Med Surg Chapter 45
Treatment for a patient diagnosed with rapidly progressive glomerulonephritis is directed towards which outcome? 1 Correction of fluid overload 2 Correction of hypotension 3 Correction of anemia and blood loss 4 Administration of parenteral antibiotics
Correct 1 With progressive renal failure, there is an increase in fluid retention. The patient will exhibit hypertension as a result of kidney damage. Patients will have anemia, but there will be no identification of acute blood loss, and this is not a priority in treatment at this point for this patient. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.
To reduce the risk of urinary tract infections (UTI), the nurse recommends that the patient increases the intake of what? 1 Nuts 2 Caffeine 3 Citrus juice 4 Cranberry juice
Correct 4 Daily intake of cranberry juice or cranberry supplements may reduce the number of urinary tract infections. Nuts, caffeine, and citrus juice should be avoided because they are potential bladder irritants that may cause urinary tract infections.
When teaching about home care to the caregiver of a patient with a history of urinary calculi and limited mobility, what instructions should the nurse provide? Select all that apply. 1 Monitor urinary output. 2 Maintain a fluid intake of 3 L/day. 3 Help the patient to sit, if possible. 4 Include purine-rich foods in the diet. 5 Change the patient's position every two hours.
Correct 1,3,5 Patients on bed rest should be turned every two hours or made to sit up with help to maximize urinary flow. Monitoring of urine output is necessary to determine whether the kidneys are functioning well. Adequate fluid intake is important to produce a urine output of approximately 2 L/day. People who are sedentary or less active should take less fluid accordingly. Therefore a fluid intake of 3 L/day is not advised. Purines yield uric acid when broken down; therefore purine-rich foods should be avoided.
A patient experiences fever, chills, flank pain, and costovertebral tenderness to percussion. The nurse recognizes that the clinical manifestations are associated with a particular renal problem and identifies risk factors for the condition. What is a patient risk factor that the nurse would identify? 1 Bacterial infection in one or more of the heart valves 2 High fluid intake that increases urinary concentration 3 An autoimmune disease that affects small and large vessels 4 Pregnancy-induced physiologic changes in the urinary system
Correct 4 Fever, chills, flank pain, and costovertebral tenderness to percussion are clinical manifestations of acute pyelonephritis. Pregnancy-induced physiologic changes in the urinary system are a risk factor for acute pyelonephritis. Bacterial infection in one or more valves indicates infective endocarditis, which is a risk factor for glomerulonephritis. High intake of fluid increases the urinary concentration and does not contribute to renal calculi. Autoimmune disease that affects the small and large vessels indicates vasculitis; it is a risk factor for glomerulonephritis.
A patient diagnosed with interstitial cystitis reports continuing severe and debilitating suprapubic pain, hesitancy, and incontinence. Because other measures to relieve the pain have been unsuccessful, the nurse anticipates that the plan of care will include what procedure? 1 Lithotripsy 2 Marsupialization 3 Transurethral incision 4 Ileal conduit diversion
Correct 4 Severe suprapubic pain, hesitancy, and incontinence are symptoms of a painful inflammatory disease called interstitial cystitis. Ileal conduit surgical urinary diversion is used for severe debilitating pain in patients with interstitial cystitis when other measures are not successful in relieving pain. Lithotripsy is a procedure used for eliminating calculi from the urinary tract. Marsupialization is used for the creation of a permanent opening of the diverticular sac into the vagina. Transurethral incision of the diverticular neck is performed in patients with urinary diverticula.
A patient is admitted with urethral diverticula. Which of the following clinical manifestations would the nurse expect to document? Select all that apply. 1 Fever 2 Gross hematuria 3 Clear, yellow urine 4 Post-void dribbling 5 Urinary incontinence
Correct 2,4,5 Post-void dribbling, urinary incontinence, and gross hematuria are classic symptoms for urethral diverticula. Fever is a symptom of pyelonephritis, not urethral diverticula. The patient would have cloudy urine, not clear, yellow urine.
Escherichia coli is resistant to what medications? Select all that apply. 1 Fosfomycin 2 Ciprofloxacin 3 Amphotericin 4 Trimethoprim 5 Sulfamethoxazole
Correct 4 E. coli is resistant to trimethoprim and sulfamethoxazole. These are used in combination to treat uncomplicated or initial urinary tract infection (UTI). Fosfomycin is a first-choice drug used to treat uncomplicated or initial UTIs. Ciprofloxacin is a fluoroquinolone derivative that is used to treat complicated UTIs. Amphotericin is the preferred therapy in patients with UTI secondary to fungi.
