Chapter 49: Management of Patients with Urinary Disorders

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

"My urine will be eliminated through a stoma."

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? A UTI A stroke An aneurysm Fecal impaction

A UTI

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? Voiding at given intervals Prompted voiding Interval voiding Bladder retraining

Bladder retraining

Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply. Acute pyelonephritis Renal abscess Cystitis Urethritis Prostatitis

Acute pyelonephritis Renal abscess

Which type of medication may be used to inhibit bladder contraction in a client with incontinence? Anticholinergic agent Estrogen hormone Tricyclic antidepressants Over-the-counter decongestant

Anticholinergic agent

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

Application of an ostomy pouch

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

Assessing present voiding patterns

The nurse working with a client after an ileal conduit notices that the pouching system is leaking small amounts of urine. What is the appropriate nursing intervention? Secure or patch it with tape. Empty the pouch. Change the wafer and pouch. Secure or patch it with barrier paste.

Change the wafer and pouch.

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. Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Drink caffeinated beverages twice a day to increase urination. Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder Bathe in warm water to soak the affected area.

Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder

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

Cloudy urine

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? Coffee in the morning Fruit juice midmorning Milk at lunch Ginger ale at dinner time

Coffee in the morning

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? Shows damage to the kidneys If risk for chronic pyelonephritis is likely Reveals causative microorganisms Detects calculi, cysts, or tumors

Detects calculi, cysts, or tumors

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? Hyperuricemia Pancreatitis Diabetes mellitus Hyperparathyroidism

Diabetes mellitus

The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which item should the nurse include? Encourage voiding immediately after catheter removal Avoid drinking fluids for 6 hours Perform straight catheterization every 4 hours Implement a 2- to 3-hour voiding schedule

Implement a 2- to 3-hour voiding schedule

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. Supplement their diet with calcium needed to replace losses to renal 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.

Increase their fluid intake so that they can excrete up to 4 liters every day.

Which medication may be ordered to relieve discomfort associated with a urinary tract infection? Nitrofurantoin Phenazopyridine Ciprofloxacin Levofloxacin

Phenazopyridine

An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client? Physical and environmental conditions History of allergies Occupational history Smoking habits

Physical and environmental conditions

The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program? Physical and environmental conditions History of allergies Occupational history Smoking habits

Physical and environmental conditions

Which characteristic is seen with a healthy stoma? Painful Pink color No bleeding when cleansing the stoma Dry in appearance

Pink color

Which term refers to inflammation of the renal pelvis? Pyelonephritis Cystitis Urethritis Interstitial nephritis

Pyelonephritis

Sympathomimetics have which of the following effects on the body? Relaxation of bladder wall Decrease of heart rate Constriction of bronchioles Constriction of pupils

Relaxation of bladder wall

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 keeps the catheter and drainage bag together when moving the client. The nursing assistant places the drainage bag on the client's abdomen for transport. The 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.

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. The pouch faceplate doesn't fit the stoma. A skin barrier was applied properly. Stoma dilation wasn't performed.

The pouch faceplate doesn't fit the stoma.

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate I can't control it, and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? Stress Urge Overflow Functional

Urge

A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? Acute glomerulonephritis Ureteral stricture Urinary calculi Renal cell carcinoma

Urinary calculi

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. What should the nurse discuss with the health care provider before catheterization? type and size of the catheter to be used administration of cleansing enemas procedure for insertion of the catheter placement of the catheter

type and size of the catheter to be used

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? Cystitis Bladder stones Urinary retention Urethral stricture

Urinary retention

Which of the following is the most common site of a nosocomial infection? Urinary tract Respiratory tract Gastrointestinal tract Skin

Urinary tract

The nurse is teaching a client with recurrent urinary tract infections (UTIs) ways to decrease risk for additional UTIs. The nurse includes which information? Take tub baths instead of showers. Void immediately after sexual intercourse. Increase intake of coffee, tea, and colas. Void every 5 hours during the day.

Void immediately after sexual intercourse.

Bladder retraining following removal of an indwelling catheter begins with encouraging the client to void immediately. advising the client to avoid urinating for at least 6 hours. performing straight catheterization after 4 hours. instructing the client to follow a 2- to 3-hour timed voiding schedule.

instructing the client to follow a 2- to 3-hour timed voiding schedule.

A client who has a history of neurogenic bladder presents with fever, burning on urination, and suprapubic pain. What would the nurse suspect is the problem? urinary tract infection urinary incontinence urinary retention urethral strictures

urinary tract infection

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

Take the antibiotic for 3 days as prescribed.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? Straight catheterize the client every 4 to 6 hours. Administer acetaminophen (Tylenol). Teach client to increase fluid intake up to 3 liters per day. Restrict fluid intake to 1 liter per day.

Teach client to increase fluid intake up to 3 liters per day.

A client has a suspected bladder cancer. What is the most common first symptom of a malignant tumor of the bladder? painless hematuria fever dysuria urgency

painless hematuria

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? Determine the stone type. Relieve any obstruction. Relieve the pain. Prevent nephron destruction.

Relieve the pain.

Which metabolic defects are associated with stone formation? Hyperparathyroidism Hypoparathyroidism Hypouricemia Hyperthyroidism

Hyperparathyroidism

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

Low purine

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? Incontinence Dysuria Hematuria Frequency

Hematuria

Which factor contributes to UTI in older adults? Low incidence of chronic illness Immunocompromise Sporadic use of antimicrobial agents Active lifestyle

Immunocompromise

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

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an IV infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output? It's a normal finding caused by blood loss during surgery. It's a normal finding associated with the client's nothing-by-mouth status. It's an abnormal finding that requires further assessment. It's an abnormal finding that will correct itself when the client ambulates.

It's an abnormal finding that requires further assessment.

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? Determine the client's ability to manage stoma care. Show pictures and drawings of placement of the stoma. Maintain skin and stomal integrity. Suggest a visit to a local ostomy group.

Maintain skin and stomal integrity.

A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care? Turn the patient every 2 hours around the clock. Administer pain medication every 2 hours. Monitor urine output hourly and report output less than 30 mL/hr. Clean the stoma with soap and water after the patient voids.

Monitor urine output hourly and report output less than 30 mL/hr.

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? Need to wear underwear made from synthetic material Importance of urinating every 4 to 6 hours while awake Suggestion to take tub baths instead of showers Need to urinate after engaging in sexual intercourse

Need to urinate after engaging in sexual intercourse

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

Painless hematuria

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use a clean technique during insertion Use a sterile technique to disconnect the catheter from the tubing to obtain urine specimens Place the catheter bag on the client's abdomen when moving the client Perform meticulous perineal care daily with soap and water

Perform meticulous perineal care daily with soap and water

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

Risk for infection

A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing? Urge incontinence Functional incontinence Stress incontinence Iatrogenic incontinence

Stress incontinence