Chapter 55: Management of Patients With Urinary Disorders

Which of the following is the procedure of choice for men with recurrent or complicated urinary tract infections (UTIs)? a) Computed tomography (CT) scan b) IV urogram c) Magnetic resonance imaging (MRI) d) Transrectal ultrasonography

d) Transrectal ultrasonography A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs.

Which type of medication may be used in the treatment of a patient with incontinence to inhibit contraction of the bladder? a) Anticholinergic agent b) Over-the-counter decongestant c) Tricyclic antidepressants d) Estrogen hormone

a) Anticholinergic agent Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions as well as increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

Which of the following medications maybe ordered to relieve discomfort associated with a urinary tract infection? a) Phenazopyridine (Pyridium) b) Ciprofloxacin (Cipro) c) Levofloxacin (Levaquin) d) Nitrofurantoin (Furadantin)

a) Phenazopyridine (Pyridium) Pyridium is urinary analgesic ordered to relieve discomfort associated with a UTI. Furadantin, Cipro, and Levaquin are antibiotics.

The nurse is conducting a history and assessment related to a patient's incontinence. Which of the following should the nurse include in the assessment before beginning a bladder training program? a) Smoking habits b) Medication usage c) History of allergies d) Occupational history

b) Medication usage It is essential to assess the patient's physical and environmental conditions before beginning a bladder training program, because the patient 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 patient. It is not so essential to assess the patient's history of allergy, occupation, and smoking habits before beginning a bladder training program.

A patient taking an alpha-adrenergic medication for the treatment of hypertension is having a problem with incontinence. What does the nurse tell the patient? a) The medication has caused permanent damage to the bladder sphincter and will require surgical correction. b) Relaxation of the supporting ligaments has occurred and the patient will need to perform pelvic floor exercises to strengthen them. c) When the medication is discontinued or changed, the incontinence will resolve. d) The patient will require a medication regimen to decrease the overactivity of the bladder.

c) When the medication is discontinued or changed, the incontinence will resolve. Iatrogenic incontinence refers to the involuntary loss of urine due to extrinsic medical factors, predominantly medications. One such example is the use of alpha-adrenergic agents to decrease blood pressure. In some people with an intact urinary system, these agents adversely affect the alpha receptors responsible for bladder neck closing pressure; the bladder neck relaxes to the point of incontinence with a minimal increase in intra-abdominal pressure, thus mimicking stress incontinence. As soon as the medication is discontinued, the apparent incontinence resolves.

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

d) "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.

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

d) A client with an indwelling urinary catheter 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.

A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands which of the following reasons that this drug is an effective treatment? a) Decreases involuntary bladder contractions b) Reduces bladder spasticity c) Increases bladder neck resistance d) Increases contraction of the detrusor muscle

a) Decreases involuntary bladder contractions c) Increases bladder neck resistance Some tricyclic antidepressant medications (amitriptyline, nortriptyline, and amoxapine) are useful in treating incontinence because they decrease bladder contractions and increase bladder neck resistance. Anticholinergic drugs such as oxybutynin chloride (Ditropan) reduce bladder spasticity and involuntary bladder contractions. Bethanechol (Urecholine) helps to increase contraction of the detrusor muscle, which assists with emptying of the bladder.

The nurse is participating in a bladder retraining program for a patient who had an indwelling catheter for 2 weeks. The nurse knows that, during this process, straight catheterization, after catheter-free intervals, can be discontinued when residual urine is: a) 500 mL b) 400 mL c) <100 mL d) 200 mL

c) <100 mL Residual urine greater than 100 mL is considered diagnostic of urinary retention. Refer to Box 28-9 in the text.

The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? a) The ureters b) The rectum c) The urethra d) The bladder

c) The urethra Because the urethra is short in women, ascending infections or microorganisms carried from the vagina or rectum are common. Males have a longer urethra, causing the organisms travel farther to the bladder. Although structures of the urinary system, the other options are where the client has bacteria and microorganisms located. The ureters connect the bladder to kidney thus do not obtain bacteria, just transmit when available.

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) Frequency c) Fever d) Painless hematuria

d) 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. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.

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

a) 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.

Sympathomimetics have which of the following effects on the body? a) Relaxation of bladder wall b) Decrease of heart rate c) Constriction of pupils d) Constriction of bronchioles

a) Relaxation of bladder wall Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document? a) Urinary urgency b) Urinary frequency c) Urinary stasis d) Urinary incontinence

a) Urinary urgency The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

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."

c) "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 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) Understand that if the infection reoccurs, the dose will be higher next time. c) Take the antibiotic for 3 days as prescribed. d) 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. 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 is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? a) Assessing present voiding patterns b) Restricting fluid intake to reduce the need to void c) Establishing a predetermined fluid intake pattern for the client d) Encouraging the client to increase the time between voidings

a) Assessing present voiding patterns 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.

The nurse advises the patient with chronic pyelonephritis that he should: a) Increase fluids to 3 to 4 L/24 hours to dilute the urine. b) Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys. c) Decrease his sodium intake to prevent fluid retention. d) Decrease his intake of calcium rich foods to prevent kidney stones.

a) Increase fluids to 3 to 4 L/24 hours to dilute the urine. Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination, and prevent dehydration. A balanced diet would be recommended but there is no need to restrict sodium or calcium.

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

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

The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate the symptoms? a) Antibiotics b) Anticholinergic agents c) Antispasmodic agents d) Urinary analgesics

b) Anticholinergic agents Anticholinergic agents inhibit bladder contraction and are considered first line medications for urge incontinence.

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) Imbalanced nutrition: Less than body requirements b) Risk for infection c) Acute pain d) Impaired urinary elimination

c) Acute pain Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled. A diagnosis of Imbalanced nutrition: Less than body requirements isn't pertinent at this time.

Which of the following is a reversible cause of urinary incontinence in the older adult? a) Constipation b) Increased fluid intake c) Decreased progesterone level in the menopausal woman d) Age

a) Constipation Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in the menopausal women. Age is a risk factor for urinary incontinence, not a reversible cause. A decreased fluid intake, rather than increased fluid intake, is a reversible cause of urinary incontinence in the older adult. Decreased estrogen, not progesterone, in the menopausal woman is a reversible cause of urinary incontinence in the older woman.

Susan Morris is going to have a surgical procedure to improve urinary control. The physician has told her that the procedure is called a periurethral bulking. Ms. Morris has forgotten what the physician has told her about what type of procedure this is. What would you tell her? a) It is the placement of small amounts of collagen in urethral walls to aid the closing pressure. b) It is the implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination. c) It is a procedure that increases support to the bladder by tightening the vaginal wall under the urethra. d) It is a procedure that increases storage capacity of the bladder.

a) It is the 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.

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

c) Pyridium The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.

A urinary diversion procedure follows a cystectomy and is performed to divert urine to another collecting system. In addition to the use with bladder tumors, it is also used for extensive pelvic malignancies and severe traumatic injury to the bladder. The type of urinary diversion that requires an external ostomy bag to collect the urine is called a a) cutaneous urinary diversion. b) urethroplasty. c) continent urinary diversion. d) cystectomy.

a) cutaneous urinary diversion. A cutaneous urinary diversion requires an external ostomy bag to collect the urine. A continent urinary diversion is the creation of a reservoir within the body for urine collection. The reservoir is catheterized to drain urine. Urethroplasty is a surgical repair of the urethra. Cystectomy is a surgical removal of the bladder and is performed for large tumors that have penetrated the muscle wall.

The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include? a) Incontinence b) Change in cognitive functioning c) Back pain d) Hematuria

b) Change in cognitive functioning The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients 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 is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone? a) Meperidine (Demerol) b) Ketoralac (Toradol) c) Morphine sulfate d) Aspirin

b) Ketoralac (Toradol) Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ketorolac (Toradol), are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.

