AMSN Renal and Urological Disorders 2 — Questions and Answers
Question 1: A patient with a urinary catheter develops a fever, flank pain, and costovertebral angle (CVA) tenderness. The nurse suspects:
- Lower UTI (cystitis)
- Pyelonephritis (upper UTI) (Correct answer)
- Nephrolithiasis
- Urethritis
Correct answer: Pyelonephritis (upper UTI)
Fever, flank pain, and CVA tenderness indicate pyelonephritis (kidney infection), which can progress to sepsis if not treated promptly.
Question 2: A patient passes a kidney stone. The nurse correctly instructs the patient to:
- Discard the stone as it has no diagnostic value
- Strain all urine and save the stone for laboratory analysis (Correct answer)
- Restrict all fluids for 24 hours
- Avoid pain medication to accurately assess symptom progression
Correct answer: Strain all urine and save the stone for laboratory analysis
Stone analysis determines composition (calcium, uric acid, struvite, cystine), which guides dietary modifications and medication therapy to prevent recurrence.
Question 3: A patient with benign prostatic hyperplasia (BPH) is unable to void and has a distended bladder. After catheterization, 900 mL of urine is drained. The nurse should:
- Continue draining until the bladder is completely empty immediately
- Clamp the catheter after 400–600 mL and monitor for hematuria or hypotension (Correct answer)
- Remove the catheter after draining 200 mL
- Irrigate the bladder with normal saline
Correct answer: Clamp the catheter after 400–600 mL and monitor for hematuria or hypotension
Rapid decompression of a severely distended bladder can cause decompression hematuria and vasovagal hypotension; clamping after 400–600 mL allows gradual decompression.
Question 4: A patient with CKD receives erythropoietin (EPO) therapy. The nurse should monitor for which serious adverse effect?
- Bleeding complications
- Hypertension and thromboembolic events (Correct answer)
- Severe hypoglycemia
- Pulmonary fibrosis
Correct answer: Hypertension and thromboembolic events
EPO stimulates RBC production and can elevate hematocrit rapidly, increasing blood viscosity and the risk of hypertension, thrombosis, and stroke.
Question 5: A patient with CKD has a serum bicarbonate of 16 mEq/L. The nurse recognizes this as:
- Metabolic alkalosis from vomiting
- Metabolic acidosis from impaired acid excretion (Correct answer)
- Respiratory alkalosis from hyperventilation
- Normal finding in CKD
Correct answer: Metabolic acidosis from impaired acid excretion
The failing kidney cannot adequately excrete hydrogen ions or reabsorb bicarbonate, causing metabolic acidosis (low bicarbonate) in CKD.
Question 6: A patient recovering from acute tubular necrosis (ATN) is now in the diuretic phase. The nurse's priority is monitoring for:
- Fluid overload and hypertension
- Dehydration, hypokalemia, and hyponatremia from excessive urine output (Correct answer)
- Oliguria returning
- Hyperkalemia
Correct answer: Dehydration, hypokalemia, and hyponatremia from excessive urine output
During the diuretic phase of ATN, massive fluid and electrolyte losses (hypokalemia, hyponatremia) can lead to dehydration and hemodynamic instability.
AMSN Renal and Urological Disorders 2
A patient with a urinary catheter develops a fever, flank pain, and costovertebral angle (CVA) tenderness.
The nurse suspects: