Chapter 55: Management of Patients w/ Urinary disorders

Which term refers to inflammation of the renal pelvis? A.) Pyelonephritis B.) Cystitis C.) Urethritis D.) Interstitial nephritis

Answer: A.) Pyelonephritis

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? A.) Voiding at given intervals B.) Prompted voiding C.) Interval voiding D.) Bladder retraining

Answer: D.) Bladder retraining Rationale: 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.

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.) Low purine C.) High protein D.) High sodium

Answer: B.) Low purine

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

Answer: D.) instructing the client to follow a 2- to 3-hour timed voiding schedule. Rationale: Immediately after the removal of the indwelling catheter, the client is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. At the given time interval, the client is instructed to void. Immediate voiding is not usually encouraged. If bladder ultrasound shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed to ensure complete bladder emptying.

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.

Answer: C.) Change the wafer and pouch.

A client is admitted with nephrolithiasis. What symptoms does the nurse expect the client to experience? Select all that apply. - Difficulty starting a urine stream - Suprapubic pain - Elevated temperature - Hematuria - Constipation

Answer: - Difficulty starting a urine stream - Suprapubic pain - Elevated temperature - Hematuria

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? A.) Acute pain B.) Risk for infection C.) Impaired urinary elimination D.) Imbalanced nutrition: Less than body requirements

Answer: A.) Acute pain

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

Answer: C.) Cloudy urine Rationale: The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise.

Which type of medication may be used to inhibit bladder contraction in a client with incontinence? A.) Anticholinergic agent B.) Estrogen hormone C.) Tricyclic antidepressants D.) Over-the-counter decongestant

Answer: A.) Anticholinergic agent

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

Answer: C.) Pyridium

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.) Urinary retention B.) Fever C.) Frequency D.) Painless hematuria

Answer: D.) Painless hematuria

Which information is important when teaching a client how to perform self-catheterization? A.) Peroxide is recommended for cleaning the urinary catheter. B.) Catheterization should occur every 4 to 6 hours and before bedtime. C.) The nurse uses nonsterile technique in the hospital setting. D.) The catheter is rinsed with sterile normal saline after being soaked in a cleaning solution.

Answer: B.) Catheterization should occur every 4 to 6 hours and before bedtime.

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

Answer: B.) Change in cognitive functioning

The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which factor as contributing to UTIs in older adults? A.) Low incidence of chronic illness B.) Immunocompromise C.) Sporadic use of antimicrobial agents D.) Active lifestyle

Answer: B.) Immunocompromise Rationale: Factors that contribute to UTIs in older adults include immunocompromise, cognitive impairment, high incidence of chronic illness, immobility, incomplete emptying of the bladder, obstructed flow of urine, and frequent use of antimicrobial agents.

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? A.) Stress B.) Urge C.) Overflow D.) Functional

Answer: B.) Urge

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

Answer: C.) Drink liberal amount of fluids.

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.) Hyperuricemia B.) Pancreatitis C.) Diabetes mellitus D.) Hyperparathyroidism

Answer: C.) Diabetes mellitus Rationale: Increased urinary glucose levels create an infection-prone environment in the urinary tract.

Which of the following nursing actions is most important in caring for the client following lithotripsy? A.) Monitor the continuous bladder irrigation. B.) Administer allopurinol (Zyloprim). C.) Strain the urine carefully for stone fragments. D.) Notify the physician of hematuria.

Answer: C.) Strain the urine carefully for stone fragments.

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

Answer: D.) Assessing present voiding patterns

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.) Compromised ligament and pelvic floor support of the urethra. B.) Uninhibited detrusor contractions. C.) Loss of motor control of the detrusor muscle. D.) A stricture or tumor in the bladder.

Answer: C.) Loss of motor control of the detrusor muscle. Rationale: 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.

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? A.) Risk for altered urinary elimination B.) Risk for deficient knowledge: self-catherization C.) Risk for fluid volume excess D.) Risk for infection

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

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

Answer: B.) Take the antibiotic for 3 days as prescribed.

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

Answer: - 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 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. - For those patients who are incontinent, insert indwelling catheters. - Perform hand hygiene prior to patient care. - Assist the patients with frequent toileting. - Provide careful perineal care. - Encourage patients to wear briefs.

Answer: - Perform hand hygiene prior to patient care. - Assist the patients with frequent toileting. - Provide careful perineal care.

A client is being treated for a malignant bladder tumor. What would be included in treatment of a small tumor? Select all that apply. - resection and fulguration - topical application of an antineoplastic drug - cystectomy - urinary diversion

Answer: - resection and fulguration - topical application of an antineoplastic drug Rationale: Small, superficial tumors may be removed by cutting (resecting) or coagulation (fulguration) with a transurethral resectoscope. Topical application of an antineoplastic drug may be used after resection and fulguration of a tumor. Cystectomy is a surgical removal of the bladder and is performed for large tumors that have penetrated the muscle wall. Urinary diversion is performed after a cystectomy.

The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement? A.) Take tub baths instead of showers. B.) Void immediately after sexual intercourse. C.) Increase intake of coffee, tea, and colas. D.) Void every 5 hours during the day.

Answer: B.) Void immediately after sexual intercourse.

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.) Diuretics C.) Anticonvulsant D>) Cholinergic

Answer: A.) Anticholinergic

A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer? A.) Painless, gross hematuria B.) Deep flank and abdominal pain C.) Muscle spasm and abdominal rigidity over the flank D.) Decreasing kidney function associated with fever and hematuria

Answer: A.) Painless, gross hematuria

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.) History of allergies C.) Occupational history D.) Smoking habits

Answer: A.) Physical and environmental conditions

A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of: A.) Permanent distention B.) Infection C.) Consistent pain D.) Daily and painful spasms

Answer: B.) Infection

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? A.) It's a normal finding caused by blood loss during surgery. B.) It's a normal finding associated with the client's nothing-by-mouth status. C.) It's an abnormal finding that requires further assessment. D.) It's an abnormal finding that will correct itself when the client ambulates.

Answer: C.) It's an abnormal finding that requires further assessment. Rationale: The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour.

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

Answer: C.) Maintain skin and stoma integrity Rationale: 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.

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

Answer: D.) Perform meticulous perineal care daily with soap and water