Ch 49 Management of Patients with Urinary Disorders

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. What should the nurse discuss with the health care provider before catheterization? A. Type and size of the catheter to be used B. Administration of cleansing enemas C. Procedure for insertion of the catheter D. Placement of the catheter

A. Type and size of the catheter to be used Before catheterization, the nurse should inquire about the type and size of the catheter to be used and if the catheter should be removed or retained in place after the bladder is empty.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence? A. Increased urine production due to metabolic conditions B. Decreased pelvic muscle tone due to multiple pregnancies C. Bladder irritation related to urinary tract infections D. Obstruction due to fecal impaction or enlarged prostate

B. Decreased pelvic muscle tone due to multiple pregnancies Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

Which medication may be ordered to relieve discomfort associated with a UTI? A. Nitrofurantoin B. Phenazopyridine C. Ciprofloxacin D. Levofloxacin

B. Phenazopyridine Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? A. Hyperuricemia B. Pancreatitis C. Diabetes mellitus D. Hyperparathyroidism

C. Diabetes mellitus Increased urinary glucose levels create an infection-prone environment in the urinary tract.

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? A. Shows damage to the kidneys B. If risk for chronic pyelonephritis is likely C. Reveals causative microorganisms D. Detects calculi, cysts, or tumors

D. Detects calculi, cysts, or tumors Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

Which of the following is a cause of a calcium renal stone? A. Excessive intake of vitamin D B. Gout C. Neurogenic bladder D. Foreign bodies

A. Excessive intake of vitamin D Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.

The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? A. Ileal conduit B. Kock Pouch C. Ureterosignmoidostomy D. Indiana Pouch

A. Ileal conduit When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cetaceous urinary diversion. Both the Kock Pouch and Indiana Pouch are continent urinary diversions. The ureterosigmoidostomy connects with the rectum for urinary drainage.

A client asks the nurse why cystitis is more common in women than in men. Which of the following body parts will the nurse include in the answer? A. The urethra B. The bladder C. The recum D. The ureters

A. The urethra Because the urethra is short in women, ascending infections or microorganisms carried from the vagina or rectum are common. Males have a longer urethra, causing the organisms travel farther to the bladder. Although structures of the urinary system, the other options are where the client has bacteria and microorganisms located. The ureters connect the bladder to kidney thus do not obtain bacteria, just transmit when available.

The nurse is assisting in the preoperative planning for stoma placement in a client scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located? A. Over a bony prominence B. Away from skin folds C. At the belt line D. At the umbilicus

B. Away from skin folds The nurse plans to have the stoma located away from skin folds and creases, bony prominences, the belt line, and the umbilicus. The stoma should be located in an area where the client can see and reach it.

A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care? A. Turn the patient every 2 hours around the clock B. Administer pain medication every 2 hours C. Monitor urine output hourly and report output less than 30 mL/hr D. Clean the stoma with soap and water after the patient voids

C. Monitor urine output hourly and report output less than 30 mL/hr In the immediate postoperative period, urine volumes are monitored hourly. Throughout the patient's hospitalization, the nurse monitors closely for complications, reports signs and symptoms of them promptly, and intervenes quickly to prevent their progression. If urinary drainage stops or decreases to less than 30 mL/hour, or if the client complains of back pain, the nurse needs to notify the physician immediately.

Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? A. Overflow B. Urge C. Reflex D. Stress

D. Stress Stress incontinence may occur with sneezing, coughing, or changing position. Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder. Urge incontinence refers to involuntary loss of urine associated with urgency. Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.

What is true about extracorporeal shock wave lithotripsy (ESWL)? Select all that apply. A. Stones are shattered into smaller particles that are passed from the urinary tract B. ESWL is a high-energy blast of pressure C. ESWL is a ureteroscopic approach D. ESWL is done while the patient is undergoing a percutaneous nephrolithotomy

A, B Stones are shattered into smaller particles that are passed from the urinary tract. ESWL is a high-energy blast of pressure. ESWL is not a ureteroscopic approach. ESWL is not done while the patient is undergoing a percutaneous nephrolithotomy.

The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply. A. For those patients who are incontinent, insert indwelling catheters B. Perform hand hygiene prior to patient care C. Assist the patients with frequent toileting D. Provide careful perineal care E. Encourage patients to wear briefs

B, C, D In institutionalized older patients, such as those in long-term care facilities, infecting pathogens are often resistant to many antibiotics. Diligent hand hygiene, careful perineal care, and frequent toileting may decrease the incidence of UTIs.

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal? A. Determine the stone type B. Relieve any obstruction C. Relieve the pain D. Prevent nephron destruction

C. Relieve the pain The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.

Which type of medication may be used to inhibit bladder contraction in a client with incontinence? A. Anticholinergic agent B. Estrogen hormone C. Tricyclic antidepressants D. Over-the-counter decongestant

A. Anticholinergic agent Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions and increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

The nurse is encouraging the client with recurrent urinary tract infections to increase fluid intake to 8 large glasses of fluids daily. Which beverage would the nurse discourage for this client? A. Coffee in the morning B. Fruit juice midmorning C. Milk at lunc D. Ginger ale at dinner time

A. Coffee in the morning The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and counted toward the daily fluid total.

A client has a suspected bladder cancer. What is the most common first symptom of a malignant tumor of the bladder? A. Painless hematuria B. Fever C. Dysuria D. Urgency

A. Painless hematuria The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency.

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. A. Urinary retention B. Deficient knowledge: management of urinary diversion C. Disturbed body image D. Risk for impaired skin integrity E. Chronic pain

B, C, D Deficient knowledge, disturbed body image, and risk for impaired skin integrity are expected problems for the client with a new ileal conduit. Urinary retention and chronic pain are not expected client problems.

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? A. "Take your temperature every 4 hours" B. "Increase your fluid intake to 2 to 3 L per day" C. "Apply an antibacterial dressing to the incision daily" D. "Be aware that your urine will be cherry-red for 5 to 7 days"

B. "Increase your fluid intake to 2 to 3 L per day" The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement? A. Take tub baths instead of showers B. Void immediately after sexual intercourse C. Increase intake of coffee, tea, and colas D. Void every 5 hours during the day

B. Void immediately after sexual intercourse Voiding flushes the urethra, expelling contaminants. Showers are encouraged, rather than tub baths, because bacteria in the bath water may enter the urethra. Coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants should be avoided. The client should be encouraged to void every 2 to 3 hours during the day and completely empty the bladder.

Bladder retraining following removal of an indwelling catheter begins with A. Encouraging the client to void immediately B. Advising the client to avoid urinating for at least 6 hours C. Performing straight catheterization after 4 hours D. Instructing the client to follow a 2 to 3 hour timed voiding schedule

D. Instructing the client to follow a 2 to 3 hour timed voiding schedule Immediately after the removal of the indwelling catheter, the client is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. At the given time interval, the client is instructed to void. Immediate voiding is not usually encouraged. If bladder ultrasound shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed to ensure complete bladder emptying.

A patient who has been treated for uric acid stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient? A. Low-calcium diet B. High-protein diet C. Low-phosphorus diet D. Low-purine diet

D. Low-purine diet For uric acid stones, the patient is placed on a low-purine diet to reduce the excretion of uric acid in the urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided, and other proteins may be limited.

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? A. Risk for altered urinary elimination B. Risk for deficient knowledge: self-catherization C. Risk for fluid volume excess D. Risk for infection

D. Risk for infection Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.

Which characteristic is seen with a healthy stoma? A. Painful B. Pink color C. No bleeding when cleansing the stoma D. Dry in appearance

B. Pink color Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.

A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to: A. Compromised ligament and pelvic floor support of the urethra B. Uninhibited detrusor contractions C. Loss of motor control of the detrusor muscle D. A stricture or tumor in the bladder

C. Loss of motor control of the detrusor muscle Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void. These patients also experience hyperreflexia in the absence of normal sensations associated with voiding.

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform? A. Determine the client's ability to manage stoma care B. Show photographs and drawings of the placement of the stoma C. Maintain skin and stoma integrity D. Suggest a visit to a local ostomy group

C. Maintain skin and stoma integrity The most important postoperative nursing management is to maintain skin and stoma integrity to avoid further complications, such as skin infections and urinary odor. Determining the client's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the preoperative procedure.

A client has developed urinary incontinence after having a urinary catheter in place for a few weeks. What is the initial nursing intervention the nurse should use to start the client with bladder training? A. Immediately after voiding, perform a bladder scan B. Instruct the client to drink more fluids at night for a full bladder in the morning C. Place client on a timed voiding schedule D. Perform straight catheterizations at specific times each day

C. Place client on a timed voiding schedule Placing the client on a timed voiding schedule after a catheter removal will promote bladder muscle retraining. The nurse should do a bladder scan immediately after voiding, but this is not the initial action. The nurse does not need to complete urinary catheterization at specific intervals for initial bladder training. The client needs to limit fluids at night.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? A. Straight catheterize the client every 4 to 6 hours B. Administer acetaminophen (Tylenol) C. Teach client to increase fluid intake up to 3 L per day D. Restrict fluid intake to 1 L per day