Which nursing intervention is beneficial to the patient who presents with renal trauma caused by a sports injury? 1 Restricting dietary salt 2 Maintaining fluid restriction 3 Performing a follow-up urine culture 4 Assessing the cardiovascular status and monitoring for shock
Correct 4 Assessing the cardiovascular status will determine any perturbations in the heart. Monitoring for shock is important in patients with renal trauma because it prevents any unwanted renal or extrarenal side effects. Restricting dietary salt is an important intervention in managing edema in patients with nephrotic syndrome. Maintaining fluid restriction is useful in patients with polycystic kidney disease. Performing a follow-up urine culture is important in patients with acute pyelonephritis. All these interventions are secondary in managing renal trauma caused by a sports injury.
A patient tells the nurse, "I involuntarily pass urine while coughing, laughing, and sneezing." The medical history of the patient reveals that the patient has undergone prostate cancer surgery. Which treatment does the nurse expect to be beneficial in the patient? 1 Reductase inhibitors 2 Vaginal estrogen creams 3 Urinary diversion surgery 4 Pelvic floor muscle exercises
Correct 4 The involuntary passage of urine while coughing, laughing, and sneezing indicates stress incontinence. These issues may occur due to prostate surgery for benign prostate hyperplasia, or prostate cancer; atrophy of the structures of the female urethra; and relaxed pelvic floor musculature. Pelvic floor muscles relax after prostate surgery. Pelvic floor muscle exercises such as Kegel exercises help to strengthen the pelvic muscles. Reductase inhibitors decrease the outlet resistance in overflow incontinence. Vaginal estrogen creams are used to treat females with urge incontinence. Urinary diversion surgery is performed to bypass the urethra and cure bladder incontinence after trauma or surgery in males and females.
A patient has been admitted to the hospital with suprapubic pain and dysuria. A urine analysis and culture have been prescribed. What instructions should the nurse include to obtain the best urine sample? 1 Collect the urine midstream. 2 Collect urine immediately after a meal. 3 Collect the urine after drinking 1 liter of water. 4 Use antiseptic to clean the periurethral area before collecting sample.
Correct 1 A clean-catch, or midstream, sample should be collected to prevent contamination of urine with bacteria present in the vagina or penis. The periurethral area should be cleaned, but the use of antiseptic should be avoided, because it can contaminate the sample and provide a false positive. A sample should not be collected directly after a meal or after drinking a liter of water, because food and water can affect the normal chemical composition of a patient's urine. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing on the NCLEX examination, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point.
A patient complains of accidental loss of urine, urgency, and increased the frequency of urination at night. On clinical examination, the primary health care provider infers the condition is due to overactivity of the detrusor muscle. Based on these data, which treatment does the nurse anticipate for this patient? 1 Containment devices 2 Surgical sphincterotomy 3 Intermittent catheterization 4 Bladder neck support devices
Correct 1 Accidental loss of urine, urgency, and increased frequency of urination at night are experienced by patients with urge incontinence; this is due to overactivity of the detrusor muscle. This condition can be treated by using containment devices. Surgical sphincterotomy is used in the treatment of reflex incontinence. Intermittent catheterization is performed for treating the overflow incontinence. Bladder neck support devices are used in the treatment of stress incontinence. Test-Taking Tip: Read the question carefully before looking at the answers. Pay attention to the symptoms and the abnormal condition of the patient to answer correctly.
The patient who is two days postoperative ileal conduit loop informs the nurse that there is mucus in the urine. Which is the correct response by the nurse? 1 "This is a normal occurrence." 2 "We will need to catheterize your stoma to remove the mucus." 3 "Let me call the health care provider to check on the outflow of your stoma." 4 "This is because of your lack of fluid intake; you will need to increase your fluids."
Correct 1 Mucus is a normal production of the intestinal liner. This will not cause any disruption in flow of the urine. Mucus in the urine is not caused by a decrease in fluid intake. It is not necessary for the health care provider to assess the stoma, because this is a normal finding. Catheterizing the stoma will not remove the mucus. STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms.
A patient is diagnosed with calcium oxalate urinary tract calculi. What actions should the nurse perform to manage this patient? Select all that apply. 1 Give calcium lactate. 2 Reduce sodium intake. 3 Reduce dietary oxalate. 4 Reduce dietary purines. 5 Give α-penicillamine and tiopronin.
Correct 1,2,3 Give calcium lactate, because it helps to precipitate oxalate in the gastrointestinal tract. Reduce daily sodium intake, because sodium can cause fluid retention and reduce the outflow of urine. Reduce dietary oxalate, because the urinary calculi diagnosed are calcium oxalate. A reduction in dietary purines is advised in cases of uric acid calculi. Give α-penicillamine and tiopronin in the case of cystine stones, which are caused by a rare hereditary defect resulting in an inborn error of cystine metabolism.
A patient is diagnosed with an early urinary tract infection (UTI). When planning for trimethoprim/sulfamethoxazole treatment for this patient, which factors does the nurse evaluate? Select all that apply. 1 This drug is relatively inexpensive. 2 This drug can be taken twice daily. 3 E. coli is resistant to this medication. 4 The treatment is given 3 to 4 times a day. 5 The patient should avoid sunlight when taking this medication.
Correct 1,2,3 The first line of treatment to empirically treat initial UTIs includes trimethoprim/sulfamethoxazole. E. coli resistance to this drug is an increasing problem and is a major disadvantage of this drug. Trimethoprim/sulfamethoxazole treatment is relatively inexpensive compared to other drugs. This drug can be taken twice daily. Nitrofurantoin (Macrodantin) is normally given three or four times daily. Patients should avoid sunlight, use sunscreen, and wear protective clothing while taking nitrofurantoin, but this is not required while taking trimethoprim/sulfamethoxazole.
An obese female patient is diagnosed with stress incontinence. What instructions should the nurse include when teaching self-care to this patient? Select all that apply. 1 Use urethral inserts. 2 Reduce excess weight. 3 Practice Kegel exercises. 4 Start oxybutynin treatment. 5 Perform bladder decompression.
Correct 1,2,3 Urethral inserts should be used to support and correct the underlying problem causing stress incontinence. Reducing excess weight can help in reducing the pressure on and relaxation of the pelvic floor muscles. Practicing pelvic floor muscle (Kegel) exercises can decrease stress incontinence, because the condition is caused by relaxed pelvic floor muscles. Oxybutynin is an anticholinergic drug, which should be used to treat central nervous system disorders such as urge incontinence. Bladder decompression should be done to prevent ureteral reflux and hydronephrosis in the case of reflex incontinence.
A patient has undergone a surgical procedure for a bladder tumor resection. When teaching this patient about postoperative care, what are the important instructions that the nurse should include? Select all that apply. 1 Observe urine for color and consistency. 2 For the first few days, the urine will be pink. 3 For the first few days, the urine will contain blood clots. 4 Drink fewer fluids during the first week after the procedure. 5 After 10 days, rust-colored specks can be seen in the urine.
Correct 1,2,5 The patient should be taught to observe the urine for color and consistency and to note any abnormality. The first few days after the procedure, the urine can be pink. After 7 to 10 days, rust-colored specks can be seen in the urine; these may be from the healing site of tumor resection. For the first few days, blood clots in the urine indicate a hemorrhage, and this is not normal. The patient should be encouraged to drink a large volume of fluid for the first weeks after the procedure to increase urine output.
A patient is suspected to have acute glomerulonephritis. The nurse is evaluating the causes and risk factors for glomerulonephritis in this patient. Which patient factors would the nurse anticipate contributed to acute glomerulonephritis? Select all that apply. 1 Hypertension 2 Chlamydial infection 3 Streptococcal throat infection 4 Human immunodeficiency virus (HIV) 5 Neurogenic hypersensitivity of the lower urinary tract
Correct 1,3,4 Hypertension can cause scarring and nephrosclerosis, which can lead to glomerulonephritis. Streptococcal throat infection can lead to acute poststreptococcal glomerulonephritis (APSGN), which is a common type and develops 5 to 21 days after an infection of the tonsils or pharynx by nephrotoxic strains of group A β-hemolytic streptococci. Viruses, such as HIV, can trigger glomerulonephritis. Chlamydial infection causes urethritis, which is an inflammation of the urethra. Neurogenic hypersensitivity of the lower urinary tract is the cause of interstitial cystitis or painful bladder syndrome.
