Renal and Urinary Flashcards
Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters?
a. Upper UTI
b. Lower UTI
c. Complicated UTI
d. Uncomplicated UTI
a. Upper UTI
An upper urinary tract infection (UTI) affects the renal parenchyma, renal pelvis, and ureters. A lower UTI is an infection of the bladder and/or urethra. A complicated UTI exists in the presence of obstruction, stones, or preexisting diseases. An uncomplicated UTI occurs in an otherwise normal urinary tract.
While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. Which clinical manifestations is the patient most likely to experience?
a. Cloudy urine and fever
b. Urethral burning and bloody urine
c. Vague abdominal discomfort and disorientation
d. Suprapubic pain and slight decline in body temperature
c. Vague abdominal discomfort and disorientation
The usual classic manifestations of UTI are often absent in older adults, who tend to experience nonlocalized abdominal discomfort and cognitive impairment characterized by confusion or decreased level of consciousness rather than dysuria and suprapubic pain.
A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient?
a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity
b. No treatment with medication unless she develops fever, chills, and flank pain
c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days
d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests
c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days
Unless a patient has a history of recurrent UTIs or a complicated UTI, trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin (Microdantin) is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment but symptomatic UTIs should always be treated.
A female patient with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding prevention of recurrence. What should the nurse include in the teaching plan instructions for this patient?
a. Empty the bladder at least 4 times a day.
b. Drink at least 2 quarts of water every day.
c. Wait to urinate until the urge is very intense.
d. Clean the urinary meatus with an antiinfective agent after voiding.
b. Drink at least 2 quarts of water per day
The bladder should be emptied at least every 3 to 4 hours. Fluid intake should be increased to about 2000 mL/day without caffeine, alcohol, citrus juices, and chocolate drinks, because they are potential bladder irritants. Cleaning the urinary meatus with an antiinfective agent after voiding will irritate the meatus but the perineal area should be wiped from front to back after urination and defecation to prevent fecal contamination of the meatus.
What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract?
a. The kidney is scarred and fibrotic.
b. The organism is resistant to antibiotics.
c. There is a preexisting abnormality of the urinary tract.
d. The patient does not take all of the antibiotics for treatment of a UTI.
c. There is a preexisting abnormality of the urinary tract
Ascending infections from the bladder to the kidney are prevented by the normal anatomy and physiology of the urinary tract unless a preexisting condition, such as vesicoureretal reflux or lower urinary tract dysfunction (bladder tumors, prostatic hyperplasia, strictures, or stones), is present. Resistance to antibiotics and failure to take a full prescription of antibiotics for a UTI usually result in relapse or reinfection of the lower urinary tract.
Which characteristic is more likely with acute pyelonephritis than with a lower UTI?
a. Fever
b. Dysuria
c. Urgency
d. Frequency
a. Fever
Systemic manifestations of fever and chills with leukocytosis and nausea and vomiting are more common in pyelonephritis than in a lower UTI. Dysuria, frequency, and urgency can be present with both.
Which test is required for a diagnosis of pyelonephritis?
a. Renal biopsy
b. Blood culture
c. Intravenous pyelogram (IVP)
d. Urine for culture and sensitivity
d. Urine for culture and sensitivity
A urine specimen specifically obtained for culture and sensitivity is required to diagnose pyelonephritis because it will show pyuria, the specific bacteriuria, and what drug the bacteria is sensitive to for treatment. The renal biopsy is used to diagnose chronic pyelonephritis or cancer. Blood cultures would be done if bacteremia is suspected. Intravenous pyelogram (IVP) would increase renal irritation, but CT urograms may be used to assess for signs of infection in the kidney and complications of pyelonephritis.
A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis?
a. Residual urine greater than 200 mL
b. A large, atonic bladder on urodynamic testing
c. A voiding pattern that indicates psychogenic urinary retention
d. Pain with bladder filling that is transiently relieved by urination
d. Pain with bladder filling that is transiently relieved by urination
The symptoms of interstitial cystitis (IC) imitate those of an infection of the bladder but the urine is free of infectious agents. Unlike a bladder infection, the pain with IC increases as urine collects in the bladder and is temporarily relieved by urination. Acidic urine is very irritating the bladder in IC and the bladder is small but urinary retention is not common.
When caring for the patient with interstitial cystitis, what can the nurse teach the patient to do?
a. Avoid foods that make the urine more alkaline.
b. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder.
c. Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia.
d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.
d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.
