CH59: Disorders of the Bladder and Urethra

The nurse is caring for a client who is scheduled for the creation of an ileal conduit. Which statement by the client provides evidence that client teaching was effective? "My urine will be eliminated through a stoma." "I will not need to worry about being incontinent of urine." "My urine will be eliminated with my feces." "A catheter will drain urine directly from my kidney."

.Correct response: "My urine will be eliminated through a stoma." Explanation: An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

The nurse has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply. 1). Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. 2). Bathe in warm water to soak the affected area. 3). Void every 2-3 hours to prevent overdistention of the bladder 4). Drink liberal amounts of fluid to flush out bacteria. 5). Drink caffeinated beverages twice a day to increase urination.

Correct Response: Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens Explanation: Clients with a urinary tract infection should clean the perineum and urethral meatus from front to back after each bowel movement to help reduce concentrations of pathogens at the urethral opening and, in women, the vaginal opening; void every 2-3 hours during the day to prevent overdistention of the bladder and compromised blood supply to the bladder wall as both predispose the patient to urinary tract infection; and drink liberal amounts of fluid to flush out bacteria. Clients with a urinary tract infection should shower rather than bathe because during a bath bacteria may enter the urethra. Clients with a urinary tract infection should avoid coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants.

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. Assist the patients with frequent toileting. Encourage patients to wear briefs. For those patients who are incontinent, insert indwelling catheters. Perform hand hygiene prior to patient care. Provide careful perineal care.

Correct Response: Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care. Explanation: 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 client has a history of neurogenic bladder and uses a permanent, indwelling catheter to facilitate urine elimination. What contributes to the likelihood of developing urinary tract or bladder infections? Select all that apply. increased ingestion of Vitamin C indwelling catheter frequent catheter hygiene decreased fluid intake

Correct Response: indwelling catheter decreased fluid intake Explanation: Decreased fluid intake results in decreased urine production. The urinary tract can contain pathogenic microbes which are washed away with sufficient urine production - which required adequate fluid intake (1.5L to 3L per day).

A nurse reinforces teaching nursing students with which of the following is the antimicrobial of choice for acute glomerulonephritis? Gentamycin Sulfonamides Erythromycin Nitrofurantoin

Correct response: Erythromycin

The patient is on postoperative day 1 after having undergone a urinary bladder procedure. He has continuous bladder irrigation (CBI). Actual urine output during continuous bladder irrigation is calculated by: Adding the total of the intravenous and irrigating solutions and then deducting the amount of output. Measuring and recording all fluid output in the drainage bag Measuring total output and deducting the amount of irrigating solution used Measuring the total output and deducting the total of the irrigating and intravenous solutions.

Correct response: Measuring total output and deducting the amount of irrigating solution used

The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day? 3,500 mL 1,250 mL 2,000 mL 2,750 mL

Correct response: 2,000 mL Explanation: Unless contraindicated by kidney injury or hydronephrosis, clients with renal stones should drink at least eight 8-oz (250 mL) glasses of water daily or have IV fluids prescribed to keep the urine dilute. Urine output exceeding 2 L a day is advisable.

A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? A client who is on bed rest following a recent episode of venous thromboembolism A client whose diagnosis of chronic kidney disease requires a fluid restriction A client who has Alzheimer disease and who is acutely agitated A client who has decreased mobility following a transmetatarsal amputation

Correct response: A client who has Alzheimer disease and who is acutely agitated Explanation: Clients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk for injury or trauma associated with indwelling catheter use.

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

Correct response: A client with an i1619 Explanation: 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.

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? Assessing present voiding patterns Restricting fluid intake to reduce the need to void Encouraging the client to increase the time between voidings Establishing a predetermined fluid intake pattern for the client

Correct response: Assessing present voiding patterns Explanation: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

A nurse reinforces teaching nursing students in which of the following is the medications appropriate in the management of a flaccid bladder? Bethanechol Oxybutinin Sodium polystyrene Atropine

Correct response: Bethanechol

The nurse working with a client after an ileal conduit notices that the pouching system is leaking small amounts of urine. What is the appropriate nursing intervention? Secure or patch it with barrier paste. Change the wafer and pouch. Secure or patch it with tape. Empty the pouch.

Correct response: Change the wafer and pouch. Explanation: Whenever a leaking pouching system is noted, the nurse should change the wafer and pouch. Attempting to secure or patch the leak with tape and/or barrier paste can trap urine under the barrier or faceplate, which will compromise peristomal skin integrity. Emptying the pouch will not rectify the leaking.

A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this client's discharge education, what is the most plausible nursing diagnosis that the nurse should address? Deficient knowledge related to care of the ileal conduit Risk for autonomic dysreflexia related to disruption of the sacral plexus Risk for deficient fluid volume related to urinary diversion Impaired mobility related to limitations posed by the ileal conduit

Correct response: Deficient knowledge related to care of the ileal conduit Explanation: The client will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.

A client being treated in the hospital has been experiencing occasional urinary retention. What voiding trigger technique would help this client? Dipping the client's hands in warm water Performing a bladder scan after voiding Using a bedpan instead of a commode Encouraging male clients to use a urinal in bed

Correct response: Dipping the client's hands in warm water Explanation: Dipping the client's hands in warm water is a urinary trigger technique that helps encourage clients to start voiding. Other trigger techniques include turning on the faucet while the client is attempting to void and stroking the abdomen or inner thighs. Using a commode instead of a bedpan is a nursing measure to encourage normal voiding patterns. Encouraging a male client to use a urinal while standing is more natural and comfortable and is also linked to voiding patterns. Bladder scanning after voiding will assess whether the client is retaining urine but is not a trigger technique.

An adult client has been hospitalized with pyelonephritis. The nurse's review of the client's intake and output records reveals that the client has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? Supplement the client's fluid intake with a high-calorie diet. Emphasize the need to limit intake to 2 L of fluid daily. Encourage the client to continue this pattern of fluid intake. Obtain an order for a high-sodium diet to prevent dilutional hyponatremia.

Correct response: Encourage the client to continue this pattern of fluid intake. Explanation: Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. Consequently, there is no need to supplement this fluid intake with additional calories or sodium.

A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image? Encourage the client to speak openly and frankly about the diversion. Emphasize that the diversion is an integral part of successful cancer treatment. Allow the client to initiate the process of providing care for the diversion. Provide the client with detailed written materials about the diversion at the time of discharge.

Correct response: Encourage the client to speak openly and frankly about the diversion. Explanation: Allowing the client to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the client is hesitant. Provision of educational materials is rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role of the diversion in cancer treatment does not directly address the client's body image.

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? Incontinence Urinary retention Incomplete bladder emptying Urgency

Correct response: Incontinence Explanation: Incontinence is noted in clients diagnosed with Parkinson disease. Urinary retention is associated with spinal cord injury. Urgency is associated with an overactive bladder. Incomplete bladder emptying is associated with diabetes mellitus.

The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response? Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose. Document the presence of a healthy stoma. Inform the primary care provider that the vascular supply may be compromised. Assess the client for further signs and symptoms of infection.

Correct response: Inform the primary care provider that the vascular supply may be compromised. Explanation: A healthy stoma is pink or red. A change from this color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma.

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? Low-purine diet High-protein diet Low-calcium diet Low-phosphorus diet

Correct response: Low-purine diet Explanation: 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.

A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? Pain management Insertion of an indwelling urinary catheter Assisting with aspiration of the stone IV fluid administration

Correct response: Pain management Explanation: The client with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the client's need for IV fluids or for catheterization. Kidney stones cannot be aspirated.

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

Correct response: Perform meticulous perineal care daily with soap and water Explanation: 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.

Which medication may be ordered to relieve discomfort associated with a UTI? Ciprofloxacin Phenazopyridine Levofloxacin Nitrofurantoin

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

The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program? Physical and environmental conditions Smoking habits History of allergies Occupational history

Correct response: Physical and environmental conditions Explanation: It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the patient 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.

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer? Smoking cessation Maintenance of a diet high in vitamins and nutrients Reduction of alcohol intake Vitamin D supplementation

Correct response: Smoking cessation Explanation: People who smoke are significantly more likely to develop bladder cancer than those who do not smoke. High alcohol intake and low vitamin intake are not noted to contribute to bladder cancer.

