Question 1

To prevent recurrence of uric acid renal calculi,the nurse teaches the patient to avoid eating

Accepted Answer

Organ meats and fish such as sardines increase purine levels and uric acid.Spinach,chocolate,and tomatoes should be avoided in patients who have oxalate stones.Milk,dairy products,legumes,and dried fruits may increase the incidence of calcium-containing stones.

Question 2

It is most important that the nurse ask a patient admitted with acute glomerulonephritis about

Accepted Answer

Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat.It is not caused by kidney stones,hypertension,or urinary tract infection (UTI).

Question 3

A 46-year-old female patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole (Bactrim)for 3 days.Which action will the nurse plan to take?

Accepted Answer

Because uncomplicated urinary tract infections (UTIs)are usually successfully treated with 3 days of antibiotic therapy,this patient will need a urine culture and sensitivity to determine appropriate antibiotic therapy.Acetaminophen would not be as effective as other over-the-counter (OTC)medications such as phenazopyridine (Pyridium)in treating dysuria.The fluid intake should be increased to at least 1800 mL/day.Because the UTI has persisted after treatment with Bactrim,the patient is likely to need a different antibiotic.

Question 4

Following rectal surgery,a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours.Which nursing action is most appropriate?

Accepted Answer

An ultrasound scanner can be used to check for residual urine after the patient voids.Because the patient's history and clinical manifestations are consistent with overflow incontinence,it is not appropriate to have the patient drink small amounts.Although overflow incontinence is not unusual after surgery,the nurse should intervene to correct the physiologic problem,not just reassure the patient.The patient may develop reflux into the renal pelvis and discomfort from a full bladder if the nurse waits to address the problem for several hours.

Question 5

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

Accepted Answer

Modifications in the environment make it easier to avoid functional incontinence.Checking for residual urine and performing the Credé maneuver are interventions for overflow incontinence.Kegel exercises are useful for stress incontinence.

Question 6

Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)?

Accepted Answer

Costovertebral tenderness is characteristic of pyelonephritis.Bladder distention,foul-smelling urine,and suprapubic discomfort are characteristic of lower UTI and are likely to be present if the patient also has an upper UTI.

Question 7

A 68-year-old female patient admitted to the hospital with dehydration is confused and incontinent of urine.Which nursing action will be best to include in the plan of care?

Accepted Answer

In older or confused patients,incontinence may be avoided by using scheduled toileting times.Indwelling catheters increase the risk for urinary tract infection (UTI).Incontinent pads increase the risk for skin breakdown.Restricting fluids is not appropriate in a patient with dehydration.

Question 8

A 28-year-old male patient is diagnosed with polycystic kidney disease.Which information is most appropriate for the nurse to include in teaching at this time?

Accepted Answer

Because a 28-year-old patient may be considering having children,the nurse should include information about genetic counseling when teaching the patient.The well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years.There is no indication that the patient has chronic pain.

Question 9

The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by

Accepted Answer

A fluid intake of 2000 to 3000 mL daily is recommended to help flush out minerals before stones can form.Avoidance of calcium is not usually recommended for patients with renal calculi.Coffee tends to increase stone recurrence.There is no need for a patient to strain all urine routinely after a stone has passed,and this will not prevent stones.

Question 10

The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with

Accepted Answer

Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis,and anticoagulation is needed.Antibiotics are used to treat a patient with flank pain caused by pyelonephritis.Fungal pyelonephritis is uncommon and is treated with antifungals.Antihypertensives are used if the patient has high blood pressure.

Question 11

When planning teaching for a 59-year-old male patient with benign nephrosclerosis the nurse should include instructions regarding

Accepted Answer

Hypertension is the major symptom of nephrosclerosis.Measurements of intake and output and daily weights are not necessary unless the patient develops renal insufficiency.Anticoagulants are not used to treat nephrosclerosis.

Question 12

The nurse determines that further instruction is needed for a patient with interstitial cystitis when the patient says which of the following?

Accepted Answer

High-potency multiple vitamins may irritate the bladder and increase symptoms.The other patient statements indicate good understanding of the teaching.

Question 13

A 55-year-old woman admitted for shoulder surgery asks the nurse for a perineal pad,stating that laughing or coughing causes leakage of urine.Which intervention is most appropriate to include in the care plan?

Accepted Answer

Kegel exercises to strengthen the pelvic floor muscles will help reduce stress incontinence.The Credé maneuver is used to help empty the bladder for patients with overflow incontinence.Placing the commode close to the bedside and assisting the patient to the bathroom are helpful for functional incontinence.

Question 14

A 56-year-old female patient is admitted to the hospital with new onset nephrotic syndrome.Which assessment data will the nurse expect?

Accepted Answer

The patient with a nephrotic syndrome will have weight gain associated with edema.Hypertension is a clinical manifestation of nephrotic syndrome.Skin turgor is normal because of the edema.Urine protein is high.

Question 15

The home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying.Which patient statement indicates that the teaching has been effective?

Accepted Answer

Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days.There is no need to use a new catheter every day,to use sterile catheters,or to take prophylactic antibiotics.

Question 16

The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs)has been effective for a 22-year-old female patient with cystitis when the patient states which of the following?

Accepted Answer

Voiding every 3 to 4 hours is recommended to prevent UTIs.Use of vaginal sprays is discouraged.The bladder should be emptied before and after intercourse,but cleaning with soap and water is not necessary.A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI.

Question 17

Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?

Accepted Answer

Because edema is a common clinical manifestation of glomerulonephritis,resolution of the edema indicates that the prescribed therapies have been effective.Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection.Antibodies to streptococcus will persist after a streptococcal infection.

Question 18

A 34-year-old male patient seen at the primary care clinic complains of feeling continued fullness after voiding and a split,spraying urine stream.The nurse will ask about a history of

Accepted Answer

The patient's clinical manifestations are consistent with urethral strictures,a possible complication of gonococcal urethritis.These symptoms are not consistent with benign prostatic hyperplasia,kidney trauma,or bladder infection.

Question 19

The nurse will plan to teach a 27-year-old female who smokes 2 packs of cigarettes daily about the increased risk for

Accepted Answer

Cigarette smoking is a risk factor for bladder cancer.The patient's risk for developing interstitial cystitis,urinary tract infection (UTI),or kidney stones will not be reduced by quitting smoking.

Question 20

Which information will the nurse include when teaching the patient with a urinary tract infection (UTI)about the use of phenazopyridine (Pyridium)?

Accepted Answer

Patients should be taught that Pyridium will color the urine deep orange.Urinary analgesics should only be needed for a few days until the prescribed antibiotics decrease the bacterial count.Pyridium does not cause photosensitivity.Taking Pyridium before intercourse will not be helpful in reducing the risk for UTI.

Quiz 46: Nursing Management: Renal and Urologic Problems