[Type text]
Chapter 66: Ministration of Patients with Urinary Problems
MULTIPLE CHOICE
1. A caregiver assesses patients on the medical-surgical unit. Which patient is at greatest risk for the
development ofbacterial cystitis?
a. A 36-year-old female who has never been pregnant
b. A 42-year-old male who is prescribed cyclophosphamide
c. A 58-year-old female who is not taking estrogen replacement
d. A 77-year-old male with mild congestive heart failure
ANSWER: C
Females at any age are more susceptible to cystitis than men because of the shorter urethra in women.
Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis
because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been
pregnant would not have a risk potential as high as the older woman who is not using hormone replacement
therapy.
DIF: Understanding/Comprehension REF: 1344
KEY: Cystitis| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Patient Needs Category: Safe and Effective Ministration Environment: Management of Ministration
2. A caregiver reviews the laboratory findings of a patient with a urinary tract infection. The laboratory report
notesa shift to the left in a patients white blood cell count. Which action should the caregiver take?
a. Request that the laboratory perform a differential analysis on the white blood cells.
b. Notify the provider and start an intravenous line for parenteral antibiotics.
c. Collaborate with the unlicensed assistive personnel (UAP) to strain the patients urine for renal calculi.
d. Assess the patient for a potential allergic reaction and anaphylactic shock.
NURSINGTB.COM
ANSWERWER: B
An increase in band cells creates a shift to the left. A left shift most commonly occurs with urosepsis and is
seen rarely with uncomplicated urinary tract infections. The caregiver will be administering antibiotics, most
likelyvia IV, so he or she should notify the provider and prepare to give the antibiotics. The shift to the left is
part of a differential white blood cell count. The caregiver would not need to strain urine for stones. Allergic
reactions are associated with elevated eosinophil cells, not band cells.
DIF: Applying/Application REF: 1347
KEY: Cystitis| assessment/diagnostic examination
MSC: Integrated Process: Nursing Process: Implementation
NOT: Patient Needs Category: Physiological Integrity: Physiological Adaptation
3. A caregiver ministrations for a postmenopausal patient who has had two episodes of bacterial urethritis
in the last 6 months. The patient asks, I never have urinary tract infections. Why is this happening now?
How should thecaregiver respond?
a. Your immune system becomes less effective as you age.
b. Low estrogen levels can make the tissue more susceptible to infection.
c. You should be more ministrationful with your personal hygiene in this area.
d. It is likely that you have an untreated sexually trANSWERmitted disease.
ANSWERWER: B
Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes,
predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this
reason. Although immune function does decrease with aging and sexually trANSWERWERmitted diseases
are a knowncause of urethritis, the most likely reason in this patient is low estrogen levels. Personal hygiene
usually does not contribute to this disease process.
DIF: Applying/Application REF: 1344
557
, [Type text]
KEY: Cystitis| patient education MSC: Integrated Process: Teaching/Learning
NOT: Patient Needs Category: Health Promotion and Maintenance
4. After teaching a patient with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the
caregiver assesses the patients understanding. Which statement made by the patient indicates a correct
understanding of theteaching?
a. I will not take this drug with food or milk.
b. If I think I am pregnant, I will stop the drug.
c. An orange color in my urine should not alarm me.
d. I will drink two glasses of cranberry juice daily.
ANSWER: C
Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many patients think they have
bloodin their urine when they see this. In addition, the urine can permanently stain clothing. Phenazopyridine is
safe to take if the patient is pregnant. There are no dietary restrictions or needs while taking this medication.
DIF: Applying/Application REF: 1349
KEY: Cystitis| medication safety MSC: Integrated Process: Teaching/Learning
NOT: Patient Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
5. After teaching a patient who has stress incontinence, the caregiver assesses the patients understanding.
Whichstatement made by the patient indicates a need for additional teaching?
a. I will limit my total intake of fluids.
b. I must avoid drinking alcoholic beverages.
c. I must avoid drinking caffeinated beverages.
d. I shall try to lose about 10% of my body weight.
ANSWER: A
Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try
to manage incontinence by limiting fluids. AlcNoUhR
olSicINaG
ndTB
ca.CffOeiM
nated beverages are bladder stimulants. Obesity
increases intra-abdominal pressure, causing incontinence.
DIF: Applying/Application REF: 1357
KEY: Cystitis| hydration
MSC: Integrated Process: Teaching/Learning
NOT: Patient Needs Category: Physiological Integrity: Basic Ministration and Comfort
6. A caregiver ministrations for adult patients who experience urge incontinence. For which patient should
the caregiver plan ahabit training program?
a. A 78-year-old female who is confused
b. A 65-year-old male with diabetes mellitus
c. A 52-year-old female with kidney failure
d. A 47-year-old male with arthritis
ANSWER: A
For a bladder training program to succeed in a patient with urge incontinence, the patient must be alert,
aware,and able to resist the urge to urinate. Habit training will work best for a confused patient. This includes
going tothe bathroom (or being assisted to the bathroom) at set times. The other patients may benefit from
another type of bladder training.
DIF: Applying/Application REF: 1357
KEY: Urinary incontinence| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Patient Needs Category: Physiological Integrity: Physiological Adaptation
7. After delegating ministration to an unlicensed assistive personnel (UAP) for a patient who is prescribed
habit trainingto manage incontinence, a caregiver evaluates the UAPs understanding. Which action indicates
the UAP needs additional teaching?
a. Toileting the patient after breakfast
558
Chapter 66: Ministration of Patients with Urinary Problems
MULTIPLE CHOICE
1. A caregiver assesses patients on the medical-surgical unit. Which patient is at greatest risk for the
development ofbacterial cystitis?
a. A 36-year-old female who has never been pregnant
b. A 42-year-old male who is prescribed cyclophosphamide
c. A 58-year-old female who is not taking estrogen replacement
d. A 77-year-old male with mild congestive heart failure
ANSWER: C
Females at any age are more susceptible to cystitis than men because of the shorter urethra in women.
Postmenopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis
because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been
pregnant would not have a risk potential as high as the older woman who is not using hormone replacement
therapy.
DIF: Understanding/Comprehension REF: 1344
KEY: Cystitis| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Patient Needs Category: Safe and Effective Ministration Environment: Management of Ministration
2. A caregiver reviews the laboratory findings of a patient with a urinary tract infection. The laboratory report
notesa shift to the left in a patients white blood cell count. Which action should the caregiver take?
a. Request that the laboratory perform a differential analysis on the white blood cells.
b. Notify the provider and start an intravenous line for parenteral antibiotics.
c. Collaborate with the unlicensed assistive personnel (UAP) to strain the patients urine for renal calculi.
d. Assess the patient for a potential allergic reaction and anaphylactic shock.
NURSINGTB.COM
ANSWERWER: B
An increase in band cells creates a shift to the left. A left shift most commonly occurs with urosepsis and is
seen rarely with uncomplicated urinary tract infections. The caregiver will be administering antibiotics, most
likelyvia IV, so he or she should notify the provider and prepare to give the antibiotics. The shift to the left is
part of a differential white blood cell count. The caregiver would not need to strain urine for stones. Allergic
reactions are associated with elevated eosinophil cells, not band cells.
DIF: Applying/Application REF: 1347
KEY: Cystitis| assessment/diagnostic examination
MSC: Integrated Process: Nursing Process: Implementation
NOT: Patient Needs Category: Physiological Integrity: Physiological Adaptation
3. A caregiver ministrations for a postmenopausal patient who has had two episodes of bacterial urethritis
in the last 6 months. The patient asks, I never have urinary tract infections. Why is this happening now?
How should thecaregiver respond?
a. Your immune system becomes less effective as you age.
b. Low estrogen levels can make the tissue more susceptible to infection.
c. You should be more ministrationful with your personal hygiene in this area.
d. It is likely that you have an untreated sexually trANSWERmitted disease.
ANSWERWER: B
Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes,
predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this
reason. Although immune function does decrease with aging and sexually trANSWERWERmitted diseases
are a knowncause of urethritis, the most likely reason in this patient is low estrogen levels. Personal hygiene
usually does not contribute to this disease process.
DIF: Applying/Application REF: 1344
557
, [Type text]
KEY: Cystitis| patient education MSC: Integrated Process: Teaching/Learning
NOT: Patient Needs Category: Health Promotion and Maintenance
4. After teaching a patient with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the
caregiver assesses the patients understanding. Which statement made by the patient indicates a correct
understanding of theteaching?
a. I will not take this drug with food or milk.
b. If I think I am pregnant, I will stop the drug.
c. An orange color in my urine should not alarm me.
d. I will drink two glasses of cranberry juice daily.
ANSWER: C
Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many patients think they have
bloodin their urine when they see this. In addition, the urine can permanently stain clothing. Phenazopyridine is
safe to take if the patient is pregnant. There are no dietary restrictions or needs while taking this medication.
DIF: Applying/Application REF: 1349
KEY: Cystitis| medication safety MSC: Integrated Process: Teaching/Learning
NOT: Patient Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
5. After teaching a patient who has stress incontinence, the caregiver assesses the patients understanding.
Whichstatement made by the patient indicates a need for additional teaching?
a. I will limit my total intake of fluids.
b. I must avoid drinking alcoholic beverages.
c. I must avoid drinking caffeinated beverages.
d. I shall try to lose about 10% of my body weight.
ANSWER: A
Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try
to manage incontinence by limiting fluids. AlcNoUhR
olSicINaG
ndTB
ca.CffOeiM
nated beverages are bladder stimulants. Obesity
increases intra-abdominal pressure, causing incontinence.
DIF: Applying/Application REF: 1357
KEY: Cystitis| hydration
MSC: Integrated Process: Teaching/Learning
NOT: Patient Needs Category: Physiological Integrity: Basic Ministration and Comfort
6. A caregiver ministrations for adult patients who experience urge incontinence. For which patient should
the caregiver plan ahabit training program?
a. A 78-year-old female who is confused
b. A 65-year-old male with diabetes mellitus
c. A 52-year-old female with kidney failure
d. A 47-year-old male with arthritis
ANSWER: A
For a bladder training program to succeed in a patient with urge incontinence, the patient must be alert,
aware,and able to resist the urge to urinate. Habit training will work best for a confused patient. This includes
going tothe bathroom (or being assisted to the bathroom) at set times. The other patients may benefit from
another type of bladder training.
DIF: Applying/Application REF: 1357
KEY: Urinary incontinence| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Patient Needs Category: Physiological Integrity: Physiological Adaptation
7. After delegating ministration to an unlicensed assistive personnel (UAP) for a patient who is prescribed
habit trainingto manage incontinence, a caregiver evaluates the UAPs understanding. Which action indicates
the UAP needs additional teaching?
a. Toileting the patient after breakfast
558
