EAQ RENAL Ch.66

Which diagnostic test can be used to palpate the prostate? a. Cystoscopy b. Renal ultrasound c. Digital rectal examination d. Voiding cystourethrography

c. Digital rectal examination Rationale: A digital rectal examination can be used to palpate the prostate for size, change in shape, consistency, or tenderness. Cystoscopy is used to diagnose bladder calculi, bladder diverticula, and urethral strictures. Renal ultrasound is used to locate the site or the presence of calculi. Voiding cystourethrography is used to diagnose urinary reflux.

Which condition may occur with an upper urinary tract infection? a. Cystitis b. Urethritis c. Prostatitis d. Acute pyelonephritis

d. Acute pyelonephritis Rationale: Acute pyelonephritis is an upper bacterial urinary tract infection of the kidney and renal pelvis. Cystitis, urethritis, and prostatitis are the acute infections of the lower urinary tract.

Which test should be performed if urine reflux is suspected? a. Cystoscopy b. Pelvic ultrasound c. Retrograde pyelography d. Voiding cystourethrography

d. Voiding cystourethrography

The nurse is teaching a group of older adult women about the signs and symptoms of a urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. a. Dysuria b. Enuresis c. Nocturia d. Urgency e. Polyuria f. Frequency

A,C,D,F a. Dysuria c. Nocturia d. Urgency f. Frequency Rationale: Dysuria (painful urination), nocturia (frequent urinating at night), urgency (having the urge to urinate quickly), and frequency are symptoms of UTI. Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.

The nurse teaches a female patient about ways to prevent urinary tract infections. Which statements made by the patient indicate effective learning? Select all that apply. a. "I should take a daily bubble bath." b. "I should drink 3 liters of fluid per day." c. "I should use flavored lubricants for intercourse." d. "I should wash the perineal area before intercourse." e. "I should include foods rich in vitamin C in my daily diet."

B,D,E b. "I should drink 3 liters of fluid per day." d. "I should wash the perineal area before intercourse." e. "I should include foods rich in vitamin C in my daily diet." Rationale: Adequate fluid intake helps flush bacteria from the urinary tract and thereby prevent urinary tract infection; therefore, the patient drinks 3 liters of fluids every day to reduce the risk of infection. Washing the perineal area before intercourse reduces the presence of bacteria and thereby reduces the risk of infection. Vitamin C increases the acidity of the urine and reduces the risk of urinary tract infections. Bubble baths may irritate the genital area and make it more susceptible to infection. Flavored lubricants may increase irritation and the risk of infection in the genital area; therefore, the patient avoids using flavored lubricants to reduce the risk of infection.

A patient is prescribed trimethoprim/sulfamethoxazole for urinary tract infection (UTI). What does the nurse instruct the patient about this therapy? Select all that apply. a. Monitor the pulse twice daily while taking this drug. b. Drink a full glass of water with each dose of the drug. c. Avoid taking the drug within 2 hours of taking an antacid. d. Wear sunscreen and protective clothing when out in the sun. e. Disclose any allergies to sulfa drugs before beginning therapy.

B,D,E b. Drink a full glass of water with each dose of the drug. d. Wear sunscreen and protective clothing when out in the sun. e. Disclose any allergies to sulfa drugs before beginning therapy. Rationale: The nurse should ensure that the patient does not have any allergies to sulfa drugs before beginning therapy since allergies to sulfa drugs are common and may require changing the drug therapy. The patient should wear sunscreen and protective clothing when out in the sun because sulfamethoxazole increases sensitivity to the sun and can lead to severe sunburns. The patient must consume a full glass of water with each dose because the drug can form crystals that precipitate in the kidney tubules and drinking at least 3 L of fluids daily prevents this complication. The patient taking fluoroquinolone is asked to monitor the pulse twice daily because this class of drugs induces serious cardiac dysrhythmias. Fluoroquinolone must not be taken within 2 hours of taking an antacid; antacids containing magnesium or aluminum interfere with drug absorption.

What clinical manifestations does the nurse expect to find in an older patient with a urinary tract infection (UTI)? Select all that apply. a. Fever b. Dysuria c. Hypotension d. Increasing mental confusion e. Sudden onset of incontinence

B,D,E b. Dysuria d. Increasing mental confusion e. Sudden onset of incontinence Rationale: Clinical manifestations of urinary tract infection (UTI) in older patients may include dysuria, increasing mental confusion, and a sudden onset of incontinence. Sometimes the only symptom may be mental confusion or worsening incontinence. Fever and hypotension without urinary symptoms may be signs of urosepsis in the older patient.

Which nursing activity illustrates proper aseptic technique during catheter care? a. Irrigating the catheter daily b. Sending a urine specimen to the laboratory for testing c. Positioning the collection bag below the height of the bladder d. Applying Betadine ointment to the perineal area after catheterization

c. Positioning the collection bag below the height of the bladder Rationale: Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract. Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized patients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation should be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.

Which complication may occur in a patient with asymptomatic bacterial urinary tract infection (ABUTI)? a. Sepsis b. Pyelonephritis c. Renal insufficiency d. Severe kidney damage

c. Renal insufficiency Rationale: Renal insufficiency may occur in a patient with ABUTI due to insufficient blood supply to the kidney caused by bacteriuria. Sepsis, pyelonephritis, and severe kidney damage can occur as a complication of infectious cystitis.

