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Flashcards in MS - Renal/Urologic Deck (130)
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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.