Urinary Disorder - Part 2 Flashcards
1
Q
ANATOMY AND PHYSIOLOGY OF THE URINARY SYSTEM
A
,
2
Q
As proteins break down, nitrogenous waste-urea, ammonia, and creatinine (a nitrogenous compound produced by metabolic processes in the body) is produced. The primary function of the kidneys is excretion of these waste products. The kidneys also assist in regulating the body’s water, electrolytes, and acid-base balance
A)true
B)false
A
A
3
Q
__________(a nitrogenous compound produced by metabolic processes in the body)
A
Creatine
4
Q
The primary function of the kidneys is excretion of uremia,ammonia and creatine
A)true
B)false
A
A
5
Q
The kidneys assist in regulating the body’s water, electrolytes, and acid-base balance.
A)true
B) false
A
A
6
Q
the three phases of urine formation and location of the processes are as follows:
A
Filtration,reabsorption and secretion
7
Q
- Filtration of water and blood products occurs in the glomerulus of Bowman’s capsule.
A)true
B)false
A
True
8
Q
- Reabsorption of water, glucose, and necessary ions back into the blood occurs primarily in the proximal convoluted tubules, Henle’s loop, and the distal convoluted tubules. This process reclaims important substances needed by the body.
A)true
B)false
A
A
9
Q
Reabsorption phase is of water, glucose, and necessary ions back into the blood occurs primarily in the proximal convoluted tubules, Henle’s loop, and the distal convoluted tubules.
A) true
B)false
A
A
10
Q
When the body has suffered increased fluid loss through hemorrhage, diaphoresis, vomiting, diarrhea, or other means, the blood pressure drops.
A)true
B)false
A
A
11
Q
the body suffer increased fluid loss through hemorrhage, diaphoresis, vomiting, diarrhea, or other means.
A)true
B)false
A
A
12
Q
The body suffers increase fluid loss by hemorrhage,diarrhea,vomiting and diaphoresis that causes the BP to
A
Drop
13
Q
Major Functions of the Kidneys
A
,
14
Q
Urine formation: Glomerular filtration, tubular reabsorption, and secretion; 1000 to 2000 ml of urine formed each day
A)true
B)false
A
A
15
Q
Fluid and electrolyte control: Maintain correct balance of fluid and electrolytes within a normal range by excretion, secretion, and reabsorption
A)true
B)false
A
A
16
Q
Kidneys maintain fluid and electrolyte balance by excretion, secretion and reabsorption.
A)true
B)false
A
A
17
Q
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
A)true
B)false
A
A
18
Q
Excretion of waste products: Direct removal of metabolic waste products contained in the glomerular filtrate
A)true
B)false
A
A
19
Q
Blood pressure regulation: Regulation of blood pressure by controlling the circulating volume and renin secretion
A)true
b)false
A
A
20
Q
Kidney also controls blood pressure by circulating the blood and renin secretion
A)true
B)false
A
A
21
Q
Red blood cell (RBC) production: Secretion of erythropoietin, which stimulates bone marrow to produce RBCs
A)true
B)false
A
A
22
Q
The kidney stimulates a hormone that tells the bone marrow to produce red blood cells is called
A
Erythropoietin
23
Q
Regulation of calcium-phosphate metabolism: Regulation of vitamin D activation
A)true
B)false
A
A
24
Q
URINE COMPOSITION AND CHARACTERISTICS
A
,
25
The word urine comes from one of its components, uric acid.
A)true
B)false
A
26
amount of urine is influenced by several factors, including mental and physical health, oral intake, and blood pressure.
A)true
B)false
A
27
Urine is 95% water; the remainder is nitrogenous wastes and salts.
A)true
B)false
A
28
Normal urine is yellow because of urochrome, a pigment resulting from the body's destruction of hemoglobin.
A)true
B)false
A
29
URINE ABNORMALITIES
,
30
A___________, which studies the physical, chemical, and microscopic properties of urine, can give important diagnostic information
urinalysis
31
•_________ in the urine indicates possible renal disease, increased blood pressure, or toxicity of the kidney cells from heavy metals.
Albumin
32
• __________ in the urine (glycosuria) most often indicates 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.
Glucose (sugar)
33
•_________ in the urine (hematuria) may indi- cate infection, tumors, or renal disease. Occasionally an individual may have a renal calculus (kidney stone), and irritation produces hematuria.
Erythrocytes
34
•_________ in the urine is called ketoaciduria (or ketonuria). It occurs when 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.
Ketone bodies
35
•_________ (white blood cells [WBCs]) are found in urine when there is an infection in the urinary tract.
Leukocytes
36
URINARY BLADDER
,
37
bladder can hold 750 to 1000 mL of urine.
A)true
B)false
A
38
When the bladder contains approximately 250 mL of urine, the individual has a conscious desire to urinate.
A)true
B)false
A
39
Person has consciousness to void when the bladder has 250 ml full
A
40
NORMAL AGING OF THE URINARY SYSTEM
,
41
In the aging woman the bladder loses tone and the perineal muscles may relax, resulting in stress incontinence.
A)true
B)false
A
42
Women are more affected by stress incontence, because of weak pelvic floor muscle do to loos of muscle tone in the external shinpter
A)true
B)false
A
43
In the aging man the prostate gland may become enlarged, leading to constriction of the urethra.
A)true
B)false
A
44
Common in older male adults is prostate enlargement, which causes constriction on the urethra.
A)true
B)false
True
45
Incomplete emptying of the bladder in both men and women increases the possibility of urinary tract infection (UTI)
A)true
B)false
A
46
Incomplete emptying of the bladder can lead to UTI
True
47
Urinary frequency, urgency, nocturia, retention, and incontinence are common with ______
aging
48
Urinary incontinence is a leading reason for institutional placement of older adults.
A)true
B)false
A
49
Urinary incontinence can lead to a loss of self-esteem and result in decreased participation in social activities.
A)true
B)false
A
50
Older women are at risk for stress incontinence because of hormonal changes and weakened pelvic musculature.
A)true
B)false
A
51
Older women are at risk of stress incontincnce due to weaken pelvic floor muscles and hormonal changes
A)true
B)false
A
52
Urinary tract infections in older adults are often associated with invasive procedures such as catheterization, diabetes mellitus, and neurologic disorders.
A)true
B)false
A
53
UTI in older adults are associated with neurological disorders, diabetes mellitus and chaterization
A)true
B)false
A
54
Inadequate fluid intake, immobility, and conditions that lead to urinary stasis increase the risk of infection in the older adult.
A)true
B)false
A
55
Inadequate fluid and immobility can lead to ______ in older adults
Infection
56
Common substances measured to monitor kidney function include total urine protein, creatinine, urea, uric acid levels, and catecholamines.
A)true
B)false
True
57
Common substances measured to monitor kidney function include total urine protein, creatinine, urea, uric acid levels, and catecholamines.
A)true
B)false
A
58
URINALYSIS
,
59
SPECIFIC GRAVITY
,
60
Specific gravity measures hydration status and gives information about the kidneys' ability to concentrate urine.
A) true
B)false
True
61
Specific gravity is decreased by high fluid intake, reduced renal concentrating ability, diabetes insipidus, and diuretic use.
A)true
B)false
True
62
It is increased in dehydration due to fever, diaphoresis, vomiting, diarrhea, and medical conditions such as diabetes mellitus (diabetic ketoacidosis or hyperglycemic h yperosmolar nonketotic coma) and inappropriate secretion of ADH.
Specific gravity
63
BLOOD (SERUM) UREA NITROGEN
,
64
Blood urea nitrogen (BUN) is a laboratory test used to determine the kidney's ability to rid the blood of non- protein nitrogen (NPN) waste and urea, which result from protein breakdown (catabolism).
A)true
B)false
True
65
Normal BUN is 10 to 20 mg / dL.
A)true
B)false
True
66
For a more accurate test result of BUN TEST, the patient should receive (NPO) for 8 hours before blood sampling.
A)true
B)false
A
67
If the BUN is elevated, institute preventive nursing measures to protect the patient from possible ___________or________
disorientation or seizures.
68
BLOOD (SERUM) CREATININE
,
69
creatinine, depends on muscle mass, which fluctuates little.
A)true
B)false
A
70
Only renal disorders (such as glomerulonephritis, pyelonephritis, acute tubular necrosis, and urinary obstruction) cause an abnormal elevation in creatinine.
A)true
B)false
A
71
The serum creatinine test, as with BUN, is used to diagnose impaired kidney function.l
A)true
B)false
A
72
Blood creatinine level is affected little by dehydration, malnutrition, or hepatic function.
A)true
B)false
True
73
Blood creatine is affected little by dehydration, hepatic function and malnutrition
A)true
B)false
A
74
The acceptable serum creatinine range is 0.5 to 1.1 mg/ dL (female) and 0.6 to 1.2 mg/ dL (male)
A)true
B)false
A
75
Normal creatine for female, 0.5-1.1 and 0.6-1.2 for male
A)true
B)false
A
76
CREATININE CLEARANCE
,
77
Creatinine, an NPN substance, is present in blood and urine. Levels are directly related to muscle mass and are usually measured for a 24-hour period
A)true
B)false
A
78
Creatinine is generated during muscle contraction and then excreted by glomerular filtration.
A)true
B)false
A
79
During the testing period, the patient avoids_________ physical activity.
excessive
80
Normal ranges are serum, 0.5 to 1.1 mg/ dL (female), 0.6 to 1.2 mg / dL (male);
A)true
B)false
A
81
Normal range for urine creatinine is , 87 to 107 mL/ min (female), 107 to 139 mL/min (male)
A)true
B) false
A
82
PROSTATE-SPECIFIC ANTIGEN
,
83
Prostate-specific antigen (PSA) is an organ-specific glycoprotein produced by normal prostatic tissue.
A)true
B)false
True
84
Test results rise with tissue manipulation; therefore obtain a blood sample before physical examination.
A)true
B)false
A
85
Obtain an blood sample before PSA because the physical examination can rise the leve
A)true
B)false
A
86
Normal range is less than 4 ng/ mL.
A)PSA
B)false 10
A
87
Elevated PSA levels result from prostate cancer, benign prostatic hypertrophy (BPH), and prostatitis.
A)true
B)false
A
88
OSMOLALITY
,
89
Assessment of urine osmolality (the weight of the solute compared with its own weight) may be preferred over specific gravity.
A)true
B) false
A
90
Assessment of urine osmolality may be preferred over specific gravity.
A)true
B)false
A
91
When pituitary disorders are suspected plasma osmolality may be done in conjunction with the urine sampling.
A)true
B)false
A
92
KIDNEY-URETER- BLADDER RADIOGRAPHY
,
93
A kidney-ureter-bladder (KUB) radiograph assesses the general status of the abdomen and the size, structure, and position of the urinary tract structures.
A)true
B)false
A
94
Abnormal findings related to the urinary system may indicate tumors, calculi, glomerulonephritis, cysts, and other conditions.
A)true
B)false
A
95
INTRAVENOUS PYELOGRAM OR INTRAVENOUS UROGRAPHY
,
96
```
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
```
A
97
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 iodine rich soils) because it is the base of the radiopaque dye that is injected into a vein for this and other radiologic examinations.
A)true
B) false
True
98
Beware of iodine-containing foods such as iodized salt, saltwater fish, seaweed products, vegetables grown in iodine rich soils)
A)true
B)false
A
99
If the patient has had an allergic reaction to iodine, the physician may order administration of a corticosteroid or an antihistamine before testing or, alternatively, may order ultrasonography.
A)true
B)false
A
100
Preparation usually includes eating a light supper, taking a non-gas- forming laxative, and remaining NPO 8 hours before testing.
IPV , IUV
101
When the dye is injected, the patient experiences a warm, flushing sensation and a metallic taste.
A)true
B)false
A
102
RETROGRADE PYELOGRAPHY
.
103
Retrograde pyelography involves examination of the lower urinary tract with a cystoscope under aseptic conditions.
A)true
B)false
A
104
Retrograde cystography: Radiopaque dye is injected through an indwelling catheter into the urinary bladder to evaluate its structure or to determine the cause of recurrent infections.
A)true
B)false
A
105
Retrograde urethrography: A catheter is inserted and dye injected as with the cystography to assess the status of the urethral structure.
A)true
B)false
A
106
VOIDING CYSTOURETHROGRAPHY
,
107
Preparation includes an enema before testing.
VOIDING CYSTOURETHROGRAPHY
108
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)true
B)false
True. BVOIDING CYSTOURETHROGRAPHY
109
ENDOSCOPIC PROCEDURES
,
110
Endoscopic procedures are visual examinations of hol- low organs using an instrument with a scope and light source
A)true
B)false
A
111
informed consent is necessarY,
A)endoscopic procedure
B)none
A
112
Cystoscopy is a visual examination to inspect, treat, or diagnose disorders of the urinary bladder and proximal structures. The patient is placed in a litho tomy position for the procedure, which may produce embarrassment and anxiety.
