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Urinary System Facts

This article dwells on some urinary system facts. The functions of the urinary system in the human body makes it indispensable for human sustenance. From elimination of wastes to balance of body fluids, this system is very beneficial to us.

Urinary system of the body plays a crucial role in our sustenance. Also referred to as the genitourinary or excretory system of the body, this system is responsible for the elimination of various metabolic waste materials from the body, in the form of urine. Essential nutrients from food ingested, is absorbed and used for their respective uses in the body. The remaining waste in the bowel and blood needs to be thrown out, thus, the kidney in coordination with the lungs, intestines and skin evacuates all wastes in the body. If the elimination of these waste substances is not done, accumulation of the same can conduce to poisoning. The urinary system gets rid of urea and other waste materials from the blood and produces urine to throw them out. Moreover, this system also controls the amount of water and mineral salts to be absorbed back into the bloodstream. Parts of the Urinary System The urinary system comprises two kidneys, two ureters, one bladder and urethra. All these parts of the urinary system coordinate with each other and eliminate wastes. Let us have a closer look at these parts and their functioning to understand the working of the urinary system. Kidneys: We have two bean-shaped, purplish-brown organs placed just below the rib cage, near the mid portion of the back. Approximately the size of one's fist, the kidneys are made up of myriads of infinitesimal filters, called nephrons, which are the functional units of the kidneys. Blood containing metabolic wastes are passed through these nephrons, which filter the urea from the blood. The remaining 99% of the body fluid is sent back to the body minus the urea. The urea filtered out is combined with water and other waste materials like organic materials and excess salts to form urine.

So kidneys are sites of urine production! About one to two liters of urine is produced on a daily basis, depending on the amount of water consumed each day. Besides this, kidneys are also responsible for maintaining fluid and salt balance in the body, thereby maintaining blood consistency. Ureters: Two tube-like structures called ureters connect the kidneys to the urinary bladder. The ureters are pipelines through which the waste-rich urine passes from the kidney to the bladder. Ureters feature the presence of muscles in their walls which undergo continuous contraction and relaxation movements, so as to force the urine downward towards the bladder. Every 10-15 seconds urine trickles from the kidneys and collects in the bladder. Urinary Bladder: This pear-shaped, hollow organ is situated in the pelvic region and is kept in place by ligaments that bind it to the pelvic bones. Like ureter muscles, these muscles also contract and relax constantly. The muscles relax to allow entry of urine from ureter and contract (when full) to send urine out of the body, via the urethra. On an average, the bladder can hold about two cups of urine, however, the urge to urinate will begin when the bladder is about a cup full. The circular sphincter muscles present around the bladder's opening prevents the urine from leaking out from the bladder. The bladder does not release urine until it is full. Thank goodness the bladder waits till it's full! Urethra: When the bladder is gorged with urine, the nerves in the bladder send signals to one's brain to urinate. The brain in response sends signals to bladder muscles to contract and release the stored urine. The sphincter muscles also receive instructions from the brain to allow the urine to pass out. Urine exits from the bladder through a small tube called urethra, out of the body. Interesting Urinary System Facts for Kids

In a healthy adult, almost 440 gallons of blood is passed through the kidneys on a daily basis, thereby resulting in formation of almost one to two liters of urine. However, this amount varies with the amount of water (or fluid) intake and the amount of sweat produced by the body.

Though we keep describing kidneys as bean-shaped organs, the beans were named after the organ and not vice versa! Moreover, one of the other urinary system facts is that, if at all one kidney fails to function, the other kidney takes up the entire load of filtration. Urine is almost odorless when it leaves a healthy body. Surprised! Well, another surprising urine fact is that urine is also sterile when it leaves the body. It does contain metabolic wastes, salts and fluids, however, it is devoid of viruses, bacteria and fungi. Once the urine comes outside the body, bacteria in the air converts chemicals present in it to other forms of smelly chemicals like ammonia, etc. So this is how the foul smell of urine comes!

Kidneys of the urinary system maintain the amount of fluid balance in the body. Consumption of excess water results in diluted, pale-colored urine and consumption of inadequate amounts of water results in conservation of water by the kidneys, thereby conducing to dark yellowcolored urine.

Sometimes people have this urge to urinate shortly after visiting the restroom. Then when they try to urinate, only a little urine comes out. This mostly happens during a bladder or urinary tract infection. Frequent urination is also a sign of pregnancy. The growing uterus applies pressure on the urinary bladder, which causes one to urinate frequently. Moreover, during pregnancy blood flow to the kidneys increases rapidly, thereby resulting in faster filtration and urine formation.

