Chapter 55 Urinary

Which of the following is the most common site of a nosocomial infection? a. Urinary tract b. Respiratory tract c. Gastrointestinal tract d. Skin

a. Urinary tract Rationale: The urinary tract is the most common site of nosocomial infection, accounting for greater than 3% of the total number reported by hospitals each year.

Which of the following is a strategy to promote urinary continence? a. Void regularly, 5 to 8 times a day b. Take diuretics after 4 PM c. Use caffeine in moderation d. Implement a low fiber diet

a. Void regularly, 5 to 8 times a day Rationale: Strategies to promote urinary continence include increasing awareness of the amount and timing of all fluid intake; avoid taking diuretics after 4 PM; avoiding bladder irritants, such as caffeine, alcohol, and aspartame (NutraSweet); taking steps to avoid constipation by drinking adequate fluids, eating a well-balanced diet high in fiber, exercising regularly, and taking stool softeners if recommended; and voiding regularly, 5 to 8 times a day (about every 2 to 3 hours).

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a. "Take your temperature every 4 hours." b. "Increase your fluid intake to 2 to 3 L per day." c. "Apply an antibacterial dressing to the incision daily." d. "Be aware that your urine will be cherry-red for 5 to 7 days."

b. "Increase your fluid intake to 2 to 3 L per day." Rationale: The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? a. Low oxalate b. Low purine c. High protein d. High sodium

b. Low purine Rationale: A low-purine diet is used for uric acid stones; the benefits, however, are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply. a. For those patients who are incontinent, insert indwelling catheters. b. Perform hand hygiene prior to patient care. c. Assist the patients with frequent toileting. d. Provide careful perineal care. e. Encourage patients to wear briefs.

b. Perform hand hygiene prior to patient care. c. Assist the patients with frequent toileting. d. Provide careful perineal care. Rationale: In institutionalized older patients, such as those in long-term care facilities, infecting pathogens are often resistant to many antibiotics. Diligent hand hygiene, careful perineal care, and frequent toileting may decrease the incidence of UTIs.

A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to: a. Compromised ligament and pelvic floor support of the urethra. b. Uninhibited detrusor contractions. c. Loss of motor control of the detrusor muscle. d. A stricture or tumor in the bladder.

c. Loss of motor control of the detrusor muscle. Rationale: Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void. These patients also experience hyperreflexia in the absence of normal sensations associated with voiding.

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. Before catheterization, the nurse would discuss with the physician information about a. insertion of a nasogastric tube. b. placement of IV and central venous pressure lines. c. the type and size of the catheter to be used. d. administering cleansing enemas.

c. the type and size of the catheter to be used. Rationale: Before catheterization, the nurse should inquire about the type and size of the catheter to be used and whether the catheter should be removed or retained in place after the bladder is empty. Inserting a nasogastric tube, administering enemas, and placing IV lines are measures taken during preoperative and postoperative preparation in the case of surgery.