Deck 48: Nursing Management: Renal and Urological Problems

Question 1

A patient with a history of renal calculi is hospitalized with gross hematuria and severe colicky left flank pain that radiates to his left testicle.In planning care for the patient,the nurse gives the highest priority to which of the following nursing diagnoses?

A) Acute pain related to irritation of stone
B) Deficient fluid volume related to inadequate intake
C) Risk for infection related to urinary system damage
D) Altered health maintenance related to lack of knowledge about prevention of stones

Answer 1

Acute pain related to irritation of stone

Question 2

Which of the following assessment findings would the nurse expect in the patient with a lower urinary tract infection (UTI)?

A) Flank pain
B) Dysuria
C) Oliguria
D) Nausea

Answer 2

Dysuria

Question 3

One week after using an over-the-counter nonsteroidal anti-inflammatory drug to treat aches resulting from a fall,a patient noticed the development of progressive edema throughout his body.Diagnostic studies confirmed a diagnosis of nephrotic syndrome.When teaching the patient about his condition,the nurse uses the knowledge that the edema results from which of the following changes?

A) Increased serum oncotic pressure exerted by dyslipidemia
B) Loss of protein through the kidney,resulting in a fall in plasma colloid osmotic pressure
C) Loss of albumin in the urine,creating an osmotic diuresis and low tissue hydrostatic pressure
D) Fluid retention caused by decreased glomerular filtration rate through kidneys damaged by trauma

Answer 3

Loss of protein through the kidney,resulting in a fall in plasma colloid osmotic pressure

Question 4

A 72-year-old man has benign prostatic hypertrophy,which has contributed to repeated bouts of cystitis.He is now admitted to the hospital with chills,fever,and nausea and vomiting.A urinalysis is positive for bacteria,red blood cells,and white blood cells.The nurse suspects the presence of an upper UTI when assessment of the patient reveals which of the following findings?

A) Suprapubic pain
B) Foul-smelling urine
C) A distended bladder
D) Costovertebral angle (CVA)tenderness

Question 5

The nurse advises genetic counselling for the children of which of the following patients?

A) A patient with interstitial cystitis
B) A patient with horseshoe kidney
C) A patient with polycystic kidney disease
D) A patient with Goodpasture syndrome

Question 6

When admitting a patient with acute glomerulonephritis,the nurse inquires about which of the following?

A) History of high blood pressure
B) Frequency of UTIs
C) Recent sore throat and fever
D) Family history of kidney disease

Question 7

A 34-year-old patient with diabetes mellitus is hospitalized with fever,anorexia,and confusion.The physician suspects acute pyelonephritis when the urinalysis reveals bacteriuria.Which of the following is an appropriate collaborative problem identified by the nurse for this patient?

A) Potential complication: urosepsis
B) Potential complication: hydronephrosis
C) Potential complication: acute kidney injury
D) Potential complication: chronic pyelonephritis

Question 8

Which of the following actions will assist the nurse in evaluating the effectiveness of treatment for the patient with nephrotic syndrome?

A) Monitoring the blood pressure every 4 hours
B) Measuring the abdominal girth daily
C) Measuring daily dietary protein intake
D) Checking the urine of each voiding for protein

Question 9

To prevent the recurrence of renal calculi,what should the nurse teach the patient to do?

A) Avoid all sources of dietary calcium.
B) Drink fluids such as cranberry juice and colas,which will acidify the urine.
C) Maintain fluid intake at 3000 mL a day,especially when physically active.
D) Empty the bladder every 2 to 4 hours to prevent urinary stasis and precipitation of urates.

Question 10

The nurse notes that the results of an intravenous pyelogram indicate a left hydroureter and hydronephrosis in a female patient who was hospitalized with a markedly distended bladder.A catheterization for residual urine obtained 1650 mL.What does the nurse understand about these findings that are characteristic of a urinary tract obstruction?

A) They are located at the bladder neck.
B) They are caused by ureteral calculi.
C) They are situated at the ureteropelvic junction.
D) They are caused by a ureteral stricture.

