MS - Renal/Urologic Flashcards Preview

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Flashcards in MS - Renal/Urologic Deck (130):
1

Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters?
a. Upper UTI
b. Lower UTI
c. Complicated UTI
d. Uncomplicated UTI

a. Upper UTI

An upper urinary tract infection (UTI) affects the renal parenchyma, renal pelvis, and ureters. A lower UTI is an infection of the bladder and/or urethra. A complicated UTI exists in the presence of obstruction, stones, or preexisting diseases. An uncomplicated UTI occurs in an otherwise normal urinary tract.

2

While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. Which clinical manifestations is the patient most likely to experience?
a. Cloudy urine and fever
b. Urethral burning and bloody urine
c. Vague abdominal discomfort and disorientation
d. Suprapubic pain and slight decline in body temperature

c. Vague abdominal discomfort and disorientation

The usual classic manifestations of UTI are often absent in older adults, who tend to experience nonlocalized abdominal discomfort and cognitive impairment characterized by confusion or decreased level of consciousness rather than dysuria and suprapubic pain.

3

A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient?
a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity
b. No treatment with medication unless she develops fever, chills, and flank pain
c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days
d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests

c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days

Unless a patient has a history of recurrent UTIs or a complicated UTI, trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin (Microdantin) is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment but symptomatic UTIs should always be treated.

4

A female patient with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding prevention of recurrence. What should the nurse include in the teaching plan instructions for this patient?
a. Empty the bladder at least 4 times a day.
b. Drink at least 2 quarts of water every day.
c. Wait to urinate until the urge is very intense.
d. Clean the urinary meatus with an antiinfective agent after voiding.

b. Drink at least 2 quarts of water per day

The bladder should be emptied at least every 3 to 4 hours. Fluid intake should be increased to about 2000 mL/day without caffeine, alcohol, citrus juices, and chocolate drinks, because they are potential bladder irritants. Cleaning the urinary meatus with an antiinfective agent after voiding will irritate the meatus but the perineal area should be wiped from front to back after urination and defecation to prevent fecal contamination of the meatus.

5

What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract?
a. The kidney is scarred and fibrotic.
b. The organism is resistant to antibiotics.
c. There is a preexisting abnormality of the urinary tract.
d. The patient does not take all of the antibiotics for treatment of a UTI.

c. There is a preexisting abnormality of the urinary tract

Ascending infections from the bladder to the kidney are prevented by the normal anatomy and physiology of the urinary tract unless a preexisting condition, such as vesicoureretal reflux or lower urinary tract dysfunction (bladder tumors, prostatic hyperplasia, strictures, or stones), is present. Resistance to antibiotics and failure to take a full prescription of antibiotics for a UTI usually result in relapse or reinfection of the lower urinary tract.

6

Which characteristic is more likely with acute pyelonephritis than with a lower UTI?
a. Fever
b. Dysuria
c. Urgency
d. Frequency

a. Fever

Systemic manifestations of fever and chills with leukocytosis and nausea and vomiting are more common in pyelonephritis than in a lower UTI. Dysuria, frequency, and urgency can be present with both.

7

Which test is required for a diagnosis of pyelonephritis?
a. Renal biopsy
b. Blood culture
c. Intravenous pyelogram (IVP)
d. Urine for culture and sensitivity

d. Urine for culture and sensitivity

A urine specimen specifically obtained for culture and sensitivity is required to diagnose pyelonephritis because it will show pyuria, the specific bacteriuria, and what drug the bacteria is sensitive to for treatment. The renal biopsy is used to diagnose chronic pyelonephritis or cancer. Blood cultures would be done if bacteremia is suspected. Intravenous pyelogram (IVP) would increase renal irritation, but CT urograms may be used to assess for signs of infection in the kidney and complications of pyelonephritis.

8

A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis?
a. Residual urine greater than 200 mL
b. A large, atonic bladder on urodynamic testing
c. A voiding pattern that indicates psychogenic urinary retention
d. Pain with bladder filling that is transiently relieved by urination

d. Pain with bladder filling that is transiently relieved by urination

The symptoms of interstitial cystitis (IC) imitate those of an infection of the bladder but the urine is free of infectious agents. Unlike a bladder infection, the pain with IC increases as urine collects in the bladder and is temporarily relieved by urination. Acidic urine is very irritating the bladder in IC and the bladder is small but urinary retention is not common.

9

When caring for the patient with interstitial cystitis, what can the nurse teach the patient to do?
a. Avoid foods that make the urine more alkaline.
b. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder.
c. Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia.
d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.

d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.

Calcium glycerophosphate (Prelief) alkalinizes the urine and can help relieve the irritation from acidic foods. A diet low in acidic foods is recommended and if a multivitamin is used, high-potency vitamins should be avoided because these products may irritate the bladder. A voiding diary is useful in diagnosis but does not need to be kept indefinitely.

10

Glomerulonephritis is characterized by glomerular damage caused by
a. growth of microorganisms in the glomeruli.
b. release of bacterial substances toxic to the glomeruli.
c. accumulation of immune complexes in the glomeruli.
d. hemolysis of red blood cells circulating in the glomeruli.

c. accumulation of immune complexes in the glomeruli.

Glomerulonephritis is not an infection but rather an antibody-induced injury to the glomerulus, where either autoantibodies against the glomerular basement membrane (GBM) directly damage the tissue or antibodies reacting with nonglomerular antigens are randomly deposited as immune complexes along the GBM. Prior infection by bacteria or viruses may stimulate the antibody production but is not present or active at the time of glomerular damage.

11

What manifestation in the patient will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)?
a. Hematuria
b. Proteinuria
c. Hypertension
d. Elevated blood urea nitrogen (BUN)

d. Elevated blood urea nitrogen (BUN)

An elevated blood urea nitrogen (BUN) indicates that the kidneys are not clearing nitrogenous wastes from the blood and protein may be restricted until the kidney recovers. Proteinuria indicates loss of protein from the blood and possibly a need for increased protein intake. Hypertension is treated with sodium and fluid restriction, diuretics, and antihypertensive drugs. The hematuria is not specifically treated.

12

The nurse plans care for the patient with APSGN based on what knowledge?
a. Most patients with APSGN recover completely or rapidly improve with conservative management.
b. Chronic glomerulonephritis leading to renal failure is a common sequel to acute glomerulonephritis.
c. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane.
d. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis, resulting in kidney failure.

a. Most patients with APSGN recover completely or rapidly improve with conservative management.

Most patients recover completely from acute poststreptococcal glomerulonephritis (APSGN) with supportive treatment. Chronic glomerulonephritis that progresses insidiously over years and rapidly progressive glomerulonephritis that results in renal failure within weeks or months occur only in a few patients with APSGN. In Goodpasture syndrome, antibodies are psent against both the GBM and alveolar basement membrane of the lungs and dysfunction of both renal and pulmonary are present.

