Learning Quiz - Renal Cysts, Obstruction, UTI

Which client is likely at the greatest risk of developing a urinary tract infection?

A 79-year-old client with an indwelling catheter

The healthcare provider is caring for a client with recurring urinary tract infections (UTIs). The client asks, "Other than taking antibiotics, what else can I do?" Which response by the healthcare provider is most accurate?

Drink lots of fluids to help relieve the signs/symptoms of UTIs.

Most common uncomplicated urinary tract infections are caused by ____ that enter through the urethra.

E. coli

The healthcare provider recognizes the most common cause of acute postinfectious glomerulonephritis as:

a streptococcal infection 7 to 12 days prior to onset. Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A beta-hemolytic streptococci and is caused by deposition of immune complexes. It also may occur after infections by other organisms, including staphylococci and a number of viral agents, such as those responsible for mumps, measles, and chickenpox.

A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the healthcare provider learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The healthcare provider should suspect the child has developed:

acute postinfectious glomerulonephritis. The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: the time needed for the development of antibodies. The primary infection usually involves the pharynx (pharyngitis), but can also result from a skin infection (impetigo). Oliguria, which develops as the GFR decreases, is one of the first symptoms.

Acute pyelonephritis is a result of:

Bacterial infection

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?

Hematuria Presenting features of renal cancer include hematuria, flank pain, and presence of a palpable flank mass. Gross or microscopic hematuria, which occurs in more than 50% of cases, is an important clinical clue. Urgency, oliguria, and cloudy urine are not as closely associated with renal carcinoma.

A healthcare provider is caring for a client who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this client?

Hydration A major goal of treatment in people who have passed kidney stones or have had them removed is to prevent their recurrence. Adequate fluid intake reduces the concentration of stone-forming crystals in the urine and needs to be encouraged.

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which measures should the client integrate into his or her lifestyle to reduce the risk of recurrence?

Increased fluid intake and dietary changes Depending on the type of stone that was present, many clients benefit from increased fluid intake and changes in diet. Weight loss, blood sugar and pressure control, and exercise are not central preventive measures. It would likely be inappropriate to recommend the use of over-the-counter diuretics as a preventive measure.

A healthcare provider is assessing a client's risk for developing a hospital-acquired urinary tract infection (UTI) and determines that which of the following places the client at greatest risk?

Indwelling urinary catheter Instrumentation and urinary catheterization are the most common predisposing factors for hospital-acquired (nosocomial) urinary tract infections. The other items increase risk factors but are not necessarily related to hospitalization.

A healthcare provider is giving discharge instructions for a client who was diagnosed with acute pyelonephritis 3 days previously. Which instruction is important for the healthcare provider to discuss when teaching the client?

It is important that the client take the prescribed antibiotic for the duration of the prescription. Acute pyelonephritis is treated with appropriate antimicrobial drugs and may also require intravenous hydration. Unless obstruction or other complications in the client occur, the symptoms usually disappear within several days. Treatment with an appropriate antimicrobial agent usually is continued for 10-14 days.

Surgical stone removal is indicated for which instance?

Obstruction of urine flow Open stone surgery may be required to remove large calculi or those that are resistant to other forms of removal. Kidney stones are a major cause of upper urinary tract obstruction.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?

Plasma proteins

Which substance would not be found in glomerular filtrate?

Proteins The glomerular filtrate has a chemical composition similar to plasma (which contains sodium, potassium and water), but it contains no proteins because large molecules do not readily cross the glomerular wall.

An older adult client has been hospitalized for the treatment of acute pyelonephritis. Which characteristic of the client is most likely implicated in the etiology of this current health problem?

Recently had a urinary tract infection

An obese client with a history of gout and a sedentary lifestyle has been advised by the primary health care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the client's susceptibility to which type of kidney stones?

Uric acid stones Uric acid stones develop in conditions of gout and when high concentrations of uric acid develop in the urine. Unlike radiopaque calcium stones, uric acid stones are not visible on x-ray films. These stones develop in clients who eat a high-purine diet like Atkins.

Which is the most important factor in reducing hospital-acquired (nosocomial) urinary tract infections?

Using urinary catheters only when necessary and their prompt removal when no longer needed