Nclex Review: Urinary Tract Infection

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1. The nurse is teaching an 4.

80-year-old client with a urinary
tract infection about the impor-
tance of increasing fluids in the
diet. Which of the following puts
this client at a risk for not obtain-
ing sufficient fluids?
1. Diminished liver function.
2. Increased production of antidi-
uretic hormone.
3. Decreased production of aldos-
terone.
4. Decreased ability to detect
thirst.
The sensation of thirst diminishes in
those greater than 60 years of age;
hence, fluid intake is decreased and dis-
solved particles in the extracellular fluid
compartment become more concentrat-
ed. There is no change in liver function
in older adults, nor is there a reduction of
ADH and aldosterone as a normal part
of aging.

2. A client with a urinary tract in- 3.

fection is to take nitrofurantoin Antibiotics have the maximum effect
(Macrodantin) four times each day. when a blood level of the medication
The client asks the nurse, "What is maintained. However, because nitro-
should I do if I forget a dose?" furantoin (Macrodantin) is readily ab-
What should the nurse tell the sorbed from the gastrointestinal tract
client? and is primarily excreted in urine, toxi-
1. "You can wait and take the next city may develop by doubling the dose.
dose when it is due." The client should not skip a dose if she
2. "Double the amount prescribed realizes that she has missed one. Ad-
with your next dose." ditional fluids, especially water, should
3. "Take the prescribed dose as be encouraged, but not forced to pro-
soon as you remember it, and if mote elimination of the antibiotic from
it is very close to the time for the the body. Adequate fluid intake aids in
next dose, delay that next dose." the prevention of urinary tract infections,
4. "Take a lot of water with a in addition to an acidic urine.
double amount of your prescribed
dose."

3. A nurse is assessing a client 1.

with a urinary tract infection who The client's urine specific gravity is ele-
takes an antihypertensive drug. vated. Specific gravity is a reflection of
The nurse reviews the client's uri- the concentrating ability of the kidneys.
nalysis results pH 6.8, RBC 3 This level indicates that the urine is con-
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per high power field, color-yellow, centrated. By increasing fluid intake, the
specific gravity-1.030 . The nurse urine will become more dilute. Antihy-
should: pertensives do not make urine more
1. Encourage the client to increase concentrated unless there is a diuret-
fluid intake. ic component within them. The nurse
2. Withhold the next dose of an- should not hold a dose of antihyperten-
tihypertensive medication. 3. Re- sive medication. Sodium tends to pull
strict the client's sodium intake. water with it; by restricting sodium, less
4. Encourage the client to eat at water, not more, will be present. Ba-
least half of a banana per day. nanas do not aid in the dilution of urine.

4. A client has nephropathy. The 1.

physician orders that a 24-hour All urine for creatinine clearance deter-
urine collection be done for crea- mination must be saved in a contain-
tinine clearance. Which of the fol- er with no preservatives and refrigerat-
lowing actions is necessary to en- ed or kept on ice. The first urine void-
sure proper collection of the spec- ed at the beginning of the collection is
imen? discarded, not the last. A self-report of
1. Collect the urine in a preserva- weight may not be accurate. It is not
tive-free container and keep it on necessary to have an indwelling urinary
ice. catheter inserted for urine collection.
2. Inform the client to discard the
last voided specimen at the con-
clusion of urine collection.
3. Ask the client what his weight is
before beginning the collection of
urine.
4. Request an order for insertion
of an indwelling urinary catheter.

5. A client who weighs 207 lb is 141 mg

to receive 1.5 mg/ kg of gentam-
icin sulfate (Garamycin) I.V. three
times each day. How many mil-
ligrams of medication should the
nurse administer for each dose?
Round to the nearest whole num-
ber. __________________ mg.

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6. A 24-year-old female client comes
to an ambulatory care clinic in
moderate distress with a probable
diagnosis of acute cystitis. When
obtaining the client's history, the
nurse should ask the client if she
has had:
1. Fever and chills.
2. Frequency and burning on uri-
nation.
3. Flank pain and nausea.
4. Hematuria.
2.
The classic symptoms of cystitis are
severe burning on urination, urgency,
and frequent urination. Systemic symp-
toms, such as fever and nausea and
vomiting, are more likely to accompany
pyelonephritis than cystitis. Hematuria
may occur, but it is not as common as
frequency and burning.

7. The client asks the nurse, "How 4.

did I get this urinary tract infec- Although various conditions may result
tion?" The nurse should explain in cystitis, the most common cause is
that in most instances, cystitis is an ascending infection from the urethra.
caused by: Strictures and urine retention can lead
1. Congenital strictures in the ure- to infections, but these are not the most
thra. common cause. Systemic infections are
2. An infection elsewhere in the rarely causes of cystitis.
body.
3. Urinary stasis in the urinary
bladder.
4. An ascending infection from the
urethra.

8. The client, who is a newlywed, 4.

is afraid to discuss her diagno- As newlyweds, the client and her hus-
sis of cystitis with her husband. band need to develop a strong commu-
Which would be the nurse's best nication base. The nurse can facilitate
approach? communication by preparing and sup-
1. Arrange a meeting with the porting the client. Given the situation, an
client, her husband, the physician, interdisciplinary conference is inappro-
and the nurse. priate and would not promote intimacy
2. Insist that the client talk with her for the client and her husband. Insisting
husband because good communi- that the client talk with her husband is
cation is necessary for a success- not addressing her fears. Being present
ful marriage. allows the nurse to facilitate the discus-

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3. Talk first with the husband alone sion of a difficult topic. Having the nurse
and then with both of them togeth- speak first with the husband alone shifts
er to share the husband's reac- responsibility away from the couple.
tions.
4. Spend time with the client ad-
dressing her concerns and then
stay with her while she talks with
her husband.

9. The nurse teaches a female client 2.

who has cystitis methods to re-
lieve her discomfort until the an-
tibiotic takes effect. Which of the
following responses by the client
would indicate that she under-
stands the nurse's instructions?
1. "I will place ice packs on my
perineum."
2. "I will take hot tub baths."
3. "I will drink a cup of warm tea
every hour."
4. "I will void every 5 to 6 hours."
Hot tub baths promote relaxation and
help relieve urgency, discomfort, and
spasm. Applying heat to the perineum
is more helpful than cold because heat
reduces inflammation. Although liberal
fluid intake should be encouraged, caf-
feinated beverages, such as tea, coffee,
and cola, can be irritating to the bladder
and should be avoided. Voiding at least
every 2 to 3 hours should be encour-
aged because it reduces urinary stasis.

10. The client with cystitis is giv- 3.

en a prescription for phenazopy- Phenazopyridine hydrochloride (Pyridi-
ridine hydrochloride (Pyridium). um) is a urinary analgesic that works
The nurse should teach the client directly on the bladder mucosa to re-
that this drug is used to treat uri- lieve the distressing symptoms of dy-
nary tract infections by: suria. Phenazopyridine does not have a
1. Releasing formaldehyde and bacteriostatic effect. It does not potenti-
providing bacteriostatic action. ate antibiotics or prevent crystallization.
2. Potentiating the action of the
antibiotic.
3. Providing an analgesic effect on
the bladder mucosa.
4. Preventing the crystallization
that can occur with sulfa drugs.

11.

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When teaching the client with a
urinary tract infection about tak-
ing phenazopyridine hydrochlo-
ride (Pyridium), the nurse should
tell the client to expect:
1. Bright orange-red urine.
2. Incontinence.
3. Constipation.
4. Slight drowsiness.
12. A client has been prescribed nitro-
furantoin (Macrodantin) for treat-
ment of a lower urinary tract in-
fection. Which of the following in-
structions should the nurse in-
clude when teaching the client
how to take this medication? Se-
lect all that apply.
1. "Take the medication on an
empty stomach."
2. "Your urine may become brown
in color."
3. "Increase your fluid intake."
4. "Take the medication until your
symptoms subside."
5. "Take the medication with an
antacid to decrease gastrointesti-
nal distress."
13. Nitrofurantoin (Macrodantin), 75 15 mL
mg four times per day, has been
prescribed for a client with a
lower urinary tract infection. The
medication comes in an oral
suspension of 25 mg/ 5 mL.
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1.
The client should be told that
phenazopyridine hydrochloride (Pyridi-
um) turns the urine a bright orange-red,
which may stain underwear. It can
be frightening for a client to see or-
ange-red urine without having been
forewarned. Other common adverse ef-
fects associated with phenazopyridine
include headaches, gastrointestinal dis-
turbances, and rash. Phenazopyridine
does not cause incontinence, constipa-
tion, or drowsiness.
2, 3.
Clients who are taking nitrofurantoin
(Macrodantin) should be instructed to
take the medication with meals and to
increase their fluid intake to minimize
gastrointestinal distress. The urine may
become brown in color. Although this
change is harmless, clients need to
be prepared for this color change. The
client should be instructed to take the
full prescription and not to stop taking
the drug because symptoms have sub-
sided. The medication should not be tak-
en with antacids as this may interfere
with the drug's absorption.
 Nclex Review: Urinary Tract Infection
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How many milliliters should the
nurse administer for each dose?
________________________ mL.
14. Which of the following statements
by the client would indicate that
she is at high risk for a recurrence
of cystitis? 1. "I can usually go
8 to 10 hours without needing to
empty my bladder."
2. "I take a tub bath every
evening."
3. "I wipe from front to back after
voiding."
4. "I drink a lot of water during the
day."
15. To prevent recurrence of cystitis,
the nurse should plan to encour-
age the female client to include
which of the following measures
in her daily routine?
1. Wearing cotton underpants.
2. Increasing citrus juice intake.
3. Douching regularly with 0.25%
acetic acid.
4. Using vaginal sprays.
16. The nurse explains to the client
the importance of drinking large
quantities of fluid to prevent cysti-
tis. The nurse should tell the client
to drink:
1. Twice as much fluid as usual.
2. At least 1 quart more than usu-
al.
3. A lot of water, juice, and oth-
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1.
Stasis of urine in the bladder is one of
the chief causes of bladder infection,
and a client who voids infrequently is at
greater risk for reinfection. A tub bath
does not promote urinary tract infec-
tions as long as the client avoids harsh
soaps and bubble baths. Scrupulous hy-
giene and liberal fluid intake (unless
contraindicated) are excellent preven-
tive measures, but the client also should
be taught to void every 2 to 3 hours
during the day.
1.
A woman can adopt several health-pro-
motion measures to prevent the re-
currence of cystitis, including avoiding
too-tight pants, noncotton underpants,
and irritating substances, such as bub-
ble baths and vaginal soaps and sprays.
Increasing citrus juice intake can be a
bladder irritant. Regular douching is not
recommended; it can alter the pH of the
vagina, increasing the risk of infection.
4.
Instructions should be as specific as
possible, and the nurse should avoid
general statements such as "a lot." A
specific goal is most useful. A mix of
fluids will increase the likelihood of client
compliance. It may not be sufficient to
tell the client to drink twice as much as
 Nclex Review: Urinary Tract Infection
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er fluids throughout the day. 4. At or 1 quart more than she usually drinks if
least 3,000 mL of fluids daily. her intake was inadequate to begin with.

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