Hinkle 55: Management of Patients With Urinary Disorders

Which type of incontinency refers to the involuntary loss of urine due to medications? a) Overflow b) Urge c) Iatrogenic d) Reflex

Iatrogenic Iatrogenic incontinence is the involuntary loss of urine due to medications. Reflex incontinence is the involuntary loss of urine due to 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 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) Ureterosigmoidostomy b) Ileal conduit c) Kock Pouch d) Indiana Pouch

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.

The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet? a) "I will eliminate milk and other dairy products from my diet." b) "I should limit my intake of meat and fish." c) "I should avoid raw fruits and vegetables." d) "Chocolate, spinach, and strawberries are not allowed."

"I should limit my intake of meat and fish." A low-purine diet is prescribed for the client with uric acid renal calculi. Organ meats, shellfish, anchovies, asparagus, and mushrooms are foods high in purine.

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 limit my fluid intake to limit my trips to the bathroom." c) "I should take a tub bath at least 3 times per week." d) "I should take at least 1,000 mg of vitamin C each day."

"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.

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

"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 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? a) "My urine will be eliminated through a stoma." b) "I will not need to worry about being incontinent of urine." c) "A catheter will drain urine directly from my kidney." d) "My urine will be eliminated with my feces."

"My urine will be eliminated through a stoma." 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.

A client presents at the clinic with complaints of urinary retention. What question should the nurse ask to obtain additional information about the client's complaint? a) "How much fluid are you drinking?" b) "Do you get up at night to urinate?" c) "When did you last urinate?" d) "Have you had a fever and chills?"

"When did you last urinate?" The nurse needs to determine the last time the client voided.

The nurse is participating in a bladder retraining program for a patient who had an indwelling catheter for 2 weeks. The nurse knows that, during this process, straight catheterization, after catheter-free intervals, can be discontinued when residual urine is: a) <100 mL b) 400 mL c) 200 mL d) 500 mL

<100 mL Residual urine greater than 100 mL is considered diagnostic of urinary retention. Refer to Box 28-9 in the text.

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis? a) Impaired urinary elimination b) Imbalanced nutrition: Less than body requirements c) Acute pain d) Risk for infection

Acute pain Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care? a) Exercises to promote sphincter control b) Application of an ostomy pouch c) Irrigating the urinary diversion d) Intermittent catheterizations

Application of an ostomy pouch An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermittent catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.

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

Assessing present voiding patterns 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 client is suspected of having interstitial cystitis. Which diagnostic test would the nurse anticipate as being used to confirm the diagnosis? a) Bladder biopsy b) Voiding cystourethrogram c) Urine culture d) Cystoscopy

Bladder biopsy A biopsy of the bladder mucosa which reveals an inflammatory process with scarring and hemorrhagic areas confirms the diagnosis. A cystoscopy would reveal a markedly inflamed bladder with pinpoint hemorrhage and a bladder capacity that is smaller than normal. A voiding cystourethrogram demonstrates a small bladder capacity. Urine culture would be negative.

The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include? a) Hematuria b) Change in cognitive functioning c) Back pain d) Incontinence

Change in cognitive functioning The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small amounts of urine. The appropriate nursing intervention is which of the following? a) Empty the pouch. b) Secure/patch it with tape. c) Secure/patch with barrier paste. d) Change wafer and pouch.

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

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective? a) Cipro b) Bactrim c) Macrodantin d) Septra

Cipro Ciprofloxacin (Cipro) is a fluoroquinolone used to treat UTIs. Co-trimoxazole (Bactrim, Septra) is a trimethoprim-sulfamethoxazole combination medication. Nitrofurantoin (Macrodantin, Furadantin) is an anti-infective urinary tract medication.

A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively? a) History of allergy to iodine and seafood b) Menstrual history c) Client's manual dexterity and vision d) Dietary habits involving cholesterol-laden food

Client's manual dexterity and vision It is essential to assess manual dexterity, vision, and level of understanding of a client who undergoes a urinary diversion procedure because this information will determine the client's ability to manage stoma care and self-catheterization following the urinary diversion procedure. The client's history of allergy to iodine and seafood, dietary habits related to high cholesterol intake, and menstrual history are not important factors for this situation.

