UTI

14. A patient with a history of renal calculi is hospitalized with gross hematuria and severe colicky left flank pain that radiates to his left testicle. In planning care for the patient, the nurse gives the highest priority to the nursing diagnosis of a. acute pain related to irritation by the stone. b. deficient fluid volume related to inadequate intake. c. risk for infection related to urinary system damage. d. risk for nausea related to pain and renal colic.

Answer: A Rationale: Although all the diagnoses are appropriate, the initial nursing actions should focus on relief of the acute pain. Cognitive Level: Application Text Reference: p. 1173 Nursing Process: Diagnosis NCLEX: Physiological Integrity

2. Trimethoprim and sulfamethoxazole (Bactrim) BID for 7 days is ordered for a patient who has a recurrent relapse of an Escherichia coli UTI. The nurse instructs the patient to a. take the antibiotic for the full 7 days, even if symptoms improve in a few days. b. return to the clinic in 3 days so that a urine culture can be done to evaluate the effectiveness of the drug. c. increase the effectiveness of the drug by taking it with cranberry juice to acidify the urine. d. take two of the pills a day for 5 days, and reserve the rest of the pills to take if the symptoms reappear.

Answer: A Rationale: Although an initial infection may be treated with a shorter course of antibiotics, the patient with a recurrent infection should take the antibiotic for 7 days. Success of treatment is evaluated by resolution of symptoms rather than by a repeat culture. Acidifying the urine when a patient is taking sulfa antibiotics may lead to stone formation. The patient is instructed to take all the antibiotics. Cognitive Level: Application Text Reference: p. 1157 Nursing Process: Implementation NCLEX: Physiological Integrity

26. Following rectal surgery, a patient voids about 50 ml of urine every 30 to 60 minutes. Which nursing action is most appropriate? a. Use an ultrasound scanner to check for residual urine after voiding. b. Have the patient take small amounts of fluid frequently throughout the day. c. Reassure the patient that this is normal after rectal surgery due to anesthesia. d. Monitor the patient's intake and output over the next few hours.

Answer: A Rationale: An ultrasound scanner can be used to check for residual urine after the patient voids. Because the patient's history and clinical manifestations are consistent with overflow incontinence, it is not appropriate to have the patient drink small amounts. Although overflow incontinence is not unusual after surgery, the nurse should intervene to correct the physiologic problem, not just reassure the patient. The patient may develop reflux into the renal pelvis as well as discomfort from a full bladder if the nurse waits to address the problem for several hours. Cognitive Level: Application Text Reference: p. 1182 Nursing Process: Implementation NCLEX: Physiological Integrity

16. A patient with a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock-wave lithotripsy. Which information is most important for the nurse to collect after lithotripsy? a. Urine output b. Pain level c. Appearance of the site d. Patient temperature

Answer: A Rationale: Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to monitor the urine output. The patient may have pain as the stones pass and bruising at the site, but these are not unexpected. Extracorporeal shock wave lithotripsy (ESWL) is not associated with a risk for infection. Cognitive Level: Application Text Reference: p. 1172 Nursing Process: Assessment NCLEX: Physiological Integrity

27. A patient in the hospital has a history of urinary incontinence. Which nursing action will be included in the plan of care? a. Place a bedside commode near the patient's bed. b. Use an ultrasound scanner to check urine residual after the patient voids. c. Demonstrate the use of the Credé maneuver to the patient. d. Teach the use of Kegel exercises to strengthen the pelvic floor.

Answer: A Rationale: Environmental changes can make it easier for the patient to avoid incontinence for patients with urinary incontinence. Checking for residual urine and performing the Credé maneuver are interventions for overflow incontinence. Kegel exercises are useful for stress incontinence. Cognitive Level: Application Text Reference: p. 1181 Nursing Process: Planning NCLEX: Physiological Integrity

25. After her bath, a 62-year-old patient asks the nurse for a perineal pad, saying that she uses them because sometimes she leaks urine when she laughs or coughs. Which intervention is most appropriate to include in the care plan for the patient? a. Teach the patient how to perform Kegel exercises. b. Demonstrate how to perform Credé's maneuver. c. Place commode at the patient's bedside. d. Assist the patient to the bathroom q3hr.

