Chapter 66: Renal Noninfectious Urinary Problems EAQ Questions (Rationales)

What information will the nurse provide to a patient who is scheduled for extracorporeal shock wave lithotripsy? Select all that apply. A. "Be sure to finish all of your antibiotics." B. "Your urine will be strained after the procedure." C. "You will need to change the incisional dressing once a day." D. "Immediately call the health care provider if you notice bruising." E. "Remember to drink at least 3 L of fluid a day to promote urine flow."

A. "Be sure to finish all of your antibiotics." B. "Your urine will be strained after the procedure." E. "Remember to drink at least 3 L of fluid a day to promote urine flow." Rationale: After lithotripsy, urine is strained to monitor the passage of stone fragments. Patients must finish the entire antibiotic prescription to decrease the risk of developing a urinary tract infection. Drinking at least 3 L of fluid a day dilutes potential stone-forming crystals, prevents dehydration, and promotes urine flow. Bruising on the flank of the affected side is expected after lithotripsy as a result of the shock waves that break the stone into small fragments. The patient must notify the health care provider if he or she develops pain, fever, chills, or difficulty with urination because these signs and symptoms may signal the beginning of an infection or the formation of another stone. There is no incision with extracorporeal shock wave lithotripsy. There may be a small incision when intracorporeal lithotripsy is performed.

The nurse finds mirabegron in the prescription of a patient with stress urinary incontinence. How does this medication reduce incontinence? A. By relaxing the detrusor smooth muscle B. By suppressing involuntary bladder contraction C. By enhancing nerve conduction to the urinary tract D. By increasing contractile force of the urethral sphincter

A. By relaxing the detrusor smooth muscle Rationale: Mirabegron is a beta 3 blocker which shows its action by relaxing the detrusor smooth muscle to increase bladder capacity and urine storage. In this way, it reduces stress urinary incontinence in a patient. Anticholinergics reduce incontinence by suppressing involuntary bladder contraction, increasing urine volume, and may increase the bladder capacity. Hormones reduce incontinence by enhancing nerve conduction to the urinary tract, improving blood flow, and reducing tissue deterioration of the urinary tract. Alpha adrenergic agonists increase contractile force of the urethral sphincter, increase resistance to urine flow, and thus reduce incontinence.

What are the permanent causes associated with the occurrence of different types of urinary incontinence? Select all that apply. A. Congenital defects B. Urethral obstruction C. Cognitive impairment D. Abnormal openings in the urinary tract E. Structural or functional defects of the bladder

A. Congenital defects C. Cognitive impairment E. Structural or functional defects of the bladder Rationale: Permanent causes associated with the occurrence of different types of urinary incontinence are organic and may be improved with treatment. These include congenital defects, cognitive impairment, and structural or functional defects of the bladder. Urethral obstruction and abnormal openings in the urinary tract are the transient causes associated with the occurrence of different types of urinary incontinence.

An older adult patient diagnosed with stress incontinence is prescribed the medication oxybutynin. Which side effects does the nurse tell the patient to expect? Select all that apply. A. Dry mouth B. Constipation C. Increased blood pressure D. Reddish-orange urine color E. Increased intraocular pressure

A. Dry mouth B. Constipation E. Increased intraocular pressure Rationale: Oxybutynin is an anticholinergic/antispasmodic. Side effects include dry mouth, urinary retention, constipation, and risk for increased intraocular pressure with the potential to make glaucoma worse. Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.

The nurse receives the change-of-shift report on four patients. Which patient does the nurse decide to assess first? A. 26-year-old admitted 2 days ago with urosepsis and an oral temperature of 99.4° F (37.4° C) B. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for a cystoscopy D. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

B. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Rationale: Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The patient who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention. The 26-year-old admitted with urosepsis and slight fever, the 32-year-old scheduled for a cystoscopy, and the 40-year-old with noninfectious urethritis are not at immediate risk for complications or deterioration.

Which patients with long-term urinary problems does the nurse refer to community resources and support groups? Select all that apply. A. 80-year-old with dementia B. 32-year-old with a cystectomy C. 48-year-old with urinary calculi D. 44-year-old with a Kock's pouch E. 78-year-old with urinary incontinence

B. 32-year-old with a cystectomy D. 44-year-old with a Kock's pouch E. 78-year-old with urinary incontinence Rationale: Patients with a cystectomy, Kock's pouch, or urinary incontinence would benefit from community resources and support groups. Others who have had their bladders removed are good sources of information and for help in establishing coping mechanisms. They can provide ideas for living with the problem or methods of curing (or minimizing) it. Urinary calculi typically are not a long-term problem that require community resources and support groups. The older adult patient with dementia would not benefit from community resources and support groups because of the patient's cognitive difficulties.