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) Hematuria c) Dysuria d) Frequency

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.

Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection? a) Drink liberal amount of fluids b) Void every 4 to 6 hours c) Use tub baths as opposed to showers d) Drink coffee or tea to increase diuresis

Drink liberal amount of fluids Patients 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 patient should shower instead of bathe in a tub because bacteria in the bath water may enter the urethra.

The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which of the following as a contributing factor for UTIs in older adults? a) Sporadic use of antimicrobial agents b) Active lifestyle c) Immunocompromise d) Low incidence of chronic illness

Immunocompromise Factors that contribute to UTIs in older adults include immunocompromise, high incidence of chronic illness, immobility, and frequent use of antimicrobial agents.

Which of the following is a factor contributing to UTI in older adults? a) Immunocompromise b) Active lifestyle c) Sporadic use of antimicrobial agents d) Low incidence of chronic illness

Immunocompromise Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, and frequent use of antimicrobial agents.

The nurse advises the patient with chronic pyelonephritis that he should: a) Decrease his sodium intake to prevent fluid retention. b) Decrease his intake of calcium rich foods to prevent kidney stones. c) Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys. d) Increase fluids to 3 to 4 L/24 hours to dilute the urine.

Increase fluids to 3 to 4 L/24 hours to dilute the urine. Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination, and prevent dehydration. A balanced diet would be recommended but there is no need to restrict sodium or calcium.

A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands that this drug is an effective treatment because it: a) Increases bladder neck resistance. b) Decreases involuntary bladder contractions. c) Reduces bladder spasticity. d) Increases contraction of the detrusor muscle.

Increases bladder neck resistance. Some tricyclic antidepressant medications (amitriptyline, nortriptyline, and amoxapine) are useful in treating incontinence because they decrease bladder contractions and increase bladder neck resistance. Anticholinergic drugs such as oxybutynin chloride (Ditropan), reduce bladder spasticity and involuntary bladder contractions. Bethanechol (Urecholine) helps to increase contraction of the detrusor muscle, which assists with emptying of the bladder.

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

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.

A patient undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which of the following? a) Determine the patient's ability to manage stoma care. b) Suggest a visit to a local ostomy group. c) Maintain skin and stoma integrity d) Show pictures and drawings of placement of the stoma.

Maintain skin and stoma integrity The most important postoperative nursing management is to maintain skin and stomal integrity to avoid further complications, such as skin infections and urinary odor. Determining the patient'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.

The nurse is conducting a history and assessment related to a patient's incontinence. Which of the following should the nurse include in the assessment before beginning a bladder training program? a) History of allergies b) Occupational history c) Medication usage d) Smoking habits

Medication usage It is essential to assess the patient'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 patient. It is not so essential to assess the patient's history of allergy, occupation, and smoking habits before beginning a bladder training program.

A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation? a) Importance of urinating every 4 to 6 hours while awake b) Suggestion to take tub baths instead of showers c) Need to urinate after engaging in sexual intercourse d) Need to wear underwear made from synthetic material

Need to urinate after engaging in sexual intercourse Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear, urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.

Which finding is an early indicator of bladder cancer? a) Nocturia b) Occasional polyuria c) Painless hematuria d) Dysuria

Painless hematuria Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.

A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? a) Urinary retention b) Painless hematuria c) Frequency d) Fever

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. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.

Ms. Simpson, age 72 years, is being seen in the clinic with a suspected bladder tumor. These tumors occur more frequently in men than women and usually affect clients 50 years of age and older. Use of tobacco products is the leading cause of bladder cancer. You are asking Ms. Simpson about symptoms that she has had that brought her to the clinic. What is the most common first symptom of a malignant tumor of the bladder? a) Urgency b) Fever c) Painless hematuria d) Dysuria

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. Painless hematuria is the most common, however.

