Chapter 50: Renal and Urologic Problems

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.

B. Obtain a midstream urine specimen for culture and sensitivity testing.

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."

D. "I will empty my bladder every 3 to 4 hours during the day."

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.

C. Phenazopyridine may change the urine color.

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

D. Costovertebral tenderness

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."

C. "I will start taking high potency multiple vitamins every morning."

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

C. Recent sore throat and fever

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.

D. The periorbital and peripheral edema are resolved.

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.

c. anticoagulants.

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

B. Recent weight gain

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.

B. sardines and liver.

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

B. Drinking 3000 mL of fluid each day

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

C. Monitoring and recording blood pressure

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

C. Options to consider for genetic counseling

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

A. Gonococcal urethritis

What risks will the nurse plan to teach a 27-yr-old woman who smokes two packs of cigarettes daily?

A. Kidney stones

B. Bladder cancer

C. Bladder infection

D. Interstitial cystitis

B. Bladder cancer

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.

C. Assist the patient to the bathroom every 2 hours during the day.

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.

D. Teach the patient how to perform Kegel exercises.

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.

C. Use an ultrasound scanner to check the postvoiding residual volume.

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.

C. Place a bedside commode close to the patient's bed.

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."

C. "I will clean the catheter carefully before and after each catheterization."

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. Provide teaching about home care for both catheters.

B. Apply continuous steady tension to the ureteral catheter.

C. Call the health care provider if the ureteral catheter output drops suddenly.

D. Clamp the ureteral catheter off when output from the urethral catheter stops.

C. Call the health care provider if the ureteral catheter output drops suddenly.

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?

A. Application of ostomy appliances

B. Barrier products for skin protection

C. Catheterization technique and schedule

D. Analgesic use before emptying the pouch

C. Catheterization technique and schedule

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.

B. Patient with a urethral stricture who has not voided for 12 hours.

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.

C. The patient has seen clots in the urine.

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

C. Emptying the bladder before the instillation

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 urinary HAI in patients admitted to the hospital?

A. Testing urine with a dipstick daily for nitrites

B. Avoiding unnecessary urinary catheterization

C. Encouraging adequate oral fluid and nutritional intake

D. Providing perineal hygiene to patients daily and as needed

B. Avoiding unnecessary urinary catheterization

Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)?

A. Low urine output

B. Bilateral flank pain

C. Nausea and vomiting

D. Burning on urination

D. Burning on urination

Which 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?

A. Flank tenderness to palpation

B. Blood pressure 90/48 mm Hg

C. Cloudy and foul-smelling urine

D. Temperature 100.1° F (57.8° C)

B. Blood pressure 90/48 mm Hg

A 58-yr-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which patient problem is present, based on these findings?

A. Poor perfusion

B. Inadequate nutrition

C. Activity intolerance

D. Excess fluid volume

D. Excess fluid volume

A 76-yr-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?

A. Insert an indwelling urinary catheter.

B. Draw blood for a serum creatinine level.

C. Schedule an intravenous pyelogram (IVP).

D. Administer lorazepam (Ativan) 0.5 mg PO.

A. Insert an indwelling urinary catheter.

Which nursing action is of highest priority for a patient with kidney stones who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?

A. Administer prescribed analgesics.

B. Monitor temperature every 4 hours.

C. Encourage increased oral fluid intake.

D. Give antiemetics as needed for nausea.

A. Administer prescribed analgesics.

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)?

A. Change the ostomy appliance.

B. Choose the appropriate ostomy bag.

C. Monitor the appearance of the stoma.

D. Assess for possible urinary tract infection (UTI).

A. Change the ostomy appliance.

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?

A. Blood in urine

B. Left flank bruising

C. Left flank discomfort

D. Decreased urine output

D. Decreased urine output

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

A. Assist the patient to soak in a 15-minute sitz bath.

B. Restrict oral fluids to equal previous urine volume.

C. Insert a straight urethral catheter and drain the bladder.

D. Teach the patient how to do isometric perineal exercises.

A. Assist the patient to soak in a 15-minute sitz bath.

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?

A. Securing the catheter to the patient's upper inner thigh

B. Cleaning around the patient's urinary meatus with soap and water

C. Disconnecting the catheter from the drainage tube to obtain a specimen

D. Using an alcohol-based gel hand cleaner before performing catheter care

C. Disconnecting the catheter from the drainage tube to obtain a specimen

A 48-yr-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma from a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon?

A. Blood pressure is 102/58.

B. Urine output is 20 mL/hr for 2 hours.

C. Incisional pain level reported as 9/10.

D. Crackles present at bilateral lung bases.

B. Urine output is 20 mL/hr for 2 hours.

A patient had a cystectomy with an ileal conduit yesterday. Which new assessment data is most important for the nurse to communicate to the health care provider?

A. Cloudy appearing urine

B. Heart rate 102 beats/min

C. Hypoactive bowel sounds

D. Continuous stoma drainage

B. Heart rate 102 beats/min

A 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?

A. Give ketorolac 10 mg PO PRN for pain.

B. Infuse 5% dextrose in normal saline at 75 mL/hr.

C. Order regular diet after patient is awake and alert.

D. Draw blood urea nitrogen (BUN) and creatinine in 2 hours.

A. Give ketorolac 10 mg PO PRN for pain.

A 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?

A. Urinary urgency

B. Left-sided flank pain

C. Intermittent hematuria

D. Burning with urination

B. Left-sided flank pain

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

A. Teach the patient about the use of antifungal medications.

B. Tell the patient to avoid tub baths until the symptoms resolve.

C. Instruct the patient to refer recent sexual partners for treatment.

D. Tell the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs).

A. Teach the patient about the use of antifungal medications.

Which action will the nurse anticipate taking for an otherwise healthy 50-yr-old who has just

been diagnosed with stage 1 renal cell carcinoma?

A. Prepare patient for a renal biopsy.

B. Provide preoperative teaching about nephrectomy.

C. Teach the patient about chemotherapy medications.

D. Schedule for a follow-up appointment in 3 months.

B. Provide preoperative teaching about nephrectomy.

Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse?

A. Blood urea nitrogen level is 70 mg/dL.

B. Urine output over the last 2 hours is 30 mL.

C. Audible crackles bilaterally over the posterior chest to the midscapular level.

D. Elevated level of antiglomerular basement membrane (anti-GBM) antibodies.

C. Audible crackles bilaterally over the posterior chest to the midscapular level.

A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first?

A. Check blood pressure and heart rate.

B. Administer morphine sulfate 4 mg IV.

C. Transport to radiology for an intravenous pyelogram.

D. Insert a urethral catheter and obtain a urine specimen.

A. Check blood pressure and heart rate.

A patient has been diagnosed with urinary tract stones that are high in uric acid. Which foods will the nurse teach the patient to avoid? (Select all that apply.)

a. Milk

b. Liver

c. Spinach

d. Chicken

e. Cabbage

f. Chocolate

b. Liver

d. Chicken