Renal and Urologic Problems

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? "I can do this exercise in a sitting or lying position." "I can do quick two-second squeezes periodically." "I am doing it right when I release the muscle to urinate." "I can tighten the muscle for 10 seconds, relax, and repeat."

"I am doing it right when I release the muscle to urinate." 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. p. 1058

The nurse is teaching a patient with acute urinary retention strategies to minimize risk. After teaching, the nurse asks the patient to discuss what has been learned. Which statement made by the patient needs correction? "I should schedule toileting." "I should sit in a warm tub of water." "I should drink brewed caffeinated tea." "I should drink large volumes of fluid over a brief period."

"I should drink large volumes of fluid over a brief period." The patient with acute urinary retention should drink small amounts of fluids throughout the day rather than drinking large volumes of fluid over a brief period. This will help with urination. Scheduled toileting is preferred to reduce capacity of the bladder. Sitting in a warm tub of water will help the patient urinate. Drinking brewed caffeinated tea helps to maximize urinary urgency. p. 1060

The nurse is evaluating a caregiver after providing instructions on changing an ileal conduit appliance. Which statement made by the caregiver indicates effective learning? "I should wash the area with hot water." "I should keep the area damp around the stoma." "I should apply the bag vertically if the patient is in bed." "I should keep the drainage pouch on same side of the bed as the stoma."

"I should keep the drainage pouch on same side of the bed as the stoma." Ileal conduit is a urinary diversion procedure in which ureters are implanted into the part of the ileum or colon that has been resected from the intestinal tract and an abdominal stoma is created. The ureters anastomose into one end of the conduit, and the other end of the bowl is brought out through the abdominal wall to form a stoma. There is no valve and no voluntary control over the stoma; this causes drops of urine to flow from the stoma every few seconds. As a result, the drainage pouch should be attached on same side of the bed as the stoma. The area should be washed with warm water. The area around the stoma should be dry and the bag should lie towards the side of the body if the patient is in bed. p. 1066

The nurse is caring for a patient with a diagnosis of urinary tract calculi. Which statement by the patient indicates a need for further education? "I will most likely have pain upon urination." "I will likely have discomfort until the stone passes." "I will need to strain all urine until the stone has passed." "I will remain on bed rest to prevent the stone from moving."

"I will remain on bed rest to prevent the stone from moving." The patient should not be on bed rest, because the stone will likely not move unless the patient is up and mobile. This statement requires education. The patient will have pain upon urination, will likely have discomfort, and should strain all urine until the stone has passed. These statements are accurate and do not require further education. p. 1049

A patient has just been told that her bladder cancer has spread to her liver and lungs. She is crying and says, "I'm tired of being in constant pain. I just don't know that I can take any more of this. I can't continue to be a burden to my daughter who looks after me. Maybe it's time to give up, but I'm so scared. What have I done to deserve all of this suffering? Would you ever want to live like this?" What is the most appropriate and therapeutic response the nurse can make? "Should I call the clergy for you? It sounds like you want someone to talk to about all of this." "You have had high spirits, and you look like you're feeling alright. You probably still have a lot of time left." "I'm hearing you say that you feel helpless and afraid. Can you tell me more about how this makes you feel?" "I know that you're tired and upset, but you have to keep fighting for your daughter. She loves you so much."

"I'm hearing you say that you feel helpless and afraid. Can you tell me more about how this makes you feel?"

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? "A triple-lumen catheter is used for frequent irrigations." "The catheter is attached to the upper thigh in women." "The catheter should be replaced based on patient assessment." "If the bag is not reused immediately, wash it with soap and water."

"If the bag is not reused immediately, wash it with soap and water." 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. p. 1062

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

"Perform light exercises to prevent constipation." 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. p. 1059

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

"This is a normal occurrence." 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. p. 1065

What are the potential complications of pelvic surgery? Select all that apply. 1. Paralytic ileus 2. Thrombophlebitis 3. Periurethral abscess 4. Small bowel obstruction 5. Secondary stone formation

1. Paralytic ileus 2. Thrombophlebitis 4. Small bowel obstruction Pelvic surgery involves the removal of part of the bowel. It increases the risk of paralytic ileus, thrombophlebitis, and small bowel obstruction. Periurethral abscess is the complication of intermittent catheterization. Insertion of a nephrostomy tube is associated with secondary stone formation. p. 1065

Which are extrarenal causes of nephrotic syndrome? Select all that apply. 1. Amyloidosis 2. Scleroderma 3. Diabetes mellitus 4. Hodgkin's lymphoma 5. Infective endocarditis

1. Amyloidosis 3. Diabetes mellitus 4. Hodgkin's lymphoma Amyloidosis, diabetes mellitus, and Hodgkin's lymphoma are extrarenal causes of nephrotic syndrome. Scleroderma is characterized by widespread alterations of connective tissue and vascular lesions in many organs. Infective endocarditis results in glomerulonephritis rather than nephrotic syndrome. p. 1044

Nurses have a major role in prevention of urinary tract infections (UTIs). Which guidelines can help prevent hospital-acquired UTIs? Select all that apply. 1. Avoid unnecessary catheterization. 2. Perform intermittent catheterization every 4 hours. 3. Wash hands before and after contact with each patient. 4. Wash around catheter insertion site with betadine daily. 5. Perform routine and thorough perineal hygiene for all hospitalized patients.

1. Avoid unnecessary catheterization. 3. Wash hands before and after contact with each patient. 5. Perform routine and thorough perineal hygiene for all hospitalized patients. The patient should not be catheterized unless absolutely necessary. Hand hygiene is the primary method of preventing the spread of infection in the hospital setting. Routine perineal care daily with soap and water is evidence-based practice to prevent UTI. Betadine should not be applied to the catheter insertion site daily. Intermittent catheterization may be less likely to cause a UTI than an indwelling catheter, but any catheterization places the patient at risk for hospital-acquired UTIs. p. 1037

Which diagnostic studies are prescribed to determine loss of kidney function due to scarring caused by urinary tract catheterization? Select all that apply. 1. Biopsy 2. Urine sediment microscopy 3. Voiding cystourethrogram (VCUG) 4. Magnetic resonance imaging (MRI) 5. Computed tomography (CT) urogram

1. Biopsy 5. Computed tomography (CT) urogram The kidneys become small and atrophic, and lose function due to scarring in chronic pyelonephritis, which is commonly caused by urinary tract catheterization. Biopsy and CT urogram results indicate the loss of functioning of the nephrons, infiltration of the parenchyma with inflammatory cells, fibrosis, visualization of the kidney size, and tumors, as observed in chronic pyelonephritis. Urine sediment microscopy reveals erythrocytes in significant numbers. VCUG is used to confirm the diagnosis of urethral diverticula. MRI is used to determine the size of the diverticulum in relation to the urethral lumen. p. 1039

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. Chills 2. Fever 3. afebrile 4. Flank pain 5. Clear, yellow urine

1. Chills 2. Fever 3. Flank pain 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. p. 1034

When examining a patient with glomerulonephritis, which clinical manifestations is the nurse likely to find? Select all that apply. 1. Hypertension 2. Nausea and vomiting 3. Dysuria, fever, and chills 4. Generalized body edema 5. Hematuria and smoky urine

1. Hypertension 4. Generalized body edema 5. Hematuria and smoky urine filtration. Generalized body edema is observed due to fluid retention, which occurs as a result of decreased glomerular filtration; initially, periorbital edema is noted, but later it progresses to involve the total body as ascites or peripheral edema in the legs. Hematuria and smoky urine can be observed due to bleeding in the upper urinary tract. Nausea and vomiting are commonly caused by pain associated with urinary tract infections and calculi. Dysuria, fever, and chills are noted in urinary tract infections and calculi. p. 1041

A patient is suspected to have acute glomerulonephritis. The nurse is evaluating the causes and risk factors for glomerulonephritis in this patient. Which patient factors would the nurse anticipate contributed to acute glomerulonephritis? Select all that apply. 1. Hypertension 2. Chlamydial infection 3. Streptococcal throat infection 4. Human immunodeficiency virus (HIV) 5. Neurogenic hypersensitivity of the lower urinary tract

1. Hypertension 3. Streptococcal throat infection 4. Human immunodeficiency virus (HIV) Hypertension can cause scarring and nephrosclerosis, which can lead to glomerulonephritis. Streptococcal throat infection can lead to acute poststreptococcal glomerulonephritis (APSGN), which is a common type and develops 5 to 21 days after an infection of the tonsils or pharynx by nephrotoxic strains of group A β-hemolytic streptococci. Viruses, such as HIV, can trigger glomerulonephritis. Chlamydial infection causes urethritis, which is an inflammation of the urethra. Neurogenic hypersensitivity of the lower urinary tract is the cause of interstitial cystitis or painful bladder syndrome. p. 1042

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.

