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A nurses colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurses management of urinary incontinence in older adults?
- A. Diuretics should be promptly discontinued when an older adult experiences incontinence.
- B. Restricting fluid intake is recommended for older adults experiencing incontinence.
- C. Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence.
- D. Urinary incontinence is not considered a normal consequence of aging.
Correct Answer: D
Rationale: Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.
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A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurses most appropriate response?
- A. Report this finding promptly to the primary care provider.
- B. Obtain a sterile urine sample and send it for culture.
- C. Obtain a urine sample and check it for\mathrm{pH}$.
- D. Reassure the patient that this is an expected phenomenon.
Correct Answer: D
Rationale: Because mucous membrane is used in forming the conduit, the patient may excrete a large amount of mucus mixed with urine. This causes anxiety in many patients. To help relieve this anxiety, the nurse reassures the patient that this is a normal occurrence after an ileal conduit procedure. Urine testing for culture or\mathrm{pH}$ is not required.
The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patients health education, what nutritional guidelines should the nurse provide?
- A. Restrict protein intake as ordered.
- B. Increase intake of potassium-rich foods.
- C. Follow a low-calcium diet.
- D. Encourage intake of food containing oxalates.
Correct Answer: A
Rationale: Protein is restricted to60 \mathrm{~g} / \mathrm{d}$, while sodium is restricted to 3 to4 \mathrm{~g} / \mathrm{d}$. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalatecontaining foods and there is no need to increase potassium intake.
The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply.
- A. Dietary history
- B. Family history of renal stones
- C. Medication history
- D. Surgical history
- E. Vaccination history
Correct Answer: A,B,C
Rationale: Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to stone formation. When caring for a patient with renal stones it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones.
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.
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.