Module ll (Urinary disorders quiz)

A client who had a lithotripsy for a renal calculus is to be discharged from the hospital. What should the nurse include in the home care instructions?

Drink at least 3 L of fluid daily for four weeks Increasing fluid intake aids in the passage of fragments of the calculus that remain after the lithotripsy. Organ meats are high in purine, an amino acid, which is a causative factor in the formation of uric acid crystals; they should be avoided by people with gout. Calcium is the major component of the most common type of calculus; the intake of dairy products, which are high in calcium, should be limited. Early ambulation is encouraged to aid in the passage of fragments of the calculus that remain after a lithotripsy.

Trimethoprim/sulfamethoxazole (Bactrim) is prescribed for a child with a urinary tract infection. Which statement by the parent about the drug indicates that the nurse's instructions about administration have been understood?

"I'll make sure to give each pill with 6 to 8 oz of fluid." This drug does not have to be given with meals; it is administered every 12 hours. This is a sulfa drug; water must be encouraged to prevent crystallization in the kidneys. Orange juice causes an alkaline urine; water is the best fluid to be administered with this drug. This drug maintains the blood level for 8 to 12 hours; it is an intermediate-acting drug.

A client is admitted with a head injury. The nurse identifies that the client's urinary retention catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause?

Deficient ADH Deficient ADH from the posterior pituitary results in diabetes insipidus. This can be caused by head trauma; water is not conserved by the body and excess amounts of urine are produced. Although increased serum glucose may cause polyuria, it is associated with diabetes mellitus, not diabetes insipidus. Ineffective renal perfusion will cause decreased urine production. While excess amounts of IV fluids may cause dilute urine, it is unlikely that a client with head trauma will be receiving excess fluid because of the danger of increased intracranial pressure.

An infant born with exstrophy of the bladder is admitted to the pediatric unit for urinary diversion surgery in which the ureters are to be transplanted to a resected section of the small intestines, with one end attached to the abdominal wall. What does the nurse call the procedure when explaining the surgery to the parents?

Ileal conduit An ileal conduit is the transplantation of the ureters into a resected portion of the ileum, which is then used to create a stoma on the abdominal wall for drainage of urine. Cystostomy is an opening into the bladder through the abdominal wall that allows urine to flow out. In ureterosigmoidostomy the ureter is transplanted into the colon and urine is excreted through the rectum. In cutaneous ureterostomy the ureter is transplanted through the abdomen and attached to the skin.

Which clinical indicators does the nurse identify that suggest that a client is experiencing urinary retention and overflow after a cerebrovascular accident (also known as a "brain attack")? Select all that apply.

Frequent voidings Supra public distension With retention, the total amount of urine produced is unaffected. Atony permits the bladder to fill without being able to empty. As pressure builds within the bladder, the urge to void occurs, and just enough urine is eliminated to relieve the pressure and the urge to void. The cycle is repeated as pressure again builds. Thus, small amounts are voided without emptying the bladder. As urine is retained and the bladder enlarges, it causes suprapubic distention. Edema is a sign of fluid volume excess, not urinary retention. Oliguria (urinary output less than 500 mL/day) is a sign of kidney failure. Continual incontinence does not occur with urinary retention.

A client who had a transurethral resection of the prostate is transferred to the postanesthesia care unit with an IV and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period?

Hemorrhage After transurethral surgery, hemorrhage is common because of venous oozing and bleeding from many small arteries in the area. Sepsis is unusual, and if it occurs it will manifest later in the postoperative course. Leaking around the catheter is not a major complication. Urinary retention is unlikely with an indwelling catheter in place.

The nurse understands that the best way to reduce catheter associated urinary tract infections (CAUTIs) in long term indwelling catheters is to do what?

A biofilm made up of bacteria develops on long term indwelling catheters. The only way to eliminate this biofilm is to replace the catheter. The efficacy of cranberry tablets in decreasing the frequency of urinary tract infections has not be established. Catheter care is external and may not eliminate the biofilm. Antibiotic therapy may increase the growth of microbes within the biofilm.

A client with a urinary retention catheter reports discomfort in the bladder and urethra. What should the nurse do first?

Checking the patency of the catheter ensures drainage and prevents bladder distention and other complications. Patency of the catheter should be established before any other intervention. Milking the tubing gently is premature; this may be necessary if the catheter is clogged and usually is required when the drainage is viscous rather than liquid. Assessment is necessary before consultation with the health care provider. Irrigation is avoided if possible because of the associated risk for infection.

What is one reason women are more susceptible to UTI than men?

Length of urethra It is shorter in females leading a shorter distance for bacteria to reach the bladder. Also the proximity of the meatus to anus in female is another reason

A lithotripsy to break up renal calculi is unsuccessful, and a nephrolithotomy is performed. Which postoperative clinical indicator should the nurse report to the health care provider?

Output should be at least 30 mL/hr or more; a decreased output may indicate obstruction or impaired kidney function. Blood, tinting the urine pink, is expected. Drainage may be pink; bright red drainage should be reported. The intake of 1750 mL in 24 hours is adequate; however, a higher intake usually is preferred (e.g., 2000 to 3000 mL).

Which between-meal snack should a nurse tell the parents of a preschooler with a urinary tract infection to offer their child?

Skim Milk for protein and carbs

A client is admitted to the hospital with severe flank pain, nausea, and hematuria caused by a ureteral calculus. A lithotripsy is scheduled. What should be the nurse's initial intervention

Administer analgesic Pain of renal colic may be excruciating; unless relief is obtained, the client will be unable to cooperate with other therapy. Urine can be saved and strained after the client's priority needs are met. Increasing fluid intake helps to mobilize the stone, but a client in severe pain may be nauseated and unable to drink. Although a culture generally is prescribed, this is not the priority when a client has severe pain.

A urine specimen is needed to test for the presence of ketones in a client who is diabetic. What should the nurse do when collecting this specimen from a urinary retention catheter?

Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine. The urinary catheter and drainage bag should always remain a closed sterile system; urine should be drawn only from the catheter port, not the collection bag. Cleaning the drainage valve and removing the urine from the catheter bag will not yield a fresh specimen indicating present acetone levels. The system should remain closed so that fewer microorganisms enter the urinary tract.

What characteristic should the nurse assess each specimin of urine for UTI?

Clarity Cloudy urinr is associated with infection

A medical/surgical nurse is completing the admission assessment on a client diagnosed with urinary tract infection. The client's admitting weight is 75 kilograms (165 pounds). The vital signs are as follows: temperature 96 degrees F (35.6 degrees C), pulse 110, respirations 20, and blood pressure is 88/56 mm Hg. The client received 3 L of normal saline in the emergency room. The total urine output for the past two hours is 20 mL via foley catheter. The nurse should call the primary health care provider and recommend which intervention?

Critical Care The client has a known infection, is exhibiting signs of sepsis, and is unresponsive to fluid therapy as evidenced by the low blood pressure. The client is showing signs of kidney failure. The client is manifesting probable signs of septic shock requiring a higher level of care.

A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the health care provider. What should the nurse do to help prevent the client from developing a urinary tract infection?

Maintain the prescribed hydration Promoting hydration maintains urine production that flushes the bladder, thereby preventing urinary stasis and possible infection. Although assessing urine specific gravity may help identify a urinary tract infection, it will not prevent it. Although collecting a weekly urine specimen for culture and sensitivity may help identify a urinary tract infection, it will not prevent it. The collection bag is emptied once every shift unless the bag is full and needs to be emptied sooner; changing the bag periodically, not emptying it, may help prevent infection.

Optimal teaching for the client with multiple sclerosis (MS) who is experiencing urinary retention includes:

Monitoring for signs of UTI, Using Credes Maneuver Crede's maneuver is the use of manual pressure over the suprapubic area to compress the bladder and promote emptying. Urinary retention is a risk factor for urinary tract infection. Physical stressors, such as infections, can trigger exacerbations in clients with multiple sclerosis. Early recognition and treatment of infection is important to decrease the risk of exacerbation in the client with multiple sclerosis. Use of an indwelling urinary catheter puts the client at risk for urinary tract infection. Some clients with urinary retention are taught intermittent self-catheterization. Risk of urinary tract infection is lower with intermittent catheterization than with the use of an indwelling urinary catheter. Oral fluids should be encouraged in the client with voiding difficulties as concentrated urine increases the risk of urinary tract infection. Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system. Stimulation of the parasympathetic nervous system causes the detrussor muscle to contract, which promotes bladder emptying. Anticholinergic medications inhibit the cholinergic response and lead to urinary retention.

client will be taking nitrofurantoin (Macrobid) 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client?

To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug.

A nurse is caring for a client with dysuria. A urinary tract infection is the presumed medical diagnosis and a urine specimen in sent to the laboratory for a culture and sensitivity examination. Which component found in the client's urine indicates the presence of a urinary tract infection?

presence of nitrate in the urine is characteristic of a urinary tract infection