Chapter 49 Management of Patients with Urinary Disorders

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

Anticholinergic agent Rationale: Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions and increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

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

Risk for infection Rationale: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.

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

Teach client to increase fluid intake up to 3 liters 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? - When did you last urinate? - How much fluid are you drinking?

When did you last urinate?

A nurse is providing post procedure 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 sandline particles through the nephrostomy tube - limit oral fluid intake for 1 to 2 weeks - report bright pink urine within 24 hours after the procedure - notify the physician about cloudy or foul-smelling urine

notify the physician about cloudy or foul-smelling urine Rationale: 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.

The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patients health education, what nutritional guidelines should the nurse provide? A) Restrict protein intake as ordered. B) Increase intake of potassium-rich foods. C) Follow a low-calcium diet. D) Encourage intake of food containing oxalates.

A) Restrict protein intake as ordered. Rationale: Protein is restricted to 60 g/d, while sodium is restricted to 3 to 4 g/d. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalate-containing foods and there is no need to increase potassium intake.

The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention? A) The patients suprapubic region is dull on percussion. B) The patient is uncharacteristically drowsy. C) The patient claims to void large amounts of urine 2 to 3 times daily. D) The patient takes a beta adrenergic blocker for the treatment of hypertension.

A) The patients suprapubic region is dull on percussion. Rationale: Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.

The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patients bladder? A) Insertion of a suprapubic catheter B) Scheduling the patient immediately for a prostatectomy C) Application of warm compresses to the perineum to assist with relaxation D) Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours

A) Insertion of a suprapubic catheter Rationale: When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.

A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice? A) Assuming a supine position for self-catheterization B) Using clean technique at home to catheterize C) Inserting the catheter 1 to 2 inches into the urethra D) Self-catheterizing every 2 hours at home

B) Using clean technique at home to catheterize Rationale: The patient may use a clean (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female patient assumes a Fowlers position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.

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 - Perform straight catheterization at specific times each day - Place client on a times voiding schedule - Instruct the client to drink more fluids at night for a full bladder in the morning

Place client on a times voiding schedule Rationale: 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.

The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite? A) Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. C) Men of all ages are less prone to UTIs, but typically experience more severe symptoms. D) The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.

B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. Rationale: The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age approaches that of women in the same age group. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs.

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 - Occupational history - Smoking habits - History of allergies

Physical and environmental conditions Rationale: It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the client may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.

A client seeks medical attention for a new onset of acute pain in the groin. Which additional finding(s) indicates to the nurse that the client is experiencing ureteral colic? Select all that apply. - Left shoulder pain - Absent urine despite the urge to void - Hematuria - Bruising around the umbilicus - Pain in midpeigastric region

Absent urine despite the urge to void* Hematuria Rationale: Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain that radiates down the thigh and genitalia. Often the client has blood in the urine (hematuria) because of the abrasive action of the stone and will have a desire to void, but little urine is passed. Ureteral stones will not cause referred pain to the left shoulder. Bruising around the umbilicus is associated with acute pancreatitis. Pain in the epigastric region is associated with symptoms of the digestive system rather than ureteral colic.

You are caring for a patient who has an indwelling urinary catheter. Which action is not indicated? - Assess the need for the catheter. - Advocate for the removal of the catheter if it is not needed. - Switch out the bag every shift. - Document the patient's output.

Switch out the bag every shift. Rationale: Switching out the bag every shift is not indicated, and it increases the risk of infection. It is appropriate to continually assess the need for the catheter, to advocate for its removal if it is no longer needed, and to document the patient's output.

Lower urinary tract infections include

- Bacterial cystitis (inflammation of urinary bladder) - Bacterial prostatitis (inflammation of prostate gland) - Bacterial urethritis (inflammation of the urethra)

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. - I need to drink eight to ten glasses of water every day - I will never have another urinary stone again - I need to take allopurinol - Tylenol is best to control my pain - I am so glad I don't have to make changes in my diet

- I will never have another urinary stone again - I need to take allopurinol - Tylenol is best to control my pain - I am so glad I don't have to make changes in my diet

The nurse is caring for a client who is prescribed an anticholinergic for urge incontinence. The nurse understands that this drug is an effective treatment for which reason(s)? Select all that apply. - reduced bladder spasticity - increases bladder neck resistance - increases how much urine the bladder can hold - decreases involuntary bladder contractions - increases relaxation of the detrusor muscle

- decreases involuntary bladder contractions - increases relaxation of the detrusor muscle - increases how much urine the bladder can hold

A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what? A) Hydronephrosis B) Nephritic syndrome C) Pyelonephritis D) Nephrotoxicity

A) Hydronephrosis Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.

What is not a risk factor for developing a lower urinary tract infection (UTI) in a younger adult? - Stroke - Pregnancy - Diabetes - Assigned male at birth

Assigned male at birth Rationale: Patients assigned male at birth are at the lowest risk of developing a UTI. Stroke, pregnancy, and diabetes are all risk factors for developing UTIs.

A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient? A) Bathe daily and keep the perineal region clean. B) Avoid voiding immediately after sexual intercourse. C) Drink liberal amounts of fluids. D) Void at least every 6 to 8 hours.

C) Drink liberal amounts of fluids. Rationale: The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather than bathe.

A nurses colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurses management of urinary incontinence in older adults? A) Diuretics should be promptly discontinued when an older adult experiences incontinence. B) Restricting fluid intake is recommended for older adults experiencing incontinence. C) Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. D) Urinary incontinence is not considered a normal consequence of aging.

D) Urinary incontinence is not considered a normal consequence of aging. Rationale: Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.

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 - Detects calculi, cysts, or tumors - Reveals causative microorganisms

Detects calculi, cysts, or tumors Rationale: Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply. A) Dietary history B) Family history of renal stones C) Medication history D) Surgical history E) Vaccination history

Dietary history* Family history of renal stones* Medication history Rationale: Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to stone formation. When caring for a patient with renal stones it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones.

A client is admitted with nephrolithiasis. What symptoms does the nurse expect the client to experience? Select all that apply. - Elevated temperature - Constipation - Suprapubic pain - Difficulty starting a urine stream - Hematuria

Elevated temperature* Suprapubic pain* Difficulty starting a urine stream* Hematuria Rationale: 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.

What is a symptom of an upper urinary tract infection (UTI) that is not seen in a lower UTI? - Painful urination - Flank pain - Back pain - Pelvic pain

Flank pain Rationale: Flank pain is a symptom of upper UTIs because they affect the kidney. Painful urination, back pain, and pelvic pain are symptoms of lower UTIs.

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? - Overflow - Urge - Iatrogenic - Reflex

Iatrogenic Rationale: 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.

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-calcium diet - High-protein diet - Low-purine diet

Low-purine diet Rationale: 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.

Which are symptoms of a urinary tract infection (UTI) in an older adult? Select all that apply. - Malaise - Nocturia - Foul-smelling urine - Fever - Dementia

Malaise* Nocturia* Foul-smelling urine* Fever

Which is not a way bacteria enter the urinary tract? - Medication given intravenously - Transurethral route - Via the bloodstream - Fistula from the intestine

Medication given intravenously Rationale: Intravenous medication is not a way bacteria enter the urinary tract. Bacteria can, however, enter via the transurethral route, bloodstream, and from a fistula in the intestine.

Which of the following is the most common symptom of bladder cancer? - Back pain - Pelvic pain - Altered vomiting - Painless gross hematuria

Painless gross hematuria Rationale: 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.

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

Pink color Rationale: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.