Chapter 45 - Disorders of the urinary system (Med Surg) EAQ's

The patient who is two days postoperative ileal conduit loop informs the nurse that there is mucus in the urine. Which is the correct response by the nurse? 1 "This is a normal occurrence." 2 "We will need to catheterize your stoma to remove the mucus." 3 "Let me call the health care provider to check on the outflow of your stoma." 4 "This is because of your lack of fluid intake; you will need to increase your fluids."

1 - "This is a normal occurrence." Mucus is a normal production of the intestinal liner. This will not cause any disruption in flow of the urine. Mucus in the urine is not caused by a decrease in fluid intake. It is not necessary for the health care provider to assess the stoma, because this is a normal finding. Catheterizing the stoma will not remove the mucus. Text Reference - p. 1065

Nurses have a major role in prevention of urinary tract infections (UTIs). Which guidelines can help prevent hospital-acquired UTIs? Select all that apply. 1 Avoid unnecessary catheterization. 2 Perform intermittent catheterization every 4 hours. 3 Wash hands before and after contact with each patient. 4 Wash around catheter insertion site with betadine daily. 5 Perform routine and thorough perineal hygiene for all hospitalized patients.

1 - Avoid unnecessary catheterization. 3 - Wash hands before and after contact with each patient. 5 - Perform routine and thorough perineal hygiene for all hospitalized patients. The patient should not be catheterized unless absolutely necessary. Hand hygiene is the primary method of preventing the spread of infection in the hospital setting. Routine perineal care daily with soap and water is evidence-based practice to prevent UTI. Betadine should not be applied to the catheter insertion site daily. Intermittent catheterization may be less likely to cause a UTI than an indwelling catheter, but any catheterization places the patient at risk for hospital-acquired UTIs. Text Reference - p. 1037

The nurse is assessing a patient with a diagnosis of upper urinary tract infection (UTI). Which symptoms should the nurse expect to find? Select all that apply. 1 Chills 2 Fever 3 afebrile 4 Flank pain 5 Clear, yellow urine

1 - Chills 2 - Fever 4 - Flank pain Upper UTI symptoms present with fever, chills, and flank pain. The patient will not be afebrile, and urine will likely be cloudy, not clear and yellow. Text Reference - p. 1034

What are the clinical manifestations of acute pyelonephritis? 1 Chills and flank pain 2 Hemoptysis and rhonchi 3 Hematuria and proteinuria 4 Pain and lower urinary tract symptoms

1 - Chills and flank pain The clinical manifestations of acute pyelonephritis vary from mild fatigue to the sudden onset of chills and flank pain. Hemoptysis and rhonchi are pulmonary symptoms of Goodpasture syndrome. Hematuria and proteinuria are clinical manifestations of acute glomerulonephritis. Pain and lower urinary tract symptoms (LUTS) are the two primary clinical manifestations of interstitial cystitis, or pain bladder syndrome. Text Reference - p. 1038

A patient has been admitted to the hospital with suprapubic pain and dysuria. A urine analysis and culture have been prescribed. What instructions should the nurse include to obtain the best urine sample? 1 Collect the urine midstream. 2 Collect urine immediately after a meal. 3 Collect the urine after drinking 1 liter of water. 4 Use antiseptic to clean the periurethral area before collecting sample.

1 - Collect the urine midstream. A clean-catch, or midstream, sample should be collected to prevent contamination of urine with bacteria present in the vagina or penis. The periurethral area should be cleaned, but the use of antiseptic should be avoided, because it can contaminate the sample and provide a false positive. A sample should not be collected directly after a meal or after drinking a liter of water, because food and water can affect the normal chemical composition of a patient's urine. Text Reference - p. 1035

Treatment for a patient diagnosed with rapidly progressive glomerulonephritis is directed towards which outcome? 1 Correction of fluid overload 2 Correction of hypotension 3 Correction of anemia and blood loss 4 Administration of parenteral antibiotics

1 - Correction of fluid overload With progressive renal failure, there is an increase in fluid retention. The patient will exhibit hypertension as a result of kidney damage. Patients will have anemia, but there will be no identification of acute blood loss, and this is not a priority in treatment at this point for this patient. Text Reference - p. 1043

A patient reports urgency and urinating approximately 10 times in a 24-hour period, with 150 mL for each voiding. The nurse suspects that the patient will be diagnosed with what? 1 Interstitial cystitis 2 Glomerulonephritis 3 Acute pyelonephritis 4 Goodpasture syndrome

1 - Interstitial cystitis Interstitial cystitis is a chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency, frequency, and pain in the bladder and pelvis. The urinary frequency of 10 voids in a 24-hour period with 150 mL in each voiding deviates from the normal value of 8 voids in a 24-hour period with at least 200 mL in each voiding and indicates that the patient has urinary frequency. Glomerulonephritis is the inflammation of the glomeruli that affects both kidneys equally. Acute pyelonephritis is the inflammation of renal parenchyma and the collecting system. Goodpasture syndrome is an autoimmune disease characterized by circulating antibodies against the glomerular and alveolar membrane. Text Reference - p. 1040

What is the nurse's priority action when changing the appliance of a patient with an ileal conduit? 1 Keep the skin free of urine 2 Inspect the peristomal area 3 Cleanse and dry the area gently 4 Affix the appliance to the faceplate

1 - Keep the skin free of urine The nurse's priority is to keep the skin free of urine, because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed, the area will be cleaned gently and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage. Text Reference - p. 1065

Which medications are used to desensitize pain in the bladder wall? Select all that apply. 1 Lidocaine 2 Vancomycin 3 Clotrimazole 4 Azathioprine 5 Dimethyl sulfoxide (DMSO)

