Question 1

Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?

Accepted Answer

The low blood pressure indicates that urosepsis and septic shock may be occurring and should be immediately reported.The other findings are typical of pyelonephritis.

Question 2

A 63-year-old male patient had a cystectomy with an ileal conduit yesterday.Which new assessment data is most important for the nurse to communicate to the physician?

Accepted Answer

Tachycardia may indicate infection,hemorrhage,or hypovolemia,which are all serious complications of this surgery.The urine from an ileal conduit normally contains mucus and is cloudy.Hypotonic bowel sounds are expected after bowel surgery.Continuous drainage of urine from the stoma is normal.

Question 3

The nurse observes unlicensed assistive personnel (UAP)taking the following actions when caring for a female patient with a urethral catheter.Which action requires that the nurse intervene?

Accepted Answer

The catheter should not be disconnected from the drainage tube because this increases the risk for urinary tract infection (UTI).The other actions are appropriate and do not require any intervention.

Question 4

A patient who had surgery for creation of an ileal conduit 3 days ago will not look at the stoma and requests that only the ostomy nurse specialist does the stoma care.The nurse identifies a nursing diagnosis of

Accepted Answer

The patient's unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best diagnosis.No data suggest that the impact on lifestyle is a concern for the patient.The patient does not appear to be ready for enhanced coping.The patient's insistence that only the ostomy nurse care for the stoma indicates that denial is not present.

Question 5

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy?

Accepted Answer

Because lithotripsy breaks the stone into small sand,which could cause obstruction,it is important to report a drop in urine output.Left flank pain,bruising,and hematuria are common after lithotripsy.

Question 6

A 68-year-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch.Which topic will be included in patient teaching?

Accepted Answer

The Indiana pouch enables the patient to self-catheterize every 4 to 6 hours.There is no need for an ostomy device or barrier products.Catheterization of the pouch is not painful.

Question 7

A 58-year-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema.Which nursing diagnosis is a priority for the patient?

Accepted Answer

The patient has massive edema,so the priority problem at this time is the excess fluid volume.The other nursing diagnoses are also appropriate,but the focus of nursing care should be resolution of the edema and ascites.

Question 8

When preparing a female patient with bladder cancer for intravesical chemotherapy,the nurse will teach about

Accepted Answer

The patient will be asked to empty the bladder before instillation of the chemotherapy.Systemic side effects are not usually experienced with intravesical chemotherapy.

Question 9

Which nursing action is of highest priority for a 68-year-old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?

Accepted Answer

Although all of the nursing actions may be used for patients with renal lithiasis,the patient's presentation indicates that management of pain is the highest priority action.If the patient has urinary obstruction,increasing oral fluids may increase the symptoms.There is no evidence of infection or nausea.

Question 10

Which assessment data reported by a 28-year-old male patient is consistent with a lower urinary tract infection (UTI)?

Accepted Answer

Pain with urination is a common symptom of a lower UTI.Urine output does not decrease,but frequency may be experienced.Flank pain and nausea are associated with an upper UTI.

Question 11

A patient in the urology clinic is diagnosed with monilial urethritis.Which action will the nurse include in the plan of care?

Accepted Answer

Monilial urethritis is caused by a fungus and antifungal medications such as nystatin (Mycostatin)or fluconazole (Diflucan)are usually used as treatment.Because monilial urethritis is not sexually transmitted,there is no need to refer sexual partners.Warm baths and NSAIDS may be used to treat symptoms.

Question 12

A 22-year-old female patient seen in the clinic for a bladder infection describes the following symptoms.Which information is most important for the nurse to report to the health care provider?

Accepted Answer

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 urinary tract infection (UTI).

Question 13

After a ureterolithotomy,a female patient has a left ureteral catheter and a urethral catheter in place.Which action will the nurse include in the plan of care?

Accepted Answer

The health care provider should be notified if the ureteral catheter output decreases because obstruction of this catheter may result in an increase in pressure in the renal pelvis.Tension on the ureteral catheter should be avoided in order to prevent catheter displacement.To avoid pressure in the renal pelvis,the catheter is not clamped.Because the patient is not usually discharged with a ureteral catheter in place,patient teaching about both catheters is not needed.

Question 14

The nurse is caring for a patient who has had an ileal conduit for several years.Which nursing action could be delegated to unlicensed assistive personnel (UAP)?

Accepted Answer

Changing the ostomy appliance for a stable patient could be done by UAP.Assessments of the site,choosing the appropriate ostomy bag,and assessing for (UTI)symptoms require more education and scope of practice and should be done by the registered nurse (RN).

Question 15

A 32-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery.Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider?

Accepted Answer

The nonsteroidal antiinflammatory drugs (NSAIDs)should be avoided in patients with decreased renal function because nephrotoxicity is a potential adverse effect.The other orders do not need any clarification or change.

Question 16

A 58-year-old male patient who weighs 242 lb (110 kg)undergoes a nephrectomy for massive kidney trauma due to a motor vehicle crash.Which postoperative assessment finding is most important to communicate to the surgeon?

Accepted Answer

Because the urine output should be at least 0.5 mL/kg/hr,a 40 mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding,inadequate fluid intake,or obstruction at the suture site.The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time.The patient should cough and deep breathe,but the crackles do not indicate a need for an immediate change in therapy.The incisional pain should be addressed,but this is not as potentially life threatening as decreased renal perfusion.In addition,the nurse can medicate the patient for pain.

Question 17

Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider?

Accepted Answer

Clots in the urine are not expected and require further follow-up.Voiding every 4 hours,use of opioids for pain,and anxiety are typical after this procedure.

Question 18

Nursing staff on a hospital unit are reviewing rates of hospital-acquired infections (HAI)of the urinary tract.Which nursing action will be most helpful in decreasing the risk for HAI in patients admitted to the hospital?

Accepted Answer

Because catheterization bypasses many of the protective mechanisms that prevent urinary tract infection (UTI),avoidance of catheterization is the most effective means of reducing HAI.The other actions will also be helpful,but are not as useful as decreasing urinary catheter use.

Question 19

A 76-year-old with benign prostatic hyperplasia (BPH)is agitated and confused,with a markedly distended bladder.Which intervention prescribed by the health care provider should the nurse implement first?

Accepted Answer

The patient's history and clinical manifestations are consistent with acute urinary retention,and the priority action is to relieve the retention by catheterization.The BUN and creatinine measurements can be obtained after the catheter is inserted.The patient's agitation may resolve once the bladder distention is corrected,and sedative drugs should be used cautiously in older patients.The IVP is an appropriate test but does not need to be done urgently.

Question 20

A 44-year-old patient is unable to void after having an open loop resection and fulguration of the bladder.Which nursing action should be implemented first?

Accepted Answer

Sitz baths will relax the perineal muscles and promote voiding.Although the patient should be encouraged to drink fluids and Kegel exercises are helpful in the prevention of incontinence,these activities would not be helpful for a patient experiencing retention.Catheter insertion increases the risk for urinary tract infection (UTI)and should be avoided when possible

Quiz 42: Nursing Management: Renal and Urological Problems