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

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

b Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of: a. Anticipatory grieving b. Situational low self esteem c. Deficient knowledge: stoma care d. Disturbed body image

d The client is exhibiting defining characteristics of disturbed body image.

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

a If not contraindicated, a liberal daily fluid intake of approximately 3000 to 4000 mL is recommended to flush infectious microorganisms from the urinary tract.

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

a Incontinence is noted in clients diagnosed with Parkinson disease. Urinary retention is associated with spinal cord injury. Urgency is associated with an overactive bladder. Incomplete bladder emptying is associated with diabetes mellitus.

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

a Signs of a bladder infection include fever, chills, and suprapubic pain.

The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate the symptoms? a. Antispasmodic agents b. Urinary analgesics c. Antibiotics d. Anticholinergic agents

d Anticholinergic agents inhibit bladder contraction and are considered first line medications for urge incontinence.

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? 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 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.

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

c The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical analysis.

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? a. Physical and environmental conditions b. History of allergies c. Occupational history d. Smoking habits

a 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.

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

b Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

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

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

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

a Following ESWL, the nurse should strain the client's urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.

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

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

The nurse is caring for a client with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a client with an indwelling catheter? a. Vigorously clean the meatus area daily. b. Apply powder to the perineal area twice daily. c. Empty the drainage bag at least every 8 hours. d. Irrigate the catheter every 8 hours with normal saline.

c To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.

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? a. Over a bony prominence b. Away from skin folds c. At the belt line d. At the umbilicus

b The nurse plans to have the stoma located away from skin folds and creases, bony prominences, the belt line, and the umbilicus. The stoma should be located in an area where the client can see and reach it.

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? a. type and size of the catheter to be used b. administration of cleansing enemas c. procedure for insertion of the catheter d. placement of the catheter

a 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 is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function? a. Monitor the client's intake and output. b. Palpate for a thrill over the vascular access. c. Inspect the skin over the fistula or graft for signs of infection. d. Note the nailbeds and mobility of the fingers.

a Monitoring and recording the client's intake and output provides information about the kidneys' function. It also helps identify any arising complications such as hydronephrosis.

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

a Periurethral bulking is the placement of small amounts of collagen in urethral walls to aid the closing pressure. Bladder augmentation is 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 is one type of surgery done to improve urinary control. Anterior repair is a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.

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? a. 350 mL b. 500 mL c. 100 mL d. 600 mL

a The bladder should not be allowed to get distended beyond 350 mL because bladder overdistention results in loss of bladder tone.

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

a 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 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. a. indwelling catheter b. decreased fluid intake c. frequent catheter hygiene d. increased ingestion of Vitamin C

a, b Decreased fluid intake results in decreased urine production. The urinary tract can contain pathogenic microbes which are washed away with sufficient urine production - which required adequate fluid intake (1.5L to 3L per day).

The nurse caring for a client after urinary diversion surgery monitors the client closely for peritonitis by assessing for which sign(s)? Select all that apply. a. Leukocytosis b. Abdominal distention c. Hyperactive bowel sounds d. Muscle flaccidity

a, b The nurse should monitor the client for the following signs and symptoms of peritonitis: leukocytosis, abdominal pain and distention, absence of bowel sounds (paralytic ileus), fever, muscle rigidity, guarding, and nausea and vomiting.

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

d 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.

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? a. recurring infection prevention b. anti-inflammatory incompatibilities c. needed dietary changes d. No option is correct.

a Chronic pyelonephritis can develop after recurrent episodes of acute pyelonephritis. Anti-inflammatory compatibilities are not a factor in acute pyelonephritis. No dietary changes are required. The client is encouraged to drink a large volume of oral fluids daily.

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? a. Remind the client that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. b. Remind the client that occasional febrile episodes are expected following ESWL. c. Tell the client to report to the ED for further assessment. d. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office.

c Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.

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.

