When planning an assessment of the urethra, what does the nurse do first?
A. Examine the meatus.
B. Note any unusual discharge.
C. Record the presence of abnormalities.
D. Don gloves.
D. Don gloves.
Rationale: Before examination begins, body fluid precautions (gloves) must be implemented first. Examining the meatus, noting unusual discharge, or recording the presence of abnormalities are things that the nurse should do after putting on gloves.
When caring for a client with uremia, the nurse assesses for which symptom?
A. Tenderness at the costovertebral angle (CVA)
B. Cyanosis of the skin
C. Nausea and vomiting
D. Insomnia
C. Nausea and vomiting
Rationale: Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue. CVA tenderness is a sign of inflammation or infection in the renal pelvis. Cyanosis is related to poor tissue perfusion. Insomnia is nonspecific and may be caused by psychoemotional factors, medications, or other problems.
Which laboratory test is the best indicator of kidney function?
A. Blood urea nitrogen (BUN)
B. Creatinine
C. Aspartate aminotransferase (AST)
D. Alkaline phosphatase
B. Creatinine
Rationale: Creatinine excretion, the end product of muscle metabolism, remains relatively steady and therefore is the best indicator of renal function. BUN may be affected by protein or fluid intake. AST and alkaline phosphatase are measures of hepatic function.
When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor?
A. Abdominal girth
B.Presence of urinary infection
C. History of hysterectomy
D. Hematuria
C. History of hysterectomy
Rationale: The scanner must be in the scan mode for female clients to ensure the scanner subtracts the volume of the uterus from the measurement, or in the scan mode for male clients for women who have undergone a hysterectomy. The nurse performs this procedure in response to distention or pressure in the bladder; girth is not a factor. This procedure detects urine retained in the bladder, not infection. The presence of retained urine in the bladder is assessed, regardless of hematuria.
The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast:
History and Physical Assessment Medications Diagnostic Findings
Polycystic kidney disease
Diabetes
Hysterectomy
Abdomen distended
Negative edema Glyburide
Metformin
Synthroid
BUN 26 mg/dL
Creatinine 1.0 mg/dL
HbA1c 6.9%
Glucose 132 mg/dL
Which intervention is essential for the nurse to perform?
A. Obtain a thyroid-stimulating hormone (TSH) level.
B. Report the blood urea nitrogen (BUN) and creatinine.
C. Hold the metformin 24 hours before and on the day of the procedure.
D. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.
C. Hold the metformin 24 hours before and on the day of the procedure.
Rationale: Before studies with contrast media are performed, the nurse must withhold metformin, which may cause lactic acidosis. The focus of this admission is the polycystic kidneys; a TSH level is not essential at this time. BUN and creatinine are normal. The glucose is only mildly elevated (if fasting), and the HbA1c is in an appropriate range.
A client has returned from a captopril renal
scan. Which teaching does the nurse provide when the client returns?
A. "Arise slowly and call for assistance when ambulating."
B. "I must measure your intake and output."
C."We must save your urine because it is radioactive."
D. "I must attach you to this cardiac monitor."
A. "Arise slowly and call for assistance when ambulating."
Rationale: Captopril can cause severe hypotension during and after the procedure, so the client should be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension. Intake and output measurement is not necessary after this procedure, unless it had been requested previously. A small amount of radionuclide is used in a renal scan; the urine is not radioactive, although the nurse should practice Standard Precautions, as always, and wear gloves. Cardiac monitoring is not needed, although the nurse should monitor for hypotension secondary to captopril.
Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation?
A.Pink-tinged urine
B.Urinary frequency
C.Temperature of 100.8° F
D. Lethargy
C.Temperature of 100.8° F
Rationale: Fever, chills, or an elevated white blood cell count after cystoscopy suggest infection after an invasive procedure; the provider must be notified immediately. Pink-tinged urine is expected after a cystoscopy; gross hematuria would require notification of the surgeon. Frequency may be noted as a result of irritation of the bladder. If sedation or anesthesia was used, lethargy is an expected effect.
