Parctice Q's

A client has nephropathy. The physician orders that a 24-hour urine collection be done for creatinine clearance. Which of the following actions is necessary to ensure proper collection of the specimen? 1. Collect the urine in a preservative-free container and keep it on ice. 2. Inform the client to discard the last voided specimen at the conclusion of urine collection. 3. Ask the client what his weight is before beginning the collection of urine. 4. Request an order for insertion of an indwelling urinary catheter.

1. All urine for creatinine clearance determination must be saved in a container with no preservatives and refrigerated or kept on ice. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate. It is not necessary to have an indwelling urinary catheter inserted for urine collection.

Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis? 1. "I can usually go 8 to 10 hours without needing to empty my bladder." 2. "I take a tub bath every evening." 3. "I wipe from front to back after voiding." 4. "I drink a lot of water during the day."

1. 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.

The nurse is caring for a client with acute pyelonephritis. Which nursing intervention is most important? 1. Administering a sitz bath twice per day 2. Increasing fluid intake to 3 L/day 3. Using an indwelling urinary catheter to measure urine output accurately 4. Encouraging the client to drink cranberry juice to acidify the urine

2 RATIONALES: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. This helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important interaction.NURSING PROCESS STEP: ImplementationCLIENT NEEDS CATEGORY: Physiological integrityCLIENT NEEDS SUBCATEGORY: Reduction of risk potentialCOGNITIVE LEVEL: Application

When a client with an indwelling urinary catheter insists on walking to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? 1. The client sets the drainage bag on the floor while sitting down. 2. The client keeps the drainage bag below the bladder at all times. 3. The client clamps the catheter drainage tubing while visiting with the family. 4. The client loops the drainage tubing below its point of entry into the drainage bag.

2 RATIONALES: To maintain effective drainage, the client should keep the drainage bag below the bladder; this allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because it could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.NURSING PROCESS STEP: EvaluationCLIENT NEEDS CATEGORY: Physiological integrityCLIENT NEEDS SUBCATEGORY: Basic care and comfortCOGNITIVE LEVEL: Application

When teaching the client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which symptoms to the health care provider (HCP)? Select all that apply. a) blood in the urine b) fever above 100° F (37.8° C) c) cloudy urine for the first few days d) mild nausea e) urinating every 3 to 4 hours f) rash

A, B, F