Chapter 63: Coordinating Care for Patients With Urinary Disorders

What is the length of the female urethra? A. 4 cm B. 2 cm C. 3 inches D. 4 inches

A

A patient admitted to the hospital with a diagnosis of gout has also been diagnosed with uric acid renal calculi. When planning meals for this patient, which diet will the nurse anticipate? 1) Low-purine diet 2) Low-sodium diet 3) A diet high in calcium 4) A diet low in calcium

1 A low-purine diet is appropriate in the management of a patient with uric acid renal calculi.

The nurse is providing care to a patient with urge incontinence. Which drug classification should the nurse include in the patient's plan of care? 1) Anticholinergic 2) Topical estrogen 3) Alpha-adrenergic agonist 4) Calcium channel blocker

1 Anticholinergic drugs are used to treat stress incontinence and mixed incontinence. They block nervous stimulation from the parasympathetic nervous system to help relax and control bladder muscle contractions.

The nurse is attempting to place a urinary catheter for an older adult female patient. The nurse is unable to visualize the patient's urinary meatus. Which alternate position for catheterization may be appropriate for this patient? 1) Side-lying, lifting up the buttock 2) Supine, with the HOB elevated at 30° 3) Supine, with the head of bed (HOB) elevated at 45° 4) Supine, with the bed flat, legs bent and apart in stirrups

1 Because of estrogen-mediated changes in the perineal area of postmenopausal women, the urinary meatus may be very difficult to visualize. The side-lying position, lifting up the buttock, is an alternative that provides better visualization of the urinary meatus.

Which intervention should the nurse include in the patient's plan of care to decrease the risk for developing a catheter-associated urinary tract infection? 1) Implementing intermittent catheterization 2) Administering the prescribed prophylactic antibiotic 3) Retaining the indwelling catheter throughout hospitalization 4) Encouraging the consumption of cranberry juice twice per day

1 Intermittent catheterization should be considered as an alternative to an indwelling catheter to reduce the risk for catheter-associated infections.

The nurse is assessing an adult patient in a urology clinic. The patient reports that she has been having "accidents" and expresses frustration about this normal part of aging. Which response by the nurse is the most appropriate? 1) "Tell me more about what you are experiencing." 2) "You may need to have surgery to manage this problem." 3) "I understand you are frustrated about this occurrence." 4) "Unfortunately, aging and incontinence go hand in hand."

1 It is appropriate for the nurse to gather more information regarding the patient's incontinence.

The nurse on the medical unit is admitting an older adult patient whose primary symptoms include fatigue, pruritus, and pain in the right flank area. When conducting this patient's assessment, which technique is the most appropriate? 1) Palpation over the costovertebral angles and flanks 2) Blunt percussion over the costovertebral angles and flanks 3) Palpation of the lower pole of both kidneys 4) Capturing of both kidneys

1 Palpation of the costovertebral angles and flanks can be used to reveal any pain or tenderness.

A nurse is providing care to a group of patients on a urology unit. Which patient does the nurse identify as being at the greatest risk for developing urinary stones? 1) A 35-year-old female with quadriplegia from an auto accident 2) A 65-year-old male with a recent history of myocardial infarction 3) A 50-year-old male with type II diabetes mellitus 4) A 25-year-old female with several episodes of urinary infection

1 The 35-year-old female with quadriplegia from an auto accident experiences prolonged immobility, which will increase calcium loss from bones and therefore increase the chance of calcium stones precipitating in the urinary system.

The nurse providing care to a patient whose medication therapy for the treatment of renal calculi has failed. Based on this data, which treatment option does the nurse anticipate for this patient? 1) Lithotripsy 2) Surgical removal 3) Dietary control 4) Initiation of IV fluids

1 When medication fails to dissolve stones, the preferred method of treatment is lithotripsy, which is using sound waves to crush the stones so they can be passed out of the urinary system.

The nurse is providing training for the clinical staff of a skilled care facility and wants to include information on functional incontinence. Which risk factors for functional incontinence will the nurse include in the training? Select all that apply. 1) Limited mobility 2) Impaired vision 3) Lack of access to facilities 4) Dementia 5) Depression

1234 An immobilized patient may experience incontinence if a call light is not within reach; a patient with Alzheimer disease, along with other forms of dementia, may perceive the urge to void but be unable to interpret its meaning or respond by seeking a bathroom. A patient with impaired vision may not be able to find the bathroom. Minimal facilities can create problems in urinary control. Depression is not usually related to incontinence.

