Chapter 59: Caring for Clients with Disorders of the Bladder and Urethra

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? "How much fluid are you drinking?" "When did you last urinate?" "Have you had a fever and chills?" "Do you get up at night to urinate?"

"When did you last urinate?" Page 1086

Which client is at highest risk for developing a hospital-acquired infection? A client who's taking prednisone (Deltasone) A client with an i1619 A client with a laceration to the left hand A client with Crohn's disease

A client with an i1619

The nurse is assessing a client admitted with renal stones. During the admission assessment, what parameters should the nurse address? Select all that apply. Family history of renal stones Medication history Dietary history Vaccination history Surgical history

Dietary history Family history of renal stones Medication history Page 1098-1099

A client who is diagnosed with calcium oxalate stones is instructed to limit calcium intake. The client is instructed to consume ______ mg of calcium per day, or less, as part of dietary treatment. 1000 2000 1500 1250

1000 Page 1098

The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day? 1,250 mL 2,000 mL 3,500 mL 2,750 mL

2,000 mL

A client with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the client's urine output hourly and notifies the health care provider when the hourly output is less than what amount? 125 mL 30 mL 50 mL 100 mL

30 mL Page 1103

A nurse is working with a female client who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment? Clearly explain the potential benefits of pelvic floor muscle exercises. Arrange for biofeedback when the client is learning to perform the exercises. Contact the client weekly to ensure that they are performing the exercises consistently. Ensure the client knows that surgery will be required if the exercises are unsuccessful.

Arrange for biofeedback when the client is learning to perform the exercises. Page 1091

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? Establishing a predetermined fluid intake pattern for the client Encouraging the client to increase the time between voidings Restricting fluid intake to reduce the need to void Assessing present voiding patterns

Assessing present voiding patterns Rationale: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

A client being treated in the hospital has been experiencing occasional urinary retention. What voiding trigger technique would help this client? Performing a bladder scan after voiding Encouraging male clients to use a urinal in bed Using a bedpan instead of a commode Dipping the client's hands in warm water

Dipping the client's hands in warm water Page 1089

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia? Hematuria Change in cognitive functioning Incontinence Back pain

Change in cognitive functioning Page 1094

The nurse working with a client after an ileal conduit notices that the pouching system is leaking small amounts of urine. What is the appropriate nursing intervention? Secure or patch it with tape. Secure or patch it with barrier paste. Empty the pouch. Change the wafer and pouch.

Change the wafer and pouch. Page 1104

A female client has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this client? Void at least every 6 to 8 hours. Bathe daily and keep the perineal region clean. Avoid voiding immediately after sexual intercourse. Drink liberal amounts of fluids.

Drink liberal amounts of fluids.

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. Bathe in warm water to soak the affected area. Drink caffeinated beverages twice a day to increase urination. Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Void every 2-3 hours to prevent overdistention of the bladder Drink liberal amounts of fluid to flush out bacteria.

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 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. Void every 2-3 hours to prevent overdistention of the bladder Drink caffeinated beverages twice a day to increase urination. Bathe in warm water to soak the affected area. Drink liberal amounts of fluid to flush out bacteria.

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

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? An output of 200mL with each voiding Cloudy urine Urine with a specific gravity of 1.005-1.022 Rebound tenderness at McBurney's point

Cloudy urine

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? Urine with a specific gravity of 1.005-1.022 An output of 200mL with each voiding Cloudy urine Rebound tenderness at McBurney's point

Cloudy urine Page 1094

The nurse is caring for a client with cystitis. Which adjunct therapy is the nurse most correct to suggest to keep bacteria from adhering to the wall of the bladder? Wiping from the urethra to rectum Flushing the system with water Drinking cranberry juice Douching with a vinegar solution

Drinking cranberry juice Page 1094

A client 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 client's body image? Encourage the client to speak openly and frankly about the diversion. Allow the client to initiate the process of providing care for the diversion. Emphasize that the diversion is an integral part of successful cancer treatment. Provide the client with detailed written materials about the diversion at the time of discharge.