About 2 to 4% pregnant women develop urinary infections, which can also be the reason for frequent urination sensation.

Urine is often diluted and added to potted plants and plants in gardens. This is because, the adequate urea content in urine is a wonderful source of nitrogen to plants. So if you have a garden, you now know what to do! Have you heard of urine therapy? Well, urine therapy involves application of urine for medical or cosmetic purposes. People apply urine on the skin and even drink urine for medicinal benefits. Don't freak out, they drink their own urine only! Moreover, during wars in historic times, urine was applied on open wounds to destroy bacteria, due to its antiseptic qualities. According to them, the darker the urine, the more effective would be the urine!

Urine should normally contain only salts, metabolic wastes and fluids. However, at times sugar is seen to be present in the urine. This is an indication of diabetes. Some other problems associated with the urinary system are polyuria (excess urine production), oliguria (little urine production), dysuria (difficulty and pain in urination), kidney failure, kidney stones, bladder control problems, prostate enlargement and urinary tract infections.

Most of us have found ourselves in situations where we have had to control our full bladders due to the unavailability of a restroom. However, there is a control limit which shouldn't be exceeded. In the year 2007, Jennifer Strange (age 28) of California participated in a radio station's contest that involved drinking the maximum water without having to visit the restroom. She won the contest, however, was found dead the next day in her house. Doctors confirmed she died of water intoxication. Thus, it is important not to take the importance of the urinary system lightly.

The urinary system is truly a fascinating body system. The way each organ functions, the coordination between different structures, etc. causes one to look at the human body with awe! By Priya Johnson Last Updated: 1/11/2012

Incontinence
Written by Administrator Friday, 01 April 2011 21:08

MULTIPLE CHOICE 1. The patient who is scheduled for a postvoid residual (PVR) test should be instructed by the nurse to: 1. call the nurse immediately after voiding. 2. after voiding, wait 10 minutes and void again. 3. void into a flowmeter. 4. avoid fluid intake for 8 hours before the test. ANS: 1 The nurse must catheterize the patient immediately after voiding and measure the amount of urine. PTS: 1 DIF: Cognitive Level: Application REF: 332 OBJ: 3 TOP: Postvoid Residual Test KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

2. Bladder training instructions are being given to a patient who has a history of urinary incontinence. The initial instructions the nurse should give the patient are to: 1. Wait until you feel the urge to void. 2. Dont void any more often than every 4 to 6 hours. 3. Void every 2 to 3 hours while awake. 4. Void any time you feel the urge. ANS: 3 Bladder training uses scheduled voiding; the patient is encouraged to delay voiding and voids only every 2 to 3 hours while awake. PTS: 1 DIF: Cognitive Level: Application REF: 333 OBJ: 3 TOP: Bladder Training KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment 3. The patient with a spinal cord injury has recently begun using reflex training to empty his bladder. The nurse is doing a catheterization to check for residual volume. The nurse understands that the reflex training is effective if the residual volume is less than: 1. 100 mL. 2. 200 mL. 3. 400 mL. 4. 500 mL. ANS: 1 Ideally, the residual volume will be less than 100 mL. PTS: 1 DIF: Cognitive Level: Analysis REF: 334 OBJ: 3 TOP: Reflex Training KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 4. A male patient with urinary incontinence has been using an external (condom) catheter. The nurse is assessing the patients technique of applying the device. The nurse should give the patient further instructions if he: 1. washes the penis with warm soapy water and dries the area well before applying the device. 2. encircles the penis with tape to secure the device. 3. uses elastic tape and wraps in a spiral pattern to secure the device. 4. assesses the penis carefully for any signs of irritation before applying the device. ANS: 2 Encircling the penis with tape can restrict circulation and cause damage to the tissue. PTS: 1 DIF: Cognitive Level: Application REF: 333 OBJ: 3 TOP: External Urine Collection Device KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment 5. A patient being assessed by the physician states, I wet my pants every time I cough. The nurse recognizes this as: 1. reflex incontinence. 2. overflow incontinence. 3. urge incontinence.

4. stress incontinence. ANS: 4 Stress incontinence is the involuntary loss of small amounts of urine during physical activity that increases abdominal pressure, such as coughing, laughing, sneezing, and lifting. PTS: 1 DIF: Cognitive Level: Knowledge REF: 338-339, Table 23-1 OBJ: 2 TOP: Stress Incontinence KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 6. The patient who has been diagnosed with stress incontinence should be instructed by the nurse to: 1. Restrict fluid intake to less than 1000 mL/day. 2. Avoid fluids such as tea, coffee, and cola. 3. Delay voiding until you feel the urge to void. 4. Void no more often than every 4 hours. ANS: 2 Fluids such as tea, coffee, and cola have a diuretic effect and should be avoided. PTS: 1 DIF: Cognitive Level: Application REF: 339 OBJ: 2 TOP: Stress Incontinence KEY: Nursing Process Step: Planning MSC: NCLEX: Physiologic Integrity 7. The home health nurse is performing an evaluation of the older adult patients home to assess for any safety issues. The nurse recognizes that an environmental factor that could lead to functional incontinence would be: 1. a night-light in the bathroom. 2. location of the patients room on the opposite end of the house from the bathroom. 3. hand rails located around the toilet and bathtub. 4. the caregivers room located close to the patients room. ANS: 2 Functional incontinence is the term used when a person voids inappropriately because of inability to get to the toilet or manage the mechanics of toileting. The patients room should be located close to the bathroom. PTS: 1 DIF: Cognitive Level: Analysis REF: 339 OBJ: 3 TOP: Functional Incontinence KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment 8. Past medical history can be related to urinary incontinence. The nurse should be sure to ask the patient specifically about: 1. diabetes mellitus. 2. impetigo. 3. hypertension. 4. trigeminal neuralgia. ANS: 1 Patients who have diabetes may develop neurologic problems that affect the bladder and are uncontrolled; they may produce large volumes of urine. PTS: 1 DIF: Cognitive Level: Comprehension REF: 341 OBJ: 4 TOP: Medical History

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiologic Integrity 9. The patient who is admitted with urinary incontinence gives the nurse a list of the medications that she is currently taking at home. The nurse recognizes that the medication that could be contributing to the patients urinary incontinence is: 1. Citrucel (methylcellulose). 2. Valium (diazepam). 3. Zocor (simvastatin). 4. Lanoxin (digoxin). ANS: 2 Valium is a sedative that can increase the incidence of incontinency of urine. PTS: 1 DIF: Cognitive Level: Analysis REF: 339, Drug Therapy table OBJ: 4 TOP: Urinary Incontinence KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiologic Integrity 10. The nurse is instructing the patient on the procedure for a clean-catch urine specimen. The patient has tried several times but is having difficulty understanding the instructions. The best action by the nurse would be to: 1. take whatever specimen the patient can obtain. 2. provide the patient with a clean bedpan to obtain the specimen. 3. ask the laboratory personnel to come and obtain a urine specimen. 4. call the physician for a catheterization order. ANS: 4 If the patient cannot cooperate with the clean-catch procedure, catheterization may be necessary. PTS: 1 DIF: Cognitive Level: Application REF: 332 OBJ: 4 TOP: Clean-Catch Urine Specimen KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiologic Integrity 11. The patient scheduled for a urodynamic test asks the nurse why he is having this test done. The nurses best response would be: 1. To test the capacity of the bladder. 2. To see how much urine is left in the bladder after you have voided. 3. To test the function of the nerves and muscles of the bladder. 4. To detect involuntary passage of urine. ANS: 3 Urodynamic procedures assess the neuromuscular function of the lower urinary tract. PTS: 1 DIF: Cognitive Level: Comprehension REF: 332 OBJ: 4 TOP: Urodynamic Test KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiologic Integrity 12. The nurse has just received a patient who had a cystoscopy from the postanesthesia recovery unit. The nurse notices that the patients urine is pink-tinged. The nurses first action should be to: 1. call the physician. 2. record the assessment in the patients record.

