Chapter 49: Management of Patients with Urinary Disorders

The nurse caring for a client after urinary diversion surgery monitors the client closely for peritonitis by assessing for which sign(s)? Select all that apply. a. Muscle flaccidity b. Leukocytosis c. Hyperactive bowel sounds d. Abdominal distention

Leukocytosis Abdominal distention (The nurse should monitor the patient for the following signs and symptoms of peritonitis: leukocytosis, abdominal distention, absence of bowel sounds, fever, muscle rigidity, guarding, and nausea and vomiting.)

A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? a. Fever b. Painless hematuria c. Urinary retention d. Frequency

Painless hematuria (The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Painless hematuria is the most common, however.)

A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate? a. "Try drinking coffee throughout the day." b. "Use scented powders to disguise any odor." c. "Make sure to eat enough fiber to prevent constipation." d. "Limit the number of times you urinate during the day."

"Make sure to eat enough fiber to prevent constipation." (Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying.)

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 the client's teaching was effective? a. "A catheter will drain urine directly from my kidney." b. "My urine will be eliminated through a stoma." c. "I will not need to worry about being incontinent of urine." d. "My urine will be eliminated with my feces."

"My urine will be eliminated through a stoma." (An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.)

A client with a urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? a. "This medication will prevent re-infection." b. "This will kill the organism causing the infection." c. "This medication should be taken at bedtime." d. "This medication will relieve your pain."

"This medication will relieve your pain." Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

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

"When did you last urinate?" The nurse needs to determine the last time the client voided.

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

A client with an i1619 (The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk.)

The nurse is caring for several older clients. For which client would the nurse be especially alert for signs and symptoms of pyelonephritis? a. A client with acute renal failure b. A client with urinary obstruction c. A client with a urinary tumor d. A female client with preexisting chronic glomerulonephritis

A client with urinary obstruction (The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumors are not at high risk for developing pyelonephritis.)

The nurse is caring for several older clients. For which client would the nurse be especially alert for signs and symptoms of pyelonephritis? a. A client with a urinary tumor b. A client with acute renal failure c. A client with urinary obstruction d. A female client with preexisting chronic glomerulonephritis

A client with urinary obstruction (is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumors are not at high risk for developing pyelonephritis.)

The nurse is caring for a client who has a type of urinary diversion that requires an external ostomy bag to collect the urine. This client has: a. a cystectomy. b. a urethroplasty. c. an incontinent urinary diversion. d. a continent urinary diversion.

An incontinent urinary diversion. An incontinent urinary diversion requires an external ostomy bag to collect the urine.

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? a. Anticholinergic b. Cholinergic c. Diuretics d. Anticonvulsant

Anticholinergic drugs (Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic medications also do not directly help with control.)

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? a. Intermittent catheterizations b. Irrigating the urinary diversion c. Exercises to promote sphincter control d. Application of an ostomy pouch

Application of an ostomy pouch (An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermittent catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.)

Which of the following is the most effective intravesical agent for recurrent bladder cancer? a. Methotrexate b. Cisplatin c. Vinblastine d. Bacillus Calmette-Guérin (BCG)

Bacillus Calmette-Guérin (BCG) (CG is now considered the most effective intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances the body's immune response to cancer. Chemotherapy with a combination of methotrexate, 5-FU, vinblastine, doxorubicin (Adriamycin), and cisplatin has been effective in producing partial remission of transitional cell carcinoma of the bladder in some patients.)

A nurse is conducting a health history on a patient who is seeing her healthcare provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? a. Due to a fistula (direct extension) b. The result of urethra abrasion (sexual intercourse) c. By ascending infection (transurethral) d. Through the bloodstream (hematogenous spread)

By ascending infection (transurethral) (The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.)

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

Change in cognitive functioning (The most common objective finding is a change in cognitive functioning, especially in those with dementia; these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.)

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? a. Secure or patch it with tape. b. Empty the pouch. c. Change the wafer and pouch. d. Secure or patch it with barrier paste.

Change the wafer and pouch. (Whenever a leaking pouching system is noted, the nurse should change the wafer and pouch. Attempting to secure or patch the leak with tape and/or barrier paste can trap urine under the barrier or faceplate, which will compromise peristomal skin integrity. Emptying the pouch will not rectify the leaking.)

