Renal-Pyelonephritis

Flashcards covering key concepts, terminology, and details related to the urinary system, including UTIs, incontinence, renal pathology, and treatments.

Question 1: Which of the following is the most common physiological route for bacteria to reach the kidneys and cause Acute Pyelonephritis?

1. Hematogenous spread via the bloodstream

2. Ascending infection from the lower urinary tract

3. Lymphatic spread from adjacent organs

4. Direct inoculation from traumatic injury

Answer: 2. Ascending infection from the lower urinary tract

Rationale: Most cases of pyelonephritis result from bacteria (usually E. coli) migrating from the urethra to the bladder, and then ascending the ureters into the renal pelvis and parenchyma.

Question 2: Which physiological changes occur in the kidney during the acute phase of Pyelonephritis? (Select all that apply)

• Renal edema

• Inflammation of the renal pelvis

• Formation of abscesses in the parenchyma

• Scarring and atrophy of the cortex

• Infiltration of white blood cells

Answer: Renal edema, Inflammation of the renal pelvis, Formation of abscesses in the parenchyma, Infiltration of white blood cells

Rationale: Acute pyelonephritis involves inflammatory cellular infiltration and swelling. Scarring and atrophy are characteristic of chronic pyelonephritis, not the initial acute stage.

Question 3: A patient presents with fever, chills, and severe flank pain. Which assessment technique should the nurse use to confirm Costovertebral Angle (CVA) tenderness?

1. Deep palpation of the RUQ

2. Percussion of the 12th rib at the back

3. Auscultation of the renal arteries

4. Assessment of rebound tenderness at McBurney’s point

Answer: 2. Percussion of the 12th rib at the back

Rationale: CVA tenderness is assessed by placing one hand over the 12th rib at the costovertebral angle and striking it with the ulnar surface of the other fist (Murphy's punch sign).

Question 4: Which clinical manifestations are considered systemic indicators of Acute Pyelonephritis? (Select all that apply)

• Tachycardia

• Nausea/Vomiting

• Suprapubic pressure

• High fever

• Leukocytosis

Answer: Tachycardia, Nausea/Vomiting, High fever, Leukocytosis

Rationale: Systemic signs indicate the body is fighting an upper-organ infection. Suprapubic pressure is a localized lower UTI (cystitis) symptom, though both may coexist.

Question 5: What is the pathognomonic diagnostic finding in a urinalysis that confirms an 'upper' urinary tract infection like Pyelonephritis?

1. Red Blood Cell (RBC) casts

2. White Blood Cell (WBC) casts

3. Positive Nitrites

4. Proteinuria

Answer: 2. White Blood Cell (WBC) casts

Rationale: WBC casts are formed only in the renal tubules; their presence in urine specifically indicates that the infection/inflammation involves the kidneys.

Question 6: Which laboratory finding in a Complete Blood Count (CBC) is most indicative of an acute bacterial pyelonephritis infection?

1. Thrombocytopenia

2. Increased neutrophils with a 'shift to the left'

3. Decreased Hemoglobin

4. Elevated Eosinophils

Answer: 2. Increased neutrophils with a 'shift to the left'

Rationale: A 'shift to the left' refers to an increase in immature neutrophils (bands), signalling the bone marrow is responding to an acute, severe bacterial infection.

Question 7: A patient with Pyelonephritis is prescribed Ciprofloxacin. This medication belongs to which drug class?

1. Third-generation Cephalosporins

2. Fluoroquinolones

3. Aminoglycosides

4. Sulfonamides

Answer: 2. Fluoroquinolones

Rationale: Fluoroquinolones like Ciprofloxacin or Levofloxacin are frequently used first-line for uncomplicated pyelonephritis due to high tissue penetration.

Question 8: Which complication should the nurse prioritize monitoring for in a patient with multi-drug resistant pyelonephritis? (Select all that apply)

• Urosepsis

• Septic Shock

• Chronic Kidney Disease (CKD)

• Diabetes Mellitus

• Acute Kidney Injury (AKI)

Answer: Urosepsis, Septic Shock, Chronic Kidney Disease (CKD), Acute Kidney Injury (AKI)

Rationale: Sepsis and shock are immediate life-threats, while AKI and CKD are functional impairments resulting from damage. Diabetes is a risk factor, not a complication.