Calcium glycerophosphate (Prelief) alkalinizes the urine and can help relieve the irritation from acidic foods. A diet low in acidic foods is recommended and if a multivitamin is used, high-potency vitamins should be avoided because these products may irritate the bladder. A voiding diary is useful in diagnosis but does not need to be kept indefinitely.
Glomerulonephritis is characterized by glomerular damage caused by
a. growth of microorganisms in the glomeruli.
b. release of bacterial substances toxic to the glomeruli.
c. accumulation of immune complexes in the glomeruli.
d. hemolysis of red blood cells circulating in the glomeruli.
c. accumulation of immune complexes in the glomeruli.
Glomerulonephritis is not an infection but rather an antibody-induced injury to the glomerulus, where either autoantibodies against the glomerular basement membrane (GBM) directly damage the tissue or antibodies reacting with nonglomerular antigens are randomly deposited as immune complexes along the GBM. Prior infection by bacteria or viruses may stimulate the antibody production but is not present or active at the time of glomerular damage.
What manifestation in the patient will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)?
a. Hematuria
b. Proteinuria
c. Hypertension
d. Elevated blood urea nitrogen (BUN)
d. Elevated blood urea nitrogen (BUN)
An elevated blood urea nitrogen (BUN) indicates that the kidneys are not clearing nitrogenous wastes from the blood and protein may be restricted until the kidney recovers. Proteinuria indicates loss of protein from the blood and possibly a need for increased protein intake. Hypertension is treated with sodium and fluid restriction, diuretics, and antihypertensive drugs. The hematuria is not specifically treated.
The nurse plans care for the patient with APSGN based on what knowledge?
a. Most patients with APSGN recover completely or rapidly improve with conservative management.
b. Chronic glomerulonephritis leading to renal failure is a common sequel to acute glomerulonephritis.
c. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane.
d. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis, resulting in kidney failure.
a. Most patients with APSGN recover completely or rapidly improve with conservative management.
Most patients recover completely from acute poststreptococcal glomerulonephritis (APSGN) with supportive treatment. Chronic glomerulonephritis that progresses insidiously over years and rapidly progressive glomerulonephritis that results in renal failure within weeks or months occur only in a few patients with APSGN. In Goodpasture syndrome, antibodies are psent against both the GBM and alveolar basement membrane of the lungs and dysfunction of both renal and pulmonary are present.
What results in the edema associated with nephrotic syndrome?
a. Hypercoagulability
b. Hyperalbuminemia
c. Decreased plasma oncotic pressure
d. Decreased glomerular filtration rate
c. Decreased plasma oncotic pressure
The massive proteinuria that results from increased glomerular membrane permeability in nephrotic syndrome leaves the blood without adequate proteins (hypoalbuminemia) to create an oncotic colloidal pressure to hold fluid in the vessels. Without oncotic pressure, fluid moves into the interstitium, causing severe edema. Hypercoagulability occurs in nephrotic syndrome but is not a factor in edema formation and glomerular filtration rate (GFR) is not necessarily affected in nephrotic syndrome.
Number in sequence the following ascending pathologic changes that occur in the urinary tract in the presence of a bladder outlet obstruction. \_\_\_\_\_ a. Hydronephrosis \_\_\_\_\_ b. Reflux of urine into ureter \_\_\_\_\_ c. Bladder detrusor muscle hypertrophy \_\_\_\_\_ d. Ureteral dilation \_\_\_\_\_ e. Renal atrophy \_\_\_\_\_ f. Vesicoureteral reflux \_\_\_\_\_ g. Large residual urine in bladder \_\_\_\_\_ h. Chronic pyelonephritis
1 -- c. Bladder detrusor muscle hypertrophy 2 -- g. Large residual urine in bladder 3 -- b. Reflux of urine into ureter 4 -- d. Ureteral dilation 5 -- f. Vesicoureteral reflux 6 -- a. Hydronephrosis 7 -- h. Chronic pyelonephritis 8 -- e. Renal atrophy
Which infection is asymptomatic in the male patient at first and then progresses to cystitis, frequent urination, burning on voiding, and epididymitis?
a. Urosepsis
b. Renal tuberculosis
c. Urethral diverticula
d. Goodpasture syndrome
b. Renal tuberculosis
The manifestations of renal tuberculosis are described. Urosepsis is when the UTI has spread systemically. Urethral diverticula are localized outpouching of the urethra and occur more often in women. Goodpasture syndrome manifests with flu-like symptoms with pulmonary symptoms that include cough, shortness of breath, and pulmonary insufficiency and renal manifestations that include hematuria, weakness, pallor, anemia, and renal failure.
What can patients at risk for renal lithiasis do to prevent the stones in many cases?
a. Lead an active lifestyle
b. Limit protein and acidic foods in the diet
c. Drink enough fluids to produce dilute urine
d. Take prophylactic antibiotics to control UTIs
c. Drink enough fluids to produce dilute urine
Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is by drinking adequate fluids to keep the urine dilute and flowing (e.g., an output of about 2 L of urine a day). Sedentary lifestyle is a risk factor for renal stones but exercise also causes fluid loss and a need for additional fluids. Protein foods high in purine should be restricted only for the small percentage of patients with uric acid stones and although UTIs contribute to stone formation, prophylactic antibiotics are not indicated.
Which type of urinary tract calculi are the most common and frequently obstruct the ureter?
a. Cystine
b. Uric acid
c. Calcium oxalate
d. Calcium phosphate
c. Calcium oxalate
Calcium oxalate calculi are most common and small enough to get trapped in the ureter.
The female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone?
a. Cystine
b. Struvite
c. Uric acid
d. Calcium phosphate
b. Struvite
Struvite calculi are most common in women and always occur with UTIs. They are also usually large staghorn type.
The male patient is Jewish, has a history of gout, and has been diagnosed with renal calculi. Which treatment will be used with this patient (see all that apply)?
a. Reduce dietary oxalate
b. Administer allopurinol
c. Administer alpha-penicillamine
d. Administer thiazide diuretics
e. Reduce animal protein intake
f. Reduce intake of milk products
b. Administer allopurinol
e. Reduce animal protein intake
This patient is most likely to have uric acid calculi, which have a high incidence in Jewish men, and gout is a predisposing factor. The treatment will include allopurinol and reducing animal protein intake to reduce purine, as uric acid is a waste product from purine metabolism. Reducing oxalate and using thiazide diuretics to treat calcium oxalate calculi. Administration of alpha-penicillamine and tiopronin prevent cystine crystallization for cystine calculi. Reducing intake of milk products to reduce calcium intake may be used with calcium calculi.
Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi?
a. Associated with alkaline urine
b. Genetic autosomal recessive defect
c. Three times as common in women as in men
d. Defective gastrointestinal (GI) and kidney absorption
a. Associated with alkaline urine
Calcium phosphate calculi are typically mixed with struvite or oxalate stones and related to alkaline urine. Cystine calculi are associated with a genetic autosomal recessive defect and defective GI and kidney absorption of cystine. Struvite calculi are three to four times more common in women than in men.
On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report?
a. A history of chronic UTIs
b. Dull, costovertebral flank pain
c. Severe, colicky back pain radiating to the groin
d. A feeling of bladder fullness with urgency and frequency
c. Severe, colicky back pain radiating to the groin
A classic sign of the passage of a calculus down the ureter is intense, colicky back pain that may radiate into the testicles, labia, or goin and may be accompanied by mild shock with cool, moist skin. Many patients with renal stones do not have a history of chronic UTIs. Stones obstructing a calyx or at the ureteropelvic junction may produce dull costovertebral flank pain and large bladder stones may cause bladder fullness and lower obstructive symptoms.
Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks?
a. Milk and milk products
b. Dried beans and dried fruits
c. Liver, kidney, and sweetbreads
d. Spinach, cabbage, and tomatoes
d. Spinach, cabbage, and tomatoes
Oxalate-rich foods should be limited to reduce oxalate excretion. Foods high in oxalate include spinach, rhubarb, asparagus, cabbage, and tomatoes, in addition to chocolate, coffee, and cocoa. Currently, it is believed that high dietary calcium intake may actually lower the risk for renal stones by reducing the intestinal oxalate absorption and therefore the urinary excretion of oxalate. Milk, milk products, dried beans, and dried fruits are high sources of calcium. Organ meats are high in purine, which contributes to uric acid lithiasis.
Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient?
a. Monitor for hematuria.
b. Encourage fluid intake of 3 L/day.
c. Apply moist heat to the flank area.
d. Strain all urine through gauze or a special strainer.
b. Encourage fluid intake of 3 L/day.
