4) Chapter 69 Care of Patients with Urinary Problems
Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A. Functional B. Overflow C. Stress D. Urge
Rationale A. Functional incontinence is not caused by a weakened pelvic floor. It is due to structural problems often resulting from injury or trauma. B. Overflow incontinence is not caused by a weakened pelvic floor. It is caused by too much urine being stored in the bladder. C. Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence. D. Urge incontinence is not caused by a weakened pelvic floor. It is caused by a problem (i.e., neurologic) with the client's urge to urinate.
Which statement made by the client who is receiving intravesicular instillations of BCG for bladder cancer indicates to the nurse that more teaching is needed? A. "Holding my urine for at least 8 hours after the treatment keeps the drug in contact with my bladder." B. "Drinking plenty of fluids during the evening after the treatment helps get the drug out of my system." C. "Sitting to urinate for 24 hours after treatment prevents exposure of other people to the drug." D. "Avoiding intercourse for 24 hours after treatment reduces my wife's exposure to the drug."
A. "Holding my urine for at least 8 hours after the treatment keeps the drug in contact with my bladder." Rationale: Retaining urine for that long distends the bladder and increases the risk that the BCG will be absorbed systemically. In addition, the discomfort may cause the client to urinate rapidly, leading to more splashing and potentially exposing others to the BCG.
Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide to this client about taking her prescribed trimethoprim/sulfamethoxazole (Bactrim)? Select all that apply. A. "Be certain to wear sunscreen and protective clothing." B. "Drink at least 3 liters of fluids every day." C. "Take this drug with 8 ounces of water." D. "Try to urinate frequently to keep your bladder empty." E. "You will need to take all of this drug to get the benefits."
A. "Be certain to wear sunscreen and protective clothing." B. "Drink at least 3 liters of fluids every day." C. "Take this drug with 8 ounces of water." E. "You will need to take all of this drug to get the benefits." Rationale Emptying the bladder is important—but not keeping it empty—as is stated here. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.
A nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences of them. Which client statement shows correct understanding of what the nurse has taught? A. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." B. "It is a good idea for me to reduce germs by taking a tub bath daily." C. "Trying to get to the bathroom to urinate every 6 hours is important for me." D. "Urinating 1000 mL on a daily basis is a good amount for me."
A. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." Rationale A. To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day. B. Showers—rather than tub baths—are recommended for women who have recurrent UTIs. C. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. D. Urinary output should be between 2 to 2.5 liters daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.
Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later—with the same symptoms. When asked about the previous UTI and medication regimen, she states, "I only took the first dose because after that, I felt better." How does the nurse respond? A. "Not completing your medication can lead to return of your infection." B. "That means your treatment will be prolonged with this new infection." C. "This means you will now have to take two drugs instead of one." D. "What you did was okay; however, let's get you started on something else."
A. "Not completing your medication can lead to return of your infection." Rationale A. Not completing the drug regimen can lead to recurrence of an infection and to bacterial drug resistance. B. Needing to be re-treated does not mean that the client will have a prolonged treatment regimen. Some treatment modalities are given over a 3-day period. Given this client's history, this might be a wise plan for her—larger doses for a shorter time span. C. The client does not need to take two drugs, and this response is punitive rather than instructive. D. This response does not inform the client with respect to improper taking of her initially prescribed drug regimen. What she did was not "okay." She needed to complete the amount of medication that was requested for her, to make certain that the infection was properly treated.
Which client with a long-term urinary problem does the nurse refer to community resources and support groups? Select all that apply. A. 32-year-old with a cystectomy B. 44-year-old with a Kock pouch C. 48-year-old with urinary calculi D. 78-year-old with urinary incontinence E. 80-year-old with dementia
A. 32-year-old with a cystectomy B. 44-year-old with a Kock pouch D. 78-year-old with urinary incontinence Rationale The client with a cystectomy would benefit from community resources and support groups. Others who have had their bladders removed are good sources for information and for help in establishing coping mechanisms.
A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A. Administers morphine sulfate 4 mg IV B. Begins an infusion of metoclopramide (Reglan) 10 mg IV C. Obtains a urine specimen for urinalysis D. Starts an infusion of 0.9% normal saline at 100 mL/hr
A. Administers morphine sulfate 4 mg IV Rationale A. Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension. B. An infusion of metoclopramide (Reglan) 10 mg IV should be begun after the client's pain is controlled. C. A urine specimen for urinalysis should be obtained after the client's pain is controlled. D. An infusion of 0.9% normal saline at 100 mL/hr should be started after the client's pain is controlled. THEY ARE KIDNEY STONES!
A nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. A. Dysuria B. Enuresis C. Frequency D. Nocturia E. Urgency F. Polyuria
A. Dysuria C. Frequency D. Nocturia E. Urgency
Which client with an indwelling urinary catheter does a nurse re-assess to determine whether the catheterization needs to be continued or can be discontinued? Select all that apply. A. Three-day postoperative client B. Client in the step-down unit C. Comatose client with careful monitoring of intake and output (I&O) D. Incontinent client with perineal skin breakdown E. Incontinent long-term care older adult
A. Three-day postoperative client B. Client in the step-down unit E. Incontinent long-term care older adult Rationale The comatose client who is on strict I&O needs to have a urinary catheter in place to keep accurate account of his or her fluid balance. Maintaining accurate records would be very challenging without one—weighing of incontinent pads, etc. These methods would be inaccurate.
A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions does the nurse provide for postprocedure home care? A. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." B. "Do not share your toilet with family members for the next 24 hours." C. "Please be sure to stand when you are urinating." D. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."
B. "Do not share your toilet with family members for the next 24 hours." Rationale A. The toilet should not be shared for 24 hours [not 12 hours] following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach. The client needs to wear gloves during the cleaning and dispose of the cloth after sealing it in a plastic bag. B. The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet. C. The client needs be sure to sit when he is urinating for at least 24 hours postprocedure. This prevents splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. D. Underwear or other clothing that has come into contact with the urine during the 24 hours after instillation should be washed separately from other clothing in a solution of 10% liquid bleach. It does not need to be discarded.
A nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A. "A small-lumen catheter will help prevent injury to my urethra." B. "I will use a new, sterile catheter each time I do the procedure." C. "My family members can be taught to help me if I need it." D. "Proper handwashing before I start the procedure is very important."
B. "I will use a new, sterile catheter each time I do the procedure." Rationale A. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. B. Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating. C. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. D. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization. It is a principle that should be stressed.
A nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) B. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed
B. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Rationale A. The 26-year-old admitted 2 days ago with urosepsis who has a temperature of 99.4° F (37.4° C) is not at immediate risk for complications or deterioration. B. Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention. C. The 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy is not at immediate risk for complications or deterioration. D. The 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed is not at immediate risk for complications or deterioration.
Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence and is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. A. Administer the drug at bedtime. B. Encourage increased fluids. C. Increase fiber. D. Limit the intake of dairy products. E. Offer hard candy for "dry" mouth.
B. Encourage increased fluids. C. Increase fiber. E. Offer hard candy for "dry" mouth. Rationale Taking the drug at night will not have an effect on the complications encountered—dry mouth and constipation. The drug is usually taken three to four times a day.
Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply. A. Dry mouth B. Endometrial cancer C. Increased intraocular pressure D. Thrombophlebitis E. Vaginitis
B. Endometrial cancer D. Thrombophlebitis
While assessing a client with overactive bladder, the nurse discovers the client also has the following health problems. Which health problem could be made worse by the drug tolterodine (Detrol)? A. Asthma B. Glaucoma C. Hypotension D. Diabetes mellitus
B. Glaucoma Rationale: Tolterodine is an anticholinergic drug that can raise intraocular pressure and make some types of glaucoma worse. It is absolutely contraindicated for clients with uncontrolled narrow- or closed-angle glaucoma. It can be used with caution for clients who are being treated for open-angle glaucoma if the disease is well controlled.