Question 9: Which patient teaching point is essential regarding the use of Phenazopyridine (Pyridium) for urinary discomfort?

1. It will turn the urine a bright orange/red color.

2. It replaces the need for antibiotic therapy.

3. It must be taken on an empty stomach.

4. It should be taken for at least 14 days.

Answer: 1. It will turn the urine a bright orange/red color.

Rationale: Phenazopyridine is a urinary analgesic. Patients must be warned about the color change to prevent alarm and to realize it only masks symptoms, not cures the infection.

Question 10: To prevent recurrence of Pyelonephritis, which lifestyle instruction should the nurse include in patient education? (Select all that apply)

• Wiping front-to-back

• Limiting daily fluid intake to 1 Liter

• Voiding immediately after sexual intercourse

• Drinking 2-3 Liters of water daily

• Wearing tight-fitting synthetic underwear

Answer: Wiping front-to-back, Voiding immediately after sexual intercourse, Drinking 2-3 Liters of water daily

Rationale: Hygiene and hydration minimize bacterial ascent. Tight synthetic fabrics trap moisture; cotton/loose clothing is preferred.

Question 11: How does chronic Pyelonephritis typically present on diagnostic imaging (e.g., CT or Ultrasound)?

1. Enlarged, edematous kidneys

2. Shrunken kidneys with fibrotic scarring

3. Bilateral renal cysts

4. Normal appearing renal cortex

Answer: 2. Shrunken kidneys with fibrotic scarring

Rationale: Repeated infections lead to the replacement of functional tissue with scar tissue, causing the kidneys to atrophy and lose function over time.

Question 12: Which finding should the nurse report immediately to the healthcare provider regarding a patient being treated for pyelonephritis?

1. Oral temperature of 100.2^{\circ}F

2. Blood pressure of 88/52 mmHg

3. Urinary frequency

4. Mild flank soreness

Answer: 2. Blood pressure of 88/52 mmHg

Rationale: Hypotension is a sign of systemic inflammatory response or urosepsis, requiring emergent IV fluid resuscitation and intervention.

Question 13: Physiological stasis of urine facilitates pyelonephritis. Which conditions contribute to this stasis? (Select all that apply)

• Kidney stones (Nephrolithiasis)

• Vesicoureteral reflux (VUR)

• Benign Prostatic Hyperplasia (BPH)

• Active lifestyle and exercise

• Pregnancy

Answer: Kidney stones, Vesicoureteral reflux (VUR), Benign Prostatic Hyperplasia (BPH), Pregnancy

Rationale: These factors cause either physical obstruction or backward flow, allowing bacteria to multiply in stagnant urine.

Question 14: What is the primary reason that a follow-up urine culture is ordered 1 to 2 weeks after completing antibiotics for pyelonephritis?

1. To check the patient's glucose level

2. To ensure complete eradication of the pathogen

3. To measure renal concentration capacity

4. To identify the patient's blood type

Answer: 2. To ensure complete eradication of the pathogen

Rationale: Persistent 'asymptomatic' bacteria can lead to rapid recurrence or chronic infection, and must be confirmed clear via culture.

Question 15: Which medication is often given IV for hospitalized patients with severe pyelonephritis due to its broad spectrum and renal safety profile?

1. Ceftriaxone

2. Gentamicin

3. Nitrofurantoin

4. Tetracycline

Answer: 1. Ceftriaxone

Rationale: Ceftriaxone is a third-gen cephalosporin effective against many uropathogens. Gentamicin (an aminoglycoside) is effective but carries higher risks for nephrotoxicity and ototoxicity.

Question 16: Why is Nitrofurantoin (Macrobid) typically NOT recommended for the treatment of Pyelonephritis?

1. It causes severe kidney damage.

2. It does not reach therapeutic levels in the renal tissue (parenchyma).

3. It is only effective against viruses.

4. It is restricted to pregnant patients only.

Answer: 2. It does not reach therapeutic levels in the renal tissue (parenchyma).

Rationale: Nitrofurantoin is concentrated only in the lower urinary tract and bladder; it does not achieve the tissue concentrations needed to treat an infection of the kidney parenchyma.

Question 17: Which diagnostic test provides a visual assessment of the renal structures and can detect abscesses or obstructions associated with pyelonephritis? (Select all that apply)

• Renal Ultrasound

• CT Scan (with or without contrast)

• Voiding Cystourethrogram (VCUG)

• Liver Function Test (LFT)

• Electrocardiogram (ECG)

Answer: Renal Ultrasound, CT Scan, Voiding Cystourethrogram (VCUG)

Rationale: Imaging is used to identify complications like abscesses or anatomical abnormalities like reflux (VCUG). LFTs and ECGs do not assess renal structure.

Question 18: A patient with pyelonephritis has a Serum Creatinine of 2.4 mg/dL (Baseline: 1.0). What does this physiologically indicate?

1. Dehydration causing concentrated blood

2. Acute Kidney Injury (AKI) resulting from inflammation

3. Successful antibiotic resolution

4. Normal physiological aging

Answer: 2. Acute Kidney Injury (AKI) resulting from inflammation

Rationale: Elevation of creatinine signifies a reduction in the glomerular filtration rate, often due to severe inflammation and edema within the nephrons during pyelonephritis.

Question 19: Which electrolyte imbalance is a high priority to monitor if a patient's pyelonephritis leads to significant renal failure?

1. Hypokalemia

2. Hyperkalemia

3. Hyponatremia

4. Hypomagnesemia

Answer: 2. Hyperkalemia

Rationale: The kidneys are responsible for excreting potassium. If kidney function drops (AKI), potassium levels rise rapidly, leading to life-threatening cardiac arrhythmias.

Question 20: When teaching a patient with pyelonephritis about nutrition, the nurse should advise avoiding which of the following? (Select all that apply)

• Caffeine

• Alcohol

• Water

• Spicy foods

• Cranberry juice

Answer: Caffeine, Alcohol, Spicy foods

Rationale: These act as bladder irritants and can exacerbate the discomfort during an active urinary tract infection. Water and cranberry juice are generally encouraged.

Question 21: Which symptom in the elderly population is most indicative of pyelonephritis despite the absence of a high fever?

1. Increased hunger

2. Acute onset of confusion or delirium

3. Improved mobility

4. Clear, odorless urine

Answer: 2. Acute onset of confusion or delirium

Rationale: Older adults often present with atypical symptoms such as altered mental status or lethargy rather than the standard fever and CVA tenderness.

Question 22: Which complication of pyelonephritis presents with gas bubbles in the renal parenchyma on imaging, primarily in diabetic patients?

1. Chronic Glomerulonephritis

2. Emphysematous Pyelonephritis

3. Nephrotic Syndrome

4. Renal Calculi

Answer: 2. Emphysematous Pyelonephritis

Rationale: This is a life-threatening, necrotizing infection caused by gas-forming organisms (like E. coli) in the renal tissue, common in patients with uncontrolled diabetes.

Question 23: During the treatment of pyelonephritis, what is the goal of administering IV fluids?

1. To 'flush' the bacteria through the urinary system

2. To cause the patient to sleep better

3. To increase blood viscosity

4. To prevent the need for antibiotics

Answer: 1. To 'flush' the bacteria through the urinary system

Rationale: High fluid flow ensures that bacteria and inflammatory debris (pus) are flushed out and maintains adequate blood flow to the kidneys.

Question 24: A pregnant patient with pyelonephritis is at risk for which complication? (Select all that apply)

• Preterm labor

• Chronic hypertension

• Sepsis

• Gestational diabetes

• Premature rupture of membranes (PROM)

Answer: Preterm labor, Sepsis, Premature rupture of membranes (PROM)

Rationale: Systemic infection causes an inflammatory surge that can trigger uterine contractions and lead to early delivery or sepsis.

Question 25: Which of the following is an expected physiological benefit of using Cranberry juice/supplements for urinary health?

1. It kills all bacteria in the kidney

2. It prevents bacteria from adhering to the urinary tract lining

3. It increases the pH of the urine to 9.0

4. It acts as an anticoagulant

Answer: 2. It prevents bacteria from adhering to the urinary tract lining

Rationale: Proanthocyanidins in cranberries prevent E. coli from binding to the epithelial cells, though it cannot treat an infection that is already established.

Question 26: What should the nurse include in the medication teaching for a patient starting Trimethoprim/Sulfamethoxazole (Bactrim) for Pyelonephritis?

1. Avoid sun exposure/wear sunscreen

2. Limit fluid intake

3. Stop the drug if you get a mild rash

4. Take it only once a week

Answer: 1. Avoid sun exposure/wear sunscreen

Rationale: Sulfonamides cause photosensitivity. Note: A rash should be reported immediately as it could be the start of Stevens-Johnson Syndrome.

Question 27: Which instruction is appropriate for a patient receiving outpatient treatment for mild pyelonephritis?

1. Bed rest for 3 weeks

2. Return to the clinic if vomiting prevents antibiotic intake

3. Decrease water intake to keep the medicine concentrated

4. Stop antibiotics when flank pain disappears

Answer: 2. Return to the clinic if vomiting prevents antibiotic intake

Rationale: If the patient cannot keep oral medications down, they must be admitted for IV therapy to prevent the infection from worsening.

Question 28: Vesicoureteral Reflux (VUR) is a physiological condition where:

1. Urine flows backward from the bladder into the ureters

2. The kidney drops lower into the pelvis

3. The urethra is blocked by a stone

4. The patient produces too much urine

Answer: 1. Urine flows backward from the bladder into the ureters

Rationale: This valvular failure allows infected bladder urine to reach the kidneys, frequently causing recurrent pyelonephritis.

Question 29: Which nursing intervention is a priority during the acute phase of pyelonephritis with severe pain?

1. Administering analgesics and applying heat to the flank

2. Forcing the patient to walk 2 miles

3. Restricting all pain medications to avoid masking symptoms

4. Providing a high-potassium diet

Answer: 1. Administering analgesics and applying heat to the flank

Rationale: Comfort measures are essential; heat helps relieve the muscle spasms associated with renal inflammation.

Question 30: Which medical history factor increases the risk of 'Complicated' Pyelonephritis? (Select all that apply)

• Male gender

• Pregnancy

• Indwelling catheter use

• Immunosuppression

• Normal anatomy

Answer: Male gender, Pregnancy, Indwelling catheter use, Immunosuppression

Rationale: Pyelonephritis in males, pregnant patients, or those with underlying health issues/hardware is always considered 'complicated' and requires aggressive management.

Question 31: Pyuria, a common finding in pyelonephritis, is defined as the presence of:

1. Glucose in the urine

2. Pus/White blood cells in the urine

3. Ketones in the urine

4. Protein in the urine

Answer: 2. Pus/White blood cells in the urine

Rationale: The term '-pyuria' refers to the inflammatory response where WBCs are shed into the urine to fight the infection.

Question 32: In Chronic Pyelonephritis, which physiological process leads to secondary hypertension?

1. Destruction of the heart valves

2. Damage to the renal vascular system and renin-angiotensin activation

3. Excessive salt consumption during illness

4. Inflammation of the carotid arteries

Answer: 2. Damage to the renal vascular system and renin-angiotensin activation

Rationale: Chronic renal tissue damage/scarring triggers the RAAS system, which increases blood pressure to maintain glomerular pressure.

Question 33: What is the primary causative agent responsible for nearly 80\% of pyelonephritis cases?

1. Pseudomonas

2. Staphylococcus

3. Escherichia coli (E. coli)

4. Candida albicans

Answer: 3. $$Escherichia coli (E. coli)

Rationale: This Gram-negative bacterium is the most common cause of both lower and upper urinary tract infections due to its proximity in the GI tract.

