Renal and Urologic Problems Lewis Test Bank

Renal and Urologic Problems Lewis: MedicalSurgical Nursing MULTIPLE CHOICE 1. A 46-yr-old female patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take? Remind the patient about the need to drink 1000 mL of fluids daily. Obtain a midstream urine specimen for culture and sensitivity testing. Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms. Teach the patient to take the prescribed trimethoprim and sulfamethoxazole for 3 more days. a. b. c. d. ANS: C Because uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3 days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine appropriate antibiotic therapy. Acetaminophen would not be as effective as other over-thecounter medications such as phenazopyridine in treating dysuria. The fluid intake should be increased to at least 1800 mL/day. Because the UTI has persisted after treatment with trimethoprim and sulfamethoxazole , the patient is likely to need a different antibiotic. 2. The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs) has been effective for a 22-yr-old female patient with cystitis when the patient states which of the following? a. “I can use vaginal antiseptic sprays to reduce bacteria.” b. “I will drink a quart of water or other fluids every day.” c. “I will wash with soap and water before sexual intercourse.” d. “I will empty my bladder every 3 to 4 hours during the day.” ANS: D Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal sprays is discouraged. The bladder should be emptied before and after intercourse, but cleaning with soap and water is not necessary to prevent UTI. A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI. 3. Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine? Take phenazopyridine for at least 7 days. Phenazopyridine may cause photosensitivity Phenazopyridine may change the urine color Take phenazopyridine before sexual intercourse. a. b. c. d. ANS: C Patients should be taught that phenazopyridine will color the urine deep orange. Urinary analgesics should only be needed for a few days until the prescribed antibiotics decrease the bacterial count. Phenazopyridine does not cause photosensitivity. Taking phenazopyridine before intercourse will not be helpful in reducing the risk for UTI. 4. Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? c. Suprapubic discomfort d. Costovertebral tenderness a. Bladder distention b. Foul-smelling urine ANS: D Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling urine, and suprapubic discomfort are characteristic of a lower UTI and are likely to be present if the patient also has an upper UTI. 5. The nurse determines that further instruction is needed for a patient with interstitial cystitis when the patient says which of the following? “I should stop having coffee and orange juice for breakfast.” “I will buy calcium glycerophosphate (Prelief) at the pharmacy.” “I will start taking high potency multiple vitamins every morning.” “I should call the doctor about increased bladder pain or foul urine.” a. b. c. d. ANS: C High-potency multiple vitamins may irritate the bladder and increase symptoms. The other patient statements indicate good understanding of the teaching. 6. To determine possible causes, the nurse will ask a patient admitted with acute glomerulonephritis about a. recent bladder infection. b. history of kidney stones. c. recent sore throat and fever. d. history of high blood pressure. ANS: C Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection. 7. Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective? a. The patient denies pain with voiding. b. The urine dipstick is negative for nitrites. c. The antistreptolysin-O (ASO) titer has decreased. d. The periorbital and peripheral edema are resolved. ANS: D Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection. 8. The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with a. antibiotics. b. antifungals. c. anticoagulants. d. antihypertensives. ANS: C Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Fungal pyelonephritis is uncommon and is treated with antifungals. Antihypertensives are used if the patient has high blood pressure. 9. A 56-yr-old female patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect? a. Poor skin turgor b. Recent weight gain c. Elevated urine ketones d. Decreased blood pressure ANS: B The patient with a nephrotic syndrome will have weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high. Ketones are not related to nephrotic syndrome. 10. To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. c. spinach and chocolate. b. sardines and liver. d. legumes and dried fruit. ANS: B Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones. 11. The nurse teaches an adult patient to prevent the recurrence of renal calculi by a. using a filter to strain all urine. b. avoiding dietary sources of calcium. c. drinking 2000 to 3000 mL of fluid each day. d. choosing diuretic fluids such as coffee and tea. ANS: C A fluid intake of 2000 to 3000 mL/day is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones. 12. When planning teaching for a patient with benign nephrosclerosis, the nurse should include instructions regarding preventing bleeding with anticoagulants. monitoring and recording blood pressure. obtaining and documenting daily weights. measuring daily intake and output volumes. a. b. c. d. ANS: B Hypertension is the major manifestation of nephrosclerosis. Measurements of intake and output and daily weights are not necessary unless the patient develops renal insufficiency. Anticoagulants are not used to treat nephrosclerosis. 13. A 28-yr-old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time? Complications of renal transplantation Methods for treating severe chronic pain Options to consider for genetic counseling Differences between hemodialysis and peritoneal dialysis a. b. c. d. ANS: C Because a 28-yr-old patient may be considering having children, the nurse should include information about genetic counseling when teaching the patient. A well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There is no indication that the patient has chronic pain. 14. A young adult male patient seen at the primary care clinic complains of feeling continued fullness after voiding and a split, spraying urine stream. The nurse will ask about a history of c. recurrent bladder infection. d. benign prostatic hyperplasia. a. recent kidney trauma. b. gonococcal urethritis. ANS: B The patient’s clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis. These symptoms are not consistent with benign prostatic hyperplasia, kidney trauma, or bladder infection. 15. The nurse will plan to teach a 27-yr-old woman who smokes two packs of cigarettes daily about the increased risk for a. kidney stones. b. bladder cancer. c. bladder infection. d. interstitial cystitis. ANS: B Cigarette smoking is a risk factor for bladder cancer. The patient’s risk for developing interstitial cystitis, urinary tract infection, or kidney stones will not be reduced by quitting smoking. 16. A 68-yr-old female patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action should be included in the plan of care? Restrict fluids between meals and after the evening meal. Insert an indwelling catheter until the symptoms have resolved. Assist the patient to the bathroom every 2 hours during the day. Apply absorbent adult incontinence diapers and pads over the bed linens. a. b. c. d. ANS: C In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling catheters increase the risk for urinary tract infection. Incontinent pads and diapers increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with dehydration. 17. A 55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is most appropriate to include in the care plan? a. Assist the patient to the bathroom q3hr. b. Place a commode at the patient’s bedside. c. Demonstrate how to perform the Credé maneuver. d. Teach the patient how to perform Kegel exercises. ANS: D Kegel exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The Credé maneuver is used to help empty the bladder for patients with overflow incontinence. Placing the commode close to the bedside and assisting the patient to the bathroom are helpful for functional incontinence. 18. Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours. Which nursing action is most appropriate? Monitor the patient’s intake and output overnight. Have the patient drink small amounts of fluid frequently. Use an ultrasound scanner to check the postvoiding residual volume. Reassure the patient that this is normal after anesthesia for rectal surgery. a. b. c. d. ANS: C An ultrasound scanner can be used to check for residual urine after the patient voids. Because the patient’s history and clinical manifestations are consistent with overflow incontinence, it is not appropriate to have the patient drink small amounts. Although overflow incontinence is not unusual after surgery, the nurse should intervene to correct the physiologic problem, not just reassure the patient. The patient may develop reflux into the renal pelvis and discomfort from a full bladder if the nurse waits to address the problem for several hours. 19. A patient admitted to the hospital with pneumonia has a history of functional urinary incontinence. Which nursing action will be included in the plan of care? Demonstrate the use of the Credé maneuver. Teach exercises to strengthen the pelvic floor. Place a bedside commode close to the patient’s bed. Use an ultrasound scanner to check postvoiding residuals. a. b. c. d. ANS: C Modifications in the environment make it easier to avoid functional incontinence. Checking for residual urine and performing the Credé maneuver are interventions for overflow incontinence. Kegel exercises are useful for stress incontinence. 20. The home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which patient statement indicates that the teaching has been effective? a. “I will buy seven new catheters weekly and use a new one every day.” b. “I will use a sterile catheter and gloves for each time I self-catheterize.” c. “I will clean the catheter carefully before and after each catheterization.” d. “I will take prophylactic antibiotics to prevent any urinary tract infections.” ANS: C Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days. There is no need to use a new catheter every day, to use sterile catheters, or to take prophylactic antibiotics. 21. After ureterolithotomy, a patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care? a. b. c. d. Provide teaching about home care for both catheters. Apply continuous steady tension to the ureteral catheter. Call the health care provider if the ureteral catheter output drops suddenly. Clamp the ureteral catheter off when output from the urethral catheter stops. ANS: C The health care provider should be notified if the ureteral catheter output decreases because obstruction of this catheter may result in an increase in pressure in the renal pelvis. Tension on the ureteral catheter should be avoided to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Because the patient is not usually discharged with a ureteral catheter in place, patient teaching about both catheters is not needed. 22. A 68-yr-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching? Application of ostomy appliances Barrier products for skin protection Catheterization technique and schedule Analgesic use before emptying the pouch a. b. c. d. ANS: C The Indiana pouch enables the patient to self-catheterize every 4 to 6 hours. There is no need for an ostomy device or barrier products. Catheterization of the pouch is not painful. 