Which urinary symptom is of most concern to the nurse when reviewing elimination patterns with a patient taking gabapentin?

• A. I usually have to get up during the night at least once to urinate.
• B. It takes me longer to urinate than it did when I was younger.
• C. My urine had a foul smell this morning.
• D. My urine is yellow and pale in color.

Answer: (C)

A new foul-smelling urine is the most concerning sign because it points to a possible urinary tract infection. In older adults, UTIs can develop quickly and lead to serious complications like delirium, dehydration, or sepsis, especially when polypharmacy and age-related changes are present. While nighttime urination, slower urination, or yellow/pale urine can be common variations with aging or hydration, they don’t by themselves indicate an infection. When foul-smelling urine is reported, the nurse should prompt a urinalysis and culture, assess for other infection signs (fever, dysuria, flank pain, confusion), check hydration and vital signs, review medications, and involve the clinician for treatment.