13

What results in the edema associated with nephrotic syndrome?
a. Hypercoagulability
b. Hyperalbuminemia
c. Decreased plasma oncotic pressure
d. Decreased glomerular filtration rate

c. Decreased plasma oncotic pressure

The massive proteinuria that results from increased glomerular membrane permeability in nephrotic syndrome leaves the blood without adequate proteins (hypoalbuminemia) to create an oncotic colloidal pressure to hold fluid in the vessels. Without oncotic pressure, fluid moves into the interstitium, causing severe edema. Hypercoagulability occurs in nephrotic syndrome but is not a factor in edema formation and glomerular filtration rate (GFR) is not necessarily affected in nephrotic syndrome.

14

Number in sequence the following ascending pathologic changes that occur in the urinary tract in the presence of a bladder outlet obstruction.
_____ a. Hydronephrosis
_____ b. Reflux of urine into ureter
_____ c. Bladder detrusor muscle hypertrophy
_____ d. Ureteral dilation
_____ e. Renal atrophy
_____ f. Vesicoureteral reflux
_____ g. Large residual urine in bladder
_____ h. Chronic pyelonephritis

1 -- c. Bladder detrusor muscle hypertrophy
2 -- g. Large residual urine in bladder
3 -- b. Reflux of urine into ureter
4 -- d. Ureteral dilation
5 -- f. Vesicoureteral reflux
6 -- a. Hydronephrosis
7 -- h. Chronic pyelonephritis
8 -- e. Renal atrophy

15

Which infection is asymptomatic in the male patient at first and then progresses to cystitis, frequent urination, burning on voiding, and epididymitis?
a. Urosepsis
b. Renal tuberculosis
c. Urethral diverticula
d. Goodpasture syndrome

b. Renal tuberculosis

The manifestations of renal tuberculosis are described. Urosepsis is when the UTI has spread systemically. Urethral diverticula are localized outpouching of the urethra and occur more often in women. Goodpasture syndrome manifests with flu-like symptoms with pulmonary symptoms that include cough, shortness of breath, and pulmonary insufficiency and renal manifestations that include hematuria, weakness, pallor, anemia, and renal failure.

16

What can patients at risk for renal lithiasis do to prevent the stones in many cases?
a. Lead an active lifestyle
b. Limit protein and acidic foods in the diet
c. Drink enough fluids to produce dilute urine
d. Take prophylactic antibiotics to control UTIs

c. Drink enough fluids to produce dilute urine

Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is by drinking adequate fluids to keep the urine dilute and flowing (e.g., an output of about 2 L of urine a day). Sedentary lifestyle is a risk factor for renal stones but exercise also causes fluid loss and a need for additional fluids. Protein foods high in purine should be restricted only for the small percentage of patients with uric acid stones and although UTIs contribute to stone formation, prophylactic antibiotics are not indicated.

17

Which type of urinary tract calculi are the most common and frequently obstruct the ureter?
a. Cystine
b. Uric acid
c. Calcium oxalate
d. Calcium phosphate

c. Calcium oxalate

Calcium oxalate calculi are most common and small enough to get trapped in the ureter.

18

The female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone?
a. Cystine
b. Struvite
c. Uric acid
d. Calcium phosphate

b. Struvite

Struvite calculi are most common in women and always occur with UTIs. They are also usually large staghorn type.

19

The male patient is Jewish, has a history of gout, and has been diagnosed with renal calculi. Which treatment will be used with this patient (see all that apply)?
a. Reduce dietary oxalate
b. Administer allopurinol
c. Administer alpha-penicillamine
d. Administer thiazide diuretics
e. Reduce animal protein intake
f. Reduce intake of milk products

b. Administer allopurinol
e. Reduce animal protein intake

This patient is most likely to have uric acid calculi, which have a high incidence in Jewish men, and gout is a predisposing factor. The treatment will include allopurinol and reducing animal protein intake to reduce purine, as uric acid is a waste product from purine metabolism. Reducing oxalate and using thiazide diuretics to treat calcium oxalate calculi. Administration of alpha-penicillamine and tiopronin prevent cystine crystallization for cystine calculi. Reducing intake of milk products to reduce calcium intake may be used with calcium calculi.

20

Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi?
a. Associated with alkaline urine
b. Genetic autosomal recessive defect
c. Three times as common in women as in men
d. Defective gastrointestinal (GI) and kidney absorption

a. Associated with alkaline urine

Calcium phosphate calculi are typically mixed with struvite or oxalate stones and related to alkaline urine. Cystine calculi are associated with a genetic autosomal recessive defect and defective GI and kidney absorption of cystine. Struvite calculi are three to four times more common in women than in men.

21

On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report?
a. A history of chronic UTIs
b. Dull, costovertebral flank pain
c. Severe, colicky back pain radiating to the groin
d. A feeling of bladder fullness with urgency and frequency

c. Severe, colicky back pain radiating to the groin

A classic sign of the passage of a calculus down the ureter is intense, colicky back pain that may radiate into the testicles, labia, or goin and may be accompanied by mild shock with cool, moist skin. Many patients with renal stones do not have a history of chronic UTIs. Stones obstructing a calyx or at the ureteropelvic junction may produce dull costovertebral flank pain and large bladder stones may cause bladder fullness and lower obstructive symptoms.

22

Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks?
a. Milk and milk products
b. Dried beans and dried fruits
c. Liver, kidney, and sweetbreads
d. Spinach, cabbage, and tomatoes

d. Spinach, cabbage, and tomatoes

Oxalate-rich foods should be limited to reduce oxalate excretion. Foods high in oxalate include spinach, rhubarb, asparagus, cabbage, and tomatoes, in addition to chocolate, coffee, and cocoa. Currently, it is believed that high dietary calcium intake may actually lower the risk for renal stones by reducing the intestinal oxalate absorption and therefore the urinary excretion of oxalate. Milk, milk products, dried beans, and dried fruits are high sources of calcium. Organ meats are high in purine, which contributes to uric acid lithiasis.

23

Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient?
a. Monitor for hematuria.
b. Encourage fluid intake of 3 L/day.
c. Apply moist heat to the flank area.
d. Strain all urine through gauze or a special strainer.

b. Encourage fluid intake of 3 L/day.

A high fluid intake maintains dilute, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals. Moist heat to the flank may be helpful to relieve muscle spasms during renal colic and all urine should be strained in patients with renal stones to collect and identify stone composition but these are not related to infection.