C. Teach client to increase fluid intake up to 3 L per day The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do? A. Take the antibiotic as well as an antifungal for the yeast infection she will probably have B. Take the antibiotic for 3 days as prescribed C. Understand that if the infection reoccurs, the dose will be higher next time D. Be sure to take the medication with grapefruit juice

B. Take the antibiotic for 3 days as prescribed The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.

Patients with urolithiasis need to be encouraged to: A. Increase their fluid intake so that they can excrete up to 4 liters every day B. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi C. Supplement their diet with calcium needed to replace losses to renal calculi D. Limit their voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system

A. Increase their fluid intake so that they can excrete up to 4 liters every day Fluids need to be increased up to 4 L/day to increase hydrostatic pressure within the urinary tract and thereby promote passage of the stone. This volume of fluid intake also helps prevent additional stone formation.

A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer? A. Painless, gross hematuria B. Deep flank and abdominal pain C. Muscle spasm and abdominal rigidity over the flank D. Decreasing kidney function associated with fever and hematuria

A. Painless, gross hematuria Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.

Which client is at highest risk for developing a hospital-acquired infection? A. A client with a laceration to the left hand B. A client who's taking prednisone (Deltasone) C. A client with an i1619 D. A client with Cronhn's disease

C. A client with an i1619 The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk.

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? A. Anticholinergic B. Diuretics C. Anticonvulsant D. Cholinergic

A. Anticholinergic Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic medications also do not directly help with control.

An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client? A. Physical and environmental conditions B. History of allergies C. Occupational history D. Smoking habits

A. Physical and environmental conditions It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the client may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.

Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? A. Low oxalate B. Low purine C. High protein D. High sodium

B. Low purine A low-purine diet is used for uric acid stones, although the benefits are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? A. Stress B. Urge C. Overflow D. Functional

B. Urge Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an over distended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? A. Use tub baths as opposed to showers B. Drink coffee or tea to increase diuresis C. Drink liberal amounts of fluids D. Void every 4 to 6 hours

C. Drink liberal amounts of fluids Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathe in a tub because bacteria in the bathwater may enter the urethra.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs? A. "I should wipe from back to front" B. "I should take a tub bath at least 3 times per week" C. "I should take at least 1,000 mg of vitamin C each day" D. "I should limit my fluid intake to limit my trips to the bathroom"

C. "I should take at least 1,000 mg of vitamin C each day" The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTI.

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? A. Incontinence B. Dysuria C. Hematuria D. Frequency

C. Hematuria The most common first symptom of a malignant tumor is hematuria. Most malignant tumors are vascular; thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of incontinence (a later sign), dysuria and frequency.

The nurse is evaluating the effectiveness of discharge teaching for the client with an ileal conduit. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. A. "I might notice a strong urine odor if I eat eggs, cheese, or asparagus" B. "I cannot wait until I can have surgery to get rid of this ostomy" C. "I will need to change the appliance every day" D. "I will need to monitor the skin around my ostomy for irritation" E. "I will need to catheterize myself every 2 to 3 hours"

B, C, E An ileal conduit is a permanent urinary diversion. In an ileal conduit, urine output is continuous and collected in an ileostomy bag, making self-catheterization unnecessary. The appliance usually remains in place as long as it is watertight. The skin surrounding the ostomy needs to be monitored for irritation and breakdown. The urine can acquire a strong odor from foods such as asparagus, cheese, and eggs.

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? A. Use clean technique during insertion B. Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens C. Place the catheter bag on the client's abdomen when moving the client D. Perform meticulous perineal care daily with soap and water

D. Perform meticulous perineal care daily with soap and water Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used when inserting a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's port to obtain specimens. The catheter bag must never be placed on the client's abdomen unless it is clamped because it may cause urine to flow back from the tubing into the bladder.

The nurse should first ask the client to _____ then perform the prescribed _____ 1: urinate, defecate, drink 2: bladder scan, urinary catheterization, laboratory testing

Drink Bladder scan Postcatheterization detrusor instability can be managed with the implementation of bladder retraining with the client. When implementing bladder retraining for a client who experiences postcatheterization detrusor instability, the nurse first asks the client to urinate.Once the client voids, the nurse then performs the prescribed bladder scan. Bladder retraining involves urination, not defecation. The client is instructed to drink a measured amount of fluid from 8 am to 10 pm with the implementation of bladder retraining to avoid bladder overdistention; however, the client is not instructed to drink at specific times during this process. After the client is asked to void, urinary catheterization is not performed unless the bladder scan indicates a residual greater than 300 ml. Laboratory testing is not completed as part of bladder retaining; however, the nurse should measure the volumes of urine voided and palpate the bladder at repeated intervals to assess for distention.