Lewis Chapter 48: Nursing Management: Renal and Urological Conditions Flashcards
The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based on this diagnosis, the nurse will expect to find which of the following presenting symptoms that occur 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, proteinuria
B. 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.
Which of the following nursing interventions is most appropriate when providing care for an adult patient who is newly diagnosed with adult onset polycystic kidney disease (PKD)?
A. Help the patient cope with the rapid progression of the disease.
B. Suggest genetic counselling 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. Polycystic kidney disease (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. The progression of PKD is slow, not rapid. Polyuria, deafness, and blindness are not associated with PKD.
The nurse is assessing an older person who has burning on urination and production of urine that he describes as “foul smelling.” Which of the following factors may predispose a patient to urinary tract infections (UTIs)?
A. High-purine diet
B. Sedentary lifestyle
C. Neurogenic bladder
D. Recent use of broad-spectrum antibiotics
C. Neurogenic bladder causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to urinary tract infections (UTIs), whereas a diet high in purines is associated with renal calculi.
The nurse is caring for a patient who has been admitted for the treatment of nephrotic syndrome. Which of the following is a priority nursing assessment 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. 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 blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the etiology of nephrotic syndrome.
Which of the following nursing diagnoses is a priority in the care of a patient with renal calculi?
A. Acute pain
B. Deficient fluid volume
C. Risk for constipation
D. Risk for powerlessness
A. 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.
Eight months after the delivery of her first child, a patient has sought care because of occasional incontinence that is experienced when sneezing or laughing. Which of the following measures 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. 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.
Organisms that cause pyelonephritis most commonly reach the kidneys through which means?
a. The bloodstream
b. The lymphatic system
c. A descending infection
d. An ascending infection
D.
What should the nurse teach the female client who has frequent urinary tract infections (UTIs)?
a. Urinate after sexual intercourse.
b. Take tub baths with bubble bath.
c. Take prophylactic sulphonamides for the rest of her life.
d. Restrict fluid intake to prevent the need for frequent voiding.
A.
Which of the following immunological mechanisms are involved in glomerulonephritis?
a. Tubular blocking by precipitates of bacteria and antibody reactions
b. Deposition of immune complexes and complement along the glomerular basement membrane (GBM)
c. Thickening of the GBM from autoimmune microangiopathic changes
d. Destruction of glomeruli by proteolytic enzymes contained in the GBM
B.
What is one of the most important roles of the nurse regarding acute poststreptococcal glomerulonephritis (APSGN)?
a. To promote early diagnosis and treatment of sore throats and skin lesions
b. To encourage clients to request antibiotic therapy for all upper respiratory infections
c. To teach clients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence
d. To monitor clients for respiratory symptoms that indicate that the disease is affecting the alveolar basement membrane
A.
Why does edema occur in nephrotic syndrome?
a. Decreased aldosterone secretion from adrenal insufficiency
b. Increased hydrostatic pressure caused by sodium retention
c. Increased fluid retention caused by decreased glomerular filtration
d. Decreased colloidal osmotic pressure caused by loss of serum albumin
D.
A client is admitted to the hospital with severe renal colic caused by renal lithiasis. What is the nurse’s first priority in management of the client?
a. To administer opioids as prescribed
b. To obtain supplies for straining all urine
c. To encourage fluid intake of 3 to 4 L/day
d. To keep the client on nothing-by-mouth status in preparation for surgery
A.
In which of the following conditions should the nurse recommend genetic counselling for the client’s children?
a. Nephrotic syndrome
b. Chronic pyelonephritis
c. Malignant nephrosclerosis
d. Adult-onset polycystic renal disease
D.
The nurse instructs a client with diabetes to maintain careful control of his blood glucose levels related to which disease-related complication?
a. Uric acid calculi and nephrolithiasis
b. Renal sugar-crystal calculi and cysts
c. Lipid deposits in the glomeruli and the nephrons
d. Thickening of the GBM and glomerulosclerosis
D.
A client with a ureterolithotomy returns from surgery with a nephrostomy tube in place. What is the priority nursing action related to caring for this client?
a. Encouraging the client to drink fruit juices and milk
b. Encouraging intake of fluids of at least 2 to 3 L/day after nausea has subsided
c. Notifying the health care provider if nephrostomy tube drainage is more than 30 mL/hr
d. Irrigating the nephrostomy tube with 10 mL of normal saline solution as needed
B.
A client has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. Which action should the nurse undertake?
a. Notify the health care provider.
b. Notify the charge nurse.
c. Irrigate the drainage tube.
d. Chart it as a normal observation.
D.
Which infectious agent is the most common cause of urinary tract infection (UTIs)?
A. Klebsiella
B. Escherichia coli
C. Candida albicans
D. Trichomonas
B. Escherichia coli
Escherichia coli (E. coli) is the most common pathogen leading to a UTI.
Which emptying symptom is indicative of lower urinary tract infection (UTI)?
A. Nocturnal enuresis
B. Urinary frequency
C. Postvoid dribbling
D. Incontinence
C. Postvoid dribbling
Postvoid dribbling is urine loss after completion of voiding. This is an emptying symptom of UTI.
Which action does the nurse take to prevent health care-associated urinary tract infections (UTIs)?
A. Hand patient toilet paper when using bedpan.
B. Use sterile technique for instrumentation of the urinary tract.
C. Change gloves at least hourly.
D. Catheterize patients on a routine schedule.
B. Use sterile technique for instrumentation of the urinary tract.
Aseptic technique must always be followed during procedures instrumentation of the urinary tract to avoid developing a health care–associated UTI.
Which intervention should be implemented for a patient with acute urinary tract infection (UTI)?
A. Providing water and encouraging intake
B. Encouraging intake of cranberry juice
C. Providing coffee and encouraging intake
D. Assisting with cool shower
A. Providing water and encouraging intake
Acute intervention for a patient with a UTI includes ensuring adequate fluid intake if it is not contraindicated. Fluids will help flush out bacteria before they have a chance to colonize in the bladder. Patients may assume that increased fluids will worsen symptoms, but fluid will dilute the urine and flush bacteria out of the urinary tract.
Which finding is consistent with the pathology of chronic nephritis?
A. Hypertrophy of the kidney
B. Thickened parenchyma
C. Loss of functioning nephrons
D. Reflux nephropathy
C. Loss of functioning nephrons
Nephrons are lost due to inflammation, infection, fibrosis, and scarring from previous illnesses.
Which condition typically arises from chlamydia or gonorrhea in men?
A. Urethritis
B. Benign prostate hyperplasia
C. Erectile dysfunction
D. Yeast infection
A. Urethritis
Urethritis is an inflammation of the urethra which usually arises from sexual transmission in men. Purulent discharge usually indicates a gonococcal urethritis and clear discharge typically signifying a nongonococcal urethritis.
Which etiology explains the development of renal tuberculosis (TB)?
A. Tuberculosis bacteria enter the kidneys via instrumentation of the urinary tract.
B. Tuberculosis bacteria are present in the kidneys of most people but remain dormant until activated by an unknown cause.
C. Tuberculosis bacteria enters the body through contaminated water and infects the kidneys as the body processes the fluid.
D. Tuberculosis bacteria travel to the kidney via the bloodstream during primary infection of the lungs.
D. Tuberculosis bacteria travel to the kidney via the bloodstream during primary infection of the lungs.
In a small percentage of patients with pulmonary TB, the tubercle bacilli reach the kidneys via the bloodstream. Onset occurs 5 to 8 years after the primary infection.
Which infection occurs in the upper urinary tract?
A. Pyelonephritis
B. Urethritis
C. Cystitis
D. Bladder infection
A. Pyelonephritis
An infection of the upper urinary tract (involving the renal parenchyma, renal pelvis, and ureters), pyelonephritis implies inflammation, usually caused by infection, of the renal parenchyma and the collecting system.