Encourage the client to speak openly and frankly about the diversion. Allowing the client to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the client is hesitant. Provision of educational materials is rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role of the diversion in cancer treatment does not directly address the client's body image. Page 1104

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-phosphorus diet Low-calcium diet High-protein diet Low-purine diet

Low-purine diet Page 1098

A client undergoes surgery to remove a malignant tumor followed by a urinary diversion procedure. Which postoperative procedure is the most important for the nurse to perform? Determine the client's ability to manage stoma care. Show photographs and drawings of the placement of the stoma. Maintain skin and stomal integrity. Suggest a visit to a local ostomy group.

Maintain skin and stomal integrity. Page 1103

Which of the following is the most common symptom of bladder cancer? Back pain Painless gross hematuria Altered voiding Pelvic pain

Painless gross hematuria Page 1100

The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply. Assist the patients with frequent toileting. For those patients who are incontinent, insert indwelling catheters. Encourage patients to wear briefs. Provide careful perineal care. Perform hand hygiene prior to patient care.

Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care. Page 1088

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use a sterile technique to disconnect the catheter from the tubing to obtain urine specimens Use a clean technique during insertion Perform meticulous perineal care daily with soap and water Place the catheter bag on the client's abdomen when moving the client

Perform meticulous perineal care daily with soap and water Page 1087

Which medication may be ordered to relieve discomfort associated with a UTI? Levofloxacin Phenazopyridine Nitrofurantoin Ciprofloxacin

Phenazopyridin Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics. Page 1094

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? Occupational history History of allergies Smoking habits Physical and environmental conditions

Physical and environmental conditions Page 1091

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

Pyridium

A client has just been diagnosed with acute pyelonephritis. What education would the nurse offer this client regarding fluids? Increase caffeinated beverages. No change in fluids needed. Significantly decrease fluid intake. Significantly increase fluid intake.

Significantly increase fluid intake.

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care? Administer a bolus of 500 mL normal saline following the procedure. Monitor the client for fluid overload following the procedure. Strain the client's urine following the procedure. Insert a urinary catheter for 24 to 48 hours after the procedure.

Strain the client's urine following the procedure.

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

Stress Page 1090

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? Be sure to take the medication with grapefruit juice. Take the antibiotic as well as an antifungal for the yeast infection she will probably have. Take the antibiotic for 3 days as prescribed. Understand that if the infection reoccurs, the dose will be higher next time.

Take the antibiotic for 3 days as prescribed.

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. Be sure to take the medication with grapefruit juice. Take the antibiotic as well as an antifungal for the yeast infection she will probably have. Understand that if the infection reoccurs, the dose will be higher next time.

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.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? Administer acetaminophen (Tylenol). Restrict fluid intake to 1 liter per day. Straight catheterize the client every 4 to 6 hours. Teach client to increase fluid intake up to 3 liters per day.

Teach client to increase fluid intake up to 3 liters per day.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? Straight catheterize the client every 4 to 6 hours. Administer acetaminophen (Tylenol). Teach client to increase fluid intake up to 3 liters per day. Restrict fluid intake to 1 liter per day.

Teach client to increase fluid intake up to 3 liters per day.

A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic? The need to undergo a series of three urine cultures after the antibiotics have been completed The need to expect a heavy menstrual period following the course of antibiotics The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy The risk of developing antibiotic resistance after the course of antibiotics

The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy

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? Reflex Overflow Urge Total

Urge

A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. Restricting fluid intake is recommended for older adults experiencing incontinence. Diuretics should be promptly discontinued when an older adult experiences incontinence. Urinary incontinence is not considered a normal consequence of aging.

Urinary incontinence is not considered a normal consequence of aging.

Which statement describing urinary incontinence in an older adult client is true? Urinary incontinence isn't a disease. Urinary incontinence is a disease. Urinary incontinence in the elderly population can't be treated. Urinary incontinence is a normal part of aging.

Urinary incontinence isn't a disease. Page 1090

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: assess suicidal risk postoperatively. assess whether the client is a good candidate for surgery. help the client cope with the anxiety associated with changes in body image. evaluate the client's need for mental health intervention.

help the client cope with the anxiety associated with changes in body image. Page 1102-1103

A client 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? Select all that apply. increased ingestion of Vitamin C indwelling catheter decreased fluid intake frequent catheter hygiene

indwelling catheter decreased fluid intake Page 1086

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 administration of cleansing enemas placement of the catheter procedure for insertion of the catheter

type and size of the 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.