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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000390116.56605.4d
CE Test

Integrating Bladder Ultrasound Into a UTI‐Reduction Project

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CE TEST DIRECTIONS

Each of the questions or incomplete statements below is followed by suggested answers or completions. Select the one that is best in each case and darken the corresponding space on the answer form on the inside back cover. Send the answer form with a check or money order for $10.00 to Lippincott Williams & Wilkins CE Department, 345 Hudson St., New York, NY 10014. Note: The discounted processing fee for this test has been made possible through an educational grant from Diagnostic Ultrasound. Within six weeks you'll be notified of your test results. A passing score for this test is 26 correct answers. If you pass, you will receive a certificate of completion. If you fail, you have the option of taking the test again at no additional cost. Lippincott Williams & Wilkins is accredited as a provider of CE in nursing by the American Nurses Credentialing Center's Commission on Accreditation and is an approved provider of CE in Alabama, California, Florida, and Iowa. (Providers' numbers: AL #ABNP0114, CA #CEP11749, FL #27F0002, IA #75).

In accordance with Iowa Board of Nursing administrative rules governing grievances, a copy of your evaluation of the CE offering may be submitted directly to the Iowa Board of Nursing.

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GENERAL PURPOSE

To provide the registered professional nurse with an update on the epidemiology, risk factors, and causes of acute and chronic urinary retention, and discuss the nursing management and prevention strategies for patients who have clinically significant urinary retention.

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OBJECTIVES

After reading this article and taking the test, you will be able to

* Discuss the epidemiology, risk factors, and causes of urinary retention.

* List assessment parameters important in monitoring patients in whom urinary retention is suspected or diagnosed.

* Explain management techniques for acute urinary retention.

* Explain management techniques for chronic urinary retention.

1. Which question should be asked when monitoring quality improvement in a UTI-reduction program?

a. “How often is the catheter reinserted?”

b. “Is the catheter secured?”

c. “Who inserted the catheter?”

d. “Has a size 18 catheter been used?”

2. Which strategy was used to promote the effectiveness of the unit champions?

a. salary increase

b. workload reduction

c. sample teaching tips and tools

d. assertiveness training seminars

3. An activated bladder scanner assesses residual urine via

a. vibration

b. alarm.

c. palpation.

d. sonar.

4. A nurse notes that the majority of urine on the bladder scanner screen isn't in the center of the crosshatch. Which of these actions should she take?

a. redirect the scan head

b. discontinue the procedure

c. encourage oral fluids

d. measure the amount present

5. Staff education regarding use of the bladder scanner should include information about

a. the costs of the procedure.

b. patient positioningp

c. maintaining urine sterility.

d. intrarater reliability measures.

6. When educating staff in the use of a bladder scanner, one objective of a competency validation is to

a. limit product liability.

b. decrease staffing levels.

c. verbalize indications for use.

d. demonstrate frequency of use.

7. A nurse should assess for postvoid residual urine approximately how many hours after catheter removal?

a. one to two

b. two to three

c. three to four

d. four to six

8. Which strategy can be used to defend against skin breakdown for a patient incontinent of urine?

a. infrequent skin pressure

b. use of a barrier cream

c. prophylactic antibiotics

d. reduction of fluid intake

9. Based on the scoring system discussed in this article, which of these patients should have a Foley catheter removed?

a. a mobile patient with no breakdown

b. a confused patient with a stage III ulcer

c. an unresponsive patient with a stage III sacral pressure ulcer

d. a deeply sedated, immobile patient

10. A patient who is partially mobile, alert, and oriented would receive which of these scores?

a. 0 points

b. 1 point

c. 2 points

d. 3 points

11. A Foley catheter is indicated in patients with hemodynamic instability, which is characterized by

a. untreated hypertension.

b. use of IV vasopressors or fluids for cerebral perfusion.

c. daily use of diuretic medication.

d. circulatory overload.

12. The ongoing use of a Foley catheter is appropriate for which of these patients?

a. a patient with an epidural catheter

b. a patient scheduled for elective surgery

c. a patient who is obtunded secondary to trauma

d. a patient who is undergoing conscious sedation

13. The leading cause of bacterial contamination in patients with indwelling catheters is

a. poor insertion technique.

b. lack of surgical asepsis.

c. frequent reinsertions

d. disconnection of tubing and bags.

14. Which measure should be used for daily catheter care?

a. applying a barrier cream

b. rinsing the perineum with ethyl alcohol solution

c. gently cleansing with soap and water

d. applying a water-soluble ointment

15. Foley drainage bags should be emptied every

a. 2 hours.

b. 4 hours.

c. 6 hours.

d. 8 hours.

16. Which method would you use as an alternative to inserting an indwelling catheter in your patient?

a. bladder massage

b. straight catheterization

c. residual measurement

d. frequent toileting

17. A patient's ongoing need for a catheter should be reevaluated

a. hourly.

b. daily.

c. weekly.

d. monthly.