1 - Lidocaine 5 - Dimethyl sulfoxide (DMSO) Instillations of heparin and hyaluronic acid are often administered with lidocaine, which rapidly desensitizes the pain receptors in the bladder wall due to their alkalinized anesthetic effect. DMSO is directly instilled into the bladder through a small catheter and it desensitizes the pain receptors in the bladder wall. Vancomycin combined with an aminoglycoside such as tobramycin is beneficial in the treatment of acute pyelonephritis. Clotrimazole is used for treating trichomonas infection associated with urethritis. Azathioprine is used in the treatment of Goodpasture syndrome. Text Reference - p. 1041

The urinalysis of a male patient reveals a high microorganism count. What data should the nurse use to determine the area of the urinary tract that is infected? Select all that apply. 1 Pain location 2 Fever and chills 3 Mental confusion 4 Urinary hesitancy 5 Urethral discharge 6 Postvoid dribbling

1 - Pain location 5 - Urethral discharge Although all the listed manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis, because flank pain is characteristic of pyelonephritis but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI, but also may occur with prostate enlargement in the male patient. Text Reference - p. 1035

When managing a female patient with active symptoms of urethritis, what actions should the nurse perform? Select all that apply. 1 Provide a warm sitz bath. 2 Obtain a urine sample for culture. 3 Teach the patient to cleanse the perineal area. 4 Suggest that the patient use a vaginal deodorant. 5 Inform the patient that sexual intercourse can be continued.

1 - Provide a warm sitz bath. 2 - Obtain a urine sample for culture. 3 - Teach the patient to cleanse the perineal area. The nurse should provide a warm sitz bath, because it can help to temporarily relieve bothersome symptoms of urethritis. A urine sample should be collected and cultured to detect the causative organism of urethritis so that specific treatment can be planned. The nurse should teach the patient to cleanse the perineal area by wiping from front to back, to reduce the risk of infection from the anus. The patient should be instructed not to use vaginal deodorants, because these can further irritate the genital area. The nurse should tell the patient to avoid sexual intercourse until the symptoms subside Text Reference - pp. 1039-1040

Which condition is referred to as the inflammation of renal parenchyma and the collecting system? 1 Pyelonephritis 2 Interstitial cystitis 3 Urethral diverticula 4 Glomerulonephritis

1 - Pyelonephritis Pyelonephritis is an inflammation of the renal parenchyma and the collecting system. Interstitial cystitis is a chronic, painful inflammatory disease of the bladder. Urethral diverticula are the localized outpouchings of the urethra. Glomerulonephritis is the inflammation of the glomeruli. Text Reference - p. 1038

A patient is diagnosed with an early urinary tract infection (UTI). When planning for trimethoprim/sulfamethoxazole treatment for this patient, which factors does the nurse evaluate? Select all that apply. 1 This drug is relatively inexpensive. 2 This drug can be taken twice daily. 3 E. coli is resistant to this medication. 4 The treatment is given 3 to 4 times a day. 5 The patient should avoid sunlight when taking this medication.

1 - This drug is relatively inexpensive. 2 - This drug can be taken twice daily. 3 - E. coli is resistant to this medication. The first line of treatment to empirically treat initial UTIs includes trimethoprim/sulfamethoxazole. E. coli resistance to this drug is an increasing problem and is a major disadvantage of this drug. Trimethoprim/sulfamethoxazole treatment is relatively inexpensive compared to other drugs. This drug can be taken twice daily. Nitrofurantoin (Macrodantin) is normally given three or four times daily. Patients should avoid sunlight, use sunscreen, and wear protective clothing while taking nitrofurantoin, but this is not required while taking trimethoprim/sulfamethoxazole. Text Reference - p. 1036

Which disorder of the urinary system is caused by Trichomonas in women? 1 Urethritis 2 Interstitial cystitis 3 Urethral diverticula 4 Chronic pyelonephritis

1 - Urethritis Urethritis is an inflammation of the urethra. It is a bacterial or viral infection, which may be caused by Trichomonas and monilial infection in women and chlamydial infection and gonorrhea in men. Interstitial cystitis is a chronic, painful inflammatory disease of the bladder. It is also called painful bladder syndrome. The symptoms of interstitial cystitis are urinary urgency, frequency, and pain in the bladder. Urethral diverticula are localized outpouchings of the urethra. They are usually caused by enlargement of obstructed periurethral glands. Chronic pyelonephritis is associated with small, atrophic, and shrunken kidneys. It is usually caused by recurring infection of the upper urinary tract. Text Reference - p. 1039

Which nursing instructions that promote safety are beneficial to a patient with interstitial cystitis (IC)? Select all that apply. 1 "Avoid using vaginal sprays." 2 "Continue the medications as prescribed." 3 "Avoid clothing that creates suprapubic pressure." 4 "Take high-potency vitamins along with the medications." 5 "Take the full course of antibiotics to ensure that bacteria have been eradicated."

2 - "Continue the medications as prescribed." 3 - "Avoid clothing that creates suprapubic pressure." 5 - "Take the full course of antibiotics to ensure that bacteria have been eradicated." Patients with interstitial cystitis should continue medications as prescribed. Clothing that creates suprapubic pressure, including pants with tight belts or restrictive waistlines, should be avoided. The nurse should encourage patients to take the full course of antibiotics to ensure that bacteria have been eradicated. Vaginal sprays should be avoided in patients with urethritis. Patients with IC should take a multivitamin containing not more than the recommended dietary allowance and avoid high-potency vitamins because they may irritate the bladder. Text Reference - pp. 1040-1041

Which instructions by the nurse are beneficial to a patient with acute pyelonephritis? Select all that apply. 1 "Avoid using vaginal deodorant sprays." 2 "Drink at least eight glasses of fluid every day." 3 "Avoid clothing that creates suprapubic pressure." 4 "Avoid sexual intercourse until symptoms subside." 5 "Take the full course of antibiotics to ensure that the bacteria are eradicated."

