Urinary Tract Infection
For which client should the nurse question the healthcare provider's order for a 7- to 10-day course of antibiotics? A. A female client with uncomplicated cystitis B. A male client with a history of antibiotic-resistant infections C. A male client with pyelonephritis D. A female client with urinary tract abnormalities
A female client with uncomplicated cystitis 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 has admitted a client to the unit for treatment of acute pyelonephritis. Which collaborative intervention does the nurse anticipate initiating as a priority? A. Order for a complete blood count (CBC) with a differential B. Administration of intravenous (IV) antibiotics C. Administration of an analgesic D. Order for a urine specimen for culture and sensitivity
Order for a urine specimen for culture and sensitivity 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.
The nurse is caring for a client with a urinary tract infection (UTI). Which condition should the nurse determine as a possible cause? (Select all that apply.) A. Structural deviations B. Excessive oral fluid intake C. Use of antibiotics D. Vesicoureteral reflux E. Renal scarring
Structural deviations Vesicoureteral reflux Renal scarring 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 providing discharge teaching to a client with a urinary tract infection (UTI). Which instruction should the nurse include? A. "We recommend that you use aseptic technique when cleansing the perineum." B. "It is important to follow this schedule for your antibiotics." C. "Be sure to complete the full course of urinary analgesics." D. "You do not need to make a follow-up appointment.
"It is important to follow this schedule for your antibiotics." 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 7dash14 days after completion of the antibiotic therapy to ensure there is complete eradication of the bacteria. Aseptic technique is not used for perineal care; it is used for clients who have an intermittent catheter or an indwelling catheter. Urinary analgesics are only taken if needed; it is not necessary to complete the course of analgesics.
The nurse is caring for a client diagnosed with a urinary tract infection (UTI). Which assessment finding supports this diagnosis? (Select all that apply.) A. Burning sensation on urination B. Flank pain C. Clear urine D. Abdominal pain E. Hypothermia
Burning sensation on urination Flank pain Abdominal pain Rationale: Assessment findings that support the diagnosis of a UTI include abdominal pain, flank pain, and a burning sensation when urinating. Cloudy, dark, foul-smelling urine is also expected with a UTI. Hyperthermia (fever), not hypothermia, supports the diagnosis of a UTI.
The nurse is teaching the parents of an 18-month-old female toddler with a urinary tract infection (UTI). Which should be included in the teaching to prevent the future risk of a UTI? A. Increase the child's fluid intake. B. Provide the child with a daily cup of low-sugar cranberry juice. C. Increase the child's intake of vitamin C. D. Cleanse the perineal area front to back
Cleanse the perineal area front to back 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 caring for a client experiencing urinary retention. Which preventive catheter-associated urinary tract infection (CAUTI) measure should the nurse take to protect the client from a urinary tract infection (UTI)? A. Review the criteria for catheter insertion. B. Obtain a urine sample for a urinalysis. C. Consider an alternative to an indwelling catheter. D. Initiate an antibiotic before inserting a catheter
Consider an alternative to an indwelling catheter. 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 postpartum client. Which intervention is the most important for the nurse to integrate into the plan of care to prevent a urinary tract infection (UTI)? A. "Change peri pads every 4 hours." B. "Empty the bladder completely." C. "Use an antiseptic preparation after voiding." D. "Increase fluid intake.
Empty the bladder completely. 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 teaching parents of school-age children practices that should decrease the risk of urinary tract infections (UTIs). Which information should the nurse include? A. "Provide drinks with sugar substitutes when possible." B. "Encourage the child to void five to six times a day." C. "Avoid large amounts of dairy in the child's diet." D. "Encourage juices to increase the acidity of the child's urine."
Encourage the child to void five to six times a day." 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 caring for a client with pyelonephritis. Which clinical manifestation should the nurse assess in the client? (Select all that apply.) A. Flank pain B. Fever C. Enuresis D. Dysuria E. Vomiting
Flank pain fever vomiting Rationale: Clinical manifestations that occur with pyelonephritis include fever, vomiting, and flank pain. Enuresis and dysuria occur with cystitis.
