AH I Final- Urinary Elimination
A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?
"I should take at least 1,000 mg of vitamin C each day."
The nurse is admitting a client who is to undergo an open renal biopsy. About which of the following comments by the client should the nurse be most concerned?
"I took my usual dose of Coumadin last night."
The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective?
"I will feel a warm sensation as the dye is injected."
A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?
"I'm allergic to shellfish."
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
"Increase your fluid intake to 2 to 3 L per day."
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 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/hour
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
An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care?
Application of an ostomy pouch
A patient has undergone a renal biopsy. After the test, while the patient is resting, the patient complains of severe pain in the back, arms, and shoulders. Which of the following appropriate nursing interventions should be offered by the nurse?
Asses the patient's back and shoulder areas for signs of internal bleeding.
After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first?
Assess peripheral pulses in the left leg.
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 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
Which of the following is a reversible cause of urinary incontinence in the older adult?
Constipation
After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the student have understood the material when they identify which of the following as a cause of stress incontinence?
Decreased pelvic muscle tone due to multiple pregnancies
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
Following a voiding cystogram, the client has a nursing diagnosis of risk for infection related to the introduction of bacterial following manipulation of the urinary tract. An appropriate nursing intervention for the client is to:
Encourage high fluid intake.
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 nurse is preparing a patient diagnosed with benign prostatic hypertrophy for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what?
Urinary retention
You are caring for an 84-year-old female patient who was brought to the emergency room by her family, who related that their mother had had mental status changes and periods of incontinence and they were very concerned. What condition would the nurse suspect the patient had?
Urinary tract infection
The nurse is caring for a patient who describes his changes in voiding patterns. The patient states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there does not seem to be a great deal of urine flow." What would the nurse expect this patient's physical assessment will likely reveal?
Urine retention
You are caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively the patient verbalizes that the stoma is a dark purplish color. This nurse is aware of what?
Vascular supply to the stoma may be compromised
Which of the following is a strategy to promote urinary continence?
Void regularly, 5 to 8 times a day
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:
continuous inflow and outflow of irrigation solution.
Bladder retraining following removal of an indwelling catheter begins with
instructing the patient to follow a 2 to 3 hour timed voiding schedule.
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 will never have another urinary stone again." • "I need to take allopurinol." • "Tylenol is best to control my pain." • "I'm so glad I don't have to make any changes in my diet."
Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply.
• Disturbed body image • Risk for impaired skin integrity • Deficient knowledge: management of urinary diversion
Which nursing intervention can help the client prevent urinary incontinence?
• Instruct the client how to perform Kegel exercises. • Remind the client to empty the bladder every 2 to 3 hours
Urodynamic testing is carried out in the urologist's office to study incontinence. Because voiding in the presence of others can cause a situational anxiety, the nurse must do what?
Help the patient relax.
Which of the following is an immediate danger after a prostate surgery?
Hemorrhagic shock
Which type of incontinency refers to the involuntary loss of urine due to medications?
Iatrogenic
The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what?
Increased fluid intake to produce a full bladder
A client reports urinary frequency, urgency, and dysuria. Which of the following would the nurse most likely suspect?
Infection
A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient?
Irrigate the catheter with 30 to 50 mL of normal saline as ordered.
After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. 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.
You are caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure?
Keep the patient NPO.
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 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
Which finding is an early indicator of bladder cancer?
Painless hematuria
A female client is undergoing a bladder training program as treatment for urinary incontinence. Which of the following techniques would be the most appropriate suggestion?
Performing Kegel exercises.
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following?
Peritonitis
Which of the following medications maybe ordered to relieve discomfort associated with a urinary tract infection?
Phenazopyridine (Pyridium)
The educator on your unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's teaching what nutritional guidelines would the educator include?
Restrict protein intake to 60 g/d.
The clinic nurse is preparing a plan of care for a patient complaining of stress incontinence. The plan of care incorporates behavioral therapy as an approach to the management of stress incontinence. What role will the nurse have in implementing the behavioral therapy approach?
Teach the patient to perform pelvic floor muscle exercises.
Which nursing assessment finding indicates the client has not met expected outcomes?
The client voids 75 cc four hours post cystoscopy.
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.
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
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 client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:
renal calculi.
The nurse is evaluating the effectiveness of discharge teaching for the client with an ileal conduit. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply.
• "I cannot wait until I can have surgery to get rid of this ostomy." • "I will need to change the appliance every day." • "I will need to catheterize myself every 2 to 3 hours."
