16 terms

Nclex Review: Urinary Tract Infection

The nurse is teaching an 80-year-old client with a urinary tract infection about the importance of increasing fluids in the diet. Which of the following puts this client at a risk for not obtaining sufficient fluids?
1. Diminished liver function.
2. Increased production of antidiuretic hormone.
3. Decreased production of aldosterone.
4. Decreased ability to detect thirst.
The sensation of thirst diminishes in those greater than 60 years of age; hence, fluid intake is decreased and dissolved particles in the extracellular fluid compartment become more concentrated. There is no change in liver function in older adults, nor is there a reduction of ADH and aldosterone as a normal part of aging.
A client with a urinary tract infection is to take nitrofurantoin (Macrodantin) four times each day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client?
1. "You can wait and take the next dose when it is due."
2. "Double the amount prescribed with your next dose."
3. "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose."
4. "Take a lot of water with a double amount of your prescribed dose."
Antibiotics have the maximum effect when a blood level of the medication is maintained. However, because nitrofurantoin (Macrodantin) is readily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by doubling the dose. The client should not skip a dose if she realizes that she has missed one. Additional fluids, especially water, should be encouraged, but not forced to promote elimination of the antibiotic from the body. Adequate fluid intake aids in the prevention of urinary tract infections, in addition to an acidic urine.
A nurse is assessing a client with a urinary tract infection who takes an antihypertensive drug. The nurse reviews the client's urinalysis results pH 6.8, RBC 3 per high power field, color-yellow, specific gravity-1.030 . The nurse should:
1. Encourage the client to increase fluid intake.
2. Withhold the next dose of antihypertensive medication. 3. Restrict the client's sodium intake.
4. Encourage the client to eat at least half of a banana per day.
The client's urine specific gravity is elevated. Specific gravity is a reflection of the concentrating ability of the kidneys. This level indicates that the urine is concentrated. By increasing fluid intake, the urine will become more dilute. Antihypertensives do not make urine more concentrated unless there is a diuretic component within them. The nurse should not hold a dose of antihypertensive medication. Sodium tends to pull water with it; by restricting sodium, less water, not more, will be present. Bananas do not aid in the dilution of urine.
A client has nephropathy. The physician orders that a 24-hour urine collection be done for creatinine clearance. Which of the following actions is necessary to ensure proper collection of the specimen?
1. Collect the urine in a preservative-free container and keep it on ice.
2. Inform the client to discard the last voided specimen at the conclusion of urine collection.
3. Ask the client what his weight is before beginning the collection of urine.
4. Request an order for insertion of an indwelling urinary catheter.
All urine for creatinine clearance determination must be saved in a container with no preservatives and refrigerated or kept on ice. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate. It is not necessary to have an indwelling urinary catheter inserted for urine collection.
A client who weighs 207 lb is to receive 1.5 mg/ kg of gentamicin sulfate (Garamycin) I.V. three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number. __________________ mg.
141 mg
A 24-year-old female client comes to an ambulatory care clinic in moderate distress with a probable diagnosis of acute cystitis. When obtaining the client's history, the nurse should ask the client if she has had:
1. Fever and chills.
2. Frequency and burning on urination.
3. Flank pain and nausea.
4. Hematuria.
The classic symptoms of cystitis are severe burning on urination, urgency, and frequent urination. Systemic symptoms, such as fever and nausea and vomiting, are more likely to accompany pyelonephritis than cystitis. Hematuria may occur, but it is not as common as frequency and burning.
The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by:
1. Congenital strictures in the urethra.
2. An infection elsewhere in the body.
3. Urinary stasis in the urinary bladder.
4. An ascending infection from the urethra.
Although various conditions may result in cystitis, the most common cause is an ascending infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.
The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which would be the nurse's best approach?
