Bladder

While caring for a patient with a nephrostomy tube, the nurse finds excessive drainage around the tube. Which is the most appropriate nursing intervention in this situation? Irrigating the tube Documenting the observation Checking the catheter for patency Notifying to the primary health care provider

Checking the catheter for patency Rationale When the patient with a nephrostomy tube experiences excessive drainage around the tube or pain, the nurse should check for patency of the catheter. Changing the tube may also help in reducing excessive drainage, but it should be done only on the order of the primary health care provider. Documenting the observation is also useful; however, it is not the most appropriate in this situation. The nurse should document the findings and appropriate actions only after notifying the primary health care provider. The nurse should notify the primary health care provider after checking the patency of the urinary catheter.

While caring for a patient with a suprapubic catheter, the nurse observes urine leakage. Which medication does the nurse expect to be beneficial to the patient? Fosmicin Oxybutynin Nitrofurantoin Sulfamethoxazole

Oxybutynin Rationale Urine leakage with a suprapubic catheter results when the patient experiences bladder spasms. Oxybutynin is an antispasmodic, which reduces the bladder spasms. Fosmicin and nitrofurantoin are the antibiotics used to treat urinary tract infections. Sulfamethoxazole is used to treat acute pyelonephritis.

While caring for a patient with suprapubic catheterization, the nurse administers an opium suppository. Which outcome in the patient indicates effective treatment? The patient will not experience flank pain. The patient will not experience bladder spasms. The patient will not experience urine loss after voiding. The patient will not experience overdistention of the kidney pelvis.

The patient will not experience bladder spasms. Rationale The patient with suprapubic catheterization may have urine leakage due to bladder spasms. An opium suppository is administered to decrease the bladder spasms. Acute pyelonephritis involves flank pain and administration of ciprofloxacin reduces the flank pain. Administration of trimethoprim will help to reduce urine loss after voiding in a urinary tract infection. Overdistention of the kidney pelvis is a complication associated with nephrostomy tubes. Instilling 5 mL of sterile saline solution will help to prevent overdistention of the kidney pelvis.

A patient with voiding dysfunction is prescribed verapamil. Which outcome in the patient indicates effective treatment? The patient will not have blood in urine. The patient will not have stones in the kidney. The patient will not have burning pain in the bladder. The patient will not have inflammation of the urethra.

The patient will not have burning pain in the bladder. Rationale Verapamil is a calcium channel blocker that is used in the treatment of voiding dysfunction to reduce burning pain in the urinary bladder. Antibiotics are used in the treatment of hematuria (blood in the urine). Acetohydroxamic acid is used in the treatment of kidney stones. Nystatin is used in the treatment of inflammation of the urethra.

A patient with urinary incontinence (UI) is on tamsulosin therapy. Which patient outcome indicates effective therapy? The patient will not have periodic urination without warning. The patient will not have involuntary urination with urinary urgency. The patient will not have leakage of urine while coughing and sneezing. The patient will not have leakage of small amounts of urine during the day and night.

The patient will not have leakage of small amounts of urine during the day and night. Rationale Tamsulosin is an α-adrenergic blocker used in the treatment of overflow incontinence. Overflow incontinence results in leakage of small amounts of urine frequently throughout the day and night. Absence of leakage of small amounts of urine throughout the day and night indicates effectiveness of the therapy. Diazepam or baclofen therapy results in preventing periodic urination without warning. No involuntary urination with urinary urgency indicates the effectiveness of anticholinergic therapy. Pelvic floor muscle exercises result in no leakage of urine during coughing and sneezing.

Which condition utilizes suprapubic catheterization? Urethral surgery Spinal cord injury Neurologic disease Bladder outlet obstruction

Urethral surgery Rationale Suprapubic catheterization is used in urethral, prostate, and bladder surgery; it provides an alternate route for elimination to promote healing. Spinal cord injuries, neurologic diseases, and bladder outlet obstruction utilize intermittent catheterization to reduce the risk of injury and infection.

Which type of urinary incontinence (UI) is associated with spondylosis? Urge incontinence Stress incontinence Reflex incontinence Overflow incontinence

Urge incontinence Rationale Conditions resulting in interference with spinal inhibitory pathways such as spondylosis cause urge incontinence. Prostrate surgery or multiple pregnancies cause stress incontinence. Spinal cord lesions above S2 cause reflex incontinence. Herniated disc and diabetic neuropathy cause overflow incontinence.

