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A female patient asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which of the following interventions is best to include in the care plan?
- A. Assist the patient to the bathroom q3hr.
- B. Place a commode at the patient's bedside.
- C. Demonstrate how to perform the Credé manoeuvre.
- D. Teach the patient how to perform Kegel exercises.
Correct Answer: D
Rationale: Exercises to strengthen the pelvic floor muscles will help reduce stress incontinence. The Credé manoeuvre is used to help empty the bladder for patients with overflow incontinence. Placing the commode close to the bedside and assisting the patient to the bathroom are helpful for functional incontinence.
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After receiving change-of-shift report, which of the following patients should the nurse assess first?
- A. A patient with nephrotic syndrome with a urinary output of 3000 mL yesterday
- B. A patient with urolithiasis who has not voided for 6 hours
- C. A patient with stage 3 chronic kidney disease who needs patient teaching
- D. A patient with stage 4 chronic kidney disease with complaints of dysuria
Correct Answer: B
Rationale: A patient with urolithiasis who has not voided for 6 hours is at risk for urinary obstruction, which can lead to hydronephrosis or renal damage, requiring immediate assessment. The other patients' conditions are less urgent; high urine output, dysuria, and teaching needs do not indicate immediate risk.
A patient returns to the clinic with recurrent dysuria after being treated with trimethoprim-sulfamethoxazole for 3 days. Which of the following actions should the nurse plan to take?
- A. Remind the patient about the need to drink 1000 mL of fluids daily.
- B. Obtain a midstream urine specimen for culture and sensitivity testing.
- C. Teach the patient to take the prescribed trimethoprim-sulfamethoxazole for at least 3 more days.
- D. Suggest that the patient drink cranberry juice to treat the symptoms.
Correct Answer: B
Rationale: Since uncomplicated urinary tract infections (UTIs) are usually successfully treated with 3 days of antibiotic therapy, this patient will need a urine culture and sensitivity to determine appropriate antibiotic therapy. Although daily intake of cranberry juice has been purported to assist in treating, there is currently no conclusive evidence to support advocating this treatment. The fluid intake should be increased to at least 1000 mL/day. Since the UTI has persisted after treatment with trimethoprim-sulfamethoxazole, the patient is likely to need a different antibiotic.
The nurse is providing teaching to a patient with impaired urinary elimination related to an UTI who weighs 70 kg. Which of the following daily fluid intake amounts should the nurse include in the teaching plan?
- A. 650 mL
- B. 1250 mL
- C. 1800 mL
- D. 2450 mL
Correct Answer: C
Rationale: The recommended daily liquid intake for the ambulatory adult is approximately 30 mL/kg body weight per day. Thus, a 70-kg person would require approximately 2100 mL each day. Among the options, 1800 mL is the closest appropriate amount to promote adequate urine output and prevent UTI recurrence.
Which of the following nursing actions is most helpful in decreasing the risk for hospital-acquired infection (HAI) of the urinary tract in patients admitted to the hospital?
- A. Avoid unnecessary catheterizations
- B. Encourage adequate oral fluid intake.
- C. Test urine with a dipstick daily for nitrites.
- D. Provide thorough perineal hygiene to patients.
Correct Answer: A
Rationale: Since catheterization bypasses many of the protective mechanisms that prevent urinary tract infection (UTI), avoidance of catheterization is the most effective means of reducing HAI. The other actions will also be helpful, but are not as useful as decreasing urinary catheter use.
The nurse is caring for a patient with benign prostatic hyperplasia who has chills, fever, and is vomiting. Which of the following findings by the nurse is most helpful in determining whether the patient has an upper urinary tract infection (UTI)?
- A. Suprapubic pain
- B. Bladder distention
- C. Foul-smelling urine
- D. Costovertebral tenderness
Correct Answer: D
Rationale: Costovertebral tenderness is characteristic of pyelonephritis. The other symptoms are characteristic of lower UTI and are likely to be present if the patient also has an upper UTI.