Which statement by the client who is performing self-catheterization indicates a need for further teaching? a) "I should lubricate the catheter before insertion." b) "I will wash my catheter will hot soapy water." c) "I will need a sterile catheter kit each time I self-catheterize." d) "I should perform self-catheterization every 4 to 6 hours."

c) "I will need a sterile catheter kit each time I self-catheterize." Clients who self-catheterize use clean technique in the home setting.

A client comes to the emergency department complaining of 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) Bladder b) Kidney c) Ureter d) Urethra

b) 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.

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

b) instructing the patient to follow a 2 to 3 hour timed voiding schedule. Immediately after the removal of the indwelling catheter, the patient is placed on a timed voiding schedule, usually 2 to 3 hours. At the given time interval, the patient is instructed to void. Immediate voiding is not usually encouraged. The patient is commonly placed on a timed voiding schedule, usually within 2 to 3 hours. Immediately after the removal of the indwelling catheter, the patient is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. If bladder ultrasound scanning shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed for complete bladder emptying.

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

c) Anticholinergic 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.

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) History of cigarette smoking b) History of untreated gonorrhea c) History of a sexually transmitted disease d) History of bladder inflammation

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.

The nurse is conducting a community education program on urinary incontinence. The nurse determines that the participants understand the teaching when they identify which of the following as risk factors for urinary incontinence? a) Sedatives b) Swimming c) Cesarean delivery d) Body mass index (BMI) of 22

a) Sedatives Use of sedatives, diuretics, hypnotics, and opioids are risk factors for urinary incontinence. Additional risk factors include high-impact exercises, a BMI greater than 40, and vaginal birth delivery.

James Roth, a 63-year-old accountant, is a client on the hospital unit where you practice nursing. Mr. Roth has developed urinary incontinence and is beginning bladder training to regain control over his urine elimination. Why is the catheter being clamped and unclamped? a) To promote normal bladder function b) To prevent bladder distention c) To prevent urinary retention d) To promote urine production

a) To promote normal bladder function The clamping and unclamping of the catheter begins to reestablish normal bladder function and capacity.

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. a) "I need to drink eight to ten glasses of water every day." b) "I need to take allopurinol." c) "I'm so glad I don't have to make any changes in my diet." d) "I will never have another urinary stone again." e) "Tylenol is best to control my pain."

b) "I need to take allopurinol." c) "I'm so glad I don't have to make any changes in my diet." d) "I will never have another urinary stone again." e) "Tylenol is best to control my pain." Nonsteroidal anti-inflammatory drugs are used to treat renal stone pain. Oxalate-containing foods should be avoided. Fluid intake should total 2 to 3 liters, if not contraindicated. Allopurinol (Zyloprim) is prescribed for uric acid stones. Recurrence of stones occurs in about half of individuals.

A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply. a) Irrigate the catheter every 24 hours. b) Empty the collection bag at least every 8 hours to reduce bacterial growth. c) Wash the perineal area with soap and water at least twice daily. d) Suspend the drainage bag off the floor. e) Disconnect the tubing to collect urine samples.

b) Empty the collection bag at least every 8 hours to reduce bacterial growth. c) Wash the perineal area with soap and water at least twice daily. d) Suspend the drainage bag off the floor. Never disconnect the tubing to collect samples, irrigate, or ambulate the patient since this will allow bacteria to enter the closed system. Drainage systems should have an aspiration or puncture port from which a specimen can be obtained. The drainage system should not be disconnected. See Box 28-8 in the text.

A nurse is conducting a health history on a patient who is seeing her health care 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)

c) 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.

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective? a) Macrodantin b) Bactrim c) Cipro d) Septra

c) Cipro Ciprofloxacin (Cipro) is a fluoroquinolone used to treat UTIs. Co-trimoxazole (Bactrim, Septra) is a trimethoprim-sulfamethoxazole combination medication. Nitrofurantoin (Macrodantin, Furadantin) is an anti-infective urinary tract medication.

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence? a) Taking the client to the bathroom twice per day b) Giving the client a glass of soda before bedtime c) Consulting with a dietitian d) Encouraging intake of at least 2 L of fluid daily

d) Encouraging intake of at least 2 L of fluid daily Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important? a) Administering a sitz bath twice per day b) Encouraging the client to drink cranberry juice to acidify the urine c) Using an indwelling urinary catheter to measure urine output accurately d) Increasing fluid intake to 3 L/day

d) Increasing fluid intake to 3 L/day Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

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? a) The skin wasn't lubricated before the pouch was applied. b) A skin barrier was applied properly. c) Stoma dilation wasn't performed. d) The pouch faceplate doesn't fit the stoma.

d) The pouch faceplate doesn't fit the stoma. If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

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

b) Decreased pelvic muscle tone due to multiple pregnancies Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

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? a) Ureterosigmoidostomy b) Ileal conduit c) Indiana Pouch d) Kock Pouch

b) 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.

A client is learning how to perform Kegel exercises. Which statement by the client indicates a need for additional teaching? a) "I should draw in my muscles like when I'm moving my bowels." b) "I should repeat the sequence of exercises 3 to 4 times a day." c) "I need to hold the position for at least 15 seconds." d) "I need to sit or stand with my legs slightly apart."

c) "I need to hold the position for at least 15 seconds." When performing Kegel exercises, the client should hold the position of contraction for 5 to 10 seconds and then relax contraction for at least 10 seconds. The client should sit or stand with the legs slightly apart, draw in the muscles as when controlling voiding or defecating, and repeat the sequence of exercises 3 to 4 times per day.

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

c) Maintain skin and stomal integrity The most important postoperative nursing management is to maintain skin and stomal integrity to avoid further complications, such as skin infections and urinary odor. Determining the patient'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 female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following? a) Interruption in the protective effect of glycosaminoglycan b) Disturbance in the normal bacterial flora of the vagina c) Reflux of urine from the urethra into the bladder d) Dysfunction of the bladder neck or urethra.

c) Reflux of urine from the urethra into the bladder With coughing, sneezing, or straining, the bladder pressure increases, which may force urine from the bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior portions of the urethra. See Figure 28-1 in the text.

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: a) Interval voiding b) Prompted voiding c) Voiding at given intervals. d) Bladder retraining

d) Bladder retraining 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.

The nurse is educating a patient who will be performing self-catheterization at home. What information provided by the nurse will help reduce the incidence of infection? a) A new catheter must be used each time catheterization is required. b) Insert the catheter for urine drainage three times per day. c) Sterilize the catheter by boiling it in water for 20 minutes. d) Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion.

d) Clean the catheter with antibacterial soap, thoroughly rinse and dry before reinsertion. When educating the patient about how to perform self-catheterization, the nurse must use aseptic technique to minimize the risk of cross-contamination. However, the patient may use a "clean" (nonsterile) technique at home, where the risk of cross-contamination is reduced. Either antibacterial liquid soap or povidone-iodine (Betadine) solution is recommended for cleaning urinary catheters at home. The catheter is thoroughly rinsed with warm tap water after soaking in the cleaning solution. It must dry before reuse. It should be kept in its own container, such as a plastic food storage bag.

A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively? a) Dietary habits involving cholesterol-laden food b) Menstrual history c) History of allergy to iodine and seafood d) Client's manual dexterity and vision

d) Client's manual dexterity and vision It is essential to assess manual dexterity, vision, and level of understanding of a client who undergoes a urinary diversion procedure because this information will determine the client's ability to manage stoma care and self-catheterization following the urinary diversion procedure. The client's history of allergy to iodine and seafood, dietary habits related to high cholesterol intake, and menstrual history are not important factors for this situation.

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

d) It's an abnormal finding that requires further assessment. 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.