Ch. 46 LEWIS RENAL UROLOGIC

32. Which nursing action should the nurse who is caring for a patient who has had an ileal conduit for several years delegate to nursing assistive personnel (NAP)?

Change the ostomy appliance.

38. A 26-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having knee surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider?

Give ketorolac (Toradol) 10 mg PO PRN for pain.

36. A patient undergoes a nephrectomy after having massive trauma to the kidney. Which assessment finding obtained postoperatively is most important to communicate to the surgeon?

Urine output is 20 mL/hr for 2 hours.

44. After change-of-shift report, which patient should the nurse assess first?

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

11. The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by

d. drinking 2000 to 3000 mL of fluid a day.

23. Two days after surgery for an ileal conduit, the patient will not look at the stoma or participate in care. The patient insists that no one but the ostomy nurse specialist care for the stoma. The nurse identifies a nursing diagnosis of

disturbed body image related to change in body function.

20. After the home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying, which patient statement indicates that the teaching has been effective?

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

28. Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?

Blood pressure 88/45 mm Hg

27. Which assessment data reported by a 28-year-old male patient is consistent with a lower urinary tract infection (UTI)?

Burning on urination

31. A patient with renal calculi is hospitalized with gross hematuria and severe colicky left flank pain. Which nursing action will be of highest priority at this time?

Administer prescribed analgesics.

8. The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with

c. anticoagulants.

29. A patient who is diagnosed with nephrotic syndrome has 3+ ankle and leg edema and ascites. Which nursing diagnosis is a priority for the patient?

Excess fluid volume related to low serum protein levels

34. Following an open loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented first?

Assist the patient to take a 15-minute sitz bath.

16. A 78-year-old who has been admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action will be best to include in the plan of care?

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

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

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

26. Which nursing action will be most helpful in decreasing the risk for hospital-acquired infection (HAI) of the urinary tract in patients admitted to the hospital?

Avoid unnecessary catheterizations.

21. Which action will the nurse include in the plan of care for a patient who has had a ureterolithotomy and has a left ureteral catheter and a urethral catheter in place?

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

22. A patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching?

Catheterization technique and schedule

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

Check blood pressure and heart rate.

35. The nurse observes nursing assistive personnel (NAP) taking the following actions when caring for a patient with a retention catheter. Which action requires that the nurse intervene?

Disconnecting the catheter from the drainage tube to obtain a specimen

33. When the nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy, which assessment finding is most important to report to the health care provider?

Drop in urine output

37. Which assessment finding for a patient who has had a cystectomy with an ileal conduit the previous day is most important for the nurse to communicate to the physician?

Heart rate 102 beats/minute

30. An 88-year-old with benign prostatic hyperplasia (BPH) has a markedly distended bladder and is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first?

Insert a urinary retention catheter.

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

LIVER AND CHICKEN

39. Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider?

Left-sided flank pain

19. A patient in the hospital has a history of functional urinary incontinence. Which nursing action will be included in the plan of care?

Place a bedside commode near the patient's bed.

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

Teach the patient about the use of antifungal medications.

17. A 62-year-old asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is most appropriate to include in the care plan?

Teach the patient how to perform Kegel exercises.

24. A patient who has had a transurethral resection with fulguration for bladder cancer 3 days previously calls the nurse at the urology clinic. Which information given by the patient is most important to report to the health care provider?

The patient has noticed clots in the urine.

18. Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes. Which nursing action is most appropriate?

Use an ultrasound scanner to check the postvoiding residual.

41. Which action will the nurse anticipate taking for an otherwise healthy 50-year-old who has just been diagnosed with Stage 1 renal cell carcinoma?

b. Provide preoperative teaching about nephrectomy.

Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine (Pyridium)?

b. Pyridium may change the urine color.

9. A 56-year-old female patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect?

b. Recent weight gain

6. It is most important that the nurse ask a patient admitted with acute glomerulonephritis about

b. recent sore throat and fever.

15. After obtaining the health history for a 25-year-old who smokes two packs of cigarettes daily, the nurse will plan to do teaching about the increased risk for

bladder cancer.

5. The nurse determines that further instruction is needed for a patient with interstitial cystitis when the patient says which of the following?

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

13. A 32-year-old patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time?

c. Discussion of options for genetic counseling

A 46-year-old female patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole (Bactrim) for 3 days. Which action will the nurse plan to take?

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

The nurse determines that instruction regarding prevention of future urinary tract infections (UTIs) has been effective for a 22-year-old female patient with cystitis when the patient states which of the following?

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

4. Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)?

d. Costovertebral tenderness

7. Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?

d. The periorbital and peripheral edema is resolved.

14. When assessing a 30-year-old man who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of

gonococcal urethritis.

12. When planning teaching for a patient with benign nephrosclerosis the nurse should include instructions regarding

monitoring and recording blood pressure.

A patient's renal calculus is analyzed as being very high in uric acid. To prevent recurrence of stones, the nurse teaches the patient to avoid eating

organ meats and sardines.

25. A patient with bladder cancer is scheduled for intravesical chemotherapy. In preparation for the treatment the nurse will teach the patient about

the need to empty the bladder before treatment.