Urinary Disorder Flashcards by B -

When heparin is administered to a patient during dialysis, it is very important not to administer injections for the next 2 to 4 hours.This restriction allows heparin to be metabolized and excreted.
A)true
B)false

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While caring for patients with chronic glomerulonephritis, the nurse should provide periods of rest throughout the day, with uninterrupted sleep at night.
A)true
B)false

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When obtaining vascular access, the nurse should avoid puncturing the same site used previously.
A)true
B)false

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Using dialysate solutions after two hours of dialysis will not allow heparin to be metabolized and excreted.
A)true
B)false

True

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A female patient undergoes dialysis as a part of treatment for kidney failure. The patient is administered heparin during dialysis to achieve therapeutic levels. Which of the following steps should the nurse take to allow heparin to be metabolized and excreted in the patient?
A)Provide periods of rest throughout the day and uninterrupted sleep at night
B)Use dialysate solutions after 2 hours
C)Puncture the same site used previously
D)Avoid administering injections for 2 to 4 hours after heparin administration

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Which of the following is used to decrease potassium level seen in acute renal failure?
A)Kayexalate
B)Sorbitol
C)IV dextrose 50%
D)Calcium supplements

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The elevated potassium levels may be reduced by administering cation-exchange resins (Kayexalate) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
A)true
B)false

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Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder?
A)Anticholinergic agent
B)Estrogen hormone
C)Tricyclic antidepressants
D)Over-the-counter decongestant

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Anticholinergic agents are considered first-line medications for urge incontinence.
A)true
B)false

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Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra.
A)true
B)false

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Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance.
A)true
B)false

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. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.
A)true
B)false

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Which of the following is a characteristic of the intrarenal category of acute renal failure?
A)Decreased creatinine
B)Increased BUN
C)High specific gravity
D)Decreased urine sodium

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The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.
A)true
B)false

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A right angle 90 degrees straightens the urethra and makes it easier to insert the catheter?
A)true
B)false

True

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To facilitate entry of a catheter into the male urethra, the penis should be positioned at which of the following degree angles (in relation to the body)?
A)90 degrees
B)45 degrees
C)180 degrees
D)270 degrees

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Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic.
A)true
B)false

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Cystitis is inflammation of the urinary bladder.
A)true
B)false

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Urethritis is inflammation of the urethra.
A)true
B)false

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Interstitial nephritis is inflammation of the kidney
A)true
B)false

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Which of the following terms is used to refer to inflammation of the renal pelvis?
A)Pyelonephritis
B)Cystitis
C)Urethritis
D)Interstitial nephritis

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Incontinence is noted in patients diagnosed with Parkinson’s disease.
A)true
B)false

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Urinary retention is associated with spinal cord injury.
A)true
B)false

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Urgency is associated with an overactive bladder.
A)true
B)false.

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Incomplete bladder emptying is associated with diabetes mellitus. A)true B)false

``` Which type of voiding dysfunction is seen in patients diagnosed with Parkinson's disease? A)Incontinence B)Urinary retention C)Urgency D)Incomplete bladder emptying ```

The metabolic acidosis of chronic renal failure usually produces no symptoms and requires no treatment. A)true B)false patient do require treatment

``` Treatment of metabolic acidosis in chronic renal failure includes? A)no treatment. B)sodium bicarbonate supplements. C)hemodialysis. D)peritoneal dialysis. ```

``` Which of the following occur in chronic glomerulonephritis. A)Anemia, hyperkalemia B) metabolic acidosis C)hyperphosphatemia D)all the above ```

``` Which of the following is a change that occurs in chronic glomerulonephritis? A)Hypokalemia B)Anemia C)Metabolic alkalosis D)Hypophosphatemia ```

A male patient is being cared for after a nephrectomy. Because of the incisional pain and restricted positioning, he frequently suffers from breathing difficulty. Which of the following measures should the nurse include in the care plan to relieve him of the distress? A)Use aseptic technique when changing the surgical dressing B)Encourage the intake of oral fluids C)Administer antibiotic therapy as prescribed D)Auscultate lung sounds once per shift

C 1. Auscultating the lungs once per shift will help to identify whether the breath sounds are normal, abnormal, or absent. 2. Using the aseptic technique when changing the surgical dressing prevents the introduction of microorganisms to the urinary tract, but may not help a patient breathe better. 3. An antibiotic therapy is prescribed for treating infections of the skin and urinary tract, while taking oral fluids helps dilute the urine and reduce the potential for pain and discomfort during urination only.

``` The most accurate indicator of fluid loss or gain in an acutely ill patient is A)blood pressure. B)weight. C)pulse rate. D)edema. ```

The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. A)true B)false

Which of the following is a reversible cause of urinary incontinence in the older adult? Choose one of the following A)Increased fluid intake B)Age C)Constipation D)Decreased progesterone level in the menopausal woman

C Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in the menopausal women.

``` Which of the following is as integumentary manifestation of chronic renal failure? Choose one of the following A)Asterixis B)Gray-brown skin color C)Tremors D)Seizures ```

Integumentary manifestations of chronic renal failure include a gray-bronze skin color and ecchymosis. A)true B)false

Asterixis, tremors, and seizures are neurological manifestations of a)chronic renal failure. B)acute renal failure. C)both a and b

Residual urine that is greater than 100 cc indicates that the suprapubic catheter cannot be discontinued A)true B) false can be continued

``` In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the patient's residual urine must be less than which of the following amounts on two separate occasions (morning and evening)? Choose one of the following A)30 cc B)50 cc C)100 cc D)400 cc ```

Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned. A)true B)false

``` Which of the following is a characteristic of a normal stoma? Choose one of the following A)Painful B)Pink color C)No bleeding when cleansing stoma D)Dry in appearance ```

What incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position. A)Stress incontinence B)Reflex incontinence C)Urge incontinence

What incontinence is their involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. A)Urge incontinence B)Reflex incontinence

What incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. A)Urge incontinence B)Overflow incontinence

What incontinence is the involuntary loss of urine associated with overdistention of the bladder. A)stress incontinence B)overflow incontinence

``` Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing? Choose one of the following A)Reflex B)Urge C)Stress D)Overflow ```

Iatrogenic incontinence is the involuntary loss of urine due to medications A)true B)false, it is itraogenic

``` Which type of incontinency refers to the involuntary loss of urine due to medications? Choose one of the following A)Reflex B)Iatrogenic C)Overflow D)Urge ```

Azotemia is the concentration of urea and other nitrogenous wastes in the blood A)true B)false

``` What is the term for the concentration of urea and other nitrogenous wastes in the blood? Choose one of the following A)Uremia B)Azotemia C)Hematuria D)Proteinuria ```

Determining the patient's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the A)postoperative procedure B)preoperative procedure.

The most important ___________nursing management is to maintain skin and stomal integrity to avoid further complications, such as skin infections and urinary odor. A)postoperative B)preoperative

A patient undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure. Which of the following postoperative procedures should the nurse perform? Choose one of the following A)Determine the patient's ability to manage stoma care B)Show photographs and drawings of the placement of the stoma C)Maintain skin and stomal integrity D)Suggest a visit to a local ostomy group

Factors that contribute to urinary tract infection in older adults include A)immunocompromise, high incidence of chronic illness B) immobility C) frequent use of antimicrobial agents. D)all the above

``` Which of the following is a factor contributing to UTI in older adults? Choose one of the following A)Low incidence of chronic illness B)Immunocompromise C)Sporadic use of antimicrobial agents D)Active lifestyle ```

``` Rejection of a transplanted kidney within 24 hours after transplant is termed Choose one of the following A)acute rejection. B)hyperacute rejection. C)chronic rejection. D)simple rejection. ```

Hyperacute rejection may require removal of the transplanted kidney. A)true B)false

True

. Acute rejection occurs within 3 to 14 days of transplantation. A)true B)false

True

. Chronic rejection occurs after many years. A)true B)false

True

Bladder retraining following removal of an indwelling catheter begins with Choose one of the following A)encouraging the patient to void immediately. B)advising the patient to avoid urinating for at least 6 hours. C)performing straight catheterization after 4 hours. D)instructing the patient to follow a 2 to 3 hour timed voiding schedule.

Stress incontinence may occur with sneezing and coughing. A)true B)false

True

Overflow incontinence refers to the involuntary loss of urine associated with over-distention of the bladder. A)true B)false

True

Urge incontinence refers to involuntary loss of urine associated with urgency. A)true B)false

True

. Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations. A)true B)false

True

``` Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? Choose one of the following A)Overflow B)Urge C)Reflex D)Stress ```

``` Which period of acute renal failure is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys? Choose one of the following A)Initiation B)Oliguria C)Diuresis D)Recovery ```

The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys, such as urea and creatinine. A)true B)false

True

The initiation periods begins with the initial insult and ends when oliguria develops. A)true B)false

True

The diuresis period is marked by a gradual increase in urine output A)true B)false

True

The nurse who provides teaching to the female patient regarding prevention of recurrent urinary tract infections includes which of the following statements? Choose one of the following A)Take tub baths instead of showers B)Void immediately after sexual intercourse C)Increase intake of coffee, tea, and colas D)Void every 5 hours during the day

``` A male patient, who is 82 years of age, suffers from urinary incontinence. Which of the following factors should the nurse assess before beginning a bladder training program for the patient? Choose one of the following A)Physical and environmental conditions B)History of allergies C)Occupational history D)Smoking habits ```

As a nurse It is essential to assess the patient's physical and environmental conditions before beginning a bladder training program, because the patient may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the patient. It is not so essential to assess the patient's history of allergy, occupation, and smoking habits before beginning a bladder training program. A)true B)false

True

``` Acute dialysis is indicated in which situation? Choose one of the following A)Dehydration B)Impending pulmonary edema C)Metabolic alkalosis D)Hypokalemia ```

Acute dialysis is indicated when there is a A)high and increasing level of serum potassium B)fluid overload C)impending pulmonary edema, or increasing acidosis. D)all the above

A patient with urinary retention needs to undergo a procedure to insert an indwelling catheter. Which information should the nurse discuss with the physician before catheterization? Choose one of the following A)Inquire about insertion of the nasogastric tube B)Inquire about the placement of IV and central venous pressure lines C)Inquire about the type and size of the catheter to be used D)Inquire about administering cleansing enemas

The nurse needs to assess the fluid volume status of a patient with chronic glomerulonephritis. Which of the following methods should the nurse use to accurately assess the patient's fluid volume status? Choose one of the following A)Weighing the patient daily, at the same time, on the same scale, with similar clothing B)Weighing the patient daily, once in the morning, on the same scale, with similar clothing C)Weighing the patient daily, at the same time, using a different scale every time, with similar clothing D)Weighing the patient daily, at the same time, on the same scale, with only minimal clothing

Weighing the patient daily, at the same time, on the same scale, with similar clothing each time is important because changes in body weight reflect changes in fluid volume status. A)true B)false

True

A patient is being treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidney's function. Which of the following measures can the nurse take to help achieve the objective? Choose one of the following A)Note the nail beds and mobility of the fingers B)Monitor the patient's intake and output C)Palpate for a thrill over the vascular access D)Inspect the skin over the fistula or graft for signs of infection

Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome? Choose one of the following A)Elevated urine protein and hypoalbuminemia B)Low triglycerides and elevated sodium levels C)Decreased high-density lipoproteins and increased iron levels DAbnormal blood clotting and elevated blood pressure

Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia A)true B)false

True

``` A patient who has an obstruction of the urinary tract may experience which complication? Choose one of the following A)Inability to control urination B)Increased urine output C)Increase in blood pressure D)Excretion of dilute urine ```

Urinary tract obstruction can lead to hypertension related to increased renin secretion. The urine output would be decreased and not diluted. A)true B)false

True

ANATOMY AND PHYSIOLOGY OF THE URINARY SYSTEM

The primary function of the kidneys is excretion of these waste products A)true B)false

True

The kidneys also assist in regulating the body's water, electrolytes, and acid-base balance. The urinary system is probably the most important system in maintaining homeostasis A)true B)false

True

The urinary system consists of two kidneys, which produce urine by removing waste, excess water, and electrolytes from the blood; A)true B)false

True

two ureters, which transport urine from the kidneys to the bladder; A)true B)false

True

one bladder, which collects and stores urine; A)true B)false

True

one urethra, which transports urine from the bladder to the outside of the body for elimination A)true B)false

True

Major Functions of the Kidneys

- Urine formation: Glomerular filtration, tubular reabsorption, and secretion; 1 000 to 2000 ml of urine formed each day Fluid and electrolyte control: - Maintain correct balance of fluid and electrolytes within a normal range by excretion, secretion, and reabsorption Acid-base balance: - Maintain pH of blood (7 .35 to 7 .45) at normal range by directly excreting hydrogen ions and forming bicarbonate for buffering Excretion of waste products: - Direct removal of metabolic waste products contained in the glomerular filtrate Blood pressure regulation: - Regulation of blood pressure by controlling the circulating volume and renin secretion Red blood cell (RBC) production: Secretion of erythropoietin, which stimulates bone marrow to produce RBCs - Regulation of calcium-phosphate metabolism:Regulation of vitamin D activation

True

URINE COMPOSITION AND CHARACTERISTICS

-The word urine comes from one of its components, uric acid. Each day, the body forms 1000 to 2000 mL of urine; this amount is influenced by several factors, including mental and physical health, oral intake, and blood pressure. A)true B)false

True

-Urine is 95% water; the remainder is nitrogenous wastes and salts. It is usually a transparent yellow with a characteristic odor. Normal urine is yellow because of urochrome, a pigment resulting from the body's destruction of hemoglobin. A)true B) false

True

-Urine is slightly acidic, with a pH of 4.6 to 8 and a specific gravity of 1.003 to 1.030. Healthy urine is sterile, but at room temperature it rapidly decomposes and smells like ammonia as a result of the breakdown of urea A)true B)false

True

URINE ABNORMALITIES

Albumin in the urine (albuminuria) indicates possible A)renal disease, increased blood pressure, or toxicity of the kidney cells from heavy metals B)false decrease in bp

Glucose (sugar) in the urine (glycosuria) most often indicates a A)high blood glucose level. The blood glucose level rises above the renal threshold (the point at which the renal tubules can no longer reabsorb), and the glucose spills into the urine. B)false

Erythrocytes in the urine (hematuria) may indicate A)infection, tumors, or renal disease. Occasionally an individual may have a renal calculus (kidney stone), and irritation produces hematuria. B)false

Ketone bodies in the urine is called ketoaciduria (or ketonuria). It occurs when A)too many fatty acids are oxidized. This condition is seen with diabetes mellitus, starvation, or any other metabolic condition in which fats are rapidly catabolized. B)false

Leukocytes (white blood cells [WBCs]) are found in urine when there is an infection in the urinary tract. A)true B)false

True

NORMAL AGING OF THE URINARY SYSTEM

With aging the kidneys lose part of their normal functioning capacity; in fact, by 70 years of age, the filtering mechanism is only 50% as efficient as at 40 years. This occurs because of decreased blood supply and loss of nephrons A)true B)false

True

In the aging woman the bladder loses tone and the perineal muscles may relax, resulting in stress incontinence. A)true B)false

True

In the aging man the prostate gland may become enlarged, leading to constriction of the urethra. A)true B)false

True

Incomplete emptying of the bladder in both men and women increases the possibility of urinary tract infection (UTI) A)true B)false

True

URINALYSIS

The most common urinary diagnostic study is the urinalysis. A)true B)false

True

Urine culture and sensitivity may be done to confirm suspected infections, to identify causative organisms, and to determine appropriate antimicrobial therapy. Cultures are also obtained for periodic screening of urine when the threat of a UTI persists. A)true B)false

True

``` Common substances measured to monitor kidney function include total A)urine protein B)creatinine, urea, uric acid levels C)catecholamines D)all the above ```

Urinalysis is completed on a clean-catch or catheterized specimen A)true B)false

True

Because the kidneys excrete substances in varying amounts and rates during a 24-hour period, the nurse may be responsible for collecting a 24-hour urine sample. Discard the first voiding and note the time at the beginning of the 24-hour urine collection. For the next 24 hours collect all urine and place it in a special laboratory container. A)true B)false

True

Life Span Considerations Older Adults Urinary Disorder

Urinary frequency, urgency, nocturia, retention, and incontinence are common with aging. These occur because of weakened musculature in the bladder and urethra, diminished neurologic sensation combined with decreased bladder capacity, and the effects of medications such as diuretics. A)true B)false

True

Urinary incontinence is a leading reason for institutional placement of older adults. • Urinary incontinence can lead to a loss of self-esteem and result in decreased participation in social activities. A)true B)false

True

• Older women are at risk for stress incontinence because of A)hormonal changes and weakened pelvic musculature B) prostatic hypertrophy.

Older men are at risk for urinary retention because of A)prostatic hypertrophy B)false, no

Urinary tract infections in older adults are often associated with invasive procedures such as A)catheterization B)diabetes mellitus C)neurologic disorders D)all the above

• Inadequate fluid intake, immobility, and conditions that lead to urinary stasis increase the risk of infection in the older adult. A)true B)false

True

• Frequent toileting and meticulous skin care can reduce the risk of skin impairment secondary to urinary incontinence. A)true B)false

True

Cultural Considerations | Urinary Disorder

Integral components of a cultural assessment include communication, time orientation, personal space, pain, religious beliefs, taboos, customs, dietary practices, health practices, family roles, and views of death. A)true B)false

True

SPECIFIC GRAVITY

_________measures the patient's hydration status and gives information about the kidneys' ability to concentrate urine. A)Specific gravity B)BUN

Specific gravity is decreased by high fluid intake, reduced renal concentrating ability, diabetes insipidus, and diuretic use. A)true B)false

True

It is increased in by dehydration due to fever, diaphoresis, vomiting, diarrhea, and medical conditions such as diabetes mellitus (diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic coma) and inappropriate secretion of ADH. A)specific gravity B)BUN

The value ranges between 1.003 and 1.030, with the lower values suggesting more dilute urine. A)specific gravity B)BUN

BLOOD (SERUM) UREA NITROGEN

_________) is a laboratory test used to determine the kidney's ability to rid the blood of nonprotein nitrogen (NPN) waste and urea, which result from protein breakdown (catabolism). A)blood urea nitrogen B)specific gravity

The acceptable serum range for BUN is 10 to 20 mg/ dL. A)true B)false

For a more accurate test result, the patient should receive nothing by mouth (NPO) for 8 hours before blood sampling. A)BUN C)specific gravity

If the BUN is elevated, institute preventive nursing measures to protect the patient from possible A)disorientation B)seizures C)both a and b

BLOOD (SERUM) CREATININE

Creatinine is a catabolic product of creatine, which is used in A)skeletal muscle contraction B)cardiac contraction C)both a and b

The daily production of creatine, and subsequently creatinine, depends on muscle mass, which fluctuates little. A)true B)false

True

Creatinine, as with BUN, is excreted entirely by the kidneys and is therefore directly proportional to renal excretory function. A)true B)false

True

with normal renal excretory function, the serum creatinine level should remain constant and normal A)true B)false,should always be changing

Only renal disorders (such as glomerulonephritis, pyelonephritis, acute tubular necrosis, and urinary obstruction) cause an abnormal elevation in creatinine A)true B)flase

True

Only renal disorders cause an abnormal elevation in creatinine such as A)glomerulonephritis, B)pyelonephritis C)acute tubular necrosis, and urinary obstruction D)all the above

is used to diagnose impaired kidney function A)serum creatinine test B)BUN test C)both a and

``` the creatinine level is affected little by A)dehydration B)malnutrition C)hepatic function D)all the above ```

The acceptable serum creatinine range is A)0.5 to 1.1 mg/ dL (female) B)0.6 to 1.2 mg/ dL (male) C)both a and b are correct

CREATININE CLEARANCE

Creatinine, an NPN substance, is present in blood and urine. A)true B)false

True

Creatinine is generated during muscle contraction and then excreted by glomerular filtration. A)true B)false

True

Levels are directly related to muscle mass and are usually measured for a 24-hour period. During the testing period, the patient avoids excessive physical activity. A)true B)false

True

Discard the initial specimen and start the 24-hour timing at that point. Collect all urine in the 24-hour period because any deviation will alter test results. A)true B)false

True

An elevation in serum levels with a decline in urine levels indicates renal disease. A)creatinine B)none

Normal ranges are serum, A)0.5 to 1.1 mg/ dL (female) B)0.6 to 1.2 mg/ dL (male); C)both a and b

Normal urine creatinine levels, A)87 to 107 mL/ min (female) B)107 to 139 mL/min (male) C)both a and b

PROSTATE-SPECIFIC ANTIGEN

is an organ-specific glycoprotein produced by normal prostatic tissue A)PSA B)BUN

Normal range is less than 4 ng/ mL. A)PSA B)BUN

``` Elevated PSA levels result from A)prostate cancer B)benign prostatic hypertrophy (BPH) C)prostatits D)all the above ```

OSMOLALITY

Assessment of urine osmolality (the weight of the solute compared with its own weight) may be preferred over specific gravity. A)true B)false

True

Plasma osmolality may be done in conjunction with the urine sampling when A)pituitary disorders are suspected B) for a count

Results provide information on the concentrating ability of the kidney. A)osmolality B)specific gravity

KIDNEY-URETER-BLADDER RADIOGRAPHY

____________) radiograph assesses the general status of the abdomen and the size, structure, and position of the urinary tract structures. A)A kidney-ureter-bladder (KUB) B)A PSA

Abnormal findings related to the urinary system may indicate tumors, calculi, glomerulonephritis, cysts, and other conditions. In a what test A)PSA,BUN B)KIDNEY-URETER-BLADDER RADIOGRAPHY

INTRAVENOUS PYELOGRAM OR INTRAVENOUS UROGRAPHY

