MS Chapter 59
A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the hourly output is less than what?
30 mL
Ron Davidson, a 45-year-old editor, is a client on the rehab unit where you practice nursing. Ron was involved in an MVA which left him with paraplegia and he is working toward living at home with his wife. He is currently developing an individualized CIC schedule, as he prefers to not wear a leg bag. What is the maximum amount of urine he should allow to collect before catheterization?
350 mL
Ryan Zimmerman, an 18-year-old college freshman, is brought to the ED via squad. He is a victim of an MVA and is unconscious. In compliance with a physician order to insert an indwelling catheter, you place the catheter and note the drainage of a large amount of yellow urine with normal odor. How much urine will you allow to drain before clamping the tube?
700mL
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?
Anticholinergic agents
You are admitting a patient diagnosed with urinary retention. What question should be included as part of the assessment?
"Do you have dribbling urine?"
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
Assessing present voiding patterns
The most common presenting objective symptoms of a UTI in older adults, especially in those with dementia, include which of the following?
Change in cognitive functioning
The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include?
Change in cognitive functioning
The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small amounts of urine. The appropriate nursing intervention is which of the following?
Change wafer and pouch.
The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which of the following should the nurse include?
Implementing a 2- to 3-hour voiding schedule
Patricia O'Connor, a 17-year-old high school student, is returning to the medical-surgical unit where you practice nursing from surgery. She has just undergone an appendectomy. She reports the need to urinate and cannot do so. What is your response to her situation as ordered by the physician?
Intermittent catheterization
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, reducing swelling and facilitating passage of the stone?
Ketoralac (Toradol)
Ms. Simpson, age 72 years, is being seen in the clinic with a suspected bladder tumor. These tumors occur more frequently in men than women and usually affect clients 50 years of age and older. Use of tobacco products is the leading cause of bladder cancer. You are asking Ms. Simpson about symptoms that she has had that brought her to the clinic. What is the most common first symptom of a malignant tumor of the bladder?
Painless hematuria
If an indwelling catheter is necessary, which of the following nursing interventions should be implemented to prevent infection?
Performing meticulous perineal care daily with soap and water
Which of the following terms is used to refer to inflammation of the renal pelvis?
Pyelonephritis
(see full question) 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 who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?
Smoking cessation
A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patient's post-procedure care?
Strain the patient's urine following the procedure.
Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing?
Stress
Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure?
Stress
A 42-year-old woman comes to the clinic complaining of intermittent urinary incontinence when she sneezes. The clinic nurse is aware this is what type of incontinence?
Stress incontinence
The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do?
Take the antibiotic for 3 days as prescribed
A client regularly recognizes the sensation of needing to void but cannot control voiding in time to reach a toilet. How would the nurse document this type of incontinence?
Urge
A nurse is caring for a female patient with urinary retention. The nurse teaches this patient to follow which principle for self-catheterization?
Use a clean technique at home to catheterize.
The nurse who provides teaching to the female patient regarding prevention of recurrent urinary tract infections includes which of the following statements?
Void immediately after sexual intercourse
Which of the following is a strategy to promote urinary continence?
Void regularly, 5 to 8 times a day
If an indwelling catheter is necessary, the nursing interventions that should be implemented to prevent infection include
performing meticulous perineal care daily with soap and water.
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."
Which client is at highest risk for developing a hospital-acquired infection?
A client with an indwelling urinary catheter
A patient has been admitted to the renal unit for lithotripsy. After the procedure you instruct the patient on straining their urine to collect stone fragments for analysis. The results of the stone analysis show that the stones are made of urate. What does this finding indicate?
A disturbance in uric acid metabolism
Which of the following is the most effective intravesical agent for recurrent bladder cancer?
Bacillus Calmette-Guérin (BCG)
A patient had a ileal conduit and is being cared for by a critical care nurse. What is a complication the nurse would monitor this patient for in the immediate postoperative unit?
Ureteral obstruction
Which of the following is a factor contributing to UTI in older adults?
Immunocompromise
A 52-year-old patient is scheduled to undergo ileal conduit surgery. The patient has several appropriate questions. What would be the most appropriate nursing diagnosis for this patient?
Knowledge deficit about the surgical procedure and postoperative care
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?
Limit the use of indwelling urinary catheters.
Which of the following medications may be ordered to relieve discomfort associated with a UTI?
