7.5 Ch. 46 Renal & Urologic Problems

65. The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

1, 2, 3 1. The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. 2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. 3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result. 4. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized. 5. The nurse can delegate placing the urine output in the proper container to the UAP; therefore, the UAP does not need to notify the nurse when the client urinates.

16. Which intervention should the nurse include when assessing the client for urinary retention? Select all that apply. 1. Inquire if the client has the sensation of fullness. 2. Percuss the suprapubic region for a dull sound. 3. Scan the bladder with the ultrasound scanner. 4. Palpate from the umbilicus to the suprapubic area. 5. Auscultate the two (2) lower abdominal quadrants.

1, 2, 3, 4 1. The nurse needs to assess the client's sensation of needing to void or feeling of fullness. 2. A dull sound heard when percussing the bladder indicates it is filled with urine. 3. A portable bladder scan is used to assess for the presence of urine, rather than using a straight catheter. 4. A distended bladder can be palpated. 5. Auscultation cannot assess the client's bladder.

81. The client with a continent urinary diversion is being discharged. Which discharge instructions should the nurse include in the teaching? 1. Have the client demonstrate catheterizing the stoma. 2. Instruct the client on how to pouch the stoma. 3. Explain the use of a bedside drainage bag at night. 4. Tell the client to call the HCP if the temperature is 99˚F or less.

1. A continent urinary diversion is a surgical procedure in which a reservoir is created to hold urine until the client can self-catheterize the stoma. The nurse should observe the client's technique before discharge.

44. The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientific rationale supports the client being hospitalized for this condition? 1. The client must be treated aggressively to prevent maternal/fetal complications. 2. The nurse can force the client to drink fluids and avoid nausea and vomiting. 3. The client will be dehydrated and there won't be sufficient blood flow to the baby. 4. Pregnant clients historically are afraid to take the antibiotics as ordered.

1. A pregnant client diagnosed with a UTI will be admitted for aggressive IV antibiotic therapy. After symptoms subside, the client will be sent home to complete the course of treatment with oral medications.

68. Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods containing cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one (1) vitamin a day with extra calcium."

1. An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate.

24. Which intervention is most important for the nurse to implement for the client with a left nephrectomy? 1. Assess the intravenous fluids for rate and volume. 2. Change surgical dressing every day at the same time. 3. Monitor the client's PT/PTT/INR level daily. 4. Monitor the percentage of each meal eaten.

1. Assessing the rate and volume of intravenous fluid is the most important intervention for the client who has one (1) kidney because an overload of fluids can result in pulmonary edema.

1. The elderly client being seen in the clinic has complaints of urinary frequency, urgency, and "leaking." Which priority intervention should the nurse implement when interviewing the client? 1. Ensure communication is nonjudgmental and respectful. 2. Set the temperature for comfort in the examination room. 3. Speak loudly to ensure the client understands the nurse. 4. Ensure the examining room has adequate lighting.

1. Clients who have urinary incontinence are often embarrassed, so it is the responsibility of the nurse to approach this subject with respect and consideration.

41. The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first? 1. A midstream urine for culture. 2. A sonogram of the kidney. 3. An intravenous pyelogram for renal calculi. 4. A CT scan of the kidneys.

1. Fever, chills, and costovertebral pain are symptoms of a urinary tract infection (acute pyelonephritis), which requires a urine culture first to confirm the diagnosis.

15. The nurse is providing discharge teaching to the client diagnosed with polycystic kidney disease. Which statement made by the client indicates the teaching has been effective? 1. "I need to avoid any activity causing a risk for injury to my kidney." 2. "I should avoid taking medications for high blood pressure." 3. "When I urinate there may be blood streaks in my urine." 4. "I may have occasional burning when I urinate with this disease."

1. Polycystic kidney disease poses an increased risk for rupture of the kidney, and therefore sports activities or occupations with risks for trauma should be avoided.

3. Which information indicates to the nurse the client teaching about treatment of urinary incontinence has been effective? 1. The client prepares a scheduled voiding plan. 2. The client verbalizes the need to increase fluid intake. 3. The client explains how to perform pelvic floor exercises. 4. The client attempts to retain the vaginal cone in place the entire day.

1. Scheduled voiding allows the client to void every two (2) to three (3) hours apart, and when the client has remained consistently dry, the interval is increased by about 15 minutes.

18. The nurse is caring for the client recovering from a percutaneous renal biopsy. Which data indicate the client is complying with client teaching? 1. The client is lying flat in the supine position. 2. The client continues oral fluids restriction while on bedrest. 3. The client uses the bedside commode to urinate. 4. The client refuses to ask for any pain medication.

1. The client needs to lie flat on the back to apply pressure to prevent bleeding.

76. The client diagnosed with cancer of the bladder is undergoing intravesical chemotherapy. Which instruction should the nurse provide the client about the pretherapy routine? 1. Instruct the client to remain NPO after midnight before the procedure. 2. Explain the use of chemotherapy in bladder cancer. 3. Teach the client to administer Neupogen, a biologic response modifier. 4. Have the client take Tylenol, an analgesic, before coming to the clinic.

1. The client will have medication instilled in the bladder which must remain in the bladder for a prescribed length of time. For this reason, the client must remain NPO before the procedure.

84. The female client diagnosed with bladder cancer who has a cutaneous urinary diversion states, "Will I be able to have children now?" Which statement is the nurse's best response? 1. "Cancer does not make you sterile, but sometimes the therapy can." 2. "Are you concerned you can't have children?" 3. "You will be able to have as many children as you want." 4. "Let me have the chaplain come to talk with you about this."

1. This client is asking for information and should be provided factual information. The surgery will not make the client sterile, but chemotherapy can induce menopause and radiation therapy to the pelvis can render a client sterile.

8. Which client should the nurse not assign to a UAP working on a surgical floor? 1. The client with a suprapubic catheter inserted yesterday. 2. The client who has had an indwelling catheter for the past week. 3. The client who is on a bladder-training regimen. 4. The client who had a catheter removed this morning and is being discharged.

1. This client requires the most skill and knowledge because this client has the greatest potential for an infection; therefore, the client should not be assigned to a UAP.

77. The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care? 1. Provide meticulous skin care and pouching. 2. Apply sterile drainage bags daily. 3. Monitor the pH of the urine weekly. 4. Assess the stoma site every day.

1. Urine is acidic, and the abdominal wall tissue is not designed to tolerate acidic environments. The stoma is pouched so urine will not touch the skin.

82. Which information regarding the care of a cutaneous ileal conduit should the nurse discuss with the client? 1. Teach the client to instill a few drops of vinegar into the pouch. 2. Tell the client the stoma should be slightly dusky colored. 3. Inform the client large clumps of mucus are expected. 4. Tell the client it is normal for the urine to be pink or red in color.

1. Vinegar will act as a deodorizing agent in the pouch and help prevent a strong urine smell.

75. The client diagnosed with cancer of the bladder is scheduled to have a cutaneous urinary diversion procedure. Which preoperative teaching intervention specific to the procedure should be included? 1. Demonstrate turn, cough, and deep breathing. 2. Explain a bag will drain the urine from now on. 3. Instruct the client on the use of a PCA pump. 4. Take the client to the ICU so the client can become familiar with it.

2. A urinary diversion procedure involves the removal of the bladder. In a cutaneous procedure, the ureters are implanted in some way to allow for stoma formation on the abdominal wall, and the urine drains into a pouch. There are numerous methods used for creating the stoma.

62. The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when ambulating the client.

2. Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope.

2. The client is experiencing urinary incontinence. Which intervention should the nurse implement? 1. Teach the client to drink prune juice weekly. 2. Encourage the client to eat a high-fiber diet. 3. Discuss the need to urinate every six (6) hours. 4. Explain the importance of wearing cotton underwear.

2. Clients experiencing incontinence should eat a high-fiber diet to avoid constipation, which increases pressure on the bladder, which may increase incontinence.

13. The nurse is teaching the female client diagnosed with tuberculosis of the urinary tract prior to discharge. Which information should the nurse include specific to this diagnosis? 1. Instruct the client to take the medication with food. 2. Explain condoms should be used during treatment. 3. Discuss the need for follow-up chest x-rays. 4. Encourage a well-balanced diet and fluid intake.

2. Clients who have been diagnosed with tuberculosis of the renal tract should use condoms to prevent transmission of the mycobacterium. If the infection is located in the penis or urethra, abstaining from sexual activity is recommended.

42. The nurse is caring for a client with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis? 1. The client has fever, chills, flank pain, and dysuria. 2. The client complains of fatigue, headaches, and increased urination. 3. The client had a group B beta-hemolytic strep infection last week. 4. The client has an acute viral pneumonia infection.

2. Fatigue, headache, and polyuria as well as loss of weight, anorexia, and excessive thirst are symptoms of chronic pyelonephritis.

69. Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? 1. Assess the client's neurological status every two (2) hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.

2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone.

79. The male client diagnosed with metastatic cancer of the bladder is emaciated and refuses to eat. Which nursing action is an example of the ethical principle of paternalism? 1. The nurse allows the client to talk about not wanting to eat. 2. The nurse tells the client if he does not eat, a feeding tube will be placed. 3. The nurse consults the dietitian about the client's nutritional needs. 4. The nurse asks the family to bring favorite foods for the client to eat.

2. Paternalism is deciding for the client what is best, similar to a parent making decisions for a child. Feeding a client, as with a feeding tube, without the client wishing to eat is paternalism.

48. The clinic nurse is caring for a client diagnosed with chronic pyelonephritis who is prescribed trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication? 1. The antibiotic will treat the bladder spasms that accompany a urinary tract infection. 2. If the urine cannot be made bacteria free, the Bactrim will suppress bacterial growth. 3. In three (3) months, the client should be rid of all bacteria in the urinary tract. 4. The HCP is providing the client with enough medication to treat future infections.

2. Some clients develop a chronic infection and must receive antibiotic therapy as a routine daily medication to suppress the bacterial growth. The prescription will be refilled after the 90 days and continued.

25. The nurse is preparing the discharge teaching plan for the male client with a left-sided nephrectomy. Which statement indicates the teaching is effective? 1. "I can't wait to start back to work next week, I really need the money." 2. "I will take my temperature and if it is above 101 I will call my doctor." 3. "I am glad I won't have to keep track of how much I urinate in the day." 4. "I am happy I will be able eat what I usually eat, I don't like this food."

2. The client or family needs to contact the surgeon if the client develops chills, flank pain, decreased urinary output, or fever.

17. The nurse is discussing how to prioritize care with the UAP. Which client should the nurse instruct the UAP to see first? 1. The immobile client who needs sequential compression devices removed. 2. The elderly woman who needs assistance ambulating to the bathroom. 3. The surgical client who needs help changing the gown after bathing. 4. The male client who needs the intravenous catheter discontinued.

2. The elderly woman may have age-related changes (decreased bladder capacity, weakened urinary sphincter, and shortened urethra) causing urinary urgency or incontinence. The elderly client is at risk for falling while attempting to get to the bathroom, so this client should be seen first.

64. Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin.

6. The nurse is preparing the plan of care for the client diagnosed with a neurogenic flaccid bladder. Which expected outcome is appropriate for this client? 1. The client has conscious control over bladder activity. 2. The client's bladder does not become overdistended. 3. The client has bladder sensation and no discomfort. 4. The client demonstrates how to check for bladder distention.

2. The treatment goal of the flaccid bladder is to prevent overdistention.

23. The nurse is preparing a teaching care plan for the client diagnosed with nephrotic syndrome. Which intervention should the nurse include? 1. Stop steroids if a moon face develops. 2. Provide teaching for taking diuretics. 3. Increase the intake of dietary sodium. 4. Report a decrease in daily weight.

2. Treatment includes diuretics to eliminate dependent edema, usually in the ankles and sacrum. Medication teaching is an appropriate intervention.

9. The nurse is caring for an elderly client who has an indwelling catheter. Which data warrant further investigation? 1. The client's temperature is 98.0˚F. 2. The client has become confused and irritable. 3. The client's urine is clear and light yellow. 4. The client feels the need to urinate.

2. When an elderly client's mental status changes to confused and irritable, the nurse should seek the etiology, which may be a UTI secondary to an indwelling catheter. Elderly clients often do not present with classic signs and symptoms of infection.

46. The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1. The client will have a blood pressure within normal limits. 2. The client will show no protein in the urine. 3. The client will maintain normal renal function. 4. The client will have clear lung sounds.

3. A long-term complication of glomerulonephritis is it can become chronic if unresponsive to treatment, and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal.

70. The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine.

3. A urinalysis can assess for hematuria, the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI.

74. Which modifiable risk factor should the nurse identify for the development of cancer of the bladder in a client? 1. Previous exposure to chemicals. 2. Pelvic radiation therapy. 3. Cigarette smoking. 4. Parasitic infections of the bladder.

3. Cigarette smoke contains more than 400 chemicals, 17 of which are known to cause cancer. The risk is directly proportional to the amount of smoking.

61. The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract.

47. The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? 1. The blood urea nitrogen is 15 mg/dL. 2. The creatinine level is 1.2 mg/dL. 3. The glomerular filtration rate is 40 mL/min. 4. The 24-hour creatinine clearance is 100 mL/min.

3. Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity.

67. The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP? 1. Monitor the amount, color, and consistency of urine output. 2. Teach the client about care of the indwelling Foley catheter. 3. Assist the client to the car when being discharged home. 4. Take the client's postprocedural vital signs.

3. The UAP could assist the client to the car once the discharge has been completed.

22. The nurse is caring for a client diagnosed with rule-out nephrotic syndrome. Which intervention should be included in the plan of care? 1. Monitor the urine for bright-red bleeding. 2. Evaluate the calorie count of the 500-mg protein diet. 3. Assess the client's sacrum for dependent edema. 4. Monitor for a high serum albumin level.

3. The classic sign/symptom of nephrotic syndrome is dependent edema located on the client's sacrum and ankles.

45. The nurse is discharging a client with a health-care facility acquired urinary tract infection. Which information should the nurse include in the discharge teaching? 1. Limit fluid intake so the urinary tract can heal. 2. Collect a routine urine specimen for culture. 3. Take all the antibiotics as prescribed. 4. Tell the client to void every five (5) to six (6) hours.

3. The client should be taught to take all the prescribed medication anytime a prescription is written for antibiotics.

10. The nurse is observing the UAP providing direct care to a client with an indwelling catheter. Which data warrant immediate intervention by the nurse? 1. The UAP secures the tubing to the client's leg with tape. 2. The UAP provides catheter care with the client's bath. 3. The UAP puts the collection bag on the client's bed. 4. The UAP cares for the catheter after washing the hands.

3. The drainage bag should be kept below the level of the bladder to prevent reflux of urine into the renal system; it should not be placed on the bed.

7. Which nursing intervention is most important before attempting to catheterize a client? 1. Determine the client's history of catheter use. 2. Evaluate the level of anxiety of the client. 3. Verify the client is not allergic to latex. 4. Assess the client's sensation level and ability to void.

3. The nurse should always assess for allergies to latex prior to inserting a latex catheter or using a drainage system because, if the client is allergic to latex, use of it could cause a life-threatening reaction.

4. Which intervention should the nurse implement first for the client who has had an incontinent episode? 1. Palpate the client's bladder to assess for urinary retention. 2. Obtain a bedside commode for the client. 3. Assist the client with changing the wet clothes. 4. Request the UAP to change the client's linens.

3. The nurse should first assist the client in getting out of the wet clothes prior to any other action. Wet clothes are embarrassing to the client and can lead to skin breakdown.

19. Which intervention should the nurse implement for the client who has had an ileal conduit? 1. Pouch the stoma with a one (1)-inch margin around the stoma. 2. Refer the client to the United Ostomy Association for discharge teaching. 3. Report to the health-care provider any decrease in urinary output. 4. Monitor the stoma for signs and symptoms of infection every shift.

3. The output should be monitored to detect a decreased amount indicating an obstruction from edema or ureteral stenosis. Any decrease should be reported to the health-care provider.

40. The nurse is examining a 15-year-old female who is complaining of pain, frequency, and urgency when urinating. After asking the parent to leave the room, which question should the nurse ask the client? 1. "When was your last menstrual cycle?" 2. "Have you noticed any change in the color of the urine?" 3. "Are you sexually active?" 4. "What have you taken for the pain?"

3. These are symptoms of cystitis, a bladder infection which may be caused by sexual intercourse as a result of the introduction of bacteria into the urethra during the physical act. A teenager may not want to divulge this information in front of the parent.

80. The client diagnosed with cancer of the bladder states, "I have young children. I am too young to die." Which statement is the nurse's best response? 1. "This cancer is treatable and you should not give up." 2. "Cancer occurs at any age. It is just one of those things." 3. "You are afraid of dying and what will happen to your children." 4. "Have you talked to your children about your dying?"

3. This is an example of restating, a therapeutic technique used to clarify the client's feelings and encourage a discussion of those feelings.

72. The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.

3. Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones.

37. The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first? 1. Start an IV with a 20-gauge catheter. 2. Initiate antibiotic therapy IVPB. 3. Collect a urine specimen for culture. 4. Change the indwelling catheter.

4. Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis.

73. The nurse is caring for clients on a renal surgery unit. After the afternoon report, which client should the nurse assess first? 1. The male client who just returned from a CT scan who states he left his glasses in the x-ray department. 2. The client who is one (1) day postoperative and has a moderate amount of serous drainage on the dressing. 3. The client who is scheduled for surgery in the morning and wants an explanation of the operative procedure before signing the permit. 4. The client who had ileal conduit surgery this morning and has not had any drainage in the drainage bag.

4. An ileal conduit is a procedure diverting urine from the bladder and provides an alternate cutaneous pathway for urine to exit the body. Urinary output should always be at least 30 mL/hr. This client should be assessed to make sure the stents placed in the ureters have not become dislodged or blocked.

43. The female client in an outpatient clinic is being sent home with a diagnosis of urinary tract infection (UTI). Which instruction should the nurse teach to prevent a recurrence of a UTI? 1. Clean the perineum from back to front after a bowel movement. 2. Take warm tub baths instead of hot showers daily. 3. Void immediately preceding sexual intercourse. 4. Avoid coffee, tea, colas, and alcoholic beverages.

4. Coffee, tea, cola, and alcoholic beverages are urinary tract irritants.

78. The nurse and a licensed practical nurse (LPN) are caring for a group of clients. Which intervention should be assigned to the LPN? 1. Assessment of the client who has had a Kock pouch procedure. 2. Monitoring of the postop client with a WBC of 22,000/mm3. 3. Administration of the prescribed antineoplastic medications. 4. Care for the client going for an MRI of the kidneys.

4. It is in the scope of practice for the LPN to care for this client.

63. The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shellfish or iodine. 2. Keep the client NPO eight (8) hours prior to the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.

4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied which produces sound waves, resulting in a picture.

66. The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Alteration in comfort.

4. Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin.

83. The client is two (2) days post-ureterosigmoidostomy for cancer of the bladder. Which assessment data warrant notification of the HCP by the nurse? 1. The client complains of pain at a "3," 30 minutes after being medicated. 2. The client complains it hurts to cough and deep breathe. 3. The client ambulates to the end of the hall and back before lunch. 4. The client is lying in a fetal position and has a rigid abdomen.

4. The client is drawn up in a position which relieves pressure off the abdomen; a rigid abdomen is an indicator of peritonitis, a medical emergency.

12. The client is 12 hours postoperative renal surgery. Which data warrant immediate intervention by the nurse? 1. The abdomen is soft, nontender, and rounded. 2. Pain is not felt with dorsal flexion of the foot. 3. The urine output is 60 mL for the past two (2) hours. 4. The client's trough vancomycin level is 24 mcg/mL.

4. The client who has restricted kidney function from surgery should be monitored for damage as a result of the use of aminoglycoside antibiotics, such as vancomycin, which are nephrotoxic. This level is high and warrants notifying the HCP.

14. The nurse is assessing a client diagnosed with urethral strictures. Which data support the diagnosis? 1. Complaints of frequency and urgency. 2. Clear yellow drainage from the urethra. 3. Complaints of burning during urination. 4. A diminished force and stream during voiding.

4. The client with urethral strictures will report a decrease in force and stream during voiding. The stricture is treated by dilation using small filiform bougies.

11. Which intervention should the nurse implement when caring for the client with a nephrostomy tube? 1. Change the dressing only if soiled by urine. 2. Clean the end of the connecting tubing with Betadine. 3. Clean the drainage system every day with bleach and water. 4. Assess the tube for kinks to prevent obstruction.

4. The nephrostomy tube should never be clamped or have kinks because an obstruction can cause pyelonephritis.

71. The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000/mm3.

4. The white blood cell count is elevated; normal is 5,000 to 10,000/mm3.

5. The elderly client recovering from a prostatectomy has been experiencing stress incontinence. Which independent nursing intervention should the nurse discuss with the client? 1. Establish a set voiding frequency of every two (2) hours while awake. 2. Encourage a family member to assist the client to the bathroom to void. 3. Apply a transurethral electrical stimulator to relieve symptoms of urinary urgency. 4. Discuss the use of a "bladder drill," including a timed voiding schedule.

4. Use of the bladder training drill is helpful in stress incontinence. The client is instructed to void at scheduled intervals. After consistently being dry, the interval is increased by 15 minutes until the client reaches an acceptable interval.

4. A risk factor for developing a lower UTI is: A. frequent urination. B. elevated potassium level. C. urinary catheterization. D. ingestion of a large amount of caffeine.

C. The presence of an indwelling urinary catheter is a risk factor for developing a lower UTI because the catheter provides a pathway for bacteria to enter the bladder.

5. Which of the following factors can contribute to the formation of renal calculi? A. Hypocalcemia B. Heart failure C. Hypothyroidism D. Changes in urine pH

D. Urine that's consistently acidic or alkaline provides a favorable medium for calculus formation.

38. The nurse is inserting an indwelling catheter into a female client. Which interventions should be implemented? Rank in the order of performance. 1. Explain the procedure to the client. 2. Set up the sterile field. 3. Inflate the catheter bulb. 4. Place absorbent pads under the client. 5. Clean the perineum from clean to dirty with Betadine.

In order of performance: 1, 4, 2, 3, 5. 1. The procedure should be explained to the client. 4. Incontinence pads should be placed under the client before beginning the sterile part of the procedure. 2. The sterile field must be set up prior to checking the bulb and cleaning the client's perineum. 3. The bulb of the catheter should be tested to make sure it will inflate and deflate prior to inserting the catheter into the client. 5. During the procedure, the perineum is swiped with Betadine swabs from front to back and also down the middle, then side to side with new swabs (clean to dirty).