What does the nurse teach a patient to do to decrease the risk for urinary tract infection (UTI)? a. Limit fluid intake. b. Limit sugar intake. c. Increase caffeine consumption. d. Drink about 3 liters of fluid daily.

d. Drink about 3 liters of fluid daily. Rationale: Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs. Fluids flush the system and should not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.

A patient in the hospital has an indwelling catheter. What intervention does the nurse perform to prevent catheter-related infection? a. Avoid the use of coated catheters. b. Clean the perineum with antibiotic ointment. c. Apply clean technique when inserting the catheter. d. Ensure the urine collection bag is below bladder level.

d. Ensure the urine collection bag is below bladder level. Rationale: The urine collection bag should be kept below bladder level at all times; elevating it above bladder level causes reflux of pathogens from the bag into the urinary tract. The nurse should apply strict sterile technique when inserting the catheter; otherwise, pathogens can be introduced into the urinary tract. The perineum and the proximal end of the catheter should be washed with soap and water, and then dried gently while providing daily catheter care. Using antibiotic ointment has not been proven to have any beneficial effect. Coated catheters must be considered for patients who may require catheterization for 3 to 5 days. The coating reduces bacterial colonization on the catheter.

The nurse in the urology clinic is providing teaching for a female patient with cystitis. Which instructions does the nurse include in the teaching plan? Select all that apply. a. If urine remains cloudy, call the clinic. b. Try to take in 64 ounces of fluid each day. c. Be sure to complete the full course of antibiotics. d. Expect some flank discomfort until the antibiotic has worked. e. Cleanse the perineum from back to front after using the bathroom.

A,B,C a. If urine remains cloudy, call the clinic. b. Try to take in 64 ounces of fluid each day. c. Be sure to complete the full course of antibiotics. Rationale: Between 64 and 100 ounces (2-3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the patient should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney.

A nurse teaching self-management skills to a patient with a history of urinary tract infections finds that the patient's symptoms are alleviated at the follow-up visit. Which actions are responsible for the improvement? Select all that apply. a. Increasing fluid intake b. Drinking cranberry juice c. Avoiding use of douches d. Taking bubble baths regularly e. Avoiding use of topical estrogens

A,B,C a. Increasing fluid intake b. Drinking cranberry juice c. Avoiding use of douches Rationale: Increasing fluid intake will help to flush bacteria and reduces the risk of bacterial infection. Cranberry juice decreases the ability of bacteria to adhere to the epithelial cells lining of the urinary tract and reduces the risk of urinary tract infection. Avoiding the use of douches prevents irritation and reduces the risk of urinary tract infection. Taking bubble baths increases the risk of urinary tract infection. Applying topical estrogen to the perineal area normalizes vaginal flora and reduces risk of urinary tract infection.

Which patient with an indwelling urinary catheter would the nurse reassess to determine if continued catheterization is necessary? Select all that apply. a. Patient in the step-down unit b. Three-day postoperative patient c. Incontinent older adult in long-term care d. Incontinent patient with perineal skin breakdown e. Comatose patient with hourly intake and output (I&O) monitoring

A,B,C a. Patient in the step-down unit b. Three-day postoperative patient c. Incontinent older adult in long-term care Rationale: Depending on the type of surgery, most postoperative patients should have the indwelling catheter removed by the third day after surgery because the risk for a urinary tract infection (UTI) increases due to bacterial colonization as early as 48 hours after catheter insertion. The patient in the step-down unit should be considered for catheter discontinuation because improved ambulation facilitates alternate methods for urination. Urinary catheterization in incontinent older adults is unnecessary because it can be better managed with less risk for UTI using adult incontinence pads. The comatose patient with hourly I&O monitoring must have a urinary catheter in place to keep an accurate record of fluid balance. The patient who is incontinent and has perineal skin breakdown may need to keep the indwelling catheter to maintain clean and dry skin to promote wound healing.

Which instructions should the nurse give to a patient who has been prescribed trimethoprim/sulfamethoxazole for a urinary tract infection to ensure safe administration? Select all that apply. a. "Avoid exposure to the sun." b. "Increase fluid consumption to 3 liters per day." c. "Avoid taking this drug while receiving metoclopramide." d. "Complete the drug regimen even if the symptoms disappear." e. "Use other methods of birth control rather than using oral contraceptives."

A,B,D a. "Avoid exposure to the sun." b. "Increase fluid consumption to 3 liters per day." d. "Complete the drug regimen even if the symptoms disappear." Rationale: Trimethoprim/sulfamethoxazole increases skin sensitivity to the sun. Therefore, the patient should avoid exposure to the sun in order to prevent sunburns. The patient should increase fluid consumption to 3 liters per day to prevent kidney stone formation. The patient should complete the drug regimen because discontinuing it can lead to the recurrence of infection and may cause bacterial drug resistance. The patient need not avoid trimethoprim/sulfamethoxazole while on metoclopramide. The patient should use other methods of birth control than oral contraceptives while taking amoxicillin/clavulanate treatment.

Which changes associated with age contribute to urinary tract infections (UTIs)? Select all that apply. a. Immunity b. Fecal incontinence c. Decreased urine pH d. Decreased estrogen e. Use of medications with cholinergic properties

A,B,D a. Immunity b. Fecal incontinence d. Decreased estrogen Rationale: Age-related factors that contribute to UTIs include immunity, fecal incontinence, and decreased estrogen. Overall immunity declines with age. Fecal incontinence contributes to bacteria in the urethra. Low estrogen in women affects the cells of the vagina and urethra, making them more susceptible to infections. Urine pH does not change with age. Medications with anticholinergic properties in older adults contribute to delayed bladder emptying, not UTIs.

