Honan, Chapter 28: Nursing Management: Patients With Urinary Disorders

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?

Location of discomfort

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?

Low purine

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-purine diet

The nurse is teaching a client how to perform self-catheterization. Which direction should the nurse include?

Catheterization should occur every 4 to 6 hours and before bedtime.

Which information is important when teaching a client how to perform self-catheterization?

Catheterization should occur every 4 to 6 hours and before bedtime.

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia?

Change in cognitive functioning

Which objective symptom of a UTI is most common in older adults, especially those with dementia?

Change in cognitive functioning

The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet?

"I should limit my intake of meat and fish."

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply.

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

A nurse is presenting at a community health promotion fair that is focused on disease prevention and screening. A middle-aged participant has brought up an article that she recently read about bladder cancer and has asked the nurse about prevention measures. How should the nurse respond to this woman's inquiry?

"If you smoke cigarettes, quitting will greatly reduce your risk of bladder cancer."

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

Which of the following accounts for the majority of ureteral injuries?

Crashes, falls, and assaults

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply.

Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?

Detects calculi, cysts, or tumors

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:

Disturbed body image

Which of the following would be least appropriate to suggest to a client with a urinary diversion to control odor?

Eat plenty of cheese and eggs.

A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply.

Empty the collection bag at least every 8 hours to reduce bacterial growth. Suspend the drainage bag off the floor. Wash the perineal area with soap and water at least twice daily.

A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction?

Urinary retention

The nurse is teaching a client with recurrent urinary tract infections (UTIs) ways to decrease risk for additional UTIs. The nurse includes which information?

Void immediately after sexual intercourse.

The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement?

Void immediately after sexual intercourse.

A patient taking an alpha-adrenergic medication for the treatment of hypertension is having a problem with incontinence. What does the nurse tell the patient?

When the medication is discontinued or changed, the incontinence will resolve.

A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate?

"Make sure to eat enough fiber to prevent constipation."

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?

"My urine will be eliminated through a stoma."

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."

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?

"When did you last urinate?"

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?

Acute pain

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?

Assessing present voiding patterns

A 69-year-old man is postoperative day 2 following a transurethral prostatic resection (TUPR). The patient had his urinary catheter removed at 06:00 this morning but has not voided in the 5 hours since the removal, despite the fact that he has been drinking large amounts of fluids. What nursing assessment will most accurately determine whether the patient is retaining urine?

Bladder ultrasound

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?

Encouraging intake of at least 2 L of fluid daily

Which of the following is a cause of a calcium renal stone?

Excessive intake of vitamin D

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder?

Hematuria

A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer?

Painless, gross hematuria

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection?

Perform meticulous perineal care daily with soap and water

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client?

Permanent drainage with a urethral catheter

Which medication may be ordered to relieve discomfort associated with a UTI?

Phenazopyridine

An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client?

Physical and environmental conditions

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

Pyridium

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find?

Pyuria

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:

notify the physician about cloudy or foul-smelling urine.

A nurse is assessing a client with suspected bladder cancer. Which finding would the nurse most likely expect to assess?

painless hematuria

Bladder retraining following removal of an indwelling catheter begins with

instructing the client to follow a 2- to 3-hour timed voiding schedule.

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform?

Maintain skin and stoma integrity

A 67-year-old woman whose medical history includes obesity, type 2 diabetes, and hypertension has admitted to her care provider that she has often been incontinent of urine over the past several months. In an effort to control her problem, she has been using absorbent pads but is motivated to find a solution to her overactive bladder. What goal should the patient and the nurse emphasize to restore the patient's urinary continence?

Making lifestyle changes that will result in weight loss

A 20-year-old male patient has been brought to the emergency department (ED) by ambulance with a gunshot wound that has resulted in urethral trauma. In light of this patient's injuries, the ED nurse should anticipate what intervention?

Insertion of a suprapubic catheter

The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. What instruction should the nurse give the patient?

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

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

Stress

The nurse advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances?

Uric acid

A female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following?

Reflux of urine from the urethra into the bladder

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal?

Relieve the pain.

In consultation with her care team, a woman with a diagnosis of cancer has had a continent urinary diversion (Indiana pouch) created. The patient is discussing the advantages and disadvantages of this procedure with her nurse. The nurse should be aware of which of the following advantages of an Indiana pouch?

The patient does not have to wear an external collection bag.

A 44-year-old woman was diagnosed with an uncomplicated urinary tract infection (UTI) and completed her prescribed 3-day course of antibiotics 2 days ago. However, she states that she is experiencing the same signs and symptoms that initially prompted her to seek care. The nurse should anticipate that:

The patient may require another short course of antibiotics followed by a longer-term regimen.

Which is the procedure of choice for men with recurrent or complicated UTIs?

Transrectal ultrasonography

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence?

Urge

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?

Ketoralac (Toradol)

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

Kidney

A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of:

Infection