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A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months. Which questions should the nurse ask?
- A. How much water do you drink every day?
- B. Do you take estrogen replacement therapy?
- C. Does anyone in your family have a history of cystitis?
- D. Do you take any immune-suppressing drugs?
- E. Do you drink grapefruit juice or orange juice daily?
Correct Answer: A,B,D
Rationale: Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidity and reduce the risk for bacterial cystitis.
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A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. Which action should the nurse take?
- A. Apply an ice pack to the site.
- B. Apply an ice pack to the site.
- C. Place the client in the prone position.
- D. Obtain serum coagulation test results.
Correct Answer: A
Rationale: The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual. Obtaining serum coagulation is a higher level of intervention. Changing the client's position will not decrease bleeding.
A nurse cares for a client admitted from a nursing home after several recent falls. What prescription should the nurse complete first?
- A. Obtain urine sample for culture and sensitivity.
- B. Administer intravenous antibiotics.
- C. Encourage protein intake and additional fluids.
- D. Consult physical therapy for gait training.
Correct Answer: A
Rationale: Although all interventions are or might be important, obtaining a urine sample for urinalysis takes priority. Often urinary tract infection (UTI) symptoms in older adults are atypical, and a UTI may present with new onset of confusion or falling. The urine sample should be obtained before starting antibiotics.
A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program?
- A. A 60-year-old female who is confused
- B. A 65-year-old female who is confused
- C. A 65-year-old female who is confused
- D. A 62-year-old female with kidney failure
Correct Answer: A
Rationale: For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from another type of bladder training.
A nurse teaches a client with functional urinary incontinence. Which statement should the nurse include in this client's teaching?
- A. You must clean around your catheter daily with soap and water.
- B. You must clean around your catheter daily with soap and water.
- C. You must clean around your catheter daily with soap and water.
- D. Operations to repair your bladder are available, and you can consider these.
- E. Buy slacks with elastic waistbands that are easy to pull down.
Correct Answer: E
Rationale: Functional urinary incontinence occurs as the result of problems not related to the client's bladder, such as trouble accessing a toilet. One goal is that the client be able to manage his or her clothing independently. Elastic waistband slacks that are easy to pull down can help the client get on the toilet in time to void. The other instructions do not relate to functional urinary incontinence.
A nurse is caring for a client who is scheduled to undergo a surgical procedure for a urinary diversion (ileal conduit). Which statement by the nurse would be most helpful?
- A. I will ask the provider to prescribe you an antianxiety medication.
- B. Would you like to discuss the procedure with your doctor once more?
- C. I think it would be nice to not have to worry about finding a bathroom.
- D. Would you like to speak with someone who has an ileal conduit?
Correct Answer: D
Rationale: The goal for the client who is scheduled to undergo a procedure such as an ileal conduit is to have a positive self-image and a positive attitude about his or her body. Discussing the procedure candidly with someone who has undergone the same procedure will foster such feelings, especially when the client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge.