CHAPTER 67 MEDSURG
The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching? "I avoid riding motorcycles." "I always wear a seat belt in the car." "I always wear pads when playing football." "I can't play any type of contact sports because my brother had kidney cancer."
"I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities should be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity. To prevent kidney and genitourinary trauma, caution should be taken when riding bicycles and motorcycles. People should wear appropriate protective clothing when participating in contact sports. Anyone riding in a car should wear a seat belt.
Which condition may occur with an upper urinary tract infection? Cystitis Urethritis Prostatitis Acute pyelonephritis
Acute pyelonephritis Acute pyelonephritis is an upper bacterial urinary tract infection of the kidney and renal pelvis. Cystitis, urethritis, and prostatitis are the acute infections of the lower urinary tract.
Which statement of the patient with interstitial cystitis indicates the need for additional teaching about self-care management? "I should consume tomato products." "I should avoid caffeine consumption." "I should avoid drinking cranberry juice." "I should take a warm sitz bath 2 to 3 times a day.
"I should consume tomato products." The patient should avoid consumption of tomato products because they cause bladder irritation. Avoiding caffeine prevents bladder irritation. Cranberry juice is not recommended because it causes irritation of the bladder in interstitial cystitis. Taking a warm sitz bath 2 to 3 times a day may provide comfort and relieves symptoms.
The nurse is educating a group of individuals at the community center about methods to prevent kidney trauma. Which statement from a member of the group indicates that further teaching is required? "I should wear a seat belt when riding in the car." "I need to use caution when riding a motorcycle." "I should quit the soccer team so I don't injure my kidneys." "It is important to wear protective gear when participating in kickboxing."
"I should quit the soccer team so I don't injure my kidneys." It is not necessary to quit sports, but it is recommended to not play contact sports if the patient has only one kidney. All individuals should wear a seat belt, wear protective gear when participating in contact sports, and use caution when riding a bicycle or motorcycle.
A patient with a urinary tract infection is prescribed sulfamethoxazole. The nurse provides the patient with education about precautions to take to prevent adverse effects. Which statement made by the patient indicates effective learning? "I should limit my intake of fluids between meals." "I should wear protective clothing when outdoors." "I should take the medication with a glass of grape juice." "I should avoid taking an antacid for 1 hour after taking the medication."
"I should wear protective clothing when outdoors." Sulfamethoxazole increases the skin's sensitivity to sunlight; therefore, the patient should wear protective clothing to prevent severe sunburn. A patient who is on sulfamethoxazole should drink adequate amounts of fluids to prevent the formation of crystals in the kidney tubules; therefore, the patient should not limit water intake. As grape juice increases the absorption of the medication, the patient should not take sulfamethoxazole with grape juice. The intake of antacids is contraindicated in a patient who is on ciprofloxacin; however, sulfamethoxazole does not have any interaction with antacids.
Which statement by a novice nurse indicates the need for further learning about factors that contribute to urinary tract infections? "Urinary stasis may be caused by incomplete bladder emptying in men." "Use of douches or perfumed pads and toilet tissue may cause colonization." "Susceptibility to periurethral colonization of coliform bacteria is increased when estrogen levels increase during menopause." "The use of drugs with intentional or unintentional anticholinergic properties in older adults contributes to delayed bladder emptying."
"Susceptibility to periurethral colonization of coliform bacteria is increased when estrogen levels increase during menopause." Susceptibility to periurethral colonization with coliform bacteria is increased when estrogen levels fall during menopause. Estrogen provides resistance to urinary tract infections, and falling estrogen levels will promote periurethral colonization of coliform bacteria. Urinary stasis may be caused by incomplete bladder emptying in men as a result of an enlarged prostate. Use of douches or perfumed pads and toilet tissue may inflame periurethral tissue and cause colonization. The use of drugs with intentional or unintentional anticholinergic properties in older adults contributes to delayed bladder emptying.
Which instruction should the nurse give to a patient who has been prescribed amoxicillin/clavulanate for urinary tract infection? "Avoid exposure to the sun." "Take the medication with food." "Wear dark glasses when in the sunlight." "Avoid taking the drug within 2 hours of taking an antacid.
"Take the medication with food." Amoxicillin/clavulanate may cause gastrointestinal upset. The nurse should instruct the patient to take the drug with food. The patient should avoid exposure to the sun while receiving ciprofloxacin treatment. The patient should wear dark glasses in sunlight while receiving hyoscyamine treatment. The patient should avoid taking levofloxacin within 2 hours of taking an antacid.
A patient with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole. What information does the nurse provide to this patient about taking this drug? Select all that apply. "Take this drug with 8 ounces of water." "Drink at least 3 liters of fluids every day." "Try to urinate frequently to keep your bladder empty." "Be certain to wear sunscreen and protective clothing." "You will need to take all of the drug to get the benefits."
"Take this drug with 8 ounces of water." "Drink at least 3 liters of fluids every day." "Be certain to wear sunscreen and protective clothing." "You will need to take all of the drug to get the benefits." Wearing sunscreen and protective clothing is important to do while on taking trimethoprim/sulfamethoxazole. Increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules; fluid intake prevents this complication. Patients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. Emptying the bladder is important, but not keeping it empty. The patient should be advised to urinate every 3-4 hours or more often if he or she feels the urge.