3. encourage the patient to drink plenty of fluids. 4. prepare the patient to return to surgery. ANS: 3 Pink-tinged urine is normal at first. Encouraging fluids will help flush the patients bladder, and then the nurse should document both the assessment and implementation. PTS: 1 DIF: Cognitive Level: Analysis REF: 333 OBJ: 3 TOP: Cystoscopy KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment 13. The nurse is asked to instruct the patient on performing Kegel exercises. The patient should be instructed to contract the muscles he or she would use to stop the flow of urine. The proper technique is to: 1. contract for 3 to 4 seconds and relax for 10 seconds. 2. contract for 10 seconds and relax for 10 seconds. 3. contract for 10 seconds and relax for 3 to 4 seconds. 4. contract for 3 to 4 seconds and relax for 3 to 4 seconds. ANS: 2 The patient should hold the contraction for 10 seconds and then relax for 10 seconds. The goal is to work up to 10 repetitions, three or four times each day. PTS: 1 DIF: Cognitive Level: Application REF: 334, Patient Teaching Plan OBJ: 3 TOP: Kegel Exercises KEY: Nursing Process Step: Planning MSC: NCLEX: Physiologic Integrity 14. The nurse is reviewing the nursing care plan of a patient with a history of urinary incontinence. The patient uses a pessary to help control the incontinence. Care of the pessary should include: 1. removal periodically for cleansing. 2. daily douching with a cleansing solution. 3. checking for proper placement once a month. 4. deflating the cuff periodically. ANS: 1 A pessary is a device that is inserted into the vagina to hold the pelvic organs in place. The device must be removed periodically for cleansing and replacement as needed. PTS: 1 DIF: Cognitive Level: Application REF: 336 OBJ: 3 TOP: Pessary KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment 15. The patient who has urinary incontinence is at risk for urinary tract infection and urinary calculi. The nurse should teach the patient and family that the best way to prevent these complications is to: 1. restrict the patients fluid intake and frequency of incontinence. 2. be sure the patients voiding schedule is no more often than every 4 hours. 3. use an indwelling catheter. 4. encourage the patient to void at least every 2 hours and to take at least 2000 mL of fluid daily. ANS: 4 The risk of urinary tract infection and calculi can be reduced by having the patient empty the bladder as scheduled and providing adequate fluids. PTS: 1 DIF: Cognitive Level: Application REF: 344 OBJ: 4 TOP: Urinary Tract Infection and Calculi

KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment 16. The patient who is having problems with fecal incontinence may benefit from a change in his diet. The nurse should encourage the patient to include: 1. raw fruits and vegetables. 2. potatoes and bread. 3. coffee and tea. 4. prune and grape juice. ANS: 2 Foods that thicken the stool, such as potatoes, bread, bananas, rice, cheese, yogurt, oatmeal, oat bran, boiled milk, and pasta, should be encouraged. PTS: 1 DIF: Cognitive Level: Application REF: 345 OBJ: 5 TOP: Dietary Changes KEY: Nursing Process Step: Planning MSC: NCLEX: Physiologic Integrity 17. When the nurse is teaching the patient about management of fecal overflow incontinence, she should be sure that the patient understands that one of the most essential factors is: 1. use of mineral oil daily. 2. regular evacuation. 3. daily administration of enemas. 4. long-term use of mineral oil. ANS: 2 Initially, the colon needs to be cleansed and then regular evacuation is essential. PTS: 1 DIF: Cognitive Level: Application REF: 346 OBJ: 3 TOP: Fecal Overflow Incontinence KEY: Nursing Process Step: Planning MSC: NCLEX: Physiologic Integrity 18. The nurse is collecting data on the patients normal bowel habits. The patient tells the nurse that his bowel movements normally occur every morning after breakfast. The nurse understands that this is due to: 1. fecal overflow. 2. gastrocolic reflex. 3. autonomic dysreflexia. 4. lack of sphincter control. ANS: 2 When food enters the stomach, it stimulates activity throughout the digestive tract and causes the movement of fecal mass into the rectum. PTS: 1 DIF: Cognitive Level: Analysis REF: 346 OBJ: 4 TOP: Gastrocolic Reflex KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiologic Integrity 19. The physicians admission report states that the patient has a history of tarry stools. The nurse knows that this means the stools are: 1. brown and formed. 2. bright red and liquid. 3. black and sticky. 4. clay-colored and pasty.

ANS: 3 Tarry is used to describe stools that are shiny, sticky, and black. This is usually an indication of blood in the stool. PTS: 1 DIF: Cognitive Level: Application REF: 347 OBJ: 4 TOP: Characteristics of Stool KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiologic Integrity 20. The patient diagnosed with anorectal incontinence should be taught by the nurse to: 1. take a laxative daily. 2. increase fiber in the diet. 3. do pelvic muscle exercises. 4. administer daily enemas. ANS: 3 Anorectal incontinence is associated with nerve damage that causes the muscles of the pelvic floor to be weak. The pelvic muscle exercises can help strengthen these muscles. The other choices would cause the incontinence to worsen. PTS: 1 DIF: Cognitive Level: Application REF: 346 OBJ: 3 TOP: Anorectal Incontinence KEY: Nursing Process Step: Planning MSC: NCLEX: Physiologic Integrity 21. The nurse can evaluate a positive bladder emptying if the post void catheterization is less than: 1. 125 mL. 2. 100 mL. 3. 75 mL. 4. 50 mL. ANS: 4 If the catheterization immediately after voiding is less than 50 mL, the voiding can be viewed as adequate or normal. PTS: 1 DIF: Cognitive Level: Application REF: 332 OBJ: 4 TOP: Postvoid Catheterization Evaluation KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiologic Integrity 22. The nurse is cleaning the patient with fecal incontinence when he says, This is so embarrassing, and it makes me really angry. The nurses best response would be: 1. Dont worry about it, its my job to clean you up. 2. You should have called me sooner and this wouldnt have happened. 3. Do you feel angry and embarrassed? 4. Would you rather let your family clean you up? ANS: 3 The nurse should use therapeutic communications of reflection to validate the patients feelings. PTS: 1 DIF: Cognitive Level: Application REF: 347 OBJ: 3 TOP: Fecal Incontinence KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 23. The nurse instructs a client that diarrhea can be caused by the inclusion in the diet of such foods as: 1. cheese. 2. cabbage.

