Prioritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam by LaCharity Linda A. & Kumagai Candice K. & Bartz Barbara

Author:LaCharity, Linda A. & Kumagai, Candice K. & Bartz, Barbara [LaCharity, Linda A.]
Language: eng
Format: epub
ISBN: 9780323113441
Publisher: Elsevier Health Sciences
Published: 2013-11-22T00:00:00+00:00

QSEN Key: PCC, Patient-Centered Care; TC, Teamwork & Collaboration; EBP, Evidence-Based Practice; QI, Quality Improvement; S, Safety; I, Informatics

Answer key

Chapter 16: Renal and urinary problems, pages 73-76

1. Ans: 4 Providing the equipment that the patient needs to collect the urine sample is within the scope of practice of a UAP. Teaching, planning, and assessing all require additional education and skill, which is appropriate to the scope of practice of professional nurses. Focus: Delegation, supervision; QSEN: TC; Concept: Collaboration

2. Ans: 3 The presence of 100,000 bacterial colonies per milliliter of urine or the presence of many white blood cells (WBCs) and red blood cells (RBCs) indicates a urinary tract infection. The WBC count is within normal limits and the hematocrit is a little low, which may need follow-up. Neither of these results indicates infection. Focus: Prioritization; QSEN: S; Concept: Clinical Judgment

3. Ans: 1 The patient with cystitis who is taking oral antibiotics is in stable condition with predictable outcomes, and caring for this patient is therefore appropriate to the scope of practice of an LPN/LVN under the supervision of an RN. The patient with a new order for lithotripsy will need teaching about the procedure, which should be accomplished by the RN. The patient in need of bladder training will need the RN to plan this intervention. The patient with flank pain needs careful and skilled assessment by the RN. Focus: Assignment; QSEN: TC, S; Concept: Collaboration

4. Ans: 2 Prostate disease increases the risk of UTIs in men because of urinary retention. The wife’s UTI should not affect the patient. The times of the catheter usage and kidney stone removal are too distant to cause this UTI. Focus: Prioritization; QSEN: PCC, S; Concept: Clinical Judgment

5. Ans: 4 A cystoscopy is needed to accurately diagnose interstitial cystitis. Urinalysis may show WBCs and RBCs, but no bacteria. The patient will probably need a urinalysis upon admission, but daily samples do not need to be obtained. Intake and output may be assessed, but results will not contribute to the diagnosis. Cystitis does not usually affect urine electrolyte levels. Focus: Prioritization; QSEN: PCC; Concept: Patient Education

6. Ans: 3 For uncomplicated cystitis, a 3-day course of antibiotics is an effective treatment, and research has shown that patients are more likely to adhere to shorter antibiotic courses. Seven-day courses of antibiotics are appropriate for complicated cystitis, and 10- to 14-day courses are prescribed for uncomplicated pyelonephritis. This patient is being discharged and should not be at risk for a nosocomial infection. Focus: Prioritization, supervision; QSEN: TC, EBP; Concept: Evidence

7. Ans: 4 Women should avoid irritating substances such as bubble bath, nylon underwear, and scented toilet tissue to prevent UTIs. Adequate fluid intake, consumption of cranberry juice, and regular voiding are all good strategies for preventing UTIs. Focus: Delegation, supervision, prioritization; QSEN: PCC, TC, S; Concept: Patient Education

8. Ans: 3 A patient with urge incontinence can be taught to control the bladder as long as the patient is alert, aware, and able to resist the urge to urinate by starting a schedule for voiding, then increasing the intervals between voids.

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