urinary / renal quiz

An older adult male patient calls the clinic because he has "not passed any urine all day long". What is the nurse's best response?

-"you could have an obstruction, so you should come in to be checked"

Which patient has the highest risk for developing a complicated urinary tract infection?

-22 year old who has a neurogenic bladder due to a spinal cord injury

A patient has urinary tract infection symptoms but there are no bacteria in the urine. The health care provider suspects interstitial cystitis. The nurse prepares patient teaching material for which diagnostic test?

-cystoscopy

What is the main concern for patients who have hydronephrosis, hydroureter, or urethral stricture?

-obstruction

Which group has the highest prevalence of urinary tract infections?

-older women

A patient has agreed to try a bladder training program. What is the priority nursing intervention in starting this therapy?

-teach the patient how to be alert, aware, and able to resist the urge to urinate

Which urine characteristic suggests that the patient is drinking a sufficient amount of fluid?

-urine is a pale yellow color

The nurse is reviewing the laboratory results for an older adult patient with an indwelling catheter. The urine culture is pending, but the urinalysis shows greater than 10(5) colony-forming units, and the differential white blood cell count shows a "left shift". The nurse will monitor for additional signs/symptoms associated with which condition?

-urosepsis

The nurse is teaching a patient about self-care measures to prevent urinary tract infections. Which daily fluid intake does the nurse recommend to the patient to prevent a bladder infection?

- 2-3 L of water

Which statement by a patient indicates effective coping with a Kock's pouch?

-"I check the pouch every 2 to 3 hours and use a catheter as needed"

The nurse is evaluating outcome criteria for a patient being treated for urge incontinence. Which statement indicates that the treatment has been successful?

-"I had trouble at first, but now I go to the toiler every 3 hours"

A patient has had a bladder suspension and a suprapubic catheter is in place. The patient wants to know how long the catheter will remain in place. What is the nurse's best response?

-"It is removed when you void and residual urine is less than 50 mL"

The nurse sees that the patient was recently started on oxybutynin. Which question is the nurse most likely to ask to evaluate whether or not the medication is having the desired effect?

-"are you still having a sudden strong urge to void and leaking large amounts of urine?"

A male college student comes in the clinic reporting burning or difficulty with urination and a discharge from the urethral meatus. Based on the patient's report, what is the most logical question for the nurse to ask?

-"could you have been exposed to a sexually transmitter disease?"

A young woman tells the nurse that she gets frequent UTIs that seem to follow sexual intercourse. Which questions would the nurse ask? (Select all that apply.)

-"do you use a diaphragm or spermicides for contraception?" -"do you and your partner(s) wash the perineal area before intercourse?" -"some positions cause more irritation during sex. Have you noticed that?" -"do you and your partner ever engage in anal intercourse?"

The nurse is teaching a man about how to prevent urinary tract infections. What information does the nurse include?

-"gently wash the genital area before intercourse"

A young female patient reports burning with urination. What question does the nurse ask to differentiate between a vaginal infection and a urinary infection?

-"have you noticed any vaginal discharge?"

A patient with stress incontinence has been attempting vaginal cone therapy for several weeks but is discouraged. She says "it isn't working. I want to try something else." What is the nurse's best response?

-"tell me about your experiences with the cone and how you are tracking your progress"

A patient has had one kidney removed as a treatment for kidney cancer. The patient's spouse asks, "Does the good kidney take over immediately? I know a person can live with just one kidney". What is the nurse's best response?

-"the other kidney will provide adequate function, but this may take days or weeks"

A patient returning to the unit after a left radical nephrectomy for kidney cell carcinoma reports having some soreness on the right side. What does the nurse tell this patient?

-"the soreness is likely to be from being positioned on your right side during surgery"

The off-going nurse is giving shift report to the oncoming nurse about the care of a patient who had a nephrostomy tube placed 12 hours ago. What is the most important point to clearly communicate about the urine drainage?

-"urine is draining only into the collection bag, not the bladder; therefore the amount of drainage must be assessed hourly for the first 24 hours"

A patient with diabetic nephropathy reports having frequent hypoglycemic episodes "so my doctor reduced my insulin, which means my diabetes is improving". What is the nurse's best response?

-"when kidney function is reduced, the insulin is available for a longer time and thus less of it is needed"

Teaching intermittent self-catheterization for incontinence is appropriate for which patient?

-25 y/o male with paraplegia

Which patient should not be advised to take cranberry juice?

-33 y/o woman with dysuria associated with interstitial cystitis

Which patient has the greatest risk for developing acute pyelonephritis?

-36 y/o woman w/ DM who is pregnant

Which patient has the highest risk for bladder cancer?

-60 y/o male patient who smokes two packs of cigarettes per day and works in a chemical factory

Which patient is most likely to have mixed incontinence?

-62 year old who had four full-term pregnancies

A patient has renal cell carcinoma that has metastasized to the lungs. What stage is the cancer?

-IV

After a nephrectomy, the patient has a large urine output because of adrenal insufficiency. What does the nurse anticipate the priority intervention for this patient will be?

-IV fluid replacement because of subsequent hypotension and oliguria

The nurse is working in a long-term care facility. Which circumstance is cause for greatest concern, because the facility has a large number of residents who are developing urinary tract infections?

-a large percentage of residents have indwelling urinary catheters

Which manifestation is primarily associated with acute pyelonephritis?

-active bacterial infection

The nurse is interviewing and assessing a patient who has the signs/symptoms of acute glomerulonephritis. Which disorder is most likely to mimic similar signs/symptoms?

-acute exacerbation of heart failure

Insertion of an indwelling urinary catheter increases the patient's risk for developing what kind of kidney disorder?

-acute pyelonephritis

The nurse is assessing a patient who reports chills, high fever and flank pain with urinary urgency and frequency. On physical examination, the patient has costovertebral angle tenderness, pulse is 110 bpm, and respirations are 28/min. How does the nurse interpret these findings?

-acute pyelonephritis

The nurse is caring for a patient with a nephrostomy. The nurse notifies the health care provider about which assessment finding?

-amount of drainage decreases and the patient has back pain

The nurse is teaching a patient a behavioral intervention for bladder compression. In order to correctly perform the Crede method, what does the nurse teach the patient to do?

-apply firm and steady pressure over the bladder area with the palm of the hand

The nurse is performing an assessment on a patient with probable stress incontinence. Which assessment technique does the nurse use to validate stress incontinence?

-ask the patient to cough while wearing a perineal pad

The nurse is assessing a patient with glomerulonephritis and notes crackles in the lung fields and neck vein distention. The patient reports mild shortness of breath. Based on these findings, what does the nurse do next?

-assess for additional signs of fluid overload

The nurse reads in the documentation that the advanced practice nurse performed a digital rectal examination and found that the rectal sphincter did not contract on digital insertion. Based on this information, which assessment is the nurse most likely to perform?

-assess for bowel and bladder incontinence

A patient had a nephrostomy and nephrostomy tube is in place. What is included in the postoperative care of this patient?

-assess the amount of drainage in the collection bag

The nurse is caring for a patient with an indwelling catheter. What intervention does the nurse use to minimize catheter-related infections?

-assess the patient daily to determine need for catheter

The nurse is caring for a patient with functional incontinence. The unlicensed assistive personnel (UAP) reports that "the linens have been changed four times within the last 6 hours, but the patient refuses to wear a diaper." What does the nurse do next?

-assess the patient for any new urinary problems and ask about toileting preferences

Which dietary change does the nurse suggest to a patient with urge incontinence?

-avoid alcohol and caffeine

A patient with reflex (overflow) urinary incontinence had surgery to relieve an obstruction. Postoperatively the nurse observes and reports that the patient is having urinary retention. Which drug has a role in addressing this problem?

-bethanechol chloride may be used short term after surgery

The nurse is caring for a patient who has an indwelling catheter and subsequently developed a urinary tract infection. The patient has been receiving antibiotics for several days but develops hypotension, a rapid pulse, and confusion. The nurse suspects urosepsis and alerts the health care provider. Which diagnostic test is the provider most likely to order to confirm sepsis?

-blood cultures

The student nurse is assisting in the postoperative care of a patient with a recent nephrectomy. The student demonstrates a reluctance to move the patient to change the linens because "the patient seems so tired". The nurse reminds the student that a priority assessment for this patient is to assess for which factor?

-blood on the linens beneath the patient

The urine output of a patient with a kidney stone has decreased from 40ml/hr to 5 ml/hr. What is the nurse's priority action?

-check patency of IV access and notify the HCP

The nurse is caring for a patient after a nephrectomy. The nurse notes that the urine flow was 50ml/hr at the beginning of the shift but several hours later has dropped to 30 ml/hr. What would the nurse do first?

-check the drainage system for kinks or obstructions to flow

The nurse is teaching a woman to prevent urinary tract infections. What information does the nurse include?

-clean the perineal area from front to back

The home health nurse reads in the patient's chart that the patient has asymptomatic bacterial urinary tract infection (ABUTI). Which intervention would the nurse perform?