23. A patient who had surgery for creation of an ileal conduit 3 days ago will not look at the stoma and requests that only the ostomy nurse specialist does the stoma care. The nurse identifies a nursing diagnosis of a. anxiety related to effects of procedure on lifestyle. b. disturbed body image related to change in function. c. readiness for enhanced coping related to need for information. d. self-care deficit (toileting) related to denial of altered body function. ANS: B The patient’s unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best way to describe the problem. No data suggest that the impact on lifestyle is a concern for the patient. The patient does not appear to be ready for enhanced coping. The patient’s insistence that only the ostomy nurse care for the stoma indicates that denial is not present. 24. Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider? a. The patient is voiding every 4 hours. b. The patient is using opioids for pain. c. The patient has seen clots in the urine. d. The patient is anxious about the cancer. ANS: C Clots in the urine are not expected and require further follow-up. Voiding every 4 hours, use of opioids for pain, and anxiety are typical after this procedure. 25. When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse will teach about premedicating to prevent nausea. obtaining wigs and scarves to wear. emptying the bladder before the medication. maintaining oral care during the treatments. a. b. c. d. ANS: C The patient will be asked to empty the bladder before instillation of the chemotherapy. Systemic side effects are not usually experienced with intravesical chemotherapy. 26. Nursing staff on a hospital unit are reviewing rates of health care-associated infections (HAI) of the urinary tract. Which nursing action will be most helpful in decreasing the risk for urinary HAI in patients admitted to the hospital? a. Testing urine with a dipstick daily for nitrites b. Avoiding unnecessary urinary catheterizations c. Encouraging adequate oral fluid and nutritional intake d. Providing perineal hygiene to patients daily and as needed ANS: B Because catheterization bypasses many of the protective mechanisms that prevent urinary tract infection (UTI), avoidance of catheterization is the most effective means of reducing HAI. The other actions will also be helpful but are not as useful as decreasing urinary catheter use. 27. Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)? a. Low urine output b. Bilateral flank pain c. Nausea and vomiting d. Burning on urination ANS: D Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI. 28. Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? c. Cloudy and foul-smelling urine d. Temperature 100.1° F (57.8° C) a. Complaint of flank pain b. Blood pressure 90/48 mm Hg ANS: B The low blood pressure indicates that urosepsis and septic shock may be occurring and should be immediately reported. The other findings are typical of pyelonephritis. 29. A 58-yr-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which patient problem is present based on these findings? c. Disturbed body image d. Altered nutrition: less than required a. Activity intolerance b. Excess fluid volume ANS: B Edema and ascites are evidence of the excess fluid volume. There are no data provided to support the other problems. 30. A 76-yr-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first? a. Insert a urinary retention catheter. b. Draw blood for a serum creatinine level. c. Schedule an intravenous pyelogram (IVP). d. Administer lorazepam (Ativan) 0.5 mg PO. ANS: A The patient’s history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient’s agitation may resolve after the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP may be used as a diagnostic test but does not need to be done urgently. 31. Which nursing action is of highest priority for a patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? a. Administer prescribed analgesics. b. Monitor temperature every 4 hours. c. Encourage increased oral fluid intake. d. Give antiemetics as needed for nausea. ANS: A Although all of the nursing actions may be used for patients with renal lithiasis, the patient’s presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea. 32. The nurse is caring for a patient who has had an ileal conduit for several years. Which nursing action could be delegated to unlicensed assistive personnel (UAP)? Change the ostomy appliance. Choose the appropriate ostomy bag. Monitor the appearance of the stoma. Assess for possible urinary tract infection (UTI). a. b. c. d. ANS: A Changing the ostomy appliance for a stable patient could be done by UAP. Assessments of the site, choosing the appropriate ostomy bag, and assessing for UTI symptoms require more education and scope of practice and should be done by the registered nurse (RN). 33. Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? c. Left flank discomfort d. Decreased urine output a. Blood in urine b. Left flank bruising ANS: D Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to report a drop in urine output. Left flank pain, bruising, and hematuria are common after lithotripsy. 34. A patient is unable to void after having an open loop resection and fulguration of the bladder. Which nursing action should be implemented? Assist the patient to soak in a 15-minute sitz bath. Restrict oral fluids to equal previous urine volume. Insert a straight urethral catheter and drain the bladder. Teach the patient how to do isometric perineal exercises. a. b. c. d. ANS: A Sitz baths will relax the perineal muscles and promote voiding. The patient should be to drink fluids. Kegel exercises are helpful in the prevention of incontinence, but would not be helpful for a patient experiencing retention. Catheter insertion increases the risk for urinary tract infection and should be avoided when possible 35. The nurse observes unlicensed assistive personnel (UAP) taking the following actions when caring for a patient with a urethral catheter. Which action requires that the nurse intervene? Taping the catheter to the skin on the patient’s upper inner thigh Cleaning around the patient’s urinary meatus with soap and water Disconnecting the catheter from the drainage tube to obtain a specimen Using an alcohol-based gel hand cleaner before performing catheter care a. b. c. d. ANS: C The catheter should not be disconnected from the drainage tube because this increases the risk for urinary tract infection. The other actions are appropriate and do not require any intervention. 36. A 48-yr-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma from a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon? a. Blood pressure is 102/58. b. Urine output is 20 mL/hr for 2 hours. c. Incisional pain level is reported as 9/10. d. Crackles are heard at bilateral lung bases. ANS: B Because the urine output should be at least 0.5 mL/kg/hr, a 40-mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life threatening as decreased renal perfusion. In addition, the nurse can medicate the patient for pain. 37. A patient had a cystectomy with an ileal conduit yesterday. Which new assessment data is most important for the nurse to communicate to the health care provider? c. Heart rate 102 beats/minute d. Continuous stoma drainage a. Cloudy appearing urine b. Hypotonic bowel sounds ANS: C Tachycardia may indicate infection, hemorrhage, or hypovolemia, which are all serious complications of this surgery. The urine from an ileal conduit normally contains mucus and is cloudy. Hypotonic bowel sounds are expected after bowel surgery. Continuous drainage of urine from the stoma is normal. 38. A patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider? a. Give ketorolac 10 mg PO PRN for pain. b. Infuse 5% dextrose in normal saline at 75 mL/hr. c. Order regular diet after patient is awake and alert. d. Draw blood urea nitrogen (BUN) and creatinine in 2 hours. ANS: A The nonsteroidal antiinflammatory drugs (NSAIDs) should be avoided in patients with decreased renal function because nephrotoxicity is a potential adverse effect. The other orders do not need any clarification or change. 39. A patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider? c. Intermittent hematuria d. Burning with urination a. Urinary urgency b. Left-sided flank pain ANS: B Flank pain indicates that the patient may have developed pyelonephritis as a complication of the bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection. 40. A patient in the urology clinic is diagnosed with monilial urethritis. Which action will the nurse include in the plan of care? Teach the patient about the use of antifungal medications. Tell the patient to avoid tub baths until the symptoms resolve. Instruct the patient to refer recent sexual partners for treatment. Teach the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs). a. b. c. d. ANS: A Monilial urethritis is caused by a fungus and antifungal medications such as nystatin or fluconazole are usually used as treatment. Because monilial urethritis is not sexually transmitted, there is no need to refer sexual partners. Warm baths and NSAIDS may be used to treat symptoms. 41. Which action will the nurse anticipate taking for an otherwise healthy 50-yr-old who has just been diagnosed with stage 1 renal cell carcinoma? Prepare patient for a renal biopsy. Provide preoperative teaching about nephrectomy. Teach the patient about chemotherapy medications. Schedule for a follow-up appointment in 3 months. a. b. c. d. ANS: B The treatment of choice in patients with localized renal tumors who have no co-morbid conditions is partial or total nephrectomy. A renal biopsy will not be needed in a patient who has already been diagnosed with renal cancer. Chemotherapy is used for metastatic renal cancer. Because renal cell cancer frequently metastasizes, treatment will be started as soon as possible after the diagnosis. 42. Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse? Blood urea nitrogen level is 70 mg/dL. Urine output over the last 2 hours is 30 mL. Audible crackles bilaterally over the posterior chest to the midscapular level. Elevated level of antiglomerular basement membrane (anti-GBM) antibodies. a. b. c. d. ANS: C Crackles heard to a high level indicate a need for rapid actions such as assessment of O2 saturation, reporting the findings to the health care provider, initiating O2 therapy, and dialysis. The other findings will also be reported but are typical of Goodpasture syndrome and do not require immediate nursing action. 43. A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first? Check blood pressure and heart rate. Administer morphine sulfate 4 mg IV. Transport to radiology for an intravenous pyelogram. Insert a urethral catheter and obtain a urine specimen. a. b. c. d. ANS: A Because the kidney is very vascular, the initial action with renal trauma will be assessment for bleeding and shock. The other actions are also important after the patient’s cardiovascular status has been determined and stabilized. 44. After change-of-shift report, which patient should the nurse assess first? a. Patient with a urethral stricture who has not voided for 12 hours b. Patient who has cloudy urine after orthotopic bladder reconstruction c. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg d. Patient who voided bright red urine immediately after returning from lithotripsy ANS: A The patient information suggests acute urinary retention, which is a medical emergency. The nurse will need to assess the patient and consider whether to insert a retention catheter. The other patients will also be assessed, but their findings are consistent with their diagnoses and do not require immediate assessment or possible intervention. MULTIPLE RESPONSE 1. A patient has been diagnosed with urinary tract calculi that are high in uric acid. Which foods will the nurse teach the patient to avoid (select all that apply)? Milk Liver Spinach Chicken Cabbage Chocolate a. b. c. d. e. f. ANS: B, D Meats contain purines, which are metabolized to uric acid. The other foods might be restricted in patients who have calcium or oxalate stones.