A patient with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole. What information does the nurse provide to this patient about taking this drug? Select all that apply. a. "Take this drug with 8 ounces of water." b. "Drink at least 3 liters of fluids every day." c. "Try to urinate frequently to keep your bladder empty." d. "Be certain to wear sunscreen and protective clothing." e. "You will need to take all of the drug to get the benefits."

A,B,D,E a. "Take this drug with 8 ounces of water." b. "Drink at least 3 liters of fluids every day." d. "Be certain to wear sunscreen and protective clothing." e. "You will need to take all of the drug to get the benefits." Rationale: Wearing sunscreen and protective clothing is important to do while on taking trimethoprim/sulfamethoxazole. Increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules; fluid intake prevents this complication. Patients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. Emptying the bladder is important, but not keeping it empty. The patient should be advised to urinate every 3-4 hours or more often if he or she feels the urge.

Which nursing interventions would be beneficial to the patient who is on fluoroquinolone therapy? Select all that apply. a. Warning the patient not to take the drug within 2 hours of taking an antacid b. Instructing the patient to call the prescriber if severe or watery diarrhea develops c. Teaching the patient to swallow extended release drugs and not to crush or chew the tablets d. Teaching the patient to keep out of the sun or to wear protective clothing and use sunscreen e. Teaching the patient to drink a full glass of water with each dose and to have a total fluid intake of 3 liters daily

A,C,D A. Warning the patient not to take the drug within 2 hours of taking an antacid C. Teaching the patient to swallow extended release drugs and not to crush or chew the tablets D. Teaching the patient to keep out of the sun or to wear protective clothing and use sunscreen Rationale: Patients on fluroquinolone therapy should be warned not to take the drug within 2 hours of taking an antacid because it may interfere with the drug's absorption. Patients on extended release drugs should be instructed to swallow them whole and not to crush or chew the tablets because this may release the drug all at once; these patients should also be taught to keep out of the sun or wear protective clothing outdoors and use sunscreen because the drug may increase sensitivity to the sun and lead to sunburn. Patients on cephalosporin therapy should be instructed to call the primary care physician if severe or watery diarrhea develops as it may cause pseudomembranous colitis. The patients on sulfonamide therapy should also be instructed to drink a full glass of water with each dose and to have an overall fluid intake of 3 liters daily to prevent crystal formation in renal tubules.

Which factors may contribute to the development of infectious cystitis? Select all that apply. a. Age b. Peritonitis c. Diabetes mellitus d. Bowel pathogens e. Elevated erythropoietin levels

A,C,D a. Age c. Diabetes mellitus d. Bowel pathogens Rationales: Age contributes to the incidence of urinary tract infections (UTI) such as cystitis for a variety of reasons including prostate enlargement in men and low estrogen levels in women. Diabetes mellitus causes excess glucose production that provides a medium for bacterial growth and development of UTI. Infectious cystitis is most commonly caused by pathogens from the bowel, which gain entry into the sterile environment of the bladder. Peritonitis and elevated erythropoietin levels are not associated with increased incidence of infectious cystitis.

A female patient has acquired a urinary tract infection (UTI) for the second time. What does the nurse instruct the patient to do to prevent future infections? Select all that apply. a. Wear loose-fitting cotton underwear. b. Take a vitamin A supplement daily. c. Clean the perineal area from back to front. d. Take 2 tablespoons of apple cider vinegar three times daily. e. Take prescribed antibiotics as directed and schedule a follow-up.

A,D,E a. Wear loose-fitting cotton underwear. d. Take 2 tablespoons of apple cider vinegar three times daily. e. Take prescribed antibiotics as directed and schedule a follow-up. Rationale: The patient with a UTI should wear loose-fitting cotton underwear and avoid wearing irritating clothing such as nylon underwear. Apple cider vinegar helps acidify the urine in the bladder and prevent infections. The patient can prevent recurring infections by taking prescribed antibiotics as directed and scheduling a follow-up appointment with the health care provider. A daily intake of 500 mg of vitamin C helps acidify the urine. The patient must clean the perineal area from front to back to prevent organisms in the stool from coming close to the urethra and causing an infection.

The nurse finds that a patient receiving treatment for urinary tract infection has blurred vision, confusion, dizziness, fast heartbeat, fever, and difficulty in urination. Which medication does the nurse suspect is the cause? a. Cefpodoxime b. Hyoscyamine c. Nitrofurantoin d. Phenazopyridine

b. Hyoscyamine Rationale: Blurred vision, confusion, dizziness, fast heartbeat, fever, and difficulty in urination are the clinical manifestations of hyoscyamine toxicity. Cefpodoxime may cause watery diarrhea as a side effect. Nitrofurantoin may cause kidney damage as an adverse effect. Phenazopyridine may result in orange colored urine.

In what location would the nurse expect to find infection in a patient with acute pyelonephritis? a. Urethra b. Kidneys c. Prostate gland d. Urinary bladder

b. Kidneys Rationale: Acute pyelonephritis is a kidney infection. Urinary tract infections are described by their location in the tract. Urethritis is an acute infection in the urethra, cystitis is an infection in the bladder, and prostatitis is an infection in the prostate gland.

