NURS305- Exam 4

A nurse is caring for a patient who is taking phenazopyridine (Pyridium, a urinary tract analgesic). The patient questions the nurse: "My urine was bright orangish-red today; is there something wrong with me?" What would be the nurse's best response?

"This is a normal finding when taking phenazopyridine." "This may be a sign of blood in the urine." "This may be the result of an injury to your bladder." "This is a sign that you are allergic to the medication and must stop it."

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client?

"This medication will prevent re-infection." "This medication should be taken at bedtime." "This medication will relieve your pain." "This will kill the organism causing the infection

A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority?

-Acute pain related to the development of the genital lesions -Deficient knowledge related to the disease and its transmission -Ineffective coping related to the increased stress associated with the infection -Hyperthermia related to body's response to an infectious process

A nurse is assisting with a physical examination of a male client. Which of the following signs and symptoms is most clearly suggestive of primary genital herpes?

-Emergence of hard, painless nodules on the shaft of the penis -Presence of purulent, whitish discharge from the penis -Production of cloudy, foul-smelling urine -Itching, pain, and the emergence of pustules on the penis

The nurse is inserting an indwelling catheter into a female client. Which interventions should be implemented? Rank in the order of performance.

-Explain the procedure to the client. -Place absorbent pads under the client. -Set up the sterile field. -Inflate the catheter bulb. -Clean the perineum from clean to dirty with Betadine.

The nurse identifies which statements about penicillins as true? (Select all that apply.)

-Penicillins are the safest antibiotics available. - The principal adverse effect of penicillins is allergic reaction. - A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. - A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. - A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin. - Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin. - Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.

The nurse has admitted a client to the unit for treatment of acute pyelonephritis. Which collaborative intervention does the nurse anticipate initiating as a priority​?

A. Administration of intravenous​ (IV) antibiotics B. Administration of an analgesic C. Order for a urine specimen for culture and sensitivity D. Order for a complete blood count​ (CBC) with a differential C. Order for a urine specimen for culture and sensitivity

Which Antibiotics have Cross Sensitivity?

Cephalosporins have a Cross Sensitivity with Penicillin

Analgesics

relieves Burning

A client who reports an allergy to penicillin is ordered to receive cephalexin (Keflex). The correct action for the nurse is to:

A. Administer the medication as ordered with additional fluids. B. Administer the medication and carefully observe for allergic reaction. C. There is a cross-sensitivity between penicillin and cephalosporin medications. The nurse should observe for allergic reactions. D. Call the physician to change the order because of the allergy history. E. Administer another antibiotic after consulting the pharmacist. B. Administer the medication and carefully observe for allergic reaction.

What do we do BEFORE we start anything?

A Urine Sample & Culture

Which statement indicates a need for further teaching of the home care client with a long-term indwelling catheter?

A. "I will keep the collecting bag below the level of the bladder at all times." B. "Intake of cranberry juice may help decrease the risk of infection." C. "Soaking in a warm tub bath may ease the irritation associated with the catheter." D. "I should use clean technique when emptying the collecting bag." C. "Soaking in a warm tub bath may ease the irritation associated with the catheter."

The nurse is providing discharge teaching to a client with a urinary tract infection​ (UTI). Which instruction should the nurse​ include?

A. "We recommend that you use aseptic technique when cleansing the​ perineum." B. ​"Be sure to complete the full course of urinary​ analgesics." C. ​"It is important to follow this schedule for your​ antibiotics." D.​"You do not need to make a​ follow-up appointment." ​C. "It is important to follow this schedule for your​ antibiotics."

Which patient has the greatest risk for developing acute pyelonephritis?

A. 80-year-old woman who takes diuretics for mild heart failure B. 80-year-old man who drinks four cans of beer a day C. 36-year-old woman with diabetes mellitus who is pregnant D. 36-year-old man with diabetes insipidus C. 36-year-old woman with diabetes mellitus who is pregnant

Which action(s) would minimize the patient's risk for injury during insertion of an indwelling urinary catheter?

A. Assessing the patient for allergies related to latex, antiseptic, tape, and/or iodine-based substances. B. Thoroughly cleansing the patient's perineal area with povidone-iodine solution before inserting the catheter C. Performing proper hand hygiene and applying gloves before inserting the catheter D. Terminating the insertion if the patient reports pain at any time during the procedure

A patient has come to the clinic for follow up of acute pyelonephritis. Which action does the nurse reinforce to the patient?

A. Complete all antibiotic regimens B. Report episodes of nocturia C. Wash hands to prevent spreading infection D. Avoid taking any over-the-counter drugs A. Complete all antibiotic regimens

What laboratory values would the nurse observe in a patient experiencing problems with urinary elimination as a result of acute pyelonephritis? SATA

A. Complete blood count for evaluation of differentials B. Blood urea nitrogen and serum creatinine levels for evaluation C. Electrolyte deficiencies, such as hypokalemia and hyponatremia D. Urine culture to identify specific organisms causing infection E. Urinalysis for bacteria, leukocyte esterase, nitrate, or red blood cells F.. C-reactive protein and erythrocyte sedimentation rate for immune response

The nurse is assessing a patient who reports chills, high fever, and flank pain with urinary urgency and frequency. On physical examination, the patient has costovertebral angle tenderness, pulse is 110 beats/min, and respirations are 28/min. How does the nurse interpret these findings?

A. Complicated cystitis B. Acute pyelonephritis C. Chronic pyelonephritis D. Acute glomerulonephritis B. Acute pyelonephritis

A patient is diagnosed with hydronephrosis. What is the primary complication that could result from this condition?

A. Damage to blood vessels and kidney tubules B. Kidney stones disease with retained stones C. Hypertension and diabetic nephropathy D. Pyelonephritis with vesicoureteral reflux A. Damage to blood vessels and kidney tubules

A patient with chronic pyelonephritis returns to the clinic for follow up. Which behavior indicates the patient is performing the self-care measures to conserve existing kidney function?

A. Drinks a liter of fluid every day B. Considers buying a home blood pressure cuff C. Reports taking antibiotics as prescribed D. Takes pain medications on a regular basis C. Reports taking antibiotics as prescribed

Client is admitted to the emergency department for possible acute pyelonephritis. Which manifestation should the nurse consider to be consistent with this​ disorder? (Select all that​ apply.)

A. Flank tenderness B. Diarrhea C. Nocturia D. Urinary frequency E. Vomiting

The health care provider informs the nurse that the patient has acute pyelonephritis that appears to have been caused by a bacterial infection in the blood. For this patient, what is the priority concept?

A. Immunity B. Elimination C. Fluid and electrolyte imbalance D. Cellular regulation A. Immunity

The nurse is caring for a client who requires intermittent straight catheterization for impaired urinary elimination. Which nursing intervention should the nurse include in the plan of care to help prevent a urinary tract infection​ (UTI)?

A. Inflating the balloon when it is in the bladder B. Using aseptic technique when inserting the straight catheter C. Maintaining gravity flow to prevent urine reflux D. Maintaining a closed drainage system

Which manifestation is primarily associated with acute pyelonephritis?

A. Obstruction caused by hydroureter B. Active bacterial infection C. Increased urinary retention D. Peripheral and facial edema B. Active bacterial infection

A client with genital herpes asks the nurse about what to expect with the infection. Which of the following responses would be most appropriate?

A. Once you take the medication, the infection will be gone for good. B. You might have to try several different medications before finding one that works. C. Even though you don't have symptoms, you could still spread the infection. D. You can expect other outbreaks, each of which will be longer than the first. C. Even though you don't have symptoms, you could still spread the infection.

Which patient has the greatest risk for developing chronic pyelonephritis?

A. Patient is bedridden and has prostate enlargement with reflux B. Patient has hematuria and dysuria related to a urinary tract infection C.Patient had a nephrectomy secondary to severe kidney trauma D. Patient reports limiting fluids in the evening to control nocturia A. Patient is bedridden and has prostate enlargement with reflux

Which patient has the greatest risk for developing a kidney abscess?

A. Patient is diagnosed with acute pyelonephritis B. Patient has flank asymmetry related to hydronephrosis C. Patient developed a urinary tract infection secondary to a urinary catheter D. Patient is diagnosed with hypertension and nephrosclerosis A. Patient is diagnosed with acute pyelonephritis

What might the nurse notice if the patient is experiencing problems with urinary elimination as a result of acute pyelonephritis? SATA

A. Patient urinates large amounts of dilute urine B. Patient reports pain and burning on urination C. Patient reports back or flank pain D. Urine is cloudy and foul smelling E. Urine may be darker or smoky or have obvious blood in it F. Patient reports nocturia

Insertion of an indwelling urinary catheter increases the patient's risk for developing what type of kidney disorder?

A. Polycystic kidney disease B. Acute pyelonephritis C. Renal stenosis D. Nephrosclerosis B. Acute pyelonephritis

The nurse is caring for a client experiencing urinary retention. Which preventive​ catheter-associated urinary tract infection​ (CAUTI) measure should the nurse take to protect the client from a urinary tract infection​ (UTI)?

A. Review the criteria for catheter insertion. B. Obtain a urine sample for a urinalysis. C.Consider an alternative to an indwelling catheter. D.Initiate an antibiotic before inserting a catheter. C.Consider an alternative to an indwelling catheter.

After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching?

a. I will not take this drug with food or milk. b. If I think I am pregnant, I will stop the drug c. An orange color in my urine should not alarm me. d. I will drink two glasses of cranberry juice daily

A nurse is caring for an alert, ambulatory, older resident in a long-term care facility who voids frequently and has difficulty making it to the bathroom in time. Which nursing intervention would be most helpful for this patient?

A. Teach the patient that incontinence is a normal occurrence with aging. B. Ask the patient's family to purchase incontinence pads for the patient. C. Teach the patient to perform Kegel exercises at regular intervals daily. D. Insert an indwelling catheter to prevent skin breakdown. C. Teach the patient to perform Kegel exercises at regular intervals daily.

The nurse is creating a plan of care for a client with pyelonephritis. Which outcome reflects the​ client's ability to decrease the severity of the bacteria in the urinary​ tract?

A. The client will use antiseptic spray regularly on the perineal area. B. The client will complete the course of antibiotics. C. The client will drink at least 1500 mL of fluid per day and void every 2dash3 hours while awake. D. The client will wipe from back to front after voiding and defecating. C. The client will drink at least 1500 mL of fluid per day and void every 2dash3 hours while awake.

A nurse caring for patients in a long-term care facility is often required to collect urine specimens from patients for laboratory testing. Which techniques for urine collection are performed correctly? Select all that apply.

A. The nurse catheterizes a patient to collect a sterile urine sample for routine urinalysis. B. The nurse collects a clean-catch urine specimen in the morning from a patient and stores it at room temperature until an afternoon pick-up. C. The nurse collects a sterile urine specimen from the collection receptacle of a patient's indwelling catheter. D. The nurse collects about 3 mL of urine from a patient's indwelling catheter to send for a urine culture. E. The nurse collects a urine specimen from a patient with a urinary diversion by catheterizing the stoma. F. The nurse discards the first urine of the day when performing a 24-hour urine specimen collection on a patient.

A patient has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the patient?

A. The virus causes "cold sores" of the lips. B. Treatment is focused on relieving symptoms. C. The virus may be cured with antibiotics. D. The virus when active may not be contracted during intercourse.

A client has relayed instructions from a physician regarding an allergy to a type of antibiotic therapy. The nurse would question which instruction?

A. Wear a Medic Alert bracelet that indicates the allergy. B. Avoid all penicillin-type drugs. C. Inform all healthcare providers of the allergy. D. Restrict fluids when taking the antibiotic. D. Restrict fluids when taking the antibiotic.

A patient is admitted to the medical-surgical unit for acute pyelonephritis. What is the priority concept to consider in the immediate nursing care of this patient?

A.Oxygenation B.Acid-base balance C. Pain D. Cellular regulation C. Pain

What are the key features associated with chronic pyelonephritis? SATA

Abscess formation Hypertension Inability to conserve sodium Decreased urine-concentrating ability resulting in nocturia Tendency to develop hyperkalemia and acidosis Sudden onset of massive proteinuria

Describe the process of cleansing the female patient with betadine during the insertion of a Foley catheter

Clean farthest Labia Minora from front to back alongside Meatus Clean front to back over Meatus Do NOT cross Sterile Field with the used swab

The nurse is caring for a client with pyelonephritis. Which clinical manifestation should the nurse assess in the​ client? (Select all that​ apply.)

Fever Vomiting Enuresis Flank pain Dysuria

A 30-year-old female patient has sought care because of the recent appearance of itchy lesions on her vulva, some of which have recently burst. The patient's description of her problem would lead you to first suspect

HIV. Gonorrhea. Chlamydia. Genital herpes.

Teachings for Betadine (Iodopovidone)?

Possible GI UPSETTING

Pyelonephritis (Upper Urinary)

Receive Priority Intervention

Ms. White, the nursing instructor, is teaching her students how to prevent infection in patients with an indwelling catheter. Which student demonstrates correct understanding?

The bag should be emptied at least every eight hours (more if there are large amounts of urine) to prevent the risk of bacterial proliferation.

Which results are normal in a urinalysis? (Select all that apply.)

pH, 6 The pH of 6 is normal, since Urine has a normal pH range of 4.5 to 8. Specific gravity, 1.015 A specific gravity of 1.018 is normal, with normal ranging from 1.010 to 1.025. Protein, 1.2 mg/dL Glucose, negative Nitrate, small Leukocyte esterase, positive

Normal components of a Urinalysis

specific gravity, wbc, leukocyte esterase, pH

Urinalysis

tests the urine specimen at hand for appearance, concentration, and content and is a broad screening for abnormalities. Presence of Protein is abnormal and could indicate a kidney problem. The number of WBCs should only by 0 - 2 and a count of 10 could indicate an Infection.

Phenazopyridine (Pyridium)

treats urinary spasms, analgesic wont treat infection only bladder discomfort liver and renal contraindication take with food and change urine organge

Use of an indwelling urinary catheter leads to the loss of bladder tone.

true