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Nursing care for urinary chapter

Terms in this set (42)

A patient hospitalized for orthopedic surgery had a urinary catheter inserted.The patient later develops a urinary tract infection (UTI)and asks the nurse what caused it.What is the appropriate response by the nurse? A) "There was a change in the pH of your urine."
B) "You probably did not void frequently enough."
C) "Bacteria probably ascended the catheter, causing the infection."
D) "There are always bacteria on your perineum that enter your urine."
C
UTIs are almost always caused by an ascending infection,starting at the external urinary meatus and progressing toward the bladder and kidneys.Instrumentation,or having instruments or tubes inserted into the urinary meatus,is a predisposing cause.A.B.D.Change in urinary pH,infrequent voiding,and presence of bacteria are not predisposing causes for UTIs.
The nurse is reinforcing 24-hour fluid intake teaching for a patient to prevent further UTIs.Which amount should the patient state that indicates that teaching has been effective?
A) "1000 mL."
B) "1500 mL."
C) "3000 mL."
D) "5000 mL."
C
To prevent UTIs,the patient should be encouraged to drink up to 3000 mL of fluid a day if there are no fluid restrictions from the physician.A.B.Less than 2 liters of fluid per day is not sufficient to prevent the onset of a UTI.D.There is no need for the patient to ingest 5 liters of fluid per day.
The nurse is reviewing the history and physical of a patient who has an infection.What term should the nurse realize describes an infection of the kidneys?
A) Cystitis
B) Hepatitis
C) Urethritis
D) Pyelonephritis
D
Pyelonephritis is infection of the renal pelvis,tubules,and interstitial tissue of one or both kidneys.A.Cystitis is inflammation and infection of the bladder wall.B.Hepatitis is inflammation and infection of the liver.C.Urethritis is inflammation of the urethra.
The nurse is reinforcing teaching provided to a patient about antibiotics prescribed for a UTI.Which patient statement indicates teaching has been effective?
A) "I will take the antibiotics until my urine is no longer cloudy."
B) "I will take the antibiotics whenever I feel discomfort from urinating."
C) "I will take the antibiotics until they are gone regardless of symptoms."
D) "I will take the antibiotics until my temperature has been normal for 3 days."
C
The patient should take the prescribed medication for a UTI until all medication has been taken.A.B.D.These statements indicate that teaching has not been effective.
The nurse is collecting data from a patient with suspected cancer of the bladder.What finding should the nurse recognize as the most common symptom of cancer of the bladder?
A) Pain
B) Hematuria
C) Urine retention
D) Burning on urination
B
Cancer of the bladder usually causes painless hematuria.A.C.D.Pain,urine retention,and burning on urination are not the most common symptoms of bladder cancer.
The nurse notes that the urine from a patient with an ileal conduit has mucus strands.
What action should the nurse take?

A) Notify the physician.
B) Send a urine sample to the laboratory for culture.
C) Ask the patient about a history of UTIs.
D) Nothing, as the nurse understands that this is a normal finding.
D
The nurse is reinforcing teaching provided to a patient about risk factors for the development of bladder cancer.What risk factor should the patient state that indicates understanding of this teaching?
A) Smoking
B) Hyperlipidemia
C) Diet high in calcium
D) Recurrent UTIs
A
The nurse is caring for a patient who has renal calculi.Which action is essential for the nurse to take?
A) Strain all urine.
B) Limit fluids at night.
C) Record blood pressure.
D) Obtain a sterile urine specimen.
A
The nurse is caring for a patient who has a nephrostomy tube.What action should the nurse take to maintain the integrity of this device?
A) Ensure tube is not kinked or clamped.
B) Limit fluids to 1000 mL per 24 hours.
C) Keep collection bag taped to abdomen.
D) Remove and clean the tube once daily.
A
A patient hourly urine output is recorded.Which output rates should be brought to the attention of the registered nurse (RN)immediately?
A) 15 mL/hr
B) 40 mL/hr
C) 60 mL/hr
D) 80 mL/hr
A
The nurse is caring for a patient who has an acute kidney injury.Which diagnostic test result should the nurse identify as most supporting this diagnosis?
A) Hematocrit 20% (normal 38% to 47%)
B) Uric acid 8 ng/dL (normal 2.5 to 5.5 ng/dL)
C) 24-hour creatinine clearance 5 mL/min (normal 100 mL/min)
D) Blood urea nitrogen 20 mg/100 mL (normal 8 to 25 mg/100 mL)
C
A patient who has diabetic nephropathy asks the nurse,"Why am I using smaller doses of insulin than I used to?" What would be the best explanation by the nurse? A) "Insulin is now more potent than it used to be."
B) "It would be best if you spoke with your physician about this."
C) "You have probably decreased the amount of food you are eating."
D) "Your kidneys are no longer breaking down the insulin as much as before."
D
A patient with chronic kidney disease is very weak due to low hemoglobin.What should the nurse understand as the best explanation for the anemia?
A) Secretion of erythropoietin by the diseased kidney is reduced.
B) There is loss of red blood cells in the urine with kidney disease.
C) Chronic hypertension associated with chronic kidney disease suppresses the bone marrow.
D) Metabolic acidosis associated with chronic kidney disease increases red blood cell fragility.
A
The nurse is caring for a patient with chronic kidney disease.Which data collection technique is the best one for the nurse to use to determine this patient's fluid volume status?
A) Vital signs
B) Skin turgor
C) Daily weight
D) Intake and output
C
A patient who is on hemodialysis for chronic kidney disease is prescribed sevelamer hydrochloride (Renagel)with meals.What explanation should be provided to the patient as the primary reason the medication is being given?
A) To prevent metabolic acidosis
B) To prevent gastrointestinal ulcer formation
C) To relieve gastric irritation from excess acid production
D) To prevent damage to bones from high phosphorus levels
D
The nurse is collecting data from a patient who has returned from a dialysis session.After dialysis,the nurse should anticipate which patient finding?
A) Weight loss
B) Hypertension
C) Increased energy
D) Distended neck veins
A
While collecting data,the nurse suspects that a patient is experiencing renal calculi.What did the nurse assess to come to this conclusion? (Select all that apply.)
A) Nausea
B) Flank pain
C) Fever and chills
D) Costovertebral tenderness
E) Pain radiating to the genitalia
A,B,D,E
The nurse is reinforcing teaching provided to a patient with chronic kidney disease.Which patient statement indicates the need for further teaching?
A) "I do not use salt substitute."
B) "My fluid intake is restricted."
C) "As long as I don't eat protein, I'll be okay."
D) "Since I'm on dialysis, I cannot eat just anything I want."
C
While participating in the creation of a teaching plan,the nurse suggests that a patient ingest cranberry juice every day to reduce the risk of developing a UTI.What information did the nurse use to make this suggestion? (Select all that apply.)
A) The fiber in cranberries reduces the amount of sediment in the urine.
B) Cranberries facilitate the removal of fluid from the interstitial spaces.
C) Compounds in cranberries inhibit the adherence ofE. coli to the urogenital mucosa.
D) Cranberries reduce the incidence of UTIs in patients after renal transplants.
E) Cranberries contain a substance that prevents bacteria from sticking on the walls of the bladder.
C,D,E
The nurse is reinforcing teaching about the most serious side effect of peritoneal dialysis with a patient scheduled for the first treatment.Which side effect should the patient state that indicates correct understanding?
A) "Peritonitis."
B) "Paralytic ileus."
C) "Respiratory distress."
D) "Cramps in the abdomen."
A
A patient with a UTI is concerned about the expectation to void every three hours.What should the nurse explain to the patient about voiding this frequently? (Select all that apply.)
A) Empties the bladder
B) Reduces urine stasis
C) Prevents reinfection
D) Cleanses the perineum
E) Lowers bacterial counts
A,B,C,E
A patient with glomerulonephritis asks,"How could I have gotten this?" How should the nurse respond?
A) "Has anyone in your family had glomerulonephritis?"
B) "Have you had a sore throat or skin infection recently?" C) "Glomerulonephritis almost always follows a bladder infection."
D) "Glomerulonephritis often results from having unprotected sex."
B
A 32-year-old female patient is diagnosed with uncomplicated cystitis.Which medications should the nurse expect to be prescribed for this patient? (Select all that apply.)
A) Ciprofloxacin (Cipro)
B) Aztreonam (Azactam)
C) Decadron (Solu-Medrol)
D) Nitrofurantoin (Macrodantin)
E) Sulfamethoxazole and trimethoprim (Bactrim, Septra)
D,E
A patient with glomerulonephritis develops acute kidney injury.Which form of kidney injury should the nurse realize has occurred with this patient?
A) Prerenal
B) Postrenal
C) Intrarenal
D) Suprabladder
C
The nursing home administrator for a skilled nursing facility is concerned because a large number of older residents are developing UTIs.What should the staff nurse explain about the development of UTIs in this population? (Select all that apply.)
A) Overuse of antibiotics
B) Diminished immune function
C) Enlarged prostate in older men
D) Presence of neurogenic bladder
E) Decline in estrogen in older women
B,C,D,E
A 19-year-old patient reports flank pain and scanty urination.The nurse notices periorbital edema,and the urinalysis reveals white blood cells,red blood cells,albumin,and casts.What question would be most important for the nurse to include in data collection?
A) "Is your vision blurred?"
B) "Are you sexually active?"
C) "Have you had any gastrointestinal problems lately?" D) "Have you had a strep infection of the throat or skin recently?"
D
The nurse is contributing to a staff education program about the risks of smoking and conditions related to smoking.Which statements by a staff member indicate correct understanding of the teaching? (Select all that apply.)
A) Kidney stones
B) Kidney cancer
C) Bladder cancer
D) Hydronephrosis
E) Diabetic nephropathy
F) UTI
B,C,E
The nurse is reinforcing teaching provided to a patient about risk factors for prerenal injury.Which risk factor should the patient state that indicates understanding of this teaching?
A) "Kidney stones."
B) "Enlarged prostate."
C) "Exposure to nephrotoxins agents."
D) "Use of nonsteroidal anti-inflammatory drugs."
D
The nurse is contributing to the plan of care for a patient with chronic kidney disease.The nurse has recognized a growing body of evidence related to restricting protein intake.Which evidence should the nurse use to develop the plan of care? (Select all that apply.)
A) Protein requirements should be based on ideal body weight.
B) Increased protein is recommended for patients on hemodialysis.
C) Protein calorie malnutrition should be avoided for patients on hemodialysis.
D) Optimum nutritional status should be maintained for all patients with kidney disease.
E) All patients with renal compromise should limit protein intake to less than 0.5 g/kg/day.
F) Protein energy malnutrition is a predictor of mortality and morbidity for patients on dialysis.
B,C,D,F
The nurse is contributing to the plan of care for a patient who is having an intravenous pyelogram (IVP)done to diagnose possible bladder cancer.Which intervention should the nurse recommend be included for the patient after the procedure?
A) Document heart rhythm.
B) Monitor creatinine level.
C) Monitor arterial blood gases (ABGs).
D) Review thyroid-stimulating hormone (TSH) and T4 levels.
B
The nurse is reinforcing teaching provided to a patient with polycystic kidney disease.Which patient statements indicate a correct understanding of the teaching? (Select all that apply.)
A) "It is a hereditary disease."
B) "It affects women more than men."
C) "Symptoms appear in early childhood."
D) "Genetic counseling is appropriate for individuals with this diagnosis."
E) "There is no effective treatment to stop the progression of the disease."
F) "It is characterized by the formation of multiple grapelike cysts in the kidney."
A,D,E,F
The nurse is caring for an unstable patient with acute kidney injury.What therapy should the nurse expect to be ordered?
A) Hemodialysis
B) Urinary catheter
C) Peritoneal dialysis
D) Continuous renal replacement therapy (CRRT)
D
The nurse is reinforcing teaching provided to a patient with chronic kidney disease who is receiving hemodialysis three times a week at a hemodialysis center.Which statements should be included? (Select all that apply.)
A) "You may feel weak and fatigued after the treatment." B) "You may not be able to eat before the treatment session."
C) "You will need to be weighed before and after the session."
D) "Your medication schedule will be the same on dialysis days."
E) "Report any numbness, swelling, redness, or drainage from the dialysis access site."
F) "You may experience some bleeding from the puncture site or a nosebleed. Report it if it doesn't stop within a few minutes."
A,B,C,E,F
A patient is diagnosed with end-stage kidney disease.The nurse realizes that what percentage of functioning nephrons have been lost in this patient?
A) 25%
B) 50%
C) 75%
D) 90%
D
The nurse is contributing to the plan of care for a patient who has chronic kidney disease.What possible effects of this condition should the nurse consider? (Select all that apply.)
A) Anemia
B) Cardiac dysrhythmias
C) Peripheral neuropathy
D) Increased bone density
E) Anorexia, nausea, vomiting
F) Increase in function of oil and sweat glands
A,B,C,E
A patient has a glomerular filtration rate of 20 mL/min.For which stage of renal failure should the nurse plan care for this patient?
A) Mild
B) Slight
C) Severe
D) Moderate
C
A patient with chronic kidney disease has a serum potassium level of 6 mEq/L.Which action should the nurse take? (Select all that apply.)
A) Obtain consent for hemodialysis.
B) Administer the patient an antacid.
C) Place the patient on a cardiac monitor.
D) Give the patient a glass of orange juice.
E) Repeat laboratory test of electrolyte levels.
F) Inform RN to notify physician.
C,F
The nurse is reinforcing teaching provided to a patient with a history of calcium oxalate kidney stones.The nurse recognizes that teaching has been effective if the patient avoids which foods? (Select all that apply.)
A) Bread
B) Cocoa
C) Lettuce
D) Spinach
E) Chicken
F) Instant coffee
B,D,F
The nurse notes it is time to administer prescribed gentamicin (Garamycin)for a patient with acute kidney injury and suspected streptococcal pneumonia.Which action should the nurse take at this time? (Select all that apply.)
A) Hold medication.
B) Administer drug as ordered.
C) Administer half of the prescribed dose.
D) Consult physician about medication order.
E) Flush the tubing with heparin before infusing.
A,D
The nurse is monitoring a patient with chronic kidney disease.Which findings should the nurse realize indicates fluid overload? (Select all that apply.)
A) Periorbital edema
B) Crackles in the lungs
C) Postural hypotension
D) Increased blood pressure
E) Decreased pulse pressure
F) Auditory wheezes on inspiration
A,B,D
The nurse is reinforcing teaching provided to a patient about caring for a new fistula in the left arm for dialysis.Which patient statements indicates correct understanding? (Select all that apply.)
A) "Do not sleep on my arm."
B) "Keep my arm elevated at all times."
C) "Keep a firm bandage on my arm."
D) "Wear loose clothing on my left arm."
E) "Avoid carrying heavy things with my left arm."
F) "Do not allow blood pressures to be taken on my left arm."
A,D,E,F
The nurse is collecting data from a patient with a vascular access graft in the right arm for dialysis.What should the nurse do when assessing this patient? (Select all that apply.)
A) Auscultate for a bruit over the site.
B) Palpate for a thrill in the right arm.
C) Observe the tubing for bright red blood.
D) Feel for a brachial pulse on the affected arm.
E) Redress the arm daily, keeping the site sterile at all times.
A,B
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