3. rice. 4. yogurt. ANS: 2 Foods such as cabbage, raw vegetables, and spicy foods can cause diarrhea. Cheese, rice, and yogurt thicken stool. PTS: 1 DIF: Cognitive Level: Application REF: 345 OBJ: 5 TOP: Dietary Changes to Reduce Diarrhea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiologic Integrity 24. The patient with fecal incontinence should be taught the importance of maintaining good skin integrity. The nurses teaching should focus on teaching the patient to: 1. cleanse the perianal area thoroughly after each stool. 2. use a fecal pouch. 3. change incontinence undergarments once a day. 4. take an over-the-counter laxative daily. ANS: 1 Skin integrity can be best maintained by keeping the perianal area clean and dry. The other choices may cause an impairment of skin integrity. PTS: 1 DIF: Cognitive Level: Application REF: 348 OBJ: 5 TOP: Skin Integrity KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment 25. The nurse uses the knowledge that symptomatic incontinence is probably having symptoms as a result of: 1. colorectal disease. 2. gastrocolic reflex. 3. constipation. 4. nerve damage. ANS: 1 Symptomatic incontinence is the result of colorectal disease. Medical care should be sought to identify and treat the cause. PTS: 1 DIF: Cognitive Level: Knowledge REF: 346 OBJ: 2 TOP: Symptomatic Incontinence KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Physiologic Integrity MULTIPLE RESPONSE 1. The nurse would evaluate the need for no further instructions if the postcystometry patient says that he or she understands that he or she should (select all that apply): 1. Drink no fluids for 6 hours after the test. 2. Report a change in my abdominal girth. 3. Notify the doctor if I have difficulty voiding. 4. Sleep on my stomach. 5. Notify my doctor if I experience burning on urination. ANS: 3, 5

Voiding difficulty and burning on urination are complications that should be reported to the doctor. Neither fluid intake nor sleeping positions are restricted. Abdominal girth is not significant to the postcystometry recovery. PTS: 1 DIF: Cognitive Level: Analysis REF: 332-333 OBJ: 3 TOP: Cystometry KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse, instructing a patient in urge suppression, would include that when the patient is aware of the urge to void, the patient should (select all that apply): 1. breathe deeply and try to relax. 2. do several Kegel maneuvers without resting in between. 3. walk to the bathroom at a normal pace while doing Kegel maneuvers. 4. distract him- or herself with a book or a TV program. 5. stop what he or she is doing and sit down or stand quietly. ANS: 1, 2, 3, 5 Breathing deeply, trying to relax, Kegel maneuvers are all helpful in urge suppression. Distraction seldom is effective. PTS: 1 DIF: Cognitive Level: Analysis REF: 334 OBJ: 3 TOP: Urge Suppression KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiologic Integrity COMPLETION 1. The patient complains, My allergies make me sneeze and pee in my pants. I take my allergy drug and I pee in my pants even more. The nurse assesses that the drug the patient is referring to is a(n) ____________________. ANS: antihistamine PTS: 1 DIF: Cognitive Level: Application REF: 339, Drug Therapy table OBJ: 4 TOP: Drugs that Increase Incontinence KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. The nurse explains that the normal bladder will empty when it reaches the capacity of ____________________ to ____________________ mL. ANS: 200 to 250 mL PTS: 1 DIF: Cognitive Level: Comprehension REF: 332 OBJ: 1 TOP: Bladder Capacity KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

Urinary Elimination

NCLEX-PN Multiple Choice Questions


1.
You ask a client to provide a clean catch urine specimen, explaining the procedure that will follow. When the client hands you the specimen, you notice that the urine has a slightly reddish color. Which of the following

actions should you take? [Hint] Notify the physician immediately of the urine color. Ask the client how long their urine has been bloody. Ask the nursing supervisor what to do. Assess the client's recent diet and medication intake.

