ENO 3.0: Renal & GU

Which sexually transmitted infection is caused by bacteria and develops as a small bump in the genitals? A. Chancroid B. Herpes simplex C. Trichomoniasis D. Gonorrhea

A A chancroid is a bacterial disease that is spread only through sexual contact. Within 1 day to 2 weeks after exposure, the infected individual develops a small bump in the genitals. Herpes simplex is a viral infection that causes blisters or ulcers mainly in the mouth or genital area. Trichomoniasis results from an infection with the protozoan Trichomonas vaginalis. Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and in the urethra in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.

Which condition may cause urine retention? A. Spinal cord injury B. Pregnancy C. Acute pancreatitis D. Urinary tract infection

A A spinal cord injury or disease can interfere with the micturition reflex. Pregnancy, acute pancreatitis, and urinary tract infection do not typically cause urine retention.

Which substance is the most common component of renal calculi? A. Calcium oxalate B. Struvite C. Uric acid D. Cystine

A About 75 percent of renal calculi are calcium combined with oxalate or phosphate. The remaining 25 percent are composed of struvite, which is associated with infection, or uric acid, which is associated with gout. Calculi rarely contain cystine.

In a patient with acute kidney injury, which electrolyte imbalance is expected? A. Hypocalcemia B. Hypernatremia C. Hypophosphatemia D. Hypermagnesemia

A Calcium and magnesium are directly related to each other, so a patient with hypocalcemia is likely to have hypomagnesemia.

Which disorder is a prerenal cause of acute kidney injury? A. Diabetes mellitus B. Sepsis C. Hypertension D. Renal calculi

B Prerenal causes of acute kidney injury are precipitated by decreased blood flow to the kidneys, leading to ischemia in the nephrons and prolonged hypoperfusion of the kidneys, which can lead to acute tubular necrosis. Disorders that decrease blood flow to the kidneys include sepsis, hypovolemic shock, heart failure, pulmonary embolism, anaphylaxis, and obstruction of the renal vascular system. Diabetes mellitus and hypertension are intrarenal causes of acute kidney injury. Renal calculi are postrenal causes of acute kidney injury.

Which bacteria is the primary organism that causes urinary tract infections? A. Escherichia coli B. Chlamydia trachomatis C. Neisseria gonorrhoeae D. Staphylococcus aureus

A Most urinary tract infections result from contamination with Escherichia coli. Chlamydia trachomatis or Neisseria gonorrhoeae should be considered with infections of the urethra and reproductive system that present with pyuria and have a negative culture on standard media. Staphylococcus aureus can occasionally cause prostatitis.

The nurse should teach a patient with which disorder not to wear tight clothing or synthetic underwear? A. Urethritis B. Pyelonephritis C. Epididymitis D. Interstitial cystitis

A Patient education about behaviors to prevent urethritis should include not wearing tight clothing or synthetic underwear, wiping from front to back after defecation, not resisting the urge to void, increasing oral fluids, and avoiding carbonated beverages, coffee, and alcohol. Patient teaching related to pyelonephritis should include instructions about sexual intercourse and the use of spermicides. Education related to epididymitis should include instructions about sexual intercourse and the use of condoms. Education related to interstitial cystitis should include measures such as dietary restrictions, smoking cessation, bladder training, and follow-up with a specialist.

Which patient should have priority for room placement and evaluation? A. A man, age 30, with signs and symptoms of testicular torsion B. A woman, age 49, with findings that suggest renal calculi C. A man, age 52, with manifestations of priapism D. A woman, age 28, with signs and symptoms of pyelonephritis

A Testicular torsion causes vascular compromise of the testes within 4 to 6 hours and can lead to infarction with a resultant atrophy and loss of spermiogenesis. Testicular torsion is a true surgical emergency. Testicular salvage depends on the time to detorsion. A patient with suspected testicular torsion should be assigned a high triage acuity level. Patients with renal calculi and priapism may receive a high priority because of pain, but a patient with testicular torsion takes the priority. A patient with pyelonephritis may have a fever and acute pain, but a patient with testicular torsion should be brought to an examination room first.

For a patient with nonoliguric acute kidney injury, which treatment is indicated? A. Volume replacement B. Furosemide (Lasix) C. Hemodialysis D. Acetylcysteine (Mucomyst)

A With nonoliguric acute kidney injury, the patient can lose a large volume of fluid and can become dehydrated and hypotensive. Volume replacement with normal saline solution or volume expanders is indicated. For a patient with acute kidney injury and oliguria, the patient may have volume overload and hypertension, so minimal fluid is given until diuretics, such as furosemide (Lasix), or hemodialysis can remove the excess volume. Acetylcysteine (Mucomyst) and sodium bicarbonate infusion can be administered to a patient with acute kidney injury when computed tomography with contrast is needed to minimize the toxic renal effects.

Medications from which drug class can cause priapism? A. Adrenergic agents B. Calcium channel blockers C. Aminoglycosides D. Spermicides

B Priapism is a persistent, painful erection that is not associated with sexual desire. It may result from sickle cell crisis, spinal cord injury, leukemia, and medications, such as calcium channel blockers, erectile dysfunction medications, phenothiazines, and illicit drugs. Adrenergic agents may be used to treat priapism because they cause vasoconstriction. Aminoglycosides are an intrarenal cause of acute kidney injury, not priapism. Spermicides may cause pyelonephritis, but not priapism.

Which disorder is a complication of sexually transmitted infections? A. Testicular ischemia B. Endocarditis C. Impotence D. Rhabdomyolysis

B The complications of untreated sexually transmitted infections include endocarditis, arthralgias, meningitis, salpingitis, chronic pelvic inflammatory disease, severe proctitis, and sterility. Testicular ischemia is a complication of testicular torsion. Impotence is a complication of priapism. Rhabdomyolysis is associated with skeletal muscle destruction but not sexually transmitted infections.

Which diagnostic test has the highest sensitivity for detecting renal calculi? A. Kidneys, ureters, and bladder radiography B. Helical computed tomography C. Intravenous pyelography D. Ultrasonography E. Ultrasonography

B Helical computed tomography has a 96 percent to 98 percent sensitivity for renal calculi and is currently the gold standard test for diagnosis. Kidneys, ureters, and bladder radiography, intravenous pyelography, and ultrasonography can also be used but do not have the same level of sensitivity in identifying renal calculi.

Which sexually transmitted infection produces epididymitis in men and pelvic inflammatory disease in women? A. Trichomoniasis B. Chancroid C. Chlamydia infection D. Syphilis

C A chlamydia infection can cause epididymitis in men, pelvic inflammatory disease in women, and urethritis with mucopurulent drainage in men and women. Trichomoniasis is a common sexually transmitted infection that affects women and men, although symptoms are more common in women and include a copious, thin, frothy discharge that is yellow, greenish, or gray and foul smelling; severe pruritus; and edema and redness of the vagina. Chancroid causes inguinal tenderness, lymphadenopathy, and dysuria. Syphilis does not produce epididymitis or pelvic inflammatory disease.

Elevation of the scrotum is likely to cause decreased pain in which disorder? A. Prostatitis B. Testicular torsion C. Epididymitis D. Renal colic

C Elevation of the scrotum to the level of the symphysis (Prehn's sign) decreases pain in patients with epididymitis. This maneuver increases pain in patients with testicular torsion. Scrotal elevation has no effect on patients with prostatitis or renal colic.

Which disorder involves the retrograde passage of infected urine? A. Urethritis B. Pyelonephritis C. Epididymitis D. Prostatitis

C Epididymitis is associated with the retrograde passage of infected urine from the prostatic urethra to the epididymis via the ejaculatory ducts and vas deferens. Urethritis is an inflammation of the urethra from any cause. Pyelonephritis commonly results from an Escherichia coli infection that ascends from the lower genitourinary tract. Prostatitis is an inflammation of the prostate gland, usually due to a bacterial infection.

For a patient with renal calculi, discharge instructions should include which dietary restriction? A. Carbonated beverages B. Blackberries C. Coffee D. Alcohol

C For a patient with renal calculi, dietary instructions should include the restriction of food and drinks that contain high levels of calcium oxalate, such as coffee, beets, chocolate, cola, nuts, rhubarb, spinach, strawberries, tea, and wheat bran. The nurse should instruct a patient with urethritis to avoid carbonated beverages, coffee, and alcohol. Blackberries may cause the urine to become dark or red but do not need to be restricted for a patient with renal calculi.

Which disorder is an intrarenal cause of acute kidney injury? A. Heart failure B. Pulmonary embolism C. Rhabdomyolysis D. Tumor

C Intrarenal causes of acute kidney injury are precipitated by actual tissue damage to the kidneys due to inflammatory or immunologic processes or prolonged hypoperfusion. Causes include an exposure to nephrotoxic agents (such as rhabdomyolysis, aminoglycosides, nonsteroidal anti-inflammatory agents, contrast dye, and crush injury), acute tubular necrosis, and diseases that damage the vascular or interstitial tissue (such as hypertension, diabetes mellitus, systemic lupus erythematosus, and infections). Heart failure and pulmonary embolism are prerenal causes of acute kidney injury. A tumor is a postrenal cause

Which statement correctly defines oliguria? A. Urine output is less than 100 mL in 24 hours. B. Glomerular filtration rate is 125 mL/minute. C. Urine output is less than 400 mL in 24 hours. D. Glomerular filtration rate is 180 L/day.

C Oliguria is defined as a urine output of less than 500 mL in 24 hours. Anuria is defined as a urine output of less than 100 mL in 24 hours. In average adults, the glomerular filtration rate normally is 125 mL/minute or 180 L/day.

Which disorder is more prevalent in patients with diabetes mellitus? A. Urethritis B. Epididymitis C. Pyelonephritis D. Interstitial cystitis

C Pyelonephritis is more prevalent in women and patients with diabetes mellitus. Urethritis, epididymitis, and interstitial cystitis are not commonly associated with diabetes mellitus. Patients with interstitial cystitis may have chronic pain syndrome diagnoses, such as irritable bowel syndrome or fibromyalgia.

Which disorder causes unbearable pain due to increased pressure and dilation of the kidney? A. Urine retention B. Azotemia C. Renal calculi D. Cystitis

C Renal calculi cause increased pressure and dilation of the kidney and urinary collecting system, resulting in sudden, unbearable pain. Urine retention can cause bladder distention and the feeling of pressure. In azotemia, the patient's blood contains abnormal levels of urea, creatinine, and other nitrogen-rich compounds. Azotemia typically results from insufficient blood filtering by the kidneys. Interstitial cystitis causes recurring discomfort or pain in the bladder and surrounding pelvic region.

The administration of azithromycin (Zithromax) is indicated for which sexually transmitted infection? A. Syphilis B. Gonorrhea C. Chlamydia infection D. Trichomoniasis

C The recommended treatment for chlamydia infection is azithromycin (Zithromax) or doxycycline (Vibramycin) administration. Treatment of syphilis calls for penicillin G benzathine (Bicillin LA). Gonnorhea is primarily treated with ceftriaxone (Rocephin). Metronidazole (Flagyl) is the recommended treatment for trichomoniasis.

Early-stream hematuria suggests an abnormality in which genitourinary structure? A. Bladder neck B. Upper genitourinary tract C. Kidneys D. Urethra

D Early-stream hematuria suggests bleeding from the urethra. Bleeding at the end of the stream suggests bladder neck or urethral bleeding. Hematuria throughout the stream indicates upper genitourinary tract bleeding, such as from the kidneys or ureters.

