Chapter 31- Urinary Elimination Nursing School Test Banks

 

1.

Information needed to calculate glomerular filtration rate (GFR) includes which of the following? Select all that apply.

A)

The patients normal daily fluid intake range.

B)

The patients age.

C)

The patients gender.

D)

The patients serum creatinine levels.

Ans:

B, C, D

Feedback:

The glomerular filtration rate (GFR) is the amount of plasma filtered through glomeruli per unit of time and is the best indicator of kidney function. Many labs now calculate an estimated GFR for all patients who have a serum creatinine test. To calculate the GFR you need the patients age, race, gender, and serum creatinine levels.

2.

A patients BUN test results are significantly elevated. When reviewing the patients history, which of the following findings is consistent with BUN elevation other than renal compromise?

A)

The patient is on a low protein diet.

B)

The patient is dehydrated.

C)

The patient has a history of osteoarthritis.

D)

The patient is lactose intolerant.

Ans:

B

Feedback:

The BUN test measures the amount of urea nitrogen in the blood. Urea, the major nitrogenous end waste product of metabolism, is formed in the liver. The bloodstream carries urea from the liver to the kidneys for excretion. When the kidneys are diseased, they are unable to excrete urea adequately, and urea begins to accumulate in the blood, causing BUN to rise. Normal BUN is 8 to 25 mg/100 mL. Because other factors, such as high dietary intake of protein, fluid deficit, infection, gout, or excessive breakdown of protein stores, can also elevate BUN, it is not a highly sensitive indicator of impaired renal function.

3.

A patient who is a paraplegic as a result of an auto accident has incontinence. The nurse correctly recognizes which type of incontinence is most likely?

A)

Stress

B)

Urge

C)

Reflex

D)

Functional

Ans:

C

Feedback:

An involuntary loss of urine that occurs at somewhat predictable intervals when a specific bladder volume is reached is called reflex incontinence. The person is unable to sense bladder fullness because of neurologic impairment, and the bladder simply empties when a certain degree of bladder stretch occurs. Bladder emptying occurs at the sacral reflex level because of impairment of the connection to the cerebrum that allows voluntary inhibition of voiding. Reflex incontinence is seen in patients with neurologic impairment, such as a spinal cord lesion, cerebrovascular accident, or brain tumor.The sudden, involuntary loss of small amounts (less than 50 mL) of urine that accompanies a sudden increase in intra-abdominal pressure is called stress incontinence. The person with urge incontinence is unable simultaneously to perceive a full bladder and to hold urine until reaching the bathroom. Functional incontinence involves the inability or unwillingness of a person with normal bladder and sphincter control to reach the bathroom in time to void.

4.

The nurse is preparing to provide education to a patient concerning prescribed medications to manage incontinence. The prescribed medication is Oxybutynin. What information can be provided?

A)

The medication will reduce the amount of urine being produced by the body, thereby lessening incontinence.

B)

The medication will help to stimulate contraction of muscles involved in voiding, thereby lessening incontinence.

C)

The medication will be used to reduce overactivity of muscles involved in voiding, thereby lessening incontinence.

D)

The medication will increase the amount of fluids retained by the body, thereby lessening the incidence of incontinence.

Ans:

B

Feedback:

Oxybutynin (an antispasmodic) may be used to treat urinary urgency and frequency caused by overactive detrusor muscle activity.

5.

The nurse is caring for an older adult patient suspected of having a urinary tract infection. What manifestation is most associated with the development of this condition in the older adult?

A)

High fever

B)

Dysuria

C)

Acute confusion

D)

Nausea

Ans:

C

Feedback:

Symptoms of UTI are different in the older adult, especially if their immune system is depressed. Rather than experiencing painful urination and a high fever, the older adult will become acutely confused.

6.

During the well-child checkup for 2-year-old twins (one boy, one girl), their mother asks the nurse about preparing to toilet train her children. What information can be provided to the parent? Select all that apply.

A)

It is typically more difficult to toilet train a female child.

B)

Nighttime continence will occur in some children after age 4 or 5 years.

C)

Daytime continence is normal in a 3-year-old child.

D)

Children who are able to remain dry for a few hours at a time may be signaling readiness for toilet training.

E)

Children old enough to undress themselves will have increased abilities to toilet train.

Ans:

C, D, E

Feedback:

Beginning sometime between 2 and 3 years of age, The American Academy of Pediatrics advises parents to watch for signs that a child may be ready for toilet training. These signs include staying dry for two hours at a time or dry after naps, as well as being able to walk to the bathroom and ability to help undress themselves. Most children will achieve daytime urinary control by 3 to 4 years of age. Sometimes, toddlers need to experience outdoor playtime without diapers to see what happens when they experience bladder fullness followed by urethral relaxation and bladder emptying. They begin to understand the relationship between bladder fullness and voluntary bladder emptying and are ready for toilet training. Nighttime continence may not occur until 4 or 5 years of age.

7.

