Chapter 49: Management of Patients with Urinary Disorders

Which term refers to inflammation of the renal pelvis? Cystitis Urethritis Interstitial nephritis Pyelonephritis

Pyelonephritis

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

"Make sure to eat enough fiber to prevent constipation."

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? Impaired urinary elimination Acute pain Risk for infection Imbalanced nutrition: Less than body requirements

Acute pain

The nurse is caring for a client with an ileal conduit is created 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 Exercises to promote sphincter control Irrigating the urinary diversion Intermittent catheterizations

Application of an ostomy pouch

Which objective symptom of a UTI is most common in older adults, especially those with dementia? Back pain Change in cognitive functioning Incontinence Hematuria

Change in cognitive functioning

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

Change the wafer and pouch.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence? Obstruction due to fecal impaction or enlarged prostate Decreased pelvic muscle tone due to multiple pregnancies Bladder irritation related to urinary tract infections Increased urine production due to metabolic conditions

Decreased pelvic muscle tone due to multiple pregnancies

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 Consulting with a dietitian Giving the client a glass of soda before bedtime Taking the client to the bathroom twice per day

Encouraging intake of at least 2 L of fluid daily

Which of the following is a cause of a calcium renal stone? Foreign bodies Gout Neurogenic bladder Excessive intake of vitamin D

Excessive intake of vitamin D

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

Iatrogenic

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? Kock Pouch Ileal conduit Indiana Pouch Ureterosigmoidostomy

Ileal conduit

A client is recovering from the creation of an ileal conduit with stents. Which action(s) will the nurse take if the conduit and stents stop draining urine? Select all that apply. Apply external pressure around the stoma. Remove the skin barrier around the stoma. Change the collection bag. Irrigate the stents with 5 to 10 mL sterile normal saline. Insert a catheter through the stoma.

Irrigate the stents with 5 to 10 mL sterile normal saline. Insert a catheter through the stoma.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an IV 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 a normal finding caused by blood loss during surgery. It's a normal finding associated with the client's nothing-by-mouth status. It's an abnormal finding that requires further assessment. It's an abnormal finding that will correct itself when the client ambulates.

It's an abnormal finding that requires further assessment.

An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client? Occupational history Smoking habits History of allergies Physical and environmental conditions

Physical and environmental conditions

Patients with urolithiasis need to be encouraged to: Increase their fluid intake so that they can excrete up to 4 liters every day. Limit their voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. Supplement their diet with calcium needed to replace losses to renal calculi.

Limit their voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system.

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

Location of discomfort

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

Low-purine diet

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? Maintain skin and stomal integrity. Determine the client's ability to manage stoma care. Show photographs and drawings of the placement of the stoma. Suggest a visit to a local ostomy group.

Maintain skin and stomal integrity.

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. Turn the patient every 2 hours around the clock. Clean the stoma with soap and water after the patient voids. Administer pain medication every 2 hours.

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

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? Urinary retention Frequency Painless hematuria Fever

Painless hematuria

Which finding is an early indicator of bladder cancer? Dysuria Nocturia Occasional polyuria Painless hematuria

Painless hematuria

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use clean technique during insertion Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens 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

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? Stoma ischemia Postoperative pneumonia Stoma retraction Peritonitis

Peritonitis

The nurse is preparing to assess a client's new stoma. Which finding would the nurse include in the documentation of a healthy stoma? Black color Pain Dry in appearance Pink color

Pink color

Sympathomimetics have which of the following effects on the body? Constriction of pupils Constriction of bronchioles Decrease of heart rate Relaxation of bladder wall

Relaxation of bladder wall

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 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. Be sure to take the medication with grapefruit juice.

Take the antibiotic for 3 days as prescribed.

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

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

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 keeps the catheter and drainage bag together when moving the client. The nursing assistant holds the drainage bag while the client moves to the wheelchair. The nursing assistant places the drainage bag on the client's abdomen for transport. 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.

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. The skin wasn't lubricated before the pouch was applied. A skin barrier was applied properly. Stoma dilation wasn't performed.

The pouch faceplate doesn't fit the stoma.

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? Acute glomerulonephritis Urinary calculi Renal cell carcinoma Ureteral stricture

Urinary calculi

Bladder retraining following removal of an indwelling catheter begins with encouraging the client to void immediately. advising the client to avoid urinating for at least 6 hours. instructing the client to follow a 2- to 3-hour timed voiding schedule. performing straight catheterization after 4 hours.

instructing the client to follow a 2- to 3-hour timed voiding schedule.

A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage? Milk Coffee Cranberry juice Prune juice

milk

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: limit oral fluid intake for 1 to 2 weeks. report the presence of fine, sandlike particles through the nephrostomy tube. notify the physician about cloudy or foul-smelling urine. report bright pink urine within 24 hours after the procedure.

notify the physician about cloudy or foul-smelling urine.

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

stress

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? Stress Functional Urge Overflow

urge