24

With which diagnosis will the patient benefit from being taught to do self-catheterization?
a. Renal trauma
b. Urethral stricture
c. Renal artery stenosis
d. Accelerated nephrosclerosis

b. Urethral stricture

The patient with urethral stricture with benefit from being taught to dilate the urethra by self-catheterization every few days. Renal trauma is treated related to the severity of the injury with bed rest, fluids, and analgesia. Renal artery stenosis includes control of hypertension with possible surgical revascularization. Accelered nephrosclerosis is associated with malignant hypertension that must be aggressively treated as well as monitoring kidney function.

25

In providing care for the patient with adult-onset polycystic kidney disease, what should the nurse do?
a. Help the patient to cope with the rapid progression of the disease
b. Suggest genetic counseling resources for children of the patient
c. Expect the patient to have polyuria and poor concentration ability of the kidneys
d. Implement measures for the patient's deafness and blindness in addition to the renal problems

b. Suggest genetic counseling resources for children of the patient

Adult-onset polycystic kidney disease is an inherited autosomal dominant disorder that often manifests after the patient has children but the children should receive genetic counseling regarding their life choices. The disease progresses slowly, eventually causing progressive renal failure. Hereditary medullary cystic disease causes poor concentration ability of the kidneys and classic Alport syndrome is a hereditary nephritis that is associated with deafness and deformities of the optic lens.

26

Which disease causes connective tissues changes that cause glomerulonephritis?
a. Gout
b. Amyloidosis
c. Diabetes mellitus
d. Systemic lupus erythematosus

d. Systemic lupus erythematosus

Systemic lupus erythematosus causes connective tissue damage that affects the glomerulus. Gout deposits uric acid crystals in the kidney. Amyloidosis deposits hyaline bodies in the kidney. Diabetes mellitus causes microvascular damage affecting the kidney.

27

When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer?
a. Smoking
b. Family history of cancer
c. Chronic use of phenacetin
d. Chronic, recurrent nephrolithiasis

a. Smoking

Both cancer of the kidney and cancer of the bladder are associated with smoking. A family history of renal cancer is a risk factor for kidney cancer and cancer of the bladder has been associated with the use of phenacetin-containing analgesics and recurrent upper UTIs.

28

Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur?
a. The only treatment modalities for the disease are palliative.
b. Diagnostic tests are not available to detect tumors before they metastasize.
c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.
d. Early metastasis to the brain impairs the patient's ability to recognize the seriousness of symptoms.

c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.

There are no early characteristic symptoms of cancer of the kidney and gross hematuria, flank pain, and a palpable mass do not occur until the disease is advanced. The treatment of choice is a partial or radical nephrectomy, which can be successful in early disease. Many kidney cancers are diagnosed as incidental imaging findings. Targeted therapy is the preferred treatment for metastatic kidney cancer. Radiation is palliative. The most common sites of metastases are the lungs, liver, and long bones.

29

Which characteristics are associated with urge incontinence (select all that apply)?
a. Treated with Kegel exercises
b. Found following prostatectomy
c. Common in postmenopausal women
d. Involunary urination preceded by pregnancy
e. Caused by the overactivity of the detrusor muscle
f. Bladder contracts by reflex, overriding central inhibition

d. Involunary urination preceded by pregnancy
e. Caused by the overactivity of the detrusor muscle
f. Bladder contracts by reflex, overriding central inhibition

Urge incontinence is involuntary urination preceded by urgency caused by overactivity of the detrusor muscle when the bladder contracts by reflex, which overrides central inhibition. Treatment including treatment the underlying cause and retraining the bladder with urge suppression, anticholinergic drugs, or containment devices. The other options are characteristics of stress incontinence. Patients may have a combination of urge and stress incontinence.

30

The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing?
a. Reflex incontinence
b. Overflow incontinence
c. Functional incontinence
d. Incontinence after trauma

a. Reflex incontinence

Reflex incontinence occurs with no warning, equally during the day and night, and with spinal cord lesions above S2. Overflow incontinence is when the pressure of urine in the overfull bladder overcomes sphincter control and is caused by bladder or urethral outlet obstruction. Functional incontinence is loss of urine resulting from cognitive, functional, or environmental factors. Incontinence after trauma or surgery occurs when fistulas have occurred or after a prostatectomy.

31

Which drugs are used to treat overflow incontinence (select all that apply)?
a. Baclofen (Lioresal)
b. Anticholinergic drugs
c. alpha-Adrenergic blockers
d. 5alpha-reductase inhibitors
e. Bethanechol (Urecholine)

c. alpha-Adrenergic blockers
d. 5alpha-reductase inhibitors
e. Bethanechol (Urecholine)

alpha-Adrenergic blockers block the stimulation of the smooth muscle of the bladder, 5alpha-reductase inhibitors decrease outlet resistance, and bethanechol enhances bladder contractions. Baclofen or diazepam is used to relax the external sphincter for reflex incontinence. Anticholinergics are used to relax bladder tone and increase sphincter tone with urge incontinence.

32

To assist the patient with stress incontinence, what is the best thing the nurse should teach the patient to do?
a. Void every 2 hours to prevent leakage.
b. Use absorptive perineal pads to contain urine.
c. Perform pelvic floor muscles exercises 40 to 50 times per day.
d. Increase intraabdominal pressure during voiding to empty the bladder completely.

c. Perform pelvic floor muscles exercises 40 to 50 times per day.

Pelvic floor exercises (Kegel exercises) increase the tone of urethral sphincters and should be done in sets of 10 or more contractions four to five times a day (total of 40 to 50 per day). Frequent bladder emptying is recommended for patients with urge incontinence and an increase in pressure on the bladder is recommended for patients with overflow incontinence. Absorptive perineal pads should only be a temporary measure because long-term use discourages continence and can lead to skin problems.

33

What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients?
a. Measuring urine output every 1 to 2 hours to ensure patency
b. Turning the patient frequently from side to side to promote drainage
c. Using strict technique during irrigation and obtaining culture specimens
d. Daily cleaning of the catheter insertion site with soap and water and application of lotion

c. Using strict technique during irrigation and obtaining culture specimens

All urinary catheters in hospitalized patients pose a very high risk for infection, especially antibiotic-resistant, health care-associated infections, and scrupulous aseptic technique is essential in the insertion and maintenance of all catheters. Routine irrigations are not performed. Turning the patient to promote drainage is not recommended only for suprapubic catheters. Cleaning the insertion site with soap and water should be performed for urethral and suprapubic catheters but lotion or powder should be avoided and site care for other catheters may require special interventions.

34

A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, what is an appropriate nursing action?
a. Milk or strip the catheter every 2 hours.
b. Measure ureteral urinary drainage every 1 to 2 hours.
c. Irrigate the catheter with 30-mL sterile saline every 4 hours.
d. Encourage ambulation to promote urinary peristaltic action.

b. Measure ureteral urinary drainage every 1 to 2 hours.

