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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.
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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 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.
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.
The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach?
- A. Provide medication teaching related to pseudoephedrine sulfate.
- B. Teach the patient to perform pelvic floor muscle exercises.
- C. Prepare the patient for an anterior vaginal repair procedure.
- D. Provide information on periurethral bulking.
Correct Answer: B
Rationale: Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions has a behavioral approach.
The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately50 \mathrm{~mL}$ of urine remaining in her bladder after voiding. What would be the nurses best response to this finding?
- A. Perform a straight catheterization on this patient.
- B. Avoid further interventions at this time, as this is an acceptable finding.
- C. Place an indwelling urinary catheter.
- D. Press on the patients bladder in an attempt to encourage complete emptying.
Correct Answer: B
Rationale: In adults older than 60 years of age, 50 to100 \mathrm{~mL}$ of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted.