Medical Surgical Chapter 46 Renal and Urologic Problems

4, 5 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. Text Reference - p. 1067

Escherichia coli is resistant to what medications? Select all that apply. 1 Fosfomycin 2 Ciprofloxacin 3 Amphotericin 4 Trimethoprim 5 Sulfamethoxazole

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. Text Reference - p. 1070

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

1, 2 Terazosin and doxazosin are alpha-adrenergic antagonists that are used to reduce urethral sphincter resistance to urinary outflow. They cause smooth muscles in the bladder neck to relax and improve urine flow rate. Finasteride is a 5 alpha reductase inhibitor that suppresses androgen, which contributes to prostate disease. Mirabegron is a β3-adrenergic agonist that improves the bladder storage capacity by relaxing the bladder muscle during filling. Propantheline is a muscarinic receptor antagonist and anticholinergic that reduces overactive urinary contractions in urge urinary incontinence (UI). Text Reference - p. 1091

The nurse identifies urethral sphincter resistance to urinary outflow in a patient. Which medications does the nurse anticipate to be beneficial for the patient? Select all that apply. 1 Terazosin 2 Doxazosin 3 Finasteride 4 Mirabegron 5 Propantheline

1, 3, 5 Upper UTI symptoms present with fever, chills, and flank pain. The patient will not be afebrile, and urine will likely be cloudy, not clear and yellow. Text Reference - p. 1065

The nurse is assessing a patient with a diagnosis of upper urinary tract infection (UTI). Which symptoms should the nurse expect to find? Select all that apply. 1 Fever 2 Clear, yellow urine 3 Chills 4 Afebrile 5 Flank pain

3, 4, 5 Encouraging the patient to move helps promote the movement of the stone from the upper to the lower urinary tract, resulting in the passage of stones. The nurse should also strain all urine voided by the patient using gauze or a urine strainer to ensure that any spontaneously passed stones are retrieved. To ensure safety, the patient is not left to walk unattended while experiencing acute renal colic, particularly when opioid analgesics are being given. Restricting fluid intake does not help; instead increasing fluid helps to dilute the urine and eases the spontaneous passage of stones. Bed rest is advised only if ordered, during which the patient should be moved every two hours. Text Reference - p. 1081

The nurse is attending to a patient with obstructing urinary calculi. The patient is treated with tamsulosin to help ease passage of the stones. In addition, opioids are administered to relieve colic pain. What actions should the nurse perform to ensure treatment effectiveness and patient safety? Select all that apply. 1 Restrict fluid intake. 2 Advise complete bed rest. 3 Encourage the patient to move. 4 Strain all urine voided by the patient. 5 Avoid letting the patient ambulate unattended.

60 To estimate the amount needed by a person in 24 hours, take the person's weight in pounds and divide it in half. That is the estimated amount of fluid needed.

The nurse is caring for a 120-pound patient who is at risk for a urinary tract infection. The nurse estimates, in ounces, the recommended fluid intake for the patient in a 24-hour period. How many ounces should the nurse recommend? Record the answer using a whole number. ____________ oz

2 With a nephrostomy tube, if the tube is occluded and irrigation is prescribed, the nurse should use 5 mL or less of sterile saline to irrigate it gently. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency. Text Reference - p. 1094

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving prescriptions, what should the nurse do? 1 Keep the patient on bed rest 2 Use 5 mL of sterile saline to irrigate 3 Use 30 mL of water to gently irrigate 4 Have the patient turn from side to side

2 Administration of the antibiotic is going to help counter the infectious process. Education and identifying the source is important, but it is not the priority, nor is scheduling the follow-up urine culture test. Text Reference - p. 1070

The nurse is developing a care plan for the patient admitted with acute pyelonephritis. Which intervention is a priority for this patient? 1 Scheduling a follow-up urine culture 2 Administration of parenteral antibiotics as prescribed by the health care provider 3 Assisting the patient with identifying foods to help prevent future infection 4 Educating the patient to continue medications as prescribed

4 Pain control is the priority with this patient, but the patient needs to be mobile to assist in passing the stone. The statement regarding the patient needing to be on bed rest requires further education. The patient reporting no pain upon voiding indicates that the stone may have passed. The patient does not need to strain urine once the stone has passed. The patient being free of pain is an ideal goal. Text Reference - p. 1081

The nurse is evaluating the care plan for the patient with a diagnosis of urinary tract calculi. Which statement by the patient indicates a need for further teaching? 1 "I have no pain upon urination." 2 "My pain level is much less now." 3 "I will not need to strain my urine because the stone is visibly passed and I no longer have pain" 4 "I will remain on bed rest to prevent the stone from moving"

2, 4, 5 Observing the color and consistency of urine is important, because urine with increased amounts of mucus, blood, or sediment may occlude the drainage tubing or catheter. Measuring and recording urine output is important, because the total urine output should be at least 0.5 mL/kg/hr. It is important to assess for urine drainage from the catheters and on the dressings to estimate the minimum amount of urine output. Never clamp the catheter unless ordered to do so by a health care provider. There is no stoma after a nephrectomy; the stoma and its care are integral part of procedures such as ileal conduit. Text Reference - p. 1095

The nurse is managing a patient who has undergone a nephrectomy. Which actions should the nurse perform during the postoperative period? Select all that apply. 1 Clamp the catheter. 2 Observe color and consistency of urine. 3 Attend to care for the stoma and collecting device. 4 Measure urine output at least every one or two hours. 5 Measure the drainage from the catheters and on the dressing.

3 E. coli is the most reported organism, and Pseudomonas is second. Catheter-associated UTIs are the most frequent hospital-acquired UTI. MRSA and Streptococcus are not usually the organisms in hospital-acquired UTIs. Text Reference - p. 1066

The nurse is preparing a lecture for nursing students on healthcare-associated urinary tract infections (UTIs). Education should include identification of the following organism as the primary cause: 1 Pseudomonas 2 Methicillin-resistant Staphylococcus aureus (MRSA) 3 Escherichia coli 4 Streptococcus

2 A patient who has had a kidney transplant will be undergoing immunosuppressive therapy and ideally should be in a private room. However, if a roommate is necessary, someone with renal calculi would be least likely to possess an infectious organism that could be spread to the immunocompromised transplant patient. A patient with hepatitis C, osteomyelitis, or bronchial pneumonia is not an appropriate roommate because of the risk of infection. Text Reference - p. 1079

The nurse is providing care for a patient who underwent kidney transplantation surgery two days ago. An appropriate roommate to cohort with the postoperative patient is the patient with a diagnosis of: 1 Hepatitis C 2 Renal calculi 3 Osteomyelitis 4 Bronchial pneumonia

3 When there is strong urge for urination, the patient should tighten the pelvic muscle quickly and squeeze hard several times until the urge passes. Pelvic floor muscle exercises should be performed in a sitting or lying down position. To perform long squeezes, the pelvic muscle should be tightened for 5 to 10 seconds before relaxing. Short squeezes require tightening the muscle quickly, squeezing for two seconds, and then relaxing. Text Reference - p. 1090

The nurse is providing instructions about pelvic floor muscle exercises to a patient with stress incontinence. Which statement made by the patient indicates the need for further teaching? 1 "I can do quick two-second squeezes periodically." 2 "I can do this exercise in a sitting or lying position." 3 "I am doing it right when I release the muscle to urinate." 4 "I can tighten the muscle for 10 seconds, relax, and repeat."

1 Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. It is due to an underactive destrusor muscle, caused by myogenic or neurogenic factors such as a herniated disc. Therefore, the patient with a herniated disc would have overflow incontinence. Central nervous system disorders such as Parkinson's disease and Alzheimer's disease lead to urge incontinence. A patient who has had multiple pregnancies experiences relaxation of the pelvic floor muscles, which can cause stress incontinence. Retropubic prostatectomy causes incontinence after trauma or surgery. Text Reference - p. 1088

The nurse is reviewing the medical reports of patients with urinary incontinence (UI). Which patient is suspected to have overflow incontinence? 1 The patient with a herniated disc 2 The patient with Parkinson's disease 3 The patient with multiple pregnancies 4 The patient with retropubic prostatectomy

4 Constipation is a frequent complication associated with urinary incontinence (UI). Therefore, patients should be taught to exercise lightly, increase intake of dietary fiber, and ensure adequate fluid intake. Lotions and sprays may irritate the skin causing skin infection and should be avoided. The patient should urinate regularly on a scheduled basis every two to three hours to empty the bladder. Coffee is a bladder irritant, which should be avoided or should be consumed in smaller amounts by patients who have UI. Text Reference - p. 1089

The nurse is teaching a patient how to manage urinary incontinence (UI). Which instruction would be beneficial to the patient? 1 "Use lotion or spray to prevent odor." 2 "Limit the times of urination during the day." 3 "Drink coffee frequently throughout the day." 4 "Perform light exercises to prevent constipation."

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. Text Reference - p. 1080

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.

2 Stress incontinence occurs when the patient coughs or sneezes. In stress incontinence, the leakage is in small amounts and may not be daily. Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. This usually occurs frequently throughout the day and night. Reflex incontinence is a condition that occurs when no warning or stress precedes periodic involuntary urination. Urination is frequent, is moderate in volume, and occurs equally during the day and night. Trauma incontinence occurs when a fistula develops as result of trauma or surgery. Text Reference - p. 1088

The patient complains of incontinence of urine while coughing or sneezing during the physical assessment. The nurse explains to the patient that this is defined as: 1 Overflow incontinence 2 Stress incontinence 3 Reflex incontinence 4 Trauma incontinence

4 ESWL is noninvasive, but anesthesia is used to maintain the patient's position. The other types of lithotripsy are invasive. Laser lithotripsy uses an ureteroscope and small fiber to reach the stone. Electrohydraulic lithotripsy positions a probe directly on the stone; then continuous saline irrigation flushes are used to rinse the stone out. Percutaneous ultrasonic lithotripsy places an ultrasonic probe in the renal pelvis via a percutaneous nephroscope inserted through an incision in the flank. Text Reference - p. 1079

The patient questions why anesthesia is needed when the lithotripsy being done is noninvasive. The nurse explains that the anesthesia is required to ensure the position is maintained during the procedure. The nurse knows that this type of lithotripsy is called: 1 Laser lithotripsy 2 Electrohydraulic lithotripsy 3 Percutaneous ultrasonic lithotripsy 4 Extracorporeal shock-wave lithotripsy (ESWL)

2 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. Text Reference - p. 1097

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 because of your lack of fluid intake; you will need to increase your fluids." 2 "This is a normal occurrence." 3 "Let me call the health care provider to check on the outflow of your stoma." 4 "We will need to catheterize your stoma to remove the mucus."

3 Two grams is equal to 2000 mg. Using ratio and proportion, multiply 200 by x and multiply 2000 × 1 to yield 200x = 2000. Divide 2000 by 200 to yield 10 mL. Text Reference - p. 1067

The patient with a severe urinary tract infection (UTI) has a prescription for cefepine 2 g intravenous (IV) q6h. The vial in the patient's medication drawer has been reconstituted and is labeled as having a concentration of 200 mg/mL. How many mL of solution should be added to the IV bag? 1 2 mL 2 5 mL 3 10 mL 4 15 mL

1 This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole should be used for uncomplicated UTIs. Text Reference - p. 1067

The patient with type 2 diabetes has a second urinary tract infection (UTI) within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection? 1 Ciprofloxacin 2 Fosfomycin 3 Nitrofurantoin 4 Trimethoprim/sulfamethoxazole

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. Text Reference - p. 1068

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

2, 3 Central nervous system disorders such as a brain tumor, and bladder disorders such as carcinoma in situ are causes of urge incontinence. Cystoscopy, neurogenic bladder, and diabetic neuropathy cause overflow incontinence. Text Reference - p. 1088

What are the causes of urge incontinence? Select all that apply. 1 Cystoscopy 2 Brain tumor 3 Carcinoma in situ 4 Neurogenic bladder 5 Diabetic neuropathy

1 The clinical manifestations of acute pyelonephritis vary from mild fatigue to the sudden onset of chills and flank pain. Hemoptysis and rhonchi are pulmonary symptoms of Goodpasture syndrome. Hematuria and proteinuria are clinical manifestations of acute glomerulonephritis. Pain and lower urinary tract symptoms (LUTS) are the two primary clinical manifestations of interstitial cystitis, or pain bladder syndrome. Text Reference - p. 1066

What are the clinical manifestations of acute pyelonephritis? 1 Chills and flank pain 2 Hemoptysis and rhonchi 3 Hematuria and proteinuria 4 Pain and lower urinary tract symptoms

2, 3, 4 Urethritis, urethral stricture, and creation of false passages are complications associated with intermittent catheterization. Infection and secondary stone formation are complications that may occur due to a nephrostomy tube. Text Reference - p. 1094

What are the complications of intermittent bladder catheterization? Select all that apply. 1 Infection 2 Urethritis 3 Urethral stricture 4 Creation of false passage 5 Secondary stone formation

2, 4 Epididymitis and renal abscesses occur due to complications of catheter-acquired urinary tract infections that are undertreated and underrecognized. Dysuria is a complication found in patients with bladder therapy or who are receiving intravesical chemotherapy. Hypertension is a predisposing factor for nephrosclerosis. Infective endocarditis causes glomerulonephritis. Text Reference - p. 1066

What are the consequences of a catheter-acquired urinary tract infection? Select all that apply. 1 Dysuria 2 Epididymitis 3 Hypertension 4 Renal abscesses 5 Infective endocarditis

2 Renal vein thrombosis may occur unilaterally or bilaterally. Renal cell cancer is one of the possible causes of renal vein thrombosis. Vascular changes from hypertension can lead to benign nephrosclerosis. Fibromuscular hyperplasia results in renal artery stenosis. Large tumors in the peritoneal cavity are extrinsic factors that can cause urethral strictures. Text Reference - p. 1082

What is a cause of renal vein thrombosis? 1 Hypertension 2 Renal cell cancer 3 Fibromuscular hyperplasia 4 Large tumors in the peritoneal cavity

2 A large intake of dietary proteins increases uric acid excretion, which is a risk factor for urinary tract calculi formation. Cigarette smoking is a risk factor for renal cell carcinoma. Human immunodeficiency virus infection is a risk factor for glomerulonephritis and nephrotic syndrome. Chronic abuse of phenacetin-containing analgesics is a risk factor for bladder cancer. Text Reference - p. 1075

What is a risk factor for urinary tract calculi? 1 Cigarette smoking 2 Large intake of dietary proteins 3 Human immunodeficiency virus (HIV) infection 4 Chronic abuse of phenacetin-containing analgesics

1 The nurse's priority is to keep the skin free of urine, because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed, the area will be cleaned gently and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage. Text Reference - p. 1097

What is the nurse's priority action when changing the appliance of a patient with an ileal conduit? 1 Keep the skin free of urine 2 Inspect the peristomal area 3 Cleanse and dry the area gently 4 Affix the appliance to the faceplate

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. Text Reference - p. 1093

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

2, 4 While assessing the effect of renal calculi on a patient's cognitive-perceptual pattern, the appropriate question to ask is if the patient has experienced any pain in his or her genitalia or any colicky pain in his or her abdomen or flank. Interviewing the patient about urinary frequency will determine the patient's elimination pattern. Inquiring about the patient's family history of renal calculi will determine health perception and health management. Asking the patient about his or her dietary intake of purine-rich food will determine the patient's nutritional-metabolic pattern. Text Reference - p. 1080

When conducting a health history interview for a patient diagnosed with renal calculi, which question is appropriate when assessing the cognitive-perceptual pattern? Select all that apply. 1 "Do you experience urinary frequency?" 2 "Do you experience pain in your genitalia?" 3 "Do you have a family history of renal calculi?" 4 "Do you experience colicky pain in your abdomen?" 5 "Do you take purine-rich foods like sardines or sweet bread?"

1, 3, 5 Practicing timed voiding, ideally every two to three hours during waking hours, can help in emptying the bladder, thereby reducing the chances of incontinence. Pelvic floor muscle training is important to strengthen the pelvic floor muscles that control the relaxation of the urinary sphincters, and improved muscle control can reduce the complaints of incontinence. Incontinence protective pads are urine-containing assistive devices that can help in cases of mild to moderate urine incontinence. Coffee is a bladder irritant and will increase the urge to urinate, thus increasing the likelihood of incontinence. Intermittent catheterization is advised in cases of urinary retention, not in urinary incontinence. Text Reference - p. 1090

When teaching a patient about techniques to manage urinary incontinence, which instructions should the nurse include as important? Select all that apply. 1 Practice timed voiding. 2 Drink a cup of coffee. 3 Perform pelvic floor muscle training. 4 Perform intermittent catheterization. 5 Use incontinence protective pads

2, 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. Text Reference - p. 1081

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 Maintain a fluid intake of 3 L/day. 2 Change the patient's position every two hours. 3 Help the patient to sit, if possible. 4 Include purine-rich foods in the diet. 5 Monitor urinary output.

1, 3, 5 Scleroderma, Goodpasture syndrome, and SLE are immune diseases that cause glomerulonephritis. Diabetic nephropathy results in scarring of glomeruli. Wegener's granulomatosis is a form of vasculitis that causes glomerulonephritis. Text Reference - p. 1073

Which are immune diseases that cause glomerulonephritis? Select all that apply. 1 Scleroderma 2 Diabetic nephropathy 3 Goodpasture syndrome 4 Wegener's granulomatosis 5 Systemic lupus erythematosus (SLE)

1 Cerebral aneurysm is a serious complication of PKD; it can rupture and cause bleeding and even irreversible brain damage. Periurethral abscess is a complication seen most frequently with the long-term use of indwelling catheters. Squamous cell cancer of the bladder occurs in individuals with chronic recurrent renal calculi. Hypercoagulability with thromboembolism is a serious complication of nephrotic syndrome. Text Reference - p. 1082

Which complication does the nurse expect when providing care to a patient diagnosed with polycystic kidney disease (PKD)? 1 Cerebral aneurysm 2 Periurethral abscess 3 Squamous cell cancer of the bladder 4 Hypercoagulability with thromboembolism

1 Pyelonephritis is an inflammation of the renal parenchyma and the collecting system. Interstitial cystitis is a chronic, painful inflammatory disease of the bladder. Urethral diverticula are the localized outpouchings of the urethra. Glomerulonephritis is the inflammation of the glomeruli. Text Reference - p. 1069

Which condition is referred to as the inflammation of renal parenchyma and the collecting system? 1 Pyelonephritis 2 Interstitial cystitis 3 Urethral diverticula 4 Glomerulonephritis

1 Suprapubic catheterization is used in urethral, prostate, and bladder surgery; it provides an alternate route for elimination to promote healing. Spinal cord injuries, neurologic diseases, and bladder outlet obstruction utilize intermittent catheterization to reduce the risk of injury and infection. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. Text Reference - p. 1094

Which condition utilizes suprapubic catheterization? 1 Urethral surgery 2 Spinal cord injury 3 Neurologic disease 4 Bladder outlet obstruction

2 A penile sheath is a containment device that directs urine into a drainage bag. Pessaries are anticontinence intravaginal support devices. A urethral plug is an anticontinence intraurethral occlusive device. Bladder neck support prostheses are intravaginal support devices that are used to control incontinence in patients. Text Reference - p. 1089

Which containment device directs urine into a drainage bag? 1 Pessary 2 Penile sheath 3 Urethral plug 4 Bladder neck support prostheses

3 Dipstick analysis is the diagnostic study that is used to detect the presence of white blood cells (pyuria) and bacteria in the urine (bacteriuria). An ultrasound or computer tomography (CT) urogram is obtained when urinary system obstruction or urinary tract infections are detected. Sensitivity testing is used to determine the bacteria's susceptibility to a variety of antibiotic drugs. Clean-catch urine sample is a voided midstream technique used for obtaining a urine culture. Text Reference - p. 1066

Which diagnostic study is performed initially to confirm the presence of white blood cells in a patient with suspected urinary tract infection? 1 Ultrasound 2 Sensitivity testing 3 Dipstick urinalysis 4 Clean-catch urine sample

1 Cystoscopy is performed to remove small stones in the bladder. Cystolitholapaxy is done to break large stones with an instrument called a lithotrite. Cystoscopic lithotripsy uses an ultrasonic lithotrite to pulverize stones. It is used to break up large stones and eliminate them. Percutaneous nephrolithotomy is performed by inserting a nephrostomy tube into the kidney pelvis. Text Reference - p. 1079

Which endourologic procedure aids in the removal of small stones? 1 Cystoscopy 2 Cystolitholapaxy 3 Cystoscopic lithotripsy 4 Percutaneous nephrolithotomy

3 The patient should empty the bladder before and after sexual intercourse to prevent recurrent urinary infections. Restricting dietary purines is important for reducing the risk of renal calculi formation. A patient with acute pyelonephritis should have a follow-up urine culture. Female patients should wipe front to back to avoid contamination with E coli. Text Reference - p. 1069

Which instruction by the nurse is beneficial to a female patient to prevent recurrent urinary tract infection? 1 "Restrict purines in your diet." 2 "Schedule a follow-up urine culture." 3 "Empty your bladder before and after sexual intercourse." 4 "Wipe back to front after urinating."

2, 5 The nurse should encourage the patient to drink at least eight glasses of fluid every day during and after treatment of acute pyelonephritis. A full course of antibiotics should be taken to ensure that the bacteria are eradicated. Avoiding the use of vaginal deodorant sprays is one of the interventions to be followed in patients with urethritis. The patient with interstitial cystitis should avoid clothing that creates suprapubic pressure, including pants with tight belts. Sexual intercourse should be avoided until symptoms subside in patients with urethritis. Text Reference - p. 1071

Which instructions by the nurse are beneficial to a patient with acute pyelonephritis? Select all that apply. 1 "Avoid using vaginal deodorant sprays." 2 "Drink at least eight glasses of fluid every day." 3 "Avoid clothing that creates suprapubic pressure." 4 "Avoid sexual intercourse until symptoms subside." 5 "Take the full course of antibiotics to ensure that the bacteria are eradicated."

2 Partial occlusion of one of the renal arteries indicates renal stenosis, which is caused by fibromuscular hyperplasia. A renal arteriogram is the most beneficial diagnostic tool to diagnose renal stenosis. Renal ultrasound, CT, and MRI are also used to diagnose renal stenosis but are considered to be of secondary importance. Text Reference - p. 1082

Which is the most beneficial diagnostic tool to diagnose the condition of a patient admitted with fibromuscular hyperplasia who is suspected of having partial occlusion of one of the renal arteries? 1 Renal ultrasound 2 Renal arteriogram 3 Computed tomography (CT) 4 Magnetic resonance imaging (MRI)

2 Pentosan is the only oral agent used in the treatment of interstitial cystitis. Penicillin is used in the treatment of streptococcal infection as seen in acute poststreptococcal glomerulonephritis. Nortriptyline and amitriptyline are tricyclic antidepressants that may be used to reduce burning pain and urinary frequency. Text Reference - p. 1072

