NCLEX Qs UTI, nephritis
The nurse is teaching a female client about the prevention of urinary tract infections (UTIs). Which information should the nurse include? A. "Wash the perineum after intercourse." B. "Avoid bubble baths." C. "Void after intercourse." D. "Empty the bladder every 2 hours."
B The information the nurse should include in the teaching about preventing UTIs is to avoid bubble baths. Avoiding bubble baths helps to maintain the integrity of the perineum. Clients should void and wash the perineum before and after intercourse. The bladder should be emptied every 3dash4 hours.
The nurse is caring for a client experiencing pain related to a urinary tract infection (UTI). Which intervention should the nurse initiate to address the client's discomfort? A. Increase in fluid intake B. Application of cold compresses C. Avoidance of contact with undergarments made of cotton D. Cleansing of the urinary meatus with antiseptic wipes
A. Increasing fluid intake will dilute the urine, reducing irritation of the inflamed bladder and urethral mucosa. Sitz baths, warm packs, and heating pads, not cold compresses are used to relax the muscles, relieve spasms, and increase the local blood supply. The perineum should be kept clean and dry, but cleaning it with antiseptic wipes can cause perianal irritation. Undergarments should contain cotton. Synthetic fibers irritate perineal tissues and promote bacterial growth.
The nurse is caring for a client with chronic urinary tract infections (UTIs) suspected of having a vesicoureteral reflux. Which collaborative intervention should the nurse anticipate? A. Intravenous pyelography B. Voiding cystourethrography C. Renal ultrasound D. Cystoscopy
A. Intravenous pyelography is used to detect structural and functional abnormalities such as vesicoureteral reflux. Cystoscopy provides direct visualization of the urethra and bladder. Renal ultrasound is used to detect pyelonephritis. Voiding cystourethrography is utilized to assess structural and functional abnormalities of the bladder and urethra.
The nurse is screening a client for the risk of nephritis. Which question should the nurse ask? (Select all that apply.) A. "Does your family have a history of kidney disease?" B. "Do you have a history of diabetes?" C. "Do you have a history of low blood pressure?" D. "Do you have a history of bladder infections?" E. "Does your family have a history of gastric reflux?
A,B,D. Diabetes and hypertension (not low blood pressure) can cause damage to the fragile vessels of the nephron, thereby putting the client at greater risk for nephritis. A family history of kidney disease also predisposes the client to developing nephritis. Infections can travel from the bladder to the kidney, thereby damaging the kidney. Gastric reflux is not related to nephritis.
The community health nurse discusses the risk factors for nephritis with a group of community members. Which risk factor should the nurse include in the teaching? (Select all that apply) A. Overuse of over-the-counter painkillers B. Diabetes C. Hypotension D. Drug abuse E. Hypothyroidism
A,B,D. Diabetes causes damage to the fragile vessels of the nephron that can result in nephritis. Drug abuse and the chronic overuse of over-the-counter painkillers increase the risk. Hypertension, not hypotension, damages the nephron to cause nephritis. Hypothyroidism is not a risk factor for nephritis.
A client asks which fluids to avoid in light of repeated urinary tract infections (UTIs). Which food should the nurse teach the client to avoid? (Select all that apply.) A. Coffee B. Citrus juices C. Alcoholic beverages D. Milk E. Cranberry juice
A,B,C. Avoiding citrus juices, alcoholic beverages, and coffee can help prevent UTIs. Caffeine, citrus juices, alcohol, and artificial sweeteners irritate bladder mucosa and the detrusor muscle and can increase urgency and bladder spasms. Increasing the intake of cranberry juice, not avoiding it, can help prevent UTIs because it acidifies the urine. Milk intake has no known effect in preventing UTIs.