Which topic is important to include in the home care teaching for a client with a urinary tract infection (UTI)? (Select all that apply.) A. Good hygiene methods B. Adequate fluid consumption C. Proper nutrition D. Voiding every 5 to 6 hours E. Wearing polyester underwear
Good hygiene methods Adequate fluid consumption Proper nutrition 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 3dash 4 hours) is encouraged.
The nurse is caring for a client experiencing pain related to a urinary tract infection (UTI). Which intervention should the nurse initiate to address the client's discomfort? A. Increase in fluid intake B. Application of cold compresses C. Cleansing of the urinary meatus with antiseptic wipes D. Avoidance of contact with undergarments made of cotton
Increase in fluid intake 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.
The nurse is caring for a client with chronic urinary tract infections (UTIs) suspected of having a vesicoureteral reflux. Which collaborative intervention should the nurse anticipate? A. Intravenous pyelography B. Voiding cystourethrography C. Cystoscopy D. Renal ultrasound
Intravenous pyelography Rationale: Intravenous pyelography is used to detect structural and functional abnormalities such as vesicoureteral reflux. Cystoscopy provides direct visualization of the urethra and bladder. Renal ultrasound is used to detect pyelonephritis. Voiding cystourethrography is utilized to assess structural and functional abnormalities of the bladder and urethra.
The nurse is caring for a client with a urinary catheter who is diagnosed with asymptomatic bacteriuria. Which collaborative treatment should the nurse anticipate as the first action? A. Removal of the catheter B. A 10- to 14-day course of antibiotic therapy C. Replacement of the catheter D. A short course of antibiotic therapy
Removal of the catheter 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 creating a plan of care for a client with pyelonephritis. Which outcome reflects the client's ability to decrease the severity of the bacteria in the urinary tract? A. The client will use antiseptic spray regularly on the perineal area. B. The client will drink at least 1500 mL of fluid per day and void every 2dash3 hours while awake. C. The client will wipe from back to front after voiding and defecating. D. The client will complete the course of antibiotics.
The client will drink at least 1500 mL of fluid per day and void every 2-3 hours while awake. 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 manager is planning a presentation for the staff nurses regarding urinary health after several members of the staff have recently been diagnosed with urinary tract infections (UTIs). Which topic is appropriate for the nurse manager to include in the presentation? A. The importance of decreasing fluid consumption during the nursing shift to decrease the need to void B. The importance of avoiding cranberry juice because it is a cause of UTI C. The importance of increasing the number of caffeinated beverages while working D. The importance of not ignoring the urge to eliminate
The importance of not ignoring the urge to eliminate 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.
A client is admitted to the emergency department for possible acute pyelonephritis. Which manifestation should the nurse consider to be consistent with this disorder? (Select all that apply.) A. Urinary frequency B. Nocturia C. Flank tenderness D. Diarrhea E. Vomiting
Urinary frequency Flank tenderness Diarrhea Vomiting 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 caring for a client who requires intermittent straight catheterization for impaired urinary elimination. Which nursing intervention should the nurse include in the plan of care to help prevent a urinary tract infection (UTI)? A. Inflating the balloon when it is in the bladder B. Maintaining a closed drainage system C. Using aseptic technique when inserting the straight catheter D. Maintaining gravity flow to prevent urine reflux
Using aseptic technique when inserting the straight catheter 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.
A client asks which fluids to avoid in light of repeated urinary tract infections (UTIs). Which food should the nurse teach the client to avoid? (Select all that apply.) A. Milk B. Alcoholic beverages C. Cranberry juice D. Coffee E. Citrus juices
alcoholic beverages coffee citrus juices 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 teaching a female client about the prevention of urinary tract infections (UTIs). Which information should the nurse include? A. "Wash the perineum after intercourse." B. "Avoid bubble baths." C. "Void after intercourse." D. "Empty the bladder every 2 hours."
"Avoid bubble baths." 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 3dash4 hours
