CHAPTER 45 Renal and Urological Problems (10th Edition) Flashcards Preview

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1. In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through

a. the bloodstream.

b. the lymphatic system.

c. a descending infection.

d. an ascending infection.

d. an ascending infection.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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2. The nurse teaches the female patient who has frequent UTIs that she should

a. take tub baths with bubble bath.

b.urinate before and after sexual intercourse.

c. take prophylactic sulfonamides for the rest of her life.

d. restrict fluid intake to prevent the need for frequent voiding.

b.urinate before and after sexual intercourse.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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3. The immunologic mechanisms involved in acute poststreptococcal glomerulonephritis include

a. tubular blocking by precipitates of bacteria and antibody reactions.

b. deposition of immune complexes and complement along the GBM.

c. thickening of the GBM from autoimmune microangiopathic changes.

d. destruction of glomeruli by proteolytic enzymes contained in the GBM.

b. deposition of immune complexes and complement along the GBM.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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4

4. One of the nurse's most important roles in relation to acute poststreptococcal glomerulonephritis is to

a. promote early diagnosis and treatment of sore throats and skin lesions.

b. encourage patients to obtain antibiotic therapy for upper respiratory tract infections.

c. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence.

d. monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane.

a. promote early diagnosis and treatment of sore throats and skin lesions.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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5

5. The edema that occurs in nephrotic syndrome is due to

a. increased hydrostatic pressure caused by sodium retention.

b. decreased aldosterone secretion from adrenal insufficiency.

c. increased fluid retention caused by decreased glomerular filtration.

d. decreased colloidal osmotic pressure caused by loss of serum albumin.

d. decreased colloidal osmotic pressure caused by loss of serum albumin.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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6

6. A patient is admitted to the hospital with severe renal colic. The nurse's first priority in management of the patient is to

a. administer opioids as prescribed.

b. obtain supplies for straining all urine.

c. encourage fluid intake of 3 to 4 L/day.

d. keep the patient NPO in preparation for surgery.

a. administer opioids as prescribed.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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7

7. The nurse recommends genetic counseling for the children of a patient with

a. nephrotic syndrome.

b. chronic pyelonephritis.

c. malignant nephrosclerosis.

d. adult-onset polycystic kidney disease.

d. adult-onset polycystic kidney disease.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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8

8. The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of

a. aspirin use.

b. tobacco use.

c. chronic alcohol abuse.

d. use of artificial sweeteners.

b. tobacco use.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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9

9. In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes

a. teaching the patient to use Kegel exercises.

b. clamping and releasing a catheter to increase bladder tone.

c. teaching the patient biofeedback mechanisms to suppress the urge to void.

d. counseling the patient concerning choice of incontinence containment device.

a. teaching the patient to use Kegel exercises.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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10

10. A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes

a. encouraging the patient to drink fruit juices and milk.

b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided.

c. irrigating the nephrostomy tube with 10 mL of normal saline solution as needed.

d. notifying the physician if nephrostomy tube drainage is more than 30 mL/hr.

b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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11

11. A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should

a. notify the physician.

b. notify the charge nurse.

c. irrigate the drainage tube.

d. chart it as a normal observation.

d. chart it as a normal observation.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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12

1. The nurse gives instructions to a 62-year-old woman taking tolterodine (Detrol) to treat urinary urgency and incontinence. The nurse should include which statement?

a. “Stop smoking for 2 to 3 weeks before starting to take this medication.”

b. “Suck on sugarless candy or chew sugarless gum if you develop a dry mouth.”

c. “Have your vision checked every 6 months because this drug can cause cataracts.”

d. “Ask your physician to prescribe an extended-release form if you have loose stools.”

b. “Suck on sugarless candy or chew sugarless gum if you develop a dry mouth.”

Dry mouth is a common side effect of tolterodine. Patients can suck on hard candy or ice chips or chew gum if dry mouth occurs. Tobacco use does not affect the initiation of this medication. Visual changes (but not cataracts) can occur while taking this medication. Constipation may occur as a side effect of this medication.

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2. The nurse teaches a 21-year-old female patient who came to the clinic to discuss interventions to prevent a recurrence of urinary tract infections. Which statement, if made by the patient, indicates that teaching was effective?

a. “I will urinate before and after having intercourse.”

b. “I will use vinegar as a vaginal douche every week.”

c. “I should drink three 8-ounce glasses of water daily.”

d. “I can stop the antibiotics when symptoms disappear.”

a. “I will urinate before and after having intercourse.”

The woman should empty her bladder before and after sexual intercourse. She should avoid vaginal douches and maintain adequate oral fluid intake (15 mL per pound of body weight). All of the antibiotics should be taken as prescribed even if symptoms are no longer present.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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14

3. The nurse provides nutritional counseling for a 45-year-old man with nephrotic syndrome. The nurse determines that teaching has been successful if the patient selects which breakfast menu?

a. Scrambled eggs, milk, yogurt, and sliced ham

b. Oatmeal, nondairy creamer, banana, and orange juice

c. Cottage cheese, peanut butter, white bread, and coffee

d. Waffle, bacon strips, tomato juice, and canned peaches

b. Oatmeal, nondairy creamer, banana, and orange juice

Patients with nephrotic syndrome should follow a low-sodium (2 to 3 g/day), low- to moderate-protein (0.5 to 0.6 g/kg/day) diet. Ham, milk products, peanut butter, and bacon are high in sodium. Eggs, milk products, and peanut butter are high in protein.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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15

*** 4. The nurse is caring for a 73-year-old man patient with a history of benign prostatic hyperplasia and symptoms of a possible urinary tract infection. Which diagnostic finding would support this diagnosis?

a. White blood cell count is 7500 cells/μL.

b. Antistreptolysin-O (ASO) titer is 106 Todd units/mL.

c. Glucose, protein, and ketones are present in the urine.

d. Nitrites and leukocyte esterase are present in the urine.

d. Nitrites and leukocyte esterase are present in the urine.

A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). Presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/μL) indicates a bacterial infection. Antistreptolysin-O (ASO) titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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5. The nurse counsels a 64-year-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the nurse teach the patient to avoid?

a. Venison, crab, and liver

b. Spinach, cabbage, and tea

c. Milk, yogurt, and dried fruit

d. Asparagus, lentils, and chocolate

a. Venison, crab, and liver

Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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17

*** 1. Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor?

a. Tighten both buttocks together.

b. Squeeze thighs together tightly.

c. Contract muscles around rectum.

d. Lie on back and lift legs together.

c. Contract muscles around rectum.

To teach pelvic floor exercises, or Kegel exercise, the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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2. The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving orders, what should the nurse do?

a. Keep the patient on bed rest.

b. Use 5 mL of sterile saline to irrigate.

c. Use 30 mL of water to gently irrigate.

d. Have the patient turn from side to side.

b. Use 5 mL of sterile saline to irrigate.

With a nephrostomy tube, if the tube is occluded and irrigation is ordered, the nurse should use 5 mL or less of sterile saline to gently irrigate it. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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3. A 22-year-old patient's blood pressure at her physical done for her new job was 110/68. At the health fair two months later, her blood pressure is 154/96. What renal problem should the nurse be aware of that could contribute to this abrupt rise in blood pressure?

a. Renal trauma

b. Renal artery stenosis

c. Renal vein thrombosis

d. Benign nephrosclerosis

b. Renal artery stenosis

Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people under 30 or over 50 years of age. Renal trauma usually has hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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20

4. The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected (select all that apply)?

a. Pain location
b. Fever and chills
c. Mental confusion
d. Urinary hesitancy
e. Urethral discharge
f. Post-void dribbling

a. Pain location

e. Urethral discharge

Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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5. Which nursing diagnosis is a priority in the care of a patient with renal calculi?

a. Acute pain

b. Risk for constipation

c. Deficient fluid volume

d. Risk for powerlessness

a. Acute pain

Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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22

6. The patient is wondering why anesthesia is needed when the lithotripsy being done is noninvasive. The nurse explains that the anesthesia is required to ensure the patient's position is maintained during the procedure. The nurse knows that this type of lithotripsy is called

a. laser lithotripsy.

b. electrohydraulic lithotripsy.

c. percutaneous ultrasonic lithotripsy.

d. extracorporeal shock-wave lithotripsy (ESWL).

d. extracorporeal shock-wave lithotripsy (ESWL).