1. Irrigation must be done under strict aseptic precautions. 2. The catheter should not be kinked, compressed, or clamped. 4. Attention should be given to any complaints of excessive pain in the area. 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. p. 1062

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. Lidocaine 5. Dimethyl sulfoxide (DMSO) 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. p. 1041

The nurse is assessing the risk factors for urinary tract calculi in a group of patients. What are the factors that the nurse knows contribute to the development of urinary tract calculi? Select all that apply. 1. Low fluid intake 2. Diet low in calcium 3. Sedentary occupation 4. Excessive intake of tea 5. Adequate intake of dietary proteins

1. Low fluid intake 3. Sedentary occupation 4. Excessive intake of tea Low fluid intake increases urinary concentration and the chances of urinary tract calculi. A sedentary occupation can cause delayed urination and increased urinary stasis, which can lead to calculi. Excessive intake of tea can elevate urinary oxalate levels, which can cause oxalate renal stones. A diet low in calcium does not increase the risk of urinary calculi; instead, a high-calcium intake with lower fluid intake can predispose a woman to stone formation. Adequate intake of dietary proteins is recommended, but a large intake of dietary proteins can increase uric acid excretion and increases the risk of forming renal calculi. p. 1045

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. Low-protein diet 2. Low-sodium diet 3. Fluid-restricted diet 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. p. 1042

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

1. Measure urine pH. 3. Administer antimicrobial agents. 4. Take measures to acidify the urine. 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. p. 1046

The nurse is caring for a patient with a suprapubic catheter. Which interventions should the nurse perform to ensure patency of the tube? Select all that apply. 1. Milking the tube 2. Lubricating the catheter 3. Turning the patient side to side 4. Instilling 5 mL of sterile saline solution 5. Preventing tube kinking by coiling the excess tubing

1. Milking the tube 3. Turning the patient side to side 5. Preventing tube kinking by coiling the excess tubing A suprapubic catheter is prone to poor drainage, because of mechanical obstruction of the tip of the catheter by clots and sediments. Milking the tube will help to prevent tube obstruction. To ensure the proper functioning of the tube and to check whether the catheter is properly inserted, the patient should be turned side to side. Preventing tube kinking by coiling the excess tubing also prevents obstruction in the tube. Lubricating the catheter is not an appropriate intervention to ensure patency of the tube. Instilling 5 mL of sterile saline solution is performed in patients with a nephrostomy tube to prevent overdistention of the kidney pelvis. p, 1062

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

1. Monitor urinary output. 3. Help the patient to sit, if possible. 5. Change the patient's position every two hours. 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. p. 1049

The nurse is caring for a diabetic patient with acute kidney injury. Which interventions should the nurse perform? Select all that apply. 1. Observe and record accurate fluid intake and output. 2. Reposition the patient often. 3. Encourage adequate oral hydration. 4. Encourage good oral care. 5. Restrict dietary fat intake.

1. Observe and record accurate fluid intake and output. 2. Reposition the patient often. 4. Encourage good oral care. The nurse must observe and record accurate fluid intake and output when caring for a diabetic patient with acute kidney injury. The patient should be weighed on the same scale at the same time each day to detect excessive gains or losses of body fluid. The nurse should reposition the patient often to prevent pressure ulcers because the patient usually develops edema and decreased muscle tone. Mouth care is important to prevent stomatitis, which develops when ammonia in saliva irritates the mucous membranes. The patient is encouraged to take just enough fluid to maintain intake-output balance, because excess fluid intake can be harmful. Dietary fat intake is increased so that the patient receives at least 30% to 40% of total calories from nonprotein sources. pp. 1038-1039

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 be pink. 3. For the first few days, the urine will contain blood clots. 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. Observe urine for color and consistency. 2. For the first few days, the urine will be pink. 5. After 10 days, rust-colored specks can be seen in the urine. 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. p. 1054

The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected? Select all that apply. 1. Pain location 2. Fever and chills 3. Mental confusion 4. Urinary hesitancy 5. Urethral discharge 6. Postvoid dribbling

1. Pain location 5. Urethral discharge Although all the listed manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis, because flank pain is characteristic of pyelonephritis but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI, but also may occur with prostate enlargement in the male patient.

When teaching a patient about techniques to manage urinary incontinence, which instructions are most important for the nurse to include? 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.

1. Practice timed voiding. 3. Perform pelvic floor muscle training. 5. Use incontinence protective pads. 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. p. 1057

When managing a female patient with active symptoms of urethritis, what actions should the nurse perform? Select all that apply. 1. Provide a warm sitz bath. 2. Obtain a urine sample for culture. 3. Teach the patient to cleanse the perineal area. 4. Suggest that the patient use a vaginal deodorant. 5. Inform the patient that sexual intercourse can be continued.

1. Provide a warm sitz bath. 2. Obtain a urine sample for culture. 3. Teach the patient to cleanse the perineal area. The nurse should provide a warm sitz bath, because it can help to temporarily relieve bothersome symptoms of urethritis. A urine sample should be collected and cultured to detect the causative organism of urethritis so that specific treatment can be planned. The nurse should teach the patient to cleanse the perineal area by wiping from front to back, to reduce the risk of infection from the anus. The patient should be instructed not to use vaginal deodorants, because these can further irritate the genital area. The nurse should tell the patient to avoid sexual intercourse until the symptoms subside. pp. 1039-1040

A patient has undergone a nephrectomy due to a renal tumor. What nursing interventions are appropriate for the postoperative care of this patient? Select all that apply. 1. Record urine output. 2. Weigh the patient daily. 3. Monitor abdominal distention. 4. Instruct the patient to minimize coughing. 5. Allow oral intake immediately after operation. 6. Provide adequate pain relief through analgesics.

1. Record urine output. 2. Weigh the patient daily. 3. Monitor abdominal distention. 6. Provide adequate pain relief through analgesics. It is important to record hourly fluid intake and output to assess kidney function in the patient. Abdominal distension is commonly present in patients who have had abdominal surgery due to paralytic ileus caused by manipulation and compression of bowel during surgery. The patient may be reluctant to turn, cough, and deep breathe because of the incisional pain. Adequate pain medication should be given to ensure patient's comfort and ability to perform coughing and deep breathing exercises. It is important to weigh the patient daily, because a significant change in daily weight can indicate a retention of fluids. Oral intake is restricted until bowel sounds are present (usually 24 to 48 hours after surgery). p. 1063

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. Scleroderma 3. Goodpasture syndrome 5. Systemic lupus erythematosus (SLE) 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. p. 1042

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. Terazosin 2. Doxazosin Terazosin and doxazosin are α-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 β 3-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). p. 1059

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

1. This drug is relatively inexpensive. 2. This drug can be taken twice daily. 3. E. coli is resistant to this medication. 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. p. 1036

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.

1. Use urethral inserts. 2. Reduce excess weight. 3. Practice Kegel exercises. 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. p. 1056

The nurse is caring for a patient with nephrotic syndrome. What nursing interventions are appropriate for this patient? Select all that apply. 1. Weighing the patient daily 2. Avoiding exposure to people with known infections 3. Ensuring the patient performs Kegel exercises regularly 4. Instructing the patient to consume a low-sodium, moderate-protein diet 5. Encouraging the intake of three big meals rather than small frequent meals

1. Weighing the patient daily 2. Avoiding exposure to people with known infections 4. Instructing the patient to consume a low-sodium, moderate-protein diet The patient suffering from nephrotic syndrome generally has edema as the main presenting symptom. Management of this edema is extremely essential in patient care. Accurate measurement of daily weight can indicate the severity of fluid gain or loss. People with nephrotic syndrome have a lowered immunity and should not be exposed to people with known infections. Sodium leads to the retention of fluids in the body and is not advised for a patient with edema. Kegel exercises are used to strengthen the pelvic floor muscles and are not of prime importance in nephrotic syndrome. Eating small meals is recommended because it makes it easier for patients to control the sodium and protein levels in their systems. p. 1044

Which nursing instructions that promote safety are beneficial to a patient with interstitial cystitis (IC)? Select all that apply. 1. "Avoid using vaginal sprays." 2. "Continue the medications as prescribed." 3. "Avoid clothing that creates suprapubic pressure." 4. "Take high-potency vitamins along with the medications." 5. "Take the full course of antibiotics to ensure that bacteria have been eradicated."

2. "Continue the medications as prescribed." 3. "Avoid clothing that creates suprapubic pressure." 5. "Take the full course of antibiotics to ensure that bacteria have been eradicated." Patients with interstitial cystitis should continue medications as prescribed. Clothing that creates suprapubic pressure, including pants with tight belts or restrictive waistlines, should be avoided. The nurse should encourage patients to take the full course of antibiotics to ensure that bacteria have been eradicated. Vaginal sprays should be avoided in patients with urethritis. Patients with IC should take a multivitamin containing not more than the recommended dietary allowance and avoid high-potency vitamins because they may irritate the bladder.

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. "Drink at least eight glasses of fluid every day." 5. "Take the full course of antibiotics to ensure that the bacteria are eradicated." 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. pp. 1038-1039

Which dietary restriction does a nurse teach the patient with uric acid stones to avoid further complications? Select all that apply. 1. Avoid cheese 2. Avoid herring 3. Avoid spinach 4. Avoid sardines 5. Avoid dried fruits

2. Avoid herring 4. Avoid sardines Herring and sardines are rich in purines that produce uric acid as the waste product and result in the formation of uric acid-related renal calculi. Cheese is highly rich in calcium and should be avoided by a patient with calcium phosphate stones. Spinach should be avoided to reduce calcium oxalate stone formation. Dried fruits are also avoided as to prevent the formation of calcium phosphate stones. p. 1049

Which complications are associated with the long-term use of indwelling catheters? Select all that apply. 1. Bowel injury 2. Bladder spasms 3. Fistula formation 4. Bladder perforation 5. Periurethral abscess

2. Bladder spasms 3. Fistula formation 5. Periurethral abscess Complications associated with long-term use of indwelling catheters include bladder spasms, fistula formation, and periurethral abscess. Bowel injury and bladder perforation are the complications associated with suburethral slings. pp. 1060-1061

The nurse is teaching patients who are at an increased risk of urinary tract infections (UTIs) about the use of cranberry products in preventing UTIs. What important instructions should the nurse include in the teaching? Select all that apply. 1. Cranberry has no effect on UTIs. 2. Cranberry juice is more effective than cranberry capsules. 3. Cranberry products have a protective effect in preventing UTIs. 4. Drinking an adequate amount of fluid is important to prevent UTIs. 5. Taking cranberry capsules and not drinking water will prevent UTIs.

2. Cranberry juice is more effective than cranberry capsules. 3. Cranberry products have a protective effect in preventing UTIs. 4. Drinking an adequate amount of fluid is important to prevent UTIs. Cranberry juice is more effective than cranberry capsules, probably due to the increased hydration from the juice. Cranberry products have a protective effect in reducing UTIs, because the juice works by preventing the attachment of bacteria to the epithelial cells in the bladder wall. Drinking an adequate amount of fluid is important to prevent UTIs, because it promotes hydration. Only taking cranberry capsules and not drinking water will not help to prevent UTIs, because adequate fluid intake is essential for proper functioning of the renal system. p. 1037

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

2. Diaphoresis 3. Blurred vision 5. GastrointestinaI cramping 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. p. 1057

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

2. Diltiazem 3. Verapamil 4. Imipramine 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. p. 1059

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. Finasteride 4. Bethanechol 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. p. 1056

A patient is admitted with urethral diverticula. Which of the following clinical manifestations would the nurse expect to document? Select all that apply. 1. Fever 2. Gross hematuria 3. Clear, yellow urine 4. Post-void dribbling 5. Urinary incontinence

2. Gross hematuria 4. Post-void dribbling 5. Urinary incontinence Post-void dribbling, urinary incontinence, and gross hematuria are classic symptoms for urethral diverticula. Fever is a symptom of pyelonephritis, not urethral diverticula. The patient would have cloudy urine, not clear, yellow urine. p. 1040

A patient has undergone a lithotripsy procedure. When preparing this patient for the postoperative period, what does the nurse inform this patient to expect after the procedure? Select all that apply. 1. There will be no pain. 2. Hematuria can be observed. 3. A ureteral stent will be placed. 4. An open surgical procedure will be performed. 5. The ureteral stent is removed within two weeks.

2. Hematuria can be observed. 3. A ureteral stent will be placed. 5. The ureteral stent is removed within two weeks. Hematuria is common after lithotripsy procedures and during the initial postoperative period. In addition, the urine may appear bright red (hematuria). A ureteral stent will be placed after the procedure to facilitate passage of shattered stone particles and prevent sand buildup within the ureter, which might lead to obstruction. The ureteral stent is removed within two weeks, after the stone particles have possibly passed out. The patient may complain of moderate to severe colicky pain during the postoperative period. Surgery may be required only if a stone is large or positioned in the mid or distal ureter. Surgery may also be considered for patients with complications like pain, infection, and obstruction. p. 1048

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. Limit consumption of colas. 4. Take in at least 3 L of fluid daily. 5. Limit intake of dried fruits and nuts. 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. pp. 1048-1049

A nurse is teaching a patient about measures to prevent the recurrence of urinary tract infections. What instructions should the nurse include? Select all that apply. 1. Drink lemon juice daily. 2. Maintain an adequate daily fluid intake. 3. Wipe from back to front after having a bowel movement or urinating. 4. Urinate regularly, approximately every three to four hours during the day. 5. Cleanse the perineal area with warm soapy water after each bowel movement.

2. Maintain an adequate daily fluid intake. 4. Urinate regularly, approximately every three to four hours during the day. 5. Cleanse the perineal area with warm soapy water after each bowel movement. It is necessary to maintain an adequate fluid intake and to urinate regularly. Delaying urination when there is an urge to urinate increases the chances of bacterial infection. Cleansing the perineal area with warm soapy water after a bowel movement reduces the risk of infection. It is important to wipe from front to back to avoid the risk of getting fecal matter near the urethra. Acidic foods and drinks like lemon juice, orange juice, and tomatoes irritate the bladder and should be avoided. p. 1037

The nurse is caring for a patient who has undergone placement of a nephrostomy tube. 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.

2. Observe color and consistency of urine. 4. Measure urine output at least every one or two hours. 5. Measure the drainage from the catheters and on the dressing. 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. p. 1062

A patient expresses to the nurse that he or she is unable to pass urine. What instructions should the nurse give this patient to relieve urinary retention? Select all that apply. 1. Perform Kegel exercises. 2. Sit in a tub of warm water. 3. Take a walk for 30 minutes every day. 4. Drink small quantities of water frequently. 5. Drink one cup of beverage like warm tea or coffee in a day.

2. Sit in a tub of warm water. 4. Drink small quantities of water frequently. 5. Drink one cup of beverage like warm tea or coffee in a day. Sitting in warm water is beneficial in producing the urge for urination. Warm tea or coffee also helps in relieving urinary retention by producing the urge for urination. Frequently drinking small quantities of water keeps the patient well hydrated and also helps in passage of urine. Kegel exercises strengthen the pelvic floor muscles and are beneficial in decreasing urinary incontinence where there is no control or strength in the pelvic floor muscles. Taking a walk is good for general health but is not an immediate treatment for the relief of urinary retention. p. 1060

When managing a patient with urinary calculi, which conditions associated with renal stones would indicate a need for lithotripsy? Select all that apply. 1. Stones that are 3 mm in diameter. 2. Stones that are 9 mm in diameter. 3. Stones causing occasional nausea. 4. Stones causing impaired renal function. 5. Stones associated with symptomatic infection.

2. Stones that are 9 mm in diameter. 4. Stones causing impaired renal function. 5. Stones associated with symptomatic infection. Stones that are greater than 7 mm are too large for spontaneous passage. Stones causing impaired renal function should be removed as soon as possible to avoid damage to the kidneys. Stones associated with a symptomatic infection increase the risk of renal damage, and lithotripsy should be considered. Stones causing occasional nausea can be treated with medications. Stones that cause persistent nausea, pain, or a paralytic ileus should be considered candidates for lithotripsy. Stones that are 3 mm in diameter are small enough to be passed spontaneously. Pharmaceutical treatment should be considered first. p. 1047

When assessing a patient with urinary calculi, which findings would indicate the possibility of renal colic? Select all that apply. 1. The patient wants to lie still in place. 2. The patient has nausea and vomiting. 3. The patient is unable to be in one position. 4. The patient has dull pain in flanks and groin. 5. The patient has flatulence and watery diarrhea.

2. The patient has nausea and vomiting. 3. The patient is unable to be in one position. 4. The patient has dull pain in flanks and groin. Renal colic is sharp, severe pain, which results from the stretching, dilation, and spasm of the ureter in response to the obstructing stone. The patient may have nausea and vomiting due to severe pain from an obstructing renal stone. Usually, the patient is unable to remain in one position due to severe pain and will change repeatedly from moving, to sitting, to lying down. Patients can have dull pain in flanks if the stone obstruction is in a calyx or at the ureteropelvic junction and may extend to the groin. Flatulence and watery diarrhea could be symptoms of other gastrointestinal causes and are not directly related to a urinary stone. pp. 1045-1046

The nurse is assessing a patient with bladder cancer scheduled for a radical cystectomy. What factors are considered related to this procedure? Select all that apply. 1. The tumor is large. 2. The tumor is invasive. 3. The tumor involves the trigone. 4. The tumor involves only one area of bladder. 5. There is no metastasis beyond the bladder area.

2. The tumor is invasive. 3. The tumor involves the trigone. 5. There is no metastasis beyond the bladder area. A radical cystectomy involves removal of the bladder, prostate, and seminal vesicles in men and means that a new way needs to be created for urine to leave the body. Indications for a radical cystectomy include an invasive tumor that involves the trigone (the area where the ureters insert into the bladder) that is free from metastases. If the tumor is merely large, segmental or partial cystectomy, rather than radical cystectomy, is indicated. If the tumor involves only one area of the bladder, segmental or partial cystectomy can be considered instead of radical cystectomy. p. 1054

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. Urethritis 3. Urethral stricture 4. Creation of false passage 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. p. 1063

After urethral instrumentation, a patient reports frequent urination, a feeling of incomplete bladder emptying, and pain during sexual intercourse. The nurse anticipates that which diagnostic studies will be prescribed? Select all that apply. 1. Urine sediment microscopy 2. Voiding cystourethrography 3. Intravenous pyelogram (IVP) 4. Computer tomography (CT) scan 5. Magnetic resonance imaging (MRI)

2. Voiding cystourethrography 5. Magnetic resonance imaging (MRI) Frequent urination, feeling of incomplete bladder emptying, and pain during sexual intercourse are the symptoms of urethral diverticula. Voiding cystourethrography is a radiographic study that is performed to confirm the diagnosis of urethral diverticula. Additional studies such as MRI are used to determine the size of the diverticulum in relation to the urethral lumen. Urine sediment microscopy is a diagnostic study used to reveal erythrocytes in significant numbers. IVP is used to determine the extent and severity of the renal disease. A CT scan can detect small kidney tumors. p. 1040

When teaching a female patient about measures to prevent recurrent urinary tract infection (UTI), what instructions should the nurse include? Select all that apply. 1. Urinate every six hours. 2. Wipe from front to back after urinating. 3. Empty the bladder before and after sexual intercourse. 4. Use vaginal douches or sprays to clean the perineal area. 5. Cleanse with warm soapy water after each bowel movement.

2. Wipe from front to back after urinating. 3. Empty the bladder before and after sexual intercourse. 5. Cleanse with warm soapy water after each bowel movement. The nurse should instruct the patient to wipe from front to back after urinating to avoid contamination by other structures, because this can increase the risk of UTIs. Emptying the bladder before and after sexual intercourse will help to keep the perineum clean and reduce the risk of UTIs. Cleansing the perineum with warm soapy water after each bowel movement to clean the anal region will reduce the risk of UTIs. Regular urination may prevent bacteria from growing; therefore the patient should be encouraged to void every two to three hours. Vaginal douches or sprays to clean the perineal area should be avoided, because these contain harsh chemicals and substances that can cause irritation and can increase the risk of urinary infection. p. 1037

The nurse should provide a patient with what education specifically related to inflammation of the urethra? Select all that apply. 1. "Avoid clothing that creates suprapubic pressure." 2. "Use a vaginal deodorant spray for improved hygiene." 3. "Avoid sexual intercourse until the symptoms subside." 4. "Take warm sitz baths to relieve bothersome symptoms." 5. "Properly cleanse the perineal area after bowel movements and urinating."

3. "Avoid sexual intercourse until the symptoms subside." 4. "Take warm sitz baths to relieve bothersome symptoms." 5. "Properly cleanse the perineal area after bowel movements and urinating." Patients with urethritis should follow instructions such as avoiding sexual intercourse until the symptoms subside. Taking warm sitz baths relieves bothersome symptoms temporarily in patients with urethritis. Patients with urethritis should cleanse the perineal area properly after bowel movements and urinating. Vaginal deodorant sprays should be avoided in patients who have inflammation of the urethra because deodorant sprays may irritate the fine mucosal lining of the vulva. Clothing that creates suprapubic pressure, including pants with tight belts or waistlines, should be avoided in patients with interstitial cystitis. pp. 1039-1040

Which patient statements indicate understanding self-management techniques in reducing the incidence of overflow incontinence? Select all that apply. 1. "I'd really like to read some materials about smoking cessation programs." 2. "Taking oxybutynin will increase my bladder tone, which will lead to fewer leaks." 3. "Regular bowel movements and avoiding constipation will help me to dribble less." 4. "Intermittent catheterization will increase the likelihood that I will have nocturnal enuresis." 5. "These Kegel exercises feel funny, but I'll be glad when I can control my pelvic floor muscles." 6. "By practicing the Valsalva maneuver, I should be able to empty my bladder more completely."

3. "Regular bowel movements and avoiding constipation will help me to dribble less." 5. "These Kegel exercises feel funny, but I'll be glad when I can control my pelvic floor muscles." 6. "By practicing the Valsalva maneuver, I should be able to empty my bladder more completely." Constipation worsens urinary leakage, so avoiding it is a proper technique for improving overflow incontinence. Strengthening pelvic floor muscles by doing Kegel exercises will also help prevent unwanted leakage. The Valsalva maneuver is the straining of abdominal muscles thereby increasing bladder pressure to allow for more complete emptying of the bladder. Oxybutynin is an anticholinergic that works to relax the muscles in the bladder to allow for increased filling. Quitting smoking reduces the incidence of stress incontinence specifically, not overflow incontinence. Taking oxybutynin would not effectively treat overflow incontinence but would instead worsen the problem. Intermittent catheterization is beneficial for people struggling with overflow incontinence and is not related to nocturnal enuresis. pp. 1055-1059

While assessing the patient's risk of developing urinary tract infections, what questions should the nurse ask? Select all that apply. 1. Is your work putting too much stress on you? 2. Have you ever received a blood transfusion? 3. Do you have a recent history of urinary calculi? 4. Do you hold your urine for long periods of time? 5. Did you have any condition that required urinary catheterization?

3. Do you have a recent history of urinary calculi? 4. Do you hold your urine for long periods of time? 5. Did you have any condition that required urinary catheterization? Urinary calculi cause obstruction that favors the growth of organisms and can lead to frequent urinary tract infections. If strict aseptic precautions are not followed, urinary catheterization also aids the entry of causative organisms into the urinary system. People who delay urination for prolonged periods of time (common in professionals like teachers, traffic police, doctors, and so on) are more susceptible to developing UTIs. Receiving a blood transfusion and stressful work situations do not increase the risk of developing a urinary tract infection. p. 1035

The nurse is caring for 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.

3. Encourage the patient to move. 4. Strain all urine voided by the patient. 5. Avoid letting the patient ambulate unattended. 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. p. 1047, 1049

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

3. Pain while urinating 4. Increased frequency of urination 5. Feeling of pressure in the suprapubic region 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. p. 1035

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

3. Radical nephrectomy 5. Radiofrequency ablation 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. p. 1053

A diagnostic assessment of a patient with acute pyelonephritis includes which of the following? Select all that apply. 1. Urethral angiogram 2. Palpation for umbilical pain 3. Urinalysis with urine culture and sensitivity 4. Computed tomography (CT) scan of kidneys 5. Radiograph of the kidneys, ureters, and bladder 6. Complete blood count (CBC) and white blood cell (WBC) differential

3. Urinalysis with urine culture and sensitivity 4. Computed tomography (CT) scan of kidneys 6. Complete blood count (CBC) and white blood cell (WBC) differential A CT scan of kidneys is the modality of choice in evaluation of acute pyelonephritis. Urinalysis with culture and sensitivity is a test used to diagnose the presence of harmful bacteria in the urinary system, as well as to determine the antibiotics to which the bacteria is most sensitive. A CBC with WBC differential is useful in determining how well a person's body is fighting off infection. A urethral angiogram is not used for diagnosing pyelonephritis. Though a patient may have umbilical pain, it is not a common finding in pyelonephritis. However, palpation of the costovertebral angle causes flank pain in these patients. Radiographic images of the kidneys, ureters, and bladder are not helpful in diagnosing pyelonephritis, as results are generally inconclusive. p. 1039

The primary health care provider orders retropubic colposuspension for a patient diagnosed with urinary incontinence (UI). Which complications might the nurse anticipate in the patient? Select all that apply. 1. Infection 2. Urinary retention 3. Vaginal prolapse 4. Bladder perforation 5. Postoperative voiding dysfunction

3. Vaginal prolapse 5. Postoperative voiding dysfunction Retropubic colposuspensions are periurethral injectables used in the treatment of urinary incontinence (UI). This procedure is performed through low transverse incisions, and may lead to complications such as vaginal prolapse, postoperative voiding dysfunction, and urgency. Infection, urinary retention, and bladder perforation occur due to the placement of a suburethral sling. p. 1058

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?"

4. "Do you have suprapubic or low back pain?" 5. "Do you have burning pain during urination?" 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. p. 1037

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

4. Trimethoprim 5. Sulfamethoxazole E. coli is resistant to trimethoprim and sulfamethoxazole. These are used in combination to treat uncomplicated or initial urinary tract infection (UTI)

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

Acetohydroxamic acid 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. p. 1046

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

Administration of parenteral antibiotics as prescribed by the health care provider 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. p. 1038

Which diagnosis does the nurse expect in a patient who presents with hematuria, progressive uremia, and sensorineural deafness? Alport syndrome Nephrotic syndrome Goodpasture syndrome Polycystic kidney disease (PKD)

Alport syndrome

Which diagnosis does the nurse expect in a patient who presents with hematuria, progressive uremia, and sensorineural deafness? Alport syndrome Nephrotic syndrome Goodpasture syndrome Polycystic kidney disease (PKD)

Alport syndrome Hematuria, progressive uremia, and sensorineural deafness are clinical manifestations of Alport syndrome. The clinical manifestations of nephrotic syndrome include peripheral edema, massive proteinuria, hypertension, and hyperlipidemia. Clinical manifestations of Goodpasture syndrome include primary symptoms such as cough, rhonchi, crackles, and mild shortness of breath. Clinical manifestations of PKD are hematuria, hypertension, and a feeling of heaviness in the abdomen. p. 1052

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

Anchor the catheter using a securement device. 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. p. 1062

A patient is brought to the emergency department with penetrating renal trauma due to a motor vehicle accident. What should be the immediate nursing action? Monitor intake and output of fluid. Assess for hematuria and myoglobinuria. Provide pain relief and comfort measures. Assess the cardiovascular system and monitor for signs of shock.

Assess the cardiovascular system and monitor for signs of shock. Because the patient may have suffered significant blood loss following this accident, assessment of the cardiovascular system and monitoring the patient for signs of shock are the most urgent actions that the nurse should perform. Other interventions can be performed once the patient is stable. p. 1050

Which nursing intervention is beneficial to the patient who presents with renal trauma caused by a sports injury? Restricting dietary salt Maintaining fluid restriction Performing a follow-up urine culture Assessing the cardiovascular status and monitoring for shock

Assessing the cardiovascular status and monitoring for shock

What is the most effective means of reducing catheter-associated urinary tract infections (CAUTI)? Emptying the catheter's collection reservoir every hour. Administering topical and oral antibiotics prophylactically. Cleaning the sample port of a Foley catheter with alcohol prior to accessing. Avoiding unnecessary catheterization and aiming for early removal of catheters.

Avoiding unnecessary catheterization and aiming for early removal of catheters. Evidence-based practice has proven that patients who have fewer days with an indwelling urinary catheter have significantly less incidence of CAUTI than those patients with more Foley days. Emptying the catheter's collection reservoir periodically is necessary, and emptying it hourly does not decrease incidence of CAUTI. Administration of prophylactic antibiotics is not encouraged, as this only strengthens an organism's bacterial resistance to the drugs. Cleaning the sample port of a Foley catheter is good nursing practice, but not the most effective way to reduce CAUTI. p. 1037

Which medication does the nurse expect to be beneficial for a patient who smokes one pack of cigarettes each day and has a history of cough, crackles, and hematuria? Colestipol Floxuridine Azathioprine Acetohydroxamic acid

Azathioprine Cough, crackles, and hematuria are clinical manifestations of Goodpasture syndrome, which is found in smokers. Azathioprine is used in the management of Goodpasture syndrome. Colestipol is used in the treatment of hyperlipidemia, which is a clinical manifestation of nephrotic syndrome. FUDR is used for treating renal cancers. Acetohydroxamic acid is used in the treatment of renal calculi. p. 1043

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)? High-purine diet Sedentary lifestyle Benign prostatic hyperplasia (BPH) Recent use of broad-spectrum antibiotics

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. p. 1035

A patient is diagnosed with overflow incontinence. Which medication is beneficial to enhance bladder contraction in the patient? Baclofen Diazepam Finasteride Bethanechol

Bethanechol Overflow incontinence occurs when the pressure of the urine in an overfull bladder overcomes sphincter control. Bethanechol enhances bladder contraction by increasing detrusor muscle tone in the bladder wall. Baclofen and diazepam are used to relax the external sphincter in reflex incontinence. Finasteride is a reductase inhibitor used to decrease outlet resistance in overflow incontinence. p. 1056

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

Bladder decompression 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. p. 1056

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

Brain tumor Carcinoma in situ Central nervous system disorders such as a brain tumor, and bladder disorders such as carcinoma in situ are causes of urge incontinence

Which is the most serious complication the nurse can expect when providing care to a patient diagnosed with polycystic kidney disease (PKD)? Cerebral aneurysm Periurethral abscess Squamous cell cancer of the bladder Hypercoagulability with thromboembolism

Cerebral aneurysm 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. p. 1052

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? Irrigating the tube Documenting the observation Checking the catheter for patency Notifying to the primary health care provider

Checking the catheter for patency 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. p. 1062

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

Chills and flank pain clinical manifestations of acute pyelonephritis vary from mild fatigue to the sudden onset of chills and flank pain. p. 1038

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? Fosfomycin Ciprofloxacin Nitrofurantoin Trimethoprim/sulfamethoxazole

Ciprofloxacin 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. p. 1036

A patient complains of accidental loss of urine, urgency, and increased frequency of urination at night. On clinical examination, the primary health care provider infers the condition is due to overactivity of the detrusor muscle. Based on these data, which treatment does the nurse anticipate for this patient? Containment devices Surgical sphincterotomy Intermittent catheterization Bladder neck support devices

Containment devices Accidental loss of urine, urgency, and increased frequency of urination at night are experienced by patients with urge incontinence; this is due to overactivity of the detrusor muscle. This condition can be treated by using containment devices. Surgical sphincterotomy is used in the treatment of reflex incontinence. Intermittent catheterization is performed for treating the overflow incontinence. Bladder neck support devices are used in the treatment of stress incontinence. p. 1056

Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? Tighten both buttocks together Squeeze thighs together tightly Contract muscles around rectum Lie on back and lift legs together

Contract muscles around rectum To teach pelvic floor, or Kegel, exercises, the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation. Squeezing the thighs together, tightening buttocks together, and lying on the back and lifting legs do not strengthen the pelvic floor muscles. p. 1058

Treatment for a patient diagnosed with rapidly progressive glomerulonephritis is directed towards which outcome? Correction of fluid overload Correction of hypotension Correction of anemia and blood loss Administration of parenteral antibiotics

Correction of fluid overload With progressive renal failure, there is an increase in fluid retention. The patient will exhibit hypertension as a result of kidney damage. Patients will have anemia, but there will be no identification of acute blood loss, and this is not a priority in treatment at this point for this patient.

A patient who is prone to urinary tract infections asks the nurse about herbal preparations that may prevent UTIs. What at-home remedy should the nurse suggest to this patient? <p>A patient who is prone to urinary tract infections asks the nurse about herbal preparations that may prevent UTIs. What at-home remedy should the nurse suggest to this patient?</p> Aloe Garlic Ginger Cranberry

Cranberry Take 300-400 mg/day for UTI prevention

The nurse suspects stoma stenosis in a patient who underwent urinary diversion surgery. What surgical procedure did the patient undergo? Ileal conduit Nephrostomy Cutaneous ureterostomy Laparoscopic nephrectomy

Cutaneous ureterostomy Cutaneous ureterostomy is a urinary diversion surgery that involves the excision of ureters from bladder through abdominal wall, and creation of a stoma. Cutaneous ureterostomy has the possibility of stoma stenosis, which involves the narrowing of the lumen of stoma. Ileal conduit is an incontinent urinary diversion procedure in which the ileum is converted into a conduit for urinary drainage. Nephrostomy has a high risk of renal infection. Laparoscopic nephrectomy is not a type of urinary diversion surgery. p. 1064

The nurse suspects stoma stenosis in a patient who underwent urinary diversion surgery. What surgical procedure did the patient undergo? Ileal conduit Nephrostomy Cutaneous ureterostomy Laparoscopic nephrectomy

Cutaneous ureterostomy Cutaneous ureterostomy is a urinary diversion surgery that involves the excision of ureters from bladder through abdominal wall, and creation of a stoma. Cutaneous ureterostomy has the possibility of stoma stenosis, which involves the narrowing of the lumen of stoma. p. 1064

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? Tamsulosin Doxorubicin 5-fluorouracil Cyclophosphamide

Cyclophosphamide 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.