A high fluid intake maintains dilute, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals. Moist heat to the flank may be helpful to relieve muscle spasms during renal colic and all urine should be strained in patients with renal stones to collect and identify stone composition but these are not related to infection.
With which diagnosis will the patient benefit from being taught to do self-catheterization?
a. Renal trauma
b. Urethral stricture
c. Renal artery stenosis
d. Accelerated nephrosclerosis
b. Urethral stricture
The patient with urethral stricture with benefit from being taught to dilate the urethra by self-catheterization every few days. Renal trauma is treated related to the severity of the injury with bed rest, fluids, and analgesia. Renal artery stenosis includes control of hypertension with possible surgical revascularization. Accelered nephrosclerosis is associated with malignant hypertension that must be aggressively treated as well as monitoring kidney function.
In providing care for the patient with adult-onset polycystic kidney disease, what should the nurse do?
a. Help the patient to cope with the rapid progression of the disease
b. Suggest genetic counseling resources for children of the patient
c. Expect the patient to have polyuria and poor concentration ability of the kidneys
d. Implement measures for the patient’s deafness and blindness in addition to the renal problems
b. Suggest genetic counseling resources for children of the patient
Adult-onset polycystic kidney disease is an inherited autosomal dominant disorder that often manifests after the patient has children but the children should receive genetic counseling regarding their life choices. The disease progresses slowly, eventually causing progressive renal failure. Hereditary medullary cystic disease causes poor concentration ability of the kidneys and classic Alport syndrome is a hereditary nephritis that is associated with deafness and deformities of the optic lens.
Which disease causes connective tissues changes that cause glomerulonephritis?
a. Gout
b. Amyloidosis
c. Diabetes mellitus
d. Systemic lupus erythematosus
d. Systemic lupus erythematosus
Systemic lupus erythematosus causes connective tissue damage that affects the glomerulus. Gout deposits uric acid crystals in the kidney. Amyloidosis deposits hyaline bodies in the kidney. Diabetes mellitus causes microvascular damage affecting the kidney.
When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer?
a. Smoking
b. Family history of cancer
c. Chronic use of phenacetin
d. Chronic, recurrent nephrolithiasis
a. Smoking
Both cancer of the kidney and cancer of the bladder are associated with smoking. A family history of renal cancer is a risk factor for kidney cancer and cancer of the bladder has been associated with the use of phenacetin-containing analgesics and recurrent upper UTIs.
Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur?
a. The only treatment modalities for the disease are palliative.
b. Diagnostic tests are not available to detect tumors before they metastasize.
c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.
d. Early metastasis to the brain impairs the patient’s ability to recognize the seriousness of symptoms.
c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.
There are no early characteristic symptoms of cancer of the kidney and gross hematuria, flank pain, and a palpable mass do not occur until the disease is advanced. The treatment of choice is a partial or radical nephrectomy, which can be successful in early disease. Many kidney cancers are diagnosed as incidental imaging findings. Targeted therapy is the preferred treatment for metastatic kidney cancer. Radiation is palliative. The most common sites of metastases are the lungs, liver, and long bones.
Which characteristics are associated with urge incontinence (select all that apply)?
a. Treated with Kegel exercises
b. Found following prostatectomy
c. Common in postmenopausal women
d. Involunary urination preceded by pregnancy
e. Caused by the overactivity of the detrusor muscle
f. Bladder contracts by reflex, overriding central inhibition
d. Involunary urination preceded by pregnancy
e. Caused by the overactivity of the detrusor muscle
f. Bladder contracts by reflex, overriding central inhibition
Urge incontinence is involuntary urination preceded by urgency caused by overactivity of the detrusor muscle when the bladder contracts by reflex, which overrides central inhibition. Treatment including treatment the underlying cause and retraining the bladder with urge suppression, anticholinergic drugs, or containment devices. The other options are characteristics of stress incontinence. Patients may have a combination of urge and stress incontinence.
The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing?
a. Reflex incontinence
b. Overflow incontinence
c. Functional incontinence
d. Incontinence after trauma
a. Reflex incontinence
Reflex incontinence occurs with no warning, equally during the day and night, and with spinal cord lesions above S2. Overflow incontinence is when the pressure of urine in the overfull bladder overcomes sphincter control and is caused by bladder or urethral outlet obstruction. Functional incontinence is loss of urine resulting from cognitive, functional, or environmental factors. Incontinence after trauma or surgery occurs when fistulas have occurred or after a prostatectomy.
Which drugs are used to treat overflow incontinence (select all that apply)?
a. Baclofen (Lioresal)
b. Anticholinergic drugs
c. alpha-Adrenergic blockers
d. 5alpha-reductase inhibitors
e. Bethanechol (Urecholine)
c. alpha-Adrenergic blockers
d. 5alpha-reductase inhibitors
e. Bethanechol (Urecholine)
alpha-Adrenergic blockers block the stimulation of the smooth muscle of the bladder, 5alpha-reductase inhibitors decrease outlet resistance, and bethanechol enhances bladder contractions. Baclofen or diazepam is used to relax the external sphincter for reflex incontinence. Anticholinergics are used to relax bladder tone and increase sphincter tone with urge incontinence.
To assist the patient with stress incontinence, what is the best thing the nurse should teach the patient to do?
a. Void every 2 hours to prevent leakage.
b. Use absorptive perineal pads to contain urine.
c. Perform pelvic floor muscles exercises 40 to 50 times per day.
d. Increase intraabdominal pressure during voiding to empty the bladder completely.
c. Perform pelvic floor muscles exercises 40 to 50 times per day.
Pelvic floor exercises (Kegel exercises) increase the tone of urethral sphincters and should be done in sets of 10 or more contractions four to five times a day (total of 40 to 50 per day). Frequent bladder emptying is recommended for patients with urge incontinence and an increase in pressure on the bladder is recommended for patients with overflow incontinence. Absorptive perineal pads should only be a temporary measure because long-term use discourages continence and can lead to skin problems.
What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients?
a. Measuring urine output every 1 to 2 hours to ensure patency
b. Turning the patient frequently from side to side to promote drainage
c. Using strict technique during irrigation and obtaining culture specimens
d. Daily cleaning of the catheter insertion site with soap and water and application of lotion
c. Using strict technique during irrigation and obtaining culture specimens
All urinary catheters in hospitalized patients pose a very high risk for infection, especially antibiotic-resistant, health care-associated infections, and scrupulous aseptic technique is essential in the insertion and maintenance of all catheters. Routine irrigations are not performed. Turning the patient to promote drainage is not recommended only for suprapubic catheters. Cleaning the insertion site with soap and water should be performed for urethral and suprapubic catheters but lotion or powder should be avoided and site care for other catheters may require special interventions.
A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, what is an appropriate nursing action?
a. Milk or strip the catheter every 2 hours.
b. Measure ureteral urinary drainage every 1 to 2 hours.
c. Irrigate the catheter with 30-mL sterile saline every 4 hours.
d. Encourage ambulation to promote urinary peristaltic action.
b. Measure ureteral urinary drainage every 1 to 2 hours.
Output from ureteral catheters must be monitored every 1 to 2 hours because an obstruction will cause overdistention of the renal pelvis and renal damage. The renal pelvis has a capacity of only 3 to 5 mL and if irrigation is ordered, no more than 5 mL of sterile saline is used. The patient with a ureteral catheter is usually kept on bed rest until specific orders for ambulation are given. Suprapubic tubes may be milked to prevent obstruction of the catheter by sediment and clots.
During assessment of the patient who has a nephrectomy, what should the nurse expect to find?
a. Shallow, slow respirations
b. Clear breath sounds in all lung fields
c. Decreased breath sounds in the lower left lobe
d. Decreased breath sounds in the right and left lower lobes
b. Clear breath sounds in all lung fields
A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breathe deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.
Which urinary diversion is a continent diversion created by the formation of an ileal pouch with a stoma for catheterization?
a. Kock pouch
b. Ileal conduit
c. Orthotopic neobladder
d. Cutaneous ureterostomy
a. Kock pouch
The Kock pouch is a continent diversion created by formation of an ileal pouch with an external stoma requiring catheterization. Ileal conduit is the most common incontinent diversion using a stoma of resected ileum with implanted ureters. Orthotopic neobladder is a new bladder from a reshaped segment of intestine in the anatomic position of the bladder with urine discharged through the urethra. A cutaneous ureterostomy diverts the ureter from the bladder to the abdominal skin but there is frequent scarring and strictures of the ureters, so ileal conduits are used more often.
