UTI
A 22-year-old patient reports dysuria, urinary frequency, and urgency for 2 days. The patient is afebrile and denies flank pain. Which test is most appropriate to help quickly evaluate the suspected UTI, and what test identifies the causative organism?
A. Urinalysis for the organism; CBC for antibiotic sensitivity
B. Urinalysis for evidence of infection; urine culture for organism identification and susceptibility
C. Urine culture only because urinalysis cannot identify infection
D. Renal ultrasound for organism identification
B. Urinalysis for evidence of infection; urine culture for organism identification and susceptibility
Rationale: A urine culture identifies the organism and can determine which antibiotics are likely to be effective. A culture is especially important for complicated infections, suspected pyelonephritis, recurrent infections, treatment failure, and other situations where the result will guide therapy.
Which type of kidney stone is most strongly associated with persistently alkaline urine and infection with urease-producing bacteria?
A. Calcium oxalate
B. Uric acid
C. Struvite
D. Cystine
C. Struvite
Rationale: Struvite stones contain magnesium ammonium phosphate and are associated with urease-producing organisms, which increase urine pH.
A patient with cystitis is prescribed phenazopyridine for dysuria. Which statement demonstrates correct understanding?
A. “This medication will eliminate the bacteria causing my infection.”
B. “My urine may turn orange-red, and this medication only relieves urinary discomfort.”
C. “I should take this medication until my urine culture is negative.”
D. “This medication prevents all future UTIs.”
B. “My urine may turn orange-red, and this medication only relieves urinary discomfort.”
Rationale: Phenazopyridine is a urinary tract analgesic that reduces discomfort during urination. It does not treat the infection. It can discolor urine orange-red and stain clothing or contact lenses. It is generally used for no more than 2 days when given with an antibacterial for a UTI.
A patient repeatedly checks the stove because of intrusive fears that the house will catch fire. The patient recognizes that the checking is excessive but feels intense anxiety when trying to stop. Which condition best fits this presentation?
A. Obsessive-compulsive disorder (OCD)
B. Obsessive-compulsive personality disorder (OCPD)
C. Bipolar I disorder
D. Antisocial personality disorder
A. Obsessive-compulsive disorder (OCD)
Rationale: OCD involves obsessions, compulsions, or both. Obsessions are intrusive, unwanted thoughts or urges; compulsions are repetitive behaviors or mental acts performed to reduce distress or prevent a feared event. OCPD is characterized by a pervasive pattern of perfectionism, orderliness, and control rather than the typical obsession-compulsion cycle.
A patient reports years of fluctuating periods of mild depressive symptoms and periods of increased energy and mood that do not meet the full criteria for major depressive episodes or hypomanic episodes. Which diagnosis is most consistent with this pattern?
A. Cyclothymic disorder
B. Bipolar I disorder
C. Major depressive disorder
D. Panic disorder
A. Cyclothymic disorder
Rationale: Cyclothymic disorder involves chronic fluctuations between hypomanic symptoms and depressive symptoms that do not meet full episode criteria. In adults, the pattern generally persists for at least 2 years, with symptoms present at least half the time and no symptom-free interval longer than 2 months.
A patient has dysuria, frequency, urgency, a temperature of 103°F (39.4°C), chills, nausea, and right-sided flank pain. Which condition should the nurse suspect?
A. Pyelonephritis
B. Uncomplicated cystitis
C. Urethritis without systemic involvement
D. Overactive bladder
A. Pyelonephritis.
Rationale: Cystitis usually causes lower urinary symptoms, such as dysuria, frequency, and urgency. Fever, chills, flank pain, nausea, and costovertebral-angle tenderness suggest infection involving the kidneys. Pyelonephritis can progress to bacteremia or sepsis.
A patient has recurrent uric acid kidney stones. Which urine characteristic most strongly promotes their formation?
A. Persistently acidic urine
B. Persistently alkaline urine
C. Excessively dilute urine
D. High urine pH caused by urease-producing bacteria
A. Persistently acidic urine
Rationale: Uric acid becomes less soluble in acidic urine and can precipitate into crystals. Low urine volume and increased uric acid concentration also contribute. Management may include increased fluid intake and prescribed urine alkalinization.
Why is phenazopyridine generally not recommended for more than 2 days when used with an antibiotic for a UTI?
A. It causes immediate bacterial resistance after 48 hours.
B. It treats symptoms rather than the underlying infection, and prolonged use can delay recognition of persistent symptoms and increase medication-related risk.
