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A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient?
- A. Bathe daily and keep the perineal region clean.
- B. Avoid voiding immediately after sexual intercourse.
- C. Drink liberal amounts of fluids.
- D. Void at least every 6 to 8 hours.
Correct Answer: C
Rationale: The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather than bathe.
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The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient?
- A. Limit oral fluid intake for 1 to 2 days.
- B. Report the presence of fine, sand like particles through the nephrostomy tube.
- C. Notify the physician about cloudy or foul-smelling urine.
- D. Report any pink-tinged urine within 24 hours after the procedure.
Correct Answer: C
Rationale: The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.
A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patients high risk for urinary retention and should implement what intervention in the patients plan of care?
- A. Relaxation techniques
- B. Sodium restriction
- C. Lower abdominal massage
- D. Double voiding
Correct Answer: D
Rationale: To enhance emptying of a flaccid bladder, the patient may be taught to double void. After each voiding, the patient is instructed to remain on the toilet, relax for 1 to 2 minutes, and then attempt to void again in an effort to further empty the bladder. Relaxation does not affect the neurologic etiology of a flaccid bladder. Sodium restriction and massage are similarly ineffective.
A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?
- A. Stress incontinence
- B. Reflex incontinence
- C. Overflow incontinence
- D. Functional incontinence
Correct Answer: A
Rationale: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to reach the toilet in time for voiding.
The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach?
- A. Provide medication teaching related to pseudoephedrine sulfate.
- B. Teach the patient to perform pelvic floor muscle exercises.
- C. Prepare the patient for an anterior vaginal repair procedure.
- D. Provide information on periurethral bulking.
Correct Answer: B
Rationale: Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions has a behavioral approach.
A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?
- A. Hydronephrosis
- B. Nephritic syndrome
- C. Pylonephritis
- D. Nephrotoxicity
Correct Answer: A
Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.