NU142- Chapter 55: Management of Patients With Urinary Disorders

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?

The pouch faceplate doesn't fit the stoma.

The nurse is caring for several older clients. For which client would the nurse be especially alert for signs and symptoms of pyelonephritis?

A client with urinary obstruction

urethrovesical reflux

An obstruction to free-flowing urine leading to the reflux of urine from the urethra into the bladder

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

The nurse has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply.

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

The nurse is assessing the client's ileal conduit stoma in the clinic. Which assessment finding would be of greatest concern to the nurse?

The stoma is dusky red.

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

Which statement describing urinary incontinence in an older adult client is true?

Urinary incontinence isn't a disease.

Which of the following is the most common site of a nosocomial infection?

Urinary tract

The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include:

WBC 50

suprapubic catheter

a urinary catheter that is inserted through a suprapubic incision into the bladder

nocturia

awakening at night to urinate

ureterovesical or vesicoureteral reflux

backward flow of urine from the bladder into one or both ureters

bacteriuria

bacteria in the urine

neurogenic bladder

bladder dysfunction that results from a disorder or dysfunction of the nervous system and leads to urinary incontinence

ureterosigmoidostomy

transplantation of the ureters into the sigmoid colon, allowing urine to flow through the colon and out the rectum

ileal conduit

transplantation of the ureters to an isolated section of the terminal ileum, with one end of the ureters brought to the abdominal wall

residual urine

urine that remains in the bladder after voiding

urinary frequency

voiding more often than every 3 hours

micturition

voiding or urination

pyuria

white blood cells in the urine

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

A client is admitted with nephrolithiasis. What symptoms does the nurse expect the client to experience? Select all that apply.

Difficulty starting a urine stream Suprapubic pain Elevated temperature Hematuria

Which instruction would be included in a teaching plan for a client diagnosed with a UTI?

Drink liberal amount of fluids.

Which of the following is the most common symptom of bladder cancer?

Painless gross hematuria

cystectomy

surgical removal of the urinary bladder

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 patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered?

Cloudy urine

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?

Away from skin folds

A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following?

By ascending infection (transurethral)

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

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

Gunshot wounds

Which metabolic defects are associated with stone formation?

Hyperparathyroidism

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications?

Iatrogenic

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 nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program?

Physical and environmental conditions

Which term refers to inflammation of the renal pelvis?

Pyelonephritis

interstitial cystitis

inflammation of the bladder wall that eventually causes disintegration of the lining and loss of bladder elasticity

prostatitis

inflammation of the prostate gland

pyelonephritis

inflammation of the renal pelvis

urethritis

inflammation of the urethra

cystitis

inflammation of the urinary bladder

The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction?

The nursing assistant places the drainage bag on the client's abdomen for transport.

A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation?

Need to urinate after engaging in sexual intercourse

Which factor contributes to UTI in older adults?

Immunocompromise

Patients with urolithiasis need to be encouraged to:

Increase their fluid intake so that they can excrete 2.5 to 4 liters every day.

A female client who suffers from urethral strictures undergoes a dilation procedure and experiences a burning sensation while voiding. Which nursing instruction would be most helpful?

Instruct the use of warm sitz baths.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an IV infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?

It's an abnormal finding that requires further assessment.

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

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action?

Maintain skin and stomal integrity.

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?

Place client on a timed voiding schedule.

Sympathomimetics have which of the following effects on the body?

Relaxation of bladder wall

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.

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

The client keeps the drainage bag below the bladder at all times.

Bladder retraining following removal of an indwelling catheter begins with

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

urinary incontinence

involuntary or uncontrolled loss of urine from the bladder

A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?

Urinary calculi

overflow incontinence

involuntary urine loss associated with overdistention of the bladder

A client is being treated for a malignant bladder tumor. What would be included in treatment of a small tumor? Select all that apply.

resection and fulguration topical application of an antineoplastic drug

urosepsis

spread of infection from the urinary tract to the bloodstream that results in a systemic infection