Which type of urinary incontinence (UI) is caused by interstitial cystitis? Urge incontinence Stress incontinence Overflow incontinence Functional incontinence

Urge incontinence Rationale Interstitial cystitis is a bladder disorder that causes urge incontinence. Stress incontinence is caused by prostate surgery for benign prostate hyperplasia. A herniated disc and diabetic neuropathy cause overflow incontinence. Problems affecting balance and mobility in older adults cause functional incontinence.

An obese female patient is diagnosed with stress incontinence. What instructions should the nurse include when teaching self-care to this patient? Select all that apply. Use urethral inserts. Reduce excess weight. Practice Kegel exercises. Start oxybutynin treatment. Perform bladder decompression.

Use urethral inserts. Reduce excess weight. Practice Kegel exercises. Rationale Urethral inserts should be used to support and correct the underlying problem causing stress incontinence. Reducing excess weight can help in reducing the pressure on and relaxation of the pelvic floor muscles. Practicing pelvic floor muscle (Kegel) exercises can decrease stress incontinence, because the condition is caused by relaxed pelvic floor muscles. Oxybutynin is an anticholinergic drug, which should be used to treat central nervous system disorders such as urge incontinence. Bladder decompression should be done to prevent ureteral reflux and hydronephrosis in the case of reflex incontinence.

The nurse is providing instructions about pelvic floor muscle exercises to a patient with stress incontinence. Which statement made by the patient indicates the need for further teaching? "I can do this exercise in a sitting or lying position." "I can do quick two-second squeezes periodically." "I am doing it right when I release the muscle to urinate." "I can tighten the muscle for 10 seconds, relax, and repeat."

"I am doing it right when I release the muscle to urinate." Rationale When there is strong urge for urination, the patient should tighten the pelvic muscle quickly and squeeze hard several times until the urge passes. Pelvic floor muscle exercises should be performed in a sitting or lying down position. To perform long squeezes, the pelvic muscle should be tightened for 5 to 10 seconds before relaxing. Short squeezes require tightening the muscle quickly, squeezing for two seconds, and then relaxing. p. 1058

The nurse is evaluating a caregiver after providing instructions on changing an ileal conduit appliance. Which statement made by the caregiver indicates effective learning? "I should wash the area with hot water." "I should keep the area damp around the stoma." "I should apply the bag vertically if the patient is in bed." "I should keep the drainage pouch on same side of the bed as the stoma."

"I should keep the drainage pouch on same side of the bed as the stoma." Rationale Ileal conduit is a urinary diversion procedure in which ureters are implanted into the part of the ileum or colon that has been resected from the intestinal tract and an abdominal stoma is created. The ureters anastomose into one end of the conduit, and the other end of the bowl is brought out through the abdominal wall to form a stoma. There is no valve and no voluntary control over the stoma; this causes drops of urine to flow from the stoma every few seconds. As a result, the drainage pouch should be attached on same side of the bed as the stoma. The area should be washed with warm water. The area around the stoma should be dry and the bag should lie towards the side of the body if the patient is in bed.

Which statement made by the student nurse regarding the management of patients with an indwelling urinary catheter indicates a need for additional teaching by the registered nurse? "A triple-lumen catheter is used for frequent irrigations." "The catheter is attached to the upper thigh in women." "The catheter should be replaced based on patient assessment." "If the bag is not reused immediately, wash it with soap and water."

"If the bag is not reused immediately, wash it with soap and water." Rationale When the collection bag is not reused immediately, it should be filled with 1/2 cup of vinegar, and drained to prevent microorganisms and to avoid odors. If there is a need for frequent irrigation, a triple-lumen catheter is used. In women, the catheter is anchored to the upper thigh. The catheter is changed based on patient assessment, and not on a routine changing schedule.

The nurse is teaching a patient how to manage urinary incontinence (UI). Which instruction would be beneficial to the patient? "Use lotion or spray to prevent odor." "Limit the times of urination during the day." "Drink coffee frequently throughout the day." "Perform light exercises to prevent constipation."

"Perform light exercises to prevent constipation." Rationale Constipation is a frequent complication associated with urinary incontinence (UI). Therefore patients should be taught to exercise lightly, increase intake of dietary fiber, and ensure adequate fluid intake. Lotions and sprays may irritate the skin causing skin infection and should be avoided. The patient should urinate regularly on a scheduled basis every two to three hours to empty the bladder. Coffee is a bladder irritant, which should be avoided or should be consumed in smaller amounts by patients who have UI.

Fill in the blank While caring for a postoperative patient with urinary retention, the primary health care provider orders the nurse to monitor and record urine output every hour. The weight of the person is 154 lbs (70kg). What should be the minimum acceptable urine output after five hours ? Record your answer using a whole number.

175 Rationale The total urine output should be 0.5 mL/kg/hr. Because the weight of the patient is 70 kg, 70 × 0.5 = 35 mL/hr. The urine output for 1 hour is 35 mL/hr and for 5 hours 175 mL/hr. p. 1063

A patient is diagnosed with overflow incontinence. Which medication is beneficial to enhance bladder contraction in the patient? Baclofen Diazepam Finasteride Bethanechol

Bethanechol Rationale Overflow incontinence occurs when the pressure of the urine in an overfull bladder overcomes sphincter control. Bethanechol enhances bladder contraction by increasing detrusor muscle tone in the bladder wall. Baclofen and diazepam are used to relax the external sphincter in reflex incontinence. Finasteride is a reductase inhibitor used to decrease outlet resistance in overflow incontinence. p. 1056

Which nursing intervention helps to prevent urethral reflux and hydronephrosis in patients with reflex incontinence? Insertion of a pessary Bladder decompression Urinary diversion surgery Administration of diazepam

Bladder decompression Rationale Reflex incontinence occurs due to detrusor hyperreflexia resulting in ureteral reflex and hydronephrosis. Bladder decompression helps to prevent urethral reflux and hydronephrosis. Insertion of a pessary will help to support prolapse in overflow incontinence. Urinary diversion surgery bypasses urethra and bladder incontinence after trauma. Administration of diazepam will help to relax the external sphincter in reflex continence.

What are the causes of urge incontinence? Select all that apply. Cystoscopy Brain tumor Carcinoma in situ Neurogenic bladder Diabetic neuropathy

Brain tumor Carcinoma in situ Rationale Central nervous system disorders such as a brain tumor, and bladder disorders such as carcinoma in situ are causes of urge incontinence. Cystoscopy, neurogenic bladder, and diabetic neuropathy cause overflow incontinence.

A patient complains of accidental loss of urine, urgency, and increased frequency of urination at night. On clinical examination, the primary health care provider infers the condition is due to overactivity of the detrusor muscle. Based on these data, which treatment does the nurse anticipate for this patient? Containment devices Surgical sphincterotomy Intermittent catheterization Bladder neck support devices

Containment devices Accidental loss of urine, urgency, and increased frequency of urination at night are experienced by patients with urge incontinence; this is due to overactivity of the detrusor muscle. This condition can be treated by using containment devices. Surgical sphincterotomy is used in the treatment of reflex incontinence. Intermittent catheterization is performed for treating the overflow incontinence. Bladder neck support devices are used in the treatment of stress incontinence.

Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? Tighten both buttocks together Squeeze thighs together tightly Contract muscles around rectum Lie on back and lift legs together

Contract muscles around rectum Rationale To teach pelvic floor, or Kegel, exercises, the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation. Squeezing the thighs together, tightening buttocks together, and lying on the back and lifting legs do not strengthen the pelvic floor muscles.

What is the effect of angiotensin-converting enzyme (ACE) inhibitors on lower urinary tract function? Polyuria Bladder irritation Urinary retention in males Cough triggering stress urinary incontinence (UI)

Cough triggering stress urinary incontinence (UI) Rationale Angiotensin-converting enzyme (ACE) inhibitors result in chronic dry cough leading to stress urinary incontinence (UI). Alcohol and diuretics cause polyuria. Methylxanthines cause bladder irritation. α-adrenergic receptor agonists cause urinary retention in males.

The nurse suspects stoma stenosis in a patient who underwent urinary diversion surgery. What surgical procedure did the patient undergo? Ileal conduit Nephrostomy Cutaneous ureterostomy Laparoscopic nephrectomy

Cutaneous ureterostomy Rationale Cutaneous ureterostomy is a urinary diversion surgery that involves the excision of ureters from bladder through abdominal wall, and creation of a stoma. Cutaneous ureterostomy has the possibility of stoma stenosis, which involves the narrowing of the lumen of stoma. Ileal conduit is an incontinent urinary diversion procedure in which the ileum is converted into a conduit for urinary drainage. Nephrostomy has a high risk of renal infection. Laparoscopic nephrectomy is not a type of urinary diversion surgery.

A patient is diagnosed with urinary retention related to benign prostatic hypertrophy. What is the purpose of urinary catheterization in this patient? Decreasing urinary stasis Facilitating bladder irrigation Collecting a sterile urine sample Facilitating medication instillation

Decreasing urinary stasis Rationale A patient with benign prostatic hypertrophy may have urinary retention due to lower urinary tract obstruction. Urinary stasis may increase the risk of infections in the patients. Therefore urinary catheterization should be performed in these patients to decrease urinary retention. Because the patient does not have an infection, bladder irrigation does not need to be performed. Therefore this could not be the reason for urinary catheterization in this patient. Urinary catheterization for collecting a sterile urine sample would not be appropriate in this patient. Facilitating medication instillation is not necessary in this patient. p. 1060

Which condition occurs due to neurologic diseases affecting the 2, 3, and 4 sacral segments? Reflex incontinence Functional incontinence Bladder outlet obstruction Deficient detrusor contraction

Deficient detrusor contraction Rationale Deficient detrusor contraction results in urinary retention when the muscle is no longer able to contract with enough force or for a sufficient time to completely empty the bladder. Deficient detrusor contraction occurs due to neurologic diseases affecting the 2, 3, and 4 sacral segments. Reflex incontinence occurs when spinal cord lesions above S2 interfere with central nervous system inhibition. Functional incontinence occurs due to problems affecting balance and mobility. Bladder outlet obstruction occurs due to enlarged prostate.

A patient who is unable to urinate reports pain in the lower abdomen. The postvoid residual (PVR) volume of the patient is 150 mL. What reason does the nurse suspect to be the cause of this finding in the patient? Obstruction with urinary stasis Deficient detrusor contraction strength Interference of urethral sphincter control Colonization and infection of the lower urinary tract

Deficient detrusor contraction strength Rationale Inability to urinate with pain in the lower abdomen indicates urinary retention. If the postvoid residual (PVR) volume is above 100 mL, it indicates urinary retention. The cause of urinary retention is deficient detrusor contraction strength, in which the muscle no longer contracts with enough force to void the bladder. Obstruction with urinary stasis can be seen in patients with stress incontinence due to prostate cancer. Interference of urethral sphincter control causes urinary incontinence (UI). Colonization and infection of the upper urinary tract cause acute pyelonephritis. p. 1060

A patient is on tolterodine therapy for urge incontinence. On a follow-up visit, the nurse finds that the patient has taken an overdose of the medication. Which complications does the nurse suspect in the patient? Select all that apply. Delirium Diaphoresis Blurred vision Urethral constriction GastrointestinaI cramping

Diaphoresis Blurred vision GastrointestinaI cramping Rationale Tolterodine is an anticholinergic medication. Anticholinergics are medications that block acetylcholine in the brain. Overdose of anticholinergics causes decreased sweating (diaphoresis), blurred vision, and gastrointestinal cramping. Delirium occurs as a side effect of opioids and alcohol. Urethral constriction is a side effect of α-adrenergic receptor agonists. p. 1057

A patient with interstitial cystitis complains of burning pain in the bladder. Which medications does the nurse expect to be beneficial to the patient? Select all that apply. Alfuzosin Diltiazem Verapamil Imipramine Phenylpropanolamine

Diltiazem Verapamil Imipramine Rationale Calcium channel blockers such as diltiazem and verapamil reduce smooth muscle contraction and help reduce burning pain. Tricyclic antidepressants such as imipramine reduce burning pain in the bladder. Alfuzosin reduces urethral sphincter resistance to urinary outflow. Phenylpropanolamine is an α-adrenergic agonist that increases urethral resistance. p. 1059

What is a common cause of bladder outlet obstruction? Overdistention Diabetes mellitus Enlarged prostate Chronic alcoholism

Enlarged prostate Rationale An enlarged prostrate is a common cause of bladder outlet obstruction. Overdistention, diabetes mellitus, and chronic alcoholism are common causes of deficient detrusor contraction.

A patient who has undergone hemorrhoidectomy reports feeling the incomplete passage of urine and frequent leakage of small amounts of urine during the day and night. Which medications are beneficial for the patient's condition? Select all that apply. Diazepam Finasteride Oxybutynin Bethanechol Trospium chloride

Finasteride Bethanechol Rationale The feeling of incomplete passage of urine and frequent leakage of small amounts of urine indicates overflow incontinence, which commonly occurs after a patient undergoes surgery or anesthesia. Finasteride is used to decrease outlet resistance and bethanechol is used to enhance bladder contractions; both are beneficial for the patient's condition. Diazepam is used to relax the external sphincter. Oxybutynin and trospium chloride are used in the treatment of urge incontinence. p. 1056

Which of the following must be completed by a registered nurse and is not in the scope of practice of a vocational or licensed practice nurse? Identifying type of incontinence Placement of the indwelling catheter placement Administering medications via bladder instillation Using a bladder scanner to measure postvoid residual volume (PRV)

Identifying type of incontinence Rationale It is a registered nurse's responsibility to assess and identify the type of incontinence and to consult with the primary health care provider on the appropriate interventions for treatment. Catheterization is within the scope of practice of any nurse. A registered nurse or a licensed practical nurse with the consent of healthcare provider can administer medications via bladder instillation. A registered nurse or a licensed practical nurse can use a bladder scanner to measure postvoid residual volume (PRV).

Which nursing intervention should the nurse include in immediate postoperative management of urinary diversion? Keeping the urine alkaline Inserting a nasogastric tube Notifying the charge nurse of stoma shreds in the drainage bag Encouraging the patient to notify the primary health care provider in case of mucus in urine

Inserting a nasogastric tube Rationale With the removal of part of the bowel, there is an increased incidence of small bowel obstruction and paralytic ileus. Therefore a nasogastric tube is inserted for few days. The urine should be acidic to prevent alkaline encrustations. Stoma shreds into the drainage bag and mucus in the urine are common in first few days after the surgery.

The nurse is caring for a patient with a ureteral catheter. Which intervention of the nurse needs correction? Check the catheter placement frequently Instructing the patient to tolerate pelvic pain Checking for drainage every one or two hours Clamping the ureteral catheter to avoid urine leakage

Instructing the patient to tolerate pelvic pain Rationale The patient should not be encouraged to tolerate pelvic pain. Adequate pain management is necessary for healing. The nurse should check the drainage from the ureteral catheter every one or two hours to prevent complications associated with the ureteral catheter. The catheter should be checked frequently to avoid tension on the catheter. The nurse should not clamp the ureteral catheter. p. 1062

A nurse is caring for a patient diagnosed with minor pelvic organ prolapse. Which device is beneficial for the patient? External collection device Penile compression device Intravaginal support device Intraurethral occlusive device

Intravaginal support device An intravaginal support device is an antiincontinence device used to relieve minor pelvic organ prolapse. An external collection device is a containment device used to direct urine into a drainage bag. A penile compression device is applied to the penis to prevent any flow or leakage via the urethra. An intraurethral occlusive device is worn in the urethra to provide mechanical obstruction to prevent urine leakage.

Which antiincontinence device helps to relieve minor pelvic organ prolapse? External collection devices Penile compression devices Intravaginal support devices Intraurethral occlusive devices

Intravaginal support devices Rationale Intravaginal support devices include pessaries and bladder neck support prostheses. These devices relieve minor organ prolapse. External collection devices such as penile sheaths help to direct the urine into a drainage bag. Penile compression devices are applied to the penis to prevent leakage through the urethra. Intraurethral occlusive devices include urethral plugs that provide mechanical obstruction to prevent urine leakage.

A nephrostomy tube (catheter) has been inserted in a patient with ureteric obstruction, and irrigation has been ordered. What precautions should the nurse take regarding care for the nephrostomy tube? Select all that apply. Irrigation must be done under strict aseptic precautions. The catheter should not be kinked, compressed, or clamped. During irrigation, 15 mL of sterile solution should be instilled at once. Attention should be given to any complaints of excessive pain in the area. Excessive drainage around the catheter is common and needs no attention.

Irrigation must be done under strict aseptic precautions. The catheter should not be kinked, compressed, or clamped. Attention should be given to any complaints of excessive pain in the area. Rationale Irrigation must be done under strict aseptic precautions to avoid any contamination and infection to the kidneys. The catheter should not be kinked, compressed, or clamped, as this can affect the passage of urine through the catheter. If the patient complains of any excessive pain in the area, the nurse should check the catheter for patency. During irrigation, no more than 5 mL of sterile saline solution should be instilled at once to prevent renal damage. If there is excessive drainage around the tube, the nurse should check the catheter for patency.

A patient with bladder cancer is scheduled for surgery to create an ileal conduit. How should the nurse explain the ileal conduit? It is a temporary procedure that can be reversed later. It conveys urine from the ureters to a stoma opening on the abdomen. It diverts urine into the sigmoid colon, where it is expelled through the rectum. It provides a bladder opening that allows urine to drain into an external pouch.

It conveys urine from the ureters to a stoma opening on the abdomen. Rationale An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected with one end of the segment closed. The ureters are surgically attached to the segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form a stoma. The patient must wear a pouch to collect the urine, which continuously flows through the conduit. An ileal conduit is a permanent urinary diversion procedure. An ileal conduit does not divert urine into the sigmoid colon or create an opening in the bladder allowing urine to drain into an external pouch.

The nurse is caring for a patient with a suprapubic catheter. Which interventions should the nurse perform to ensure patency of the tube? Select all that apply. Milking the tube Lubricating the catheter Turning the patient side to side Instilling 5 mL of sterile saline solution Preventing tube kinking by coiling the excess tubing

Milking the tube Turning the patient side to side Preventing tube kinking by coiling the excess tubing Rationale A suprapubic catheter is prone to poor drainage, because of mechanical obstruction of the tip of the catheter by clots and sediments. Milking the tube will help to prevent tube obstruction. To ensure the proper functioning of the tube and to check whether the catheter is properly inserted, the patient should be turned side to side. Preventing tube kinking by coiling the excess tubing also prevents obstruction in the tube. Lubricating the catheter is not an appropriate intervention to ensure patency of the tube. Instilling 5 mL of sterile saline solution is performed in patients with a nephrostomy tube to prevent overdistention of the kidney pelvis.

Which medication increases the bladder's storage capacity in a patient with voiding dysfunction? Tamsulosin Finasteride Imipramine Mirabegron

Mirabegron

The nurse is caring for a patient who has undergone placement of a nephrostomy tube. Which actions should the nurse perform during the postoperative period? Select all that apply. Clamp the catheter. Observe color and consistency of urine. Attend to care for the stoma and collecting device. Measure urine output at least every one or two hours. Measure the drainage from the catheters and on the dressing.

Observe color and consistency of urine. Measure urine output at least every one or two hours. Measure the drainage from the catheters and on the dressing. Rationale Observing the color and consistency of urine is important, because urine with increased amounts of mucus, blood, or sediment may occlude the drainage tubing or catheter. Measuring and recording urine output is important, because the total urine output should be at least 0.5 mL/kg/hr. It is important to assess for urine drainage from the catheters and on the dressings to estimate the minimum amount of urine output. Never clamp the catheter unless ordered to do so by a health care provider. There is no stoma after a nephrectomy; the stoma and its care are integral part of procedures such as ileal conduit.

What are the potential complications of pelvic surgery? Select all that apply. Paralytic ileus Thrombophlebitis Periurethral abscess Small bowel obstruction Secondary stone formation

Paralytic ileus Thrombophlebitis Small bowel obstruction Rationale Pelvic surgery involves the removal of part of the bowel. It increases the risk of paralytic ileus, thrombophlebitis, and small bowel obstruction. Periurethral abscess is the complication of intermittent catheterization. Insertion of a nephrostomy tube is associated with secondary stone formation.

A patient tells the nurse, "I involuntarily pass urine while coughing, laughing, and sneezing." The medical history of the patient reveals that the patient has undergone prostate cancer surgery. Which treatment does the nurse expect to be beneficial in the patient? Reductase inhibitors Vaginal estrogen creams Urinary diversion surgery Pelvic floor muscle exercises

Pelvic floor muscle exercises Rationale The involuntary passage of urine while coughing, laughing, and sneezing indicates stress incontinence. These issues may occur due to prostate surgery for benign prostate hyperplasia, or prostate cancer; atrophy of the structures of the female urethra; and relaxed pelvic floor musculature. Pelvic floor muscles relax after prostate surgery. Pelvic floor muscle exercises such as Kegel exercises help to strengthen the pelvic muscles. Reductase inhibitors decrease the outlet resistance in overflow incontinence. Vaginal estrogen creams are used to treat females with urge incontinence. Urinary diversion surgery is performed to bypass the urethra and cure bladder incontinence after trauma or surgery in males and females.

Which containment device directs urine into a drainage bag? Pessary Urethral Plug Penile Sheath Bladder neck support prostheses

Penile Sheath Rationale: A penile sheath is a containment device that directs urine into a drainage bag. Pessaries are anticontinence intravaginal support devices. A urethral plug is an anticontinence intraurethral occlusive device. Bladder neck support prostheses are intravaginal support devices that are used to control incontinence in patients.

A patient with involuntary passage of urine underwent a surgical therapy. On a follow up visit, the nurse finds bladder perforation. Which surgery does the nurse suspect to be the cause of this condition? Urinary diversion surgery Laparoscopic nephrectomy Retropubic colposuspension Pubovaginal sling placement

Pubovaginal sling placement Rationale Urinary incontinence (UI) is the involuntary passage of urine. Surgical therapy is performed based on the type of incontinence. Bladder perforation is a complication resulting from pubovaginal sling placement. Urinary diversion surgery is associated with complications such as stoma stenosis. Laparoscopic nephrectomy may cause abdominal distension. Retropubic colposuspension is associated with vaginal prolapse, postoperative voiding dysfunction, and urgency. p. 1056

While caring for a postoperative patient with urinary diversion surgery, the nurse observes mucus shreds in the drainage bag. What would be the appropriate nursing intervention in this condition? Irrigate the drainage bag Apply lotion around the skin Record it as a normal observation Notify the primary health care provider

Record it as a normal observation Rationale After the surgery, mucus may be present in the drainage tube for few days; this is a normal observation. The nurse should irrigate the drainage bag only with an order from the primary health care provider. Lotions or creams should never be applied, because they increase the risk of infection around the surgical area. Notifying the primary health care provider is not an appropriate intervention, because the mucus is a normal finding.

The primary health care provider performs a surgical technique in a patient with incontinence to increase the urethral closure pressure and periurethral electromyography activity. Which type of incontinence would the nurse suspect in the patient? Stress incontinence Reflex incontinence Overflow incontinence Incontinence after trauma or surgery

Stress incontinence Rationale Injecting autologous stem cells into the rhabdosphincter and urethral submucosa is a recent surgical technique done for stress urinary incontinence (UI) to increase the closure pressure and periurethral electromyography activity. Reflex incontinence is cured by surgical sphincterotomy. Overflow incontinence can be cured by urinary or intermittent catheterization. Incontinence after trauma or surgery is treated by placing an artificial implantable sphincter. pp. 1057-1058

The patient complains of incontinence of urine while coughing or sneezing during the physical assessment. The nurse explains to the patient that this is defined as what? Stress incontinence Reflex incontinence Trauma incontinence Overflow incontinence

Stress incontinence Rationale Stress incontinence occurs when the patient coughs or sneezes. In stress incontinence, the leakage is in small amounts and may not be daily. Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. This usually occurs frequently throughout the day and night. Reflex incontinence is a condition that occurs when no warning or stress precedes periodic involuntary urination. Urination is frequent, is moderate in volume, and occurs equally during the day and night. Trauma incontinence occurs when a fistula develops as result of trauma or surgery.

A patient reports frequent leakage of small amounts of urine throughout the day and night. On assessing the patient, the nurse finds the bladder is palpable and distended. Which medication does the nurse expect to be beneficial to the patient? Oxybutynin (Oxytrol) Baclofen Terazosin Solifenacin

Terazosin Rationale Leakage of small amounts of urine throughout the day and night indicates overflow incontinence. Overflow incontinence is a condition in which the pressure of urine in an overfull bladder overcomes sphincter control. The bladder remains distended and is palpable in patients with overflow incontinence. Terazosin is an alpha-blocker, which relaxes the smooth muscles around the bladder and relieves the need of frequent or urgent urination even during the night. Oxybutynin (Oxytrol) is an anticholinergic medication used in the treatment of urge incontinence. Baclofen is effective in patients with reflex incontinence. Solifenacin, an anticholinergic medication, is used to treat urge incontinence. p. 1059

The nurse identifies urethral sphincter resistance to urinary outflow in a patient. Which medications does the nurse anticipate to be beneficial for the patient? Select all that apply. Terazosin Doxazosin Finasteride Mirabegron Propantheline

Terazosin Doxazosin Rationale Terazosin and doxazosin are α-adrenergic antagonists that are used to reduce urethral sphincter resistance to urinary outflow. They cause smooth muscles in the bladder neck to relax and improve urine flow rate. Finasteride is a 5 alpha reductase inhibitor that suppresses androgen, which contributes to prostate disease. Mirabegron is a β 3-adrenergic agonist that improves the bladder storage capacity by relaxing the bladder muscle during filling. Propantheline is a muscarinic receptor antagonist and anticholinergic that reduces overactive urinary contractions in urge urinary incontinence (UI). p. 1059

The nurse is reviewing the medical reports of patients with urinary incontinence (UI). Which patient is suspected to have overflow incontinence? The patient with a herniated disc The patient with Parkinson's disease The patient with multiple pregnancies The patient with retropubic prostatectomy

The patient with a herniated disc Rationale Overflow incontinence occurs when the pressure of urine in an overfull bladder overcomes sphincter control. It is due to an underactive detrusor muscle, caused by myogenic or neurogenic factors such as a herniated disc. Therefore, the patient with a herniated disc would have overflow incontinence. Central nervous system disorders such as Parkinson's disease and Alzheimer's disease lead to urge incontinence. A patient who has had multiple pregnancies experiences relaxation of the pelvic floor muscles, which can cause stress incontinence. Retropubic prostatectomy causes incontinence after trauma or surgery.

What is the role of a registered nurse during catheterization? To anchor the catheter in place To irrigate the catheter in case of obstruction To choose the appropriate type and size of catheter To insert an indwelling catheter for uncomplicated patients

To choose the appropriate type and size of catheter Rationale The registered nurse chooses the type and size of the catheter during catheterization. Anchoring the catheter in place is the role of unlicensed assistive personnel (UAP). A licensed practical/vocational nurse irrigates the catheter if obstruction is suspected and inserts an indwelling catheter for uncomplicated patients.

While caring for a patient with urinary incontinence (UI), the nurse attaches a urethral plug to the patient's urethra. What is the rationale behind this intervention? To support the bladder neck To direct urine into the drainage bag To prevent leakage through the urethra To provide mechanical obstruction to prevent urine leakage

To provide mechanical obstruction to prevent urine leakage Rationale A urethral plug is an intraurethral occlusive device, which is worn in the urethra to provide mechanical obstruction to prevent urine leakage. Pessaries and bladder neck support prostheses are devices that help to support the bladder neck. Urine is directed into a drainage bag through external catheter systems. Penile compression devices are applied to the penis to prevent leakage through the urethra. p. 1057

The primary health care provider orders retropubic colposuspension for a patient diagnosed with urinary incontinence (UI). Which complications might the nurse anticipate in the patient? Select all that apply. Infection Urinary retention Vaginal prolapse Bladder perforation Postoperative voiding dysfunction

Vaginal prolapse Postoperative voiding dysfunction Rationale Retropubic colposuspensions are periurethral injectables used in the treatment of urinary incontinence (UI). This procedure is performed through low transverse incisions, and may lead to complications such as vaginal prolapse, postoperative voiding dysfunction, and urgency. Infection, urinary retention, and bladder perforation occur due to the placement of a suburethral sling.