Lewis Medical Surgical Nursing Chap
50: Renal and Urologic Problems
A 28-yr-old male affected person has just been recognized with polycystic kidney disease.
Which information would the nurse encompass all through the primary coaching consultation?
A. Complications of renal transplantation
b. Methods for treating severe chronic pain
c. Options to keep in mind for genetic counseling
d. Differences between hemodialysis and peritoneal dialysis - ANS-ANS: C Because a
28-yr-antique affected person may be considering having children, the nurse might include facts
approximately genetic counseling when coaching the patient. A affected person with true
healthmanagement will not want to pick among hemodialysis and peritoneal dialysis or realize
approximately the outcomes of transplantation for decades. There is not any indication that the
patient has continual pain
A forty six-year-antique lady affected person returns to the health center with continued dysuria
after being handled with trimethoprim and sulfamethoxazole for 3 days. Which movement will
the nurse plan to take?
A. Remind the patient about the want to drink a thousand mL of fluids daily.
B. Obtain a midstream urine specimen for culture and sensitivity trying out.
C. Suggest that the affected person use acetaminophen (Tylenol) to alleviate signs. D. Tell the
affected person to take the trimethoprim and sulfamethoxazole for three more days - ANS-ANS:
B Because uncomplicated urinary tract infections (UTIs) are generally efficiently dealt with with
three days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine
appropriate antibiotic remedy. Acetaminophen might now not be as powerful as other
over-the-counter medications which includes phenazopyridine in treating dysuria. The fluid
consumption have to be increased to at the least 1800 mL/day. Because the UTI has
persevered after remedy with trimethoprim and sulfamethoxazole, the affected person is likely to
want a exclusive antibiotic.
A forty eight-year-vintage male patient who weighs 242 lb (a hundred and ten kg) undergoes a
left nephrectomy for huge kidney trauma from a motor vehicle crash. Which postoperative
evaluation finding is maximum important to speak to the health care professional?
A. Blood stress is 102/fifty eight.
B. Urine output is 20 mL/hr for 2 hours.
C. Incisional ache stage mentioned as 9/10.
D. Crackles present at bilateral lung bases. - ANS-ANS: B Because the urine output need to be
at least 0.5 mL/kg/hr, a 40-mL output for 2 hours indicates that the patient can also have
reduced perfusion to the last kidney due to bleeding, insufficient fluid consumption, or
obstruction on the suture web page. The blood pressure requires ongoing monitoring however
does now not indicate inadequate perfusion right now. The affected person should cough and
, deep breathe, however the crackles do not suggest a need for a right away change in remedy.
The incisional ache have to be addressed, however this isn't as potentially lifestyles threatening
as decreased renal perfusion. In addition, the nurse can medicate the affected person for pain.
A fifty five-12 months-old lady admitted for shoulder surgical operation asks the nurse for a
perineal pad, pointing out that giggling or coughing causes leakage of urine. Which intervention
is appropriate to include in the care plan?
A. Place a commode at the patient's bedside.
B. Assist the patient to the toilet each 3 hours.
C. Demonstrate how to perform the Credé maneuver.
D. Teach the affected person how to perform Kegel physical activities. - ANS-ANS: D Kegel
sports to strengthen the pelvic floor muscle tissues will assist 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 supporting the patient to the toilet are helpful for
purposeful incontinence.
A 68-year-vintage affected person admitted to the medical institution with dehydration is
pressured and incontinent of urine. Which action would the nurse encompass inside the plan of
care? A. Restrict fluids among meals and after the nighttime meal.
B. Insert an indwelling catheter until the symptoms have resolved.
C. Assist the patient to the rest room each 2 hours for the duration of the day.
D. Apply absorbent adult incontinence diapers and pads over the bed linens - ANS-ANS: C In
older or pressured sufferers, incontinence can be prevented by way of the usage of scheduled
toileting times. Indwelling catheters increase the danger for urinary tract contamination.
Incontinent pads and diapers growth the risk for skin breakdown. Restricting fluids isn't
appropriate in a patient with dehydration.
A 76-yr-antique with benign prostatic hyperplasia (BPH) is agitated and burdened, with a
markedly distended bladder. Which intervention prescribed with the aid of the fitness care
provider would the nurse enforce first?
A. Insert an indwelling urinary catheter.
B. Draw blood for a serum creatinine level.
C. Schedule an intravenous pyelogram (IVP).
D. Administer lorazepam (Ativan) zero.5 mg PO. - ANS-ANS: A The affected person's records
and clinical manifestations are regular with acute urinary retention, and the priority movement is
to relieve the retention by catheterization. The BUN and creatinine measurements may be
obtained after the catheter is inserted. The patient's agitation may resolve after the bladder
distention is corrected, and sedative pills might be used carefully in older sufferers. The IVP can
be carried out as a diagnostic check but does not need to be done urgently
A girl patient within the urology sanatorium is recognized with monilial urethritis. Which action
will the nurse include within the plan of care?
A. Teach the patient approximately using antifungal medicinal drugs.
B. Tell the affected person to keep away from bathtub baths until the symptoms resolve.
C. Instruct the affected person to refer latest sexual partners for remedy.
D. Tell the patient to keep away from nonsteroidal antiinflammatory tablets (NSAIDs) -
ANS-ANS: A Monilial urethritis is because of a fungus and antifungal medications such as
nystatin or fluconazole are generally used as treatment. Because monilial urethritis isn't sexually
50: Renal and Urologic Problems
A 28-yr-old male affected person has just been recognized with polycystic kidney disease.