The nurse is assessing the risk factors for urinary tract calculi in a group of patients. What are the factors that the nurse knows contribute to the development of urinary tract calculi? Select all that apply. 1 Low fluid intake 2 Diet low in calcium 3 Sedentary occupation 4 Excessive intake of tea 5 Adequate intake of dietary proteins
Correct 1,3,4 Low fluid intake increases urinary concentration and the chances of urinary tract calculi. A sedentary occupation can cause delayed urination and increased urinary stasis, which can lead to calculi. Excessive intake of tea can elevate urinary oxalate levels, which can cause oxalate renal stones. A diet low in calcium does not increase the risk of urinary calculi; instead, a high-calcium intake with lower fluid intake can predispose a woman to stone formation. Adequate intake of dietary proteins is recommended, but a large intake of dietary proteins can increase uric acid excretion and increases the risk of forming renal calculi.
A patient is suspected of having struvite urinary calculi. What appropriate actions should the nurse perform to manage this patient? Select all that apply. 1 Measure urine pH. 2 Give cholestyramine. 3 Administer antimicrobial agents. 4 Take measures to acidify the urine. 5 Alkalinize the urine with potassium citrate.
Correct 1,3,4 Measuring urine pH aids in the diagnosis of struvite urinary stones, which have a tendency to be alkaline, or have high pH. The nurse should take measures to acidify the urine, because the urine is alkaline in patients with struvite urinary stones. Antimicrobial agents should be given, because the treatment of struvite stones requires control of the infection. Cholestyramine should be given in the case of calcium oxalate stones binding to oxalate. The urine should be alkalinized with potassium citrate if the stones are made of calcium oxalate, uric acid, or cystine, because acidic urine is responsible for formation of these types of stones.
The nurse is caring for a patient with a suprapubic catheter. Which interventions should the nurse perform to ensure patency of the tube? Select all that apply. 1 Milking the tube 2 Lubricating the catheter 3 Turning the patient side to side 4 Instilling 5 mL of sterile saline solution 5 Preventing tube kinking by coiling the excess tubing
Correct 1,3,5 A suprapubic catheter is prone to poor drainage, because of mechanical obstruction of the tip of the catheter by clots and sediments. Milking the tube will help to prevent tube obstruction. To ensure the proper functioning of the tube and to check whether the catheter is properly inserted, the patient should be turned side to side. Preventing tube kinking by coiling the excess tubing also prevents obstruction in the tube. Lubricating the catheter is not an appropriate intervention to ensure patency of the tube. Instilling 5 mL of sterile saline solution is performed in patients with a nephrostomy tube to prevent overdistention of the kidney pelvis. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
When examining a patient with glomerulonephritis, which clinical manifestations is the nurse likely to find? Select all that apply. 1 Hypertension 2 Nausea and vomiting 3 Dysuria, fever, and chills 4 Generalized body edema 5 Hematuria and smoky urine
Correct 1,4,5 Hypertension can result from increased extracellular fluid volume due to decreased glomerular filtration. Generalized body edema is observed due to fluid retention, which occurs as a result of decreased glomerular filtration; initially, periorbital edema is noted, but later it progresses to involve the total body as ascites or peripheral edema in the legs. Hematuria and smoky urine can be observed due to bleeding in the upper urinary tract. Nausea and vomiting are commonly caused by pain associated with urinary tract infections and calculi. Dysuria, fever, and chills are noted in urinary tract infections and calculi.
Which medications are used to desensitize pain in the bladder wall? Select all that apply. 1 Lidocaine 2 Vancomycin 3 Clotrimazole 4 Azathioprine 5 Dimethyl sulfoxide (DMSO)
Correct 1,5 Instillations of heparin and hyaluronic acid are often administered with lidocaine, which rapidly desensitizes the pain receptors in the bladder wall due to their alkalinized anesthetic effect. DMSO is directly instilled into the bladder through a small catheter and it desensitizes the pain receptors in the bladder wall. Vancomycin combined with an aminoglycoside such as tobramycin is beneficial in the treatment of acute pyelonephritis. Clotrimazole is used for treating trichomonas infection associated with urethritis. Azathioprine is used in the treatment of Goodpasture syndrome. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
A patient reports fever, chills, pain while urinating, and urgency. The nurse identifies the symptoms as severe, because blood and bacteria are present in the urine. The nurse anticipates that which medication will be prescribed? 1 Doxycycline 2 Vancomycin 3 Metronidazole 4 Dimethyl sulfoxide
Correct 2 The symptoms of fever, chills, pain while urinating, and urgency with the presence of blood (hematuria) and bacteria in the urine (pyuria) indicate acute pyelonephritis. Vancomycin combined with an aminoglycoside such as tobramycin is beneficial in the treatment of acute pyelonephritis. Doxycycline is used in the treatment of chlamydial infections associated with urethritis. Metronidazole is used for treating trichomonas infection. Dimethyl sulfoxide is instilled into the bladder for the treatment of interstitial cystitis. Test-Taking Tip: Focus on the unique symptoms associated with the patient's condition by ruling out the common symptoms that occur in other disorders.
The nurse anticipates that which diagnostic procedure will be prescribed for a patient with a urinary tract infection, renal abscesses, and anatomic abnormalities? 1 Urinalysis 2 Ultrasonography 3 Magnetic resonance imaging (MRI) 4 Computed tomography (CT) urogram
Correct 2 Ultrasonography of the urinary system is performed to identify renal abscesses and anatomic abnormalities, which are the clinical manifestations of acute pyelonephritis. The results of urinalysis indicate the presence of pyuria, bacteriuria, and hematuria. MRI is used to determine the size of diverticulum in relation to the urethral lumen. A CT urogram is used to assess for signs of infection in the kidney and complications of pyelonephritis. Test-Taking Tip: Read the question carefully before looking at the answers. Try to determine if there is any specific emphasis on the symptoms or on any abnormal condition of the patient to help answer the question correctly.
A patient with interstitial cystitis complains of burning pain in the bladder. Which medications does the nurse expect to be beneficial to the patient? Select all that apply. 1 Alfuzosin 2 Diltiazem 3 Verapamil 4 Imipramine 5 Phenylpropanolamine
Correct 2,3,4 Calcium channel blockers such as diltiazem and verapamil reduce smooth muscle contraction and help reduce burning pain. Tricyclic antidepressants such as imipramine reduce burning pain in the bladder. Alfuzosin reduces urethral sphincter resistance to urinary outflow. Phenylpropanolamine is an α-adrenergic agonist that increases urethral resistance.
What is the role of a registered nurse during catheterization? 1 To anchor the catheter in place 2 To irrigate the catheter in case of obstruction 3 To choose the appropriate type and size of catheter 4 To insert an indwelling catheter for uncomplicated patients
Correct 3 The registered nurse chooses the type and size of the catheter during catheterization. Anchoring the catheter in place is the role of unlicensed assistive personnel (UAP). A licensed practical/vocational nurse irrigates the catheter if obstruction is suspected and inserts an indwelling catheter for uncomplicated patients.
The nurse is teaching patients who are at an increased risk of urinary tract infections (UTIs) about the use of cranberry products in preventing UTIs. What important instructions should the nurse include in the teaching? Select all that apply. 1 Cranberry has no effect on UTIs. 2 Cranberry juice is more effective than cranberry capsules. 3 Cranberry products have a protective effect in preventing UTIs. 4 Drinking an adequate amount of fluid is important to prevent UTIs. 5 Taking cranberry capsules and not drinking water will prevent UTIs.
Correct 2,3,4 Cranberry juice is more effective than cranberry capsules, probably due to the increased hydration from the juice. Cranberry products have a protective effect in reducing UTIs, because the juice works by preventing the attachment of bacteria to the epithelial cells in the bladder wall. Drinking an adequate amount of fluid is important to prevent UTIs, because it promotes hydration. Only taking cranberry capsules and not drinking water will not help to prevent UTIs, because adequate fluid intake is essential for proper functioning of the renal system.
A patient has undergone a lithotripsy procedure. When preparing this patient for the postoperative period, what does the nurse inform this patient to expect after the procedure? Select all that apply. 1 There will be no pain. 2 Hematuria can be observed. 3 A ureteral stent will be placed. 4 An open surgical procedure will be performed. 5 The ureteral stent is removed within two weeks.
Correct 2,3,5 Hematuria is common after lithotripsy procedures and during the initial postoperative period. In addition, the urine may appear bright red (hematuria). A ureteral stent will be placed after the procedure to facilitate passage of shattered stone particles and prevent sand buildup within the ureter, which might lead to obstruction. The ureteral stent is removed within two weeks, after the stone particles have possibly passed out. The patient may complain of moderate to severe colicky pain during the postoperative period. Surgery may be required only if a stone is large or positioned in the mid or distal ureter. Surgery may also be considered for patients with complications like pain, infection, and obstruction.
Which nursing instructions that promote safety are beneficial to a patient with interstitial cystitis (IC)? Select all that apply. 1 "Avoid using vaginal sprays." 2 "Continue the medications as prescribed." 3 "Avoid clothing that creates suprapubic pressure." 4 "Take high-potency vitamins along with the medications." 5 "Take the full course of antibiotics to ensure that bacteria have been eradicated."
Correct 2,3,5 Patients with interstitial cystitis should continue medications as prescribed. Clothing that creates suprapubic pressure, including pants with tight belts or restrictive waistlines, should be avoided. The nurse should encourage patients to take the full course of antibiotics to ensure that bacteria have been eradicated. Vaginal sprays should be avoided in patients with urethritis. Patients with IC should take a multivitamin containing not more than the recommended dietary allowance and avoid high-potency vitamins because they may irritate the bladder. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
When teaching a female patient about measures to prevent recurrent urinary tract infection (UTI), what instructions should the nurse include? Select all that apply. 1 Urinate every six hours. 2 Wipe from front to back after urinating. 3 Empty the bladder before and after sexual intercourse. 4 Use vaginal douches or sprays to clean the perineal area. 5 Cleanse with warm soapy water after each bowel movement.
Correct 2,3,5 The nurse should instruct the patient to wipe from front to back after urinating to avoid contamination by other structures, because this can increase the risk of UTIs. Emptying the bladder before and after sexual intercourse will help to keep the perineum clean and reduce the risk of UTIs. Cleansing the perineum with warm soapy water after each bowel movement to clean the anal region will reduce the risk of UTIs. Regular urination may prevent bacteria from growing; therefore the patient should be encouraged to void every two to three hours. Vaginal douches or sprays to clean the perineal area should be avoided, because these contain harsh chemicals and substances that can cause irritation and can increase the risk of urinary infection.
A patient is on tolterodine therapy for urge incontinence. On a follow-up visit, the nurse finds that the patient has taken an overdose of the medication. Which complications does the nurse suspect in the patient? Select all that apply. 1 Delirium 2 Diaphoresis 3 Blurred vision 4 Urethral constriction 5 GastrointestinaI cramping
Correct 2,3,5 Tolterodine is an anticholinergic medication. Anticholinergics are medications that block acetylcholine in the brain. Overdose of anticholinergics causes decreased sweating (diaphoresis), blurred vision, and gastrointestinal cramping. Delirium occurs as a side effect of opioids and alcohol. Urethral constriction is a side effect of α-adrenergic receptor agonists.
The nurse is teaching a patient who recently had an episode of urolithiasis with calcium oxalate stones about nutritional therapy. What instructions should the nurse include? Select all that apply. 1 Increase intake of milk. 2 Limit consumption of colas. 3 Increase consumption of coffee. 4 Take in at least 3 L of fluid daily. 5 Limit intake of dried fruits and nuts.
Correct 2,4,5 The patient should be instructed to limit consumption of colas, because these contain substances that increase the risk of recurring renal calculi. Patients should take in at least 3 L of fluid daily to produce a urine output of at least 2 L per day. High urine output helps to dilute the urine and promotes excretion of minerals within the urine, thus preventing stone formation. Intake of dried fruits and nuts should be limited, because they contain high amounts of calcium and the patient had suffered from calcium oxalate stones. Increasing the intake of milk is not recommended, because milk contains high amounts of calcium and the patient had suffered from calcium oxalate stones. Consumption of coffee should be restricted, because it contains substances such as cocoa oxalate that increase the risk of recurring renal calculi.
