Med Surg 2 Final Exam Comprehensive Resource To Help You Ace Exams Includes Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS Guaranteed Pass First Attempt!! Current Update!! Instant Download Pdf

Med Surg 2 Final Exam Comprehensive Resource To Help You Ace Exams Includes Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS Guaranteed Pass First Attempt!! Current Update!! Instant Download Pdf 1. What is pyelonephritis? A. A fungal infection of the bladder B. A kidney stone causing ureteral obstruction C. A UTI that spreads to the kidneys D. Inflammation of the renal pelvis from autoimmune disease Pyelonephritis is a urinary tract infection that has spread to one or both kidneys. It is an upper UTI distinguished from lower UTI (cystitis) by the involvement of renal tissue, and is a serious infection that can lead to kidney damage or sepsis if untreated. 2. What are the most common causative organisms of pyelonephritis? A. Staphylococcus aureus and Candida albicans B. Escherichia coli and Enterococcus faecalis C. Klebsiella and Pseudomonas D. Streptococcus and Proteus mirabilis E. coli is the most common cause of pyelonephritis, responsible for approximately 80% of cases. Enterococcus faecalis is another common gram-positive causative organism. Both are common intestinal flora that ascend the urinary tract to infect the kidneys. 3. How does acute pyelonephritis differ from chronic pyelonephritis? A. Acute is caused by fungi; chronic is caused by bacteria B. Acute affects both kidneys; chronic affects only one C. Acute is an active bacterial infection; chronic occurs with structural deformities, urinary stasis, obstruction, or reflux D. Acute is painless; chronic presents with severe flank pain Acute pyelonephritis is an active bacterial infection presenting with sudden onset of fever and flank pain. Chronic pyelonephritis develops over time — often secondary to structural abnormalities (vesicoureteral reflux, obstruction, urinary stasis) that cause repeated infections and progressive renal scarring. 4. What are the classic signs and symptoms of ACUTE pyelonephritis? A. Hypertension, nocturia, and hyperkalemia B. Frequency, dysuria, and suprapubic pain only C. Fever, chills, tachycardia, tachypnea, flank/back/loin pain, CVA tenderness, and abdominal discomfort D. Confusion, decreased urine concentration, and metabolic acidosis Acute pyelonephritis presents with systemic infection signs: fever (often high grade), chills, tachycardia, and tachypnea — indicating a systemic inflammatory response. Local signs include flank, back, or loin pain and costovertebral angle (CVA) tenderness on percussion, indicating renal involvement. 5. What are the signs and symptoms of CHRONIC pyelonephritis? A. Fever, chills, and CVA tenderness B. Hypertension, inability to conserve sodium, nocturia, hyperkalemia, and metabolic acidosis C. Hematuria, urgency, and suprapubic pain D. Severe flank pain, restlessness, and diaphoresis Chronic pyelonephritis manifests as progressive renal dysfunction: hypertension (damaged kidneys cannot regulate BP), impaired sodium conservation, decreased urine concentration (causing nocturia), hyperkalemia, and metabolic acidosis — all reflecting loss of normal tubular and glomerular function over time. 6. Who is most commonly affected by pyelonephritis? A. Elderly men with BPH B. Children under age 5 with congenital abnormalities C.Sexually active young females D. Immunocompromised patients on chemotherapy Sexually active young females are the most commonly affected population. Women are anatomically predisposed (shorter urethra, proximity of urethra to rectum), and sexual activity increases bacterial introduction into the urethra. Catheter use, pregnancy, and diabetes are additional risk factors. 7. What psychosocial factors should nurses assess in patients with pyelonephritis? A. Financial stress related to hospital bills B. Body image disturbance from weight changes C. New onset of confusion, anxiety, guilt, and embarrassment D. Fear of renal transplantation Pyelonephritis — a urinary infection — can cause significant psychosocial distress including embarrassment (about urinary symptoms), guilt (feeling responsible), anxiety (about recurrence or kidney damage), and new onset confusion (particularly in older adults, where delirium may be the first sign of sepsis). 8. What laboratory method is used for diagnosing UTIs? A. Random urine dipstick test only B. 24-hour urine collection C. Clean-catch midstream urine specimen for culture and sensitivity (C&S) D. Suprapubic bladder aspiration in all cases A clean-catch midstream urine specimen for culture and sensitivity (C&S) is the gold standard for UTI diagnosis. The clean-catch method reduces contamination from perineal flora. C&S identifies the specific causative organism and determines antibiotic sensitivity to guide targeted therapy. 9. What does a positive nitrite test on a urine dipstick indicate? A Elevated protein suggesting glomerulonephritis B Presence of red blood cells indicating hematuria C Presence of glucose indicating uncontrolled diabetes D Presence of a UTI — bacteria convert urinary nitrates to nitrites A positive nitrite test on urine dipstick indicates a UTI. Many gram-negative bacteria (especially E. coli) reduce urinary nitrates to nitrites. A positive nitrite combined with leukocyte esterase (WBCs) is highly suggestive of bacterial UTI and prompts further C&S testing. 10 . What are recommended nonsurgical interventions for pyelonephritis? A Strict bed rest, fluid restriction, and steroids B Drug therapy (acetaminophen, broad-spectrum antibiotics) and nutritional therapy with 2 L/day fluid intake C IV corticosteroids and prophylactic antifungals D NSAID monotherapy and cranberry supplements Nonsurgical management: acetaminophen for fever/pain, broad-spectrum antibiotics (narrowed once C&S results return), and nutritional therapy including 2 L/day fluid intake to flush bacteria from the urinary tract. Adequate hydration is one of the most important nursing interventions for all UTIs. 10. What surgical interventions may be required for pyelonephritis? A Cystoscopy and bladder irrigation only B Pyelolithotomy, nephrectomy, ureteral diversion, or reimplantation of ureter(s) C Renal transplantation and dialysis initiation D Laser lithotripsy and ureteral stenting only Surgical interventions for pyelonephritis are indicated when anatomical abnormalities cause recurrent infection. Options include pyelolithotomy (stone removal from renal pelvis), nephrectomy (removal of severely damaged kidney), ureteral diversion, or ureteral reimplantation to correct vesicoureteral reflux or obstruction.