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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.
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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 nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment?
- A. Clearly explain the potential benefits of pelvic floor muscle exercises.
- B. Ensure the patient knows that surgery will be required if the exercises are unsuccessful.
- C. Arrange for biofeedback when the patient is learning to perform the exercises.
- D. Contact the patient weekly to ensure that she is performing the exercises consistently.
Correct Answer: C
Rationale: Research shows that written or verbal instruction alone is usually inadequate to teach an individual how to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted pelvic muscle exercise (PME) uses either electromyography or manometry to help the individual identify the pelvic muscles as he or she attempts to learn which muscle group is involved when performing PME. This objective assessment is likely superior to weekly contact with the patient. Surgery is not necessarily indicated if behavioral techniques are unsuccessful.
A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patients plan of care?
- A. Impaired physical mobility related to presence of an indwelling urinary catheter
- B. Risk for infection related to presence of an indwelling urinary catheter
- C. Toileting self-care deficit related to urinary catheterization
- D. Disturbed body image related to urinary catheterization
Correct Answer: B
Rationale: Catheters create a high risk for UTIs. Because of this acute physiologic threat, the patients risk for infection is usually prioritized over functional and psychosocial diagnoses.
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.
The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patients bladder?
- A. Insertion of a suprapubic catheter
- B. Scheduling the patient immediately for a prostatectomy
- C. Application of warm compresses to the perineum to assist with relaxation
- D. Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours
Correct Answer: A
Rationale: When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.