Question 34: A patient asks why they must finish a 14-day course of antibiotics instead of 3 days. The nurse explains:

1. 14 days is required to prevent deep kidney abscesses and recurrence

2. 3 days is enough, the doctor made a mistake

3. Longer courses prevent the patient from getting a cold

4. It ensures the patient builds immunity to the bacteria

Answer: 1. 14 days is required to prevent deep kidney abscesses and recurrence

Rationale: Unlike simple cystitis (3-5 days), pyelonephritis involves deeper tissue and requires longer therapy to ensure complete eradication.

Question 35: Which urinary diagnostic result suggests a bacterial infection? (Select all that apply)

• Positive Nitrites

• Positive Leukocyte Esterase

• Specific Gravity of 1.010

• Negative Glucose

• Bacteria on microscopy

Answer: Positive Nitrites, Positive Leukocyte Esterase, Bacteria on microscopy

Rationale: Nitrites indicate Gram-negative bacteria; Leukocyte esterase indicates WBC activity. Specific gravity and glucose are not primary indicators of infection.

Question 36: Physiologically, why is Pyelonephritis more common in women?

1. Longer ureters

2. Shorter urethra and closer proximity of the anus to the meatus

3. Larger bladder capacity

4. Higher systemic blood pressure

Answer: 2. Shorter urethra and closer proximity of the anus to the meatus

Rationale: Bacteria have a shorter distance to travel to reach the urinary tract and kidneys in females compared to males.

Question 37: Which of the following is a symptom of 'Urosepsis' resulting from pyelonephritis?

1. Bradycardia

2. Altered mental status and increased respiratory rate

3. Hypertension

4. Dry, warm skin

Answer: 2. Altered mental status and increased respiratory rate

Rationale: Tachypnea and confusion are early signs of poor tissue perfusion and systemic inflammatory response (SIRS) caused by urosepsis.

Question 38: What patient education is vital for a patient with recurrent pyelonephritis regarding contraceptive use?

1. Using spermicides increases the risk of UTI

2. Using condoms decreases the risk of UTI

3. Birth control pills cure the infection

4. Contraception has no relation to UTIs

Answer: 1. Using spermicides increases the risk of UTI

Rationale: Spermicidal foams and jellies can alter the normal vaginal flora, making it easier for E. coli to colonize and ascend to the kidneys.

Question 39: During IV infusion of Gentamicin for pyelonephritis, which assessment is most critical?

1. Daily weights and Serum Creatinine

2. Checking for a skin rash

3. Monitoring the heart rate for bradycardia

4. Measuring the patient's height

Answer: 1. Daily weights and Serum Creatinine

Rationale: Aminoglycosides are nephrotoxic; monitoring creatinine and urine output is essential to detect early drug-induced kidney injury.

Question 40: What is the physiological purpose of 'White Blood Cell (WBC) casts'?

1. They are used to transport oxygen to the kidney

2. They are 'molds' formed in the renal tubules consisting of inflammatory cells

3. They are part of the blood clotting mechanism

4. They represent the breakdown of old red blood cells

Answer: 2. They are 'molds' formed in the renal tubules consisting of inflammatory cells

Rationale: Because they are cast in the shape of the tubules, they prove the inflammation is happening deep within the kidney structure.

Question 41: Which instruction should the nurse provide regarding hygiene to prevent pyelonephritis? (Select all that apply)

• Avoid douching

• Avoid bubble baths

• Wear silk or lace underwear daily

• Empty the bladder as soon as the urge is felt

• Drink lots of sodas and coffee

Answer: Avoid douching, Avoid bubble baths, Empty the bladder as soon as the urge is felt

Rationale: Avoiding irritants and ensuring complete/timely bladder emptying reduces the risk of bacterial colonization.

Question 42: Chronic Pyelonephritis can eventually lead to End-Stage Renal Disease (ESRD). This means the patient will likely need:

1. A high-protein diet

2. Dialysis or Kidney Transplantation

3. Only oral antibiotics for life

4. Daily exercise to fix the scars

Answer: 2. Dialysis or Kidney Transplantation

Rationale: Once enough nephrons are replaced by scar tissue, the kidneys can no longer filter blood well enough to sustain life, necessitating renal replacement therapy.