A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient’s first postoperative day, what should the nurse plan to do?
a. Measure and fit the stoma for a permanent appliance.
b. Encourage high oral intake to flush mucus from the conduit.
c. Teach the patient to self-catheterize the stoma every 4 to 6 hours.
d. Empty the drainage bag every 2 to 3 hours and measure the urinary input.
d. Empty the drainage bag every 2 to 3 hours and measure the urinary input.
Urine drains continuously from an ileal conduit and the drainage bag must be emptied every 2 to 3 hours and measured to ensure adequate urinary output. Fitting for a permanent appliance is not done until the stoma shrinks to its normal size in a few weeks. With an ileal conduit, mucus is present in the urine because it is secreted by the ileal segment as a result of the irritating effect of the urine but the surgery causes paralytic ileus and the patient will be NPO for several days postoperatively. Self-catheterization is performed when patients have formation of a continent Kock pouch.
A teaching plan developed by a nurse for the patient with a new ileal conduit includes instructions to do what?
a. Clean the skin around the stoma with alcohol every day.
b. Use a wick to keep the skin dry during appliance changes.
c. Use sterile supplies and technique during care of the stoma.
d. Change the appliance every day and wash it with soap and water.
b. Use a wick to keep the skin dry during appliance changes.
Because the stoma continuously drains urine, a wick formed of a rolled-up 4 x 4 gauze or a tampon is held against the stoma to absorb the urine while the skin is cleaned and a new appliance is attached. The skin is cleaned with warm water only because soap and other agents cause drying and irritation and clean, not sterile, technique is used. The appliance should be left in place for as long as possible before it loosens and allows leakage onto the skin, perhaps up to 14 days.
Which nursing interventions could be delegated to unlicensed assistive personnel (UAP) (select all that apply)?
a. Assess the need for catheterization.
b. Use bladder scanner to estimate residual urine.
c. Teach patient pelvic floor muscles (Kegel) exercises.
d. Insert indwelling catheter for uncomplicated patient.
e. Assist incontinent patient to commode at regular intervals.
f. Provide perineal care with soap and water around a urinary catheter.
e. Assist incontinent patient to commode at regular intervals.
f. Provide perineal care with soap and water around a urinary catheter.
The unlicensed assistive personnel (UAP) may assist the incontinent patient to void at regular intervals and provide perineal care. An RN should perform the assessments and teaching. In long-term care and rehabilitation facilities, UAP may use bladder scanners after they are trained.
In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through
a. the bloodstream.
b. the lymphatic system.
c. a descending infection.
d. an ascending infection.
d. an ascending infection.
The organisms that usually cause urinary tract infections (UTIs) are introduced via the ascending route from the urethra, and the infections originate in the perineum.
The nurse teaches the female patient who has frequent UTIs that she should
a. take tub baths with bubble bath.
b. urinate before and after sexual intercourse.
c. take prophylactic sulfonamides for the rest of her life.
d. restrict fluid intake to prevent the need for frequent voiding.
b. urinate before and after sexual intercourse.
When teaching a patient to prevent a recurrence of a urinary tract infection, the nurse should explain the importance of emptying the bladder before and after sexual intercourse.
The immunologic mechanisms involved in acute poststreptococcal glomerulonephritis include
a. tubular blocking by precipitates of bacteria and antibody reactions.
b. deposition of immune complexes and complement along the GBM.
c. thickening of the GBM from autoimmune microangiopathic changes.
d. destruction of glomeruli by proteolytic enzymes contained in the GBM.
b. deposition of immune complexes and complement along the GBM.
All forms of immune complex disease are characterized by an accumulation of antigen, antibody, and complement in the glomeruli, which can result in tissue injury. The immune complexes activate complement. Complement activation results in the release of chemotactic factors that attract polymorphonuclear leukocytes, histamine, and other inflammatory mediators. The result of these processes is glomerular injury.
One of the nurse’s most important roles in relation to acute post-streptococcal glomerulonephritis is to
a. promote early diagnosis and treatment of sore throats and skin lesions.
b. encourage patients to obtain antibiotic therapy for upper respiratory tract infection.
c. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence.
d. monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane.
a. promote early diagnosis and treatment of sore throats and skin lesions.
Acute poststreptococcal glomerulonephritis (APSGN) develops 5 to 21 days after an infection of the tonsils, pharynx, or skin (e.g., streptococcal sore throat, impetigo) by nephrotoxic strains of group A β-hemolytic streptococci. The most important ways to prevent the development of APSGN are early diagnosis and treatment of sore throats and skin lesions.