Which interventions are helpful in preventing bladder cancer? Select all that apply. A. Drinking 2½ liters of fluid a day B. Showering after working with or around chemicals C. Stopping the use of tobacco D. Using pelvic floor muscle exercises E. Wearing a lead apron when working with chemicals F. Wearing gloves and a mask when working around chemicals and fumes
B. Showering after working with or around chemicals C. Stopping the use of tobacco F. Wearing gloves and a mask when working around chemicals and fumes Rationale Increasing fluid intake is helpful for some urinary problems such as urinary tract infection (UTI), but no correlation has been noted between fluid intake and bladder cancer risk.
A nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A. "I must avoid drinking carbonated beverages." B. "I need to douche vaginally once a week." C. "I should drink 2½ liters of fluid every day." D. "I will not drink fluids after 8 PM each evening."
C. "I should drink 2½ liters of fluid every day." Rationale A. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. B. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. C. Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis. D. Avoiding fluids after 8 PM would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late night fluid intake to 120 mL.
A cognitively impaired client has urge incontinence. Which method for achieving continence does a nurse include in the client's care plan? A. Bladder training B. Credé method C. Habit training D. Kegel exercises
C. Habit training Rationale A. Bladder training requires that the client be alert and able to assist with his or her training. B. The Credé method requires that the client be alert and able to assist with his or her training. C. Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis. D. Learning Kegel exercises requires that the client be alert, cooperative, and able to assist with his or her training.
Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? A. "They can relieve your anxiety associated with incontinence." B. "They help your bladder to empty." C. "They may be used to improve urethral resistance." D. "They decrease your bladder's tone."
C. "They may be used to improve urethral resistance." Rationale A. Relieving anxiety has not been shown to improve stress incontinence. B. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual, or if that is not possible, by using a catheter. C. Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance. D. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.
The client prescribed cephalexin (Keflex) for cystitis reports that she has had a severe allergic reaction to penicillin in the past. What is the nurse's best action? A. Reassure the client that Keflex is not penicillin. B. Place an allergy alert band on the client's wrist. C. Notify the prescriber before administering the first Keflex dose. D. Highlight this important information in the client's medical record.
C. Notify the prescriber before administering the first Keflex dose. Rationale: Cephalexin is a cephalosporin and has a chemical structure very similar to the structure of penicillin. Often a person who is allergic to penicillin is also allergic to cephalosporins. Even if the prescriber wishes to proceed with cephalosporin therapy, he or she may first prescribe premedication to reduce the risk for an allergic response.
Which nursing activity illustrates proper aseptic technique during catheter care? A. Applying Betadine ointment to the perineal area after catheterization B. Irrigating the catheter daily C. Positioning the collection bag below the height of the bladder D. Sending a urine specimen to the laboratory for testing
C. Positioning the collection bag below the height of the bladder
The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? A. Nutritional and dietary care B. Respiratory care C. Stoma and pouch care D. Wiping from front to back (asepsis)
C. Stoma and pouch care Rationale A. The registered dietitian (RD) teaches the cystectomy client about nutritional care. B. The respiratory therapist teaches the cystectomy client about respiratory care. C. The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms. D. The client with a cystectomy does not require instruction about front to back wiping.
Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the nurse expect the health care provider to prescribe? A. Nitrofurantoin after intercourse B. Premarin C. Trimethoprim/sulfamethoxazole D. Trimethoprim with intercourse
C. Trimethoprim/sulfamethoxazole Rationale A. Drugs from this class reduce bacteria in the urinary tract by inhibiting bacterial reproduction—bacteriostatic action. This client needs a drug that will kill bacteria. B. Estrogen cream may help prevent recurrent UTIs in postmenopausal women—which this client is not (at age 32). Use of Premarin is related to problems with incontinence. C. Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women. D. Trimethoprim is used for long-term management of older clients with frequent UTIs. The client in this scenario is 32 years old.