2 - "Drink at least eight glasses of fluid every day." 5 - "Take the full course of antibiotics to ensure that the bacteria are eradicated." The nurse should encourage the patient to drink at least eight glasses of fluid every day during and after treatment of acute pyelonephritis. A full course of antibiotics should be taken to ensure that the bacteria are eradicated. Avoiding the use of vaginal deodorant sprays is one of the interventions to be followed in patients with urethritis. The patient with interstitial cystitis should avoid clothing that creates suprapubic pressure, including pants with tight belts. Sexual intercourse should be avoided until symptoms subside in patients with urethritis. Text Reference - pp. 1038-1039

The patient with type 2 diabetes has a second urinary tract infection (UTI) within one month of being treated for a previous UTI. Which medication should the nurse expect to teach the patient about taking for this infection? 1 Fosfomycin 2 Ciprofloxacin 3 Nitrofurantoin 4 Trimethoprim/sulfamethoxazole

2 - Ciprofloxacin This UTI is a complicated UTI because the patient has type 2 diabetes and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole should be used for uncomplicated UTIs. Text Reference - p. 1036

The nurse is teaching patients who are at an increased risk of urinary tract infections (UTIs) about the use of cranberry products in preventing UTIs. What important instructions should the nurse include in the teaching? Select all that apply. 1 Cranberry has no effect on UTIs. 2 Cranberry juice is more effective than cranberry capsules. 3 Cranberry products have a protective effect in preventing UTIs. 4 Drinking an adequate amount of fluid is important to prevent UTIs. 5 Taking cranberry capsules and not drinking water will prevent UTIs.

2 - Cranberry juice is more effective than cranberry capsules. 3 - Cranberry products have a protective effect in preventing UTIs. 4 - Drinking an adequate amount of fluid is important to prevent UTIs. Cranberry juice is more effective than cranberry capsules, probably due to the increased hydration from the juice. Cranberry products have a protective effect in reducing UTIs, because the juice works by preventing the attachment of bacteria to the epithelial cells in the bladder wall. Drinking an adequate amount of fluid is important to prevent UTIs, because it promotes hydration. Only taking cranberry capsules and not drinking water will not help to prevent UTIs, because adequate fluid intake is essential for proper functioning of the renal system. Text Reference - p. 1037

A patient is admitted with urethral diverticula. Which of the following clinical manifestations would the nurse expect to document? Select all that apply. 1 Fever 2 Gross hematuria 3 Clear, yellow urine 4 Post-void dribbling 5 Urinary incontinence

2 - Gross hematuria 4 - Post-void dribbling 5 - Urinary incontinence Post-void dribbling, urinary incontinence, and gross hematuria are classic symptoms for urethral diverticula. Fever is a symptom of pyelonephritis, not urethral diverticula. The patient would have cloudy urine, not clear, yellow urine. Text Reference - p. 1040

A nurse is teaching a patient about measures to prevent the recurrence of urinary tract infections. What instructions should the nurse include? Select all that apply. 1 Drink lemon juice daily. 2 Maintain an adequate daily fluid intake. 3 Wipe from back to front after having a bowel movement or urinating. 4 Urinate regularly, approximately every three to four hours during the day. 5 Cleanse the perineal area with warm soapy water after each bowel movement.

2 - Maintain an adequate daily fluid intake. 4 - Urinate regularly, approximately every three to four hours during the day. 5 - Cleanse the perineal area with warm soapy water after each bowel movement. It is necessary to maintain an adequate fluid intake and to urinate regularly. Delaying urination when there is an urge to urinate increases the chances of bacterial infection. Cleansing the perineal area with warm soapy water after a bowel movement reduces the risk of infection. It is important to wipe from front to back to avoid the risk of getting fecal matter near the urethra. Acidic foods and drinks like lemon juice, orange juice, and tomatoes irritate the bladder and should be avoided. Text Reference - p. 1037

Which is the only oral agent approved for the treatment of interstitial cystitis? 1 Penicillin 2 Pentosan 3 Nortriptyline 4 Amitriptyline

2 - Pentosan Pentosan is the only oral agent used in the treatment of interstitial cystitis. Penicillin is used in the treatment of streptococcal infection as seen in acute poststreptococcal glomerulonephritis. Nortriptyline and amitriptyline are tricyclic antidepressants that may be used to reduce burning pain and urinary frequency. Text Reference - p. 1040

A patient expresses to the nurse that he or she is unable to pass urine. What instructions should the nurse give this patient to relieve urinary retention? Select all that apply. 1 Perform Kegel exercises. 2 Sit in a tub of warm water. 3 Take a walk for 30 minutes every day. 4 Drink small quantities of water frequently. 5 Drink one cup of beverage like warm tea or coffee in a day.

2 - Sit in a tub of warm water. 4 - Drink small quantities of water frequently. 5 - Drink one cup of beverage like warm tea or coffee in a day. Sitting in warm water is beneficial in producing the urge for urination. Warm tea or coffee also helps in relieving urinary retention by producing the urge for urination. Frequently drinking small quantities of water keeps the patient well hydrated and also helps in passage of urine. Kegel exercises strengthen the pelvic floor muscles and are beneficial in decreasing urinary incontinence where there is no control or strength in the pelvic floor muscles. Taking a walk is good for general health but is not an immediate treatment for the relief of urinary retention. Text Reference - p. 1060

The nurse is assessing a patient with bladder cancer scheduled for a radical cystectomy. What factors are considered related to this procedure? Select all that apply. 1 The tumor is large. 2 The tumor is invasive. 3 The tumor involves the trigone. 4 The tumor involves only one area of bladder. 5 There is no metastasis beyond the bladder area.