Which is the only oral agent approved for the treatment of interstitial cystitis? 1 Penicillin 2 Pentosan 3 Nortriptyline 4 Amitriptyline

4 Deposition of immune complexes and activation of complement cause inflammation, resulting in poststreptococcal glomerulonephritis. Infiltration of tissues with amyloid causes amyloidosis. Colonization and infection of the patient's normal flora of lower urinary tract via the ascending urethral route causes acute pyelonephritis. Deposition of IgA in the glomeruli results in immunoglobulin nephropathy. Text Reference - p. 1074

Which mechanism is involved in poststreptococcal glomerulonephritis? 1 Infiltration of tissues with amyloid 2 Colonization and infection of lower urinary tract 3 Deposition of immunoglobulin A (IgA) in the glomeruli 4 Deposition of immune complexes and activation of complement

1 Prazosin is an α-adrenergic receptor antagonist that causes stress urinary incontinence (UI) in females through vasodilatation. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor; a side-effect of this medication is cough. Coughing may trigger stress UI, but this is a secondary effect due to cough and unrelated to the drug itself. Calcium channel blockers such as verapamil cause urinary retention and constipation. Thioridazine is an antiseizure medication that causes anticholinergic effects and sedation. Text Reference - p. 1087

Which medication causes stress urinary incontinence (UI) in females? 1 Prazosin 2 Enalapril 3 Verapamil 4 Thioridazine

3 Klebsiella, Pseudomonas, and Proteus are microorganisms that make urine alkaline and contribute to the formation of struvite stones with staghorn configuration. Administration of antimicrobial agents such as acetohydroxamic acid is administered to treat the struvite stone renal calculi. Allopurinol is administered to prevent hyperuricemia and formation of calcium oxalate renal stones. Potassium citrate is administered to maintain alkaline urine that has calcium oxalate crystals entrapped in the kidney. Alpha-penicillamine and tiopronin are given to prevent cystine crystallization. Text Reference - p. 1077

Which medication is prescribed for a patient with alkaline urine and struvite stones in the kidney? 1 Allopurinol 2 Potassium citrate 3 Acetohydroxamic acid 4 Alpha-penicillamine and tiopronin

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. Text Reference - p. 1072

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)

1 Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to result from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care. Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment. Text Reference - p. 1081

Which nursing diagnosis is a priority in the care of a patient with renal calculi? 1 Acute pain 2 Risk for constipation 3 Deficient fluid volume 4 Risk for powerlessness

2 Reflex incontinence occurs due to detrusor hyperreflexia resulting in ureteral reflex and hydronephrosis. Bladder decompression helps to prevent urethral reflux and hydronephrosis. Insertion of a pessary will help to support prolapse in overflow incontinence. Urinary diversion surgery bypasses urethra and bladder incontinence after trauma. Administration of diazepam will help to relax the external sphincter in reflex continence. Text Reference - p. 1088

Which nursing intervention helps to prevent urethral reflux and hydronephrosis in patients with reflex incontinence? 1 Insertion of a pessary 2 Bladder decompression 3 Urinary diversion surgery 4 Administration of diazepam

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. Text Reference - p. 1082

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

2 With the removal of part of the bowel, there is an increased incidence of small bowel obstruction and paralytic ileus. Therefore, a nasogastric tube is inserted for few days. The urine should be acidic to prevent alkaline encrustations. Stoma shreds into the drainage bag and mucus in the urine are common in first few days after the surgery. Text Reference - p. 1097

Which nursing intervention should the nurse include in immediate postoperative management of urinary diversion? 1 Keeping the urine alkaline 2 Inserting a nasogastric tube 3 Notifying the charge nurse of stoma shreds in the drainage bag 4 Encouraging the patient to notify the primary health care provider in case of mucus in urine

1 It is a registered nurse's responsibility to assess and identify the type of incontinence and to consult with the primary health care provider on the appropriate interventions for treatment. Catheterization is within the scope of practice of any nurse. A registered nurse or a licensed practical nurse with the consent of healthcare provider can administer medications via bladder instillation. A registered nurse or a licensed practical nurse can use a bladder scanner to measure postvoid residual volume (PRV). Text Reference - p. 1091

Which of the following must be completed by a registered nurse and is not in the scope of practice of a vocational or licensed practice nurse? 1 Identifying type of incontinence 2 Placement of the indwelling catheter placement 3 Administering medications via bladder instillation 4 Using a bladder scanner to measure postvoid residual volume (PRV)

2 Calcium oxalate calculi are small and often become trapped in the ureter. This type of urinary tract calculi have the predisposing factor of hyperoxaluria. Acidic urine is a predisposing factor for cystine urinary tract calculi. Urinary tract infection caused by Proteus is a risk factor for struvite urinary tract calculi. Primary hyperparathyroidism is a risk factor for the calcium phosphate urinary tract calculi. Text Reference - p. 1078

Which predisposing factor is associated with small renal calculi that become trapped in the ureter? 1 Acidic urine 2 Hyperoxaluria 3 Urinary tract infection 4 Primary hyperthyroidism

4, 5 While assessing the effect of urinary tract infections on the cognitive-perceptual pattern, the nurse should ask the patient if he or she has any suprapubic or low back pain or if he or she has experienced any burning pain when urinating. Asking the patient about hesitancy helps in assessing the effect of the urinary tract infection on the elimination pattern. Interviewing the patient about vomiting and chills helps assess the effect that urinary tract infections have on the nutrition-metabolic pattern. Gaining information about urinary hygiene practices helps assess health perception-health management. Text Reference - p. 1068

Which questions are appropriate for the nurse to ask a patient when assessing the cognitive-perceptual pattern of a patient diagnosed with urinary tract infection? Select all that apply. 1 "Do you experience hesitancy?" 2 "Do you often have vomiting and chills?" 3 "Do you follow urinary hygiene practices?" 4 "Do you have suprapubic or low back pain?" 5 "Do you have burning pain during urination?"

1 Urethritis is an inflammation of the urethra. It is a bacterial or viral infection, which may be caused by Trichomonas and monilial infection in women and chlamydial infection and gonorrhea in men. Interstitial cystitis is a chronic, painful inflammatory disease of the bladder. It is also called painful bladder syndrome. The symptoms of interstitial cystitis are urinary urgency, frequency, and pain in the bladder. Urethral diverticula are localized outpouchings of the urethra. They are usually caused by enlargement of obstructed periurethral glands. Chronic pyelonephritis is associated with small, atrophic, and shrunken kidneys. It is usually caused by recurring infection of the upper urinary tract. Text Reference - p. 1071

Which renal disease is caused by Trichomonas in women? 1 Urethritis 2 Interstitial cystitis 3 Urethral diverticula 4 Chronic pyelonephritis

4 When the collection bag is not reused immediately, it should be filled with 1/2 cup of vinegar, and drained to prevent microorganisms and to avoid odors. If there is a need for frequent irrigation, a triple-lumen catheter is used. In women, the catheter is anchored to the upper thigh. The catheter is changed based on patient assessment, and not on a routine changing schedule. Text Reference - p. 1093

Which statement made by the student nurse regarding the management of patients with an indwelling urinary catheter indicates a need for additional teaching by the registered nurse? 1 "A triple-lumen catheter is used for frequent irrigations." 2 "The catheter is attached to the upper thigh in women." 3 "The catheter should be replaced based on patient assessment." 4 "If the bag is not reused immediately, wash it with soap and water."

2 Involuntary or accidental urine loss or leakage is referred to as incontinence. Dysuria refers to painful or difficult urination. Intermittency is the interruption of the urinary stream while voiding. Postvoid dribbling is urine loss after completion of voiding. Text Reference - p. 1066

Which term is used to refer to involuntary or accidental urine loss? 1 Dysuria 2 Incontinence 3 Intermittency 4 Postvoid dribbling

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. Text Reference - p. 1084

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

4 Overflow incontinence occurs after a patient receives anesthesia. Urge incontinence occurs due to bladder obstruction, central nervous system disorders, or bladder disorders. Prostate surgery causes stress incontinence. Reflex incontinence results when spinal cord lesions above S2 interfere with central nervous system inhibition. Text Reference - p. 1088

Which type of incontinence might occur in a patient after receiving anesthesia? 1 Urge incontinence 2 Stress incontinence 3 Reflex incontinence 4 Overflow incontinence

1 Conditions resulting in interference with spinal inhibitory pathways such as spondylosis cause urge incontinence. Prostrate surgery or multiple pregnancies cause stress incontinence. Spinal cord lesions above S2 cause reflex incontinence. Herniated disc and diabetic neuropathy cause overflow incontinence. Text Reference - p. 1088

Which type of urinary incontinence (UI) is associated with spondylosis? 1 Urge incontinence 2 Stress incontinence 3 Reflex incontinence 4 Overflow incontinence

1 Interstitial cystitis is a bladder disorder that causes urge incontinence. Stress incontinence is caused by prostate surgery for benign prostate hyperplasia. A herniated disc and diabetic neuropathy cause overflow incontinence. Problems affecting balance and mobility in older adults cause functional incontinence. Text Reference - p. 1088

Which type of urinary incontinence (UI) is caused by interstitial cystitis? 1 Urge incontinence 2 Stress incontinence 3 Overflow incontinence 4 Functional incontinence

4, 5 Hematuria, red blood cell casts, and proteinuria are clinical manifestations of rapidly progressive glomerulonephritis (RPGN). SLE and APSGN are underlying causes of RPGN. Hodgkin's lymphoma is a form of neoplasm that causes nephrotic syndrome. Obstructive uropathies cause polycystic kidney disease (PKD). Focal glomerulonephritis is a primary glomerular disease that results in nephrotic syndrome. Text Reference - p. 1074

Which underlying cause does the nurse expect in a patient who presents with hematuria, red blood cell casts, and proteinuria? Select all that apply. 1 Hodgkin's lymphoma 2 Obstructive uropathies 3 Focal glomerulonephritis 4 Systemic lupus erythematosus (SLE) 5 Acute poststreptococcal glomerulonephritis (APSGN

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. Text Reference - p. 1094

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

2 The patient with suprapubic catheterization may have urine leakage due to bladder spasms. An opium suppository is administered to decrease the bladder spasms. Acute pyelonephritis involves flank pain and administration of ciprofloxacin reduces the flank pain. Administration of trimethoprim will help to reduce urine loss after voiding in a urinary tract infection. Overdistention of the kidney pelvis is a complication associated with nephrostomy tubes. Instilling 5 mL of sterile saline solution will help to prevent overdistention of the kidney pelvis. Text Reference - p. 1094

While caring for a patient with suprapubic catheterization, the nurse administers an opium suppository. Which outcome in the patient indicates effective treatment? 1 The patient will not experience flank pain. 2 The patient will not experience bladder spasms. 3 The patient will not experience urine loss after voiding. 4 The patient will not experience overdistention of the kidney pelvis.

1, 2, 4 Irrigation must be done under strict aseptic precautions to avoid any contamination and infection to the kidneys. The catheter should not be kinked, compressed, or clamped, as this can affect the passage of urine through the catheter. If the patient complains of any excessive pain in the area, the nurse should check the catheter for patency. During irrigation, no more than 5 mL of sterile saline solution should be instilled at once to prevent renal damage. If there is excessive drainage around the tube, the nurse should check the catheter for patency. Text Reference - p. 1094

A nephrostomy tube (catheter) has been inserted in a patient with ureteric obstruction, and irrigation has been ordered. What precautions should the nurse take regarding care for the nephrostomy tube? Select all that apply. 1 Irrigation must be done under strict aseptic precautions. 2 The catheter should not be kinked, compressed, or clamped. 3 During irrigation, 15 mL of sterile solution should be instilled at once. 4 Attention should be given to any complaints of excessive pain in the area. 5 Excessive drainage around the catheter is common and needs no attention.

