Nokea
The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention?
- A. The patients suprapubic region is dull on percussion.
- B. The patient is uncharacteristically drowsy.
- C. The patient claims to void large amounts of urine 2 to 3 times daily.
- D. The patient takes a beta adrenergic blocker for the treatment of hypertension.
Correct Answer: A
Rationale: Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.
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The nurse has tested the\mathrm{pH}$ of urine from a patients newly created ileal conduit and obtained a result of 6.8. What is the nurses best response to this assessment finding?
- A. Obtain an order to increase the patients dose of ascorbic acid.
- B. Administer IV sodium bicarbonate as ordered.
- C. Encourage the patient to drink at least500 \mathrm{~mL}$ of water and retest in 3 hours.
- D. Irrigate the ileal conduit with a dilute citric acid solution as ordered.
Correct Answer: A
Rationale: Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine\mathrm{pH}$ is kept below 6.5 by administration of ascorbic acid by mouth. An increased\mathrm{pH}$ may suggest a need to increase ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, nor by increasing fluid intake.
The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient?
- A. Limit oral fluid intake for 1 to 2 days.
- B. Report the presence of fine, sand like particles through the nephrostomy tube.
- C. Notify the physician about cloudy or foul-smelling urine.
- D. Report any pink-tinged urine within 24 hours after the procedure.
Correct Answer: C
Rationale: The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.
A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic?
- A. The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy
- B. The need to expect a heavy menstrual period following the course of antibiotics
- C. The risk of developing antibiotic resistance after the course of antibiotics
- D. The need to undergo a series of three urine cultures after the antibiotics have been completed
Correct Answer: A
Rationale: Yeast vaginitis occurs in as many as25 % of patients treated with antimicrobial agents that affect vaginal flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original UTI. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.
A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?
- A. Hydronephrosis
- B. Nephritic syndrome
- C. Pylonephritis
- D. Nephrotoxicity
Correct Answer: A
Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.
A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patients post-procedure care?
- A. Strain the patients urine following the procedure.
- B. Administer a bolus of500 \mathrm{~mL}$ normal saline following the procedure.
- C. Monitor the patient for fluid overload following the procedure.
- D. Insert a urinary catheter for 24 to 48 hours after the procedure.
Correct Answer: A
Rationale: Following ESWL, the nurse should strain the patients urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.