C. It permanently suppresses bladder contractions after 2 days.
D. It prevents antibiotics from entering the kidneys.
B. It treats symptoms rather than the underlying infection, and prolonged use can delay recognition of persistent symptoms and increase medication-related risk.
Rationale: Phenazopyridine provides symptomatic relief but does not eradicate bacteria. The short-term limit helps prevent masking an infection that is not improving and reduces unnecessary exposure to a medication that can cause adverse effects, including hemolysis and methemoglobinemia. Renal impairment increases the risk of toxicity.
A patient with OCD repeatedly asks the nurse whether the door is locked. The nurse has already checked it and confirmed that it is secure. Which response is most therapeutic?
A. “I promise nothing bad will happen, so stop worrying.”
B. “I will check it every time you ask so you feel safe.”
C. “I can see this is causing anxiety. We have checked the door, and let's practice the coping strategy you learned.”
D. “Your fear is irrational, and you need to ignore it.”
C. “I can see this is causing anxiety. We have checked the door, and let's practice the coping strategy you learned.”
Rationale: Acknowledge distress without judgment, maintain appropriate safety, and encourage evidence-based coping skills. Repeated reassurance can reinforce the OCD cycle by providing temporary relief that strengthens future reassurance-seeking. Avoid shaming the patient or abruptly forcing them to stop rituals.
Which finding distinguishes bipolar I disorder from bipolar II disorder?
A. Bipolar I requires a history of major depressive episodes.
B. Bipolar I is defined by at least one manic episode; bipolar II involves hypomanic and major depressive episodes without a history of mania.
C. Bipolar II includes full mania, whereas bipolar I does not.
D. Neither disorder includes changes in energy or sleep.
B. Bipolar I is defined by at least one manic episode; bipolar II involves hypomanic and major depressive episodes without a history of mania.
Rationale: A manic episode is the defining feature of bipolar I and may cause severe impairment, hospitalization, or psychosis. Bipolar II involves hypomanic episodes and major depressive episodes but no history of a full manic episode. A major depressive episode is not required for bipolar I.
A patient with a suspected UTI has a temperature of 102.8°F, HR 124/min, BP 88/54 mmHg, and new confusion. What should the nurse do first?
A. Administer a urinary analgesic
B. Encourage oral fluids and reassess in 1 hour
C. Initiate urgent assessment and escalation for possible sepsis, support circulation, and anticipate prompt cultures and IV antibiotics
D. Wait for the urine culture before notifying the provider
C. Initiate urgent assessment and escalation for possible sepsis, support circulation, and anticipate prompt cultures and IV antibiotics
Rationale: Hypotension, tachycardia, and altered mental status suggest possible sepsis with impaired perfusion. Activate the facility's emergency or sepsis pathway, assess ABCs, obtain ordered cultures without unnecessarily delaying antibiotics, and anticipate IV fluids and prompt antimicrobial therapy. Do not wait for culture results.
A patient with benign prostatic hyperplasia reports hesitancy, a weak stream, dribbling, and incomplete bladder emptying. Which mechanism best explains these findings?
A. Increased glomerular filtration causes excessive urine production
B. Prostate enlargement compresses the urethra and increases resistance to urinary flow
C. Bacterial destruction of the bladder lining prevents urine storage
D. Loss of antidiuretic hormone causes urinary retention
B. Prostate enlargement compresses the urethra and increases resistance to urinary flow
Rationale: Prostate enlargement can obstruct the urethra, causing bladder outlet resistance. The bladder must work harder to expel urine, which can lead to residual urine, urinary retention, recurrent UTIs, bladder changes, and potentially hydronephrosis or renal impairment.
A patient with BPH is prescribed tamsulosin. Which explanation best describes how this medication improves urination?
A. It inhibits 5-alpha-reductase and gradually shrinks the prostate.
B. It blocks alpha-1 receptors, relaxing smooth muscle in the prostate and bladder neck.
C. It increases bladder contraction through muscarinic stimulation.
D. It reduces urine production by inhibiting sodium reabsorption in the loop of Henle.
B. It blocks alpha-1 receptors, relaxing smooth muscle in the prostate and bladder neck.
Rationale: Tamsulosin is an alpha-1 adrenergic blocker. It relaxes smooth muscle around the prostate and bladder neck, reducing outlet resistance. It can improve symptoms relatively quickly but does not significantly shrink the prostate. Important adverse effects include dizziness, orthostatic hypotension, and ejaculatory changes.
A patient with OCD reports spending 4 hours each day washing their hands. Which treatment is particularly effective and specifically targets the cycle of obsession, anxiety, and compulsion?
