Lewis Chapter 48 TEST BANK

Question 1

patient returns to the clinic with recurrent dysuria after being treated with trimethoprimsulfamethoxazole for 3 days. Which of the following actions should the nurse plan to take?

a. Remind the patient about the need to drink 1000 mL of fluids daily.
b. Obtain a midstream urine specimen for culture and sensitivity testing.
c. Teach the patient to take the prescribed trimethoprim-sulfamethoxazole for at least
3 more days.
d. Suggest that the patient drink cranberry juice to treat the symptoms.

Answer 1

ANS: B
Since uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3
days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine
appropriate antibiotic therapy. Although daily intake of cranberry juice have been purported to
assist in treating there is currently no conclusive evidence to support advocating this
treatment. The fluid intake should be increased to at least 1800 mL/day. Since the UTI has
persisted after treatment with trimethoprim-sulfamethoxazole, the patient is likely to need a
different antibiotic.

Question 2

The nurse is providing patient teaching to a patient with cystitis regarding prevention of future urinary tract infections (UTIs). Which of the following patient statements indicate that
teaching has been effective?

a. “I can use vaginal sprays to reduce bacteria.”
b. “I will drink a litre of water or other fluids every day.”
c. “I will wash with soap and water before sexual intercourse.”
d. “I will empty my bladder every 2–4 hours during the day.”

Answer 2

ANS: D
Voiding every 2–4 hours is recommended to prevent UTIs. Use of vaginal sprays is
discouraged. The bladder should be emptied before and after intercourse, but cleaning with
soap and water is not necessary. A litre of fluids is insufficient to provide adequate urine
output to decrease risk for UTI.

Question 3

The nurse is caring for a patient who has had a segmental cystectomy. Which of the following
information should the nurse include in the postoperative teaching for the patient?

a. Limit fluid intake for at least 7 days.
b. Urine should be amber and not contain blood clots.
c. In about one week urine will have rust-coloured flecks.
d. Avoid sitz baths for a week after surgery.

Answer 3

ANS: C
Approximately 7–10 days following tumour resection or ablation, the patient may observe
dark red or rust-coloured flecks in the urine. These are anticipated and represent scabs from
the healing tumour resection sites. Other postoperative instructions for a segmental
cystectomy includes to drink a large volume of fluid each day for the first week following the
procedure and to avoid intake of alcoholic beverages. Urine is anticipated to be pink during
the first several days after the procedure, but it should not be bright red or contain blood clots.
The patient can be encouraged to take a 15–20-minute sitz bath two to three times a day to
promote muscle relaxation and to reduce the risk of urinary retention.

Question 4

The nurse is caring for a patient with benign prostatic hyperplasia who has chills, fever, and is vomiting. Which of the following findings by the nurse is most helpful in determining
whether the patient has an upper urinary tract infection (UTI)?

a. Suprapubic pain
b. Bladder distention
c. Foul-smelling urine
d. Costovertebral tenderness

Answer 4

ANS: D
Costovertebral tenderness is characteristic of pyelonephritis. The other symptoms are
characteristic of lower UTI and are likely to be present if the patient also has an upper UTI.

Question 5

The nurse is teaching a patient with interstitial cystitis about management of the condition.
Which of the following patient statements indicate that further instruction is required?

a. “I will have to stop having coffee and orange juice for breakfast.”
b. “I should start taking a high potency multiple vitamin every morning.”
c. “I will buy some calcium glycerophosphate (Prelief) at the pharmacy.”
d. “I should call the doctor about increased bladder pain or odorous urine.”

Answer 5

ANS: B
High-potency multiple vitamins may irritate the bladder and increase symptoms. The other
patient statements indicate good understanding of the teaching.

Question 6

The nurse is admitting a patient with acute glomerulonephritis. Which of the following
assessments is most important for the nurse to include?

a. Recent sore throat and fever
b. History of high blood pressure
c. Frequency of bladder infections
d. Family history of kidney stones

Answer 6

ANS: A
Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat.
It is not caused by hypertension, urinary tract infection (UTI), or kidney stones.

Question 7

Which of the following findings by the nurse for a patient admitted with glomerulonephritis
indicates that treatment has been effective?

a. The patient denies pain with voiding.
b. The urine dipstick is negative for nitrites.
c. Peripheral and periorbital edema is resolved.
d. The antistreptolysin-O (ASO) titre is decreased.

Answer 7

ANS: C
Since edema is a common clinical manifestation of glomerulonephritis, resolution of the
edema indicates that the prescribed therapies have been effective. Antibodies to streptococcus
will persist after a streptococcal infection. Nitrites will be negative and the patient will not
experience dysuria since the patient does not have a urinary tract infection.

Question 8

The nurse is caring for a patient with nephrotic syndrome who develops flank pain. Which of
the following medication classifications should the nurse anticipate including in the patient
teaching plan?

a. Antibiotics
b. Anticoagulants
c. Corticosteroids
d. Antihypertensives

Answer 8

ANS: B
Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is
needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis.
Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis.

Question 9

The nurse is admitting a patient with new onset nephrotic syndrome. Which of the following
findings should the nurse expect to assess related to this illness?

a. Poor skin turgor
b. High urine ketones
c. Recent weight gain
d. Low blood pressure

Answer 9

ANS: C
The patient with a nephrotic syndrome will have weight gain associated with edema.
Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high.

Question 10

The nurse is caring for a patient whose renal calculus is analyzed as being very high in uric
acid. To prevent recurrence of stones, which of the following foods should the nurse teach the
patient to avoid eating?

a. Milk and dairy products
b. Legumes and dried fruits
c. Organ meats and sardines
d. Spinach, chocolate, and tea

Answer 10

ANS: C
Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate,
and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products,
legumes, and dried fruits may increase the incidence of calcium-containing stones.

Question 11

Which of the following actions should the nurse teach to a patient to help prevent the
recurrence of renal calculi?

a. Use a filter to strain all urine.
b. Avoid dietary sources of calcium.
c. Drink diuretic fluids such as coffee.
d. Have 2000–3000 mL of fluid a day.

Answer 11

ANS: D
A fluid intake of 2000–2200 mL daily is recommended to help flush out minerals before
stones can form. Avoidance of calcium is not usually recommended for patients with renal
calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.

Question 12

The nurse is planning teaching for a patient with benign nephrosclerosis. Which of the
following information should the nurse include in the teaching plan?

a. Monitor and record blood pressure daily.
b. Obtain and document daily weights.
c. Measure daily intake and output amounts.
d. Prevent bleeding caused by anticoagulants.

Answer 12

ANS: A
Hypertension is the major symptom of nephrosclerosis. Measurements of intake and output and daily weights are not necessary unless the patient develops renal insufficiency.
Anticoagulants are not used to treat nephrosclerosis.

Question 13

The nurse is caring for a young adult female patient who is diagnosed with polycystic kidney
disease. Which of the following information should the nurse include in teaching at this time?

a. Importance of genetic counselling
b. Complications of renal transplantation
c. Methods for treating persistent and severe pain
d. Differences between hemodialysis and peritoneal dialysis

Answer 13

ANS: A
Because a young female patient may be considering having children, the nurse should include information about genetic counselling when teaching the patient. The well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There is no indication that the patient has persistent pain

Question 14

The nurse is assessing a male patient with symptoms of a feeling of incomplete bladder
emptying and a split, spraying urine stream. Which of the following conditions should the
nurse question the patient about when taking a health history?

a. Bladder infection
b. Recent kidney trauma
c. Gonococcal urethritis
d. Benign prostatic hyperplasia

Answer 14

ANS: C
The patient’s clinical manifestations are consistent with urethral strictures, a possible
complication of gonococcal urethritis. These symptoms are not consistent with benign
prostatic hyperplasia, kidney trauma, or bladder infection

Question 15

The nurse is obtaining the health history for a patient who smokes two packs of cigarettes
daily. Which of the following conditions should the nurse include in the teaching plan that the
patient is at an increased risk for developing?

a. Kidney stones
b. Bladder cancer
c. Bladder infection
d. Interstitial cystitis

Answer 15

ANS: B
Cigarette smoking is a risk factor for bladder cancer. The patient’s risk for developing
interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by
quitting smoking

Question 16

The nurse is admitting an older-adult patient with dehydration who is confused and
incontinent of urine. Which of the following nursing actions is best to include in the plan of
care?

a. Apply absorbent incontinent pads.
b. Restrict fluids after the evening meal.
c. Insert an in-dwelling catheter until the symptoms have resolved.
d. Assist the patient to the bathroom every 2 hours during the day

Answer 16

ANS: D
In older or confused patients, incontinence may be avoided by using scheduled toileting times.
In-dwelling catheters increase the risk for urinary tract infection (UTI). Incontinent pads
increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with
dehydration

Question 17

A female patient asks the nurse for a perineal pad, stating that laughing or coughing causes
leakage of urine. Which of the following interventions is best to include in the care plan?

a. Assist the patient to the bathroom q3hr.
b. Place a commode at the patient’s bedside.
c. Demonstrate how to perform the Credé manoeuvre.
d. Teach the patient how to perform Kegel exercises

Answer 17

ANS: D
Exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The
Credé manoeuvre is used to help empty the bladder for patients with overflow incontinence.
Placing the commode close to the bedside and assisting the patient to the bathroom are helpful
for functional incontinence

Question 18

The nurse is caring for a patient following rectal surgery who voids about 50 mL of urine
every 30–60 minutes. Which of the following nursing actions is best?

a. Use a bladder scan device to check the postvoiding residual.
b. Monitor the patient’s intake and output over the next few hours.
c. Have the patient take small amounts of fluid frequently throughout the day.
d. Reassure the patient that this is normal after rectal surgery because of anesthesia.

Answer 18

ANS: A
A bladder scan device can be used to check for residual urine after the patient voids. Because
the patient’s history and clinical manifestations are consistent with overflow incontinence, it is
not appropriate to have the patient drink small amounts. Although overflow incontinence is
not unusual after surgery, the nurse should intervene to correct the physiological problem, not just reassure the patient. The patient may develop reflux into the renal pelvis as well as
discomfort from a full bladder if the nurse waits to address the problem for several hours.

Question 19

The nurse is caring for a patient who has a history of functional urinary incontinence. Which of the following nursing actions should be included in the plan of care?

a. Place a bedside commode near the patient’s bed.
b. Demonstrate the use of the Credé manoeuvre to the patient.
c. Use an ultrasound scanner to check postvoiding residuals.
d. Teach the use of Kegel exercises to strengthen the pelvic floor.

Answer 19

ANS: A
Modifications in the environment make it easier to avoid functional incontinence. Checking
for residual urine and performing the Credé manoeuvre are interventions for overflow
incontinence. Kegel exercises are useful for stress incontinence.

Question 20

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

a. “I will use a sterile catheter and gloves for each time I self-catheterize.”
b. “I will clean the catheter carefully before and after each catheterization.”
c. “I will need to buy seven new catheters weekly and use a new one every day.”
d. “I will need to take prophylactic antibiotics to prevent any urinary tract infections.”

Answer 20

ANS: B
Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days. There is no need to use a new catheter every day, to use
sterile catheters, or to take prophylactic antibiotics.

Question 21

The nurse is caring for a patient who has had an ureterolithotomy with a left ureteral catheter
and a urethral catheter in place. Which of the following actions should the nurse include in the plan of care?

a. Provide education about home care for both catheters.
b. Apply continuous steady tension to the ureteral catheter.
c. Clamp the ureteral catheter unless output from the urethral catheter stops.
d. Call the health care provider if the ureteral catheter output drops suddenly

Answer 21

ANS: D
The health care provider should be notified if the ureteral catheter output decreases since
obstruction of this catheter may result in an increase in pressure in the renal pelvis. Tension on the ureteral catheter should be avoided in order to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Since the patient is not usually
discharged with a ureteral catheter in place, patient teaching about both catheters is not
needed.

Question 22

The nurse is caring for a patient who has bladder cancer and had a cystectomy with creation of an Indiana pouch. Which of the following topics should the nurse include in patient teaching?

a. Application of ostomy appliances
b. Catheterization technique and schedule
c. Analgesic use before emptying the pouch
d. Use of barrier products for skin protection

Answer 22

ANS: B
The Indiana pouch enables the patient to self-catheterize every 4–6 hours. There is no need for
an ostomy device or barrier products. Catheterization of the pouch is not painful.

Question 23

The nurse is caring for a patient who is two days postoperative with an ileal conduit, and the patient will not look at the stoma or participate in care and insists that no one but the ostomy
nurse specialist care for the stoma. Which of the following nursing diagnoses best reflects the
data that the nurse has obtained?

a. Anxiety related to threat to current status (effects of procedure on lifestyle)
b. Disturbed body image related to alteration in self-perception
c. Ineffective coping related to insufficient sense of control
d. Ineffective denial related to ineffective coping strategies (denial of altered body
function)

Answer 23

ANS: B
The patient’s unwillingness to look at the stoma or participate in care indicates that disturbed
body image is the best diagnosis. No data suggest that the impact on lifestyle is a concern for the patient, or that ineffective coping is a result of an insufficient sense of control. The
patient’s insistence that only the ostomy nurse care for the stoma indicates that denial is not
present.