Output from ureteral catheters must be monitored every 1 to 2 hours because an obstruction will cause overdistention of the renal pelvis and renal damage. The renal pelvis has a capacity of only 3 to 5 mL and if irrigation is ordered, no more than 5 mL of sterile saline is used. The patient with a ureteral catheter is usually kept on bed rest until specific orders for ambulation are given. Suprapubic tubes may be milked to prevent obstruction of the catheter by sediment and clots.

35

During assessment of the patient who has a nephrectomy, what should the nurse expect to find?
a. Shallow, slow respirations
b. Clear breath sounds in all lung fields
c. Decreased breath sounds in the lower left lobe
d. Decreased breath sounds in the right and left lower lobes

b. Clear breath sounds in all lung fields

A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breathe deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.

36

Which urinary diversion is a continent diversion created by the formation of an ileal pouch with a stoma for catheterization?
a. Kock pouch
b. Ileal conduit
c. Orthotopic neobladder
d. Cutaneous ureterostomy

a. Kock pouch

The Kock pouch is a continent diversion created by formation of an ileal pouch with an external stoma requiring catheterization. Ileal conduit is the most common incontinent diversion using a stoma of resected ileum with implanted ureters. Orthotopic neobladder is a new bladder from a reshaped segment of intestine in the anatomic position of the bladder with urine discharged through the urethra. A cutaneous ureterostomy diverts the ureter from the bladder to the abdominal skin but there is frequent scarring and strictures of the ureters, so ileal conduits are used more often.

37

A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, what should the nurse plan to do?
a. Measure and fit the stoma for a permanent appliance.
b. Encourage high oral intake to flush mucus from the conduit.
c. Teach the patient to self-catheterize the stoma every 4 to 6 hours.
d. Empty the drainage bag every 2 to 3 hours and measure the urinary input.

d. Empty the drainage bag every 2 to 3 hours and measure the urinary input.

Urine drains continuously from an ileal conduit and the drainage bag must be emptied every 2 to 3 hours and measured to ensure adequate urinary output. Fitting for a permanent appliance is not done until the stoma shrinks to its normal size in a few weeks. With an ileal conduit, mucus is present in the urine because it is secreted by the ileal segment as a result of the irritating effect of the urine but the surgery causes paralytic ileus and the patient will be NPO for several days postoperatively. Self-catheterization is performed when patients have formation of a continent Kock pouch.

38

A teaching plan developed by a nurse for the patient with a new ileal conduit includes instructions to do what?
a. Clean the skin around the stoma with alcohol every day.
b. Use a wick to keep the skin dry during appliance changes.
c. Use sterile supplies and technique during care of the stoma.
d. Change the appliance every day and wash it with soap and water.

b. Use a wick to keep the skin dry during appliance changes.

Because the stoma continuously drains urine, a wick formed of a rolled-up 4 x 4 gauze or a tampon is held against the stoma to absorb the urine while the skin is cleaned and a new appliance is attached. The skin is cleaned with warm water only because soap and other agents cause drying and irritation and clean, not sterile, technique is used. The appliance should be left in place for as long as possible before it loosens and allows leakage onto the skin, perhaps up to 14 days.

39

Which nursing interventions could be delegated to unlicensed assistive personnel (UAP) (select all that apply)?
a. Assess the need for catheterization.
b. Use bladder scanner to estimate residual urine.
c. Teach patient pelvic floor muscles (Kegel) exercises.
d. Insert indwelling catheter for uncomplicated patient.
e. Assist incontinent patient to commode at regular intervals.
f. Provide perineal care with soap and water around a urinary catheter.

e. Assist incontinent patient to commode at regular intervals.
f. Provide perineal care with soap and water around a urinary catheter.

The unlicensed assistive personnel (UAP) may assist the incontinent patient to void at regular intervals and provide perineal care. An RN should perform the assessments and teaching. In long-term care and rehabilitation facilities, UAP may use bladder scanners after they are trained.

40

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.

The organisms that usually cause urinary tract infections (UTIs) are introduced via the ascending route from the urethra, and the infections originate in the perineum.

41

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.

When teaching a patient to prevent a recurrence of a urinary tract infection, the nurse should explain the importance of emptying the bladder before and after sexual intercourse.

42

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.

All forms of immune complex disease are characterized by an accumulation of antigen, antibody, and complement in the glomeruli, which can result in tissue injury. The immune complexes activate complement. Complement activation results in the release of chemotactic factors that attract polymorphonuclear leukocytes, histamine, and other inflammatory mediators. The result of these processes is glomerular injury.

43

One of the nurse's most important roles in relation to acute post-streptococcal 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 infection.
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.

Acute poststreptococcal glomerulonephritis (APSGN) develops 5 to 21 days after an infection of the tonsils, pharynx, or skin (e.g., streptococcal sore throat, impetigo) by nephrotoxic strains of group A β-hemolytic streptococci. The most important ways to prevent the development of APSGN are early diagnosis and treatment of sore throats and skin lesions.

44

The edema that occurs in nephrotic syndrome is due to
a. increased hydrostatic pressure caused by sodium retention.
b. decreased aldosterone secretion 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. decreased colloidal osmotic pressure caused by loss of serum albumin.

The increased permeability of the glomerular membrane found in nephrotic syndrome is responsible for the massive excretion of protein in the urine. This results in decreased serum protein levels and subsequent edema formation. Ascites and anasarca (i.e., massive generalized edema) develop if hypoalbuminemia is severe.

45

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.

Pain management and patient comfort are primary nursing responsibilities in managing an obstructing stone and renal colic.

46

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.

The adult form of polycystic kidney disease (PKD) is an autosomal dominant disorder. If one parent has the disease, the child has a 50% chance of developing PKD. Many patients who have adult PKD have had children by the time the disease is diagnosed. Patients need appropriate counseling regarding plans for having more children, and genetic counseling resources should be provided for the children.

47

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.

Cigarette smoking is the most significant risk factor for renal cell carcinoma. An increased incidence has also been identified in first-degree relatives of patients with this condition. Other risk factors include obesity, hypertension, and exposure to asbestos, cadmium, and gasoline. Risk for renal cancer is also increased in individuals who have acquired cystic disease of the kidney in association with end-stage renal disease. Risk factors for bladder cancer include smoking, exposure to dyes used in the rubber and cable industries, and chronic abuse of phenacetin-containing analgesics.

48

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.

Pelvic floor muscle training (i.e., Kegel exercises) is used to manage stress, urge, or mixed urinary incontinence.

49

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.

The nephrostomy tube is inserted directly into the renal pelvis and attached to connecting tubing for closed drainage. The catheter should never be kinked, compressed, or clamped. If the patient complains of excessive pain in the area, or if drainage around the tube is excessive, check the catheter for patency. If irrigation is ordered, strict aseptic technique is required. To prevent overdistention of the renal pelvis and renal damage, no more than 5 mL of sterile saline solution is gently instilled at one time. Infection and secondary stone formation are complications associated with the insertion of a nephrostomy tube. Patients should drink 2 to 3 L of fluid per day to reduce risk of infection and stone formation.

50

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.

Patients with an ileal conduit have mucus in the urine. The mucus is secreted by intestinal mucosa, which is used to create the ileal conduit, in response to the irritating effect of urine.

51

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.

52

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.

53

An older male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)?
A. High-purine diet
B. Sedentary lifestyle
C. Benign prostatic hyperplasia (BPH)
D. Recent use of broad-spectrum antibiotics

C. Benign prostatic hyperplasia (BPH)

BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.

54

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.

55

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.

56

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.

57

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.

58

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.

59

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.

60

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.

61

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.

62

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.

63

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.

64

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.

65

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.

66

Antibiotics for uncomplicated and complicated UTIs

Uncomplicated UTI: TMP/SMX (Bactrim), Nitrofurantoin (Macrodantin), Macrobid

Complicated UTI: Cipro, Levaquin

67

Which urinalysis results most likely indicate a urinary tract infection (UTI)?
a. Yellow; protein 6 mg/dL; ph 6.8; 10^2/mL bacteria
b. Cloudy, yellow; WBC >5/hpf; pH 8.2; numerous casts
c. Cloudy, brown; ammonia odor; specific gravity 1.030; RBC 3/hpf
d. Clear; colorless; glucose: trace; ketones: trace; osmolality 500 mOsm/kg (500 mmol/kg)

b. Cloudy, yellow; WBC >5/hpf; pH 8.2; numerous casts

Cloudiness in a fresh urine specimen, WBC count above 5 per high-power field (hpf), and the presence of casts are all indicative of urinary tract infection (UTI). The pH is usually elevated because bacteria in urine split the urea alkaline ammonia. Cloudy, brown urine usually indicates hematuria or the presence of bile. Colorless urine is usually very dilute. Option a is characteristic of normal urine.

68

A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH?
a. BPH is a benign tumor that does not spread beyond the prostate gland.
b. BPH is a precursor to prostate cancer but does not yet show any malignant changes.
c. BPH is an enlargement of the gland caused by an increase in the size of existing cells.
d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.

d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.

69

When taking a nursing history from a patient with BPH, the nurse would expect to report
a. nocturia, dysuria, and bladder spasms.
b. urinary frequency, hematuria, and perineal pain.
c. urinary hesitancy, postvoid dribbling, and weak urinary stream.
d. urinary urgency with a forceful urinary stream and cloudy urine.

c. urinary hesitancy, postvoid dribbling, and weak urinary stream.

70

The extent of urinary obstruction caused by BPH can be determined by which diagnostic study?
a. A cystometrogram
b. Transrectal ultrasound
c. Urodynamic flow studies
d. Postvoiding catheterization

c. Urodynamic flow studies

71

What is the effect of finasteride (Proscar) in the treatment of BPH?
a. A reduction in the size of the prostate gland
b. Relaxation of the smooth muscle of the urethra
c. Increased bladder tone that promotes bladder emptying
d. Relaxation of the bladder detrusor muscle promoting urine flow

a. A reduction in the size of the prostate gland

72

On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what?
a. The effects of general anesthesia
b. The possibility of short-term incontinence
c. Home management of an indwelling catheter
d. Monitoring for postoperative urinary retention

c. Home management of an indwelling catheter

73

What is the most common screening intervention for detecting BPH in men over age 50?
a. PSA level
b. Urinalysis
c. Cystoscopy
d. Digital rectal examination

d. Digital rectal examination

74

Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue?
a. Laser prostatectomy
b. Transurethral needle ablation (TUNA)
c. Transurethral microwave thermotherapy (TUMT)
d. Transurethral electrovaporization of prostate (TUVP)

b. Transurethral needle ablation (TUNA)

75

Which characteristics best describe transurethral resection of the prostate (TURP) (select all that apply)?
a. Best used for a very large prostate gland
b. Inappropriate for men with rectal problems
c. Involves an external incision prostatectomy
d. Uses transurethral incisions into the prostate
e. Most common surgical procedure to treat BPH
f. Resectoscopic excision and cauterization of prostate tissue

e. Most common surgical procedure to treat BPH
f. Resectoscopic excision and cauterization of prostate tissue

76

Which therapies for BPH are done on an outpatient basis (select all that apply)?
a. Intraprostatic urethral stents
b. Transurethral needle ablation (TUNA)
c. Transurethral incision of prostate (TURP)
d. Transurethral microwave therapy (TUMT)
e. Visual laser ablation of the prostate (VLAP)

b. Transurethral needle ablation (TUNA)
c. Transurethral incision of prostate (TURP)
d. Transurethral microwave therapy (TUMT)

77

The male patient is admitted with a diagnosis of benign prostatic hyperplasia (BPH). What urination characteristics should the nurse expect to assess in this patient?
a. Oliguria
b. Hesitancy
c. Hematuria
d. Pneumaturia

b. Hesitancy

Hesitancy is difficulty starting the urine stream and is common with benign prostatic hyperplasia (BPH). Oliguria is scanty urine formation and output. Hematuria is blood in the urine. Pneumaturia is urine containing gas, as is caused by a fistula between the bowel and bladder.

78

The patient complains of "wetting when she sneezes." How does the nurse document this information?
a. Nocturia
b. Micturition
c. Urge incontinence
d. Stress incontinence

d. Stress incontinence

Stress incontinence is involuntary urination with increased pressure when sneezing or coughing and is seen with weakness of sphincter control. Nocturia is frequent urination at night. Micturition is the evacuation of urine. Urge incontinence is involuntary urination preceded by urinary urgency.

79

The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition is a cause for these findings?
1. Overhydration.
2. Anemia.
3. Dehydration.
4. Renal failure.

3. Dehydration.

Dehydration results in concentrated serum, causing laboratory values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower.

80

The client who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the HCP?
1. The pump keeps sounding an alarm indicating the high pressure has been reached.
2. Intake is 1,800 mL, NGT output is 550 mL, and Foley output is 950 mL.
3. On auscultation, crackles and rhonchi in all lung fields are noted.
4. Client has negative pedal edema and an increasing level of consciousness.

3. On auscultation, crackles and rhonchi in all lung fields are noted.

Crackles and rhonchi in all lung fields indicate the body is ont able to process the amount of fluid being infused. This should be brought to the HCP's attention.

81

The nurse writes the client problem of "fluid volume excess" (FVE). Which intervention should be included in the plan of care?
1. Change the IV fluid from 0.9% NS to D5W.
2. Restrict the sodium in the client's diet.
3. Monitor blood glucose levels.
4. Prepare the client for hemodialysis.