A patient reports to the nurse the constant dribbling of urine. On assessment, the nurse finds that the bladder is distended up to the level of the umbilicus. What could be the causes associated with this type of incontinence? Select all that apply. A. Epispadias B. Genital prolapse C. Multiple sclerosis D. Myelomeningocele E. Diabetic neuropathy

B. Genital prolapse C. Multiple sclerosis E. Diabetic neuropathy Rationale: The constant dribbling of urine is the clinical manifestation associated with distention of the bladder up to the level of the umbilicus; it is associated with overflow incontinence. The causes associated with this type of incontinence include genital prolapse, multiple sclerosis, and diabetic neuropathy. Epispadias and myelomeningocele are not the causes of overflow incontinence. However, they are the causes associated with stress incontinence.

The nurse is teaching behavioral techniques to a patient with reflux urinary incontinence. What does the nurse teach the patient about the Credé method? A. Use a warm sitz bath. B. Press over the bladder area. C. Run water in the sink simultaneously. D. Breathe to increase abdominal pressure.

B. Press over the bladder area. Rationale: Credé method is a bladder compression technique in which the patient presses over the bladder area to increase its pressure. In the Valsalva maneuver, breathing techniques increase chest and abdominal pressure; this increased pressure is then directed toward the bladder during exhalation. Water is left running in the sink to help the patient undergoing bladder training to urinate at that time. The patient with cystitis should use a warm sitz bath for comfort.

Which surgical procedure uses an abdominal, vaginal, or combined approach to treat intrinsic sphincter deficiencies in a patient with stress urinary incontinence? A. Midurethral sling B. Pubovaginal sling C. Retropubic suspension D. Needle bladder neck suspension

B. Pubovaginal sling Rationale: The pubovaginal sling procedure uses an abdominal, vaginal, or combined approach to treat intrinsic sphincter deficiencies in a patient with stress urinary incontinence. Midurethral sling procedure uses a vaginal approach to improve the symptoms of stress incontinence. Retropubic suspension requires a low abdominal incision and a urethral or suprapubic catheter for several days postoperatively. Needle bladder neck suspension uses combined vaginal approach with a needle and a small suprapubic skin incision.

The certified Wound, Ostomy, and Continence Nurse (CWOCN) or enterostomal therapist (ET) teaches a patient who has had a cystectomy about which care principles for the patient's post-discharge activities? A. Respiratory care B. Stoma and pouch care C. Nutritional and dietary care D. Wiping from front to back (asepsis)

B. Stoma and pouch care Rationale: The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms. The registered dietitian (RD) teaches the cystectomy patient about nutritional care. The respiratory therapist teaches the cystectomy patient about respiratory care. The patient with a cystectomy does not require instruction about front-to-back wiping.

How does a primary health care provider confirm stress urinary incontinence in a patient diagnosed with a urinary disorder? A. By assessing the abdomen B. By inspecting the external genitalia C. By asking the patient to cough while wearing a perineal pad D. By asking the patient to voluntarily start and stop urine flow during a void

C. By asking the patient to cough while wearing a perineal pad Rationale: Asking the patient to cough while wearing a perineal pad is useful in evaluating stress incontinence; a wet pad on forceful coughing may indicate stress incontinence. The abdomen is assessed to estimate bladder fullness, to rule out palpable hard stool, and to evaluate bowel sounds. Inspecting the genitalia helps to determine whether there is apparent urethral or uterine prolapse. Asking the patient to voluntarily start and stop urine flow during a void helps to determine pelvic muscle strength.

What is the purpose of periurethral injection of collagen or siloxane in the treatment of a patient with stress urinary incontinence? A. To elevate the bladder neck B. To elevate the urethral position C. To provide support around the bladder neck D. To facilitate opening and closing of the urethra

C. To provide support around the bladder neck Rationale: The purpose of periurethral injection of collagen or siloxane in the treatment of a patient with stress urinary incontinence is to provide support around the bladder neck. The purpose of pubovaginal sling procedures is to elevate the bladder neck. The purpose of anterior vaginal repair and retropubic suspension is to elevate the urethral position. The purpose of artificial sphincters is to facilitate opening and closing of the urethra.

Which factor does the nurse attribute to stress urinary incontinence in a patient? A. Impaired cognition B. Spasmodic bladder C. Weak pelvic muscles D. Decreased bladder capacity

C. Weak pelvic muscles Rationale: Weak pelvic muscles and structural supports can cause stress urinary incontinence in a patient. Impaired cognition or neuromuscular limitations are related to functional urinary incontinence. Urge urinary incontinence is related to bladder spasms and decreased bladder capacity.

What teaching will the nurse provide that would be most beneficial to the patient with urinary incontinence? A. "Avoid using douches." B. "Drink cranberry juice." C. "Empty your bladder before and after sex." D. "Avoid exercises such as running and jogging."

