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 D

Explanation

A. Wear sleeveless or short-sleeved shirts and shorts to better visualize any skin issues: While wearing loose or visible clothing may allow skin issues to be seen, it does not directly prevent bleeding complications, and there are more effective measures to focus on.

B. Use a floss pick instead of the floss string to floss in between the teeth: Flossing in any form, especially using a floss pick, can still increase the risk of gum bleeding in thrombocytopenic clients. It is safer to avoid flossing altogether or consult a dentist.

C. Apply an ice pack over a bleeding wound: While applying an ice pack may reduce bleeding once it occurs, it does not prevent bleeding. The focus should be on avoiding activities that increase the risk of bleeding.

D. Only use a soft-bristle toothbrush: Using a soft-bristle toothbrush helps reduce the risk of bleeding from the gums, which is a common issue for clients with thrombocytopenia due to the reduced platelet count.

A. (Select All that Apply.) B. "I will try not to gain weight." C. “I will sleep with the head of my bed elevated." D. “I will drink less fluid." E. “I will lie down for one half hour after meals." F. “I will consume less caffeine and spicy foods."

Correct Answer is ["A","B","E"]

Explanation

A. "I will try not to gain weight." Weight gain can increase pressure on the diaphragm and abdomen, worsening symptoms of hiatal hernia. Maintaining a healthy weight helps reduce this pressure.

B. “I will sleep with the head of my bed elevated." Elevating the head of the bed helps prevent stomach acid from refluxing into the esophagus while lying down, a common issue in both hiatal hernia and GERD.

C. "I will drink less fluid": Reducing fluid intake is not a recommended strategy for managing hiatal hernia symptoms. Fluid is essential for digestion and overall health.

D. "I will lie down for one half hour after meals": Lying down after meals can worsen reflux symptoms because gravity is no longer helping keep stomach contents in place. Patients should remain upright after eating.

E. "I will consume less caffeine and spicy foods." Caffeine and spicy foods can increase acid production and irritate the esophagus, worsening symptoms of hiatal hernia.

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Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who has end-stage liver disease and a recent diagnosis of thrombocytopenia. Which of the following statements provides the best recommendation to prevent complications of bleeding?

Correct Answer is D

Explanation

Which of the following client statements demonstrates a comprehensive understanding of the dietary and lifestyle modifications necessary for managing symptoms associated with a hiatal hernia? (Select all that apply.)

Correct Answer is ["A","B","E"]

Explanation

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