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care? Monitor the client for fluid overload following the procedure. Insert a urinary catheter for 24 to 48 hours after the procedure. Administer a bolus of 500 mL normal saline following the procedure. Strain the client's urine following the procedure.

Correct response: Strain the client's urine following the procedure. Explanation: Following ESWL, the nurse should strain the client's urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.

Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing? Reflex Urge Stress Overflow

Correct response: Stress Explanation: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position. Reflex incontinence is the involuntary loss of urine because of hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.

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? Take the antibiotic for 3 days as prescribed. Be sure to take the medication with grapefruit juice. Understand that if the infection reoccurs, the dose will be higher next time. Take the antibiotic as well as an antifungal for the yeast infection she will probably have.

Correct response: Take the antibiotic for 3 days as prescribed. Explanation: 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.

A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client? Remind the client that occasional febrile episodes are expected following ESWL. Tell the client to report to the ED for further assessment. Remind the client that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office.

Correct response: Tell the client to report to the ED for further assessment. Explanation: Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.

The nurse is working with a client whose health history includes occasional episodes of urinary retention. What assessment finding would suggest that the client is currently retaining urine? 1) The client claims to void large amounts of urine two to three times daily. 2) The client's suprapubic region is dull on percussion. 3) The client takes a beta adrenergic blocker for the treatment of hypertension. 4) The client is uncharacteristically drowsy.

Correct response: The client's suprapubic region is dull on percussion. Explanation: Dullness on percussion of the suprapubic region is suggestive of urinary retention. Clients retaining urine are typically restless, not drowsy. A client experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.

A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic? The risk of developing antibiotic resistance after the course of antibiotics The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy The need to expect a heavy menstrual period following the course of antibiotics The need to undergo a series of three urine cultures after the antibiotics have been completed

Correct response: The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy Explanation: Yeast vaginitis occurs in many clients treated with antimicrobial agents that affect vaginal flora. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.

A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. Diuretics should be promptly discontinued when an older adult experiences incontinence. Urinary incontinence is not considered a normal consequence of aging. Restricting fluid intake is recommended for older adults experiencing incontinence.

Correct response: Urinary incontinence is not considered a normal consequence of aging. Explanation: 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 nurse is caring for a female client whose urinary retention has not responded to conservative treatment. When educating this client about self-catheterization, the nurse should encourage what practice? Using clean technique at home to catheterize Self-catheterizing every 2 hours at home Assuming a supine position for self-catheterization Inserting the catheter 1 to 2 inches (2.5 to 5 cm) into the urethra

Correct response: Using clean technique at home to catheterize Explanation: The client may use a "clean" (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female client assumes a Fowler position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.

The nurse recognizes that test results that most likely indicate a urinary tract infection include: RBC 3 WBC 50 proteinuria glucose trace

Correct response: WBC 50 Explanation: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.

The nurse needs to assess the fluid volume status of a client with chronic glomerulonephritis. To accurately assess the client's fluid volume status, the nurse should weigh the client daily: at the same time, on the same scale, with similar clothing. at the same time, using a different scale every time, with similar clothing. once in the morning, on the same scale, with similar clothing. at the same time, on the same scale, with only minimal clothing.

Correct response: at the same time, on the same scale, with similar clothing. Explanation: Weighing the client daily, at the same time, on the same scale, with similar clothing each time, is important because changes in body weight reflect changes in fluid volume status. Weighing the patient once in the morning, with any scale, or wearing minimal clothing may not reflect the accurate changes. They may cause incorrect assessment of the variation in fluid volume status.

A client has been admitted to the renal unit with acute pyelonephritis, and is undergoing parenteral antibiotic treatment. What would be a significant aspect of this client's discharge education? needed dietary changes anti-inflammatory incompatibilities No option is correct. recurring infection prevention

Correct response: recurring infection prevention Explanation: Chronic pyelonephritis can develop after recurrent episodes of acute pyelonephritis. Anti-inflammatory compatibilities are not a factor in acute pyelonephritis. No dietary changes are required. The client is encouraged to drink a large volume of oral fluids daily.

The nurse provides care for a client who is prescribed bladder retraining following urinary catheterization. The nurse should first ask the client to ________________________, then perform the prescribed ____________________. defecate, drink, urinate bladder scan, laboratory testing, urinary catheterization

urinate, bladder scan Explanation: 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.