Adult Health Chapter 66 - Care of Patients with Urinary Problems
The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? A "I take my medication only when I have symptoms." B "I always wipe front to back." C "I don't use bubble baths and other scented bath products." D "I try to drink 3 liters of fluid a day."
A Clients with UTIs must complete all prescribed antibiotic therapy, even when symptoms of infection are absent. Wiping front to back helps prevent UTIs because it prevents infection-causing microorganisms in the stool from getting near the urethra. Limiting bubble baths and drinking 3 liters of fluid a day help prevent UTIs.
A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A Administer morphine sulfate 4 mg IV. B Begin an infusion of metoclopramide (Reglan) 10 mg IV. C Obtain a urine specimen for urinalysis. D Start an infusion of 0.9% normal saline at 100 mL/hr.
A Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension. An infusion of metoclopramide (Reglan) 10 mg IV should be begun after the client's pain is controlled. A urine specimen for urinalysis should be obtained and an infusion of 0.9% normal saline at 100 mL/hr should be started after the client's pain is controlled.
A client who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the client states, "I only took the first dose because after that, I felt better." How does the nurse respond? A "Not completing your medication can lead to return of your infection." B "That means your treatment will be prolonged with this new infection." C "This means you will now have to take two drugs instead of one." D "What you did was okay; however, let's get you started on something else."
A Not completing the drug regimen can lead to recurrence of an infection and bacterial drug resistance. Needing to be re-treated does not mean that the client will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this client's history, larger doses for a shorter time span may be a wise plan. The client does not need to take two drugs, and this response is punitive rather than instructive. Saying that the client's actions were okay does not inform the client with respect to nonadherence. The client needed to take all the prescribed medication to make certain that the infection was properly treated.
The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? A "I should be drinking at least 1.5 to 2.5 liters of fluids every day." B "It is a good idea for me to reduce germs by taking a tub bath daily." C "Trying to get to the bathroom to urinate every 6 hours is important for me." D "Urinating 1000 mL on a daily basis is a good amount for me."
A To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day. Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output should be at least 1.5 liters daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.
A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (Select all that apply.) A "Be certain to wear sunscreen and protective clothing." B "Drink at least 3 liters of fluids every day." C "Take this drug with 8 ounces of water." D "Try to urinate frequently to keep your bladder empty." E "You will need to take all of this drug to get the benefits."
A, B, C, E Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole. Increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules; fluid intake prevents this complication. Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. Emptying the bladder is important, but not keeping it empty. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.
What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? (Select all that apply.) A "Your urine will be strained after the procedure." B "Be sure to finish all of your antibiotics." C "Immediately call the health care provider if you notice bruising." D "Remember to drink at least 3 liters of fluid a day to promote urine flow." E "You will need to change the incisional dressing once a day."
A, B, D After lithotripsy, urine is strained to monitor the passage of stone fragments. Clients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow. Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The client must notify the health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.
Which clients with long-term urinary problems does the nurse refer to community resources and support groups? (Select all that apply.) A 32-year-old with a cystectomy B 44-year-old with a Kock pouch C 48-year-old with urinary calculi D 78-year-old with urinary incontinence E 80-year-old with dementia
A, B, D Clients with a cystectomy, Kock pouch, or urinary incontinence would benefit from community resources and support groups. Others who have had their bladders removed are good sources of information and for help in establishing coping mechanisms. They can provide ideas for living with the problem or methods of curing (or minimizing) it. Urinary calculi typically are not a long-term problem that requires community resources and support groups. The older adult client with dementia would not benefit from community resources and support groups because of the client's cognitive difficulties.
Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued? (Select all that apply.) A. Three-day postoperative client B. Client in the stepdown unit C. Comatose client with careful monitoring of intake and output (I&O) D. Incontinent client with perineal skin breakdown E. Incontinent older adult in long-term care
A, B, E Three days after surgery, the postoperative client probably should be able to urinate on his or her own. This may be influenced by the type of surgery, but most clients do not need long-term catheterization after they have surgery. The incidence of complications (colonization of bacteria) begins to increase after 48 hours postinsertion. The client in the stepdown unit is definitely one who should be considered for catheter discontinuation; he or she should be somewhat ambulatory and able to get to a bedside commode. Incontinence in older adults does not necessarily mean that they have to be catheterized. The introduction of a catheter invites the possibility of infection. These clients can often be managed with adult incontinence pads with less risk for developing a urinary tract infection. These infections in the older adult population are serious and should be avoided. The comatose client who is on strict I&O must have a urinary catheter in place to keep an accurate account of fluid balance. A client who is incontinent with no breakdown areas would be considered, but perineal skin problems in this situation make a catheter necessary for this client's skin to have a clean, dry environment for healing.
An older adult client diagnosed with stress incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? (Select all that apply.) A Dry mouth B Increased blood pressure C Increased intraocular pressure D Constipation E Reddish-orange urine color
A, C, D Oxybutynin is an anticholinergic/antispasmodic. Side effects include dry mouth, urinary retention, constipation, and risk for increased intraocular pressure with the potential to make glaucoma worse. Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.
