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NUR 206
UNIT TEST 3
| Question | Answer |
|---|---|
| A hollow muscular organ, serves as a reservoir for urine; the inner lining of the bladder is a mucous membrane. | The Bladder |
| Controlled by the detrusor muscle in the wall of the bladder. | Involuntary urethral sphincter |
| voluntarily controls release of urine to the outside. | controlled by the detrusor muscle in the wall of the bladder. |
| Increases the reabsorption of sodium and excretion of potassium | Aldosterone |
| Antidiuretic hormone (ADH) | Increases permeability in the tubules and reabsorption of water |
| Increases the excretion of sodium | Atrial natriuretic hormone |
| Brain or B natriuretic hormone | Increases the excretion of sodium |
| Stimulates the bone marrow to increase red blood cell (RBC) production; increased production is triggered by a demand for oxygen or when RBC level falls below normal. | Erythropoietin |
| Increases absorption of calcium and phosphorus | Calcitriol (active vitamin D) |
| Assists in the regulation of blood pressure | Renin |
| Works in conjunction with calcitriol to increase absorption of calcium and phosphorus | Parathyroid hormone |
| Cortisol | Promotes sodium and water retention |
| Hormones that Circulate in the Blood to Influence Urine Volume and Concentration | Aldosterone Antidiuretic hormone (ADH) Atrial natriuretic hormone |
| Hormones that are Produced by the Kidney | Erythropoietin Calcitriol (active vitamin D) Renin |
| Hormones that Affect Kidney Function | Parathyroid hormone Cortisol |
| Glomerular filtration rate (GFR) | The amount of blood filtered by the glomeruli in a given time (average GFR is about 125 mL/min). |
| Hematuria | blood in the urine |
| the abnormal presence of protein in the urine | Proteinuria |
| Anuria | Absence of urine |
| Diminished or abnormally decreased flow of urine; may result from dehydration, renal failure, or obstruction. Urine output less than 400 mL/day. | Oliguria |
| Abnormally high and dilute urine output; the result of excessive solutes and increased excretion of water. Possible causes include hypercalcemia, diabetes insipidus, uncontrolled diabetes mellitus, and increased fluid intake. | Polyuria |
| Nocturia | Urination that occurs during the night; may be related to the decreased ability of the aging kidney to concentrate urine. |
| Urinary frequency | Voiding more often than every 2 hours. This can be the result of inflammation, decreased bladder capacity, psychological disorders, pregnancy, or increased fluid intake. |
| A delay in starting the stream of urine; may be related to partial obstruction. | Urinary hesitancy |
| Urinary retention | Retaining or holding urine in the bladder; various causes include neurologic, psychological, medication, obstruction, or anesthesia. |
| Residual urine | Urine left in the bladder after voiding; related to poor muscle tone or partial obstruction. |
| painful urination | Dysuria |
| Problem statements commonly associated with urologic problems and disturbances in urinary flow include the following: | • Altered urinary function due to inflammation. • Fluid volume overload due to inability of kidneys to produce urine. • Pain due to ureteral spasm, bladder spasm, or inflammation. • Fatigue due to effect of the accumulation of waste products. • Insufficient knowledge due to prevention of UTI. • Fear due to potential cause of hematuria or possibility of malignancy. • Altered body image due to urinary diversion. |
| most common screening tests for kidney function | BUN and Serum Creatinine |
| What characteristics of a fresh urine specimen might indicate an infection? | Cloudiness, foul odor, hematuria, or a discoloration could indicate infection. |
| Why should UTIs be treated promptly? | Prompt treatment of the active infection is recommended to prevent destruction and scarring of the kidney cells. |
| The health care provider ordered removal of an indwelling catheter. Three hours later the patient complains of bladder fullness with inability to void. What should you do? | Assess the degree of bladder distention, using gentle palpation, or if available a bladder scanner. Provide privacy and adequate time for voiding efforts. A caffeinated drink, followed by a warm bath, may help. Listening to a running water faucet or placing the hands in water may also help. Obtain an order to insert a catheter if interventions are not successful within 8 hours. |
| Which measure is usually included in the care of a patient with stress incontinence? | Teaching the patient pelvic floor strengthening exercises. The use of strengthening exercises (such as Kegel exercises) is helpful in the management of stress incontinence. |
| The nurse is caring for a patient who has a urinary catheter. Which nursing intervention should be done to help prevent infection? | Perform perineal care at least twice daily, cleaning the urinary meatus and catheter with soap and water. |
| A patient with cystitis is given a urinary antiseptic, phenazopyridine. Which statement, if made by the patient, indicates that the patient understood the instructions regarding the drug? | “It’s likely that my urine will turn orange.” The use of phenazopyridine will turn urine orange. |
| A patient’s blood urea nitrogen (BUN) is found to be elevated. This finding is most suggestive of the fact that the patient has which condition? | Dehydration BUN is the most common test used to evaluate kidney function and hydration status. High BUN levels can indicate poor kidney function, dehydration, or increased breakdown of body protein as caused by severe burns or excessive exercise. |
| The nurse notes the patient’s urine is dark orange in color. What question is most appropriate for the nurse to ask the patient? | “How much fluid intake have you had recently?” Dark amber or orange urine is associated with dehydration or increased metabolic state (e.g., fever), urobilinogen (a by-product of bilirubin normally excreted through stool and urine), or bilirubin (a component of bile normally metabolized and excreted via stool and urine). Foods that may result in this color of urine include carrots. |
| When collecting a 24-h urine specimen, nursing responsibilities include which action? | Starting the timing of the collection after the first voided urine. Unless otherwise ordered, the first void should be discarded; the collection should then be timed and begun for all urine voided for the next 24hrs. |
| When a urine culture is ordered, nursing responsibilities include which action? | Instructing the patient to perform the clean-catch method for specimen collection. A urine culture is used to determine pathogens in voided urine. The patient is instructed to perform the clean-catch method for specimen collection. A sterile specimen can also be obtained via urinary catheterization. It is not necessary to collect the first voided urine. The specimen should not be kept warm. There is no need to collect 200 mL of urine to perform the test. |
| A patient has been admitted to the unit with a urinary tract obstruction and has been scheduled for an intravenous pyelogram (IVP). Nursing responsibilities for this patient will include which action? | Asking about allergies to contrast media. The IVP is used to visualize the kidneys, ureters, and bladder. It is used to detect obstructions related to stones or tumors. Because the contrast medium generally used contains iodine, allergies to shellfish or iodine-containing substances are significant. |
| The nursing assessment of a patient with a suspected disorder of the urinary system should include which data? | Abdominal distention Initiation of voiding Urine specific gravity Volume of urine voided |
| When obtaining a history on a patient with suspected kidney disease, the most significant information would be a personal or family history of which condition(s)? | Diabetes Hypertension Cardiovascular disease |
| What is the difference between a urethral catheter and a ureteral catheter? Why is it important to know the difference between these two catheter sites? | A urethral catheter is inserted into the tip of the penis or the woman’s urethra using sterile technique; the catheter can be used for one time drainage of the bladder for a patient that cannot urinate or an indwelling catheter to monitor urinary output or facilitate urine passage. The surgeon inserts the ureteral catheter into the patient’s ureter. The catheter may be used for diagnostic or interventional purposes and drains urine from the ureter not the bladder. |
| What signs and symptoms might indicate that a patient undergoing peritoneal dialysis has peritonitis? | A cloudy appearance d drainage with discoloration or a foul odor suggests the presence of infection. The patient may have diffuse abdominal pain or abdominal rigidity, malaise, fever, and weakness. Confusion may be present. |
| You are caring for a patient admitted with pneumonia. One year ago, the patient received a kidney transplant. What precautions are needed when caring for this patient? | The anti-rejection medications that the patient must take for life make them susceptible to infection which may be why they now have pneumonia. Care must be taken to not introduce additional microorganisms that could cause further infection. Many antibiotics are nephrotoxic. You must verify that the ordered antibiotics are appropriate for the condition and will not injure the transplanted kidney. |
| What kinds of behaviors would suggest caregiver role strain in the spouse of a patient who has ESRD? | The caregiver may directly express frustration in dealing with an incurable illness, rigid dietary restrictions, or sexual difficulties. The caregiver may appear tired or develop a physical illness. Expressions of anger or apathy may be directed toward the patient or the staff. |
| Your patient with CRF is withdrawn and sullen at times but is sharp and demanding at other times. How will you respond to this? How will you help the family deal with this behavior? | Recognize and help the family to recognize that daily fluctuations in subjective symptoms, such as fatigue or discomfort, along with ambivalent feelings toward the therapeutic regimen are expected. Acknowledge the patient’s feelings and encourage expression of those feelings. Remind the patient and family that everybody is working toward the common goal of quality of life for the patient and the family unit. Offer family counseling resources if appropriate. |
| After urologic surgery, nursing interventions should focus of which patient need? | Promoting unimpeded urine flow. The patient who has had urologic surgery is at risk for inflammation and other complications. |
| Regarding long-term care, patients who have kidney transplants should be given which instruction? | They have increased susceptibility to infection. Transplant patients will be placed on antirejection medications. These medications reduce the patients’ immunity and increase their risk for the development of infection. |
| The LPN/LVN should understand that invasive procedures are postponed for 4 to 6 h after hemodialysis for which reason? | Heparin is used during the procedure. Invasive procedures are postponed for 4 to 6 h after dialysis because the clotting time is extended from the heparin used during dialysis and prolonged bleeding could occur. |
| The nurse is caring for the patient with end-stage renal disease (ESRD). The patient’s serum calcium level is critically low, which places the patient at risk for which complication? | Seizures During ESRD, calcium is not absorbed from the intestinal tract, and this leads to the loss of calcium from the body and a corresponding drop in serum calcium. If the hypocalcemia is not corrected, the patient will eventually suffer from muscle cramps, twitching, and possibly seizures. |
| A late sign of renal impairment is which symptom? | Oliguria The symptoms of CRF do not appear early in the disease The loss of kidney function is not a slow steady decline. As renal failure progresses, the kidneys may not be able to produce much urine at all, oliguria and eventually anuria. |
| Which finding, if present in a patient’s history, is most closely related to the patient’s developing acute glomerulonephritis? | “I had strep throat about 2 or 3 weeks ago.” Glomerulonephritis is primarily seen in children and young adults, and it affects males more than females. It most commonly occurs about 2 to 3 weeks after a group A beta-hemolytic streptococcal infection, such as “strep throat” or impetigo; however, it can occur in response to bacterial, viral, or parasitic infections elsewhere in the body. It is an immunologic problem caused by an antigen-antibody reaction |
| A patient with glomerulonephritis requests a snack. Which is most appropriate? | Applesauce Applesauce will provide additional vitamins and carbohydrates needed for healing. |
| The female patient presents to the clinic complaining of urinary frequency and burning. The nurse suspects a urinary tract infection (UTI) that was most likely caused by which organism? | Escherichia coli E. coli causes 80% of UTIs in females. |
| The patient presents to the clinic complaining of urinary urgency, frequency, dysuria, and low back pain. The nurse suspects cystitis and prepares to educate the patient on taking which medications? | Trimethoprim-sulfamethoxazole Phenazopyridine The patient with cystitis would be prescribed an antibiotic such as trimethoprim-sulfamethoxazole as well as phenazopyridine, which is a urinary analgesic. |
| The patient presents to the clinic with urinary frequency, burning, and dysuria and is diagnosed with a UTI. The nurse should recommend which nonpharmacologic interventions to help treat the infection and control symptoms? | Consumption of 64 to 96 ounces of water daily Cranberry juice Sitz baths Nonpharmacologic interventions for UTIs include sitz baths, cranberry juice, and increased fluid intake. Vaginal douches are not recommended because they alter the vaginal pH and destroy healthy flora. Alcohol is not helpful for UTIs. |
| the functional unit of the kidney | The nephron -there are 1 million nephrons in a kidney |
| What is creatinine ? | waste products of protein metabolism and skeletal muscle contraction. |
| Cystitis | an inflammation of the urinary bladder |
| Urethritis | inflammation of the urethra |
| Honeymoon cystitis | bacteria that have entered the urethra by way of friction during intercourse |
| urinary stasis | Urine that sits in the bladder |
| Drug Commonly Used for Urinary Tract Infections | Trimethoprim-sulfamethoxazole (Bactrim) |
| The symptoms of urethritis (UTI) | burning, itching, frequency in voiding, and painful urination |
| Acute pyelonephritis | An infection of the kidneys; bacteria (such as E. coli) from a bladder infection travel up the ureters to infect the kidneys. A common cause of pyelonephritis is an obstruction, causing stasis of urine and stones that cause irritation of the tissue. When bacteria enter the renal pelvis, inflammation and infection occur. |
| What is a nurse expected to see in a patient with chronic kidney disease? | Oliguria |
| Urethral catheter | Placed through the urethra to the bladder for one-time drainage or to obtain a specimen. |
| A urethral catheter but indwelling and placed for continuous urine drainage from the bladder. | Foley catheter |
| Continuous drainage of urine from the bladder; inserted in suprapubic area of abdomen through abdominal and bladder wall. | Suprapubic catheter |
| Ureteral catheter | Used in procedures to inject contrast for imaging or to access the ureter for intervention. Are removed when the procedure is complete; placed by a physician. |
| Tube placed in ureter to hold it open during healing or to facilitate stone passage. One end is in the renal pelvis, and the other end is in the bladder. | Ureteral stent |
| Nephrostomy tube | Placed into the pelvis of the kidney through the skin to provide drainage of urine directly from the kidney to an external collection bag. |
| Labs and Dx for Urosepsis | UA/UC PRIOR TO ADMINSITERING ABX |
| Labs and Dx for Urethritis | UA/UC , STI/STD testing |
| Labs and Dx for Ureteritis | dependent upon causative organism (bacterial/viral infections. pyelonephritis). |
| Uremic Syndrome | an accumulation of nitrogenous waste products in the blood caused by the kidney's inability to filter out waste products. |
| Symptoms of Uremic syndrome | N/V altered level of consciousness anemia hematuria terrible BP Extra waste in urine and blood Dysrhythmias |
| Treatments for Uremic syndrome | Hemodialysis Peritoneal Dialysis hemofiltration Renal replacement therapy |
| Labs for Uremic syndrome | U/A BUN Creatinine Electrolyte levels Hemolytic work up Stool culture |
| Interventions for for Uremic syndrome | Monitor VS for Tachycardia, hyper/hypotension monitor serum electrolyte levels Monitor I&O's High protein diet Low sodium, nitrogen, phosphate and potassium diet |
| Polycystic Kidney disease | Cystic formation and hypertrophy of the kidneys; can lead to rupture, infection formation of scar tissue and damage to nephrons. |
| Interventions for Polycystic Kidney disease | monitor for gross hematuria increase sodium and water intake bedrest Adm. hypertensives as prescribed NO NSAIDS die to increased Nephrotoxicity |
| Labs for Polycystic Kidney disease | U/A Creatinine clearance Hematocrit Serum electrolyte levels US Excretory urography MRI/CT scan |
| Assessment for Polycystic Kidney disease | Flank, Lumbar (back), or abd pain that worsens with activity Fever and chills recurrent UTI Hematuria, proteinuria, pyuria Calculi Hypotension Palpable abd masses Enlarged Kidneys Increased abd. girth |
| Glomerulonephritis | Inflammation and scarring of the kidneys |
| Cause of Glomerulonephritis | Infection-Usually strep and gone in 14 days. |
| Symptoms of Glomerulonephritis | Fever High WBC low protein recent strep infection |
| Treatments for Glomerulonephritis | treat infection finish all abx limit protein antihypertensive meds. |
| Nephrosis (Nephrotic syndrome Chronic) | Inflammation and scarring |
| Cause of Nephrosis (Nephrotic syndrome) | Lupus Triggers are the 4 ss Stress sickness or sepsis smoking sun |
| Signs and sxs of Nephrosis (Nephrotic syndrome) | High proteinuria Low Albumin-Hypoalbuminemia |
| Complication of of Nephrosis (Nephrotic syndrome) | Renal failure HTN crisis |
Created by:
shondell1971
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