A nurse cares for a middle-aged female client with diabetes ...

[Beheh]

A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, What can I do to help prevent these infections? How should the nurse respond?
 
  a. Test your urine daily for the presence of ketone bodies and proteins.
  b. Use tampons rather than sanitary napkins during your menstrual period.
  c. Drink more water and empty your bladder more frequently during the day.
  d. Keep your hemoglobin A1c under 9 by keeping your blood sugar controlled.

Question 2

A nurse evaluates a client with acute glomerulonephritis (GN). Which manifestation should the nurse recognize as a positive response to the prescribed treatment?
 
  a. The client has lost 11 pounds in the past 10 days.
  b. The client's urine specific gravity is 1.048.
  c. No blood is observed in the client's urine.
  d. The client's blood pressure is 152/88 mm Hg.

[meow1234]

Answer to Question 1

ANS: C
Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and providing a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth. Testing urine and using tampons will not help prevent pyelonephritis. A hemoglobin A1c of 9 is too high.

Answer to Question 2

ANS: A
Fluid retention is a major feature of acute GN. This weight loss represents fluid loss, indicating that the glomeruli are performing the function of filtration. A urine specific gravity of 1.048 is high. Blood is not usually seen in GN, so this finding would be expected. A blood pressure of 152/88 mm Hg is too high; this may indicate kidney damage or fluid overload.

[Beheh]

Excellent

[kusterl]

TYSM