Which statement of the patient with interstitial cystitis indicates the need for additional teaching about self-care management? a. "I should consume tomato products." b. "I should avoid caffeine consumption." c. "I should avoid drinking cranberry juice." d. "I should take a warm sitz bath 2 to 3 times a day."

a. "I should consume tomato products." Rationale: The patient should avoid consumption of tomato products because they cause bladder irritation. Avoiding caffeine prevents bladder irritation. Cranberry juice is not recommended because it causes irritation of the bladder in interstitial cystitis. Taking a warm sitz bath 2 to 3 times a day may provide comfort and relieves symptoms.

The nurse is educating a female patient about hygiene measures to reduce her risk for a urinary tract infection (UTI). What does the nurse instruct the patient to do? a. "Wipe from front to back." b. "Use only white toilet paper." c. "Douche—but only once a month." d. "Wipe with the softest toilet paper available."

a. "Wipe from front to back." Rationale: Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection. Douching is an unhealthy behavior because it removes beneficial organisms as well as the harmful ones. White toilet paper helps prevent allergies, not infections. Using soft toilet paper does not prevent infection.

What does the nurse identify as urosepsis in a patient? a. Infection spreads from the urinary tract to the bloodstream. b. Escherichia coli from the intestinal tract infects the urinary tract. c. Normal flora protection decreases following long-term antibiotic therapy. d. Decline in estrogen causes changes to the skin and mucous membranes.

a. Infection spreads from the urinary tract to the bloodstream. Rationale: Urosepsis is caused by the spread of infection from the urinary tract to the bloodstream. It can lead to overwhelming organ failure, shock, and death. Infectious cystitis is caused by organisms from the intestinal tract, mainly Escherichia coli. The decline in estrogen causes changes to the skin and mucous membranes, facilitating the colonization of E. coli. Long-term antibiotic therapy reduces normal protective flora, which leads to fungal infections such as those caused by Candida.

Which nursing intervention is beneficial for a patient reporting irritation in the bladder who is taking cranberry capsules to treat a urinary tract infection? a. Notifying the primary health care provider b. Instructing the patient to continue the treatment for 4 more weeks c. Instructing the patient to take the cranberry capsule on empty stomach d. Asking the patient to consume tomato juice along with the cranberry capsule

a. Notifying the primary health care provider Rationale: Drinking cranberry juice daily decreases urinary tract infection by decreasing the ability of bacteria to adhere to the epithelial cells lining the urinary tract. However, extensive use of cranberry juice may irritate the bladder in a patient with interstitial cystitis, so the nurse should contact the primary health care provider immediately. Continuing the cranberry capsule for 4 more weeks or taking cranberry capsule on an empty stomach may further irritate the bladder. The patient with bladder irritation due to cystitis would benefit by avoiding tomato products and cranberry capsules.

Which complication does the nurse monitor for in a pregnant patient who is diagnosed with cystitis? a. Preterm labor b. Stone formation c. Gestational diabetes d. Orthostatic hypotension

a. Preterm labor Rationale: Cystitis is associated with a risk of acute pyelonephritis during pregnancy, which can increase the risk of preterm labor. Hyperuricemia condition increases the risk of stone formation. Cystitis does not cause gestational diabetes. The patient who is receiving amitriptyline treatment has a higher risk of orthostatic hypotension.

Which factor does the nurse suspect to be responsible for cystitis due to a fungal infection in a patient? a. Prolonged use of antibiotics b. Exposure to radiation therapy c. Consumption of high-fiber food d. Drinking about 3 liters of water every day

a. Prolonged use of antibiotics Rationale: Cystitis is an inflammation and infection of the urinary bladder. Fungal ( Candida) infections can occur during long-term antibiotic therapy because they alter the functioning of the normal protective flora and increase the adherence and virulence of pathogenic bacteria. Noninfectious cystitis may result from chemical exposure, such as radiation therapy, and cyclophosphamide. Consumption of high-fiber food does not cause fungal infections. Drinking 3 liters of water daily is sufficient to flush out the kidneys and reduces the risk of infections.

A patient who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this patient? a. Refers the patient to the clinic nurse practitioner (CNP) for immediate follow-up b. Discharges the patient to her home for strict bedrest for the duration of the pregnancy c. Instructs the patient to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria d. Recommends that the patient refrain from having sexual intercourse until after she has delivered her baby

a. Refers the patient to the clinic nurse practitioner (CNP) for immediate follow-up Rationale: Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus. It is unsafe for the patient to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the patient's problem. The patient's symptoms need follow-up with a health care provider.

Which diagnostic test would be instrumental in diagnosing a patient with a suspected urinary tract infection (UTI) if the laboratory report shows pyuria and the presence of 24 epithelial cells/high power field (hpf)? a. Urinalysis b. Cystoscopy c. Pelvic ultrasound d. Retrograde pyelography

a. Urinalysis rationale: Pyuria is indicated by the presence of 100,000 colonies/mL bacteria or the presence of three or more white blood cells. The presence of more than 20 epithelial cells/hpf suggests contamination. Urinalysis is used to identify the microscopic bacteria, total number of red blood cells, and white blood cells in the urine. Cystoscopy is used to accurately diagnose interstitial cystitis. Pelvic ultrasound is used to locate a site of obstruction. Retrograde pyelography is used to show outlines and images of the drainage tract.

The nurse is assessing a patient with frequency-dysuria syndrome whose culture test reveals the presence of Chlamydia. Which finding may provide further evidence for the diagnosis? a.Pyuria b. Oliguria c. Cystocele d.Hematuria

a.Pyuria Rationale: Urethritis is an inflammation of the urethra and is also referred to as frequency-dysuria syndrome. Chlamydia is a sexually transmitted gram-negative bacterium that may lead to urethritis. Urinalysis may show pyuria due to infection. Oliguria is a clinical manifestation of urolithiasis due to obstruction of urinary flow in the urinary tract by calculi. Cystocele or herniation of the bladder into the vagina is observed in patients with urinary inconsistency. A patient with cystitis may have hematuria or presence of blood in the urine due to severe infection.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which patient statement shows a correct understanding of what the nurse has taught? a."Urinating 1000 mL on a daily basis is a good amount for me." b. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." c. "It is a good idea for me to reduce germs by taking a tub bath daily." d. "Trying to get to the bathroom to urinate every 6 hours is important for me."

b. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." Rationale: To reduce the number of UTIs, patients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day. Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output should be at least 1.5 liters daily. Ensuring this amount "out" is a good indicator that the patient is drinking an adequate amount of fluid.Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.

Which statement made by the patient indicates effective learning about tips to prevent urinary tract infections? a. "I should take a bubble bath regularly." b. "I should clean the perineum from front to back." c. "I should drink high fructose cranberry juice daily." d. "I should use spermicidal agents with intercourse."

b. "I should clean the perineum from front to back." Rationale: Maintaining proper perineal hygiene reduces the risk of urinary tract infections. Cleaning the perineum from front to back prevents the entry of bacteria into the urinary tract and therefore reduces the risk of urinary tract infection. Taking a bubble bath or using scented toilet tissue and wearing tight-fitting underwear may lead to irritation. High fructose cranberry juice is rich in sugar, which creates an ideal medium for bacterial growth. Spermicides and antiseptics may suppress the activity of natural protective bacteria and result in urinary tract infections.

The nurse is instructing an older adult female patient about interventions to decrease the risk for cystitis. Which patient comment indicates that the teaching was effective? a. "I need to douche vaginally once a week." c. "I must avoid drinking carbonated beverages." d. "I will not drink fluids after 8 pm each evening."

b. "I should drink 2½ liters of fluid every day." Rationale: Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8 pm would help prevent nocturia but not cystitis. It is recommended that patients with incontinence problems limit their late-night fluid intake to 120 mL.Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses.

A patient with a urinary tract infection is prescribed sulfamethoxazole. The nurse provides the patient with education about precautions to take to prevent adverse effects. Which statement made by the patient indicates effective learning? a. "I should limit my intake of fluids between meals." b. "I should wear protective clothing when outdoors." c. "I should take the medication with a glass of grape juice." d. "I should avoid taking an antacid for 1 hour after taking the medication."

b. "I should wear protective clothing when outdoors." Rationale: Sulfamethoxazole increases the skin's sensitivity to sunlight; therefore, the patient should wear protective clothing to prevent severe sunburn. A patient who is on sulfamethoxazole should drink adequate amounts of fluids to prevent the formation of crystals in the kidney tubules; therefore, the patient should not limit water intake. As grape juice increases the absorption of the medication, the patient should not take sulfamethoxazole with grape juice. The intake of antacids is contraindicated in a patient who is on ciprofloxacin; however, sulfamethoxazole does not have any interaction with antacids.

A patient who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the patient states, "I only took the first dose because after that, I felt better." How does the nurse respond? a. "This means you will now have to take two drugs instead of one." b. "Not completing your medication can lead to return of your infection." c. "That means your treatment will be prolonged with this new infection." d."What you did was okay; however, let's get you started on something else."

b. "Not completing your medication can lead to return of your infection." Rationale: Not completing the drug regimen can lead to recurrence of an infection and bacterial drug resistance. Needing to be re-treated does not mean that the patient will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this patient's history, larger doses for a shorter time span may be a wise plan. The patient does not need to take two drugs, and this response is punitive rather than instructive. Saying that the patient's actions were okay does not inform the patient with respect to nonadherence. The patient needed to take all the prescribed medication to make certain that the infection was properly treated.

Which instruction should the nurse give to a patient who has been prescribed amoxicillin/clavulanate for urinary tract infection? a. "Avoid exposure to the sun." b. "Take the medication with food." c. "Wear dark glasses when in the sunlight." d. "Avoid taking the drug within 2 hours of taking an antacid."

b. "Take the medication with food." Rationale: Amoxicillin/clavulanate may cause gastrointestinal upset. The nurse should instruct the patient to take the drug with food. The patient should avoid exposure to the sun while receiving ciprofloxacin treatment. The patient should wear dark glasses in sunlight while receiving hyoscyamine treatment. The patient should avoid taking levofloxacin within 2 hours of taking an antacid.

What does the nurse teach a patient with cystitis about preventing further flare-ups of the disease? a. Take tub baths often. b. Consume at least 2 to 3 L of fluids daily. c. Empty the bladder at least every 6 hours. d. Wash the perineal area with antiseptic solution.

b. Consume at least 2 to 3 L of fluids daily. Rationale: The patient should be instructed to drink at least 2 to 3 L of fluids daily. Water is preferable over sugared fluids. This generates a sufficient amount of urine to clear the bladder and prevent concentration of urine. Tub baths promote urinary tract infections and should be avoided. The patient must shower daily and clean the perineal area with soap and water; use of antiseptic solution has not been proven to be beneficial. The patient must empty the bladder every 3 to 4 hours to prevent urinary stasis.

The nurse is caring for a patient with cystitis. What does the nurse ask the patient to include in the diet as part of nutritional therapy? a. Caffeine b. Cranberry juice c. Tomato products d. Carbonated beverages

b. Cranberry juice Rationale: The patient with cystitis should consume 50 mL of concentrated cranberry juice daily because it is known to decrease the ability of bacteria to adhere to the epithelial cells lining the urinary tract, decreasing the incidence of symptomatic urinary tract infections in some patients. Cranberry juice must be consumed for 3 to 4 weeks to be effective. Caffeine, carbonated beverages, and tomato products must be avoided to decrease bladder irritation during cystitis.

Which organism is most likely to cause infectious cystitis? a. Proteus species b. Escherichia coli c. Candida species d. Klebsiella pneumoniae

b. Escherichia coli Rationale: Infectious cystitis is an inflammatory disease that is caused by pathogens from the bowel or the vagina. About 90% of UTIs are caused by Escherichia coli (E. coli). Proteus and Candida species and Klebsiella pneumonia also can cause cystitis but are not as likely to as are E. coli.

A female patient presents to the clinic with complaints of "burning when urinating." What findings does the nurse anticipate when assessing the perineal area? a.Vaginal discharge b. Pink urethral meatus c. Inflamed labial tissue d. Ulcerations around the urethral meatus

b. Pink urethral meatus Rationale: The nurse can anticipate finding a pink urethral meatus. A urinary tract infection does not change the color of the meatus. To help differentiate between a vaginal and a urinary tract infection, the assessment of the urethral meatus and vaginal opening should be performed. Vaginal discharge, inflamed labial tissue, and ulcerations around the urethral meatus are not related to urinary tract infections.

A patient is ordered phenazopyridine to reduce bladder pain and burning on urination. What does the nurse teach the patient about this drug regimen? a. Report blurred vision. b. Take the drug with a meal. c. Report if the urine turns red. d.Wear dark glasses in sunlight.

b. Take the drug with a meal. Rationale: The patient should take the drug with a meal to prevent gastrointestinal disturbances. The patient need not report the finding of urine that appears as red or orange because this is an expected response to the drug. The patient taking antispasmodics for relieving bladder spasms is asked to report blurred vision, which is a manifestation of toxicity. The patient taking antispasmodics, not analgesics, is asked to wear dark glasses in sunlight because the drug dilates the pupil and increases eye sensitivity to light.

Which patient has the highest risk of fungal urinary tract infection? a. The patient on fluconazole b. The patient on corticosteroids c. The patient with multiple sclerosis d. The patient with bladder diverticula

b. The patient on corticosteroids Rationale: Corticosteroids suppress immune function and increase the risk of fungal urinary tract infection. Fluconazole is used to treat fungal urinary tract infections. The patient with multiple sclerosis has a risk of urinary incontinence. The patient with bladder diverticula has risk of cystitis.

The nurse is caring for an older adult who is experiencing increased mental confusion and worsening incontinence. The laboratory results reveal an elevated white blood cell count with a shift to the left. Based on the clinical findings, what does the nurse suspect? a. Cystitis b. Urosepsis c. Pyelonephritis d. Urinary tract infection

b. Urosepsis Rationale: Based on these clinical findings, the most likely infectious process is urosepsis. A left shift most often occurs with urosepsis and rarely occurs with cystitis. Cystitis is an uncomplicated and localized infection. Pyelonephritis is an ascending urinary tract infection that has reached the pelvis of the kidney. Bacteria from the urinary tract system enters the bloodstream and is the cause of urosepsis. A urinary tract infection is confined to the urinary tract with findings of pyuria and hematuria.

What principle will the nurse adhere to in order to minimize catheter-associated urinary tract infections (CAUTIs)? a. Use of indwelling catheter for routine measurement of urine b. Use of intermittent catheterization for postoperative urinary retention c. Use of antimicrobial catheters for patients who require a urinary catheter d. Use of antiseptic solutions to cleanse the periurethral area for routine hygiene

b. Use of intermittent catheterization for postoperative urinary retention Rationale: In order to minimize CAUTIs, the nurse will use intermittent catheterization for postoperative urinary retention. Indwelling catheters have a higher risk for infection and should only be used in specific circumstances, and routine measurement of urine is not necessary with a catheter unless the patient is critically ill. The use of antimicrobial catheters is recommended for patients requiring urinary catheters for more than 3 to 5 days. Antiseptic cleaning solutions are not recommended for routine hygiene.

The nurse is questioning a female patient with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the patient indicates a need for further instruction? a. "I always wipe front to back." b. "I try to drink 3 liters of fluid a day." c. "I take my medication only when I have symptoms." d. "I don't use bubble baths and other scented bath products."

c. "I take my medication only when I have symptoms." Rationale: Patients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent. Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 liters of fluid a day help prevent UTIs.