A patient is admitted to a hospital with a diagnosis of spastic, neurogenic bladder. The nurse is aware that the pathophysiology of this condition is primarily due to which of the following occurrences? a) Inability of the bladder muscle to contract forcefully b) Presence of a lower motor neuron lesion c) Bladder distended until overflow incontinence occurs d) Patient's inability to exert motor control

Patient's inability to exert motor control Neurogenic bladder dysfunction results from a lesion of the nervous system that results in urinary incontinence. Spastic bladder is caused by any spinal cord lesion above the voiding reflex. There is a loss of conscious sensation and control. A spastic bladder empties on reflex.

The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following? a) Stoma ischemia b) Stoma retraction c) Peritonitis d) Postoperative pneumonia

Peritonitis Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.

Which of the following medications may be ordered to relieve discomfort associated with a UTI? a) Nitrofurantoin (Furadantin) b) Levofloxacin (Levaquin) c) Phenazopyridine (Pyridium) d) Ciprofloxacin (Cipro)

Phenazopyridine (Pyridium) Pyridium is a urinary analgesic ordered to relieve discomfort associated with UTIs. Furadantin, Cipro, and Levaquin are antibiotics.

A male patient, who is 82 years of age, suffers from urinary incontinence. Which of the following factors should the nurse assess before beginning a bladder training program for the patient? a) Smoking habits b) Physical and environmental conditions c) Occupational history d) History of allergies

Physical and environmental conditions It is essential to assess the patient'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 patient. It is not so essential to assess the patient's history of allergy, occupation, and smoking habits before beginning a bladder training program.

Which of the following is a characteristic of a normal stoma? a) Painful b) Dry in appearance c) Pink color d) No bleeding when cleansing stoma

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.

Sympathomimetics have which of the following effects on the body? a) Constriction of pupils b) Decrease of heart rate c) Relaxation of bladder wall d) Constriction of bronchioles

Relaxation of bladder wall Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.

The nurse is conducting a community education program on urinary incontinence. The nurse determines that the participants understand the teaching when they identify which of the following as risk factors for urinary incontinence? a) Cesarean delivery b) Sedatives c) Body mass index (BMI) of 22 d) Swimming

Sedatives Use of sedatives, diuretics, hypnotics, and opioids are risk factors for urinary incontinence. Additional risk factors include high-impact exercises, a BMI greater than 40, and vaginal birth delivery.

The nurse is teaching a patient how to perform self-catheterization. Which of the following directions should the nurse include? a) The catheterization should occur 4 to 6 hours and before bedtime. b) The nurse uses nonsterile technique in the hospital setting. c) The catheter is rinsed with sterile normal saline after soaking in a cleaning solution. d) Peroxide is recommended for cleaning the urinary catheter.

The catheterization should occur 4 to 6 hours and before bedtime. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The catheter is rinsed with tap water after soaking in a cleaning solution. Either antibacterial soap or Betadine solution is recommended for cleaning urinary catheters at home. The nurse uses sterile technique in the hospital setting.

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a) The client keeps the drainage bag below the bladder at all times. b) The client loops the drainage tubing below its point of entry into the drainage bag. c) The client sets the drainage bag on the floor while sitting down. d) The client clamps the catheter drainage tubing while visiting with the family.

The client keeps the drainage bag below the bladder at all times. To maintain effective drainage, the client should keep the drainage bag below the bladder; doing so allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because the bag could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action, made by the nursing assistant, would require instruction? a) The nursing assistant places the drainage bag on the lower area of the wheelchair for transport. b) The nursing assistant places the drainage bag on the client's abdomen for transport. c) The nursing assistant holds the drainage bag while the client moves to the wheelchair. d) The nursing assistant keeps the catheter and drainage bag together when moving the client.

The nursing assistant places the drainage bag on the client's abdomen for transport. The nurse would instruct the nursing assistant to maintain the drainage bag lower than the genital region to avoid a backflow of urine into the bladder. The nursing assistant is correct to move the catheter and drainage bag with the client to not put tension on the catheter, place the drainage bag on the lower area of the wheelchair, and hold the drainage bag while the client is in the process of moving.