-closely monitor for conditions that cause progression to acute infection

A patient has come to the clinic for follow up of acute pyelonephritis. Which action does the nurse reinforce to the patient?

-complete all antibiotic regimens

Which laboratory values would the nurse observe in a patient experiencing problems with urinary elimination as a result of acute pyelonephritis?

-complete blood count for elevation of differentials -blood urea nitrogen and serum creatinine levels for elevation -urine culture to identify specific organisms causing infection -urinalysis for bacteria, leukocyte esterase, nitrate, or red blood cells -c-reactive protein and erythrocyte sedimentation rate for immune response

A patient is diagnosed with hydronephrosis. What is the primary complication that could result from this condition?

-damage to blood vessels and kidney tubules

What are the key factors of renovascular disease?

-decreased glomerular filtration rate -elevated serum creatinine -poorly controlled diabetes or sustained hyperglycemia -significant, difficult-to-control high blood pressure

What change in diabetic therapy may be needed for the patient who has diabetic nephropathy?

-decreased insulin doses

A patient comes to the clinic and reports severe flank pain, bladder distention and nausea and vomiting with increasingly smaller amounts of urine with flank blood. The patient states, "I have kidney stones and I just need a prescription for pain medication." What is the priority concern in the interdisciplinary care of this patient?

-determining if there is an obstruction

Patients who have central nervous system lesions from stroke, multiple sclerosis, or parasacral spinal cord lesions may develop which type of urinary incontinence?

-detrusor hyperreflexia

Several patients at the clinic have been diagnosed with urinary tract infections. Which patients may need longer antibiotic treatment (7-21 days) or different agents than the typical first line medications?

-diabetic female patient -immunosuppressed male patient -pregnant female patient -older male patient who engages in anal intercourse

The nurse is teaching a patient with urge incontinence about dietary modifications. What is the best information for the nurse to give about fluid intake?

-drink 120 ml every hour or 240 ml every 2 hours and limit fluids after dinner

The nurse is counseling a patient with recurrent symptomatic urinary tract infections (UTIs) about diet therapy. What information does the nurse need to give to the patient?

-drink cranberry juice but avoid products with high fructose

The nurse is assessing a patient with possible acute glomerulonephritis. During the inspection of the hands, face and eyelids, what is the nurse primarily observing for?

-edema

The nurse is caring for a patient with kidney cell carcinoma who manifests paraneoplastic syndromes. What findings does the nurse expect to see in this patient?

-erythrocytosis -hypercalcemia -liver dysfunction -hypertension

The patient sustained traumatic kidney injury and needs the best diagnostic test to determine the extent of injury to the kidney. What does the nurse do?

-explain a computed tomography

The nurse is teaching self care measures to a patient who had shock wave lithotripsy for kidney stones. What information does the nurse include?

-finish the entire prescription of antibiotics to prevent infection -balance regular exercise with sleep and rest -drink at least 3 L of fluid a day -urine may be bloody for several days

Which clinical manifestation in a patient with an obstruction in the urinary system is associated specifically with a hydronephrosis?

-flank asymmetry

The nurse is caring for a patient with kidney cell carcinoma. What does the nurse expect to find documented about the patient's initial assessment?

-flank pain, gross hematuria, palpable kidney mass, and renal bruit

A patient is diagnosed with a fungal urinary tract infection. Which drug does the nurse anticipate the patient will be treated with?

-fluconazole

To prevent recurrence of superficial bladder cancer, the patient receives intravesical instillation of bacille Calmette-Guerin at the outpatient cancer clinic. What home care instructions should be given to this patient?

-for 24 hrs, others should not share your toilet; afterward clean the toilet with 10% bleach

An older adult patient with a cognitive impairment is living in an extended-care facility. The patient is incontinent, but as the family points out, "he will urinate in the toilet if somebody helps him". Which type of incontinence does the nurse suspect in this patient?

-functional

The nurse is caring for a patient who had a nephrectomy yesterday. To manage the patient's pain, what is the best plan for analgesia therapy?

-give parenteral medications on a schedule

Which patient with incontinence is most likely to benefit from a surgical sling or bladder suspension procedure?

-has stress incontinence and altered urethral competency

A patient's recurrent cystitis appears to be related to sexual intercourse. The patient seems uncomfortable talking about the situation. What communication technique does the nurse use to assist the patient?

-have an open and sensitive discussion with the patient

What are the key features associated with chronic pyelonephritis?