Answer: A Rationale: Exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The Credé maneuver is used to help empty the bladder for patients with overflow incontinence. Placing the commode close to the bedside and assisting the patient to the bathroom are helpful for functional incontinence. Cognitive Level: Application Text Reference: pp. 1181-1184 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

23. Following an open-loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented? a. Assist the patient to take a 15-minute sitz bath. b. Encourage the patient to drink several glasses of water. c. Teach the patient how to do isometric perineal exercises. d. Insert a straight catheter and drain the bladder.

Answer: A Rationale: Sitz baths will relax the perineal muscles and promote voiding. Although the patient should be encouraged to drink fluids, this would not be appropriate when the patient is experiencing retention. Kegel exercises are helpful in the prevention of incontinence. Catheter insertion increases the risk for infection. Cognitive Level: Application Text Reference: p. 1179 Nursing Process: Implementation NCLEX: Physiological Integrity

37. A 26-year-old patient with a history of polycystic kidney disease is admitted to the surgical unit after having knee surgery. Which of the routine postoperative orders is most important for the nurse discuss with the health care provider? a. Give ketorolac (Toradol) 10 mg PO PRN for pain. b. Infuse 5% dextrose in normal saline at 75 ml/hr. c. Obtain BUN, creatinine, and electrolytes in 2 hours. d. Order regular diet after patient is awake and alert.

Answer: A Rationale: The NSAIDs should be avoided in patients with decreased renal function because nephrotoxicity is a potential adverse effect. The other orders do not need any clarification or change. Cognitive Level: Application Text Reference: p. 1173 Nursing Process: Implementation NCLEX: Physiological Integrity

11. A patient who is diagnosed with nephrotic syndrome has 3+ ankle and leg edema and ascites. Which nursing diagnosis is a priority for the patient? a. Fluid-volume excess related to low serum protein levels b. Altered nutrition: less than required related to protein restriction c. Activity intolerance related to increased weight and fatigue d. Disturbed body image related to peripheral edema and ascites

Answer: A Rationale: The patient has massive edema, so the priority problem at this time is the excess of fluid volume. The other nursing diagnoses are also appropriate, but the focus of nursing care should be resolution of the edema and ascites. Cognitive Level: Application Text Reference: pp. 1167-1168 Nursing Process: Diagnosis NCLEX: Physiological Integrity

36. A patient with bladder cancer is scheduled for intravesical chemotherapy. In preparation for the treatment the nurse will teach the patient about a. the need to empty the bladder prior to treatment. b. premedicating to prevent nausea. c. the importance of oral care during treatment. d. where to obtain wigs and scarves.

Answer: A Rationale: The patient will be asked to empty the bladder before instillation of the chemotherapy. Systemic side effects are not experienced with intravesical chemotherapy. Cognitive Level: Application Text Reference: p. 1180 Nursing Process: Implementation NCLEX: Physiological Integrity

3. The nurse determines that instruction regarding prevention of future UTIs for a patient with cystitis has been effective when the patient states, a. "I will empty my bladder every 3 to 4 hours during the day." b. "I can use vaginal sprays to reduce bacteria." c. "I will wash with soap and water before sexual intercourse." d. "I will drink a quart of water or other fluids every day."

Answer: A Rationale: Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal sprays is discouraged. The bladder should be emptied before and after intercourse, but cleaning with soap and water is not necessary. A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI. Cognitive Level: Application Text Reference: p. 1161 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance

30. A patient undergoes a nephrectomy for massive trauma to the kidney resulting from a fall from a scaffold. Which assessment data obtained postoperatively are most important to communicate to the surgeon? a. Blood pressure is 102/48. b. Urine output is 20 ml/hr for 2 hours. c. Crackles are heard at both lung bases. d. Incisional pain level is 8/10.