2. You are caring for a patient with a urinary tract infection. You would expect the plan of care to include: (a) antibiotics and phenazopyridine. (b) erythropoetin and stent placement. (c) hormonal therapy and intravenous fluids. (d) hourly urine output measurements and antibiotics.

a

5. Care of the postoperative nephrectomy patient includes: (a) assessing the wound site for redness, swelling, or drainage. (b) giving diuretics to enhance urinary output. (c) monitoring urinary output every 2 hours. (d) encouraging intake of cranberry juice to acidify the urine.

a

1. Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI b. Lower UTI c. Complicated UTI d. Uncomplicated UTI

a. An upper urinary tract infection (UTI) affects the renal parenchyma, renal pelvis, and ureters. A lower UTI is an infection of the bladder and/or urethra. A complicated UTI exists in the presence of obstruction, stones, or preexisting diseases. An uncomplicated UTI occurs in an otherwise normal urinary tract.

27. When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer? a. Smoking b. Family history of cancer c. Chronic use of phenacetin d. Chronic, recurrent nephrolithiasis

a. Both cancer of the kidney and cancer of the bladder are associated with smoking. A family history of renal cancer is a risk factor for kidney cancer and cancer of the bladder has been associated with the use of phenacetin-containing analgesics and recurrent upper UTIs.

20. Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective gastrointestinal (GI) and kidney absorption

a. Calcium phosphate calculi are typically mixed with struvite or oxalate stones and related to alkaline urine. Cystine calculi are associated with a genetic autosomal recessive defect and defective GI and kidney absorption of cystine. Struvite calculi are three to four times more common in women than in men.

12. The nurse plans care for the patient with APSGN based on what knowledge? a. Most patients with APSGN recover completely or rapidly improve with conservative management. b. Chronic glomerulonephritis leading to renal failure is a common sequela to acute glomerulonephritis. c. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane. d. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis, resulting in kidney failure.

a. Most patients recover completely from acute poststreptococcal glomerulonephritis (APSGN) with supportive treatment. Chronic glomerulonephritis that progresses insidiously over years and rapidly progressive glomerulonephritis that results in renal failure within weeks or months occur in only a few patients with APSGN. In Goodpasture syndrome, antibodies are present against both the GBM and the alveolar basement membrane of the lungs and dysfunction of both renal and pulmonary are present.

30. The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing? a. Reflex incontinence b. Overflow incontinence c. Functional incontinence d. Incontinence after trauma

a. Reflex incontinence occurs with no warning, equally during the day and night, and with spinal cord lesions above S2. Overflow incontinence is when the pressure of urine in the overfull bladder overcomes sphincter control and is caused by bladder or urethral outlet obstruction. Functional incontinence is loss of urine resulting from cognitive, functional, or environmental factors. Incontinence after trauma or surgery occurs when fistulas have occurred or after a prostatectomy.

6. Which characteristic is more likely with acute pyelonephritis than with a lower UTI? a. Fever b. Dysuria c. Urgency d. Frequency

a. Systemic manifestations of fever and chills with leukocytosis and nausea and vomiting are more common in pyelonephritis than in a lower UTI. Dysuria, frequency, and urgency can be present with both.

36. Which urinary diversion is a continent diversion created by formation of an ileal pouch with a stoma for catheterization? a. Kock pouch b. Ileal conduit c. Orthotopic neobladder d. Cutaneous ureterostomy

a. The Kock pouch is a continent diversion created by formation of an ileal pouch with an external stoma requiring catheterization. Ileal conduit is the most common incontinent diversion using a stoma of resected ileum with implanted ureters. Orthotopic neobladder is a new bladder from a reshaped segment of intestine in the anatomic position of the bladder with urine discharged through the urethra. A cutaneous ureterostomy diverts the ureter from the bladder to the abdominal skin but there is frequent scarring and strictures of the ureters, so ileal conduits are used more often.

14. Number in sequence the following ascending pathologic changes that occur in the urinary tract in the presence of a bladder outlet obstruction. a. Hydronephrosis b. Reflux of urine into ureter c. Bladder detrusor muscle hypertrophy d. Ureteral dilation e. Renal atrophy f. Vesicoureteral reflux g. Large residual urine in bladder h. Chronic pyelonephritis

a. 6; b. 3; c. 1; d. 4; e. 8; f. 5; g. 2; h. 7

1. Patients with nephrolithiasis or kidney stones need to increase fluid intake. This is to: (a) concentrate the urine. (b) help flush the stones through the urinary tract. (c) crystallize the struvite from the renal tubules. (d) break down the stones into smaller pieces that will more easily pass through the urinary tract.

b

19. The male patient is Jewish, has a history of gout, and has been diagnosed with renal calculi. Which treatment will be used with this patient (select all that apply)? a. Reduce dietary oxalate b. Administer allopurinol c. Administer α-penicillamine d. Administer thiazide diuretics e. Reduce animal protein intake f. Reduce intake of milk products

b, e. This patient is most likely to have uric acid calculi, which have a high incidence in Jewish men, and gout is a predisposing factor. The treatment will include allopurinol and reducing animal protein intake to reduce purine, as uric acid is a waste product from purine metabolism. Reducing oxalate and using thiazide diuretics help to treat calcium oxalate calculi. Administration of α-penicillamine and tiopronin prevent cystine crystallization for cystine calculi. Reducing intake of milk products to reduce calcium intake may be used with calcium calculi.

23. Priority Decision: Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria. b. Encourage fluid intake of 3 L/day. c. Apply moist heat to the flank area. d. Strain all urine through gauze or a special strainer.

b. A high fluid intake maintains dilute urine, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals. Moist heat to the flank may be helpful to relieve muscle spasms during renal colic and all urine should be strained in patients with renal stones to collect and identify stone composition but these are not related to infection.

35. During assessment of the patient who has a nephrectomy, what should the nurse expect to find? a. Shallow, slow respirations b. Clear breath sounds in all lung fields c. Decreased breath sounds in the lower left lobe d. Decreased breath sounds in the right and left lower lobes

b. A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breathe deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.

