LACHARITY 16 Renal and Urinary Problems Flashcards
The nurse is reviewing the lab values for a patient with risk for urinary
problems. Which finding is of most concern to the nurse?
1. Blood urea nitrogen (BUN) of 10 mg/mL (3.6 mmol/L)
2. Presence of glucose and protein in urine
3. Serum creatinine of 0.6 mg/mL (53 mcmol/L)
4. Urinary pH of 8
Ans: 2 When blood glucose levels are greater than 220 mg/dL (12.2 mmol/L),
some glucose stays in the filtrate and is present in the urine. Normally, almost
all glucose and most proteins are reabsorbed and are not present in the urine.
Report the presence of glucose or proteins in the urine of a patient
undergoing a screening examination to the health care provider because this
is an abnormal finding and requires further assessment. Focus: Prioritization.
For which patient is the nurse most concerned about the risk for developing
kidney disease?
1. A 25-year-old patient who developed a urinary tract infection (UTI) during
pregnancy
2. A 55-year-old patient with a history of kidney stones
3. A 63-year-old patient with type 2 diabetes
4. A 79-year-old patient with stress urinary incontinence
Ans: 3 A history of chronic health problems, especially diabetes and
hypertension, increases the risk for development of kidney disease. Focus:
Prioritization.
The nurse is caring for a patient with risk for kidney disease for whom a
urinalysis has been ordered. What time would the nurse instruct the
unlicensed assistive personnel is best to collect this sample?
1. With first morning void
2. Before any meal
3. At bedtime
4. Immediately
Ans: 1 Urinalysis is a part of any complete physical examination and is
especially useful for patients with suspected kidney or urologic disorders.
Ideally, the urine specimen is collected at the morning’s first voiding.
Specimens obtained at other times may be too dilute. Focus: Delegation,
Supervision.
The nurse has delegated collection of a urinalysis specimen to an experienced
unlicensed assistive personnel (UAP). For which action must the nurse
intervene?
1. The UAP provides the patient with a specimen cup.
2. The UAP reminds the patient of the need for the specimen.
3. The UAP assists the patient to the bathroom.
4. The UAP allows the specimen to sit for more than 1 hour.
Ans: 4 Urine specimens become more alkaline when left standing
unrefrigerated for more than 1 hour, when bacteria are present, or when a
specimen is left uncovered. Alkaline urine increases cell breakdown; thus, the
presence of red blood cells may be missed on analysis. Ensure that urine
specimens are covered and delivered to the laboratory promptly or
refrigerated. Actions 1, 2, and 3 are appropriate for urinalysis specimen
collection. Focus: Delegation, Supervision.
The nurse is caring for a patient with risk for incomplete bladder emptying.
Which noninvasive finding best supports this problem?
1. Patient is able to void additional 100 mL after nurse massages over the
bladder.
2. Patient voids additional 350 mL with insertion of an intermittent catheter.
3. Patient has postvoid residual of 275 mL documented by bedside bladder
scanner.
4. Patient has constant dribbling between voidings.
Ans: 3 The use of portable ultrasound scanners in the hospital and
rehabilitation setting by nurses is a noninvasive method of estimating
bladder volume. Bladder scanners are used to screen for postvoid residual
volumes and to determine the need for intermittent catheterization based on
the amount of urine in the bladder rather than the time between
catheterizations. There is no discomfort with the scan, and no patient
preparation beyond an explanation of what to expect is required. Use of
bladder massage or presence of urinary dribbling is inexact, and intermittent
catheterization is invasive. Focus: Prioritization.
The nurse is providing care for a patient after a kidney biopsy. Which actions
301should the nurse delegate to an experienced unlicensed assistive personnel
(UAP)? Select all that apply.
1. Check vital signs every 4 hours for 24 hours.
2. Remind the patient about strict bed rest for 2 to 6 hours.
3. Reposition the patient by log-rolling with supporting backroll.
4. Measure and record urine output.
5. Assess the dressing site for bleeding and check complete blood count
results.
6. Teach the patient to resume normal activities after 24 hours if there is no
bleeding.
Ans: 1, 2, 3, 4 Checking vital signs, repositioning patients, and recording
intake and output are within the scope of practice for a UAP. Assessing and
teaching are more within the scope of practice for professional nurses. If no
bleeding occurs, the patient can resume general activities after 24 hours.
However, instruct him or her to avoid lifting heavy objects, exercising, and
performing other strenuous activities for 1 to 2 weeks after the biopsy
procedure. Driving may also be restricted. Focus: Delegation, Supervision.
