Chapter 30. Urinary Elimination

Chapter 30. Urinary Elimination

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.         What is the most significant change in kidney function that occurs with aging?

1)

Decreased glomerular filtration rate

2)

Proliferation of micro blood vessels to renal cortex

3)

Formation of urate crystals

4)

Increased renal mass

 

ANS:   1

Glomerular filtration rate is the amount of filtrate formed by the kidneys in 1 minute. Renal blood flow progressively decreases with aging primarily because of reduced blood supply through the micro blood vessels of the kidney. A decrease in glomerular filtration is the most important functional deficit caused by aging. Urate crystals are somewhat common in the newborn period. They might indicate that the infant is dehydrated. In older people, they result from too much uric acid in the blood, although this is not related to aging. Renal mass (weight) decreases over time, starting around age 30 to 40.

 

PTS:    1          DIF:    Difficult          REF:    p. 1013

KEY:   Nursing process: N/A | Client need: PHSI | Cognitive level: Recall

 

 

 

____    2.         While performing a physical assessment, the student nurse tells her instructor that she cannot palpate her patient’s bladder. Which statement by the instructor is best? “You should:

1)

Try to palpate it again; it takes practice but you will locate it.”

2)

Palpate the patient’s bladder only when it is distended by urine.”

3)

Document this abnormal finding on the patient’s chart.”

4)

Immediately notify the nurse assigned to the care of your patient.”

 

ANS:   2

The bladder is not palpable unless it is distended by urine. It is not difficult to palpate the bladder when distended. The nurse should document her finding, but it is not an abnormal finding. It is not necessary to notify the nurse assigned to the patient.

 

PTS:    1          DIF:    Easy    REF:    p. 1014

KEY:   Nursing process: Assessment | Client need: PSI | Cognitive level: Application

 

 

 

____    3.         Which urine specific gravity would be expected in a patient admitted with dehydration?

1)

1.002

2)

1.010

3)

1.025

4)

1.030

 

ANS:   4

Normal urine specific gravity ranges from 1.010 to 1.025. Specific gravity less than 1.010 indicates fluid volume excess, such as when the patient has fluid overload (too much IV fluid) or when the kidneys fail to concentrate urine. Specific gravity greater than 1.025 is a sign of deficient fluid volume that occurs, for example, as a result of blood loss or dehydration.

 

PTS:    1          DIF:    Moderate         REF:    p. 1015

KEY:   Nursing process: Assessment | Client need: PSI | Cognitive level: Application

 

 

 

____    4.         Which medication class will the primary care provider most likely prescribe to increase urine output in the patient admitted with congestive heart failure?

1)

Thiazide diuretic

2)

Loop diuretic

3)

MAO inhibitor

4)

Anticholinergic

 

ANS:   2

A loop diuretic [e.g., Furosemide (Lasix)] increases urine elimination. It works by limiting the reabsorption of water in the renal tubules and is used to reduce congestion in the cardiopulmonary circulation. A thiazide diuretic is used to treat high blood pressure by reducing the amount of sodium and water in the blood vessels. An MAO inhibitor [e.g., phenelzine (Nardil)] is an antidepressant that is used after other medications have proven unsuccessful in lifting symptoms of serious depression. Anticholinergics [e.g., ipratropium (Atrovent)] relax smooth muscle in the airways. Also known as antispasmodics, they reduce airway constriction experienced by those with asthma, for example.

is a cholesterol-lowering drug. Although high cholesterol is a leading factor for heart disease, the medication is used to reduce cholesterol in the blood—not to promote diuresis to reduce the demand on the heart and backflow into the lungs.

 

PTS:    1          DIF:    Moderate         REF:    p. 1016; not stated directly in the text and requires critical thinking

KEY:   Nursing process: Planning | Client need: SECE | Cognitive level: Application

 

 

 

____    5.         The nurse identifies the nursing diagnosis Urinary Incontinence (Total) in an older adult patient admitted after a stroke. Urinary Incontinence places the patient at risk for which complication?

1)

Skin breakdown

2)

Urinary tract infection

3)

Bowel incontinence

4)

Renal calculi

 

ANS:   1

Urine contains ammonia, which may cause excoriation with prolonged contact with the skin. Bowel incontinence, not urinary incontinence, increases the patient’s risk for urinary tract infection. Immobility and high consumption of calcium-containing foods increase the risk for renal calculi.

 

PTS:    1          DIF:    Moderate         REF:    p. 1021

KEY:   Nursing process: Planning | Client need: PSI | Cognitive level: Application