Answer: B Rationale: Because the urine output should be at least 0.5 ml/kg/hr, a 40-ml output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life-threatening as decreased renal perfusion. In addition, the nurse can medicate the patient for pain. Cognitive Level: Application Text Reference: p. 1188 Nursing Process: Assessment NCLEX: Physiological Integrity

7. After teaching a patient with interstitial cystitis about management of the condition, the nurse determines that further instruction is needed when the patient says, a. "I will have to stop having coffee and orange juice for breakfast." b. "I should start taking a high-potency multiple vitamin every morning." c. "I should call the doctor about increased bladder pain or odorous urine." d. "I will buy some calcium glycerophosphate (Prelief) at the pharmacy."

Answer: B Rationale: High-potency multiple vitamins may irritate the bladder and increase symptoms. The other patient statements indicate good understanding of the teaching. Cognitive Level: Application Text Reference: p. 1164 Nursing Process: Evaluation NCLEX: Physiological Integrity

5. A 34-year-old patient with diabetes mellitus is hospitalized with fever, anorexia, and confusion. The health care provider suspects acute pyelonephritis when the urinalysis reveals bacteriuria. An appropriate collaborative problem identified by the nurse for the patient is potential complication a. hydronephrosis. b. urosepsis. c. acute renal failure. d. chronic pyelonephritis.

Answer: B Rationale: Infection can easily spread from the kidney to the circulation, causing urosepsis. A patient with a urinary tract obstruction will be at risk for hydronephrosis. Acute renal failure is not a common complication of acute pyelonephritis unless urosepsis and septic shock develop. Chronic pyelonephritis may occur after recurrent upper UTIs. Cognitive Level: Application Text Reference: p. 1161 Nursing Process: Diagnosis NCLEX: Physiological Integrity

17. The composition of a patient's renal calculus is identified as uric acid. To prevent recurrence of stones, the nurse teaches the patient to avoid a. spinach, chocolate, and tomatoes. b. organ meats and fish with fine bones. c. milk and dairy products. d. legumes and dried fruits.

Answer: B Rationale: Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones. Cognitive Level: Application Text Reference: pp. 1170-1171 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

1. When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about a. flank pain. b. pain with urination. c. poor urine output. d. nausea.

Answer: B Rationale: Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI. Cognitive Level: Application Text Reference: p. 1157 Nursing Process: Assessment NCLEX: Physiological Integrity

32. A patient has a cystectomy and a Kock continent diversion created for treatment of bladder cancer. During postoperative teaching of the patient, it is important that the nurse include instructions regarding a. application of ostomy appliances. b. catheterization technique and schedule. c. use of barrier products for skin protection. d. analgesic use before emptying the pouch.

Answer: B Rationale: The Kock pouch enables the patient to self-catheterize every 4 to 6 hours. There is no need for an ostomy device or barrier products. Catheterization of the pouch is not painful. Cognitive Level: Application Text Reference: p. 1190 Nursing Process: Implementation NCLEX: Physiological Integrity

29. The nurse observes a nursing assistant (NA) doing all of the following when caring for a patient with a retention catheter. Which action requires that the nurse intervene? a. The NA uses an alcohol-based hand cleaner before performing catheter care. b. The NA disconnects the catheter from the drainage tube to obtain a specimen. c. The NA uses soap and water when cleaning around the urinary meatus. d. The NA tapes the catheter to the skin on the patient's upper inner thigh.

Answer: B Rationale: The catheter should not be disconnected from the drainage tube because this increases the risk for UTI. The other actions are appropriate and do not require any intervention. Cognitive Level: Application Text Reference: p. 1186 Nursing Process: Assessment NCLEX: Physiological Integrity

15. The nurse instructs a patient seen in the outpatient clinic with symptoms of renal calculi to strain all urine and to a. report the pain level when the stone passed. b. collect the stone and bring it to the clinic. c. record the time that the stone passed. d. save a urine specimen to check for blood.