10. A nurse cares for a client who is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take? a. Document the finding in the clients record. b. Evaluate the tube as working in the hand-off report. c. Clamp the tube in preparation for removing it. d. Assess the clients abdomen and vital signs.
ANS: D The nephrostomy tube should continue to have a consistent amount of drainage. If the drainage slows or stops, it may be obstructed. The nurse must notify the provider, but first should carefully assess the clients abdomen for pain and distention and check vital signs so that this information can be reported as well. The other interventions are not appropriate.
A 60-year-old adult patient presents to the emergency department coughing up blood with difficulty breathing. The patient states, "I had the flu a little over a week ago, and I am a type II diabetic." Upon assessment, the nurse notes that the patient is dyspneic and has generalized edema. The patient's vital signs are temperature 99.9°F, pulse 98 bpm, respiration 26 breaths per minute, blood pressure 158/100 mm Hg, and oxygen saturation 88%. Based on the patient's information and assessment findings, what is most likely the primary pathophysiological disease? Pulmonary edema Pulmonary embolism Congestive heart failure Acute glomerulonephritis
Acute glomerulonephritis Based on the assessment findings, the most likely primary pathophysiological disease is acute glomerulonephritis (GN). Acute GN develops suddenly from an excess immune response within the kidney tissues. Usually an infection is noticed before the kidney symptoms of acute GN are present. The onset of symptoms is usually about 10 days from the time of infection. Pulmonary edema and congestive heart failure are a result of an underlying pathological cause such as acute GN. The patient has no risk factors for a pulmonary embolism.
Which factors may contribute to the development of infectious cystitis? Select all that apply. Age Peritonitis Diabetes mellitus Bowel pathogens Elevated erythropoietin levels
Age Diabetes mellitus Bowel pathogens Age contributes to the incidence of urinary tract infections (UTI) such as cystitis for a variety of reasons including prostate enlargement in men and low estrogen levels in women. Diabetes mellitus causes excess glucose production that provides a medium for bacterial growth and development of UTI. Infectious cystitis is most commonly caused by pathogens from the bowel, which gain entry into the sterile environment of the bladder. Peritonitis and elevated erythropoietin levels are not associated with increased incidence of infectious cystitis.
Which patient assessment finding may indicate adrenal insufficiency following radical nephrectomy? Patient report of back pain Metallic taste in the mouth Bleeding at the surgical site Altered level of consciousness
Altered level of consciousness Symptoms of adrenal insufficiency can include altered level of consciousness, as well as water depletion and hypotension. Complaints of back pain may be a result of positioning during surgery, not adrenal insufficiency. A metallic taste in the mouth is caused by the use of antibiotics, not adrenal insufficiency. Bleeding at the surgical site is caused by damage to blood vessels, not adrenal insufficiency.
What cultural factor increases an American Indian patient's risk for developing end-stage kidney disease (ESKD)? American Indian patients do not respond to conventional medicine as do other populations. American Indian patients have greater incidences of hypertension than do other populations. American Indian patients do not respond to changes in electrolyte levels as do other populations. American Indian patients have greater incidences of genetic alterations of the kidney than do other populations.
American Indian patients have greater incidences of hypertension than do other populations. Hypertension is more common in African American and American Indian patients than in other populations. This increases the risk for developing ESKD. American Indian patients do not respond differently to conventional medicine or to changes in electrolyte levels than other populations. American Indian patients do not have greater incidences of genetic alterations of the kidney than other populations.
A nurse is caring for a patient with a degenerative kidney disorder with chronic hypertension. What action by the nurse best promotes the patient's adherence to therapy for the treatment of this disorder? Determine the patient's financial status. Determine the patient's cultural influences. Teach the patient about complications from the disorder. Assess the patient for knowledge deficit about the disorder.
Assess the patient for knowledge deficit about the disorder. Lack of knowledge or misinformation about hypertension poses many challenges to health care providers working with patients who have hypertension. By assessing the patient for knowledge deficit of the disorder, the nurse is best promoting the patient's adherence to therapy. While determining the patient's financial status and cultural influences are appropriate interventions, these do not best promote the patient's adherence to therapy. Teaching the patient about complications from the disorder is an appropriate intervention; however, this does not best promote the patient's adherence to therapy.
The nurse is providing postoperative care for a patient who underwent nephrectomy. What actions should the nurse take? Select all that apply. Assess the urine output every hour. Monitor blood pressure every 4 hours. Monitor the respiratory rate every hour. Monitor the hemoglobin level every 24 hours. Inspect the abdomen for distention every shift.
Assess the urine output every hour. Monitor blood pressure every 4 hours. Inspect the abdomen for distention every shift. The patient's blood pressure should be frequently monitored for hypotension. A decrease in blood pressure is an early sign of hemorrhage and adrenal insufficiency. The patient's abdomen should be inspected for distention from bleeding. Urine output is assessed every hour. Large water and sodium losses occur in patients with adrenal insufficiency; this is followed by hypotension. IV replacements of fluids and packed blood cells may be needed. Hemoglobin levels are monitored every 6 to 12 hours. The patient's respiratory rate, temperature, and pulse rate are monitored every 4 hours.
When assessing a patient with acute pyelonephritis, which findings does the nurse anticipate will be present? Select all that apply. Chills Dysuria Oliguria Vomiting Suprapubic pain
Chills Dysuria Vomiting Nausea and vomiting are symptoms of acute pyelonephritis. Chills along with fever may also occur, as well as burning (dysuria), urgency, and frequency. Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.
The nurse is caring for a 76-year-old patient on prolonged bedrest related to a history of stroke. Which condition is the patient at risk of developing? Renal abscess Acute pyelonephritis Chronic glomerulonephritis Chronic pyelonephritis
Chronic pyelonephritis Chronic pyelonephritis can occur with structural deformities, urinary stasis, obstruction, or reflux. Conditions that lead to urinary stasis include prolonged bedrest and paralysis, as is often seen in older adult patients following a stroke. Abscesses, which are pockets of infection, can occur anywhere in the kidney, but are not necessarily related to urinary stasis, bedrest, or paralysis. Single episodes of acute pyelonephritis result from bacterial infection, with or without obstruction or reflux. This is also unrelated to urinary stasis, bedrest, or paralysis in the patient. Chronic glomerulonephritis results from slow, cumulative damage and scarring of the glomeruli. The specific cause of most cases of chronic glomerulonephritis is unknown.
A patient with a pulse rate of 130 beats per minute, a white blood cell count of 14,000 per microliter, and the presence of red blood cells in the urine has fever, nocturia, pyuria, and low back pain. Which medication would the nurse expect to see ordered? Oxybutynin Tolterodine Ciprofloxacin Chlorothiazide
Ciprofloxacin Fever, nocturia, pyuria, and lower back pain are symptoms of urinary tract infection. A heart rate of 130 beats per minute indicates tachycardia. The white blood cell count of 14,000 per microliter indicates infection. The presence of red blood cells in the urine indicates hematuria. Fluoroquinolone antibiotics such as ciprofloxacin should be administered to the patient to treat urinary tract infection. Oxybutynin and tolterodine are used to treat urinary incontinence. Chlorothiazide is used to treat hypercalciuria.
A nurse is caring for a patient who has sustained trauma to the kidney and urethra. When attempting to insert an indwelling urinary catheter, the nurse notes that the patient's urethral opening is bleeding. What is the nurse's priority action? Contact the patient's health care provider. Prepare for an in-and-out catheter placement. Clean the urethral opening prior to insertion of the catheter. Do not wipe the blood in order to maintain sterile technique.
Contact the patient's health care provider. If the urethral opening is bleeding when attempting to insert an indwelling catheter, the nurse should contact the patient's health care provider prior to attempting to insert the catheter. The nurse will not prepare for an in-and-out catheter placement. The nurse will not clean the urethral opening or wipe the blood without first contacting the patient's health care provider if there is bleeding at the patient's urethral opening.
What clinical manifestations does the nurse expect to find in an older patient with a urinary tract infection (UTI)? Select all that apply. Fever Dysuria Hypotension Increasing mental confusion Sudden onset of incontinence
Dysuria Increasing mental confusion Sudden onset of incontinence Clinical manifestations of urinary tract infection (UTI) in older patients may include dysuria, increasing mental confusion, and a sudden onset of incontinence. Sometimes the only symptom may be mental confusion or worsening incontinence. Fever and hypotension without urinary symptoms may be signs of urosepsis in the older patient.
Which clinical manifestation in a patient with pyelonephritis indicates that treatment has been effective? Decreased urine output Increased red blood cell count Increased urine specific gravity Decreased white blood cells in urine
Decreased white blood cells in urine A decreased presence of white blood cells in the urine indicates the eradication of infection. A decreased urine output, an increased red blood cell count, and increased urine specific gravity are not symptoms of pyelonephritis.
What does the nurse teach a patient to do to decrease the risk for urinary tract infection (UTI)? Limit fluid intake. Limit sugar intake. Increase caffeine consumption. Drink about 3 liters of fluid daily.
Drink about 3 liters of fluid daily. Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs. Fluids flush the system and should not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.
Which finding is typical of chronic glomerulonephritis? Polyuria Dyspnea Malnutrition Hypotension
Dyspnea An expected finding for the patient diagnosed with chronic glomerulonephritis includes dyspnea, which occurs due to fluid overload and decreased urine output. Polyuria is not associated with chronic glomerulonephritis; however, nocturia and dysuria are common assessment findings. Hypertension is an expected finding in the patient with chronic glomerulonephritis. Malnutrition is not associated with chronic glomerulonephritis.
A patient presented with symptoms of acute glomerulonephritis. Which sample of urine is likely to be collected for accurate urinalysis? Daytime sample Late night sample Early morning sample Randomly collected sample
Early morning sample Urine analysis is done in patients with acute glomerulonephritis to identify the presence of hematuria and proteinuria. An early morning urine sample is highly acidic in nature and tends to keep all the formed elements intact; therefore, it is considered most reliable for urine analysis. A daytime sample of urine lacks in acidic composition and could possibly lead to false negative results. A late night sample and a randomly collected sample lack in acidic composition; these too can possibly lead to false negative results.
Which organism is most likely to cause infectious cystitis? Proteus species Escherichia coli Candida species Klebsiella pneumoniae
Escherichia coli Infectious cystitis is an inflammatory disease that is caused by pathogens from the bowel or the vagina. About 90% of UTIs are caused by Escherichia coli (E. coli). Proteus and Candida species and Klebsiella pneumonia also can cause cystitis but are not as likely to as are E. coli.
What is the primary cause of high blood pressure resulting from trauma and injury to the kidney? Hypertension may result from a blood clot caused by the injury. Hypertension may result from too much fluid being administered. Hypertension may result from a decrease in the level of antidiuretic hormone. Hypertension may result from the activation of the renin-angiotensin-aldosterone system.
Hypertension may result from the activation of the renin-angiotensin-aldosterone system. Traumatic kidney injury can also cause hypertension from changes in perfusion and activation of the renin-angiotensin-aldosterone system. While hypertension may result from a blood clot or fluid overload, these are not the primary causes of hypertension associated with trauma to the kidney. Hypertension typically occurs with an increased, not decreased, level of antidiuretic hormone and is not associated with trauma to the kidney.
A nurse teaching self-management skills to a patient with a history of urinary tract infections finds that the patient's symptoms are alleviated at the follow-up visit. Which actions are responsible for the improvement? Select all that apply. Increasing fluid intake Drinking cranberry juice Avoiding use of douches Taking bubble baths regularly Avoiding use of topical estrogens
Increasing fluid intake Drinking cranberry juice Avoiding use of douches Increasing fluid intake will help to flush bacteria and reduces the risk of bacterial infection. Cranberry juice decreases the ability of bacteria to adhere to the epithelial cells lining of the urinary tract and reduces the risk of urinary tract infection. Avoiding the use of douches prevents irritation and reduces the risk of urinary tract infection. Taking bubble baths increases the risk of urinary tract infection. Applying topical estrogen to the perineal area normalizes vaginal flora and reduces risk of urinary tract infection.
When taking the health history of a patient with acute glomerulonephritis, the nurse questions the patient about which related cause of the problem? Hypertension Neoplastic disease Unexplained weight loss Recent respiratory infection
Recent respiratory infection An infection often occurs before the kidney manifestations of acute glomerulonephritis (GN). The onset of symptoms is about 10 days from the time of infection. Hypertension is a result of glomerulonephritis, not a cause. Weight gain, not weight loss, is symptomatic of fluid retention in GN. Neoplastic disease is not part of the cause of GN.
A patient is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? "Why are you hesitant?" "Don't worry, no one else will know." "Take your time. What is bothering you the most?" "You need to tell me so we can determine what is wrong."
"Take your time. What is bothering you the most?" Asking the patient what is bothering him or her expresses patience and understanding when trying to identify the patient's problem. Telling the patient that others will not know is untrue because the patient's symptoms will be in the medical record for other health care personnel to see. Asking why the patient is hesitant can seem accusatory and threatening to the patient. Admonishing the patient to disclose his or her symptoms is too demanding; the nurse must be more understanding of the patient's embarrassment.
A nurse is providing discharge instructions to a patient who was admitted and treated for a kidney injury sustained from a fall off of a ladder. What statements will the nurse include in the teaching? Select all that apply. "Report any discomfort to the health care provider immediately." "Urine leakage is a common complication that may occur after this type of injury." "Report any cloudy, foul-smelling urine to the health care provider immediately." "Delayed bleeding is a common complication that may occur after this type of injury." "Increased body temperature is a common complication that may occur after this type of injury."
"Urine leakage is a common complication that may occur after this type of injury." "Report any cloudy, foul-smelling urine to the health care provider immediately." "Delayed bleeding is a common complication that may occur after this type of injury." "Increased body temperature is a common complication that may occur after this type of injury." The nurse should teach the patient to report any cloudy, foul-smelling urine to the health care provider immediately because this may be a sign of infection. The nurse will tell the patient that urine leakage and delayed bleeding are common complications that may occur after a kidney trauma. The patient will have some discomfort and reporting any discomfort to the health care provider is not necessary. Increased body temperature indicates a fever, which is a sign of systemic infection. The nurse will not teach the patient that increased body temperature is a common complication of kidney trauma.
A nurse provides health screening for a community health center with a large population of African- American clients. Which priority assessment should the nurse include when working with this population? a. Measure height and weight. b. Assess blood pressure. c. Observe for any signs of abuse. d. Ask about medications.
ANS: B All interventions are important for the visiting nurse to accomplish. However, African Americans have a high rate of hypertension leading to end-stage renal disease. Each encounter that the nurse has with an African- American client provides a chance to detect hypertension and treat it. If the client is already on antihypertensive medication, assessing blood pressure monitors therapy.
An emergency department nurse assesses a client with kidney trauma and notes that the clients abdomen is tender and distended and blood is visible at the urinary meatus. Which prescription should the nurse consult the provider about before implementation? a. Assessing vital signs every 15 minutes b. Inserting an indwelling urinary catheter c. Administering intravenous fluids at 125 mL/hr d. Typing and crossmatching for blood products
ANS: B Clients with blood at the urinary meatus should not have a urinary catheter inserted via the urethra before additional diagnostic studies are done. The urethra could be torn. The nurse should question the provider about the need for a catheter; if one is needed, the provider can insert a suprapubic catheter. The nurse should monitor the clients vital signs closely, send blood for type and crossmatch in case the client needs blood products, and administer intravenous fluids.
A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.) a. Clear drainage b. Bloody drainage at site c. Client reports headache d. Foul-smelling drainage e. Urine draining from site
ANS: B, D, E After a nephrostomy, the nurse should assess the client for complications and urgently notify the provider if drainage decreases or stops, drainage is cloudy or foul-smelling, the nephrostomy sites leaks blood or urine, or the client has back pain. Clear drainage is normal. A headache would be an unrelated findi...
A nurse cares for a client who has pyelonephritis. The client states, I am embarrassed to talk about my symptoms. How should the nurse respond? a. I am a professional. Your symptoms will be kept in confidence. b. I understand. Elimination is a private topic and shouldnt be discussed. c. Take your time. It is okay to use words that are familiar to you. d. You seem anxious. Would you like a nurse of the same gender to care for you?
ANS: C Clients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse should encourage the client to use language that is familiar to the client. The nurse should not make promises that cannot be kept, like keeping the clients symptoms confidential. The nurse must assess the client and cannot take the time to stop the discussion or find another nurse to complete the assessment.
A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, What can I do to help prevent these infections? How should the nurse respond? a. Test your urine daily for the presence of ketone bodies and proteins. b. Use tampons rather than sanitary napkins during your menstrual period. c. Drink more water and empty your bladder more frequently during the day. d. Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled.
ANS: C Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the clients sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1c of 9% is too high.
A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma. Which statement should the nurse include in this clients teaching? a. Since you only have one kidney, a salt and fluid restriction is required. b. Your therapy will include hemodialysis while you recover. c. Medication will be prescribed to control your high blood pressure. d. You need to avoid participating in contact sports like football.
ANS: D Clients with one kidney need to avoid contact sports because the kidneys are easily injured. The client will not be required to restrict salt and fluids, end up on dialysis, or have new hypertension because of the nephrectomy.
The nurse receives a report on a patient with hydronephrosis. Which laboratory study does the nurse monitor? Lipid levels White blood cell (WBC) count Hemoglobin and hematocrit (H&H) Blood urea nitrogen (BUN) and creatinine
Blood urea nitrogen (BUN) and creatinine Blood urea nitrogen (BUN) and creatinine are kidney function tests. With back pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction; Hemoglobin and hematocrit (H&H) monitors for anemia and blood loss, while WBC count indicates infection. Elevated lipid levels are associated with nephrotic syndrome, not with obstruction and hydronephrosis.
A patient in the hospital has an indwelling catheter. What intervention does the nurse perform to prevent catheter-related infection? Avoid the use of coated catheters. Clean the perineum with antibiotic ointment. Apply clean technique when inserting the catheter. Ensure the urine collection bag is below bladder level
Ensure the urine collection bag is below bladder level. The urine collection bag should be kept below bladder level at all times; elevating it above bladder level causes reflux of pathogens from the bag into the urinary tract. The nurse should apply strict sterile technique when inserting the catheter; otherwise, pathogens can be introduced into the urinary tract. The perineum and the proximal end of the catheter should be washed with soap and water, and then dried gently while providing daily catheter care. Using antibiotic ointment has not been proven to have any beneficial effect. Coated catheters must be considered for patients who may require catheterization for 3 to 5 days. The coating reduces bacterial colonization on the catheter.
A hospitalized patient is 12 hours post nephrostomy. Which clinical manifestations should be assessed for monitoring the complication-like infection? Select all that apply. Fever Onset of back pain Change in urine character Presence of red-tinged urine in collecting bag Leaking of urine or blood from site of nephrostomy
Fever Change in urine character The incidence of fever and change in the urine character should be assessed by the nurse because these are the clinical manifestations of complication-like infection. Onset of back pain, a decrease in flow or complete stoppage of urine outflow, and leaking of urine or blood from the nephrostomy site are indicative of obstruction of the nephrostomy tube. Such incidences should be immediately reported to the primary healthcare provider. If the amount of urine drainage decreases and the patient has back pain, the tube may be clogged; back pain is not indicative of infection occurrence. The presence of red-tinged urine is obvious in the first 12 to 24 hours after the nephrostomy, and the urine gradually gets cleared after 24 hours. Leakage of the urine or blood from site of the nephrostomy is not indicative of infection.
The nurse in the urology clinic is providing teaching for a female patient with cystitis. Which instructions does the nurse include in the teaching plan? Select all that apply. If urine remains cloudy, call the clinic. Try to take in 64 ounces of fluid each day. Be sure to complete the full course of antibiotics. Expect some flank discomfort until the antibiotic has worked. Cleanse the perineum from back to front after using the bathroom.
If urine remains cloudy, call the clinic. Try to take in 64 ounces of fluid each day. Be sure to complete the full course of antibiotics. Between 64 and 100 ounces (2-3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the patient should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney.
The nurse is teaching a patient with polycystic kidney disease about controlling hypertension. Which instruction would be helpful in slowing the progression of kidney dysfunction? Increase intake of dietary fiber Follow a sodium-restricted diet Monitor the serum creatinine levels Increase the daily fluid intake up to 2 liters/day
Increase the daily fluid intake up to 2 liters/day Most patients with polycystic kidney disease present with hypertension which results in the impairment of renal functions. Adequate hydration is essential to preserve the kidney functions and to impede progression of disease; hence the patient must be educated to increase the daily fluid intake up to 2 liters/day. Monitoring serum creatinine level has no role in controlling hypertension, and it helps identify the event of nephrotoxicity due to antibiotics. A sodium-restricted diet is not recommended as it may lead to salt wasting. Eating a high fiber diet will only help ease the symptoms of constipation.
A patient with hydronephrosis is scheduled for a nephrostomy. What diagnostic test is most important for this patient before the procedure? Serum creatinine Renal echography Blood urea nitrogen (BUN) International normalized ratio (INR)
International normalized ratio (INR) International normalized ratio (INR) is the most important diagnostic test for this patient because clotting studies such as INR, prothrombin time (PT), and partial thromboplastin time (PTT) should be normal or corrected before the procedure to prevent the risk for bleeding. Renal echography helps identify the urinary outflow obstruction. Elevated values of serum creatinine and BUN are expected in this condition.
The renal echography for a patient indicates hydronephrosis. What does the nurse tell the patient about this condition? The ureter dilates above the obstruction. It is caused by an obstruction in the renal pelvis. The bladder dilates following urethral obstruction. It is caused by an obstruction in the lower part of the ureter.
It is caused by an obstruction in the renal pelvis. In hydronephrosis, the kidney enlarges as urine collects in the renal pelvis and kidney tissue. This occurs following an obstruction in the pelvis or at the point where the ureter joins the renal pelvis. Hydroureter or enlargement of the ureter is caused by an obstruction in the lower part of the ureter. The ureter dilates above this obstruction. The bladder dilates following urethral obstruction. In patients with a urethral stricture, the obstruction is very low in the urinary tract, causing bladder distention before hydroureter and hydronephrosis.
In what location would the nurse expect to find infection in a patient with acute pyelonephritis? Urethra Kidneys Prostate gland Urinary bladder
Kidneys Acute pyelonephritis is a kidney infection. Urinary tract infections are described by their location in the tract. Urethritis is an acute infection in the urethra, cystitis is an infection in the bladder, and prostatitis is an infection in the prostate gland.
The nurse is reviewing the laboratory results of a patient with altered kidney function. What laboratory findings suggest the onset of nephrotic syndrome? Select all that apply. Lipiduria Severe proteinuria Decreased coagulation Increased serum lipid level Increased serum albumin level
Lipiduria Severe proteinuria Increased serum lipid level The key feature of nephrotic syndrome is severe proteinuria (more than 3.5 g of protein in 24 hours). Patients may also have high serum lipid levels and fats in the urine (lipiduria) because of changes in liver function. In nephrotic syndrome, more protein is lost in the urine because of increased glomerular membrane permeability. This leads to a decrease in serum albumin levels. The patient also presents with increased coagulation because of altered liver function.
Where is the obstruction located in the kidney for a patient diagnosed with a hydroureter? Throughout the ureter Upper part of the ureter Lower part of the ureter The ureter is not obstructed; it is dilated.
Lower part of the ureter The obstruction is located in the lower part of the ureter in a patient diagnosed with a hydroureter. With hydroureter, the obstruction is not throughout the ureter. For a diagnosis of hydronephrosis, the obstruction is located in the upper part of the ureter. The ureter is not dilated with hydroureter.
Which goal for a patient with diabetes mellitus will best help prevent diabetic nephropathy? Maintaining HbA 1C at 7% or less Emptying the bladder regularly Avoiding carbohydrates in the diet Taking insulin at the same time every day
Maintaining HbA 1C at 7% or less Long-term control of blood glucose will help prevent the progression of diabetic nephropathy. Maintaining HbA 1C levels at or below 7% accomplishes this goal. Voiding when the patient has the urge prevents the backflow of urine and infection, but does not prevent diabetic nephropathy. The diabetic diet is composed of carbohydrates, proteins, and fats. Avoidance of carbohydrates is not recommended and will not prevent diabetic nephropathy. Although taking insulin at the same time each day may indirectly help control blood glucose, it does not directly prevent diabetic nephropathy, so is not the best goal.
Which signs of uremia would the nurse expect to find when assessing a patient with glomerulonephritis? Select all that apply. Nausea Vomiting Anorexia Hypotension Hypothermia
Nausea Vomiting Anorexia Uremia is the buildup of nitrogenous waste products in the bloodstream due to poorly functioning kidneys. The symptoms include nausea, vomiting, and anorexia. The patient would be hypertensive from fluid volume buildup. Due to the immune response, the patient would have a fever, not hypothermia.