The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? (Select all that apply.) A Dysuria B Enuresis C Frequency D Nocturia E Urgency F Polyuria
A, C, D, E Dysuria (painful urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly) are symptoms of UTI. Enuresis (bed-wetting) and polyuria (increased amounts of urine production) are not signs of a UTI.
The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) B A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed
B Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention. The 26-year-old admitted with urosepsis and slight fever, the 32-year-old scheduled for cystoscopy, and the 40-year-old with noninfectious urethritis are not at immediate risk for complications or deterioration.
The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A "A small-lumen catheter will help prevent injury to my urethra." B "I will use a new, sterile catheter each time I do the procedure." C "My family members can be taught to help me if I need it." D "Proper handwashing before I start the procedure is very important."
B Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that should be stressed.
A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for postprocedure home care? A "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." B "Do not share your toilet with family members for the next 24 hours." C "Please be sure to stand when you are urinating." D "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."
B The toilet should not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach. The client must sit when he is urinating for at least 24 hours postprocedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation should be washed separately from other clothing in a solution of 10% liquid bleach; it does not need to be discarded.
The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? (Select all that apply.) A Cleanse the perineum from back to front after using the bathroom. B Try to take in 64 ounces of fluid each day. C Be sure to complete the full course of antibiotics. D If urine remains cloudy, call the clinic. E Expect some flank discomfort until the antibiotic has worked.
B, C, D Between 64 and 100 ounces (2 to 3 liters) of fluid should be taken daily to dilute bacteria and prevent infection. Not completing the course of antibiotics could suppress the bacteria, but would not destroy all bacteria, causing the infection to resurface. For persistent symptoms of infection, the client should contact the provider. The perineal area should be cleansed from front to back or "clean to dirty" to prevent infection. Cystitis produces suprapubic symptoms; flank pain occurs with infection or inflammation of the kidney. Awarded 0.0 points out of 3.0 possible points.
A client diagnosed with stress incontinence is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? (Select all that apply.) A Take the drug at bedtime. B Encourage increased fluids. C Increase fiber intake. D Limit the intake of dairy products. E Use hard candy for dry mouth.
B, C, E Anticholinergics cause constipation; increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth. Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.
Which interventions are helpful in preventing bladder cancer? (Select all that apply.) A. Drinking 2½ liters of fluid a day B. Showering after working with or around chemicals C C. Stopping the use of tobacco D. Using pelvic floor muscle exercises E. Wearing a lead apron when working with chemicals F. Wearing gloves and a mask when working around chemicals and fumes
B, C, F Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer. Increasing fluid intake is helpful for some urinary problems such as urinary tract infection, but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence, but no data show that these exercises prevent bladder cancer. Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.
A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? "Blood in my urine has become less noticeable, so maybe I don't need this procedure." "I have been taking cephalexin (Keflex) for an infection." "I previously had several ESWL procedures performed." "I take over-the-counter naproxen (Aleve) twice a day for joint pain."
Because a high risk for bleeding during ESWL has been noted, clients should not take nonsteroidal anti-inflammatory drugs before this procedure; the ESWL will have to be rescheduled for this client. Blood in the client's urine should be reported to the health care provider, but will not require rescheduling of the procedure because blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The client's taking cephalexin (Keflex) and the fact that the client has had several previous ESWL procedures should be reported, but will not require rescheduling of the procedure.
A 53-year-old postmenopausal woman reports "leaking urine" when she laughs and is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? A "They can relieve your anxiety associated with incontinence." B "They help your bladder to empty." C "They may be used to improve urethral resistance." D "They decrease your bladder's tone."
C Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance. Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual or, if that is not possible, by using a catheter. Decreasing bladder tone would not be the desired outcome for a woman with incontinence.
The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A "I must avoid drinking carbonated beverages." B "I need to douche vaginally once a week." C "I should drink 2½ liters of fluid every day." D "I will not drink fluids after 8 PM each evening."
C Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.
A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the health care provider prescribe? A Nitrofurantoin (Macrodantin) after intercourse B Estrogen (Premarin) C Trimethoprim/sulfamethoxazole (Bactrim) D Phenazopyridine (Pyridium) with intercourse
C Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired UTI in women. Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This client needs a drug that will kill bacteria. Estrogen cream may help prevent recurrent UTIs in postmenopausal women, which this client is not (at age 32). Use of Premarin is related to problems with incontinence. Phenazopyridine (Pyridium) is not used to treat infection, but symptoms of a UTI.
A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? A Bladder training B Credé method C Habit training D Kegel exercises
C Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis. Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.
Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A Functional B Overflow C Stress D Urge
C Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence. Functional incontinence is not caused by a weakened pelvic floor; rather, it is due to structural problems often resulting from injury or trauma. Overflow incontinence is caused by too much urine being stored in the bladder. Urge incontinence is caused by a problem (i.e., neurologic) with the client's urge to urinate.
The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? A Nutritional and dietary care B Respiratory care C Stoma and pouch care D Wiping from front to back (asepsis)
C The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms. The registered dietitian teaches the cystectomy client about nutritional care. The respiratory therapist teaches the cystectomy client about respiratory care. The client with a cystectomy does not require instruction about front-to-back wiping.
Which nursing activity illustrates proper aseptic technique during catheter care? A Applying Betadine ointment to the perineal area after catheterization B Irrigating the catheter daily C Positioning the collection bag below the height of the bladder D Sending a urine specimen to the laboratory for testing
C Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract. Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation should be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.
The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? A "Douche—but only once a month." B "Use only white toilet paper." C "Wipe from front to back." D "Wipe with the softest toilet paper available."
C Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection. Douching is an unhealthy behavior because it removes beneficial organisms as well as the harmful ones. White toilet paper helps prevent allergies, not infections. Using soft toilet paper does not prevent infection.
What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? A Limit fluid intake. B Increase caffeine consumption. C Limit sugar intake. D Drink about 3 liters of fluid daily.
D Drinking about 3 liters of fluid daily, if another medical problem does not require fluid restriction, helps prevent dehydration and UTIs. Fluids flush the system and should not be limited. Increased caffeine intake and limiting sugar intake will not prevent UTIs.
The nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by the health care provider for a client with a urinary tract infection (UTI), does the nurse question? A Bactrim B Cipro C Noroxin D Tegretol
D Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin (gatifloxacin) and Tegretol (carbamazepine). The former is used for UTI, and the latter is prescribed as an oral anticonvulsant. Bactrim (trimethoprim/sulfamethoxazole), Cipro (ciprofloxacin), and Noroxin (norfloxacin) are drugs used to treat UTI.
The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures? A "If I restrict my oral intake of fluids, the adjustment will be easier." B "I must go to the restroom more often because my urine will be excreted through my anus." C "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." D "I will have to drain my pouch with a catheter."
D For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter. Fluids should not be restricted. A neobladder does not require the use of an ostomy bag.
Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? A 42-year-old with painless hematuria who needs an admission assessment B 46-year-old scheduled for cystectomy who needs help in selecting a stoma site C 48-year-old receiving intravesical chemotherapy for bladder cancer D 55-year-old with incontinence who has intermittent catheterization prescribed
D Insertion of catheters is within the education and legal scope of practice for LPN/LVNs. Admission assessments and intravesical chemotherapy should be done by an RN. Preoperative preparation for cystectomy and stoma site selection should be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse or an enterostomal therapy nurse.
The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A "I am so relieved that I can continue eating my fried fish meals every week." B "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D "I will no longer be able to have red wine with my dinner
D Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.
The health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? A "It will act as an antibacterial drug." B "This drug will treat your infection, not the symptoms of it." C "You need to take the drug on an empty stomach." D "Your urine will turn red or orange while on the drug."
D Phenazopyridine will turn the client's urine red or orange. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed, and care should be taken because it will stain undergarments. Phenazopyridine reduces bladder pain and burning by exerting a local analgesic/anesthetic effect on the mucosa of the urinary tract. It does treat the symptoms of bladder infection; it has no antibacterial action. Phenazopyridine should be taken with a meal or immediately after eating.
A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? A Discharges the client to her home for strict bedrest for the duration of the pregnancy B Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria C Recommends that the client refrain from having sexual intercourse until after she has delivered her baby D Refers the client to the clinic nurse practitioner for immediate follow-up
D Pregnant women with UTIs require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor with adverse effects for the fetus. It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated without delay. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need follow-up with a health care provider.
An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? A "Don't worry about it. You need them." B "Shop at night, when stores are less crowded." C "Tell everyone that they are for your husband." D "That is tough. What do you think might help?"
D Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem. Telling the client not to worry is dismissive of the client's concerns. Telling the client to shop at night does not empower the client, and it reaffirms the client's embarrassment. Suggesting to the client that she tell everyone they are for her husband also does not empower the client; rather, it suggests to the client that telling untruths is acceptable.
Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A Encouraging them to drink fluids B Irrigating all catheters daily with sterile saline C Recommending that catheters be placed in all clients D Periodically re-evaluating the need for indwelling catheters
D Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTIs in the hospital setting. Encouraging fluids, although it is a valuable practice for clients with catheters, will not necessarily prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with congestive heart failure and kidney failure. Irrigating catheters daily is contraindicated; any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.
A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (unlicensed assistive personnel [UAP])? A Assisting the client in developing a schedule for when to take prescribed antibiotics B Inserting a straight catheter as necessary if the client is unable to empty the bladder C Teaching the client how to use the Credé maneuver to empty the bladder more fully D Using a bladder scanner (with training) to check residual bladder volume after the client voids
D Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill. Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.
The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A "For the best effect, perform all of your exercises while you are seated on the toilet." B "Limit your exercises to 5 minutes twice a day, or you will injure yourself." C "Results should be visible to you within 72 hours." D "You know that you are exercising correct muscles if you can stop urine flow in midstream."
D When the client can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and should be performed more often than 5 minutes twice daily. Noticeable results take several weeks.