Which instruction does the nurse give a client who needs a clean-catch urine specimen?
A. "Save all urine for 24 hours."
B. "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup."
C."Do not touch the inside of the container."
D. "You will receive an isotope injection, then I will collect your urine."
C."Do not touch the inside of the container."
Rationale: A clean-catch specimen is used to obtain urine for culture and sensitivity of organisms present; contamination by the client's hands will render the specimen invalid and alter results. Saving urine for 24 hours is not necessary for a midstream clean-catch urine specimen. After cleaning, the client should initiate voiding into the commode, then stop and resume voiding into the container. Only 1 ounce (30 mL) is needed; the remainder of the urine may be discarded into the commode. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. A clean-catch specimen for culture does not require an injection of isotope, simply cleansing of the perineum.
The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day?
A. Client with chronic kidney disease
B. Client with heart failure
C. Client with complete bowel obstruction
D. Client with hyperparathyroidism
D. Client with hyperparathyroidism
Rationale: A major feature of hyperparathyroidism is hypercalcemia, which predisposes a client to kidney stones; this client should remain hydrated. A client with chronic kidney disease should not consume 2 to 3 liters of water because the kidneys are not functioning properly, and this could lead to fluid retention. People with heart failure typically have fluid volume excess. A client with complete bowel obstruction may experience vomiting and should be NPO.
A client with these assessment data is preparing to undergo a computed tomography scan with contrast:
Physical Assessment Diagnostic Findings Medications
Flank pain BUN 54 mg/dL Captopril
Dysuria Creatinine 2.4 mg/dL Metformin
Bilateral knee pain Calcium 8.5 mg/dL Acetylcysteine
Which medication does the nurse plan to administer before the procedure? A. Acetylcysteine (Mucosil)
B. Metformin (Glucophage)
C. Captopril (Capoten)
D. Acetaminophen (Tylenol)
A. Acetylcysteine (Mucosil)
Rationale: This client has kidney impairment demonstrated by increased creatinine. Acetylcysteine (an antioxidant) may be used to prevent contrast-induced nephrotoxic effects. Metformin is held at least 24 hours before procedures using contrast. Although captopril and acetaminophen may be administered with a sip of water with permission of the provider, this is not essential before the procedure.
The
nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first?
A. Administer heparin intravenously.
B. Remove the urinary catheter.
C.Notify the health care provider.
D. Irrigate the catheter with sterile saline.
C.Notify the health care provider.
Rationale: Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. The nurse should monitor urine output and notify the health care provider of obvious blood clots or a decreased or absent urine output. Heparin will not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and should not be removed at this time. The Foley catheter may be irrigated with sterile saline, as ordered.
A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take?
A. Asks the client to sign the informed consent
B. Cancels the procedure
C. Asks the client's spouse to sign the form
D.Notifies the department and the provider
D.Notifies the department and the provider
Rationale: The client may be asked to sign the consent form in the department; notifying both the provider and the department ensures communication across the continuum of care, with less likelihood of omission of information. The provider gives the client a complete description of and reasons for the procedure and explains complications; the nurse reinforces this information. The procedure should not be cancelled without an attempt to correct the situation. The client has not received sedation, so nothing suggests that the client is not competent to consent.
An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response?
A. "Have you tried using the toilet at least every couple of hours?"
B."How does that make you feel?"
C. "We can fix that."
D. "That happens when we get older."
A. "Have you tried using the toilet at least every couple of hours?"
Rationale: By emptying the bladder on a regular basis, urinary incontinence from overflow may be avoided, which may give the client some sense of control. The client has already stated how she feels; asking her again how she feels does not address her concern nor does it allow for nursing education. The nurse cannot assert that the problem can be fixed because this may be untrue. Suggesting that the problem occurs as we get older does not address the client's concern and does not provide for nursing education.
A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client?
A. Increased oral fluids
B.IV fluids
C. Privacy
D. Health history forms
C. Privacy
Rationale: The nurse should provide privacy, assistance, and voiding stimulants, such as warm water over the perineum, as needed, for the client with urinary problems. Increased oral fluids and IV fluids would exacerbate the client's problem. Obtaining a health history is not the priority for this client's care.
The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective?
A. "I must clean with the wipes and then urinate directly into the cup."
B. "I will have to drink 2 liters of fluid before providing the sample."
C. "I'll start to urinate in the toilet, stop, and then urinate into the cup."
D. "It is best to provide the sample while I am bathing."
C. "I'll start to urinate in the toilet, stop, and then urinate into the cup."
Rationale: To provide a clean-catch urine sample, the client should initiate voiding, then stop, then resume voiding into the container. A midstream collection further removes secretions and bacteria because urine flushes the distal portion of the internal urethra. Although cleaning with wipes before providing a clean-catch urine sample is proper procedure, a step is missing. It is not necessary to drink 2 liters of fluid before providing a clean-catch urine sample. Providing a clean-catch urine sample does not involve bathing.
Which age-related change can cause nocturia?
A. Decreased
ability to concentrate urine
B. Decreased production of antidiuretic hormone
C. Increased production of erythropoietin
D. Increased secretion of aldosterone
A. Decreased ability to concentrate urine
Rationale: Nocturia may result from decreased kidney-concentrating ability associated with aging. Increased production of antidiuretic hormone, decreased production of erythropoietin, and decreased secretion of aldosterone are age-related changes.
Which urinary assessment information for a client indicates the potential need for increased fluids?
A.Increased blood urea nitrogen
B. Increased creatinine
C.Pale-colored urine
D. Decreased sodium
A.Increased blood urea nitrogen
Rationale: Increased blood urea nitrogen can indicate dehydration. Increased creatinine indicates kidney impairment. Pale-colored urine signifies diluted urine, which indicates adequate fluid intake. Increased, not decreased, sodium indicates dehydration.
Which percussion technique does the nurse use to assess a client who reports flank pain?
A. Place outstretched fingers over the flank area and percuss with the fingertips.
B. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank.
C. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank.
D. Quickly tap the flank area with cupped hands.
B. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank.
Rationale: While the client assumes a sitting, side-lying, or supine position, the nurse forms one of the hands into a clenched fist. The other hand is placed flat over the costovertebral (CVA) angle of the client. Then, a firm thump is quickly delivered to the hand over the CVA area. Percussion is not appropriate for flank pain. Placing one hand palm up is not the correct technique. Percussion therapy, not assessment, involves tapping the flank area.
Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter?
A. Disconnect the Foley catheter from the drainage
tube and collect urine directly from the Foley.
B. Remove the existing catheter and obtain a sample during the process of inserting a new Foley.
C. Use a sterile syringe to withdraw urine from the urine collection bag.
D. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.
D. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.
Rationale: Clamping the tubing, attaching a syringe to the specimen, and withdrawing at least 5 mL of urine is the correct technique for obtaining a sterile urine specimen from the client with a Foley catheter. Disconnecting the Foley catheter from the drainage tube and collecting urine directly from the Foley increases the risk for microbe exposure. A Foley catheter should not be removed to get a urine sample. Microbes may be in the urine collection bag from standing urine, so using a sterile syringe to withdraw urine from the urine collection bag is not the proper technique to obtain a urine sample.
A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client?
A. Maintaining bedrest
B.Medicating for pain
C.Monitoring for hematuria
D. Promoting fluid intake
D. Promoting fluid intake
Rationale: The nurse should ensure adequate hydration by urging the client to take oral fluid or by giving IV fluids. Hydration reduces the risk for kidney damage. Bedrest is not indicated for the client who has undergone a CT scan with contrast dye. CT with contrast dye is not a painful procedure, so pain medication is not indicated. The client who has undergone CT with contrast dye is not at risk for hematuria.
The charge nurse is making client assignments for the day shift. Which
client is best to assign to an LPN/LVN?