25. In providing care for the patient with adult-onset polycystic kidney disease, what should the nurse do? a. Help the patient to cope with the rapid progression of the disease b. Suggest genetic counseling resources for the children of the patient c. Expect the patient to have polyuria and poor concentration ability of the kidneys d. Implement measures for the patient's deafness and blindness in addition to the renal problems

b. Adult-onset polycystic kidney disease is an inherited autosomal dominant disorder that often manifests after the patient has children but the children should receive genetic counseling regarding their life choices. The disease progresses slowly, eventually causing progressive renal failure. Hereditary medullary cystic disease causes poor concentration ability of the kidneys and classic Alport syndrome is a hereditary nephritis that is associated with deafness and deformities of the optic lens.

38. A teaching plan developed by the nurse for the patient with a new ileal conduit includes instructions to do what? a. Clean the skin around the stoma with alcohol every day. b. Use a wick to keep the skin dry during appliance changes. c. Use sterile supplies and technique during care of the stoma. d. Change the appliance every day and wash it with soap and warm water.

b. Because the stoma continuously drains urine, a wick formed of a rolled-up 4 × 4 gauze or a tampon is held against the stoma to absorb the urine while the skin is cleaned and a new appliance is attached. The skin is cleaned with warm water only because soap and other agents cause drying and irritation and clean, not sterile, technique is used. The appliance should be left in place for as long as possible before it loosens and allows leakage onto the skin, perhaps up to 14 days.

34. A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, what is an appropriate nursing action? a. Milk or strip the catheter every 2 hours. b. Measure ureteral urinary drainage every 1 to 2 hours. c. Irrigate the catheter with 30-mL sterile saline every 4 hours. d. Encourage ambulation to promote urinary peristaltic action.

b. Output from ureteral catheters must be monitored every 1 to 2 hours because an obstruction will cause overdistention of the renal pelvis and renal damage. The renal pelvis has a capacity of only 3 to 5 mL and if irrigation is ordered, no more than 5 mL of sterile saline is used. The patient with a ureteral catheter is usually kept on bed rest until specific orders for ambulation are given. Suprapubic tubes may be milked to prevent obstruction of the catheter by sediment and clots.

18. The female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone? a. Cystine b. Struvite c. Uric acid d. Calcium phosphate

b. Struvite calculi are most common in women and always occur with UTIs. They are also usually large staghorn type.

4. A female patient with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding prevention of recurrence. What should the nurse include in the teaching plan instructions for this patient? a. Empty the bladder at least 4 times a day. b. Drink at least 2 quarts of water every day. c. Wait to urinate until the urge is very intense. d. Clean the urinary meatus with an antiinfective agent after voiding.

b. The bladder should be emptied at least every 3 to 4 hours. Fluid intake should be increased to about 2000 mL/day without caffeine, alcohol, citrus juices, and chocolate drinks, because they are potential bladder irritants. Cleaning the urinary meatus with an antiinfective agent after voiding will irritate the meatus but the perineal area should be wiped from front to back after urination and defecation to prevent fecal contamination of the meatus.

15. Which infection is asymptomatic in the male patient at first and then progresses to cystitis, frequent urination, burning on voiding, and epididymitis? a. Urosepsis b. Renal tuberculosis c. Urethral diverticula d. Goodpasture syndrome

b. The manifestations of renal tuberculosis are described. Urosepsis is when the UTI has spread systemically. Urethral diverticula are localized outpouching of the urethra and occur more often in women. Goodpasture syndrome manifests with flu-like symptoms with pulmonary symptoms that include cough, shortness of breath, and pulmonary insufficiency and renal manifestations that include hematuria, weakness, pallor, anemia, and renal failure.

24. With which diagnosis will the patient benefit from being taught to do self-catheterization? a. Renal trauma b. Urethral stricture c. Renal artery stenosis d. Accelerated nephrosclerosis

b. The patient with urethral stricture will benefit from being taught to dilate the urethra by self-catheterization every few days. Renal trauma is treated related to the severity of the injury with bed rest, fluids, and analgesia. Renal artery stenosis includes control of hypertension with possible surgical revascularization. Accelerated nephrosclerosis is associated with malignant hypertension that must be aggressively treated as well as monitoring kidney function.

3. Patients with bladder cancer typically exhibit symptoms of: (a) weight loss and low back pain. (b) fatigue and anemia. (c) hematuria and change in urinary pattern. (d) difficulty initiating urinary stream and nocturia.

c

4. Teach a patient at risk for testicular cancer to: (a) restrict potassium, phosphate, sodium, and protein in diet. (b) self-catheterize ileal reservoir. (c) perform testicular self-exam. (d) monitor change in color of urine.

c

6. You are caring for a patient who has had a transurethral resection of the prostate for benign prostatic hypertrophy. There is a continuous bladder irrigation set up. You would notify the physician if you noted: (a) any signs of hematuria. (b) a decrease in the amount of blood in the urine. (c) a change from clear red output to thicker, bright red output. (d) the development of uremic pruritis.

c

31. Which drugs are used to treat overflow incontinence (select all that apply)? a. Baclofen (Lioresal) b. Anticholinergic drugs c. α-Adrenergic blockers d. 5α-reductase inhibitors e. Bethanechol (Urecholine)

c, d, e. α-Adrenergic blockers block the stimulation of the smooth muscle of the bladder, 5α-reductase inhibitors decrease outlet resistance, and bethanechol enhances bladder contractions. Baclofen or diazepam is used to relax the external sphincter for reflex incontinence. Anticholinergics are used to relax bladder tone and increase sphincter tone with urge incontinence.

21. On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report? a. A history of chronic UTIs b. Dull, costovertebral flank pain c. Severe, colicky back pain radiating to the groin d. A feeling of bladder fullness with urgency and frequency

c. A classic sign of the passage of a calculus down the ureter is intense, colicky back pain that may radiate into the testicles, labia, or groin and may be accompanied by mild shock with cool, moist skin. Many patients with renal stones do not have a history of chronic UTIs. Stones obstructing a calyx or at the ureteropelvic junction may produce dull costovertebral flank pain and large bladder stones may cause bladder fullness and lower obstructive symptoms.

33. What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients? a. Measuring urine output every 1 to 2 hours to ensure patency b. Turning the patient frequently from side to side to promote drainage c. Using strict sterile technique during irrigation and obtaining culture specimens d. Daily cleaning of the catheter insertion site with soap and water and application of lotion

c. All urinary catheters in hospitalized patients pose a very high risk for infection, especially antibiotic-resistant, health care-associated infections, and scrupulous aseptic technique is essential in the insertion and maintenance of all catheters. Routine irrigations are not performed. Turning the patient to promote drainage is recommended only for suprapubic catheters. Cleaning the insertion site with soap and water should be performed for urethral and suprapubic catheters but lotion or powder should be avoided and site care for other catheters may require special interventions.

5. What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract? a. The kidney is scarred and fibrotic. b. The organism is resistant to antibiotics. c. There is a preexisting abnormality of the urinary tract. d. The patient does not take all of the antibiotics for treatment of a UTI.

c. Ascending infections from the bladder to the kidney are prevented by the normal anatomy and physiology of the urinary tract unless a preexisting condition, such as vesicoureteral reflux or lower urinary tract dysfunction (bladder tumors, prostatic hyperplasia, strictures, or stones), is present. Resistance to antibiotics and failure to take a full prescription of antibiotics for a UTI usually result in relapse or reinfection of the lower urinary tract.

16. What can patients at risk for renal lithiasis do to prevent the stones in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

c. Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is by drinking adequate fluids to keep the urine dilute and flowing (e.g., an output of about 2 L of urine a day). Sedentary lifestyle is a risk factor for renal stones but exercise also causes fluid loss and a need for additional fluids. Protein foods high in purine should be restricted only for the small percentage of patients with uric acid stones and although UTIs contribute to stone formation, prophylactic antibiotics are not indicated.

17. Which type of urinary tract calculi are the most common and frequently obstruct the ureter? a. Cystine b. Uric acid c. Calcium oxalate d. Calcium phosphate

c. Calcium oxalate calculi are most common and small enough to get trapped in the ureter.

10. Glomerulonephritis is characterized by glomerular damage caused by a. growth of microorganisms in the glomeruli. b. release of bacterial substances toxic to the glomeruli. c. accumulation of immune complexes in the glomeruli. d. hemolysis of red blood cells circulating in the glomeruli.

c. Glomerulonephritis is not an infection but rather an antibody-induced injury to the glomerulus, where either autoantibodies against the glomerular basement membrane (GBM) directly damage the tissue or antibodies reacting with nonglomerular antigens are randomly deposited as immune complexes along the GBM. Prior infection by bacteria or viruses may stimulate the antibody production but is not present or active at the time of glomerular damage.

32. To assist the patient with stress incontinence, what is the best thing the nurse should teach the patient to do? a. Void every 2 hours to prevent leakage. b. Use absorptive perineal pads to contain urine. c. Perform pelvic floor muscle exercises 40 to 50 times per day. d. Increase intraabdominal pressure during voiding to empty the bladder completely.

c. Pelvic floor exercises (Kegel exercises) increase the tone of the urethral sphincters and should be done in sets of 10 or more contractions four to five times a day (total of 40 to 50 per day). Frequent bladder emptying is recommended for patients with urge incontinence and an increase in pressure on the bladder is recommended for patients with overflow incontinence. Absorptive perineal pads should be only a temporary measure because long term use discourages continence and can lead to skin problems.

13. What results in the edema associated with nephrotic syndrome? a. Hypercoagulability b. Hyperalbuminemia c. Decreased plasma oncotic pressure d. Decreased glomerular filtration rate

c. The massive proteinuria that results from increased glomerular membrane permeability in nephrotic syndrome leaves the blood without adequate proteins (hypoalbuminemia) to create an oncotic colloidal pressure to hold fluid in the vessels. Without oncotic pressure, fluid moves into the interstitium, causing severe edema. Hypercoagulability occurs in nephrotic syndrome but is not a factor in edema formation and glomerular filtration rate (GFR) is not necessarily affected in nephrotic syndrome.

2. While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient most likely to experience? a. Cloudy urine and fever b. Urethral burning and bloody urine c. Vague abdominal discomfort and disorientation d. Suprapubic pain and slight decline in body temperature

c. The usual classic manifestations of UTI are often absent in older adults, who tend to experience nonlocalized abdominal discomfort and cognitive impairment characterized by confusion or decreased level of consciousness rather than dysuria and suprapubic pain.

28. Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur? a. The only treatment modalities for the disease are palliative. b. Diagnostic tests are not available to detect tumors before they metastasize. c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced. d. Early metastasis to the brain impairs the patient's ability to recognize the seriousness of symptoms.

c. There are no early characteristic symptoms of cancer of the kidney and gross hematuria, flank pain, and a palpable mass do not occur until the disease is advanced. The treatment of choice is a partial or radical nephrectomy, which can be successful in early disease. Many kidney cancers are diagnosed as incidental imaging findings. Targeted therapy is the preferred treatment for metastatic kidney cancer. Radiation is palliative. The most common sites of metastases are the lungs, liver, and long bones.

3. A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity b. No treatment with medication unless she develops fever, chills, and flank pain c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests

c. Unless a patient has a history of recurrent UTIs or a complicated UTI, trimethoprim-sulfamethoxazole (TMPSMX) or nitrofurantoin (Macrodantin) is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment but symptomatic UTIs should always be treated.