A. Exposure and response prevention (ERP)
B. Avoidance of all anxiety-provoking situations
C. Reassurance after every intrusive thought
D. Punishment for ritualistic behaviors
A. Exposure and response prevention (ERP)
Rationale: ERP is a form of cognitive behavioral therapy (CBT). The patient gradually confronts triggers while resisting the compulsion, learning that anxiety can decrease without performing the ritual. SSRIs are also commonly used. Effective care may combine medication with ERP.
A patient tells the nurse, “You are the only person who understands me,” but later says, “You are just like everyone else; you don't care about me,” after a limit is set. Which nursing approach is best?
A. Change the limit to prevent the patient from becoming upset.
B. Maintain consistent boundaries, acknowledge the patient's feelings, and communicate calmly.
C. Tell the patient the behavior is manipulative and unacceptable.
D. Avoid interacting with the patient for the rest of the shift.
B. Maintain consistent boundaries, acknowledge the patient's feelings, and communicate calmly.
Rationale: Borderline personality disorder (BPD) may involve intense emotions, fear of abandonment, unstable relationships, and difficulty regulating distress. Consistent boundaries, validation, a nonjudgmental approach, and clear communication promote safety and therapeutic rapport
A patient reports severe intermittent left flank pain radiating to the groin, nausea, and visible blood in the urine. The patient is afebrile and restless. Which condition is most likely?
A. Acute pyelonephritis
B. Ureteral calculus
C. Uncomplicated cystitis
D. Nephrotic syndrome
B. Ureteral calculus
Rationale: Renal colic commonly causes severe, wave-like flank pain radiating toward the groin, hematuria, nausea, and restlessness. Pyelonephritis more commonly produces fever, chills, and systemic symptoms.
A patient with BPH has not voided for 9 hours and reports intense suprapubic pain. The lower abdomen is distended, and a bladder scan shows 850 mL of retained urine. What is the priority nursing action?
A. Restrict fluids for the remainder of the day
B. Administer a loop diuretic
C. Notify the provider and anticipate prompt bladder decompression according to protocol
D. Encourage the patient to wait until the next scheduled voiding time
C. Notify the provider and anticipate prompt bladder decompression according to protocol
Rationale: Acute urinary retention requires prompt assessment and relief of obstruction, commonly with catheterization when appropriate and ordered or protocol-authorized. Prolonged retention can damage the bladder and kidneys. Diuretics do not correct an obstructed outlet.
A patient with an enlarged prostate asks why finasteride may take months to improve urinary symptoms while tamsulosin may work sooner. Which response is most accurate?
A. Finasteride immediately relaxes the bladder neck, while tamsulosin reduces prostate size.
B. Finasteride inhibits conversion of testosterone to dihydrotestosterone, gradually reducing prostate volume; tamsulosin relaxes smooth muscle.
C. Both medications work by increasing bladder contractions.
D. Finasteride treats a bacterial infection, while tamsulosin prevents kidney stones.
B. Finasteride inhibits conversion of testosterone to dihydrotestosterone, gradually reducing prostate volume; tamsulosin relaxes smooth muscle.
Rationale: Finasteride inhibits 5-alpha-reductase, reducing dihydrotestosterone (DHT) and gradually shrinking the prostate. Benefits may take several months. Tamsulosin works on smooth muscle and generally improves urinary flow sooner. Finasteride can cause sexual adverse effects and lower PSA levels, which must be considered during prostate cancer screening.
A patient has persistent, severe OCD despite adequate trials of two SSRIs and a course of CBT. Which treatment plan is most appropriate to consider?
A. Discontinue all treatment because further improvement is unlikely.
B. Reassess adherence, dose, duration, diagnosis, and comorbidities; optimize ERP and consider specialist-guided medication augmentation.
C. Add an antipsychotic as the only treatment without reassessing the current plan.
D. Replace all treatment with a benzodiazepine for long-term daily use.
B. Reassess adherence, dose, duration, diagnosis, and comorbidities; optimize ERP and consider specialist-guided medication augmentation.
Rationale: Treatment resistance requires a systematic review of whether treatments were adequate and whether the diagnosis or coexisting conditions affect response. ERP should be optimized, and an appropriately selected SSRI or clomipramine may be considered.
A patient with BPD says, “Everyone would be better off without me,” following a conflict with a family member. What should the nurse do first?
A. Assume the statement is attention-seeking.
B. Tell the patient to use distraction techniques and reassess tomorrow.
C. Immediately assess for suicidal thoughts, intent, plan, access to means, and immediate safety needs.
D. Promise not to tell anyone what the patient says.
C. Immediately assess for suicidal thoughts, intent, plan, access to means, and immediate safety needs.
Rationale: Never dismiss possible suicidal communication as manipulation or attention-seeking. Direct assessment of suicidal ideation, intent, plan, access to means, previous attempts, and protective factors guides the safety response. Maintain appropriate observation and initiate the facility's suicide precautions when indicated.
A patient with a known ureteral stone develops fever, rigors, severe flank pain, HR 130/min, and BP 90/56 mmHg. CT shows hydronephrosis (swelling of one or both kidneys) caused by the obstructing stone. Which intervention is the priority?
A. Administer an oral antibiotic and arrange outpatient follow-up
B. Encourage ambulation to help the stone pass
C. Urgently escalate for sepsis management, IV antibiotics, and emergency urinary drainage
D. Administer an antispasmodic and reassess the pain
C. Urgently escalate for sepsis management, IV antibiotics, and emergency urinary drainage.
Rationale: An infected, obstructed urinary system can rapidly cause urosepsis. Antibiotics alone may be insufficient because the obstruction prevents adequate drainage. Time-sensitive emergency
A patient with recurrent kidney stones asks how to reduce the risk of recurrence. Which teaching points are appropriate? Select all that apply.
A. Increase fluid intake as recommended to produce adequate urine volume.
B. Eliminate all dietary calcium regardless of stone type.
C. Have the stone analyzed when available.
D. Follow a prevention plan based on stone composition and metabolic evaluation.
E. Recognize fever or chills with flank pain as warning signs requiring urgent assessment.
F. Assume that all stones can be dissolved with medication.
A, C, D, E
Rationale: Hydration helps dilute urine, and stone analysis guides individualized prevention. Most patients with calcium oxalate stones should maintain appropriate dietary calcium rather than eliminate it. Some stones can be medically dissolved or prevented under specific conditions, but not all stones respond to medication. Fever or chills with an obstructing stone can indicate a life-threatening infection.
A patient with BPH takes tamsulosin and is prescribed an antimuscarinic medication for urgency and frequency. The patient now reports a weak stream and increasing difficulty voiding. What is the nurse's best response?
A. Explain that this is an expected effect and recommend doubling the antimuscarinic dose.
B. Encourage the patient to reduce fluid intake substantially.
C. Recommend taking both medications only when symptoms are severe.
D. Assess for urinary retention and notify the prescriber because antimuscarinics can worsen bladder emptying.
D. Assess for urinary retention and notify the prescriber because antimuscarinics can worsen bladder emptying.
Rationale: Antimuscarinics reduce detrusor muscle contractions and can worsen urinary retention in patients with bladder outlet obstruction. Assess the patient's ability to void, consider a bladder scan as appropriate, and escalate the change. These medications can be useful in selected patients with BPH and storage symptoms, but retention risk must be evaluated.
A patient repeatedly pulls out their hair, reports mounting tension before pulling, and experiences temporary relief afterward. Examination reveals irregular patches of hair loss. Which intervention is most appropriate?
A. Treat the behavior as deliberate misconduct and impose consequences.
B. Recommend habit reversal training as part of behavioral therapy and assess for associated distress or impairment.
C. Explain that hair pulling is always a form of psychosis.
D. Recommend an SSRI as a guaranteed cure.
B. Recommend habit reversal training as part of behavioral therapy and assess for associated distress or impairment.
Rationale: Habit reversal training, often within comprehensive behavioral therapy, is a key treatment. Medication may be considered in selected cases, but no medication is a guaranteed cure.
A hospitalized patient with schizophrenia suddenly becomes mute, remains motionless for prolonged periods, and resists repositioning. What is the nurse's priority action?
A. Assume the patient is experiencing negative symptoms and wait until the next shift.
B. Administer an additional antipsychotic dose without further assessment.
C. Encourage the patient to exercise independently.
D. Assess immediately for catatonia and medical causes, including vital-sign abnormalities, hydration, immobility complications, and possible neuroleptic malignant syndrome.
D. Assess immediately for catatonia and medical causes, including vital-sign abnormalities, hydration, immobility complications, and possible neuroleptic malignant syndrome.
Rationale: Urgent assessment is essential because complications can include dehydration, venous thromboembolism, pressure injuries, and malignant catatonia. Fever, rigidity, autonomic instability, or recent antipsychotic changes raise concern for neuroleptic malignant syndrome or other emergencies.