Which statement by a novice nurse indicates the need for further learning about factors that contribute to urinary tract infections? a. "Urinary stasis may be caused by incomplete bladder emptying in men." b. "Use of douches or perfumed pads and toilet tissue may cause colonization." c. "Susceptibility to periurethral colonization of coliform bacteria is increased when estrogen levels increase during menopause." d. "The use of drugs with intentional or unintentional anticholinergic properties in older adults contributes to delayed bladder emptying."

c. "Susceptibility to periurethral colonization of coliform bacteria is increased when estrogen levels increase during menopause." Rationale: Susceptibility to periurethral colonization with coliform bacteria is increased when estrogen levels fall during menopause. Estrogen provides resistance to urinary tract infections, and falling estrogen levels will promote periurethral colonization of coliform bacteria. Urinary stasis may be caused by incomplete bladder emptying in men as a result of an enlarged prostate. Use of douches or perfumed pads and toilet tissue may inflame periurethral tissue and cause colonization. The use of drugs with intentional or unintentional anticholinergic properties in older adults contributes to delayed bladder emptying.

The health care provider requests phenazopyridine (Pyridium) for a patient with cystitis. What does the nurse tell the patient about the drug? a. "It will act as an antibacterial drug." b. "You need to take the drug on an empty stomach." c. "Your urine will turn red or orange while on the drug." d. "This drug will treat your infection, not the symptoms of it."

c. "Your urine will turn red or orange while on the drug." Rationale: Phenazopyridine will turn the patient's urine red or orange. Patients should be warned about this effect of the drug because it will be alarming to them if they are not informed, and care should be taken because it will stain undergarments. Phenazopyridine reduces bladder pain and burning by exerting a local analgesic/anesthetic effect on the mucosa of the urinary tract. It does treat the symptoms of bladder infection; it has no antibacterial action. Phenazopyridine should be taken with a meal or immediately after eating.

What clinical finding in a postmenopausal patient with urethritis does the nurse attribute to low estrogen levels? a. The urinalysis indicates pyuria. b. The urethral culture is positive for bacteria. c. A pelvic examination shows tissue changes. d. The urinalysis indicates the presence of bacteria.

c. A pelvic examination shows tissue changes. Rationale: A pelvic examination of a postmenopausal patient shows tissue changes because of low estrogen. The patient with urethritis does not have pyuria or white blood cells (WBCs) in the urine. The urethral culture and urinalysis is usually negative for bacteria. These patients may have improvement in their urethral symptoms with the use of estrogen vaginal cream.

The nurse is caring for patients on a renal/kidney medical-surgical unit. Which drug, requested by the health care provider for a patient with a urinary tract infection (UTI), does the nurse question? a. Norfloxacin b. Ciprofloxacin c. Carbamazepine d. Sulfamethoxazole/Trimethoprim

c. Carbamazepine Rationale: Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs gatifoxacin and carbamazepine. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant. Trimethoprim/sulfamethoxazole, ciprofloxacin, and norfloxacin are drugs used to treat UTI.

A patient with a pulse rate of 130 beats per minute, a white blood cell count of 14,000 per microliter, and the presence of red blood cells in the urine has fever, nocturia, pyuria, and low back pain. Which medication would the nurse expect to see ordered? a. Oxybutynin b. Tolterodine c. Ciprofloxacin d. Chlorothiazide

c. Ciprofloxacin Rationale: Fever, nocturia, pyuria, and lower back pain are symptoms of urinary tract infection. A heart rate of 130 beats per minute indicates tachycardia. The white blood cell count of 14,000 per microliter indicates infection. The presence of red blood cells in the urine indicates hematuria. Fluoroquinolone antibiotics such as ciprofloxacin should be administered to the patient to treat urinary tract infection. Oxybutynin and tolterodine are used to treat urinary incontinence. Chlorothiazide is used to treat hypercalciuria.

The nurse is assessing a female patient who has a history of recurrent urinary tract infection (UTI) after sexual intercourse. What does the nurse teach this patient to prevent future infections? a. Practice vaginal douching. b. Use scented or flavored vaginal lubricants. c. Empty the bladder before and after intercourse. d. Wash the perineal area vigorously with antiseptic soap.

c. Empty the bladder before and after intercourse. Rationale: The patient should empty the bladder before and after intercourse to help prevent urinary tract infections (UTIs). A full bladder predisposes the patient to infection. Also, urinating after sex will flush any bacteria out of the urethra that may have migrated there during sex. Although perineal cleaning before intercourse is helpful, vigorous cleaning with harsh soaps and vaginal douching may irritate the perineal tissues and increase the risk for UTI. The patient can use adequate lubrication, both natural or artificial, to prevent trauma during intercourse; however, the use of scented or flavored vaginal lubricants must be avoided because they cause tissue irritation.

What medication for treating a urinary tract infection may cause red-colored urine when voiding? a. Cefdinir b. Levofloxacin c. Phenazopyridine d. Amoxicillin/clavulanate

c. Phenazopyridine Rationale: Phenazopyridine is a bladder analgesic used to treat bladder pain and burning with urination. It may produce red-colored urine. Cefdinir may cause watery diarrhea as a side effect. Levofloxacin may cause severe sunburn with sun exposure as a side effect. Amoxicillin/clavulanate may cause gastrointestinal upset and diarrhea as a side effect.