The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? a) The ureters b) The rectum c) The urethra d) The bladder

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.

Which of the following is the procedure of choice for men with recurrent or complicated UTIs? a) CT scan b) MRI c) IV urogram d) Transrectal ultrasonography

Transrectal ultrasonography A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs.

A 32-year-old client has a history of neurogenic bladder and presents with fever, burning, and suprapubic pain. What would you suspect is the problem? a) Urethral strictures b) Urinary incontinence c) Urinary tract infection d) Urinary retention

Urinary tract infection Signs of a bladder infection include fever, chills, and suprapubic pain.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? a) Urinary stasis b) Urinary urgency c) Urinary incontinence d) Urinary frequency

Urinary urgency The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

Which of the following is a strategy to promote urinary continence? a) Implement a low fiber diet b) Take diuretics after 4 PM c) Use caffeine in moderation d) Void regularly, 5 to 8 times a day

Void regularly, 5 to 8 times a day Strategies to promote urinary continence include increasing awareness of the amount and timing of all fluid intake; avoid taking diuretics after 4 PM; avoiding bladder irritants, such as caffeine, alcohol, and aspartame (NutraSweet); taking steps to avoid constipation by drinking adequate fluids, eating a well-balanced diet high in fiber, exercising regularly, and taking stool softeners if recommended; and voiding regularly, 5 to 8 times a day (about every 2 to 3 hours).

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to: a) assess whether the client is a good candidate for surgery. b) assess suicidal risk postoperatively. c) evaluate the client's need for mental health intervention. d) help the client cope with the anxiety associated with changes in body image.

help the client cope with the anxiety associated with changes in body image. Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the client at risk for suicide. Although evaluating the need for mental health intervention is always important, this client displays no behavioral changes that suggest intervention is necessary at this time.

If an indwelling catheter is necessary, the nursing interventions that should be implemented to prevent infection include a) placing the catheter bag on the patient's abdomen when moving the patient. b) using sterile technique to disconnect the catheter from tubing to obtain urine specimens. c) using clean technique during insertion. d) performing meticulous perineal care daily with soap and water.

performing meticulous perineal care daily with soap and water. Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used during insertion of 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 patient's abdomen unless it is clamped because it may cause backflow of urine from the tubing into the bladder.

A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply. a) Wash the perineal area with soap and water at least twice daily. b) Disconnect the tubing to collect urine samples. c) Empty the collection bag at least every 8 hours to reduce bacterial growth. d) Irrigate the catheter every 24 hours. e) Suspend the drainage bag off the floor.

• Empty the collection bag at least every 8 hours to reduce bacterial growth. • Suspend the drainage bag off the floor. • Wash the perineal area with soap and water at least twice daily. Never disconnect the tubing to collect samples, irrigate, or ambulate the patient since this will allow bacteria to enter the closed system. Drainage systems should have an aspiration or puncture port from which a specimen can be obtained. The drainage system should not be disconnected. See Box 28-8 in the text.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? a) "This will kill the organism causing the infection." b) "This medication should be taken at bedtime." c) "This medication will prevent re-infection." d) "This medication will relieve your pain."

"This medication will relieve your pain." Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? a) Cloudy urine b) Rebound tenderness at McBurney's point c) An output of 200mL with each voiding d) Urine with a specific gravity of 1.005-1.022

Cloudy urine The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise

The nurse is caring for an older patient whose chart reveals that the patient has a reversible cause of urinary incontinence. The nurse creates a plan of care for which of the following conditions? a) Constipation b) Asthma c) Bladder cancer d) Decreased progesterone levels

Constipation Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in the menopausal woman. The other answers do not apply.

The nurse, in assessing a patient's newly created stoma, observes that the stoma color is now dark purple. The appropriate nursing intervention is to do which of the following? a) Remove the urinary stents. b) Apply Karaya powder. c) Change the pouching system. d) Contact the physician.

Contact the physician. The appropriate nursing intervention when a newly created stoma is dark purple is to notify the physician. The physician or wound, ostomy, and continence (WOC) nurse will assess the stoma to determine if it the stoma has superficial ischemia or if it is necrotic.