D. "Avoid exercises such as running and jogging." Rationale: A patient with urinary incontinence should avoid exercise like jogging and running. Although instructions to avoid douches, drink cranberry juice, and urinate before and after sex may be helpful, they are geared toward prevention of urinary tract infections, not managing incontinence.

The nurse is discharging a patient who has undergone lithotripsy for urinary calculi. Which patient statement indicates the need for additional education by the nurse? A. "I'll drink at least 3 L of fluid a day." B. "I'll check my urine pH three times a day." C. "I'll be off work for at least 1 day, but it could be longer." D. "I'll notify the doctor right away if my urine is bloody."

D. "I'll notify the doctor right away if my urine is bloody." Rationale: Blood in the urine may be noted for several days after lithotripsy, so the patient does not need to notify the physician of this finding. The patient should drink 3 L a day of fluid to flush out any potential stone-forming crystals. Urine pH should be checked three times a day. The patient may return to work 2 days to 6 weeks after surgery, depending on his or her tolerance and the recommendation of the health care provider.

The nurse is teaching a patient about pelvic muscle exercises. What information does the nurse include? A. "Results should be visible to you within 72 hours." B. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." C. "For the best effect, perform all of your exercises while you are seated on the toilet." D. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

D. "You know that you are exercising correct muscles if you can stop urine flow in midstream." Rationale: When the patient can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and should be performed more often than 5 minutes twice daily. Noticeable results take several weeks.

Which patient does the nurse manager on the medical unit assign to an experienced LPN/LVN? A. 42-year-old with painless hematuria who needs an admission assessment B. 48-year-old receiving intravesical chemotherapy for bladder cancer C. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site D. 55-year-old with incontinence who has intermittent catheterization prescribed

D. 55-year-old with incontinence who has intermittent catheterization prescribed Rationale: Insertion of catheters is within the education and legal scope of practice for LPN/LVNs. Admission assessments and intravesical chemotherapy should be done by an RN. Preoperative preparation for cystectomy and stoma site selection should be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse (CWOCN) or an enterostomal therapy (ET) nurse.

A patient with dementia and problems with mobility is most likely to experience which type of incontinence? A. Urge incontinence B. Stress incontinence C. Detrusor hyperreflexia D. Functional incontinence

D. Functional incontinence Rationale: Functional incontinence, which is leakage of urine caused by factors other than disease of the lower urinary tract, is most likely to occur in individuals with decreased cognition such as with dementia, and with an inability to walk to the toilet. Urge incontinence is more likely to result from idiopathic causes, brain and nerve disorders, bladder inflammation or infection, and bladder cancer. Stress incontinence can result from weakening of bladder neck supports, intrinsic sphincter deficiency, acquitted anatomic damage to the urethral sphincter, or vaginal prolapse from vaginal birth or aging. Deltrusor hyperreflexia often results from central nervous system lesions from stroke, multiple sclerosis, and parasacral spinal cord lesions.

Which nursing diagnosis observed in a patient with urinary incontinence is related to impaired cognition and neuromuscular limitations? A. Urge urinary incontinence B. Stress urinary incontinence C. Reflex urinary incontinence D. Functional urinary incontinence

D. Functional urinary incontinence Rationale: The functional urinary incontinence is the nursing diagnosis observed in a patient related to impaired cognition and neuromuscular limitations. Urge urinary incontinence is related to decreased bladder capacity, bladder spasms, diet, and neurological impairment. Stress urinary incontinence is related to weak pelvic muscles and structural supports. Reflex urinary incontinence is related to neurological impairment.

The nurse finds allopurinol and febuxostat in the prescription of a patient with nephrolithiasis. The nurse also instructs the patient to include lemon or orange juice in the diet plan. What could be the patient's condition? A. High levels of cystine in the urine B. High levels of calcium in the urine C. High levels of oxalic acid in the urine D. High levels of uric acid crystals in the urine

D. High levels of uric acid crystals in the urine Rationale: Nephrolithiasis is the formation of stones in the kidneys. For patients with hyperuricemia or high levels of uric acid crystals in the urine, treatment with both allopurinol and febuxostat prevent the formation of urate stones. Ingestion of lemon or orange juice provides the source of citrate. Cystinuria or high levels of cystine in the urine require treatment with both alpha-mercaptopropionylglycine and captopril. Thiazide diuretics are helpful in the treatment of hypercalciuria or high levels of calcium in the urine. Hyperoxaluria or high levels of uric acid in the urine require treatment with allopurinol and febuxostat.