Phenazopyridine (Pyridium)
Which of the following medications maybe ordered to relieve discomfort associated with a urinary tract infection?
Phenazopyridine (Pyridium)
The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach?
Teach the patient to perform pelvic floor muscle exercises
The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention?
The patient's suprapubic region is dull on percussion.
James Roth, a 63-year-old accountant, is a client on the hospital unit where you practice nursing. Mr. Roth has developed urinary incontinence and is beginning bladder training to regain control over his urine elimination. Why is the catheter being clamped and unclamped?
To promote normal bladder function
A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. Which of the following should the nurse inquire about with the physician before catheterization?
Type and size of the catheter to be used
A nurse's colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults?
Urinary incontinence is not considered a normal consequence of aging.
Which statement describing urinary incontinence in an elderly client is true?
Urinary incontinence isn't a disease.
A 32-year-old client has a history of neurogenic bladder and presents with fever, burning, and discharge at her catheter insertion site. What would you suspect is the problem?
Urinary tract infection
A 32-year-old client has a history of neurogenic bladder and presents with fever, burning, and suprapubic pain. What would you suspect is the problem?
Urinary tract infection
The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include:
WBC 50
The nurse needs to assess the fluid volume status of a client with chronic glomerulonephritis. Which of the following methods should the nurse use to accurately assess the client's fluid volume status?
Weighing the client daily, at the same time, on the same scale, with similar clothing
A urinary diversion procedure follows a cystectomy and is performed to divert urine to another collecting system. In addition to the use with bladder tumors, it is also used for extensive pelvic malignancies and severe traumatic injury to the bladder. The type of urinary diversion that requires an external ostomy bag to collect the urine is called a
cutaneous urinary diversion.
Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder?
Anticholinergic agent
The nurse has implemented a bladder retraining program in a 65-year-old woman after the removal of an indwelling urinary catheter from this patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient has 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding?
Avoid further interventions at this time, as this is an acceptable finding
A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice?
Using clean technique at home to catheterize
A client presents at the clinic with complaints of urinary retention. What question should the nurse ask to obtain additional information about the client's complaint?
"When did you last urinate?"
Ron Davidson, a 45-year-old editor, is a client on the rehab unit where you practice nursing. Ron was involved in an MVA, which left him with paraplegia, and he is working toward living at home with his wife. He is currently developing an individualized CIC schedule, as he prefers to not wear a leg bag. What is the maximum amount of urine he should allow to collect before catheterization?
350 mL
A nurse on a busy medical unit provides care for many patients 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 patient?
A patient who has Alzheimer's disease and who is acutely agitated
The nurse is assisting in the preoperative planning for stoma placement in a patient scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located?
Away from skin folds
A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective?
Cipro
John Ericsson, a 57-year-old railroad worker, is a client on the hospital unit where you practice nursing. As a result of trauma, Mr. Ericsson has developed urinary incontinence and is beginning bladder training to regain control over his urine elimination. What is the initial step to begin bladder training for a client with an indwelling catheter?
Clamp the catheter.
You are writing a nursing plan of care for a patient with a UTI. What would be an appropriate nursing diagnosis for this patient?
Deficient knowledge about factors predisposing to infection
A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patient's discharge education, what is the most plausible nursing diagnosis that the nurse should address?
Deficient knowledge related to care of the ileal conduit
The nurse caring for a patient with a urinary diversion notices mucus around the stents and in the patient's urine. The appropriate nursing intervention is to do which of the following?
Document presence of mucus in the urine.
Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection?
Drink liberal amount of fluids
A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient?
Drink liberal amounts of fluids.
The clinic nurse is teaching a young wife about preventing recurrent urinary tract infections. What information should the nurse include?
Drink liberal amounts of fluids.
The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling catheter?
Empty the drainage bag at least every 8 hours.
An adult patient has been hospitalized with pyelonephritis. The nurse's review of the patient's intake and output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding?
Encourage the patient to continue this pattern of fluid intake.
A patient 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 patient's body image?
Encourage the patient to speak openly and frankly about the diversion.
An 82-year-old female is brought to the clinic by her daughter for transient episodes of incontinence. While assessing this patient, what question should be a priority for the nurse to ask the patient and the family?
Has there been a change in other systems of the body?
Resection of a patient's bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following?