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

Cystoscopy 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. p. 1047

The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. What are priority nursing assessments in the care of this patient? Assessment of pain and level of consciousness Assessment of serum calcium and phosphorus levels Blood pressure and assessment for orthostatic hypotension Daily weights and measurement of the patient's abdominal girth

Daily weights and measurement of the patient's abdominal girth Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weight, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome. p. 1044

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

Decreasing urinary stasis 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.

Which condition occurs due to neurologic diseases affecting the 2, 3, and 4 sacral segments? Reflex incontinence Functional incontinence Bladder outlet obstruction Deficient detrusor contraction

Deficient detrusor contraction Deficient detrusor contraction results in urinary retention when the muscle is no longer able to contract with enough force or for a sufficient time to completely empty the bladder. Deficient detrusor contraction occurs due to neurologic diseases affecting the 2, 3, and 4 sacral segments. Reflex incontinence occurs when spinal cord lesions above S2 interfere with central nervous system inhibition. Functional incontinence occurs due to problems affecting balance and mobility. Bladder outlet obstruction occurs due to enlarged prostate. p. 1060

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? Obstruction with urinary stasis Deficient detrusor contraction strength Interference of urethral sphincter control Colonization and infection of the lower urinary tract

Deficient detrusor contraction strength 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.

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

Deposition of immune complexes and activation of complement 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. p. 1041

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

Dipstick analysis is the diagnostic study that is used to detect the presence of white blood cells (pyuria) and bacteria in the urine (bacteriuria). p. 1035

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 what? Laser lithotripsy Electrohydraulic lithotripsy Percutaneous ultrasonic lithotripsy Extracorporeal shock-wave lithotripsy (ESWL)

Extracorporeal shock-wave lithotripsy (ESWL) ESWL is noninvasive, but anesthesia is used to maintain the patient's position. The other types of lithotripsy are invasive.

Which medication is beneficial for a patient with a urinary tract infection (UTI) secondary to fungal infection? Ampicillin Norfloxacin Fluconazole Phenazopyridine

Fluconazole Fluconazole is used in patients with UTIs secondary to fungi. Ampicillin is used to treat uncomplicated UTIs. Norfloxacin is a fluoroquinolone that is used to treat complicated UTIs. Phenazopyridine is a urinary analgesic that is used to relieve discomfort caused by dysuria. p. 1036

Which is a clinical manifestation of urethral stricture? Foamy urine Hyperlipidemia Frequent urge to urinate Sharp pain in flank area

Frequent urge to urinate Urethral strictures can be asymptomatic or can cause numerous symptoms, which range from mild to severe. Some of the possible symptoms and complications include sudden and frequent urges to urinate, difficulty urinating, inability to urinate or completely empty the bladder, and pain during urination. p. 1050

A patient is diagnosed with calcium oxalate urinary tract calculi. What actions should the nurse perform to manage this patient? Select all that apply. Give calcium lactate. Reduce sodium intake. Reduce dietary oxalate. Reduce dietary purines. Give α-penicillamine and tiopronin.

Give calcium lactate. Reduce sodium intake. Reduce dietary oxalate. Give calcium lactate, because it helps to precipitate oxalate in the gastrointestinal tract. Reduce daily sodium intake, because sodium can cause fluid retention and reduce the outflow of urine. Reduce dietary oxalate, because the urinary calculi diagnosed are calcium oxalate. A reduction in dietary purines is advised in cases of uric acid calculi. Give α-penicillamine and tiopronin in the case of cystine stones, which are caused by a rare hereditary defect resulting in an inborn error of cystine metabolism. p. 1046

A nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find what clinical manifestations as the "classic triad" occurring in patients with renal cancer? Fever, chills, flank pain Hematuria, flank pain, palpable mass Hematuria, proteinuria, palpable mass Flank pain, palpable abdominal mass, and proteinuria

Hematuria, flank pain, palpable mass There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease. Fever, chills, and proteinuria are not signs of renal carcinoma. p. 1053

A nurse should instruct a patient with nephrotic syndrome in which type of diet? Low in fat Low in protein High in protein High in carbohydrates

High protein 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. p. 1044

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

Hyperoxaluria 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. p. 1046

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? Identifying type of incontinence Placement of the indwelling catheter placement Administering medications via bladder instillation Using a bladder scanner to measure postvoid residual volume (PRV)

Identifying type of incontinence 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). p. 1059

A patient diagnosed with interstitial cystitis reports continuing severe and debilitating suprapubic pain, hesitancy, and incontinence. Because other measures to relieve the pain have been unsuccessful, the nurse anticipates that the plan of care will include what procedure? Lithotripsy Marsupialization Transurethral incision Ileal conduit diversion

Ileal conduit diversion Severe suprapubic pain, hesitancy, and incontinence are symptoms of a painful inflammatory disease called interstitial cystitis. Ileal conduit surgical urinary diversion is used for severe debilitating pain in patients with interstitial cystitis when other measures are not successful in relieving pain. p. 1041

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

Inserting a nasogastric tube 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. p. 1065

The nurse is caring for a patient with a ureteral catheter. Which intervention of the nurse needs correction? Check the catheter placement frequently Instructing the patient to tolerate pelvic pain Checking for drainage every one or two hours Clamping the ureteral catheter to avoid urine leakage

Instructing the patient to tolerate pelvic pain

The nurse is caring for a patient with a ureteral catheter. Which intervention of the nurse needs correction? Check the catheter placement frequently Instructing the patient to tolerate pelvic pain Checking for drainage every one or two hours Clamping the ureteral catheter to avoid urine leakage

Instructing the patient to tolerate pelvic pain The patient should not be encouraged to tolerate pelvic pain. Adequate pain management is necessary for healing. The nurse should check the drainage from the ureteral catheter every one or two hours to prevent complications associated with the ureteral catheter. The catheter should be checked frequently to avoid tension on the catheter. The nurse should not clamp the ureteral catheter.

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? Interstitial cystitis Glomerulonephritis Acute pyelonephritis Goodpasture syndrome

Interstitial cystitis 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. p. 1040

Which antiincontinence device helps to relieve minor pelvic organ prolapse? Which device is beneficial for the patient? External collection devices Penile compression devices Intravaginal support devices Intraurethral occlusive devices

Intravaginal support devices Intravaginal support devices include pessaries and bladder neck support prostheses. These devices relieve minor organ prolapse. External collection devices such as penile sheaths help to direct the urine into a drainage bag. Penile compression devices are applied to the penis to prevent leakage through the urethra. Intraurethral occlusive devices include urethral plugs that provide mechanical obstruction to prevent urine leakage. p. 1057

A patient with bladder cancer is scheduled for surgery to create an ileal conduit. How should the nurse explain the ileal conduit? It is a temporary procedure that can be reversed later. It conveys urine from the ureters to a stoma opening on the abdomen. It diverts urine into the sigmoid colon, where it is expelled through the rectum. It provides a bladder opening that allows urine to drain into an external pouch.

It conveys urine from the ureters to a stoma opening on the abdomen. An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected with one end of the segment closed. The ureters are surgically attached to the segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form a stoma. The patient must wear a pouch to collect the urine, which continuously flows through the conduit. An ileal conduit is a permanent urinary diversion procedure. An ileal conduit does not divert urine into the sigmoid colon or create an opening in the bladder allowing urine to drain into an external pouch. p. 1064

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

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. p. 1038

Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which measure should the nurse first recommend in an attempt to resolve the woman's incontinence? Kegel exercises Use of adult incontinence pads Intermittent self-catheterization Dietary changes including fluid restriction

Kegel exercises Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence. p. 1056

The nurse anticipates that which procedure will be prescribed as a therapeutic medical intervention for renal calculi? Lithotripsy Myelogram Renal sonogram Intravenous pyelogram

Lithotripsy Lithotripsy (also known as extracorporeal shock wave) is a noninvasive therapeutic treatment in which high-energy shock waves are used to crush or pulverize renal calculi in the renal pelvis, ureter, and bladder. Once crushed into smaller particles, the calculi can be more easily eliminated from the genitourinary tract with the aid of increased fluids and pain medication. The myelogram is a neurologic diagnostic procedure most commonly used for spinal issues. The renal sonogram and intravenous pyelography are diagnostic tools for renal problems, but they are not medical interventions. p. 1047

Which medication increases the bladder's storage capacity in a patient with voiding dysfunction? Tamsulosin Finasteride Imipramine Mirabegron

Mirabegron Mirabegron is a β 3-adrenergic agonist that relaxes the bladder muscle during filling, thereby improving the bladder's storage capacity. Tamsulosin is an α-adrenergic antagonist that reduces urethral sphincter resistance. Finasteride is a 5α-reductase inhibitor that causes epithelial atrophy through androgen suppression, resulting in a decrease in total prostate size. Imipramine is a tricyclic antidepressant that reduces sensory urgency and burning pain of interstitial cystitis. p. 1059

first-line drug that is used to treat initial uncomplicated UTI

Nitrofurantoin

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

Overflow incontinence

While caring for a patient with a suprapubic catheter, the nurse observes urine leakage. Which medication does the nurse expect to be beneficial to the patient? Fosmicin Oxybutynin Nitrofurantoin Sulfamethoxazole

Oxybutynin Urine leakage with a suprapubic catheter results when the patient experiences bladder spasms. Oxybutynin is an antispasmodic, which reduces the bladder spasms. Fosmicin and nitrofurantoin are the antibiotics used to treat urinary tract infections. Sulfamethoxazole is used to treat acute pyelonephritis. p. 1062

Which medication is beneficial for a patient with a lower urinary tract infection who reports severe pain while urinating? Nystatin Clotrimazole Amitriptyline Phenazopyridine

Pain while urinating is called dysuria. Phenazopyridine is a urinary analgesic that is used to relieve severe discomfort caused by dysuria due to its topical analgesic effect on the urinary tract mucosa. Nystatin is prescribed for monilial infections. Clotrimazole is used for treating Trichomonas infection associated with urethritis. Amitriptyline is a tricyclic antidepressant used for reducing burning pain and urinary frequency. p. 1036

A patient tells the nurse, "I involuntarily pass urine while coughing, laughing, and sneezing." The medical history of the patient reveals that the patient has undergone prostate cancer surgery. Which treatment does the nurse expect to be beneficial in the patient? Reductase inhibitors Vaginal estrogen creams Urinary diversion surgery Pelvic floor muscle exercises

Pelvic floor muscle exercises The involuntary passage of urine while coughing, laughing, and sneezing indicates stress incontinence. These issues may occur due to prostate surgery for benign prostate hyperplasia, or prostate cancer; atrophy of the structures of the female urethra; and relaxed pelvic floor musculature. Pelvic floor muscles relax after prostate surgery. Pelvic floor muscle exercises such as Kegel exercises help to strengthen the pelvic muscles. Reductase inhibitors decrease the outlet resistance in overflow incontinence. Vaginal estrogen creams are used to treat females with urge incontinence. Urinary diversion surgery is performed to bypass the urethra and cure bladder incontinence after trauma or surgery in males and females. p. 1056

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

Pentosan 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. p. 1040

Which medication does the nurse expect to be prescribed for a patient with bladder tumors who reports painful urination? Fluconazole Ciprofloxacin Nitrofurantoin Phenazopyridine

Phenazopyridine A patient with bladder tumors usually experiences increased frequency and dysuria. A urinary analgesic such as phenazopyridine relieves discomfort caused by pain during urination (dysuria) by exerting an analgesic effect on the urinary tract mucosa.

A patient experiences fever, chills, flank pain, and costovertebral tenderness to percussion. The nurse recognizes that the clinical manifestations are associated with a particular renal problem and identifies risk factors for the condition. What is a patient risk factor that the nurse would identify? Bacterial infection in one or more of the heart valves High fluid intake that increases urinary concentration Autoimmune disease that affects small and large vessels Pregnancy-induced physiologic changes in the urinary system

Pregnancy-induced physiologic changes in the urinary system Fever, chills, flank pain, and costovertebral tenderness to percussion are clinical manifestations of acute pyelonephritis. Pregnancy-induced physiologic changes in the urinary system are a risk factor for acute pyelonephritis. Bacterial infection in one or more valves indicates infective endocarditis, which is a risk factor for glomerulonephritis. High intake of fluid increases the urinary concentration and does not contribute to renal calculi. Autoimmune disease that affects the small and large vessels indicates vasculitis; it is a risk factor for glomerulonephritis. p. 1038

Which is the most important nursing intervention when educating a patient about how to prevent acute poststreptococcal glomerulonephritis? Instructing the patient to evacuate the bowel regularly Instructing the patient to maintain good personal hygiene Promoting early diagnosis and treatment of sore throats and skin lesions Encouraging the patient to obtain antibiotic therapy to ensure that bacteria are eradicated

Promoting early diagnosis and treatment of sore throats and skin lesions Promoting early diagnosis and treatment of sore throats and skin lesions is the most important way to prevent streptococcal glomerulonephritis. Evacuating the bowel regularly prevents urinary tract infections. Maintaining good personal hygiene helps in the prevention of bacterial infections and is of secondary importance to prevent post streptococcal glomerulonephritis. Encouraging the patient to obtain antibiotic therapy to ensure that bacteria are eradicated will not prevent poststreptococcal glomerulonephritis. p. 1042

A patient with involuntary passage of urine underwent a surgical therapy. On a follow up visit, the nurse finds bladder perforation. Which surgery does the nurse suspect to be the cause of this condition? Urinary diversion surgery Laparoscopic nephrectomy Retropubic colposuspension Pubovaginal sling placement

Pubovaginal sling placement Urinary incontinence (UI) is the involuntary passage of urine. Surgical therapy is performed based on the type of incontinence. Bladder perforation is a complication resulting from pubovaginal sling placement. Urinary diversion surgery is associated with complications such as stoma stenosis. Laparoscopic nephrectomy may cause abdominal distension. Retropubic colposuspension is associated with vaginal prolapse, postoperative voiding dysfunction, and urgency. p. 1056

Which diagnostic study can be used to diagnose suspected metastases due to renal tumors? Ultrasound Computed tomography (CT) Radionuclide isotope scanning Magnetic resonance imaging (MRI)

Radionuclide isotope scanning Radionuclide isotope scanning is used to detect metastases when cancer spreads from one part of the body to another. Ultrasound examination is a diagnostic procedure and has the ability to differentiate solid mass tumors and cysts. CT is used in the diagnosis and detection of small kidney tumors. MRI is used to detect renal tumors. p. 1053

While caring for a postoperative patient with urinary diversion surgery, the nurse observes mucus shreds in the drainage bag. What would be the appropriate nursing intervention in this condition? Irrigate the drainage bag Apply lotion around the skin Record it as a normal observation Notify the primary health care provider

Record it as a normal observation After the surgery, mucus may be present in the drainage tube for few days; this is a normal observation. The nurse should irrigate the drainage bag only with an order from the primary health care provider. Lotions or creams should never be applied, because they increase the risk of infection around the surgical area. Notifying the primary health care provider is not an appropriate intervention, because the mucus is a normal finding.

A 22-year-old female patient had a physical for a new job. Her blood pressure was 110/68. At the health fair two months later, her blood pressure is 154/96. What renal problem should the nurse be aware of that could contribute to this abrupt rise in blood pressure? Renal trauma Renal artery stenosis Renal vein thrombosis Benign nephrosclerosis

Renal artery stenosis Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people under 30 or over 50 years of age. Renal trauma usually causes hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension. p. 1051

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

Renal cell cancer 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.

When caring for a patient with nephrotic syndrome, the nurse should know the patient understands dietary teaching when the patient selects which food item? Peanut butter and crackers One small grilled pork chop Salad made of fresh vegetables Spaghetti with canned spaghetti sauce

Salad made of fresh vegetables Of the options listed, only salad made with fresh vegetables would be acceptable for the diet that limits sodium and protein as well as saturated fat. Peanut butter and crackers are processed, so they contain significant sodium, and peanut butter contains some protein. A pork chop is a high-protein food with saturated fat. Canned spaghetti sauce is also high in sodium. p. 1044

Which surgery does the nurse expect to be performed for a patient who has frequent urination, accidental loss of urine, and pain during sexual intercourse? Cystoscopy Cystolitholapaxy Spence procedure Electro hydraulic lithotripsy

Spence procedure Frequent urination, accidental loss of urine, and pain during sexual intercourse are the clinical manifestations of urethral diverticula. A Spence procedure is performed for marsupialization (creation of permanent opening) of the diverticular sac into the vagina in patients with urethral diverticula.

The nurse prepares to discharge a patient who has a renal calculus. What is the most important instruction for the nurse to include in the patient's teaching? Maintain bed rest. Continue a clear-liquid diet. Strain all urine at home for stones. Perform relaxation exercises to ease pain.