1. Arrange a meeting with the client, her husband, the physician, and the nurse.
2. Insist that the client talk with her husband because good communication is necessary for a successful marriage.
3. Talk first with the husband alone and then with both of them together to share the husband's reactions.
4. Spend time with the client addressing her concerns and then stay with her while she talks with her husband.
As newlyweds, the client and her husband need to develop a strong communication base. The nurse can facilitate communication by preparing and supporting the client. Given the situation, an interdisciplinary conference is inappropriate and would not promote intimacy for the client and her husband. Insisting that the client talk with her husband is not addressing her fears. Being present allows the nurse to facilitate the discussion of a difficult topic. Having the nurse speak first with the husband alone shifts responsibility away from the couple.
The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse's instructions?
1. "I will place ice packs on my perineum."
2. "I will take hot tub baths."
3. "I will drink a cup of warm tea every hour."
4. "I will void every 5 to 6 hours."
Hot tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffeinated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encouraged because it reduces urinary stasis.
The client with cystitis is given a prescription for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by:
1. Releasing formaldehyde and providing bacteriostatic action.
2. Potentiating the action of the antibiotic.
3. Providing an analgesic effect on the bladder mucosa.
4. Preventing the crystallization that can occur with sulfa drugs.
Phenazopyridine hydrochloride (Pyridium) is a urinary analgesic that works directly on the bladder mucosa to relieve the distressing symptoms of dysuria. Phenazopyridine does not have a bacteriostatic effect. It does not potentiate antibiotics or prevent crystallization.
When teaching the client with a urinary tract infection about taking phenazopyridine hydrochloride (Pyridium), the nurse should tell the client to expect:
1. Bright orange-red urine.
2. Incontinence.
3. Constipation.
4. Slight drowsiness.
The client should be told that phenazopyridine hydrochloride (Pyridium) turns the urine a bright orange-red, which may stain underwear. It can be frightening for a client to see orange-red urine without having been forewarned. Other common adverse effects associated with phenazopyridine include headaches, gastrointestinal disturbances, and rash. Phenazopyridine does not cause incontinence, constipation, or drowsiness.
A client has been prescribed nitrofurantoin (Macrodantin) for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client how to take this medication? Select all that apply.
1. "Take the medication on an empty stomach."
2. "Your urine may become brown in color."
3. "Increase your fluid intake."
4. "Take the medication until your symptoms subside."
5. "Take the medication with an antacid to decrease gastrointestinal distress."
2, 3.
Clients who are taking nitrofurantoin (Macrodantin) should be instructed to take the medication with meals and to increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need to be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medication should not be taken with antacids as this may interfere with the drug's absorption.
Nitrofurantoin (Macrodantin), 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/ 5 mL. How many milliliters should the nurse administer for each dose? ________________________ mL.
15 mL
Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis? 1. "I can usually go 8 to 10 hours without needing to empty my bladder."
2. "I take a tub bath every evening."
3. "I wipe from front to back after voiding."
4. "I drink a lot of water during the day."
Stasis of urine in the bladder is one of the chief causes of bladder infection, and a client who voids infrequently is at greater risk for reinfection. A tub bath does not promote urinary tract infections as long as the client avoids harsh soaps and bubble baths. Scrupulous hygiene and liberal fluid intake (unless contraindicated) are excellent preventive measures, but the client also should be taught to void every 2 to 3 hours during the day.
To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which of the following measures in her daily routine?
1. Wearing cotton underpants.
2. Increasing citrus juice intake.
3. Douching regularly with 0.25% acetic acid.
4. Using vaginal sprays.
A woman can adopt several health-promotion measures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncotton underpants, and irritating substances, such as bubble baths and vaginal soaps and sprays. Increasing citrus juice intake can be a bladder irritant. Regular douching is not recommended; it can alter the pH of the vagina, increasing the risk of infection.
The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink:
1. Twice as much fluid as usual.
2. At least 1 quart more than usual.
3. A lot of water, juice, and other fluids throughout the day. 4. At least 3,000 mL of fluids daily.
Instructions should be as specific as possible, and the nurse should avoid general statements such as "a lot." A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 quart more than she usually drinks if her intake was inadequate to begin with.