The nurse is triaging a patient who presents to the urgent care clinic with symptoms of severe flank pain with spasms, nausea, vomiting, and oliguria. The patient states that the pain was initially intermittent and radiated from the lower back to the lower quadrants of the abdomen. Which action by the nurse is the most appropriate? 1) Complete the physical assessment 2) Refer the patient to a urologist 3) Instruct the patient to increase fluids 4) Obtain a urine specimen for culture

2 Hydroureter is a complication that occurs when a renal calculus moves into the ureter and blocks and dilates the ureter. Symptoms include severe pain and spasms, nausea, vomiting, and diminished volume of urine. Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; medical collaboration should be initiated immediately.

The nurse educator is speaking with a group of students about renal disorders. Which statement is appropriate for the educator to include regarding renal stones? 1) "Older adult patients are particularly at risk for urolithiasis." 2) "Young- or middle-age adult men are at an increased risk for stones." 3) "Women have a greater risk overall than men." 4) "Frequency is greater in the northern United States."

2 Men who are in young to middle age are affected two to three times more than women of that age.

The nurse is providing care to a patient who is experiencing urine leakage when coughing or laughing. Which type of incontinence should the nurse include in this patient's plan of care? 1) Urge 2) Stress 3) Overflow 4) Functional

2 Stress incontinence is more common in women and occurs when abdominal pressure increases: laughing, coughing, lifting, exercising.

The nurse is caring for a patient who will be discharged with an indwelling catheter. The nurse has provided education to the patient and family about catheter care once the patient is discharged. Which patient or family action indicates a correct understanding of the information presented? 1) Hanging the drainage bag on the towel rod 2) Taking a shower each day instead of taking a tub bath 3) Restricting the amounts of fluids per day 4) Emptying the drainage bag twice a day

2 The patient should take a shower rather than a tub bath because sitting in a tub allows bacteria to easily access the urinary tract.

The nurse is providing care to a patient with stress incontinence. Which drug classification should the nurse include in the patient's plan of care? 1) Anticholinergic 2) Topical estrogen 3) Alpha-adrenergic agonist 4) Calcium channel blocker

2 Topical estrogens are used in stress incontinence to help restore moisture and flexibility of the urethra.

The nurse is providing care to a patient who is diagnosed with stress incontinence. Which assessment data would the nurse expect to collect while performing the patient's health history and physical? Select all that apply. 1) Urine leakage while talking 2) Urine leakage while coughing 3) Urine leakage while laughing 4) Skin breakdown on the buttock 5) A urinary catheter

234 Stress incontinence involves a small leakage of urine when a patient laughs, coughs, or lifts something heavy, not if a patient just carries on a conversation. If the patient has been experiencing incontinence, the nurse might expect to see the skin inflamed and irritated because urine is very irritating to the skin. A patient with incontinence would wear some kind of undergarment pad; a urinary catheter is not an expected finding.

The nurse provides education for a patient who is experiencing urinary incontinence. Which statement by the patient indicates the need for further education? 1) "Relaxation of pelvic muscles may be a factor in incontinence." 2) "Reduced urethral resistance can be a cause of incontinence." 3) "Incontinence is normal with aging." 4) "A disturbance of my bladder is a factor in the development of incontinence."

3 A disturbance of the bladder, relaxation of the pelvic muscles, and reduced urethral resistance are all potential factors in the development of incontinence.

A patient with urinary calculi is admitted to the hospital. When planning care for this patient, which goal is most appropriate? 1) The patient will lose 25 pounds in three months. 2) The patient will ambulate three times a day. 3) The patient will request pain medication at the onset of pain. 4) The patient will shower independently.

3 Intense pain is the hallmark of urinary calculi, or kidney stones, that are passing through the urinary system. The nurse teaches the patient to request pain medication at the onset of pain in order to provide faster relief.

The nurse is providing care to a patient with a spinal cord injury. Which type of incontinence should the nurse include in this patient's plan of care? 1) Urge 2) Stress 3) Overflow 4) Functional

3 Overflow incontinence occurs with spinal cord injury. The bladder is flaccid/enlarged due to obstruction, and the patient experiences frequent urination.

The nurse is caring for a patient with a history of chronic urinary tract infections. The nurse is planning care for this patient based on the priority nursing diagnosis of urinary retention related to scarring. Based on this data, which prescription does the nurse anticipate from the health-care provider? 1) Antibiotic therapy 2) An anticholinergic medication 3) Intermittent straight catheterization 4) Removal of bladder stone

3 The health-care provider may order straight catheterization so the patient can be taught to self-catheterize and manage the urinary retention at home.

The nurse is providing care to a patient who is diagnosed with bladder cancer and receiving Bacille Calmette-Guérin therapy. Which is the priority teaching point for this patient? 1) Straining all urine to assess for calculi 2) Flushing the toilet immediately after urination 3) Pouring two cups of bleach in the toilet and flushing 20 minutes later 4) Notifying the health-care provider if the patient does not void every two hours

3 The patient should be taught to pour two cups of bleach into the toilet after urination and allow it to sit for 20 minutes prior to flushing. This is to ensure that others are not infected with the bacteria used in this treatment regimen.

The nurse is caring for a patient with a urinary catheter. Which nursing diagnosis is a priority for this patient? 1) Chronic Pain related to an obstruction 2) Risk for Impaired Skin Integrity related to incontinence 3) Risk for Infection related to catheter placement 4) Self-Care Deficit related to presence of urinary catheter

3 The patient who has a urinary catheter in place is at an increased risk for infection, which is the priority diagnosis.

A patient is admitted to the emergency department and diagnosed with urinary calculi after experiencing symptoms for one week. When planning care for this patient, which nursing diagnosis is the most appropriate? 1) Risk for Constipation 2) Risk for Disuse Syndrome 3) Imbalanced Nutrition 4) Activity Intolerance

3 The patient with urinary calculi, or kidney stones, of lengthy duration is at risk for imbalanced nutrition from the resulting nausea.

The nurse is reviewing discharge instructions for a patient diagnosed with urinary incontinence resulting from a urinary tract infection. Which statement made by the patient indicates the need for further education? 1) "I should drink plenty of water to prevent damage to my kidneys while I am on the antibiotics for the infection." 2) "Drinking cranberry juice will decrease the risk for developing urinary tract infections." 3) "I will contact the health-care provider prior to taking over-the-counter medications while on my antibiotic." 4) "I will continue to hold my urine while in public so that I do not get another infection."

4 A patient who is diagnosed with urinary incontinence secondary to a urinary tract infection will require specific education. The patient who states that he or she will hold their urine while in public to decrease the risk of another infection requires more education. Urinary retention is a contributing factor to urinary tract infections.

The nurse is providing care to a patient with benign prostatic hyperplasia (BPH). Which drug classification should the nurse include in the patient's plan of care? 1) Diuretic 2) Anticholinergic 3) Topical estrogen 4) Alpha-adrenergic agonist

4 Alpha-adrenergic agonists, beta-adrenergic agonists, and calcium channel blockers all promote urethral relaxation; aid in issues of urinary retention, for example, issues associated with BPH.

The nurse is caring for a patient with a history of kidney stones. The stones have been analyzed and are all composed of calcium phosphate. Based on this data, which foods should the nurse teach the patient to avoid? 1) Chicken, beef, and ham products 2) Organ meats, sardines, and seafood 3) Tomatoes, fruits, and nuts 4) Flour, milk, and ice cream

4 Flour, milk, and milk products such as ice cream have high calcium levels and, therefore, are recommended to be reduced to decrease the risk of further episodes of calcium-containing calculi.

The nurse is working in a urology clinic and is providing care for a patient with urinary stress incontinence. The nurse has chosen the diagnosis of Stress Urinary Incontinence related to sphincter incompetence. Which is the desired outcome for a patient with this diagnosis? 1) The patient will stop the flow of urine when voiding. 2) The patient will improve her incontinence within one month. 3) The patient will empty her bladder every time she voids. 4) The patient will perform four to five squeezes (Kegel exercises) for 10-15 seconds

4 Performing four to five squeezes for 10-15 seconds is the goal to start with when teaching a patient Kegel exercises, which are used for stress and urge incontinence

The nurse is preparing to discharge a patient who underwent lithotripsy in the treatment of a kidney stone. What should the nurse teach the patient to prevent further complications of urinary calculi after discharge? 1) "You will need to increase your oral fluid intake to 1 L/day." 2) "It will be important that you not drive while taking pain medications." 3) "It will be important to maintain a diet high in purines." 4) "You will need to monitor for the signs and symptoms of a urinary tract infection (UTI)."

4 The patient with stones may develop a UTI when formed stones obstruct urinary flow. These symptoms should be reported as early as possible to the primary care provider.

Which action by Heather indicates the need for further teaching about her prescribed medicines? A. Heather calls in a panic because her urine is an orange color. B. Heather is scheduling her follow-up appointment even though her dysuria resolved with phenazopyridine (Pyridium). C. Heather states her understanding that phenazopyridine (Pyridium) should be taken no more than 3 days. D. She reports her symptoms have improvedbut continues to take her trimethoprim/ sulfamethoxazole (Bactrim DS) as prescribed.

Answer: A Rationale: Pyridium causes urine to turn orange or rust colored.

This structure provides voluntary control of micturition: A. External sphincter B. Detrusor muscle C. Posterior urethral valves D. Internal sphincter

Answer: A Rationale: The external sphincter is under voluntary control. The internal sphincter is involuntary.

Which statements are true regarding UTIs? (Select all that apply.) A. Urinary tract infections are more common in women because of the close proximity of the urethra, vagina, and rectum. B. Sexual intercourse does not increase the risk for UTIs. C. It is more common for males to develop a UTI because of the length of the urethra. D. Sexual intercourse increases the risk for a UTI. E. Flank pain is a symptom of lower UTIs.

