Chapter 59: Caring for Clients with Disorders of the Bladder and Urethra

A client who is diagnosed with calcium oxalate stones is instructed to limit calcium intake. The client is instructed to consume ______ mg of calcium per day, or less, as part of dietary treatment. 1000 1250 1500 2000

1000

A client with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the client's urine output hourly and notifies the health care provider when the hourly output is less than what? 30 mL 50 mL 100 mL 125 mL

30 mL

A client is a victim of an MVA and is unconscious. In compliance with a physician's order to insert an indwelling catheter, the nurse places the catheter and notes the drainage of a large amount of yellow urine with normal odor. How much urine will the nurse allow to drain before clamping the tube? 700 mL 250 mL 500 mL 1000 mL

700 mL

The nurse and urologist have both been unsuccessful in catheterizing a client with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the health care provider to use to drain the client's bladder? Insertion of a suprapubic catheter Scheduling the client immediately for a prostatectomy Application of warm compresses to the perineum to assist with relaxation Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours

Insertion of a suprapubic catheter

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

Low-purine diet

A nurse is preparing a care plan for a client with Alzheimer's disease. The client is unable to communicate or feel the pain and discomfort associated with acute urinary retention. Which nursing measures should be taken while caring for such a client? Select all that apply. Measure fluid intake and output. Palpate the abdomen to check for distended bladder. Promote catheterization. Instruct the client on how to minimize urinary odor.

Measure fluid intake and output Palpate the abdomen to check for distended bladder

The nurse is caring for a client who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the client? Limit oral fluid intake for 1 to 2 days. Report the presence of fine, sand like particles through the nephrostomy tube. Notify the health care provider about cloudy or foul-smelling urine. Report any pink-tinged urine within 24 hours after the procedure.

Notify the health care provider about cloudy or foul-smelling urine.

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

Phenazopyridine

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

A client is going to have a surgical procedure called a periurethral bulking to improve urinary control. Periurethral bulking is: placement of small amounts of collagen in urethral walls to aid the closing pressure. a procedure that increases storage capacity of the bladder. implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination. a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.

Placement of small amounts of collagen in urethral walls to aid the closing pressure

A client being treated in the hospital has been experiencing occasional urinary retention. What is the best nursing action? Use a slipper bedpan. Apply a cold compress to the perineum. Have the client lie in a supine position. Provide privacy for the client.

Provide privacy for the client

The nurse is working with a client whose health history includes occasional episodes of urinary retention. What assessment finding would suggest that the client is currently retaining urine? The client's suprapubic region is dull on percussion. The client is uncharacteristically drowsy. The client claims to void large amounts of urine two to three times daily. The client takes a beta adrenergic blocker for the treatment of hypertension.

The client's suprarubic region is dull on percussion

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

Change in cognitive functioning

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

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective? Bactrim Cipro Macrodantin Septra

Cipro

A gerontologic nurse is assessing a client who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. Food cravings Upper abdominal pain Insatiable thirst Fever New onset of confusion

Fever New onset of confusion

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

Immunocompromise

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? Incontinence Urinary retention Urgency Incomplete bladder emptying

Incontinence

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? Use tub baths as opposed to showers. Drink coffee or tea to increase diuresis. Drink liberal amount of fluids. Void every 4 to 6 hours.

Drink liberal amounts of fluids

An adult client has been hospitalized with pyelonephritis. The nurse's review of the client's intake and output records reveals that the client has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? Supplement the client's fluid intake with a high-calorie diet. Emphasize the need to limit intake to 2 L of fluid daily. Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. Encourage the client to continue this pattern of fluid intake.

Encourage the client to continue this pattern of fluid intake

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?" "How much fluid are you drinking?" "Do you get up at night to urinate?" "When did you last urinate?"

"When did you last urinate?"

The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a client how to manage her new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices? Empty the collection bag when it is between one-half and two-thirds full. Limit fluid intake to prevent production of large volumes of dilute urine. Reinforce the appliance with tape if small leaks are detected. Avoid using moisturizing soaps and body washes when cleaning the peristomal area.

Avoid using moisturizing soaps and body washes when cleaning the peristomal area

Urethral strictures may be caused by infections such as untreated gonorrhea or chronic nongonococcal urethritis, or by trauma to the lower urinary tract or pelvis. They may also be congenital. What are possible modes of medical or surgical management for urethral strictures? Select all that apply. dilatation urethroplasty fulguration antibiotic treatment

Dilatation Urethroplasty

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: assess whether the client is a good candidate for surgery. help the client cope with the anxiety associated with changes in body image. assess suicidal risk postoperatively. evaluate the client's need for mental health intervention.

Help the client cope with the anxiety associated with changes in body image.

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care? Strain the client's urine following the procedure. Administer a bolus of 500 mL normal saline following the procedure. Monitor the client for fluid overload following the procedure. Insert a urinary catheter for 24 to 48 hours after the procedure.

Strain the client;s urine following the procedure

Which of the following nursing actions is most important in caring for the client following lithotripsy? Monitor the continuous bladder irrigation. Administer allopurinol (Zyloprim). Strain the urine carefully for stone fragments. Notify the physician of hematuria.

Strain the urine carefully for stone fragments

The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, thereby reducing swelling and facilitating passage of the stone? Morphine sulfate Aspirin Ketoralac (Toradol) Meperidine (Demerol)

Ketoralac (Toradol)

A nurse is caring for a female client whose urinary retention has not responded to conservative treatment. When educating this client about self-catheterization, the nurse should encourage what practice? Assuming a supine position for self-catheterization Using clean technique at home to catheterize Inserting the catheter 1 to 2 inches (2.5 to 5 cm) into the urethra Self-catheterizing every 2 hours at home

Using clean technique at home to catheterize

The nurse recognizes that test results that most likely indicate a urinary tract infection include: proteinuria WBC 50 RBC 3 glucose trace

WBC 50

An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the client for factors that may have contributed to incontinence, the nurse should prioritize what assessment? Reviewing the client's 24-hour food recall for changes in diet Assessing for recent contact with individuals who have UTIs Assessing for changes in the client's level of psychosocial stress Reviewing the client's medication administration record for recent changes

Reviewing the client's medication administration record for recent changes

A client has just been diagnosed with acute pyelonephritis. What education would the nurse offer this client regarding fluids? Significantly increase fluid intake. Increase caffeinated beverages. Significantly decrease fluid intake. No change in fluids needed.

Significantly increase fluid intake

A nurse is teaching a client how to do Kegel exercises. Place in order from first to last the correct steps in performing these exercises.

Sit or stand with legs slightly apart. Draw in perivaginal muscles and anal sphincter as when controlling voiding or defecating. Hold position of contraction for 5 seconds (count or time with a watch). Relax contraction for at least 10 seconds. Repeat exercises 5 to 6 times, increasing slowly to 25 times.

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer? Smoking cessation Reduction of alcohol intake Maintenance of a diet high in vitamins and nutrients Vitamin D supplementation

Smoking cessation

Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing? Reflex Urge Stress Overflow

Stress

A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence? Stress incontinence Reflex incontinence Overflow incontinence Functional incontinence

Stress incontinence

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

A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client? Remind the client that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. Remind the client that occasional febrile episodes are expected following ESWL. Tell the client to report to the ED for further assessment. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office.

Tell the client to report to the ED for further assessment

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

"This medication will relieve your pain."

A client who was involved in an MVA which resulted in paraplegia is working toward living at home. The client is currently developing an individualized CIC schedule, preferring not to wear a leg bag. What is the maximum amount of urine the client should allow to collect before catheterization? 350 mL 500 mL 100 mL 600 mL

350 mL

A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? A client whose diagnosis of chronic kidney disease requires a fluid restriction A client who has Alzheimer disease and who is acutely agitated A client who is on bed rest following a recent episode of venous thromboembolism A client who has decreased mobility following a transmetatarsal amputation

A client who has Alzheimer disease and who is acutely agitated

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 needs to assess the fluid volume status of a client with chronic glomerulonephritis. To accurately assess the client's fluid volume status, the nurse should weigh the client daily: at the same time, on the same scale, with similar clothing. once in the morning, on the same scale, with similar clothing. at the same time, using a different scale every time, with similar clothing. at the same time, on the same scale, with only minimal clothing.

At the same time, on the same scale, with similar clothing.

The nurse is assisting in the preoperative planning for stoma placement in a client scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located? Over a bony prominence Away from skin folds At the belt line At the umbilicus

Away from skin folds

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? Through the bloodstream (hematogenous spread) By ascending infection (transurethral) Due to a fistula (direct extension) The result of urethra abrasion (sexual intercourse)

By ascending infection (transurethral)

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

A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this client's discharge education, what is the most plausible nursing diagnosis that the nurse should address? Impaired mobility related to limitations posed by the ileal conduit Deficient knowledge related to care of the ileal conduit Risk for deficient fluid volume related to urinary diversion Risk for autonomic dysreflexia related to disruption of the sacral plexus

Deficient knowledge related to care of the ileal conduit

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

Difficulty starting a urine stream Elevated temperature Hematuria Suprapubic pain

A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image? Emphasize that the diversion is an integral part of successful cancer treatment. Encourage the client to speak openly and frankly about the diversion. Allow the client to initiate the process of providing care for the diversion. Provide the client with detailed written materials about the diversion at the time of discharge.

Encourage the client to speak openly and frankly about the diversion

Resection of a client's bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following? Remain NPO for 12 hours prior to the treatment. Hold the solution in the bladder for 2 hours before voiding. Drink the intravesical solution quickly and on an empty stomach. Avoid acidic foods and beverages until the full cycle of treatment is complete.

Hold the solution in the bladder for 2 hours before voiding

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.

A client has a history of neurogenic bladder and uses a permanent, indwelling catheter to facilitate urine elimination. What contributes to the likelihood of developing urinary tract or bladder infections? Select all that apply. indwelling catheter decreased fluid intake frequent catheter hygiene increased ingestion of Vitamin C

Indwelling catheter decreased fluid intake

The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response? Document the presence of a healthy stoma. Assess the client for further signs and symptoms of infection. Inform the primary provider that the vascular supply may be compromised. Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.

Inform the primary provider that the vascular supply may be compromised

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 client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? IV fluid administration Insertion of an indwelling urinary catheter Pain management Assisting with aspiration of the stone

Pain management

Which finding is an early indicator of bladder cancer? Painless hematuria Occasional polyuria Nocturia Dysuria

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

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

Place client on a timed voiding schedule

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

Pyridium

One of the potential problems for a client with a urinary diversion is disturbed body image related to change in appearance and function. The expected outcome is that the client will accept the altered appearance and perform self-care. Which activities would help in achieving that expected outcome? Select all that apply. Reassure the client that nursing staff will provide care until he or she is ready. Discuss the change in function and let the client know what to expect when recovery from surgery is complete. Help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice. Begin exposure to the stoma immediately to help the client adapt properly.

Reassure the client that nursing staff will provide care until he or she is ready. Discuss the change in function and let the client know what to expect when recovery from surgery is complete. Help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice.

A client has been admitted to the renal unit with acute pyelonephritis, and is undergoing parenteral antibiotic treatment. What would be a significant aspect of this client's discharge education? recurring infection prevention anti-inflammatory incompatibilities needed dietary changes No option is correct.

Recurring infection prevention

A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic? The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy The need to expect a heavy menstrual period following the course of antibiotics The risk of developing antibiotic resistance after the course of antibiotics The need to undergo a series of three urine cultures after the antibiotics have been completed

The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy

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

Urinary incontinence is not considered a normal consequence of aging.

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

Urinary incontinence isn't a disease

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

Urinary tract infection

A female client's most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse's data analysis should be informed by what principle? Most UTIs in female clients are caused by viruses and do not cause obvious symptoms. A diagnosis of bacteriuria requires three consecutive positive results. Urine contains varying levels of healthy bacterial flora. Urine samples are frequently contaminated by bacteria normally present in the urethral area.

Urine samples are frequently contaminated by bacteria normally present in the urethral area

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.

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