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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank

Chapter 45: Renal and Urologic Problems Harding: Lewis’s Medical-Surgical Nursing, 11th Edition MULTIPLE CHOICE 1. A 46-yr-old female patient returns to the clinic with continued dysuria after being treated with

trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take? a. Remind the patient about the need to drink 1000 mL of fluids daily. b. Obtain a midstream urine specimen for culture and sensitivity testing. c. Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms. d. Tell the patient to take the trimethoprim and sulfamethoxazole for 3 more days. ANS: B

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 medications such as phenazopyridine in treating dysuria. The fluid intake should be increased to at least 1800 mL/day. Because the UTI has persisted after treatment with trimethoprim and sulfamethoxazole, the patient is likely to need a different antibiotic. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Planning

2. Which statement by a 22-yr-old female patient with cystitis indicates to the nurse that

instruction regarding prevention of future urinary tract infections (UTIs) has been effective? a. “I can use vaginal antiseptic sprays to reduce bacteria.” b. “I will drink a quart of water or other fluids every day.” c. “I will wash with soap and water before sexual intercourse.” d. “I will empty my bladder every 3 to 4 hours during the day.” ANS: D

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 to prevent UTI. A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI. DIF: Cognitive Level: Apply (application) TOP: MSC: NCLEX: Health Promotion and Maintenance

Nursing Process: Evaluation

3. Which information will the nurse include when teaching the patient with a urinary tract

infection (UTI) about the use of phenazopyridine? a. Take phenazopyridine for at least 7 days. b. Phenazopyridine may cause photosensitivity. c. Phenazopyridine may change the urine color. d. Take phenazopyridine before sexual intercourse. ANS: C

Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank Patients should be taught that phenazopyridine will color the urine deep orange. Urinary analgesics should be needed for only a few days until the prescribed antibiotics decrease the bacterial count. Phenazopyridine does not cause photosensitivity. Taking phenazopyridine before intercourse will not be helpful in reducing the risk for UTI. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 4. Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient

with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? a. Bladder distention b. Foul-smelling urine c. Suprapubic discomfort d. Costovertebral tenderness ANS: D

Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling urine, and suprapubic discomfort are characteristic of a lower UTI and are likely to be present if the patient also has an upper UTI. DIF: Cognitive Level: Analyze (analysis) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 5. Which statement by a patient with interstitial cystitis indicates to the nurse that further

instruction is needed? a. “I should stop having coffee and orange juice for breakfast.” b. “I will buy calcium glycerophosphate (Prelief) at the pharmacy.” c. “I will start taking high potency multiple vitamins every morning.” d. “I should call the doctor about increased bladder pain or foul urine.” ANS: C

High-potency multiple vitamins may irritate the bladder and increase symptoms. The other patient statements indicate good understanding of the teaching. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Evaluation

6. What should the nurse ask the patient about to determine possible causes of acute

glomerulonephritis? a. Recent bladder infection b. History of kidney stones c. Recent sore throat and fever d. History of high blood pressure ANS: C

Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank 7. Which finding for a patient admitted with glomerulonephritis indicates to the nurse that

treatment has been effective? a. The urine dipstick is negative for nitrites. b. The patient denies pain or burning with voiding. c. The antistreptolysin-O (ASO) titer has decreased. d. The periorbital and peripheral edema are resolved. ANS: D

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. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Evaluation

8. The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain

about treatment with: antibiotics. antifungals. anticoagulants. antihypertensives.

a. b. c. d.

ANS: C

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. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Planning

9. An adult patient is admitted to the hospital with new-onset nephrotic syndrome. Which

assessment data will the nurse expect? a. Poor skin turgor b. Recent weight gain c. Elevated urine ketones d. Decreased blood pressure ANS: B

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. Ketones are not related to nephrotic syndrome. DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 10. To prevent recurrence of uric acid kidney stones, the nurse teaches the patient to avoid eating: a. milk and cheese. b. sardines and liver. c. spinach and chocolate. d. legumes and dried fruit.

Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank ANS: B

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. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11. What should the nurse include when teaching an adult patient to prevent the recurrence of

kidney stones? a. Using a filter to strain all urine b. Drinking 3000 mL of fluid each day c. Avoiding dietary sources of calcium d. Choosing diuretic fluids such as coffee ANS: B

A fluid intake of 2000 to 3000 mL/day is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with kidney stones. Coffee tends to increase stone recurrence. Straining all urine routinely after a stone has passed will not prevent stones. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 12. Which topic should the nurse include when planning a teaching session for a patient with

benign nephrosclerosis? a. Preventing bleeding with anticoagulants b. Obtaining and documenting daily weight c. Monitoring and recording blood pressure d. Measuring daily intake and output volumes ANS: C

Hypertension is the major manifestation 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. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Planning

13. A 28-yr-old male patient has just been diagnosed with polycystic kidney disease. Which

information should the nurse include in teaching during the first teaching session? a. Complications of renal transplantation b. Methods for treating severe chronic pain c. Options to consider for genetic counseling d. Differences between hemodialysis and peritoneal dialysis ANS: C

Because a 28-yr-old patient may be considering having children, the nurse should include information about genetic counseling when teaching the patient. A 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.

Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank

DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 14. A young adult male patient seen at the primary care clinic reports feeling continued fullness

after voiding and a split, spraying urine stream. What should the nurse ask about the patient’s history? a. Gonococcal urethritis b. Recent kidney trauma c. Recurrent bladder infection d. Benign prostatic hyperplasia ANS: A

The patient’s clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis. The symptoms are not consistent with benign prostatic hyperplasia, kidney trauma, or bladder infection. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 15. What risks will the nurse plan to teach a 27-yr-old woman who smokes two packs of

cigarettes daily? Kidney stones Bladder cancer Bladder infection Interstitial cystitis

a. b. c. d.

ANS: B

Cigarette smoking is a risk factor for bladder cancer. The patient’s risk for developing interstitial cystitis, urinary tract infection, or kidney stones will not be reduced by quitting smoking. DIF: Cognitive Level: Apply (application) TOP: MSC: NCLEX: Health Promotion and Maintenance

Nursing Process: Planning

16. A 68-yr-old patient admitted to the hospital with dehydration is confused and incontinent of

urine. Which nursing action should be included in the plan of care? a. Restrict fluids between meals and after the evening meal. b. Insert an indwelling catheter until the symptoms have resolved. c. Assist the patient to the bathroom every 2 hours during the day. d. Apply absorbent adult incontinence diapers and pads over the bed linens. ANS: C

In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling catheters increase the risk for urinary tract infection. Incontinent pads and diapers increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with dehydration. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Planning

Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank 17. A 55-yr-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 appropriate to include in the care plan? a. Assist the patient to the bathroom q3hr. b. Place a commode at the patient’s bedside. c. Demonstrate how to perform the Credé maneuver. d. Teach the patient how to perform Kegel exercises. ANS: D

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. DIF: Cognitive Level: Apply (application) TOP: MSC: NCLEX: Health Promotion and Maintenance

Nursing Process: Planning

18. 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 the priority? a. Encourage the patient to drink more fluids. b. Plan to monitor the patient’s intake and output. c. Use an ultrasound scanner to check the postvoiding residual volume. d. Reassure the patient that urinary problems are common after rectal surgery. ANS: C

The patient’s history and clinical manifestations are consistent with overflow incontinence, so an ultrasound scanner can be used to check for residual urine after the patient voids. The other interventions may also be useful, but the priority patient problem is the potentially overfilled bladder. DIF: Cognitive Level: Analyze (analysis) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 19. 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? a. Demonstrate the use of the Credé maneuver. b. Teach exercises to strengthen the pelvic floor. c. Place a bedside commode close to the patient’s bed. d. Use an ultrasound scanner to check postvoiding residuals. ANS: C

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. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Planning

20. 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? a. “I will buy seven new catheters weekly and use a new one every day.”

Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank b. “I will use a sterile catheter and gloves for each time I self-catheterize.” c. “I will clean the catheter carefully before and after each catheterization.” d. “I will take prophylactic antibiotics to prevent any urinary tract infections.” ANS: C

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. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Evaluation

21. After ureterolithotomy, a patient has a left ureteral catheter and a urethral catheter in place.

Which action will the nurse include in the plan of care? Provide teaching about home care for both catheters. Apply continuous steady tension to the ureteral catheter. Call the health care provider if the ureteral catheter output drops suddenly. Clamp the ureteral catheter off when output from the urethral catheter stops.

a. b. c. d.

ANS: C

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 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. DIF: Cognitive Level: Apply (application) MSC: NCLEX: Physiological Integrity

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Nursing Process: Planning

22. A 68-yr-old male patient who has bladder cancer had a cystectomy with creation of an Indiana

pouch. Which topic will be included in patient teaching? Application of ostomy appliances Barrier products for skin protection Catheterization technique and schedule Analgesic use before emptying the pouch

a. b. c. d.

ANS: C

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. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 23. After change-of-shift report, which patient should the nurse assess first? a. Patient who has cloudy urine after bladder reconstruction. b. Patient with a urethral stricture who has not voided for 12 hours. c. Patient who voided bright red urine after returning from lithotripsy. d. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg. ANS: B

Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank Not voiding for 12 hours suggests acute urinary retention, which is a medical emergency. The nurse will need to assess the patient and consider whether to insert a retention catheter. The other patients will be assessed, but their findings are consistent with their diagnoses and do not require immediate assessment or intervention. DIF: Cognitive Level: Analyze (analysis) OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 24. 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? a. The patient is voiding every 4 hours. b. The patient is using opioids for pain. c. The patient has seen clots in the urine. d. The patient is anxious about the cancer. ANS: C

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. DIF: Cognitive Level: Analyze (analysis) OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 25. What should the nurse will teach about when preparing a patient with bladder cancer for

intravesical chemotherapy? a. Coping with hair loss b. Premedicating to prevent nausea c. Emptying the bladder before the instillation d. Maintaining oral care during the treatments ANS: C

The patient will be asked to empty the bladder before instillation of the chemotherapy. Systemic side effects are not usually experienced with intravesical chemotherapy. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 26. Nursing staff on a hospital unit are reviewing rates of health care-associated infe...