18. One benefit of using the bladder scanner is that it allows for

a. a voiding schedule based on volume.

b. continued use of indwelling catheters.

c. an invasive determination of residual urine volume.

d. determinations of voiding to be based on time.

19. Bladder scanners should be used every two hours until a patient has a residual urine volume of

a. 10 cc.

b. 50 cc.

c. 100 cc.

d. 150 cc.

20. Foley catheters in male patients should be secured to

a. the bedside.

b. the inner thigh.

c. the lower abdomen.

d. the lower leg.

21. A nurse should collect a large-volume urine sample from

a. the distal port.

b. the collection port.

c. the inflated balloon.

d. the drainage bag.

22. Indwellinig catheters should be changed

a. daily.

b. weekly.

c. monthly.

d. only if occluded.

23. Which patient statement indicates that instructions to decrease the risk of UTI have been successful?

a. “I will drink plenty of fluids daily.”

b. “I will clean the perineal area with alcohol daily.”

c. “I will place the drainage bag on the bed.”

d. “I lilw allow the catheter to remain unsecured.”

24. Which factor may produce a “high” bladder-scanner reading?

a. cable failure

b. bladder with less than 20 cc urine

c. inadequate pressure on the scanner head

d. loose connectors in the system

25. which factor is most highly associated with bacteriuria in female patients?

a. intraluminal infection

b. extraluminal nigratiom of bacteria

c. urine reflux

d. disconnection of drainage systems

26. Which symptom should a nurse expect to assess in a patient with a UTI?

a. polyuria

b. fever

c. anuria

d. bladder atony

27. Which factor increases the risk of UTIs in elderly patients?

a. impaired bladder emptying

b. decreased fluid intake

c. more frequent catheterization

d. increased bactericidal prostate secretions

28. Which medical condition increases the risk of developing a UTI?

a. hypertension

b. renal failure

c. diabetes mellitus

d. angina pectoris

29. Which anatomic factor in a female patient increases the risk of UTI?

a. vaginal spasms

b. short urethra

c. bladder position

d. uterine fibroids

30. The use of a bladder scanner may enable a patient to avoid

a. intermittent catheterization.

b. incontinence.

c. surgical diversions.

d. irrigation.

31. A nurse should recognize which sign as indicative of a UTI?

a. leukocytosis

b. decreased renal clearance

c. oliguria

d. glycosuria

32. Which of these Gram-positive cocci is more likely to enter a female patient's bladder by an extraluminal route?

a. Enterobacter

b. Streptococcus

c. Enterococcus

d. Gonorrhea

33. A nurse should include which instruction for a patient with an indwelling catheter?

a. Label urine receptacles.

b. Use the same receptacle for all body drainage fluids.

c. Unseal the catheter daily.

d. Place tension on the catheter each morning.

34. Which patient behavior indicates the need for additional instructions?

a. securing the catheter to the leg in a female patient

b. keeping the drainage bag

dependent

c. cleansing the perineum with soap and water

d. touching the spigot to the drainage graduate when emptying the bag

35. Symptoms such as bladder spasms, elevated body temperature, and bladder irritability suggest

a. atonic bladder.

b. a urinary tract infection.

c. renal failure.

d. underinflated catheter balloon.

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OPINION SURVEY

Now that you've completed this continuing education activity, please take a few moments to complete the following opinion survey. Your comments are important to us and will help us to improve and plan future continuing education activities.

Directions: Select the response that most closely matches your opinion for each of the following questions. Record your answers by blackening the corresponding answer space on the Enrollment Form/Answer Form (Section C).

1. Did the learning objectives listed on page 13 of this supplement relate to the general purpose of this CE activity?

a. Yes

b. No

2. Did the content relate to the learning objectives of this CE activity?

a. Yes

b. No

3. Having completed this CE activity, do you feel that all of the learning objectives have been met?

a. Yes

b. No

4. Was this independent/home-study format an appropriate way to present this material?

a. Yes

b. No

5. Was the topic covered adequately?

a. Yes

b. No

6. Was the content organized and presented in a clear and logical manner?

a. Yes

b. No

7. Did the author present material that was current to nursing practice?

a. Yes

b. No

8. The content of this CE activity was:

a. too basic for me.

b. too advanced for me.

c. appropriate for me.

9. Did this CE activity meet your professional needs?

a. Yes

b. No

10. Why did you choose this CE activity?

a. Because of the topic

b. Because of the convenience of completing it at home

c. Because of the price

d. Other, please explain

11. Have your personal objectives been met?

a. Yes

b. No

12. Are you certified in your specialty area?

a. Yes

b. No

13. If so, which organization awarded the certification?

14. How long did it take you to complete this CE activity?

15. What topics do you recommend for future CE activities?

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