urinary tract infection practice questions
A 76 year old female is admitted due to a recent fall. The patient is confused and agitated. The family members report that this is not normal behavior for the patient. They explain that the patient is very active in the community and cares for herself. Based on the information you have gathered about the patient, which physician's order takes priority? A. "Collect a urinalysis" B. "Collect a T3 and T4 level" C. "Insert a Foley Catheter" D. "Keep patient NPO"
A. "Collect a urinalysis" The answer is A. Elderly patients do NOT exhibit the typical signs and symptoms of a UTI. Instead, they may become confused, experience falls, become agitated etc. This can occurs in elderly patients who are normally alert and oriented and active. If this is seen in your patient, think UTI. Collecting a urinalysis (per MD order) is very important to help determine the sudden cause of confused/agitation and falling. If the U/A comes back positive for WBCs and bacteria the patient can start receiving the proper treatment.
During a head-to-toe assessment on a patient with a possible urinary tract infection, you perform costovertebral angle percussion. The costovertebral angle is found? A. between the bottom of the 12th rib and spine B. between the right upper quadrant and umbilicus C. between the sternal notch and angle of Louis D. between the ischial spine and umbilicus
A. between the bottom of the 12th rib and spine The answer is A. The costovertebral angle is located at the angle under the 12th rib and the spine. This is where the kidneys reside. If percussion is performed at this angle and tenderness is reported it may demonstrate the kidney is inflamed due to infection. Therefore, the patient may have a kidney infection.
The nurse is caring for a postpartum client. Which intervention is the most important for the nurse to integrate into the plan of care to prevent a urinary tract infection (UTI)? A."Increase fluid intake." B."Use an antiseptic preparation after voiding." C."Change peri pads every 4 hours." D."Empty the bladder completely."
D."Empty the bladder completely." -The postpartum woman is at an increased risk of developing urinary tract problems caused by normal postpartum diuresis, increased bladder capacity, and decreased bladder sensitivity from stretching or trauma. These factors make it essential for the mother to empty her bladder completely with each voiding. Fluid intake is important, but it is not related to the main cause of UTIs in the postpartum period. Peri pads should be changed every time the client voids, followed by perineal cleansing before placement of a new pad. Antiseptic solutions are not used on the perineum of a postpartum client.
A client asks which fluids to avoid in light of repeated urinary tract infections (UTIs). Which food should the nurse teach the client to avoid? (Select all that apply.) A.Alcoholic beverages B.Citrus juices C.Coffee D.Milk E.Cranberry juice
A,B,C A.Alcoholic beverages B.Citrus juices C.Coffee -Avoiding citrus juices, alcoholic beverages, and coffee can help prevent UTIs. Caffeine, citrus juices, alcohol, and artificial sweeteners irritate bladder mucosa and the detrusor muscle and can increase urgency and bladder spasms. Increasing the intake of cranberry juice, not avoiding it, can help prevent UTIs because it acidifies the urine. Milk intake has no known effect in preventing UTIs.
Which topic is important to include in the home care teaching for a client with a urinary tract infection (UTI)? (Select all that apply.) A.Proper nutrition B.Good hygiene methods C.Wearing polyester underwear D.Voiding every 5 to 6 hours E.Adequate fluid consumption
A,B,E A.Proper nutrition B.Good hygiene methods E.Adequate fluid consumption -Home care teaching for a client with a UTI includes information about good hygiene methods, proper nutrition, and adequate fluid consumption. Increased fluids dilute the urine, reducing irritation of the inflamed bladder and urethral mucosa. Instruct women to cleanse the perineal area from front to back after voiding and defecating, to prevent the transfer of gastrointestinal bacteria to the urethra. Teach clients to void and wash the perineal area before and after sexual intercourse to flush out bacteria introduced into the urethra and bladder. Teach measures to maintain the integrity of perineal tissues, such as avoiding bubble baths, feminine hygiene sprays, and vaginal douches, and wearing cotton briefs rather than underwear made from synthetic materials. Frequent voiding (every 3dash 4 hours) is encouraged.
The nurse is caring for a client with pyelonephritis. Which clinical manifestation should the nurse assess in the client? (Select all that apply.) A.Vomiting B.Fever C.Enuresis D.Dysuria E.Flank pain
A,B,E A.Vomiting B.Fever E.Flank pain -Clinical manifestations that occur with pyelonephritis include fever, vomiting, and flank pain. Enuresis and dysuria occur with cyst
On your nursing care plan for a patient with a urinary tract infection, which of the following would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY: A. Encourage voiding every 2-3 hours while awake. B. Restrict fluid intake to 1-2 liters per day. C. Monitor intake and output daily. D. The patient verbalizes the importance of using vaginal sprays to decrease reoccurrence of urinary tract infections prior to discharge home.