Which topic is important to include in the home care teaching for a client with a urinary tract infection (UTI)? (Select all that apply.) A. Adequate fluid consumption B. Good hygiene methods C. Proper nutrition D. Wearing polyester underwear E. Voiding every 5 to 6 hours
A,B,C. Home care teaching for a client with a UTI includes information about good hygiene methods, proper nutrition, and adequate fluid consumption. Increased fluids dilute the urine, reducing irritation of the inflamed bladder and urethral mucosa. Instruct women to cleanse the perineal area from front to back after voiding and defecating, to prevent the transfer of gastrointestinal bacteria to the urethra. Teach clients to void and wash the perineal area before and after sexual intercourse to flush out bacteria introduced into the urethra and bladder. Teach measures to maintain the integrity of perineal tissues, such as avoiding bubble baths, feminine hygiene sprays, and vaginal douches, and wearing cotton briefs rather than underwear made from synthetic materials. Frequent voiding (every 3dash 4 hours) is encouraged.
The nurse instructs a pregnant client diagnosed with nephritis about the possible effects of nephritis on the pregnancy. Which should the nurse include in the teaching? (Select all that apply.) A. Fetal loss B. Preterm delivery C. Preeclampsia D. Infant with low birthweight E. Abruptio placenta
A,B,C. Nephritis is associated with adverse maternal and fetal outcomes such as preeclampsia, fetal loss, and preterm delivery. Abruptio placenta and infants with low birthweight have not been shown to occur with nephritis.
The nurse is caring for a client with pyelonephritis. Which clinical manifestation should the nurse assess in the client? (Select all that apply.) A. Fever B. Vomiting C. Enuresis D. Flank pain E. Dysuria
A,B,D Clinical manifestations that occur with pyelonephritis include fever, vomiting, and flank pain. Enuresis and dysuria occur with cystitis.
Which assessment finding should alert the nurse to a possible client diagnosis of nephritis? (Select all that apply.) A. Presence of facial edema B. History of diabetes C. Complaint of weight loss D. Complaint of cough E. Presence of infection
A,B,D,E. Facial edema is a manifestation of nephritis due to the retention of sodium and water. A client complaint of cough may indicate Goodpasture syndrome, a rare genetic disorder that causes nephritis and may cause a cough due to antibody destruction of alveoli. Infection may cause nephritis. A client with diabetes is more prone to developing nephritis due to vascular damage to the glomerulus. Weight loss is not a manifestation of nephritis.
A client is admitted to the emergency department for possible acute pyelonephritis. Which manifestation should the nurse consider to be consistent with this disorder? (Select all that apply.) A. Flank tenderness B. Diarrhea C. Nocturia D. Urinary frequency E. Vomiting
A,B,D,E. The nurse should monitor a client with suspected acute pyelonephritis for flank tenderness, vomiting, diarrhea, and urinary frequency. Other manifestations the client may present with are high fever, chills, costovertebral angle tenderness, and moderate to severe dehydration. Nocturia is a manifestation of cystitis, not acute pyelonephritis.
The nurse is caring for a client diagnosed with a urinary tract infection (UTI). Which assessment finding supports this diagnosis? (Select all that apply.) A. Abdominal pain B. Burning sensation on urination C. Clear urine D. Hypothermia E. Flank pain
A,B,E. Assessment findings that support the diagnosis of a UTI include abdominal pain, flank pain, and a burning sensation when urinating. Cloudy, dark, foul-smelling urine is also expected with a UTI. Hyperthermia (fever), not hypothermia, supports the diagnosis of a UTI.
When planning care for a client with acute glomerulonephritis, the nurse should prioritize which intervention? (Select all that apply.) A. Promoting nutritional balance B. Promoting an adequate sleep pattern C. Using standard precautions D. Maintaining skin integrity E. Maintaining fluid balance
A,C,D,E. Interventions for a client with acute glomerulonephritis primarily focus on preventing infection, maintaining skin integrity, promoting nutritional balance, and maintaining fluid balance. Promoting an adequate sleep pattern may be an appropriate intervention; however, this is not a primary focus for this client.
The nurse admits a client diagnosed with glomerulonephritis. The nurse should identify which characteristic that occurs with glomerulonephritis? (Select all that apply.) A. Gradual decline in renal function B. Surfaces of the kidneys becoming soft and boggy C. Symmetrical decrease in the size of the kidneys D. Entire nephrons eventually being lost E. Slow, progressive destruction of the glomeruli
A,C,D,E. Characteristics of chronic glomerulonephritis include a slow, progressive destruction of the glomeruli, a gradual decline in renal function, a symmetrical decrease in the size of the kidneys, and an eventual loss of the entire nephron. The surfaces of the kidneys become granular or roughened, not soft and boggy.