``` Intravenous pyelogram (IVP) or intravenous urography (IVU) evaluates structures of the urinary tract, filling of the renal pelvis with urine, and transport of urine via the ureters to the bladder. A)true B)false ```

True

It is vital to determine whether the patient has an allergy to iodine (or iodine-containing foods such as iodized salt, saltwater fish, seaweed products, vegetables grown in iodinerich soils) because it is the base of the radiopaque dye that is injected into a vein for this and other radiologic examinations. A) INTRAVENOUS PYELOGRAM B)INTRAVENOUS UROGRAPHY C)both a and b

If the patient has had an allergic reaction to the iodine, the physician may order administration of a A)corticosteroid or an antihistamine before testing B)alternatively, may order ultrasonography C)both a and b

``` Preparation usually of the intravenous pyelogram (IVP) or intravenous urography (IVU) includes A)eating a light supper B)taking a non-gasforming laxative C)remaining NPO 8 hours before testing D)all the above ```

In planning the testing regimen, schedule urography before barium-based studies. A)true B)false

True

When the dye is injected, the patient experiences a warm, flushing sensation and a metallic taste. A)true B)false

True

During the procedure, monitor vital signs frequently. Radiographs are taken at various intervals to monitor movement of the dye. A)true B)false

``` Abnormal findings may indicate A)structural deviations, hydronephrosis B)calculi within the urinary tract, polycystic renal (kidney) disease (PKD) C) tumors, and other conditions D)all the above ```

RETROGRADE PYELOGRAPHY

_________involves examination of the lower urinary tract with a cystoscope under aseptic conditions. The urologist injects radiopaque dye directly into the ureters to visualize the upper urinary tract. Urine samples can be obtained directly from the renal pelvis. A)Retrograde pyelography B)retrograde gram

: Radiopaque dye is injected through an indwelling catheter into the urinary bladder to evaluate its structure or to determine tl1e cause of recurrent infections A)Retrograde cystography B)Retrograde urethrography:

A catheter is inserted and dye injected to assess the status of the urethral structure. A)Retrograde cystography B)Retrograde urethrography:

VOIDING CYSTOURETHROGRAPHY

is used in conjunction with other diagnostic studies to detect abnormalities of the urinary bladder and the urethra. Preparation includes an enema before testing. An indwelling catheter is inserted into the urinary bladder, and dye is injected to outline the lower urinary tract. Radiographs are taken, and the catheter is then removed. The patient is asked to void while radiographs are being taken. A)Voiding cystourethrography B)Endoscopic procedures

Structural abnormalities, diverticula, and reflux into the ureter may be detected. A)Voiding cystourethrography B)Endoscopic procedure

ENDOSCOPIC PROCEDURES

are visual examinations of hollow organs using an instrument with a scope and light source. Because of the invasive nature of the procedure, informed consent is necessarY, and because the procedure is most often performed in the surgical suite, preoperative preparation is indicated A)endoscopic procedures B)voiding procedure

is a visual examination to inspect, treat, or diagnose disorders of the urinary bladder and proximal structures. Patient preparation includes a description of the procedure. Usually the procedure is carried out using a local anesthetic after the patient has been sedated. Patient safety is paramount when the patient is sedated. The patient is placed in a lithotomy position for the procedure, which may produce embarrassment and anxiety. The thought of a scope being passed while the patient is awake may intensify these feelings. Provide an opportunity for the patient to verbalize feelings. A)Cystoscopy B)endoscopy

What position is the patient place in a cystocopy A)semi fowlers B)lithotomy C)dorsal recumbent

Care after the procedure includes hydration to dilute the urine. Monitor the first voiding after the procedure, assessing time, amount, color, and any dysuria (painful or difficult urination). The first voiding is occasionally blood tinged due to the trauma of the procedure. A)cystoscopy B)none

The urologist can perform a brush biopsy via a ureteral catheter during a cystoscopy. A nylon brush is inserted through the catheter to obtain specimens from the renal pelvis or calyces. A)true B)false

True

Nephroscopy (renal endoscopy) is done using the percutaneous (through the skin) route and provides direct visualization of the upper urinary structures. The urologist can obtain biopsy or urine specimens or remove calculi. A)true B)false

True

RENAL ANGIOGRAPHY

aids in evaluating blood supply to the kidneys, evaluates masses, and detects possible complications after kidney transplantation. Withhold oral intake the night before the procedure. A)renal angiogram B)renal venogram

The procedure requires the passing of a small radiopaque catheter into an artery (usually the femoral artery) to provide a port for the injection of radiopaque dye. Therefore, when the procedure is completed, the nurse should perform which of the following after an renal angiogram. A) have the patient lie flat in bed for several hours to minimize the risk of bleeding B)Assess the puncture site for bleeding or hematoma, and maintain the pressure dressing at the site C) Assess circulatory status of the involved extremity every 15 minutes for 1 hour, then every 2 hours for 24 hours. D) all the above

RENAL VENOGRAM

provides information about the kidney's venous drainage. Access for the radiopaque catheter is the femoral vein. Monitor the patient afterward for bleeding at the puncture site. A) renal angiogram B) renal venogram

COMPUTED TOMOGRAPHY

A computed tomography (CT) scan differentiates masses of the kidney. Images are obtained by a computer-controlled scanner. A radiopaque dye may be injected to enhance the image. A serum urea and a creatinine level are obtained before use of radiopaque dye. The dye is not used if inadequate kidney function is noted. A)true B)false.

True

Inform the patient that the table on which he or she is placed and the machine "taking pictures" will move at intervals and that it is important to lie still. The CT body-scanning unit takes multiple cross-sectional pictures at several different sites, creating a three-dimensional map of the renal structure. A)CT scan B)angiogram

The adrenals, the bladder, and the prostate may also be visualized through they A)CT scan B)renal angiogram

MAGNETIC RESONANCE IMAGING

Magnetic resonance imaging (MRI) uses nuclear magnetic resonance as its source of energy to obtain a visual assessment of body tissues. The patient requires no special preparation other than removal of all metal objects that might be attracted by the magnet. A)true B)false

True

``` Patients with metal prostheses such as which of the following cannot undergo MRI. A) heart valves B) orthopedic screws C) cardiac pacemakers D)all the above ```

Emphasize that the examination area will be confining and that a repetitive "pounding" sound will be heard (somewhat like the sound of a muffled jackhammer). A) MRI B) renal scan

can be used for diagnoses of pathologic conditions of the renal system. A)MRI B)BUN

RENAL SCAN

A radionuclide tracer substance that will be taken up by renal tubular cells or excreted by the glomerular filtrate is injected intravenously. A series of computery. generated images is then made. The scan provides data related to functional parenchyma (the essential parts of an organ that are concerned with its function). A)MRI B)renal scan

No special preparation is needed. Check facility policy concerning the disposal of the patient's urine for the first 24 hours. Pregnant nurses should refrain from caring for this patient during this time A)renal scan B)catheter care

ULTRASONOGRAPHY

is a diagnostic tool that uses the reflection of sound waves to produce images of deep body structures. Inform the patient that a conducting jelly will be applied on the skin over the area to be studied; this improves the transmission of sound waves. The sound waves are high frequency and inaudible to the human ear; the waves are converted into electrical impulses that are photographed for study. A)Transrectal ultrasound B)Ultrasonography

can visualize size, shape, and position of the kidney and delineate any irregularities in structure. Deviations from normal findings may indicate tumor, congenital anomalies, cysts, or obstructions. No special preparations are necessary. A)Ultrasonography B)RENAL BIOPSY

TRANSRECTAL ULTRASOUND

What procedure provides clear images of prostatic tumors that otherwise might go undiagnosed. A)transrectal ultrasound B)transrectal biopsy

Transrectal ultrasound guided biopsy is performed to obtain samples of prostatic tissue from various areas with minimal discomfort to the patient. A)true B)false

RENAL BIOPSY

The kidney can be biopsied by an open procedure similar to other surgical procedures on the kidney or by the less invasive method of needle biopsy, also called a percutaneous biopsy. Tell the patient that he or she may experience pain during the procedure and should follow instructions, such as holding the breath. A)renal biopsy B)transrectal biopsy C)both a and b

Bed rest is instituted for 24 hours after the procedure. Mobility is restricted to bathroom privileges for the next 24 hours, and gradual resumption of activities is allowed after 48 to 72 hours. For which of the following procedure. A)renal biopsy B)rectal biopsy C)both a and b

URODYNAMIC STUDIES

are indicated when neurologic disease is suspected of being an underlying cause of incontinence. The studies evaluate detrusor reflex. The patient may experience embarrassment and slight discomfort. A)urodynamic studies B)renal studies

During cystometrogram a catheter is inserted into the bladder, then connected to a cystometer, which measures bladder capacity and pressure. The examiner asks the patient about sensations of heat, cold, and urge to void and instructs the patient at times to void and change position A)true B)false

___________&___________ medications may be administered during urodynamic studies to determine their effects on bladder function. A)Cholinergic and anticholinergic B)NSAID AND HISTIMINE

A cholinergic drug, such as _________ stimulates the atonic bladder; A)bethanechol [Urecholine) B)atropine

anticholinergic drug, such as ________, brings an overactive bladder to a more normal level or function. A)atropine B)sympathetic drug

MEDICATION CONSIDERATIONS

The kidneys filter a wide range of water-soluble products from the blood, including medications A)true B)false

True

such as renal disease, changes in the pH of urine, and age. Patients with renal disease are given reduced dosages of medications to minimize further damage or drug toxicity. Alteration in urinary pH affects the absorption rate of certain medications. A)medication are used for B)false

Older patients may have decreased physiologic functioning, diminishing the kidneys' capacity to excrete drugs. Diminished kidney function interferes . with the filtration of water-soluble medications A)true B)false

True

DIURETICS TO ENHANCE URINARY OUTPUT

Diuretics are administered to enhance urinary output A)true B)false

True

They achieve this by increasing the kidney's filtration of sodium, chloride, and water at different sites in the kidney. A)diuretics B)disease kidney

Diuretics are used in the management of a variety of disorders, such as A)heart failure B) hypertension C)both a and b

Diuretics are classified by chemical structure and by the site and type of action on the kidney. A)true B)false

True

Thiazide Diuretics

What diuretic act at the distal convoluted tubule to impair sodium and chloride reabsorption, leading to excretion of electrolytes and water. A)thiazide diuretic B)loop diuretic

``` The thiazide diuretic chlorothiazide (Diuril) affects electrolytes to cause A)hypokalemia B) hyponatremia C)hypercalcemia D) all the above ```

hypokalemia A)(extreme potassium depletion in blood) B)(decreased sodium concentration in blood) C)(excessive amounts of calcium in blood)

, hyponatremia A)(extreme potassium depletion in blood) B)(decreased sodium concentration in blood) C) (excessive amounts of calcium in blood)

hypercalcemia A)(excessive amounts of calcium in blood) B)(extreme potassium depletion in blood) C) (decreased sodium concentration in blood)

Hypochloremic alkalosis occurs from a deficiency of chloride. A)true B)false

True

The main uses are management of systemic edema and control of mild to moderate hypertension, although it may take a month to achieve the full antihypertensive effect. A)Thiazide diuretics B)loop diuretics

Chlorothiazide is contraindicated in anuria. A)true B)false

True

Loop (or High-Ceiling) Diuretics

act primarily in the ascending Henle's loop to inhibit tubular reabsorption of sodium and chloride. This group is the most potent of all diuretics and may lead to significant electrolyte depletion. These diuretics are effective for use in patients with impaired kidney function. A)thiazides diuretics B)loop diuretics

The loop diuretic furosemide (Lasix) aHects electrolytes to cause hypokalemia, hypochloremia, hyponatremia, hypocalcemia (abnormally low blood calcium), and/or hypomagnesemia (decreased magnesium in the blood) A)true B)false

The effect on acid-base balance is the development of hypochloremic alkalosis A)true B)false

True

``` Furosemide is used in a)nephrotic syndrome B) heart failure C)pulmonary edema D)all the above ```

``` Side effects are those associated with a)rapid fluid loss: vertigo, b)hypotension, and possible circulatory collapse C)both a and b D)none of the above ```

Potassium-Sparing Diuretics

act on the distal convoluted tubule to inhibit sodium reabsorption and potassium secretion. A A)thiazides diuretics B)Potassium-sparing diuretics C)both a and b

Potassium-sparing diuretics decrease the sodium-potassium exchange A)true B)false

True

Potassium-sparing diuretics are contraindicated in patients who experience A)hyperkalemia, since further retention of potassium could cause a fatal cardiac dysrhythmia B)contraindications there are no for this diuretic

There are two types of potassium-sparing diuretics: A) aldosterone antagonists and nonaldosterone antagonists B)renin antagonists and nonrenin antagonists

The aldosterone antagonist spironolactone (Aldactone) blocks aldosterone in the distal tubule to promote potassium uptake in exchange for sodium secretion. Although it can be used in combination with other diuretics, primarily in the treatment of hypertension and edema, spironolactone is most frequently used for its potassium-sparing quality. A)true B) false

True

The nonaldosterone antagonist triamterene (Dyrenium) directly reduces ion transportation in the tubule, though it has little diuretic effect. Triamterene is instead used to help limit the potassium-wasting effect of other diuretics. A)true B) false

True

Osmotic Diuretics

``` act at the proximal convoluted tubule to increase plasma osmotic pressure, causing redistribution of fluid toward the circulatory vessels. A)Osmotic diuretics B)loop diuretics C)thiazides diuretics D)all the above ```

Osmotic diuretics are used to manage A)edema, promote systemic diuresis in cerebral edema B)decrease intraocular pressure C)improve kidney function in acute renal failure (ARF) D)all the above

In ARF, osmotics are used to prevent irreversible failure, but they are contraindicated in advanced states of renal failure A)true B)false

True

The osmotic diuretic mannitol (Osrnitrol) increases osmolarity of glomerular filtrate; decreases reabsorption of water electrolytes; and increases urinary output, sodium, and chloride, which actually has minimal effect on acid-base balance. A)true B)false

True

______________ is used to prevent or treat the oliguric phase of ARF, promote systemic diuresis in cerebral edema, and decrease intraocular pressure. A)mannitol B)thiazides diuretics

Careful assessment of what system before administering mannitol is essential because of the high risk of inducing heart failure A) neurological B)muscukuloskeletal C)cardiovascular system

``` Avoid extravasation (escape of the medication from the blood vessel into the tissues), which may lead to tissue irritation or necrosis A)true B)false ```

True

Carbonic Anhydrase Inhibitor Diuretics

acetazolamide (Diarnox) interferes with the bonding of water and carbon dioxide by the enzyme carbonic anhydraanhydrase (present in red blood cells) at the proximal convoluted tubule. Although it has limited usefulness as a diuretic, acetazolamide is used to lower intraocular pressure. A)thiazides diuretics B)carbonic anhydrase inhibitor diuretic C)loop diuretics

Although it has limited usefulness as a diuretic, acetazolamide is used to lower A) intraocular pressure B)false, rise introular pressure

Nursing Interventions

Because patients receiving diuretics often have complicated disease conditions such as heart failure and pulmonary edema. The nurse will A)monitor for signs and symptoms of fluid overload: changes in pulse rate, respirations, cardiac sounds, and lung fields. B)Record daily morning weights for the patient receiving diuretics. Keep accurate intake and output (I&O) records, and document blood pressure, pulse, and respirations four times a day until the medication is regulated and the vital signs stabilize. C) Assess BUN, serum electrolytes, and urine as ordered. Diet instruction to the patient and the family should include a warning to avoid overuse of salt in cooking or as a table additive D)all the above

The use of most diuretics, with the exception of the potassium-sparing diuretics, requires adding daily potassium sources (e.g., baked potatoes, raw bananas, apricots, or navel oranges). In some cases the physician orders potassium supplements to be taken with the diuretic. A)true B)false

True

``` potassium sources are?select all that apply A) baked potatoes B) raw bananas C)apricots D)navel oranges ```

A B C D

Carefully monitor this potentiating effect to prevent toxicity from other medications. For example, as diuretics effectively decrease the volume of extracellular fluid, the serum level of digoxin may increase proportionately, resulting in Carefully monitor this potentiating effect to prevent digitoxicity A)true B)false

True

MEDICATIONS FOR URINARY TRACT INFECTIONS

Urinary antiseptics inhibit bacteria growth and are used to prevent and treat urethritis and cystitis. A)true B)false

True

Urinary antiseptics are divided into four groups: quinolones, nitrofurantoins, methenamines, and fluoroquinolones A)true B)false

True

Nalidixic acid (NegGram) is used to treat UTis caused by gram-negative microbes (e.g., Escherichia coli and Proteus mirabilis). The common side effects are drowsiness, vertigo, weakness, nausea, and vomiting. The use of nalidixic acid is contraindicated in renal impairment. A)Quinolone B)Nitrofurantoin C)Methenamine

This is a normal side effect that causes the urine to turn orange A)Quinolone B)Nitrofurantoin

(Macrodantin) is effective against both gram-positive and gram-negative mi-ncrobes (e.g., Streptococcus Jaecalis, E. coli, and P. mirabi.lis) in the urinary tract. Common side effects are loss of appetite, nausea, and vomiting. A)Nitrofurantoin compound B)Methenamine mandelate (Mandelamine)

(Mandelamine) suppresses fungi and gram-negative and gram-positive organisms (e.g., E. coli, staphylococci, and enterococci). Acidification of the urine with an acid-ash diet or other acidifiers to a pH of less than 5.5 is necessary for effective action. Methenamine mandelate is used for patients with chronic, recurrent UTis as a preventive measure after antibiotics have cleared the infection. Although side effects are rare, they include nausea, vomiting, skin rash, and urticaria (hives) A)Methenamine mandelate B)Fluoroquinolone

Norfloxacin (Noroxin) is a broad-spectrum antibiotic effective against gram-positive and gram-negative organisms (e.g., E. coli, P. mirabilis, Pseudomonas organisms, Staphylococcus aureus, and Staphylococcus epidermidis). It is used in the treatment of UTis, gonorrhea, and gonococcal urethritis. It is administered with a full glass of water 1 hour before or 2 hours after meals or with antacids A)Methenamine B)Fluoroquinolone

Nursing Interventions

Hydrate the patient to produce daily urinary output of 2000 mL, unless contraindicated A)true B)false

True

When indicated, teach the patient to use the acid-ash diet to help maintain a urine pH of 5.5. A)true B)false

True

Soothe skin irritations with cornstarch or a bath of bicarbonate of soda or dilute vinegar. A)true B)false.

True

Report continuing signs of infection. A)true B)false

True

Observe the patient receiving nalidixic acid for visual disturbances and offer appropriate assistance for ambulation or transfer. A)true B)false

True

Monitor the patient receiving nitrofurantoin for signs of allergic response (such as erythema, chills, fever, and dyspnea). If these signs or symptoms develop, discontinue the medication and notify the physician (trial doses of this medication may be used to detect possible allergic reaction before administering full dosage). A)true B)false

True

NUTRITIONAL CONSIDERATIONS

Acid-Ash and Alkaline-Ash Foods

ACID-ASH FOODS* A)Meat, whole grains, eggs, cheese, cranberries, prunes, and plums B)Milk, vegetables, fruits (except cranberries, prunes, and plums)

ALKALINE-ASH FOODS A)Milk, vegetables, fruits (except cranberries, prunes, and plums) B) Meat, whole grains, eggs, cheese, cranberries, prunes, and plums

MAINTAINING ADEQUATE URINARY DRAINAGE

Urine clears the body of waste materials and helps balance electrolytes. A)true B)false

True

Urethral catheters range from 14 to 24 F for adult patients. Ureteral catheters are usually 4 to 6 F. The physician always inserts ureteral catheters, whereas the nurse usually inserts indwelling urethral catheters A)true B)false

True

TYPES OF CATHETERS

has a tapered tip and is selected for ease of insertion when enlargement of the prostate gland is suspected. The _______ is less traumatic during insertion because it is stiffer and more easily controlled than the straight-tip catheter A)foley catheter B)coude catheter

a balloon near its tip that may be inflated after insertion, holding the catheter in the urinary bladder for continuous drainage. A)foley catheter B) coude catheter

Malecot and de Pezzer, or mushroom, A)catheters are used to drain urine from the renal pelvis of the kidney B) has multiple openings in its tip to facilitate intermittent drainage

The Robinson catheter A)has multiple openings in its tip to facilitate intermittent drainage B)are long and slender to pass into the ureters.

Ureteral catheters A)are long and slender to pass into the ureters. B)has a slanted, larger orifice at its tip to be used if there is blood in the urine

The whistle-tip catheter A)has a slanted, larger orifice at its tip to be used if there is blood in the urine B) is introduced by the physician through the abdominal wall above the symphysis pubis. This catheter diverts urine flow from the urethra as needed to treat injury to the bony pelvis, the urinary tract, or surrounding organs; strictures; or obstruction

The cystostomy, vesicostomy, or suprapubic catheter A)is introduced by the physician through the abdominal wall above the symphysis pubis. This catheter diverts urine flow from the urethra as needed to treat injury to the bony pelvis, the urinary tract, or surrounding organs; strictures; or obstruction B) is not actually a catheter but rather a drainage system connected to the external male genitalia. This noninvasive appliance is used for the incontinent male to minimize skin irritation from urine and to reduce risk of infection from an indwelling catheter. The appliance is removed daily for cleansing and inspecting the skin. Use of the . external catheter allows the patient to have a more normal lifestyl

When the measured residual urine is consistently less than 50 mL, the catheter is usually removed and a sterile dressing is placed over the wound A)true B)false

True

is not actually a catheter but rather a drainage system connected to the external male genitalia. This noninvasive appliance is used for the incontinent male to minimize skin irritation from urine and to reduce risk of infection from an indwelling catheter. The appliance is removed daily for cleansing and inspecting the skin. Use of the . external catheter allows the patient to have a more normal lifestyle A)An external (Texas or condom) catheter B)foley cather

NURSING INTERVENTIONS AND PATIENT TEACHING

Nursing interventions for the patient with a urinary drainage system involve a number of principles to prevent and detect infection and trauma:

1. Follow aseptic technique to avoid introducing microorganisms from the environment. Never rest the collecting bag on the floor. 2. Record I&O For precision monitoring, such as hourly urinary output, add a urometer to the drainage system. If urinary output falls below 50 mL/hr, check the drainage system for proper placement and function before contacting the physician. 3. Adequately hydrate the patient to flush the urinary tract. A)true B)false

4. Do not open the drainage system after it is in place except to irrigate the catheter, and then only with physician orders. It is important to maintain a closed system to prevent UTI's. 5. Perform catheter care twice daily and as needed, using standard precautions. Each institution has a specific protocol for catheter care. Cleanse the perineum with mild soap and warm water, rinse well, and pat dry. At times an antiseptic y. solution or ointment may be ordered to use at the catheter incision site. 6. Check the drainage system daily for leaks. A)true B)false

True

7. Avoid placement of the urinary drainage bag above the level of the catheter insertion, which would cause urine to reenter the drainage system and contaminate the urinary tract. 8. Prevent tension on the system or backflow of urine while transferring the patient. 9. Ambulate the patient if possible to facilitate urine flow. If the patient's activity must be restricted, turn and reposition every H-1 hours. A)true B)false

True

10. Avoid kinks or compression of the drainage tube that may cause pooling of the urine within the urinary tract. Gently coil excess tubing, secure with a clamp or pin to avoid dislodging the catheter, and release the tubing before transferring or repositioning the patient. A)true B)false

True

Evidence-Based Practice

Application to Nursing Practice

Incontinence and/or frequency are experienced by adults of all ages, ethnicities, educational levels, economic status, and health status. Many adults wrongly believe that urinary incontinence and/ or frequency are an expected part of the aging process and that there are no treatments available. A)true B)1st is true C)false

True

Older adults of culturally diverse backgrounds are willing to discuss bladder control issues with nurses. Older adults are receptive to different forms of education and are interested in learning. A)true B)false

True

NEUROGENIC BLADDER

means the loss of voluntary voiding control, resulting in urinary retention or incontinence. The lesion may be caused by a congenital anomaly (e.g., spina bifida), a neurologic disease (e.g., multiple sclerosis), or trauma (as in spinal cord injury). The two types of neurogenic bladder are spastic and flaccid. A)Neurogenic bladder B)nephritis C)hydronephrotic

bladder is caused by a lesion above the voiding reflex arc (upper motor neuron) that results in a loss of the urge to void and a loss of motor control. The bladder wall atrophies, decreasing bladder capacity. Urine is released on reflex, with little or no conscious control. A)Spastic (reflex or automatic) B)A flaccid (atonic, nonreflex)

bladder, caused by alesion of a lower motor neuron, continues to fill and distend, with pooling of urine and incomplete emptying. Because of the accompanying loss of sensation, the patient may not experience discomfort that would indicate retention A)spastic B)A flaccid (atonic, nonreflex)

Prevention of complications is a major concern; infection occurs from urinary stasis and repeated catheterization. Retention of urine may lead to backup of urine (reflux) into the upper urinary tract and to the distention of the structures of the urinary tract. A)nephritis B)nephrosis C)Neurogenic bladder

Assessment Subjective data include patient complaints of diaphoresis, flushing and nausea before reflex incontinence, or infrequent voiding. Collection of objective data involves investigating the urinary status of the patient at risk for ;neurogenic bladder this includes patients with a congenital anomaly, a neurologic disease, or a spinal cord injury. The patient with a spastic bladder experiences UI, whereas the patient with a flaccid bladder describes infrequent voiding. A)neurogenic bladder B)nephritis

chemistry studies monitor change in BUN and creatinine levels. Radiographic studies outline structural changes that occur. This is diagnostic test for A)neurogenic bladder B)nephritis C)calculi

The patient is aided by the use of parasympathomimetic medication (e.g., bethanechol) to increase the bladder's contractility. The patient may need to use intermittent self catheterization or a urinary collection system if continence is not achieved. This is medical management of A)neurogenic bladder B)nephritis C)both a and b

Sacral Nerve Modulation (Sacral Neuromodulation) and Stimulation

is the use of a permanently implantable electrical stimulation device to change neuronal activity in the sacral efferent and afferent nerves to reduce urinary urge incontinence. A)neruo-dorsal stimulation bladder B)Sacral Nerve Modulation (Sacral Neuromodulation) and Stimulation

delivers continuous low-level electrical impulses to the bladder and urethral sphincters via the sacral nerve. It corrects UI by modulating the neural reflexes, reducing stimulation to an overactive bladder, or boosting stimulation to an under-active one. The action of the impulses is unknown. A)Sacral Nerve Modulation (Sacral Neuromodulation) and Stimulation B)electric shock therapy bladder

The patient tests this temporary implant for 1 to 2 weeks. If the patient achieves 50% continence, a permanent implant is put in place. A)Sacral Nerve Modulation (Sacral Neuromodulation) and Stimulation B)false, not for any patient

Nursing Interventions and Patient Teaching

goal for the patient with neurogenic bladder is to establish urinary elimination and prevent complications. A)true B)false

True

The patient with a spastic bladder may be placed on a bladder training program, with self-stimulation used every 2 hours to empty the bladder: The patient tries to initiate voiding using bladder compressions by applying pressure to the abdomen suprapubically or by digital stimulation of the anal sphincter. A)true B)false

True

Management of the patient with a flaccid bladder is similar. Place the patient on a 2-hour voiding schedule for bladder training. Issues of self-esteem are crucial for this patient to remain in social settings. Provide a supportive, sensitive environment for the patient to discuss ways to adapt to an altered self-image. A)flaccid bladder B)spastic bladder

INFLAMMATORY AND INFECTIOUS DISORDERS OF THE URINARY SYSTEM

UR1NARY TRACT INFECTIONS

is the presence of micxoorganisms in any urinary system structure.Bacteriuria (bacteria in the urine) is the most common of all nosocomial infections, most are associated with the use of urinary catheters. A)UTI B)urinary retention

UTis are common in older patients, related to bladder obstruction, insufficient bladder emptying, decreased bactericidal secretions of the prostate, and increased perineal soiling in women. Immobility, sensory impairment, and multiple organ impairment may increase the chances of infection in older adults. A)true B)false

True

Women are more susceptible to UTis than men because the urethra is short and proximal to the vagina and rectum. A)true B)false

True

urinary obstruction, neurogenic bladder, ureterovesical or urethrovesical reflux, sexual intercourse, and catheterization may introduce bacteria into the urinary system which can cause A)UTI B)PSA

Many chronic health problems predispose the patient to a UTI: A) diabetes mellitus, multiple sclerosis, B)spinal cord injuries, hypertension, C) renal diseases. D)all the above

Gram-negative microorganisms that commonly infect the urinary tract are usually from the gastrointestinal tract and ascend through the urinary meatus A)E. coli and Klebsiella, Proteus, B)Pseudomonas organisms C)both a and b

If there is incomplete emptying of the bladder or reflux of urine, the retained urine supports growth of bacteria. A)true B)false

True

common signs and symptoms associated with UTI are urgency, frequency, burning on urination, and microscopic to gross (visible without aid of microscope) hematuria. A)UTI B)nerogenic bladder

UTis are identified by the location of the infection: urethritis (urethra), cystitis (urinary bladder), pyelonephritis (kidney), and prostatitis (prostate gland). A)true B)flase

True

Sections of the bladder are said to be lower UTis, whereas infections of the kidneys are upper UTis. A)true B)false

True

Assessment Subjective data include patient complaints of pain or burning on urination, urgency, frequency, and nocturia (excessive urination at night). The patient may also have related asthenia (a general feeling of tiredness and listlessness). Abdominal discomfort, perineal pain, or back pain may be present, depending on the extent of the disease process and site of infection. Collection of objective data involves palpation of the lower abdomen, which may produce discomfort over the urinary bladder. Urine may be cloudy or blood tinged. A)UTI B)PSA C)nephritis

``` Diagnostic Tests for UTI WOULD BE A)Urine culture and bacteriologic tests confirm the diagnosis. For patients with recurrent UTis or systemic disease B)BUN C)NPN D)all the above ```

The physician prescribes antiinfective medications in either oral or parenteral single or multiple doses, depending on the severity of the infection, microbial sensitivity, cost, and patient tolerance. Urinary antiseptics, such as methenamine mandelate, may be used prophylactically in recurrent infections A)medical management of UTI B) medical management of nephritis

Nursing Interventions UTI

Nursing interventions should be supportive, with patient education for adequate hydration and hygiene. A)true for UTI B)false FOR UTI

Comfort measures include a regimen of antiinfective agents, urinary analgesics (e.g., phenazopyridine [Pyridium]), adequate fluid intake, and perineal care. If treatment is effective, the patient should receive relief quickly. A)UTI INTERVENTION B)PSA INTERVENTION

is septic poisoning due to retention and absorption of urinary products in the tissues. A)Urosepsis B)sepsis

Because of the high incidence of nosocomial UTis, regular staff in service review of basic procedures for catheter insertion and maintenance is important A)true B)false

True

Complementary & Alternative Therapies Urinary Disorders

Cranberry (Cranberry Plus, Ultra Cranberry} has been used to prevent urinary tract infections (UTis}, particularly in women prone to recurrent infection. It has also been used to treat acute UTI. Monitor patients for lack of therapeutic effect. A)true B)false

True

Echinacea stimulates the immune system and treats UTI. Patients with human immunodeficiency virus infections, including acquired immunodeficiency syndrome, tuberculosis, collagen disease, multiple sclerosis, or other autoimmune disease, should avoid use. Echinacea should not be used in place of antibiotic therapy. A)true B)false

True

``` Sea holly (Eryngium campestre) aboveground plant parts have a mild diuretic effect. Roots have an antispasmodic effect. Aboveground parts are used in UTI and prostatitis; roots are used to treat kidney and bladder calculi, renal colic, kidney and urinary tract inflammation, and urinary retention. A)true B)false ```

True

Nettle (Urtica dioica) is currently being investigated as an irrigation for the urinary tract and also to treat benign prostatic hypertrophy. Patients with fluid retention caused by reduced cardiac or renal activity should not use this herb. A)true B)false

True

Caffeine increases urine production. • A)true B)false

True

Some believe that acupuncture applied to the abdominal meridian may help relieve cystitis. • a)true B)false

True

Some advocate massage with diluted rosemary, juniper, or lavender to aid in relieving pain associated with cystitis. A)true B)false

True

URETHRITIS

is classified by the presence or absence of gonorrhea. A)urethritis B)nephritis

Nongonorrheal urethritis is called nonspecific urethritis (NSU). NSU may be caused by candida or trichomonal infections in women. A)true B)false

True

__________ Is inflammation of the urethra with pus formation in the mucus-forming glands within the urethral lining. A)nephritis B)urethritis

With _______________, acute infection of the mucous membrane of the urethra causes a purulent exudate from the meatus; the patient feels discomfort, frequency, and burning on urination. A)gonorrheal urethritis B)non gonorrheal urethritis

Assessment of urethritis

___________what data of urethritis vary, since the patient may be asymptomatic or may complain of dysuria, urethral pruritus, and urethral discharge. Women may complain of vaginal discharge or vulvar irritation. A)objective data B)subjective data

Collection of what type of data, includes light palpation of the lower abdomen, which may produce discomfort over the urinary bladder. Inspection of the urethra may reveal purulent exudates or inflammation. Culture and sensitivity may be ordered; follow the institution's procedure A)subjective data B)objective data

Diagnostic test perform for urethritis? A) Gram stain of the exudate to identify the pathogen. B)renal scan

Drugs that may be prescribed are or What drugs may be given to patients with urethritis ? A) sulfamethoxazoletrirnethoprim (Bactrim, Septra) B)metronidazole (FJagyl), clotrimazole (Mycelex) C)nystatin (Mycostatin) D)all the above

``` Comfort measures include antibiotics, adequate fluid intake to flush the system, warm sitz baths, and special care of the perineum using clean technique. For which following condtion? A)urethritis B)sprain ankle C)herpes simplex D)all the above ```

Nursing Interventions for patients with urethritis

Nursing interventions focus on patient education: Avoid sexual activity until the infection clears; take all medications, especially antibiotics, to ensure the infection is resolved; and use condoms for protection from reinfection A)nursing intervention for patients with urethritis B)nursing intervention for patients with herpes

CYSTITIS

____________inflammation of the wall of the urinary bladder, usually caused by urethrovesical reflux, introduction of a catheter or similar instrument, or contamination from feces. A)cystitis B)urethritis

The most common microorganism causing acute cystitis is A)E. coli. B)herpes simplex C)MRSA

Cystitis is most common in __________ because of the ease of entrance of pathogens through the short urethra, even during voiding. A)men B)young adult C)women

Conflicting data exist about the role of bubble baths, clothing, and hygiene in increasing the risk of cystitis in women. A)true B)false

True

Cystitis in men usually occurs secondary to another infection, such as A)prostatitis B)epididymitis C)both a and b

``` Signs and symptoms of cystitis would be. A)dysuria B)urinary frequency C)pyuria D)all the above ```

Assessment of cystitis

Collection of ____________ includes assessment of the lower abdomen, which may produce discomfort over the urinary bladder. Patient complaints include burning on urination, dysuria, frequency, urgency, and nocturia. A)subjective data of cystitis B)objective data of cystitis

Collection of _________ includes a clean-catch or catheterized urinalysis with culture and sensitivity to aid in confirming the diagnosis and in determining the appropriate treatment. A)subjective data of cystitis B)objective data of cystitis

What type of diagnostic test is used to find cystitis A)Microscopic inspection of the urine often reveals bacteria and hematuria. B)Diagnosis is confirmed by a clean-catch, midstream urinalysis that reveals a bacterial count greater than 100,000 organisms/ mL C)both a and b

short-term therapy with an anti infective agent.A repeat urinalysis 1 to 3 days after initiation of the medication confirms the effectiveness of the intervention A)medical management for patient with cystitis B)medical management for patient with herpes

Nursing Interventions and Patient Teaching for cystitis

Nursing interventions focus on teaching that these infections tend to recur by either reinfection or persistent infection.Encourage the patient to drink 2000 mL of fluid per day. Record accurate I&O. A)nursing intervention for patient with cystitis B)nursing intervention for patient with herpes

Clean catch urine you would have the patient void to collect a midstream A)true B)false

True

Prognosis

Successful treatment depends on the patient's ability to adequately flush the urinary tract and completion of the antibiotics prescribed. A)true B)false

True

Safety Alert! Cystitis

Teach the woman to cleanse the perineal area anteriorly to posteriorly to prevent contamination of pathogens (especially E. colt) from the rectum to the short urethra. A)true B)false

True

Encourage drinking 2000 ml of liquids per day unless contraindicated. • A)true B)false

True

Instruct the patient to take all the prescribed medications even though symptoms may subside quickly. A)true B)false

True

Instruct the patient about early detection and testing with Chemstrip LN. A)true B)false

True

INTERSTITIAL CYSTITIS

is a chronic pelvic pain disorder with recurring discomfort or pain in the urinary bladder and surrounding region. It mostly affects middle-age white women. A)interstitial cystitis B)UTI

The pathophysiology is unknown, but bacteria do not trigger it. A)UTI B)interstitial cystitis C)both a and b

it seems to be caused by a breech in the bladder's protective mucosal lining that allows urine to seep through to the bladder wall, resulting in pain, inflammation, and small vessel bleeding A)interstitial cystitis B)UTI C)renal tumor

If a patient has signs and symptoms of a UTI but no bacteriuria, pyuria, or positive urine culture, _________ is suspected A)interstitial cystitis B) renal tumor C)gonorrheal

Other disorders that produce signs and symptoms similar to those of IC (such as UTI or endometriosis) must be excluded A)true B)false

True

most patients are women with a median age of 40 years. A)have interstitial cystitis B)herpes simplex

``` Signs and symptoms of interstitial cystitis A)dysuria B)urinary frequency C)microscopic bleeding D)all the above ```

``` ______is characterized by urinary frequency, urgency, suprapubic pain, and dyspareunia (an abnormal pain during sexual intercourse); it is often associated with fibromyalgia and irritable bowel syndrome. A)renal tumor B)prostatits C)interstitial cystitis D)both b and c ```

Assessment of interstitial cystitis

_________ include complaints of discomfort over the urinary bladder, dysuria, frequency, urgency, and nocturia A)subjective data of IC B)objective data of IC

Collection of _____________ includes assessment of the lower abdomen, which may produce discomfort over the urinary bladder and the lower quadrants of the abdomen. A clean-catch midsh·eam sample for urinalysis is used to rule out infection. Cystoscopy and tissue biopsy are used to establish a differential diagnosis. A)subjective data of IC B)objective data of IC

IC, Medications are prescribed for pain relief and inflammation, including A)low-dose cyclosporine (Neoral, SandirnmLme) B)doxycycline (Vibramycin) C)pentosan polysulfate sodium (Elmiron) D)all the above

Amitriptyline (Elavil) and nortriptyline (Aventyl) are two antidepressants that reduce the burning pain and frequency of urination. A)true B)false

True

The only oral medication approved by the FDA to treat the pain or discomfort of IC is A)pentosan B)none

The only oral medication approved by the FDA to treat the pain or discomfort of IC is_____________. It improves the bladder's protective mucosal layer and relieves pain from IC by decreasing the irritative effects of urine on the bladder wall. A)pentosan B)none

It takes between 4 weeks to 3 months for significant improvement to occur (Page et al., 2005). For immediate relief, a brief course of opioid analgesics may be prescribed. A)true B)false

True

Nursing Interventions and Patient Teaching of IC

Pelvic floor exercise may help decrease urgency and nocturia. Patients may be asked to keep a daily bladder diary; this information can be used to make treatment decisions A)true for patient with IC B) true for patient with UTI

Potential dietary irritants include spicy and acidic floods, such as tomatoes, alcohol, citrus fruits, dark chocolate, and coffee. An elimination diet may help identify foods that trigger A)true for patient with IC B)true for patients with UTI

PROSTATITIS

_______defined as inflammation and/ or irLfection of the prostate gland, is actually a group of diseases. A)prostatits B)UTI

Bacterial prostatitis is caused by infectious organisms such as Pseudomonas organisms and S.faecalis traveling up the urethra. A)true B)false

True

Nonbacterial prostatitis may result from a variety of conditions related to occlusion of the urethra (e.g., enlargement of the prostate gland). A)true B)false

True

Prostatodynia (pain in the prostate gland) manifests with neither inflammation nor infection but demonstrates the other symptoms typical of prostatitis. A)true B)false

True

The patient may experience fever; chills; malaise; arthralgia; myalgia; perineal prostatic pain; dysuria; obstructive urinary tract symptoms, including frequency, urgency, dysuria, nocturia, hesitancy, weak stream, and incomplete voiding; low back pain; low abdominal pain; spontaneous urethral discharge; ejaculatory pain; and erectile dysfunction A)signs and symptoms of prostatits B)signs and symptoms of UTI

Chronic bacterial prostatitis may be asymptomatic. A)true B)false

True

Edema of the prostate gland may serve as an obstruction, causing urinary retention as a complication to the prostatitis. A)true B)false

True

acute bacterial prostatitis are often the same as those of UTI, with pain in the low back, perineum, or rectum. The condition may become chronic. A)true B)false

True

The expressed prostate secretion (EPS) is considered useful in the diagnosis of prostatitis. EPS is obtained using a premassage and postrnassage test. The patient is asked to void into a specimen cup just before and just after a vigorous prostate massage. A)diagnostic test for patient with prostatits B)diagnostic test for patient with UTI

``` Prostatic massage (for EPS) should be avoided if acute bacterial prostatitis is suspected, since compression is extremely painful and increases the risk of bacterial spread A)true B)false ```

True

Assessment of prostatits

________________ include complaints of chills and low back and perineal pain. Chronic bacterial prostatitis causes dysuria; urgency; frequency; nocturia; and pain in the lower abdomen or back, perineum, or genitalia. A)subjective data of prostatitis B)objective data of prostatitis

Collection of ________________ involves assessing for elevated temperature and rectal palpation of the prostate gland by the physician, which may reveal it to be firm, edematous, and tender. A)subjective data of prostatitis B)objective data of prostatitis

``` Antibiotics commonly used for acute and chronic bacterial prostatitis include A)trimethoprim-sulfamethoxazole B)ciprom-sfloxin (Cipro) C)ofloxacin (Floxin) D)all the above ```

Doxycycline or tetracycline may be prescribed for patients with multiple sex partners. Antibiotics are usually given orally for up to 4 weeks for acute bacterial prostatitis A)true B)false

True

Patients with chronic bacterial prostatitis are given oral antibiotic therapy for 4 to 16 weeks. A)true B)false

True

Antiinflammatories are the most common agents used for pain control in prostatitis, but these provide only moderate pain relief. Opioid analgesics can be given, but cautiously, since this pain can be chronic. A)true B)false

True

Nursing Interventions and Patient Teaching of prostatitis

comfort measures used are analgesics, sitz baths, and stool softeners to reduce pain, edema, spasm, and straining pressure in the pelvis. A)nursing intervention for patients with prostatitis B)nursing intervention for patients with UTI

Warn the patient with acute prostatitis to avoid sexual arousal and intercourse so the prostate can rest; however, intercourse may be beneficial in the treatment of chronic prostatitis. A)nursing interventions for patients with prostatitis B)nursing intervention for patients with UTI/cystitis

PYELONEPHRITIS

is an inflammation of the structures of the kidney-renal pelvis, renal tubules, and interstitial tissue A) Pyelonephritis B) prostatitis C)nephritis

Pyelonephritis is almost always caused by A)E. coli. B)herpes

The kidney becomes edematous and inflamed,The kidney becomes edematous and inflamed, and the blood vessels are congested. The urine may be cloudy and contain pus (pyuria), mucus, and blood. Small abscesses may form in the kidney. A)Pyelonephritis B)nephritis

_________is usually seen in association with pregnancy; chronic health problems, such as Diabetes mellitus or polycystic or hypertensive renal disease; insult to the urinary tract from catheterization; or infection, obstruction, or trauma A)Pyelonephritis B)PSA

``` Acute pyelonephritis may be unilateral or bilateral, causing select all that apply A)chills B)fever C)prostration D)flank pain ```

A B C D

Azotemia (the retention of excessive amounts of nitrogenous compounds in the blood) develops if enough nephrons are A)nonfunctional B)functional hyperactive

Azotemia (the retention of excessive amounts of nitrogenous compounds in the blood) develops if enough nephrons are nonfunctional. A)puyuria B)Azotemia C)toxicuria

Assessment of PYELONEPHRITIS

_____________ in acute pyelonephritis includes a patient who is acutely ill, with malaise and pain in the costovertebral angle (CVA) (one of two angles that outline a space over the kidneys). CVA tenderness to percussion is a common finding in pyelonephritis. In the chronic phase the patient may show unremarkable symptoms, such as nausea and general malaise. A)subjective data of pyelonephritis B)objective data of pyelonephritis

costovertebral angle (CVA) A)(one of two angles that outline a space over the kidneys). B)(two of five angles that outline a space over the kidneys).

