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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.
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A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice?
- A. Assuming a supine position for self-catheterization
- B. Using clean technique at home to catheterize
- C. Inserting the catheter 1 to 2 inches into the urethra
- D. Self-catheterizing every 2 hours at home
Correct Answer: B
Rationale: The patient may use a clean (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female patient assumes a Fowlers position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter7.5 \mathrm{~cm}$ ( 3 inches) into the urethra, in a downward and backward direction.
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.
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.
The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?
- A. Smoking cessation
- B. Reduction of alcohol intake
- C. Maintenance of a diet high in vitamins and nutrients
- D. Vitamin D supplementation
Correct Answer: A
Rationale: People who smoke develop bladder cancer twice as often as those who do not smoke. High alcohol intake and low vitamin intake are not noted to contribute to bladder cancer.
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.