3 n addition to severe flank pain and possible abdominal pain, nausea and vomiting are associated with renal calculi because the nerves that innervate the kidneys also serve the stomach. Constipation, polyuria, and diarrhea are not associated with renal calculi. Sometimes these patients may experience abdominal pain and fever. Patients with renal calculi may also have hematuria. Text Reference - p. 1077

A nurse assesses a patient with renal calculi and expects to find what clinical manifestations? 1 Abdominal pain and constipation 2 Polyuria and fever 3 Vomiting and flank pain 4 Hematuria and diarrhea

3 An intravaginal support device is an anti-incontinence device used to relieve minor pelvic organ prolapse. An external collection device is a containment device used to direct urine into a drainage bag. A penile compression device is applied to the penis to prevent any flow or leakage via the urethra. An intraurethral occlusive device is worn in the urethra to provide mechanical obstruction to prevent urine leakage. Text Reference - p. 1089

A nurse is caring for a patient diagnosed with minor pelvic organ prolapse. Which device is beneficial for the patient? 1 External collection device 2 Penile compression device 3 Intravaginal support device 4 Intraurethral occlusive device

4 Decreased levels of serum albumin and serum protein and elevated serum cholesterol indicate that the patient has nephrotic syndrome. Cyclophosphamide is used to treat nephrotic syndrome. Tamsulosin is used to facilitate the passage of stones. Doxorubicin is used in the treatment of invasive bladder cancer. 5-fluorouracil is used in the chemotherapeutic treatment of metastatic cancer. Test-Taking Tip: Read the question carefully before looking at the answers. Focus on the laboratory findings of the patient to answer correctly. Text Reference - p. 1075

A nurse is caring for a patient who is suspected to have a kidney disorder. The laboratory findings indicate decreased serum albumin, decreased total serum protein, and elevated cholesterol. Which medication does the nurse expect will be prescribed to the patient? 1 Tamsulosin 2 Doxorubicin 3 5-fluorouracil 4 Cyclophosphamide

3 The first symptom of a kidney stone is usually severe pain in the flank area, back, or lower abdomen. Abdominal distension and fever may occur later in the course of the disease. Bacteria on urine analysis is not a predictor of urinary calculi but is observed when a patient has a urinary tract infection. Text Reference - p. 1077

A nurse is performing a physical examination on a patient suspected of having urinary tract calculi. For what primary manifestation should the nurse be observant during the assessment? 1 Fever 2 Abdominal distension 3 Sharp pain in the flanks 4 Bacteria on a urine analysis

3 Most patients with nephrotic syndrome are advised to consume a high-protein diet to replace protein lost through the kidneys and to correct hypoalbuminemia. The dietary instructions in the other answer options are not specific recommendations related to nephrotic syndrome. Text Reference - p. 1075

A nurse should instruct a patient with nephrotic syndrome in which type of diet? 1 Low in fat 2 Low in protein 3 High in protein 4 High in carbohydrate

2 Catheters should be anchored to the upper thigh in women and to the lower abdomen in men to prevent catheter movement and urethral tension. Catheters should not be changed routinely. The patient should be monitored for indications of obstruction or complications before changing the catheter. The catheter should not be removed to collect a urine sample. Instead, small volumes of urine should be aspirated from the urinary port by means of a sterile syringe and a needle when needed. Perineal care should be provided by cleaning the meatus-catheter junction with soap and water. Use of lotions or powder near the catheter may lead to infection. Text Reference - p. 1093

A patient has been catheterized with an indwelling urinary catheter. What nursing action should the nurse perform for catheter care? 1 Change the catheter routinely. 2 Anchor the catheter using a securement device. 3 Remove the catheter to obtain a urine sample. 4 Apply powder around the perineal area to keep the area dry

3 Hypertension and edema, along with headaches and oliguria, are common complications of glomerulonephritis and tend to recur. Fever, UTI, and upper respiratory infections are not primarily associated with glomerulonephritis. Text Reference - p. 1074

A patient has glomerulonephritis. The nurse recalls that which common complications of the disorder tend to recur frequently? 1 Fever and edema 2 Urinary tract infections 3 Hypertension and edema 4 Upper respiratory infections

3 A ureteral catheter is used after surgery to splint the ureters and to prevent them from being obstructed. Urethral catheters are the most commonly used catheters. The urethral catheter is inserted through the external meatus, to the urethra, past the internal sphincter, and into the bladder. A suprapubic catheter is placed while the patient is under general anesthesia. A nephrostomy catheter is inserted on a temporary basis to preserve renal function when the ureter is completely obstructed. Text Reference - p. 1094

A patient has undergone a lithotripsy procedure and is at risk of obstruction of the ureter by edema. Which catheter should be used for preventing obstruction of the ureter? 1 Urethral catheter 2 Suprapubic catheter 3 Ureteral catheter 4 Nephrostomy catheter

1, 3, 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. Text Reference - p. 1086

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 contain blood clots. 3 For the first few days, the urine will be pink. 4 Drink fewer fluids during the first week after the procedure. 5 After 10 days, rust-colored specks can be seen in the urine.

1 Glomerulonephritis is an inflammatory process, usually resulting from antibodies reacting with group A hemolytic streptococcal antigens, the organism responsible for strep throat. Allergies, fluid intake, and measles exposure are not germane to the diagnosis of acute glomerulonephritis. Text Reference - p. 1074

A patient is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which question is most important for the nurse to ask the patient? 1 "Have you recently had strep throat?" 2 "Do you have susceptibility to allergies?" 3 "How much fluid do you drink in a day?" 4 "Have you had any contact with anyone who has measles?"