ESWL is noninvasive, but anesthesia is used to maintain the patient's position. The other types of lithotripsy are invasive. Laser lithotripsy uses an ureteroscope and small fiber to reach the stone. Electrohydraulic lithotripsy positions a probe directly on the stone; then continuous saline irrigation flushes are used to rinse the stone out. Percutaneous ultrasonic lithotripsy places an ultrasonic probe in the renal pelvis via a percutaneous nephroscope inserted through an incision in the flank.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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7. Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)?

a. Help the patient cope with the rapid progression of the disease.

b. Suggest genetic counseling resources for the children of the patient.

c. Expect the patient to have polyuria and poor concentration ability of the kidneys.

d. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

b. Suggest genetic counseling resources for the children of the patient.

PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.

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8. Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence?

a. Kegel exercises

b. Use of adult incontinence pads

c. Intermittent self-catheterization

d. Dietary changes including fluid restriction

a. Kegel exercises

Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem, and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.

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9. When caring for a patient with nephrotic syndrome, the nurse should know the patient understands dietary teaching when the patient selects which food item?

a. Peanut butter and crackers

b. One small grilled pork chop

c. Salad made of fresh vegetables

d. Spaghetti with canned spaghetti sauce

c. Salad made of fresh vegetables

Of the options listed, only salad made with fresh vegetables would be acceptable for the diet that limits sodium and protein as well as saturated fat if hyperlipidemia is present. Peanut butter and crackers are processed so they contain significant sodium, and peanut butter contains some protein. A pork chop is a high-protein food with saturated fat. Canned spaghetti sauce is also high in sodium.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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*** 10. The patient with type 2 diabetes has a second UTI within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection?

a. Ciprofloxacin (Cipro)

b. Fosfomycin (Monurol)

c. Nitrofurantoin (Macrodantin)

d. Trimethoprim/sulfamethoxazole (Bactrim)

a. Ciprofloxacin (Cipro)

This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin (Cipro) would be used for a complicated UTI. Fosfomycin (Monurol), nitrofurantoin (Macrodantin), and trimethoprim/sulfamethoxazole (Bactrim) should be used for uncomplicated UTIs.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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11. The patient has scleroderma and is experiencing hypertension. The nurse should know that this could be related to which renal problem?

a. Obstructive uropathy

b. Goodpasture syndrome

c. Chronic glomerulonephritis

d. Calcium oxalate urinary calculi

c. Chronic glomerulonephritis

Hypertension occurs with chronic glomerulonephritis that may be found in patients with scleroderma. Obstructive uropathy, Goodpasture syndrome, and calcium oxalate urinary calculi are not related to scleroderma and do not cause hypertension.

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12. A nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find what clinical manifestations as the "classic triad" occurring in patients with renal cancer?

a. Fever, chills, flank pain

b. Hematuria, flank pain, palpable mass

c. Hematuria, proteinuria, palpable mass

d. Flank pain, palpable abdominal mass, and proteinuria

b. Hematuria, flank pain, palpable mass

There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.

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13. The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. What are priority nursing assessments in the care of this patient?

a. Assessment of pain and level of consciousness

b. Assessment of serum calcium and phosphorus levels

c. Blood pressure and assessment for orthostatic hypotension

d. Daily weights and measurement of the patient's abdominal girth

d. Daily weights and measurement of the patient's abdominal girth

Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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14. What is the nurse's priority when changing the appliance of a patient with an ileal conduit?

a. Keep the skin free of urine.

b. Inspect the peristomal area.

c. Cleanse and dry the area gently.

d. Affix the appliance to the faceplate.

a. Keep the skin free of urine.

The nurse's priority is to keep the skin free of urine because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed; the area will be gently cleaned and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.

Chapter 46 Nursing Management: Renal and Urologic Problems (9th Edition)
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