CH55 management of urinary disorders
A client is suspected of having interstitial cystitis. Which diagnostic test would the nurse anticipate as being used to confirm the diagnosis? Bladder biopsy
A biopsy of the bladder mucosa which reveals an inflammatory process with scarring and hemorrhagic areas confirms the diagnosis.
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 catheter to be used
Before catheterization, the nurse should inquire about the type and size of the catheter to be used and if the catheter should be removed or retained in place after the bladder is empty.
A client who has a history of neurogenic bladder presents with fever, burning, and suprapubic pain. What would the nurse suspect is the problem? urinary tract infection
Signs of a bladder infection include fever, chills, and suprapubic pain.
A client is prescribed amitriptyline (an antidepressant) for incontinence. The nurse understands that this drug is an effective treatment because it: Increases bladder neck resistance
Some tricyclic antidepressant medications (amitriptyline, nortriptyline, and amoxapine) are useful in treating incontinence because they decrease bladder contractions and increase bladder neck resistance.
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
Stress incontinence may occur with sneezing, coughing, or changing position
Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Latrogenic
Iatrogenic incontinence is the involuntary loss of urine due to extrinsic medical factors, predominantly medications.
The nurse recognizes that test results that most likely indicate a urinary tract infection include: WBC 50
Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.
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 guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding.
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
The most important postoperative nursing management is to maintain skin and stoma integrity to avoid further complications, such as skin infections and urinary odor.
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
The nurse plans to have the stoma located away from skin folds and creases, bony prominences, the belt line, and the umbilicus. The stoma should be located in an area where the client can see and reach it.
Which of the following nursing actions is most important in caring for the client following lithotripsy? Strain the urine carefully for stone fragments
The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical analysis.
Which of the following is the most common site of a nosocomial infection? Urinary tract
The urinary tract is the most common site of nosocomial infection, accounting for greater than 3% of the total number reported by hospitals each year.
A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care? Monitor urine output hourly and report output less than 30 mL/hr
n the immediate postoperative period, urine volumes are monitored hourly. Throughout the patient's hospitalization, the nurse monitors closely for complications, reports signs and symptoms of them promptly, and intervenes quickly to prevent their progression. If urinary drainage stops or decreases to less than 30 mL/hour, or if the client complains of back pain, the nurse needs to notify the physician immediately.
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
symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi.
Which instruction would be included in a teaching plan for a client diagnosed with a UTI? Drink liberal amount of fluids
Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathing in a tub because bacteria in the bath water may enter the urethra.
Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? Low purine
A low-purine diet is used for uric acid stones, although the benefits are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate
Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what? Bladder retraining
Bladder retraining includes a timed voiding schedule and urinary urge inhibition exercises. These exercises involve delaying voiding to help the patient stay dry for a set period of time. When one time interval is reached, another is set. The time is usually increased by 10 to 15 minutes, until an acceptable voiding interval is achieved.
A client is going to have a surgical procedure called a periurethral bulking to improve urinary control. Periurethral bulking is: placement of small amounts of collagen in urethral walls to aid the closing pressure.
Periurethral bulking is the placement of small amounts of collagen in urethral walls to aid the closing pressure.
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
Placing the client on a timed voiding schedule after a catheter removal will promote bladder muscle retraining. The nurse should do a bladder scan immediately after voiding, but this is not the initial action.
Sympathomimetics have which of the following effects on the body? Relaxation of bladder wall
Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.
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
Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled
Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? Incontinence
Incontinence is noted in clients diagnosed with Parkinson disease. Urinary retention is associated with spinal cord injury. Urgency is associated with an overactive bladder. Incomplete bladder emptying is associated with diabetes mellitus.
Which of the following is the most common symptom of bladder cancer? Painless gross hematuria
Painless gross hematuria is the most common symptom of bladder cancer. Pelvic and back pain may occur with metastasis. Any alteration in voiding or change in the urine may indicate cancer of the bladder.
A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to: Loss of motor control of the detrusor muscle.
Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void.
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
The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.
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
Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.
The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? Ileal conduit
When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cetaceous urinary diversion
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
Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.
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
Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void.
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 doesnt fit the stoma
If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin
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.
The nurse would instruct the nursing assistant to maintain the drainage bag lower than the genital region to avoid a backflow of urine into the bladder. The nursing assistant is correct to move the catheter and drainage bag with the client to not put tension on the catheter, place the drainage bag on the lower area of the wheelchair, and hold the drainage bag while the client is in the process of moving.
A client postoperatively reports to the nurse the need to urinate, but is unable to void. What should the nurse expect the healthcare provider to order? Select all that apply. Complete a straight catheterization. Perform a bladder scan.
Acute retention that is likely to resolve quickly (e.g., after anesthesia) probably will be treated by bladder scanning and straight catheterization.
The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? Anticholinergic
Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs.
The nurse planning care for a client with overflow and stress incontinence includes preparation for which intervention? Transrectal resection
A transrectal resection is the procedure of choice for men with overflow and stress incontinence.
The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation.
A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours
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
Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an overdistended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.
