med surg chapter 59 disorders of bladder/urethra

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? A) Coffee in the morning B) Fruit juice midmorning C) Milk at lunch D) Ginger ale at dinner time

Ans: A Feedback: 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 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 urethra B) The bladder C) The rectum D) The ureters

Ans: A Feedback: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 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) Client's manual dexterity and vision B) History of allergy to iodine and seafood C) Dietary habits involving cholesterol-laden food D) Menstrual history

Ans: A Feedback: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.

The nurse is caring for a client diagnosed with bladder stones. The client is scheduled for a litholapaxy. Which nursing action is most important to complete prior to the procedure? A) Strain all urine B) Maintain the intake and output C) Maintain 12 hours of nothing by mouth D) Make sure that the nurse has the consent signed

Ans: A Feedback:It is most important to strain all urine up to the time of the procedure. Should the client pass the stone, the procedure may be able to be cancelled. Maintaining intake and output is important in considering fluid balance. Most clients are ordered nothing by mouth after midnight for a morning procedure. The physician is responsible for explaining the procedure and obtaining the signatures on the consent.

The nurse is employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? A) Anticholinergic B) Diuretics C) Anticonvulsant D) Cholinergic

Ans: A Feedback: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 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) Ileal conduit B) Kock Pouch C) Ureterosigmoidostomy D) Indiana Pouch

Ans: A Feedback:When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cutaneous urinary diversion. Both the Kock Pouch and Indiana Pouch are continent urinary diversions. The ureterosigmoidostomy connects with the rectum for urinary drainage.

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

Ans: A Feedback: 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 caring for a 13-year-old female client diagnosed with urethritis. Which of the following assessment answers would indicate that further instruction is needed? Select all that apply. A) "I change my sanitary napkin when it is full." B) "My mom buys just regular toilet paper." C) "I take a bubble bath a couple of times per week." D) "I clean my private area with soap and water." E) "I drink fruit drinks because I do not like water."

Ans: A, C, D Feedback:The answers that require further instruction are those that can cause urethritis. Sanitary napkins need to be changed every 3 to 4 hours and as needed. Taking a bubble bath and cleansing with soap can be irritating to the sensitive tissues. It is correct to buy tissue paper without scents and drink fruit juices.

The nurse is providing instruction in stoma care with temporary bag following an ileal conduit surgery. Which of the following instructions is accurate? Select all that apply. A) Ascorbic acid suppresses urine odors. B) Change temporary ostomy bag when it becomes three-quarters (3/4) full. C) Change the pouch every 4 to 7 days if it is a two-piece pouch. D) Change the pouch daily if it is a one-piece pouch. E) Apply an appliance deodorant to decrease odors.

Ans: A, C, E Feedback: The nurse is accurate to instruct the client that ascorbic acid and an appliance deodorant decreases odors. Also, a two-piece pouch is changed no less than one time per week. Temporary bags should be emptied when the bag becomes half full to prevent leakage and stress on the stoma site. A one-piece pouch is changed every 3 days.

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

Ans: B Feedback: 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.

An older adult male client is participating in a bladder retraining program as part of the treatment for urinary incontinence. The nurse advises him to wear barrier garments such as liners and protective pants. Which suggestion would be most appropriate to help the client maintain skin integrity? A) Avoiding the application of moisture sealant B) Exposing the affected area to air C) Using scented sprays or perfumes D) Avoiding using an electric room deodorizer

Ans: B Feedback: To maintain skin integrity to avoid skin infections, the client should be advised to wash the perineum, change linens, and expose the affected area to air. These are important measures that help avoid skin infection or irritation. The application of moisture sealant will help protect the skin, and using an electric room deodorizer helps prevent urinary odors. The client should be advised not to use scented sprays or perfumes, which can be irritating.

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? A) Douching with a vinegar solution B) Drinking cranberry juice C) Flushing the system with water D) Wiping from the urethra to rectum

Ans: B Feedback:Cranberry juice or vitamin C may be recommended to keep the bacteria from adhering to the wall of the bladder and thus promoting their excretion and enhancing the effectiveness of drug therapy. Douching is suggested for cleansing the female reproductive tract. It is always appropriate to flush the system with water; however, cranberry juice changes the pH of the urine to more acidic diminishing the number of bacteria in addition to the changes is the bladder wall. Wiping from the urethra to the rectum is helpful in prevent urinary tract infection

The nurse is caring for four clients on a urinary medical unit. For which client does the nurse need no further medical interventions? A) The client has pain of 7 out of 10 in the mid-abdomen. B) The client has a residual urine of 90 mL on a bedside ultrasound bladder scan. C) The client has a WBC count of 15,000 on recent lab reports. D) The client is unable to void in the morning hours.

Ans: BFeedback:A residual urine in the bladder of 90 mL is not considered urinary retention and would need no further follow-up at this time. Client symptoms of pain need a medical order for medication. An elevated WBC count would need the attention of the physician. The client should be able to void in the morning hours especially after the night. Further interventions may be necessary.

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? A) Suprapubic cystostomy tube B) Permanent drainage with a urethral catheter C) Clean intermittent catheterization D) Credé voiding procedure

Ans: B Feedback:Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones; renal diseases; bladder infections; and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.

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 frequency B) Urinary urgency C) Urinary incontinence D) Urinary stasis

Ans: B Feedback: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 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) Stress B) Urge C) Overflow D) Functional

Ans: B Feedback: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.

