Urinary System Disorders | NCLEX Quiz 107

1. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include in her discharge teaching?

Take cool baths

Avoid tampon use

Avoid sexual activity

Drink 8 to 10 eight-oz glasses of water daily

Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.

Explanation

Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps flush the bacteria from the bladder. The patient should be instructed to void after sexual activity.

2. What is the priority nursing diagnosis with your patient diagnosed with end-stage renal disease?

Activity intolerance

Fluid volume excess

Knowledge deficit

Pain

Fluid volume excess because the kidneys aren’t removing fluid and wastes. The other diagnoses may apply. but they don’t take priority.

Explanation

Fluid volume excess because the kidneys aren’t removing fluid and wastes. The other diagnoses may apply. but they don’t take priority.

3. Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?

The patient shouldn’t feel pain during initiation of dialysis

The patient feels best immediately after the dialysis treatment

Using a stethoscope for auscultating the fistula is contraindicated

Taking a blood pressure reading on the affected arm can cause clotting of the fistula

Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting. so avoid taking blood pressure on the affected arm.

Explanation

Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting. so avoid taking blood pressure on the affected arm.

4. A 22 y.o. patient with diabetic nephropathy says. "I have two kidneys and I'm still young. If I stick to my insulin schedule. I don't have to worry about kidney damage. right?" Which of the following statements is the best response?

“You have little to worry about as long as your kidneys keep making urine.”

“You should talk to your doctor because statistics show that you’re being unrealistic.”

“You would be correct if your diabetes could be managed with insulin.”

“Even with insulin. kidney damage is still a concern.”

Kidney damage is still a concern. Microvascular changes occur in both of the patient’s kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.

Explanation

Kidney damage is still a concern. Microvascular changes occur in both of the patient’s kidneys as a complication of the diabetes. Diabetic nephropathy is the leading cause of end-stage renal disease. The kidneys continue to produce urine until the end stage. Nephropathy occurs even with insulin management.

5. You're planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include?

“Your urine might turn bright orange.”

“You need to take this antibiotic for 7 days.”

“Take this drug between meals and at bedtime.”

“Don’t take this drug if you’re allergic to penicillin.”

The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.

Explanation

The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.

6. A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments?

Low-protein diet with unlimited amounts of water

Low-protein diet with a prescribed amount of water

No protein in the diet and use of a salt substitute

No restrictions

The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs.Option C: Salt substitutes shouldn’t be used without a doctor’s order because it may contain potassium. which could make the patient hyperkalemic.Option D: Fluid and protein restrictions are needed.

Explanation

The patient should follow a low-protein diet with a prescribed amount of water. The patient requires some protein to meet metabolic needs.Option C: Salt substitutes shouldn’t be used without a doctor’s order because it may contain potassium. which could make the patient hyperkalemic.Option D: Fluid and protein restrictions are needed.

7. A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care?

Apply pressure to the needle site upon discontinuing hemodialysis

Keep the head of the bed elevated 45 degrees

Place the left arm on an arm board for at least 30 minutes

Keep the left arm dry

Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.

Explanation

Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients.

8. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?

Dysuria. frequency. and urgency

Back pain. nausea. and vomiting

Hypertension. oliguria. and fatigue

Fever. chills. and right upper quadrant pain radiating to the back

Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.

Explanation

Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia.

9. Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs over the past two years. She is fatigued from lack of sleep. has lost weight. and urinates frequently even in the night. Her labs show: sodium. 154 mEq/L; osmolarity 340 mOsm/L; glucose. 127 mg/dl; and potassium. 3.9 mEq/L. Which nursing diagnosis is priority?

Fluid volume deficit related to osmotic diuresis induced by hyponatremia

Fluid volume deficit related to inability to conserve water

Altered nutrition: Less than body requirements related to hypermetabolic state

Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency

1.11E+22

Explanation

1.11E+22

10. Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?

Infection

Disequilibrium syndrome

Air embolus

Acute hemolysis

Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

Explanation

Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.