Lewis Chapter 48 TEST BANK Flashcards
patient returns to the clinic with recurrent dysuria after being treated with trimethoprimsulfamethoxazole for 3 days. Which of the following actions should the nurse plan to take?
a. Remind the patient about the need to drink 1000 mL of fluids daily.
b. Obtain a midstream urine specimen for culture and sensitivity testing.
c. Teach the patient to take the prescribed trimethoprim-sulfamethoxazole for at least
3 more days.
d. Suggest that the patient drink cranberry juice to treat the symptoms.
ANS: B
Since uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3
days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine
appropriate antibiotic therapy. Although daily intake of cranberry juice have been purported to
assist in treating there is currently no conclusive evidence to support advocating this
treatment. The fluid intake should be increased to at least 1800 mL/day. Since the UTI has
persisted after treatment with trimethoprim-sulfamethoxazole, the patient is likely to need a
different antibiotic.
The nurse is providing patient teaching to a patient with cystitis regarding prevention of future urinary tract infections (UTIs). Which of the following patient statements indicate that
teaching has been effective?
a. “I can use vaginal sprays to reduce bacteria.”
b. “I will drink a litre 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.”
ANS: 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 litre of fluids is insufficient to provide adequate urine
output to decrease risk for UTI.
The nurse is caring for a patient who has had a segmental cystectomy. Which of the following
information should the nurse include in the postoperative teaching for the patient?
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.
ANS: 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 patient 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 patient has an upper urinary tract infection (UTI)?
a. Suprapubic pain
b. Bladder distention
c. Foul-smelling urine
d. Costovertebral tenderness
ANS: D
Costovertebral tenderness is characteristic of pyelonephritis. The other symptoms are
characteristic of lower UTI and are likely to be present if the patient also has an upper UTI.
The nurse is teaching a patient with interstitial cystitis about management of the condition.
Which of the following patient 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.”
ANS: B
High-potency multiple vitamins may irritate the bladder and increase symptoms. The other
patient statements indicate good understanding of the teaching.
The nurse is admitting a patient 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
ANS: 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 patient admitted with glomerulonephritis
indicates that treatment has been effective?
a. The patient 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.
ANS: 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 patient will not
experience dysuria since the patient does not have a urinary tract infection.
The nurse is caring for a patient with nephrotic syndrome who develops flank pain. Which of
the following medication classifications should the nurse anticipate including in the patient
teaching plan?
a. Antibiotics
b. Anticoagulants
c. Corticosteroids
d. Antihypertensives
ANS: B
Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is
needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis.
Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis.
The nurse is admitting a patient 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
ANS: C
The patient 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 patient 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
patient to avoid eating?
a. Milk and dairy products
b. Legumes and dried fruits
c. Organ meats and sardines
d. Spinach, chocolate, and tea
ANS: C
Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate,
and tomatoes should be avoided in patients 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 patient 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 2000–3000 mL of fluid a day.
ANS: D
A fluid intake of 2000–2200 mL daily is recommended to help flush out minerals before
stones can form. Avoidance of calcium is not usually recommended for patients with renal
calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
The nurse is planning teaching for a patient 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.
ANS: A
Hypertension is the major symptom of nephrosclerosis. Measurements of intake and output and daily weights are not necessary unless the patient develops renal insufficiency.
Anticoagulants are not used to treat nephrosclerosis.
The nurse is caring for a young adult female patient 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 persistent and severe pain
d. Differences between hemodialysis and peritoneal dialysis
ANS: A
Because a young female patient may be considering having children, the nurse should include information about genetic counselling when teaching the patient. The well-managed patient 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 patient has persistent pain
The nurse is assessing a male patient 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 patient about when taking a health history?
a. Bladder infection
b. Recent kidney trauma
c. Gonococcal urethritis
d. Benign prostatic hyperplasia
ANS: C
The patient’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 patient who smokes two packs of cigarettes
daily. Which of the following conditions should the nurse include in the teaching plan that the
patient is at an increased risk for developing?
a. Kidney stones
b. Bladder cancer
c. Bladder infection
d. Interstitial cystitis
ANS: B
Cigarette smoking is a risk factor for bladder cancer. The patient’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 patient 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 patient to the bathroom every 2 hours during the day
ANS: D
In older or confused patients, 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 patient with
dehydration
A female patient 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 patient to the bathroom q3hr.
b. Place a commode at the patient’s bedside.
c. Demonstrate how to perform the Credé manoeuvre.
d. Teach the patient how to perform Kegel exercises
ANS: D
Exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The
Credé manoeuvre is used to help empty the bladder for patients with overflow incontinence.
Placing the commode close to the bedside and assisting the patient to the bathroom are helpful
for functional incontinence
The nurse is caring for a patient 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 patient’s intake and output over the next few hours.
c. Have the patient take small amounts of fluid frequently throughout the day.
d. Reassure the patient that this is normal after rectal surgery because of anesthesia.
ANS: A
A bladder scan device can be used to check for residual urine after the patient voids. Because
the patient’s history and clinical manifestations are consistent with overflow incontinence, it is
not appropriate to have the patient drink small amounts. Although overflow incontinence is
not unusual after surgery, the nurse should intervene to correct the physiological problem, not just reassure the patient. The patient 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 patient 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 patient’s bed.
b. Demonstrate the use of the Credé manoeuvre to the patient.
c. Use an ultrasound scanner to check postvoiding residuals.
d. Teach the use of Kegel exercises to strengthen the pelvic floor.
ANS: 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 patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which of the following patient 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.”
ANS: B
Patients 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 patient 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
ANS: 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 patient is not usually
discharged with a ureteral catheter in place, patient teaching about both catheters is not
needed.
The nurse is caring for a patient who has bladder cancer and had a cystectomy with creation of an Indiana pouch. Which of the following topics should the nurse include in patient 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
ANS: B
The Indiana pouch enables the patient 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 patient who is two days postoperative with an ileal conduit, and the patient 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)
ANS: B
The patient’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 patient, or that ineffective coping is a result of an insufficient sense of control. The
patient’s insistence that only the ostomy nurse care for the stoma indicates that denial is not
present.
A patient 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 patient is most important to report to the health care provider?
a. The patient is using opioids for pain.
b. The patient has noticed clots in the urine.
c. The patient is very anxious about the cancer.
d. The patient is taking a 15-minute sitz bath twice a day.
ANS: 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
