Deck 46: Nursing Management: Renal and Urologic Problems

Question 1

In planning teaching for a patient with benign nephrosclerosis, the nurse should include instructions regarding

A) measuring daily intake and output amounts.
B) obtaining and documenting daily weights.
C) monitoring and recording blood pressure.
D) preventing bleeding caused by anticoagulants.

Answer 1

monitoring and recording blood pressure.

Question 2

A 34-year-old patient with diabetes mellitus is hospitalized with fever, anorexia, and confusion. The health care provider suspects acute pyelonephritis when the urinalysis reveals bacteriuria. An appropriate collaborative problem identified by the nurse for the patient is potential complication

A) hydronephrosis.
B) urosepsis.
C) acute renal failure.
D) chronic pyelonephritis.

Answer 2

urosepsis.

Question 3

The composition of a patient's renal calculus is identified as uric acid. To prevent recurrence of stones, the nurse teaches the patient to avoid

A) spinach, chocolate, and tomatoes.
B) organ meats and fish with fine bones.
C) milk and dairy products.
D) legumes and dried fruits.

Answer 3

organ meats and fish with fine bones.

Question 4

The nurse determines that instruction regarding prevention of future UTIs for a patient with cystitis has been effective when the patient states,

A) "I will empty my bladder every 3 to 4 hours during the day."
B) "I can use vaginal sprays to reduce bacteria."
C) "I will wash with soap and water before sexual intercourse."
D) "I will drink a quart of water or other fluids every day."

Question 5

A patient is admitted to the hospital with nephrotic syndrome after taking an OTC nonsteroidal antiinflammatory drug (NSAID) a week earlier. Which assessment data will the nurse expect to find related to this illness?

A) Low blood pressure
B) Recent weight gain
C) Poor skin turgor
D) High urine ketones

Question 6

A patient with a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock-wave lithotripsy. Which information is most important for the nurse to collect after lithotripsy?

A) Urine output
B) Pain level
C) Appearance of the site
D) Patient temperature

Question 7

When admitting a patient with acute glomerulonephritis, the nurse will ask the patient about

A) history of high blood pressure.
B) frequency of UTIs.
C) recent sore throat and fever.
D) family history of kidney disease.

Question 8

When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about

A) flank pain.
B) pain with urination.
C) poor urine output.
D) nausea.

Question 9

A patient with a history of renal calculi is hospitalized with gross hematuria and severe colicky left flank pain that radiates to his left testicle. In planning care for the patient, the nurse gives the highest priority to the nursing diagnosis of

A) acute pain related to irritation by the stone.
B) deficient fluid volume related to inadequate intake.
C) risk for infection related to urinary system damage.
D) risk for nausea related to pain and renal colic.

Question 10

A 98-year-old patient with benign prostatic hyperplasia has a markedly distended bladder and is agitated and confused. All the following orders are received from the emergency department health care provider. Which order should the nurse act on first?

A) Draw blood for blood urea nitrogen (BUN) and creatinine.
B) Administer lorazepam (Ativan) 0.5 mg.
C) Insert 16 French retention catheter.
D) Schedule for IVP.

Question 11

A patient who is diagnosed with nephrotic syndrome has 3+ ankle and leg edema and ascites. Which nursing diagnosis is a priority for the patient?

A) Fluid-volume excess related to low serum protein levels
B) Altered nutrition: less than required related to protein restriction
C) Activity intolerance related to increased weight and fatigue
D) Disturbed body image related to peripheral edema and ascites

Question 12

A patient with nephrotic syndrome develops flank pain. The nurse will anticipate treatment with

A) antibiotics.
B) antihypertensives.
C) anticoagulants.
D) corticosteroids.

Question 13

The nurse instructs a patient seen in the outpatient clinic with symptoms of renal calculi to strain all urine and to

A) report the pain level when the stone passed.
B) collect the stone and bring it to the clinic.
C) record the time that the stone passed.
D) save a urine specimen to check for blood.