2 - The tumor is invasive. 3 - The tumor involves the trigone. 5 - There is no metastasis beyond the bladder area. A radical cystectomy involves removal of the bladder, prostate, and seminal vesicles in men and means that a new way needs to be created for urine to leave the body. Indications for a radical cystectomy include an invasive tumor that involves the trigone (the area where the ureters insert into the bladder) that is free from metastases. If the tumor is merely large, segmental or partial cystectomy, rather than radical cystectomy, is indicated. If the tumor involves only one area of the bladder, segmental or partial cystectomy can be considered instead of radical cystectomy. Text Reference - p. 1054

The nurse anticipates that which diagnostic procedure will be prescribed for a patient with a urinary tract infection, renal abscesses, and anatomic abnormalities? 1 Urinalysis 2 Ultrasonography 3 Magnetic resonance imaging (MRI) 4 Computed tomography (CT) urogram

2 - Ultrasonography Ultrasonography of the urinary system is performed to identify renal abscesses and anatomic abnormalities, which are the clinical manifestations of acute pyelonephritis. The results of urinalysis indicate the presence of pyuria, bacteriuria, and hematuria. MRI is used to determine the size of diverticulum in relation to the urethral lumen. A CT urogram is used to assess for signs of infection in the kidney and complications of pyelonephritis. Text Reference - p. 1038

Which urinary disorder is most common in Jewish men? 1 Bladder cancer 2 Uric acid stones 3 Urinary tract calculi 4 Urinary incontinence

2 - Uric acid stones Uric acid stones are most common in Jewish men who have a family history or incidence of gout. Bladder cancer is more common in Caucasian men. Urinary tract calculi are more common in Caucasians than in African Americans. Urinary incontinence is underreported because culturally it is seen as a social hygiene problem causing patient embarrassmen Text Reference - p. 1046

Which factors put a patient at risk for urinary stasis? Select all that apply. 1 Constipation 2 Urinary retention 3 Diabetes mellitus 4 Renal impairment 5 Urinary tract calculi

2 - Urinary retention 4 - Renal impairment 5 - Urinary tract calculi Urinary retention (including neurogenic bladder and low bladder wall compliance), renal impairment, and urinary tract calculi all are factors that can lead to urinary stasis. Constipation is a functional disorder that may increase risk for urinary tract infection. Diabetes mellitus is a disease process that compromises immune response, thereby increasing risk for urinary tract infection. Text Reference - p. 1035

A patient reports fever, chills, pain while urinating, and urgency. The nurse identifies the symptoms as severe, because blood and bacteria are present in the urine. The nurse anticipates that which medication will be prescribed? 1 Doxycycline 2 Vancomycin 3 Metronidazole 4 Dimethyl sulfoxide

2 - Vancomycin The symptoms of fever, chills, pain while urinating, and urgency with the presence of blood (hematuria) and bacteria in the urine (pyuria) indicate acute pyelonephritis. Vancomycin combined with an aminoglycoside such as tobramycin is beneficial in the treatment of acute pyelonephritis. Doxycycline is used in the treatment of chlamydial infections associated with urethritis. Metronidazole is used for treating trichomonas infection. Dimethyl sulfoxide is instilled into the bladder for the treatment of interstitial cystitis. Text Reference - p. 1039

After urethral instrumentation, a patient reports frequent urination, a feeling of incomplete bladder emptying, and pain during sexual intercourse. The nurse anticipates that which diagnostic studies will be prescribed? Select all that apply. 1 Urine sediment microscopy 2 Voiding cystourethrography 3 Intravenous pyelogram (IVP) 4 Computer tomography (CT) scan 5 Magnetic resonance imaging (MRI)

2 - Voiding cystourethrography 5 - Magnetic resonance imaging (MRI) Frequent urination, feeling of incomplete bladder emptying, and pain during sexual intercourse are the symptoms of urethral diverticula. Voiding cystourethrography is a radiographic study that is performed to confirm the diagnosis of urethral diverticula. Additional studies such as MRI are used to determine the size of the diverticulum in relation to the urethral lumen. Urine sediment microscopy is a diagnostic study used to reveal erythrocytes in significant numbers. IVP is used to determine the extent and severity of the renal disease. A CT scan can detect small kidney tumors. Text Reference - p. 1040

When teaching a female patient about measures to prevent recurrent urinary tract infection (UTI), what instructions should the nurse include? Select all that apply. 1 Urinate every six hours. 2 Wipe from front to back after urinating. 3 Empty the bladder before and after sexual intercourse. 4 Use vaginal douches or sprays to clean the perineal area. 5 Cleanse with warm soapy water after each bowel movement.

2 - Wipe from front to back after urinating. 3 - Empty the bladder before and after sexual intercourse. 5 - Cleanse with warm soapy water after each bowel movement. The nurse should instruct the patient to wipe from front to back after urinating to avoid contamination by other structures, because this can increase the risk of UTIs. Emptying the bladder before and after sexual intercourse will help to keep the perineum clean and reduce the risk of UTIs. Cleansing the perineum with warm soapy water after each bowel movement to clean the anal region will reduce the risk of UTIs. Regular urination may prevent bacteria from growing; therefore the patient should be encouraged to void every two to three hours. Vaginal douches or sprays to clean the perineal area should be avoided, because these contain harsh chemicals and substances that can cause irritation and can increase the risk of urinary infection. Text Reference - p. 1037

The nurse should provide a patient with what education specifically related to inflammation of the urethra? Select all that apply. 1 "Avoid clothing that creates suprapubic pressure." 2 "Use a vaginal deodorant spray for improved hygiene." 3 "Avoid sexual intercourse until the symptoms subside." 4 "Take warm sitz baths to relieve bothersome symptoms." 5 "Properly cleanse the perineal area after bowel movements and urinating."