1, 2, 3 A low-protein diet should be maintained. An elevation in BUN is evidence of an increase in nitrogenous wastes in the patient. A low-sodium diet is necessary to control the patient's edema; this edema is due to decreased glomerular filtration. A fluid-restricted diet will also help control fluid retention, because the patient has edema. A nonvegetarian diet is not advisable, because it is rich in protein; the patient has elevated BUN levels and a low-protein diet should be maintained. Increased fruit juices should be avoided, because the increased fluid intake and additional sodium may exacerbate edema and fluid retention. Text Reference - p. 1074

A patient is diagnosed with acute poststreptococcal glomerulonephritis. On examination, the nurse finds that the patient is hypertensive and has edema and increased blood urea nitrogen (BUN) levels. What type of diet should the nurse plan for this patient? Select all that apply. 1 Low-protein diet 2 Low-sodium diet 3 Fluid-restricted diet 4 Nonvegetarian diet 5 Increased fruit juices

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. Text Reference - p. 1067

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 E. coli is resistant to this medication. 2 This drug is relatively inexpensive. 3 This drug can be taken twice daily. 4 The treatment is given 3 to 4 times a day. 5 The patient should avoid sunlight when taking this medication.

1 A patient with benign prostatic hypertrophy may have urinary retention due to lower urinary tract obstruction. Urinary stasis may increase the risk of infections in the patients. Therefore, urinary catheterization should be performed in these patients to decrease urinary retention. Because the patient does not have an infection, bladder irrigation does not need to be performed. Therefore, this could not be the reason for urinary catheterization in this patient. Urinary catheterization for collecting a sterile urine sample would not be appropriate in this patient. Facilitating medication instillation is not necessary in this patient. Text Reference - p. 1092

A patient is diagnosed with urinary retention related to benign prostatic hypertrophy. What is the purpose of urinary catheterization in this patient? 1 Decreasing urinary stasis 2 Facilitating bladder irrigation 3 Collecting a sterile urine sample 4 Facilitating medication instillation

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. Text Reference - p. 1089

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

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. Text Reference - p. 1078

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 Take measures to acidify the urine. 4 Administer antimicrobial agents. 5 Alkalinize the urine with potassium citrate

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. Text Reference - p. 1066

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 Feeling of pressure in the suprapubic region

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. Text Reference - p. 1070

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

4 The presence of blood in the urine (hematuria), discharge of pus from the genital organs (dyspareunia), and lower abdominal pain (suprapubic pain) are the symptoms of urethra diverticula. Stress incontinence is a potential complication of the surgery. Urosepsis is a complication seen more frequently with the long-term use of an indwelling catheter. Septic shock is the outcome of unresolved bacteremia involving a gram-negative organism due to improper eradication of urosepsis. End-stage kidney disease occurs as a result of chronic pyelonephritis. Text Reference - p. 1071

A patient reports the presence of blood in the urine, discharge of pus from the genital organs, and lower abdominal pain. After a diagnosis is made, surgery is performed as a treatment strategy. The nurse should monitor the patient for what postoperative complication? 1 Urosepsis 2 Septic shock 3 End-stage kidney disease 4 Stress incontinence

1 Interstitial cystitis is a chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency, frequency, and pain in the bladder and pelvis. The urinary frequency of 10 voids in a 24-hour period with 150 mL in each voiding deviates from the normal value of 8 voids in a 24-hour period with at least 200 mL in each voiding and indicates that the patient has urinary frequency. Glomerulonephritis is the inflammation of the glomeruli that affects both kidneys equally. Acute pyelonephritis is the inflammation of renal parenchyma and the collecting system. Goodpasture syndrome is an autoimmune disease characterized by circulating antibodies against the glomerular and alveolar membrane. Text Reference - p. 1066

A patient reports urgency and urinating approximately 10 times in a 24-hour period, with 150 mL for each voiding. The nurse suspects that the patient will be diagnosed with what? 1 Interstitial cystitis 2 Glomerulonephritis 3 Acute pyelonephritis 4 Goodpasture syndrome

2, 4 The feeling of incomplete passage of urine and frequent leakage of small amounts of urine indicates overflow incontinence, which commonly occurs after a patient undergoes surgery or anesthesia. Finasteride is used to decrease outlet resistance and bethanechol is used to enhance bladder contractions; both are beneficial for the patient's condition. Diazepam is used to relax the external sphincter. Oxybutynin and trospium chloride are used in the treatment of urge incontinence. Text Reference - p. 1088

A patient who has undergone hemorrhoidectomy reports feeling the incomplete passage of urine and frequent leakage of small amounts of urine during the day and night. Which medications are beneficial for the patient's condition? Select all that apply. 1 Diazepam 2 Finasteride 3 Oxybutynin 4 Bethanechol 5 Trospium chloride

2 Inability to urinate with pain in the lower abdomen indicates urinary retention. If the postvoid residual (PVR) volume is above 100 mL, it indicates urinary retention. The cause of urinary retention is deficient detrusor contraction strength, in which the muscle no longer contracts with enough force to void the bladder. Obstruction with urinary stasis can be seen in patients with stress incontinence due to prostate cancer. Interference of urethral sphincter control causes urinary incontinence (UI). Colonization and infection of the upper urinary tract cause acute pyelonephritis. Text Reference - p. 1091

A patient who is unable to urinate reports pain in the lower abdomen. The postvoid residual (PVR) volume of the patient is 150 mL. What reason does the nurse suspect to be the cause of this finding in the patient? 1 Obstruction with urinary stasis 2 Deficient detrusor contraction strength 3 Interference of urethral sphincter control 4 Colonization and infection of the lower urinary tract

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. Text Reference - p. 1091

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

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.

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.

3 BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi. Text Reference - p. 1066

An older male patient visits his primary health care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)? 1 High-purine diet 2 Sedentary lifestyle 3 Benign prostatic hyperplasia (BPH) 4 Recent use of broad-spectrum antibiotics