The edema that occurs in nephrotic syndrome is due to
a. increased hydrostatic pressure caused by sodium retention.
b. decreased aldosterone secretion caused by sodium retention.
c. increased fluid retention caused by decreased glomerular filtration.
d. decreased colloidal osmotic pressure caused by loss of serum albumin.
d. decreased colloidal osmotic pressure caused by loss of serum albumin.
The increased permeability of the glomerular membrane found in nephrotic syndrome is responsible for the massive excretion of protein in the urine. This results in decreased serum protein levels and subsequent edema formation. Ascites and anasarca (i.e., massive generalized edema) develop if hypoalbuminemia is severe.
A patient is admitted to the hospital with severe renal colic. The nurse’s first priority in management of the patient is to
a. administer opioids as prescribed.
b. obtain supplies for straining all urine.
c. encourage fluid intake of 3 to 4 L/day.
d. keep the patient NPO in preparation for surgery.
a. administer opioids as prescribed.
Pain management and patient comfort are primary nursing responsibilities in managing an obstructing stone and renal colic.
The nurse recommends genetic counseling for the children of a patient with
a. nephrotic syndrome.
b. chronic pyelonephritis.
c. malignant nephrosclerosis.
d. adult-onset polycystic kidney disease.
d. adult-onset polycystic kidney disease.
The adult form of polycystic kidney disease (PKD) is an autosomal dominant disorder. If one parent has the disease, the child has a 50% chance of developing PKD. Many patients who have adult PKD have had children by the time the disease is diagnosed. Patients need appropriate counseling regarding plans for having more children, and genetic counseling resources should be provided for the children.
The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of
a. aspirin use.
b. tobacco use.
c. chronic alcohol abuse.
d. use of artificial sweeteners.
b. tobacco use.
Cigarette smoking is the most significant risk factor for renal cell carcinoma. An increased incidence has also been identified in first-degree relatives of patients with this condition. Other risk factors include obesity, hypertension, and exposure to asbestos, cadmium, and gasoline. Risk for renal cancer is also increased in individuals who have acquired cystic disease of the kidney in association with end-stage renal disease. Risk factors for bladder cancer include smoking, exposure to dyes used in the rubber and cable industries, and chronic abuse of phenacetin-containing analgesics.
In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes
a. teaching the patient to use Kegel exercises.
b. clamping and releasing a catheter to increase bladder tone.
c. teaching the patient biofeedback mechanisms to suppress the urge to void.
d. counseling the patient concerning choice of incontinence containment device.
a. teaching the patient to use Kegel exercises.
Pelvic floor muscle training (i.e., Kegel exercises) is used to manage stress, urge, or mixed urinary incontinence.
A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes
a. encouraging the patient to drink fruit juices and milk.
b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided.
c. irrigating the nephrostomy tube with 10 mL of normal saline solution as needed.
d. notifying the physician if nephrostomy tube drainage is more than 30 mL/hr.
b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided.
The nephrostomy tube is inserted directly into the renal pelvis and attached to connecting tubing for closed drainage. The catheter should never be kinked, compressed, or clamped. If the patient complains of excessive pain in the area, or if drainage around the tube is excessive, check the catheter for patency. If irrigation is ordered, strict aseptic technique is required. To prevent overdistention of the renal pelvis and renal damage, no more than 5 mL of sterile saline solution is gently instilled at one time. Infection and secondary stone formation are complications associated with the insertion of a nephrostomy tube. Patients should drink 2 to 3 L of fluid per day to reduce risk of infection and stone formation.
A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should
a. notify the physician.
b. notify the charge nurse.
c. irrigate the drainage tube.
d. chart it as a normal observation.
d. chart it as a normal observation.
Patients with an ileal conduit have mucus in the urine. The mucus is secreted by intestinal mucosa, which is used to create the ileal conduit, in response to the irritating effect of urine.
A nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find what clinical manifestations as the “classic triad” occurring in patients with renal cancer?
A. Fever, chills, flank pain
B. Hematuria, flank pain, palpable mass
C. Hematuria, proteinuria, palpable mass
D. Flank pain, palpable abdominal mass, and proteinuria
B. Hematuria, flank pain, palpable mass
There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.
