Chapter 55: Management of Patients With Urinary Disorders NCLEX

Patricia O'Connor, a 17-year-old high school student, is returning to the medical-surgical unit where you practice nursing from surgery. She has just undergone an appendectomy. She reports the need to urinate and cannot do so. What is your response to her situation as ordered by the physician? a) Intermittent catheterization b) Clean intermittent catheterization c) Indwelling catheterization d) All options are correct.

A (Acute retention that is likely to resolve quickly (e.g., after anesthesia) probably will be treated by intermittent catheterization.)

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

A (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 of the following is the most common symptom of bladder cancer? a) Painless gross hematuria b) Altered voiding c) Back pain d) Pelvic pain

A (Painless gross hematuria is the most common symptom of bladder cancer. Pelvic and back pain may occur with metastasis. Any alteration in voiding or change in the urine may indicate cancer of the bladder.)

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? a) "Increase your fluid intake to 2 to 3 L per day." b) "Apply an antibacterial dressing to the incision daily." c) "Take your temperature every 4 hours." d) "Be aware that your urine will be cherry-red for 5 to 7 days."

A (The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.)

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a) The client keeps the drainage bag below the bladder at all times. b) The client loops the drainage tubing below its point of entry into the drainage bag. c) The client sets the drainage bag on the floor while sitting down. d) The client clamps the catheter drainage tubing while visiting with the family.

A (To maintain effective drainage, the client should keep the drainage bag below the bladder; doing so allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because the bag could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.)

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) Urge b) Functional c) Stress d) Overflow

A (Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an overdistended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.)

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 will never have another urinary stone again." b) "Tylenol is best to control my pain." c) "I'm so glad I don't have to make any changes in my diet." d) "I need to drink eight to ten glasses of water every day." e) "I need to take allopurinol."

A, B, C, E (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.)

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) Urinary retention c) Risk for impaired skin integrity d) Disturbed body image e) Chronic pain

A, C, D (Deficient knowledge, disturbed body image, and risk for impaired skin integrity are expected problems for the client with a new ileal conduit. Urinary retention and chronic pain are not expected client problems.)

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

A, C, E (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.)

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

B (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.)

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? a) Incontinence b) Hematuria c) Dysuria d) Frequency

B (The most common first symptom of a malignant tumor is hematuria. Most malignant tumors are vascular; thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of incontinence (a later sign), dysuria and frequency.)

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) Painless hematuria c) Frequency d) Fever

B (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.)

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

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

B (The nurse would instruct the nursing assistant to maintain the drainage bag lower than the genital region to avoid a 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.)

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) Kock Pouch d) Indiana Pouch

B (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.)

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? a) High protein b) Low oxalate c) Low purine d) High sodium

C (A low-purine diet is used for uric acid stones, although the benefits 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 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) Deep flank and abdominal pain b) Muscle spasm and abdominal rigidity over the flank c) Painless, gross hematuria d) Decreasing kidney function associated with fever and hematuria

C (Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.)

Which of the following is a characteristic of a normal stoma? a) Painful b) Dry in appearance c) Pink color d) No bleeding when cleansing stoma

C (Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.)

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) Stoma retraction c) Peritonitis d) Postoperative pneumonia

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

Which finding is an early indicator of bladder cancer? a) Nocturia b) Occasional polyuria c) Painless hematuria d) Dysuria

C (Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.)

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

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

Ms. Simpson, age 72 years, is being seen in the clinic with a suspected bladder tumor. You are asking Ms. Simpson about symptoms that she has had that brought her to the clinic. What is the most common first symptom of a malignant tumor of the bladder? a) Urgency b) Fever c) Painless hematuria d) Dysuria

C (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.)

When describing the types of bladder tumors that may occur, which type would the nurse identify as most common? a) Squamous cell carcinoma b) Adenocarcinoma c) Transitional cell carcinoma d) Papillary carcinoma

C (The most common type of bladder tumor is a transitional cell carcinoma which develops in the bladder's epithelial lining. The tumors are classified as papillary or nonpapillary. Papillary lesions are superficial and extend outward from the mucosal layer. Nonpapillary tumors are solid growths that grow inward, deep into the bladder wall. This type is more likely to metastasize, usually to the lymph nodes, liver, lungs, and bone. Other types include squamous cell carcinoma and adenocarcinoma.)

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

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

C (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.)

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

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

D (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 is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to: a) assess whether the client is a good candidate for surgery. b) assess suicidal risk postoperatively. c) evaluate the client's need for mental health intervention. d) help the client cope with the anxiety associated with changes in body image.

D (Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the client at risk for suicide. Although evaluating the need for mental health intervention is always important, this client displays no behavioral changes that suggest intervention is necessary at this time.)

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

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

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

D (Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.)

Which of the following terms is used to refer to inflammation of the renal pelvis? a) Urethritis b) Cystitis c) Interstitial nephritis d) Pyelonephritis

D (Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.)

The nurse, in assessing a patient's newly created stoma, observes that the stoma color is now dark purple. The appropriate nursing intervention is to do which of the following? a) Remove the urinary stents. b) Apply Karaya powder. c) Change the pouching system. d) Contact the physician.

D (The appropriate nursing intervention when a newly created stoma is dark purple is to notify the physician. The physician or wound, ostomy, and continence (WOC) nurse will assess the stoma to determine if it the stoma has superficial ischemia or if it is necrotic.)

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

D (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.)

The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small amounts of urine. The appropriate nursing intervention is which of the following? a) Empty the pouch. b) Secure/patch it with tape. c) Secure/patch with barrier paste. d) Change wafer and pouch.

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