Question 14

To relieve the symptoms of a lower UTI for which the patient is taking prescribed antibiotics, the nurse suggests that the patient use the OTC urinary analgesic phenazopyridine (Pyridium) but cautions the patient that this preparation

A) contains methylene blue, which turns the urine blue or green.
B) should be taken on an empty stomach for maximum effect.
C) causes the urine to turn reddish orange and can stain underclothing.
D) frequently causes allergic reactions and should be stopped if a rash occurs.

Question 15

To prevent the recurrence of renal calculi, the nurse teaches the patient to

A) avoid all sources of dietary calcium.
B) drink diuretic fluids such as coffee.
C) drink 2000 to 3000 ml of fluid a day.
D) use a filter to strain all urine.

Question 16

A 32-year-old patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time?

A) Differences between hemodialysis and peritoneal dialysis
B) Complications of renal transplantation
C) Methods for treating chronic and severe pain
D) Importance of genetic counseling

Question 17

After teaching a patient with interstitial cystitis about management of the condition, the nurse determines that further instruction is needed when the patient says,

A) "I will have to stop having coffee and orange juice for breakfast."
B) "I should start taking a high-potency multiple vitamin every morning."
C) "I should call the doctor about increased bladder pain or odorous urine."
D) "I will buy some calcium glycerophosphate (Prelief) at the pharmacy."

Question 18

Trimethoprim and sulfamethoxazole (Bactrim) BID for 7 days is ordered for a patient who has a recurrent relapse of an Escherichia coli UTI. The nurse instructs the patient to

A) take the antibiotic for the full 7 days, even if symptoms improve in a few days.
B) return to the clinic in 3 days so that a urine culture can be done to evaluate the effectiveness of the drug.
C) increase the effectiveness of the drug by taking it with cranberry juice to acidify the urine.
D) take two of the pills a day for 5 days, and reserve the rest of the pills to take if the symptoms reappear.

Question 19

The nurse establishes a nursing diagnosis of excess fluid volume related to inflammation at the glomerular basement membrane in a patient with acute glomerulonephritis. To best evaluate whether the problem identified in the nursing diagnosis has resolved, the nurse will monitor for

A) proteinuria.
B) elevated creatinine.
C) periorbital edema.
D) hematuria.

Question 20

A 72-year-old patient with benign prostatic hyperplasia and a history of frequent UTIs is admitted to the hospital with chills, fever, and nausea and vomiting. To determine whether the patient has an upper UTI, the nurse will assess for

A) suprapubic pain.
B) foul-smelling urine.
C) bladder distension.
D) costovertebral angle (CVA) tenderness.

Question 21

Following a cystectomy, a patient has an ileal conduit created. The nurse identifies the nursing diagnosis of risk for infection related to altered urinary structures. An appropriate nursing intervention for this problem is to

A) clamp the drainage bag while the patient sleeps.
B) empty the drainage appliance every 2 to 3 hours or when it is one-third full.
C) use liquid antiseptic in the appliance to decrease bacterial colonization.
D) drain the conduit every 4 hours using a sterile catheter.

Question 22

A patient undergoes a nephrectomy for massive trauma to the kidney resulting from a fall from a scaffold. Which assessment data obtained postoperatively are most important to communicate to the surgeon?

A) Blood pressure is 102/48.
B) Urine output is 20 ml/hr for 2 hours.
C) Crackles are heard at both lung bases.
D) Incisional pain level is 8/10.

Question 23

A patient has a cystectomy and a Kock continent diversion created for treatment of bladder cancer. During postoperative teaching of the patient, it is important that the nurse include instructions regarding

A) application of ostomy appliances.
B) catheterization technique and schedule.
C) use of barrier products for skin protection.
D) analgesic use before emptying the pouch.

Question 24

When assessing a patient who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of

A) recurrent renal calculi.
B) kidney trauma.
C) bladder infection.
D) gonococcal urethritis.

Question 25

When obtaining the health history for a 30-year-old patient who smokes two packs of cigarettes daily, the nurse will plan to do teaching about the increased risk for

A) interstitial cystitis.
B) UTI.
C) kidney stones.
D) bladder cancer.

Question 26

After 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 need to 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 need to take prophylactic antibiotics to prevent any urinary tract infections."
D) "I will wash the catheter with soap and water before and after each catheterization."

Question 27

The nurse working in a urology clinic receives a call from a patient who had a transurethral resection with fulguration for bladder cancer 3 days previously. Which information given by the patient is of most concern to the nurse?

A) The patient is voiding every 4 hours at night.
B) The patient is using opioids for pain.
C) The patient is very anxious about the cancer.
D) There are clots in the urine.

Question 28

The nurse observes a nursing assistant (NA) doing all of the following when caring for a patient with a retention catheter. Which action requires that the nurse intervene?

A) The NA uses an alcohol-based hand cleaner before performing catheter care.
B) The NA disconnects the catheter from the drainage tube to obtain a specimen.
C) The NA uses soap and water when cleaning around the urinary meatus.
D) The NA tapes the catheter to the skin on the patient's upper inner thigh.

Question 29

A 26-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having knee surgery. Which of the routine postoperative orders is most important for the nurse discuss with the health care provider?

A) Give ketorolac (Toradol) 10 mg PO PRN for pain.
B) Infuse 5% dextrose in normal saline at 75 ml/hr.
C) Obtain BUN, creatinine, and electrolytes in 2 hours.
D) Order regular diet after patient is awake and alert.

Question 30

A patient undergoing a left ureterolithotomy returns to the surgical unit with a left ureteral catheter and a urethral catheter in place. When caring for the patient, the nurse will plan to

A) aspirate the ureteral catheter if output decreases.
B) clamp the ureteral catheter unless output from the urethral catheter stops.
C) keep the patient on bed rest until the ureteral catheter is discontinued.
D) teach the patient about home care for both catheters.

Question 31

After her bath, a 62-year-old patient asks the nurse for a perineal pad, saying that she uses them because sometimes she leaks urine when she laughs or coughs. Which intervention is most appropriate to include in the care plan for the patient?

A) Teach the patient how to perform Kegel exercises.
B) Demonstrate how to perform Credé's maneuver.
C) Place commode at the patient's bedside.
D) Assist the patient to the bathroom q3hr.

Question 32

A patient in the hospital has a history of urinary incontinence. Which nursing action will be included in the plan of care?

A) Place a bedside commode near the patient's bed.
B) Use an ultrasound scanner to check urine residual after the patient voids.
C) Demonstrate the use of the Credé maneuver to the patient.
D) Teach the use of Kegel exercises to strengthen the pelvic floor.

Question 33

Two days after surgery for an ileal conduit, the patient will not look at the stoma or participate in care. The patient insists that no one but the ostomy nurse specialist care for the stoma. The nurse identifies a nursing diagnosis of

A) anxiety related to effects of procedure on lifestyle.
B) disturbed body image related to change in body function.
C) ineffective health maintenance related to refusal to participate in care.
D) self-care deficit, toileting, related to denial of altered body function.

Question 34

Following an open-loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented?

A) Assist the patient to take a 15-minute sitz bath.
B) Encourage the patient to drink several glasses of water.
C) Teach the patient how to do isometric perineal exercises.
D) Insert a straight catheter and drain the bladder.

Question 35

A patient with bladder cancer is scheduled for intravesical chemotherapy. In preparation for the treatment the nurse will teach the patient about

A) the need to empty the bladder prior to treatment.
B) premedicating to prevent nausea.
C) the importance of oral care during treatment.
D) where to obtain wigs and scarves.

Question 36

Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider?

A) Dysuria
B) Temperature 100.1° F
C) Left-sided flank pain
D) Hematuria

Question 37

A 78-year-old patient is admitted to the hospital with dehydration and electrolyte imbalance. The patient is confused and incontinent of urine on admission. In developing a plan of care for the patient, an appropriate nursing intervention for the patient's incontinence is to

A) insert an indwelling catheter.
B) apply absorbent incontinent pads.
C) assist the patient to the bathroom q2hr.
D) restrict fluids after the evening meal.

Question 38

Following rectal surgery, a patient voids about 50 ml of urine every 30 to 60 minutes. Which nursing action is most appropriate?

A) Use an ultrasound scanner to check for residual urine after voiding.
B) Have the patient take small amounts of fluid frequently throughout the day.
C) Reassure the patient that this is normal after rectal surgery due to anesthesia.
D) Monitor the patient's intake and output over the next few hours.