Management of Patients With Urinary Disorders

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

"Increase your fluid intake to 2 to 3 L per day." (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.)

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?

"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.)

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?"

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

Strain the urine carefully for stone fragments.

A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing?

Stress incontinence (Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position (Meiner, 2011; Miller, 2012).)

The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest?

A low-purine diet

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 patient taking an alpha-adrenergic medication for the treatment of hypertension is having a problem with incontinence. What does the nurse tell the patient?

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.

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

Perform meticulous perineal care daily with soap and water

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?

Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.

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?

Urge

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

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

Bladder retraining following removal of an indwelling catheter begins with

instructing the client to follow a 2- to 3-hour timed voiding schedule.

Which medication may be ordered to relieve discomfort associated with a urinary tract infection?

Phenazopyridine (Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.)

The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet?

"I should limit my intake of meat and fish."

Which of the following is a strategy to promote urinary continence?

Void regularly, 5 to 8 times a day

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

Excessive intake of vitamin D

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence?

Decreased pelvic muscle tone due to multiple pregnancies

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?

Detects calculi, cysts, or tumors (Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.)

Patients with urolithiasis need to be encouraged to:

Increase their fluid intake so that they can excrete 2.5 to 4 liters every day.

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 (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.)

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

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 (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.)

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

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.)

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

Pyridium

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

Sympathomimetics have which of the following effects on the body?

Relaxation of bladder wall

Which term refers to inflammation of the renal pelvis?

Pyelonephritis

Which of the following would be least appropriate to suggest to a client with a urinary diversion to control odor?

Eat plenty of cheese and eggs.

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 (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.)

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

Iatrogenic (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.)

The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which factor as contributing to UTIs in older adults?

Immunocompromise

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

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 (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.)

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action?

Maintain skin and stomal integrity.

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. (The most important nursing management in postoperative procedure is to maintain skin and stomal integrity to avoid further complications, such as skin infections and urinary odor.)

A client is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function?

Monitor the client's intake and output.

An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client?

Physical and environmental conditions (It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the client 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.)

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

Risk for infection

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do?

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.)

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?

The urethra

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 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?

Painless, gross hematuria

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

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?

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.)

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered?

Cloudy urine

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

A client has developed urinary incontinence and is beginning bladder training to regain control over urine elimination. The catheter would be clamped and unclamped to

promote normal bladder function.

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 (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 nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation?

Need to urinate after engaging in sexual intercourse. (Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear, urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.)

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?

Urge (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.)

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 (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.)