A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? A. "Blood in my urine has become less noticeable; maybe I don't need this procedure." B. "I have been taking cephalexin (Keflex) for an infection." C. "I previously had several ESWL procedures performed." D. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."
D. "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Rationale A. Blood in the client's urine should be reported to the health care provider but will not require rescheduling of the procedure. Blood is frequently present in the client's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. B. The client's taking cephalexin (Keflex).should be reported to the health care provider but will not require rescheduling of the procedure. C. The fact that the client has had several previous ESWL procedures should be reported to the health care provider but will not affect continuation of the procedure. D. Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.
A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates correct understanding of these procedures? A. "If I restrict my oral intake of fluids, the adjustment will be easier." B. "I must go to the restroom more often because my urine will be excreted through my anus." C. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." D. "I will have to drain my pouch with a catheter."
D. "I will have to drain my pouch with a catheter." Rationale A. Fluids should not be restricted. B. For the client with a neobladder and a Kock pouch, urine is collected in a pouch. It is not excreted via the anus. C. A neobladder does not require the use of an ostomy bag. D. For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.
A health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? A. "It will act as an antibacterial drug." B. "This drug will treat your infection, not the symptoms of it." C. "You need to take the drug on an empty stomach." D. "Your urine will turn red or orange while on the drug."
D. "Your urine will turn red or orange while on the drug." Rationale: Phenazopyridine (Pyridium) will turn the client's urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.
Which client does the nurse manager on a medical unit assign to an experienced LPN/LVN? A. 42-year-old with painless hematuria who needs an admission assessment B. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site C. 48-year-old receiving intravesical chemotherapy for bladder cancer D. 55-year-old with incontinence who has intermittent catheterization prescribed
D. 55-year-old with incontinence who has intermittent catheterization prescribed Rationale A. Admission assessments should be done by an RN. B. Preoperative preparation for cystectomy and stoma site selection should be done by an RN and either a certified wound, ostomy, continence nurse (CWOCN) or an enterostomal therapy (ET) nurse. C. Intravesical chemotherapy should be done by an RN. D. Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.
A client who is 6 months pregnant comes to the Prenatal Clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? A. Discharges the client to her home for strict bedrest for the duration of the pregnancy B. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria C. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby D. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up
D. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up Rationale A. It is unsafe for the client to be sent home without analysis of the symptoms that she has. Her problem needs to be investigated. B. Although drinking increased amounts of fluids is helpful, it will not cure an infection. Her problem should be investigated without delay. C. Having sexual intercourse (or not having it) is not related to the client's problem. The client's symptoms need to be followed-up with a health care provider. D. Pregnant women with UTI require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor—with adverse effects for the fetus.
A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a health care provider, for a client with a urinary tract infection (UTI) does the nurse question? A. Bactrim B. Cipro C. Noroxin D. Tegretol
D. Tegretol Rationale A. Bactrim is a drug used to treat UTI. B. Cipro is a drug used to treat UTI. C. Noroxin is a drug used to treat UTI. D. Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.
A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide (unlicensed assistive personnel [UAP])? A. Assisting the client in developing a schedule for when to take prescribed antibiotics B. Inserting a straight catheter as necessary if the client is unable to empty the bladder C. Teaching the client how to use the Credé maneuver to empty the bladder more fully D. Using a bladder scanner (with training) to check residual bladder volume after the client voids
D. Using a bladder scanner (with training) to check residual bladder volume after the client voids
A nurse is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? A. Children's terms that are easily understood B. Slang words and terms that are heard "socially" C. Technical and medical terminology D. Words that the client uses
D. Words that the client uses