A)true
B) false
A
113
The patient experiences a feeling of pressure as the scope is passed. Continuous fluid irrigation of the bladder is necessary to facilitate visualization . 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)true
B)false
A
114
Nephroscopy (renal endos- copy) 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
A
115
RENAL ANGIOGRAPHY
,
116
Renal angiography aids in evaluating blood supply to the kidneys, evaluates masses, and detects possible complications after kidney transplantation.
A)true
B)false
True
117
when the procedure is completed, have the patient lie flat in bed for several hours to minimize the risk of bleeding. Assess the puncture site for bleeding or hematoma, and maintain the pressure dressing at the site. Assess circulatory status of the involved extremity every 15 minutes for 1 hour, then every 2 hours for 24 hours.
Renal angiogram
118
Life Span Considerations
| Older Adults Urinary Disorder
,
119
RENAL VENOGRAM
,
120
renal venogram provides information about the kidney's venous drainage
A)true
B) false
A
121
COMPUTED TOMOGRAPHY
,
122
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 creatinine level are obtained before use of radi- opaque dye.
A)true
B)false
A
123
MAGNETIC RESONANCE IMAGING
L
124
Magnetic resonance imaging (MRI) uses nuclear magnetic resonance as its source of energy to obtain a visual assessment of body tissues.
A)true
B)false
A
125
Patients with metal prostheses (such as heart valves, orthopedic screws, or cardiac pacemakers) cannot undergo MRI.
A) true
B)false
A
126
Patient will hear a pounding sound during MRI THAT IS NORMAL
A)true
B)false
A
127
RENAL SCAN
,
128
The scan provides data related to functional parenchyma (the essential parts of an organ that are concerned with its function). No special preparation is needed
A)true
B)false
A
129
Pregnant nurses should refrain from caring for this patient during this time.
Renal scam
130
ULTRASONOGRAPHY
,
131
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.
A)true
B)false
A
132
Deviations from normal findings may indicate tumor, congenital anomalies, cysts, or obstructions. No special preparations are necessary.
Ultrasonography
133
TRANSRECTAL ULTRASOUND
,
134
Transrectal ultrasound instrumentation of the prostate gland provides clear images of prostatic tumors that otherwise might go undiagnosed.
A)true
B)false
A
135
RENAL BIOPSY
,
136
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.
A)true
N)false
True
137
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.
Renal biopsy
138
holding the breath.during the renal biopsy procedure
A)true
B)false
A
139
URODYNAMIC STUDIES
,
140
Urodynarnic studies are indicated when neurologic disease is suspected of being an underlying cause of incontinence.
A)true
B)false
True
141
The studies evaluate detrusor reflex.
Urodynamic
142
During cystometrogram a catheter is inserted into the bladder, then connected to a cystometer, which measures bladder capacity and pressure
Urodynamic studies
143
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 during a
Cystogramometer of urodynamic studies
144
Cholinergic and anticholinergic medications may be administered during urodynamic studies to determine their effects on bladder function
A)true
B) false
A
145
Cholinergic and anticholinergic are medications administered during urodynamic studies to determine their effects on bladder function
A)true
B)false
True
146
(A cholinergic drug, such as bethanechol [Urecholine], stimulates the atonic bladder;
A)true
B)false
A
147
an anticholinergic drug, such as atropine, brings an overactive bladder to a more n ormal level or function.
A)true
B)false
A
148
MEDICATION CONSIDERATIONS
,
149
The kidneys' effectiveness of removing medications from the blood may be affected by various conditions, such as renal disease, changes in the pH of urine, and age.
A)true
B)false
A
150
Changes in ph, renal disease and age can affect the kidneys on removing medications in the blood
A)true
B)false
A
151
DIURETICS TO ENHANCE URINARY OUTPUT
,
152
Diuretics are administered to enhance urinary output.
A)true
B)false
A
153
Diuretics increase urinary output.
A) true
B)false
A
154
_________They achieve this by increasing the kidney's filtration of sodium, chloride, and water at different sites in the kidney.
Diuretics
155
Diuretics, Are achieve by increasing filtration of sodium, chloride, and water at different sites in the kidney.
A)true
B)false
A
156
Diuretics are used to mange hypertension and heart failure.
A)true
B) false
A
157
Thiazide Diuretics
,
158
________impair sodium and chloride reabsorption, leading to excretion of electrolytes and water.
Thiazides
159
The thiazide diuretic chlorothiazide (Diuril) affects electrolytes to cause hypokalemia, hyponatremia, and/ or hypercalcemia.
A)true
B)false
A
160
Hypochloremic alkalosis occurs from a deficiency of chloride
A)true
B)false
A
161
The main uses of________ diuretics is management of systemic edema and control of mild to moderate hypertension, although it may take a month to achieve the full antihypertensive effect.
Thiazides
162
Chlorothiazide is contraindicated in anuria.
A)true
B)false
A
163
Thiazides diuretics main use is for edema and mild to moderate hypertension
A)true
B) false
A
164
Loop (or High-Ceiling) Diuretics
,
165
Loop (or High-Ceiling) Diuretics inhibit sodium and chloride tubular reabsorption.
A)true
B)false
A
166
___________ This group of diuretics is the most potent of all diure tics and may lead to significant electrolyte depletion
Loop (or High-Ceiling) Diuretics
167
These diuretics are effective for use in patients with impaired kidney function .
Loop Diuretics
168
The loop diuretic furosemide (Lasix) affects electrolytes to cause hypokalemia, hypochloremia, hyponatremia, hypocalcemia, and /or hypomagnesemia.
A)true
B)false
A
169
Furosemide is used in nephrotic syndrome, heart failure, and pulmonary edema.
A)true
B)false
A
170
Furosemide is a loop diuretic used in nephrotic syndrome, heart failure, and pulmonary edema.
A)true
B)false
A
171
Potassium-Sparing Diuretics
,
172
_______Diuretics act on distal con. tubule to inhibit sodium reabsorption and potassium secretion.
Potassium-Sparing Diuretics
173
diuretics decrease the sodium-potassium exchange
Potassium sparing diuretics
174
Potassium-sparing diuretics are contraindicated in patients who experience______________, since further retention of potassium could cause a fatal cardiac dysrhythmia
hyperkalemia
175
Retention of extra potassium can cause fatal dysrythymia of the heart
A)true
B)false
A
176
There are two types of potassi um-sparing diuretics: aldosterone antagonists and nonaldosterone antagonists.
A)true
B)false
A
177
Corticosteroid hormone that stimulates absorption of sodium, to regulate water and salt balance.
Aldosterone
178
The aldosterone antagonist spironolactone (Aldactone) blocks aldosterone in the distal tubule to promote potassium uptake in exchange for sodium secretion.