A female infant has voided for the first time. The nurse notes the urine is light pink tinged. What actions by the nurse are indicated?

A)

Document the finding as normal, recognizing that they have been caused by the withdrawal of maternal hormones.

B)

Document the findings as normal, recognizing that they have been caused by an accumulation of uric acid crystals.

C)

Document the abnormal finding and report it to the charge nurse.

D)

Document the finding and report it to the attending physician.

Ans:

B

Feedback:

The first voiding may be of slightly pink-tinged urine, caused by an accumulation of uric acid crystals.

8.

You are the guest speaker at a womens club. Most of the women are over the age of 40 years. The women have asked you to speak on health promotion topics. In the area of urinary urgency, you instruct the women to

A)

Limit fluid intake

B)

Increase caffeine daily

C)

Take an antispasmodic

D)

Perform Kegel exercises

Ans:

D

Feedback:

Pelvic floor exercises or Kegel exercises strengthen the pubococcygeal muscles and effectively promote urinary control.

9.

The nurse is reviewing the urinalysis of a patient suspected of having a urinary tract infection. The presence of which of the following will support the potential diagnosis?

A)

Protein

B)

Calculi

C)

Pus

D)

Casts

Ans:

C

Feedback:

Pyuria is the presence of pus in the urine. Pyuria occurs in the presence of any UTI.

10.

A patient has a urinary tract infection. The patient is told to take phenazopyridine (Pyridium) to decrease urinary discomfort. The patient should be instructed that her urine will turn

A)

Orange

B)

Pink

C)

Blue

D)

Green

Ans:

A

Feedback:

Phenazopyridine (Pyridium) causes urine to turn bright orange.

11.

An elderly patient has come to the emergency room stating she has not voided for 24 hours. Which of the following statements by the patient contributes to her inability to void?

A)

My physician has prescribed a diuretic and potassium supplement to manage my hypertension. I take Maxidex for my high blood pressure.

B)

I drink eight glasses of water per day.

C)

Yesterday I was congested so I took several doses of Benadryl.

D)

I have a bowel movement every day.

Ans:

C

Feedback:

Diphenhydramine (Benadryl) is an antihistamine agent that can cause urinary retention. The use of a diuretic will promote voiding. Potassium supplementation will ensure potassium levels remain within desired ranges. Neither medication will result in urinary retention.

12.

The nurse is caring for a patient who has been experiencing difficulty voiding since her vaginal birth. The patient voices concern to the nurse. What information should be provided to the patient?

A)

The delivery can cause perineal swelling

B)

A neurogenic bladder results from local anesthesia

C)

A urinary tract infection results from the birth process

D)

Catheterization is necessary for 1 week

Ans:

A

Feedback:

Trauma from vaginal delivery causes swelling in the perineal area, which can obstruct the flow of urine and cause urinary retention during the early postpartum period.

13.

A patient has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this patient is related to a

A)

Cystocele

B)

Enuresis

C)

Overactive bladder

D)

Neurogenic bladder

Ans:

D

Feedback:

Neurologic injury after a stroke or spinal cord injury can disrupt normal patterns of urinary elimination. This condition is called neurogenic bladder. A cystocele is a herniation of the urinary bladder. Enuresis is the clinical term for bedwetting. An overactive bladder is the term used when a person has increased urinary urge, increased urinary frequency, or both.

14.

The nurse should instruct the female patient who has experienced two urinary tract infections within the past year to

A)

Void following sexual intercourse

B)

Use shower gels and bubble bath

C)

Avoid drinking cranberry juice

D)

Apply powder to the perineum

Ans:

A

Feedback:

Factors that increase the incidence of urinary tract infections include incorrect wiping of the anal area after bowel movements; sexual intercourse, which can bring perineal microorganisms into closer contact with the urethral meatus; and any procedure that places an object in the urethra or bladder for diagnostic procedures or therapeutic reasons.

15.

Which of the following terms describes obstruction within the urinary system leading to distention of the renal pelvis?

A)

Pyuria

B)

Hematuria

C)

Hydronephrosis

D)

Urethritis

Ans:

C

Feedback:

One of the complications of obstruction within the urinary system is hydronephrosis, which is distention of the kidney pelvis with urine secondary to the increased resistance caused by obstruction to normal urine flow. Pyuria refers to the presence of pus in the urine. This manifestation is associated with an infection. Hematuria is the presence of blood in the urine. Urethritis is the inflammation of the urethra .

16.

A woman informs the nurse that when she is experiencing stress it is difficult to void and wonders why this happens. The nurse explains

A)

Stress causes the muscles to become tense.

B)

You require greater privacy to void.

C)

You might have a neurologic condition.

D)

What medications are you taking?

Ans:

A

Feedback:

A persons muscles may become so tense that relaxation of the perineal muscles does not occur, and voiding is inhibited.

17.