Question 11

The nurse determines that instruction regarding prevention of future UTIs for a patient with cystitis has been effective when the patient gives which of the following responses?

A) "I will limit my fluid intake to 1000 mL/day to prevent symptoms of frequency and urgency."
B) "I will increase my fluid intake and empty my bladder every 2 to 4 hours during waking hours."
C) "I should use an antiseptic vaginal deodorant spray twice a day to reduce the bacterial growth in the perineal area."
D) "I will wash my perineal area with soap and water after each bowel movement and before and after sexual intercourse."

Question 12

In planning teaching for a patient with nephrosclerosis,what should the nurse include instructions about?

A) Monitoring of daily intake and output amounts
B) Maintenance of fluid restriction at 1000 mL/day
C) Techniques of monitoring and recording blood pressure
D) Prevention and detection of bleeding from anticoagulation therapy

Question 13

The nurse instructs a patient seen in the outpatient clinic with symptoms of renal calculi to strain all urine for which of the following primary purposes?

A) To validate the diagnosis of kidney stones
B) To obtain a stone for analysis of composition
C) To determine when a stone has passed from the system
D) To determine the extent of damage to the urinary system

Question 14

What is one of the most important ways to prevent the development of acute post-streptococcal glomerulonephritis?

A) Control of blood pressure with exercise
B) Early diagnosis and treatment of sore throat
C) Ensuring complete bladder emptying when the patient voids
D) Daily intake of high-potency multivitamins

Question 15

A patient with a confirmed renal calculus in the proximal left ureter undergoes extracorporeal shock wave lithotripsy,which successfully shatters the stone.After the lithotripsy,the nurse encourages fluids to 3000 mL/day and knows that the interventions for the patient have been effective based on which of the following findings?

A) Free flow of urine is present.
B) Adequate fluid balance is maintained.
C) The patient verbalizes a decrease in pain.
D) There is no indication of UTI.

Question 16

A patient with nephrotic syndrome develops flank pain.The nurse will anticipate treatment with which of the following?

A) Antibiotics
B) Antihypertensives
C) Anticoagulants
D) Corticosteroids

Question 17

The composition of a patient's renal calculi is identified as uric acid.To prevent recurrence of stones,what should the nurse teach the patient to avoid?

A) Milk and dairy products
B) Legumes and dried fruits
C) Spinach,chocolate,and tomatoes
D) Organ meats and fish with fine bones

Question 18

To relieve the symptoms of a lower UTI for which the patient is taking prescribed antibiotics,the nurse suggests that the patient use the over-the-counter urinary analgesic of phenazopyridine (Pyridium),but should give the patient which of the following cautions?

A) This preparation contains methylene blue,which turns the urine blue or green.
B) This preparation must be taken with food to prevent gastrointestinal irritation.
C) This preparation causes the urine to turn reddish orange and can stain underclothing.
D) This preparation frequently causes allergic reactions and should be stopped if a rash occurs.

Question 19

The nurse establishes a nursing diagnosis of excess fluid volume related to decreased glomerular filtration rate in a patient with acute post-streptococcal glomerulonephritis.Which of the following clinical data support this nursing diagnosis?

A) Proteinuria
B) Elevated blood urea nitrogen
C) Periorbital edema
D) Hematuria with smoky urine

Question 20

After teaching a patient with interstitial cystitis about management of the condition,the nurse determines that further instruction is needed when the patient makes which of the following comments?

A) "I will avoid eating citrus products and aged cheese."
B) "I should take a high-potency multivitamin daily."
C) "I should report the development of bladder pain or odorous urine."
D) "I can use the dietary supplement calcium glycerophosphate (Prelief)to control my symptoms."

Question 21

To promote muscle relaxation and induce voiding after the patient has undergone an open loop resection and fulguration of the bladder,what is an appropriate intervention for the nurse to use?

A) Sitz baths four times per day
B) Encouraging fluids to 3000 mL/day
C) Isometric exercises of the perineal muscles every 2 hours
D) Application of warm compresses to the suprapubic area four times per day

Question 22

The nurse anticipates that the patient with Goodpasture syndrome will be prescribed which one of the following medications?

