A female client presents to the clinic with complaints of foul-smelling urine, a low-grade fever of 37.7° C (100° F), and dysuria for the past three days. She also reports increased urinary frequency and urgency but states that she has not noticed any blood in her urine. Upon examination. the nurse notes mild CVA tenderness on the right side. The nurse reviews the client's recent medical history, noting that she has a history of recurrent urinary tract infections (UTIs) and is currently taking no medications other than a daily multivitamin.

Vital Signs

blood pressure 120/78 mm Hg

heart rate 88 beats per minute

respiratory rate 18 breaths per minute

temperature 37.7° C (100° F)

increased fluid intake and patient education on hydration

Blood cultures

Urine culture and sensitivity testing

Repeat urinalysis after antibiotic treatment completion.

Foley catheter placement

Oral antibiotics, such as trimethoprim-sulfamethoxazole or ciprofloxacin

Answer and Explanation

Correct Answer : A,C,D,F

A. Increased fluid intake and patient education on hydration: Encouraging increased fluid intake helps to flush bacteria from the urinary tract and prevent further infection. Hydration is a key component of managing UTIs, as it dilutes urine and promotes frequent urination, reducing bacterial colonization.

B. Blood cultures: Blood cultures are not typically indicated for uncomplicated UTIs, especially in a patient without signs of systemic infection or sepsis (e.g., high fever, hypotension, tachycardia). Blood cultures are more relevant in severe or complicated UTIs, or when there is concern for urosepsis.

C. Urine culture and sensitivity testing: A urine culture and sensitivity is essential for identifying the specific bacteria causing the infection and determining the appropriate antibiotic for treatment. This is especially important for patients with a history of recurrent UTIs to ensure the right antibiotic is selected and to avoid antibiotic resistance.

D. Repeat urinalysis after antibiotic treatment completion: A repeat urinalysis after antibiotic treatment is often ordered to ensure that the infection has been resolved, particularly in patients with recurrent infections.

E. Foley catheter placement: A Foley catheter is not appropriate for this patient, as there is no indication of urinary retention, and catheterization increases the risk of introducing new infections.

F. Oral antibiotics, such as trimethoprim-sulfamethoxazole or ciprofloxacin: Oral antibiotics like trimethoprim-sulfamethoxazole (TMP-SMX) or ciprofloxacin are commonly prescribed for treating uncomplicated UTIs. Given the patient’s history of recurrent UTIs, empiric antibiotic therapy is appropriate pending urine culture results.

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Correct Answer is ["B","C","D","E"]

Explanation

A. Incontinence: Incontinence is not a typical symptom of renal calculi. Pain, urgency, and difficulty urinating are more common.

B. Gastrointestinal upset: Nausea, vomiting, and gastrointestinal upset can occur as a result of renal colic due to the proximity of the kidneys to the gastrointestinal system.

C. Urinary urgency: Clients with renal calculi may experience urinary urgency due to irritation of the urinary tract.

D. Fever: Fever may indicate an infection related to the obstruction caused by the stone, such as pyelonephritis.

E. Flank pain: Flank pain, often severe and radiating to the lower abdomen or groin, is a classic symptom of renal calculi as the stone moves through the urinary tract.

A. Measure abdominal girth daily. B. Moisten the client's lips with lemon-glycerin swabs. C. Maintain the client in Fowler's position. D. Use sterile water to irrigate the nasogastric tube.

Correct Answer is A

Explanation

A. Measure abdominal girth daily. Measuring abdominal girth daily helps assess for changes in distention, which is important in monitoring the effectiveness of the decompression.

B. Moisten the client's lips with lemon-glycerin swabs: This is incorrect because lemon-glycerin swabs can dry the oral mucosa. Using plain water or normal saline swabs would be more appropriate.

C. Maintain the client in Fowler's position: This is appropriate as it helps promote drainage from the nasogastric tube and reduces the risk of aspiration.

D. Use sterile water to irrigate the nasogastric tube: Irrigation is typically done with normal saline to maintain electrolyte balance. Sterile water is not recommended for this purpose.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client admitted for renal calculus. Which of the following assessment findings should the nurse associate with renal calculi? (Select All that Apply.)

Correct Answer is ["B","C","D","E"]

Explanation

A nurse is contributing to the plan of care for a client who has an intestinal obstruction and is receiving continuous gastrointestinal decompression using a nasogastric tube. Which of the following interventions should the nurse include in the plan of care?

Correct Answer is A

Explanation

A nurse is caring for a client who is experiencing an acute exacerbation of ulcerative colitis. The nurse should recognize that which of the following actions is the priority?

A patient with a history of ulcerative colitis presents to the emergency department with severe abdominal pain, frequent bloody diarrhea, and signs of dehydration. Which medication should the nurse anticipate administering during this exacerbation of ulcerative colitis?

A male patient presents with complaints of chronic stomach pain and is diagnosed with a Helicobacter pylori infection. The physician decides to initiate triple therapy. Which combination of medications is most appropriate for this treatment?

A patient with chronic kidney disease (CKD) is being evaluated for medication management. Which of the following medications should be avoided due to its potential nephrotoxic effects?

A nurse is assisting with teaching a client who is preoperative for a sigmoid colostomy. Which of the following statements should the nurse include?

A patient with a nasogastric (NG) tube in place is experiencing respiratory distress. What is the most appropriate initial nursing intervention?

A female patient presents with right upper quadrant pain, nausea and vomiting. She has been diagnosed with acute cholecystitis. What is the most appropriate nursing action to alleviate her symptoms?

A nurse is gathering data on a client who was admitted with pyelonephritis. Which of the following manifestations should the nurse expect the client to be exhibiting? (Select All that Apply.)