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

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

After teaching a group of students about malignant bladder tumors, the instructor determines that the teaching was successful when the students identify which of the following clients as having the greatest risk for developing a malignant bladder tumor? a. Client with a history of cigarette smoking b. Client with a history of bladder inflammation c. Client with a history of a sexually transmitted disease d. Client with a history of untreated gonorrhea

Client with a history of cigarette smoking (Environmental and occupational health hazards are associated with bladder tumors. Therefore, the client who smokes is at the greatest risk for a malignant tumor. The client with a history of untreated gonorrhea is most vulnerable to urethral strictures, while the client with a history of bladder inflammation may be vulnerable to interstitial cystitis. Finally, the client with sexually transmitted disease may be vulnerable to acquiring urethritis.)

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. a. Deficient knowledge: management of urinary diversion b. Chronic pain c. Risk for impaired skin integrity d. Urinary retention e. Disturbed body image

Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity

An older adult client is being evaluated for suspected pyelonephritis and is ordered a kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? a. Shows damage to the kidneys b. Detects calculi, cysts, or tumors c. If the risk for chronic pyelonephritis is likely d. Reveals causative microorganisms

Detects calculi, cysts, or tumors (Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.)

A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? a. Diabetes mellitus b. Hyperparathyroidism c. Hyperuricemia d. Pancreatitis

Diabetes mellitus (Increased urinary glucose levels create an infection-prone environment in the urinary tract.)

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? a. Drink coffee or tea to increase diuresis. b. Void every 4 to 6 hours. c. Drink liberal amount of fluids. d. Use tub baths as opposed to showers.

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.

Which of the following is a cause of a calcium renal stone?

Excessive intake of vitamin D Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.

The nurse is caring for a client who has been diagnosed with a mild urinary tract infection and is prescribed an antibiotic. What class of antibiotics is used as an effective first-line agent in treating urinary tract infections? a. fluoroquinolones b. sulfonamides c. macrolides d. cephalosporins

Fluoroquinolones A fluoroquinolone is a routine choice for short-course therapy of uncomplicated, mild to moderate UTIs. Ciprofloxacin is a fluoroquinolone commonly used to treat UTIs. The other classifications are not used as commonly. (Fluoroquinolones include ciprofloxacin (Cipro), gemifloxacin(Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), and ofloxacin (Floxin).) (Some may develop potentially permanent side effects on the tendons, muscles, joints, nerves, and central nervous system.)

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? a. Iatrogenic b. Reflex c. Urge d. Overflow

Iatrogenic Incontinence (Iatrogenic incontinence is the involuntary loss of urine due to extrinsic medical factors, predominantly medications. Reflex incontinence is the involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.)

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 a temporary pouch. In gathering information for the client, which urinary diversion would the nurse select? a. Ileal conduit b. Ureterosigmoidostomy c. Kock Pouch d. Indiana Pouch

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. Both the Kock Pouch and Indiana Pouch are continent urinary diversions. The ureterosigmoidostomy connects with the rectum for urinary drainage.)

The nurse is assisting in the development of a protocol for bladder retraining following the removal of an indwelling catheter. Which item should the nurse include? a. Implement a 2- to 3-hour voiding schedule b. Perform straight catheterization every 4 hours c. Avoid drinking fluids for 6 hours d. Encourage voiding immediately after catheter removal

Implement a 2- to 3-hour voiding schedule (Immediately after the removal of the indwelling catheter, the client is placed on a voiding schedule, usually 2 to 3 hours. At the given time, the client is instructed to void. Immediate voiding is not usually encouraged.)

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson's disease? a. Urinary retention b. Incontinence c. Incomplete bladder emptying d. Urgency

Incontinence Incontinence is noted in clients diagnosed with Parkinson's disease. Urinary retention is associated with spinal cord injury. Urgency is associated with an overactive bladder. Incomplete bladder emptying is associated with diabetes mellitus.

The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? a. Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. b. Limit voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system. c. Add calcium supplements to the diet to replace losses to renal calculi. d. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi.

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 nurse caring for a patient with a neurogenic bladder knows to assess for the major complications of: a. Consistent pain b. Permanent distention c. Infection d. Daily and painful spasms

Infection Infection is caused by an increase urinary bacterial count that results from incomplete and delayed emptying of the bladder.

The treatment of choice for a spinal cord-injured patient with impaired bladder emptying would include which of the following? a. Intermittent self-catheterization b. No catheterization is necessary c. Indwelling catheterization d. Condom catheterization

Intermittent self-catheterization Intermittent self-catheterization is the treatment of choice in patients with spinal cord injury and other neurologic disorders, such as multiple sclerosis (MS), when the ability to empty the bladder is impaired.

A client comes to the emergency department complaining of a sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? a) Ureter b) Kidney c) Bladder d) Urethra

Kidney (The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.)

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? a. Structural defects in the kidneys b. Location of discomfort c. Abnormalities in urine Elevated calcium levels

Location of discomfort (The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.)

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: a. A stricture or tumor in the bladder. b. Uninhibited detrusor contractions. c. Loss of motor control of the detrusor muscle. d. Compromised ligament and pelvic floor support of the urethra.

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. These patients also experience hyperreflexia in the absence of normal sensations associated with voiding.)

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? a. Low oxalate b. High sodium c. Low purine d. High protein

Low purine (A low-purine diet is used for uric acid stones; the benefits, however, are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.)

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

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. Determining the client's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the preoperative procedure.)

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? a. Monitor urine output hourly and report output less than 30 mL/hr. b. Turn the patient every 2 hours around the clock. c. Administer pain medication every 2 hours. d. Clean the stoma with soap and water after the patient voids.

Monitor urine output hourly and report output less than 30 mL/hr. (In 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.)

The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? a. New diagnosis of urosepsis b. Diagnostic studies reporting bladder stones c. A white blood count of 12,000 cells/mm3 d. Crusted drainage around the cystoscopy tube

New diagnosis of urosepsis All of the options are typical risk factors for a client with a cystoscopy tube. The most concerning risk factor is urosepsis, which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream.

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

Perform meticulous perineal care daily with soap and water. (Cleanliness of the area will reduce the potential for infection. A strict aseptic technique must be used when inserting a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's port to obtain specimens. The catheter bag must never be placed on the client's abdomen unless it is clamped because it may cause urine to flow back from the tubing into the bladder.)

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? a. Stoma ischemia b. Postoperative pneumonia c. Peritonitis d. Stoma retraction

Peritonitis Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? a. Permanent drainage with a urethral catheter b. Credé voiding procedure c. Suprapubic cystostomy tube Clean intermittent catheterization

Permanent drainage with a urethral catheter (Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones, renal diseases, bladder infections, and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream.) (Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention.) (The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.)

Which medication may be ordered to relieve discomfort associated with a urinary tract infection?

Phenazopyridine

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? a. Physical and environmental conditions b. Occupational history c. History of allergies d. Smoking habits

Physical and environmental conditions (It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the client may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.)

A client is going to have a surgical procedure called periurethral bulking to improve urinary control. Periurethral bulking is: a. a procedure that increases support to the bladder by tightening the vaginal wall under the urethra. b. placement of small amounts of collagen in urethral walls to aid the closing pressure. c. a procedure that increases the storage capacity of the bladder. d. implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination.

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. Bladder augmentation is a procedure that increases storage capacity of the bladder. Implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination is one type of surgery done to improve urinary control. Anterior repair is a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.)

Which condition or laboratory result supports a diagnosis of pyelonephritis? a. Ketonuria b. Myoglobinuria c. Pyuria d. Low white blood cell (WBC) count

Pyuria (Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria (presence of pus in the urine) and bacteriuria. The client exhibits fever, chills and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low.)

A woman comes to her healthcare provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal? a. Relieve any obstruction. b. Prevent nephron destruction. c. Relieve the pain. d. Determine the stone type.

Relieve the pain. The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? a. Risk for fluid volume excess b. Risk for infection c. Risk for altered urinary elimination d. Risk for deficient knowledge: self-catherization

Risk for infection (Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.)

Which type of incontinence refers to the involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? a. Stress b. Overflow c. Urge d. Reflex

Stress (Stress incontinence may occur with sneezing, coughing, or changing position. Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder. Urge incontinence refers to the involuntary loss of urine associated with urgency. Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.)

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

Stress urinary incontinence (SUI): involuntary urine leakage associated with specific activities (e.g., sneezing and coughing)

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? a. Be sure to take the medication with grapefruit juice. b. Take the antibiotic as well as an antifungal for the yeast infection she will probably have. c. Take the antibiotic for 3 days as prescribed. d. 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.)

A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client? a. Remind the client that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. b. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office. c. Remind the client that occasional febrile episodes are expected following ESWL. d. Tell the client to report to the ED for further assessment.

Tell the client to report to the ED for further assessment. Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.

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? a. The nursing assistant places the drainage bag on the client's abdomen for transport. b. The nursing assistant keeps the catheter and drainage bag together when moving the client. c. The nursing assistant holds the drainage bag while the client moves to the wheelchair. d. The nursing assistant places the drainage bag on the lower area of the wheelchair for transport.

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 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.)

Which is the procedure of choice for men with recurrent or complicated UTIs? a.MRI b. Transrectal ultrasonography c. CT d. IV urogram

Transrectal ultrasonography

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? a. Calcium b. Cystine c. Uric acid d. Struvite

Uric acid

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

Urinary incontinence isn't a disease. (Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.)

A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction? a. Bladder stones b. Cystitis c. Urethral stricture d. Urinary retention

Urinary retention