2. Restrict the sodium in the client's diet.

Fluid volume excess refers to an isotonic expansion of the extracellular fluid by an abnormal expansion of water and sodium. Therefore, sodium is restricted to allow the body to excrete the extra volume.

82

The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented?
1. Encourage fluids orally.
2. Administer 10% saline solution IVPB.
3. Administer antidiuretic hormone intranasally.
4. Place on seizure precautions.

4. Place on seizure precautions.

Clients with sodium levels less than 120 mEq/L are at risk for seizures as a complication. The lower the sodium level, the greater the risk of a seizure.

83

The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first?
1. The client in normal sinus rhythm with peaked T wave.
2. The client diagnosed with atrial fibrillation with a rate of 100.
3. The client diagnosed with a myocardial infarction who has occasional PVCs.
4. The client with a first-degree atrioventricular block and a rate of 92.

1. The client in normal sinus rhythm with peaked T wave.

A client with a peaked T wave could be experiencing hyperkalemia. Changes in potassium levels can initiate cardiac dysrhythmias and instability.

84

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find
a. a pH of 8.4.
b. RBCs of 4/hpf.
c. color: yellow, cloudy.
d. specific gravity of 1.035.

d. specific gravity of 1.035

Normal specific gravity of urine is 1.003 to 1.030; the concentrating ability of the kidneys is maximal in producing morning urine (1.025 to 1.030). A high urinary specific gravity value indicates dehydration.

85

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply)
a. nonpalpable left kidney.
b. auscultation of renal artery bruit.
c. CVA tenderness elicited by a kidney punch.
d. no CVA tenderness elicited by a kidney punch.
e. palpable bladder to the level of the pubic symphysis.

a, d (nonpalpable left kidney; no CVA tenderness elicited by a kidney punch)

In the physical assessment of the urinary system, normal findings include no CVA tenderness, nonpalpable kidneys and bladder, and no palpable masses.

86

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes
a. hyperaldosteronism.
b. serotonin deficiency.
c. adrenal insufficiency.
d. hyperparathyroidism.

d. hyperparathyroidism

Excessive levels of circulating parathyroid hormone (PTH) usually lead to hypercalcemia and hypophosphatemia. In the kidneys, the excess calcium cannot be reabsorbed, and so the calcium levels in the urine increase (i.e., hypercalciuria). This excess urinary calcium, along with a large amount of urinary phosphate, can lead to calculi formation.

87

The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first?
1. Start an IV with a 20-gauge catheter.
2. Initiate antibiotic therapy IVPB.
3. Collect a urine specimen for culture.
4. Change the indwelling catheter.

4. Change the indwelling catheter.

Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis.

88

The nurse is inserted an indwelling catheter into a female patient. Which interventions should be implemented? Rank in the order of performance.
1. Explain the procedure to the client.
2. Set up the sterile field.
3. Inflate the catheter bulb.
4. Place absorbent pads under the client.
5. Clean the perineum from clean to dirty with Betadine.

1. Explain the procedure to the client.
4. Place absorbent pads under the client.
2. Set up the sterile field.
3. Inflate the catheter bulb.
5. Clean the perineum from clean to dirty with Betadine.

89

The nurse is examining a 15-year-old female who is complaining of pain, frequency, and urgency when urinating. After asking the parent to leave the room, which question should the nurse ask the client?
1. "When was your last menstrual cycle?"
2. "Have you noticed any change in the color of your urine?"
3. "Are you sexually active?"
4. "What have you taken for the pain?"

3. "Are you sexually active?"

These are the symptoms of cystitis, a bladder infection which may be caused by sexual intercourse as a result of the introduction of bacteria into the urethra during the physical act. A teenager may not want to divulge this information in front of the parent.

90

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first?
1. A midstream urine for culture.
2. A sonogram for the kidney.
3. An intravenous pyelogram for renal calculi.
4. A CT scan of the kidneys.

1. A midstream urine for culture.

Fevers, chills, and costovertebral pain are symptoms of a urinary tract infection (acute pyelonephritis), which requires a urine culture first to confirm the diagnosis.

91

The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis?
1. The client has fever, chills, flank pain, and dysuria.
2. The client complains of fatigue, headaches, and increased urination.
3. The client had a group of B beta-hemolytic strep infection last week.
4. The client has an acute viral pneumonia infection.

2. The client complains of fatigue, headaches, and increased urination.

Fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis.

1. Fever, chills, and flank pain are symptoms of acute pyelonephritis, not chronic pyelonephritis.
3. Group B beta-hemolytic streptococcus infections cause acute glomerulonephritis.
4. Acute viral pneumonia is a cause of acute glomerulonephritis.

92

The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI?
1. Clean the perineum from back to front after a bowel movement.
2. Take warm tub baths instead of hot showers daily.
3. Void immediately preceding sexual intercourse.
4. Avoid coffee, tea, colas, and alcoholic beverages.

4. Avoid coffee, tea, colas, and alcoholic beverages.

93

The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientific rationale supports the client being hospitalized for this condition?
1. The client must be treated aggressively to prevent maternal/fetal complications.
2. The nurse can force the client to drink fluids and avoid nausea and vomiting.
3. The client will be dehydrated and there won't be sufficient blood flow to the baby.
4. Pregnant clients historically are afraid to take the antibiotics as ordered.

1. The client must be treated aggressively to prevent maternal/fetal complications.

A pregnant client diagnosed with a UTI will be admitted for aggressive IV antibiotic therapy. After symptoms subside, the client will be sent home to complete the course of treatment with oral medications.

94

The nurse is discharging a client with a health-care facility acquired urinary tract infection. Which information should the nurse include in the discharge teaching?
1. Limit fluid intake so the urinary tract can heal.
2. Collect a routine urine specimen for culture.
3. Take all the antibiotics as prescribed.
4. Tell the client to void every 5 to 6 hours.

3. Take all the antibiotics as prescribed.

95

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal?
1. The client will have blood pressure within normal limits.
2. The client will show no protein in the urine.
3. The client will maintain normal renal function.
4. The client will have clear lung sounds.

3. The client will maintain normal renal function.

A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment, and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal.

(The other 3 are appropriate short-term goals.)

96

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse?
1. The blood urea nitrogen is 15 mg/dL.
2. The creatinine level is 1.2 mg/dL.
3. The glomerular filtration rate is 40 mL/min.
4. The 24-hour creatinine clearance is 100 mL/min.

3. The glomerular filtration rate is 40 mL/min.

Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity.

97

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. Urgency
C. Flank pain
D. Hematuria

C. Flank pain

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 UTI.

98

The nurse teaches a female client who has cystitis methods to relieve her discomfort. Which of the following responses by the client would indicate that she understands the nurse’s instructions?
A. “I will place ice packs on my perineum.”
B. “I will take hot tub baths.”
C. “I will drink a cup of warm tea every hour.”
D. “I will void every 5 to 6 hours.”

B. “I will take hot tub baths.”

99

An appropriate nursing diagnosis for the client with nephrotic syndrome is
A. Risk for injury related to decreased clotting function
B. Risk for impaired skin integrity related to immobility
C. Risk for infection related to altered immune responses
D. Imbalanced nutrition: more than body requirements related to high cholesterol intake

C. Risk for infection related to altered immune responses

100

A client admitted with possible kidney stones develops sudden complaints of acute crampy pain on the left side that radiates into the groin. He is nauseated, and vomits clear fluid. On voiding, his urine is pink. What is a priority nursing action?
A. Obtain a bladder scan to assess for residual urine.
B. Administer the prescribed analgesic.
C. Notify the physician.
D. Strain all urine.

C. Notify the physician.

101

Following lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. An appropriate nursing intervention for the patient is to
A. Monitor for hematuria
B. Encourage high fluid intake
C. Apply moist heat to the flank area
D. Strain all urine through gauze or a special strainer

B. Encourage high fluid intake

102

The nurse has taught the client with polycystic kidney disease about management of the disorder and prevention and recognition of complications. The nurse determines that the client understands the instructions if the client states that there is no reason to be concerned about:
A. Burning on urination
B. A temperature of 100.6 °F
C. New-onset shortness of breath
D. A blood pressure of 105/68 mmHg

D. A blood pressure of 105/68 mmHg

103

A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse incorporate into the discharge instruction? Select all that apply.
A. Drink at least 3,000 ml of fluid each day.
B. Minimize daily activities.
C. Keep urine alkaline to prevent urinary tract infection.
D. Keep ostomy pouch on for 3 to 7 days before changing it

A. Drink at least 3,000 ml of fluid each day.
D. Keep ostomy pouch on for 3 to 7 days before changing it

104

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client who is one (1) day postoperative TURP. Which intervention should the nurse implement?
1. Remove the indwelling catheter.
2. Titrate the NS irrigation to run faster.
3. Administer protamine sulfate IVP.
4. Administer vitamin K slowly.

2. Titrate the NS irrigation to run faster.

Increasing the irrigation fluid will flush out the clots and blood.

105

Which data supports the client's diagnosis of acute bacterial prostatitis?

1. Terminal dribbling.
2. Urinary frequency.
3. Stress incontinence.
4. Sudden fever and chills.

4. Sudden fever and chills.

Client with acute bacterial prostatitis will frequently experience a sudden onset of fever and chills. Clients with chronic prostatitis have milder symptoms.

106

Which nursing diagnosis is priority for the client who has undergone a TURP?
1. Potential for sexual dysfunction.
2. Potential for an altered body image.
3. Potential for chronic infection.
4. Potential for hemorrhage.

4. Potential for hemorrhage.

This is a potentially life-threatening problem.

107

Which statement indicates discharge teaching has been effective for the client who is postoperative TURP?
1. "I will call the surgeon if I experience any difficulty urinating."
2. "I will take my Proscar daily, the same as before my surgery."
3. "I will continue restricting my oral fluid intake."
4. "I will take my pain medication routinely even if I do not hurt."

1. "I will call the surgeon if I experience any difficulty urinating."

This indicates the teaching is effective.

108

The client with a TURP who has a continuous irrigation catheter complains of the need to urinate. Which intervention should the nurse implement first?
1. Call the surgeon to inform the HCP of the client's complaint.
2. Administer the client a narcotic medication for pain.
3. Explain to the client this sensation happens frequently.
4. Assess the continuous irrigation catheter for patency.

4. Assess the continuous irrigation catheter for patency.

The nurse should always assess any complaint before dismissing it as a commonly occurring problem.

109

The client asks, "What does an elevated PSA mean?" On which scientific rationale should the nurse base the response?
1. An elevated PSA can result from several different causes.
2. An elevated PSA can be only from prostate cancer.
3. An elevated PSA can be diagnostic for testicular cancer.
4. An elevated PSA is the only test used to diagnose BPH.

1. An elevated PSA can result from several different causes.

An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct.

110

The client returned from surgery after having a TURP and has a P 110, R 24, BP 90/40, and cool and clammy skin. Which interventions should the nurse implement? Select all that apply.
1. Assess the urine in the continuous irrigation drainage bag.
2. Decrease the irrigation fluid in the continuous irrigation catheter.
3. Lower the head of the bed while raising the foot of the bed.
4. Contact the surgeon to give an update on the client's condition.
5. Check the client's postoperative creatinine and BUN.

1. Assess the urine in the continuous irrigation drainage bag.
The nurse should assess the drain postoperatively.

3. Lower the head of the bed while raising the foot of the bed.
The head of the bed should be lowered and the foot should be elevated to shunt blood to the central circulating system.

4. Contact the surgeon to give an update on the client's condition.
The surgeon needs to be notified of the change in condition.

111

The nurse is caring for a client with a TURP. Which expected outcome indicates the client's condition is improving?
1. The client is using the maximum amount allowed by the PCA pump.
2. The client's bladder spasms are relieved by medication.
3. The client's scrotum is swollen and tender with movement.
4. The client has passed a large, hard, brown stool this morning.

2. The client's bladder spasms are relieved by medication.

Bladder spasms are common, but being relieved with medication indicates the condition is improving.

112

The laboratory data reveals a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement?
1. Encourage the client to eat a low-purine diet and limit foods such as organ meats.
2. Explain the importance of not drinking water two (2) hours before bedtime.
3. Discuss the importance of limiting vitamin D-enriched foods.
4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

3. Discuss the importance of limiting vitamin D-enriched foods.

Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract.

113

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first?
1. Monitor the client's urinary output.
2. Assess the client's pain and rule out complications.
3. Increase the client's oral fluid intake.
4. Use a safety gait belt when ambulating the client.

2. Assess the client's pain and rule out complications.

Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypertension and syncope.

114

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone?
1. Dull, aching flank pain and microscopic hematuria.
2. Nausea; vomiting; pallor; and cool, clammy skin.
3. Gross hematuria and dull suprapubic pain with voiding.
4. The client with be asymptomatic.

2. Nausea; vomiting; pallor; and cool, clammy skin.

The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin.

1. Associated with stone in the kidney.
3. Stone in bladder.

115

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply.
1. Check for the ordered diet and medication modifications.
2. Instruct the client to urinate, and discard this urine when starting collection.
3. Collect all urine during 24 hours and place in appropriate specimen container.
4. Insert an indwelling catheter in client after having the client empty the bladder.
5. Instruct the UAP to notify the nurse when the client urinates.

1. Check for the ordered diet and medication modifications.
The HCP may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid.

2. Instruct the client to urinate, and discard this urine when starting collection.
When the collection begins, the client should completely empty the bladder and discard the urine. The test is started after the bladder is empty.

3. Collect all urine during 24 hours and place in appropriate specimen container.
All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result.

116

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client?
1. Fluid volume loss.
2. Knowledge deficit.
3. Impaired urinary elimination.
4. Alteration in comfort.

4. Alteration in comfort.

Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.

117

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation?
1. "I should increase my fluid intake, especially in warm weather."
2. "I should eat foods containing cocoa and chocolate."
3. "I will walk about a mile every week and not exercise often."
4. "I should take one (1) vitamin a day with extra calcium."

1. "I should increase my fluid intake, especially in warm weather."

An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate.

118

The client had surgery to remove a kidney stone. What laboratory assessment data warrants immediate intervention by the nurse?
1. A serum potassium level of 3.8 mEq/L.
2. A urinalysis shows microscopic hematuria.
3. A creatinine level of 0.8/100 mL.
4. A white blood cell count of 14,000/mm3.

4. A white blood cell count of 14,000/mm3.

The white blood cell count is elevated; normal is 5,000 to 10,000 mm3.

119

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence?
1. Beer and colas.
2. Asparagus and cabbage.
3. Venison and sardines.
4. Cheese and eggs.

3. Venison and sardines.

Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.

120

Which intervention should be included in the plan of care for a client with an ileal conduit?
1. Instruct the client to place a tampon in the stoma site when changing the pouch.
2. Tell the client to use a new drainage bag daily when pouching the ostomy.
3. Recommend the client drink 30 mL of vinegar a day to help with the odor.
4. Discuss the need to decrease fluid intake when changing the ostomy appliance.

1. Instruct the client to place a tampon in the stoma site when changing the pouch.

Urine is acidic, and the abdominal wall tissue is not designed to tolerate acidic environments. Placing a tampon in the stoma site will prevent urine leakage when changing the pouch.

121

The client diagnosed with renal calculi is admitted to the medical unit. Which priority intervention should the nurse implement first?
1. Monitor the client's urinary output.
2. Strain the client's urine.
3. Increase the client's oral fluid intake.
4. Use a safety gait belt when walking the client.

2. Strain the client's urine.

The client may pass the calculi when urinating. The HCP must be notified the calculi has passed so no other medical treatments will be instituted. The calculi must be sent to the laboratory for further analysis so it can be determined if dietary changes must be made.

122

The nurse is caring for clients on a renal surgery unit. After the afternoon report, which client should the nurse assess first?
1. The male client who just returned from a CT scan who states he left his glasses in the x-ray department.
2. The client who is one (1) day postoperative and has a moderate amount of serous drainage on the dressing.
3. The client who is scheduled for surgery in the morning and wants an explanation of the operative procedure before signing the permit.
4. The client who had an ileal conduit surgery this morning and has not had any drainage in the drainage bag.

4. The client who had an ileal conduit surgery this morning and has not had any drainage in the drainage bag.

Urinary output should always be at least 30 mL/hr. This client should be assessed to make sure the stents placed in the ureters have not become dislodged or blocked.

123

Which modifiable risk factor should the nurse identify for the development of cancer of the bladder in a client?
1. Previous exposure to chemicals.
2. Pelvic radiation therapy.
3. Cigarette smoking.
4. Parasitic infections of the bladder.

3. Cigarette smoking.

124

The client diagnosed with cancer of the bladder is scheduled to have a cutaneous urinary diversion procedure. Which operative teaching intervention specific to the procedure should be included?
1. Demonstrate turn, cough, and deep breathing.
2. Explain a bag will drain the urine from now on.
3. Instruct the client on the use of a PCA pump.
4. Take the client to the ICU so the client can become familiar with it.

2. Explain a bag will drain the urine from now on.

In a cutaneous procedure, the ureters are implanted in some way to allow for stoma formation on the abdominal wall, and the urine drains into a pouch. There are numerous methods for creating the stoma.

125

The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care?
1. Provide meticulous skin care and pouching.
2. Apply sterile drainage bags daily.
3. Monitor the pH of the urine weekly.
4. Assess the stoma site every day.

1. Provide meticulous skin care and pouching.

Urine is acidic, and the abdominal wall tissue is not designed to tolerate acidic environments. The stoma is pouched so urine will not touch the skin.

126

The client diagnosed with cancer of the bladder states, "I have young children. I am too young to die." Which statement is the nurse's best response?
1. "This cancer is treatable and you should not give up."
2. "Cancer occurs at any age. It is just one of those things."
3. "You are afraid of dying and what will happen to your children."
4. "Have you talked to your children about your dying?"

3. "You are afraid of dying and what will happen to your children."

This is an example of restating, a therapeutic technique used to clarify the client's feelings and encourage a discussion of those feelings.

127

The client with a continent urinary diversion is being discharged. Which discharge instructions should the nurse include include in the teaching?
1. Have the client demonstrate catheterizing the stoma.
2. Instruct the client on how to pouch the stoma.
3. Explain the use of a bedside drainage bag at night.
4. Tell the client to call the HCP if the temperature is 99F or less.

1. Have the client demonstrate catheterizing the stoma.

A continent urinary diversion is a surgical procedure in which a reservoir is created to hold urine until the client can self-catheterize the stoma. The nurse should observe the client's technique before discharge.

128

Which information regarding the care of a cutaneous ileal conduit should the nurse discuss with the client?
1. Teach the client to install a few drops of vinegar into the pouch.
2. Tell the client the stoma should be slightly dusky colored.
3. Inform the client large clumps of mucus are expected.
4. Tell the client it is normal for the urine to be pink or red in color.

1. Teach the client to install a few drops of vinegar into the pouch.

Vinegar will act as a deodorizing agent in the pouch and help prevent a strong urine smell.

129

The client is two (2) days post-uretersigmoidostomy for cancer of the bladder. Which assessment data warrants notification of the HCP by the nurse?
1. The client complains of pain at a "3," 30 minutes after being medicated.
2. The client complains it hurts to cough and deep breathe.
3. The client ambulates to the end of the hall and back before lunch.
4. The client is lying in a fetal position and has a rigid abdomen.

4. The client is lying in a fetal position and has a rigid abdomen.

The client is drawn up in a position which relieves pressure off the abdomen; a rigid abdomen is an indicator of peritonitis, a medical emergency.

130

The female client diagnosed with bladder cancer who has a cutaneous urinary diversion states, "Will I be able to have children now?" Which statement is the nurse's best response?
1. "Cancer does not make you sterile, but sometimes the therapy can."
2. "Are you concerned you can't have children?"
3. "You will be able to have as many children as you want."
4. "Let me have the chaplain come to talk with you about this."

1. "Cancer does not make you sterile, but sometimes the therapy can."

This client is asking for information and should be provided factual information. The surgery will not make the client sterile, but chemotherapy can induce menopause and radiation therapy to the pelvis can render a client sterile.