2.

During the shift report, you learn that your assigned client has "nocturia." Which of the following questions should you ask this client? [Hint] "How often do you wet the bed at night?" "Are you eating salty snacks in the evening?" "How many times do you get up to void at night?" "When did these bladder spasms at night begin?" When teaching older adults about incontinence, you most need to inform older adults that: [Hint] incontinence is not a normal consequence of aging and often can be treated. the bladder loses its muscle tone with aging, so Kegel exercises are the only help. it is necessary to go to the bathroom more often in order to prevent incontinence. 99 percent of incontinence in the elderly is caused by a form of urinary retention. When assessing a client who has a diagnosis of neurogenic bladder, what would you most likely find the client to say? [Hint] "My bladder always feels full." "I am often unable to control my urination." "I have a nervous bladder." "I urinate about 5 to 7 times each 24-hour day." The physician orders a client to be catheterized for residual urine after the next voiding. The nurse responsible for catheterizing this client will most need to: [Hint] instruct the client to put on their call light after voiding. catheterize the client within 30 minutes of voiding. catheterize the client immediately after the client voids. chart the residual amount obtained if it is more than 30mL/hour. When collecting a clean catch or midstream specimen from a client, it is most important that the nurse: [Hint]

3.

4.

5.

6.

provide the client with a sterile specimen container and a lid. instruct the client to squat or stand while voiding into the container. have the client wear a pair of clean or sterile gloves. give the client an antibacterial soap to use in cleansing the urethral area.

7.

The physician has written an order for your assigned client to have a 24hour urine collection sent to the laboratory for specific testing. You realize that you must:[Hint] inform the client that they must save all urine for 24 hours beginning at 12:01 a.m. start the urine collection at either 12:01 a.m. or 12:01 p.m. at the start of the collection period, have the client void and discard this urine. provide enough sterile receptacles for the urine collection. Your nursing instructor comes into your assigned client's room and hands you a urinometer or a hydrometer. You realize that the instructor wants you to do which of the following things? [Hint] Measure the client's urine specific gravity. Find out if the client has protein in the urine. Measure the force of the urine stream. Determine the urine pH. When reading the lab reports of your assigned clients, you find that one of your clients has a urine pH of 6. You determine that this urine pH is: [Hint] strongly alkalinic. slightly acidic. abnormal. neutral. Which of the following statements by a client with recurrent urinary infections would indicate the client understood your teaching about the best fluids to drink to prevent urinary infections? [Hint] "My daily diet includes two to three glasses of vegetable juice." "Each day I drink two glasses of a blend of fruit and yogurt." "I drink two to three glasses of cranberry juice every day." "Each morning and evening I have a glass of orange juice."

8.

9.

10 .

1. Your Answer: Assess the client's recent diet and medication intake. 2. Your Answer: 3. Your Answer:
"How many times do you get up to void at night?" incontinence is not a normal consequence of aging and often can be treated.

4. Correct Answer: "I am often unable to control my urination."


The client with a neurogenic bladder does not perceive bladder fullness and is unable to control the urinary sphincters. There may be frequent involuntary urination.

5. Correct Answer: catheterize the client immediately after the client


voids. The nurse needs to get the cateterization equipment ready and ask the client to notify her/him just before going to the bathroom to void so the nurse can catheterize the client immediately after voiding.

Answer:

6. Your provide the client with a sterile specimen container and a lid. 7. Correct Answer: at the start of the collection

period, have the client void and discard this urine. At the start of the collection period, have the client void and discard this urine.

8. Your Measure the client's urine specific Answer: gravity. 9. Correct Answer: slightly acidic.
A pH of 7 is neutral, with less being acidic and greater than 7 being alkalinic.

10. Correct Answer: "I drink two to three


glasses of cranberry juice every day." Urine acidity can be increased through regular intake of vitamin C and drinking two to three glasses of cranberry juice daily. A slightly acidic urine helps prevent urinary tract infections.

1. a. b. c. d. 2.

The nurse is aware that the following findings would be further evidence of a urethral injury in a male A low-riding prostate The presence of a boggy mass Absent sphincter tone A positive Hemoccult When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital

client during rectal examination?

lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a. b. c. d. 3. a. b. c. The client sets the drainage bag on the floor while sitting down. The client keeps the drainage bag below the bladder at all times. The client clamps the catheter drainage tubing while visiting with the family. The client loops the drainage tubing below its point of entry into the drainage bag. A female client has just been diagnosed with condylomata acuminata (genital warts). What This condition puts her at a higher risk for cervical cancer; therefore, she should have a The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 The potential for transmission to her sexual partner will be eliminated if condoms are used every time

information is appropriate to tell this client? Papanicolaou (Pap) smear annually. to 10 days. they have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, cant be transmitted during oral sex. 4. A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this clients pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude? a. b. c. d. The skin wasnt lubricated before the pouch was applied. The pouch faceplate doesnt fit the stoma. A skin barrier was applied properly. Stoma dilation wasnt performed.

5. a. b. c. d. 6. a. b. c. d. 7. a. b. c. d. 8. a. b. c. d. 9. a. b. c. d. 10. a. b. c. d. 11. a. b. c. d.

The nurse is aware that the following laboratory values supports a diagnosis of pyelonephritis? Myoglobinuria Ketonuria Pyuria Low white blood cell (WBC) count A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hematuria. weight loss. increased urine output. increased blood pressure. Nurse Lea is assessing a male client diagnosed with gonorrhea. Which symptom most likely Rashes on the palms of the hands and soles of the feet Cauliflower-like warts on the penis Painful red papules on the shaft of the penis Foul-smelling discharge from the penis Nurse Agnes is reviewing the report of a clients routine urinalysis. Which value should the nurse Specific gravity of 1.03 Urine pH of 3.0 Absence of protein Absence of glucose A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is 1 minute. 30 minutes. 1 hour. 24 hours. A male client in the short-procedure unit is recovering from renal angiography in which a femoral keep the clients knee on the affected side bent for 6 hours. apply pressure to the puncture site for 30 minutes. check the clients pedal pulses frequently. remove the dressing on the puncture site after vital signs stabilize. A female client is admitted for treatment of chronic renal failure (CRF). Nurse Juliet knows that this water and sodium retention secondary to a severe decrease in the glomerular filtration rate. a decreased serum phosphate level secondary to kidney failure. an increased serum calcium level secondary to kidney failure. metabolic alkalosis secondary to retention of hydrogen ions.

hemodialysis, nurse Sarah knows that the client is most likely to experience:

prompted the client to seek medical attention?

consider abnormal?

done to assess the kidneys ability to remove a substance from the plasma in:

puncture site was used. When providing postprocedure care, the nurse should:

disorder increases the clients risk of:

12. a. b. c. d. 13. a. b. c. d. 14. a. b. c. d. 15.

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female clients Potassium level of 3.5 mEq/L Hematocrit (HCT) of 35% Blood glucose level of 200 mg/dl White blood cell (WBC) count of 20,000/mm3 For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is Encouraging coughing and deep breathing Promoting carbohydrate intake Limiting fluid intake Providing pain-relief measures A female client requires hemodialysis. Which of the following drugs should be withheld before this Phosphate binders Insulin Antibiotics Cardiac glycosides A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital

uremia. Which finding signals a significant problem during this procedure?

most important?

procedure?

irritation. Suspecting a sexually transmitted disease (STD), Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department? a. b. c. d. 16. a. b. c. d. 17. Chlamydia Gonorrhea Genital herpes Human papillomavirus infection A male client with acute pyelonephritis receives a prescription for co-trimoxazole (Septra) P.O. twice Urine output increases to 2,000 ml/day. Flank and abdominal discomfort decrease. Bacteria are absent on urine culture. The red blood cell (RBC) count is normal. A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on

daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen?

urination and frequent, urgent voiding of small amounts of urine. Shes placed on trimethoprimsulfamethoxazole (Bactrim) to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed? a. b. c. d. 18. nitrofurantoin (Macrodantin) ibuprofen (Motrin) acetaminophen with codeine phenazopyridine (Pyridium) A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a

transurethral resection of the prostate. In addition to balloon inflation, the nurse is aware that the functions of the three lumens include:

a. b. c. d. 19. a. b. c. d. 20.

