A sexually active 23 year old woman presents with dysuria, hematuria, and frequency.
What is the first step in her assessment?
A pregnancy test.
A history and physical examination.
A urine culture.
A 3-day course of antibiotics.
The Correct Answer is B
Choice A rationale
While a pregnancy test is important in a sexually active woman presenting with urinary symptoms to rule out ectopic pregnancy or potential teratogenic antibiotic exposure, the initial step must be to gather comprehensive data. A pregnancy test is a diagnostic tool, and its necessity follows the initial data collection for context.
Choice B rationale
A thorough history and physical examination is the fundamental first step in evaluating any patient, regardless of the chief complaint. This process allows the healthcare provider to gather subjective and objective data, assess risk factors, narrow the differential diagnosis for the dysuria, hematuria, and frequency, and guide appropriate diagnostic testing, such as a urine sample.
Choice C rationale
A urine culture is a specific diagnostic test used to identify the causative organism in a suspected urinary tract infection. Although a urine sample collection will likely follow the initial assessment, ordering the culture before a thorough history and physical is premature and does not follow the standard, systematic approach to patient care.
Choice D rationale
Starting empiric antibiotics without a thorough assessment and potential diagnostic confirmation is poor medical practice. Although the symptoms strongly suggest a urinary tract infection, a course of antibiotics should only be initiated after a history and physical and, ideally, after obtaining a urine sample for testing to ensure appropriate, targeted therapy. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Overflow incontinence occurs when the bladder becomes overly full and distended, exceeding its capacity, leading to involuntary loss of small amounts of urine frequently. This is often due to an obstruction, such as an enlarged prostate, or poor detrusor muscle contractility, resulting in incomplete bladder emptying and retention. The clinical picture of frequent leakage and bladder distension confirms this type.
Choice B rationale
Reflex incontinence involves the involuntary loss of urine that occurs at somewhat predictable intervals when the bladder volume reaches a specific level. This type is typically associated with spinal cord damage or neurological impairment above the sacral reflex arc, which causes the detrusor muscle to contract reflexively without the client's sensation of needing to void.
Choice C rationale
Urge incontinence is characterized by the sudden, strong urge to void immediately preceding an involuntary loss of urine. It is typically caused by bladder instability or overactivity of the detrusor muscle, often termed an overactive bladder. The client with urge incontinence generally does not have associated urinary retention or chronic bladder distension.
Choice D rationale
Stress incontinence involves the involuntary leakage of small amounts of urine that occurs with increased intra-abdominal pressure, such as coughing, sneezing, laughing, or physical exertion. This is usually due to weakened pelvic floor muscles and/or a deficient urethral sphincter mechanism, which cannot withstand the momentary pressure increase. —.
Correct Answer is D
Explanation
Choice A rationale
Consuming a low-fiber diet is generally inappropriate for managing constipation, as fiber adds bulk to stool and facilitates normal bowel movements by absorbing water and stimulating peristalsis. Adequate intake of dietary fiber, typically 25 to 30 grams per day for adults, is essential to prevent and treat constipation, thereby promoting softer, easier-to-pass stools and regularity.
Choice B rationale
Attempting to defecate at different times of the day is generally discouraged because establishing a consistent, regular time, often after a meal due to the gastrocolic reflex, is key to retraining the colon. This reflex increases motility after food intake, making it the most opportune time for successful, non-straining bowel evacuation and promoting a predictable pattern.
Choice C rationale
Reducing daily activity is counterproductive for constipation management, since physical activity, such as walking or light exercise, stimulates peristalsis and promotes intestinal motility. Increased physical movement helps move stool through the colon more efficiently, making an active lifestyle a beneficial non-pharmacological intervention for preventing and relieving chronic constipation.
Choice D rationale
Increasing daily fluid intake is a crucial intervention for constipation because water is absorbed by fiber in the stool, significantly increasing its volume and making it softer. This increased fluid volume within the gastrointestinal tract reduces transit time, lessens the need for straining, and promotes easier and more complete evacuation.
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