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A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population?
- A. Administer prophylactic antibiotics as ordered.
- B. Limit the use of indwelling urinary catheters.
- C. Encourage frequent mobility and repositioning.
- D. Toilet residents who are immobile on a scheduled basis.
Correct Answer: B
Rationale: When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adults risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally administered. Mobility does not have a direct effect on UTI risk.
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A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic?
- A. The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy
- B. The need to expect a heavy menstrual period following the course of antibiotics
- C. The risk of developing antibiotic resistance after the course of antibiotics
- D. The need to undergo a series of three urine cultures after the antibiotics have been completed
Correct Answer: A
Rationale: Yeast vaginitis occurs in as many as25 % of patients treated with antimicrobial agents that affect vaginal flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original UTI. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.
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 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 been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the patients discharge education accordingly. What preventative measure should the nurse encourage the patient to adopt?
- A. Increasing intake of protein from plant sources
- B. Increasing fluid intake
- C. Adopting a high-calcium diet
- D. Eating several small meals each day
Correct Answer: B
Rationale: Increased fluid intake is encouraged to prevent the recurrence of kidney stones. Protein intake from all sources should be limited. Most patients do not require a low-calcium diet, but increased calcium intake would be contraindicated for all patients. Eating small, frequent meals does not influence the risk for recurrence.
A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding?
- A. Use a slipper bedpan.
- B. Apply a cold compress to the perineum.
- C. Have the patient lie in a supine position.
- D. Provide privacy for the patient.
Correct Answer: D
Rationale: Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the patient with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.