The nurse is caring for a client with suspected acute glomerulonephritis. Which clinical manifestation supports this suspicion? (Select all that apply.) A. Crackles auscultated in lungs B. Low blood pressure C. Tea-colored urine D. Microscopic hematuria E. Weight loss
A,C,D. Manifestations of acute glomerulonephritis include crackles in the lungs, tea-colored urine, microscopic hematuria, high blood
The nurse assesses a client suspected of having glomerulonephritis. Which assessment finding should indicate to the nurse that the suspected diagnosis is correct? A. Facial and peripheral edema B. Peripheral and central cyanosis C. Prolonged capillary refill D. Decreased bowel sounds
A. Because renal function is impaired in glomerulonephritis, the client will exhibit facial, periorbital, and peripheral edema. Peripheral cyanosis indicates hypoxia and is a respiratory problem. Prolonged capillary refill and decreased bowel sounds are not signs of glomerulonephritis.
A client is suspected of having acute postinfectious glomerulonephritis. Which test result, if elevated, should lead the nurse to determine that the suspected diagnosis is correct? A. Erythrocyte sedimentation rate (ESR) B. Creatinine clearance C. Blood urea nitrogen (BUN) D. Antistreptolysin O (ASO) titer
A. The ESR is a general indicator of inflammatory response and may be elevated in acute postinfectious glomerulonephritis and in lupus nephritis. BUN measures urea nitrogen, the end product of protein metabolism, created by the breakdown and metabolism of dietary and body proteins. Creatinine clearance is a specific indicator of renal function used to evaluate the glomerular filtration rate (GFR). The ASO titer detects streptococcal exoenzymes.
The client diagnosed with nephritis states, "No one in my family has ever had any kidney disease. Where do you think this nephritis came from?" Which response by the nurse is most accurate? A. "Your congestive heart failure might have damaged your kidneys." B. "I think your celiac disease must have damaged your kidneys." C. "It is possible that your history of arthritis caused the nephritis." D. "The fact that you have thyroid disease probably caused damage to your kidneys."
A. While the cause of nephritis is unknown, many diseases can damage the kidneys and cause nephritis. Congestive heart failure is one of them due to poor perfusion to the kidneys. Thyroid disease, celiac disease, and arthritis do not.
The nurse is caring for a client in the acute phase of postinfectious glomerulonephritis. Which intervention should the nurse implement? (Select all that apply.) A. Chest physiotherapy B. Protein restriction C. Fluid restriction D. Bedrest E. Parenteral nutrition
B,C,D. A client in the acute phase of postinfectious glomerulonephritis is placed on bedrest, so the body can conserve energy. Only sensible fluid loss is replaced until the renal status is known. Because of the azotemia, protein consumption is limited. Chest physiotherapy is used to clear the lungs of secretions in pulmonary diseases. Parenteral nutrition is not necessary with glomerulonephritis, as the client will still be able to eat.
The nurse is caring for a client with a urinary tract infection (UTI). Which condition should the nurse determine as a possible cause? (Select all that apply.) A. Excessive oral fluid intake B. Vesicoureteral reflux C. Renal scarring D. Structural deviations E. Use of antibiotics
B,C,D. The causes of UTIs include structural deviations, renal scarring, and vesicoureteral reflux. Excessive oral fluid intake or use of antibiotics does not cause UTIs.
The nurse planning care for a client diagnosed with nephritis assigns a goal of maintaining fluid volume balance. Which intervention should the nurse include in the client's plan of care? (Select all that apply.) A. Keeping sheets tight and wrinkle-free B. Providing a low-sodium diet C. Measuring abdominal girth D. Encouraging fluid intake E. Offering ice chips frequently
B,C,E. The client diagnosed with nephritis will be on a fluid restriction diet. Fluids are restricted, not pushed. Measuring abdominal girth allows the nurse to monitor the degree of ascites. Offering frequent ice chips is a means to relieve thirst. Providing a low-sodium diet will decrease fluid retention by the kidneys. Keeping sheets tight and without wrinkles helps to promote skin integrity.
