ch28 part 2
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 repeat the sequence of exercises 3 to 4 times a day." "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 need to hold the position for at least 15 seconds." 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.
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? "Have you had a fever and chills?" "Do you get up at night to urinate?" "How much fluid are you drinking?" "When did you last urinate?"
"When did you last urinate?" The nurse needs to determine the last time the client voided.
In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the client's residual urine must be less than which amount on two separate occasions (morning and evening)? 30 mL 50 mL 100 mL 400 mL
100 mL If the client complains of discomfort or pain, the suprapubic catheter is usually left in place until the client can void successfully. Residual urine must be less than 100 mL to be able to discontinue the suprapubic catheter. Residual urine may be greater than 30 mL and still allow use of a suprapubic catheter to be discontinued.
The nurse is caring for several older clients. For which client would the nurse be especially alert for signs and symptoms of pyelonephritis? A client with urinary obstruction A female client with preexisting chronic glomerulonephritis A client with acute renal failure A client with a urinary tumor
A client with urinary obstruction The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high risk for developing pyelonephritis.
Nursing assessment of a patient who is complaining about urinary retention must include a history of current medications. Which of the following medications can cause urine retention by increasing bladder outlet resistance? Imipramine Doxepin Belladonna Propranolol
Propranolol Beta-adrenergic blockers (i.e., propranolol) increase bladder outlet resistance, which leads to increased urinary retention.
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. Prevent nephron destruction. Determine the stone type. Relieve the pain.
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? Risk for altered urinary elimination Risk for infection Risk for fluid volume excess Risk for deficient knowledge: self-catherization
Risk for infection Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.
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? Dietary habits involving cholesterol-laden food Menstrual history History of allergy to iodine and seafood Client's manual dexterity and vision
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.
Which of the following would be least appropriate to suggest to a client with a urinary diversion to control odor? Add a few drops of diluted white vinegar to the pouch. Eat plenty of cheese and eggs. Avoid pouches with carbon filters. Avoid foods such as buttermilk or yogurt.
Eat plenty of cheese and eggs. 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.
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action? Maintain skin and stomal integrity. Show pictures and drawings of placement of the stoma. Suggest a visit to a local ostomy group. Determine the client's ability to manage stoma care.
Maintain skin and stomal 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 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.
A client is admitted with nephrolithiasis. What symptoms does the nurse expect the client to experience? Select all that apply. Suprapubic pain Hematuria Elevated temperature Difficulty starting a urine stream Constipation
Hematuria Elevated temperature Difficulty starting a urine stream Suprapubic pain Symptoms of nephrolithiasis include hematuria, suprapubic pain, difficulty starting the urinary stream, symptoms of a bladder infection, and a feeling that the bladder is not completely empty. Diarrhea and abdominal discomfort are due to renointestinal reflexes and the anatomic proximity of the kidneys to the stomach, pancreas, and large intestine. Some clients may have few or no symptoms.
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? Kock Pouch Indiana Pouch Ileal conduit Ureterosigmoidostomy
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 assessing a patient admitted to the unit with kidney stones. What assessment parameters would be priorities for the nurse to address? Select all that apply. Medication history Family history of renal stones Dietary history Vaccination history Surgical history
Medication history Family history of renal stones Dietary history Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to the formation of stones. When caring for a patient with renal stones, it would not be a priority to assess the vaccination history or surgical history.
A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of: Permanent distention Daily and painful spasms Infection Consistent pain
Infection Infection is caused by an increased urinary bacterial count that results from incomplete and delayed emptying of the bladder.
Which nursing intervention can help the client prevent urinary incontinence? Select all that apply. Instruct the client to increase consumption of caffeine. Administer hydrochlorothiazide (HydroDIURIL) after 4 pm. Instruct the client how to perform Kegel exercises. Instruct the client to use a bedpan frequently. Remind the client to empty the bladder every 2 to 3 hours.
Instruct the client how to perform Kegel exercises. Remind the client to empty the bladder every 2 to 3 hours. Nursing interventions to minimize episodes of urinary incontinence include reminding the client to empty the bladder every 2 to 3 hours and instructing the client how to perform Kegel exercises. The client should use the toilet or bedside commode, rather than the bedpan, to promote a more natural position for voiding. Caffeine consumption should be decreased, because it is irritating to the bladder and increases the risk of urinary incontinence. Diuretics, such as hydrochlorothiazide (HydroDIURIL), should be administered before 4 pm.
The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? New diagnosis of urosepsis Diagnostic studies reporting bladder stones Crusted drainage around the cystoscopy tube A white blood count of 12,000 cells/mm3
New diagnosis of urosepsis All of the options are typical risk factors for a client with a cystoscopy tube. The most concerning risk factor is of urosepsis, which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream.
A 44-year-old woman was diagnosed with an uncomplicated urinary tract infection (UTI) and completed her prescribed 3-day course of antibiotics 2 days ago. However, she states that she is experiencing the same signs and symptoms that initially prompted her to seek care. The nurse should anticipate that: The patient may require another short course of antibiotics followed by a longer-term regimen. The patient will likely require a course of IV antibiotics. The patient will need to continue taking
The patient may require another short course of antibiotics followed by a longer-term regimen. If infection recurs after completing antimicrobial therapy, another short course (3 to 4 days) of full-dose antimicrobial therapy followed by a regular bedtime dose of an antimicrobial agent may be prescribed. In addition, continuous prophylaxis via a 4- to 12-month course of antibiotics may be considered, either nightly or every other night. IV antibiotics are not likely necessary, and the infection may not be self-limiting.
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? The skin wasn't lubricated before the pouch was applied. Stoma dilation wasn't performed. The pouch faceplate doesn't fit the stoma. A skin barrier was applied properly.
The pouch faceplate doesn't fit the stoma. 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.
A client is prescribed amitriptyline (an antidepressant) for incontinence. The nurse understands that this drug is an effective treatment because it: increases contraction of the detrusor muscle. increases bladder neck resistance. decreases involuntary bladder contractions. reduces bladder spasticity.
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.
Bladder retraining following removal of an indwelling catheter begins with performing straight catheterization after 4 hours. instructing the client to follow a 2- to 3-hour timed voiding schedule. encouraging the client to void immediately. advising the client to avoid urinating for at least 6 hours.
instructing the client to follow a 2- to 3-hour timed voiding schedule. Immediately after the removal of the indwelling catheter, the client is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. At the given time interval, the client is instructed to void. Immediate voiding is not usually encouraged. If bladder ultrasound shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed to ensure complete bladder emptying.
The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate the symptoms? Antispasmodic agents Urinary analgesics Antibiotics Anticholinergic agents
Anticholinergic agents Anticholinergic agents inhibit bladder contraction and are considered first line medications for urge incontinence.
The nurse is educating a client who will be performing self-catheterization at home. What information provided by the nurse will help reduce the incidence of infection? Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion. Sterilize the catheter by boiling it in water for 20 minutes. Insert the catheter for urine drainage three times per day. A new catheter must be used each time catheterization is required.
Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion. When educating the patient about how to perform self-catheterization, the nurse must use aseptic technique to minimize the risk of cross-contamination. However, the patient may use a "clean" (nonsterile) technique at home, where the risk of cross-contamination is reduced. Either antibacterial liquid soap or povidone-iodine (Betadine) solution is recommended for cleaning urinary catheters at home. The catheter is thoroughly rinsed with warm tap water after soaking in the cleaning solution. It must dry before reuse. It should be kept in its own container, such as a plastic food storage bag.
