UTI NCLEX
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?
Intravenous pyelography is used to detect structural and functional abnormalities such as vesicoureteral reflux.
Renal ultrasound
is used to detect pyelonephritis
Voiding cystourethrography
is utilized to assess structural and functional abnormalities of the bladder and urethra.
Cystoscopy
provides direct visualization of the urethra and bladder.
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.)
Rationale: 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.
The nurse is caring for a client with pyelonephritis. Which clinical manifestation should the nurse assess in the client? (Select all that apply.)
Rationale: Clinical manifestations that occur with pyelonephritis include fever, vomiting, and flank pain. Enuresis and dysuria occur with cystitis.
The nurse is providing discharge teaching to a client with a urinary tract infection (UTI). Which instruction should the nurse include?
Rationale: 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 7-14 days after completion of the antibiotic therapy to ensure there is complete eradication of the bacteria. Aseptic technique is not used for perinealcare; it is used for clients who have an intermittent catheter or an indwelling catheter. Urinary analgesics are only taken ifneeded; it is not necessary to complete the course of analgesics.
Which topic is important to include in the home care teaching for a client with a urinary tract infection (UTI)? (Select all that apply.)
Rationale: 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 3-4 hrs.
A client is admitted to the emergency department for possible acute pyelonephritis (kidney infection). Which manifestation should the nurse consider to be consistent with this disorder? (Select all that apply.)
Rationale: 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 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?
Rationale: 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 experiencing pain related to a urinary tract infection (UTI). Which intervention should the nurse initiate to address the client's discomfort?
Rationale: 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. Next Question
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?
Rationale: 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.
For which client should the nurse question the healthcare provider's order for a 7- to 10-day course of antibiotics?
Rationale: 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 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)?
Rationale: 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 diagnosed with a urinary tract infection (UTI). Which assessment finding supports this diagnosis? (Select all that apply.)
Rationale: The causes of UTIs include structural deviations, renal scarring, and vesicoureteral reflux. Excessive oral fluid intake or use of antibiotics does not cause UTIs.
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?
Rationale: 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 teaching parents of school-age children practices that should decrease the risk of urinary tract infections (UTIs). Which information should the nurse include?
Rationale: 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.
The nurse is teaching a female client about the prevention of urinary tract infections (UTIs). Which information should the nurse include?
Rationale: 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 3-4 hours
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?
Rationale: 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.
**Asymptomatic bacteriuria is the presence of bacteria in the properly collected urine of a patient that has no signs or symptoms of a urinary tract infection.
Rationale: 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 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)?
Rationale: 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.
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)?
Rationale: 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.