Which of the following is a cause of a calcium renal stone? a) Neurogenic bladder b) Gout c) Foreign bodies d) Excessive intake of vitamin D

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.

A 60-year-old woman has begun a course of oral antibiotics for the treatment of a urinary tract infection (UTI). The patient's nurse should recognize that the causative microorganisms most likely originated from: a) Ingested microorganisms b)Colonization of the patient's urethra from bloodborne pathogens c) Fecal contamination from the patient's perineum d) Proliferation of normal microbiotic flora

Fecal contamination from the patient's perineum Most of the microorganisms the result in UTIs are a result of fecal contamination. UTIs do not usually result from proliferation of normal microbiota or ingested microorganisms.

Which of the following accounts for the majority of ureteral injuries? a) Sports injuries b) Unintentional injuries c) Gunshot wounds d) Knife wounds

Gunshot wounds Gunshot wounds account for 95% of ureteral injuries, which may range from contusions to complete transection. Unintentional injury to the ureter may occur during gynecologic or urologic surgery. Knife wounds and sports injuries do not account for the majority of ureteral injuries.

The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which of the following should the nurse include? a) Implementing a 2- to 3-hour voiding schedule b) Avoiding drinking fluids for 6 hours c) Performing straight catheterization every 4 hours d) Encouraging voiding immediately after catheter removal

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

The nurse is educating a patient with urolithiasis about preventative measures to avoid another occurrence. What should the patient be encouraged to do? a) Add calcium supplements to the diet to replace losses to renal calculi. b) Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. c) Limit voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system. d) Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation.

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours (Meschi et al., 2011).

The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest? a) A diet high in fruits and vegetables b) A low-purine diet c) A diet high in calcium d) A low-sodium diet

A low-purine diet The nurse would suggest a low-purine diet. Foods to avoid are anchovies, animal organs and sardines. The other options do not lower the uric acids levels.

The nurse is employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? a) Diuretics b) Anticholinergic c) Cholinergic d) Anticonvulsant

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.

Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as: a) Voiding at given intervals. b) Bladder retaining c) Interval voiding d) Prompted voiding

Bladder retaining Bladder retraining includes a timed voiding schedule and urinary urge inhibition exercises. These exercises involve delaying voiding to help the patient stay dry for a set period of time. When one time interval is reached, another is set. The time is usually increased by 10 to 15 minutes, until an acceptable voiding interval is achieved.

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

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.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important? a) Encouraging the client to drink cranberry juice to acidify the urine b) Administering a sitz bath twice per day c) Using an indwelling urinary catheter to measure urine output accurately d) Increasing fluid intake to 3 L/day

Increasing fluid intake to 3 L/day Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

Patricia O'Connor, a 17-year-old high school student, is returning to the medical-surgical unit where you practice nursing from surgery. She has just undergone an appendectomy. She reports the need to urinate and cannot do so. What is your response to her situation as ordered by the physician? a) Intermittent catheterization b) Clean intermittent catheterization c) Indwelling catheterization d) All options are correct.

Intermittent catheterization Acute retention that is likely to resolve quickly (e.g., after anesthesia) probably will be treated by intermittent catheterization.

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) A stricture or tumor in the bladder. b) Loss of motor control of the detrusor muscle. c) Compromised ligament and pelvic floor support of the urethra. d) Uninhibited detrusor contractions.

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.

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? a) High protein b) Low oxalate c) Low purine d) High sodium

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.

Which of the following is the most common symptom of bladder cancer? a) Painless gross hematuria b) Altered voiding c) Back pain d) Pelvic pain

Painless gross hematuria Painless gross hematuria is the most common symptom of bladder cancer. Pelvic and back pain may occur with metastasis. Any alteration in voiding or change in the urine may indicate cancer of the bladder.

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) Deep flank and abdominal pain b) Muscle spasm and abdominal rigidity over the flank c) Painless, gross hematuria d) Decreasing kidney function associated with fever and hematuria

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

Which of the following terms is used to refer to inflammation of the renal pelvis? a) Urethritis b) Cystitis c) Interstitial nephritis d) Pyelonephritis

Pyelonephritis Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.