Which information would the nurse encompass all through the primary coaching consultation?
A. Complications of renal transplantation
b. Methods for treating severe chronic pain
c. Options to keep in mind for genetic counseling
d. Differences between hemodialysis and peritoneal dialysis - ANS-ANS: C Because a
28-yr-antique affected person may be considering having children, the nurse might include facts
approximately genetic counseling when coaching the patient. A affected person with true
healthmanagement will not want to pick among hemodialysis and peritoneal dialysis or realize
approximately the outcomes of transplantation for decades. There is not any indication that the
patient has continual pain
A forty six-year-antique lady affected person returns to the health center with continued dysuria
after being handled with trimethoprim and sulfamethoxazole for 3 days. Which movement will
the nurse plan to take?
A. Remind the patient about the want to drink a thousand mL of fluids daily.
B. Obtain a midstream urine specimen for culture and sensitivity trying out.
C. Suggest that the affected person use acetaminophen (Tylenol) to alleviate signs. D. Tell the
affected person to take the trimethoprim and sulfamethoxazole for three more days - ANS-ANS:
B Because uncomplicated urinary tract infections (UTIs) are generally efficiently dealt with with
three days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine
appropriate antibiotic remedy. Acetaminophen might now not be as powerful as other
over-the-counter medications which includes phenazopyridine in treating dysuria. The fluid
consumption have to be increased to at the least 1800 mL/day. Because the UTI has
persevered after remedy with trimethoprim and sulfamethoxazole, the affected person is likely to
want a exclusive antibiotic.
A forty eight-year-vintage male patient who weighs 242 lb (a hundred and ten kg) undergoes a
left nephrectomy for huge kidney trauma from a motor vehicle crash. Which postoperative
evaluation finding is maximum important to speak to the health care professional?
A. Blood stress is 102/fifty eight.
B. Urine output is 20 mL/hr for 2 hours.
C. Incisional ache stage mentioned as 9/10.
D. Crackles present at bilateral lung bases. - ANS-ANS: B Because the urine output need to be
at least 0.5 mL/kg/hr, a 40-mL output for 2 hours indicates that the patient can also have
reduced perfusion to the last kidney due to bleeding, insufficient fluid consumption, or
obstruction on the suture web page. The blood pressure requires ongoing monitoring however
does now not indicate inadequate perfusion right now. The affected person should cough and
, deep breathe, however the crackles do not suggest a need for a right away change in remedy.
The incisional ache have to be addressed, however this isn't as potentially lifestyles threatening
as decreased renal perfusion. In addition, the nurse can medicate the affected person for pain.
A fifty five-12 months-old lady admitted for shoulder surgical operation asks the nurse for a
perineal pad, pointing out that giggling or coughing causes leakage of urine. Which intervention
is appropriate to include in the care plan?
A. Place a commode at the patient's bedside.
B. Assist the patient to the toilet each 3 hours.
C. Demonstrate how to perform the Credé maneuver.
D. Teach the affected person how to perform Kegel physical activities. - ANS-ANS: D Kegel
sports to strengthen the pelvic floor muscle tissues will assist 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 supporting the patient to the toilet are helpful for
purposeful incontinence.
A 68-year-vintage affected person admitted to the medical institution with dehydration is
pressured and incontinent of urine. Which action would the nurse encompass inside the plan of
care? A. Restrict fluids among meals and after the nighttime meal.
B. Insert an indwelling catheter until the symptoms have resolved.
C. Assist the patient to the rest room each 2 hours for the duration of the day.
D. Apply absorbent adult incontinence diapers and pads over the bed linens - ANS-ANS: C In
older or pressured sufferers, incontinence can be prevented by way of the usage of scheduled
toileting times. Indwelling catheters increase the danger for urinary tract contamination.
Incontinent pads and diapers growth the risk for skin breakdown. Restricting fluids isn't
appropriate in a patient with dehydration.
A 76-yr-antique with benign prostatic hyperplasia (BPH) is agitated and burdened, with a
markedly distended bladder. Which intervention prescribed with the aid of the fitness care
provider would the nurse enforce first?
A. Insert an indwelling urinary catheter.
B. Draw blood for a serum creatinine level.
C. Schedule an intravenous pyelogram (IVP).
D. Administer lorazepam (Ativan) zero.5 mg PO. - ANS-ANS: A The affected person's records
and clinical manifestations are regular with acute urinary retention, and the priority movement is
to relieve the retention by catheterization. The BUN and creatinine measurements may be
obtained after the catheter is inserted. The patient's agitation may resolve after the bladder
distention is corrected, and sedative pills might be used carefully in older sufferers. The IVP can
be carried out as a diagnostic check but does not need to be done urgently
A girl patient within the urology sanatorium is recognized with monilial urethritis. Which action
will the nurse include within the plan of care?
A. Teach the patient approximately using antifungal medicinal drugs.
B. Tell the affected person to keep away from bathtub baths until the symptoms resolve.
C. Instruct the affected person to refer latest sexual partners for remedy.
D. Tell the patient to keep away from nonsteroidal antiinflammatory tablets (NSAIDs) -
ANS-ANS: A Monilial urethritis is because of a fungus and antifungal medications such as
nystatin or fluconazole are generally used as treatment. Because monilial urethritis isn't sexually