Question 43: A patient feels much better after 48 hours of IV antibiotics for pyelonephritis. What should the nurse explain?

1. 'You can stop the medicine now and go home.'
2. 'You still need to complete the full course to prevent the infection from returning.'
3. 'The infection was likely just a mild cold.'
4. 'Wait until your fever returns to take more medicine.'

Answer: 2. 'You still need to complete the full course to prevent the infection from returning.'

Rationale: Symptomatic improvement happens quickly, but a deep kidney infection requires full therapy to kill all bacteria in the parenchyma.

Question 44: Which diagnostic procedure involves injecting dye to visualize the ureters and renal pelvis for possible obstructions?

1. MRI of the Brain
2. Intravenous Pyelogram (IVP)
3. Holter Monitor
4. Pulmonary Function Test

Answer: 2. Intravenous Pyelogram (IVP)

Rationale: An IVP uses contrast to highlight the urinary tract, identifying stones or strictures that could be causing pyelonephritis.

Question 45: What physiological finding in urine might be present if pyelonephritis is complicated by kidney stones?

1. Hematuria (Blood in urine)
2. Absence of bacteria
3. Low potassium in urine
4. Increased pH of 4.5

Answer: 1. Hematuria (Blood in urine)

Rationale: Stones (calculi) cause trauma to the lining of the urinary tract, often leading to hematuria as they pass or cause obstruction.

Question 46: Which of the following is a symptom of Acute Pyelonephritis? (Select all that apply)

• Malaise/Fatigue
• Pain at the costovertebral angle
• Bradycardia
• Vomiting
• Dysuria

Answer: Malaise/Fatigue, Pain at the costovertebral angle, Vomiting, Dysuria

Rationale: Standard presentation includes systemic fatigue, localized back pain, GI upset, and lower urinary symptoms.

Question 47: When managing pyelonephritis, which vital sign change suggests the patient is worsening and potentially developing septic shock?

1. BP drops, HR increases
2. BP increases, HR decreases
3. Temperature drops to 98.6^{\circ}F
4. Oxygen saturation of 98\%

Answer: 1. BP drops, HR increases

Rationale: Systemic vasodilation leads to hypotension, and the heart compensates by beating faster (tachycardia) to maintain cardiac output.

Question 48: Which group of people should be screened for 'Asymptomatic Bacteriuria' due to the high risk of it progressing to Pyelonephritis?

1. All adult males
2. Pregnant women
3. Teenagers
4. Professional athletes

Answer: 2. Pregnant women

Rationale: Asymptomatic bacteria in pregnancy have a high likelihood of ascending to the kidneys, so they are routinely screened and treated to prevent pyelonephritis/preterm labor.

Question 49: Phenazopyridine (Pyridium) treatment for pyelonephritis should be limited to how many days typically?

1. 2 days
2. 30 days
3. 1 year
4. Until the antibiotics are finished

Answer: 1. 2 days

Rationale: Long-term use is not recommended because it can mask the persistence of symptoms or worsening of the actual infection.

Question 50: Which of the following is a physiological defense mechanism of the urinary tract against infection?

1. Secretion of high-glucose urine
2. Acidic pH and frequent flushing (voiding)
3. Slowing down urine flow
4. Keeping the urine in the bladder as long as possible

Answer: 2. Acidic pH and frequent flushing (voiding)

Rationale: Acidity inhibits bacterial growth, and regular voiding physically removes bacteria before they can ascend.

Question 51: A patient has chronic pyelonephritis and a GFR (Glomerular Filtration Rate) of 30 mL/min. This indicates:

1. Moderate Stage 3 Chronic Kidney Disease
2. Hyper-efficient kidneys
3. A need for a massive high-protein diet
4. Acute hydration is needed only

Answer: 1. Moderate Stage 3 Chronic Kidney Disease

Rationale: GFR is the best measure of kidney function; 30 mL/min indicates significant loss of filtration capacity due to chronic damage/scarring.

Question 52: Which medication is often withheld if a pyelonephritis patient already has pre-existing Chronic Kidney Disease? (Select all that apply)

• NSAIDs (like Ibuprofen)
• Gentamicin
• Acetaminophen
• Ceftriaxone
• IV Contrast dye

Answer: NSAIDs, Gentamicin, IV Contrast dye

Rationale: These are nephrotoxic and can cause further damage to overstressed kidneys. Acetaminophen and Ceftriaxone are generally safer alternatives.

Question 53: Pain associated with Pyelonephritis is usually felt in which area?

1. Epigastrium
2. Lower back/Flank
3. Right Lower Quadrant
4. Shoulders

Answer: 2. Lower back/Flank

Rationale: The kidneys are retroperitoneal organs located in the flank area; inflammation causes pain in the upper back/sides.

Question 54: What is the significance of 'Leukocyte Esterase' on a urine dipstick?

1. It indicates the presence of glucose
2. It indicates the presence of neutrophils/inflammation
3. It measures the concentration of urine
4. It shows the presence of blood

Answer: 2. It indicates the presence of neutrophils/inflammation

Rationale: It is an enzyme released by WBCs, suggesting that the body is reacting to an infection in the urinary tract.

Question 55: Inflammation in the kidneys can lead to 'renal parenchyma' damage. What is the parenchyma?

1. The outer skin of the kidney
2. The functional tissue, including nephrons and tubules
3. The large artery entering the kidney
4. The fatty tissue surrounding the organ

Answer: 2. The functional tissue, including nephrons and tubules

Rationale: Damage to this tissue is why pyelonephritis can lead to permanent kidney failure (CKD).

Question 56: Which vital sign is most helpful in monitoring for sepsis in a patient with pyelonephritis? (Select all that apply)

• Temperature
• Heart Rate
• Respiratory Rate
• Blood Pressure
• Blood Glucose

Answer: Temperature, Heart Rate, Respiratory Rate, Blood Pressure

Rationale: These four represent the core components of SIRS (Systemic Inflammatory Response Syndrome), which precedes sepsis.

Question 57: A patient with pyelonephritis asks if they can use a heating pad. The nurse should say:

1. 'Yes, apply it to the painful flank area for comfort.'
2. 'No, heat will make the bacteria grow faster.'
3. 'Yes, but only if you have a fever over $$104^{\circ}F$.'
4. 'Only on the soles of your feet.'

Answer: 1. 'Yes, apply it to the painful flank area for comfort.'

Rationale: Local heat is an effective non-pharmacological comfort measure for renal colic and muscle spasms.

Question 58: A patient finishes their antibiotics for pyelonephritis. Which behavior indicates successful education?

1. They schedule their follow-up urine culture.
2. They stop drinking water immediately.
3. They start douching daily.
4. They resume using spermicides for birth control.

Answer: 1. They schedule their follow-up urine culture.

Rationale: Following up to ensure 'test of cure' is vital to prevent silent chronic progression.

Question 59: Which condition causes 'physiologic' obstruction in the ureter during pregnancy, increasing pyelonephritis risk?

1. Direct compression by the enlarging uterus and progesterone-induced relaxation
2. Dehydration
3. A high-calcium diet
4. Frequent walking

Answer: 1. Direct compression by the enlarging uterus and progesterone-induced relaxation

Rationale: The physical size of the uterus and hormonal changes slow down urine movement, allowing bacteria to ascend and stay in the ureters longer.

Question 60: Which statement by the nurse correctly summarizes Pyelonephritis to a patient?

1. 'It is a simple bladder infection.'
2. 'It is a serious infection of your kidney tissue that requires proper treatment to prevent damage.'
3. 'It is a viral illness that will go away on its own.'
4. 'It is an infection caused by eating too many sweets.'

Answer: 2. 'It is a serious infection of your kidney tissue that requires proper treatment to prevent damage.'

Rationale: Emphasizing the seriousness (kidney tissue) and the need for treatment (prevention of damage)