A patient reports frequent leakage of small amounts of urine throughout the day and night. On assessing the patient, the nurse finds the bladder is palpable and distended. Which medication does the nurse expect to be beneficial to the patient? 1 Oxybutynin (Oxytrol) 2 Baclofen 3 Terazosin 4 Solifenacin
Correct 3 Leakage of small amounts of urine throughout the day and night indicates overflow incontinence. Overflow incontinence is a condition in which the pressure of urine in an overfull bladder overcomes sphincter control. The bladder remains distended and is palpable in patients with overflow incontinence. Terazosin is an alpha-blocker, which relaxes the smooth muscles around the bladder and relieves the need of frequent or urgent urination even during the night. Oxybutynin (Oxytrol) is an anticholinergic medication used in the treatment of urge incontinence. Baclofen is effective in patients with reflex incontinence. Solifenacin, an anticholinergic medication, is used to treat urge incontinence.
While caring for a patient with a nephrostomy tube, the nurse finds excessive drainage around the tube. Which is the most appropriate nursing intervention in this situation? 1 Irrigating the tube 2 Documenting the observation 3 Checking the catheter for patency 4 Notifying to the primary health care provider
Correct 3 When the patient with a nephrostomy tube experiences excessive drainage around the tube or pain, the nurse should check for patency of the catheter. Changing the tube may also help in reducing excessive drainage, but it should be done only on the order of the primary health care provider. Documenting the observation is also useful; however, it is not the most appropriate in this situation. The nurse should document the findings and appropriate actions only after notifying the primary health care provider. The nurse should notify the primary health care provider after checking the patency of the urinary catheter. Test-Taking Tip: The nursing intervention should bring positive insight towards health promotion of the patient.
The primary health care provider orders retropubic colposuspension for a patient diagnosed with urinary incontinence (UI). Which complications might the nurse anticipate in the patient? Select all that apply. 1 Infection 2 Urinary retention 3 Vaginal prolapse 4 Bladder perforation 5 Postoperative voiding dysfunction
Correct 3 ,5 Retropubic colposuspensions are periurethral injectables used in the treatment of urinary incontinence (UI). This procedure is performed through low transverse incisions, and may lead to complications such as vaginal prolapse, postoperative voiding dysfunction, and urgency. Infection, urinary retention, and bladder perforation occur due to the placement of a suburethral sling. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.
A patient presents with discomfort in the lower abdomen, and on assessment, the nurse suspects a lower urinary tract infection. Which symptoms should the nurse evaluate? Select all that apply. 1 Fever 2 Pain in the flank 3 Pain while urinating 4 Increased frequency of urination 5 A feeling of pressure in the suprapubic region
Correct 3,4,5 Because symptoms of a lower urinary tract infection are related to either bladder storage or bladder emptying, there is dysuria, or painful urination. Increased frequency of urination (more than every two hours) is related to bladder storage and emptying, which occurs because of infection of the lower urinary tract. A feeling of pressure or discomfort in the suprapubic region is common in the presence of a lower urinary tract infection, because the infection affects bladder storage. Chills and fever are observed in an infection involving the upper urinary tract. Pain in the flank is observed in infections involving the upper urinary tract. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.
Which treatment does the nurse expect for a patient who presents with hematuria, flank pain, and a palpable mass in the abdomen? Select all that apply. 1 Ileal conduit 2 Marsupialization 3 Radical nephrectomy 4 Cystoscopic lithotripsy 5 Radiofrequency ablation
Correct 3,5 Hematuria, flank pain, and palpable mass in the abdomen are common clinical manifestations of renal cancer. Radical nephrectomy involves removal of a kidney, the adrenal gland, and part of the ureter. Radiofrequency ablation involves destroying a tumor by using heat from radiofrequency. Ileal conduit is a surgical urinary diversion used to treat painful bladder syndrome. Marsupialization is a creation of a permanent opening of a diverticular sac in the vagina. Cystoscopic lithotripsy uses an ultrasonic lithotrite to pulverize a renal stone.
While caring for a patient with urinary incontinence (UI), the nurse attaches a urethral plug to the patient's urethra. What is the rationale behind this intervention? 1 To support the bladder neck 2 To direct urine into the drainage bag 3 To prevent leakage through the urethra 4 To provide mechanical obstruction to prevent urine leakage
Correct 4 A urethral plug is an intraurethral occlusive device, which is worn in the urethra to provide mechanical obstruction to prevent urine leakage. Pessaries and bladder neck support prostheses are devices that help to support the bladder neck. Urine is directed into a drainage bag through external catheter systems. Penile compression devices are applied to the penis to prevent leakage through the urethra.