Chapter 50: Renal and Urologic Problems ||Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

MULTIPLE CHOICE 1. A 46-yr-old female patient returns to the clinic with continued dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take? a. Remind the patient about the need to drink 1000 mL of fluids daily. b. Obtain a midstream urine specimen for culture and sensitivity testing. c. Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms. d. Tell the patient to take the trimethoprim and sulfamethoxazole for 3 more days. ANS: B Because uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3 days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine appropriate antibiotic therapy. Acetaminophen would not be as effective as other over-the-counter medications such as phenazopyridine in treating dysuria. The fluid intake should be increased to at least 1800 mL/day. Because the UTI has persisted after treatment with trimethoprim and sulfamethoxazole, the patient is likely to need a different antibiotic. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 2. Which statement by a 22-yr-old female patient with cystitis indicates to the nurse that instruction about preventing future urinary tract infections (UTIs) has been effective? a. “I can use vaginal antiseptic sprays to reduce bacteria.” b. “I will drink a quart of water or other fluids every day.” c. “I will wash with soap and water before sexual intercourse.” d. “I will empty my bladder every 3 to 4 hours during the day.” ANS: D Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal sprays is discouraged. The bladder should be emptied before and after intercourse, but cleaning with soap and water prior to intercourse is not necessary to prevent UTI. A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 3. Which information about phenazopyridine will the nurse teach the patient with a urinary tract infection (UTI)? a. Take the drug for at least 7 days. b. The drug may cause photosensitivity. c. The drug may change your urine color. d. Take the drug before sexual intercourse. ANS: C Patients should be taught that phenazopyridine will color the urine deep orange. Urinary analgesics would be taken as needed for dysuria and should be needed for only a few days until the prescribed antibiotics decrease the bacterial count. Phenazopyridine does not cause photosensitivity. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 4. Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? a. Bladder distention b. Foul-smelling urine c. Suprapubic discomfort d. Costovertebral tenderness