Exam 2--Ch 55: Management of Patients With Urinary Disorders

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?" Explanation: The nurse needs to determine the last time the client voided.

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?

Application of an ostomy pouch Explanation: 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.

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?

By ascending infection (transurethral) Explanation: The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.

Which of the following is a cause of a calcium renal stone?

Excessive intake of vitamin D Explanation: Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? You Selected: Risk for infection Correct response: Risk for infection Explanation: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? You Selected: Risk for infection Correct response: Risk for infection Explanation: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.

Which of the following accounts for the majority of ureteral injuries?

Gunshot wounds Explanation: Gunshot wounds account for 95% of ureteral injuries, which may range from contusions to complete transection. Unintentional injury to the ureter may occur during gynecologic or urologic surgery. Knife wounds and sports injuries do not account for the majority of ureteral injuries.

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease?

Incontinence Explanation: Incontinence is noted in clients diagnosed with Parkinson disease. Urinary retention is associated with spinal cord injury. Urgency is associated with an overactive bladder. Incomplete bladder emptying is associated with diabetes mellitus.

The treatment of choice for a spinal cord-injured patient with impaired bladder emptying would include which of the following?

Intermittent self-catheterization Explanation: Intermittent self-catheterization is the treatment of choice in patients with spinal cord injury and other neurologic disorders, such as multiple sclerosis (MS), when the ability to empty the bladder is impaired.

Sympathomimetics have which of the following effects on the body?

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

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis?

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

Which of the following nursing actions is most important in caring for the client following lithotripsy?

Strain the urine carefully for stone fragments. Explanation: The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.

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

Stress Explanation: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position. Reflex incontinence is the involuntary loss of urine because of hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.

In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the client's residual urine must be less than which amount?

100 mL Explanation: Residual urine less than 100 mL indicates that the suprapubic catheter can be discontinued. If the client complains of discomfort or pain, however, the suprapubic catheter is usually left in place until the client can void successfully.

The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client?

Coffee in the morning Explanation: The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and countered toward the daily fluid total.

Which nursing diagnosis is appropriate for the client with a new ileal conduit?

Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity Explanation: 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 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 Explanation: 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.

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?

Hematuria Explanation: 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.

The nurse advises the patient with chronic pyelonephritis that he should:

Increase fluids to 3 to 4 L/24 hours to dilute the urine. Explanation: 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.

Patients with urolithiasis need to be encouraged to:

Increase their fluid intake so that they can excrete 2.5 to 4 liters every day. Explanation: Fluids need to be increased up to 4 L/day to help prevent additional stone formation.

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?

Kidney Explanation: 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.

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?

Low purine Explanation: A low-purine diet is used for uric acid stones; the benefits, however, 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.

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?

Medication usage Explanation: It is essential to assess the client'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 client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.

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

Phenazopyridine Explanation: Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

A patient has a suprapubic catheter inserted postoperatively. What would be the advantages of the suprapubic catheter versus a urethral catheter?

The patient can void sooner than with a urethral catheter. The suprapubic catheter allows for more mobility. The suprapubic catheter permits measurement of residual urine without urethral instrumentation. Explanation: Suprapubic drainage offers certain advantages. Patients can usually void sooner after surgery than those with urethral catheters, and they may be more comfortable. The catheter allows greater mobility, permits measurement of residual urine without urethral instrumentation, and presents less risk of bladder infection.

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

WBC 50 Explanation: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.

Which of the following accounts for the majority of ureteral injuries? You Selected: Unintentional injuries Correct response: Gunshot wounds Explanation: Gunshot wounds account for 95% of ureteral injuries, which may range from contusions to complete transection. Unintentional injury to the ureter may occur during gynecologic or urologic surgery. Knife wounds and sports injuries do not account for the majority of ureteral injuries.

Which of the following accounts for the majority of ureteral injuries? You Selected: Unintentional injuries Correct response: Gunshot wounds Explanation: Gunshot wounds account for 95% of ureteral injuries, which may range from contusions to complete transection. Unintentional injury to the ureter may occur during gynecologic or urologic surgery. Knife wounds and sports injuries do not account for the majority of ureteral injuries.

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.

"I will never have another urinary stone again." "I need to take allopurinol." "Tylenol is best to control my pain." "I'm so glad I don't have to make any changes in my diet." Explanation: 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 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?

Relieve the pain. Explanation: The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.

A client has just undergone a urinary diversion procedure. What management issues related specifically to urinary diversion would be included in this client's care plan?

Observe for leakage of urine or stool from the anastomosis. Maintain renal function. Assess for signs and symptoms of peritonitis. Explanation: Management issues related specifically to urinary diversion procedures include observing for leakage of urine or stool from the anastomosis, maintaining renal function, assessing for signs and symptoms of peritonitis, maintaining integrity of the urinary diversion and urine collection devices, maintaining skin and stomal integrity, promoting a positive body image, and teaching the client how to manage the diversion. Oral intake is important for any postoperative patient after it is approved by the physician; however, this is not specific to the care of the urinary diversion client.

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?

Urinary calculi Explanation: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?

Anticholinergic Explanation: 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.

The nurse is conducting discharge teaching for a client who was admitted with a kidney stone. The nurse includes which instruction as a measure to prevent additional kidney stones?

Avoid drinking tea. Explanation: The nurse should teach the client to avoid tea and other oxalate-containing foods, such as spinach, strawberries, rhubarb, peanuts, and wheat bran. The client should restrict protein intake to 60 g/day and should drink two glasses of water at bedtime. Low-calcium diets are generally not recommended.

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

Change in cognitive functioning Explanation: The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these clients 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.

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:

Loss of motor control of the detrusor muscle. Explanation: 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.

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?

Peritonitis Explanation: Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.

Which term refers to inflammation of the renal pelvis?

Pyelonephritis Explanation: 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.

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

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

The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement?

Void immediately after sexual intercourse. Explanation: Voiding flushes the urethra, expelling contaminants. Showers are encouraged, rather than tub baths, because bacteria in the bath water may enter the urethra. Coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants should be avoided. The client should be encouraged to void every 2 to 3 hours during the day and completely empty the bladder.

Which of the following is a cause of a calcium renal stone? You Selected: Neurogenic bladder Correct response: Excessive intake of vitamin D Explanation: Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.

Which of the following is a cause of a calcium renal stone? You Selected: Neurogenic bladder Correct response: Excessive intake of vitamin D Explanation: Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.

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 Explanation: The most common objective finding is a change in cognitive functioning, especially in those with dementia; these clients 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.

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?

Acute pain Explanation: 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 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?

Ileal conduit Explanation: 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 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?

Painless hematuria Explanation: 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 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 places the drainage bag on the client's abdomen for transport. Explanation: 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.

A client has a suspected bladder tumor. What is the most common first symptom of a malignant tumor of the bladder?

painless hematuria Explanation: 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.

A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction?

Urinary retention Explanation: Urinary retention and urinary incontinence are voiding dysfunctions, temporary or permanent alterations in the ability to urinate normally. Cystitis is an infectious disorder. Bladder stones and urethral stricture are obstructive disorders.

Which metabolic defects are associated with stone formation?

Hyperparathyroidism Explanation: Metabolic defects such as hyperparathyroidism and hyperuricemia (gout) are associated with stone formation. Hypoparathyroidism, hyperthyroidism, and hypouricemia are not associated with stone formation.

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

Iatrogenic Explanation: Iatrogenic incontinence is the involuntary loss of urine due to extrinsic medical factors, predominantly medications. Reflex incontinence is the involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.

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

Painless gross hematuria Explanation: 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 has been admitted for an outpatient cystoscopy because of a suspected interstitial cystitis. Which statement best describes the pathology of this disorder?

The bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa. Explanation: With interstitial cystitis, the bladder wall contains multiple pinpoint hemorrhagic areas that join and form larger hemorrhagic areas that may progress to fissuring and scarring of the bladder mucosa. A common cause of urethritis in men is infection with Chlamydia trachomatis. Cystitis is usually caused by bacterial infection. The surface of the bladder becomes edematous and reddened, and ulcerations may develop. With urinary incontinence, the bladder can contract without warning, fail to accommodate adequate volumes of urine, or fail to empty completely. Reference:

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?

When the medication is discontinued or changed, the incontinence will resolve. Explanation: 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.

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?

Diabetes mellitus Explanation: Increased urinary glucose levels create an infection-prone environment in the urinary tract.

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? You Selected: Acute glomerulonephritis Correct response: Urinary calculi Explanation: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

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? You Selected: Acute glomerulonephritis Correct response: Urinary calculi Explanation: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

One of the potential problems for a client with a urinary diversion is disturbed body image related to change in appearance and function. The expected outcome is that the client will accept the altered appearance and perform self-care. Which activities would help in achieving that expected outcome?

Reassure the client that nursing staff will provide care until he or she is ready. Discuss the change in function and let the client know what to expect when recovery from surgery is complete. Help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice. Explanation: The following are all activities that would help in achieving the expected outcome: reassure the client that nursing staff will provide care until he or she is ready; discuss the change in function and let the client know what to expect when recovery from surgery is complete; and help the client gain independence by reinforcing that self-care is quite manageable and providing time for practice. Gradual exposure is part of rehabilitation. The nurse supports the client's process.

The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client? You Selected: Ginger ale at dinner time Correct response: Coffee in the morning Explanation: The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and countered toward the daily fluid total.

The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client? You Selected: Ginger ale at dinner time Correct response: Coffee in the morning Explanation: The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and countered toward the daily fluid total.