7. One of your patients is awaiting lab results for kidney function. The patient has recently recovered from a streptococcal throat infection. The patient has most likely developed symptoms of: (a) pyelonephritis. (b) nephrolithiasis. (c) chronic renal failure. (d) glomerulonephritis.

d

8. Symptoms of prostate cancer include: (a) nocturia and intermittent stream of urination. (b) diminished force of urinary stream and urgency. (c) difficulty initiating stream of urine and frequency. (d) all of the above.

d

29. Which characteristics are associated with urge incontinence (select all that apply)? a. Treated with Kegel exercises b. Found following prostatectomy c. Common in postmenopausal women d. Involuntary urination preceded by urgency e. Caused by overactivity of the detrusor muscle f. Bladder contracts by reflex, overriding central inhibition

d, e, f. Urge incontinence is involuntary urination preceded by urgency caused by overactivity of the detrusor muscle when the bladder contracts by reflex, which overrides central inhibition. Treatment includes treating the underlying cause and retraining the bladder with urge suppression, anticholinergic drugs, or containment devices. The other options are characteristic of stress incontinence. Patients may have a combination of urge and stress incontinence.

7. Which test is required for a diagnosis of pyelonephritis? a. Renal biopsy b. Blood culture c. Intravenous pyelogram (IVP) d. Urine for culture and sensitivity

d. A urine specimen specifically obtained for culture and sensitivity is required to diagnose pyelonephritis because it will show pyuria, the specific bacteriuria, and what drug the bacteria is sensitive to for treatment. The renal biopsy is used to diagnose chronic pyelonephritis or cancer. Blood cultures would be done if bacteremia is suspected. Intravenous pyelogram (IVP) would increase renal irritation, but CT urograms may be used to assess for signs of infection in the kidney and complications of pyelonephritis.

11. What manifestation in the patient will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)? a. Hematuria b. Proteinuria c. Hypertension d. Elevated blood urea nitrogen (BUN)

d. An elevated blood urea nitrogen (BUN) indicates that the kidneys are not clearing nitrogenous wastes from the blood and protein may be restricted until the kidney recovers. Proteinuria indicates loss of protein from the blood and possibly a need for increased protein intake. Hypertension is treated with sodium and fluid restriction, diuretics, and antihypertensive drugs. The hematuria is not specifically treated.

9. When caring for the patient with interstitial cystitis, what can the nurse teach the patient to do? a. Avoid foods that make the urine more alkaline. b. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder. c. Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia. d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.

d. Calcium glycerophosphate (Prelief) alkalinizes the urine and can help to relieve the irritation from acidic foods. A diet low in acidic foods is recommended and if a multivitamin is used, high-potency vitamins should be avoided because these products may irritate the bladder. A voiding diary is useful in diagnosis but does not need to be kept indefinitely.

22. Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks? a. Milk and milk products b. Dried beans and dried fruits c. Liver, kidney, and sweetbreads d. Spinach, cabbage, and tomatoes

d. Oxalate-rich foods should be limited to reduce oxalate excretion. Foods high in oxalate include spinach, rhubarb, asparagus, cabbage, and tomatoes, in addition to chocolate, coffee, and cocoa. Currently, it is believed that high dietary calcium intake may actually lower the risk for renal stones by reducing the intestinal oxalate absorption and therefore the urinary excretion of oxalate. Milk, milk products, dried beans, and dried fruits are high sources of calcium. Organ meats are high in purine, which contributes to uric acid lithiasis.

26. Which disease causes connective tissue changes that cause glomerulonephritis? a. Gout b. Amyloidosis c. Diabetes mellitus d. Systemic lupus erythematosus

d. Systemic lupus erythematosus causes connective tissue damage that affects the glomerulus. Gout deposits uric acid crystals in the kidney. Amyloidosis deposits hyaline bodies in the kidney. Diabetes mellitus causes microvascular damage affecting the kidney.

8. A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis? a. Residual urine greater than 200 mL b. A large, atonic bladder on urodynamic testing c. A voiding pattern that indicates psychogenic urinary retention d. Pain with bladder filling that is transiently relieved by urination

d. The symptoms of interstitial cystitis (IC) imitate those of an infection of the bladder but the urine is free of infectious agents. Unlike a bladder infection, the pain with IC increases as urine collects in the bladder and is temporarily relieved by urination. Acidic urine is very irritating to the bladder in IC and the bladder is small but urinary retention is not common.

37. A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, what should the nurse plan to do? a. Measure and fit the stoma for a permanent appliance. b. Encourage high oral intake to flush mucus from the conduit. c. Teach the patient to self-catheterize the stoma every 4 to 6 hours. d. Empty the drainage bag every 2 to 3 hours and measure the urinary output.

d. Urine drains continuously from an ileal conduit and the drainage bag must be emptied every 2 to 3 hours and measured to ensure adequate urinary output. Fitting for a permanent appliance is not done until the stoma shrinks to its normal size in a few weeks. With an ileal conduit, mucus is present in the urine because it is secreted by the ileal segment as a result of the irritating effect of the urine but the surgery causes paralytic ileus and the patient will be NPO for several days postoperatively. Self-catheterization is performed when patients have formation of a continent Kock pouch.

39. Delegation Decision: Which nursing interventions could be delegated to unlicensed assistive personnel (UAP) (select all that apply)? a. Assess the need for catheterization. b. Use bladder scanner to estimate residual urine. c. Teach patient pelvic floor muscle (Kegel) exercises. d. Insert indwelling catheter for uncomplicated patient. e. Assist incontinent patient to commode at regular intervals. f. Provide perineal care with soap and water around a urinary catheter.

e, f. The unlicensed assistive personnel (UAP) may assist the incontinent patient to void at regular intervals and provide perineal care. An RN should perform the assessments and teaching. In long-term care and rehabilitation facilities, UAP may use bladder scanners after they are trained.