Nokea
The nurse is assessing a patient who has a lower urinary tract infection (UTI). Which of the following symptoms should the nurse ask about initially?
- A. Nausea
- B. Flank pain
- C. Poor urine output
- D. Pain with urination
Correct Answer: D
Rationale: Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI.
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After receiving change-of-shift report, which of the following patients should the nurse assess first?
- A. A patient with nephrotic syndrome with a urinary output of 3000 mL yesterday
- B. A patient with urolithiasis who has not voided for 6 hours
- C. A patient with stage 3 chronic kidney disease who needs patient teaching
- D. A patient with stage 4 chronic kidney disease with complaints of dysuria
Correct Answer: B
Rationale: A patient with urolithiasis who has not voided for 6 hours is at risk for urinary obstruction, which can lead to hydronephrosis or renal damage, requiring immediate assessment. The other patients' conditions are less urgent; high urine output, dysuria, and teaching needs do not indicate immediate risk.
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
Correct Answer: B
Rationale: 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 with benign prostatic hyperplasia (BPH) and a markedly distended bladder who is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first?
- A. Insert a urinary retention catheter.
- B. Schedule an intravenous pyelogram.
- C. Administer lorazepam 0.5 mg PO.
- D. Draw blood for blood urea nitrogen (BUN) and creatinine testing.
Correct Answer: A
Rationale: The patient's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test, but does not need to be done urgently.
The nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy. Which of the following findings is most important to report?
- A. Blood in urine
- B. Left flank pain
- C. Left flank bruising
- D. Drop in urine output
Correct Answer: D
Rationale: A drop in urine output after lithotripsy may indicate obstruction or renal damage, which is a critical complication requiring immediate reporting. Hematuria, left flank pain, and bruising are common post-lithotripsy findings and are less urgent unless severe or persistent.
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.
Correct Answer: A
Rationale: 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.