3 - "Avoid sexual intercourse until the symptoms subside." 4 - "Take warm sitz baths to relieve bothersome symptoms." 5 - "Properly cleanse the perineal area after bowel movements and urinating." Patients with urethritis should follow instructions such as avoiding sexual intercourse until the symptoms subside. Taking warm sitz baths relieves bothersome symptoms temporarily in patients with urethritis. Patients with urethritis should cleanse the perineal area properly after bowel movements and urinating. Vaginal deodorant sprays should be avoided in patients who have inflammation of the urethra because deodorant sprays may irritate the fine mucosal lining of the vulva. Clothing that creates suprapubic pressure, including pants with tight belts or waistlines, should be avoided in patients with interstitial cystitis. Text Reference - pp. 1039-1040

A patient has just been told that her bladder cancer has spread to her liver and lungs. She is crying and says, "I'm tired of being in constant pain. I just don't know that I can take any more of this. I can't continue to be a burden to my daughter who looks after me. Maybe it's time to give up, but I'm so scared. What have I done to deserve all of this suffering? Would you ever want to live like this?" What is the most appropriate and therapeutic response the nurse can make? 1 "Should I call the clergy for you? It sounds like you want someone to talk to about all of this." 2 "You have had high spirits, and you look like you're feeling alright. You probably still have a lot of time left." 3 "I'm hearing you say that you feel helpless and afraid. Can you tell me more about how this makes you feel?" 4 "I know that you're tired and upset, but you have to keep fighting for your daughter. She loves you so much."

3 - "I'm hearing you say that you feel helpless and afraid. Can you tell me more about how this makes you feel?" Encouraging the patient to explore and share thoughts while validating feelings allows that patient to process grief in her own way. It is appropriate to ask before calling clergy, but this response may be interpreted as a lack of interest in the patient's emotional well-being. It is not beneficial to the patient to make false promises regarding prognosis. Telling a patient that she needs to continue treatment for the sake of another person can lead to feelings of guilt. Text Reference - pp. 1053-1055

A patient presents with discomfort in the lower abdomen, and on assessment, the nurse suspects a lower urinary tract infection. Which symptoms should the nurse evaluate? Select all that apply. 1 Fever 2 Pain in the flank 3 Pain while urinating 4 Increased frequency of urination 5 Feeling of pressure in the suprapubic region

3 - Pain while urinating 4 - Increased frequency of urination 5 - Feeling of pressure in the suprapubic region Because symptoms of a lower urinary tract infection are related to either bladder storage or bladder emptying, there is dysuria, or painful urination. Increased frequency of urination (more than every two hours) is related to bladder storage and emptying, which occurs because of infection of the lower urinary tract. A feeling of pressure or discomfort in the suprapubic region is common in the presence of a lower urinary tract infection, because the infection affects bladder storage. Chills and fever are observed in an infection involving the upper urinary tract. Pain in the flank is observed in infections involving the upper urinary tract. Text Reference - p. 1035

Which surgery does the nurse expect to be performed for a patient who has frequent urination, accidental loss of urine, and pain during sexual intercourse? 1 Cystoscopy 2 Cystolitholapaxy 3 Spence procedure 4 Electro hydraulic lithotripsy

3 - Spence procedure Frequent urination, accidental loss of urine, and pain during sexual intercourse are the clinical manifestations of urethral diverticula. A Spence procedure is performed for marsupialization (creation of permanent opening) of the diverticular sac into the vagina in patients with urethral diverticula. Cystoscopy is a procedure used to remove small stones from the kidneys. Cystolitholapaxy is a procedure that is used to break up large stones. Electrohydraulic lithotripsy is used in conjunction with an ureteroscope to pulverize a stone. Text Reference - p. 1040

A patient reports the presence of blood in the urine, discharge of pus from the genital organs, and lower abdominal pain. After a diagnosis is made, surgery is performed as a treatment strategy. The nurse should monitor the patient for what postoperative complication? 1 Urosepsis 2 Septic shock 3 Stress incontinence 4 End-stage kidney disease

3 - Stress incontinence The presence of blood in the urine (hematuria), discharge of pus from the genital organs (dyspareunia), and lower abdominal pain (suprapubic pain) are the symptoms of urethra diverticula. Stress incontinence is a potential complication of the surgery. Urosepsis is a complication seen more frequently with the long-term use of an indwelling catheter. Septic shock is the outcome of unresolved bacteremia involving a gram-negative organism due to improper eradication of urosepsis. End-stage kidney disease occurs as a result of chronic pyelonephritis. Text Reference - p. 1056

A patient presents with frequent urination, dysuria, low-grade fever, and fatigue and is diagnosed with bacterial infection of the kidney. The nurse identifies that which bacteria is the likely cause of the patient's condition? 1 Klebsiella 2 Streptococci 3 Tubercle bacilli 4 Escherichia coli

3 - Tubercle bacilli Frequent urination, pain while urinating (dysuria), and low-grade fever are clinical manifestations of renal tuberculosis caused by Tubercle bacilli that infect the kidneys. Klebsiella makes the urine alkaline and contributes to the formation of struvite stones. Streptococci cause streptococcal sore throat and impetigo, resulting in acute poststreptococcal glomerulonephritis. Escherichia coli is the most common pathogen that causes urinary tract infections. Text Reference - p. 1041

Which questions are appropriate for the nurse to ask a patient when assessing the cognitive-perceptual pattern of a patient diagnosed with urinary tract infection? Select all that apply. 1 "Do you experience hesitancy?" 2 "Do you often have vomiting and chills?" 3 "Do you follow urinary hygiene practices?" 4 "Do you have suprapubic or low back pain?" 5 "Do you have burning pain during urination?"

4 - "Do you have suprapubic or low back pain?" 5 - "Do you have burning pain during urination?" While assessing the effect of urinary tract infections on the cognitive-perceptual pattern, the nurse should ask the patient if he or she has any suprapubic or low back pain or if he or she has experienced any burning pain when urinating. Asking the patient about hesitancy helps in assessing the effect of the urinary tract infection on the elimination pattern. Interviewing the patient about vomiting and chills helps assess the effect that urinary tract infections have on the nutrition-metabolic pattern. Gaining information about urinary hygiene practices helps assess health perception-health management. Text Reference - p. 1037

Which instruction by the nurse is beneficial to a female patient to prevent recurrent urinary tract infection? 1 "Restrict purines in your diet." 2 "Wipe back to front after urinating." 3 "Schedule a follow-up urine culture." 4 "Empty your bladder before and after sexual intercourse."

4 - "Empty your bladder before and after sexual intercourse." The patient should empty the bladder before and after sexual intercourse to prevent recurrent urinary infections. Restricting dietary purines is important for reducing the risk of renal calculi formation. A patient with acute pyelonephritis should have a follow-up urine culture. Female patients should wipe front to back to avoid contamination with E coli. Text Reference - p. 1037

The nurse is caring for a patient with a diagnosis of urinary tract calculi. Which statement by the patient indicates a need for further education? 1 "I will most likely have pain upon urination." 2 "I will likely have discomfort until the stone passes." 3 "I will need to strain all urine until the stone has passed." 4 "I will remain on bed rest to prevent the stone from moving."

4 - "I will remain on bed rest to prevent the stone from moving." The patient should not be on bed rest, because the stone will likely not move unless the patient is up and mobile. This statement requires education. The patient will have pain upon urination, will likely have discomfort, and should strain all urine until the stone has passed. These statements are accurate and do not require further education. Text Reference - p. 1049

What is the most effective means of reducing catheter-associated urinary tract infections (CAUTI)? 1 Emptying the catheter's collection reservoir every hour. 2 Administering topical and oral antibiotics prophylactically. 3 Cleaning the sample port of a Foley catheter with alcohol prior to accessing. 4 Avoiding unnecessary catheterization and aiming for early removal of catheters.

4 - Avoiding unnecessary catheterization and aiming for early removal of catheters. Evidence-based practice has proven that patients who have fewer days with an indwelling urinary catheter have significantly less incidence of CAUTI than those patients with more Foley days. Emptying the catheter's collection reservoir periodically is necessary, and emptying it hourly does not decrease incidence of CAUTI. Administration of prophylactic antibiotics is not encouraged, as this only strengthens an organism's bacterial resistance to the drugs. Cleaning the sample port of a Foley catheter is good nursing practice, but not the most effective way to reduce CAUTI. Text Reference - p. 1037

It is suspected that a patient with recurrent urinary tract infections has an obstruction of the urinary tract. The nurse expects that what diagnostic test will be performed? 1 Sensitivity testing 2 Dipstick urinalysis 3 Clean-catch urine sample 4 Computed tomography (CT) urogram

4 - Computed tomography (CT) urogram A CT urogram or ultrasound may be obtained when there are recurrent urinary tract infections or when an obstruction of the urinary tract is suspected. Sensitivity testing is used to determine the bacteria's susceptibility to a variety of antibiotic drugs. Dipstick urinalysis is used to identify nitrites, white blood cells, and leukocyte esterase. A clean-catch urine sample is preferable for obtaining cultures. Text Reference - p. 1036

To reduce the risk of urinary tract infections (UTI), the nurse recommends that the patient increases the intake of what? 1 Nuts 2 Caffeine 3 Citrus juice 4 Cranberry juice

4 - Cranberry juice Daily intake of cranberry juice or cranberry supplements may reduce the number of urinary tract infections. Nuts, caffeine, and citrus juice should be avoided because they are potential bladder irritants that may cause urinary tract infections. Text Reference - p. 1037

The patient questions why anesthesia is needed when the lithotripsy being done is noninvasive. The nurse explains that the anesthesia is required to ensure the position is maintained during the procedure. The nurse knows that this type of lithotripsy is called what? 1 Laser lithotripsy 2 Electrohydraulic lithotripsy 3 Percutaneous ultrasonic lithotripsy 4 Extracorporeal shock-wave lithotripsy (ESWL)

4 - Extracorporeal shock-wave lithotripsy (ESWL) ESWL is noninvasive, but anesthesia is used to maintain the patient's position. The other types of lithotripsy are invasive. Laser lithotripsy uses an ureteroscope and small fiber to reach the stone. Electrohydraulic lithotripsy positions a probe directly on the stone; then continuous saline irrigation flushes are used to rinse the stone out. Percutaneous ultrasonic lithotripsy places an ultrasonic probe in the renal pelvis via a percutaneous nephroscope inserted through an incision in the flank. Text Reference - p. 1048

A patient diagnosed with interstitial cystitis reports continuing severe and debilitating suprapubic pain, hesitancy, and incontinence. Because other measures to relieve the pain have been unsuccessful, the nurse anticipates that the plan of care will include what procedure? 1 Lithotripsy 2 Marsupialization 3 Transurethral incision 4 Ileal conduit diversion

4 - Ileal conduit diversion Severe suprapubic pain, hesitancy, and incontinence are symptoms of a painful inflammatory disease called interstitial cystitis. Ileal conduit surgical urinary diversion is used for severe debilitating pain in patients with interstitial cystitis when other measures are not successful in relieving pain. Lithotripsy is a procedure used for eliminating calculi from the urinary tract. Marsupialization is used for the creation of a permanent opening of the diverticular sac into the vagina. Transurethral incision of the diverticular neck is performed in patients with urinary diverticula. Text Reference - p. 1041

Which medication does the nurse expect to be prescribed for a patient with bladder tumors who reports painful urination? 1 Fluconazole 2 Ciprofloxacin 3 Nitrofurantoin 4 Phenazopyridine

4 - Phenazopyridine A patient with bladder tumors usually experiences increased frequency and dysuria. A urinary analgesic such as phenazopyridine relieves discomfort caused by pain during urination (dysuria) by exerting an analgesic effect on the urinary tract mucosa. Fluconazole is the preferred therapy in patients with urinary tract calculi secondary to fungi. Ciprofloxacin is an antibiotic used to treat complicated urinary tract infection (UTI). Nitrofurantoin is a first-line drug that is used to treat initial uncomplicated UTI. Text Reference - p. 1036

Which medication is beneficial for a patient with a lower urinary tract infection who reports severe pain while urinating? 1 Nystatin 2 Clotrimazole 3 Amitriptyline 4 Phenazopyridine

4 - Phenazopyridine Pain while urinating is called dysuria. Phenazopyridine is a urinary analgesic that is used to relieve severe discomfort caused by dysuria due to its topical analgesic effect on the urinary tract mucosa. Nystatin is prescribed for monilial infections. Clotrimazole is used for treating Trichomonas infection associated with urethritis. Amitriptyline is a tricyclic antidepressant used for reducing burning pain and urinary frequency. Text Reference - p. 1036

A patient experiences fever, chills, flank pain, and costovertebral tenderness to percussion. The nurse recognizes that the clinical manifestations are associated with a particular renal problem and identifies risk factors for the condition. What is a patient risk factor that the nurse would identify? 1 Bacterial infection in one or more of the heart valves 2 High fluid intake that increases urinary concentration 3 Autoimmune disease that affects small and large vessels 4 Pregnancy-induced physiologic changes in the urinary system

4 - Pregnancy-induced physiologic changes in the urinary system Fever, chills, flank pain, and costovertebral tenderness to percussion are clinical manifestations of acute pyelonephritis. Pregnancy-induced physiologic changes in the urinary system are a risk factor for acute pyelonephritis. Bacterial infection in one or more valves indicates infective endocarditis, which is a risk factor for glomerulonephritis. High intake of fluid increases the urinary concentration and does not contribute to renal calculi. Autoimmune disease that affects the small and large vessels indicates vasculitis; it is a risk factor for glomerulonephritis. Text Reference - p. 1038

Escherichia coli is resistant to what medications? Select all that apply. 1 Fosfomycin 2 Ciprofloxacin 3 Amphotericin 4 Trimethoprim 5 Sulfamethoxazole

4 - Trimethoprim 5 - Sulfamethoxazole E. coli is resistant to trimethoprim and sulfamethoxazole. These are used in combination to treat uncomplicated or initial urinary tract infection (UTI). Fosfomycin is a first-choice drug used to treat uncomplicated or initial UTIs. Ciprofloxacin is a fluoroquinolone derivative that is used to treat complicated UTIs. Amphotericin is the preferred therapy in patients with UTI secondary to fungi. Text Reference - p. 1036

The nurse is caring for a 120-pound (54.54kg) patient who is at risk for a urinary tract infection. The nurse estimates, in ounces, the recommended fluid intake for the patient in a 24-hour period. Taking into account fluids obtained from food, how many fluid ounces should the nurse recommend? Record the answer using a whole number. ____________ oz

48 ounces To estimate the amount of fluid intake that a patient should have in 24 hours, divide the person's weight in pounds by 2, then multiply this number by 80%, because 20% of a person's fluid is obtained from food. So 120/2 = 60, 60 x.80 = 48 ounces to be drunk each day, or six 8-ounce glasses of water. Text Reference - p. 1037

The nurse is teaching people at the retirement village about avoiding urinary tract infections (UTIs). One person asks how much fluid one should drink each day. The nurse determines that the patient weighs 140 pounds (63.6 kg). Taking into account how much fluid is obtained from food, calculate how many ounces of fluid this person should drink each day total. Fill in the blank using a whole number. __ ounces

56 ounces Divide the weight in pounds by 2, then multiply this number by 80%, because 20% of a person's fluid is obtained from food. So 140/2 = 70, 70 x.80 = 56 ounces to be drunk each day, or seven 8-ounce glasses of water. Text Reference - p. 1037

Which patient statements indicate understanding self-management techniques in reducing the incidence of overflow incontinence? Select all that apply. 1 "I'd really like to read some materials about smoking cessation programs." 2 "Taking oxybutynin will increase my bladder tone, which will lead to fewer leaks." 3 "Regular bowel movements and avoiding constipation will help me to dribble less." 4 "Intermittent catheterization will increase the likelihood that I will have nocturnal enuresis." 5 "These Kegel exercises feel funny, but I'll be glad when I can control my pelvic floor muscles." 6 "By practicing the Valsalva maneuver, I should be able to empty my bladder more completely."