Answer: B Rationale: The patient should save the stone for analysis of the stone composition, which will help in determining treatment. Reporting the pain level and recording the time the stone passed are not essential. Hematuria is common with urinary calculi, so it is not necessary to test the urine for blood. Cognitive Level: Application Text Reference: p. 1173 Nursing Process: Implementation NCLEX: Physiological Integrity

12. A patient is admitted to the hospital with nephrotic syndrome after taking an OTC nonsteroidal antiinflammatory drug (NSAID) a week earlier. Which assessment data will the nurse expect to find related to this illness? a. Low blood pressure b. Recent weight gain c. Poor skin turgor d. High urine ketones

Answer: B Rationale: The patient with a rapid-onset nephrotic syndrome will have rapid weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high. Cognitive Level: Application Text Reference: p. 1167 Nursing Process: Assessment NCLEX: Physiological Integrity

33. Following a cystectomy, a patient has an ileal conduit created. The nurse identifies the nursing diagnosis of risk for infection related to altered urinary structures. An appropriate nursing intervention for this problem is to a. clamp the drainage bag while the patient sleeps. b. empty the drainage appliance every 2 to 3 hours or when it is one-third full. c. use liquid antiseptic in the appliance to decrease bacterial colonization. d. drain the conduit every 4 hours using a sterile catheter.

Answer: B Rationale: The patient with an ileal conduit will have an appliance to hold urine, which should be emptied to avoid reflux of urine back into the conduit. The drainage bag should not be clamped. The use of a liquid antiseptic will not decrease risk for infection. Unlike a continent pouch, the ileal conduit will drain continuously and is not drained with a catheter. Cognitive Level: Application Text Reference: p. 1193 Nursing Process: Implementation NCLEX: Physiological Integrity

34. Two days after surgery for an ileal conduit, the patient will not look at the stoma or participate in care. The patient insists that no one but the ostomy nurse specialist care for the stoma. The nurse identifies a nursing diagnosis of a. anxiety related to effects of procedure on lifestyle. b. disturbed body image related to change in body function. c. ineffective health maintenance related to refusal to participate in care. d. self-care deficit, toileting, related to denial of altered body function.

Answer: B Rationale: The patient's unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best diagnosis. There are no data suggesting that the impact on lifestyle is a concern for the patient. The patient may be at risk for ineffective health maintenance if the lack of participation in care continues, but the patient's behavior is normal 2 days after surgery. The patient does not appear to be in denial. Cognitive Level: Application Text Reference: p. 1191 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

18. To prevent the recurrence of renal calculi, the nurse teaches the patient to a. avoid all sources of dietary calcium. b. drink diuretic fluids such as coffee. c. drink 2000 to 3000 ml of fluid a day. d. use a filter to strain all urine.

Answer: C Rationale: A fluid intake of 2000 to 3000 ml daily is recommended help flush out minerals before stones can form. Patients are not advised to avoid all calcium-containing foods and a high calcium intake may decrease the incidence of some types of stones. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones. Cognitive Level: Application Text Reference: p. 1172 Nursing Process: Implementation NCLEX: Physiological Integrity

8. When admitting a patient with acute glomerulonephritis, the nurse will ask the patient about a. history of high blood pressure. b. frequency of UTIs. c. recent sore throat and fever. d. family history of kidney disease.

Answer: C Rationale: Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by hypertension, UTI, or related to family history. Cognitive Level: Application Text Reference: p. 1165 Nursing Process: Assessment NCLEX: Physiological Integrity

10. A patient with nephrotic syndrome develops flank pain. The nurse will anticipate treatment with a. antibiotics. b. antihypertensives. c. anticoagulants. d. corticosteroids.

Answer: C Rationale: Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis. Cognitive Level: Application Text Reference: p. 1175 Nursing Process: Planning NCLEX: Physiological Integrity

38. Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider? a. Dysuria b. Temperature 100.1° F c. Left-sided flank pain d. Hematuria

Answer: C Rationale: Flank pain indicates that the patient may have developed pyelonephritis as a complication of the bladder infection. The other clinical manifestations are consistent with a lower UTI. Cognitive Level: Application Text Reference: p. 1161 Nursing Process: Assessment NCLEX: Physiological Integrity

19. In planning teaching for a patient with benign nephrosclerosis, the nurse should include instructions regarding a. measuring daily intake and output amounts. b. obtaining and documenting daily weights. c. monitoring and recording blood pressure. d. preventing bleeding caused by anticoagulants.

Answer: C Rationale: Hypertension is the major symptom of nephrosclerosis. Measurements of intake and output and daily weights are not necessary unless the patient develops renal insufficiency. Anticoagulants are not used to treat nephrosclerosis. Cognitive Level: Application Text Reference: p. 1175 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

24. A 78-year-old patient is admitted to the hospital with dehydration and electrolyte imbalance. The patient is confused and incontinent of urine on admission. In developing a plan of care for the patient, an appropriate nursing intervention for the patient's incontinence is to a. insert an indwelling catheter. b. apply absorbent incontinent pads. c. assist the patient to the bathroom q2hr. d. restrict fluids after the evening meal.

Answer: C Rationale: In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling catheters increase the risk for UTI. Incontinent pads increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with dehydration. Cognitive Level: Application Text Reference: pp. 1183-1185 Nursing Process: Planning NCLEX: Physiological Integrity

4. To relieve the symptoms of a lower UTI for which the patient is taking prescribed antibiotics, the nurse suggests that the patient use the OTC urinary analgesic phenazopyridine (Pyridium) but cautions the patient that this preparation a. contains methylene blue, which turns the urine blue or green. b. should be taken on an empty stomach for maximum effect. c. causes the urine to turn reddish orange and can stain underclothing. d. frequently causes allergic reactions and should be stopped if a rash occurs.

Answer: C Rationale: Patients should be taught that Pyridium will color the urine deep orange and stain underclothing. Urised may turn the urine blue or green. The medication can cause gastrointestinal distress and should be taken with food. Although an allergic reaction may occur, this is not common. Cognitive Level: Comprehension Text Reference: p. 1158 Nursing Process: Implementation NCLEX: Physiological Integrity

9. The nurse establishes a nursing diagnosis of excess fluid volume related to inflammation at the glomerular basement membrane in a patient with acute glomerulonephritis. To best evaluate whether the problem identified in the nursing diagnosis has resolved, the nurse will monitor for a. proteinuria. b. elevated creatinine. c. periorbital edema. d. hematuria.

Answer: C Rationale: Resolution of the excess fluid volume is best evaluated by changes in edema. The other data may indicate whether the glomerulonephritis is resolving but do not provide data about fluid volume. Cognitive Level: Application Text Reference: p. 1165 Nursing Process: Evaluation NCLEX: Physiological Integrity

13. A 98-year-old patient with benign prostatic hyperplasia has a markedly distended bladder and is agitated and confused. All the following orders are received from the emergency department health care provider. Which order should the nurse act on first? a. Draw blood for blood urea nitrogen (BUN) and creatinine. b. Administer lorazepam (Ativan) 0.5 mg. c. Insert 16 French retention catheter. d. Schedule for IVP.

Answer: C Rationale: The patient's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test, but does not need to be done urgently. Cognitive Level: Application Text Reference: p. 1185 Nursing Process: Implementation NCLEX: Physiological Integrity

31. A patient undergoing a left ureterolithotomy returns to the surgical unit with a left ureteral catheter and a urethral catheter in place. When caring for the patient, the nurse will plan to a. aspirate the ureteral catheter if output decreases. b. clamp the ureteral catheter unless output from the urethral catheter stops. c. keep the patient on bed rest until the ureteral catheter is discontinued. d. teach the patient about home care for both catheters.

Answer: C Rationale: To avoid displacing the ureteral catheter, the patient is usually on bed rest until the catheter is removed. Aspiration of the ureteral catheter might damage tissue in the renal pelvis. The catheter is not clamped. The patient is not usually discharged with a ureteral catheter in place. Cognitive Level: Application Text Reference: p. 1187 Nursing Process: Planning NCLEX: Physiological Integrity

20. A 32-year-old patient is diagnosed with polycystic kidney disease. Which information is most appropriate for the nurse to include in teaching at this time? a. Differences between hemodialysis and peritoneal dialysis b. Complications of renal transplantation c. Methods for treating chronic and severe pain d. Importance of genetic counseling

Answer: D Rationale: Because a 32-year-old patient may be considering having children, the nurse should include information about genetic counseling when teaching the patient. The well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There is no indication that the patient has chronic pain. Cognitive Level: Application Text Reference: p. 1176 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

6. A 72-year-old patient with benign prostatic hyperplasia and a history of frequent UTIs is admitted to the hospital with chills, fever, and nausea and vomiting. To determine whether the patient has an upper UTI, the nurse will assess for a. suprapubic pain. b. foul-smelling urine. c. bladder distension. d. costovertebral angle (CVA) tenderness.

Answer: D Rationale: CVA tenderness is characteristic of pyelonephritis. The other symptoms are characteristic of lower UTI and are likely to be present if the patient also has an upper UTI. Cognitive Level: Application Text Reference: p. 1161 Nursing Process: Assessment NCLEX: Physiological Integrity

22. When obtaining the health history for a 30-year-old patient who smokes two packs of cigarettes daily, the nurse will plan to do teaching about the increased risk for a. interstitial cystitis. b. UTI. c. kidney stones. d. bladder cancer.

Answer: D Rationale: Cigarette smoking is a risk factor for bladder cancer. The patient's risk for developing interstitial cystitis, UTI, or kidney stones will not be reduced by quitting smoking. Cognitive Level: Application Text Reference: p. 1178 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

35. The nurse working in a urology clinic receives a call from a patient who had a transurethral resection with fulguration for bladder cancer 3 days previously. Which information given by the patient is of most concern to the nurse? a. The patient is voiding every 4 hours at night. b. The patient is using opioids for pain. c. The patient is very anxious about the cancer. d. There are clots in the urine.

Answer: D Rationale: Clots in the urine are not expected and require further follow-up. Voiding every 4 hours, use of opioids for pain, and anxiety are typical after this procedure. Cognitive Level: Application Text Reference: p. 1179 Nursing Process: Assessment NCLEX: Physiological Integrity

28. After the home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying, which patient statement indicates that the teaching has been effective? a. "I will need to buy seven new catheters weekly and use a new one every day." b. "I will use a sterile catheter and gloves for each time I self-catheterize." c. "I will need to take prophylactic antibiotics to prevent any urinary tract infections." d. "I will wash the catheter with soap and water before and after each catheterization."

Answer: D Rationale: Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days. There is no need to use a new catheter every day, to use sterile catheters, or to take prophylactic antibiotics. Cognitive Level: Application Text Reference: p. 1188 Nursing Process: Evaluation NCLEX: Safe and Effective Care Environment

21. When assessing a patient who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of a. recurrent renal calculi. b. kidney trauma. c. bladder infection. d. gonococcal urethritis.

Answer: D Rationale: The patient's clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis. These symptoms are not consistent with renal calculi, kidney trauma, or bladder infection. Cognitive Level: Application Text Reference: p. 1174 Nursing Process: Assessment NCLEX: Physiological Integrity