urinary leakage

Question 10

IVP - What is it?

Answer 10

An IVP shows the kidneys, ureter, and bladder via x-ray imaging as the dye moves through the upper and then the lower urinary system..

Question 11

Suprapubic catheter size

Answer 11

16-24F

Question 12

RN actions post-IVP

Answer 12

Monitor patient closely for allergic reaction, and monitor urine output.

Maintain hydration status.

Question 13

Amount of urine produced by kidneys

Answer 13

1-2 L / day

Question 14

anuria

Answer 14

UOP <50 mL in 24 hr period

Question 15

Complicated UTI (upper or lower)

Answer 15

Often acquired in the hospital and related to catheterization, occur in patients with urologic abnormalities, pregnancy, immunosuppression, diabetes, and obstruction, and usually recurrent
Broader spectrum of organisms than uncomplicated; lower response to tx ⤻ tend to recur

Question 16

It is important to monitor …. in a patient who has undergone a ureterosigmoidoscopy

Answer 16

Fluid & Electrolytes

as bowel mucosa exposed to urine and electrolyte reabsorption - K and Mag can cause diarrhea.

Question 17

Primary symptom of primary glomerular disease

Answer 17

hematuria

Question 18

Medications that increase risk of urinary incontinence

Answer 18

Diuretics, sedatives, hypnotics, opioids

Question 19

Primary symptom of acute pyelonephritis

Answer 19

Tenderness in the area of the costovertebral angle

Question 20

Food that create odors:

Answer 20

asparagus, cheese, eggs

Question 21

What should you ask the patient about if they have bright yellow urine?

Answer 21

Multi-vitamin intake

Question 22

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client’s pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?

1. The skin wasn’t lubricated before the pouch was applied.
2. The pouch faceplate doesn’t fit the stoma.
3. A skin barrier was applied properly.
4. Stoma dilation wasn’t performed.

Answer 22

2. The pouch faceplate doesn’t fit the stoma.

Question 23

The nurse advises the patient with chronic pyelonephritis that he should:

1. Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys.
2. Decrease his sodium intake to prevent fluid retention.
3. Increase fluids to 3 to 4 L/24 hours to dilute the urine.
4. Decrease his intake of calcium rich foods to prevent kidney stones.

Answer 23

3. Increase fluids to 3 to 4 L/24 hours to dilute the urine.

Question 24

Important to know about urinary incontinence…

Answer 24

It is NOT inevitable with illness or aging; it is often reversible and treatable

Question 25

Fluids normally ingested by a person in a day

Answer 25

1300 mL of liquid | 1000 mL from food

Question 26

Iatrogenic incontinence

Answer 26

``` Involuntary loss of urine due to extrinsic medical factors Predominantly medications (alpha-adrenergic blocking agents for HTN) keeping bladder neck relaxed ⤻ alfuzosin/Uroxatral, doxazosin/Cardura, tamsulosin/Flomax ```

Question 27

What is an expected finding for the first 48hr after patient receives ileal conduit?

Answer 27

Hematuria (resolves spontaneously)

Question 28

If a PT has recurrent UTIs the RN should discourage the consumption of...

Answer 28

Coffee, tea, alcohol, & colas (urinary irritants)

Question 29

strategies for promoting urinary continence

Answer 29

Avoid bladder irritants – caffeine, ETOH, artificial sweeteners Avoid diuretics after 4pm ⇧ awareness of the amount and timing of all fluid intake Perform pelvic floor exercises as prescribed, every day Stop smoking (decreases coughing) Take steps to avoid constipation Void regularly – 5-8 times a day – every 2-3 hours First thing in am, before each meal, before bed, one during night if needed

Question 30

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence? 1. Encouraging intake of at least 2 L of fluid daily 2. Giving the client a glass of soda before bedtime 3. Taking the client to the bathroom twice per day 4. Consulting with a dietitian

Answer 30

1. Encouraging intake of at least 2 L of fluid daily

Question 31

Urethra in females...

Answer 31

is short at 3-4cm ⤻ external urethral orifice opens just anterior to the opening for the vagina.

Question 32

condition that ⇧ risk of kidney stones

Answer 32

hyperparathyroid

Question 33

Normal micturation (urination)

Answer 33

8 x / 24 hr period

Question 34

Catheter size for women

Answer 34

12-14F

Question 35

Maintenance guidelines for prevention of CAUTIs

Answer 35

Daily assessment of need (EMR alerts), tamper evident seal is intact, catheter secured to prevent migration, hand hygiene, drainage bag emptied into clean container that is provided for each patient every 8 hours or less, twice daily perineal care with soap and water – no powder and avoid to- and fro- motion, ensure unobstructed flow of urine

Question 36

Most common urinary diversion

Answer 36

ileal conduit

Question 37

After a PT has an indwelling catheter removed, when would the RN expect the PT to void and would bladder scan the PT?

Answer 37

4-6 hr mark

Question 38

Post-infectious causes of primary glomerular disease

Answer 38

Post-infectious causes are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2-3 weeks

Question 39

Catheter irrigation...

Answer 39

should NOT be done routinely -- | only if clot or large sediment is present and a three way catheter should be utilized.

Question 40

Prevention of urolithiasis and nephrolithiasis

Answer 40

Avoid protein intake to decrease urinary excretion of calcium and uric acid (purine is an amino acid that forms uric acid when metabolized) Limit sodium to 3-4g/day – competes with calcium for reabsorption in the kidneys Low-calcium diets for only those with true absorptive hypercalcemia Avoid intake of oxalate-containing foods (spinach, strawberries, rhubarb, tea, peanuts, wheat bran) Add cranberry juice to fluid intake Avoid dehydration and excessive sweating Call provider first sign of UTI

Question 41

Functional incontinence

Answer 41

Involuntary loss of urine due to severe cognitive impairment (Alzheimer's, dementia) Can’t identify they need to void or unable to physically reach the toilet ⤻ urinary function intact

Question 42

Most common route of infection for lower UTIs

Answer 42

transurethral

Question 43

oliguria

Answer 43

UOP < 0.5 mL/kg/hr

Question 44

Catheter size for men

Answer 44

16-18F

Question 45

IVP - Assessment

Answer 45

ASSESS for allergy to iodine or shellfish and renal function ⤻ ALWAYS BEFORE ANY CONTRAST DYE FOR ANY PROCEDURE/STUDY

Question 46

Where does the urine go when a PT has a continent ileal urinary reservoir (Indiana pouch)?

Answer 46

The colon pouch stores the urine

Question 47

Appropriate intervention for a patient with urinary retention

Answer 47

Have them use the bathroom or BSC rather than a bed pan; | Males should stand when using their urinal.

Question 48

Chronic urinary retention can lead to...

Answer 48

Overflow incontinence

Question 49

One kg = how much fluid?

Answer 49

1000 mL

Question 50

Complication to assess for in patients with lower UTIs

Answer 50

Urosepsis

Question 51

Causes of hypercalcemia/hypercalciuria

Answer 51

Excessive intake of vitamin D, milk, and alkali (dietary supplements to prevent osteoporosis & antacids)

Question 52

One pound = how much fluid?

Answer 52

500 mL

Question 53

Stress incontinence

Answer 53

Involuntary loss of urine through intact urethra as a result of sneezing, coughing, changing positions Common in women who have had vaginal deliveries and men after radical prostatectomy

Question 54

When should a patient perform intermittent self-catheterization?

Answer 54

Every 4-6 hr and HS (bedtime)

Question 55

⇧ risk for UTIs

Answer 55

``` females DM pregnancy neurodisorders gout immunosuppression catheterization cystoscope procedures inability to fully empty bladder/obstruction of urine ```

Question 56

Urge incontinence

Answer 56

Involuntary loss of urine associated with a strong urge to void that cannot be suppressed Seen with neurologic dysfunction that impairs inhibition of bladder contraction and in patients without overt neurologic dysfunction

Question 57

Normal residual urine in older adults

Answer 57

50-100mL

Question 58

What is an important teaching/nursing intervention for patients with a continent ileal urinary reservoir (Indiana pouch)?

Answer 58

The pouch MUST be drained at regular intervals to prevent reabsorption of metabolic waste from urine, reflux of urine to ureters, and UTI

Question 59

Normal residual urine in middle age adults

Answer 59

No more than 50 mL