Prioritization, Delegation, AssignmentChapter16 Q&A 2023

1. You are providing nursing care for a 24-year-old female patient admitted to the unit with a diagnosis of cystitis. Which intervention should you delegate to the UAP? 1. Teaching the patient how to secure a clean-catch urine sample 2. Assessing the patient's urine for color, odor, and sediment 3. Reviewing the nursing care plan and add nursing interventions 4. Providing the patient with a clean-catch urine sample container - Ans: 4 Providing the patient with a clean-catch urine sample container Providing the equipment that the patient needs to collect the urine sample is within the scope of practice of a UAP. Teaching, planning, and assessing all require additional education and skill, which is appropriate to the scope of practice of professional nurses. Focus: Delegation, supervision 2. Which laboratory result is of most concern to you for an adult patient with cystitis? 1. Serum white blood cell (WBC) count of 9000/mm3 2. Urinalysis results showing 1 or 2 WBCs present 3. Urine bacteria count of 100,000 colonies per milliliter 4. Serum hematocrit of 36% - Ans: 3 Urine bacteria count of 100,000 colonies per milliliter The presence of 100,000 bacterial colonies per milliliter of urine or the presence of many white blood cells (WBCs) and red blood cells (RBCs) indicates a urinary tract infection. The WBC count is within normal limits and the hematocrit is a little low, which may need follow-up. Neither of these results indicates infection. Focus: Prioritization 3. As charge nurse, you would assign the nursing care of which patient to an LPN/LVN, working under the supervision of an RN? 1. 48-year-old with cystitis who is taking oral antibiotics 2. 64-year-old with kidney stones who has a new order for lithotripsy 3. 72-year-old with urinary incontinence who needs bladder training 4. 52-year-old with pyelonephritis who has severe acute flank pain - Ans: 1 48-year-old with cystitis who is taking oral antibiotics The patient with cystitis who is taking oral antibiotics is in stable condition with predictable outcomes, and caring for this patient is therefore appropriate to the scope of practice of an LPN/LVN under the supervision of an RN. The patient with a new order for lithotripsy will need teaching about the procedure, which should be accomplished by the RN. The patient in need of bladder training will need the RN to plan this intervention. The patient with flank pain needs careful and skilled assessment by the RN. Focus: Assignment 4. You are admitting a 66-year-old male patient suspected of having a urinary tract infection (UTI). Which piece of the patient's medical history supports this diagnosis? 1. Patient's wife had a UTI 1 month ago 2. Followed for prostate disease for 2 years 3. Intermittent catheterization 6 months ago 4. Kidney stone removal 1 year ago - Ans: 2 Followed for prostate disease for 2 years Prostate disease increases the risk of UTIs in men because of urinary retention. The wife's UTI should not affect the patient. The times of the catheter usage and kidney stone removal are too distant to cause this UTI. Focus: Prioritization 5. A patient is being admitted to rule out interstitial cystitis. What should your plan of care for this patient include? 1. Take daily urine samples for urinalysis. 2. Maintain accurate intake and output records. 3. Obtain an admission urine sample to determine electrolyte levels. 4. Teach the patient about the cystoscopy procedure. - Ans: 4 Teach the patient about the cystoscopy procedure. A cystoscopy is needed to accurately diagnose interstitial cystitis. Urinalysis may show WBCs and RBCs, but no bacteria. The patient will probably need a urinalysis upon admission, but daily samples do not need to be obtained. Intake and output may be assessed, but results will not contribute to the diagnosis. Cystitis does not usually affect urine electrolyte levels. Focus: Prioritization 6. You are supervising a new RN graduate who is on orientation to the unit. The new RN asks you why the patient with uncomplicated cystitis is being discharged with orders for ciprofloxacin (Cipro) 250 mg twice a day for only 3 days. What is your best response? 1. "We should check with the physician, because the patient should take this drug for 10 to 14 days." 2. "A 3-day course of ciprofloxacin is not the appropriate treatment for a patient with uncomplicated cystitis." 3. "Research has shown that, with a 3-day course of ciprofloxacin, there is increased patient adherence to the plan of care." 4. "Longer courses of antibiotic therapy are required for hospitalized patients to prevent nosocomial infections." - Ans: 3 "Research has shown that, with a 3-day course of ciprofloxacin, there is increased patient adherence to the plan of care." For uncomplicated cystitis, a 3-day course of antibiotics is an effective treatment, and research has shown that patients are more likely to adhere to shorter antibiotic courses. Seven-day courses of antibiotics are appropriate for complicated cystitis, and 10- to 14- day courses are prescribed for uncomplicated pyelonephritis. This patient is being discharged and should not be at risk for a nosocomial infection. Focus: Prioritization, supervision 7. A 28-year-old married female patient with cystitis requires instruction about how to prevent future UTIs, and you have delegated this teaching to a newly-graduated RN. Which statement by the new nurse requires that you intervene?...