PrepU GU Quiz

Which client is at highest risk for developing a hospital-acquired infection?

A client with an indwelling urinary catheter The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?

Acute glomerulonephritis

After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first?

Assess peripheral pulses in the left leg. The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight after the procedure. Calf pain isn't a symptom of anaphylaxis.

The client is admitted to the hospital with a diagnosis of acute glomerulonephritis. Which clinical manifestation would the nurse expect to find?

Cola-colored urine Clinical manifestations of acute glomerulonephritis include cola-colored urine, hematuria, edema, azotemia, and proteinuria.

A pediatric nurse is providing care for a 7-year-old boy who has been diagnosed with glomerulonephritis. In addition to monitoring this child's blood work closely, what other assessment should prioritized in order to gauge the progression of his disease?

Daily weights The most accurate indicator of fluid loss or gain in an acutely ill patient with renal disease is weight, as accurate intake and output and assessment of insensible losses may be difficult. Daily weights would thus be prioritized over respiratory auscultation and apical heart rate, although each should be conducted because of their relevance to the complications of glomerulonephritis. Assessment of skin turgor is not an accurate indicator of fluid balance.

The nurse is caring for a client who had transurethral resection of the prostate (TURP) 1 day ago. Which assessment finding(s) does the nurse expect? Select all that apply.

Large amounts of amber-colored urine in the drainage bag Reports of the urge to void from the client Drainage tube secured to the inner thigh Irrigation fluids will increase the amount of fluid in the drainage bag. A change in color from pink to amber indicates reduced bleeding. To prevent traction on the bladder, the drainage tube (not the catheter) is secured to the inner thigh. The nurse explains that the urge to void results from the presence of the catheter and from bladder spasms. Rounded swelling above the pubis is a manifestation of an over distended bladder. Increasing pulse rate and diaphoresis are signs of distress and need to be reported.

The nurse is caring for a patient who had a transurethral resection of the prostate (TURP). The health care provider has ordered continuous bladder irrigation, and the patient is now around 20 hours postoperative. During the nurse's shift assessment, what color urine would the nurse expect to find in the drainage bag?

Light pink The urine drainage following a TURP usually begins as a reddish pink and then clears to a light pink 24 hours after surgery.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?

Location of discomfort The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

A patient is recovering in the PACU following a transurethral resection of the prostate (TURP). The patient is receiving continuous bladder irrigation (CBI), and the nurse has observed several clots in the collection bag and tubing. In the last few minutes, output has ceased despite the continued infusion of normal saline through the patient's triple-lumen urinary catheter. How should the nurse respond to this assessment finding?

Manually irrigate the patient's catheter with normal saline. The nurse monitors the CBI drainage tubing and irrigates the system as prescribed to relieve any obstruction that may cause discomfort. Usually, if clots impede urinary drainage, the catheter is irrigated with 50 to 60 mL of irrigating fluid at a time. It would be inappropriate to remove the catheter, and it would be ineffective to slow the infusion or reposition the patient.

The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply.

Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care. In institutionalized older patients, such as those in long-term care facilities, infecting pathogens are often resistant to many antibiotics. Diligent hand hygiene, careful perineal care, and frequent toileting may decrease the incidence of UTIs.

The nurse is caring for several older clients. For which client would the nurse be especially alert for signs and symptoms of pyelonephritis?

A client with urinary obstruction The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high risk for developing pyelonephritis.

A female client is undergoing a bladder training program as treatment for urinary incontinence. Which technique would be the most appropriate for the nurse to suggest?

Performing Kegel exercises Instructing the client on Kegel exercises will help the client achieve continence. These exercises improve muscle tone and voluntary control. Reducing fluids will not change continence or aid in muscle strength. Holding the urine until the sensation is felt will not aid in muscle strength. Warm sitz baths may be suggested to a client in the event of urethra inflammation.

Which condition or laboratory result supports a diagnosis of pyelonephritis?

Pyuria Pyelonephritis is diagnosed by the presence of pyuria, leukocytosis, hematuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Myoglobinuria is seen with any disease process that destroys muscle. Ketonuria indicates a diabetic state. Because the client with pyelonephritis typically has signs of infection, the WBC count is more likely to be high rather than low.

A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?

Recent history of streptococcal infection Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client's risk for chronic pyelonephritis.

After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?

The client reports bladder spasms and the urge to void. Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.

The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern?

New diagnosis of urosepsis All of the options are typical risk factors for a client with a cystoscopy tube. The most concerning risk factor is of urosepsis, which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream.