Chapter 59: Caring for Clients with Disorders of the Bladder and Urethra

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?

"When did you last urinate?"

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.

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

A nurse is teaching a client how to do Kegel exercises. Place in order from first to last the correct steps in performing these exercises.

-Sit or stand with legs slightly apart. -Draw in perivaginal muscles and anal sphincter as when controlling voiding or defecating. -Hold position of contraction for 5 seconds (count or time with a watch). -Relax contraction for at least 10 seconds. -Repeat exercises 5 to 6 times, increasing slowly to 25 times.

The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day?

2,000 mL

A client who was involved in an MVA which resulted in paraplegia is working toward living at home. The client is currently developing an individualized CIC schedule, preferring not to wear a leg bag. What is the maximum amount of urine the client should allow to collect before catheterization?

350 mL

Which client is at highest risk for developing a hospital-acquired infection?

A client with an i1619

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?

Assessing present voiding patterns

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia?

Change in cognitive functioning

Which objective symptom of a UTI is most common in older adults, especially those with dementia?

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?

Change the wafer and pouch.

A client being treated in the hospital has been experiencing occasional urinary retention. What voiding trigger technique would help this client?

Dipping the client's hands in warm water

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection?

Drink liberal amount of fluids.

The nurse is caring for a client with cystitis. Which adjunct therapy is the nurse most correct to suggest to keep bacteria from adhering to the wall of the bladder?

Drinking cranberry juice

A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image?

Encourage the client to speak openly and frankly about the diversion.

Resection of a client's bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following?

Hold the solution in the bladder for 2 hours before voiding.

The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which item should the nurse include?

Implement a 2- to 3-hour voiding schedule

The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response?

Inform the primary care provider that the vascular supply may be compromised.

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, thereby reducing swelling and facilitating passage of the stone?

Ketoralac (Toradol)

A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population?

Limit the use of indwelling urinary catheters.

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-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.

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.

A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize?

Pain management

Which of the following is the most common symptom of bladder cancer?

Painless gross hematuria

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection?

Perform meticulous perineal care daily with soap and water

Which medication may be ordered to relieve discomfort associated with a UTI?

Phenazopyridine

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?

Physical and environmental conditions

A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?

Pyridium

A client with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the client's plan of care?

Risk for infection related to presence of an indwelling urinary catheter

A client has just been diagnosed with acute pyelonephritis. What education would the nurse offer this client regarding fluids?

Significantly increase fluid intake.

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?

Smoking cessation

A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care?

Strain the client's urine following the procedure.

A 42-year-old woman comes to the clinic reporting occasional urinary incontinence when sneezing. The clinic nurse should recognize what type of incontinence?

Stress incontinence

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 for 3 days as prescribed.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

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

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?

Tell the client to report to the ED for further assessment.

A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic?

The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy

A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults?

Urinary incontinence is not considered a normal consequence of aging.

The nurse provides care for a client who is prescribed bladder retraining following urinary catheterization. Complete the following sentence by choosing from the lists of options. The nurse should first ask the client to <______________> then perform the prescribed <______________>

Urinate Bladder Scan

The nurse recognizes that test results that most likely indicate a urinary tract infection include:

WBC 50

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:

an incontinent urinary diversion.

Which factor contributes to UTI in older adults?

immunocompromise

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. What should the nurse discuss with the health care provider before catheterization?

type and size of the catheter to be used

A client who has a history of neurogenic bladder presents with fever, burning on urination, and suprapubic pain. What would the nurse suspect is the problem?

urinary tract infection