The practical nurse is caring for a preschooler with spina bifida who was admitted with a febrile urinary tract infection.
Which action should the practical nurse prioritize to minimize complications of vesicoureteral reflux?
Assess elimination hygiene habits.
Complete post void bladder scans.
Implement a frequent voiding schedule.
Encourage adequate oral fluid intake.
The Correct Answer is C
Choice A rationale
Assessing elimination hygiene habits is important for preventing recurrent UTIs, but it does not directly address the immediate goal of minimizing complications of vesicoureteral reflux (VUR) in an acute febrile UTI. While good hygiene reduces bacterial entry, VUR involves retrograde urine flow.
Choice B rationale
Completing post-void bladder scans helps assess bladder emptying and residual urine, which are risk factors for UTIs. However, in the context of VUR and a febrile UTI, it's a diagnostic tool rather than a primary intervention to actively minimize the reflux itself during the infection.
Choice C rationale
Implementing a frequent voiding schedule minimizes the volume of urine in the bladder and reduces the duration of bladder distention. This decreases the likelihood of vesicoureteral reflux and helps to flush out bacteria, thus minimizing the risk of renal parenchymal damage during a febrile UTI.
Choice D rationale
Encouraging adequate oral fluid intake helps flush bacteria from the urinary tract and prevents dehydration, which is beneficial for overall health and UTI management. However, while important, it does not directly impact the mechanics of vesicoureteral reflux as effectively as frequent bladder emptying.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Involution is the process by which the uterus returns to its non-pregnant state, involving uterine contractions that decrease uterine size and minimize blood loss. Problems with involution, such as subinvolution, would typically present with prolonged lochial discharge and a boggy uterus, not primarily severe cramping immediately following breastfeeding.
Choice B rationale
An ileus is a temporary lack of normal muscle contractions in the intestines, leading to a build-up of food material. This condition would manifest as abdominal distension, absent bowel sounds, nausea, and vomiting. While possible post-delivery, it is not directly related to breastfeeding and would not typically cause severe cramping immediately after nursing.
Choice C rationale
A retained placenta refers to fragments of the placenta remaining in the uterus after delivery. This condition typically causes persistent postpartum bleeding, uterine atony, and a risk of infection. While it can cause uterine cramping due to the body's attempts to expel the tissue, the severe cramping immediately after breastfeeding is more directly related to hormonal release.
Choice D rationale
Breastfeeding stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a hormone that causes uterine contractions, which are essential for uterine involution and preventing postpartum hemorrhage by compressing blood vessels. These contractions, often referred to as "afterpains," are more pronounced during breastfeeding due to the surge in oxytocin.
Correct Answer is D
Explanation
Choice A rationale
Giving prescribed digoxin and furosemide is part of the long-term management for cardiac conditions, but these medications do not provide immediate relief for an acute hypoxic spell. Digoxin improves cardiac contractility, and furosemide promotes fluid excretion, but their onset of action is not rapid enough for emergent situations.
Choice B rationale
Returning the child to bed and elevating the head of the bed might provide some comfort but does not directly address the underlying physiological cause of the hypoxic spell. Elevating the head of the bed may slightly improve respiratory effort but won't reverse cyanosis effectively.
Choice C rationale
Offering to play a board game with the child as a distraction does not address the physiological emergency of a hypoxic spell. Distraction may be helpful for anxiety but is not an intervention for cyanosis, tachypnea, and tachycardia, which require medical intervention.
Choice D rationale
Providing oxygen increases the available oxygen for gas exchange, and promoting the knee-chest position reduces venous return to the heart, thereby decreasing right-to-left shunting and improving pulmonary blood flow in conditions like Tetralogy of Fallot, which commonly presents with "squatting" and hypoxic spells.
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