Urinary Disorder Flashcards
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
A
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
A
When obtaining vascular access, the nurse should avoid puncturing the same site used previously.
A)true
B)false
A
Using dialysate solutions after two hours of dialysis will not allow heparin to be metabolized and excreted.
A)true
B)false
True
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
D
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
A
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
A
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
A
Anticholinergic agents are considered first-line medications for urge incontinence.
A)true
B)false
A
Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra.
A)true
B)false
A
Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance.
A)true
B)false
A
. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.
A)true
B)false
A
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
B
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
A
A right angle 90 degrees straightens the urethra and makes it easier to insert the catheter?
A)true
B)false
True
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
A
Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic.
A)true
B)false
A
Cystitis is inflammation of the urinary bladder.
A)true
B)false
A
Urethritis is inflammation of the urethra.
A)true
B)false
A
Interstitial nephritis is inflammation of the kidney
A)true
B)false
A
Which of the following terms is used to refer to inflammation of the renal pelvis? A)Pyelonephritis B)Cystitis C)Urethritis D)Interstitial nephritis
A
Incontinence is noted in patients diagnosed with Parkinson’s disease.
A)true
B)false
A
Urinary retention is associated with spinal cord injury.
A)true
B)false
A
Urgency is associated with an overactive bladder.
A)true
B)false.
A
Incomplete bladder emptying is associated with diabetes mellitus.
A)true
B)false
A
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
A
The metabolic acidosis of chronic renal failure usually produces no symptoms and requires no treatment.
A)true
B)false patient do require treatment
A
Treatment of metabolic acidosis in chronic renal failure includes? A)no treatment. B)sodium bicarbonate supplements. C)hemodialysis. D)peritoneal dialysis.
A
Which of the following occur in chronic glomerulonephritis. A)Anemia, hyperkalemia B) metabolic acidosis C)hyperphosphatemia D)all the above
D
Which of the following is a change that occurs in chronic glomerulonephritis? A)Hypokalemia B)Anemia C)Metabolic alkalosis D)Hypophosphatemia
B
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
- Auscultating the lungs once per shift will help to identify whether the breath sounds are normal, abnormal, or absent.
- 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.
- 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.
B
The most accurate indicator of fluid loss or gain in an acutely ill patient is weight.
A)true
B)false
A
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
B
Integumentary manifestations of chronic renal failure include a gray-bronze skin color and ecchymosis.
A)true
B)false
A
Asterixis, tremors, and seizures are neurological manifestations of
a)chronic renal failure.
B)acute renal failure.
C)both a and b
A
Residual urine that is greater than 100 cc indicates that the suprapubic catheter cannot be discontinued
A)true
B) false can be continued
A
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
C
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
A
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
B
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
A
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
B
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
A
What incontinence is the involuntary loss of urine associated with overdistention of the bladder.
A)stress incontinence
B)overflow incontinence
B
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
C
Iatrogenic incontinence is the involuntary loss of urine due to medications
A)true
B)false, it is itraogenic
A
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
B
Azotemia is the concentration of urea and other nitrogenous wastes in the blood
A)true
B)false
A
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
B
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.
B
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
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
C
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
D
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
B
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.
B
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.
D
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
D
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
B
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
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
B
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
B
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
A
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
B
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
D
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
C
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
A
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
B
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
A
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
C
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
A
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
A
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
A
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
A
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
D
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.
A
Older men are at risk for urinary retention because of
A)prostatic hypertrophy
B)false, no
A
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
D
• 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
A
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
A
The value ranges between 1.003 and 1.030, with the lower values suggesting more dilute urine.
A)specific gravity
B)BUN
A
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
A
The acceptable serum range for BUN is 10 to 20 mg/ dL.
A)true
B)false
A
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
A
If the BUN is elevated, institute preventive nursing measures to protect the patient from possible
A)disorientation
B)seizures
C)both a and b
C
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
A
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
A
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
D
is used to diagnose impaired kidney function
A)serum creatinine test
B)BUN test
C)both a and
C
the creatinine level is affected little by A)dehydration B)malnutrition C)hepatic function D)all the above
D
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
C
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
A
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
C
Normal urine creatinine levels,
A)87 to 107 mL/ min (female)
B)107 to 139 mL/min (male)
C)both a and b
C
PROSTATE-SPECIFIC ANTIGEN
.
is an organ-specific glycoprotein produced by normal prostatic tissue
A)PSA
B)BUN
A
Normal range is less than 4 ng/ mL.
A)PSA
B)BUN
A
Elevated PSA levels result from A)prostate cancer B)benign prostatic hypertrophy (BPH) C)prostatits D)all the above
D
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
A
Results provide information on the concentrating ability of the kidney.
A)osmolality
B)specific gravity
A
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
A
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
B
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
C
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
C
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
D
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
A
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
D
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
A
: 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
A catheter is inserted and dye injected to assess the status of the urethral structure.