A,C A. Encourage voiding every 2-3 hours while awake C. Monitor intake and output daily. -The answers are A and C. Option D is wrong become this is not a nursing intervention but a patient goal. In addition, it is an incorrect patient goal for preventing UTIs. Vaginal sprays should be avoided. Option B is wrong because fluid intake should be encouraged of 2-3 liters per day. This will help the urinary system flush out the presenting infection.
A client is admitted to the emergency department for possible acute pyelonephritis. Which manifestation should the nurse consider to be consistent with this disorder? (Select all that apply.) A.Urinary frequency B.Nocturia C.Flank tenderness D.Vomiting E.Diarrhea
A,C,D,E A.Urinary frequency C.Flank tenderness D.Vomiting E.Diarrhea The nurse should monitor a client with suspected acute pyelonephritis for flank tenderness, vomiting, diarrhea, and urinary frequency. Other manifestations the client may present with are high fever, chills, costovertebral angle tenderness, and moderate to severe dehydration. Nocturia is a manifestation of cystitis, not acute pyelonephritis.
The nurse is caring for a client with a urinary tract infection (UTI). Which condition should the nurse determine as a possible cause? (Select all that apply.) A.Structural deviations B.Excessive oral fluid intake C.Renal scarring D.Use of antibiotics E.Vesicoureteral reflux
A,C,E A.Structural deviations C.Renal scarring E.Vesicoureteral reflux The causes of UTIs include structural deviations, renal scarring, and vesicoureteral reflux. Excessive oral fluid intake or use of antibiotics does not cause UTIs.
You're caring for a patient with an indwelling catheter. The patient complains of spasm like pain at the catheter insertion site. Which of the following options below are other signs and symptoms the patient could experience or the nurse could observe if a urinary tract infection was present? SELECT-ALL-THAT-APPLY: A. Increased WBC B. Crystalluria C. Positive McBurney's Sign D. Feeling the need to void even though a catheter is present E. Dark and cloudy urine F. Cramping
A,D,E,F A. Increased WBC D. Feeling the need to void even though a catheter is present E. Dark and cloudy urine F. Cramping The answers are A, D, E and F. These are common signs and symptoms of a urinary tract infection. Options B and C are not.
The nurse is caring for a client experiencing urinary retention. Which preventive catheter-associated urinary tract infection (CAUTI) measure should the nurse take to protect the client from a urinary tract infection (UTI)? A.Consider an alternative to an indwelling catheter. B.Review the criteria for catheter insertion. C.Initiate an antibiotic before inserting a catheter. D.Obtain a urine sample for a urinalysis.
A.Consider an alternative to an indwelling catheter. -The alternative to an indwelling catheter is to use intermittent straight catheterization to relieve urinary retention. Using intermittent straight catheterization allows the bladder to fill and completely empty more normally, maintaining physiologic function. Obtaining a urine sample for a urinalysis will not address the problem of urinary retention. Reviewing the criteria for catheter insertion is a preventive CAUTI measure, but urinary retention is one of the criteria for urinary catheterization. Initiating an antibiotic before inserting a catheter is unnecessary and contributes to the development of antibiotic-resistant organisms.
The nurse is caring for a client with a urinary catheter who is diagnosed with asymptomatic bacteriuria. Which collaborative treatment should the nurse anticipate as the first action? A.Removal of the catheter B.Replacement of the catheter C. A 10- to 14-day course of antibiotic therapy D.A short course of antibiotic therapy
A.Removal of the catheter -The nurse can anticipate the healthcare provider to prescribe a 10- to 14-day course of antibiotic therapy after removal of the catheter. Replacement of the catheter is not a priority treatment for asymptomatic bacteriuria. A short course of antibiotic therapy is not used for the treatment of asymptomatic bacteriuria.
The nurse is caring for a client diagnosed with a urinary tract infection (UTI). Which assessment finding supports this diagnosis? (Select all that apply.) A.Clear urine B.Abdominal pain C.Flank pain D.Burning sensation on urination E.Hypothermia
B,C,D B.Abdominal pain C.Flank pain D.Burning sensation on urination -Assessment findings that support the diagnosis of a UTI include abdominal pain, flank pain, and a burning sensation when urinating. Cloudy, dark, foul-smelling urine is also expected with a UTI. Hyperthermia (fever), not hypothermia, supports the diagnosis of a UTI.
A patient with a urinary tract infection is taking Bactrim (Sulfamethoxazole/Trimethoprim). As the nurse you know it is important that the patient consumes 2.5 to 3 L of fluid per day to prevent which of the following complications? A. Brown urine B. Crystalluria C. Renal Stenosis D. Renal Calculi
B. Crystalluria The answer is B. Antibiotics called sulfonamides such as Bactrim (Sulfamethoxazole/Trimethoprim) can cause crystalluria. This complication tends to happen when the urine is concentrated. Therefore, the patient should consume 2.5 to 3L of fluid per day to keep the urine diluted.
The nurse is teaching the parents of an 18-month-old female toddler with a urinary tract infection (UTI). Which should be included in the teaching to prevent the future risk of a UTI? A.Increase the child's fluid intake. B.Cleanse the perineal area front to back. C.Provide the child with a daily cup of low-sugar cranberry juice. D.Increase the child's intake of vitamin C.
B.Cleanse the perineal area front to back. -The incidence of UTIs in toddlers and children is higher among girls than boys because the shorter female urethra has a closer proximity to the anus and vagina, increasing the risk of contamination by fecal bacteria. When cleansing the perineal area, it is important to wipe from front to back to prevent the transfer of gastrointestinal bacteria to the urethra. Adequate fluids should be provided to prevent dehydration. Two daily cups of low-sugar cranberry juice and increased vitamin C is recommended to prevent UTIs in adults.
The nurse is caring for a client experiencing pain related to a urinary tract infection (UTI). Which intervention should the nurse initiate to address the client's discomfort? A.Avoidance of contact with undergarments made of cotton B.Increase in fluid intake C.Cleansing of the urinary meatus with antiseptic wipes D.Application of cold compresses
B.Increase in fluid intake -Increasing fluid intake will dilute the urine, reducing irritation of the inflamed bladder and urethral mucosa. Sitz baths, warm packs, and heating pads, not cold compresses are used to relax the muscles, relieve spasms, and increase the local blood supply. The perineum should be kept clean and dry, but cleaning it with antiseptic wipes can cause perianal irritation. Undergarments should contain cotton. Synthetic fibers irritate perineal tissues and promote bacterial growth.
The nurse is caring for a client with chronic urinary tract infections (UTIs) suspected of having a vesicoureteral reflux. Which collaborative intervention should the nurse anticipate? A.Voiding cystourethrography B.Intravenous pyelography C.Renal ultrasound D.Cystoscopy
B.Intravenous pyelography -Intravenous pyelography is used to detect structural and functional abnormalities such as vesicoureteral reflux. Cystoscopy provides direct visualization of the urethra and bladder. Renal ultrasound is used to detect pyelonephritis. Voiding cystourethrography is utilized to assess structural and functional abnormalities of the bladder and urethra.
The nurse is creating a plan of care for a client with pyelonephritis. Which outcome reflects the client's ability to decrease the severity of the bacteria in the urinary tract? A.The client will complete the course of antibiotics. B.The client will drink at least 1500 mL of fluid per day and void every 2dash3 hours while awake. C.The client will use antiseptic spray regularly on the perineal area. D.The client will wipe from back to front after voiding and defecating.
B.The client will drink at least 1500 mL of fluid per day and void every 2dash3 hours while awake. -Increasing fluid intake and the frequency of voiding each day flushes the bacteria from the urinary tract. The goal for completing the course of antibiotics is to eradicate the infectious organism. Although antiseptic solutions may be ordered for catheter care, they can dry perineal tissues and reduce normal flora, increasing the risk of colonization by pathogens. These solutions should not be used routinely. Women should cleanse the perineal area from front to back after voiding and defecating to prevent the transfer of gastrointestinal bacteria to the urethra.
The nurse is caring for a client who requires intermittent straight catheterization for impaired urinary elimination. Which nursing intervention should the nurse include in the plan of care to help prevent a urinary tract infection (UTI)? A.Maintaining a closed drainage system B.Using aseptic technique when inserting the straight catheter C.Maintaining gravity flow to prevent urine reflux D.Inflating the balloon when it is in the bladder
B.Using aseptic technique when inserting the straight catheter -Using aseptic technique when inserting the catheter minimizes the risk of a bacterial infection. Maintaining a closed drainage system, inflating the balloon, and maintaining gravity flow are principles for preventing infection when using an indwelling catheter.
