Adult II--Ch. 66

A patient reports symptoms indicating a UTI. Results from which diagnostic test will verify a UTI?

Urinalysis to test for leukocyte esterase and nitrate.

the nurse is teaching a patient about self-care measures to prevent UTIs. Which daily fluid intake does the nurse recommend to the patient to prevent a bladder infection?

2 to 3 L of water.

Teaching intermittent self catheterization for incontinence is appropriate for which patient?

25-year-old male patient with paraplegia.

Which patient is most likely to have mixed incontinence?

54-year-old woman who had four full-term pregnancies.

Which patient has the highest risk for bladder cancer?

60-year-old female patient who smokes two packs of cigarettes per day and works in a chemical factory.

Which patient has the highest risk for developing a complicated UTI?

A 22-year-old man who has a neurogenic bladder due to spinal cord injury.

Which patient should not be advised to take cranberry juice?

A 33-year-old woman with dysuria associated with interstitial cystitis.

The nurse is working in a long-term care facility. Which circumstance is cause for greatest concern, because the facility has a large number of residents who are developing UTIs?

A large percentage of residents have indwelling urinary catheters.

The nurse is teaching a patient a behavioral intervention for bladder compression. In order to correctly perform the Crede method, what does the nurse teach the patient to do?

Apply firm and steady pressure over the bladder area with the palm of the hand.

The nurse is performing an assessment on a patient with probable stress incontinence. Which assessment technique does the nurse use to validate stress incontinence?

Ask the patient to cough while wearing a perineal pad.

The nurse is caring for a patient with an indwelling catheter. What intervention does the nurse used to minimize catheter related infections?

Assess the patient daily to determine need for the catheter.

The nurse is caring for a patient with functional incontinence. The UAP reports that "the linens have been changed four times within the past six hours, but the patient refuses to wear a diaper." What does the nurse do next?

Assess the patient for any new urinary problems and ask about toileting preferences.

Which dietary changes does the nurse suggest to a patient with urge incontinence?

Avoid alcohol and caffeine.

what role does drug therapy have as an intervention for reflex, overflow, urinary incontinence?

Bethanechol Chloride, Urecholine, may be used short term after surgery.

The nurse is caring for a patient who has an indwelling catheter and subsequently developed a UTI. The patient has been receiving antibiotics for several days, but develops hypotension, a rapid pulse, and confusion. The nurse suspects urosepsis and alerts the healthcare provider. Which diagnostic test is the provider most likely to order to confirm urosepsis?

Blood culture.

The nurse is teaching a woman how to prevent UTIs. What information does the nurse include?

Clean the perineal area from front to back.

The home health nurse reads in the patient's chart that the patient has asymptomatic bacterial urinary tract infection. Which intervention will the nurse performed?

Closely monitor for conditions that cause progression to acute infection.

For a patient who needs an indwelling catheter for at least two weeks, which intervention would help reduce the bacterial colonization along the catheter?

Consider the use of a coated catheter.

A male college student comes to the clinic reporting burning or difficulty with urination and a discharge from the urethral meatus. Based on the patient's chief complaint, what is the most logical question for the nurse to ask about the patient's past medical history?

Could you have been exposed to a sexually transmitted disease?

A patient has UTI symptoms but there are no bacteria in the urine. The healthcare provider suspects interstitial cystitis. The nurse prepares patient teaching materials for which diagnostic test?

Cystoscopy.

A patient comes to the clinic and reports severe flank pain, bladder distention, and nausea and vomiting with increasingly smaller amounts of urine with frank blood. The patient states," I have kidney stones and they just need a prescription for pain medication.." What is the nurse's priority concern?

Determining if there is an obstruction.

Patients who have central nervous system lesions from stroke, multiple sclerosis, or parasacral spinal cord lesions may have which type of urinary incontinence?

Detrusor hyperreflexia.

Several patients at the clinic have just been diagnosed with UTIs. Which patients may need longer antibiotic treatment, 7 to 21 days, or different agents than the typical first-line medications?

Diabetic patient. Immunosuppressed patient. Pregnant patient.

A patient is diagnosed with a urethral stricture. The nurse prepares the patient for which temporary treatment?

Dilation of the urethra.

A young woman tells the nurse that she gets frequent UTIs that seem to follow sexual intercourse. Which questions with the nurse ask?

Do you use a diaphragm or spermicides for contraception? Do you or your partner wash the perineal area before intercourse? Some positions cause more irritation during sex. Have you noticed this?

The nurse is teaching a patient with urge incontinence about dietary modifications. What is the best information the nurse gives to the patient about fluid intake?

Drink 120 mL every hour or 240 mL every two hours and limit fluids after dinner.

