Chapter 69 NCLEX Review

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide to this client about taking her prescribed trimethoprim/sulfamethoxazole (Bactrim)? Select all that apply. a. "Be certain to wear sunscreen and protective clothing." b. "Drink at least 3 liters of fluids every day." c. "Take this drug with 8 ounces of water." d. "Try to urinate frequently to keep your bladder empty." e. "You will need to take all of this drug to get the benefits."

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

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

a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.

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

a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." c. Frequency d. Nocturia e. Urgency (a) Dysuria-painful urination-is a symptom of a UTI. (c) Frequency-frequent urinating and in small amounts-is a sign of a UTI. (d) Nocturia-urinating at night-is (or can be) a symptom of a UTI. (e) Urgency-having the urge to urinate quickly-is a symptom of a UTI. INCORRECT: (b) Enuresis-bed-wetting-is not a sign of a UTI. (f) Polyuria-increased amounts of urine production-is not a sign of a UTI.

Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later-with the same symptoms. When asked about the previous UTI and medication regimen, she states, "I only took the first dose because after that, I felt better." How does the nurse respond? a. "Not completing your medication can lead to return of your infection." b. "That means your treatment will be prolonged with this new infection." c. "This means you will now have to take two drugs instead of one." d. "What you did was okay; however, let's get you started on something else."

a. "Not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and to bacterial drug resistance.

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? a. "Blood in my urine has become less noticeable; maybe I don't need this procedure." b. "I have been taking cephalexin (Keflex) for an infection." c. "I previously had several ESWL procedures performed." d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.

Which client with a long-term urinary problem does the nurse refer to community resources and support groups? Select all that apply. a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch c. 48-year-old with urinary calculi d. 78-year-old with urinary incontinence e. 80-year-old with dementia

a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch d. 78-year-old with urinary incontinence (a) The client with a cystectomy would benefit from community resources and support groups. Others who have had their bladders removed are good sources for information and for help in establishing coping mechanisms. (b) The client with a Kock pouch would benefit from community resources and support groups. Others who have had their bladders removed and are using an alternate method for urinating are good sources for information and for help in establishing coping mechanisms. (d) The older adult client with urinary incontinence would benefit from community resources and support groups. Others who have had this problem can provide methods of living with the problem or methods of curing (or minimizing) it.

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? a. Administers morphine sulfate 4 mg IV b. Begins an infusion of metoclopramide (Reglan) 10 mg IV c. Obtains a urine specimen for urinalysis d. Starts an infusion of 0.9% normal saline at 100 mL/hr

a. Administers morphine sulfate 4 mg IV Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.

Which client with an indwelling urinary catheter does a nurse re-assess to determine whether the catheterization needs to be continued or can be discontinued? Select all that apply. a. Three-day postoperative client b. Client in the step-down unit c. Comatose client with careful monitoring of intake and output (I&O) d. Incontinent client with perineal skin breakdown e. Incontinent long-term care older adult

a. Three-day postoperative client b. Client in the step-down unit e. Incontinent long-term care older adult (a) Three days after surgery, the client probably should be able to urinate on his or her own. This may be influenced by the type of surgery, which is not stated in the scenario. If the surgery was a bladder or urethral repair, then discontinuing the catheter might not be a consideration so soon. However, most clients do not need long-term catheterization after they have surgery. The incidence of complications (colonization of bacteria) begins to increase after 48 hours postinsertion. (b) The client who is out of an intensive care situation is definitely one who should be considered for discontinuation of his or her catheter. He or she should be somewhat ambulatory and able to get to a bedside commode. (e) Incontinency in older adults does not necessarily mean that they have to be catheterized. Often, the introduction of a catheter invites the possibility of infection. They can be managed with adult incontinent pads with less risk for developing a urinary tract infection (UTI). These infections in the older adult population are serious and should be avoided.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions does the nurse provide for postprocedure home care? a. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." b. "Do not share your toilet with family members for the next 24 hours." c. "Please be sure to stand when you are urinating." d. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

b. "Do not share your toilet with family members for the next 24 hours." The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet.

A nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? a. "A small-lumen catheter will help prevent injury to my urethra." b. "I will use a new, sterile catheter each time I do the procedure." c. "My family members can be taught to help me if I need it." d. "Proper handwashing before I start the procedure is very important."

b. "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating.

A nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? a. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours c. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy d. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence and is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. a. Administer the drug at bedtime. b. Encourage increased fluids. c. Increase fiber. d. Limit the intake of dairy products. e. Offer hard candy for "dry" mouth.

b. Encourage increased fluids. c. Increase fiber. e. Offer hard candy for "dry" mouth. (b) Anticholinergics cause constipation. Increasing fluids will help with this problem. (c) Anticholinergics cause constipation. An increase in daily fiber in the client's diet will help. (e) Anticholinergics cause extreme dry mouth. INCORRECT: (a) Taking the drug at night will not have an effect on the complications encountered-dry mouth and constipation. The drug is usually taken three to four times a day. (d) Limiting dairy products does not have an effect on the complications encountered-dry mouth and constipation.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply. a. Dry mouth b. Endometrial cancer c. Increased intraocular pressure d. Thrombophlebitis e. Vaginitis

b. Endometrial cancer d. Thrombophlebitis (b) Estrogen use can increase the risk for endometrial cancer. (d) Estrogen use can increase the risk for thrombophlebitis. Women who smoke-especially-should not use this drug. INCORRECT: (a) Dry mouth is not a side effect of estrogen use. (c) Increased intraocular pressure is not a side effect of estrogen use. It is a problem with anticholinergic use. (e) Vaginitis is not a side effect of estrogen use. However, clients should report any unusual vaginal bleeding.

Which interventions are helpful in preventing bladder cancer? Select all that apply. a. Drinking 2½ liters of fluid a day b. Showering after working with or around chemicals c. Stopping the use of tobacco d. Using pelvic floor muscle exercises e. Wearing a lead apron when working with chemicals f. Wearing gloves and a mask when working around chemicals and fumes

b. Showering after working with or around chemicals c. Stopping the use of tobacco f. Wearing gloves and a mask when working around chemicals and fumes (b)Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Bathing after exposure to them is advisable. (c) Tobacco use is one of the highest if not the highest risk factor in the development of bladder cancer. (f) Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. INCORRECT: (a) Increasing fluid intake is helpful for some urinary problems such as urinary tract infection (UTI), but no correlation has been noted between fluid intake and bladder cancer risk. (d) Using pelvic floor muscle strengthening exercises (Kegel) is helpful with certain types of incontinence; but no data show that these exercises prevent bladder cancer. (e) Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.

A nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? a. "I must avoid drinking carbonated beverages." b. "I need to douche vaginally once a week." c. "I should drink 2½ liters of fluid every day." d. "I will not drink fluids after 8 PM each evening."

c. "I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.

Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? a. "They can relieve your anxiety associated with incontinence." b. "They help your bladder to empty." c. "They may be used to improve urethral resistance." d. "They decrease your bladder's tone."

c. "They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.

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

c. "Wipe from your front to your back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.

A cognitively impaired client has urge incontinence. Which method for achieving continence does a nurse include in the client's care plan? a. Bladder training b. Credé method c. Habit training d. Kegel exercises

c. Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.

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

c. Positioning the collection bag below the height of the bladder Keep urine collection bags 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.

The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? a. Nutritional and dietary care b. Respiratory care c. Stoma and pouch care d. Wiping from front to back (asepsis)

c. Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? a. Functional b. Overflow c. Stress d. Urge

c. Stress Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.

Situation: A 32-year-old female with a urinary tract infection 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 nurse expect the health care provider to prescribe? a. Nitrofurantoin after intercourse b. Premarin c. Trimethoprim/sulfamethoxazole d. Trimethoprim with intercourse

c. Trimethoprim/sulfamethoxazole Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women.

An older adult woman confides to a nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? a. "Don't worry about it. You need them." b. "Shop at night-when stores are less crowded." c. "Tell everyone that they are for your husband." d. "That is tough. What do you think might help?"

d. "That is tough. What do you think might help?" This response acknowledges the client's concerns and attempts to help the client think of methods to solve her problem.

A nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? a. "For the best effect, perform all your exercises while you are seated on the toilet." b. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." c. "Results should be visible to you within 72 hours." d. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

d. "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used.

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

d. "Your urine will turn red or orange while on the drug." Phenazopyridine (Pyridium) will turn the client's urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.

Which client does the nurse manager on a medical unit assign to an experienced LPN/LVN? a. 42-year-old with painless hematuria who needs an admission assessment b. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site c. 48-year-old receiving intravesical chemotherapy for bladder cancer d. 55-year-old with incontinence who has intermittent catheterization prescribed

d. 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.

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

d. Re-evaluating periodically the need for indwelling catheters Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTI in the hospital setting.

A client 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 client? a. Discharges the client to her home for strict bedrest for the duration of the pregnancy b. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria c. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up

d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up Pregnant women with UTI 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.

A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a health care provider, for a client with a urinary tract infection (UTI) does the nurse question? a. Bactrim b. Cipro c. Noroxin d. Tegretol

d. Tegretol Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide (unlicensed assistive personnel [UAP])? a. Assisting the client in developing a schedule for when to take prescribed antibiotics b. Inserting a straight catheter as necessary if the client is unable to empty the bladder c. Teaching the client how to use the Credé maneuver to empty the bladder more fully d. Using a bladder scanner (with training) to check residual bladder volume after the client voids

d. Using a bladder scanner (with training) to check residual bladder volume after the client voids Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.

A nurse is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses

d. Words that the client uses The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client.

A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates correct understanding of these procedures? a. "If I restrict my oral intake of fluids, the adjustment will be easier." b. "I must go to the restroom more often because my urine will be excreted through my anus." c. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." d."I will have to drain my pouch with a catheter."

d."I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.