Chapter 49- Management of Patients with Urinary Disorders

A urine output below _________ mL/kg/hr may indicate dehydration or an ____________ in the ileal conduit, with possible backflow/leakage from the ureteroileal anastomosis.

0.5mL/kg/hr Obstruction

Bacteria enters the urinary tract in one of three ways:

1) By the transurethral route (ascending infection) 2) Through the bloodstream (hematogenous spread) 3) By means of a fistula from the intestine (direct extension)

Bladder retraining: Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule, usually ever ____-____ hours. At the given interval patient is instructed to void. Bladder is then scanned using portable ultrasonic bladder scanner, and if bladder has not emptied completely, straight catheterization may be performed.

2-3

Although pharmacologic treatment of UTIS for 3 days is usually adequate in women, infection recurs in about ________% of women treated for uncomplicated UTIs.

20%

Various treatment regimens have been successful in treating uncomplicated lower UTIs in women: single-dose administration, short-course (________- day) regimens, or _______ day regimens. Most cases are cured after 3 days. Longer medication courses are indicated for men and pregnant women, also women with complicated UTIs or pyelonephritis.

3, 7

If the ureteral stents are not draining, the nurse may be instructed to carefully irrigate with ____-_____mL sterile normal saline solution, being careful not to exert tension that could dislodge the stent.

5-10mL

Risk factors for urinary incontinence include: SATA A) Age-related changes in urinary tract B) Caregiver/toilet unavailable C) Cognitive disturbances-dementia, Parkinson's disease D) Class III obesity E) Diabetes F) Genitourinary surgery G) High-impact exercise H) Immobility I) Incompetent urethra due to trauma or sphincter relaxation J) Medications- diuretic, sedative, hypnotic, and opioid agents K) Menopause L) Pelvic muscle weakness M) Pregnancy-vaginal delivery, episiotomy N) Stroke O) Cardiovascular disease

A) Age-related changes in urinary tract B) Caregiver/toilet unavailable C) Cognitive disturbances-dementia, Parkinson's disease D) Class III obesity E) Diabetes F) Genitourinary surgery G) High-impact exercise H) Immobility I) Incompetent urethra due to trauma or sphincter relaxation J) Medications- diuretic, sedative, hypnotic, and opioid agents K) Menopause L) Pelvic muscle weakness M) Pregnancy-vaginal delivery, episiotomy N) Stroke

The nurse has tested the pH of urine from a patient's newly created ileal conduit and obtained a result of 6.8. What is the nurse's best response to this assessment finding? A) Obtain an order to increase the patient's dose of ascorbic acid. B) Administer IV sodium bicarbonate as ordered. C) Encourage the patient to drink at least 500 mL of water and retest in 3 hours. D) Irrigate the ileal conduit with a dilute citric acid solution as ordered.

A) Obtain an order to increase the patient's dose of ascorbic acid. (Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept below 6.5 by administration of ascorbic acid by mouth. An increased pH may suggest a need to increase ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, nor by increasing fluid intake.)

The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach? A) Provide medication teaching related to pseudoephedrine sulfate. B) Teach the patient to perform pelvic floor muscle exercises. C) Prepare the patient for an anterior vaginal repair procedure. D) Provide information on periurethral bulking.

B) Teach the patient to perform pelvic floor muscle exercises. (Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions has a behavioral approach.)

A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patient's high risk for urinary retention and should implement what intervention in the patient's plan of care? A) Relaxation techniques B) Sodium restriction C) Lower abdominal massage D) Double voiding

D) Double voiding (To enhance emptying of a flaccid bladder, the patient may be taught to "double void." After each voiding, the patient is instructed to remain on the toilet, relax for 1 to 2 minutes, and then attempt to void again in an effort to further empty the bladder. Relaxation does not affect the neurologic etiology of a flaccid bladder. Sodium restriction and massage are similarly ineffective.)

A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. A) Food cravings B) Upper abdominal pain C) Insatiable thirst D) Uncharacteristic fatigue E) New onset of confusion

D) Uncharacteristic fatigue (The most common subjective presenting symptom of UTI in older adults is generalized fatigue. The most common objective finding is a change in cognitive functioning. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none is directly suggestive of a UTI.)

What is present in about 1/2 of patients with an acute UTI?

Microscopic hematuria (blood in urine)

Management of UTIs typically involve what two things?

Pharmacologic therapy and patient education

Men with UTIS should be evaluated for possible what?

Prostatitis

Occurs in all patients with UTI, not specific for bacterial infection. These are white blood cells (WBCs) in urine.

Pyuria

In women, the ___________ urethra offers little resistance to the movement of uropathogenic bacteria. Penile-vaginal intercourse forces the bacteria from the urethra into the bladder. This accounts for the increased # of UTIs in women who have penile-vaginal intercourse.

Short

Regardless of the type of appliance used, a ____________ barrier is essential to protect the skin from irritation and excoriation. To maintain skin integrity, a skin barrier/leaking pouch is NEVER patched with tape to prevent accumulation of urine under the skin barrier or faceplate.

Skin

A condition known as postcatheterization detrusor instability can be managed with the retraining of what?

The bladder

The ileal bag drains __________ not feces continuously. The appliance (bag) usually remains in place as long as it is watertight; it is changed when necessary to prevent leakage of urine.

Urine

The stoma is inspected frequently for _________ and ______________. A healthy stoma is ________ or ________. A change from this normal color to purple, brown, or black suggests that the vascular supply may be compromised. Skin should also be inspected for signs of irritation/bleeding of the stoma mucosa, encrustation and skin irritation around the stoma, rashes, redness, pruritus, or other signs of impairment of would infections.

color, viability pink, red

The most common route of infection is what? Where bacteria (often from fecal contamination) colonize the periurethral area and subsequently enter the bladder by means of the urethra.

transurethral route

When educating patient how to perform self-catheterization the nurse teaches the patient to use what type of technique? Antibacterial soap recommended for cleaning urinary catheters at home. The catheter is thoroughly rinsed with warm tap water and must be dried before reuse. Should be kept in its own container, such as a plastic food storage bag.

"Clean technique" (nonsterile)

Patient is instructed to empty the ostomy bag/pouch by means of a drain valve when it is how full?

1/3 full b/c weight of more urine will cause pouch to separate from the skin.

A UTI is diagnosed by bacteria in the urine culture. A colony count greater than _________________ CFU/mL of urine on a clean-catch midstream or catheterized specimen indicates infection.

100,000 CFU/mL

When an ileal conduit surgical procedure is performed, the urine is diverted by implanting the ureter into a ______ cm loop of ileum that is led out through the abdominal wall.

12

Frequent voiding (every _____-_____ hours) is encouraged to empty the bladder completely, because doing so can lower urine bacterial counts, reduce urinary stasis, and prevent infection.

2-3 hours

If infection recurs after completing antimicrobial therapy, another short course (_____-_____ days) of full-dose antimicrobial therapy followed by a regular bedtime dose of an antimicrobial agent may be prescribed.

3-4

The reusable appliance is rinsed in warm water and soaked in a ____ to ___ solution of water and white vinegar or a commercial deodorizing solution for 30 mins. Rinsed with tepid water, and air-dried away from direct sunlight as hot water and exposure to direct sunlight dry the pouch and increase incidence of cracking.

3:1

A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the hourly output is less than what? A) 30 mL B) 50 mL C) 100 mL D) 125 mL

A) 30 mL (A urine output below 30 mL/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis.)

A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what? A) Hydronephrosis B) Nephritic syndrome C) Pylonephritis D) Nephrotoxicity

A) Hydronephrosis (If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.)

Other diagnostic tools for UTIS include: SATA A) X-ray images B) Computed tomography (CT) scan C) Ultrasonography D) Kidney scans E) Hemoglobin test

A) X-ray images B) Computed tomography (CT) scan C) Ultrasonography D) Kidney scans

Help relieve pain and spasm

Analgesic agents and application of heat

Useful in relieving bladder irritability

Antispasmodic agents

A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? A) Administer prophylactic antibiotics as ordered. B) Limit the use of indwelling urinary catheters. C) Encourage frequent mobility and repositioning. D) Toilet residents who are immobile on a scheduled basis.

B) Limit the use of indwelling urinary catheters. (When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally administered. Mobility does not have a direct effect on UTI risk.)

The term used to describe the presence of bacteria in the urine

Bacteriuria

Samples especially in women, can be easily contaminated by bacteria normally present in the urethral area. Therefore a _______-______ midstream urine specimen is the measure used to establish bacteriuria.

Clean-catch

An adult patient has been hospitalized with pyelonephritis. The nurse's review of the patient's intake and output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? A) Supplement the patient's fluid intake with a high-calorie diet. B) Emphasize the need to limit intake to 2 L of fluid daily. C) Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. D) Encourage the patient to continue this pattern of fluid intake.

D) Encourage the patient to continue this pattern of fluid intake. (Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. No need to supplement this fluid intake with additional calories or sodium.)

A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding? A) Use a slipper bedpan. B) Apply a cold compress to the perineum. C) Have the patient lie in a supine position. D) Provide privacy for the patient.

D) Provide privacy for the patient. (Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the patient with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.)

A nurse's colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? A) Diuretics should be promptly discontinued when an older adult experiences incontinence. B) Restricting fluid intake is recommended for older adults experiencing incontinence. C) Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. D) Urinary incontinence is not considered a normal consequence of aging.

D) Urinary incontinence is not considered a normal consequence of aging. (Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.)

A female patient's most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurse's data analysis should be informed by what principle? A) Most UTIs in female patients are caused by viruses and do not cause obvious symptoms. B) A diagnosis of bacteriuria requires three consecutive positive results. C) Urine contains varying levels of healthy bacterial flora. D) Urine samples are frequently contaminated by bacteria normally present in the urethral area.

D) Urine samples are frequently contaminated by bacteria normally present in the urethral area. ( Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.)

The pain associated with a UTI is quickly relieved once what is initiated?

Effective antimicrobial therapy

Many UTIs result from

Fecal organisms ascending from perineum to the urethra and the bladder and then adhering to the mucosal surfaces.

Nurse should emphasize the importance of frequent what with self catheterization? The average daytime clean intermittent catheterization schedule is every 4-6 hours and just before bed.

Frequent catheterization and emptying the bladder at prescribed time

In the immediate postoperative period of an ileal conduit, urine volumes are monitored ___________.

Hourly

The oldest and most common of the urinary diversion procedures in use because of the low # of complications and simplicity of procedure is what? This is also well known to health care professionals, there is no need for bladder retraining, and no nocturnal incontinence.

Ileal Conduit (Ileal loop)

Provides periodic drainage of urine from the bladder=

Intermittent self-catheterization

This is the treatment of choice in some patients with spinal cord injury and other neurologic disorders, such as multiple sclerosis, when the ability to empty the bladder is impaired. This method promotes independence, results in few complications, and enhances self-esteem and quality of life.

Intermittent self-catheterization

The patient is encouraged to drink __________ amounts of fluids (water and cranberry juice are the best choices) to promote renal blood flow and to flush the bacteria from the urinary tract.

Liberal

This type of UTI includes bacterial cystitis (inflammation of the urinary bladder), bacterial prostatitis (inflammation of the prostate gland), and bacterial urethritis (inflammation of the urethra).

Lower UTIs

Patient is advised to avoid what when cleaning the area where the ostomy bag is located?

Moisturizing soaps/body washes b/c they interfere with the adhesion of the pouch.

Because mucous membrane is used in forming the conduit, the patient may excrete a large amount of __________ mixed with urine. This can cause anxiety in patients. To help relieve anxiety, reassure patient that this is a normal occurrence after an ileal conduit procedure. Should encourage patient to have adequate fluid intake and ________ the ileal conduit and decrease the accumulation of mucus.

Mucus Flush

Bladder function usually returns to __________. If the patient has had an indwelling catheter in place for an extended period of time (greater than ___ month), bladder retraining will take longer; in some cases, function may never return to normal, and long-term intermittent catheterization may become necessary.

Normal 1

Regardless of regimen prescribed, patient is instructed to take ALL doses prescribed, even if ___________ of symptoms occurs promptly.

Relief

50% of all hospital-acquired infections are what? And in the majority of cases there are catheter-associated urinary tract infections (CAUTI)- associated with indwelling urinary catheters.

UTIs

This type of infection is caused by pathogenic microorganisms in the urinary tract. Generally classified by location as infections of the lower urinary tract, involving the bladder and structures below the bladder, or upper urinary tract, involving the kidneys and ureters.

Urinary tract infections (UTIs)

A multiple-test dipstick often includes testing for what?

WBCs- known as the leukocyte esterase test Nitrate testing

The following groups of patients should have urine cultures obtained when bacteriuria is present: SATA A) All children B) All men C) Patients who have been recently hospitalized/live in long-term care facilities D) Patients who have undergone recent instrumentation (including catheterization) of the urinary tract E) Patients with diabetes F) Patients with prolonged/persistent symptoms G) Patients with 3/more UTIs in previous year H) Women who are postmenopausal I) Women who are pregnant J) Women who are sexually active K) Women who have new sexual partners L) Women with a history of compromised immune function/renal problems M) Women who are obese

A) All children B) All men C) Patients who have been recently hospitalized/live in long-term care facilities D) Patients who have undergone recent instrumentation (including catheterization) of the urinary tract E) Patients with diabetes F) Patients with prolonged/persistent symptoms G) Patients with 3/more UTIs in previous year H) Women who are postmenopausal I) Women who are pregnant J) Women who are sexually active K) Women who have new sexual partners L) Women with a history of compromised immune function/renal problems

Patient is instructed to avoid foods that give urine a strong odor such as: SATA (If odor is present a few drops of liquid deodorizer/diluted white vinegar may be introduced through the drain spout at bottom of pouch with syringe or eye dropper) A) Asparagus B) Red meat C) Cheese D) Eggs

A) Asparagus C) Cheese D) Eggs

For self-catheterization in male patient, he should: SATA A) Assume a Fowler position B) Lubricate catheter C) Retract foreskin of penis w/one hand while grabbing penis/holding it at right angle of body D) Insert catheter 15-25 cm (6-10 inches) until urine begins to flow E) Insert catheter 10-20 cm (4-8 inches) until urine begins to flow F) After removal- clean, rinse, dry, and place catheter in plastic bag/case.

A) Assume a Fowler position B) Lubricate catheter C) Retract foreskin of penis w/one hand while grabbing penis/holding it at right angle of body D) Insert catheter 15-25 cm (6-10 inches) until urine begins to flow F) After removal- clean, rinse, dry, and place catheter in plastic bag/case.

For self-catheterization in female patient, she should: SATA A) Assume a Fowler position B) Use mirror to help locate the urinary meatus C) Lubricate the catheter D) Insert catheter 7.5 cm (3 inches) into urethra in a down and back direction E) Insert catheter 2 inches into urethra in a down and back direction F) Assume a prone position G) After removal- clean, rinse, dry, and place catheter in plastic bag/case.

A) Assume a Fowler position B) Use mirror to help locate the urinary meatus C) Lubricate the catheter D) Insert catheter 7.5 cm (3 inches) into urethra in a down and back direction G) After removal- clean, rinse, dry, and place catheter in plastic bag/case.

Signs and symptoms of a complicated UTI include: SATA A) Asymptomatic bacteriuria B) Gram-negative sepsis with shock C) Lower response rate to treatment D) Urosepsis (spread of infection from urinary tract to bloodstream that results in systematic infection). E) Increased HR

A) Asymptomatic bacteriuria B) Gram-negative sepsis with shock C) Lower response rate to treatment D) Urosepsis (spread of infection from urinary tract to bloodstream that results in systematic infection).

Results of various tests such as what indicate a UTI? SATA A) Bacterial colony counts B) Cellular studies C) Urine cultures D) Blood tests

A) Bacterial colony counts B) Cellular studies C) Urine cultures

Signs and symptoms of an uncomplicated UTI include: SATA A) Burning on urination B) Urinary frequency (voiding more than every 3 hours) C) Urgency D) Nocturia (awakening at night to urinate) E) Incontinence F) Suprapublic/pelvic pain G) Sepsis

A) Burning on urination B) Urinary frequency (voiding more than every 3 hours) C) Urgency D) Nocturia (awakening at night to urinate) E) Incontinence F) Suprapublic/pelvic pain

Urinary tract irritants including what should be avoided? SATA A) Coffee B) Tea C) Milk D) Spices E) Citrus F) Alcohol G) Cola

A) Coffee B) Tea D) Spices E) Citrus F) Alcohol G) Cola

The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a patient how to manage her new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices? A) Empty the collection bag when it is between one-half and two-thirds full. B) Limit fluid intake to prevent production of large volumes of dilute urine. C) Reinforce the appliance with tape if small leaks are detected. D) Avoid using moisturizing soaps and body washes when cleaning the peristomal area.

A) Empty the collection bag when it is between one-half and two-thirds full. Rationale: The patient is instructed to avoid moisturizing soaps and body washes when cleaning the area because they interfere with the adhesion of the pouch. To maintain skin integrity, a skin barrier or leaking pouch is never patched with tape to prevent accumulation of urine under the skin barrier or faceplate. Fluids should be encouraged, not limited, and the collection bag should not be allowed to become more than one-third full.

Common antibiotics used for UTIS are: SATA A) Fluroquinolone- Ciprofloxacin, Ofloxacin, Norfloxacin, or Gatifloxacin B) Fluoroquinolone- Levofloxacin (uncomplicated UTI) C) Penicillin- ampicillin or amoxicillin D) Trimethoprim- Co-trimoxazole E) Urinary analgesic agent- Phenazopyridine F) Fluconozole

A) Fluroquinolone- Ciprofloxacin, Ofloxacin, Norfloxacin, or Gatifloxacin B) Fluoroquinolone- Levofloxacin (uncomplicated UTI) C) Penicillin- ampicillin or amoxicillin D) Trimethoprim- Co-trimoxazole E) Urinary analgesic agent- Phenazopyridine

A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence? A) Stress incontinence B) Reflex incontinence C) Overflow incontinence D) Functional incontinence

A) Stress incontinence ( Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to reach the toilet in time for voiding.)

The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention? A) The patient's suprapubic region is dull on percussion. B) The patient is uncharacteristically drowsy. C) The patient claims to void large amounts of urine 2 to 3 times daily. D) The patient takes a beta adrenergic blocker for the treatment of hypertension.

A) The patient's suprapubic region is dull on percussion. (Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.)

A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic? A) The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy B) The need to expect a heavy menstrual period following the course of antibiotics C) The risk of developing antibiotic resistance after the course of antibiotics D) The need to undergo a series of three urine cultures after the antibiotics have been completed

A) The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy (Yeast vaginitis occurs in as many as 25% of patients treated with antimicrobial agents that affect vaginal flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original UTI. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.)

Some delayed complications that may follow placement of an ileal conduit include: SATA A) Ureteral obstruction B) Contraction/stenosis (narrowing) of stoma C) Kidney deterioration due to chronic reflux D) Peristomal hernia E) Retraction F) Pyelonephritis G) Renal calculi H) Cancer recurrence I) Infertility

A) Ureteral obstruction B) Contraction/stenosis (narrowing) of stoma C) Kidney deterioration due to chronic reflux D) Peristomal hernia E) Retraction F) Pyelonephritis G) Renal calculi H) Cancer recurrence

Complications that may follow placement of an ileal conduit include: SATA A) Wound infection B) Wound dehiscence C) Urinary leakage D) Ureteral obstruction E) Hyperchloremic acidosis F) Small bowel obstruction G) Ileus H) Gangene of the stoma I) Hypertension

A) Wound infection B) Wound dehiscence C) Urinary leakage D) Ureteral obstruction E) Hyperchloremic acidosis F) Small bowel obstruction G) Ileus H) Gangene of the stoma

The ideal medication for treatment of UTI in women is an _____________ agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora, thereby minimizing the incidence of vaginal yeast infections.

Antibacterial

A nurse on a busy medical unit provides care for many patients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which patient? A) A patient whose diagnosis of chronic kidney disease requires a fluid restriction B) A patient who has Alzheimer's disease and who is acutely agitated C) A patient who is on bed rest following a recent episode of venous thromboembolism D) A patient who has decreased mobility following a transmetatarsal amputation

B) A patient who has Alzheimer's disease and who is acutely agitated ( Patients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk for injury or trauma associated with indwelling catheter use.)

The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding? A) Perform a straight catheterization on this patient. B) Avoid further interventions at this time, as this is an acceptable finding. C) Place an indwelling urinary catheter. D) Press on the patient's bladder in an attempt to encourage complete emptying.

B) Avoid further interventions at this time, as this is an acceptable finding. ( In adults older than 60 years of age, 50 to 100 mL of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted.)

A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patient's discharge education, what is the most plausible nursing diagnosis that the nurse should address? A) Impaired mobility related to limitations posed by the ileal conduit B) Deficient knowledge related to care of the ileal conduit C) Risk for deficient fluid volume related to urinary diversion D) Risk for autonomic dysreflexia related to disruption of the sacral plexus

B) Deficient knowledge related to care of the ileal conduit (The patient will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.)

A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patient's plan of care? A) Impaired physical mobility related to presence of an indwelling urinary catheter B) Risk for infection related to presence of an indwelling urinary catheter C) Toileting self-care deficit related to urinary catheterization D) Disturbed body image related to urinary catheterization

B) Risk for infection related to presence of an indwelling urinary catheter (Catheters create a high risk for UTIs. Because of this acute physiologic threat, the patient's risk for infection is usually prioritized over functional and psychosocial diagnoses.)

The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite? A) Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. C) Men of all ages are less prone to UTIs, but typically experience more severe symptoms. D) The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.

B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. (The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age approaches that of women in the same age group. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs.)

A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice? A) Assuming a supine position for self-catheterization B) Using clean technique at home to catheterize C) Inserting the catheter 1 to 2 inches into the urethra D) Self-catheterizing every 2 hours at home

B) Using clean technique at home to catheterize (The patient may use a "clean" (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female patient assumes a Fowler's position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.)

A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment? A) Clearly explain the potential benefits of pelvic floor muscle exercises. B) Ensure the patient knows that surgery will be required if the exercises are unsuccessful. C) Arrange for biofeedback when the patient is learning to perform the exercises. D) Contact the patient weekly to ensure that she is performing the exercises consistently.

C) Arrange for biofeedback when the patient is learning to perform the exercises. (Research shows that written or verbal instruction alone is usually inadequate to teach an individual how to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted pelvic muscle exercise (PME) uses either electromyography or manometry to help the individual identify the pelvic muscles as he or she attempts to learn which muscle group is involved when performing PME. This objective assessment is likely superior to weekly contact with the patient. Surgery is not necessarily indicated if behavioral techniques are unsuccessful.)

A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient? A) Bathe daily and keep the perineal region clean. B) Avoid voiding immediately after sexual intercourse. C) Drink liberal amounts of fluids. D) Void at least every 6 to 8 hours.

C) Drink liberal amounts of fluids. (The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather than bathe.)

The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling catheter? A) Vigorously clean the meatus area daily. B) Apply powder to the perineal area twice daily. C) Empty the drainage bag at least every 8 hours. D) Irrigate the catheter every 8 hours with normal saline.

C) Empty the drainage bag at least every 8 hours. (To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.)

A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the patient's admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply. A) Diarrhea B) High fever C) Hematuria D) Urinary frequency E) Acute pain

C) Hematuria D) Urinary frequency E) Acute pain (Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia. Often, the patient has a desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteral colic. Diarrhea is not associated with this presentation and a fever is usually absent due to the noninfectious nature of the health problem.)

A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response? A) Inform the patient that urgency and occasional incontinence are expected for the first few weeks post-removal. B) Obtain an order for a loop diuretic in order to enhance urine output and bladder function. C) Inform the patient that this is not unexpected in the short term and scan the patient's bladder following each void. D) Obtain an order to reinsert the patient's urinary catheter and attempt removal in 24 to 48 hours.

C) Inform the patient that this is not unexpected in the short term and scan the patient's bladder following each void. (Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule, usually every 2 to 3 hours. At the given time interval, the patient is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely, straight catheterization may be performed. An indwelling catheter would not be reinserted to resolve the problem and diuretics would not be beneficial. Ongoing incontinence is not an expected finding after catheter removal.)

The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response? A) Document the presence of a healthy stoma. B) Assess the patient for further signs and symptoms of infection. C) Inform the primary care provider that the vascular supply may be compromised. D) Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.

C) Inform the primary care provider that the vascular supply may be compromised. (A healthy stoma is pink or red. A change from this normal color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma.)

The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient? A) Limit oral fluid intake for 1 to 2 days. B) Report the presence of fine, sand like particles through the nephrostomy tube. C) Notify the physician about cloudy or foul-smelling urine. D) Report any pink-tinged urine within 24 hours after the procedure.

C) Notify the physician about cloudy or foul-smelling urine. (The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.)

A patient has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed? A) The circumference of the stoma B) The narrowest part of the stoma C) The widest part of the stoma D) Half the width of the stoma

C) The widest part of the stoma ( The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage.)

A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurse's most appropriate response? A) Report this finding promptly to the primary care provider. B) Obtain a sterile urine sample and send it for culture. C) Obtain a urine sample and check it for pH. D) Reassure the patient that this is an expected phenomenon.

D) Reassure the patient that this is an expected phenomenon. (Because mucous membrane is used in forming the conduit, the patient may excrete a large amount of mucus mixed with urine. This causes anxiety in many patients. To help relieve this anxiety, the nurse reassures the patient that this is a normal occurrence after an ileal conduit procedure. Urine testing for culture or pH is not required.)

An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment? A) Reviewing the patient's 24-hour food recall for changes in diet B) Assessing for recent contact with individuals who have UTIs C) Assessing for changes in the patient's level of psychosocial stress D) Reviewing the patient's medication administration record for recent changes

D) Reviewing the patient's medication administration record for recent changes (Many medications affect urinary continence in addition to causing other unwanted or unexpected effects. Stress and dietary changes could potentially affect the patient's continence, but medications are more frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result from contact with infected individuals.)

Moisture of bed linens/clothing or the odor of urine around patient should alert the nurse of the possibility of what?

Leakage from the appliance, potential infection, or a problem in hygienic management.

The nurse is instrumental in selecting an appropriate ostomy appliance. The choice of appliance is determined by the location of the ___________ and by the patient's normal activity, manual dexterity, visual function, body build, economic resources, and preference.

Stoma

The involuntary loss of urine through an intact urethra as a result of exertion, sneezing, coughing, or changing position. It predominately effects women who have had vaginal deliveries and is thought to be the result of decreasing ligament and pelvic floor support of the urethra and decreasing/absence of estrogen levels within the urethral walls and bladder.

Stress incontinence