Chapter 66: Care of Patients with Urinary Problems

Chapter 66: Care of Patients with Urinary Problems

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis?
   1. A 36-year-old female who has never been pregnant
   2. A 42-year-old male who is prescribed cyclophosphamide
   3. A 58-year-old female who is not taking estrogen replacement
   4. A 77-year-old male with mild congestive heart failure

ANS:   C

Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been pregnant would not have a risk potential as high as the older woman who is not using hormone replacement therapy.

DIF:     Understanding/Comprehension         REF: 1367

KEY:   Cystitis| health screening

MSC:   Integrated Process: Nursing Process: Assessment                 NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

2. A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a “shift to the left” in a client’s white blood cell count. Which action should the nurse take?
   1. Request that the laboratory perform a differential analysis on the white blood cells.
   2. Notify the provider and start an intravenous line for parenteral antibiotics.
   3. Collaborate with the unlicensed assistive personnel (UAP) to strain the client’s urine for renal calculi.
   4. Assess the client for a potential allergic reaction and anaphylactic shock.

ANS:   B

An increase in band cells creates a “shift to the left.” A left shift most commonly occurs with urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be administering antibiotics, most likely via IV, so he or she should notify the provider and prepare to give the antibiotics. The shift to the left is part of a differential white blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are associated with elevated eosinophil cells, not band cells.

DIF:     Applying/Application                         REF: 1370                   KEY: Cystitis| assessment/diagnostic examination                MSC:                         Integrated Process: Nursing Process: Implementation                                 NOT:                          Client Needs Category: Physiological Integrity: Physiological Adaptation

3. A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, “I never have urinary tract infections. Why is this happening now?” How should the nurse respond?
   1. “Your immune system becomes less effective as you age.”
   2. “Low estrogen levels can make the tissue more susceptible to infection.”
   3. “You should be more careful with your personal hygiene in this area.”
   4. “It is likely that you have an untreated sexually transmitted disease.”

ANS:           B

Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this client is low estrogen levels. Personal hygiene usually does not contribute to this disease process.

DIF:            Applying/Application                         REF:    1367                 KEY: Cystitis| patient education                     MSC:                                                  Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

4. After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?
   1. “I will not take this drug with food or milk.”
   2. “If I think I am pregnant, I will stop the drug.”
   3. “An orange color in my urine should not alarm me.”
   4. “I will drink two glasses of cranberry juice daily.”

ANS:           C

Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. Phenazopyridine is safe to take if the client is pregnant. There are no dietary restrictions or needs while taking this medication.

DIF:            Applying/Application                         REF:    1372                 KEY: Cystitis| medication safety                     MSC:                                                  Integrated Process: Teaching/Learning NOT:                     Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

5. After teaching a client who has stress incontinence, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional teaching?
   1. “I will limit my total intake of fluids.”
   2. “I must avoid drinking alcoholic beverages.”
   3. “I must avoid drinking caffeinated beverages.”
   4. “I shall try to lose about 10% of my body weight.”

ANS:           A

Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence.

DIF:            Applying/Application                         REF:    1380                KEY: Cystitis| hydration

MSC:          Integrated Process: Teaching/Learning                                  NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort