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WorksheetsExam 2 (MedSurg): Urinary Problems
Total questions: 100
Worksheet time: 52mins
Where does the adrenal gland lie in relation to the kidney?
Below the kidney
On top of the kidney
Next to the kidney
Inside the kidney
The capsule of the kidney is a ________ membrane cover.
fibrous
mucous
serous
cartilaginous
On the medial side of the kidney, what enters and exits?
Arteries and nerves enter, veins and ureters exit
Veins and nerves enter, arteries and ureters exit
Only arteries enter
Only veins exit
What is the functional unit of the kidney?
Nephron
Glomerulus
Tubule
Capsule
The renal artery arises from the ________.
aorta
inferior vena cava
pulmonary artery
hepatic vein
Each renal artery divides into smaller branches, each forming an ________ arteriole.
afferent
efferent
glomerular
distal
Afferent arteriole divides into a capillary network called the ________.
glomerulus
Bowman's capsule
loop of Henle
collecting duct
Blood is filtered through hydrostatic pressure in which part of the kidney?
Tubule
Glomerulus
Capsule
Ureter
What is the normal glomerular filtration rate (GFR)?
125 mL/min
80 mL/min
200 mL/min
50 mL/min
What percentage of electrolytes is reabsorbed in the proximal convoluted tubule?
50%
80%
100%
20%
Which part of the nephron is responsible for MOST of renal water reabsorption?
Proximal convoluted tubule
Loop of Henle
Bowman's capsule
Glomerulus
What is the function of the descending loop of the nephron?
Reabsorption of chloride and sodium
Reabsorption of water, some sodium, urea, and other solutes
Secretion of erythropoietin
Regulation of blood pressure
What is reabsorbed in the ascending loop of the nephron?
Water
Chloride and sodium
Urea
RBCs
The ureters join the renal pelvis at the ________ junction.
ureteropelvic
ureterovesical
pelvicalyceal
cystoureteric
The ureters join the bladder at the ________ junction.
ureterovesical
vesicoureteral
ureteropelvic
bladder-ureter
Fill in the blank: The muscle of the bladder is called ________.
detrusor
sphincter
pectoralis
rectus
What is the length of the female urethra?
8-10 inches, 20-25 cm
1-2 inches, 3-5 cm
5-8 inches, 10-15 cm
2-4 inches, 5-10 cm
What is the length of the male urethra?
1-2 inches, 3-5 cm
8-10 inches, 20-25 cm
5-8 inches, 10-15 cm
2-4 inches, 5-10 cm
Between ages 30 and 90, size and weight of kidneys decrease by what percentage?
10-20%
20-30%
30-50%
50-70%
By the seventh decade, there is a loss of ________% glomerular function.
30-50
10-20
50-70
70-90
Atherosclerosis accelerates the ________ of renal size with age.
DECREASE
INCREASE
STABILIZATION
ENLARGEMENT
Fill in the blank: Decreased renal blood flow results in decreased ________.
GFR
urine glucose
blood pressure
serum sodium
Physiologic changes in the urinary system include loss of ______ and muscle support.
elasticity
calcium
glucose
vitamin D
During physical exam of the urinary system, which of the following is rarely palpable?
Right kidney
Left kidney
Bladder
Prostate
Percussion during urinary system assessment may include a kidney punch to check for ______ tenderness.
CVA
hepatic
splenic
costal
Fill in the blank: The bell should be placed at the _______ angle to listen for bruits in the kidneys during auscultation.
costovertebral
subcostal
sternoclavicular
iliac
Fill in the blank: Urinalysis should ideally be performed on the _______ and examined within 1 hour.
first void of the day
second void of the day
last void of the day
it doesn't matter which void is used for specimen collection
Fill in the blank: Creatinine clearance is measured by collecting a _______-hour urine specimen and closely approximates GFR.
24
12
6
48
Which factors are involved in the stone formation of renal calculi?
Metabolic, genetic, climate, lifestyle
Occupational influences
Urinary pH, solute load, inhibitors in urine
All of the above
Fill in the blank: Obstruction with urinary _______ is a factor in the pathophysiology of renal calculi.
stasis
infection
pressure
flow
Fill in the blank: Types of calculi include calcium phosphate and calcium _______.
oxalate
carbonate
sulfate
chloride
Which of the following is NOT a type of urinary tract calculus?
Uric acid
Cystine
Struvite
Glucose
Fill in the blank: Struvite stones are composed of magnesium, ammonium, and _______.
phosphate
calcium
sulfate
oxalate
What is the term used to describe the movement associated with severe pain due to kidney stones?
Kidney stone dance
Renal shuffle
Stone agony walk
Nephritic wriggle
Which diagnostic study is used to assess for hematuria and crystalluria in patients with renal calculi?
Noncontrast Spinal CT (CT/KUB)
Ultrasound
Complete urinalysis
Intravenous Pyelography/IVP
List two serum measurements that are important in the diagnosis of renal calculi.