The nurse finds the presence of kidney stones in the x-ray report of a patient with urinary disorder. On reviewing the medical history the nurse finds that the patient has gout disorder and was also on thiazide diuretics therapy. Based on these findings, which metabolic deficit could be a cause for the formation of kidney stones in the patient? A. Struvite B. Cystinuria C. Hyperoxaluria D. Hyperuricemia

D. Hyperuricemia Rationale: The metabolic deficit that is associated with the formation of kidney stones in a patient with history of gout disorder and who is on thiazide diuretics therapy is hyperuricemia. Struvite is formed by urea splitting by bacteria, most commonly proteus mirabilis. Cystinuria is an autosomal recessive defect of amino acid metabolism that precipitates insoluble cystine crystals in the urine. Hyperoxaluria is an autosomal recessive trait that results in high oxalate production. It is also associated with dietary consumption of foods such as spinach and rhubarb.

What procedure does the nurse expect the health care provider to prescribe for the removal of a large, impacted stone in a patient's kidney? A. Stenting B. Lithotripsy C. Pyelolithotomy D. Nephrolithotomy

D. Nephrolithotomy Rationale: Nephrolithotomy, an open surgical procedure, is often prescribed to remove a large, impacted stone in the kidney. This method is performed if all other procedures fail and there is a possible risk for a lasting injury to the ureter or kidney. Lithotripsy is the use of sound, laser, or dry shock waves to break stones into small fragments. Stenting is a minimally invasive procedure performed by placing a stent in the ureter by ureteroscopy. The stent dilates the ureter, enlarging the passageway for the stone or stone fragments. Pyelolithotomy is an open surgical procedure to remove stones in the kidney pelvis.

A cognitively impaired patient has urge incontinence. Which method for achieving continence would the nurse include in the patient's plan of care? A. Habit training B. Credé method C. Bladder training D. Kegel exercises

C. Bladder training Rationale: Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired patient because the caregiver is responsible for helping the patient to a toilet on a scheduled basis. Bladder training, the Credé method, and learning Kegel exercises require that the patient be alert, cooperative, and able to assist in his or her own care.

A patient is prescribed prophylactic immunotherapy with intravesical instillation of Bacille Calmette-Guérin (BCG) to prevent the recurrence of a bladder tumor. What does the nurse inform the patient about this therapy? A. Flush the toilet three times after use. B. The procedure is done in an inpatient setting. C. Dispose of clothing that comes in contact with urine in 24 hours. D. The BCG virus compound is allowed to dwell in the bladder for 2 hours.

D. The BCG virus compound is allowed to dwell in the bladder for 2 hours. Rationale: The Bacille Calmette-Guérin (BCG) virus compound is allowed to dwell in the bladder for 2 hours. The live virus will be excreted when the patient urinates. The instillation procedure is done in an outpatient setting. The patient must not share the toilet with other household members for 24 hours after instillation; the toilet must be flushed and cleaned with a solution of 10% liquid bleach. The patient must wash all clothing separately with 10% liquid bleach that has come into contact with urine during the 24 hours after instillation.

The nurse is teaching a patient about pelvic floor muscle exercises. Which patient statements indicate a need for further teaching? Select all that apply. A. "I should tighten my pelvic muscles at a fast rate." B. "I should never do these exercises more than once a day." C. "I should perform exercises sitting, standing, and lying down." D. "I should perform 45 exercises in three sets of 15 exercises each." E. "I should try to contract my pelvic muscles for as long as possible." F. "I should practice stopping the flow of urine after I've begun urinating to identify my pelvic muscles."

A. "I should tighten my pelvic muscles at a fast rate." B. "I should never do these exercises more than once a day." E. "I should try to contract my pelvic muscles for as long as possible." Rationale: The nurse would teach the patient to do pelvic muscle exercises using a slow count and to practice at least twice a day, so if the patient states that they plan to do the exercises at a fast pace, only once daily, further teaching is needed. The patient does not need to contract his or her pelvic muscle as long as possible; rather, these exercises are best performed by alternating contractions with short periods of relaxing the muscles. If the patient makes this statement, this is also an indication that further teaching is needed. The remaining statements indicate understanding. The patient should perform 45 exercises in three sets of 15 each. The patient should practice stopping the flow of urine after urination has begun to identify the pelvic muscles. The patient should practice these exercises while sitting, standing, and lying down.

The nurse is teaching a patient who is scheduled for a neobladder and a Kock's pouch. Which patient statement indicates a correct understanding of these procedures? A. "I will have to drain my pouch with a catheter." B. "If I restrict my oral intake of fluids, the adjustment will be easier." C. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." D. "I must go to the restroom more often because my urine will be excreted through my anus."

A. "I will have to drain my pouch with a catheter." Rationale: For the patient with a neobladder and a Kock's pouch, urine is collected in a pouch and is drained with the use of a catheter. Fluids should not be restricted. A neobladder does not require the use of an ostomy bag.

The nurse is teaching the importance of a low purine diet to a patient admitted with urolithiasis consisting of uric acid. Which statement by the patient indicates that teaching was effective? A. "I will no longer be able to have red wine with my dinner." B. "I am so relieved that I can continue eating my fried fish meals every week." C. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." D. "My wife will be happy to know that I can keep enjoying her liver and onions recipe."

A. "I will no longer be able to have red wine with my dinner." Rationale: Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the patient should decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stone consists of calcium oxalate.

A cognitively impaired patient has urge incontinence. Which method for achieving continence would the nurse include in the patient's plan of care? A. Habit training B. Credé method C. Bladder training D. Kegel exercises

A. Habit training Rationale: Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired patient because the caregiver is responsible for helping the patient to a toilet on a scheduled basis. Bladder training, the Credé method, and learning Kegel exercises require that the patient be alert, cooperative, and able to assist in his or her own care.

What are the risk factors for bladder cancer? Select all that apply. A. History of cigarette smoking B. Infection by Klebsiella pneumoniae C. Repeated use of indwelling catheters D. Infection by Schistosoma haematobium E. Exposure to textile industry chemicals

A. History of cigarette smoking D. Infection by Schistosoma haematobium E. Exposure to textile industry chemicals Rationale: The greatest risk factor for bladder cancer is the use of tobacco. Many compounds in tobacco enter the bloodstream and affect distant organs, such as the bladder. Infection by Schistosoma haematobium, a parasite, is another bladder cancer risk factor. Exposure to toxins, especially chemicals used in the hairdressing, rubber, paint, electric cable, and textile industries, also increase the risk for bladder cancer. Klebsiella pneumoniae causes infectious cystitis. The repeated use of indwelling catheters causes urinary tract infection.

What nonsurgical methods does the nurse teach the patient to manage stress incontinence? Select all that apply. A. Perform Kegel exercises. B. Reduce excess body weight. C. Practice vaginal cone therapy. D. Walk to strengthen pelvic muscles. E. Use artificial sweeteners instead of sugar.

A. Perform Kegel exercises. B. Reduce excess body weight. C. Practice vaginal cone therapy. Rationale: The patient with stress incontinence should reduce excess weight because increased abdominal pressure aggravates stress incontinence. Kegel exercise therapy strengthens the muscles of the pelvic floor, and weighted vaginal cones are used to strengthen pelvic muscles and decrease stress incontinence. Walking is a good exercise; however, it does not help to increase pelvic strength. The patient must avoid foods that irritate the bladder such as artificial sweeteners, alcohol, nicotine, citrus, and caffeine.

What clinical findings does the nurse attribute to the presence of kidney stones? Select all that apply. A. Smoky urine B. Urine pH of 6 C. Odorless urine D. Increased serum calcium E. Increased serum phosphate

A. Smoky urine D. Increased serum calcium E. Increased serum phosphate Rationale: Smoky or rusty urine is common in patients with kidney stones and indicates hematuria. Increases in serum calcium and phosphate levels indicate that excess minerals are present and may contribute to stone formation. The urine generally has an odor, indicating infection. Normal urine is alkaline, with a pH between 5 and 6. If urine contains uric acid or cystine stones, it is highly acidic. If urine contains calcium phosphate and struvite stones, it is alkaline.

Which foods should the patient with urinary calcium oxalate stones avoid to prevent future stone formation? Select all that apply. A. Spinach B. Black tea C. Sardines D. Rhubarb E. Organ meats

A. Spinach B. Black tea D. Rhubarb Rationale: The patient with calcium oxalate stones should avoid foods that are rich in calcium oxalate such as spinach, black tea, and rhubarb. This helps prevent formation of calcium oxalate stones. Patients with uric acid stones are asked to decrease intake of organ meats and sardines. The reduction of urinary purine content may help prevent formation of these stones.

What method of emptying the bladder is helpful for a patient with a large cystocele? A. Splinting B. Credé method C. Double-voiding D. Valsalva maneuver

A. Splinting Rationale: The patient with a large cystocele or prolapse of the bladder into the vagina may use splinting to reduce renal urinary incontinence. This is achieved by inserting fingers into the vagina and lifting the cystocele to urinate. The patient using the Credé method presses over the bladder area to increase pressure. The patient may also trigger nerve stimulation by tugging at the pubic hair or massaging the genital area. In the double-voiding technique, the patient empties the bladder once and then attempts a second voiding within a few minutes. The Valsalva maneuver is a breathing technique that increases chest and abdominal pressure. Increased pressure is directed toward the bladder during exhalation.

Which interventions are helpful in preventing bladder cancer? Select all that apply. A. Stopping the use of tobacco B. Drinking 2½ liters of fluid a day C. Using pelvic floor muscle exercises D. Showering after working with or around chemicals E. Wearing a lead apron when working with chemicals F. Wearing gloves and a mask when working around chemicals and fumes

A. Stopping the use of tobacco D. Showering after working with or around chemicals F. Wearing gloves and a mask when working around chemicals and fumes Rationale: Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer. Increasing fluid intake is helpful for some urinary problems such as urinary tract infection (UTI), but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence; however, no data show that these exercises prevent bladder cancer. Precautions should be taken when working with chemicals. Lead aprons are used to protect from radiation.

Which type of incontinence is also known as an overactive bladder (OAB)? A. Urge B. Mixed C. Overflow D. Functional

A. Urge Rationale: Urge incontinence is also known as an overactive bladder (OAB). Overactivity may be the result of abnormal detrusor contractions. Mixed, overflow, and functional incontinence are not known as an OAB. Mixed incontinence is the presence of more than one type of incontinence. Overflow incontinence is also known as reflex incontinence or underactive bladder. Functional incontinence is the incontinence occurring as a result of factors other than the abnormal function of the bladder and urethra.

Which test does the primary health care provider recommend as the first step in assessment of incontinence in patients of any age? A. Urinalysis B. Digital rectal examination (DRE) C. Voiding cystourethrogram (VCUG) D. Electromyography (EMG) of the pelvic muscles

A. Urinalysis Rationale: The first step in the assessment of incontinence in patients of any age includes urinalysis; this helps to rule out infection. Digital rectal examination (DRE) helps to detect impaction of stool which is a cause of transient urinary incontinence. To assess the size, shape, support, and function of the urinary tract system, a voiding cystourethrogram (VCUG) is recommended. Electromyography (EMG) of the pelvic muscles is a part of the urodynamic studies.

A patient with bladder cancer is scheduled for a ureterosigmoidostomy. What is the outcome of this procedure? A. Urine is diverted to the large intestine. B. Urine is diverted into a surgically created pouch. C. Urine is diverted directly to the skin surface through a stoma. D. Urine is collected in a portion of the intestine and let out through a stoma.

A. Urine is diverted to the large intestine. Rationale: A ureterosigmoidostomy diverts urine to the large intestine so that urine is excreted with bowel movements. An ileal reservoir diverts urine into a surgically created pouch that functions as a bladder. The stoma is continent, and the patient removes urine by regular self-catheterization. A ureterostomy diverts urine directly to the skin surface through a stoma. The patient wears a pouch after a ureterostomy. A conduit collects urine in a portion of the intestine, which is then opened onto the skin surface as a stoma. After the creation of a conduit, the patient must wear a pouch.

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A. Urge B. Stress C. Overflow D. Functional

B. Stress Rationale: Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence. Functional incontinence is not caused by a weakened pelvic floor; rather it is due to structural problems often resulting from injury or trauma. Overflow incontinence is caused by too much urine being stored in the bladder. Urge incontinence is caused by a problem (i.e., neurologic) with the patient's urge to urinate.

Which type of incontinence is characterized by the involuntary loss of urine during activities that increase abdominal or detrusor pressure? A. Urge B. Stress C. Overflow D. Functional

B. Stress Rationale: Stress incontinence is associated with the involuntary loss of urine during activities that increase abdominal or detrusor pressure. Urge incontinence is the involuntary loss of urine associated with a strong desire to urinate. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder when the bladder's capacity has reached its maximum. Functional incontinence is the leakage of urine caused by factors other than disease of the lower urinary tract.

The nurse is performing a pelvic examination in a patient with a urinary disorder and finds hypermobility of the urethra or bladder neck with valsalva maneuvers. Which type of incontinence does the nurse expect in the patient based on this finding? A. Urge B. Stress C. Overflow D. Functional

B. Stress Rationale: The clinical manifestations associated with stress incontinence include hypermobility of the urethra or bladder neck with valsalva maneuvers during pelvic examination. Urge incontinence, overflow incontinence, and functional incontinence are not associated with hypermobility of the urethra or bladder neck with valsalva maneuvers during pelvic examination. The clinical manifestations associated with urge incontinence include an abrupt and strong urge to void. Bladder distention up to the level of the umbilicus is the clinical manifestation associated with overflow incontinence. Variations in the quantity and timings of urine leakage are the clinical manifestations associated with functional incontinence.

A patient is prescribed the extended-release form of the anticholinergic drug oxybutynin as first-line management for urge incontinence. Which instruction would the nurse give the patient regarding drug administration? A. Chew the tablet. B. Swallow the tablet whole. C. Crush and dissolve the tablet in water. D. Perform an allergy test before taking the tablet.

B. Swallow the tablet whole. Rationale: Extended-release forms of anticholinergic drugs have a gradual effect over time. The patient should swallow the drug whole because chewing or crushing the tablet destroys the extended-release feature of the drug, causing the entire dose to be absorbed quickly and increasing its side effects. The patient who is prescribed collagen or a Siloxane injection to manage urge incontinence must take an allergy test before being injected with the drug. This would not be the case for oxybutynin.

