Chapter 55: Management of Patients With Urinary Disorders (Exam 2)

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? "Increase your fluid intake to 2 to 3 L per day." "Be aware that your urine will be cherry-red for 5 to 7 days." "Take your temperature every 4 hours." "Apply an antibacterial dressing to the incision daily."

"Increase your fluid intake to 2 to 3 L per day." The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client? Milk at lunch Coffee in the morning Fruit juice midmorning Ginger ale at dinner time

Coffee in the morning 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 countered toward the daily fluid total.

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 Frequency Hematuria Dysuria

Hematuria 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.

Which of the following is a cause of a calcium renal stone? Neurogenic bladder Excessive intake of vitamin D Gout Foreign bodies

Excessive intake of vitamin D Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.

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

Immunocompromise Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, frequent use of antimicrobial agents, incomplete emptying of the bladder, and obstructed urine flow.

A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of: Infection Permanent distention Consistent pain Daily and painful spasms

Infection Infection is caused by an increased urinary bacterial count that results from incomplete and delayed emptying of the bladder.

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? Urethra Ureter Kidney Bladder

Kidney The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

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? Monitor urine output hourly and report output less than 30 mL/hr. Clean the stoma with soap and water after the patient voids. 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. In the immediate postoperative period, urine volumes are monitored hourly. Throughout the patient's hospitalization, the nurse monitors closely for complications, reports signs and symptoms of them promptly, and intervenes quickly to prevent their progression. If urinary drainage stops or decreases to less than 30 mL/hour, or if the client complains of back pain, the nurse needs to notify the physician immediately.

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

Pink color 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.

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

Relaxation of bladder wall Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.

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 Struvite Uric acid Calcium

Uric acid Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.

The nurse recognizes that which risk factor does NOT predispose a client to the development of kidney stones? immobilization hypoparathyroidism hyperparathyroidism gout

hypoparathyroidism Hypoparathyroidism is not a risk factor for the development of kidney stones. Immobilization, gout, and hyperparathyroidism are risk factors.

A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? "This medication will prevent re-infection." "This medication will relieve your pain." "This medication should be taken at bedtime." "This will kill the organism causing the infection."

"This medication will relieve your pain." Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

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 Hyperparathyroidism Diabetes mellitus Pancreatitis

Diabetes mellitus Increased urinary glucose levels create an infection-prone environment in the urinary tract.

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

Relieve the pain. The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.

A 60-year-old woman has begun a course of oral antibiotics for the treatment of a urinary tract infection (UTI). The patient's nurse should recognize that the causative microorganisms most likely originated from: Proliferation of normal microbiotic flora Colonization of the patient's urethra from bloodborne pathogens Fecal contamination from the patient's perineum Ingested microorganisms

Fecal contamination from the patient's perineum Most of the microorganisms the result in UTIs are a result of fecal contamination. UTIs do not usually result from proliferation of normal microbiota or ingested microorganisms.

The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which factor as contributing to UTIs in older adults? Low incidence of chronic illness Sporadic use of antimicrobial agents Active lifestyle Immunocompromise

Immunocompromise Factors that contribute to UTIs in older adults include immunocompromise, cognitive impairment, high incidence of chronic illness, immobility, incomplete emptying of the bladder, obstructed flow of urine, and frequent use of antimicrobial agents.

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 Painless, gross hematuria Decreasing kidney function associated with fever and hematuria

Painless, gross hematuria Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.

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? Functional Stress Overflow Urge

Urge Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an over distended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.

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 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.

Which statement describing urinary incontinence in an older adult client is true? Urinary incontinence isn't a disease. Urinary incontinence is a normal part of aging. Urinary incontinence in the elderly population can't be treated. Urinary incontinence is a disease.

Urinary incontinence isn't a disease. Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

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 placement of the catheter procedure for insertion of the catheter administration of cleansing enemas

type and size of the catheter to be used Before catheterization, the nurse should inquire about the type and size of the catheter to be used and if the catheter should be removed or retained in place after the bladder is empty.

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis? Impaired urinary elimination Risk for infection Acute pain Imbalanced nutrition: Less than body requirements

Acute pain Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

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? Irrigating the urinary diversion Intermittent catheterizations Exercises to promote sphincter control Application of an ostomy pouch

Application of an ostomy pouch 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.

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

Physical and environmental conditions 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.

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

Pyelonephritis Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.

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

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.

A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? Due to a fistula (direct extension) Through the bloodstream (hematogenous spread) The result of urethra abrasion (sexual intercourse) By ascending infection (transurethral)

By ascending infection (transurethral) The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.

