chapter 48 Flashcards
A client returns to the clinic with recurrent dysuria after being treated with
trimethoprim-sulfamethoxazole for 3 days. Which of the following actions should the
nurse plan to take?
a. Remind the client about the need to drink 1 000 mL of fluids daily.
b. Obtain a midstream urine specimen for culture and sensitivity testing.
c. Teach the client to take the prescribed trimethoprim-sulfamethoxazole for at least 3
more days.
d. Suggest that the client use acetaminophen to treat the symptoms.
B
Since uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3
days of antibiotic therapy, this client will need a urine culture and sensitivity to determine
appropriate antibiotic therapy. Acetaminophen would not be as effective as other
over-the-counter (OTC) medications such as phenazopyridine in treating dysuria. The
fluid intake should be increased to at least 1 800 mL/day. Since the UTI has persisted after
treatment with trimethoprim-sulfamethoxazole, the client is likely to need a different
antibiotic.
The nurse is providing client teaching to a client with cystitis regarding prevention of
future urinary tract infections (UTIs). Which of the following client statements indicate
that teaching has been effective?
a. “I can use vaginal sprays to reduce bacteria.”
b. “I will drink a quart of water or other fluids every day.”
c. “I will wash with soap and water before sexual intercourse.”
d. “I will empty my bladder every 2–4 hours during the day.”
D
Voiding every 2–4 hours is recommended to prevent UTIs. Use of vaginal sprays is
discouraged. The bladder should be emptied before and after intercourse, but cleaning with
soap and water is not necessary. A quart of fluids is insufficient to provide adequate urine
output to decrease risk for UTI.
The nurse is caring for a client who has had a segmental cystectomy. Which of the
following information should the nurse include in the postoperative teaching for the client?
a. Limit fluid intake for at least 7 days.
b. Urine should be amber and not contain blood clots.
c. In about one week urine will have rust-coloured flecks.
d. Avoid sitz baths for a week after surgery.
C
Approximately 7–10 days following tumour resection or ablation, the patient may observe
dark red or rust-coloured flecks in the urine. These are anticipated and represent scabs
from the healing tumour resection sites. Other postoperative instructions for a segmental
cystectomy includes to drink a large volume of fluid each day for the first week following
the procedure and to avoid intake of alcoholic beverages. Urine is anticipated to be pink
during the first several days after the procedure, but it should not be bright red or contain
blood clots. The patient can be encouraged to take a 15–20-minute sitz bath two to three
times a day to promote muscle relaxation and to reduce the risk of urinary retention.
The nurse is caring for a client with benign prostatic hyperplasia who has chills, fever, and
is vomiting. Which of the following findings by the nurse is most helpful in determining
whether the client has an upper urinary tract infection (UTI)?
a. Suprapubic pain
b. Bladder distention
c. Foul-smelling urine
d. Costovertebral tenderness
D
Costovertebral tenderness is characteristic of pyelonephritis. The other symptoms are
characteristic of lower UTI and are likely to be present if the client also has an upper UTI.
The nurse is teaching a client with interstitial cystitis about management of the condition.
Which of the following client statements indicate that further instruction is required?
a. “I will have to stop having coffee and orange juice for breakfast.”
b. “I should start taking a high potency multiple vitamin every morning.”
c. “I will buy some calcium glycerophosphate (Prelief) at the pharmacy.”
d. “I should call the doctor about increased bladder pain or odorous urine.”
B
High-potency multiple vitamins may irritate the bladder and increase symptoms. The other
client statements indicate good understanding of the teaching.
The nurse is admitting a client with acute glomerulonephritis. Which of the following
assessments is most important for the nurse to include?
a. Recent sore throat and fever
b. History of high blood pressure
c. Frequency of bladder infections
d. Family history of kidney stones
A
Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep
throat. It is not caused by hypertension, urinary tract infection (UTI), or kidney stones.
Which of the following findings by the nurse for a client admitted with glomerulonephritis
indicates that treatment has been effective?
a. The client denies pain with voiding.
b. The urine dipstick is negative for nitrites.
c. Peripheral and periorbital edema is resolved.
d. The antistreptolysin-O (ASO) titre is decreased.
C
Since edema is a common clinical manifestation of glomerulonephritis, resolution of the
edema indicates that the prescribed therapies have been effective. Antibodies to
streptococcus will persist after a streptococcal infection. Nitrites will be negative and the
client will not experience dysuria since the client does not have a urinary tract infection.
The nurse is caring for a client with nephrotic syndrome who develops flank pain. Which
of the following medication classifications should the nurse anticipate including in the
client teaching plan?
a. Antibiotics
b. Anticoagulants
c. Corticosteroids
d. Antihypertensives
B
Flank pain in a client with nephrosis suggests a renal vein thrombosis, and anticoagulation
is needed. Antibiotics are used to treat a client with flank pain caused by pyelonephritis.
Antihypertensives are used if the client has high blood pressure. Corticosteroids may be
used to treat nephrotic syndrome but will not resolve a thrombosis.
The nurse is admitting a client with new onset nephrotic syndrome. Which of the
following findings should the nurse expect to assess related to this illness?
a. Poor skin turgor
b. High urine ketones
c. Recent weight gain
d. Low blood pressure
C
The client with a nephrotic syndrome will have weight gain associated with edema.
Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal
because of the edema. Urine protein is high.
The nurse is caring for a client whose renal calculus is analyzed as being very high in uric
acid. To prevent recurrence of stones, which of the following foods should the nurse teach
the client to avoid eating?
a. Milk and dairy products
b. Legumes and dried fruits
c. Organ meats and sardines
d. Spinach, chocolate, and tea
C
Organ meats and fish such as sardines increase purine levels and uric acid. Spinach,
chocolate, and tomatoes should be avoided in clients who have oxalate stones. Milk, dairy
products, legumes, and dried fruits may increase the incidence of calcium-containing
stones.
Which of the following actions should the nurse teach to a client to help prevent the
recurrence of renal calculi?
a. Use a filter to strain all urine.
b. Avoid dietary sources of calcium.
c. Drink diuretic fluids such as coffee.
d. Have 2 000–3 000 mL of fluid a day.
D
A fluid intake of 2 000–2 200 mL daily is recommended to help flush out minerals before
stones can form. Avoidance of calcium is not usually recommended for clients with renal
calculi. Coffee tends to increase stone recurrence. There is no need for a client to strain all
urine routinely after a stone has passed, and this will not prevent stones.
The nurse is planning teaching for a client with benign nephrosclerosis. Which of the
following information should the nurse include in the teaching plan?
a. Monitor and record blood pressure daily.
b. Obtain and document daily weights.
c. Measure daily intake and output amounts.
d. Prevent bleeding caused by anticoagulants.
A
Hypertension is the major symptom of nephrosclerosis. Measurements of intake and
output and daily weights are not necessary unless the client develops renal insufficiency.
Anticoagulants are not used to treat nephrosclerosis.
The nurse is caring for a young adult female client who is diagnosed with polycystic
kidney disease. Which of the following information should the nurse include in teaching at
this time?
a. Importance of genetic counselling
b. Complications of renal transplantation
c. Methods for treating chronic and severe pain
d. Differences between hemodialysis and peritoneal dialysis
A
Because a young female client may be considering having children, the nurse should
include information about genetic counselling when teaching the client. The well-managed
client will not need to choose between hemodialysis and peritoneal dialysis or know about
the effects of transplantation for many years. There is no indication that the client has
chronic pain.
The nurse is assessing a male client with symptoms of a feeling of incomplete bladder
emptying and a split, spraying urine stream. Which of the following conditions should the
nurse question the client about when taking a health history?
a. Bladder infection
b. Recent kidney trauma
c. Gonococcal urethritis
d. Benign prostatic hyperplasia
C
The client’s clinical manifestations are consistent with urethral strictures, a possible
complication of gonococcal urethritis. These symptoms are not consistent with benign
prostatic hyperplasia, kidney trauma, or bladder infection.
The nurse is obtaining the health history for a client who smokes two packs of cigarettes
daily. Which of the following conditions should the nurse include in the teaching plan that
the client is at an increased risk for developing?
a. Kidney stones
b. Bladder cancer
c. Bladder infection
d. Interstitial cystitis
B
Cigarette smoking is a risk factor for bladder cancer. The client’s risk for developing
interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by
quitting smoking.
The nurse is admitting an older-adult client with dehydration who is confused and
incontinent of urine. Which of the following nursing actions is best to include in the plan
of care?
a. Apply absorbent incontinent pads.
b. Restrict fluids after the evening meal.
c. Insert an in-dwelling catheter until the symptoms have resolved.
d. Assist the client to the bathroom every 2 hours during the day.
D
In older or confused clients, incontinence may be avoided by using scheduled toileting
times. In-dwelling catheters increase the risk for urinary tract infection (UTI). Incontinent
pads increase the risk for skin breakdown. Restricting fluids is not appropriate in a client
with dehydration.
A female client asks the nurse for a perineal pad, stating that laughing or coughing causes
leakage of urine. Which of the following interventions is best to include in the care plan?
a. Assist the client to the bathroom q3hr.
b. Place a commode at the client’s bedside.
c. Demonstrate how to perform the Credé manoeuvre.
d. Teach the client how to perform Kegel exercises.
D
Exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The
Credé manoeuvre is used to help empty the bladder for clients with overflow incontinence.
Placing the commode close to the bedside and assisting the client to the bathroom are
helpful for functional incontinence.
The nurse is caring for a client following rectal surgery who voids about 50 mL of urine
every 30–60 minutes. Which of the following nursing actions is best?
a. Use a bladder scan device to check the postvoiding residual.
b. Monitor the client’s intake and output over the next few hours.
c. Have the client take small amounts of fluid frequently throughout the day.
d. Reassure the client that this is normal after rectal surgery because of anesthesia.
A
A bladder scan device can be used to check for residual urine after the client voids.
Because the client’s history and clinical manifestations are consistent with overflow
incontinence, it is not appropriate to have the client drink small amounts. Although
overflow incontinence is not unusual after surgery, the nurse should intervene to correct
the physiological problem, not just reassure the client. The client may develop reflux into
the renal pelvis as well as discomfort from a full bladder if the nurse waits to address the
problem for several hours.
The nurse is caring for a client who has a history of functional urinary incontinence.
Which of the following nursing actions should be included in the plan of care?
a. Place a bedside commode near the client’s bed.
b. Demonstrate the use of the Credé manoeuvre to the client.
c. Use an ultrasound scanner to check postvoiding residuals.
d. Teach the use of Kegel exercises to strengthen the pelvic floor.
A
Modifications in the environment make it easier to avoid functional incontinence.
Checking for residual urine and performing the Credé manoeuvre are interventions for
overflow incontinence. Kegel exercises are useful for stress incontinence.
The home health nurse is teaching a client with a neurogenic bladder how to use
intermittent catheterization for bladder emptying. Which of the following client statements
indicates that the teaching has been effective?
a. “I will use a sterile catheter and gloves for each time I self-catheterize.”
b. “I will clean the catheter carefully before and after each catheterization.”
c. “I will need to buy seven new catheters weekly and use a new one every day.”
d. “I will need to take prophylactic antibiotics to prevent any urinary tract infections.”
B
Clients who are at home can use a clean technique for intermittent self-catheterization and
change the catheter every 7 days. There is no need to use a new catheter every day, to use
sterile catheters, or to take prophylactic antibiotics.
The nurse is caring for a client who has had an ureterolithotomy with a left ureteral
catheter and a urethral catheter in place. Which of the following actions should the nurse
include in the plan of care?
a. Provide education about home care for both catheters.
b. Apply continuous steady tension to the ureteral catheter.
c. Clamp the ureteral catheter unless output from the urethral catheter stops.
d. Call the health care provider if the ureteral catheter output drops suddenly.
D
The health care provider should be notified if the ureteral catheter output decreases since
obstruction of this catheter may result in an increase in pressure in the renal pelvis.
Tension on the ureteral catheter should be avoided in order to prevent catheter
displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Since the
client is not usually discharged with a ureteral catheter in place, client teaching about both
catheters is not needed.
The nurse is caring for a client who has bladder cancer and had a cystectomy with creation
of an Indiana pouch. Which of the following topics should the nurse include in client
teaching?
a. Application of ostomy appliances
b. Catheterization technique and schedule
c. Analgesic use before emptying the pouch
d. Use of barrier products for skin protection
B
The Indiana pouch enables the client to self-catheterize every 4–6 hours. There is no need
for an ostomy device or barrier products. Catheterization of the pouch is not painful.
The nurse is caring for a client who is two days postoperative with an ileal conduit, and the
client will not look at the stoma or participate in care, and insists that no one but the
ostomy nurse specialist care for the stoma. Which of the following nursing diagnoses best
reflects the data that the nurse has obtained?
a. Anxiety related to threat to current status (effects of procedure on lifestyle)
b. Disturbed body image related to alteration in self-perception
c. Ineffective coping related to insufficient sense of control
d. Ineffective denial related to ineffective coping strategies (denial of altered body
function)
B
The client’s unwillingness to look at the stoma or participate in care indicates that
disturbed body image is the best diagnosis. No data suggest that the impact on lifestyle is a
concern for the client, or that ineffective coping is a result of an insufficient sense of
control. The client’s insistence that only the ostomy nurse care for the stoma indicates that
denial is not present.
A client who has had a transurethral resection with fulguration for bladder cancer 3 days
previously calls the nurse at the urology clinic. Which of the following information given
by the client is most important to report to the health care provider?
a. The client is using opioids for pain.
b. The client has noticed clots in the urine.
c. The client is very anxious about the cancer.
d. The client is taking a 15-minute sitz bath twice a day.
B
Clots in the urine are not expected and require further follow-up. Sitz baths two to three
times a day, use of opioids for pain, and anxiety are typical after this procedure.