CVA tenderness to percussion is a common finding in A)pyelonephritis. B)renal tumor C)both a and b

Collection of ______________ includes assessing the patient for signs of infection: elevated temperature, vomiting, and chills. The chronic disease results in systemic signs: elevated blood pressure and gastrointestinal irritation such as vomiting and diarrhea. A)subjective data of pyelonephritis B)objective data of pyelonephritis

______________ diagnostic is confirmed by bacteria and pus in the urine, varying degrees of hematuria, "WBCs and WBC casts in the urine (indicating involvement of the renal parenchyma), and leukocytosis. A)renal tumor B)pyelonephritis

To prevent spread of infection in the early stages of acute pyelonephritis, imaging examinations such as an IUP or CT scan requiring intrauterine injection of contrast materials are usually not performed. A)true B)false

True

Ultrasound of the urinary system is often done to identify anatomical abnormalities such as renal abscesses, obstructing calculus, or hydronephrosis. A)true B)false

True

The patient with mild signs and symptoms may be treated on an outpatient basis with antibiotics for 14 to 21 days. Parenteral antibiotics are often given initially in the hospital to establish high serum and urinary medication levels A)renal tumors B)pyelonephritis C)both and b

``` Adequate fluids (at least eight 8-ounce glasses per day) are encouraged. Urinary analgesics such as phenazopyridine are helpful. A)true for patients with pyelonephritis B)false, patient need to be on strict NPO by 12 hours ```

Nursing Interventions and Patient Teaching for pyelonephritis

Teach the patient to identify the signs and symptoms of infection: elevated temperature, flank pain, chills, fever, nausea and vomiting, urgency, fatigue, and general malaise A)nursing intervention of renal tumor B)nursing intervention for pyelonephritis

OBSTRUCTIVE DISORDERS OF THE URINARY TRACT

URINARY OBSTRUCTION

Causes of obstruction include strictures, kinks, cysts, tumors, calculi, and prostatic hypertrophy. Obstruction may lead to alterations in blood chemistry, infection that thrives as a result of urine stasis, ischemia due to compression, or atrophy of renal tissue. A)urinary obstructions B)kidney stone

The patient may be unaware of any problems at first if the obstruction is partial, allowing urine to drain and kidney function to remain within normal limits. A)urinary obstruction B)kidney stones

With prostatic hypertrophy the obstructive process may be so gradual that the patient ignores the vague symptom of dull flank pain and seeks medical attention only when urination becomes acutely difficult. A)true,urinary obstructions B)true ,PSA SIGN

Acute pain occurs as the musculature is stretched by increasing pressure from urine accumulation and as muscular contractions increase in an attempt to move urine past the obstruction. This acute pain is called renal colic and is a classic symptom of renal calculi A)true B)false

True

Assessment of urinary obstructions

_____________ include the patient's cardinal complaint of a sensation of needing to void but only being able to void small amounts. Pain may range from dull flank pain to acute, incapacitating pain. Nausea often accompanies acute pain? A)subjective data of urinary obstructions B)objective data of urinary obstructions

Collection of ___________ includes noting on physical assessment if the bladder is palpable suprapubically because of urine retention. The affected kidney may also be palpable. Retention with overflow occurs when the patient is unable to completely empty the urinary bladder and it quickly refills, causing the urge to void again. Assess time and amount of voiding. A)subjective data of urinary obstruction B)objective data of urinary obstruction

Diagnostic test of Renal ultrasonography or IVP provides definitive information about structural changes. A)urinary obstructions B)false, renal tumor

Conservative measures include inserting an indwelling catheter and administering an analgesic (usually opioid) and an anticholinergic agent (atropine) to decrease smooth muscle motility. It may be necessary to establish urine drainage surgically by inserting a catheter directly into the bladder through the abdominal wall (suprapubic cystostomy), into a ureter (ureterostomy), or into the kidney (nephrostomy).which would be best? A)true, for urinary obstructions B) true, for prostatitis C)both a and b

Stent insertion is used for patients who are poor operative risks. A meshlike tube or coil-shaped device is inserted through an endoscope into the ureter. The stent holds the tubular structure open to facilitate drainage. Stents may be permanent or temporary. Closely monitor the patient for signs of infection, obstruction, and pain. A)for patients with urinary infections B)for patients with urinary obstructions

Nursing Interventions for urinary obstructions

After surgery, observe the patient for hemorrhage, provide aseptic care of the surgical site, and provide a safe environment to prevent injury and infection. A) nursing intervention for urinary obstructions B)nursing intervention for infections of the urethra

HYDRONEPHROSIS

``` the dilation of the renal pelvis and calyces,may be congenital or may develop at any time A)urinary obstructions B)hydronephrosis C)kidney stones D)all the above ```

It can occur unilaterally or bilaterally. ___________ is caused by obstructions in the lower urinary tract, the ureters, or the kidneys. The location of the obstruction determines whether one or both kidneys are affected. A)urinary obstructions B)hydronephrosis C)kidney stones

``` An obstruction generates pressure from accumulated urine that cannot flow past it. Thls pressure may cause functional and anatomical damage to the renal system. The renal pelvis and ureters dilate and hypertrophy. This pressure, if prolonged, causes fibrosis and loss of function in affected nephrons. If the condition is left untreated, the kidney may be destroyed. A)urinary obstructions B)hydronephrosis C)kidney stones D)prostatitis ```

The amount of pain is proportional to the rate of stretching of urinary tract struch1res. Slowly developing hydronephrosis may cause only a dull flank pain, whereas a sudden occlusion of the ureter, such as from a caJculus, causes a severe stabbing (colicky) pain in the flank A)true B)false

True

Nausea and vomiting, which often accompany hydronephrosis, are a reflex reaction to the pain and usually subside when the pain is controlled. A)true B)false

True

_______________, which often accompany hydronephrosis, are a reflex reaction to the pain and usually subside when the pain is controlled. A)Nausea and vomiting B)hemorrhage C)both a and b

Assessment of hydronephrosis

___________ include patient reports of pain, including location, intensity, and character, and nausea. Discuss the patient's voiding pattern: frequency, difficulty starting a stream of urine, dribbling at the end of micturition (voiding), nochlria, and burning on urination. Note any history of obstructive disorders. A)subjective data of hydronephrosis B)objective data of hydronephrosis C)both a and b

Collection of _____________ includes assessing patients suspected of having hydronephrosis for vomiting, hemahuia, urinary output, edema, a palpable mass in the abdomen, bladder distention (detected on palpation), and tenderness over the kidneys or bladder. A)subjective data of hydronephrosis B)objective data of hydronephrosis C)both a and b

``` Diagnostic test used for A urinalysis and serum kidney function studies that include measurement of urea and creatinine are obtained for which of the following A)urinary obstructions B)hydronephrosis C)kidney stones D)prostatitis ```

``` Surgery relieves the obstruction and preserves kidney function. If the kidney is severely dam. aged, a nephrectomy may be necessary. A)urinary obstructions B)hydronephrosis C)kidney stones D)prostatitis ```

``` If infection is present, antiillfective medications are administered: penicillill in combination with sulfasoxazole (Gantrisin) or suJ£amethoxazole-trimethoprim (Bactrim). Opioids, such as morphille and meperidine, in combination with antispasmodic drugs, such as propantheline (Pro-Banthine) and belladonna preparations, are usually necessary to relieve severe, colicky pain. For which of the following? A)urinary obstructions B)kidney stones C)hydronephrosis D)prostatitis ```

Nursing Interventions and Patient Teaching for hydronephrosis

include administering medications as ordered, monitoringI&O, observing for signs and symptoms of infection, and monitoring vital signs. Encourage the patient to take fluids, and assess the patient for pain. Keep any drainage tubes open and anchored to avoid inadvertent displacement. If a catheter is present, provide catheter care A)nursing interventions for hydronephrosis B)nursing intervention for prostatits C)nursing intervention for kidney stones

Describe measures to prevent infection, such as adequate fluid intake, perineal hygiene daily with nilld soap and water (drying thoroughly), and regular emptying of the bladder. A)nursing interventions for hydronephrosis B)nursing intervention for prostatitis C)nursing intervention for kidney stones

UROLITHIASIS

____________ (formation of urinary calculi) can develop in any area of the urinary tract. A)

``` ________is a general term that encompasses all urinary calculi, but specific names are also used to indicate where they are located or formed: A)urinary obstructions B)hydronephrosis C)Urolithiasis D)prostatitis ```

nephrolithiasis (stones in the kidney), ureterolithiasis (stones in the ureter), and cystolithiasis (stones in the bladder). Other descriptive terms are lithiasis and calculi (the formation of stones) A)true B)false

True

``` develops from minerals that have precipitated out of solution and adhere, formmg stones that vary in size and shape. A)urinary obstructions B)hydronephrosis C)Urolithiasis D)prostatitis ```

``` predisposed to urolithiasis: A)people who are immobile, B)hyperparathyroid (calcium leaves the bones and accumulates in the bloodstream) C)have recurrent UTis D)all the above ```

``` Symptoms depend on the stones' size and degree of mobility. The patient with renal colic seeks care immediately, whereas a person with a less mobile stone may not seek assistance nntil signs of infection or hydronephrosis occur A)urinary obstructions B)hydronephrosis C)Urolithiasis D)prostatitis ```

Assessment of Urolithiasis

______________ include the patient with mobile calculi complaining of intractable pain (pain that is unrelieved by ordinary medical measures and is usually accompanied by nausea and vomiting). The patient describes the pain as starting in the flank and radiating into the groin, the genitalia, and the inner thigh. The patient with a less mobile stone may develop signs and symptoms associated with UTI secondary to hydronephrosis A)subjective data of Urolithiasis B)objective data of Urolithiasis C)both a and b

Collection of objective data includes assessing for hematuria and vomiting A)subjective data of Urolithiasis B)objective data of Urolithiasis C)both a and b

``` Diagnostic tests include KUB and IVP or IVU radiography, ultrasonnd, cystoscopy, and urinalysis. For which of the following A)urinary obstructions B)hydronephrosis C)Urolithiasis D)prostatitis ```

Twenty-four-hour urine hexamination may be done to detect abnormal excretion of calcium oxalate, phosphorus, or uric acid. A)true for Urolithiasis B)false for Urolithiasis

Antiinfective agents may be administered to treat infection or prophylactically. A)true for Urolithiasis B)false for Urolithiasis

Stones in the lower tract can be removed by cystoscopy with stone manipulation or by surgical incision. A) true for Urolithiasis B)false for Urolithiasis

Extracorporeal shock wave lithotripsy is an alternative to surgery. The patient is submerged in a special tank of water, and ultrasonic shock waves are used to pulverize the stone. A)true for Urolithiasis B)false for Urolithiasis

Long-term management may include dietary adjustments to alter urine pH or to decrease availability of certain substances that cause stone formation. A)true for Urolithiasis B)false for Urolithiasis

Moderate reduction of foods containing calcium phosphorus and purine may help when stones are caused by metabolic abnormalities. A)true for kidney stones B)false for kidney stones

Foods to avoid include cheese, greens, whole grains, carbonated beverages, nuts, chocolate, shellfish, and organ meat. A) true for kidney stones B)false for kidney stones

Daily fluid intake of 2000 mL (unless clinically contraindicated) helps cleanse the urinary tract A)true B)false

True

Nursing Interventions and Patient Teaching for kidney stones

Stones are more likely to be passed if the patient remains active and increases fluid intake. A)true nursing intervention B)false nursing intervention

If pain is so severe that it requires opioid medication, be cautious when allowing the patient out of bed. If nausea inhibits oral intake, the physician may order supplemental intravenous fluids. A)true for kidney stones B)false for kidney stones

Encourage fluids and administer analgesics as ordered. Assess urine for possible hematuria. Monitor BUN and creatinine for indications of continuing urinary tract obstruction. A) true for kidney stones B)false for kidney stones

The patient should avoid inactivity by walking frequently. A)nursing interventions for hydronephrosis B)nursing intervention for prostatitis C)nursing intervention for Urolithiasis

Encourage a fluid intake of at least 2000 mL in 24 hours, unless contraindicated. People who are calcium stone formers may need to curtail their intake of dietary calcium (dairy products, antacids) to within minimum recommended dietary allowance guidelines A)nursing interventions for hydronephrosis B)nursing intervention for prostatitis C)nursing intervention for Urolithiasis

New research on the impact of diet on the development of calcium oxalate kidney stones concludes that restricting consumption of animal protein and salt in combination with normal calcium intake reduces the risk of kidney stones better than the traditional low-calcium diet. A)nursing interventions for hydronephrosis B)nursing intervention for prostatitis C)nursing intervention for Urolithiasis

TUMORS OF THE URINARY SYSTEM

RENAL TUMORS

The majority of renal tumors are malignant adenocarcinomas, also known as renal cell carcinoma, that develop unilaterally and are often large when first detected. Renal cell carcinoma as a primary malignant tumor appears to arise from cells of the proximal convoluted tubules. A)true B)false

True

``` This is the tenth most common cancer, accounting for 3% of all cancers in adults, with a median age at diagnosis of 65 years. Twice as many men as women are diagnosed with renal cancer. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` some studies have suggested a relationship to obesity and smoking.strongest risk factors appear to be genetic A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` associated with a high risk of renal malignancies; the most prominent is von Hippei-Lindau disease, an autosomally dominant hereditary disease originating from chromosome 3p. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` von . Hippel-Lindau disease is characterized by central nervous system hemangioblastomas, renal adenocarcinomas, and other anomalies is associated with A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` sign and symptom triad of renal adenocarcinoma is A)hematuria B)flank pain C)flank mass D) all the above ```

``` Most cases with these symptoms are advanced and incurable. Other common signs and symptoms are hypercalcemia, fever, anemia, weakness, and erythrocytosis. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

most common sites of metastases are the lungs, the adrenal glands, the liver, and bones. A)true B)false

True

Check the patient's home medications for anticoagulant therapy, since this may be the cause of hematuria. A) true B)false

True

Assessment of renal tumors

___________ include a patient history of blood in the urine, which "comes and goes." When the bleeding occurs, there is usually no associated pain. In advanced stages of the illness, the patient experiences weight loss, fatigue, and dull flank pain. A)subjective data of renal tumors B)objective data of renal tumors C)both a and b

Collection of ___________ involves a physical assessment that reveals a mass in the patient's flank in the advanced stages of the illness. Hematuria and . signs related to systemic metastasis may be obvious. A)subjective data of renal tumors B)objective data of renal tumors C)both a and b

``` these tumors are often discovered incidentally during evaluation of other complaints. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` Diagnostic test for Patients with gross hematuria should be assessed by a urologist. A cystoscopy followed by an IVP with tomography should be performed. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

radiation therapy has little or no role in its treatment. A)true B)false

True

``` Surgery is the sole intervention capable of cure. The standard procedure is radical nephrectomy along with removal of adjacent lymph nodes and tissue A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

Nursing Interventions and Patient Teaching for renal tumors

Instruct the patient about community resources, support groups, and home health care. Emphasize the importance of follow-up care, including following discharge instructions and keeping return appointment. A)nursing interventions for renal cysts B)nursing intervention for renal tumor C)nursing intervention for tumor of the urinary bladder

RENAL CYSTS

``` Acquired cysts are usually simple: round and sharply demarcated with smooth walls. They may be single or multiple. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` Single cysts are isolated and are most often detected incidentally. They are clinically insignificant, but must be distinguished from other more significant cystic renal disorders and renal masses such as renal cell carcinoma A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` Renal cell carcinoma is typically irregular or multiloculated with irregular walls and areas of unclear demarcation. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

some physicians periodically screen patients with acquired cysts for renal carcinoma using ultrasonography or CT. A)true B)false

True

________ is a genetic disorder characterized by the growth of numerous fluid-filled cysts, which can slowly replace much of the kidney. A patient with longstanding renal insufficiency or a dialysis patient may develop polycystic disease. Kidney function is compromised by the pressure of the cysts on renal structures, secondary infections, and tissue scarring caused by rupture of the cysts. The patient may progress to end-stage renal disease (ESRD) A)PKD B)NKD

``` The most common site is the collecting ducts, which fill with urine and/or blood. As the disease progresses, fewer nephrons are available to maintain normal kidney function. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

Class I lesions are simple, benign cysts and do not warrant further workup. Class 2 lesions are minimally complicated with some features that cause concern. They have smooth, sharp margins; are thicker; and require follow-up scruming. Class 3 lesions have irregular and thickened walls and multiloculated cysts; they require surgical exploration. Class 4 lesions show nonuniform wall thickening and irregular margins; they contain solid components visible on CT A)The Bosniak Classification of Renal Cysts classifies lesions according to their character B)none of the above

Assessment of renal cysts

___________ include the most common symptoms of abdominal and flank pain, followed by headache, gastrointestinal complaints, voiding disturbances, and a history of recurrent UTis. A)subjective data of renal cysts B)objective data of renal cysts C)both a and b

Collection of _________ involves observation for systemic changes. Closely monitor blood pressure, which is usually elevated, and hematuria. Document patient complaints and response to intervention. A)subjective data of renal cysts B)objective data of renal cysts C)both a and b

``` Diagnosis is established by family history, physical examination, excretory urography, and imaging of cysts on radiographic examination or sonography. Blood chemistry results, such as urea and creatinine levels, are used to monitor the level of kidney function. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

Heat and analgesics may relieve some of the discomfort caused by the enlarging kidneys. If the patient bleeds, discontinue heat and place the patient on bed rest. A)true B)false

True

Hypertension is treated vigorously with antihypertensive agents, diuretics, and fluid and dietary modifications. A)true for renal cysts B)false for renal cysts

True

Because infections are common, antibiotics are often prescribed. A)true for renal cysts B)false for renal cysts

As the disease progresses, dialysis or kidney transplantation may be required A)true for renal cysts B)false for renal cysts

True

Nursing Interventions for renal cysts

Provide information to patients and family members about the availability of genetic counseling. Emphasize the need to report any changes in health status to the physician. A)nursing interventions for renal cysts B)nursing intervention for renal tumor C)nursing intervention for tumor of the urinary bladder

TUMORS OF THE URINARY BLADDER

The bladder is the most common site of cancer in the urinary tract. A bladder tumor is an excess growth of cells that line the inside of the bladder, in many cases because the cells were exposed to certain chemicals. A)true B)false

True

Most bladder cancer happens because the bladder was A)over worked B)exposed to chemicals C)none of the above

Papillomas have the potential to become cancerous and are removed when detected. A)true B)false

True

A noncancerous bladder tumor is usually a small, wartlike growth that does not spread. A)true B)fase

True

black patients were 35% more likely to die of bladder cancer than white patients. Men are more likely to develop bladder cancer than women; cigarette smoking is a major factor. A)true B)false

True

``` what type of patients were 35% more likely to die of bladder cancer than white patients. A)Asians B)Hispanics C) Indians D) blacks ```

Men are more likely to develop bladder cancer than women; cigarette smoking is a major factor A)true B)false

True

TCC involves development of a papillary tumor that projects into the bladder lumen and, if untreated, continues into the bladder muscle, where it can metastasize. A)transitional cell carcinoma B) cancer

``` The patient may delay seeking medical attention because the primary sign of bladder cancer is painless, intermittent hematuria. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

The patient may delay seeking medical attention because the primary sign of bladder cancer is A)painless, intermittent hematuria B)testicle pain

Assessment of urinary bladder cancer

__________ include symptoms such as changes in voiding patterns, signs of urinary obstruction, or renal failure, depending on the extent of the disease process. A)subjective data of tumor of the urinary bladder B)objective data of tumor of the urinary bladder C)both a and b

Collection of __________ includes assessing the patient's understanding of current health status, which will aid in planning teaching interventions. Accurately document the time and amount of voiding, including the urine description. A)subjective data of tumor of the urinary bladder B)objective data of tumor of the urinary bladder C)both a and b

``` Diagnostic tests include a urine cytologic evaluation (study of cells) and/ or one of several available bladder cancer markers. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

``` Local disease may be treated by removing the tissue by burning with an electric spark (fulguration), laser, instillation of chemotherapy agents, or radiation therapy. Closely monitor these patients with cytologic studies and cystoscopy, since the recurrence rate is as high as 60%. A partial or total cystectomy may be performed to remove invasive lesions. A)renal tumor B)renal cysts C)Urolithiasis D) tumor of the urinary bladder ```

With complete removal of the urinary bladder, urinary diversion is necessary. A)true B)false

True

Nursing Interventions and Patient Teaching tumor of the urinary bladder

Observe voiding patterns and urine characteristics to monitor response to these therapies. Provide teaching and support so that the patient can return to optimum performance of ADLs. Emphasize the importance of follow-up care for the patient with papillomas. A)nursing interventions for renal cysts B)nursing intervention for renal tumor C)nursing intervention for tumor of the urinary bladder

CONDITIONS AFFECTING THE PROSTATE GLAND

BENIGN PROSTATIC HYPERTROPHY

The prostate gland encircles the male urethra at the base of the urinary bladder. It secretes an alkaline fluid . that helps neutralize seminal fluid and increases sperm motility. A)true B)fase

True

``` is common in men older than 50 years of age. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` The prostate enlarges, exerting pressure on the urethra and vesicle neck of the urinary bladder, which prevents complete emptying. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` The patient has symptoms associated with urinary obstruction. Other clinical manifestations include complications of urinary obstruction, such as UTI, hematuria, oliguria, and signs of renal insufficiency. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Assessment for BENIGN PROSTATIC HYPERTROPHY

__________ include the patient describing the urine stream as difficult to start, slow, and painful, with complaints of frequency and nocturia. Collectively these symptoms may be referred to as prostatism (any condition of the prostate gland that causes retention of urine in the bladder) A)subjective data of BENIGN PROSTATIC HYPERTROPHY B)objective data of BENIGN PROSTATIC HYPERTROPHY C)both a and b

Collection of _________ involves eliciting information about voiding patterns to aid in determining the severity of the obstruction A)subjective data of BENIGN PROSTATIC HYPERTROPHY B)objective data of BENIGN PROSTATIC HYPERTROPHY C)both a and b

On rectal examination the physician may palpate the enlarged prostate gland, which has an elastic consistency. A)true B)false

True

``` Pharmacologic agents such as dutasteride (Avodart) convert testosterone to dihydrotestosterone, a key enzyme in the development and growth rate of prostatic hyperplasia. This medication may take 3 to 6 months to shrink the prostate gland, decreasing its size as much as 25% A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Terazosin (Hytrin) is an antil1ypertensive that dilates arteries and veins and decreases conh·actions in smooth muscle of the prostatic capsule. This decreases symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia). A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Transurethral microwave thermotherapy (TUMT) is one of various procedures used for the treatment of lower urinary tract symptoms due to BPH. A)true B)false

True

TUMT involves the insertion of a specially designed urinary catheter into the bladder, allowing a microwave antenna to be positioned within the prostate; there, it heats and destroys hyperplastic prostate tissue. The goal of TUMT is to provide a one-time treatment. A)Transurethral Microwave Thermotherapy B)Transurethral Needle Ablation (TUNA)

Candidates for TUMT include persons with moderate-to severe voiding symptoms due to BPH, those with side effects to medical therapy, those in whom medical therapy has failed, and those who choose to not be treated medically. A)Transurethral Microwave Thermotherapy B)Transurethral Needle Ablation (TUNA)

Posttreatment convalescence is relatively rapid, with most patients able to void and recover in less than 5 days at home. A)Transurethral Microwave Thermotherapy B)Transurethral Needle Ablation (TUNA)

Transurethral needle ablation (TUNA) of the prostate is anotl1er procedure used to treat BPH. It is performed . by placing interstitial radiofrequency needles ilirough the urethra and into the lateral lobes of tl1e prostate, causing heat-induced coagulation necrosis. The tissue is heated to 230° F (110° C) for approximately 3 minutes per lesion. A coagulation defect is created. A comprehensive history and physical examination must be done to determine the benefits of using this procedure. Urethrocystoscopy may be indicated to help select the optimal form of therapy. A)Transurethral Needle Ablation (TUNA) B)Photoselective Vaporization of the Prostate

Photoselective vaporization of the prostate (PVP) using the GreenLight laser is another option for the treatment of BPH. PVP is a safe alternative for patients who are seriously ill, are taking anticoagulants, or have unfavorable anatomy (i.e., a large prostate). A)Photoselective Vaporization of the Prostate B)Transurethral Needle Ablation (TUNA)

The technique employs a laser beam, which emits a visible green light at a wavelength that has shallow tissue penetration and is selectively absorbed by blood. A urologist delivers the laser's energy by way of a thin fiber inserted into the urethra through a 23-F continuous-flow cystoscopy. The GreenLight laser vaporizes the prostate tissue. A)Photoselective Vaporization of the Prostate B)Transurethral Needle Ablation (TUNA)

Nursing Interventions BENIGN PROSTATIC HYPERTROPHY

Take care to avoid rapid decompression of the bladder to prevent rupture of mucosal blood vessels. Usually no more than 1000 mL of urine should be removed from a distended bladder initially. Follow physician's orders . for the individual patient. A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Prostatectomy (removal of the prostate gland) is indicated to relieve or prevent further obstruction of the urethra. A)true B)false

True

Preoperatively the physician may order an enema to reduce the possibility of the patient's straining to defecate after surgery, which could cause bleeding. A)Prostatectomy B)false

The patient who has a TURP may have continuous closed bladder irrigation or intermittent irrigation to prevent occlusion of the catheter with blood clots, which would cause bladder spasms. Inform the patient and the family that hematuria is expected after prostatic surgery. Monitor vital signs and urine color every 2 hours for the first 24 hours to detect early signs of complications. With continuous bladder irrigation the urine will be light red to pink, and with intermittent irrigation the urine will be a clear, cherry red. A)true B)false

. With continuous bladder irrigation the urine will be A)light red to pink B)clear, cherry red

with intermittent irrigation the urine will be a A)clear, cherry red B) light red to pink

Continuous irrigation is achieved with a three-way catheter (one lumen for irrigation fluid, one for urine drainage, and one to the retention balloon) or by using two catheters (Foley and suprapubic-one for irrigation fluid and one for urine drainage). The irrigant is an isotonic solution. A)true B)false

True

To determine urinary output, subtract the amount of irrigation fluid used from the Foley catheter output. This is reported as "actual urinary output." Check catheter drainage tubes frequently for kinks that would occlude urine flow and cause bladder spasms. Advise the patient not to try to void around the catheter because this will contribute to bladder spasms. A)true B)false

True

Belladonna and opium rectal suppositories are helpful to relieve bladder spasms but are not used in the retropubic approach because rectal stimulation is contraindicated. A)true B) false

True

Have the patient avoid prolonged sitting because the increased intraabdominal pressure may cause the operative site to bleed. A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Inform the patient that initially he may experience frequency, voiding small amounts with some dribbling. Instruct him to void with the first urge to prevent increased bladder pressure against the operative site. A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Four Prostatectomy Techniques

``` ____________ is done by approaching the gland through the penis and bladder using a resectoscope, a surgical instrument with an electric cutting wire for resection and cautery to resect the lobes away from the capsule (see Figure 1 0-8, A). A)Transurethral prostatectomy B)Radical perineal prostatectomy C)Suprapubic prostatectomy D)Retropubic prostatectom ```

``` ____________ is accomplished by an incision through the abdomen; the bladder is opened, and the gland is removed from above with the finger. A)Transurethral prostatectomy B)Radical perineal prostatectomy C)Suprapubic prostatectomy D)Retropubic prostatectom ```

``` _________________ requires an incision through the perineum between the scrotum and the rectum (see Figure 1 0-8, C). 4. Retropubic prostatectomy requires a low abdominal incision, but the bladder is not opened. The gland is removed by making an incision into the capsule encasing the prostate gland. A)Transurethral prostatectomy B)Radical perineal prostatectomy C)Suprapubic prostatectomy D)Retropubic prostatectomy ```

``` ______________ requires a low abdominal incision, but the bladder is not opened. The gland is removed by making an incision into the capsule encasing the prostate gland A)Transurethral prostatectomy B)Radical perineal prostatectomy C)Suprapubic prostatectomy D)Retropubic prostatectom ```

CANCER OF THE PROSTATE

Prostatic cancer is common in men older than 50 years of age. A)true B)false

True

``` usually starts as a nodule on the posterior portion of the prostate without noticeable symptoms. When the tumor causes urinary symptoms, the cancer is in advanced stages. At this point, metastasis is common; frequent sites are the pelvic lymph nodes and bone A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Assessment CANCER OF THE PROSTATE

The patient may seek medical intervention for BPH, which often accompanies prostate cancer, or when he experiences back pain or sciatica from metastatic changes in the bony pelvis. The patient may complain of dysuria, frequency, and nocturia. A)subjective data of CANCER OF THE PROSTATE B)objective data of CANCER OF THE PROSTATE C)both a and b

___________ include metastatic dtanges in the lymph glands of the pelvis and in the bones of the lower spine, the pelvis, and the hips with associated signs. Hematuria may or may not be present, depending on the stage of the malignancy. A)subjective data of CANCER OF THE PROSTATE B)objective data of CANCER OF THE PROSTATE C)both a and b

``` On rectal examination by the physician, the involved area of the prostate gland feels firm and fixed with hardened nodules typically in the posterior lobe of the gland. Diagnostic test. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Men should consider a yearly PSA and digital rectal examination starting at age 50 or at age 45 if at high risk (blacks or men with a father or brother diagnosed with prostate cancer at an early age). PSA is greatly increasing the odds of early diagnosis. A)true B)false

True

The normal PSA is 0 to 4 ng/ mL A)true B)false

True

Grade 1 represents the most well differentiated (most like the original cells), and grade 5 represents the most poorly differentiated (undifferentiated) A)Gleason Grading System B)false

Gleason grades are given to the two most commonly occurring patterns of cells and added together. The Gleason score, a number from 2 to 10, is used to predict how quickly the cancer will progress. A)true B)false

True

Localized prostate cancer can be cured by radiation therapy or surgery A)true B)false

True

``` A treatment in which radioactive seed implants are placed directly in the prostate gland while sparing the surrounding tissue (rectum and bladder) is called A)seed therapy B)brachytherapy C)tachytherapy D)all the above ```

_____________ by the perineal approach is used in patients with early-stage clinical disease and is considered one of the most effective ways of eradicating the tumor. This procedure involves removing the entire prostate, including the true prostatic capsule, seminal vesicles, and a portion of the bladder neck. The remaining portion of the bladder neck is reanastomosed to the urethra. A)Radical prostatectomy B)prostatstomy

``` The three goals of a radical prostatectomy are A)removing all the tumor B)preserving urine control C)preserving sexual function D)all the above ```

Extent of sexual function may not be known for 6 to 12 months postoperatively Of a A)radical prostatectomy B)false, only 2weeks

In cases of advanced prostatic cancer, hormonal deprivation therapy may be used in an attempt to alter the tumor growth by blocking androgen (testosterone) production. Hormone deprivation therapy includes estrogens, gonadotropin-releasing hormone analogs, and an-rtiandrogens. A)true B)false

True

``` Hormone deprivation therapy includes what for a prostatic cancer A)estrogens B)gonadotropin-releasing hormone analogs C) antiandrogens D)all the above ```

Nursing Interventions and Patient Teaching for CANCER OF THE PROSTATE

Postoperative nursing management is similar to that for perineal surgery, with special attention to maintenance of bowel and bladder function while keeping the surgical wound clean and avoiding pressure on the perineum and wound. A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Adequate fluid intake, modification of dietary selections, and perineal exercises may be used to promote regulation of bowel and bladder function. Take extreme care to prevent trauma to the perineum, which could lead to fistuJa formation A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Rectal temperature-taking, enemas, and use of rectal tubes are therefore forbidden. Also take care not to place tension on the Foley catheter, which would disturb the surgical area. A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Observe the color of the urine for signs of bleeding. The patient will also have a tissue drain inserted during surgery to promote drainage from the wound in the perineum. Initially there may be a small amount of urine from the drain, but this should cease in 1 or 2 days. A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Follow surgical asepsis during dressing changes. Irrigation of the perineum may be ordered to cleanse the wound and soothe the patient. Administer comfort measures and analgesics as ordered for pain control in the lower back, pelvis, upper thighs, and operative site. A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Emphasize the need for adequate fluid intake, exercise, and rest. Instruct the patient in pain-relieving measures (e.g., exercise, warmth, and medication). A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Patient Teaching | Postprostatectomy

• Rest for 48 hours to help prevent postoperative bleeding. • Do not take aspirin or anticoagulant medications. • Do not drive for 48 hours. • Avoid sexual activity for 2 weeks, or as directed by physician. • If prescribed antibiotics, take medication as prescribed until all are gone. A)patient teaching for nephrotectomy B)patient teaching for prostatectomy

• Prevent constipation. • Observe for signs and symptoms of urinary tract infection. • A list of contact numbers. • An appointment card for follow-up visit. A)patient teaching for prostatectomy B)patient teaching for nephroectmy

Managing Urinary Incontinence • It usually takes several weeks to achieve urinary continence. Continence may improve for up to 12 months. • Maintain oral fluids between 2000 and 3000 mUday (unless contraindicated). A)patient teaching for prostatectomy B)patient teaching for nephroectmy

Erectile Dysfunction • Sexual counseling and treatment options may be necessary if erectile dysfunction becomes a chronic or permanent problem. A)patient teaching for prostatectomy B)patient teaching for nephroectmy

Indwelling Catheter • If the patient goes home with an indwelling catheter, send instructions for the catheter care and local stores where the supplies can be purchased A)patient teaching for prostatectomy B)patient teaching for nephroectmy

URETHRAL STRICTURES

``` is a narrowing of the lumen of the urethra that interferes with urine flow. Narrowing may be congenital or acquired. Acquired strictures may be caused by chronic infection, trauma, or tumor or occur as a complication of radiation treatment of the pelvis A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Signs and symptoms include dysuria, weak stream, splaying (spreading out) of the urine stream, nocturia, and increasing pain with bladder distention. In the presence of infection, fever and malaise may be apparent. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Assessment URETHRAL STRICTURES

____________ include patient complaints of difficulty initiating the urine stream and the stream seeming to splay more than usual or even seeming to "fork." A)subjective data of URETHRAL STRICTURES B)objective data of URETHRAL STRICTURES C)both a and b

Collection of __________ includes assessing for signs that may indicate an infectious process and for information indicating the extent of the stricture and possible presence of an obstruction. A)subjective data of URETHRAL STRICTURES B)objective data of URETHRAL STRICTURES C)both a and b

``` Diagnosis can be confirmed by a voiding cystourethrogram, which demonstrates stricture. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Correction of the stricture may be achieved by dilation with metal sounds or surgical release (internal urethrotomy) A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Nursing Interventions URETHRAL STRICTURES

Care includes adequate hydration to decrease discomfort when voiding and monitoring urinary output. Mild analgesics should relieve discomfort. . A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

Sitz baths may encourage voiding. Reconstruction of the urethra (urethroplasty) may require temporary urinary diversion. After the procedure a splinting catheter supports the suture line. Take care not to place tension on the catheter A)nursing interventions for BENIGN PROSTATIC HYPERTROPHY B)nursing intervention for CANCER OF THE PROSTATE C)nursing intervention for URETHRAL STRICTURES D)nursing intervention for URINARY TRACT TRAUMA

URINARY TRACT TRAUMA

``` Such injuries may include contusions or rupture of the urinary structures. Also observe a patient who has undergone abdominal surgery for incidental injury sustained during the operation. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Traumatic invasion of the urinary tract may be evident in open wounds to the lower abdomen, such as gunshot or stab wounds. Trauma to the bladder can occur from a fractured pelvis. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Contusion or laceration of the urethra may lead to urethral stricture and possible impotence in men secondary to soft tissue, blood vessel, and nerve damage. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Monitor urinary output hourly for amount and color. Report any evidence of hematuria. Assess the patient for abdominal pain and tenderness, which may indicate internal hemorrhage, peritonitis, or seepage of urine into the tissues. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Assessment of URINARY TRACT TRAUMA

Collection of __________ involves understanding that the trauma patient may be unable to relate any symptoms that would aid in the assessment of urinary tract involvement. If the patient is able to respond, asking about signs of hematuria is extremely important. A)subjective data of URINARY TRACT TRAUMA B)objective data of URINARY TRACT TRAUMA C)both a and b

Collection of __________ includes a comprehensive assessment of the trauma patient, reviewing all body systems. Assessment related to the urinary tract includes hourly measurement of I&O; observation of urine character or difficulty voiding; evaluation of complaints of abdominal, flank, or referred shoulder pain; and evaluation of abdominal distention and girth. A)subjective data of URINARY TRACT TRAUMA B)objective data of URINARY TRACT TRAUMA C)both a and b

``` Diagnosis of traumatic involvement of the urinary tract may be aided by KUB radiograph, fVP, urinalysis, excretory urogram, and cystoscopy. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Surgical intervention is necessary for correction of tears or rupture of the urinary tract to reinstate urine flow. If damage is severe, removal of the kidney or the bladder may be necessary with the creation of urinary diversion,. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

``` Management of possible hemorrhage and prevention of infection are necessary both before and after surgery. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

Nursing Interventions URINARY TRACT TRAUMA

``` Nursing responsibility centers on identifying individuals at risk and detecting variations in assessment findings that indicate trauma to the urinary tract. Document and report all findings. A)BENIGN PROSTATIC HYPERTROPHY B)CANCER OF THE PROSTATE C)URETHRAL STRICTURES D) URINARY TRACT TRAUMA ```

IMMUNOLOGIC DISORDERS OF THE KIDNEY

``` Nephrotic syndrome (nephrosis) is characterized by marked proteinuria, hypoalbuminemia, and edema. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` the primary form of nephrosis occurs in the absence of glomerulonephritis or systemic disease, with the inciting event being an upper respiratory tract infection or allergic reaction A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` is characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and edema. The most common sign is excess fluid in the body. This may take several forms: edema around the eyes, characteristically in the morning; pitting edema over the legs; fluid in the pleural cavity (pleural effusion); or fluid in the peritoneal cavity (ascites). A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` the glomeruli become damaged due to inflan1mation, so that small proteins, such as albumins, immunoglobulins, and antithrombin, can pass through the kidneys into urine. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Blood protein is allowed to pass into the urine (proteinuria), causing a loss of serum protein (hypoalbuminemia). This decreases serum osmotic pressure, thus allowing fluid to seep into interstitial spaces, and edema occurs. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Immune responses, both humoral and cellular, are altered in nephrotic syndrome; as a result, infection is an important cause of morbidity and mortality. A)true B)false

True

``` The patient has severe generalized edema (anasarca), anorexia, fatigue, and altered kidney function. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Assessment of NEPHROTIC SYNDROME

_______ include patient complaints of loss of interest in eating, constant fatigue, foamy urine from the presence of protein, and decreased urinary output (oliguria), less than 500 mL in 24 hours. A)subjective data of NEPHROTIC SYNDROME B)objective data of NEPHROTIC SYNDROME C)both a and b

Collection of ___________ includes assessing the degree of fluid retention by monitoring daily weight, I&O, respiratory effort, and level of consciousness. The patient may relate problems with "swelling" of the face, hands, and feet. Assess skin integrity to determine special needs. A)subjective data of NEPHROTIC SYNDROME B)objective data of NEPHROTIC SYNDROME C)both a and b

``` Blood chemistry findings include hypoalbuminemia and hyperlipidemia. Renal biopsy provides identification of the type and extent of tissue change. Diagnostics test A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` may include the use of corticosteroids (prednisone); antineoplastic agents for immunosuppressive effect; loop diuretics; and a low-sodium, high-protein diet for therapeutic management of edema. Hypoproteinemia may be treated with normal serum albumin and protein-rich nutrition replacement therapy. Medical management of A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Nursing Interventions and Patient Teaching NEPHROTIC SYNDROME

include monitoring fluid balance (weight, measurement of abdominal girth, I&0), maintaining bed rest in the presence of extreme edema (recumbent position may initiate diuresis), and assessing for electrolyte imbalance. Skin care is important, as is a gradual increase in activity as the edema is resolved. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Blood pressure is often elevated and should be monitored closely for changes. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Diet includes protein replacement using foods that provide high biologic value (meat, fish, poultry, cheese, eggs) and restriction of sodium to decrease edema. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

As the patient begins to convalesce, the teaching plan includes the medication regimen (type, dosage, side effects, and need to finish all prescriptions), nutrition (high protein, low sodium), self-assessment of fluid status (monitor weight, presence of edema), signs and symptoms indicating need for medical attention (increase in edema, fatigue, headache, infection), and the need for follow-up care. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

nutrition (high protein, low sodium), A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

NEPHRITIS

characterized by inflammation of the kidney-involving the glomeruli, tubules, or interstitial tissue-and abnormal function. Included in this group of disorders is acute and chronic glomerulonephritis. A)nephritis B)cancer

Acute Glomerulonephritis

``` The health history commonly reveals that the onset of acute glomerulonephritis was preceded by an infection, such as a sore throat or skin infection (most commonly [3-hemolytic streptococci) 2 to 3 weeks earlier, -or other preexisting multisystem diseases, such as systemic lupus erythematosus. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` was preceded by an infection, such as a sore throat or skin infection (most commonly [3-hemolytic streptococci) 2 to 3 weeks earlier, -or other preexisting multisystem diseases, such as systemic lupus erythematosus A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` This condition is common in cllildren and young adults A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Often family members first note that the individual has "swelling" of the face, especially around the eyes. Some patients may be acutely iJJ with a multitude of symptoms, whereas others may be diagnosed on routine examination with only vague symptoms. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Assessment of Acute Glomerulonephritis

``` _________ include symptoms indicative of anorexia, nocturia, malaise, and exertional dyspnea. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Collection of __________ includes assessment of skin integrity and general condition of skin; the presence and degree of edema with associated difficulty in breathing on exertion, when recumbent, or as evidenced by changes in lung and heart sounds (unusual heart sounds, crackles over lung fields, distention of neck veins); hematuria with changes in urine color from "cola" to frank sanguineous; or changes in voiding, decrease in amount of urinary output, or dysuria A)subjective data of Acute Glomerulonephritis B)objective data of Acute Glomerulonephritis C)both a and b

``` Diagnostic tests reveal elevation of BUN, serum creatinine, potassium, erythrocyte sedimentation rate, and antistreptolysin-0 titer. Urinalysis shows red blood red cells, casts, and/ or protein. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` includes treatment of primary symptoms while preventing complications to cerebral and cardiac function. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Serum electrolyte levels (sodium and potassium) may indicate a need to adjust dietary intake of sodium and potassium. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Level of consciousness should be monitored when the BUN is elevated. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Bed rest and fluid intake adjustments are guided by urinary output until diuresis is adequate A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` A prophylactic antimicrobial agent, such as penicillin, may be administered for several months after the acute phase of the illness to protect against recurrence of infection. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Diuretics may be prescribed to control fluid retention and antihypertensives to reduce blood pressure. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Nursing Interventions and Patient Teaching Acute Glomerulonephritis

Dietary intake includes protein restrictions (to decrease blood urea levels), with carbohydrates providing a source of energy. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Monitor I&0 and vital signs. Determine the level of activity based on the degree of edema, hypertension, proteinuria, and hematuria, since excessive activity may increase these signs A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Proteinuria and hematuria may exist microscopically even when other symptoms subside. Although fatigue may be present, these patients usually feel well; therefore they often must be convinced of the need to continue prescribed treatment and to return for follow-up care. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Teach about prescribed sodium and fluid restrictions (provide written information regarding sodium content of foods, as necessary). Include information about protein restrictions and carbohydrate sources. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Stress the need to pace activities with rest if fatigue is present; to avoid trauma and infection (which may exacerbate the illness); and to obtain follow-up health care. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Health Promotion | The Patient with Nephritis

Activity • Keep patient on bed rest until edema and blood pressure are reduced. • Encourage quiet diversional activities. • Ambulate gradually with assistance. • Space activity to lessen fatigue. A)true B)false

True

``` Fluid Balance Maintenance • Implement dietary restrictions. • Monitor intake and output. • Document reactions to medication. A)true B)false ```

True

Diet Therapy • Restrict protein to decrease nitrogenous wastes. • Restrict sodium to prevent further fluid retention. • Increase calories for energy source. A)true B)false

True

``` Drug Therapy • Prophylactic antibiotics • Antihypertensives • Diuretics • Drug interactions, side effects to expect and report A)true B)false ```

True

Health Maintenance • Recovery may be extended. • Physician will monitor urine for albumin and red blood cells (RBCs). • Teach early signs of fluid retention. • Signs and symptoms may resolve and then become worse. • Normal activities may be resumed after urine is free of albumin and RBCs for 1 month, although the patient is not considered cured until the urine is free of albumin and RBCs for 6 months. • Report hematuria, headache, edema. A)true B)false

True

Chronic Glomerulonephritis

``` Because other chronic illnesses (e.g., di.abetes mellitus or systemic lupus erythematosus) may mask the symptoms of renal degeneration, many patients do not seek medical attention until kidney function is compromised. Chronic glomerulonephritis is characterized by slow, progressive destruction of glomeruli with related loss of function. The kidneys . atrophy (actually decrease in size). A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Signs and symptoms may include malaise, morning headaches, dyspnea with exertion, visual and digestive disturbances, edema, and fatigue. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Physical findings include hypertension, anemia, proteinuria, anasarca, and cardiac and cerebral manifestations. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Assessment of chronic Glomerulonephritis

__________ include patient complaints of fatigue and a decreased ability to perform ADLs as a result of dyspnea and decreasing ability to concentrate. Investigate complaints of morning headaches (their location, pattern, and character), and note the presence of any visual disturbance. A)subjective data of chronic Glomerulonephritis B)objective data of chronic Glomerulonephritis C)both a and b

Collection of ___________ includes clarifying outward manifestations of the headache and respiratory effort that may interfere with daily task performance. Assess mental functioning, irritability, slurred speech, ataxia, or tremors. Carefully assess and document the degree of edema, noting specific location and response to pressure by pressing the fingers into the edematous area and observing for pitting (see Figure 8-17). Note skin color, ecchymoses (irregularly formed hemorrhagic areas of the skin) or rash, dry skin, and scratching. Observe urine color and amount. Monitor vital signs, including a chest assessment for cardiac and pulmonary signs of fluid retention: unusual heart sounds, crackles over lung fields, and distention of neck veins. A)subjective data of chronic Glomerulonephritis B)objective data of chronic Glomerulonephritis C)both a and b

``` Early disease shows albumin and red blood cells in the urine, although kidney function test results are within normal limits. With advanced destruction of nephrons, the specific gravity becomes fixed and blood levels of NPN wastes (creatinine and urea) increase. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Creatinine . clearance normal range of A)107 to 139 mL/min in men B)87 to 107 mL/ min in women. C)both a and b

``` Early disease shows albumin and red blood cells in the urine, although kidney function test results are within normal limits. With advanced destruction of nephrons, the specific gravity becomes fixed and blood levels of wastes. NPN wastes (creatinine and urea) increase. Creatinine . clearance may be as low as 5 to 10 mL/ min, compared with the normal range of 107 to 139 mL/min in men and 87 to 107 mL/ min in women A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Meclical management includes control of secondary side effects as discussed with acute glomerulonephritis, with the use of renal dialysis and possible kidney transplantation to provide elimination of wastes from the body. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Nursing Interventions and Patient Teaching for chronic Glomerulonephritis

Monitor changes in vital signs and cliagnostic tests to aid in choosing proper nursing interventions. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Chronic glomerulonephritis may progress to ESRD A)true B)false

True

Assess the patient's understanding of therapeutic inte.rventions. Note I&O every hour (or more often). Monitor signs and symptoms of fluid excess: weight gain, hypertension, edema, dyspnea. Provide ice chips for thirst with prescribed diet. Monitor and report abnormal laboratory results A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Assess level of activity tolerance. Encourage patient to report activities that increase his or her fatigue. Plan activities to minimize fatigue. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

emphasizing a health-promoting lifestyle, -with prevention and early treatment of infections. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

RENAL FAILURE

is characterized by the kidneys' inability to remove wastes, concentrate urine, and conserve or eliminate electrolytes. Diabetes mellitus is the most common cause of renal failure, accounting for more than 40% of new cases. Other predisposing concurrent illnesses include burns, trauma, heart failure, volume depletion, and renal disease. A)renal failure B)chronic failure

Diabetes mellitus is the most common cause of renal failure, accounting for more than 40% of new cases. Other predisposing concurrent illnesses include burns, trauma, heart failure, volume depletion, and renal disease. A)true B)false

Yrue

Nmsing interventions to prevent the development of renal failure include A)providing adequate hydration, preventing infections B) monitoring for signs and symptoms of shock C)teaching drug side effects to report immediately D)all the above

ACUTE RENAL FAILURE

``` ARF can be caused by a number of meclical conditions, such as hemorrhage, trauma, infection, and decreased cardiac output. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` In the oliguric phase, BUN and serum creatinine levels rise while urinary output decreases to less than 20 mL/hr (less than 400 mL/24 hr). The oliguric phase may last from several days to 4 weeks to several month A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Some patients may experience the nonoliguric form, usually caused by nephrotoxic antibiotics, in which urinary output may exceed 2 L/ 24 hr. In the diuretic phase, r. blood chemistry levels begin to return to normal and urinary output increases to 1 to 2 L/24 hr. The diuretic phase usually lasts 1 to 3 weeks. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Return to normal or near-normal function occurs in the recovery phase. Recovery begins as the glomerular filtration rate rises. Recovery can take up to 1 year A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` The patient may experience anorexia, nausea, vomiting, edema, and associated signs and symptoms of diminished kidney function. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Assessment of ARF

_____________ include patient reports of lethargy, loss of appetite, nausea, and headache A)subjective data of ACUTE RENAL FAILURE B)objective data of ACUTE RENAL FAILURE C)both a and b

_____________ involve physical findings of progression of the clisease process. Assess for dry mucous membranes, poor skin turgor, urinary output of less than 400 mL/ 24 hr, vomiting, diarrhea, and anasarca. Assessment findings may include central nervous system manifestations of drowsiness, muscle twitching, and seizures A)subjective data of ACUTE RENAL FAILURE B)objective data of ACUTE RENAL FAILURE C)both a and b

``` Physical assessment, history, and elevated blood chemistry tests such as BUN and creatinine (azotemia) confirm the diagnosis. After the patient is stabilized, further studies may be done to assess for residual damage.diagnostic test. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Measures include administration of fluids and osmotic preparations to prevent decreased renal perfusion, manage fluid volume, and treat electrolyte imbalances. Medical management A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Diet should be protein sparing, high in carbohydrates, and low in potassium and sodium. A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Drug therapy may include diuretics to increase urinary output (e.g., furosemide, hydrochlorothiazide [HydroDTURIL]). A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

``` Potassium-lowering agents are used to remove potassium through the gastrointestinal tract; sodium polystyrene sulfonate (Kayexalate) is administered orally, per nasogastric tube, or as a retention enema. Antibiotics that are not dependent on kidney excretion are used to eradicate or prevent infection A)NEPHROTIC SYNDROME B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE ```

Nursing Interventions and Patient Teaching of ARF

Accurately document urinary output to identify the level of kidney function. Azotemia may be revealed by blood chemistry studies. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Observe the patient with azotemia for changes in level of consciousness. . A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Closely monitor fluid status, vital signs, and response to therapies. Frequent skin care with tepid water to remove urea crystals will be comforting. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Provide nutritional support with specialized enteral formulas, which may contain essential amino acids and minerals, in addition to replacement of electrolytes (especially sodium to match insensible loss) and provision of caloric needs. Make a nutritional assessment with appropriate modifications daily. A)nursing interventions for NEPHROTIC SYNDROME B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Prognosis of ARF A)The leading cause of death is infection, such as that of the urinary tract, Lungs, and peritoneum. Mortality from fluid overload and acidosis has been reduced as a result of dialysis and other forms of therapy. B)false statement from A

CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE)

Chronic renal failure, or ESRD, exists when the kidneys are unable to regain normal function. ESRD develops slowly over an extended period as a result of renal disease or other disease processes that compromise renal blood perfusion. As much as 80% of nephrons may be severely impaired before loss of kidney function is detected. The most common causes of ESRD are pyelonephritis, chronic glomerulonephritis, glomerulosclerosis, chronic urinary obstruction, severe hypertension, diabetes mellitus, gout, and PKD. A)CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE

As much as 80% of nephrons may be severely impaired before loss of kidney function is detected. The most common causes of ESRD are pyelonephritis, chronic glomerulonephritis, glomerulosclerosis, chronic urinary obstruction, severe hypertension, diabetes mellitus, gout, and PKD. A)CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE

Whatever the cause, dialysis or kidney transplantation is needed to maintain life. A)CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)Acute Glomerulonephritis C)Nephritis D) ACUTE RENAL FAILURE

Common symptoms are headache; lethargy; asthenia (decreased strength or energy); anorexia; pruritus; elimination changes; anuria (urinary output of less than 100 mL/ day); muscle cramps or twitching; impotence; characteristic dusky yellow-tan or gray skin color from retained urochrome pigments; and signs and symptoms characteristic of central nervous system involvement, such as disorientation and mental lapses A)CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE

Azotemia develops as excessive amounts of nitrogenous compounds build in the blood. A)CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE

Anemia occurs when the production of renal erythropoietin is decreased as a result of loss of kidney function. Acidosis, hypertension, and glucose intolerance may be present as a result of the insult to homeostasis. A)CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE

Assessment of CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE)

_________ include patient complaints of joint pain and edema; severe headaches; nausea; anorexia; intermittent chest pain; weakness; and in particular, fatigue, intractable singultus (hiccups), decreased libido, menstrual irregularities, and impaired concentration. The clinical consequences of renal failure are far reaching, affecting nearly every body system. A)subjective data of CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)objective data of CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) C)both a and b

Collection of ____________ involves a nursing assessment that may yield unremarkable results, except for signs and symptoms that support the patient complaints. Uremic encephalopathy affects the central nervous system. Usually the first sign is a reduction in alertness and awareness. The patient exhibits Kussmaul's respirations (abnormally deep, very rapid sighing respirations), and coma develops. The accumulation of urates results in halitosis with a urine odor and "uremic frost" on the skin in the form of a white powder. A)subjective data of CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)objective data of CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) C)both a and b

Diagnosis of ESRD is confirmed by elevated BUN of at least 5O mg/ dL and serum creatinine levels greater than 5 mg/ dL, electrolyte imbalance (including a decreased number of bicarbonate and magnesium and an increased number of potassium, sodium, and phosphatase ions), and other indicators related to the Underlying cause.diagnostic test A)CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)Acute Glomerulonephritis C)chronic Glomerulonephritis D) ACUTE RENAL FAILURE

Drug therapy may include chronic renal failure ESRD A)anticonvulsants to control seizure activity (phenytoin [Dilantin], diazepam [Valium]), antianemics, B)vitamin supplements to counteract nutritional deficiencies, antiemetics (prochlorperazine [Compazine]), antipruritics (cyproheptadine [Periactin]), C)biologic response modifiers to stimulate red cell production (epoetin alfa [Epogen, EPO]) to treat anemia caused by a reduced production of erythropoietin. Iron deficiency anemia . must be treated with ferrous sulfate orally or iron dextran (DexFerrum per Z-track intramuscular method) before epoetin alfa will be effective. D)all the above

Nursing Interventions and Patient Teaching of ESRD

Measures to control fluid and electrolyte balance vary greatly, according to individual patient needs. Nutritional therapy is aimed at preserving protein stores and preventing production of additional protein waste products that the kidney would have to clear. High biologic proteins are used to provide the essential amino acids. A)nursing interventions for CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Nutritional therapy is aimed at preserving protein stores and preventing production of additional protein waste products that the kidney would have to clear. High biologic proteins are used to provide the essential amino acids. A)nursing interventions for CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

The diet is high in calories from carbohydrates and fats from polyunsaturated sources (to maintain weight and spare protein), at least 2500 to 3000 calories daily. Other dietary restrictions are related to the patient's degree of acidosis. Potassium is retained, so foods high in potassium are restricted. Sodium is controlled at a level sufficient to replace sodium loss without causing fluid retention. A)nursing interventions for CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

The patient may have fluid equal to the amount excreted in the urine plus about 300 to 600 mL to compensate for insensible (imperceptible) fluid loss (fluid lost truough the lungs, perspiration, and feces). Salt substitutes are not advised because most contain potassium. If seizure activity occurs, institute safety measures to protect the patient. A)nursing interventions for CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Encow·age the patient to increase activity as tolerated; maintain impeccable skin care; prevent infection and injury; and develop coping behaviors to adapt to lifestyle changes for patient, family, and caregiver. A)nursing interventions for CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE) B)nursing intervention for Acute Glomerulonephritis C)nursing intervention for chronic Glomerulonephritis D)nursing intervention for ACUTE RENAL FAILURE

Health Promotion | The Patient with Renal Failure

Fluid and Electrolyte Balance • Assess intake and output (hourly may be indicated). • Weigh daily (same time, same clothing, same scale). • Assess overt (open to view) signs of hydration status: edema, turgor. • Assess covert (hidden) signs of hydration status: breath sounds, laboratory studies, and so on. A)true B)false

True

Nutrition • Provide prescribed diet. • Guide patient food selection. • Plan fluid intake per shift within prescribed limits and according to patient preference. • Reinforce diet instructions as indicated. A)true B)false

True

Comfort and Safety • Provide quiet environment (sound and lighting). • Space nursing interventions to conserve patient energy. • Medicate as needed for comfort. • Provide skin care to alleviate discomfort from pruritus. • Provide mouth care as needed. • Maintain asepsis during procedures. • Prevent exposure to pathogens. A)true B)false

True

Coping Behaviors • Listen (to patient and significant others). • Refer to pastoral care or religious support group. • Provide private times with significant others. • Offer interview with social services. A)true B)false

True

Documentation and Reporting • Document all relevant findings. • Maintain open communications with supervisory staff. • Adjust nursing care plan as indicated to meet changing patient needs. • Maintain dietary restrictions: food exchange, measuring fluids, food diary. • Take health promotion-illness prevention measures. A)true B)false

True

CARE OF THE PATIENT REQUIRING DIALYSIS

Dialysis is a medical procedure for the removal of certain elements from the blood; the process is based on the difference in their rates of diffusion through an external semipermeable membrane or, in the case of peritoneal dialysis, through the peritoneum. A)true B)false

True

Dialysis mimics kidney function, helping to restore balance when normal kidney function is interrupted temporarily or permanently. Dialysis involves either diffusion of wastes, drugs, and/ or excess electrolytes and/ or osmosis of water across a semipermeable membrane into a dialysate fluid that is prescribed to meet individual needs. A)true B)false

True

Dialysis is achieved by the process of hemodialysis or peritoneal dialysis A)true B)false

True

HEMODIALYSIS

Hemodialysis is used for patients with acute or irreversible renal failure and fluid and electrolyte imbalances. A)true B)false

True

Hemodialysis requires access to the patient's circulatory system to route blood through the artificial kidney (dialyzer} for removal of wastes, fluids, and electrolytes; the blood is then returned to the patient's body. A)true B)false

True

Temporary methods include subclavian or femoral catheters or an external shunt placed in the nondominant forearm. A)true B) fase

True

In ESRD, access can be achieved by constructing a direct or a graft arteriovenous (AV) fistula (Figure 10-10}. The AV fistula is preferred for permanent access A)true B)false

True

Hemodialysis is usually scheduled three times a week for 3 to 6 hours. Patients can be maintained on dialysis therapy indefinitely or while waiting for kidney transplantation. A)true B)false

True

Closely monitor blood levels of drugs excreted by the kidney to maintain therapeutic levels and prevent toxic accumulations. Dose adjustments are affected by glomerular filtration rate, dialysis, vomiting, and doses missed during hospital treatments. Medication may include antihypertensives, cardiac glycosides, antibiotics, and antidysrhythmics. Instruct the patient not to take over-the-counter medications without consulting the physician. A)true hemodialysis B)flase

True

Nursing Interventions for hemodialysis

Nurses have a key responsibility for maintaining access sites and preventing or managing infection. Use a structured teaching program, with individualized patient teaching strategies to accommodate culture and knowledge level. A)nursing intervention for hemodialysis B)none

Nursing Intervention Guidelines - for the Patient Undergoing Hemodialysis

PATIENT TEACHING • Reinforce explanation of dialysis procedure. • Inform of community resources. • Explain dietary restrictions. • Teach about self-care, general information. A)true B)false

True

MONITORING DURING DIALYSIS • Maintain asepsis and universal precautions. • Weigh before and after treatment. • Obtain vital signs every 30 to 60 minutes (take blood pressure in arm without fistula). • Maintain orientation (thought processes may be altered). • Assess for hemorrhage resulting from heparin use during dialysis. • Monitor equipment (interruption of procedure). A)true B)false

True

ACTIVITY • Provide diversions (reading, television, sleep). • Ensure patient comfort (reclining, sitting, lying). • Monitor dietary intake (may be hungry or nauseated). A)true B)false

True

CARE AFTER DIALYSIS OR BETWEEN TREATMENTS • Schedule fluid intake within restrictions. • Monitor for signs of fluid and electrolyte imbalance. • Assess the access site for signs of infection, adequate circulation. • Post signs regarding location of access site; do not take blood pressure or perform a venipuncture on arm with access site. • Auscultate arteriovenous fistula for bruit (adventitious sound of venous or arterial origin heard on auscultation); palpate arteriovenous fistula for thrill (abnormal tremor). • Assess, document, and report changes in general status. • Provide skin care: bathe with tepid water to remove urea deposit. A)true B)false

True

PERITONEAL DIALYSIS

Peritoneal dialysis can be performed with a minimum of equipment and by an ambulatory patient. A)true B)false

True

Unlike hemodialysis, peritoneal dialysis is performed four times a day, 7 days a week. One exchange cycle usually requires 30 to 40 minutes. The principle of osmosis and diffusion through a semipermeable membrane is the same as in hemodialysis, but the peritoneum is used as the semipermeable membrane instead of the artificial kidney. A)true B)false

True

Peritoneal dialysis is contraindicated for patients with systemic inflammatory disease, previous abdominal surgery, and chronic back pain, among other conditions A)true B)false

True

The patient with ESRD may be maintained on peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPO), or continuous cycle peritoneal dialysis (CCPD). A)true B)false

True

Nocturnal intermittent peritoneal dialysis can be done three to five times per week for 10 to 12 hours. The patient is taught how to do the dialysis, which allows for more freedom. Although hemodialysis can also be done at home using strict aseptic technique, it is much more expensive and confining than CAPO. A)true B)false

True

Nursing Interventions for PERITONEAL DIALYSIS

Hypotension may occur with excessive sodium and fluid removal. Peritonitis may arise from sepsis. Pain and hemorrhage may accompany instillation of the dialysate. A)true B)false

True

Nursing Intervention Guidelines for the Patient Undergoing Peritoneal Dialysis

