NURSING 204 : Multidimensional Care 3 • • A nurse cares for a patient with urinary incontinence. The patient states, “I am so embarrassed. My bladder leaks like a young child’s bladder.” How would the nurse respond? Selected Answer: d. “I can teach you strategies to help control your incontinence.” Answers: a. “I understand how you feel. I would be mortified.” b. “More people experience incontinence than you might think.” c. “Incontinence pads will minimize leaks in public.” Response Feedback: • Question 2 d. “I can teach you strategies to help control your incontinence.” The nurse should accept and acknowledge the patient’s concerns, and assist the patient to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the patient’s concerns with the use of pads or stating statistics about the occurrence of incontinence. 0 out of 1 points A nurse provides phone triage to a pregnant patient. The patient states, “I am experiencing a burning pain when I urinate.” How would the nurse respond? Selected Answer: c. “This means labor will start soon. Prepare to go to the hospital.” Answers: a. “You probably have a urinary tract infection. Drink more cranberry juice.” b. “Your pelvic wall is weakening. Pelvic muscle exercises should help.” c. “This means labor will start soon. Prepare to go to the hospital.” NURSING 204 : Multidimensional Care 3 Response Feedback: • Question 3 d. “Make an appointment with your provider to have your infection treated.” Pregnant patients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the patient to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles. 0 out of 1 points A nurse cares for a patient who has pyelonephritis. The patient states, “I am embarrassed to talk about my symptoms.” How would the nurse respond? Selected Answer: c. “You seem anxious. Would you like a nurse of the same gender to care for you?” Answers: a. “Take your time. It is okay to use words that are familiar to you.” b. “I understand. Elimination is a private topic and shouldn’t be discussed.” c. “You seem anxious. Would you like a nurse of the same gender to care for you?” d. “I am a professional. Your symptoms will be kept in confidence.” Response Feedback: • Question 4 Patients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the patient to use language that is familiar to the patient. The nurse would not make promises that cannot be kept, like keeping the patient’s symptoms confidential. The nurse must assess the patient and cannot take the time to stop the discussion or find another nurse to complete the assessment. 1 out of 1 points NURSING 204 : Multidimensional Care 3 A nurse assesses a patient who has had two episodes of bacterial cystitis in the last 6 months. Which questions would the nurse ask? (Select all that apply.) Selected Answers: a. “Are you on steroids or other immune-suppressing drugs?” c. “Does anyone in your family have a history of cystitis?” e. “Do you take estrogen replacement therapy?” Answers: a. “Are you on steroids or other immune-suppressing drugs?” b. “How much water do you drink every day?” c. “Does anyone in your family have a history of cystitis?” d. “Do you drink grapefruit juice or orange juice daily?” e. “Do you take estrogen replacement therapy?” Response Feedback: • Question 5 Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis. 2 out of 1 points A nurse teaches patients about the difference between urge incontinence and stress incontinence. Which statements would the nurse include in this education? (Select all that apply.) Selected Answers: b. “Urge incontinence occurs due to abnormal bladder contractions.” e. “Stress incontinence occurs due to weak pelvic floor muscles.” Answers: a. “Urge incontinence involves a post-void residual volume less than 50 mL.” b. “Urge incontinence occurs due to abnormal bladder contractions.” NURSING 204 : Multidimensional Care 3 Response Feedback: • Question 6 c. “Stress incontinence usually occurs in people with dementia.” d. “Urge incontinence can be managed by increasing fluid intake.” e. “Stress incontinence occurs due to weak pelvic floor muscles.” Patients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincter and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle. Abnormal detrusor contractions may be a result of neurologic abnormalities including dementia, or may occur with no known abnormality. Postvoid residual is associated with reflex incontinence, not with urge incontinence or stress incontinence. Management of urge incontinence includes decreasing fluid intake, especially in the evening hours. 0 out of 1 points A nurse assesses a patient with a fungal urinary tract infection (UTI). Which assessments would the nurse complete? (Select all that apply.) Selected Answers: b. Palpate the kidneys and bladder. c. Assess the medical history and current medical problems. d. Obtain a current list of medications. Answers: a. Inquire about recent travel to foreign countries. b. Palpate the kidneys and bladder. c. Assess the medical history and current medical problems. d. Obtain a current list of medications. e. Perform a bladder scan to assess postvoid residual. NURSING 204 : Multidimensional Care 3 Response Feedback: • Question 7 Patients who are severely immunocompromised or who have diabetes mellitus are more prone to fungal UTIs. The nurse should assess for these factors by asking about medical history, current medical problems, and current medication list. A physical examination and a postvoid residual may be needed, but not until further information is obtained indicating that these examinations are necessary. Travel to foreign countries probably would not be important because, even if exposed, the patient needs some degree of compromised immunity to develop a fungal UTI. 1 out of 1 points A nurse cares for patients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation? (Select all that apply.) Selected Answers: a. Urge incontinence—loss of urine upon feeling the need to void b. Overflow incontinence—constant dribbling of urine d. Stress incontinence—urine loss with physical exertion Answers: a. Urge incontinence—loss of urine upon feeling the need to void b. Overflow incontinence—constant dribbling of urine c. Functional incontinence—urine loss results from abnormal detrusor contractions d. Stress incontinence—urine loss with physical exertion e. Reflex incontinence—leakage of urine without lower urinary tract disorder Response Feedback: Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine. Functional incontinence is the leakage of urine caused by factors other than a disorder of the lower urinary tract. Reflex NURSING 204 : Multidimensional Care 3 • Question 8 incontinence results from abnormal detrusor contractions from a neurologic abnormality. 0 out of 1 points A nurse teaches a patient about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements would the nurse include in this patient’s discharge teaching? (Select all that apply.) Selected Answers: b. “It is normal to experience pain and difficulty urinating.” c. “Finish the prescribed antibiotic even if you are feeling better.” d. “Drink at least 3 L of fluid each day.” e. “Report any blood present in your urine.” Answers: a. “The bruising on your back may take several weeks to resolve.” b. “It is normal to experience pain and difficulty urinating.” c. “Finish the prescribed antibiotic even if you are feeling better.” d. “Drink at least 3 L of fluid each day.” e. “Report any blood present in your urine.” Response Feedback: • Question 9 The patient should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The patient should drink at least 3 L of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the patient should expect bruising that may take several weeks to resolve. The patient should also experience blood in the urine for several days. The patient should report any pain, fever, chills, or difficulty with urination to the provider as these may signal the beginning of an infection or the formation of another stone