What treatment is preferred for a kidney trauma patient with a grade 5 injury? Drug therapy Fluid therapy Nephrectomy Angiographic embolization
Nephrectomy An avulsion of renal blood vessels and a completely shattered kidney are observed in a grade 5 kidney injury. A nephrectomy is the appropriate treatment. Drug therapy, fluid therapy, and angiographic embolization are not preferred to treat a grade 5 kidney trauma.
What are the key features of acute pyelonephritis? Select all that apply. Nocturia Flank pain Hypertension Abdominal discomfort Decreased ability to concentrate urine
Nocturia Flank pain Abdominal discomfort The key features of acute pyelonephritis include nocturia, flank pain, and abdominal discomfort. Hypertension and the decreased ability to concentrate urine occur with chronic pyelonephritis.
Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized patients? Encouraging them to drink fluids Irrigating all catheters daily with sterile saline Recommending that catheters be placed in all patients Periodically reevaluating the need for indwelling catheters
Periodically reevaluating the need for indwelling catheters Studies have shown that reevaluating the need for indwelling catheters in patients is the most effective way to prevent UTIs in the hospital setting. Encouraging fluids, although it is a valuable practice for patients with catheters, will not necessarily prevent the occurrence of UTIs in the hospital setting. In some patients, their conditions do not permit an increase in fluids, such as those with congestive heart failure and kidney failure. Irrigating catheters daily is contraindicated; any time a closed system is opened, bacteria may be introduced. Placing catheters in all patients is unnecessary and unrealistic. This practice would place more patients at risk for the development of UTIs.
A female patient presents to the clinic with complaints of "burning when urinating." What findings does the nurse anticipate when assessing the perineal area? Vaginal discharge Pink urethral meatus Inflamed labial tissue Ulcerations around the urethral meatus
Pink urethral meatus The nurse can anticipate finding a pink urethral meatus. A urinary tract infection does not change the color of the meatus. To help differentiate between a vaginal and a urinary tract infection, the assessment of the urethral meatus and vaginal opening should be performed. Vaginal discharge, inflamed labial tissue, and ulcerations around the urethral meatus are not related to urinary tract infections.
Which nursing activity illustrates proper aseptic technique during catheter care? Irrigating the catheter daily Sending a urine specimen to the laboratory for testing Positioning the collection bag below the height of the bladder Applying Betadine ointment to the perineal area after catheterization
Positioning the collection bag below the height of the bladder Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract. Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized patients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation should be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.
Which complication does the nurse monitor for in a pregnant patient who is diagnosed with cystitis? Preterm labor Stone formation Gestational diabetes Orthostatic hypotension
Preterm labor Cystitis is associated with a risk of acute pyelonephritis during pregnancy, which can increase the risk of preterm labor. Hyperuricemia condition increases the risk of stone formation. Cystitis does not cause gestational diabetes. The patient who is receiving amitriptyline treatment has a higher risk of orthostatic hypotension.
The nurse is assessing a patient with frequency-dysuria syndrome whose culture test reveals the presence of Chlamydia. Which finding may provide further evidence for the diagnosis? Pyuria Oliguria Cystocele Hematuria
Pyuria Urethritis is an inflammation of the urethra and is also referred to as frequency-dysuria syndrome. Chlamydia is a sexually transmitted gram-negative bacterium that may lead to urethritis. Urinalysis may show pyuria due to infection. Oliguria is a clinical manifestation of urolithiasis due to obstruction of urinary flow in the urinary tract by calculi. Cystocele or herniation of the bladder into the vagina is observed in patients with urinary inconsistency. A patient with cystitis may have hematuria or presence of blood in the urine due to severe infection.
Which staff member should care for a newly admitted patient who is diabetic, has pyelonephritis and prescriptions for intravenous antibiotics, and who needs blood glucose monitoring every 2 hours and insulin administration? RN who is caring for a patient who just returned after having renal artery balloon angioplasty RN who has just completed preoperative teaching for a patient who is scheduled for nephrectomy RN who is currently admitting a patient with acute hypertension and possible renal artery stenosis RN whose other assignments include a patient receiving chemotherapy for renal cell carcinoma
RN who has just completed preoperative teaching for a patient who is scheduled for nephrectomy The patient scheduled for nephrectomy is the most stable patient; the RN caring for this patient will have time to perform the frequent monitoring and interventions that are needed for the newly admitted patient. The patient receiving chemotherapy will require frequent monitoring by the RN. The patient after angioplasty will require frequent vital sign assessment and observation for hemorrhage and arterial occlusion. The patient with acute hypertension will need frequent monitoring and medication administration.
A patient who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this patient? Refers the patient to the clinic nurse practitioner (CNP) for immediate follow-up Discharges the patient to her home for strict bedrest for the duration of the pregnancy Instructs the patient to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria Recommends that the patient refrain from having sexual intercourse until after she has delivered her baby
Refers the patient to the clinic nurse practitioner (CNP) for immediate follow-up Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus. It is unsafe for the patient to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the patient's problem. The patient's symptoms need follow-up with a health care provider.
Which antibiotic for treating cystitis may cause side effects of sunburn and skin darkening? Amoxicillin Fosfomycin Cefpodoxime Sulfamethoxazole
Sulfamethoxazole Sulfonamides such as sulfamethoxazole are drugs that cause photosensitivity and increased skin irritation and pigmentation. They may also lead to sunburn upon exposure to the sun. Amoxicillin may reduce bacteria in the urinary tract by interrupting bacterial cell wall synthesis. It may reduce the gastric flora leading to diarrhea. Fosfomycin reduces the incidence of cystitis but has side effects of dizziness and vaginal itching. Cefpodoxime is a cephalosporin that is likely to lead to rashes in a patient with allergies to penicillin.
The nurse assesses a patient who has undergone nephrostomy and determines that the patient's drainage tube has become dislodged. What finding supports the nurse's conclusion? Drainage increases. The drainage is clear. The patient reports increased back pain. Red-tinged urine for the first hour following the patient's surgery.
The patient reports increased back pain. A patient whose nephrostomy tube has been dislodged will experience an increase in back pain. Clear drainage indicates that the patient does not have an infection. A patient with a dislodged tube will have a gradual decrease in drainage. An increase in drainage is a normal finding. The presence of red-tinged urine is a normal finding in a patient who has undergone nephrostomy.
Which sign or symptom when assessed in a patient with chronic glomerulonephritis (GN) warrants a call to the health care provider? Itchy skin Mild proteinuria Third heart sound (S 3) Serum potassium of 5.0 mEq/L
Third heart sound (S 3) S 3 indicates fluid overload secondary to failing kidneys; therefore, the provider should be notified and instructions obtained. Mild proteinuria is an expected finding in glomerulonephritis (GN). A serum potassium of 5.0 mEq/L reflects a normal value; intervention would be needed for hyperkalemia. Although itchy skin may be present as kidney function declines, it is not a priority over fluid excess.
Which diagnostic test would be instrumental in diagnosing a patient with a suspected urinary tract infection (UTI) if the laboratory report shows pyuria and the presence of 24 epithelial cells/high power field (hpf)? Urinalysis Cystoscopy Pelvic ultrasound Retrograde pyelography
Urinalysis Pyuria is indicated by the presence of 100,000 colonies/mL bacteria or the presence of three or more white blood cells. The presence of more than 20 epithelial cells/hpf suggests contamination. Urinalysis is used to identify the microscopic bacteria, total number of red blood cells, and white blood cells in the urine. Cystoscopy is used to accurately diagnose interstitial cystitis. Pelvic ultrasound is used to locate a site of obstruction. Retrograde pyelography is used to show outlines and images of the drainage tract.
The nurse is caring for an older adult who is experiencing increased mental confusion and worsening incontinence. The laboratory results reveal an elevated white blood cell count with a shift to the left. Based on the clinical findings, what does the nurse suspect? Cystitis Urosepsis Pyelonephritis Urinary tract infection
Urosepsis Based on these clinical findings, the most likely infectious process is urosepsis. A left shift most often occurs with urosepsis and rarely occurs with cystitis. Cystitis is an uncomplicated and localized infection. Pyelonephritis is an ascending urinary tract infection that has reached the pelvis of the kidney. Bacteria from the urinary tract system enters the bloodstream and is the cause of urosepsis. A urinary tract infection is confined to the urinary tract with findings of pyuria and hematuria.
A patient with a history of diabetes mellitus and cataracts is diagnosed with pyelonephritis. What does the nurse identify as the possible cause of pyelonephritis in the patient? Use of antibiotics Use of antihypertensive drugs Use of oral hypoglycemic drugs Use of nonsteroidal anti-inflammatory drugs
Use of nonsteroidal anti-inflammatory drugs Prolonged and extensive use of nonsteroidal anti-inflammatory drugs may lead to necrosis and reflux of urine, resulting in pyelonephritis. Use of antibiotics and oral hypoglycemic drugs do not lead to pyelonephritis. Antihypertensive drugs are used to lower blood pressure levels in patients with kidney disease; they are not associated with pyelonephritis.
A 55-year-old patient who presents to the primary care clinic with a sudden onset of hypertension tells the nurse, "I don't understand why I would have high blood pressure. No one in my family has high blood pressure." What teaching will the nurse most likely provide to the patient? Instructions on decreasing overall daily stress Instructions on increasing overall daily fluid intake Ways to decrease the development and progression of atherosclerosis Ways to decrease the development and progression of chronic kidney infection
Ways to decrease the development and progression of atherosclerosis The patient most likely has renovascular disease, a condition that results from narrowing of the renal arteries due to atherosclerosis, which is the buildup of plaque on the vessels (including the renal vessels). The most likely teaching the nurse will provide is teaching the patient about ways to decrease the development and progression of atherosclerosis. While teaching about stress reduction, fluid management, and methods to decrease kidney infection are appropriate nursing interventions, these are not appropriate to the teaching of a patient with nephrosclerosis.