``` PATIENT TEACHING • Explanation of procedure • Signs of complications • Diet or fluid restrictions • Medication (schedule in relation to dialysis time) • Dialysate kept at body temperature to lessen discomfort A)true B)false ```

True

MONITORING DURING DIALYSIS • Weight before and after procedure • Hemorrhage (smoky, pink, or red-tinged dialysate) • Type of dialysate (tailored to patient needs) • Amount and timing of dialysate instillation • Vital signs A)true B)false

True

``` CARE BETWEEN DIALYSES • Signs of peritonitis (pain, fever, cloudy fluid) • Strict aseptic care of catheter site • Weigh daily A)true B)false ```

True

Surgical Procedures for Urinary Dysfunction

SURGICAL INTERVENTION

``` : Surgical procedure in which an incision is made on the patient's flank, so that a catheter can be inserted into the renal pelvis for drainage A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` : Surgical removal of the kidney A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` : Surgical removal of the bladder A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` Surgical procedure in which a ureter is implanted in the sigmoid colon of the intestinal tract A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` : Surgical implantation of the terminal ends of the ureter under the skin A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

NURSING INTERVENTION PRIORITIES

``` Meticulous skin care, assessment for hemorrhage, accurate intake and output (I&O). A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` Assessment for hemorrhage, promotion of respiratory effort, accurate I&O A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` Promotion of urinary drainage via ileal conduit, I&O A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` Meticulous skin care, monitoring of electrolyte imbalance, assessment of signs and symptoms of infection A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

``` Meticulous skin care, assessment of urinary obstruction, accurate I&O A)Nephrostomy B)Nephrectomy C)Cystectomy D)Ureterosigmoidostomy E)Cutaneous ureterostomy ```

NEPHRECTOMY

Nephrectomy is the surgical removal of the kidney, either a small portion or the entire organ and surrounding tissues. A)true B)false

True

In partial nephrectomy, only the diseased or infected portion of the kidney is removed. A)true B)false

True

Radical nephrectomy involves removing the entire kidney, a section of the ureter, the adrenal gland, and the fatty tissue surrounding the kidney. A)true B)false

True

Postoperative management for surgical removal of the kidney is based on the prevention and detection of hemorrhage by monitoring vital signs, especially pulse and blood pressure; observation for restlessness and for gastrointestinal complications of nausea, vomiting, and abdominal distention; and establishment of adequate urinary drainage. Record I&O A)true B)false

True

If the thoracic cavity is opened during surgery, the patient will have chest tubes (see Chapter 9). Pain may compromise respiratory efficiency. Administer analgesics as ordered to facilitate lung expansion and the patient's activity level. Reposition the patient every 2 hours and ambulate as ordered. Change dressings according to the physician's order, and record the amount and color of any drainage. Maintain close surveillance on the function of the remaining kidney. A)true B)false

True

Reposition the patient every 2 hours and ambulate as ordered. Change dressings according to the physician's order, and record the amount and color of any drainage. Maintain close surveillance on the function of the remaining kidney. A)true B)false

True

Instruct the patient to avoid heavy lifting, drink 2000 mL of fluid each day (unless contraindicated), monitor output, avoid use of alcohol, and avoid respiratory tract infections and hazardous activities that could damage the remaining kidney. A)patient teaching for NEPHRECTOMY B)patient teaching for NG

NEPHROSTOMY

A nephrostomy is an incision created between the kidney and the skin to drain urine directly from the renal pelvis. A nephrostomy is performed when an occlusion keeps urine from passing from the kidney, through the ureter, and into the urinary bladder. Without a way for urine to drain, pressure would rise within the urinary system and damage the kidneys. The most com. mon cause of obstruction is cancer. This procedure can also be used to remove kidney stones. A)nephrostomy true B)false

True

-Catheters are used to drain the wound. Take care to prevent obstruction of the catheters with blood clots postoperatively. -Measure and record the amount and nature of drainage from the catheters, and change dressings frequently, keeping the skin clean using surgical sepsis. - Turn the patient and position on the affected side as ordered to facilitate drainage and assist in respiratory ventilation. -Never damp a nephrostomy catheter (tube); acute pyelonephritis may result. If ordered by the physician, irrigate a nephrostomy catheter using strict aseptic technique. -Gentle instillation of no more than 5 mL of sterile saline solution at one time prevents renal damage. A)true B)false

True

KIDNEY TRANSPLANTATION

Kidney transplantation is performed as an intervention in irreversible renal failure. The kidney is surgically placed retroperitoneally in the iliac fossa. A) true B)false

True

Usually, the kidney begins to function immediately. A) kidney transplant B) false

-Selection of a transplant recipient is based on careful evaluation of the patient's medical, immunologic, and psychosocial status. -Usually a recipient is younger than age 70, has an estimated life expectancy of 2 years or more, and is expected to have an improved quality of life after transplantation. Through conservative management and dialysis, the patient's state is as nontoxic as possible. A)true B)false

True

Preoperative nursing intervention is complicated by the patient's fear and anxiety about transplantation and about possible rejection of the implanted organ. The patient is dialyzed until surgery . can be satisfactorily completed. In surgery the nonfunctioning kidney remains in place and the donor kidney is positioned in the iliac fossa anterior to the crest of the ileum. The ureter is anastomosed into either the patient's ureter or bladder A) true B)false

True

However, bilateral nephrectomy may be performed before the transplantation procedure for persistent or active bacterial pyleonephritis, uncontrolled reninmediated hypertension, polycystic kidneys, or rapidly progressive glomemlonephritis. A)true B)false

True

Postoperatively, assess the patient for signs of rejection and infection: apprehension, generalized edema, fever, increased blood pressure, oliguria, edema, and tenderness over the graft site. A)true B)false

True

An immunosuppressive agent, such as cyclosporine, is used alone or in conjunction with steroids. -Cyclosporine is considered an effective drug in suppressing the immLme system's efforts to reject tissue while leaving the recipient sufficient immune activity to combat infection. -Mycophenolate (CeiiCept) and tacrolimus (Prograf) are drugs used to prevent rejection of kidney transplants; they are used in combination with corticosteroids. A)true B)false

True

Immunosuppressive therapy increases the risk for infection and possible steroid-induced bleeding. A)true B)false

True

Postoperative care includes special assessment of kidney function and electrolyte balance. A)true patient teaching B)false

-Home follow-up becomes a life pattern for the transplantation patient. -Patient education is extensive: diet, fluids, daily weights, strict I&O measurements, prevention of infection, and avoidance of activities that may compromise the integrity of the urinary tract. - Community support groups, sponsored by the American Association of Kidney Patients, help the patient and the family adapt to living with dialysis and transplantation. -The National Kidney Foundation has a written protocol for the procurement of organs for donation A)true B)false

True

URINARY DIVERSION

The most common urinary diversion procedure is the ileal conduit (Bricker's procedure or ileal loop), the ureters are implanted into a loop of the ileum that is isolated and brought to the surface of the abdominal wall.Occasionally a segment of the sigmoid colon is isolated and used instead of the ileum to form a sigmoid conduit. A)true B)false

True

A drainage bag (urostomy bag or appliance) is fitted over the stoma to contain the constant drainage of urine. Continuous urine drainage prevents increased pressure within the conduit that would cause backflow to the kidneys, compromise the circulatory integrity of the conduit, or rupture the surgical anastomosis. Decreased urinary output and low abdominal pain may signal the onset of such problems. Complications of this procedure are wound infection, dehiscence, urinary leakage, ureteral obstruction, small bowel obstruction, stomal gangrene or atrophy, pyelonephritis, renal calculi, and compromised respiratory status secondary to incisional pain A)true B)false

True

Complications of this procedure are wound infection, dehiscence, urinary leakage, ureteral obstruction, small bowel obstruction, stomal gangrene or atrophy, pyelonephritis, renal calculi, and compromised respiratory status secondary to incisional pain A)ileal conduit (Bricker's procedure or ileal loop) B)false no complications

Postoperatively, measure urine flow hourly. Report y. output less than 30 mL/hr to the physician immediately. A)true B) false

True

A healthy stoma appears A)moist and pink and may even bleed slightly. B)necrosis

Inspect the skin around the stoma daily for signs of bleeding, excoriation, and infection. Mucus is present in the urine from the intestinal secretions. A)true B)false

True

The patient should ingest large quantities of water to flush the ileal conduit. A)true B)flase

True

Any odor of urine about the patient may indicate an infection or leak of urine from the drainage bag. Early signs of urinary leakage (indicating a leak in an anastomosis) include A)increased abdominal girth; B) fever; C)drainage through the incision, tubes, or drains. D)all the above

Ureteral separation from the conduit may cause urine to seep into the peritoneal cavity; observe the patient for signs and symptoms of peritonitis such as A)fever, abdominal pain and rigidity B) absence of bowel sounds C)both a and b

Care of the patient with an ileal conduit is a nursing challenge because of the continuous drainage of urine through the stoma. A)true B)false

True

To change the urostomy bag, A) remove and drain it. B)Cleanse the skin with water, and apply the new appliance as outlined in the institution's standards of care. C)When the peristomal skin is healed, the bag is emptied at 2- to 3-hour intervals. D)At night a straight drainage tube is connected to a drainage bag. E)all the above

A permanent urostomy bag can be left in place 4 to 7 days if it remains sealed. -Recommend that the patient have two bags, so one can be worn while the other is washed. Some patients prefer to use disposable bags. - Odor is controlled by using deodorant drops or tablets in the urostomy bag; -avoiding odor-producing foods, such as beans, onions, cabbage, asparagus, high-fiber wheat, simple sugars, and milk in the lactose-intolerant patient; and cleansing the urostomy bag with a vinegar and water rinse and thoroughly drying. A)true B)false

True

Odor is controlled by using deodorant drops or tablets in the urostomy bag; A)true B)false

True

avoiding odor-producing foods, such as beans, onions, cabbage, asparagus, high-fiber wheat, simple sugars, A)true B)false

True

cleansing the urostomy bag with a A)vinegar and water rinse and thoroughly drying. B)false

avoiding odor-producing foods, such as beans, onions, cabbage, asparagus, high-fiber wheat, simple sugars, and milk in the lactose-intolerant patient; A)true B)false

True

, is created by implantation of the ureters into a segment of the small intestine that has been surgically removed from the rest of the bowel and anastomosed to the abdominal wall. Urine flow is controlled by a nipplelike valve that prevents leakage. To drain urine from the reservoir, the patient inserts a catheter through the valve at regular intervals, thus minimizing the reabsorption of waste materials from the urine and reflux into the ureters A)The continent ileal urinary reservoir, or Kock pouch B)stoma

care of the stoma, nutrition, fluid intake, maintenance of self-esteem in light of altered body image, modification of sexual activities, and early detection of complications. A)patient teaching B)false

Patient teaching begins with selecting an appliance, sizing the stoma, and changing the appliances. The home health nurse can assist the patient in modifying care in the home environment and by providing support during this stressful adjustment period A)true B)false

True

Home Care Considerations | Urinary Diversion Warning Signs

Provide the patient and significant other with a list of warning signs and symptoms to report to the physician when home. Be certain to compose the list in clear, concise language. A)true B)false

True

• Keep this list handy and call the physician (phone number ----' if you notice any of the following signs or symptoms: -Decrease in urinary output - Change in urine color: bloody, cloudy -Fever greater than 101 o F - Change in appearance of stoma: pale color, swelling, "drawing-in" of stoma -Skin changes around stoma: redness, burning, breakdown -General feeling of weakness -Nausea and vomiting -Abdominal distention or pain -Any other health changes that are new or worse A)true B)false

True

NURSING PROCESS for the Patient with a Urinary Disorder

Assessment

-Assessment of the urinary tract is included in baseline data for all patients. -The assessment includes subjective data: the patient's description of urination patterns and associated sensations, such as complaints of burning or pain on urination or difficulty maintaining the urine stream. -Supplement subjective data with objective data by assessing for signs of fluid overload or depletion. -The skin provides easily assessed clues about the patient's state of hydration. For example, dryness and pruritus (itching) can occur as a result of electrolyte imbalance or the buildup of waste products. A)true B)false

True

Urinary disorders are associated with a number of systemic malformations and structural anomalies in newborns. A)true B)false

True

Pediatric patients, especially girls, are susceptible to urinary tract infections because of the short urethra. A)true B)false

Geriatric patients may experience weakened musculature and sphincter tone, with resultant difficulty in bladder control. A)true B)false

True

In male patients, enlargement of the prostate gland may interfere with initiating and maintaining an adequate urine stream. A)true B)false

True

Occupational and environmental factors also contribute to the development of renal disease. Nephrotoxins are substances with specific destructive properties for the kidneys. Sources include A)industrial exposure to heavy metals, such as lead and mercury B)medical treatment with cisplatin, arninoglycoside antibiotics (gentamicin or kanamycin), nonsteroidal antiinflammatory drugs, or radiopaque contrast media C)both a and b

``` Other vulnerable populations include patients experiencing systemic changes from altered health states, such as A)pregnancy B) diabetes mellitus C)hypertension. D)all the above ```

Nursing Diagnosis

``` -Impaired urinary elimination • Ineffective tissue perfusion: renal • Acute pain; chronic pain • Risk for infection • Risk for deficient fluid volume • Excess fluid volume • Ineffective sexuality patterns • Deficient knowledge ```

Implementation

Teach the female patient the importance of cleansing from anterior to posterior in the perineal area after a bowel movement to prevent contamination of the urethra with Escherichia coli. A)true B)false

True

NCLEX PREP

When reading the urinalysis report, the nurse recognizes this result as abnormal: 1. turbidity clear. 2. pH 6.0. 3. glucose negative. 4. red blood cells, 15 to 20.

After renal angiography, the patient assessment priority is the: 1. blood pressure. 2. respiratory effort. 3. puncture site. 4. urinary output.

The nursing care plan includes teaching the patient Kegel exercises. The nurse teaches the patient to alternately tighten and relax which group of muscles? 1. Perineal floor 2. Pubococcygeal 3. Abdominis rectus 4. Detrusor

The physician has talked to the patient and his wife about the treatment plan for his bladder cancer. Later, the patient tells the nurse he does not understand what the doctor is going to do. The most appropriate response by the nurse would be: 1. "Okay. I'll explain it to you again." 2. "Make a list of questions for the doctor." 3. "Try not to think about the treatment." 4. "Tell me what you know about the treatment."

5. Which activity would be harmful for the incontinent patient? 1. Restricting fluid intake 2. Drinking only water 3. Fluid intake of 2000 ml/day 4. Restricting acidic fruit juice intake

6. The nurse recognizes that the most common causative organism in pyelonephritis is: 1. Candida albicans. 2. Klebsiella. 3. Escherichia coli. 4. Pseudomonas.

The most important factor to foster patient compliance with the treatment plan is to provide the patient with: 1. a set time schedule to follow. 2. data on success rates. 3. written information of the plan. 4. an active role in the planning.

8. When scheduling the administration of furosemide (lasix), it would be in the patient's best interest to schedule the medication to be given at: 1. 9 AM. 2. 12 PM (noon). 3. 2100. 4. 12 AM (midnight).

9. In discussion with the patient with ESRD about dietary needs, the nurse recognizes that foods highest in potassium include: 1. apples, applesauce, grapes, and raisins. 2. bananas, nuts, and chocolate. 3. grapefruit, tomatoes, oranges, and bananas. 4. milk, grapefruit, orange juice, and sugar.

Which patient report indicates that phenazopyridine hydrochloride (Pyridium) is being effective? 1. Decreased bladder spasms 2. Decrease in burning 3. Increased urinary output 4. Increased pain tolerance

11. When calculating actual urinary output during continuous bladder irrigations, the nurse would: 1. measure and record all fluid output in the drainage bag. 2. measure the total output and deduct the amount of irrigation solution used. 3. add the total of all intravenous and irrigation solutions and deduct output. 4. measure total output and deduct the total intravenous solutions.

12. What statement by the patient indicates the need for further teaching before renal angiography? 1. "I will miss having breakfast." 2. "I know the nurse will be checking my pulse after the test." 3. "I'm glad I don't have to stay in bed after the test." 4. "I had a test similar to this 3 years ago.

The nurse performs a catheterization immediately after the patient voids and obtains 30 ml residual urine. The next step would be to: 1. document the procedure with outcome data. 2. continue the catheterization routine after each voiding. 3. restrict fluid intake after dinner. 4. immediately notify the physician of the results.

14. Which goal would have priority in planning care of the aging patient with urinary incontinence? 1. Recognizes the urge to void 2. Mobility necessary for toileting independently 3. Episodes of incontinency decrease 4. Drinks a minimum of 2000 ml of fluid per day 15. The goal for peritoneal dialysis is to: 1. remove toxins and metabolic waste. 2. produce rapid fluid shifts. 3. increase clearance of dialysate flow. 4. restore normal kidney function.

15. The goal for peritoneal dialysis is to: 1. remove toxins and metabolic waste. 2. produce rapid fluid shifts. 3. increase clearance of dialysate flow. 4. restore normal kidney function.

16. In postoperative care of the patient with an arteriovenous shunt, the nurse should: 1. secure the shunt with an elastic bandage. 2. notify the physician if a bruit or thrill is present. 3. change the shunt if clotting occurs. 4. use strict surgical asepsis for dressing changes.

17. The teaching priority for the patient with acute renal failure is: 1. treatment of hyponatremia. 2. prevention of infection. 3. maintenance urinary output at 50 mL/hr. 4. control of caloric intake.

18. The patient with ESRD receiving hemodialysis is at risk for: 1. sepsis. 2. renal insufficiency. 3. anemia. 4. Klebsiella infection.

19. The primary function of the kidney is: 1. regulation of enzymes. 2. filtration of water and blood products. 3. collection of urine from the body. 4. control of the adrenal glands.

20. The priority short-term goal for disorders of the urinary system is: 1. patient confidentiality. 2. privacy. 3. education for patient and family. 4. normal patterns of urinary elimination.

21. Assessment of the patient with a urinary disorder may be complicated by: 1. European practices to withhold personal information. 2. marital status. 3. coexisting pathologic condition. 4. social taboos surrounding sexuality.

22. The nurse making rounds discovers that there is no urine drainage from a postoperative patient's Foley catheter. The first nursing action is to: 1. ensure patency. 2. irrigate until clear. 3. call the physician. 4. insert larger lumen catheter.

23. Which problem constitutes a medical emergency? 1. Anuria 2. Polyuria 3. Dysuria 4. Dyspnea

EXTRA INFORMATION

the nurse is teaching skin care to a patient with an ileal conduit.the patient should be instructed to empt the collection bag A)when it is one third full B)half way full

the nurse is providing diet teachhing to a patient with calcium oxalate.which snack should the patient be advised to avoid A)strawberries B)chesse

A strawbarries and peaanuts spinch are high in oxylate

a male patient is admitted to the hospital because it is suspected that he has kidney stones. one of his nursing diagnose is pain related to ureteral spasms.because of this diagnosis which intervention is most appropriate A)straining all urine B)administering pain meds

one of thee earliest sign of renal impairment is A)polyuria B))oliguria

uremia A)yellow gray skin color B)sezzurres

serum calcuim is low patient at risk for seziures A)true B)false

invasive procedures are postpone for 4 to 6 hours after hemodialysis because A)heparin is used during the procedure B)none

A nurse is preparing a care plan for a patient with Alzheimer's disease. The patient is unable to communicate or feel the pain and discomfort associated with acute urinary retention. Which of the following nursing measures should be taken while caring for such a patient? Select all that apply: A)Check the peristomal skin near the stoma B)Help the patient come to terms with sexual dysfunction C)Promote catheterization D)Instruct the patient on how to minimize urinary odor

A C D

``` A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? Choose one of the following A Acute renal failure B Acute glomerulonephritis C Chronic renal failure D Nephrotic syndrome ```

``` Which of the following medications maybe ordered to relieve discomfort associated with a urinary tract infection? Choose one of the following A Nitrofurantoin (Furadantin) B Phenazopyridine (Pyridium) C Ciprofloxacin (Cipro) D Levofloxacin (Levaquin) ```

Pyridium is urinary analgesic ordered to relieve discomfort associated with a UTI. A)true B)false

Furadantin, Cipro, and Levaquin are antibiotics. A)true B) false

True

``` Which of the following is the hallmark of the diagnosis of nephritic syndrome? Choose one of the following A Hyponatremia B Proteinuria C Hypoalbuminemia D Hypokalemia ```

Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephritic syndrome. A)true B)false

``` The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include? Choose one of the following A Incontinence B Change in cognitive functioning C Hematuria D Back pain ```

The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI. A)true B)false

True

``` Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection? Choose one of the following A Use tub baths as opposed to showers B Drink coffee or tea to increase diuresis C Drink liberal amount of fluids D Void every 4 to 6 hours ```

Coffee and tea are urinary irritants A)true B)false

True

``` Which of the following is the procedure of choice for men with recurrent or complicated UTIs? Choose one of the following A Transrectal ultrasonography B IV urogram C CT scan D MRI ```

A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs. A)true B)false

True

When teaching the patient how to perform self-catheterization, which of the following is important? Choose one of the following A Peroxide is recommended for cleaning the urinary catheter. B The catheterization should occur 4 to 6 hours and before bedtime. C The nurse uses non sterile technique in the hospital setting. D The catheter is rinsed with sterile NS after soaking in a cleaning solution.

The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The catheter is rinsed with tap water after soaking in a cleaning solution. Either antibacterial soap or Betadine solution is recommended for cleaning urinary catheters at home. The nurse uses sterile technique in the hospital setting. A)true B)false

True

The nurse is helping a patient to correctly perform peritoneal dialysis at home. The nurse must educate the patient about the procedure. Which educational information should the nurse provide to the patient? Choose one of the following A Wear a mask while handling any dialysate solutions B Keep the catheter stabilized to the abdomen, below the belt line C Keep the dialysis supplies in a clean area, away from children and pets D Clean the catheter insertion site daily with soap

``` When caring for a patient with an uncomplicated, mild urinary tract infection (UTI), the nurse knows that recent studies have shown which of the following drugs to be a good choice for short-course (eg, 3 day) therapy? Choose one of the following A Levofloxacin (Levaquin) B Trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra) C Nitrofurantoin (Macrodantin, Furadantin) D Ciprofloxacin (Cipro) ```

Levofloxacin, a fluoroquinolone, is a good choice for short-course therapy of uncomplicated, mild to moderate UTI. Clinical trial data show high patient compliance with the 3-day regimen (95.6%) and a high eradication rate for all pathogens (96.4%). A)true B)false

True

Trimethoprim-sulfamethoxazole is a commonly used medication for treatment of a complicated UTI, such as pyelonephritis. A)true B)false

True

Nitrofurantoin is a commonly used medication for treatment of a complicated UTI, such as pyelonephritis. A)true B)false

True

Ciprofloxacin is a good choice for treatment of a complicated UTI. Recent studies have found ciprofloxacin to be significantly more effective than TMP-SMZ in community-based patients and in nursing home residents. A)true B)false

True

When providing care to the patient with bilateral nephrostomy tubes, the nurse should avoid which of the following? Choose one of the following A Reports a dislodged nephrostomy tube immediately B Clamps each nephrostomy tube when the patient is moved C Measures urine output from each tube separately D Irrigates each nephrostomy tube with 30 cc of normal saline as ordered

The nurse must never clamp a nephrostomy tube because it could cause obstruction and resultant pyelonephritis. A dislodged nephrostomy tube must be reported immediately to allow the surgeon to replace the tube immediately to prevent the opening from contracting. The output from each tube is assessed, indicating the functioning of the tube. The nurse may irrigate a nephrostomy tube with specific orders to do so. A)true B)false

True

A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse? Choose one of the following A Distract the patient's attention from the pain B Provide analgesics to the patient C Enable the patient to sit up and ambulate D Assess the patient's back and shoulder areas for signs of internal bleeding

``` Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? Choose one of the following A 20 B 30 C 40 D 50 ```

``` Which of the following terms refers to casts in the urine? Choose one of the following A Cylindruria B Crystalluria C Pyuria D Bacteriuria ```

Casts may be identified through microscopic examination of the urine sediment after centrifuging. Crystalluria is the term used to refer to crystals in the urine. Pyuria is the term used to refer to pus in the urine. Bacteriuria refers to a bacterial count higher than 100,000 colonies per mL in the urine. A)true B) false

True

``` A patient is scheduled for an invasive procedure. Which of the following should the nurse document in the chart regarding the procedure? Choose one of the following A A report from the dietician B A signed consent form from the patient C A detailed urinalysis report D A signed consent form from the patient's family ```

``` Which is the correct term for the ability of the kidneys to clear solutes from the plasma? Choose one of the following A Renal clearance B GFR C Specific gravity D Tubular secretion ```

Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta. A)true B)false

``` Retention of which electrolyte is the most life-threatening effect of renal failure? Choose one of the following A)Calcium B)Sodium C)Potassium D)Phosphorous ```

``` When the bladder contains 300 mL or more of urine, this is referred to as Choose one of the following A)anuria. B)specific gravity C)functional capacity D)renal clearance ```

-The specific gravity of water is 1.000. -A urine specific gravity of less than 1.010 may indicate inadequate fluid intake. -A urine specific gravity greater than 1.025 may indicate overhydration. A)true B)false

True

Urine specific gravity is a measurement of the kidney's ability to concentrate urine. A)true B)false

True

``` In order to assess circulating oxygen levels the "2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines" recommends the use of which of the following diagnostic tests? Choose one of the following A)Hemoglobin B)Hematocrit C)Serum iron levels D)Arterial blood gases ```

Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status A)true B)false

True

``` Which of the following is a normal BUN to creatinine ratio? Choose one of the following A)4:1 B)6:1 C)8:1 D)10:1 ```

``` Which hormone causes the kidney to reabsorb sodium? Choose one of the following A)ADH B)Aldosterone C)Growth hormone D)Prostaglandins ```

To obtain information about the chief complaint and medical history of an older male patient, the nurse asks the patient about his medication history. What is the importance of obtaining a medication history? Choose one of the following A)It may indicate the patient's general health. B)It may reflect the patient's childhood and family illnesses. C)It may indicate multiple medications administered by the patient. D)It may indicate drugs that should not be prescribed to the patient.

``` The term used to describe total urine output of less than 400 mL in 24 hours is Choose one of the following A)oliguria. B)anuria. C)nocturia. D)dysuria. ```

The nurse observes the patient's urine to be orange. Which additional assessment would be important for this patient? Choose one of the following A)Bleeding B)Intake of medication such as phenytoin (Dilantin) C)Intake of multiple vitamin preparations D)Infection

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)? Choose one of the following A)Ascending urinary tract infection and vomiting B)Gross hematuria and massive generalized edema C)Bilateral flank masses and impaired lung development D)Elevated systemic blood pressure and severe pain

Which symptom would you expect to find in a patient being evaluated for kidney stones? Choose one of the following A)Increased thirst and increased urinary output B)Elevation in systemic blood pressure and frequent urination C)Acute onset of colicky or dull and achy intermittent flank pain D)A visible abdominal mass and abdominal pain

``` Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor? Choose one of the following A)Massive generalized edema B)A visible fine red rash on the body C)Anomalies of the genitourinary system D)Presence of a palpable flank mass ```

Which condition increases a patient's chance of developing an ascending urinary tract infection? Choose one of the following A)Transfer of pathogens in the course of septicemia B)Obstruction of urine outflow from the kidney C)The presence of high levels of glucose in the urine D)Seeding of the kidney in the course of infective endocarditis

``` What area of the body should be examined to evaluate the presence of edema in a patient with nephrotic syndrome? Choose one of the following A)Entire abdomen B)Lower extremities C)Eyelids D)Hands ```

Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome? Choose one of the following A)Elevated urine protein and hypoalbuminemia B)Low triglycerides and elevated sodium levels C)Decreased high-density lipoproteins and increased iron levels D)Abnormal blood clotting and elevated blood pressure

A patient has undergone kidney transplantation and voices concerns about organ rejection. Which response should you make to the patient to best address their concerns? Choose one of the following A)"You will be given medication to decrease the ability of your immune system to attack your new kidney." B)"Kidney transplantation is 100% successful and there is no need for you to worry." C)"Your new kidney will continue to work fine as long as you do not drink any alcohol." D)"There is no need to worry about rejection because the occurrence of rejection is low with kidney transplantation."

What is the expected relationship of blood urea nitrogen (BUN) and serum creatinine levels in a patient who has prerenal kidney failure? Choose one of the following A)The BUN to creatinine ratio is 10:1. B)BUN elevates and creatinine decreases. C)The BUN to creatinine ratio is 20:1. D)Creatinine level rises and BUN decreases.

A 35-year-old patient is diagnosed with acute renal failure (ARF) and is started on hemodialysis. The patient is concerned with the diagnosis and wants to know what to expect during the progression of this disorder. Which statement best addresses the patient's concern? Choose one of the following A)"The occurrence of acute renal failure will always eventually result in chronic renal failure." B)"Acute renal failure is abrupt in onset and often reversible if recognized early and treated appropriately." C)"Once your condition improves you can be placed on peritoneal dialysis for the rest of your life."

``` A patient with chronic kidney disease on hemodialysis should be encouraged to avoid which foods? Choose one of the following A)Whole grains B)Raw carrots C)Lean meats D)Fresh apples ```

``` Which dietary change should a patient diagnosed with chronic kidney disease (CKD) make to help reduce nausea and vomiting? Choose one of the following A)Increase intake of fruit juice. B)Restrict intake of dietary protein. C)Increase intake of carbohydrates. D)Restrict intake of dietary fat. ```

Early morning nausea is common in CKD. Nausea and vomiting often improve with the restriction of dietary protein, and after initiation of dialysis, and disappear after kidney transplant. A)true B)false

True

``` Which physiologic change in the elderly population contributes to urinary incontinence? Choose one of the following A)Side effects of medication B)Increased bladder contractility C)Increased bladder capacity D)Decline in detrusor muscle function ```

``` What happens to bladder function immediately following a spinal cord injury? Choose one of the following A)The external sphincter relaxes. B)The bladder becomes atonic. C)The internal sphincter contracts. D)The bladder become hyperactive. ```

``` Which symptom is the most common sign associated with cancer of the bladder? Choose one of the following A)Urinary frequency B)Painless hematuria C)Continual dysuria D)Intermittent urgency ```

Which noninvasive treatment should you recommend to a 40-year-old female patient who complains of involuntary loss of urine when she coughs or sneezes? Choose one of the following A)Implanted artificial sphincter B)Periurethral injection of a bulking agent C)Kegel exercises D)Self-catheterization

``` Which urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure? Choose one of the following A)Internal urethra B)Urinary vesicle C)Detrusor muscle D)External sphincter ```

Which occurrence in the renal system will cause an increase in urination? Choose one of the following A)A decrease in antidiuretic hormone B)Reduction in glomerular filtration rate C)Activation of the angiotensin system D)Excessive secretion of aldosterone

``` Which substance released by the atria causes vasodilation of the afferent and efferent arterioles, which results in an increase in renal blood flow and glomerular filtration rate (GFR)? Choose one of the following A)Aldosterone B)Angiotensin I C)Atrial natriuretic peptide (ANP) D)Antidiuretic hormone (ADH) ```

What is the action of renin in the renin-angiotensin-aldosterone mechanism? Choose one of the following A)Breaks down insulin for excretion by the kidneys B)Increases reabsorption of sodium in the distal tubule C)Catabolizes angiotensin II to aldosterone D)Converts angiotensin to angiotensin I

``` Which substance should you expect to see on the laboratory report of a routine urine test? Choose one of the following A)Protein B)Glucose C)Albumin D)Creatinine ```

``` Which diuretic acts by preventing sodium chloride reabsorption in the distal convoluted tubule? Choose one of the following A)Osmotic diuretics B)Thiazide diuretics C)Potassium sparing diuretics D)Loop diuretics ```

``` Which substance should not normally be found in the glomerular filtrate? Choose one of the following A)Protein B)Potassium C)Water D)Sodium ```

``` Which factor has been implicated in the progression of diabetic nephropathy? Choose one of the following A)Increased sodium intake B)Cigarette smoking C)Decreased blood pressure D)Elevated cholesterol ```

Hypertension and cigarette smoking have been implicated in the progression of diabetic nephropathy A)true B)false

Which nonsurgical method of treatment is used to treat renal calculi (kidney stones)? Choose one of the following A)Retrograde ureteroscopy B)Percutaneous nephrolithotomy C)Percutaneous ureterolithotomy D)Extracorporeal shock wave lithotripsy (ESWL)

``` Which signs and symptoms would you expect to see in a patient diagnosed with acute nephritic syndrome? Choose one of the following A)Hematuria and azotemia B)Proteinuria and hyperlipidemia C)Generalized edema and hypotension D)Hypoalbuminemia and lipiduria ```

The acute nephritic syndromes evoke an inflammatory response in the glomeruli and are characterized by hematuria with red cell casts in the urine, diminished glomerular filtration rate, azotemia, oliguria, and hypertension A)true B)false

Which factor contributes to the development of polycystic kidney disease? Choose one of the following A)A reduction in pre-renal blood flow to the kidneys B)Multiple recurrent urinary tract infections C)Enlargement in the basement membrane of the kidney D)Hereditary mutations in polycystin I and II

What is the most common cause of acute postinfectious glomerulonephritis? Choose one of the following A)Uncontrolled diabetes with increased proteinuria B)Prolonged blockage of the ureter with a stone C)Drug-induced damage to the renal glomeruli D)A streptococcal infection 7 to 12 days prior to onset

``` Which agents can cause injury to the kidney glomerulus? Select all that apply: A)Asthma B)Arthritis C)Immunologic D)Heredity E)Nonimmunologic F)Diabetes ```

C D E F

``` A patient who is diagnosed and treated for a calcium oxalate stone should be encouraged to make which change in their dietary habits? Choose one of the following A)Take a thiazide diuretic B)Avoid spinach and peanuts C)Avoid milk and dairy products D)Increase intake of citrus juices ```

Renal carcinoma is often silent in the early stages, and symptoms often indicate advanced disease. Choose one of the following A)True B)False

``` Which condition has the potential to cause postrenal kidney failure in men? Choose one of the following A)Severe hypovolemia B)Prostatic hyperplasia C)Intratubular obstruction D)Acute pyelonephritis ```

``` What is the allowable fluid intake recommendation for a patient with chronic kidney disease (CKD)? Choose one of the following A)850 to 1000 mL/day B)500 to 800 mL/day C)400-600 mL/day D)1050-1200 mL/day ```

A 45-year-old patient with chronic kidney disease (CKD) voices concern about their dialysis treatment. The patient would like to work and spend time with their family. Which type of dialysis will best fit this patient's lifestyle? Choose one of the following A)Nocturnal intermittent peritoneal dialysis (NIPD) B)Continuous ambulatory peritoneal dialysis C)Hemodialysis D)Continuous cyclic peritoneal dialysis

In NIPD the patient is give 10 hours of automatic cycling each night, with the abdomen left dry during the day. This is the most beneficial for this patient. Individual preference, manual ability, lifestyle, knowledge of the procedure, and physiologic response to treatment are used to determine the type of dialysis that is used. A)true B)false

Bruising of the skin is a manifestation of bleeding disorders in patients with CKD. Choose one of the following A)True B)False

``` Which laboratory test best measures overall kidney function? Choose one of the following A)Glomerular filtration rate (GFR) B)Urine albumin levels C)Blood urea nitrogen (BUN) D)Serum creatinine levels ```

Which body systems are most commonly affected by chronic kidney disease (CKD) in the elderly? Choose one of the following A)Skeletal and gastrointestinal systems B)Cardiovascular and cerebrovascular systems C)Hematologic and reproductive systems D)Immune and integumentary systems

``` Which condition is considered to be an early manifestation of chronic kidney disease (CKD)? Choose one of the following A)Terry nails B)Asterixis C)Impotence D)Hypertension ```

``` A patient being treated with an aminoglycoside (gentamicin) is at risk for which type of renal failure? Choose one of the following A)Chronic kidney disease B)Ischemic acute tubular necrosis C)Postrenal failure D)Nephrotoxic acute tubular necrosis ```

``` Which symptom occurs in a patient with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism? Choose one of the following A)Pruritus B)Asterixis C)Uremia D)Azotemia ```

Which of the following four patients is at the greatest risk of developing bladder cancer? Choose one of the following A)A 65-year old white male with a history of bladder stones B)A 50-year old white woman with a history of two bladder infections C)A 30-year old African American woman with a 2-year history of smoking D)A 40-year old African American man with a history of prostate enlargement

Cancer of the bladder is the fourth most common malignancy in men A)true B)false

Which diagnoses should be considered in children who present with urinary symptoms without bacteriuria? Choose one of the following A)Acute abdomen, renal stones, or spastic bladder dysfunction B)Vaginitis, sexual molestation, or pinworms C)Constipation, irritable bowels, or flaccid bladder D)Overflow urge, bladder hypertrophy, or overactive bladder

Urinary symptoms in the absence of bacteriuria suggest vaginitis, urethritis, and use of irritating bubble baths, sexual molestation, pinworms, or viral cystitis A)true B)false

``` A patient diagnosed with flaccid neurogenic bladder is taught to apply pressure with the hand above the symphysis pubis while in the sitting position. What is the expected outcome of this technique? Choose one of the following A)Relaxation of the internal sphincter B)Triggers sacral micturition reflex C)Increases intravesical pressure D)Activates the micturition center ```

``` A patient undergoes surgical treatment for cancer of the bladder. The patient now has an alternative reservoir called an ileal loop. Which surgical treatment did this patient have? Choose one of the following A)Diathermy B)Cystectomy C)Endoscopic resection D)Segmental surgical resection ```

Which methods are most commonly used to treat detrusor-sphincter dyssynergia? Choose one of the following A)Anticholinergic medications and urinary catheterization B)Internal sphincter dilation and cholinergic medications C)Muscle relaxing medications and urinary diversion D)Scheduled toileting and intermittent catheterization

One of the complications of asymptomatic urinary tract infection (UTI) during pregnancy is the risk of preterm birth. Choose one of the following A)True B)False

``` Which type of bladder dysfunction results from lesions at the level of the sacral reflexes/peripheral nerves that innervate the bladder in patients with neurogenic bladder? Choose one of the following A)Bladder paralysis dysfunction B)Detrusor-sphincter dyssynergia C)Spastic bladder dysfunction D)Flaccid bladder dysfunction ```

``` Hospitalized patients are at the greatest risk of developing septicemia related to which procedure? Choose one of the following A)Obstructive pyelonephritis B)Catheter-associated bacteriuria C)Acute viral cystitis D)Asymptomatic bacteriuria ```

``` A patient diagnosed with urinary obstruction exhibits a weak, small urinary stream and hesitancy. Which compensatory mechanism is this patient most likely experiencing? Choose one of the following A)Compensatory phase B)Decompensation C)Early obstruction D)Spasmodic phase ```

The signs of urinary decompensation include hesitancy, frequency, need to strain to urinate, a weak, small stream, and termination of the stream before the bladder is completely empty. A)true B)false

True

___________ dysfunction results from lesions at the level of the sacral reflexes or the peripheral nerves that innervate the bladder. A)Flaccid bladder B)Spastic bladder

_________ dysfunction, such as detrusor-sphincter dyssynergia and those caused by spinal injury, usually results from neurologic lesions located above the level of the sacral micturition reflexes. A) Spastic bladder B) flaccid bladder

The methods used to treat spastic bladder and detrusor-sphincter dyssynergia are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. A)true B)false

``` An adult has a serum sample taken to evaluate their BUN–creatinine ratio. Which result indicates a normal test? Choose one of the following A)BUN 10 mg/dL to creatinine 1 mg/dL B)BUN 40 mg/dL to creatinine 2 mg/dL C)BUN 25 mg/dL to creatinine 1 mg/dL D)BUN 30 mg/dL to creatinine 2.5 mg/dL ```

``` Which condition cause an elevation in the level of blood urea nitrogen (BUN) level? Choose one of the following A)Gastrointestinal bleeding B)Heart disease C)Pituitary disease D)Excessive fluid intake ```

Which effect will a diuretic have on the kidney? Choose one of the following A)Diuretics activate the renin-angiotensin system. B)Diuretics block the tubular reabsorption of sodium. C)Diuretics cause a decrease in glomerular filtration rate (GFR). D)Diuretics cause a release of antidiuretic hormone (ADH).

``` Which condition can cause elevation in urinary protein levels (proteinuria) on a urine test? Choose one of the following A)Poor fluid intake B)A decrease in antidiuretic hormone C)Urinary tract infection D)Abnormal glomeruli filtration ```

Which function of the kidney helps to maintain the normal composition of internal body fluids? Choose one of the following A)Reabsorption of hydrogen and urate are secreted into the tubular fluids B)Excretion of renin-angiotensin to maintain circulating blood volume C)Production of erythropoietin to stimulate red blood cell production D)Selective filtration and reabsorption of substances, such as sodium and potassium

``` What percentage of cardiac output perfuses the kidneys? Choose one of the following A)20% to 25% B)35% to 40% C)12% to 18% D)10% to 20% ```

``` What happens to sodium levels when aldosterone is released by the adrenal glands? Choose one of the following A)A reduction in urinary sodium levels B)A reduction in serum sodium levels C)Serum sodium levels are unchanged D)Sodium is excreted in the urine ```

``` Which condition is often found in patients who have chronic renal disease? Choose one of the following A)Elevated serum protein B)Anemia C)Lung disease D)Liver disease ```

Which function of the kidneys helps to maintain the pH balance in the body? Choose one of the following A)The proximal tubule actively secretes large amounts of different organic anions. B)Uric acid is freely filtered in the glomerulus and is absorbed and secreted into the proximal tubule. C)The glomerulus freely filters sodium and potassium, but unlike sodium, potassium is reabsorbed from and secreted into the tubular fluid D)The kidneys conserve base bicarbonate and eliminate hydrogen ions

``` Kidney stones and gout can be caused by the elevation of which substance in the blood stream and in the kidneys? Choose one of the following A)Albumin B)Uric acid C)Urea D)Protein ```

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