A)true
B)false
A
179
The aldosterone antagonist spironolactone (Aldactone) blocks aldosterone to promote potassium uptake in exchange for sodium secretion.
A)true
B)false
A
180
The aldosterone antagonist spironolactone (Aldactone). Although it can be used in combination with other diuretics, primarily in the treatment of hypertension and edema.
A)true
B)false
A
181
The nonaldosterone antagonist triamterene (Dyrenium). Triamterene is instead used to help limit the potassium-wasting effect of other diuretics.
A) true
B) false
A
182
Osmotic Diuretics
,
183
_________increase plasma osmotic pressure, causing redistribution of fluid toward the circulatory vessels.
Osmotic diuretics
184
Osmotic diuretics are used to manage edema, promote systemic diuresis in cerebral edema, decrease intraocular pressure, and improve kidney function in acute renal failure (ARF).
A)true
B)false
A
185
Osmotic diuretics are used to manage all edema, decrease intraocular pressure, and improve kidney function in acute renal failure (ARF).
A)true
B)false
A
186
Mannitol is used to prevent or treat the oliguric phase of ARF, promote systemic diuresis in cerebral edema, and decrease intraocular pressure.
Osmotic diuretic
187
Carbonic Anhydrase Inhibitor Diuretics
,
188
interferes with the bonding of water and carbon dioxide by the enzyme carbonic anhydrase (present in red blood cells ) at the proximal convoluted tubule. acetazolamide is used to lower intraocular pressure.
Carbonic Anhydrase Inhibitor Diuretics
189
Nursing Interventions
,
190
Because patients receiving diuretics often have complicated disease conditions such as heart failure and pulmonary edema, monitor for signs and symptoms of fluid overload: changes in pulse rate, respirations, cardiac sounds, and lung fields.
A)true
B)false
A
191
Diet instruction to the patient and the family should include a warning to avoid overuse of salt in cooking or as a table additive.
A)true
B)false
A, for diuretics
192
The use of most diuretics, with the exception of the potassium-sparing diuretics, requires adding daily potassium sources.
A)true
B)false
A
193
(e.g., baked potatoes, raw ban anas, apricots, or navel oranges). The following just listed are
Potassium sources
194
MEDICATIONS FOR
| URINARY TRACT INFECTIONS
,
195
Urinary antiseptics are divided into four groups: quinolones, nitrofurantoins, methenamines, and fluoroquinolones
A)true
B)false
A
196
Quinolone Nalidixic acid (NegGram) is used to treat UTis. The common side effects are drowsiness,vertigo, weakness.
A)true
B)false
A
197
The use of nalidixic acid is contraindicated in renal impairment.
A)true
B)false
A
198
```
Nitrofurantoin compound (Macrodantin) is effective against both gram-positive and gram-negative microbes,in the urinary tract. Common side effects are loss of appetite.
A)true
B)false
```
A
199
```
Methenamine mandelate (Mandelamine) suppresses fungi and gram-negative and gram-positive organisms. 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. is used for patients with chronic, recurrent UTis as a preventive measure after antibiotics have cleared the infection. side effects are rare, they include, skin rash, and urticaria (hives).
A)true
B)false
```
A
200
Norfloxacin (Noroxin) is a broad-spectrum antibiotic effective against gram-positive and gram-negative or- ganisms. 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) true
B)false
A
201
Nursing Interventions
,
202
Hydrate the patient to produce daily urinary output of 2000 mL, unless contraindicated.
A)true
B)false
A
203
When indicated, teach the patient to use the acid-ash diet to help maintain a urine pH of 5.5
A)true
B) false
A
204
Soothe skin irritations with cornstarch or a bath of bicarbonate of soda or dilute vinegar.
A)true
B)false
A
205
Monitor the patient receiving nitrofurantoin for signs of allergic response (such as erythema, chills, fever, and dyspnea).
A)true
B)false
A
206
NUTRITIONAL CONSIDERATIONS
,
207
·Acid-ash diets should be supplemented with vitamins C and A and folic acid.
A) true
B)false
A
208
MAINTAINING ADEQUATE
| URINARY DRAINAGE
,
209
__________ are used to maintain urine flow, to divert urine flow to facilitate healing postoperatively, to introduce medications by irrigation, and to dilate or prevent narrowing of some portions of the urinary tract.
Urinary catheters
210
Urethral catheters range from 14 to 24 (16)F for adult patients.
Ureteral catheters are usually 4 to 6 F.
A)true
B)false
A
211
TYPES OF CATHETERS
,
212
The________ catheter has a tapered tip and is selected for ease of insertion when enlargement of the prostate gland is suspected.
A)coude
B) foley
A
213
_____a balloon near its tip that may be inflated after insertion, holding the catheter in the urinary bladder for continuous drainage.
Foley
214
Malecot and de Pezzer, or mushroom, catheters are used to drain urine from the renal pelvis of the kidney.
A)true
B)false
A
215
The Robinson catheter has multiple openings in its tip to facilitate intermittent drainage.
A)true
B)false
A
216
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
A
217
Nursing interventions for the patient with a urinary drainage system involve a number of principles to prevent and detect infection and trauma:
,
218
If urinary output falls below 50 mL/hr, check the drainage system for proper placement and function before contacting the physician.
A)true
B)false
A
219
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 UTis.
A)true
B)false
A
220
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 solution or ointment may be ordered to use at the catheter incision site.
A)true
B)false
A
221
Ambulate the patient if possible to facilitate urine flow. If the patient's activity must be restricted, turn and reposition every 1-2 hours.
A)true
B)false
A
222
PATHOLOGICAL
,
223
Incontinence may be permanent, as with spinal cord trauma, or temporary, as with pregnancy.
A)true
B)false
A
224
UI m ay also result from physiologic conditions such as obesity, chronic lung disease, smoking, and surgery.
A)TURE
B)false
A
225
Lack of estrogen in postmenopausal women contributes to atrophy of the vaginal and urethral walls with subsequent loss of muscle tone that may result in postvoiding urine retention and possible prolapse of the bladder.
A)true
B)false
A
226
The cardinal sign of Ul is the involuntary loss of urine.
A)true
B)false
A
227
A woman may complain of urine leaking when she coughs, sneezes, lifts heavy objects, or has intercourse
A)UI
B)IC
A, subjective data
228
Stress incontinence related to sphincter weakness may be treated with collagen implant injections. The patient may require temporary or permanent urinary diversion or management with an indwelling catheter.
A)true
B)false
A
229
UI IS MANGE BY COLLAGEN INJECTIONS, INDWELLING CHAT, AND URINARY DIVERSIONS
A)true
B)false
A
230
Management of stress incontinence should include behavior modification, pelvic floor muscle therapies, medications, and mechanical devices before resorting to surgical procedures.