The nurse is caring for a patient who has had a urinary catheter in place for three weeks. Nursing assessment findings include temperature of 100.1°F, pulse 99 bpm, respirations 22 breaths per minute, and blood pressure 118/62 mm Hg. The nurse notes that the patient's urine is cloudy and blood-tinged. The health care provider is notified, and orders for a urine culture and antibiotic are received. What is the nurse's priority action? a. Administer the ordered antibiotic. b. Obtain a urine specimen and administer the antibiotic. c. Replace the catheter, and then obtain a urine specimen for culture. d. Use aseptic technique to obtain a sample of the urine from the catheter bag.

c. Replace the catheter, and then obtain a urine specimen for culture. Rationale: The nurse's priority action for the patient with a suspected urinary tract infection from an indwelling catheter is to replace the catheter and obtain a urine specimen for culture. If a catheter has been in place for more than 2 weeks, it is necessary to replace the catheter, and then obtain a sterile specimen for culture. A culture must be obtained before administering an antibiotic so the appropriate organism can be identified and treated. Aseptic technique should always be used when obtaining a sample of urine from the catheter bag, but the urine sample obtained should be from fresh urine.

The nurse is teaching a student nurse about a urinary catheterization. Which action by the student nurse indicates the need for further teaching? a. The student nurse washes the perineum with soap and water. b. The student nurse uses a 14 Fr catheter with a small balloon. c. The student nurse places the urine collection bag above the bladder. d. The student nurse injects 10 mL of irrigation solution into the balloon.

c. The student nurse places the urine collection bag above the bladder. Rationale: After a urinary catheterization, the urine collection bag should be kept below rather than above the level of the bladder to prevent the reflux of pathogens from the bag into the urinary tract. The student nurse washes the perineum area with soap and water to ensure that the area is free from bacteria and to reduce the risk of infection. The student nurse injects 10 mL of irrigation solution into the balloon, as an injection of excess solution will increase the risk of infection. A catheter size of 14 Fr is appropriate, and the balloon size should be small because a large balloon will increase the risk of infection.

A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the health care provider prescribe? a.Estrogen b.Nitrofurantoin after intercourse c. Trimethoprim/sulfamethoxazole d.Phenazopyridine with intercourse

c. Trimethoprim/sulfamethoxazole Rationale: Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired urinary tract infection (UTI) in women. Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This patient needs a drug that will kill bacteria. Estrogen cream may help prevent recurrent UTIs in postmenopausal women, which this patient is not (at age 32). Use of estrogen is related to problems with incontinence. Phenazopyridine is not used to treat infection, but symptoms of a UTI.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

Which complication may occur in a patient who is receiving ciprofloxacin treatment? a. Anemia b. Diarrhea c. Glaucoma d. Cardiac dysrhythmia

d. Cardiac dysrhythmia Rationale: Ciprofloxacin is a fluoroquinolone, which treats urinary tract infections. Ciprofloxacin may produce irregular heartbeats and cause cardiac dysrhythmia as a side effect. Ciprofloxacin does not decrease red blood cell count so does not cause anemia. Cefpodoxime causes diarrhea as a side effect. Oxybutynin increases intraocular pressure and causes glaucoma as a side effect.

Which condition is likely to occur in a patient who is on immunosuppressant medication? a. Cystitis b. Acute infection c. Renal insufficiency d. Fungal urinary tract infection

d. Fungal urinary tract infection Rationale: Fungal urinary tract infection is caused by the change in normal protective flora that reduces the adherence and virulence of pathogenic bacteria. Cystitis may occur in patients with gynecologic cancers or pelvic inflammatory disorders. Acute infection or renal insufficiency may occur in a patient with asymptomatic bacterial urinary tract infection.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized patients? a.Encouraging them to drink fluids b. Irrigating all catheters daily with sterile saline c. Recommending that catheters be placed in all patients d. Periodically reevaluating the need for indwelling catheters

d. Periodically reevaluating the need for indwelling catheters Rationale: Studies have shown that reevaluating the need for indwelling catheters in patients is the most effective way to prevent UTIs in the hospital setting. Encouraging fluids, although it is a valuable practice for patients with catheters, will not necessarily prevent the occurrence of UTIs in the hospital setting. In some patients, their conditions do not permit an increase in fluids, such as those with congestive heart failure and kidney failure. Irrigating catheters daily is contraindicated; any time a closed system is opened, bacteria may be introduced. Placing catheters in all patients is unnecessary and unrealistic. This practice would place more patients at risk for the development of UTIs.Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is influenced by:" and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer.

What leads the nurse to determine that a urine specimen taken for a urine culture has been contaminated? a. Absence of colonies in the culture b.Presence of 10 3 colony-forming units c. Presence of 10 5 colony-forming units d. Presence of different organisms in low colony counts

d. Presence of different organisms in low colony counts rationale: The presence of many different organisms in low colony counts of a urine culture usually indicates that the specimen is contaminated. The patient does not have a urinary tract infection (UTI) if there are no colonies in the culture. The presence of 10 5 colony-forming units indicates the presence of UTI. If other symptoms of UTI are observed in the patient, the presence of 10 3 colony-forming units may also indicate UTI.

Which antibiotic for treating cystitis may cause side effects of sunburn and skin darkening? a. Amoxicillin b. Fosfomycin c. Cefpodoxime d. Sulfamethoxazole

d. Sulfamethoxazole Rationale: Sulfonamides such as sulfamethoxazole are drugs that cause photosensitivity and increased skin irritation and pigmentation. They may also lead to sunburn upon exposure to the sun. Amoxicillin may reduce bacteria in the urinary tract by interrupting bacterial cell wall synthesis. It may reduce the gastric flora leading to diarrhea. Fosfomycin reduces the incidence of cystitis but has side effects of dizziness and vaginal itching. Cefpodoxime is a cephalosporin that is likely to lead to rashes in a patient with allergies to penicillin.