NUR 2244 RENAL
and ENDOCRINE
SYSTEM EXAM
RENAL SYSTEM:
- After having transurethral resection of the prostate (TURP), a Mr. Locke returns to the
unit with a three-way indwelling urinary catheter and continuous closed bladder
irrigation. Which finding suggests that the client’s catheter is occluded?
a. The urine in the drainage bag appears red to pink.
b. The client reports bladder spasms and the urge to void.
c. The normal saline irrigant is infusing at a rate of 50 drops/minute.
d. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been
returned.
Rationale:
Reports of bladder spasms and the urge to void suggest that a blood clot may be
occluding the catheter. After TURP, urine normally appears red to pink, and normal
saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility
protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of
instilled fluid, plus the client’s urine output (1,000 ml + 200 ml), which reflects catheter
patency. - Nurse Myrna is inserting a urinary catheter into a client who is extremely anxious
about the procedure. The nurse can facilitate the insertion by asking the client to:
a. initiate a stream of urine.
b. breathe deeply.
c. turn to the side.
d. hold the labia or shaft of penis.
Rationale:
When inserting a urinary catheter, facilitate insertion by asking the client to breathe
deeply. Doing this will relax the urinary sphincter. Initiating a stream of urine isn’t
recommended during catheter insertion. Turning to the side or holding the labia or penis
won’t ease insertion, and doing so may contaminate the sterile field. - A female adult client admitted with a gunshot wound to the abdomen is transferred to
the intensive care unit after an exploratory laparotomy. Which assessment finding
suggests that the client is experiencing acute renal failure (ARF)?
a. Blood urea nitrogen (BUN) level of 22 mg/dl
b. Serum creatinine level of 1.2 mg/dl
c. Serum creatinine level of 1.2 mg/dl
d. Urine output of 400 ml/24 hours
Rationale:
ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which
is demonstrated by a urine output of 400 ml/24 hours. A serum creatinine level of 1.2
mg/dl isn’t diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F
(37.8° C) wouldn’t result from this disorder. - A 55-year old client with benign prostatic hyperplasia doesn’t respond to medical
treatment and is admitted to the facility for prostate gland removal. Before providing
preoperative and postoperative instructions to the client, nurse Gail asks the surgeon
which prostatectomy procedure will be done. What is the most widely used procedure
for prostate gland removal?
a. Transurethral resection of the prostate (TURP)
b. Suprapubic prostatectomy
c. Retropubic prostatectomy
d. Transurethral laser incision of the prostate
Rationale:
TURP is the most widely used procedure for prostate gland removal. Because it
requires no incision, TURP is especially suitable for men with relatively minor prostatic
enlargements and for those who are poor surgical risks. Suprapubic prostatectomy,
retropubic prostatectomy, and transurethral laser incision of the prostate are less
common procedures; they all require an incision.
- A female client with suspected renal dysfunction is scheduled for excretory
urography. Nurse July reviews the history for conditions that may warrant changes in
client preparation. Normally, a client should be mildly hypovolemic (fluid depleted)
before excretory urography. Which history finding would call for the client to be well
hydrated instead?
a. Cystic fibrosis
b. Multiple myeloma
c. Gout
d. Myasthenia gravis
Rationale:
Fluid depletion before excretory urography is contraindicated in clients with multiple
myeloma, severe diabetes mellitus, and uric acid nephropathy — conditions that can
seriously compromise renal function in fluid-depleted clients with reduced renal
perfusion. If these clients must undergo excretory urography, they should be well
hydrated before the test. Cystic fibrosis, gout, and myasthenia gravis don’t necessitate
changes in client preparation for excretory urography. - Nurse Kim is caring for a client who had a cerebrovascular accident (CVA). Which
nursing intervention promotes urinary continence?