Adult Health Exam 4-Renal, Urinary, Gastrointestinal & Metabolic

1. A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient? A. Bathe daily and keep the perineal region clean. B. Avoid voiding immediately after sexual intercourse. C. Drink liberal amounts of fluids. D. Void at least every 6 to 8 hours. Ans: C. The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather than bathe. 2. A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence? A. Stress incontinence B. Reflex incontinence C. Overflow incontinence D. Functional incontinence Ans: A. Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to reach the toilet in time for voiding. 3. A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice? A. Assuming a supine position for self-catheterization B. Using clean technique at home to catheterize C. Inserting the catheter 1 to 2 inches into the urethra D. Self-catheterizing every 2 hours at home Ans: B. The patient may use a clean (nonsterile) technique at home, where the risk of cross- contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female patient assumes a Fowlers position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction. 4. A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patients discharge education, what is the most plausible nursing diagnosis that the nurse should address? A. Impaired mobility related to limitations posed by the ileal conduit B. Deficient knowledge related to care of the ileal conduit C. Risk for deficient fluid volume related to urinary diversion D. Risk for autonomic dysreflexia related to disruption of the sacral plexus Ans: B. The patient will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus I not threatened by the creation of a urinary diversion. 1 5. The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patients health education, what nutritional guidelines should the nurse provide? A. Restrict protein intake as ordered. B. Increase intake of potassium-rich foods. C. Follow a low-calcium diet. D. Encourage intake of food containing oxalates. Ans: A. Protein is restricted to 60 g/d, while sodium is restricted to 3 to 4 g/d. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalate- containing foods and there is no need to increase potassium intake. 6. The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient? A. Limit oral fluid intake for 1 to 2 days. B. Report the presence of fine, sand like particles through the nephrostomy tube. C. Notify the physician about cloudy or foul-smelling urine. D. Report any pink-tinged urine within 24 hours after the procedure. Ans: C. The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy. 7. A female patients most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurses data analysis should be informed by what principle? A. Most UTIs in female patients are caused by viruses and do not cause obvious symptoms. B. A diagnosis of bacteriuria requires three consecutive positive results. C. Urine contains varying levels of healthy bacterial flora. D. Urine samples are frequently contaminated by bacteria normally present in the urethral area. Ans: D. Because urine samples (especially in women) are commonly contaminated by the 5bacteria normally present in the urethral area, a bacterial count exceeding 1 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology. 8. The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach? A. Provide medication teaching related to pseudoephedrine sulfate. B. Teach the patient to perform pelvic floor muscle exercises. C. Prepare the patient for an anterior vaginal repair procedure. D. Provide information on periurethral bulking. Ans: B. Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions has a behavioral approach. 9. The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patients bladder? A. Insertion of a suprapubic catheter B. Scheduling the patient immediately for a prostatectomy C. Application of warm compresses to the perineum to assist with relaxation D. Medication administration to relax the bladder muscles and reattempting catheterization in 6hrs Ans: A. When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm. 10. The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately 50 mL of urine remaining in her bladder after voiding. What would be the nurses best response to this finding? A. Perform a straight catheterization on this patient. B. Avoid further interventions at this time, as this is an acceptable finding. C. Place an indwelling urinary catheter. D. Press on the patients bladder in an attempt to encourage complete emptying Ans: B. In adults older than 60 years of age, 50 to 100 mL of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted. 11. The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day? A. 1,250 mL B. 2,000 mL C. 2,750 mL D. 3,500 mL Ans: B. Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output exceeding 2 L a day is advisable. 12. A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patients urine output hourly and notifies the physician when the hourly output is less than what? A. 30 mL B. 50 mL C. 100 mL D. 125 mL Ans: A. A urine output below 30 mL/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis. 13. The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling catheter? A. Vigorously clean the meatus area daily. B. Apply powder to the perineal area twice daily. C. Empty the drainage bag at least every 8 hours. D. Irrigate the catheter every 8 hours with normal saline. Ans: C. To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection. 14. The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite? A. Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. B. The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. C. Men of all ages are less prone to UTIs, but typically experience more severe symptoms. D. The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs. Ans: B. The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age approaches that of women in the same age group. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs. 15. A patient has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed? A. The circumference of the stoma B. The narrowest part of the stoma C. The widest part of the stoma D. Half the width of the stoma Ans: C. The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage. 16.A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding? A. Use a slipper bedpan. B. Apply a cold compress to the perineum. C. Have the patient lie in a supine position. D. Provide privacy for the patient. Ans: D. Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the patient with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding. 17.A nurses colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurses management of urinary incontinence in older adults? A. Diuretics should be promptly discontinued when an older adult experiences incontinence. B. Restricting fluid intake is recommended for older adults experiencing incontinence. C. Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. D. Urinary incontinence is not considered a normal consequence of aging. Ans: D. Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence. 18. The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention? A. The patients suprapubic region is dull on percussion. B. The patient is uncharacteristically drowsy. C. The patient claims to void large amounts of urine 2 to 3 times daily. D. The patient takes a beta adrenergic blocker for the treatment of hypertension. Ans: A. Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention. 19.A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patients post-procedure care? A. Strain the patients urine following the procedure. B. Administer a bolus of 500 mL normal saline following the procedure. C. Monitor the patient for fluid overload following the procedure. D. Insert a urinary catheter for 24 to 48 hours after the procedure. Ans: A. Following ESWL, the nurse should strain the patients urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL. 20. The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurses assessment reveals that the stoma is a dark purplish color. What is the nurses most appropriate response? A. Document the presence of a healthy stoma. B. Assess the patient for further signs and symptoms of infection. C. Inform the primary care provider that the vascular supply may be compromised. D. Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose. Ans: C. A healthy stoma is pink or red. A change from this normal color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma. 21.A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what? A. Hydronephrosis B. Nephritic syndrome C. Pylonephritis D. Nephrotoxicity Ans: A. If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high- pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes. 22. The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply. A. Dietary history B. Family history of renal stones C. Medication history D. Surgical history Ans: A, B, C. Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to stone formation. When caring for a patient with renal stones it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones. 23.A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? A. Administer prophylactic antibiotics as ordered. B. Limit the use of indwelling urinary catheters. C. Encourage frequent mobility and repositioning. D. Toilet residents who are immobile on a scheduled basis. Ans: B. When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adults risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally administered. Mobility does not have a direct effect on UTI risk. 24.A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. A. Food cravings B. Upper abdominal pain C. Insatiable thirst D. Uncharacteristic fatigue E. New onset of confusion Ans: D. The most common subjective presenting symptom of UTI in older adults is generalized fatigue. The most common objective finding is a change in cognitive functioning. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none is directly suggestive of a UTI. 25.A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic? A. The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy B. The need to expect a heavy menstrual period following the course of antibiotics C. The risk of developing antibiotic resistance after the course of antibiotics D. The need to undergo a series of three urine cultures after the antibiotics have been completed Ans: A. Yeast vaginitis occurs in as many as 25% of patients treated with antimicrobial agents that affect vaginal flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original UTI. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics. 26. An adult patient has been hospitalized with pyelonephritis. The nurses review of the patients intake and output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? A. Supplement the patients fluid intake with a high-calorie diet. B. Emphasize the need to limit intake to 2 L of fluid daily. C. Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. D. Encourage the patient to continue this pattern of fluid intake. Ans: D. Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. 27. An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment? A. Reviewing the patients 24-hour food recall for changes in diet B. Assessing for recent contact with individuals who have UTIs C. Assessing for changes in the patients level of psychosocial stress D. Reviewing the patients medication administration record for recent changes Ans: D. Many medications affect urinary continence in addition to causing other unwanted or unexpected effects. Stress and dietary changes could potentially affect the patients continence, but medications are more frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result from contact with infected individuals. 28.A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment? A. Clearly explain the potential benefits of pelvic floor muscle exercises. B. Ensure the patient knows that surgery will be required if the exercises are unsuccessful. C. Arrange for biofeedback when the patient is learning to perform the exercises. D. Contact the patient weekly to ensure that she is performing the exercises consistently. Ans: C. Research shows that written or verbal instruction alone is usually inadequate to teach an individual how to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted pelvic muscle exercise (PME) uses either electromyography or manometry to help the individual identify the pelvic muscles as he or she attempts to learn which muscle group is involved when performing PME. This objective assessment is likely superior to weekly contact with the patient. Surgery is not necessarily indicated if behavioral techniques are unsuccessful. 29.A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patients plan of care? A. Impaired physical mobility related to presence of an indwelling urinary catheter B. Risk for infection related to presence of an indwelling urinary catheter C. Toileting self-care deficit related to urinary catheterization D. Disturbed body image related to urinary catheterization Ans: B. Catheters create a high risk for UTIs. Because of this acute physiologic threat, the patients risk for infection is usually prioritized over functional and psychosocial diagnoses. 30.A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurses best response? A. Inform the patient that urgency and occasional incontinence are expected for the first few weeks post-removal. B. Obtain an order for a loop diuretic in order to enhance urine output and bladder function. C. Inform the patient that this is not unexpected in the short term and scan the patients bladder following each void. D. Obtain an order to reinsert the patients urinary catheter and attempt removal in 24 to 48 hours. Ans: C. Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule, usually every 2 to 3 hours. At the given time interval, the patient is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely, straight catheterization may be performed. An indwelling catheter would not be reinserted to resolve the problem and diuretics would not be beneficial. Ongoing incontinence is not an expected finding after catheter removal.