Chapter 34: Care of Patients with Disorders of the Urinary System |DeWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. The nurse is caring for a 90-year-old resident in a long-term care facility who is becoming progressively confused and irritable. What should the nurse do next? a. Request an order for a urinalysis. b. Hold the patient’s antihypertensive medications. c. Assess the patient for fecal impaction. d. Notify the charge nurse. ANS: A Sudden confusion and irritability may indicate a urinary tract infection (UTI) in the older adult. There is no supportive information indicating issues with the patient’s antihypertensive medications or the presence of a fecal impaction. PTS: 1 DIF: Cognitive Level: Application REF: 786, Older Adult Care Points OBJ: 1 (theory) TOP: UTI in the Older Adult KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. While reviewing a patient’s medications, the nurse notes that a patient has been prescribed liquid nitrofurantoin (Furadantin). Which intervention should the nurse add to the nursing care plan? a. Administer nitrofurantoin on an empty stomach. b. Provide a straw and instruct the patient to rinse the mouth after taking nitrofurantoin. c. Administer nitrofurantoin early in the morning to avoid insomnia. d. Assess the urine for hematuria. ANS: B The liquid form of this drug will stain the teeth. The patient should use a straw and rise the mouth after taking this medication. The drug causes drowsiness and should be given at night. Hematuria is not a concern. PTS:1 DIF: Cognitive Level: Application REF: 787, Table 34-1 OBJ:1 (theory) TOP: Nitrofurantoin: Nursing Considerations KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 3. A 25-year-old woman comes to the emergency department with nonspecific urethritis. Which information is most important for the nurse to obtain? a. “How many servings of green vegetables do eat each day?” b. “How often, if any, do you consume alcohol?” c. “How often do you use bath salts or take bubble baths?” d. “Do you take a daily multivitamin?” ANS: C Urethritis refers to inflammation of the urethra. The use of bath salts, spermicidal jelly, body powders, and feminine hygiene sprays can cause irritation and lead to urethritis. Green vegetable intake, alcohol consumption, and multivitamin intake do not directly relate to causative factors for urethritis. PTS:1 DIF: Cognitive Level: Application REF: 788 OBJ:1 (theory) TOP: Urethritis: Signs and Symptoms KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. A 25-year-old man comes to the college clinic with fever of 101° F, nausea, and flank pain that radiates into the thig hand genitals. The nurse anticipates that the patient will undergo workup for which infection? a. Urethritis b. Pyelonephritis c. Glomerulonephritis d. Cystitis ANS: B Acute pyelonephritis is an infection of the kidneys. It is thought to occur when bacteria (such as Escherichia coli) from a bladder infection travel up the ureters to infect the kidneys. A frequent cause of pyelonephritis is an obstruction, causing stasis of urine and stones that cause irritation of the tissue. Both situations provide an environment in which bacteria can grow. When bacteria enter the renal pelvis, inflammation and infection occur. Pyelonephritis causes nausea and vomiting, flank pain, temperature elevation with chills, headache, and malaise. Urethritis and cystitis often cause dysuria. Glomerulonephritis commonly occurs about 2 to 3 weeks after a group A beta-hemolytic streptococcal infection, such as “strep throat” or impetigo. The patient with acute glomerulonephritis usually becomes suddenly ill with fever, chills, flank pain, widespread edema, puffiness about the eyes, visual disturbances, and marked hypertension. PTS:1 DIF: Cognitive Level: Comprehension REF: 788 OBJ:1 (theory) TOP: Pyelonephritis: Signs and Symptoms KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse is caring for a young man who has been prescribed ciprofloxacin (Cipro) for pyelonephritis. Which information should the nurse include in order to prevent recurrence?