Ch20 Urinary System

1. An elderly female client says to the nurse, "I wish I could have a complete night's sleep without having to get up every two hours to urinate." The nurse realizes this client is experiencing:

Benign prostatic hypertrophy

Nocturia

Oliguria

Polyuria

Nocturia, nighttime urination, occurs in the elderly, because when the client is at rest in the supine position, the heart is able to pump blood through the kidneys more efficiently, facilitating the excretion of urine. This factor, combined with weakened bladder and urethral muscles, contributes to nocturnal micturition.

Benign prostatic hypertrophy is a common cause of urinary retention and obstruction in elderly males. It may also cause the symptom of nocturia.

Oliguria is decreased urinary output.

Polyuria is increased urination which occurs throughout the day and is not related to aging or rest in a supine position.

Explanation

Nocturia, nighttime urination, occurs in the elderly, because when the client is at rest in the supine position, the heart is able to pump blood through the kidneys more efficiently, facilitating the excretion of urine. This factor, combined with weakened bladder and urethral muscles, contributes to nocturnal micturition.

Benign prostatic hypertrophy is a common cause of urinary retention and obstruction in elderly males. It may also cause the symptom of nocturia.

Oliguria is decreased urinary output.

Polyuria is increased urination which occurs throughout the day and is not related to aging or rest in a supine position.

2. When the nurse observes the client's urine, it is noted to be normal in appearance with a dark, cloudy color.

True

False

Dark and cloudy are abnormal findings.

Explanation

Dark and cloudy are abnormal findings.

3. When the nurse is obtaining the history from Ms. Basset, which statement made by the client indicates a need for further teaching?

“I am not going to drink much water because it burns so bad when I use the bathroom.”

“The nurse said that I need to cleanse my genital area from front to back.”

“I am not going to wear tight clothes anymore.”

“I need to urinate after I have intercourse with my boyfriend."

The client should force fluids because of the urinary tract infection.

The nurse should teach the client to cleanse from front to back to prevent organisms from the rectal area from entering the vagina or urethra.

The nurse should teach the client to prevent irritation of the urethra by avoiding tight clothing and that she should wear pantyhose without cotton linings.

The nurse should teach the client to urinate before and after intercourse to help prevent urinary tract infections.

Explanation

The client should force fluids because of the urinary tract infection.

The nurse should teach the client to cleanse from front to back to prevent organisms from the rectal area from entering the vagina or urethra.

The nurse should teach the client to prevent irritation of the urethra by avoiding tight clothing and that she should wear pantyhose without cotton linings.

The nurse should teach the client to urinate before and after intercourse to help prevent urinary tract infections.

4. The nurse knows that diabetes does not increase the risk of urinary tract infections.

True

False

Diabetes increases the risk for the development of UTI.

Explanation

Diabetes increases the risk for the development of UTI.

5. When performing an assessment on a client, the nurse notes tenderness to blunt percussion over the costovertebral angle. What might this finding suggest?

Bladder inflammation

Inflammation of the inguinal region

Inflammation of the peritoneum

Inflammation of the kidneys

The costovertebral angle (CVA) is the area on the lower back formed by the vertebral column and the downward curve of the twelfth rib.
Pain or discomfort with direct percussion over this area suggests inflammation of the kidneys. This finding is correlated with history information and other assessment findings.

The bladder is assessed anteriorly in the hypogastric region.

The inguinal region is located anteriorly, near the femoral pulse. The inguinal region is not percussed to determine if there is inflammation.

Inflammation of the peritoneum would be assessed anteriorly via indirect percussion. This individual would also exhibit rebound tenderness to palpation.

Explanation

The costovertebral angle (CVA) is the area on the lower back formed by the vertebral column and the downward curve of the twelfth rib.
Pain or discomfort with direct percussion over this area suggests inflammation of the kidneys. This finding is correlated with history information and other assessment findings.

The bladder is assessed anteriorly in the hypogastric region.

The inguinal region is located anteriorly, near the femoral pulse. The inguinal region is not percussed to determine if there is inflammation.

Inflammation of the peritoneum would be assessed anteriorly via indirect percussion. This individual would also exhibit rebound tenderness to palpation.

6. A client three weeks postpartum comes into the clinic with the complaints of urinary frequency and burning with urination. Which of the following can the nurse explain to this client about these symptoms?

This is a common and normal symptom after delivery.

Your bladder is stretched from pregnancy. These symptoms should soon resolve.

The symptoms that you are experiencing are often the result of sexually transmitted infections.

In the postpartum period, edema and hyperemia of the bladder mucosa cause decreased sensation and contribute to overdistention of the bladder. Incomplete emptying of the bladder often accompanies this condition, increasing the client's susceptibility to urinary tract infections (UTIs).

The client is experiencing UTI symptoms that are not normal, even after delivery.

The client's bladder may be overdistended after delivery; however, the symptoms of a UTI are not likely to resolve on their own.

Without additional information, discussing STIs at this point is not warranted.

Explanation

In the postpartum period, edema and hyperemia of the bladder mucosa cause decreased sensation and contribute to overdistention of the bladder. Incomplete emptying of the bladder often accompanies this condition, increasing the client's susceptibility to urinary tract infections (UTIs).

The client is experiencing UTI symptoms that are not normal, even after delivery.

The client's bladder may be overdistended after delivery; however, the symptoms of a UTI are not likely to resolve on their own.

Without additional information, discussing STIs at this point is not warranted.

7. During the abdominal assessment of a male client, the nurse palpates a large round mass in the hypogastric region. Which of the following could explain what this nurse has palpated?

The presence of an enlarged spermatic cord

The presence of stool in the sigmoid region

The client has a distended or full bladder

A blockage of the ureter

When larger amounts of urine are present, the bladder becomes distended and rises above the symphysis pubis.

The spermatic cord ascends along the posterior border of the testis and through the inguinal canal and down behind the bladder. An enlarged spermatic cord would not cause a palpable mass in the hypogastric region.

The presence of stool in the sigmoid region would be palpable low in the right lower quadrant. The ureter is located between the kidney and the bladder.

A blockage in the ureter would cause urine to back up into the kidney, not the bladder.

Explanation

When larger amounts of urine are present, the bladder becomes distended and rises above the symphysis pubis.

The spermatic cord ascends along the posterior border of the testis and through the inguinal canal and down behind the bladder. An enlarged spermatic cord would not cause a palpable mass in the hypogastric region.

The presence of stool in the sigmoid region would be palpable low in the right lower quadrant. The ureter is located between the kidney and the bladder.

A blockage in the ureter would cause urine to back up into the kidney, not the bladder.

8. When the nurse collects Ms. Basset's vital signs, which of the following should be reported to the physician as soon as possible?

Pulse rate of 68

Respirations 20

Blood pressure 106/82

Temperature of 101.2°F

This is considered to be an elevated temperature and should be reported to the physician as soon as possible.

Explanation

This is considered to be an elevated temperature and should be reported to the physician as soon as possible.

9. An elderly client reports that she is incontinent of urine when she coughs or sneezes. The nurse realizes this client is describing:

Stress incontinence

Reflex incontinence

Urge incontinence

Functional incontinence

Stress incontinence, involuntary urination, occurs when intra-abdominal pressure is increased during coughing, sneezing, or straining. Changes related to aging may also contribute to stress incontinence.

Reflex incontinence occurs when urine is involuntarily lost in clients with spinal cord damage.

Urge incontinence may be caused by consuming a significant volume of fluids over a short period of time, or it may be due to diminished bladder capacity.

Functional incontinence occurs when the client is unable to reach the toilet in time because of environmental, psychosocial, or physical factors.

Explanation

Stress incontinence, involuntary urination, occurs when intra-abdominal pressure is increased during coughing, sneezing, or straining. Changes related to aging may also contribute to stress incontinence.

Reflex incontinence occurs when urine is involuntarily lost in clients with spinal cord damage.

Urge incontinence may be caused by consuming a significant volume of fluids over a short period of time, or it may be due to diminished bladder capacity.

Functional incontinence occurs when the client is unable to reach the toilet in time because of environmental, psychosocial, or physical factors.

10. The mother of a two-year-old child tells the nurse that the baby was born deaf. The most appropriate nursing action is to:

Assess the infant's sleep patterns

Assess the infant's bowel elimination patterns

Assess the infant's urinary elimination patterns

Assess the infant's dietary patterns

The ears and kidneys develop at the same time in utero. Congenital deafness is associated with renal disease.

Assessment of the infant's sleep, dietary, and bowel elimination patterns is included in an overall assessment of an infant, but is not specific to the child's condition of deafness and potential for renal disease.

Explanation

The ears and kidneys develop at the same time in utero. Congenital deafness is associated with renal disease.

Assessment of the infant's sleep, dietary, and bowel elimination patterns is included in an overall assessment of an infant, but is not specific to the child's condition of deafness and potential for renal disease.

11. When performing an assessment on an adult client, the nurse is unable to palpate the right or left kidney. What does this finding suggest to the nurse?

This is a normal, expected finding.

Ask the client about a previous history of renal problems.

The nurse should notify the health care provider.

Additional assessment of the abdomen is needed.

Normally, the kidneys are rarely palpable. If the kidneys are enlarged, they may be palpable.

This normal finding does not indicate a need to ask additional history questions regarding renal problems.

There is no need to notify the health care provider or perform additional assessment techniques.

Explanation

Normally, the kidneys are rarely palpable. If the kidneys are enlarged, they may be palpable.

This normal finding does not indicate a need to ask additional history questions regarding renal problems.

There is no need to notify the health care provider or perform additional assessment techniques.

12. The mother of a four-year-old male child tells the nurse, "I can't believe that he's still wetting the bed at night." Which of the following statements made by the nurse is most appropriate in this situation?

"He is a little old to still be wetting the bed."

"Is he embarrassed about his bed wetting?"

"This is not unusual for children of his age."

"Bed wetting occurs more often in girls than in boys."

Bed wetting (enuresis) generally is not considered problematic unless the child has no daytime dryness after 4 years of age or nighttime dryness after 6 years of age. Inform parents that most bed wetting ceases by age four or five.

Parents should be encouraged to seek health care if the condition persists at age six or seven. Limiting fluid intake before bedtime or waking the child to void are some methods to address the situation.

The child's confidence and social development may be affected by bed wetting; however, the nurse should first provide information about the condition to the parents.

Enuresis is common in children, especially males.

Explanation

Bed wetting (enuresis) generally is not considered problematic unless the child has no daytime dryness after 4 years of age or nighttime dryness after 6 years of age. Inform parents that most bed wetting ceases by age four or five.

Parents should be encouraged to seek health care if the condition persists at age six or seven. Limiting fluid intake before bedtime or waking the child to void are some methods to address the situation.

The child's confidence and social development may be affected by bed wetting; however, the nurse should first provide information about the condition to the parents.

Enuresis is common in children, especially males.

13. A nurse is providing education to a client with a history of renal calculi. Which of the following would the nurse include?

Discuss that renal calculi are usually caused by bacteria.

Discuss the importance of taking all of the antibiotic medication, even when symptoms subside.

Drink enough fluid in a 24-hour period to produce 2 quarts of urine.

Recommend calling the health care provider if a fever develops.

Renal calculi (stones) are usually composed of calcium, struvite, or a combination of magnesium, ammonium, phosphate, and uric acid. Pain is the primary symptom. Other symptoms include nausea, dysuria, frequency and urgency of urination, and hematuria.

Individuals should have adequate fluid intake to produce 2 quarts of urine in a 24-hour period to reduce the development of renal calculi.

Calculi are not caused by bacteria as seen in urinary tract infections.

Antibiotics are prescribed for urinary tract infections, but are not the routine treatment for renal calculi.

The presence of a fever is seen with infection.

Explanation

Renal calculi (stones) are usually composed of calcium, struvite, or a combination of magnesium, ammonium, phosphate, and uric acid. Pain is the primary symptom. Other symptoms include nausea, dysuria, frequency and urgency of urination, and hematuria.

Individuals should have adequate fluid intake to produce 2 quarts of urine in a 24-hour period to reduce the development of renal calculi.

Calculi are not caused by bacteria as seen in urinary tract infections.

Antibiotics are prescribed for urinary tract infections, but are not the routine treatment for renal calculi.

The presence of a fever is seen with infection.

14. A 55-year-old female tells the nurse, "Since I stopped having menstrual periods a year or so ago, I have noticed a leakage of urine." Which of the following should the nurse explain to this client?

Changes in progesterone levels after menopause often cause urinary leakage.

After menopause, the uterus loses elasticity and enlarges, which can press on the bladder and cause leakage of urine.

The decrease in estrogen after menopause can cause spasm of the bladder and leakage of urine.

Postmenopausal females experience a decrease in estrogen, which affects the strength of the pubic muscles and may lead to leakage of urine, reduced acidity in the lower urinary tract, and the development of urinary tract infections.

Alterations in progesterone levels do not have an effect on urinary leakage.

The uterus doesn't enlarge after menopause. Sexual organs atrophy after menopause.

A decreased amount of estrogen does not cause bladder spasms.

Explanation

Postmenopausal females experience a decrease in estrogen, which affects the strength of the pubic muscles and may lead to leakage of urine, reduced acidity in the lower urinary tract, and the development of urinary tract infections.

Alterations in progesterone levels do not have an effect on urinary leakage.

The uterus doesn't enlarge after menopause. Sexual organs atrophy after menopause.

A decreased amount of estrogen does not cause bladder spasms.

15. The nurse is assessing a client with urinary incontinence. The nurse knows that the client is at risk for which of the following?

Urinary tract infections

Dehydration

Constipation

Psychosocial problems

Clients with incontinence are at increased risk for social isolation, self-esteem disturbance, and other psychosocial problems.

Incontinence is not a contributing factor to the development of urinary tract infections.

Dehydration can cause a decreased urinary output, but is not related to urinary incontinence.

Constipation is not related to urinary incontinence.

Explanation

Clients with incontinence are at increased risk for social isolation, self-esteem disturbance, and other psychosocial problems.

Incontinence is not a contributing factor to the development of urinary tract infections.

Dehydration can cause a decreased urinary output, but is not related to urinary incontinence.

Constipation is not related to urinary incontinence.

16. A client has been diagnosed with a kidney stone, lodged within the medulla of the right kidney. Which of the following will this stone most affect?

The collection of urine

The filtration of blood

Lymphatic circulation in the kidney

The clearance of toxins

The renal medulla is composed of structures called pyramids and calyces. The calyces collect urine and transport it into the renal pelvis, which is the funnel-shaped superior end of the ureter.

The filtration of blood begins in the glomeruli.

Lymphatic vessels pass through the hilus and renal sinuses.

The clearance of toxins occurs in the the renal corpuscle and glomerulus.

Explanation

The renal medulla is composed of structures called pyramids and calyces. The calyces collect urine and transport it into the renal pelvis, which is the funnel-shaped superior end of the ureter.

The filtration of blood begins in the glomeruli.

Lymphatic vessels pass through the hilus and renal sinuses.

The clearance of toxins occurs in the the renal corpuscle and glomerulus.

17. Where should the nurse place the stethoscope to assess the renal arteries for the presence of bruits?

Epigastric region

Extended midclavicular line

Hypogastric region

Costovertebral angle

Gently place the bell of the stethoscope over the extended midclavicular line, just under the costal angle on either side of the abdominal aorta above the level of the umbilicus to auscultate the renal arteries. There should be no bruits present. A bruit is an abnormal blowing or whooshing sound produced by turbulent blood flow through an artery.

The nurse auscultates for bruits of the abdominal aorta in the epigastric area.

The bladder and uterus are assessed in the hypogastric region.

The costovertebral angle, located posteriorly at the level of the twelfth rib, is where the nurse performs direct percussion, not auscultation, to determine whether there is pain or tenderness, which might indicate inflammation.

Explanation

Gently place the bell of the stethoscope over the extended midclavicular line, just under the costal angle on either side of the abdominal aorta above the level of the umbilicus to auscultate the renal arteries. There should be no bruits present. A bruit is an abnormal blowing or whooshing sound produced by turbulent blood flow through an artery.

The nurse auscultates for bruits of the abdominal aorta in the epigastric area.

The bladder and uterus are assessed in the hypogastric region.

The costovertebral angle, located posteriorly at the level of the twelfth rib, is where the nurse performs direct percussion, not auscultation, to determine whether there is pain or tenderness, which might indicate inflammation.

18. One of the objectives of Healthy People 2020 is to reduce the rate of new cases of end-stage renal disease. Which of the following actions are recommended to achieve this objective? Select all that apply.

Urine screening

Early identification of people at risk

Control of diabetes and hypertension

Education related to diet and exercise

Routine glucose screening

Urine screening-Urine screening does not reduce the rate of new cases of renal disease.

Early identification of people at risk-Reducing the rate of new cases of end-stage renal disease is focused on prevention, which would include the early identification of individuals at risk for development of the disease, such as those with diabetes and hypertension.

Control of diabetes and hypertension-Control of diabetes and hypertension helps to prevent the development of renal disease.

Education related to diet and exercise- Education regarding diet and exercise is a preventative measure in the development of diabetes and hypertension.

Routine glucose screening-Routine glucose screening does not reduce the rate of new cases of renal disease.

Explanation

Urine screening-Urine screening does not reduce the rate of new cases of renal disease.

Early identification of people at risk-Reducing the rate of new cases of end-stage renal disease is focused on prevention, which would include the early identification of individuals at risk for development of the disease, such as those with diabetes and hypertension.

Control of diabetes and hypertension-Control of diabetes and hypertension helps to prevent the development of renal disease.

Education related to diet and exercise- Education regarding diet and exercise is a preventative measure in the development of diabetes and hypertension.

Routine glucose screening-Routine glucose screening does not reduce the rate of new cases of renal disease.

Submit

19. Which of the following findings might the nurse note when performing an assessment on a client with long-standing renal disease? Select all that apply.

A distended bladder

The client appears fatigued

Peripheral edema

Indications of pruritis

Crackles at the bases of the lungs

A distended bladder - Is not a finding specifically associated with renal disease. It may be seen in individuals who need to void and perhaps are unable to do so.

The client appears fatigued - Clients with chronic kidney disorders frequently look tired and experience fatigue.

Peripheral edema - Individuals with kidney disease may exhibit signs of circulatory overload (pulmonary edema) or peripheral edema (puffy face, fingers, lower extremities)

Indications of pruritus - Itching is present in individuals with kidney disease as well as mental confusion from elevated nitrogenous wastes.

Crackles present in the lung bases - Signs of circulatory overload such as crackles in the lung fields, or pulmonary edema may be present in individuals with kidney disease.

Explanation

A distended bladder - Is not a finding specifically associated with renal disease. It may be seen in individuals who need to void and perhaps are unable to do so.

The client appears fatigued - Clients with chronic kidney disorders frequently look tired and experience fatigue.

Peripheral edema - Individuals with kidney disease may exhibit signs of circulatory overload (pulmonary edema) or peripheral edema (puffy face, fingers, lower extremities)

Indications of pruritus - Itching is present in individuals with kidney disease as well as mental confusion from elevated nitrogenous wastes.

Crackles present in the lung bases - Signs of circulatory overload such as crackles in the lung fields, or pulmonary edema may be present in individuals with kidney disease.

Submit

20. The nurse knows that urinary tract infections can occur at any age and that females are more susceptible to UTIs because of their short urethra.

True

False

UTIs can occur at any age. Females are more susceptible because of their short urethra.

Explanation

UTIs can occur at any age. Females are more susceptible because of their short urethra.