-hypertension -inability to conserve sodium -decreased urine-concentrating ability -tendency to develop hyperkalemia and acidosis

The nurse hears in report that the patient is being treated for a fungal urinary tract infection (UTI). In addition to performing routine care and assessments, the nurse is extra vigilant for signs/symptoms of which systemic disorder that may underlie the fungal UTI?

-immune system compromise

The health care provider informs the nurse that the patient has acute pyelonephritis that appears to have been caused by a bacterial infection in the blood. For this patient, what is the priority concept?

-immunity

An older adult male patient reports an acute problem with urine retention. The nurse advises the patient to seek medical attention because permanent kidney damage can occur in what time frame?

-in less than 48 hrs

A patient is returning from the postanesthesia care unit after surgery for bladder cancer and has a cutaneous ureterostomy. Where does the nurse expect the stoma to be located?

-in the midabdominal area

A patient with urinary incontinence is prescribed oxybutynin. What precautions or instructions does the nurse provide related to this therapy?

-increase fluids and dietary fiber intake

The nurse is caring for an older adult patient with urinary incontinence. The patient is alert and oriented but refuses to use the call bell and has fallen several times while trying to get to the bathroom. What is the nurse's priority concern for this patient?

-initiating fall prevention measures

The nursing student sees an order for a urinalysis for a patient with frequency, urgency, and dysuria. In order to collect the specimen, what does the student do?

-instruct the patient on how to collect a clean-catch specimen

The nurse is caring for a postoperative nephrectomy patient. The nurse notes during the first several hours of the shift, a marked and steady downward trend in blood pressure. How does the nurse interpret this finding?

-internal hemorrhage is possible

Which factor is the strongest predictor for a patient to develop a catheter-associated urinary tract infection?

-length of time catheter dwells in patient

The health care provider verbally informs the nurse that the patient needs a fluroquinolone antibiotic to treat a urinary tract infection. The pharmacy delivers gabapentin. What should the nurse do first?

-look at the written order and take steps to correct the error

A patient is diagnosed with urethral stricture. What is the priority assessment?

-monitor urinary output

The home health nurse is assessing an older adult patient who refuses to leave the house to see friends or participate in usual activities. She reports taking a bath several times a day and becomes very upset when she has an incontinent episode. What is the priority problem for this patient?

-negative self image

Several attempts to obtain a clean catch urine specimen from an older patient are unsuccessful because the patient has poor manual dexterity and poor control over stopping and starting the stream. What is the nurse's best action?

-obtain an order for straight catheterization and use a small diameter (6Fr) catheter

For a patient who needs an indwelling catheter for at least 2 weeks, which intervention would help reduce the bacterial colonization along the catheter?

-obtain an order to insert an antiseptic catheter

The nurse is caring for an obese older patient with dementia. The patient is alert and ambulatory but has functional incontinence. Which nursing intervention is best for this patient?

-offer assistance with toileting every 2 hours

The nurse is caring for a patient with urolithiasis. Which type of medication is likely to be given in the acute phase to relieve the patient's severe pain?

-opioid analgesics

A patient is admitted to the medical-surgical unit for acute pyelonephritis. What is the priority concept to consider in the immediate nursing care of this patient?

-pain

The nurse is talking to a 68 y/o male patient who has lifestyle choices and occupational exposure that put him at high risk for bladder cancer. The nurse is most concerned about which urinary characteristic?

-painless hematuria

In which patient circumstance would the nurse question the order for the insertion of an indwelling catheter?

-patient has functional incontinence related to Alzheimer's disease

A patient has been performing kegel exercises for two months. Which outcome statement indicates that the goal of therapy has been met?

-patient is able to voluntarily stop the urinary stream

Which patient has the greatest risk for developing chronic pyelonephritis?

-patient is bedridden and has prostate enlargement with reflux

What might the nurse notice if the patient is experiencing problems with urinary elimination as a result of acute pyelonephritis?

-patient reports pain and burning on urination -patient reports back or flank pain -urine is cloudy and foul smelling -urine may be darker or smoky or have obvious blood in it -patient reports nocturia

Which clinical manifestation indicates to the nurse that interventions for the patient's renal colic are effective?

-patient reports that pain is relieved

The health care provider has recommended intermittent self-catheterization for a patient with long-term problems of incomplete bladder emptying. Which information does the nurse give the patient about the procedure?

-perform proper handwashing and cleaning of the catheter to reduce the risk of infection

The emergency department nurse is preparing a patient with kidney trauma for emergency surgery. What is the best task to delegate to unlicensed assistive personnel?

-pick up the units of packed red cells from the blood bank

A patient reports symptoms indicating a urinary tract infection (UTI). Which urine test results most strongly indicates a UTI?

-presence of leukocyte esterase and nitrate

A patient with chronic pyelonephritis returns to the clinic for a follow up. Which behavior indicates the patient is performing the self-care measures to conserve existing kidney function?

-reports taking antibiotics as prescribed

A patient is admitted for an electric orthopedic surgical procedure. The patient also has a personal and family history for urolithiasis. Which circumstance creates the greatest risk for recurrent urolithiasis?

-restricting food and fluids for extended periods

A patient with a history of kidney stones presents with severe flank pain, nausea, vomiting, pallor, and diaphoresis. He reports freely passing urine, but it is bloody. What is the priority concern?

-severe pain

A patient received an antibiotic prescription several hours ago and has started the medication but requests "some relief from the burning." What comfort measures does the nurse suggest to the patient?

-sit in a sitz bath and urinate into the warm water

The nurse is reviewing a care plan for a patient who has functional incontinence. There is a note that containment is recommended, especially at night. What is the major concern with this approach?

-skin integrity

After a nephrectomy, one adrenal gland remains. Based on this knowledge, which type of medication replacement therapy does the nurse expect if the remaining adrenal gland function is insufficient?

-steroid

A patient returns to the medical-surgical unit after having shock wave lithotripsy. What is an appropriate nursing intervention for the postprocedural care of this patient?

-strain the urine to monitor the passage of stone fragments

A patient reports the loss of small amounts of urine during coughing, sneezing, jogging or lifting. Which type of incontinence is the patient describing?

-stress

A 53 year old patient is newly diagnosed with renal artery stenosis. Which clinical manifestation is the nurse most likely to observe when the patient first seeks healthcare?

-sudden onset of hypertension

A middle-aged woman has urinary stress incontinence related to weak pelvic muscles. Which intervention does the nurse include in the treatment plan?

-suggest keeping a detailed diary of urine leakage, activities, and foods eaten -suggest wearing absorbent undergarments during the assessment process -teach pelvic floor (kegel) exercise therapy -refer to the nutritionist for diet therapy for weight reduction

A patient is diagnosed with kidney cancer and the healthcare provider recommends the best therapy. Which treatment does the nurse anticipate teaching the patient about?

-surgical removal

The nurse is reviewing the medical history of a patient who was admitted for acute glomerulonephritis. Which systematic conditions may have caused acute glomerulonephritis and should be included in the overall plan of care?

-systemic lupus erythematosus and diabetic glomerulopathy

A patient is brought into the emergency department because he was in a fight and was repeatedly kicked and punched in the back. What does the nurse include in the initial physical assessment?

-take complete vital signs -check apical and peripheral pulses -inspect flanks for bruising, asymmetry, or penetrating injuries -inspect abdomen, chest and lower back for bruising or penetrating wounds -inspect urethra for gross bleeding

The nurse is designing a habit training bladder program for an older adult patient who is alert but mildly confused. What task associated with the training program is delegated to the unlicensed assistive personnel?

-tell the patient it is time to go to the toilet and assist him to go on a regular schedule

The nurse is reviewing the laboratory results for a patient being evaluated for difficulties with passing urine. The urinalysis shows tubular epithelial cells on microscopic examination. How does the nurse interpret this finding?

-the obstruction is prolonged

A patient reports intense urgency, frequency, and bladder pain. Urinalysis results show no white blood cells and no red blood cells and urine culture results are negative for infection. How does the nurse interpret these findings?

-these findings are associated with a diagnosis of interstitial cystitis

The nurse is caring for a patient who had a mid-urethral sling procedure. What instructions does the nurse give to unlicensed assistive personnel to prevent postoperative complications?

-urethral catheter must be secured in place with a tube holder

A patient reports straining to pass very small amounts of urine today, despite a normal fluid intake, and reports having the urge to urinate. The nurse palpates the bladder and finds that it is distended. Which condition is most likely to be associated with these findings?

-urethral stricture

A patient reports severe flank pain. The report indicates that urine is turbid, malodorous, and rust colored; red blood cells, white blood cells and bacteria are present; and microscopic analysis shows crystals. What does this data suggest?

-urolithiasis and infection

The employee health nurse is conducting a presentation for employees who work in a paint manufacturing plant. In order to protect against bladder cancer, what advice does the nurse give to personnel who directly work with chemicals?

-use personal protective equipment such as gloves and masks

Which task related to care of patients who have indwelling catheters can be delegated to unlicensed assistive personnel (UAP)?

-wash the perineum daily and frequently empty the drainage bag using a separate, clean container for each patient