PrepU CH 49: Management of Patients with Urinary Disorders
A client is learning how to perform Kegel exercises. Which statement by the client indicates a need for additional teaching? "I need to sit or stand with my legs slightly apart." "I should draw in my muscles like when I'm moving my bowels." "I need to hold the position for at least 15 seconds." "I should repeat the sequence of exercises 3 to 4 times a day."
"I need to hold the position for at least 15 seconds." Explanation: When performing Kegel exercises, the client should hold the position of contraction for 5 to 10 seconds and then relax contraction for at least 10 seconds. The client should sit or stand with the legs slightly apart, draw in the muscles as when controlling voiding or defecating, and repeat the sequence of exercises 3 to 4 times per day. Chapter 49: Management of Patients with Urinary Disorders, Urinary Incontinence, p. 1614.
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? "This will kill the organism causing the infection." "This medication should be taken at bedtime." "This medication will relieve your pain." "This medication will prevent re-infection."
"This medication will relieve your pain." Explanation: Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1608.
The nurse is caring for a patient with dementia in the long-term care facility when the patient has a change in cognitive function. What should the nurse suspect this patient may be experiencing? Fecal impaction An aneurysm A stroke A UTI
A UTI Explanation: The most common subjective presenting symptom of UTI in older adults is generalized fatigue. 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1606.
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? Ginger ale at dinner time Milk at lunch Fruit juice midmorning Coffee in the morning
Coffee in the morning Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1609.
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? Hyperparathyroidism Pancreatitis Hyperuricemia Diabetes mellitus
Diabetes mellitus Explanation: Increased urinary glucose levels create an infection-prone environment in the urinary tract. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1607.
Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? Drink liberal amount of fluids. Void every 4 to 6 hours. Use tub baths as opposed to showers. Drink coffee or tea to increase diuresis.
Drink liberal amount of fluids. Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1609.
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? Hematuria Frequency Dysuria Incontinence
Hematuria Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, p. 1625.
Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? Incontinence Incomplete bladder emptying Urgency Urinary retention
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. Chapter 49: Management of Patients with Urinary Disorders, ADULT VOIDING DYSFUNCTION, p. 1611.
The nurse advises the patient with chronic pyelonephritis that he should: Decrease his sodium intake to prevent fluid retention. Decrease his intake of calcium rich foods to prevent kidney stones. Increase fluids to 3 to 4 L/24 hours to dilute the urine. Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys.
Increase fluids to 3 to 4 L/24 hours to dilute the urine. Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Upper Urinary Tract Infections, p. 1611.
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? Suggestion to take tub baths instead of showers Need to urinate after engaging in sexual intercourse Importance of urinating every 4 to 6 hours while awake Need to wear underwear made from synthetic material
Need to urinate after engaging in sexual intercourse Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1608.
Which of the following is the most common symptom of bladder cancer? Painless gross hematuria Pelvic pain Back pain Altered voiding
Painless gross hematuria Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Cancer of the Bladder, p. 1626.
Which finding is an early indicator of bladder cancer? Dysuria Painless hematuria Nocturia Occasional polyuria
Painless hematuria Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Cancer of the Bladder, p. 1626.
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? Deep flank and abdominal pain Muscle spasm and abdominal rigidity over the flank Decreasing kidney function associated with fever and hematuria Painless, gross hematuria
Painless, gross hematuria Explanation: Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer. Chapter 49: Management of Patients with Urinary Disorders, Cancer of the Bladder, p. 1626.
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? Postoperative pneumonia Stoma ischemia Stoma retraction Peritonitis
Peritonitis Explanation: Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs. Chapter 49: Management of Patients with Urinary Disorders, Other Continent Urinary Diversion Procedures, p. 1634.
The nurse advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances? Cystine Uric acid Struvite Calcium
Uric acid Explanation: Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, p. 1622.
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? Urethral stricture Urinary retention Bladder stones Cystitis
Urinary retention Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, ADULT VOIDING DYSFUNCTION, p. 1611.
The nurse recognizes that test results that most likely indicate a urinary tract infection include: WBC 50 glucose trace proteinuria RBC 3
WBC 50 Explanation: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1607.
The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? Diuretics Cholinergic Anticonvulsant Anticholinergic
Anticholinergic Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Urinary Incontinence, p. 1613.
A client presents at the clinic with reports of urinary retention. What question should the nurse ask to obtain additional information about the client's report? "Do you get up at night to urinate?" "When did you last urinate?" "Have you had a fever and chills?" "How much fluid are you drinking?"
"When did you last urinate?" Explanation: The nurse needs to determine the last time the client voided. Chapter 49: Management of Patients with Urinary Disorders, Urinary Retention, p. 1616.
Which of the following would be least appropriate to suggest to a client with a urinary diversion to control odor? Avoid pouches with carbon filters. Avoid foods such as buttermilk or yogurt. Add a few drops of diluted white vinegar to the pouch. Eat plenty of cheese and eggs.
Eat plenty of cheese and eggs. Explanation: To help control odor, the client should use pouches with carbon filters or other odor barriers or add a few drops of liquid deodorizer or diluted white vinegar to the pouch. Foods such as cranberry juice, yogurt or buttermilk may help to decrease odor while foods such as asparagus, cheese, and eggs may impart an odor to the urine. Chapter 49: Management of Patients with Urinary Disorders, Ileal Conduit, p. 1629.
Which nursing intervention should the nurse caring for the client with pyelonephritis implement? Straight catheterize the client every 4 to 6 hours. Restrict fluid intake to 1 liter per day. Administer acetaminophen (Tylenol). Teach client to increase fluid intake up to 3 liters per day.
Teach client to increase fluid intake up to 3 liters per day. Explanation: The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract. Chapter 49: Management of Patients with Urinary Disorders, Upper Urinary Tract Infections, p. 1610.
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 catheter will drain urine directly from my kidney." "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."
"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. Chapter 49: Management of Patients with Urinary Disorders, Ileal Conduit, p. 1628.
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.
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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, pp. 1607-1608.
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)
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. Chapter 49: Management of Patients with Urinary Disorders, Urinary Catheters, p. 1619.
Which objective symptom of a UTI is most common in older adults, especially those with dementia? Change in cognitive functioning Hematuria Incontinence Back pain
Change in cognitive functioning Explanation: The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these clients 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1606.
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 stricture or tumor in the bladder. Loss of motor control of the detrusor muscle. Compromised ligament and pelvic floor support of the urethra. Uninhibited detrusor contractions.
Loss of motor control of the detrusor muscle. Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Urinary Retention, p. 1616.
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? Urge Overflow Stress Reflex
Stress Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, ADULT VOIDING DYSFUNCTION, p. 1612.
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-phosphorus diet Low-purine diet Low-calcium diet High-protein diet
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. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, p. 1622.
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform? Maintain skin and stoma integrity Suggest a visit to a local ostomy group Show photographs and drawings of the placement of the stoma Determine the client's ability to manage stoma care
Maintain skin and stoma integrity Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Other Continent Urinary Diversion Procedures, p. 1634.
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 renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. Remind the client that occasional febrile episodes are expected following ESWL. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office. Tell the client to report to the ED for further assessment.
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. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, p. 1625.
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 what? Prompted voiding Interval voiding Bladder retraining Voiding at given intervals
Bladder retraining Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Urinary Incontinence, p. 1614.
A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence? Giving the client a glass of soda before bedtime Taking the client to the bathroom twice per day Consulting with a dietitian Encouraging intake of at least 2 L of fluid daily
Encouraging intake of at least 2 L of fluid daily Explanation: Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence. Chapter 49: Management of Patients with Urinary Disorders, Urinary Incontinence, p. 1614.
The nurse has tested the pH of urine from a client's newly created ileal conduit and obtained a result of 6.8. What is the nurse's best response to this assessment finding? Encourage the client to drink at least 500 mL of water and retest in 3 hours. Irrigate the ileal conduit with a dilute citric acid solution as prescribed. Obtain an order to increase the client's dose of ascorbic acid. Administer IV sodium bicarbonate as prescribed.
Obtain an order to increase the client's dose of ascorbic acid. Explanation: Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept below 6.5 by administration of ascorbic acid by mouth. An increased pH may suggest a need to increase ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, or by increasing fluid intake. Chapter 49: Management of Patients with Urinary Disorders, Ileal Conduit, p. 1629.
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 Use clean technique during insertion Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens Perform meticulous perineal care daily with soap and water
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. Chapter 49: Management of Patients with Urinary Disorders, Urinary Catheters, p. 1617.
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? Encouraging the client to increase the time between voidings Restricting fluid intake to reduce the need to void Establishing a predetermined fluid intake pattern for the client Assessing present voiding patterns
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. Chapter 49: Management of Patients with Urinary Disorders, Neurogenic Bladder, p. 1617.
In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the client's residual urine must be less than which amount? 30 mL 50 mL 100 mL 400 mL
100 mL Explanation: Residual urine less than 100 mL indicates that the suprapubic catheter can be discontinued. If the client complains of discomfort or pain, however, the suprapubic catheter is usually left in place until the client can void successfully. Chapter 49: Management of Patients with Urinary Disorders, Urinary Catheters, p. 1618.
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? Intermittent catheterizations Exercises to promote sphincter control Application of an ostomy pouch Irrigating the urinary diversion
Application of an ostomy pouch Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Ileal Conduit, p. 1628.
Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Urge Reflex Iatrogenic Overflow
Iatrogenic Explanation: Iatrogenic incontinence is the involuntary loss of urine due to extrinsic medical factors, predominantly 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. Chapter 49: Management of Patients with Urinary Disorders, ADULT VOIDING DYSFUNCTION, p. 1612.
Patients with urolithiasis need to be encouraged to: Increase their fluid intake so that they can excrete up to 4 liters every day. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. 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. Supplement their diet with calcium needed to replace losses to renal calculi.
Increase their fluid intake so that they can excrete up to 4 liters every day. Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, p. 1624.
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. Perform hand hygiene prior to patient care. Provide careful perineal care. Assist the patients with frequent toileting. For those patients who are incontinent, insert indwelling catheters. Encourage patients to wear briefs.
Perform hand hygiene prior to patient care. Provide careful perineal care. Assist the patients with frequent toileting. 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1607.
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? The nursing assistant places the drainage bag on the lower area of the wheelchair for transport. The nursing assistant holds the drainage bag while the client moves to the wheelchair. The nursing assistant places the drainage bag on the client's abdomen for transport. 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. Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Urinary Catheters, p. 1619.
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 diet high in calcium A low-purine diet A low-sodium diet A diet high in fruits and vegetables
A low-purine diet Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, p. 1622.
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: evaluate the client's need for mental health intervention. help the client cope with the anxiety associated with changes in body image. assess whether the client is a good candidate for surgery. assess suicidal risk postoperatively.
help the client cope with the anxiety associated with changes in body image. Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Other Continent Urinary Diversion Procedures, p. 1634.
A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate? "Limit the number of times you urinate during the day." "Use scented powders to disguise any odor." "Make sure to eat enough fiber to prevent constipation." "Try drinking coffee throughout the day."
"Make sure to eat enough fiber to prevent constipation." Explanation: Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying. Chapter 49: Management of Patients with Urinary Disorders, Urinary Incontinence, p. 1615.
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? Relieve any obstruction. Determine the stone type. Relieve the pain. Prevent nephron destruction.
Relieve the pain. Explanation: The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, pp. 1621-1622.
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? Decreased pelvic muscle tone due to multiple pregnancies Bladder irritation related to urinary tract infections Obstruction due to fecal impaction or enlarged prostate Increased urine production due to metabolic conditions
Decreased pelvic muscle tone due to multiple pregnancies Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Urinary Incontinence, p. 1612.
Which medication may be ordered to relieve discomfort associated with a urinary tract infection? Phenazopyridine Levofloxacin Nitrofurantoin Ciprofloxacin
Phenazopyridine Explanation: Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1608.
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? Immediately after voiding, perform a bladder scan. Place client on a timed voiding schedule. Perform straight catheterizations at specific times each day. Instruct the client to drink more fluids at night for a full bladder in the morning.
Place client on a timed voiding schedule. Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Neurogenic Bladder, p. 1617.
The nurse provides care for a client who is prescribed bladder retraining following urinary catheterization. Complete the following sentence by choosing from the lists of options. The nurse should first ask the client to: > urinate > drink > defecate then perform the prescribed: > laboratory testing > urinary catheterization > bladder scan
The nurse should first ask the client to urinate then perform the prescribed 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. Chapter 49: Management of Patients with Urinary Disorders, Chart 49-10: Bladder Retraining After Indwelling Catheterization, p. 1620.
A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude? A skin barrier was applied properly. The skin wasn't lubricated before the pouch was applied. Stoma dilation wasn't performed. The pouch faceplate doesn't fit the stoma.
The pouch faceplate doesn't fit the stoma. Explanation: If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered. Chapter 49: Management of Patients with Urinary Disorders, Ileal Conduit, p. 1629.
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? The rectum The bladder The ureters The urethra
The urethra Explanation: 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1605.
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. 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. Drink caffeinated beverages twice a day to increase urination. Bathe in warm water to soak the affected area. 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. Drink liberal amounts of fluid to flush out bacteria. 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. Chapter 49: Management of Patients with Urinary Disorders, Lower Urinary Tract Infections, p. 1609.
A patient taking an alpha-adrenergic medication for the treatment of hypertension is having a problem with incontinence. What does the nurse tell the patient? Relaxation of the supporting ligaments has occurred and the patient will need to perform pelvic floor exercises to strengthen them. When the medication is discontinued or changed, the incontinence will resolve. The patient will require a medication regimen to decrease the overactivity of the bladder. The medication has caused permanent damage to the bladder sphincter and will require surgical correction.
When the medication is discontinued or changed, the incontinence will resolve. Explanation: Iatrogenic incontinence refers to the involuntary loss of urine due to extrinsic medical factors, predominantly medications. One such example is the use of alpha-adrenergic agents to decrease blood pressure. In some people with an intact urinary system, these agents adversely affect the alpha receptors responsible for bladder neck closing pressure; the bladder neck relaxes to the point of incontinence with a minimal increase in intra-abdominal pressure, thus mimicking stress incontinence. As soon as the medication is discontinued, the apparent incontinence resolves. Chapter 49: Management of Patients with Urinary Disorders, Urinary Incontinence, p. 1612.
A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: report the presence of fine, sandlike particles through the nephrostomy tube. limit oral fluid intake for 1 to 2 weeks. notify the physician about cloudy or foul-smelling urine. report bright pink urine within 24 hours after the procedure.
notify the physician about cloudy or foul-smelling urine. Explanation: The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy. Chapter 49: Management of Patients with Urinary Disorders, UROLITHIASIS AND NEPHROLITHIASIS, p. 1622.