The nurse is teaching parents of school-age children practices that should decrease the risk of urinary tract infections (UTIs). Which information should the nurse include? A."Provide drinks with sugar substitutes when possible." B."Encourage the child to void five to six times a day." C."Encourage juices to increase the acidity of the child's urine." D."Avoid large amounts of dairy in the child's diet."
B."Encourage the child to void five to six times a day." -The information the nurse can include in the teaching to prevent UTIs in children is to encourage them to void five to six times a day. Infrequent voiding, which is common in school-age children, results in incomplete emptying of the bladder and urinary stasis, both of which are factors in the development of UTIs. Dairy is associated with an increased risk of UTIs, but it is not the major contributing factor for UTIs in children. Juices and sugar substitutes in drinks are associated with UTIs.
A 36 year old female, who is 29 weeks pregnant, reports she is experiencing burning when voiding. The physician orders a urinalysis. Which statement by the patient demonstrates she understands how to collect the specimen? A. "I'll hold the cup firmly against the urethra while collecting the sample." B. "I will cleanse back to front with the antiseptic wipe before peeing in the cup." C. "First, I will pee a small amount of urine in the toilet and then collect the rest in the cup." D. "I will be sure to drink a lot of fluids to keep the urine diluted before peeing into the cup."
C. "First, I will pee a small amount of urine in the toilet and then collect the rest in the cup." The answer is C. When collecting a urinalysis it is important to avoid contaminating the sample. So, the patient will collect the urine during mid-stream. The patient will void a small amount in the toilet and then void the rest into the cup (until it is halfway full). The cup should be placed a few inches away from the urethra and prior to voiding the patient should use an antiseptic wipe to cleanse the labia from front to back. It is best to collect the sample when the bladder has been full for 2-3 hours, therefore the urine in concentrated not diluted.
The nurse is providing discharge teaching to a client with a urinary tract infection (UTI). Which instruction should the nurse include? A."Be sure to complete the full course of urinary analgesics." B."You do not need to make a follow-up appointment." C. "It is important to follow this schedule for your antibiotics." D."We recommend that you use aseptic technique when cleansing the perineum."
C. "It is important to follow this schedule for your antibiotics." Help the client to develop a plan to take their antibiotic medications so they do not miss doses. Missed doses of antibiotics may cause a subtherapeutic medication blood level, which can reduce effectiveness. The client should follow up with the healthcare provider 7dash14 days after completion of the antibiotic therapy to ensure there is complete eradication of the bacteria. Aseptic technique is not used for perineal care; it is used for clients who have an intermittent catheter or an indwelling catheter. Urinary analgesics are only taken if needed; it is not necessary to complete the course of analgesics.
The physician orders a urine culture on your patient in room 5505 with a urinary tract infection. In addition, the patient is ordered to start IV Bactrim (Sulfamethoxazole/Trimethoprim). How will you proceed with following this order? A. First, hang the antibiotic, and then collect the urine culture. B. First, hang the antibiotic and when the antibiotic is finished infusing collect the urine culture. C. First, collect the urine culture, and then hang the antibiotic. D. First, collect the urine culture and then hold the dose of the antibiotic until the urine culture is back from the lab.
C. First, collect the urine culture, and then hang the antibiotic. The answer is C. It is very important to collect the urine culture FIRST and then immediately hang the antibiotic. If the antibiotic is hung first it will decrease the lab's ability to properly identify the bacteria growing in the urine (hence the antibiotic is fighting the infection). It takes approximately 2 days for a urine culture result to come back. Therefore, antibiotic therapy should not be held. The patient needs treatment to prevent the infection from spreading.
The nurse is teaching a female client about the prevention of urinary tract infections (UTIs). Which information should the nurse include? A."Empty the bladder every 2 hours." B."Void after intercourse." C."Avoid bubble baths." D."Wash the perineum after intercourse."
C."Avoid bubble baths." -The information the nurse should include in the teaching about preventing UTIs is to avoid bubble baths. Avoiding bubble baths helps to maintain the integrity of the perineum. Clients should void and wash the perineum before and after intercourse. The bladder should be emptied every 3dash4 hours.
For which client should the nurse question the healthcare provider's order for a 7- to 10-day course of antibiotics? A.A male client with pyelonephritis B.A male client with a history of antibiotic-resistant infections C.A female client with uncomplicated cystitis D.A female client with urinary tract abnormalities
C.A female client with uncomplicated cystitis Most uncomplicated infections of the lower urinary tract can be treated with a short course of antibiotic therapy, either a single antibiotic dose or a 3-day course of treatment. Single-dose therapy is associated with a higher rate of recurrent infection and continued vaginal colonization with Escherichia coli, making a 3-day course of treatment the preferred option for uncomplicated cystitis. Men and women with pyelonephritis, urinary tract abnormalities or stones, or a history of antibiotic-resistant infections require a 7- to 10-day course of trimethoprim-sulfamethoxazole, ciprofloxacin, ofloxacin, or an alternative antibiotic.
The nurse has admitted a client to the unit for treatment of acute pyelonephritis. Which collaborative intervention does the nurse anticipate initiating as a priority? A.Order for a complete blood count (CBC) with a differential B.Administration of an analgesic C.Order for a urine specimen for culture and sensitivity D.Administration of intravenous (IV) antibiotics
C.Order for a urine specimen for culture and sensitivity -The nurse can anticipate an order for a urine specimen for a culture and sensitivity to identify the infecting organism before antibiotics are started. An analgesic can be given if needed, but treatment of the infection is a priority. A CBC with a differential can be obtained to examine the WBC count for changes typically associated with infection. IV antibiotics can be administered after the urine sample for a culture and sensitivity has been obtained.
You're providing discharge teaching to a female patient on how to prevent urinary tract infections. Which statement is INCORRECT? A. "Void immediately after sexual intercourse." B. "Avoid wearing tight fitting underwear." C. "Try to void every 2-3 hours." D. "Use scented sanitary napkins or tampons during menstruation."
D. "Use scented sanitary napkins or tampons during menstruation." The answer is D. Options A, B, C are all correct statements in how to avoid a UTI. Option D is wrong because the patient should AVOID scented sanitary napkins or tampons during menstruation. It is also best to use sanitary napkins that are NOT SCENTED and AVOID using tampons (scented or not scented).
You're assessing your patients during morning rounding. Which patient below is at MOST risk for developing a urinary tract infection? A. A 25 year old patient who finished a regime of antibiotics for strep throat 10 weeks ago. B. A 55 year old female who is post-opt day 7 from hip surgery. C. A 68 year old male who is experiencing nausea and vomiting. D. A 87 year old female with Alzheimer's disease who is experiencing bowel incontinence.
D. A 87 year old female with Alzheimer's disease who is experiencing bowel incontinence. The answer is D. This patient has many risks factors for developing a UTI. The patient is postmenopausal which leads to flora changes in the vaginal area. This can increase the risk of developing a UTI. In addition, bowel incontinence increases the risk of a UTI due to the anatomy of the female (short urethra) and the close proximity between the rectum to the urethra. Also, patients with Alzheimer's disease may experience bladder retention due to the inability to communicate the need to void which increases the amount of time the urine is left in the bladder. Option A is wrong because although antibiotics can increase the risk of developing a UTI the patient finished the antibiotics 10 weeks ago. Options B and C are wrong because they do not provide enough information to determine if the patients are at risk for a UTI.
A patient, who is having spasms and burning while urinating due to a UTI, is prescribed "Pyridium" (Phenazopyridine). Which option below is a normal side effect of this drug? A. Hematuria B. Crystalluria C. Urethra mucous D. Orange colored urine
D. Orange colored urine The answer is D. Orange colored urine is a normal side effect of Pyridium which acts as a pain reliever to decreasing frequent urination and pain associated with a UTI.
The nurse manager is planning a presentation for the staff nurses regarding urinary health after several members of the staff have recently been diagnosed with urinary tract infections (UTIs). Which topic is appropriate for the nurse manager to include in the presentation? A.The importance of increasing the number of caffeinated beverages while working B.The importance of avoiding cranberry juice because it is a cause of UTI C.The importance of decreasing fluid consumption during the nursing shift to decrease the need to void D.The importance of not ignoring the urge to eliminate
D.The importance of not ignoring the urge to eliminate -It is important to remind the nursing staff that they should not ignore the urge to void because doing so increases the risk of UTI. The staff would be reminded to decrease caffeinated beverages, increase fluid consumption, and add cranberry juice to their fluid regimen as ways of decreasing UTIs.