Continuous inflow and outflow of irrigation solution. Intermittent inflow and continuous outflow of irrigation solution. Continuous inflow and intermittent outflow of irrigation solution. Intermittent flow of irrigation solution and prevention of hemorrhage. Nurse Claudine is reviewing a clients fluid intake and output record. Fluid intake and urine output Fluid intake should be double the urine output. Fluid intake should be approximately equal to the urine output. Fluid intake should be half the urine output. Fluid intake should be inversely proportional to the urine output. After trying to conceive for a year, a couple consults an infertility specialist. When obtaining a history

should relate in which way?

from the husband, nurse Jenny inquires about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility? a. b. c. d. 21. Chickenpox Measles Mumps Scarlet fever A male client comes to the emergency department complaining of sudden onset of sharp, severe

pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? a. b. c. d. 22. Kidney Ureter Bladder Urethra A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge

monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: a. b. c. d. 23. confusion, headache, and seizures. acute bone pain and confusion. weakness, tingling, and cardiac arrhythmias. hypotension, tachycardia, and tachypnea. Dr. Marquez prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily, for a client with a urinary

tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin therapy is: a. b. c. d. 24. 3 to 5 days. 7 to 10 days. 12 to 14 days. 10 to 21 days. Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In

this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates

ultrahigh-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. b. c. d. 25. a. b. c. d. limit oral fluid intake for 1 to 2 weeks. report the presence of fine, sandlike particles through the nephrostomy tube. notify the physician about cloudy or foul-smelling urine. report bright pink urine within 24 hours after the procedure. A client is frustrated and embarrassed by urinary incontinence. Which of the following measures Establishing a predetermined fluid intake pattern for the client Encouraging the client to increase the time between voidings Restricting fluid intake to reduce the need to void Assessing present elimination patterns

should nurse Bea include in a bladder retraining program?

ANSWERS 1. Answer B. When the urethra is ruptured, a hematoma or collection of blood separates the two sections of urethra. This may feel like a boggy mass on rectal examination. Because of the rupture and hematoma, the prostate becomes high riding. A palpable prostate gland usually indicates a nonurethral injury. Absent sphincter tone would refer to a spinal cord injury. The presence of blood would probably correlate with GI bleeding or a colon injury. 2. Answer B. To maintain effective drainage, the client should keep the drainage bag below the bladder; this allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldnt lay the drainage bag on the floor because it could becom e grossly contaminated. The client shouldnt clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above not below its point of entry into the drainage bag. 3. Answer A. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom wont protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx. 4. Answer B. If the pouch faceplate doesnt fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldnt be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isnt performed with an ileal conduit, although it may be done with a colostomy if ordered. 5. Answer C. Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low, as indicated in option D. Ketonuria indicates a diabetic state. 6. Answer B. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesnt increase urine output because it doesnt correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

7.

Answer D. Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis

and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes. 8. Answer B. Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine specific gravity normally ranges from 1.002 to 1.035, making this clients value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, its color ranging from pale yellow to deep amber. 9. Answer A. The renal clearance test determines the kidneys ability to remove a substance from the plasma in 1 minute. It doesnt measure the kidneys ability to remove a substance over a longer period. 10. Answer C. After renal angiography involving a femoral puncture site, the nurse should check the clients pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the clients knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse shouldnt remove this dressing for several hours and only if instructed to do so. 11. Answer A. A client with CRF is at risk for fluid imbalance dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys inability to excrete phosphorus; such imbalances may lead t o hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions. 12. Answer D. An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; its readily treatable with sliding -scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isnt abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin. 13. Answer C. During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesnt take precedence over fluid limitation. Controlling pain isnt important because ARF rarely causes pain. 14. Answer D. Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Phosphate binders and insulin can be administered because they arent removed from the blood by dialysis. Some antibiotics are removed by dialysis and

should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis. 15. Answer B. Gonorrhea must be reported to the public health department. Chlamydia, genital herpes, and human papillomavirus infection arent reportable diseases. 16. Answer C. Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, absence of bacteria on urine culture indicates that the drug has achieved its desired effect. Although flank pain may decrease as the infection resolves, this isnt a reliable indicator of the drugs effectiveness. Co-trimoxazole doesnt affect urine output or the RBC count. 17. Answer D. Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties. While ibuprofen and acetaminophen with codeine are analgesics, they dont exert a direct effect on the urinary mucosa. 18. Answer A. When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution. 19. Answer B. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isnt inversely proportional to the urine output. 20. Answer C. Mumps is the most significant childhood infectious disease affecting male fertility. Chickenpox, measles, and scarlet fever dont affect male fertility. 21. Answer A. The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation. 22. Answer A. Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication. 23. Answer B. For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Taking the drug for less than 7 days wouldnt eradicate such an infection. Taking it for more than 10 days isnt necessary. Only a client with a complicated UTI must take norfloxacin for 10 to 21 days. 24. Answer C. The client should report the presence of foul-smelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal due to residual stone products. Hematuria is common after lithotripsy. 25. Answer D. The guidelines for initiating bladder retraining include assessing the clients intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the clients fluid intake wont

reduce or prevent incontinence. The client should actually be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

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