A)Retrograde cystography
B)Retrograde urethrography:
B
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
A
Structural abnormalities, diverticula, and reflux into the ureter may be detected.
A)Voiding cystourethrography
B)Endoscopic procedure
A
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
A
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
A
What position is the patient place in a cystocopy
A)semi fowlers
B)lithotomy
C)dorsal recumbent
B
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
A
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
A
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
D
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
B
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
A
The adrenals, the bladder, and the prostate may also be visualized through they
A)CT scan
B)renal angiogram
A
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
D
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
A
can be used for diagnoses of pathologic conditions of the renal system.
A)MRI
B)BUN
A
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
B
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
A
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
B
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
A
TRANSRECTAL ULTRASOUND
.
What procedure provides clear images of prostatic tumors that otherwise might go undiagnosed.
A)transrectal ultrasound
B)transrectal biopsy
A
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
A
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
A
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
A
URODYNAMIC STUDIES
.
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
A
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
A
___________&___________ medications may be administered during urodynamic studies to determine their effects on bladder function.
A)Cholinergic and anticholinergic
B)NSAID AND HISTIMINE
A
A cholinergic drug, such as _________ stimulates the atonic bladder;
A)bethanechol [Urecholine)
B)atropine
A
anticholinergic drug, such as ________, brings an overactive bladder to a more normal
level or function.
A)atropine
B)sympathetic drug
A
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
A
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
A
Diuretics are used in the management of a variety of disorders, such as
A)heart failure
B) hypertension
C)both a and b
C
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
A
The thiazide diuretic chlorothiazide (Diuril) affects electrolytes to cause A)hypokalemia B) hyponatremia C)hypercalcemia D) all the above
Pd
hypokalemia
A)(extreme potassium depletion in blood)
B)(decreased sodium concentration in blood)
C)(excessive amounts of calcium in blood)
A
, hyponatremia
A)(extreme potassium depletion in blood)
B)(decreased sodium concentration in blood)
C) (excessive amounts of calcium in blood)
B
hypercalcemia
A)(excessive amounts of calcium in blood)
B)(extreme potassium depletion in blood)
C) (decreased sodium concentration in blood)
A
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
A
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
B
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
A
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
D
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
C
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
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
A
There are two types of potassium-sparing diuretics:
A) aldosterone antagonists and nonaldosterone antagonists
B)renin antagonists and nonrenin antagonists
A
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
A
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
D
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
A
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
C
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
B
Although it has limited usefulness as a diuretic, acetazolamide is used to lower
A) intraocular pressure
B)false, rise introular pressure
A
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
D
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
A
This is a normal side effect that causes the urine to turn orange
A)Quinolone
B)Nitrofurantoin
A
(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)
A
(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
A
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
B
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)
A
ALKALINE-ASH FOODS
A)Milk, vegetables, fruits (except cranberries, prunes, and plums)
B) Meat, whole grains, eggs, cheese, cranberries, prunes, and plums
A
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
B
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
A
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
A
The Robinson catheter
A)has multiple openings in its tip to facilitate intermittent drainage
B)are long and slender to pass into the ureters.
A
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
A
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
A
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
A
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
A
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:
.
- Follow aseptic technique to avoid introducing microorganisms from the environment. Never rest the collecting bag on the floor.
- 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.
- Adequately hydrate the patient to flush the urinary tract.
A)true
B)false
A
- 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.
- 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.
- Check the drainage system daily for leaks.
A)true
B)false
True
- 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.
- Prevent tension on the system or backflow of urine while transferring the patient.
- 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
- 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
A
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)
A
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)
B
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
C
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
A
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
A
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
A
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
B
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
A
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
A
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
A
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)flaccid bladder
B)spastic bladder
B
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
A
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
A
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
D
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
C
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
A
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
A
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
A
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
A
Nursing Interventions UTI
.
Nursing interventions should be supportive, with patient education for adequate hydration and hygiene.
A)true for UTI
B)false FOR UTI
A
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
A
is septic poisoning due to retention and absorption of urinary products in the tissues.
A)Urosepsis
B)sepsis
A
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
A
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
B
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
A
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
B
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
B
Diagnostic test perform for urethritis?
A) Gram stain of the exudate to identify the pathogen.
B)renal scan
A
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
D
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
A
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
A
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
A
The most common microorganism causing acute cystitis is
A)E. coli.
B)herpes simplex
C)MRSA
A
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
C
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
C
Signs and symptoms of cystitis would be. A)dysuria B)urinary frequency C)pyuria D)all the above
D
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
A
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
B
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
C
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
A
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
A
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
A
The pathophysiology is unknown, but bacteria do not trigger it.
A)UTI
B)interstitial cystitis
C)both a and b
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
A
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
A
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
A
Signs and symptoms of interstitial cystitis A)dysuria B)urinary frequency C)microscopic bleeding D)all the above
D
\_\_\_\_\_\_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
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
A
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
B
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
D
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
A
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
A