Hold the solution in the bladder for 2 hours before voiding.
A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?
Hydronephrosis
Which type of voiding dysfunction is seen in patients diagnosed with Parkinson's disease?
Incontinence
Which of the following is the most common symptom of bladder cancer?
Painless gross hematuria
A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response?
Inform the patient that this is not unexpected in the short term and scan the patient's bladder following each void.
The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response?
Inform the primary care provider that the vascular supply may be compromised.
The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patient's bladder?
Insertion of a suprapubic catheter
You are a urology nurse caring for a male patient admitted to your unit with bladder distention from prostatic hypertrophy. The physician orders placement of an indwelling urinary catheter. The nurse and urologist are both unsuccessful in catheterizing this patient due to the prostatic obstruction. What approach does the nurse anticipate the physician using to drain the patient's bladder?
Insertion of a suprapubic catheter
A 17-year-old high school student is returning to the medical-surgical unit following an appendectomy. She reports the need to urinate and cannot do so. What type of procedure will you perform to resolve her difficulty?
Intermittent catheterization under sterile conditions
A patient who has been treated with uric acid for stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient
Low-purine diet
A patient undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure. Which of the following postoperative procedures should the nurse perform?
Maintain skin and stomal integrity
A client undergoes surgery for removing a malignant tumor followed by a urinary diversion procedure. Which of the following postoperative procedures is the most important for the nurse to perform?
Maintain skin and stomal integrity.
A client undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure. Which of the following postoperative procedures should the nurse perform?
Maintain skin and stomal integrity.
The nurse is conducting a history and assessment related to a patient's incontinence. Which of the following should the nurse include in the assessment before beginning a bladder training program?
Medication usage
The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient?
Notify the physician about cloudy or foul-smelling urine.
A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the patient's cardiopulmonary status is stable, what aspect of care should the nurse prioritize?
Pain management
The nurse is preparing to assess a patient's newly created stoma. Which of the following findings would the nurse include in the documentation of a healthy stoma?
Pink color
Which of the following is a characteristic of a normal stoma?
Pink color
The nurse is writing a plan of care for a patient who has just returned from the PACU following surgery for urinary diversion. What would be a major postoperative nursing diagnosis following surgery for urinary diversion?
Potential for sexual dysfunction related to structural and physiologic alterations
A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding?
Provide privacy for the patient.
An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment?
Reviewing the patient's medication administration record for recent changes
A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patient's plan of care?
Risk for infection related to presence of an indwelling urinary catheter
The nurse is conducting a community education program on urinary incontinence. The nurse determines that the participants understand the teaching when they identify which of the following as risk factors for urinary incontinence?
Sedatives
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.
A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic?
The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy
A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:
help the client cope with the anxiety associated with changes in body image.
A 39-year-old client is being seen by a physician today because of symptoms indicating urinary tract infection. Especially in women, what is important education information in preventing urinary tract infections? Choose all correct options.
• Appropriate post-bowel movement hygiene • Appropriate bathing procedure
A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the patient's admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply.
• Hematuria • Urinary frequency • Acute pain
Susan Hopkins, a 32-year-old administrative assistant, is being seen by a physician with the urology practice where you practice nursing. She 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? Choose all correct options.
• Indwelling catheter • Decreased fluid intake
The nurse caring for a patient after urinary diversion surgery monitors the patient closely for peritonitis by assessing for which of the following? Select all that apply.
• Leukocytosis • Abdominal distention
A nurse is preparing a care plan for a client with Alzheimer's disease. The client is unable to communicate or feel the pain and discomfort associated with acute urinary retention. Which of the following nursing measures should be taken while caring for such a client? Choose all correct options.
• Measure fluid intake and output. • Palpate the abdomen to check for distended bladder.
Ms. Simpson is being treated for a malignant bladder tumor. The tumor is small so treatment will probably include which of the following? Select all that are correct.
• Resection and fulguration • Topical application of an antineoplastic drug
A client who has had a urinary diversion procedure is going to be discharged from your nursing unit. You are discussing care of the stoma and collection pouch. What information would you include? Select all that apply.
• When changing the adhesive wafer (to which the urostomy collection bag is attached), remove all remaining adhesive before applying a new wafer. • Drain the continent urostomy four times a day or as directed by the physician. • Wash the urinary collection pouch thoroughly after changing.
