Chapter 33: The Urinary System |DeWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. An 85-year-old patient who has been NPO since midnight last night for diagnostic testing just completed the procedure. Which intervention is most important? a. Inform the patient about the test results. b. Obtain the patient’s weight for comparison to the morning value. c. Turn the patient every 2 hours. d. Offer 4 ounces of water or juice every hour. ANS: D Offering small amounts of fluid every hour will rehydrate the older adult without resorting to intravenous fluids. The older adult has very little fluid reserve and has lost the ability to concentrate the urine; consequently, a long period without fluid intake can cause dehydration. The doctor should inform the patient about the test results. Weighing the patient again is unnecessary. While prevention of skin breakdown is important, there is no indication that the patient cannot reposition independently. PTS: 1 DIF: Cognitive Level: Application REF: 769, Older Adult Care Points OBJ: 1 (clinical) TOP: Dehydration in the Older Adult KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. The nurse cautions the diabetic patient that diabetes affects the blood flow through the kidney. Which statement indicates that the patient understands the nurse’s teaching? a. “Long-term high blood sugars provide an environment for bacteria to grow, which can damage my kidneys.” b. “Diabetes causes changes to blood vessels, which impacts blood flow to my kidneys.” c. “Diabetes causes an immune response and exposes my kidneys to antibody complexes.” d. “Long-term insulin use leads to scarring on the kidneys.” ANS: B The long-term effect of diabetes is generalized vasoconstriction, which leads many diabetic patients to renal insufficiency and renal failure. Diabetes can increase a patient’s risk for infection. Diabetes does not cause exposure to antibody complexes. Insulin usage does not scar the kidneys. PTS: 1 DIF: Cognitive Level: Application REF: 767 OBJ 2 (theory) TOP: Renal Insufficiency: Related to Mellitus Diabetes KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse explains that when the kidney suffers an autoimmune inflammatory reaction, the glomeruli lose their ability to function effectively. The nurse is describing the etiology of which problem? a. Glomerulonephritis b. Renal calculi c. Hydronephrosis d. Acute pyelonephritis ANS: A Glomerulonephritis occurs when the inflammatory process alters the effectiveness of the semipermeable membrane in the glomeruli. Renal calculi are kidney stones; causative factions include urinary infections, inadequate fluid intake, and sluggish urine flow. Hydronephrosis results when flow of urine from the kidney is obstructed, and the kidney dilates and fills with fluid. Acute pyelonephritis an infection of the kidneys thought to occur when bacteria (such as Escherichia coli) from a bladder infection travel up the ureters to infect the kidneys. PTS:1 DIF: Cognitive Level: Comprehension REF: 767 OBJ:2 (theory) TOP: Glomerulonephritis: Etiology KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse is caring for a confused patient who requires bladder training. Which component of the bladder training program can the nurse safely delegate to the nursing assistant? a. Teaching the patient about a voiding diary b. Creating a schedule for voiding c. Creating a schedule for fluids d. Recording instances of linen changes and fluids offered ANS: D In planning and implementing a bladder training program for your confused patient, there are several ways in which the UAP can provide help. The nurse appropriately delegates reporting and recording any fluids offered and consumed, along with frequency of linen changes. The nurse should perform patient teaching about the diary, especially since the patient is confused; the nurse is responsible for determining the patient’s level of comprehension. The nurse should create the schedule for voiding and fluids, and once the schedule is established, the nursing assistant can help the patient to follow the schedule. PTS: 1 DIF: Cognitive Level: Analysis REF: 782, Assignment Considerations OBJ: 9 (theory) TOP: Bladder Training KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, and Effective Care Environment: Coordinated Care 5. When the patient asks why he has so many urinary tract infections (UTIs), the nurse informs the patient that his recurrent UTIs most likely result from which causative factor? a. Bacteria that colonize in the kidney b. Viral infections generating debris in the bladder c. Carelessness in handwashing d. Spicy foods irritating the bladder wall