Serum calcium and serum uric acid
Serum sodium and serum potassium
Serum glucose and serum cholesterol
Serum bilirubin and serum albumin
Which medication is mentioned as a treatment for acute attacks of kidney STONES?
Antibiotics
Opioids
Antihistamines
Diuretics
Which of the following is NOT a part of patient education for kidney stone prevention?
Adequate hydration
Dietary sodium restrictions
Increased sugar intake
Drugs to minimize stone formation
What is the purpose of lithotripsy in the management of kidney stones?
To break up stones into smaller fragments
To dissolve stones chemically
To remove stones surgically
To prevent stone formation
Select the following types of lithotripsy used to treat renal calculi:
Laser lithotripsy
Extracorporeal shockwave lithotripsy
Percutaneous ultrasonic lithotripsy
Electrohydraulic lithotripsy
Subcostal pneumatic lithotripsy
How much urine should be produced per day to ensure adequate fluid intake for prevention of renal calculi recurrence?
Approximately 2L of urine per day
Less than 500ml of urine per day
About 500ml to 1L of urine per day
More than 4L of urine per day
Which of the following is part of education on management of acute episodes of renal calculi?
Drug information
Self-monitor urinary pH
Pain management and comfort measures
All of the above
Straining all urine is recommended in the management of acute episodes of renal calculi.
True
False
What is the most common bacterial infection in women?
UTI
Pneumonia
Tuberculosis
Renal Calculi
At least ___% of women will develop a UTI in their lifetime.
20%
10%
35%
50%
What is the term for colonizing bacteria in the bladder of healthy individuals that does not justify treatment?
Symptomatic bacteriuria
Asymptomatic bacteriuria
Pyelonephritis
Cystitis
Which is the most common pathogen causing UTI?
Staphylococcus aureus
E. coli
Klebsiella
Pseudomonas
E. coli can come from which of the following sources?
Contaminated food
Contact with animals
Indwelling catheters
All of the above
Urine bacterial counts greater than or equal to ___ CFU (colony forming units)/mL indicate significant UTI.
105
103
102
104
Urine bacterial counts as low as ___ CFU/mL with s/s are indicative of UTI.
102
103
104
105
Which of the following are at-risk patients for UTIs?
Immunosuppressed
Diabetic
Having undergone multiple antibiotic courses
Have traveled to developing countries
All of the above
Upper urinary tract infection involves which organs?
A) Kidneys, pelvis, and ureters
B) Bladder and urethra
C) Liver and pancreas
D) Lungs and heart
Lower urinary tract infection usually has which type of manifestations?
Systemic
No systemic
Neurological
Respiratory
What are the two main types of urinary tract infections (UTIs)?
Cystitis and urethritis
Uncomplicated UTI and complicated UTI
Acute and chronic UTI
Bladder and kidney UTI
Uncomplicated UTI usually involves only the _______.
bladder
kidney
urethra
ureter
Which of the following is NOT a condition that coexists with complicated UTI?
Obstruction, stones
Catheters
Diabetes, neurologic disease
Hypertension
The urinary tract above the urethra is sterile in healthy people.
True
False
Which of the following is a defense mechanism that helps prevent UTIs?
High urea concentration
Low pH
Decreased peristaltic activity
Reduced glycoproteins
Complete emptying of the _______ is a defense mechanism against UTIs.
bladder
stomach
lung
intestine
SATA: Select the following factors that increase urinary stasis.
benign prostate hypertrophy
bladder tumor
increased peristaltic activity
neurogenic bladder
abundant glycoproteins
How are organisms most commonly introduced to cause UTIs?
Via the ascending route from urethra and originate in the perineum
Through the bloodstream from distant organs
By direct inoculation during surgery
Via lymphatic spread from adjacent tissues
Which are less common routes for organisms to cause UTIs?
Bloodstream, lymphatic system
Ascending from urethra
Direct extension from adjacent organs
Descending from kidneys
Gram negative bacilli normally found in the GI tract is a common cause of UTIs.
True
False
What does urologic instrumentation allow bacteria to enter?
Urethra and bladder
Kidneys and liver
Lungs and heart
Stomach and intestines
Kidney infection occurring from hematogenous transmission is always preceded by what?
Injury to the tract
Urinary retention
Bladder stone formation
Obstruction of the ureter
Which of the following is NOT a consequence of kidney infection from hematogenous transmission?
Obstruction of ureter
Damage from stones
Renal scars
Increased urine production
Which organism is often responsible for hospital-acquired UTIs?
E. coli
Staphylococcus aureus
Pseudomonas aeruginosa
Candida albicans
Catheter acquired UTIs/CAUTIs are caused by bacteria biofilms developing on what?
Inner surface of catheter
Outer surface of bladder
Tip of the needle
Surface of urine bag
In a patient with renal calculi, pain will slowly move to the lower quadrants of the abdomen as the stone nears the _______.
ureterovesicular junction
ureteropelvic junction
loop of Henle
glomerulus
A patient is recovering from renal calculi. Which substance should the RN suggest the patient remove from their diet?
sodium
potassium
purines
nitrates
tyramines
SATA: Select all of the coexisting complications that may be present with a complicated UTI.
indwelling catheters
pregnancy
renal calculi
diabetes
neurologic disease
Urine pH is ______ as a defense mechanism against UTIs.
alkaline
acidic
neutral
high
UTI symptoms are related to bladder ______ or bladder _______.
degeneration, regeneration
growth, shrinkage
storing, emptying
heating, cooling
SATA: Select all of the UTI manifestations that relate to bladder STORAGE.
urinating more than every 2 hours
sudden strong desire to void immediately
loss of urine during sleep
difficulty starting urine stream
constant interruption of the urine stream
A UTI that presents with chills and fever is likely associated with infection of the ______ urinary tract.
lower
upper
distal
proximal
In older adults, fever is MORE likely for both upper and lower tract UTIs.
True
Falase
Typical signs and symptoms of UTIs are often ______ in older adults.
enhanced
absent
more pronounced
more painful
SATA: Urine dipstick urinalysis can identify the presence of:
nitrites
white blood cells
leukocyte esterase
sodium
potassium
While a standard clean catch urine sample is good, a specimen obtained from ______ or suprapubic needle aspiration will yield the most accurate results.
the purewick canister
the bedpan
the indwelling catheter
the warm urinal sitting uncomfortably close to the patient's dinner tray
How long will an antibiotic regimen be for a patient with uncomplicated cystitis?
2-4 weeks
30 minutes
1-3 days
4-7 days
How long will an antibiotic regimen be for a patient with a complicated UTI?
6-12 months
2-4 weeks
7-14 days
10-12 weeks
What is the purpose for using phenazopyridine (Pyridium) for UTIs?
kills bacteria
kills viruses
soothes urinary tract mucosa
blocks all nociceptive input to urinary tract
When a patient is receiving phenazopyridine (Pyridium), what may happen to their urine?
it becomes filled with blood
it is stained bright blue
it is stained deep orange
it is stained dark green
it becomes filled with large particulates
When a patient defecates, how should they wipe to avoid contracting UTIs?
Front to back
Back to front
Side to side
Let it crust
SATA: What are the MOST important things health care workers can do to avoid nosocomial UTIs?
avoid external catheters at all costs
avoid unnecessary indwelling catheterization
avoid removing indwelling catheters prematurely
wipe for patients whenever possible
avoid using sterile gloves for indwelling catheter placement
What do patients with indwelling catheters REQUIRE EVERY SHIFT to prevent UTIs?
CHG baths and cleaning of catheter tubing
Room temperatures of 80 degrees F or warmer
EKG baths and cleaning of catheter tubing
A new statlock
What is a normal voiding pattern?
Every 10 minutes
Every 1-2 hours
Every 3-4 hours
Every 4-6 hours
Twice daily
Pyelonephritis is inflammation of the renal _______ caused by an infection.
emphysema
lower urinary tract
parenchyma
perineum
A patient with untreated pyelonephritis can develop ______, which is life threatening.
complicated UTI
renal calculi
CVA tenderness
urosepsis
What is vesicoureteral reflux?
when urine moves backwards from the upper urinary tract to the lower urinary tract
when urine moves backwards from the lower urinary tract to the upper urinary tract
when urine moves backwards from the glomerulus to the bladder
when urine moves backwards from the loop of Henle to the distal convoluted tubule
SATA: Most manifestations of pyelonephritis can subside in a few days after onset, even without treatment. However _____ and ______ will remain if untreated.
glycosuria
pyuria
polyuria
bacteriuria
ketonuria
Patients with pyelonephritis will have a urine sample sent for cultures. If the HCP suspects bacteremia, _______ may also be ordered.
BMP
Type and Screen
Blood Cultures
Anti-Xa
Once a patient with pyelonephritis is being treated with effective therapy, their symptoms will typically improve in _______ hours.
1-2
12-24
48-72
24-48
Prompt treatment of cystitis is crucial to prevent ______ infections.
bladder
lower urinary tract
upper urinary tract
urethral
Empiric antibiotic therapy means:
infection is treated with a specific agent the pathogen has been confirmed to be sensitive to
infection is treated with antibiotics only after cultures have come back from the lab
infection is treated with broad spectrum antibiotics based on factors like site of infection, geographic location, and intensity of symptoms
infection is treated with empirical narrow-spectrum macrolides as a first line treatment
A noncontrast spinal CT scan is a preferred diagnostic imaging study for:
lower urinary tract infection
upper urinary tract infection
renal calculi
pyelonephritis
SATA: Which clinical manifestations of UTIs are associated with bladder EMPTYING?
weak stream
urine loss after completion
urinary retention
nocturia
strong desire to void immediately
Patients with obesity are _____ likely to contract UTIs.
more
less
not
The RN should educate patients recovering from UTIs to always void after intercourse.
True
False
Which type of pathogen is the MOST common cause of pyelonephritis?
protozoa
viruses
bacteria
fungi