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? History of allergy to iodine and seafood Client's manual dexterity and vision Dietary habits involving cholesterol-laden food Menstrual history

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.

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 Urine with a specific gravity of 1.005-1.022 Cloudy urine An output of 200mL with each voiding

Cloudy urine The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise.

A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms? Pyridium Bactrim Septra Levaquin

Pyridium The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.

A client is prescribed amitriptyline (an antidepressant) for incontinence. The nurse understands that this drug is an effective treatment because it: increases bladder neck resistance. decreases involuntary bladder contractions. reduces bladder spasticity. increases contraction of the detrusor muscle.

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.

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: help the client cope with the anxiety associated with changes in body image. evaluate the client's need for mental health intervention. 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. 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.

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? Urinary retention Cystitis Urethral stricture Bladder stones

Urinary retention 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.

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 with my feces." "I will not need to worry about being incontinent of urine." "My urine will be eliminated through a stoma."

"My urine will be eliminated through a stoma." 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.

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? Cholinergic Anticholinergic Diuretics Anticonvulsant

Anticholinergic 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.

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 Voiding at given intervals Bladder retraining

Bladder retraining 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.

Which objective symptom of a UTI is most common in older adults, especially those with dementia? Change in cognitive functioning Incontinence Back pain Hematuria

Change in cognitive functioning 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.

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? Obstruction due to fecal impaction or enlarged prostate Bladder irritation related to urinary tract infections Increased urine production due to metabolic conditions Decreased pelvic muscle tone due to multiple pregnancies

Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity Deficient knowledge, disturbed body image, and risk for impaired skin integrity are expected problems for the client with a new ileal conduit. Urinary retention and chronic pain are not expected client problems.

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. 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. Add calcium supplements to the diet to replace losses to renal calculi. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi.

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours (Meschi et al., 2011).

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform? Suggest a visit to a local ostomy group Determine the client's ability to manage stoma care Maintain skin and stoma integrity Show photographs and drawings of the placement of the stoma

Maintain skin and stoma integrity 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.

Which is the procedure of choice for men with recurrent or complicated UTIs? IV urogram CT Transrectal ultrasonography MRI

Transrectal ultrasonography A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs.

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. Encourage patients to wear briefs. For those patients who are incontinent, insert indwelling catheters. Perform hand hygiene prior to patient care. Provide careful perineal care. Assist the patients with frequent toileting.

Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care. 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.

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

Perform meticulous perineal care daily with soap and water 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.

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

Take the antibiotic for 3 days as prescribed. 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.

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

painless hematuria The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs? "I should wipe from back to front." "I should take a tub bath at least 3 times per week." "I should take at least 1,000 mg of vitamin C each day." "I should limit my fluid intake to limit my trips to the bathroom."

"I should take at least 1,000 mg of vitamin C each day." The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTI.

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? Obstruction due to fecal impaction or enlarged prostate Bladder irritation related to urinary tract infections Increased urine production due to metabolic conditions Decreased pelvic muscle tone due to multiple pregnancies

Decreased pelvic muscle tone due to multiple pregnancies 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.

Patients with urolithiasis need to be encouraged to: 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 2.5 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.

Increase their fluid intake so that they can excrete 2.5 to 4 liters every day. Fluids need to be increased up to 4 L/day to help prevent additional stone formation.

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

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.

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

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

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 holds the drainage bag while the client moves to the wheelchair. The nursing assistant keeps the catheter and drainage bag together when moving the client. The nursing assistant places the drainage bag on the lower area of the wheelchair for transport. The nursing assistant places the drainage bag on the client's abdomen for transport.

The nursing assistant places the drainage bag on the client's abdomen for transport. 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.

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

Urinary tract The urinary tract is the most common site of nosocomial infection, accounting for greater than 3% of the total number reported by hospitals each year.

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 Assessing present voiding patterns Establishing a predetermined fluid intake pattern for the client Restricting fluid intake to reduce the need to void

Assessing present voiding patterns 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.

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. Secure or patch it with barrier paste. Change the wafer and pouch.

Change the wafer and pouch. Whenever a leaking pouching system is noted, the nurse should change the wafer and pouch. Attempting to secure or patch the leak with tape and/or barrier paste can trap urine under the barrier or faceplate, which will compromise peristomal skin integrity. Emptying the pouch will not rectify the leaking.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? Structural defects in the kidneys Location of discomfort Abnormalities in urine Elevated calcium levels

Location of discomfort The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

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? Occupational history History of allergies Smoking habits Medication usage

Medication usage It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the patient 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 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? Fever Urinary retention Frequency Painless hematuria

Painless hematuria The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.