NURS 620 Exam 3 Questions With 100% Correct Answers 2024 Maryville (VERIFIED)

NURS 620 Exam 3 Questions With 100% Correct Answers 2024 Maryville (VERIFIED). Pyleonephritis correct answers Low back pain is an indication of what form of complicated UTI? Pregnant geriatric correct answers What population is at increased risk of pyleonephritis? Pyleonephritis (upper UTI) STI Tumor/bladder cancer Interstital cystitis Vaginitis correct answers Possible differential diagnosis for lower/uncomplicated UTI? Fever Chills WBC casts CVAT correct answers What signs of sepsis will not be seen with lower/uncomplicated UTI? pharmacological antimicrobial tx correct answers What is the mainstay of treatment for uncomplicated UTI? Ampicillin and sulfonamides correct answers Which classes of antibiotics are becoming increasingly resistant to bacteria associated with UTI? gram-negative correct answers Which bacteria is nitrofurantoin most effective on? 1 DS BID x 3 days correct answers What is the antibiotic regimin for bactrim or septra with uncomplicated UTI? 500 mg BID x 5 days correct answers What is the antibiotic regmin for cefdinir with uncomplicated UTI? 100 mg BID x 5-7 days correct answers What is the antibiotic regimin for nitrofurantoin with uncomplicated UTI? Bactrim correct answers Which antibiotic is teratogenic and should be avoided in the 1st trimester of pregnancy? Nitrofurantoin (Macrobid) correct answers Which antibiotic is on the Beers list for geriatric patients? Cefdinir correct answers Which antibiotic has a low interaction rate with other medications and is also a good consideration for geriatric patients? 3-5 day dosing correct answers How many days can a healthy patient be successfully treated for uncomplicated UTI? 7 days correct answers How long should patients who are geriatric or present with comorbidities, immunocompromise, etc. be treated for uncomplicated UTI? Area resistance Patient history of antibiotic use Bacteria resistance (culture) correct answers What is a key factor to consider when determining which antibiotic to use for uncomplicated UTI? Fluoroguinolones correct answers Which antibiotic class is known to have widespread efficacy in treating UTI? Amoxicillin, nitrofurantoin, or cephalexin x 1 week correct answers Empirical therapy for lower UTI? Flouroguinolones correct answers Which class of antibiotc should be avoided if possible for lower UTI? premature delivery correct answers What complications may arise during pregnancy with UTI? Fluconazole 200 mg qd x 7-14 days correct answers What is the treatment for fungal UTI? Pre-urological procedures After removal of a bladder catheter Any patient with underlying structural abnormality correct answers When is antibiotic treatment considered in patients who may not present with current lower UTI? 2 or more symptomatic UTIs w/in 6 months 3 or more within 12 months correct answers Who should receive antibiotic prophylaxis for recurrent UTI? Once negative urine culture is obtained. correct answers When should prophylaxis be started for recurrent UTI? Take antibiotics 3-4 days after intercourse or when symptoms begin correct answers What is the regimin for post-coital or self-medication UTI prophylaxis? Daily dosing of low dose antibiotic therapy for 6 months. correct answers What is the antibiotic regimin for prophylactix with chronic UTI? It does not correct answers How does interstitial cystitis respond to antibiotic treatment? Q 4-6 weeks correct answers How often should indwelling catheters be changed? -Maintain adequate hydration and monitor UO -Obstruction must be identified and removed -Prescribe analgesics for patients to reduce pain associated with UTI. correct answers Important follow up points for lower UTI Notify if flank pain, hematuria, or lack of response to tx occurs. correct answers Patient instructions for physician notification following visit and prescribed treatment for lower UTI. -Complete full course of antibiotic -increase fluid intake to 8-8oz glasses of H20/day -Take cranberry supplement/drink cranbery juice -self-medicate as indicated -Avoid harsh soaps or feminie hygeine products -Use condoms -Use proper self-cath techniques -Empty bladder frequently -Take showers instead of tub baths -Keep voiding diary that includes symptoms -Empty bladder completely. -Proper hygeine-wipe front to back -cotton undergarments -empty bladder after sexual intercourse -Avoid bladder irritants-caffeine, sugary drinks, etc. correct answers Important patient teaching points regaring uncomplicated UTI Chronic pelvic pain correct answers Non-cyclic pain of 6 or more months duration that is localized to the pelvis and is of sufficient severity to cause functional disability endometriosis interstital cystitis IBS correct answers 3 most common causes of chronic pelvic pain. interstitial cystitis correct answers Noninfectious; similar presentation to UTI interstitial cystitis correct answers •Chronic inflammatory condition of the bladder clinically characterized by irritable voiding symptoms or urgency and frequency, in the absence of objective evidence of another disease" Intercourse perimentraul status correct answers Worsening factors of Interstitial cystitis Determine what the underlying cause of the symptoms is correct answers Important goal of intersitial cystitis diagnosis and treatment. None specific. Is a diagnosis of exclusion correct answers Lab tests for interstitial cystitis UTI bladder cancer Kidney stone pyelonephritis correct answers What are some potential differential diagnoses to exclude with interstitial cystitis? Gynecological-PAP IVP cystoscopy correct answers What are important diagnostic tests that should be included when excluding other causes for diagnosis of interstitial cystitis? 5 correct answers What score on the PUF scale is indicative of likely interstitial cystitis? Avoid acidic foods and beverges such a cranberry juice, tomatoe juice, etc. correct answers WHat dietary recommendations are present with interstitial cystitis? Longer urethra correct answers Why is UTI less common in males? Dysuria Urgency/frequency Cloudy urine Penile discharge-not likely but should be addressed. correct answers Clinical presentation of UTI in male population. Pyleonephritis prostatitis BPH Prostate cancer correct answers Differential diagnosis for UTI in males? Nitrofurantoin correct answers Which antibiotic used in females is not used in the male population because it does not adhere well due to length of urethra? hesitency correct answers Which urinary symptom in males may be good indication of need for urology referral for IVP/cystoscopy? 10-14 days correct answers How long should antibiotic treatment be for male UTI? Pyleonephritis (upper UTI) correct answers Complicated infection of the kidney characterized by infection within the renal pelvis, tubules, or interstital tissue. Acute correct answers Type of pyleonephritis that is caused by an ascending infection from the bladder. Chronic correct answers Type of pyleonephritis that is caused by no specific pathological explanation usually. -Anatomical abnormalities such as ureterovesical reflux -Urinary obstruction -Stress incontinence -Multiple or recurrent UTIs - Renal disease -Kidney trauma -Pregnancy -Metabolic disorders -Agressive bacterial infection -geriatrics -underlying renal disorders correct answers What are predisposing factors that put patients at greater risk for pyleonephritis? -Chills -Fever -Flank Pain CVA tenderness -Urinary symptoms -fatigue -Diarrhea -may be largely asymptomatic correct answers What is the clinical presentation of acute pyleonephritis? Hospitalization or close monitoring correct answers Recommended plan of action for patient with pyelo? -Mild-Moderate: Septra DS or Cipro 7-10 days (cephalosporin or quinolones) -Severe: 14 days -Slow responders: 21 days correct answers What is the recommended treatment for pyelo? Follow up urine culture correct answers What follow up should be performed with pyelo? If has N/V, signs of sepsis or is pregnant/geriatric correct answers When should patient with pyelo be considered for inpatient antibiotic treatment Caused by fecal flora that colonize the vaginal introitus and subsequently ascend along the urinary tract to the kidneys; Bacteria enters through urethral meatus and ascends upward toward one or both kidneys via ureters, bloodstream, or lymphatic system. correct answers What is the typical pathophysiology of pyelo? Acute pyelonephritis correct answers Swelling of renal parenchyma occurs as a result of patchy distribution of the acute infectious process. Chronic Pyelonephritis correct answers Usually caused by a recurrent or chronic bacterial infection of the kidney, often related to the presence of catheters. - Fatigue -Nausea -decreased appetite with wt loss -nocturia &/or polyuria -symptoms of renal failure correct answers Clinical presentation of chronic pyelonephritis. Marked tenderness on deep abdominal palpation Hypertension correct answers What are two frequent physical exam findings with pyelo? Patient presents with impaired renal function caused by damage to kidneys correct answers When is chronic pyelo usually first diagnosed? Positive for bacteria, proteinuria, leukocyte esterase, urinary nitrites, hematuria, pyuria, WBC casts Urine culture 100,000 correct answers Presentation of UA/C&S with pyelo? Blood cultures cysto with urethral catheterization Renal ultrasound or IVP Kidney biopsy sometimes appropriate for diagnosis correct answers What diagnostic testing may be performed with pyelo other than UA/C&S? Presence of WBC casts correct answers What is the main