The nurse admits a hypertensive client diagnosed with glomerulonephritis. Which medication should the nurse expect to be ordered for the client? A. Beta blocker B. Angiotensin-converting enzyme (ACE) inhibitor C. Glucocorticoid D. Antibiotic
B. ACE inhibitors or angiotensin receptor blockers (ARBs) are the first choice for antihypertensive agents in glomerulonephritis. These medications slow the progression of renal failure. They also reduce protein loss associated with nephrotic syndrome. Beta blockers are not indicated in glomerulonephritis; they are used to reduce hypertension and cardiac workload. Antibiotics are used to treat infections and glucocorticoids reduce inflammation.
The nurse teaches a client diagnosed with nephritis about risk factors for the disease. Which disease should the nurse list as being likely to cause nephritis? A. Graves disease B. Congestive heart failure C. Celiac disease D. Asthma
B. Congestive heart failure can damage the kidneys due to hypoxia and hypoperfusion, thereby causing nephritis. None of the other diseases listed in this question causes nephritis.
The nurse is caring for a client who requires intermittent straight catheterization for impaired urinary elimination. Which nursing intervention should the nurse include in the plan of care to help prevent a urinary tract infection (UTI)? A. Inflating the balloon when it is in the bladder B. Using aseptic technique when inserting the straight catheter C. Maintaining gravity flow to prevent urine reflux D. Maintaining a closed drainage system
B. Using aseptic technique when inserting the catheter minimizes the risk of a bacterial infection. Maintaining a closed drainage system, inflating the balloon, and maintaining gravity flow are principles for preventing infection when using an indwelling catheter.
For which client should the nurse question the healthcare provider's order for a 7- to 10-day course of antibiotics? A. A male client with pyelonephritis B. A male client with a history of antibiotic-resistant infections C. A female client with uncomplicated cystitis D. A female client with urinary tract abnormalities
C Most uncomplicated infections of the lower urinary tract can be treated with a short course of antibiotic therapy, either a single antibiotic dose or a 3-day course of treatment. Single-dose therapy is associated with a higher rate of recurrent infection and continued vaginal colonization with Escherichia coli, making a 3-day course of treatment the preferred option for uncomplicated cystitis. Men and women with pyelonephritis, urinary tract abnormalities or stones, or a history of antibiotic-resistant infections require a 7- to 10-day course of trimethoprim-sulfamethoxazole, ciprofloxacin, ofloxacin, or an alternative antibiotic.
The nurse is teaching parents of school-age children practices that should decrease the risk of urinary tract infections (UTIs). Which information should the nurse include? A. "Avoid large amounts of dairy in the child's diet." B. "Provide drinks with sugar substitutes when possible." C. "Encourage the child to void five to six times a day." D. "Encourage juices to increase the acidity of the child's urine."
C The information the nurse can include in the teaching to prevent UTIs in children is to encourage them to void five to six times a day. Infrequent voiding, which is common in school-age children, results in incomplete emptying of the bladder and urinary stasis, both of which are factors in the development of UTIs. Dairy is associated with an increased risk of UTIs, but it is not the major contributing factor for UTIs in children. Juices and sugar substitutes in drinks are associated with UTIs.
The nurse has admitted a client to the unit for treatment of acute pyelonephritis. Which collaborative intervention does the nurse anticipate initiating as a priority? A. Administration of intravenous (IV) antibiotics B. Administration of an analgesic C. Order for a urine specimen for culture and sensitivity D. Order for a complete blood count (CBC) with a differential
C The nurse can anticipate an order for a urine specimen for a culture and sensitivity to identify the infecting organism before antibiotics are started. An analgesic can be given if needed, but treatment of the infection is a priority. A CBC with a differential can be obtained to examine the WBC count for changes typically associated with infection. IV antibiotics can be administered after the urine sample for a culture and sensitivity has been obtained.
The nurse is providing discharge teaching to a client with a urinary tract infection (UTI). Which instruction should the nurse include? A. "We recommend that you use aseptic technique when cleansing the perineum." B. "Be sure to complete the full course of urinary analgesics." C. "It is important to follow this schedule for your antibiotics." D. "You do not need to make a follow-up appointment."
C. Help the client to develop a plan to take their antibiotic medications so they do not miss doses. Missed doses of antibiotics may cause a subtherapeutic medication blood level, which can reduce effectiveness. The client should follow up with the healthcare provider 7dash14 days after completion of the antibiotic therapy to ensure there is complete eradication of the bacteria. Aseptic technique is not used for perineal care; it is used for clients who have an intermittent catheter or an indwelling catheter. Urinary analgesics are only taken if needed; it is not necessary to complete the course of analgesics.
The nurse is creating a plan of care for a client with pyelonephritis. Which outcome reflects the client's ability to decrease the severity of the bacteria in the urinary tract? A. The client will use antiseptic spray regularly on the perineal area. B. The client will complete the course of antibiotics. C. The client will drink at least 1500 mL of fluid per day and void every 2dash3 hours while awake. D. The client will wipe from back to front after voiding and defecating.
C. Increasing fluid intake and the frequency of voiding each day flushes the bacteria from the urinary tract. The goal for completing the course of antibiotics is to eradicate the infectious organism. Although antiseptic solutions may be ordered for catheter care, they can dry perineal tissues and reduce normal flora, increasing the risk of colonization by pathogens. These solutions should not be used routinely. Women should cleanse the perineal area from front to back after voiding and defecating to prevent the transfer of gastrointestinal bacteria to the urethra.
The community health nurse speaks with a group of older adult community members about reasons they are at a higher risk for nephritis. Which reason should the nurse include? A. Higher incidence of cardiac problems B. Long-term use of antihypertensives C. Long-term use of proton pump inhibitors (PPIs) D. Lower risk of developing chronic kidney disease
C. Medications such as PPIs and certain antibiotics (not antihypertensives) are associated with an increase in nephritis. Older adults have a higher risk of developing chronic kidney disease. Cardiac problems are not shown to increase the risk of nephritis.
The nurse is caring for a client diagnosed with nephritis. Which assessment finding on discharge leads the nurse to determine that treatment was successful? A. The client's sodium level is 150 mEq/L. B. The client has gained less than 5 pounds. C. The client has regained urine output. D. The client's temperature is 101.5degreesF.
C. Successful treatment of nephritis is evidenced by the client maintaining or regaining a normal urine output. The client's weight should return to the pre-admission weight as all retained fluid is excreted. An elevated temperature indicates that the client might be experiencing an infection. The client's sodium level should return to normal levels (135dash145 mEq/L)
The nurse is caring for a client experiencing urinary retention. Which preventive catheter-associated urinary tract infection (CAUTI) measure should the nurse take to protect the client from a urinary tract infection (UTI)? A. Review the criteria for catheter insertion. B. Obtain a urine sample for a urinalysis. C. Consider an alternative to an indwelling catheter. D. Initiate an antibiotic before inserting a catheter.
C. The alternative to an indwelling catheter is to use intermittent straight catheterization to relieve urinary retention. Using intermittent straight catheterization allows the bladder to fill and completely empty more normally, maintaining physiologic function. Obtaining a urine sample for a urinalysis will not address the problem of urinary retention. Reviewing the criteria for catheter insertion is a preventive CAUTI measure, but urinary retention is one of the criteria for urinary catheterization. Initiating an antibiotic before inserting a catheter is unnecessary and contributes to the development of antibiotic-resistant organisms.
A client suspected of having nephritis is scheduled for a test at the nuclear medicine department. The client asks the nurse, "What test am I having?" Which test should the nurse identify? A. Renal ultrasound B. Kidney, ureter, bladder (KUB) C. Kidney scan D. Renal biopsy
C. The kidney scan uses nuclear medicine to visualize the kidney after intravenous administration of a radioisotope. The KUB (kidney, ureter, bladder) is an abdominal x-ray that evaluates kidney size and may rule out other causes. The renal ultrasound does not use nuclear medicine. The renal biopsy is a microscopic examination of kidney tissue and does not use nuclear medicine.
The nurse is discussing ways to prevent the development of nephritis with a client. Which strategy should the nurse include? A. Maintaining good dental hygiene B. Cutting down on smoking C. Maintaining blood pressure control D. Practicing stress-reduction techniques
C. While the exact cause of nephritis is unknown, maintaining good blood pressure control (controlling hypertension) is one way to prevent damage to the kidneys and reduce the incidence of nephritis. Quitting smoking, not cutting down, is recommended. Good dental hygiene and reducing stress are not associated with the risk of developing nephritis.
The nurse manager is planning a presentation for the staff nurses regarding urinary health after several members of the staff have recently been diagnosed with urinary tract infections (UTIs). Which topic is appropriate for the nurse manager to include in the presentation? A. The importance of decreasing fluid consumption during the nursing shift to decrease the need to void B. The importance of increasing the number of caffeinated beverages while working C. The importance of avoiding cranberry juice because it is a cause of UTI D. The importance of not ignoring the urge to eliminate
D. It is important to remind the nursing staff that they should not ignore the urge to void because doing so increases the risk of UTI. The staff would be reminded to decrease caffeinated beverages, increase fluid consumption, and add cranberry juice to their fluid regimen as ways of decreasing UTIs
The nurse is teaching the parents of an 18-month-old female toddler with a urinary tract infection (UTI). Which should be included in the teaching to prevent the future risk of a UTI? A. Increase the child's fluid intake. B. Increase the child's intake of vitamin C. C. Provide the child with a daily cup of low-sugar cranberry juice. D. Cleanse the perineal area front to back.
D. The incidence of UTIs in toddlers and children is higher among girls than boys because the shorter female urethra has a closer proximity to the anus and vagina, increasing the risk of contamination by fecal bacteria. When cleansing the perineal area, it is important to wipe from front to back to prevent the transfer of gastrointestinal bacteria to the urethra. Adequate fluids should be provided to prevent dehydration. Two daily cups of low-sugar cranberry juice and increased vitamin C is recommended to prevent UTIs in adults.
The nurse is caring for a client with a urinary catheter who is diagnosed with asymptomatic bacteriuria. Which collaborative treatment should the nurse anticipate as the first action? A. A short course of antibiotic therapy B. A 10- to 14-day course of antibiotic therapy C. Replacement of the catheter D. Removal of the catheter
D. The nurse can anticipate the healthcare provider to prescribe a 10- to 14-day course of antibiotic therapy after removal of the catheter. Replacement of the catheter is not a priority treatment for asymptomatic bacteriuria. A short course of antibiotic therapy is not used for the treatment of asymptomatic bacteriuria.
The nurse is caring for a postpartum client. Which intervention is the most important for the nurse to integrate into the plan of care to prevent a urinary tract infection (UTI)? A. "Change peri pads every 4 hours." B. "Use an antiseptic preparation after voiding." C. "Increase fluid intake." D. "Empty the bladder completely."
D. The postpartum woman is at an increased risk of developing urinary tract problems caused by normal postpartum diuresis, increased bladder capacity, and decreased bladder sensitivity from stretching or trauma. These factors make it essential for the mother to empty her bladder completely with each voiding. Fluid intake is important, but it is not related to the main cause of UTIs in the postpartum period. Peri pads should be changed every time the client voids, followed by perineal cleansing before placement of a new pad. Antiseptic solutions are not used on the perineum of a postpartum client.
A client is admitted with acute postinfectious glomerulonephritis. Which medication should the nurse expect to be prescribed for the client to reduce inflammation? A. Antihypertensive B. Angiotensin-converting enzyme (ACE) Inhibitor C. Glucocorticoid D. Immunosuppressant
D. To control inflammation caused by acute postinfectious glomerulonephritis, the nurse will administer an immunosuppressant. A glucocorticoid also decreases inflammation. However, this medication is contraindicated in acute postinfectious glomerulonephritis. An ACE inhibitor is used in the management of this condition; however, it is used to reduce proteinuria and slow the progression of renal failure. An antihypertensive is also used in the management of this condition; however, it is used to treat hypertension.
Which problem is a priority for the nurse to address when caring for a client with acute glomerulonephritis? A. Impaired nutrition B. Impaired skin integrity C. Fatigue D. Impaired fluid balance
D. While all choices are problems that should be addressed in planning care for the client diagnosed with nephritis, impaired fluid balance is a priority as this problem may be life-threatening if not addressed.