A. Client who has just returned from having a kidney artery angioplasty
B. Client with polycystic kidney disease who is having a kidney ultrasound
C.Client who is going for a cystoscopy and cystourethroscopy
D. Client with glomerulonephritis who is having a kidney biopsy
B. Client with polycystic kidney disease who is having a kidney ultrasound
Rationale: Kidney ultrasounds are noninvasive procedures without complications; the LPN/LVN can provide this care. A kidney artery angioplasty is an invasive procedure that requires postprocedure monitoring for complications, especially hemorrhage; a registered nurse is needed. Cystoscopy and cystourethroscopy are procedures that are associated with potentially serious complications such as bleeding and infection. These clients should be assigned to RN staff members. Kidney biopsy is associated with potentially serious complications such as bleeding, and this client should be assigned to RN staff members.
The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first?
A. Obtain blood urea nitrogen (BUN) and creatinine.
B. Position the client supine.
C. Administer pain medications.
D. Check urine for hematuria.
B. Position the client supine.
Rationale: The client is positioned supine for several hours after a kidney biopsy to decrease the risk for hemorrhage. BUN and creatinine would be obtained before the procedure is performed. Only local discomfort should be noted around the procedure site; severe pain would indicate hematoma. Although pink urine may develop, the nurse should position the client to prevent bleeding first; the other actions are appropriate after this procedure, but do not need to be done immediately after the biopsy.
When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first?
A. Give lispro (Humalog) insulin, 12 units subcutaneously.
B. Request a breakfast tray for the client.
C. Infuse 0.45% normal saline at 125 mL/hr.
D. Administer captopril (Capoten).
C. Infuse 0.45% normal saline at 125 mL/hr
Rationale: Fluids are needed because the dye used in a CT scan with contrast has an osmotic effect, causing dehydration and potential kidney failure. Lispro is not administered until the breakfast tray arrives. A breakfast tray will be requested, but preventing complications of the procedure is done first. Because the client may be hypovolemic, the nurse should monitor blood pressure and administer IV fluids before deciding whether administration of captopril is appropriate.
One of the nurse's roles 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
Rationale: 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. The use of children's terms is demeaning to adult clients. The use of slang terms is unprofessional. Technical terms should not be used because the client may not know what they mean.
For which clients scheduled for a computed tomography
(CT) scan with contrast does the nurse communicate safety concerns to the health care provider? (Select all that apply.)
A. Client with an allergy to shrimp
B. Client with a history of asthma
C. Client who requests morphine sulfate every 3 hours
D. Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL
E. Client who took metformin (Glucophage) 4 hours ago
A. Client with an allergy to shrimp
B. Client
with a history of asthma
D. Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL
E. Client who took metformin (Glucophage) 4 hours ago
Rationale: The client who will be undergoing a CT scan with contrast should be asked about known hay fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. Contrast reactions have been reported to be as high as 15% in these clients. Clients with asthma have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. The risk for contrast-induced nephropathy is increased in clients who have pre-existing renal insufficiency (e.g., serum creatinine levels greater than 1.5 mg/dL or estimated glomerular filtration rate less than 45 mL/min). Metformin must be discontinued at least 24 hours before and for at least 48 hours after any study using contrast media because the life-threatening complication of lactic acidosis, although rare, could occur. There are no contraindications to undergo CT with contrast while taking morphine sulfate. CT with contrast may help to identify the underlying cause of pain.
The client arrives to the primary care clinic with a problem of new abdominal pain and blood in her urine. She is afebrile. Which information is most important for the nurse to obtain from this client's history?
A. Kidney cancer in the client's family
B.
Injury or trauma to the abdomen or pelvis
C. Treatment for a urinary tract infection in the past 12 months
D. Recent exposure to heavy metals, drugs, or other nephrotoxins
B. Injury or trauma to the abdomen or pelvis
Rationale: Bladder trauma or injury should be considered in the patient with abdominal pain. Lack of fever reduces suspicion for infection; pain is not usually associated with kidney cancer or acute and chronic kidney injury from nephrotoxins
The client's urinalysis shows all of the following abnormal results. Which result does the nurse report to the health care provider immediately?
A. pH 7.8
B. Protein 31 mg
C. Sodium 15 mEq/L
D. Leukoesterase and nitrate positive
D. Leukoesterase and nitrate positive
Rationale: Although the alkaline pH is abnormal, it may be the results of diet or other benign factors; the slight increase in protein is concerning but not urgent and may be explained by diet, strenuous activity, or other benign causes, similar to the slightly elevated sodium, which could be from salty food ingestion. However, the most common cause of positive leukoesterase result is a UTI, and this test is further confirmed with a positive nitrate result.
Which assessments are most important for the nurse to perform when monitoring a client who returns to
the medical-surgical unit after a dye-enhanced CT scan?
A. Body temperature and urine odor
B. Kidney tenderness and flank pain
C. Urine volume and color
D. Specific gravity and pH
C. Urine volume and color
Rationale: To prevent dye-induced nephrotoxicity, the nurse should evaluate the urine and ensure a large, dilute output for several hours after the test. Generally, the amount of contrast does not cause dehydration; the concern is that the high osmolar content of some dyes has a direct nephrotoxic affect. Kidney tenderness and flank pain may indicate bleeding, a complication from a kidney biopsy. Body temperature and urine odor may indicate a UTI after manipulation of the urinary tract system and manipulation (e.g., placement of a urinary catheter or instilling of fluid into the bladder) does not occur with a CT scan.
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
Rationale: Urine collection bags must be kept 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. Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation should be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.
The 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."
Rationale: Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL
The nurse is educating a female client 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 front to back."
D. "Wipe with the softest toilet paper available."
C. "Wipe from front to back.
Rationale: Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection. Douching is an unhealthy behavior because it removes beneficial organisms as well as the harmful ones. White toilet paper helps prevent allergies, not infections. Using soft toilet paper does not prevent infection.
The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include?
A. "For the best effect, perform all of 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."
Rationale: When the client can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and should be performed more often than 5 minutes twice daily. Noticeable results take several weeks.
The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective?
A. "I am so relieved that I can continue eating my fried fish meals every week."
B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore."
C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe."
D. "I will no longer be able to have red wine with my dinner."
D. "I will no longer be able to have red wine with my dinner."
Rationale: Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.
An older adult woman confides to the 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?"
Rationale: Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem. Telling the client not to worry is dismissive of the client's concerns. Telling the client to shop at night does not empower the client, and it reaffirms the client's embarrassment. Suggesting to the client that she tell everyone they are for her husband also does not empower the client; rather, it suggests to the client that telling untruths is acceptable.
he nurse is teaching a client who
is scheduled for a neobladder and a Kock pouch. Which client statement indicates a 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."
Rationale: 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. Fluids should not be restricted. A neobladder does not require the use of an ostomy bag.
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 that catheters be placed in all clients
D. Periodically re-evaluating the need for indwelling catheters
D. Periodically re-evaluating the need for indwelling catheters
Rationale: Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTIs in the hospital setting. Encouraging fluids, although it is a valuable practice for clients with catheters, will not necessarily prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with congestive heart failure and kidney failure. Irrigating catheters daily is contraindicated; any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.
Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise?
A. Functional
B. Overflow
C. Stress
D. Urge
C. Stress
Rationale: Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence. Functional incontinence is not caused by a weakened pelvic floor; rather, it is due to structural problems often resulting from injury or trauma. Overflow incontinence is caused by too much urine being stored in the bladder. Urge incontinence is caused by a problem (i.e., neurologic) with the client's urge to urinate.
The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist 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
Rationale: The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms. The registered dietitian teaches the cystectomy client about nutritional care. The respiratory therapist teaches the cystectomy client about respiratory care. The client with a cystectomy does not require instruction about front-to-back wiping.
The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a 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."
Rationale: 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. Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output should be at least 1.5 liters daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.
The 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."
Rationale: Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that should be stressed.
A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction 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.
Rationale: The toilet should not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach. The client must sit when he is urinating for at least 24 hours postprocedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation should be washed separately from other clothing in a solution of 10% liquid bleach; it does not need to be discarded.
Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN?
A. A 42-year-old with painless hematuria who needs an admission
assessment
B. A 46-year-old scheduled for cystectomy who needs help in selecting a stoma site
C. A 48-year-old receiving intravesical chemotherapy for bladder cancer
D. A 55-year-old with incontinence who has intermittent catheterization prescribed
D. A 55-year-old with incontinence who has intermittent catheterization prescribed
Rationale: Insertion of catheters is within the education and legal scope of practice for LPN/LVNs. Admission assessments and intravesical chemotherapy should be done by an RN. Preoperative preparation for cystectomy and stoma site selection should be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse or an enterostomal therapy nurse.
A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the
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
Rationale: 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. Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.
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. Administer morphine sulfate 4 mg IV.
B. Begin an infusion of metoclopramide (Reglan) 10 mg IV.
C. Obtain a urine specimen for urinalysis.
D. Start an infusion of 0.9% normal saline at 100 mL/hr.
A. Administer morphine sulfate 4 mg IV.
Rationale: Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension. An infusion of metoclopramide (Reglan) 10 mg IV should be begun after the client's pain is controlled. A urine specimen for urinalysis should be obtained and an infusion of 0.9% normal saline at 100 mL/hr should be started after the client's pain is controlled.
The nurse receives the
change-of-shift report on four clients. Which client does the nurse decide to assess first?
A. A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C)
B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours
C. A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy
D. A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed
B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours
Rationale: Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention. The 26-year-old admitted with urosepsis and slight fever, the 32-year-old scheduled for cystoscopy, and the 40-year-old with noninfectious urethritis are not at immediate risk for complications or deterioration
A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan?
A. Bladder training
B.Credé method
C. Habit training
D. Kegel exercises
C. Habit training
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, so 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.
Rationale: Because a high risk for bleeding during ESWL has been noted, clients should not take nonsteroidal anti-inflammatory drugs before this procedure; the ESWL will have to be rescheduled for this client. Blood in the client's urine should be reported to the health care provider, but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures should be reported, but will not require rescheduling of the procedure.
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 for immediate follow-up
D. Refers the client to the clinic nurse practitioner for immediate follow-up
Rationale: Pregnant women with UTIs 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. It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need follow-up with a health care provider.
A 53-year-old postmenopausal woman reports "leaking urine" when she laughs, and 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."
Rationale: Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance. Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual or, if that is not possible, by using a catheter. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.
A 32-year-old female with a urinary tract infection (UTI) 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 health care provider prescribe?
A. Nitrofurantoin (Macrodantin) after intercourse
B. Estrogen (Premarin)
C.Trimethoprim/sulfamethoxazole (Bactrim)
D. Phenazopyridine (Pyridium) with intercourse
C.Trimethoprim/sulfamethoxazole (Bactrim)
Rationale: Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired UTI in women. Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This client needs a drug that will kill bacteria. Estrogen cream may help prevent recurrent UTIs in postmenopausal women, which this client is not (at age 32). Use of Premarin is related to problems with incontinence. Phenazopyridine (Pyridium) is not used to treat infection, but symptoms of a UTI.
A client who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the client 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."
Rationale: Not completing the drug regimen can lead to recurrence of an infection and bacterial drug resistance. Needing to be re-treated does not mean that the client will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this client's history, larger doses for a shorter time span may be a wise plan. The client does not need to take two drugs, and this response is punitive rather than instructive. Saying that the client's actions were okay does not inform the client with respect to nonadherence. The client needed to take all the prescribed medication to make certain that the infection was properly treated.
The nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by the 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
Rationale: Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin (gatifloxacin) and Tegretol (carbamazepine). The former is used for UTI, and the latter is prescribed as an oral anticonvulsant. Bactrim (trimethoprim/sulfamethoxazole), Cipro (ciprofloxacin), and Noroxin (norfloxacin) are drugs used to treat UTI.
The 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.
Rationale: Phenazopyridine will turn the client's urine red or orange. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed, and care should be taken because it will stain undergarments. Phenazopyridine reduces bladder pain and burning by exerting a local analgesic/anesthetic effect on the mucosa of the urinary tract. It does treat the symptoms of bladder infection; it has no antibacterial action. Phenazopyridine should be taken with a meal or immediately after eating.
What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)?
A. Limit fluid intake.
B.Increase caffeine consumption.
C. Limit sugar intake.
D. Drink about 3 liters of fluid daily
D. Drink about 3 liters of fluid daily
Rationale: Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs. Fluids flush the system and should not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.
The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction?
A. "I take my medication only when I have symptoms."
B. "I always wipe front to back."
C. "I don't use bubble baths and other scented bath products."
D. "I try to drink 3 liters of fluid a day."
A. "I take my medication only when I have symptoms."
Rationale: Clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent. Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 liters of fluid a day help prevent UTIs.
Which clients with an indwelling urinary catheter does the nurse reassess 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 stepdown unit
C. Comatose client with careful monitoring of intake and output (I&O)
D. Incontinent client with perineal skin breakdown
E. Incontinent older adult in long-term care
A. Three-day postoperative client
B. Client in the stepdown unit
E. Incontinent older adult in long-term care
Rationale: Three days after surgery, the postoperative client probably should be able to urinate on his or her own. This may be influenced by the type of surgery, but 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. The client in the stepdown unit is definitely one who should be considered for catheter discontinuation; he or she should be somewhat ambulatory and able to get to a bedside commode. Incontinence in older adults does not necessarily mean that they have to be catheterized. The introduction of a catheter invites the possibility of infection. These clients can often be managed with adult incontinence pads with less risk for developing a urinary tract infection. These infections in the older adult population are serious and should be avoided. The comatose client who is on strict I&O must have a urinary catheter in place to keep an accurate account of fluid balance. A client who is incontinent with no breakdown areas would be considered, but perineal skin problems in this situation make a catheter necessary for this client's skin to have a clean, dry environment for healing.
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
Rationale: 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. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer. Increasing fluid intake is helpful for some urinary problems such as urinary tract infection, but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence, but no data show that these exercises prevent bladder cancer. Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.
Which clients with long-term urinary problems does the nurse refer to community resources and support groups? (Select all that apply.)
A. A 32-year-old with a cystectomy
B. A 44-year-old with a Kock pouch
C. A 48-year-old with urinary calculi
D. A 78-year-old with urinary incontinence
D. An 80-year-old with dementia
A. A 32-year-old with a cystectomy
B. A 44-year-old with a Kock pouch
D. A 78-year-old with urinary incontinence
Rationale: Clients with a cystectomy, Kock pouch, or urinary incontinence would benefit from community resources and support groups. Others who have had their bladders removed are good sources of information and for help in establishing coping mechanisms. They can provide ideas for living with the problem or methods of curing (or minimizing) it. Urinary calculi typically are not a long-term problem that requires community resources and support groups. The older adult client with dementia would not benefit from community resources and support groups because of the client's cognitive difficulties.
The 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. Dysuria
C.Frequency
D.Nocturia
E Urgency
Rationale: Dysuria (painful urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly) are symptoms of UTI. Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.
An older adult client diagnosed with stress incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? (Select all that apply.)
A. Dry mouth
B. Increased blood pressure
C. Increased intraocular pressure
D.Constipation
E. Reddish-orange urine color
A. Dry
mouth
C. Increased intraocular pressure
D.Constipation
Rationale: Oxybutynin is an anticholinergic/antispasmodic. Side effects include dry mouth, urinary retention, constipation, and risk for increased intraocular pressure with the potential to make glaucoma worse. Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.
A client diagnosed with stress incontinence 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. Take the drug at bedtime.
B. Encourage increased fluids.
C.Increase fiber intake.
D. Limit the intake of dairy products.
E. Use hard candy for dry mouth
B. Encourage increased fluids.
C.Increase fiber intake.
E. Use hard candy for dry mouth
Rationale: Anticholinergics cause constipation; increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth. Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.
A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (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."
Rationale: Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole. Increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules; fluid intake prevents this complication. Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. Emptying the bladder is important, but not keeping it empty. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.
The nurse in the urology clinic is
providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? (Select all that apply.)
A. Cleanse the perineum from back to front after using the bathroom.
B. Try to take in 64 ounces of fluid each day.
C. Be sure to complete the full course of antibiotics.
D. If urine remains cloudy, call the clinic.
E. Expect some flank discomfort until the antibiotic has worked.
B. Try to
take in 64 ounces of fluid each day.
C. Be sure to complete the full course of antibiotics.
D. If urine remains cloudy, call the clinic.
Rationale: Between 64 and 100 ounces (2 to 3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the client should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney.
What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? (Select all that apply.)
A. "Your urine will be strained after the procedure."
B. "Be sure to finish all of your antibiotics."
C. "Immediately call the health care provider if you notice bruising."
D. "Remember to drink at least 3 liters of fluid a day to promote urine flow."
E. "You will need to change the incisional dressing once a day."
A. "Your urine will be strained after the procedure."
B. "Be sure to finish all of your antibiotics."
D. "Remember to drink at least 3 liters of fluid a day to promote urine flow."
Rationale: After lithotripsy, urine is strained to monitor the passage of stone fragments. Clients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow. Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The client must notify the health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.
A client in the community health clinic is prescribed trimethoprim/sulfamethoxazole for cystitis. She reports that she developed
hives to "something called Septra." What is the nurse's best action?
A. Reassure the client that Septra is not trimethoprim/sulfamethoxazole.
B. Highlight this important information in the client's medical record.
C. Place an allergy alert band on the client's wrist.
D. Notify the prescriber immediately.
D. Notify the prescriber immediately.
Rationale: Septra is a brand name for TMP-SMX, a sulfa-based antibiotic with multiple brand names. It is inappropriate to band a wrist in a community health clinic. This information may need to be added to the client's medical record, but simply highlighting the information will not prevent an avoidable adverse drug event. The provider needs the allergy information in order to substitute another effective antibiotic.
For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter?
A. 36-year-old woman who is blind
receiving diuretics
B. 46-year-old man who has paraplegia and is admitted for asthma management
C. 56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes
D. 66-year-old man who has severe osteoarthritis and high risk for falling
C. 56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes
C. 56-year-old woman who is admitted with a vaginal-rectal fistula and diabetes
The client passes a urinary stone that laboratory analysis indicates is composed of calcium oxalate. Based on this analysis, which instruction does the nurse specifically include for dietary prevention of the problem?
A. "Increase your intake of meat, fish, and cranberry juice."
B. "Avoid citrus fruits and citrus juices such as oranges."
C. "Avoid dark green leafy vegetables such as spinach."
D. "Decrease your intake of dairy products, especially milk."
C. Avoid dark green leafy vegetables such as spinach."
Rationale: Calcium oxalate stones form more easily in the presence of oxalate. Sources of oxalate include spinach, black tea, and rhubarb. Avoiding these sources of oxalate may reduce the number of stones formed. Citrus intake is not restricted in this type of stone and is often suggested to be increased. Dietary intake of calcium does not appear to affect calcium-based stone formation, although the client should avoid calcium mineral supplements. Moderation of meat reduces stone formation in general.
A 65-year old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer?
A. Smoking
B. Urine with a high specific gravity
C. Recurrent urinary tract infections
D. History of cancer in another organ or tissue
A. Smoking
Rationale: Many compounds in tobacco enter the bloodstream and affect other organs, such as the bladder. Concentrated urine is associated with kidney stones and UTIs. The urinary bladder is not a common site for metastases.