A woman complains of bladder urgency. It is most important to assess

A)

Exercise

B)

Weight

C)

Caffeine intake

D)

Vitamin supplements

Ans:

C

Feedback:

Alcohol and caffeine-containing fluids or food, such as coffee, tea, cola, or chocolate, irritate the bladder and contain a diuretic that can increase urine output when ingested in large amounts.

18.

Which of the following symptoms will have a great impact on the extracellular fluid for water conservation?

A)

Burns

B)

Fracture

C)

Small laceration

D)

Pain

Ans:

A

Feedback:

The water saving to regulate the concentration of solutes in the ECF results in decreased urine output. Increased loss of body fluids can occur with vomiting, diarrhea, excessive diaphoresis secondary to fever or exercise, excessive wound drainage, extensive burns, or blood loss from trauma or surgery.

19.

Which of the following statements should be included in the nurses teaching plan for older adults regarding urinary elimination?

A)

Most older adults experience an increased blood flow to the kidneys

B)

Kidney function progressively increases as the body ages

C)

The kidneys become more effective in filtration with age

D)

Nocturia and urinary retention are more common in older adults

Ans:

D

Feedback:

Nocturia and urinary retention are more common in older adults.

20.

Which of the following statements should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence?

A)

Incontinence after the age of 3 years is not normal

B)

Boys may take longer for daytime continence than girls

C)

Boys may walk by 1 year and should be continent by 3 years

D)

Daytime continence is usually not achieved by boys until age 5

Ans:

B

Feedback:

Children in North American cultures usually achieve daytime urinary continence by 3 years of age; boys may take longer than girls. Nighttime continence may not occur until 4 or 5 years of age.

21.

An infant is born with spina bifida. She may have

A)

Alterations in urinary elimination

B)

Increased urine production

C)

Renal failure

D)

Excessive loss of sodium in the urine

Ans:

A

Feedback:

Congenital malformations of the central nervous system may cause serious alterations in urinary elimination.

22.

Which of the following ranges for urine output in 24 hours is considered normal for an adult?

A)

1,0001,200 cc

B)

1,2001,500 cc

C)

1,6001,900 cc

D)

2,0002,400 cc

Ans:

B

Feedback:

The total amount of urine voided during a 24-hour period usually ranges between 1,200 and 1,500 mL.

23.

When a patient is diagnosed with a urinary tract infection, the nurse anticipates that the patients urine will be

A)

Transparent with an aromatic odor

B)

Light yellow with a faint ammonia odor

C)

Cloudy with an offensive odor

D)

Greenish with a strong ammonia odor

Ans:

C

Feedback:

A strong, offensive odor is not normally present in urine that is free of infection.

24.

A patient has been NPO after midnight for surgery. It is 11:00 AM and the nurse has asked her to void before being transferred to the surgical suite. The nurse should expect her urine to be

A)

Pale yellow

B)

Colorless

C)

Dark amber

D)

Tea colored

Ans:

C

Feedback:

Urine may be dark amber or orange-brown if it is very concentrated secondary to a decreased fluid intake. Urine is lighter than normal if it is diluted. Foods or drugs can also alter the color of urine. Tea-colored or very dark urine is a sign of dehydration.

25.

The micturition reflex is the

A)

Process of filtration beginning with the glomerulus

B)

Act of bladder contraction and perceived need to void

C)

Reabsorption of the substances the body wants to retain

D)

Secretion of electrolytes that are harmful to the body

Ans:

B

Feedback:

Several words are used to describe the process of excreting urine from the body, including urination, voiding, and micturition.

26.

A patient is suspected of having a disease process affecting the functional unit of the kidney. The nurse correctly recognizes which of the following structures is most likely involved?

A)

Glomerulus

B)

Bowmans capsule

C)

Loop of Henle

D)

Nephron

Ans:

D

Feedback:

The functional unit of the kidney is called the nephron. Each kidney has more than 1 million nephrons, and each nephron is capable of forming urine. The nephron consists of the glomerulus, Bowmans capsule, proximal convoluted tubules, loop of Henle, distal tubule, and collecting duct. The glomerulus is a network of blood vessels, surrounded by Bowmans capsule, where urine formation begins. The tubules, loop of Henle, and collecting ducts are passageways that permit urine to flow to the renal pelvis and then to the ureters.

27.

Which type of incontinence is caused by an overactive detrusor muscle causing involuntary bladder contractions?

A)

Urge

B)

Stress

C)

Overflow

D)

Functional

Ans:

A

Feedback:

Urge incontinence is caused by an overactive detrusor muscle causing involuntary bladder contractions.

28.

Which type of incontinence is caused by pelvic floor muscle weakness?

A)

Urge

B)

Overflow

C)

Functional

D)

Stress

Ans:

D

Feedback:

Stress incontinence is caused by pelvic floor muscle weakness. Urge incontinence is the inability to suppress urination after sensing the need to do so; many physical and psychological issues can be related to this problem. Overflow incontinence is related to overdistention or overflow of the bladder. Causes of functional incontinence include environmental barriers, physical limitations, memory loss, and disorientation.

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