Nokea
The nurse is assessing a patient who has a history of a bladder infection. Which of the following findings indicates that the bladder infection has extended into the upper urinary tract?
- A. Dysuria
- B. Urinary frequency
- C. Flank pain
- D. Urinary urgency
Correct Answer: C
Rationale: Flank pain indicates that the patient may have developed pyelonephritis as a complication of the bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection (UTI).
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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.
Correct Answer: B
Rationale: 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.
A patient 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 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.
Correct Answer: B
Rationale: 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 has 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 1000 mL/day. Since the UTI has persisted after treatment with trimethoprim-sulfamethoxazole, the patient is likely to need a different antibiotic.
The nurse is caring for a patient who had a nephrectomy after having massive trauma to the kidney. Which of the following assessment findings obtained postoperatively is most important to communicate to the surgeon?
- A. Blood pressure is 102/58.
- B. Incisional pain level is 8/10.
- C. Urine output is 20 ml/hour for 2 hours.
- D. Crackles are heard at both lung bases.
Correct Answer: C
Rationale: Because the urine output should be at least 0.5 ml/kg/hour, a 20 ml output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life-threatening as decreased renal perfusion.
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 indwelling catheter until the symptoms have resolved.
- D. Assist the patient to the bathroom every 2 hours during the day.
Correct Answer: D
Rationale: In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling 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.
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
Correct Answer: C
Rationale: 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.