Nokea
A female patients most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurses data analysis should be informed by what principle?
- A. Most UTIs in female patients are caused by viruses and do not cause obvious symptoms.
- B. A diagnosis of bacteriuria requires three consecutive positive results.
- C. Urine contains varying levels of healthy bacterial flora.
- D. Urine samples are frequently contaminated by bacteria normally present in the urethral area.
Correct Answer: D
Rationale: Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding10^5$ colonies/ \mathrm{mL}$ of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.
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A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patients post-procedure care?
- A. Strain the patients urine following the procedure.
- B. Administer a bolus of500 \mathrm{~mL}$ normal saline following the procedure.
- C. Monitor the patient for fluid overload following the procedure.
- D. Insert a urinary catheter for 24 to 48 hours after the procedure.
Correct Answer: A
Rationale: Following ESWL, the nurse should strain the patients urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.
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.
The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day?
- A. $1,250 \mathrm{~mL}$
- B. $2,000 \mathrm{~mL}$
- C. $2,750 \mathrm{~mL}$
- D. $3,500 \mathrm{~mL}$
Correct Answer: B
Rationale: Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output exceeding2 \mathrm{~L}$ a day is advisable.
The nurse has tested the\mathrm{pH}$ of urine from a patients newly created ileal conduit and obtained a result of 6.8. What is the nurses best response to this assessment finding?
- A. Obtain an order to increase the patients dose of ascorbic acid.
- B. Administer IV sodium bicarbonate as ordered.
- C. Encourage the patient to drink at least500 \mathrm{~mL}$ of water and retest in 3 hours.
- D. Irrigate the ileal conduit with a dilute citric acid solution as ordered.
Correct Answer: A
Rationale: Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine\mathrm{pH}$ is kept below 6.5 by administration of ascorbic acid by mouth. An increased\mathrm{pH}$ may suggest a need to increase ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, nor by increasing fluid intake.
The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling catheter?
- A. Vigorously clean the meatus area daily.
- B. Apply powder to the perineal area twice daily.
- C. Empty the drainage bag at least every 8 hours.
- D. Irrigate the catheter every 8 hours with normal saline.
Correct Answer: C
Rationale: To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.