3 - "Regular bowel movements and avoiding constipation will help me to dribble less." 5 - "These Kegel exercises feel funny, but I'll be glad when I can control my pelvic floor muscles." 6 - "By practicing the Valsalva maneuver, I should be able to empty my bladder more completely." Constipation worsens urinary leakage, so avoiding it is a proper technique for improving overflow incontinence. Strengthening pelvic floor muscles by doing Kegel exercises will also help prevent unwanted leakage. The Valsalva maneuver is the straining of abdominal muscles thereby increasing bladder pressure to allow for more complete emptying of the bladder. Oxybutynin is an anticholinergic that works to relax the muscles in the bladder to allow for increased filling. Quitting smoking reduces the incidence of stress incontinence specifically, not overflow incontinence. Taking oxybutynin would not effectively treat overflow incontinence but would instead worsen the problem. Intermittent catheterization is beneficial for people struggling with overflow incontinence and is not related to nocturnal enuresis. Text Reference - pp. 1055-1059

The patient with a severe urinary tract infection (UTI) has a prescription for cefepime 2 g intravenous (IV) q6h. The vial in the patient's medication drawer has been reconstituted and is labeled as having a concentration of 200 mg/mL. How many mL of solution should be added to the IV bag? 1 2 mL 2 5 mL 3 10 mL 4 15 mL

3 - 10 mL Two grams is equal to 2000 mg. Using ratio and proportion, multiply 200 by x and multiply 2000 × 1 to yield 200x = 2000. Divide 2000 by 200 to yield 10 mL. Text Reference - p. 1036

An older male patient visits his primary health care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for what factor that may put him at risk for a urinary tract infection (UTI)? 1 High-purine diet 2 Sedentary lifestyle 3 Benign prostatic hyperplasia (BPH) 4 Recent use of broad-spectrum antibiotics

3 - Benign prostatic hyperplasia (BPH) BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi. Text Reference - p. 1035

Which diagnostic study is performed initially to confirm the presence of white blood cells in a patient with suspected urinary tract infection? 1 Ultrasound 2 Sensitivity testing 3 Dipstick urinalysis 4 Clean-catch urine sample

3 - Dipstick urinalysis Dipstick analysis is the diagnostic study that is used to detect the presence of white blood cells (pyuria) and bacteria in the urine (bacteriuria). An ultrasound or computer tomography (CT) urogram is obtained when urinary system obstruction or urinary tract infections are detected. Sensitivity testing is used to determine the bacteria's susceptibility to a variety of antibiotic drugs. Clean-catch urine sample is a voided midstream technique used for obtaining a urine culture. Text Reference - p. 1035

While assessing the patient's risk of developing urinary tract infections, what questions should the nurse ask? Select all that apply. 1 Is your work putting too much stress on you? 2 Have you ever received a blood transfusion? 3 Do you have a recent history of urinary calculi? 4 Do you hold your urine for long periods of time? 5 Did you have any condition that required urinary catheterization?

3 - Do you have a recent history of urinary calculi? 4 - Do you hold your urine for long periods of time? 5 - Did you have any condition that required urinary catheterization? Urinary calculi cause obstruction that favors the growth of organisms and can lead to frequent urinary tract infections. If strict aseptic precautions are not followed, urinary catheterization also aids the entry of causative organisms into the urinary system. People who delay urination for prolonged periods of time (common in professionals like teachers, traffic police, doctors, and so on) are more susceptible to developing UTIs. Receiving a blood transfusion and stressful work situations do not increase the risk of developing a urinary tract infection. Text Reference - p. 1035

The nurse is preparing a lecture for nursing students on healthcare-associated urinary tract infections (UTIs). Education should include identification of which organism as the primary cause? 1 Pseudomonas 2 Streptococcus 3 Escherichia coli 4 Methicillin-resistant Staphylococcus aureus (MRSA)

3 - Escherichia coli E. coli is the most reported organism, and Pseudomonas is second. Catheter-associated UTIs are the most frequent hospital-acquired UTI. MRSA and Streptococcus are not usually the organisms in hospital-acquired UTIs. Text Reference - p. 1034

Which medication is beneficial for a patient with a urinary tract infection (UTI) secondary to fungal infection? 1 Ampicillin 2 Norfloxacin 3 Fluconazole 4 Phenazopyridine

3 - Fluconazole Fluconazole is used in patients with UTIs secondary to fungi. Ampicillin is used to treat uncomplicated UTIs. Norfloxacin is a fluoroquinolone that is used to treat complicated UTIs. Phenazopyridine is a urinary analgesic that is used to relieve discomfort caused by dysuria. Text Reference - p. 1036

Which is a clinical manifestation of urethral stricture? 1 Foamy urine 2 Hyperlipidemia 3 Frequent urge to urinate 4 Sharp pain in flank area

3 - Frequent urge to urinate Urethral strictures can be asymptomatic or can cause numerous symptoms, which range from mild to severe. Some of the possible symptoms and complications include sudden and frequent urges to urinate, difficulty urinating, inability to urinate or completely empty the bladder, and pain during urination. Hyperlipidemia is one of the clinical manifestations of nephrotic syndrome. Foamy urine is a symptom of glomerulonephritis. Sharp pain in the flank area is a primary (and usually the first) symptom of a kidney stone. Text Reference - p. 1050

Which term is used to refer to involuntary or accidental urine loss? 1 Dysuria 2 Intermittency 3 Incontinence 4 Postvoid dribbling

3 - Incontinence Involuntary or accidental urine loss or leakage is referred to as incontinence. Dysuria refers to painful or difficult urination. Intermittency is the interruption of the urinary stream while voiding. Postvoid dribbling is urine loss after completion of voiding. Text Reference - p. 1055