A female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following? a) Disturbance in the normal bacterial flora of the vagina b) Dysfunction of the bladder neck or urethra. c) Reflux of urine from the urethra into the bladder d) Interruption in the protective effect of glycosaminoglycan

Reflux of urine from the urethra into the bladder With coughing, sneezing, or straining, the bladder pressure increases, which may force urine from the bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior portions of the urethra. See Figure 28-1 in the text.

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.

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

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? a) Risk for fluid volume excess b) Risk for deficient knowledge: self-catherization c) Risk for altered urinary elimination d) Risk for infection

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

Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Notify the physician of hematuria. b) Administer allopurinol (Zyloprim). c) Strain the urine carefully for stone fragments. d) Monitor the continuous bladder irrigation.

Strain the urine carefully for stone fragments. The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.

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

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.

James Roth, a 63-year-old accountant, is a client on the hospital unit where you practice nursing. Mr. Roth has developed urinary incontinence and is beginning bladder training to regain control over his urine elimination. Why is the catheter being clamped and unclamped? a) To prevent bladder distention b) To promote normal bladder function c) To prevent urinary retention d) To promote urine production

To promote normal bladder function The clamping and unclamping of the catheter begins to reestablish normal bladder function and capacity.

When describing the types of bladder tumors that may occur, which type would the nurse identify as most common? a) Squamous cell carcinoma b) Adenocarcinoma c) Transitional cell carcinoma d) Papillary carcinoma

Transitional cell carcinoma The most common type of bladder tumor is a transitional cell carcinoma which develops in the bladder's epithelial lining. The tumors are classified as papillary or nonpapillary. Papillary lesions are superficial and extend outward from the mucosal layer. Nonpapillary tumors are solid growths that grow inward, deep into the bladder wall. This type is more likely to metastasize, usually to the lymph nodes, liver, lungs, and bone. Other types include squamous cell carcinoma and adenocarcinoma.

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) Urge b) Functional c) Stress d) Overflow

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 overdistended 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.

A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction? a) Cystitis b) Bladder stones c) Urethral stricture d) Urinary retention

Urinary retention Urinary retention and urinary incontinence are voiding dysfunctions, temporary or permanent alterations in the ability to urinate normally. Cystitis is an infectious disorder. Bladder stones and urethral stricture are obstructive disorders.

The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include: a) proteinuria b) RBC 3 c) WBC 50 d) glucose trace

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

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) placement of the catheter b) administration of cleansing c) enemas procedure for insertion of the catheter d) type and size of the catheter to be used

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.

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. a) "I will never have another urinary stone again." b) "Tylenol is best to control my pain." c) "I'm so glad I don't have to make any changes in my diet." d) "I need to drink eight to ten glasses of water every day." e) "I need to take allopurinol."

• "I'm so glad I don't have to make any changes in my diet." • "Tylenol is best to control my pain." • "I will never have another urinary stone again." • "I need to take allopurinol." Nonsteroidal anti-inflammatory drugs are used to treat renal stone pain. Oxalate-containing foods should be avoided. Fluid intake should total 2 to 3 liters, if not contraindicated. Allopurinol (Zyloprim) is prescribed for uric acid stones. Recurrence of stones occurs in about half of individuals.

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. a) Deficient knowledge: management of urinary diversion b) Urinary retention c) Risk for impaired skin integrity d) Disturbed body image e) Chronic pain

• Deficient knowledge: management of urinary diversion • Disturbed body image • Risk for impaired skin integrity 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.

The nurse caring for a patient after urinary diversion surgery monitors the patient closely for peritonitis by assessing for which of the following? Select all that apply. a) Hyperactive bowel sounds b) Muscle flaccidity c) Leukocytosis d) Abdominal distention

• Leukocytosis • Abdominal distention The nurse should monitor the patient for the following signs and symptoms of peritonitis: leukocytosis, abdominal distention, absence of bowel sounds, fever, muscle rigidity, guarding, and nausea and vomiting.