The nurse is providing nursing care for a 24-year-old female patient admitted
to the acute care unit with a diagnosis of cystitis. Which intervention should
the nurse delegate to the unlicensed assistive personnel (UAP)?
1. Teaching the patient how to secure a clean-catch urine sample
2. Assessing the patient’s urine for color, odor, and sediment
3. Reviewing the nursing care plan and add nursing interventions
4. Providing the patient with a clean-catch urine sample container
Ans: 4 Providing the equipment that the patient needs to collect the urine
sample is within the scope of practice of a UAP. Teaching, planning, and
assessing all require additional education and skill, which is appropriate to
309the scope of practice of professional nurses. Focus: Delegation, Supervision.
Which laboratory result is of most concern to the nurse for an adult patient
with cystitis?
1. Serum white blood cell (WBC) count of 9000/mm 3 (9 x 109/L)
2. Urinalysis results showing 1 or 2 WBCs present
3. Urine bacteria count of 100,000 colonies per milliliter
4. Serum hematocrit of 36%
Ans: 3 The presence of 100,000 bacterial colonies per milliliter of urine or the
presence of many white blood cells (WBCs) and red blood cells (RBCs)
indicates a urinary tract infection. This WBC count is within normal limits,
and the hematocrit is a little low, which may need follow-up. Neither of these
results indicates infection. Focus: Prioritization; Test Taking Tip: It is
essential that the nurse be alert to any signs or symptoms of infection for a
patient. In this case, the presence of so many bacterial colonies indicate the
presence of an infection in the bladder, which needs to be treated with
antibiotics.
The charge nurse would assign the nursing care of which patient to an
LPN/LVN, working under the supervision of an RN?
1. A 48-year-old patient with cystitis who is taking oral antibiotics
2. A 64-year-old patient with kidney stones who has a new order for
lithotripsy
3. A 72-year-old patient with urinary incontinence who needs bladder
training
4. A 52-year-old patient with pyelonephritis who has severe acute flank pain
Ans: 1 The patient with cystitis who is taking oral antibiotics is in stable
condition with predictable outcomes, and caring for this patient is therefore
appropriate to the scope of practice of an LPN/LVN under the supervision of
an RN. The patient with a new order for lithotripsy will need teaching about
the procedure, which should be accomplished by the RN. The patient in need
of bladder training will need the RN to plan this intervention. The patient
with flank pain needs careful and skilled assessment by the RN. Focus:
Assignment.
The nurse is admitting a 66-year-old male patient suspected of having a
urinary tract infection (UTI). Which part of the patient’s medical history
supports this diagnosis?
1. Patient’s wife had a UTI 1 month ago
2. Followed for prostate disease for 2 years
3. Intermittent catheterization 6 months ago
4. Kidney stone removal 1 year ago
Ans: 2 Prostate disease increases the risk of UTIs in men because of urinary
retention. The wife’s UTI should not affect the patient. The times of the
catheter usage and kidney stone removal are too distant to cause this UTI.
Focus: Prioritization.
A patient is being admitted to rule out interstitial cystitis. What should the
302nurse’s plan of care for this patient include specific to this diagnosis?
1. Take daily urine samples for urinalysis.
2. Maintain accurate intake and output records.
3. Obtain an admission urine sample to determine electrolyte levels.
4. Teach the patient about the cystoscopy procedure.
Ans: 4 A cystoscopy is needed to accurately diagnose interstitial cystitis.
Urinalysis may show white blood cells and red blood cells but no bacteria.
The patient will probably need a urinalysis upon admission, but daily
samples do not need to be obtained. Intake and output may be assessed, but
results will not contribute to the diagnosis. Cystitis does not usually affect
urine electrolyte levels. Focus: Prioritization.
The RN is supervising a new graduate nurse who is orientating to the unit.
The new nurse asks why the patient with uncomplicated cystitis is being
discharged with a prescription for ciprofloxacin 250 mg twice a day for only 3
days. What is the RN’s best response?
1. “We should check with the health care provider because the patient should
take this drug for 10 to 14 days.”
2. “A 3-day course of ciprofloxacin is not the appropriate treatment for a
patient with uncomplicated cystitis.”
3. “Research has shown that a 3-day course of ciprofloxacin is effective for
uncomplicated cystitis and there is increased patient adherence to the plan
of care.”
4. “Longer courses of antibiotic therapy are required for hospitalized patients
to prevent nosocomial infections.”
Ans: 3 For uncomplicated cystitis, a 3-day course of antibiotics is an effective
treatment, and research has shown that patients are more likely to adhere to
shorter antibiotic courses. Seven-day courses of antibiotics are appropriate for
complicated cystitis, and 10- to 14-day courses are prescribed for
uncomplicated pyelonephritis. This patient is being discharged and should
not be at risk for a nosocomial infection. Focus: Prioritization, Supervision.
A 28-year-old married female patient with cystitis requires instruction about
how to prevent future urinary tract infections (UTIs). The supervising RN has
assigned this teaching to a newly graduated nurse. Which statement by the
new graduate requires that the supervising RN intervene?
1. “You should always drink 2 to 3 L of fluid every day.”
2. “Empty your bladder regularly even if you do not feel the urge to urinate.”
3. “Drinking cranberry juice daily will decrease the number of bacteria in
your bladder.”
4. “It’s okay to soak in the tub with bubble bath because it will keep you
clean.”
Ans: 4 Women should avoid irritating substances such as bubble baths,
nylon underwear, and scented toilet tissue to prevent UTIs. Adequate fluid
intake, consumption of cranberry juice, and regular voiding are all good
strategies for preventing UTIs. Focus: Assignment, Supervision,
Prioritization.
The nurse is creating a care plan for older adult patients with incontinence.
For which patient will a bladder-training program be an appropriate
intervention?
1. Patient with functional incontinence caused by mental status changes
2. Patient with stress incontinence due to weakened bladder neck support
3. Patient with urge incontinence and abnormal detrusor muscle contractions
4. Patient with transient incontinence related to loss of cognitive function
Ans: 3 A patient with urge incontinence can be taught to control the bladder
as long as the patient is alert, aware, and able to resist the urge to urinate by
starting a schedule for voiding, then increasing the intervals between voids.
Patients with functional incontinence related to mental status changes or loss
310of cognitive function are not able to follow a bladder-training program. A
better treatment for a patient with stress incontinence is exercises such as
pelvic floor (Kegel) exercises to strengthen the pelvic floor muscles. Focus:
Prioritization.
A patient with incontinence will be taking oxybutynin chloride 5 mg by
mouth three times a day after discharge. Which information would a nurse be
sure to teach this patient before discharge?
1. “Drink fluids or use hard candy when you experience a dry mouth.”
2. “Be sure to notify your health care provider (HCP) if you experience a dry
303mouth.”
3. “If necessary, your HCP can increase your dose up to 40 mg/day.”
4. “You should take this medication with meals to avoid stomach ulcers.”
Ans: 1 Oxybutynin is an anticholinergic agent, and these drugs often cause
an extremely dry mouth. The maximum dosage is 20 mg/day. Oxybutynin
should be taken between meals because food interferes with absorption of the
drug. Focus: Prioritization.
The nurse is providing care for a patient with reflex urinary incontinence.
Which action could be appropriately assigned to a new LPN/LVN?
1. Teaching the patient bladder emptying by the Credé method
2. Demonstrating how to perform intermittent self-catheterization
3. Discussing when to report the side effects of bethanechol chloride to the
health care provider (HCP)
4. Reinforcing the importance of proper hand washing to prevent infection
Ans: 4 Teaching about bladder emptying, self-catheterization, and when to
notify the HCP about medication side effects requires additional knowledge
and training and is appropriate to the scope of practice of the RN. The
LPN/LVN can reinforce information that has already been taught to the
patient. Focus: Assignment, Supervision.
A patient has urolithiasis and is passing the stones into the lower urinary
tract. What is the priority nursing concern for the patient at this time?
1. Pain
2. Infection
3. Injury
4. Anxiety
Ans: 1 When patients with urolithiasis pass stones, they can be in
excruciating pain for as much as 24 to 36 hours. All of the other nursing
concerns for this patient are accurate; however, at this time, pain is the most
urgent concern for the patient. Focus: Prioritization.
The RN is supervising a nurse orientating to the acute care unit who is
discharging a patient admitted with kidney stones and who underwent
lithotripsy. Which statement by the orienting nurse to the patient requires
that the supervising RN intervene?
1. “You should finish all of your antibiotics to make sure that you don’t get a
urinary tract infection (UTI).”
2. “Remember to drink at least 3 L of fluids every day to prevent another
stone from forming.”
3. “Report any signs of bruising to your health care provider (HCP)
immediately because this indicates bleeding.”
4. “You can return to work in 2 days to 6 weeks, depending on what your
HCP prescribes.”
Ans: 3 Bruising is to be expected after lithotripsy. It may be quite extensive
and take several weeks to resolve. All of the other statements are accurate for
a patient after lithotripsy. Focus: Assignment, Supervision, Prioritization
The RN is teaching a patient how to perform intermittent self-catheterization
for a long-term problem with incomplete bladder emptying. Which are
important points for teaching this technique? Select all that apply.
