Nokea
The home health nurse is teaching a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which of the following patient statements indicates that the teaching has been effective?
- A. I will use a sterile catheter and gloves for each time I self-catheterize.
- B. I will clean the catheter carefully before and after each catheterization.
- C. I will need to buy seven new catheters weekly and use a new one every day.
- D. I will need to take prophylactic antibiotics to prevent any urinary tract infections.
Correct Answer: B
Rationale: Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days. There is no need to use a new catheter every day, to use sterile catheters, or to take prophylactic antibiotics.
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The nurse is assessing a patient who has a lower urinary tract infection (UTI). Which of the following symptoms should the nurse ask about initially?
- A. Nausea
- B. Flank pain
- C. Poor urine output
- D. Pain with urination
Correct Answer: D
Rationale: Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI.
The nurse observes an unregulated care provider (UCP) taking the following actions when caring for a patient with an indwelling catheter. Which of the following actions requires the nurse to intervene?
- A. Taping the catheter to the skin on the patient's upper inner thigh
- B. Cleaning around the patient's urinary meatus with soap and water
- C. Using alcohol-based hand cleaner before handling the catheter
- D. Disconnecting the catheter from the drainage tube to obtain a specimen
Correct Answer: D
Rationale: The catheter should not be disconnected from the drainage tube because this increases the risk for urinary tract infection (UTI). The other actions are appropriate and do not require any intervention.
The nurse is caring for a patient following rectal surgery who voids about 50 mL of urine every 30-60 minutes. Which of the following nursing actions is best?
- A. Use a bladder scan device to check the postvoiding residual.
- B. Monitor the patient's intake and output over the next few hours.
- C. Have the patient take small amounts of fluid frequently throughout the day.
- D. Reassure the patient that this is normal after rectal surgery because of anesthesia.
Correct Answer: A
Rationale: A bladder scan device can be used to check for residual urine after the patient voids. Because the patient's history and clinical manifestations are consistent with overflow incontinence, it is not appropriate to have the patient drink small amounts. Although overflow incontinence is not unusual after surgery, the nurse should intervene to correct the physiological problem, not just reassure the patient. The patient may develop reflux into the renal pelvis as well as discomfort from a full bladder if the nurse waits to address the problem for several hours.
The nurse is caring for a patient with benign prostatic hyperplasia (BPH) and a markedly distended bladder who is agitated and confused. Which of the following interventions prescribed by the health care provider should the nurse implement first?
- A. Insert a urinary retention catheter.
- B. Schedule an intravenous pyelogram.
- C. Administer lorazepam 0.5 mg PO.
- D. Draw blood for blood urea nitrogen (BUN) and creatinine testing.
Correct Answer: A
Rationale: The patient's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve once the bladder distention is corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test, but does not need to be done urgently.
The nurse is assessing a male patient with symptoms of a feeling of incomplete bladder emptying and a split, spraying urine stream. Which of the following conditions should the nurse question the patient about when taking a health history?
- A. Bladder infection
- B. Recent kidney trauma
- C. Gonococcal urethritis
- D. Benign prostatic hyperplasia
Correct Answer: C
Rationale: The patient's clinical manifestations are consistent with urethral strictures, a possible complication of gonococcal urethritis. These symptoms are not consistent with benign prostatic hyperplasia, kidney trauma, or bladder infection.