Which of the following is the most effective intravesical agent for recurrent bladder cancer? a. Bacillus Calmette-Guérin (BCG) b. Methotrexate c. Cisplatin d. Vinblastine

a BCG is now considered the most effective intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances the body's immune response to cancer. Chemotherapy with a combination of methotrexate, 5-FU, vinblastine, doxorubicin (Adriamycin), and cisplatin has been effective in producing partial remission of transitional cell carcinoma of the bladder in some patients.

Which finding is an early indicator of bladder cancer? a. Painless hematuria b. Occasional polyuria c. Nocturia d. Dysuria

a Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.

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

a Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

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? a. Stress incontinence b. Reflex incontinence c. Overflow incontinence d. Functional incontinence

a Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the client to reach the toilet in time for voiding.

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? a. The client's suprapubic region is dull on percussion. b. The client is uncharacteristically drowsy. c. The client claims to void large amounts of urine two to three times daily. d. The client takes a beta adrenergic blocker for the treatment of hypertension.

a Dullness on percussion of the suprapubic region is suggestive of urinary retention. Clients retaining urine are typically restless, not drowsy. A client experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.

As a result of trauma, a client has developed urinary incontinence and is beginning bladder training to regain control over urine elimination. What is the initial step to begin bladder training for a client with an indwelling catheter? a. Clamp the catheter. b. Unclamp the catheter. c. Remove the catheter. d. Perform catheter care.

a One method of bladder training for the client with an indwelling urethral catheter is to alternately clamp and unclamp the catheter. The clamping and unclamping of the catheter begins to reestablish normal bladder function and capacity. In the beginning, the catheter may be unclamped for 5 minutes every 1 or 2 hours. Clamping is the initial step. Removing the catheter is not correct. Catheter care should be done routinely on all patients.

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? a. 700 mL b. 250 mL c. 500 mL d. 1000 mL

a The nurse selects the appropriate catheter and inserts it under sterile conditions, noting the characteristics and volume of urine returned. If the volume of urine is large (>700 mL), it may be necessary to clamp the catheter.

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: a. at the same time, on the same scale, with similar clothing. b. once in the morning, on the same scale, with similar clothing. c. at the same time, using a different scale every time, with similar clothing. d. at the same time, on the same scale, with only minimal clothing.

a Weighing the client daily, at the same time, on the same scale, with similar clothing each time, is important because changes in body weight reflect changes in fluid volume status. Weighing the patient once in the morning, with any scale, or wearing minimal clothing may not reflect the accurate changes. They may cause incorrect assessment of the variation in fluid volume status.

A client postoperatively reports to the nurse the need to urinate, but is unable to void. What should the nurse expect the healthcare provider to order? Select all that apply. a. Complete a straight catheterization. b. Place an indwelling catheterization. c. Schedule a suprapubic catheter insertion. d. Perform a bladder scan. e. Ambulate the client.

a, d Acute retention that is likely to resolve quickly (e.g., after anesthesia) probably will be treated by bladder scanning and straight catheterization. An indwelling catheter is not recommended for short-term relief. Suprapubic catheters are used for obstructions and in situations in which it is not possible to insert catheters into the urethra. Ambulating the client will not help the client to void.

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

b 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.

A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? a. Administer prophylactic antibiotics as prescribed. b. Limit the use of indwelling urinary catheters. c. Encourage frequent mobility and repositioning. d. Toilet residents who are immobile on a scheduled basis.

b When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally given. Mobility does not have a direct effect on UTI risk.

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? a. Emphasize that the diversion is an integral part of successful cancer treatment. b. Encourage the client to speak openly and frankly about the diversion. c. Allow the client to initiate the process of providing care for the diversion. d. Provide the client with detailed written materials about the diversion at the time of discharge.

b Allowing the client to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the client is hesitant. Provision of educational materials is rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role of the diversion in cancer treatment does not directly address the client's body image.

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

b 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.

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. A client whose diagnosis of chronic kidney disease requires a fluid restriction b. A client who has Alzheimer disease and who is acutely agitated c. A client who is on bed rest following a recent episode of venous thromboembolism d. A client who has decreased mobility following a transmetatarsal amputation

b Clients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk for injury or trauma associated with indwelling catheter use.

The nurse is teaching a client how to perform self-catheterization. Which direction should the nurse include? a. Peroxide is recommended for cleaning the urinary catheter. b. Catheterization should occur every 4 to 6 hours and before bedtime. c. The nurse uses nonsterile technique in the hospital setting. d. The catheter is rinsed with sterile normal saline after soaking in a cleaning solution.

b The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The catheter is rinsed with tap water after soaking in a cleaning solution. Either antibacterial soap or povidone-iodine solution is recommended for cleaning urinary catheters at home. The nurse uses sterile technique in the hospital setting.

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? a. Remain NPO for 12 hours prior to the treatment. b. Hold the solution in the bladder for 2 hours before voiding. c. Drink the intravesical solution quickly and on an empty stomach. d. Avoid acidic foods and beverages until the full cycle of treatment is complete.

b The client is allowed to eat and drink before the instillation procedure. Once the bladder is full, the client must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.

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? a. Impaired mobility related to limitations posed by the ileal conduit b. Deficient knowledge related to care of the ileal conduit c. Risk for deficient fluid volume related to urinary diversion d. Risk for autonomic dysreflexia related to disruption of the sacral plexus

b The client will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.

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

b 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.

The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day? a. 1,250 mL b. 2,000 mL c. 2,750 mL d. 3,500 mL

b Unless contraindicated by kidney injury or hydronephrosis, clients with renal stones should drink at least eight 8-oz (250 mL) glasses of water daily or have IV fluids prescribed to keep the urine dilute. Urine output exceeding 2 L a day is advisable.

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

b, c, d 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.

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? a. Immediately after voiding, perform a bladder scan. b. Instruct the client to drink more fluids at night for a full bladder in the morning. c. Place client on a timed voiding schedule. d. Perform straight catheterizations at specific times each day.

c 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.

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include? a. Limit fluid intake to reduce the need to urinate. b. Take medication ordered for a UTI until the symptoms subside. c. Notify the physician if urinary urgency, burning, frequency, or difficulty occurs. d. Wear only nylon underwear to reduce the chance of irritation.

c Urgency, burning, frequency, and difficulty urinating are all common symptoms of a UTI. The client should notify the physician so that a microscopic urinalysis can be done and appropriate treatment can be initiated. The client should be instructed to drink 2 to 3 L of fluid per day to dilute the urine and reduce irritation of the bladder mucosa. To prevent UTI recurrence, the full amount of antibiotics ordered must be taken despite the fact that the symptoms may have subsided. Women are told to avoid scented toilet tissue and bubble baths and to wear cotton underwear, not nylon, to reduce the chance of irritation.

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

c Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathing in a tub because bacteria in the bath water may enter the urethra.

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? a. Morphine sulfate b. Aspirin c. Ketoralac (Toradol) d. Meperidine (Demerol)

c Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac (Toradol) are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.

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

c The client should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.

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? a. IV fluid administration b. Insertion of an indwelling urinary catheter c. Pain management d. Assisting with aspiration of the stone

c The client with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the client's need for IV fluids or for catheterization. Kidney stones cannot be aspirated.

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

c The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

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? a. Secure or patch it with tape. b. Empty the pouch. c. Change the wafer and pouch. d. Secure or patch it with barrier paste.

c 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.

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? a. Most UTIs in female clients are caused by viruses and do not cause obvious symptoms. b. A diagnosis of bacteriuria requires three consecutive positive results. c. Urine contains varying levels of healthy bacterial flora. d. Urine samples are frequently contaminated by bacteria normally present in the urethral area.

d Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.

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

d 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.

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

d Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the client with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.

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? a. "Have you had a fever and chills?" b. "How much fluid are you drinking?" c. "Do you get up at night to urinate?" d. "When did you last urinate?"

d The nurse needs to determine the last time the client voided.