The nurse is counseling a patient with recurrent symptomatic UTIs about dietary therapy. What information does the nurse give to the patient?

Drink 50 mL of concentrated cranberry juice every day.

The urine output of a patient with a kidney stone has decreased from 40 mL per hour to 5 mL per hour. What is the nurse's priority action?

Ensure IV access and notify the healthcare provider.

The nurse is teaching self-care measures to a patient who had lithotripsy for kidney stones. What information does the nurse include?

Finish the entire prescription of antibiotics to prevent UTIs. Balance regular exercise with sleep and rest. Drink at least 3 L of fluid a day. Urine may be bloody for several days.

A patient is diagnosed with a fungal UTI. Which drug does the nurse anticipate the patient will be treated with?

Fluconazole-Diflucan.

An older adult patient with a cognitive impairment is living in an extended care facility. The patient is incontinent, but as the family points out, "he will urinate in the toilet if somebody helps him." Which type of incontinence does the nurse suspect in this patient?

Functional.

The nurse is teaching a man about how to prevent UTIs. What information does the nurse include?

Gently wash the genital area before intercourse.

A patient's recurrent cystitis appears to be related to sexual intercourse. The patient seems uncomfortable talking about the situation. What communication technique does the nurse use to assist the patient?

Have a frank and sensitive discussion with the patient.

A young female patient reports experiencing burning with urination what question does the nurse ask to differentiate between a vaginal infection and a urinary infection?

Have you noticed any vaginal discharge?

which statement by patient indicates effective coping with a Kock's pouch?

I check the pouch every 2 to 3 hours depending on my fluid and diet.

The nurse is evaluating outcome criteria for a patient being treated for urge incontinence. Which statement indicates the treatment has been successful?

I had trouble at first, but now I go to the toilet every three hours.

The nurse hears a report that the patient is being treated for a fungal UTI. In addition to performing routine care and assessments, the nurse is extra vigilant for signs and symptoms of which systemic disorder that may underlie the fungal UTI?

Immune system compromise.

A patient is returning from the postanesthesia care unit after surgery for bladder cancer resulting in a cutaneous ureter ostomy. Where does the nurse expect the stoma to be located?

In the mid-abdominal area.

A patient with urinary incontinence is prescribed oxybutynin, Ditropan. what precautions or instructions does the nurse provide related to this therapy?

Increase fluids and dietary fiber intake.

The nursing student sees an order for a urinalysis for a patient with frequency, urgency, and dysuria. In order to collect the specimen, what does the student do?

Instruct the patient on how to collect a clean catch specimen.

A patient reports intense urgency, frequency, and bladder pain. Urinalysis results show white blood cells and red blood cells and urine culture results are negative for infection. How does the nurse interpret these findings?

Interstitial cystitis.

The cystoscopy results for a patient include a small capacity bladder, the presence of Hunner's ulcers, and small hemorrhages after bladder distention. How does the nurse interpret this report?

Interstitial cystitis.

a patient has had surgery for bladder cancer. To prevent recurrence of superficial bladder cancer, the nurse anticipates that the healthcare provider is likely to recommend which treatment?

Intravesical installation of bacille Calmette-Guerin.

The patient is considering vaginal cone therapy, but is a little hesitant because she does not understand how it works. What does the nurse tell her about how vaginal cone therapy improves incontinence?

It strengthens pelvic floor muscles.

A patient has had a bladder suspension and a suprapubic catheter is in place. The patient wants to know how long the catheter will remain in place. What is the nurse's best response?

It will be removed when you can void and residual urine is less than 50 mL.

The healthcare provider verbally informs the nurse that the patient needs a fluorolquinolone antibiotic to treat a UTI. The pharmacy delivers gabapentin, Neurontin. what should the nurse do first?

Look at the written order to clarify the name of the medication.

The nurse is caring for a patient with urolithiasis. which medication is likely to be given in the acute phase to relieve the patient's severe pain?

Morphine sulfate, Astramorph.

The home health nurse is assessing an older adult patient who refuses to leave the house to see friends or participate in usual activities. She reports taking a bath several times a day and becomes very upset when she has an incontinent episode. What is the priority problem for this patient?

Negative self-image.

the advanced practice nurse is performing a digital rectal exam and notes that the rectal sphincter contracts on digital insertion. How does the nurse interpret this finding?

Nerve supply to the bladder is most likely intact.

The nurse is caring for an obese older adult patient with dementia. The patient is alert and ambulatory, but has functional incontinence. Which nursing intervention is best for this patient?

Offer assistance with toileting every two hours.

Which group has the highest prevalence of urinary tract infections?

Older women.

A patient is diagnosed with urethral stricture. What findings does the nurse expect to see documented in the patient's chart for this condition?

Overflow incontinence.

The nurse is talking to a 68-year-old male patient who has lifestyle choices and occupational exposure that put him at high risk for bladder cancer. The nurse is most concerned about which urinary characteristic?

Painless hematuria.

Which clinical manifestation indicates to the nurse that interventions for the patient's renal colic are effective?

Patient reports that pain is relieved.

Which patient with incontinence is most likely to benefit from a surgical intervention?

Patient with reflex, overflow, incontinence caused by obstruction.

Which task related to care of patients who have indwelling catheters can be delegated to unlicensed assistive personnel?

Perform daily catheter care by washing the perineum and proximal portion of the catheter with soap and water.

The healthcare provider has recommended intermittent self catheterization for a patient with long-term problems of incomplete bladder emptying. Which information does the nurse give the patient about the procedure?

Perform proper hand washing and cleaning of the catheter to reduce the risk for infection.

The nurse is caring for an older adult patient with urinary incontinence. The patient is alert and oriented, but refuses to use the call Bell and has fallen several times while trying to get to the bathroom. What is the nurse's priority concern for this patient?

Providing fall prevention measures.

A patient has been started on oxybutynin, Ditropan, for urinary incontinence. What is the major action of this medication?

Relaxes bladder muscles.

A patient with a history of kidney stones presents with severe flank pain, nausea, vomiting, pallor, and diaphoresis. He reports freely passing urine, but it is bloody. A priority for nursing care is to monitor for which patient problem?

Severe pain.

The patient received an antibiotic prescription several hours ago and has started the medication, but requests "some relief from the burning." What comfort measures that the nurse suggested the patient?

Sit in a sitz bath and urinate into the warm water.

The nurse is reviewing a care plan for a patient who has functional incontinence. There is a note that containment is recommended, especially at night. What is the major concern with this approach?

Skin integrity.

a patient returns to the medical surgical unit after having shockwave lithotripsy. What is an appropriate nursing intervention for the post procedural care of this patient?

Strain urine to monitor the passage of stone fragments.

A patient reports the loss of small amounts of urine during coughing, sneezing, jogging, or lifting. Which type of incontinence do these symptoms describe?

Stress.

A middle-aged woman has urinary stress incontinence related to weak pelvic muscles. The patient is highly motivated to participate in self-care. Which interventions does the nurse include in the treatment plan?

Suggest keeping a detailed diary of urine leakage, activities, and foods eaten. Suggest wearing absorbent undergarments during the assessment process. Teach pelvic floor, Kegel, exercise therapy. Teach about vaginal cone therapy. Referr to a nutritionist for diet therapy for weight reduction.

A patient has agreed to try a bladder training program. What is the priority nursing intervention in starting this therapy?

Teach the patient how to be alert, aware, and able to resist the urge to urinate.

The nurse is designing a habit training bladder program for an older adult patient who is alert but mildly confused. What task associated with the training program is delegated to the UAP?

Tell the patient it is time to go to the toilet and assist him to go on a regular schedule.

A patient has been performing Kegel exercises for two months. How does the nurse know whether the exercises are working?

The patient is able to stop the urinary stream.

Which urine characteristics suggest that the patient is drinking a sufficient amount of fluid?

Urine is a pale yellow color.

A patient reports severe flank pain. The report indicates that urine is turbid, malodorous, and rust colored; rbc's, WBCs, and bacteria are present; and microscopic analysis shows crystals. What does this data suggests?

Urolithiasis And infection.

The employee health nurse is conducting a presentation for employees who work in a paint manufacturing plant. In order to protect against bladder cancer, the nurse advises that everyone who works with chemicals should do what?

Use personal protective equipment such as gloves and masks.

A patient is admitted for an elective orthopedic surgical procedure. The patient also has a personal or family history for urolithiasis. which circumstance creates the greatest risk for recurrent urolithiasis?

keeping the patient NPO for extended periods.

What does the nurse include in the care plan for a patient who had pyelolithotomy?

monitor the amount of bleeding from incisions. Strain the urine to monitor the passage of stone fragments. Encourage fluids to avoid dehydration and super saturation. Monitor changes in urine output. Administer antibiotics to eliminate or prevent infections.

in which patient circumstance would the nurse question the order for the insertion of an indwelling catheter?

patient has functional incontinence related to Alzheimer's disease.

The nurse is reviewing the laboratory results for an older adult patient with an indwelling catheter. The urine culture is pending, but the urinalysis shows greater than 10 to the fifth colony forming units, and the differential WBC count shows a "left shift." How does the nurse interpret these findings?

urosepsis.