A) A diuretic
B) An antihypertensive
C) A corticosteroid
D) Vitamin K injections

Question 23

A patient undergoes a nephrectomy for massive trauma to the kidney resulting from a fall from a scaffold.Immediately postoperatively,which of the following assessment data is most important to communicate to the surgeon?

A) Blood pressure is 102/48 mm Hg.
B) Urinary output is 20 mL/hour for 2 hours.
C) Crackles are heard at both lung bases.
D) Incisional pain level is 8 on a scale of 10.

Question 24

After her bath,a 62-year-old woman asks the nurse for a perineal pad,saying that she uses them because sometimes she leaks urine when she laughs or coughs.Which of the following interventions is most appropriate to include in a teaching plan to assist the patient with this problem?

A) Performance of Kegel exercises
B) Performance of Credé manoeuvre
C) Use of bladder neck support devices
D) Establishment of a pattern of urinating every 3 hours

Question 25

Which of the following is considered a storage symptom of a lower UTI?

A) Dysuria
B) Hesitancy
C) Intermittency
D) Urgency

Question 26

When teaching a patient about adequate fluid intake,what does the nurse tell the patient regarding an appropriate amount of daily intake per kilogram of body weight?

A) 25 mL
B) 33 mL
C) 42 mL
D) 50 mL

Question 27

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

A) Use an ultrasound scanner to check for residual urine after voiding.
B) Have the patient take small amounts of fluid frequently throughout the day.
C) Reassure the patient that this is normal after rectal surgery because of the anaesthesia.
D) Monitor the patient's intake and output over the next few hours.

Question 28

A patient undergoing a left ureterolithotomy returns to the surgical unit with a left ureteral catheter and a urethral catheter in place.To care for the catheters,what should the nurse do?

A) Irrigate the ureteral catheter with 5 mL normal saline hourly.
B) Clamp the ureteral catheter when drainage is less than 10 mL/hour.
C) Keep the patient on bed rest until the catheter is removed.
D) Alternately clamp and unclamp the ureteral catheter every other hour to determine total urinary output.

Question 29

What is the most common type of urinary tract calculi?

A) Uric acid
B) Cystine
C) Calcium oxalate
D) Struvite

Question 30

The physician suspects transitional-cell bladder cancer in a 69-year-old patient who has gross hematuria and history of a 9-kg weight loss during the last 3 months,and schedules diagnostic testing.When obtaining a nursing history from the patient,the nurse identifies a significant risk factor for bladder cancer when the patient reports which of the following histories?

A) Chronic cystitis
B) Cigarette smoking
C) High caffeine intake
D) Use of artificial sweeteners

Question 31

A 78-year-old woman is admitted to the hospital with dehydration and electrolyte imbalance.She is confused and incontinent of urine on admission.In developing a plan of care for the patient,what is an appropriate nursing intervention for the patient's incontinence?

A) Insert an in-dwelling catheter.
B) Apply absorbent incontinence pads.
C) Restrict fluids after the evening meal.
D) Assist the patient to the bathroom every 2 hours.

Question 32

A patient with a neurogenic bladder is to be taught intermittent catheterization for bladder emptying.What should the nurse teach the patient to do?

A) Use a clean procedure with a new catheter each day.
B) Use a new,sterile catheter and sterile gloves and procedure for each catheterization.
C) Request prophylactic antibiotics if clean,rather than sterile,technique is going to be used.
D) Wash and rinse the catheter and the hands with soap and water before and after each catheterization.

Question 33

When assessing a patient who complains of a feeling of incomplete bladder emptying and a split,spraying urine stream,what history should the nurse ask about more specifically?

A) Renal calculi
B) Kidney trauma
C) Bladder infection
D) Gonococcal urethritis

Question 34

To prevent the incidence of UTIs in a catheterized patient,which of the following actions should the nurse implement?

A) Irrigate the catheter with an antiseptic solution.
B) Apply an antiseptic solution to the perineum daily.
C) Perform perineal cleansing with mild soap and water twice daily and as needed.
D) Apply an antibiotic ointment around the catheter at the urinary meatus at least twice a day.