Med-Surg Ch 45 Renal and Urologic Problems

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

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

Nursing staff on a hospital unit are reviewing rates of hospital-acquired infections (HAI) of the urinary tract. Which nursing action will be most helpful in decreasing the risk for HAI in patients admitted to the hospital?

Avoiding unnecessary urinary catheterizations

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

Blood pressure 90/48 mm Hg

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

Burning on urination

After a ureterolithotomy, a female patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care?

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

A 68-year-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching?

Catheterization technique and schedule

The nurse is caring for a patient who has had an ileal conduit for several years. Which nursing action could be delegated to unlicensed assistive personnel (UAP)?

Change the ostomy appliance.

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

-Liver -Chicken

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

Check blood pressure and heart rate.

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

Costovertebral tenderness

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy?

Decreased urine output

The nurse observes unlicensed assistive personnel (UAP) taking the following actions when caring for a female patient with a urethral catheter. Which action requires that the nurse intervene?

Disconnecting the catheter from the drainage tube to obtain a specimen

A 28-year-old male patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time?

Discussion of options for genetic counseling

A 58-year-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which nursing diagnosis is a priority for the patient?

Excess fluid volume related to low serum protein levels

A 32-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider?

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

A 63-year-old male patient had a cystectomy with an ileal conduit yesterday. Which new assessment data is most important for the nurse to communicate to the physician?

Heart rate 102 beats/minute

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

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

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

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

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

I will start taking high potency multiple vitamins every morning.

A 58-year-old male patient who weighs 242 lb (110 kg) undergoes a nephrectomy for massive kidney trauma due to a motor vehicle crash. Which postoperative assessment finding is most important to communicate to the surgeon?

Urine output is 20 mL/hr for 2 hours.

Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours. Which nursing action is most appropriate?

Use an ultrasound scanner to check the postvoiding residual volume.

A 76-year-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first?

Insert a urinary retention catheter.

A 22-year-old female patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider?

Left-sided flank pain

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

Obtain a midstream urine specimen for culture and sensitivity testing.

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

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

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

Place a bedside commode close to the patients bed.

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

Pyridium may change the urine color.

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

Recent weight gain

Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider?

The patient has seen clots in the urine.

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

The periorbital and peripheral edema is resolved.

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

anticoagulants.

The nurse will plan to teach a 27-year-old female who smokes 2 packs of cigarettes daily about the increased risk for

bladder cancer.

A patient who had surgery for creation of an ileal conduit 3 days ago will not look at the stoma and requests that only the ostomy nurse specialist does the stoma care. The nurse identifies a nursing diagnosis of

disturbed body image related to change in function.

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

drinking 2000 to 3000 mL of fluid a day.

A 44-year-old patient is unable to void after having an open loop resection and fulguration of the bladder. Which nursing action should be implemented first?

Assist the patient to soak in a 15-minute sitz bath.

A 68-year-old female patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action will be best to include in the plan of care?

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

When preparing a female patient with bladder cancer for intravesical chemotherapy, the nurse will teach about

emptying the bladder before the medication.

A 34-year-old male patient seen at the primary care clinic complains of feeling continued fullness after voiding and a split, spraying urine stream. The nurse will ask about a history of

gonococcal urethritis.

When planning teaching for a 59-year-old male patient with benign nephrosclerosis the nurse should include instructions regarding

monitoring and recording blood pressure.

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

recent sore throat and fever.

To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating

sardines and liver.

Which nursing action is of highest priority for a 68-year-old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain?

Administer prescribed analgesics.

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

Provide preoperative teaching about nephrectomy.

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

Teach the patient about the use of antifungal medications.

A 55-year-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is most appropriate to include in the care plan?

Teach the patient how to perform Kegel exercises.