Answer: A and D Rationale: It is less common for males to develop urinary tract infections due to the length of the urethra. Flank pain is a symptom of upper urinary tract actions.

The patient is prescribed CIC for incontinence management. The nurse tells the patient that this will do what? (Select all that apply.) A. Decrease urinary tract infection precipitated by retention of urine B. Reestablish control of urinary elimination C. Prevent frequent feeling of the need to void D. Decrease episodes of hematuria E. Cure incontinence

Answer: A, B, and C Rationale: CIC will not decrease episodes of hematuria or cure incontinence.

The nurse understands a trial of passage is indicated in the patient: A. Who is febrile with gross hematuria B. Who has a 3mm lower ureter stone without N/V C. Who is non febrile with 6 mm lower ureter stone D. Who has a 3mm lower ureter stone with N/V

Answer: B Rationale: A trial of passage is indicated for small stones, <5mm, in patients that are not febrile, and not nauseated and vomiting

Which statement by Heather regarding new flank pain indicates teaching has been effective? A. "I'll call the doctor for pain medicine if the flank pain comes back." B. "Does new flank pain mean I might have an infection in my kidneys?" C. "New flank pain means the infection has spread to my gallbladder." D. "This pain may mean the infection could involve my reproductive system."

Answer: B Rationale: Flank pain indicates infection might have traveled to the upper urinary system.

Which statement by the patient indicates teaching about tamsulosin (Flomax) has been effective? A. "Will this medicine help my nausea?" B. "So this medicine will help me pass the stone by relaxing the muscles?" C. "I need to take this medicine so I don't get an infection." D. "This medicine is for my pain."

Answer: B Rationale: Flomax is prescribed to relax the muscles to allow the stone to pass. It is not for pain, nausea, or infection.

The nurse understands that superficial cancers affect only: A. Muscle and surrounding fat B. The urothelium, or inner lining of the bladder C. Structures adjacent to the bladder D. The lobes of the prostate

Answer: B Rationale: Superficial bladder cancers only affect the inner lining of the bladder. They have not invaded the surrounding muscle, adjacent structures, or the prostate.

The nurse recognizes which patient is at greatest risk for a UTI? A. A 35-year-old sexually active male B. A 23-year-old sexually active female C. A 50-year-old sexually active female D. An 18-year-old sexually active male

Answer: B Rationale: Urinary tract infections are most common in women due to the close proximity of the urethra, vagina, and rectum. They are also more common in young women thought to be due to honeymoon cystitis with frequent sexual activity. They are less common in men due to the length of the urethra.

The nurse understands which population is at increased risk for developing urinary stones? A. Black females living in Florida B. White males living in Georgia C. Black males living in New York D. White females living in Oregon

Answer: B Rationale: Urolithiasis are most prevalent in Caucasians, males, and those living in a warm, humid environment.

The nurse recognizes Heather's urinalysis is suspicious for a UTI by the presence of the following: (Select all that apply.) A. Ketones B. White blood cells C. Bacteria D. Bilirubin E. Protein

Answer: B and C Rationale: White blood cells, bacteria, and nitrites can be found in urine during a urinary tract infection.

The nurse understands which common signs indicate a lower UTI? (Select all that apply.) A. Fever B. Dysuria C. Frequency D. Hematuria E. Nausea

Answer: B, C, and D Rationale: Nausea and fever are signs of upper urinary tract infections.

The lower urinary tract includes: A. Kidneys and ureters B. Bladder and ureters C. Bladder and urethra D. Kidneys and bladder

Answer: C Rationale: Kidney and ureters are a part of the upper urinary tract.

Motor stimulation of the bladder that mediates bladder contraction is provided by: A. Sympathetic nervous system B. Efferent innervation C. Parasympathetic nervous system D. Detrusor muscle

Answer: C Rationale: The parasympathetic system provides the stimulus for bladder contraction.

The patient with stress incontinence is prescribed Kegel exercises. The nurse tells the patient that Kegel exercises will help: A. Strengthen the detrusor muscle B. The posterior urethral valves C. Strengthen the internal sphincter D. Strengthen the external sphincter

Answer: D Rationale: Kegel exercises specifically strengthen the external sphincter muscle.

The inner lining of the urinary tract is composed of: A. Muscle B. Transitional cells C. Basement membrane D. Urge receptors

B

Case Study

Heather understands the importance of completing her antibiotics as directed to prevent bacterial resistance. She is encouraged to increase her fluid intake to flush her urine and to call her provider for fever or flank pain or if her symptoms do not improve after completing the antibiotics. She is provided with education on how to prevent future UTIs, such as wiping front to back after using the toilet and urinating after sexual intercourse.