RENAL Lewis Ch 45: Renal and Urologic Problems Flashcards
A 46-yr-old female patient returns to the clinic with continued dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will 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. Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms.
d. Tell the patient to take the trimethoprim and sulfamethoxazole for 3 more days.
b. Obtain a midstream urine specimen for culture and sensitivity testing.
Because 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. Acetaminophen would not be as effective as other over-the-counter medications such as phenazopyridine in treating dysuria. The fluid intake should be increased to at least 1800 mL/day. Because the UTI has persisted after treatment with trimethoprim and sulfamethoxazole, the patient is likely to need a different antibiotic.
Which statement by a 22-yr-old female patient with cystitis indicates to the nurse that instruction regarding prevention of future urinary tract infections (UTIs) has been effective?
a. “I can use vaginal antiseptic sprays to reduce bacteria.”
b. “I will drink a quart 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 3 to 4 hours during the day.”
d. “I will empty my bladder every 3 to 4 hours during the day.”
Voiding every 3 to 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 to prevent UTI. A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI.
Which information will the nurse include when teaching the patient with a urinary tract infection (UTI) about the use of phenazopyridine?
a. Take phenazopyridine for at least 7 days.
b. Phenazopyridine may cause photosensitivity.
c. Phenazopyridine may change the urine color.
d. Take phenazopyridine before sexual intercourse.
c. Phenazopyridine may change the urine color.
Patients should be taught that phenazopyridine will color the urine deep orange. Urinary analgesics should be needed for only a few days until the prescribed antibiotics decrease the bacterial count. Phenazopyridine does not cause photosensitivity. Taking phenazopyridine before intercourse will not be helpful in reducing the risk for UTI.
Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)?
a. Bladder distention
b. Foul-smelling urine
c. Suprapubic discomfort
d. Costovertebral tenderness
d. Costovertebral tenderness
Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling urine, and suprapubic discomfort are characteristic of a lower UTI and are likely to be present if the patient also has an upper UTI.
Which statement by a patient with interstitial cystitis indicates to the nurse that further instruction is needed?
a. “I should stop having coffee and orange juice for breakfast.”
b. “I will buy calcium glycerophosphate (Prelief) at the pharmacy.”
c. “I will start taking high potency multiple vitamins every morning.”
d. “I should call the doctor about increased bladder pain or foul urine.”
c. “I will start taking high potency multiple vitamins every morning.”
High-potency multiple vitamins may irritate the bladder and increase symptoms. The other patient statements indicate good understanding of the teaching.
What should the nurse ask the patient about to determine possible causes of acute glomerulonephritis?
a. Recent bladder infection
b. History of kidney stones
c. Recent sore throat and fever
d. History of high blood pressure
c. Recent sore throat and fever
Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection.
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?
a. The urine dipstick is negative for nitrites.
b. The patient denies pain or burning with voiding.
c. The antistreptolysin-O (ASO) titer has decreased.
d. The periorbital and peripheral edema are resolved.
d. The periorbital and peripheral edema are resolved.
Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative, and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection.
The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with:
a. antibiotics.
b. antifungals.
c. anticoagulants.
d. antihypertensives.
c. anticoagulants.
Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis and
anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by
pyelonephritis. Fungal pyelonephritis is uncommon and is treated with antifungals.
Antihypertensives are used if the patient has high blood pressure.
An adult patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect?
a. Poor skin turgor
b. Recent weight gain
c. Elevated urine ketones
d. Decreased blood pressure
b. Recent weight gain
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. Ketones are not related to nephrotic syndrome.
To prevent recurrence of uric acid kidney stones, the nurse teaches the patient to avoid eating:
a. milk and cheese.
b. sardines and liver.
c. spinach and chocolate.
d. legumes and dried fruit.
b. sardines and liver.
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.
What should the nurse include when teaching an adult patient to prevent the recurrence of kidney stones?
a. Using a filter to strain all urine
b. Drinking 3000 mL of fluid each day
c. Avoiding dietary sources of calcium
d. Choosing diuretic fluids such as coffee
b. Drinking 3000 mL of fluid each day
A fluid intake of 2000 to 3000 mL/day is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with kidney stones. Coffee tends to increase stone recurrence. Straining all urine routinely after a stone has passed will not prevent stones.
Which topic should the nurse include when planning a teaching session for a patient with benign nephrosclerosis?
a. Preventing bleeding with anticoagulants
b. Obtaining and documenting daily weight
c. Monitoring and recording blood pressure
d. Measuring daily intake and output volumes
c. Monitoring and recording blood pressure
Hypertension is the major manifestation 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.
A 28-yr-old male patient has just been diagnosed with polycystic kidney disease. Which information should the nurse include in teaching during the first teaching session?
a. Complications of renal transplantation
b. Methods for treating severe chronic pain
c. Options to consider for genetic counseling
d. Differences between hemodialysis and peritoneal dialysis
c. Options to consider for genetic counseling
Because a 28-yr-old patient may be considering having children, the nurse should include information about genetic counseling when teaching the patient. A 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 chronic pain.
A young adult male patient seen at the primary care clinic reports feeling continued fullness after voiding and a split, spraying urine stream. What should the nurse ask about the patient’s history?
a. Gonococcal urethritis
b. Recent kidney trauma
c. Recurrent bladder infection
d. Benign prostatic hyperplasia
a. Gonococcal urethritis
The patient’s clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis. The symptoms are not consistent with benign prostatic hyperplasia, kidney trauma, or bladder infection.
What risks will the nurse plan to teach a 27-yr-old woman who smokes two packs of cigarettes daily?
a. Kidney stones
b. Bladder cancer
c. Bladder infection
d. Interstitial cystitis
b. Bladder cancer
Cigarette smoking is a risk factor for bladder cancer. The patient’s risk for developing interstitial cystitis, urinary tract infection, or kidney stones will not be reduced by quitting smoking.
A 68-yr-old patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action should be included in the plan of care?
a. Restrict fluids between meals and after the evening meal.
b. Insert an indwelling catheter until the symptoms have resolved.
c. Assist the patient to the bathroom every 2 hours during the day.
d. Apply absorbent adult incontinence diapers and pads over the bed linens.
c. Assist the patient to the bathroom every 2 hours during the day.
In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling catheters increase the risk for urinary tract infection. Incontinent pads and diapers increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with dehydration.
A 55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is appropriate 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 maneuver.
d. Teach the patient how to perform Kegel exercises.
d. Teach the patient how to perform Kegel exercises.
Kegel exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The Credé maneuver 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.