A)true
B)false
A
231
Estrogen replacement for the treatment of UI is controversial and its reported effectiveness varies.
A)true
B)false
A
232
Topical administration of prednisone and estrogen may help restore turgor and elasticity of the vaginal submucosa.
A)true, UI
B)false,UI
A,
233
```
Transdermal oxybutynin (Oxytrol) is effective in reducing the symptoms of an overactive bladder with few side effects.
A)true
B)false
```
A
234
The incontinent patient may reduce fluid intake to decrease voiding, but without adequate fluids, urine may become more concentrated, irritating the bladder mucosa and increasing the urge to urinate.
A)true
B)false
A
235
Teach the patient bladder training exercises to improve the tone of the perineal muscles.
A)UI
B)IC
A
236
Establish a 2-hour schedule for the patient to go to the bathroom.
A)care plan for UI
B)false
A
237
Alcoholic and caffeinated drinks stimulate urgency and urination; advise the patient not to drink too much liquid just before bedtime.
A)true,UI
B)false,UI
A
238
NEUROGENIC BLADDER
,
239
________ means the loss of voluntary voiding control, resulting in urinary retention or incontinence. is caused by a lesion of the nervous system that interferes with normal nerve conduction to the urinary bladder. 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
Neurogenic bladder
240
Neurogenic bladder 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)true
B)false
A
241
Spastic (reflex or automatic) 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)true
B)false
A
242
```
A flaccid (atonic, nonreflex) bladder, caused by a lesion 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)true
B)false
```
A
243
Subjective data include patient complaints of diaphoresis, flushing and nausea before reflex incontinence, or infrequent voiding.
A)UI
B)neurogenic bladder
B
244
To assess the type and extent of damage to the urinary tract, chemistry studies monitor change in BUN and creatinine levels.
A)diagnosis of neruogenic bladder
B)diagnosis of UI
A
245
Sacral Nerve Modulation
| (Sacral Neuromodulation) and Stimulation
,
246
It corrects UI by modulating the neural reflexes, reducing stimulation to an overactive bladder, or boos ting stimulation to an underactive one. If the patient achieves 50% continence, a permanent implant is put in place.
A)true
B)false
A
247
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
A
248
Management of the patient with a flaccid bladder is similar. Place the patient on a 2-hour voiding schedule for bladder training.
A)true
B)false
A
249
UR1NARY TRACT INFECTIONS
,
250
A UTI is the presence of micoorganisms 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)true
B)false
A
251
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 .
A)true
B)false
A
252
Immobility, sensory impairment, and multiple organ impairment may increase the chances of infection in older adults.
A)UTI
B)IC
A
253
UTis are caused by pathogens that enter the urinary tract, with or w ithout symptoms.
A)true
B)false
A
254
Many chronic health problems predispose the patient to a UTI: diabetes mellitus, multiple sclerosis, spinal cord injuries, hypertension, and renal diseases.
A)TURE
B)false
A
255
The patient with a compromised in1mune system does not seem to be predis posed to UTI infections
A)true
B)false
A
256
Gram-negative microorganisms that commonly infect the urinary tract (e.g., E. coli and Klebsiella, Proteus, or Pseudomonas organisms) are usually from the gastrointestinal tract and ascend through the urinary meatus.
A)true
B)false
A
257
If there is incomplete emptying of the bladder or reflux of urine, the retained urine supports growth of bacteria.
A)creates UTI
B)false
A
258
The common signs and symptoms associated with UTI are urgency, frequency, burning on urination, and hematuria.
A)true
B)false
A
259
```
UTis are identified by the location of the in- fection:
urethritis (urethra),
cystitis (urinary bladder),
pyelonephritis (kidney),
and prostatitis (prostate gland).
A)true
B)false
```
A
260
include patient complaints of pain or burning on urination, urgency, frequen cy, and nocturia. The patient may also have related asthenia. Abdominal discomfort, perineal pain, or back pain may be present, depending on the extent of the disease process and site of infection .
Subjective data UTI
261
Urine culture and bacteriologic tests confirm the diagnosis of UTI
A)true
B)false
A
262
Urinary antiseptics, such as methenamine mandelate, may be used prophy lactically in recurrent infections.for
A)UTI
B)IC
A
263
For neurogenic bladder or other retention, intermittent catheterization permits urinary drainage.
A)true
B)false
A
264
Comfort measures include a regimen of antiinfective agents, urinary analgesics (e.g., phenazopyridine [Pyridium]), adequate fluid intake, and perineal care.
A)true for UTI
B)TURE for UI
A
265
Urosepsis is septic poisoning due to re tention and absorption of urinary products in the tissues.
A)true
B)false
A
266
Complementary & Alternative Therapies Urinary Disorders
,
267
Cranberry used to prevent UTI
A)true
B)false
A
268
Echinacea stimulates the immune system and treats UTI.
A)true
B)false
A
269
```
Sea holly (Eryngium campestre) aboveground plant parts have a mild diuretic effect.
A)true
B)false
```
A
270
Nettle (Urtica dioica) is currently being investigated as an irrigation for the urinary tract and also to treat benign prostatic hypertrophy
A)true
B)false
A
271
Caffeine increases urine production.
A)true
B)false
A
272
Some believe that acupuncture applied to the abdominal meridian may help relieve cystitis.
A)true
B)false
A
273
Some advocate massage with diluted rosemary, juniper, or lavender to aid in relieving pain associated with cystitis.
A)true
B)false
A
274
URETHRITIS
,
275
, inflammation of the urethra, is classified by the presence or absence of gonorrhea. Nongonorrheal urethritis is called nonspecific urethritis (NSU). NSU may be caused by candidail or trichomonal infections in women.
Urethritis
276
With gonorrheal urethritis, 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)true
B)false
A
277
Subjective data 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. From
Urethritis
278
The first step in medical management is prevention of injury to the urethra during catheterization or sexual intercourse.for
Urethritis
279
Comfort measures include antibiotics, adequate fluid intake to flush the system , warm sitz baths, and special care of the perineum using clean technique. For
Urethritis
280
CYSTITIS
,
281
Cystitis is an inflammation of the wall of the urinary bladder, usually caused by urethrovesical reflux, introduction of a catheter or similar instrument, or contamination from feces. The most common microorganism causing acute cystitis is E. coli.
A)true
B)false
A
282
Cystitis in men usually occurs sec- ondary to another infection, such as prostatitis or epididymitis
A)true
B)false
A
283
The common signs and symptoms associated with cystitis are dysuria, urinary frequency, and pyuria.