At what stage of tumor growth would the nurse expect the health care provider to prescribe a simple excision for a patient with urothelial cancer? A. The tumor has spread to the muscle area. B. The tumor is confined to the bladder mucosa. C. The tumor is deep, but not in the muscle layer. D. The tumor has spread to the surrounding tissue.

B. The tumor is confined to the bladder mucosa. Rationale: Urothelial cancers are malignant tumors of the urothelium. Most urothelial cancers occur in the bladder. Tumors confined to the bladder mucosa are treated by a simple excision. Tumors that have spread to the muscle layer are treated with chemotherapy, radiation therapy, and radical cystectomy with urinary diversion. Tumors that are deep in the bladder mucosa, but not in the muscle layer, are treated with excision and intravesical chemotherapy. If the tumor has spread to the surrounding tissue, it also spreads to the distant organs, ultimately leading to death.

The nurse asks the patient diagnosed with a urinary disorder to voluntarily start and stop urine flow during a void at least twice. What is the rationale for this instruction? A. To detect impaction of stool B. To determine pelvic muscle strength C. To locate abnormalities in the kidneys and ureters D. To assess support and functioning of the urinary tract system

B. To determine pelvic muscle strength Rationale: The nurse asks the patient to voluntarily start and stop urine flow during a void at least twice to determine pelvic muscle strength. This test is known as urine stream interruption test. To detect impaction of stool caused by a transient cause, a digital rectal examination (DRE) is performed. A computed tomography (CT) scan is ordered to locate abnormalities in the kidneys and ureters. To assess support and functioning of the urinary tract system, a voiding cystourethrogram (VCUG) is ordered.

A patient is scheduled for a lithotripsy to break down existing kidney stones into small fragments. What does the nurse tell the patient about the procedure? A. It is done under general anesthesia. B. Urine must be strained after lithotripsy. C. Bruising after the procedure must be reported. D. An anesthetic cream is applied to the skin just before the procedure.

B. Urine must be strained after lithotripsy. Rationale: Urine must be strained after lithotripsy to monitor the passage of stone fragments. The procedure is done under moderate anesthesia. An anesthetic cream is applied to the skin 45 minutes before the procedure. Bruising often occurs on the flank of the affected side; this is an expected outcome and need not be reported.

A patient has urinary incontinence due to protrusion of pelvic organs into the vaginal lumen. Which treatment strategy would be beneficial to the patient in this situation? A. Vaginal cone therapy B. Vaginal pessary therapy C. Magnetic resonance therapy D. Electrical stimulation therapy

B. Vaginal pessary therapy Rationale: A prolapse occurs when the supportive tissue in the vagina weakens and stretches, allowing the pelvic organs to protrude into the vaginal lumen. A ring-shaped pessary inserted into the vagina is helpful when the prolapsed uterus or bladder is contributing to urinary incontinence. Vaginal cone therapy strengthens the pelvic muscles and decreases stress incontinence but may not help with pelvic prolapse. Magnetic resonance therapy reduces stress-induced incontinence similar to drug-induced relaxation of muscles and nerves. Electrical stimulation therapy helps in the treatment of both urge and stress incontinence by decreasing the sensation of urgency through either intravaginal or intrarectal stimulation.

A patient is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? A. "I have been taking cephalexin for an infection." B. "I previously had several ESWL procedures performed." C. "I take over-the-counter naproxen twice a day for joint pain." D. "Blood in my urine has become less noticeable, so maybe I don't need this procedure."

C. "I take over-the-counter naproxen twice a day for joint pain." Rationale: Because a high risk for bleeding during ESWL has been noted, patients should not take NSAIDs before this procedure; the ESWL will have to be rescheduled for this patient. Blood in the patient's urine should be reported to the health care provider, but will not require rescheduling of the procedure because blood is frequently present in the patient's urine when kidney stones are present. A diminished amount of blood would not eliminate the need for the procedure. The patient's taking cephalexin and the fact that the patient has had several previous ESWL procedures should be reported, but will not require rescheduling of the procedure.

The nurse is teaching a patient with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which patient statement indicates a need for further clarification? A. "My family members can be taught to help me if I need it." B. "A small-lumen catheter will help prevent injury to my urethra." C. "I will use a new, sterile catheter each time I do the procedure." D. "Proper handwashing before I start the procedure is very important."

C. "I will use a new, sterile catheter each time I do the procedure." Rationale: Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in patients who use intermittent self-catheterization and is a principle that should be stressed.

A 53-year-old postmenopausal woman reports "leaking urine" when she laughs, and is diagnosed with stress incontinence. What does the nurse tell the patient about how certain drugs may be able to help with her stress incontinence? A. "They help your bladder to empty." B. "They decrease your bladder's tone." C. "They may be used to improve urethral resistance." D. "They can relieve your anxiety associated with incontinence."

C. "They may be used to improve urethral resistance." Rationale: Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance. Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual, or if that is not possible, by using a catheter. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.

Which clinical manifestation would the nurse assess for in a patient with overflow incontinence? A. Abrupt and strong urge to void B. Urine loss with physical exertion C. Bladder distention with constant dribbling D. Post-void residual urine less than or equal to 50 mL

C. Bladder distention with constant dribbling Rationale: The nurse would assess for palpable bladder distention and constant urine loss through dribbling in a patient with overflow incontinence. An abrupt and strong urge to void is seen with urge incontinence. Urine loss with physical exertion is associated with stress incontinence. A post-void residual urine measurement of less than or equal to 50 mL indicates effective bladder emptying.

The nurse is assisting a primary health care provider while assessing a patient suspected with a urinary disorder. During assessment, the nurse observes that the primary health care provider is determining whether there is tactile sensation in the anal area. Which test is the primary health care provider performing in the patient by this intervention? A. Electromyography (EMG) B. Computed tomography (CT) C. Digital rectal examination (DRE) D. Voiding cystourethrogram (VCUG)

C. Digital rectal examination (DRE) Rationale: A digital rectal examination (DRE) provides information about the nerve integrity of the bladder. The primary health care provider determines whether there is tactile sensation in the anal area by observing whether the rectal sphincter is relaxed or contracted on digital insertion. Electromyography (EMG), computed tomography (CT), and voiding cystourethrogram (VCUG) do not help in determination of tactile sensation in the anal area. EMG of the pelvic muscles is a part of the urodynamic studies. CT scans are useful in locating abnormalities in the kidneys and ureters. To assess the size, shape, support, and function of the urinary tract system, VCUG is performed.

During assessment of a patient, what finding does the nurse associate with the presence of kidney stones? A. Oliguria B. Dysuria C. Flank pain D. Flank pain extending to the scrotum

C. Flank pain Rationale: The major manifestation of kidney stones is renal colic, which begins suddenly and is described as "unbearable." Flank pain indicates that the stone is in the kidney or the upper ureter. Oliguria, or scant urine output, indicates an obstruction at the bladder neck or urethra. Dysuria and frequency occur when the stone reaches the bladder and causes irritation. Flank pain extending to the scrotum suggests that the stones are in the ureters or bladder. The pain is most intense when the stone is moving or when the ureter is obstructed.

A patient has a medication history of using warfarin for heart disease. If this patient has urinary incontinence, which drug may interact with warfarin if prescribed for the patient? A. Midodrine B. Oxybutynin C. Mirabegron D. Imipramine

C. Mirabegron Rationale: Mirabegron is a selective beta blocker which has some potential to increase blood pressure. It is one of the drugs that can be prescribed for treating urinary incontinence. As the patient is already on warfarin therapy, prescribing mirabegron may be contraindicated because it would interact with warfarin and may cause the risk of bleeding in the patient. Midodrine is an alpha adrenergic agonist that is used for treating urinary incontinence. Oxybutynin is an antispasmodic and can be prescribed for the patient to treat urinary incontinence. Imipramine is a tricyclic antidepressant. It strengthens the urinary sphincters and acts as an anticholinergic; therefore, it can be prescribed for treating urinary incontinence. These drugs would not interact with warfarin.

A patient reports experiencing involuntary loss and constant dribbling of urine because of an enlarged prostate. How does the nurse document this incontinence? A. Urge incontinence B. Stress incontinence C. Reflex incontinence D. Overflow incontinence

D. Overflow incontinence Rationale: This patient's condition is known as overflow incontinence. The urethra in the patient is obstructed because of the enlarged prostate; the urethra fails to relax sufficiently to allow the urine to flow, resulting in incomplete bladder emptying or complete urinary retention. Loss of urine following physical exertion, cough, or sneeze is documented as stress incontinence. Stress incontinence occurs because of intrinsic sphincter deficiency or acquired anatomic damage to the urethral sphincter. The patient with urge incontinence experiences an involuntary loss of urine with a strong desire to urinate. The patient with reflex incontinence has a post-void residual less than 50 mL.

Why is it important for the patient with calcium phosphate and calcium oxalate stones to reduce sodium intake? A. To dilute the urine. B. To reduce acidic urine. C. To reduce urinary purine content. D. To increase calcium reabsorption.

D. To increase calcium reabsorption. Rationale: The patient with calcium phosphate and calcium oxalate stones should reduce sodium intake to increase calcium reabsorption by kidney tubules; therefore, less calcium is precipitated in the urine. Increasing oral fluid intake helps dilute urine and prevent formation of cystine crystals. Reducing protein intake helps reduce acidic urine and prevent calcium precipitation. Decreasing the intake of organ meats, poultry, and fish helps reduce urinary purine content.