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A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?
- A. Hydronephrosis
- B. Nephritic syndrome
- C. Pylonephritis
- D. Nephrotoxicity
Correct Answer: A
Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.
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Resection of a patients bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following?
- A. Remain NPO for 12 hours prior to the treatment.
- B. Hold the solution in the bladder for 2 hours before voiding.
- C. Drink the intravesical solution quickly and on an empty stomach.
- D. Avoid acidic foods and beverages until the full cycle of treatment is complete.
Correct Answer: B
Rationale: The patient is allowed to eat and drink before the instillation procedure. Once the bladder is full, the patient must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.
A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient?
- A. Bathe daily and keep the perineal region clean.
- B. Avoid voiding immediately after sexual intercourse.
- C. Drink liberal amounts of fluids.
- D. Void at least every 6 to 8 hours.
Correct Answer: C
Rationale: The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather than bathe.
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.
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.
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.