Which sexually transmitted infection causes pink-gray soft lesions with no discharge? A. Syphilis B. Chancroid C. Herpes simplex D. Human papillomavirus

D Human papillomavirus causes pink-gray, soft lesions that are singular or grouped. These lesions are tall and may bleed, but no discharge is associated with them. Syphilis begins with a papule that progresses to an indurated ulcer (chancre) that is painless and associated with lymphadenopathy but not discharge. Chancroid causes painful ulcers with a base that is covered with a grey or yellowish-grey material. No discharge occurs with this infection. The signs of herpes simplex include small painful vesicles on an erythematous base that may ulcerate and a purulent urethral discharge.

In a patient with acute kidney injury, which cardiac dysrhythmia is expected? A. Depressed ST segment B. Shortened QRS interval C. Inverted T waves D. Prolonged PR interval

D In acute kidney injury, electrolyte imbalances result from the kidneys' inability to excrete potassium. Severe hyperkalemia results in life-threatening cardiac dysrhythmias. Specific electrocardiogram changes associated with hyperkalemia include prolonged PR intervals, tall peaked T waves, and a widened QRS interval. A patient with hypokalemia may have depressed ST segments, inverted T waves, and U waves.

Which medication causes urine retention? A. Acetylcysteine (Mucomyst) B. Phenytoin (Dilantin) C. Sodium bicarbonate D. Diphenhydramine (Benadryl)

D Over-the-counter nasal decongestants that contain anticholinergics, such as diphenhydramine (Benadryl ) can cause urine retention. Phenytoin (Dilantin), sodium bicarbonate, and acetylcysteine (Mucomyst) do not produce urine retention. Acetylcysteine and sodium bicarbonate can be administered to a patient with acute kidney injury when a computed tomography with contrast is needed because they minimize the toxic renal effects. Phenytoin is a common cause of red or dark urine that is unrelated to hematuria. Sodium bicarbonate is an alkalizing agent and is used to treat rhabdomyolysis and hyperkalemia.

Which disorder is a postrenal cause of acute kidney injury? A. Systemic lupus erythematosus B. Anaphylaxis C. Contrast medium D. Prostatic hypertrophy

D Postrenal causes of acute kidney injury are precipitated by an obstruction in the urinary collecting system that impedes urine outflow. The causes include prostatic hypertrophy, renal calculi, tumors, strictures, or neurologic disorders that affect the emptying of the urinary system. Anaphylaxis is a prerenal cause of acute kidney injury. Systemic lupus erythematosus and contrast medium are intrarenal causes.

In a patient with acute kidney injury, which medication is used to improve cardiac conductivity? A. Glucose B. Sodium bicarbonate C. Sodium polystyrene sulfonate (Kayexalate) D. Calcium chloride

D The administration of intravenous calcium may be needed to antagonize the effects of hyperkalemia on the myocardial membranes and improve cardiac conductivity until emergency dialysis can remove the excess potassium. The infusion of glucose, sodium bicarbonate, and insulin redistributes extracellular potassium into the intracellular fluid. A cation exchange resin, such as sodium polystyrene sulfonate (Kayexalate), can be administered last for a patient with hyperkalemia. Glucose, sodium bicarbonate, and sodium polystyrene sulfonate (Kayexalate) do not affect the myocardium but disburse potassium.

Which laboratory test is the primary diagnostic indicator of rhabdomyolysis? A. Creatinine level B. Blood urea nitrogen level C. Aspartate aminotransferase level D. Serum creatine phosphokinase level

D The primary diagnostic indicator of rhabdomyolysis is a serum creatine phosphokinase level at least five times the normal value. This degree of elevation generally excludes myocardial infarction and other causes of an increased creatine phosphokinase level. Although the blood urea nitrogen, aspartate aminotransferase, and creatinine levels are elevated in rhabdomyolysis, they are not diagnostic of rhabdomyolysis.