1. Always use sterile techniques.
2. Proper hand washing and cleaning of the catheter reduce the risk for
infection.
3. A small lumen and good lubrication of the catheter prevent urethral
trauma.
4. A regular schedule for bladder emptying prevents distention and mucosal
trauma.
5. The social work department can help you with the purchase of sterile
supplies.
3046. If you are uncomfortable with this procedure, a home health nurse can do
it.
Ans: 2, 3, 4 Intermittent self-catheterization is often used to help patients
with long-term problems of incomplete bladder emptying. It is not a sterile
procedure and does not require sterile equipment. It is a clean procedure.
Important teaching points include responses 2, 3, and 4 of this question.
Focus: Prioritization
The charge nurse must rearrange room assignments to admit a new patient.
Which two patients would be best suited to be roommates?
1. A 58-year-old patient with urothelial cancer receiving multiagent
chemotherapy
2. A 63-year-old patient with kidney stones who has just undergone open
ureterolithotomy
3. A 24-year-old patient with acute pyelonephritis and severe flank pain
4. A 76-year-old patient with urge incontinence and a urinary tract infection
(UTI)
Ans: 3, 4 Both of these patients will need frequent assessments and
medications. The patient receiving chemotherapy and the patient who has
just undergone surgery should not be exposed to any patient with infection.
Focus: Assignment, Prioritization
The patient problem of constipation related to compression of the intestinal
tract has been identified in a patient with polycystic kidney disease. Which
care action should the nurse assign to a newly-trained LPN/LVN?
1. Instructing the patient about foods that are high in fiber
2. Teaching the patient about foods that assist in promoting bowel regularity
3. Assessing the patient for previous bowel problems and bowel routine
4. Administering docusate sodium 100 mg by mouth twice a day
Ans: 4 Administering oral medications appropriately is covered in the
educational program for LPNs/LVNs and is within their scope of practice.
Teaching and assessing the patient require additional education and skill and
are appropriate to the scope of practice of RNs. Focus: Assignment,
Supervision.
A male patient must undergo intermittent catheterization. The nurse is
preparing to insert a catheter to assess the patient for postvoid residual. Place
the steps for intermittent catheterization in the correct order.
1. Assist the patient to the bathroom and ask the patient to attempt to void.
2. Retract the foreskin and hold the penis at a 60- to 90-degree angle.
3. Open the catheterization kit and put on sterile gloves.
4. Lubricate the catheter and insert it through the meatus of the penis.
5. Position the patient supine in bed or with the head slightly elevated.
6. Drain all the urine present in the bladder into a container.
7. Cleanse the glans penis starting at the meatus and working outward.
8. Remove the catheter, clean the penis, and measure the amount of urine
returned
Ans: 1, 5, 3, 2, 7, 4, 6, 8 Before checking postvoid residual, the RN should ask
the patient to void and then position him. Next the nurse should open the
catheterization kit and put on sterile gloves, position the patient’s penis, clean
the meatus, and then lubricate and insert the catheter. All urine must be
drained from the bladder to assess the amount of postvoid residual the
patient has. Finally, the catheter is removed, the penis cleaned, and the urine
measured. Focus: Prioritization; Test Taking Tip: For this type of question,
the nurse must stop and think about the correct steps for performing a
nursing action and then place them in the correct order.
The nurse is admitting a patient with nephrotic syndrome. Which
assessment finding supports this diagnosis?
1. Edema formation
2. Hypotension
3. Increased urine output
4. Flank pain
Ans: 1 The underlying pathophysiology of nephrotic syndrome involves
increased glomerular permeability, which allows larger molecules to pass
through the membrane into the urine and be removed from the blood. This
process causes massive loss of protein, edema formation, and decreased
serum albumin levels. Key features include hypertension and renal
insufficiency (decreased urine output) related to concurrent renal vein
thrombosis, which may be a cause or an effect of nephrotic syndrome. Flank
pain is seen in patients with acute pyelonephritis. Focus: Prioritization.
When the nurse must apply containment strategies for a patient with incontinence, what is the major risk? 3051. Incontinence-associated dermatitis 2. Skin breakdown 3. Infection 4. Fluid imbalance
Ans: 2 A major concern with the use of wearable protective pads is the risk
for skin breakdown. Some patients may develop incontinence-associated
dermatitis even when the skin is kept free of contact with urine because
wearable pads generate heat and sweat in the area and can cause dermatitis.
Infection becomes a risk when skin breakdown occurs. Focus: Prioritization.