Strain all urine at home for stones. The renal calculus could pass after the patient is discharged and be expelled in the urine. Laboratory analysis of the stone reveals the exact contents and will guide further treatment. Bed rest is not recommended or necessary. A clear-liquid diet may not be necessary if the patient can tolerate the usual diet. Having the patient perform relaxation exercises to ease pain is secondary in importance to straining the urine. p. 1049

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? Urosepsis Septic shock Stress incontinence End-stage kidney disease

Stress Incontinence 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. p. 1056

The primary health care provider performs a surgical technique in a patient with incontinence to increase the urethral closure pressure and periurethral electromyography activity. Which type of incontinence would the nurse suspect in the patient? Stress incontinence Reflex incontinence Overflow incontinence Incontinence after trauma or surgery

Stress incontinence Injecting autologous stem cells into the rhabdosphincter and urethral submucosa is a recent surgical technique done for stress urinary incontinence (UI) to increase the closure pressure and periurethral electromyography activity. Reflex incontinence is cured by surgical sphincterotomy. Overflow incontinence can be cured by urinary or intermittent catheterization. Incontinence after trauma or surgery is treated by placing an artificial implantable sphincter. pp. 1057-1058

Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? Help the patient cope with the rapid progression of the disease. Suggest genetic counseling resources for the children of the patient. Expect the patient to have polyuria and poor concentration ability of the kidneys. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

Suggest genetic counseling resources for the children of the patient. PKD is one of the most common genetic diseases and genetic counseling should be suggested. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD. p. 1051

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

Systemic lupus erythematosus (SLE) Acute poststreptococcal glomerulonephritis (APSGN) 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. p. 1043

A patient reports frequent leakage of small amounts of urine throughout the day and night. On assessing the patient, the nurse finds the bladder is palpable and distended. Which medication does the nurse expect to be beneficial to the patient? Oxybutynin (Oxytrol) Baclofen Terazosin Solifenacin

Terazosin Leakage of small amounts of urine throughout the day and night indicates overflow incontinence. Overflow incontinence is a condition in which the pressure of urine in an overfull bladder overcomes sphincter control. The bladder remains distended and is palpable in patients with overflow incontinence. Terazosin is an alpha-blocker, which relaxes the smooth muscles around the bladder and relieves the need of frequent or urgent urination even during the night. Oxybutynin (Oxytrol) is an anticholinergic medication used in the treatment of urge incontinence. Baclofen is effective in patients with reflex incontinence. Solifenacin, an anticholinergic medication, is used to treat urge incontinence. p. 1059

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

The patient will not experience bladder spasms. 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. p. 1062

A patient with voiding dysfunction is prescribed verapamil. Which outcome in the patient indicates effective treatment? The patient will not have blood in urine. The patient will not have stones in the kidney. The patient will not have burning pain in the bladder. The patient will not have inflammation of the urethra.

The patient will not have burning pain in the bladder. Verapamil is a calcium channel blocker that is used in the treatment of voiding dysfunction to reduce burning pain in the urinary bladder. Antibiotics are used in the treatment of hematuria (blood in the urine). Acetohydroxamic acid is used in the treatment of kidney stones. Nystatin is used in the treatment of inflammation of the urethra. p. 1059

A patient with urinary incontinence (UI) is on tamsulosin therapy. Which patient outcome indicates effective therapy? The patient will not have periodic urination without warning. The patient will not have involuntary urination with urinary urgency. The patient will not have leakage of urine while coughing and sneezing. The patient will not have leakage of small amounts of urine during the day and night.

The patient will not have leakage of small amounts of urine during the day and night. Tamsulosin is an α-adrenergic blocker used in the treatment of overflow incontinence. Overflow incontinence results in leakage of small amounts of urine frequently throughout the day and night. p. 1059

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

The patient with a herniated disc Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. It is due to an underactive detrusor 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. p. 1056

How is a suprapubic catheter inserted? Through the external meatus into the urethra Through a small incision in the abdominal wall Through threading up the urethra and bladder to the ureters Through a small flank incision directly into the pelvis of the kidney

Through a small incision in the abdominal wall Suprapubic catheterization is the simplest and oldest method of urinary diversion; it involves a small incision in the abdominal wall. A urethral catheter is inserted through the external meatus into the urethra. A ureteral catheter is inserted by threading up the urethra and bladder to the ureters. A nephrostomy tube is inserted through a small flank incision directly into the pelvis of the kidney. p. 1062

What is the role of a registered nurse during catheterization? To anchor the catheter in place To irrigate the catheter in case of obstruction To choose the appropriate type and size of catheter To insert an indwelling catheter for uncomplicated patients

To choose the appropriate type and size of catheter 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. p. 1061

While caring for a patient with urinary incontinence (UI), the nurse attaches a urethral plug to the patient's urethra. What is the rationale behind this intervention? To support the bladder neck To direct urine into the drainage bag To prevent leakage through the urethra To provide mechanical obstruction to prevent urine leakage

To provide mechanical obstruction to prevent urine leakage A urethral plug is an intraurethral occlusive device, which is worn in the urethra to provide mechanical obstruction to prevent urine leakage. Pessaries and bladder neck support prostheses are devices that help to support the bladder neck. Urine is directed into a drainage bag through external catheter systems. Penile compression devices are applied to the penis to prevent leakage through the urethra. p. 1057

The nurse anticipates that which diagnostic procedure will be prescribed for a patient with a urinary tract infection, renal abscesses, and anatomic abnormalities? Urinalysis Ultrasonography Magnetic resonance imaging (MRI) Computed tomography (CT) urogram

Ultrasonography Ultrasonography of the urinary system is performed to identify renal abscesses and anatomic abnormalities, which are the clinical manifestations of acute pyelonephritis.

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? Urethral catheter Ureteral catheter Suprapubic catheter Nephrostomy catheter

Ureteral catheter 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. p. 1048

Which surgical procedure is beneficial to treat a patient who is diagnosed with an obstructive urethral stricture? Urethroplasty Laser lithotripsy Spence procedure Retrograde urethrography

Urethroplasty Urethroplasty is an open surgical procedure that is the most definitive therapy for an obstructive urethral stricture. Laser lithotripsy is used to fragment ureteral and large bladder stones. Spence procedure involves marsupialization (creation of a permanent opening) of the diverticular sac in the vagina. Retrograde urethrography is also used for urethral stricture, but is used to determine the stricture length, location, and caliber. p. 1050

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

Urge incontinence 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. p. 1056

Which urinary disorder is most common in Jewish men? Bladder cancer Uric acid stones Urinary tract calculi Urinary incontinence

Uric acid stones Uric acid stones are most common in Jewish men who have a family history or incidence of gout. Bladder cancer is more common in Caucasian men. Urinary tract calculi are more common in Caucasians than in African Americans. Urinary incontinence is underreported because culturally it is seen as a social hygiene problem causing patient embarrassment. p. 1046

A patient from a long-term care facility is admitted to the medical unit with pyelonephritis. What is a common cause of pyelonephritis for patients residing in long-term care facilities? Fever Gram-negative bacilli Urinary tract catheterization Urethral trauma from childbearing

Urinary tract catheterization For residents of long-term care facilities, urinary tract catheterization is a common cause of pyelonephritis. Fever is a symptom of pyelonephritis, but does not cause it. Gram-negative bacilli cause urinary tract infections, not pyelonephritis. Urethral trauma from childbearing can cause urethral diverticula, not pyelonephritis. p. 1038

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

Use 5 mL of sterile saline to irrigate 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. p. 1062

A patient has undergone a retropubic colposuspension surgical technique for involuntary urine passage due to increased abdominal pressure. Which complication should the nurse suspect for this patient? Vaginal prolapse Bladder perforation Small bowel obstruction Overdistention of the pelvis

Vaginal prolapse Involuntary urine passage caused by increased abdominal pressure while coughing or exercising occurs due to stress incontinence. Retropubic colposuspension is the preferred surgical therapy for stress incontinence. However, this surgical therapy may lead to vaginal prolapse. Bladder perforation is a complication that occurs due to pubovaginal sling placement. Small bowel obstruction is a complication that occurs due to pelvic surgery. Overdistension of the pelvis is a complication associated with the insertion of a nephrostomy tube. pp. 1057-1058

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? Doxycycline Vancomycin Metronidazole Dimethyl sulfoxide

Vancomycin 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. p. 1039

A patient has a history of calcium phosphate renal calculi. The nurse provides teaching about recommended food choices. The patient says, "So I need to eat foods low in calcium like yogurt, oranges, chicken, cranberry juice, spinach, and eggs?" Which of the patient's food choices, indicate that further instruction is required? Select all that apply. Eggs Yogurt Oranges Chicken Spinach Cranberry juice

Yogurt Spinach Milk and milk products are the richest sources of calcium. Dark-green leafy vegetables are also high in calcium. The choice of yogurt and spinach demonstrates that the patient lacks knowledge about a calcium-restricted diet. Oranges, chicken, cranberry juice, and eggs do not contain high levels of calcium and are therefore not restricted from the patient's diet. p. 1049