Question 24

A patient who has had a transurethral resection with fulguration for bladder cancer 3 days
previously calls the nurse at the urology clinic. Which of the following information given by
the patient is most important to report to the health care provider?

a. The patient is using opioids for pain.
b. The patient has noticed clots in the urine.
c. The patient is very anxious about the cancer.
d. The patient is taking a 15-minute sitz bath twice a day.

Answer 24

ANS: B
Clots in the urine are not expected and require further follow-up. Sitz baths two to three times
a day, use of opioids for pain, and anxiety are typical after this procedure

Question 25

The nurse is preparing a patient with bladder cancer for intravesical chemotherapy. Which of
the following information should the nurse teach the patient about in preparation for the
treatment?

a. Premedicating to prevent nausea
b. Where to obtain wigs and scarves
c. The importance of oral care during treatment
d. The need to empty the bladder before treatment

Answer 25

ANS: D
Intravesical chemotherapy is the instillation of the agent directly into the bladder; therefore
the patient needs to have an empty bladder before the instillation of the chemotherapy.
Systemic adverse effects are not experienced with intravesical chemotherapy.

Question 26

Which of the following nursing actions is most helpful in decreasing the risk for hospitalacquired infection (HAI) of the urinary tract in patients admitted to the hospital?

a. Avoid unnecessary catheterizations.
b. Encourage adequate oral fluid intake.
c. Test urine with a dipstick daily for nitrites.
d. Provide thorough perineal hygiene to patients

Answer 26

ANS: A
Since catheterization bypasses many of the protective mechanisms that prevent urinary tract infection (UTI), avoidance of catheterization is the most effective means of reducing HAI.
The other actions will also be helpful, but are not as useful as decreasing urinary catheter use.

Question 27

The nurse is assessing a patient who has a lower urinary tract infection (UTI). Which of the
following symptoms should the nurse ask about initially?

a. Nausea
b. Flank pain
c. Poor urine output
d. Pain with urination

Answer 27

ANS: D
Pain with urination is a common symptom of a lower UTI. Urine output does not decrease,
but frequency may be experienced. Flank pain and nausea are associated with an upper UTI.

Question 28

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?

a. Foul-smelling urine
b. Complaint of flank pain
c. Blood pressure 88/45 mm Hg
d. Temperature 37.8C (100F)

Answer 28

ANS: C
The low blood pressure indicates that urosepsis and septic shock may be occurring and should
be immediately reported. The other findings are typical of pyelonephritis.

Question 29

The nurse is caring for a patient who is diagnosed with nephrotic syndrome and has 3+ ankle and leg edema with ascites. Which of the following nursing diagnoses is a priority for the
patient?

a. Excess fluid volume related to low serum protein levels
b. Activity intolerance related to increased weight and fatigue
c. Disturbed body image related to peripheral edema and ascites
d. Altered nutrition: less than required related to protein restriction

Answer 29

ANS: A
The patient has massive edema, so the priority problem at this time is the excess fluid volume.
The other nursing diagnoses also are appropriate, but the focus of nursing care should be resolution of the edema and ascites.

Question 30

The nurse is caring for a patient with benign prostatic hyperplasia (BPH) and a markedly
distended bladder who is agitated and confused. Which of the following interventions
prescribed by the health care provider should the nurse implement first?

a. Insert a urinary retention catheter.
b. Schedule an intravenous pyelogram.
c. Administer lorazepam 0.5 mg PO.
d. Draw blood for blood urea nitrogen (BUN) and creatinine testing.

Answer 30

ANS: A
The patient’s history and clinical manifestations are consistent with acute urinary retention,
and the priority action is to relieve the retention by catheterization. The BUN and creatinine
measurements can be obtained after the catheter is inserted. The patient’s agitation may
resolve once the bladder distention is corrected, and sedative drugs should be used cautiously
in older patients. The IVP is an appropriate test, but does not need to be done urgently.