diagnostic criteria that differentiates pyelo from cystitis? Identify persistent pyuria & positive urine cultures correct answers How is the definitive diagnosis of pyelo determined? -48 hrs after antibiotic intiiation to evaluate responsiveness to therapy & consider discharge in hospital setting correct answers When should patient be reassessed following intiation of treatment for pyelo? Reculture @ 2, 6, and 12 weeks after antibiotc therapy is initiated. correct answers When should you reculture with recurrent pyelo? Refer to nephrologist correct answers Recommended referral plan for chronic pyelo? Prerenal, renal, post renal, false, or benign correct answers What is the potential pathogenesis to consider with hematuria? -color of the urine -concurrent symptoms (fever, N/V, frequency, dysuria -Medications-NSAIDS, blood thinners? -Potential trauma -Prostate problems? correct answers What is the clinical findings and examination considerations with hematuria? -UTI/pyelonephritis -Cancers -BPH correct answers Potential differential diagnosis for hematuria -Abdominal exam (tenderness, masses, CVA tenderness, pelvic/prostate exam correct answers Physical examination for hematuria Pyelonephritis or kidney stone correct answers Common causes of CVA tenderness? Check for vaginal or uterine bleeding correct answers Why do you perform a pelvic exam in women with hematuria? UA/C&S ANA, CMP, CBC IVP/cystoscopy correct answers Diagnostic testing for hematuria Geriatric-comes and goes due to bladder atrophy correct answers Which population commonly has idopathic hematuria and why? -Antibiotic therapy if bacterial infection present -Urology or nephrology referral correct answers What is the recommended management and follow up for hematuria? -social isolation -depression -skin problems -UTIs -Falls correct answers What are the potential adverse outcomes of urinary incontinence? -Have you had an accident? -Do you check out the location of the bathroom wherever you go? -How often do you experience leakage of urine? -How much do you lose each time? correct answers Assessment questions for urinary incontinence. -Delerium & dementia -Infections -Atrophic vaginitis -Psychological: depression -Pharmacological-diuretics, nicotine, caffeine -Endocrine-DM, Hypercalcemia, hyperthyroid -Restricted mobility -Stool in rectal vault correct answers Risk factors for incontinence (DIAPPERS) Postmenopausal women correct answers Which population is most affected by atrophic vaginitis associated with urinary incontinence? Overflow correct answers Incontinence associated with urethral blockage causing bladder to be unable to empty properly. Caused by overdistended bladder and inability to feel voiding sensation. Stress correct answers Incontinence associated with a relaxed pelvic floor causing increased abdominal pressure. Urethral sphincter muscle is weak; weak pelvic floor muscles; brought on by coughing, sneezing, straining. Sagging and weakness of the bladder neck present. Urge correct answers Incontinence associated with bladder oversensitivity from infection; common with neurologic disorders. Detrusor instability. Involuntary leakage due to inability to delay voiding. Sensation of full bladder & unable to hold. Urge, stress, mixed, or overflow correct answers Type of urinary incontinence -Complete H&P with pelvic exam -Voiding diary -UA/C&S -urodynamics: Q-tip test & cystomyetrogram (CMG) correct answers Assessment for urinary incontinence Diabetes Congenital disorders correct answers What underlying disorders are associated with urinary incontinence? Q-tip test correct answers Urodynamic test in which a Q-tip is swirled around the urethra to test the reflex response. -Kegals-40-60 contractions daily -Pelvic floor muscle training -Vaginal cones or pessaries -Weight loss -Limit fluids & diuretics in evening -Dietary changes -Quit smoking -Vaginal estrogen (vaginal atrophy) -Surgical intervention correct answers Recommended management of stress incontinence -10 @ a time (gradually increase pressure and holding with kegal and slowly release the muscle relaxation correct answers How should you educate patients to perform kegal excercises? Should feel tightness around finger during pelvic exam correct answers How do you assess that a patent is doing kegals properly using the pelvic floor muscles rather than abdominal muscles? Decongestants (psuedophedrine-good 1st option if no htn) Anticholinergic medications tricyclic antidepressants correct answers Medication management for urge incontinence. Overactive bladder correct answers Bladder contracts involuntarily; detrusor muscle instability; unable to postpone;urgency. -Bladder training -urgency control strategies. correct answers What are behavioral therapy techniques for OAB? -Cold remedies (Sudafed) -Chocolate -Carbonation/colas