Nokea
A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply.
- A. Food cravings
- B. Upper abdominal pain
- C. Insatiable thirst
- D. Uncharacteristic fatigue
- E. New onset of confusion
Correct Answer: D,E
Rationale: The most common subjective presenting symptom of UTI in older adults is generalized fatigue. The most common objective finding is a change in cognitive functioning. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none is directly suggestive of a UTI.
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An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment?
- A. Reviewing the patients 24-hour food recall for changes in diet
- B. Assessing for recent contact with individuals who have UTIs
- C. Assessing for changes in the patients level of psychosocial stress
- D. Reviewing the patients medication administration record for recent changes
Correct Answer: D
Rationale: Many medications affect urinary continence in addition to causing other unwanted or unexpected effects. Stress and dietary changes could potentially affect the patients continence, but medications are more frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result from contact with infected individuals.
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.
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 is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention?
- A. The patients suprapubic region is dull on percussion.
- B. The patient is uncharacteristically drowsy.
- C. The patient claims to void large amounts of urine 2 to 3 times daily.
- D. The patient takes a beta adrenergic blocker for the treatment of hypertension.
Correct Answer: A
Rationale: Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.
A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurses best response?
- A. Inform the patient that urgency and occasional incontinence are expected for the first few weeks post-removal.
- B. Obtain an order for a loop diuretic in order to enhance urine output and bladder function.
- C. Inform the patient that this is not unexpected in the short term and scan the patients bladder following each void.
- D. Obtain an order to reinsert the patients urinary catheter and attempt removal in 24 to 48 hours.
Correct Answer: C
Rationale: Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule, usually every 2 to 3 hours. At the given time interval, the patient is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely, straight catheterization may be performed. An indwelling catheter would not be reinserted to resolve the problem and diuretics would not be beneficial. Ongoing incontinence is not an expected finding after catheter removal.