UTI's

19. The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine? A. Blood B. Pus C. White blood cells D. Glucose

19) A. Blood

1. A client is diagnosed with cystitis. Client teaching aimed at preventing a recurrence should include which instruction? A. Bathe in a tub. B. Wear cotton underwear. C. Use a feminine hygiene spray. D. Limit your intake of cranberry juice.

1) B. Cotton underwear prevents infection because it allows for air to flow to the perineum. Women should shower instead of taking a tub bath to prevent infection. Feminine hygiene spray can act as an irritant. Cranberry juice helps prevent cystitis because it increases urine acidity; alkaline urine supports bacterial growth, so cranberry juice intake should be increased, not limited.

10. To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which of the following measures in her daily routine? A. Wearing cotton underpants. B. Increasing citrus juice intake. C. Douching regularly with 0.25% acetic acid. D. Using vaginal sprays.

10) A. A woman can adopt several health-promotion measures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncotton underpants, and irritating substances, such as bubble baths and vaginal soaps and sprays. Increasing citrus juice intake can be a bladder irritant. Regular douching is not recommended; it can alter the pH of the vagina, increasing the risk of infection.

11. The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink: A. Twice as much fluid as usual. B. At least 1 quart more than usual. C. A lot of water, juice, and other fluids throughout the day. D. At least 3,000 mL of fluids daily

11) D. Instructions should be as specific as possible, and the nurse should avoid general statements such as "a lot." A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 quart more than she usually drinks if her intake was inadequate to begin with

12. A client admitted for acute pyelonephritis is about to start antibiotic therapy. Which symptom would be expected in this client? A. Hypertension B. Flank pain on the affected side C. Pain that radiates toward the unaffected side D. No tenderness with deep palpation over the CVA

12) B. The client may complain of pain on the affected side because the kidney is enlarged and might have formed an abscess. Hypertension is associated with chronic pyelonephritis. Pain may radiate down the ureters or to the epigastrium. The client would have tenderness with deep palpation over the CVA.

13. Discharge instructions for a client treated for acute pyelonephritis should include which statement? A. Avoid taking any dairy products. B. Return for follow-up urine cultures. C. Stop taking the prescribed antibiotics when the symptoms subside. D. Recurrence is unlikely because you've been treated with antibiotics.

13) B. The client needs to return for follow-up urine cultures because bacteriuria may be present but asymptomatic. Intake of dairy products won't contribute to pyelonephritis. Antibiotics need to be taken for the full course of therapy regardless of the symptoms. Pyelonephritis typically recurs as a relapse or new infection and frequently recurs within 2 weeks of completing therapy.

14. A nurse is assessing a client diagnosed with acute pyelonephritis. Which of the following symptoms does the nurse expect to see? A. Jaundice and flank pain B. Costovertebral angle tenderness and chills C. Burning sensation on urination D. Polyuria and nocturia

14) B. Costovertebral angle tenderness and chills are symptoms of acute pyelonephritis (inflammation of the kidney and renal pelvis). Jaundice indicates gallbladder or liver obstruction. A burning sensation on urination is a sign of lower urinary tract infection (UTI). Nocturia is associated with a lower UTI or benign prostatic hyperplasia. Polyuria is seen with diabetes mellitus, diabetes insipidus, or the use of diuretics.

15. Which of the following complaints is common in a client with pyelonephritis? A. Right upper quadrant pain B. Left upper quadrant pain C. Pain at the costovertebral region D. Pain at the suprapubic region

15) C. Pain at the costovertebral region

16. Diagnosis of acute pyelonephritis has been established your nursing intervention includes the following except: A. Provide health teaching and discharge planning B. Administer antibiotic C. Measure I and O D. Provide adequate comfort and rest

16) C. Measure I and O

17. A client is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. What finding is the nurse most likely to find in the client's history? A. Renal calculi B. Renal trauma C. Recent sore throat D. Family history of acute glomerulonephritis

17) C. Recent sore throat. Typically, acute glomerulonephritis occurs 2 to 3 weeks after a strep throat infection. The Most Common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. Renal calculi and renal trauma aren't known to cause acute glomerulonephritis. A family history isn't associated with the development of acute glomerulonephritis.

18. A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. During history-taking the nurse first asks the client about a recent history of: A. Bleeding ulcer B. Deep vein thrombosis C. Myocardial infarction D. Streptococcal infection

18) D. Streptococcal infection

2. A nurse is writing the teaching plan for a client with cystitis who's receiving phenazopyridine (Pyridium). What instruction should the nurse include? A. Call the physician if urine turns orange-red B. Take phenazopyridine just before urination to relieve pain C. Discontinue prescribed antibiotics after painful urination is relieved D. Stop taking phenazopyridine after painful urination is relieved.

2) D. Phenazopyridine is taken to relieve dysuria because it provides an analgesic and anesthetic effect on the urinary tract mucosa. The client can stop taking it after the dysuria is relieved. Warn the client that the dye in the drug (azo dye) may temporarily turn the urine red or orange but that isn't cause for calling the physician. Phenazopyridine is usually taken three times per day for 2 days. It isn't taken just before voiding. Antibiotics must be taken for the full course of therapy, even if the burning on urination is relieved.

20. A nurse is assigned to care for a client with nephrotic syndrome. The nurse assesses which important parameter on a daily basis? A. Weight B. Albumin levels C. Activity tolerance D. Blood urea nitrogen (BUN) level

20) A. Weight

21. Situation: Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. The diagnosis of Idiopathic Nephrotic Syndrome has been confirmed. Which unexpected finding would the nurse report? A. Proteinuria B. Distended abdomen C. Blood in the urine D. Elevated serum lipid levels

21) C. Blood in the urine Hematuria is rare in nephrotic syndrome but it is profuse is acute glomerulonephritis The manifestations of nephrotic syndrome are: Proteinuria - nephrosis is believed to be due to immunologic response that results in increased permeability of glomerular membrane to proteins resulting in massive protein losses in the urine -- proteinuria and albuminuria (+3 +4), the child losses 50-100 mg/kg weight/day from proteinuria. Hypoalbuminemia - loss of protein in blood results in hypoalbumenimia Edema - cardinal sign and appears first in the periorbital region followed by dependent edema and accompanied by pallor, fatigue and lethargy. Hypoalbuminemia leads to decreased oncotic pressure resulting in fluid shift from intravascular to interstitial causing generalized edema or anasarca. The child has lost appetite but gained weight -- puffiness of the eyes on awakening decreases during the day but appears on the legs and abdomen. Fluid shift causes decreased blood volume that leads to decreased blood supply to kidney. Decreased blood supply to kidney initiates release of aldosterone. Aldosterone causes sodium retention (in interstitial spaces so child will have hyponatremia) and water retention contributing to edema. Hypocholesteronemia and hyperlipidemia - triglycerides and fats are released by the liver in the blood to make up for the protein loss

22. Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. Carlo's potential for impairment of skin integrity is related to: A. Joint inflammation B. Drug therapy C. Edema D. Generalized body rash

22) C. Edema - management: reduce protein excretion Prevention of Skin Breakdown from Edema frequent turning keep nails short to prevent scratching meticulous skin care to dependent and edematous areas - sacrum, scrotum, labia, abdomen, legs loose clothing Monitor Edema weigh daily and monitor I and O check for pulmonary edema manifested by crackles on auscultation ascites - measure abdominal girth Prevention of Infection - pulmonary edema predisposes to respiratory infection and generalized edema predisposes to skin breakdown. Avoid contact with persons who have infection. Diet - usually anorexic because of GI edema high protein diet sodium restriction if with severe edema fluid intake equal to output and insensible loss vitamin and iron supplements small feedings, give favorite foods

23. Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome. Prednisone is prescribed for Carlo. The nurse evaluates its effectiveness by: A. Checking his BP every 4 hours B. Checking his urine for protein C. Weighing him each morning before breakfast D. Observing him for behavioral changes

23) B. Checking his urine for protein Monitor side effect of prolonged steroid therapy Hyperglycemia - test urine monitor growth of child by checking height because steroid has growth suppressing effect by preventing calcium deposition in the bones Gastric Irritation - give milk or meals, test for occult blood, administer with antacids Avoid exposure to infection because child is immunosuppressed

3. A nurse is assessing a client who is diagnosed with cystitis. Which assessment finding is inconsistent with the typical clinical manifestations noted in this disorder? A. Hematuria B. Low back pain C. Urinary retention D. Burning on urination

3) C. Urinary retention

4. A 24-year-old female client comes to an ambulatory care clinic in moderate distress with a probable diagnosis of acute cystitis. When obtaining the client's history, the nurse should ask the client if she has had: A. Fever and chills. B. Frequency and burning on urination. C. Flank pain and nausea. D. Hematuria.

4) B. The classic symptoms of cystitis are severe burning on urination, urgency, and frequent urination. Systemic symptoms, such as fever and nausea and vomiting, are more likely to accompany pyelonephritis than cystitis. Hematuria may occur, but it is not as common as frequency and burning.

5. The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by: A. Congenital strictures in the urethra. B. An infection elsewhere in the body. C. Urinary stasis in the urinary bladder. D. An ascending infection from the urethra.

5) D. Although various conditions may result in cystitis, the most common cause is an ascending infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.

6. The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which would be the nurse's best approach? A. Arrange a meeting with the client, her husband, the physician, and the nurse. B. Insist that the client talk with her husband because good communication is necessary for a successful marriage. C. Talk first with the husband alone and then with both of them together to share the husband's reactions. D. Spend time with the client addressing her concerns and then stay with her while she talks with her husband

6) D. As newlyweds, the client and her husband need to develop a strong communication base. The nurse can facilitate communication by preparing and supporting the client. Given the situation, an interdisciplinary conference is inappropriate and would not promote intimacy for the client and her husband. Insisting that the client talk with her husband is not addressing her fears. Being present allows the nurse to facilitate the discussion of a difficult topic. Having the nurse speak first with the husband alone shifts responsibility away from the couple.

7. The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse's instructions? A. "I will place ice packs on my perineum." B. "I will take hot tub baths." C. "I will drink a cup of warm tea every hour." D. "I will void every 5 to 6 hours."

7) B. Hot tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffeinated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encouraged because it reduces urinary stasis.

8. The client with cystitis is given a prescription for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by: A. Releasing formaldehyde and providing bacteriostatic action. B. Potentiating the action of the antibiotic. C. Providing an analgesic effect on the bladder mucosa. D. Preventing the crystallization that can occur with sulfa drugs.

8) C. Phenazopyridine hydrochloride (Pyridium) is a urinary analgesic that works directly on the bladder mucosa to relieve the distressing symptoms of dysuria. Phenazopyridine does not have a bacteriostatic effect. It does not potentiate antibiotics or prevent crystallization.

9. Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis? A. "I can usually go 8 to 10 hours without needing to empty my bladder." B. "I take a tub bath every evening." C. "I wipe from front to back after voiding." D. "I drink a lot of water during the day."

9) A. Stasis of urine in the bladder is one of the chief causes of bladder infection, and a client who voids infrequently is at greater risk for reinfection. A tub bath does not promote urinary tract infections as long as the client avoids harsh soaps and bubble baths. Scrupulous hygiene and liberal fluid intake (unless contraindicated) are excellent preventive measures, but the client also should be taught to void every 2 to 3 hours during the day.