A)true
B)false
A
284
Patient complaints include burning on urination, dysuria, frequency, urgency, and nocturia.
Subjective data for cystitis
285
A voiding cystogram may be used to identify reflux of urine into the bladder. To confirm cystitis
A)true
B)false
A
286
INTERSTITIAL CYSTITIS
,
287
IC 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)true
B)false
A
288
If a patient has signs and symptoms of a UTI but no bacteriuria, pyuria, or positive urine culture, IC is suspected
A)true
B)false
A
289
ADLs and personal relationships may be disrupted by voiding patterns do to IC.
A)true
B) false
A
290
IC 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)true
B)false
A
291
Amitriptyline (Elavil) and nortriptyline (Aventyl) are two antidepressants that reduce the burning pain and frequency of urination of IC
A)true
B)false
A
292
The only oral medication approved by the FDA to trea t the pain or discomfort of IC is pentosan. 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)true
B)false
A
293
Potential dietary irritants include spicy and acidic floods, such as tomatoes, alcohol, citrus fruits, dark chocolate, and coffee.
For IC
True
294
PROSTATITIS
,
295
Bacterial prostatitis is caused by infectious organisms such as Pseudomonas organisms and S. faecal is traveling up the urethra.
A)true
B)false
A
296
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
A
297
Prostatodynia (pain in the prostate gland) manifests with neither inflammation nor infection but demonstrates the other symptoms typical of prostatitis
A)true
B)false
A
298
Edema of the prostate gland may serve as an obstruction, causing urinary retention as a complication to the prostatitis.
A)true
B)false
A
299
symptoms of acute bacterial prostatitis are often the same as those of UTI, with pain in the low back, perineum, or rectum
A)true
B)false
A
300
The expressed prostate secretion (EPS) is considered useful in the diagnosis of prostatitis.
A)true
B)false
A
301
```
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)for prostatitis
B)false
```
A
302
Antibiotics commonly used for acute and chronic bacterial prostatitis include trimethoprim-sulfamethoxazole, ciprofloxin (Cipro), and ofloxacin (Floxin).
A)true
B)false
A
303
Antibiotics are usually given orally for up to 4 weeks for acute bacterial prostatitis.
A)true
B)false
A
304
Patients with chronic bacterial prostatitis are given oral antibiotic therapy for 4 to 16 weeks.
A)true
B) false
A
305
Regardless of the pathologic basis, comfort measures used are analgesics, sitz baths, and stool softeners to reduce pain, edema, spasm, and straining pressure in the pelvis.
A)for prostatits
B)false
A
306
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)true
B)false
A
307
PYELONEPHRITIS
,
308
Pyelonephritis is an inflammation of the structures of the kidney-renal pelvis, renal tubules, and interstitial tissue.Pyelonephritis is almost always caused by E. coli.
A)true
B) false
A
309
The kidney becomes edematous and inflamed, and the blood vessels are congested
Phynephritis
310
Pyelonephritis 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)true
B)false
A
311
Acute pyelonephritis may be unilateral or bilateral, causing chills, fever, prostration, and flank pain.
A)true
B)false
A
312
Repeated episodes of pyelonephritis lead to a chronic disease pattern, with atrophy of the kidney as the nephrons are destroyed.
A)true
B)false
A
313
Azotemia develops if enough nephrons are nonfunctional.in plyenephritiis
A)true
B)false
A
314
CVA tenderness to percussion is a common finding in pyelonephritis.
A)true
B)false
A
315
Diagnosis is confirmed by bacteria and pus in the urine, varying degrees of hematuria, "WBCs and WBC casts in the urine (incticating involvement of the renal parenchyma), and leukocytosis.for
Pyelonephritis
316
The patient with mild signs and symptoms may be treated on an outpatient basis with antibiotics for 14 to 21 days for
Plyenephritiis
317
Antibiotics are selected according to results of urinalysis culture and sensitivity and may include broad-spectrum medications such as ampicillin or vancomycin combined with an aminoglycoside; other treatment options include trimethoprim-sulfamethoxazole and fluoroquinolones such as ciprofloxin and ofloxacin.
A)true
B)false
Plyenephritiis
318
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
Plyenephritiis
319
URINARY OBSTRUCTION
,
320
Causes of obstruction include strictures, kinks, cysts, tumors,calculi, and prostatic hypertrophy.is what condition
Urianary obstruction
321
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
Urinary obstruction
322
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.
Is an ex of
Urinary obstruction
323
patient's cardinal complaint of a sensation of needing to void but only being able to void small amounts.
Urinary obstruction
324
As a quick evaluation, the physician may order a KUB radiograph. Renal ultrasonography or IVP provides definitive information about structural changes.to diagnosis
A)urinary obstruction
B)herpes
A
325
Conservative measures include inserting an indwelling catheter and administering an analgesic (usually opioid) and an anticholinergic agent (atropine) to decrease smooth muscle motility.
A)true, urinary obstruction
B)false
A
326
Surgical correction of an obstruction in the urinary system may involve a tube, called a stent. Stent insertion is used for patients who are poor operative risks.The stent holds the tubular structure open to facilitate drainage.Stents may be permanent or temporary.
A)true
B)false
A
327
observe the patient for hemorrhage, provide aseptic care of the surgical site, and provide a safe environment to prevent injury and infection.nursing intervention for
Urinary obstruction
328
HYDRONEPHROSIS
,
329
is caused by obstructions in the lower urinary tract, the ureters, or the kidneys.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)hydronephrosis
B) plyenephritiis
A
330
Slowly developing hydronephrosis may cause only a dull flank pain, whereas a sudden occlusion of the ureter, such as from a calculus, causes a severe stabbing (colicky) pain in the flank.
A)hydronephrosis
B)plyenephritiis
A
331
Nausea and vomiting, which often accompany hydronephrosis, area reflex reaction to the pain and usually subside when the pain is controlled
A)true
B)false
A
332
Discuss the patient's voiding pattern: frequency, difficulty starting a stream of urine, dribbling at the end of micturition (voiding), noctouria, and burning on urination. Note any history of obstructive disorders.
A)true
B)false
Hydronephrosis
333
assessing patients suspected of having hydronephrosis for vomiting, hematuria, urinary output, edema, a palpable mass in the abdomen, bladder distention (detected on palpa- tion), and tenderness over the kidneys or bladder.