Question 31

The nurse is caring for a patient with renal calculi, gross hematuria, and severe colicky left
flank pain. Which of the following actions is priority at this time?

a. Encourage oral fluid intake.
b. Administer prescribed analgesics.
c. Monitor temperature every 4 hours.
d. Give antiemetics as needed for nausea.

Answer 31

ANS: B
Although all of the nursing actions may be used for patients with renal lithiasis, the patient’s
presentation indicates that management of pain is the highest priority action. If the patient has
urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of
infection or nausea.

Question 32

The nurse is providing teaching to a patient with impaired urinary elimination related to an
UTI who weighs 70 kg. Which of the following daily fluid intake amounts should the nurse
include in the teaching plan?

a. 650 mL
b. 1250 mL
c. 1850 mL
d. 2450 mL

Answer 32

ANS: C
The recommended daily liquid intake for the ambulatory adult is approximately 33 mL/kg of
body weight per day. Thus, a 70-kg person would require 2310 mL each day. Because the
person will obtain approximately 20% of this fluid from food, this leaves 1848 mL obtained
by drinking, or nearly eight 236-mL glasses of fluid.

Question 33

The nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy.
Which of the following findings is most important to report to the health care provider?

a. Blood in urine
b. Left flank pain
c. Left flank bruising
d. Drop in urine output

Answer 33

ANS: D
Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is
important to report a drop in urine output. Left flank pain, bruising, and hematuria are
common after lithotripsy.

Question 34

The nurse is caring for a patient following an open loop resection and fulguration of the
bladder who is unable to void. Which of the following actions should the nurse implement
first?

a. Insert a straight catheter and drain the bladder.
b. Assist the patient to take a 15-minute sitz bath.
c. Encourage the patient to drink several glasses of water.
d. Teach the patient how to do isometric perineal exercises.

Answer 34

ANS: B
Sitz baths will relax the perineal muscles and promote voiding. Although the patient should be
encouraged to drink fluids and Kegel exercises are helpful in the prevention of incontinence,
these activities would not be helpful for a patient experiencing retention. Catheter insertion
increases the risk for urinary tract infection (UTI) and should be avoided when possible.

Question 35

The nurse observes an unregulated care provider (UCP) taking the following actions when caring for a patient with a retention catheter. Which of the following actions require the nurse to intervene with patient care?

a. Taping the catheter to the skin on the patient’s upper inner thigh
b. Cleaning around the patient’s urinary meatus with soap and water
c. Using an alcohol-based hand cleaner before performing catheter care
d. Disconnecting the catheter from the drainage tube to obtain a specimen

Answer 35

ANS: D
The catheter should not be disconnected from the drainage tube because this increases the risk
for urinary tract infection (UTI). The other actions are appropriate and do not require any
intervention

Question 36

The nurse is caring for a patient who had a nephrectomy after having massive trauma to the kidney. Which of the following assessment findings obtained postoperatively is most
important to communicate to the surgeon?

a. Blood pressure is 102/58.
b. Incisional pain level is 8/10.
c. Urine output is 20 mL/hour for 2 hours.
d. Crackles are heard at both lung bases.

Answer 36

ANS: C
Because the urine output should be at least 0.5 mL/kg/hour, a 40 mL output for 2 hours
indicates that the patient may have decreased renal perfusion because of bleeding, inadequate
fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring
but does not indicate inadequate perfusion at this time. The patient should cough and deep
breathe, but the crackles do not indicate a need for an immediate change in therapy. The
incisional pain should be addressed, but this is not as potentially life-threatening as decreased
renal perfusion. In addition, the nurse can medicate the patient for pain.

Question 37

Which of the following findings for a patient who has had a cystectomy with an ileal conduit
the previous day is most important for the nurse to communicate to the health care provider?

a. Cloudy appearing urine
b. Hypotonic bowel sounds
c. Heart rate 134 beats/minute
d. Continuous drainage from stoma

Answer 37

ANS: C
Tachycardia may indicate infection, hemorrhage, or postoperative atelectasis and shock,
which are all serious complications of this surgery. The urine from an ileal conduit normally
contains mucus and is cloudy. Hypotonic bowel sounds are expected after bowel surgery.
Continuous drainage of urine from the stoma is normal.

Question 38

Which of the following information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider?

a. Dysuria
b. Hematuria
c. Left-sided flank pain
d. Temperature 37.8 C (100 F)

Answer 38

ANS: C
Flank pain indicates that the patient may have developed pyelonephritis as a complication of
the bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection (UTI).