C45 - Lewis Book Med Surg PDF

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Chapter 45: Renal and Urologic Problems Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A 46-yr-old female patient returns to the clinic with recurrent 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. Teach the patient to take the prescribed trimethoprim and sulfamethoxazole for 3 more days. ANS: C

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 (applicatio n) REF: 1041 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 2. The nurse determines that instruction regarding prevention of future urinary tract infections

(UTIs) has been effective for a 22-yr-old female patient with cystitis when the patient states which of the following? 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) REF: 1038 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 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

Patients should be taught that phenazopyridine will color the urine deep orange. Urinary analgesics should only be needed for 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) REF: 1036 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 c. Suprapubic discomfort b. Foul-smelling urine 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) REF: 1038 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 5. The nurse determines that further instruction is needed for a patient with interstitial cystitis

when the patient says which of the following? 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) REF: 1041 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 6. To determine possible causes, the nurse will ask a patient admitted with acute

glomerulonephritis about 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) REF: 1041 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 7. Which finding for a patient admitted with glomerulonephritis indicates to the nurse that

treatment has been effective? a. The patient denies pain with voiding. b. The urine dipstick is negative for nitrites. 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) REF: 1042 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 8. The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain

about treatment with a. antibiotics. b. antifungals.

c. anticoagulants. d. antihypertensives.

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) REF: 1051 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 9. A 56-yr-old female 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) REF: 1044 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 10. To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. c. spinach and chocolate. b. sardines and liver. d. legumes and dried fruit. 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) REF: 1046 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11. The nurse teaches an adult patient to prevent the recurrence of renal calculi by a. using a filter to strain all urine.

b. avoiding dietary sources of calcium. c. drinking 2000 to 3000 mL of fluid each day. d. choosing diuretic fluids such as coffee and tea. ANS: C

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 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. DIF: Cognitive Level: Apply (application) REF: 1048 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 12. When planning teaching for a patient with benign nephrosclerosis, the nurse should include

instructions regarding a. preventing bleeding with anticoagulants. b. monitoring and recording blood pressure. c. obtaining and documenting daily weights. d. measuring daily intake and output volumes. ANS: B

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) REF: 1050 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 13. A 28- yr-old male patient is diagnosed with polycystic kidney disease. Which information is

most appropriate for the nurse to include in teaching at this time? 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. DIF: Cognitive Level: Apply (application) REF: 1051 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 14. A young adult 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 a. recent kidney trauma. c. recurrent bladder infection. b. gonococcal urethritis. d. benign prostatic hyperplasia. ANS: B

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. DIF: Cognitive Level: Apply (application) REF: 1039 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 15. The nurse will plan to teach a 27- yr-old woman who smokes two packs of cigarettes daily

about the increased risk for a. kidney stones. b. bladder cancer.

c. bladder infection. d. interstitial cystitis.

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) REF: 1054 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 16. A 68- yr-old female 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) REF: 1059 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 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 most 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) REF: 1056 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

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 most appropriate? a. Monitor the patient’s intake and output overnight. b. Have the patient drink small amounts of fluid frequently. c. Use an ultrasound scanner to check the postvoiding residual volume. d. Reassure the patient that this is normal after anesthesia for rectal surgery. ANS: C

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. DIF: Cognitive Level: Analyze (analysis) REF: 1061 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) REF: 1059 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 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.” 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) REF: 1063 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 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?

a. b. c. d.

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.

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) REF: 1062 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 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) REF: 1065 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 23. 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 a. anxiety related to effects of procedure on lifestyle. b. disturbed body image related to change in function. c. readiness for enhanced coping related to need for information. d. self-care deficit (toileting) related to denial of altered body function. ANS: B

The patient’s unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best way to describe the problem. 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. DIF: Cognitive Level: Apply (application) REF: 1065 TOP: Nursing Process: Analysis MSC: NCLEX: Psychosocial 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) REF: 1054 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 25. When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse

will teach about premedicating to prevent nausea. obtaining wigs and scarves to wear. emptying the bladder before the medication. maintaining oral care during the treatments.

a. b. c. d.

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) REF: 1055 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 26. Nursing staff on a hospital unit are reviewing rates of health care-associated infections (HAI)

of the urinary tract. Which nursing action will be most helpful in decreasing the risk for urin...