A)true
B)false
A
334
A urinalysis and serum kidney function studies that include measurement of urea and creatinine are obtained. for hydronephrosis
A)true
B)false
A
335
Radiographic examinations may include IVP or IVU, KUB radiograph, CT scan, or ultrasound evaluation.for diagnosis of hydronephrosis
A)true
B)false
A
336
antiillfective medications are administered: penicillill in combination with sulfasoxazole (Gantrisin) or suJ£ame thoxazole-trimethoprim (Bactrim).for hydronephrosis
A)true
B)false
A
337
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.
A)true
B)false
A
338
Describe measures to prevent infection, such as adequate fluid intake, perineal hygiene d aily with nilld soap and water (drying thoroughly), and regular emptying of the bladder.
A)true for hydronephrosis
B)false
A
339
UROLITHIASIS
,
340
However, some individuals are predisposed to urolithiasis: people who are immobile, are hyperparathyroid (cakiwn leaves the bones and accumulates in the bloodstream), or have recurrent UTis.
A)true
B)false
A
341
The patient describes the pain as starting in the flank and radiating into the groin, the genitalia, and the inner thigh. For kidney stones s/s.
A)true
B)false
A
342
Diagnostic tests to confirm kidney stones include KUB and IVP or IVU radiography, ultrasonnd, cystoscopy, and urinalysis.
A) true
B)false
A
343
Antiinfective agents may be administered to treat infection or prophylactically.for kidney stones.
A) true
B)false
A
344
Stones in the lower tract can be removed by cystoscopy with stone manipulation or by surgical incision.
A)true
B)false
A
345
Chemolytic agents, either alkylating or acidifying agents, may be instilled to dissolve stones.
A)true
B)false
A
346
_______agents, either alkylating or acidifying agents, may be instilled to dissolve stones.
Chemolytic
347
Long-term management may include dietary adjustments to alter urine pH or to decrease availability of certain substances that cause stone formation.
A) true
B)false
A
348
Foods to avoid include cheese, greens, whole grains, carbonated beverages, nuts, chocolate, shellfish, and organ meat. Daily fluid intake of 2000 mL (unless clinically contraindicated) helps cleanse the urinary tract.
A)true
B)false
A
349
Drug therapy depends on stone composition. In calcium stone formation, sodium cellulose phosphate binds with ingested calcium and prevents its absorption.
A)true
B)false
A
350
Stones are more likely to be passed if the patient remains active and increases fluid intake.
A)true
B)false
A
351
All urine is strained. Because stones may be any size, save even the smallest speck for as- sessment. Encourage fluid s and administer analgesics as ordered .
A)true
B)false
A
352
Monitor BUN and creatinine for indications of continuing urinary tract obstruction.
A)true
B)false
A
353
The patient should avoid inactivity by walking frequently.
A)true
B)false
A
354
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)true
B)false
A
355
TUMORS OF THE URINARY SYSTEM
,
356
RENAL TUMORS
,
357
Renal cell carcinoma as a primary malignant tumor appears to arise from cells of the proximal convoluted tubules.
A)renal tumor
B)cancer
A
358
Twice as many men as women are diagnosed with renal cancer. And the average age is 65
A)renal tumor
B) herpes
A
359
The strongest risk factors appear to be genetic; multifocal renal adenocarcinomas have a hereditary basis, which is being studied intensively.
A)renal tumor
B)false
A
360
The historic sign and symptom triad of renal adenocarcinoma is hematuria, flank pain, and a flank mass.
A)true
B)false
A
361
Other common signs and symptoms of renal tumor are hypercalcemia, fever, anemia, weakness, and erythrocytosis.
A)true
B)false
A
362
Check the patient's home medications for anticoagulant therapy, since this may be the cause of hematuria.
A) true
B)false
A
363
Subjective data include a patient history of blood in the urine, which " comes and goes." When the bleed- ing occurs, there is usually no associated pain. In advanced stages of the illness, the patient experiences weight loss, fatigue, and dull flank pain.
A)true
B) false
A
364
Because renal adenocarcinoma is relatively radioresistant, radiation therapy has little or no role in its treatment.Surgery is the sole intervention capable of cure.
A)true
B)false
A
365
RENAL CYSTS
,
366
Multiple cysts are most common in patients with chronic renal failure, especially those undergoing hemodialysis.
A)true
B)false
A
367
PKD 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.
A)true
B)false
A
368
The patient may progress to end-stage renal disease (ESRD). With renal cysts
A)true
B)false
A
369
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.
Renal cysts
370
The Bosniak Classification of Renal Cysts classifies lesions according to their character. 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 IV lesions show nonuniform wall thickening and irregular margins; they contain solid components visible on CT.
These lesions are clearly malignant, and a total nephrectomy is warranted.
True
371
Subjective data include the most common symptoms of abdominal and flank pain, followed by headache, gastrointestinal complaints, voiding disturbances, and a history of recurrent UTis.
Renal cysts
372
Closely monitor blood pressure, which is usually elevated, and hematuria.
Renal cysts
373
Diagnosis of renal cysts is established by family history, physical examination, excretory urography, and imaging of cysts on radiographic examination or sonography.
A)true
B)false
A
374
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.
Nursing interventions for renal cystsn
375
Hypertension is treated vigorously with antihypertensive agents, diuretics, and fluid and dietary modifications.
A)true
B)false
A
376
Because infections are common, antibiotics are often prescribed
A)true for renal cysts
B)false
A
377
TUMORS OF THE URINARY BLADDER
,
378
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 bladd er, in many cases because the cells were exposed to certain chemicals.
Tumor of the urinary bladder
379
Papillomas have the potential to become cancerous and are removed when detected . A noncancerous bladder tumor is usually a small, wartlike growth that does no t spread.
A)true
B)false
A
380
black patients were 35% more likely to die of bladder cancer than white patients.
A)true
B)false
A
381
Men are more likely to develop bladder cancer than women; cigarette smoking is a major factor
A)true
B)false
A
382
primary sign of bladder cancer is painless, intermittent hematuria.
A)true
B)false
A
383
Local disease may be treated by removing the tissue by burning with an electric spark (fulguration), laser, instillation of chemotherapy agents, or radiation therapy.
A)true
B)false
A
384
Closely monitor these patients with cytologic studies and cystoscopy, since the recurrence rate is as high as 60%.
A)true
B)false
A
385
BENIGN PROSTATIC HYPERTROPHY
,
386
The prostate enlarges, exerting pressure on the urethra and vesicle neck of the urinary bladder, which prevents complete emptying.
A)BPH
B)none
A
387
prostatism (any condition of the prostate gland that causes retention of urine in the bladder)
A)true
B)false
A
388
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)true
B)false
A
389
Terazosin (Hytrin) is an antihypertensive that dilates arteries and veins and decreases contractions in smooth muscle of the prostatic capsule.
A)true
B)false
A
390
Initial management is aimed at relieving the obstruction, usually by insertion of a Foley catheter. 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.
A)true for BPH
B)false
A
391
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.
A)true
B)false
A
392
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
A
393
Inform the patient and the family that hematuria is expected after prostatic surgery.
A)true
B)false
A
394
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.
A)true
B)false
A
395
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
A
396
prolonged sitting because the increased intraabdominal pressure may cause the operative site to bleed.
A)true
B)false
A
397
Remove the catheter when the urine becomes clear.
A)true
B)false
A
398
CANCER OF THE PROSTATE
,
399
PSA is greatly increasing the odds of early diagnosis.
A)true, prostate cancer
B)false
A
400
The normal PSA is 0 to 4 ng/ mL.
A)true
B) false
A
401
The Gleason Grading System is the most widely used system for grading prostate cancer.
A)true
B)false
A
402
Grade 1 represents the most well differentiated (most like the original cells), and grade 5 represents the most poorly differentiated (undifferentiated).
A)true
B)false
A
403
The three goals of a radical prostatectomy are removing all the tumor, preserving urine control, and preserving sexual function.
A)true
B)false
A
404
Hormone deprivation therapy includes estrogens, gonadotropin-releasing hormone analogs, and antiandrogens
A)prostate cancer
B)false
A
405
Bilateral orchiectomy eliminates 95% of testosterone production, a step that is useful in managing metastatic disease. The patient may receive relief from such symptoms as pain or obstruction, but may experience feminization, increased incidence of cardiac disease, thrombophlebitis, pulmonary embolus, and stroke.
A)prostate cancer
B)false
A
406
Radiation therapy may be used in advanced stages of the illness as primary or palliative treatment.
A)prostate cancer
B)false
A
407
Rectal temperature-taking, enemas, and use of rectal tubes are therefore forbidden
A)true
B)false
A
408
URETHRAL STRICTURES
,
409
Diagnosis can be confirmed by a voiding cystourethrogram, which demonstrates stricture.
A)true
B)false
A
410
Correction of the stricture may be achieved by dilation with metal sounds or surgical release (internal urethrotomy).
A)true
B)false
A
411
NEPHROTIC SYNDROME
,
412
Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
A)true
B)false
A
413
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
A
414
severe generalized edema (anasarca), anorexia, fatigue, and altered kidney function.
A)nephrotic syndrome
B)cancer
A
415
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)nephrotic syndrome
B)cancer
A
416
Blood chemistry findings include hypoalbuminemia and hyperlipidemia
A)nephrotic syndrome
B)prostate
A
417
Medical management depends on the extent of tissue involvement and 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.
A)nephrotic syndrome
B)prostatits
A
418
Hypoproteinemia may be treated with normal serum albumin and protein-rich nutrition replacement therapy.
A)nephrotic syndrome
B)nephritis
A
419
Acute Glomerulonephritis
,
420
Diagnos tic tests reveal elevation of BUN, serum creatinine, potassium, erythrocyte sedimentation rate, and antistreptolysin-0 titer. Urinalysis shows red blood cells, casts, and/ or protein.
A)Acute Glomerulonephritis
B)false
A
421
Dietary intake includes protein restrictions (to decrease blood urea levels), with carbohydrates providing a source of energy.
A)acute Glemrolinephritis
B)chronic glumurinehpritis
A
422
Proteinuria and hematuria may exist microscopically even when other symptoms subside
A)true
B)false
AGN
423
Chronic Glomerulonephritis
,
424
With advanced destruction of nephrons, the specific gravity becomes fixed and blood levels of NPN wastes (creatinine and urea) increase.
A)true
B) false
CGN A
425
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)true
B)false
A
426
RENAL FAILURE
,
427
Renal failure is characterized by the kidneys' inability to remove wastes, concentrate urine, and conserve or eliminate electrolytes.
A)true
B)false
A
428
Diabetes mellitus is the most common cause of renal failure, accounting for more than 40% of new cases.
A)true
B)false
A
429
Other predisposing concurrent illnesses that can cause renal failure include burns, trauma, heart failure, volume depletion, and renal disease.
A)true
B)false
A
430
ACUTE RENAL FAILURE
,
431
ARF can be caused by a number of meclical conditions, such as hemorrhage, trauma, infection, and decreased cardiac output.
A)true
B)false
A
432
Subjective data include patient reports of lethargy, loss of appetite, nausea, and headache.
A)ARF
B)ESRD
A
433
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)ARF
B)ESRD
A
434
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.
A)ARF
B) ESRD
A
435
Measures include administration of fluids and osmotic preparations to prevent decreased renal perfusion,.
A)true
B)false
A
436
Diet should be protein sp aring, high in carbohydrates, and low in potassium and sodium. Drug therapy may include diuretics to increase urinary output (e.g., furosemide, hydrochlorothiazide [HydroDTU- RIL]).
A)ARF
B)ESRD
A
437
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.
A)ARF
B)ESRD
A
438
CHRONIC RENAL FAILURE (END-STAGE RENAL DISEASE)
,
439
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)true
B)false
A
440
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)true
B)false
A
441
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.
A)ARF
B)ESRD
B
442
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.
A)ESRD
B)ARF
A
443
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)ESRD
B)ARF
A
444
PERITONEAL DIALYSIS
,
445
Peritoneal dialysis is contraindicated for patients with systemic inflammatory disease, previous abdominal surgery, and chronic back pain, among other conditions.
A)true
B)false
A
446
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 .
A)true
B)false
A
447
Hypotension may occur with excessive sodium and fluid removal
A)true
B)false
A
448
NEPHROSTOMY
,
449
Turn the patient and position on the affected side as ordered to facilitate drainage and assist in respiratory ventilation. Never clamp 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
A
450
KIDNEY TRANSPLANTATION
,
451
The kidney is surgically placed retroperitoneally in the iliac fossa .
A)kidney transplant
B)cancer
A
452
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)kidney transplant
B)false
A
453
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.
A)kidney transplant
B)nephritis
A
454
Mycophenolate (CeiiCept) and tacrolimus (Prograf) are drugs used to prevent rejection of kidney transplants; they are used in combination with corticosteroids.
A)kidney transplant
B)false
A
455
Immunosuppressive therapy increases the risk for infection and possible steroid induced bleeding.
A)true
B)false
A
456
URINARY DIVERSION
,
457
Postoperatively, measure urine flow hourly. Report output less than 30 mL/hr to the physician immedi- ately. A healthy stoma appears moist and pink and may even bleed s lightly.
A)true
B)false
A
458
When the peristomal skin is healed, the bag is emptied at 2- to 3-hour intervals
A) true
B) false
A
