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A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight hematuria during the first void after the procedure. What is the nurses most appropriate action?
- A. Administer a STAT dose of vitamin\mathrm{K}$, as ordered.
- B. Reassure the patient that this is not unexpected and then monitor the patient for further bleeding.
- C. Promptly inform the physician of this assessment finding.
- D. Position the patient supine and insert a Foley catheter, as ordered.
Correct Answer: B
Rationale: Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected after cystoscopy. The nurse should explain this to the patient and ensure that the bleeding resolves. No clear need exists to report this finding and it does not warrant insertion of a Foley catheter or vitamin\mathrm{K}$ administration.
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A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system?
- A. Increased ability to concentrate urine
- B. Increased bladder capacity
- C. Urinary incontinence
- D. Decreased glomerular filtration rate
Correct Answer: D
Rationale: Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of the older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.
A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include?
- A. The need to be NPO for 12 hours prior to the test
- B. Relaxation techniques to apply during the test
- C. The need for conscious sedation prior to the test
- D. The need to limit fluid intake to 1 liter in the 24 hours before the test
Correct Answer: B
Rationale: Patient preparation should include teaching relaxation techniques because the patient needs to remain still during an MRI. The patient does not normally need to be NPO or fluid-restricted before the test and conscious sedation is not usually implemented.
The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesnt seem to be a great deal of urine flow. What would the nurse expect this patients physical assessment to reveal?
- A. Hematuria
- B. Urine retention
- C. Dehydration
- D. Renal failure
Correct Answer: B
Rationale: Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and renal failure both result in a decrease in urine output, but the patient with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany renal failure and dehydration due to decreased urine production.
A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acidbase balance?
- A. Sequestering free hydrogen ions in the nephrons
- B. Returning bicarbonate to the bodys circulation
- C. Returning acid to the bodys circulation
- D. Excreting bicarbonate in the urine
Correct Answer: B
Rationale: The kidney performs two major functions to assist in acidbase balance. The first is to reabsorb and return to the bodys circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.
A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value?
- A. Hematocrit
- B. Hemoglobin
- C. Erythrocyte sedimentation rate (ESR)
- D. Serum creatinine
Correct Answer: B
Rationale: Although historically hematocrit has been the blood test of choice when assessing a patient for anemia, use of the hemoglobin level rather than hematocrit is currently recommended, because that measurement is a better assessment of the oxygen transport ability of the blood. ESR and creatinine levels are not indicative of oxygen transport ability.