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) Low oxalate B) Low purine C) High protein D) High sodium

Ans: B Feedback: 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.

. The nurse is caring for several clients on a urinary medical unit. Which client is at an increased risk for bladder stones? A) The client with frequent urinary tract infections B) The client who is paraplegic C) The client with difficulty ambulating D) The client with abdominal surgery

Ans: B Feedback: The client who is immobile or who is paraplegic may also tend to form bladder stones. Clients with incomplete urinary elimination, urinary stasis, or concentrated urine are at higher risk for stone formation. There is not as strong correlation between infections, difficulty ambulating, and surgery

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) A low-sodium diet B) A low-purine diet C) A diet high in fruits and vegetables D) A diet high in calcium

Ans: B Feedback: The nurse would suggest a low-purine diet. Foods to avoid are anchovies, animal organs and sardines. The other options do not lower the uric acids levels.

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) Increases contraction of the detrusor muscle B) Increases bladder neck resistance C) Reduces bladder spasticity D) Decreases involuntary bladder contractions

Ans: B,D Feedback: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 caring for a client with a urinary tract infection and a urethral stricture. Which complication of the condition is the primary cause of infection? A) The bladder mucosa attracts bacteria. B) There is a backflow of urine causing a diverticulum. C) Urine leakage occurs as urine passes through the stricture. D) Urine production is limited due to the urine remaining in the bladder.

Ans: BFeedback:It is common for a client with a stricture to have a urinary tract infection due to the backflow of urine and the stasis of the urine, causing an outpouching or diverticulum. Interstitial cystitis is an inflammatory disease where bacteria cling to the bladder mucosa. Urine leakage is characteristic in urinary incontinence. Urine production is impacted, urine excretion is impacted.

The nurse is caring for a client with chronic bladder infections and inflammation. The physician has ruled out several medical diagnoses and is considering interstitial cystitis. The nurse is most correct to anticipate which diagnostic test to confirm the disorder? A) A cystoscopy B) A voiding cystourethrogram C) A bladder biopsy D) A potassium sensitivity test

Ans: C Feedback: A bladder biopsy of the bladder mucosa reveals an inflammatory process with scarring and hemorrhagic areas and confirms the diagnosis. A cystoscopy reveals an inflamed bladder, bladder mucosa with pinpoint hemorrhages and a bladder capacity smaller than normal. A voiding cystourethrogram demonstrates a small bladder capacity. A potassium sensitivity test reveals pain from the potassium instilled and is used in suggesting the presence of bladder inflammation and irritation.

The nurse is caring for a 37-year-old female client with potential interstitial cystitis. Which question, asked by the nurse, is helpful in suggesting the disease? A) "Have you noted any unusual vaginal drainage?" B) "Have you experienced hematuria with cramping?" C) "When was your last menstrual period?" D) "Do you drink alcoholic beverages on a frequent basis?"

Ans: C Feedback:Although the cause of interstitial cystitis is unknown, there appears to be a connection with female hormones as a link between flare-ups prior to menstruation has been noted. Unusual vaginal drainage is a symptom of a sexually transmitted disease. Hematuria is a symptom of many urinary tract disorders and not helpful in specifically suggesting interstitial cystitis. Alcoholic beverage consumption is not an indicator.

The nurse is caring for a client who is following a treatment plan to decrease urinary tract infections. Which of the following indicates the need to change the treatment plan? A) The client has history of repeated antibiotic therapy. B) The client has improved personal hygiene methods. C) The client exhibits continued symptoms. D) The client has diluted urine.

Ans: C Feedback:If the client exhibits continued symptoms, the treatment plan is ineffective and the plan needs revised. Having a history of antibiotic therapy indicates the need to establish a treatment plan. Having improved hygiene indicates that the client is following the treatment plan. Having diluted urine indicates that the client has increased fluids which are a part of typical treatment plans.

The nurse is completing a plan of care for a client with chronic urinary incontinence. Which of the following outcomes is a priority? A) The client will decrease fluid intake to 1000 mL/day. B) The client will use the bathroom every 30 minutes while awake. C) The client will maintain perineal skin integrity. D) The client will express feelings of acceptance related to condition.

Ans: C Feedback:The nurse planning care would identify the priority outcome being to maintain skin integrity. Due to the urinary incontinence, perineal skin breakdown may occur due to the warm, moist environment. A skin barrier or moisture sealant is suggested. The nurse would not decrease fluid intake dramatically or use the bathroom every 30 minutes in a chronic condition. It is important to accept those things that cannot be controlled.

As the nurse comes from morning report, the nurse is instructed to use a bladder scanner on a client following a client's attempt at urination. The client is able to void 300 mL. The client denies any pain on urination. The nurse scans 250 mL of remaining urine in the bladder. Which entry is most correct when documenting the intervention? A) Client voided 300 mL without dysuria B) Client voided 550 mL of urine for the daylight shift C) Client voided 300 mL with 250 mL residual volume D) Bladder scanning resulted in 250 mL

Ans: C Feedback:When documenting the results of using a bladder scanner, it is best to note the amount voided and then the residual urine remaining in the bladder. This documentation enables the analysis of the client's ability to empty the bladder.

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) Dysuria C) Hematuria D) Frequency

Ans: C Feedback: 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 is caring for a male client who has a significant urinary narrowing secondary to an enlarged prostate. Which nursing action is best to relieve his urinary retention? A) Use a 22 French catheter to remove urine from bladder. B) Teach the Credé's maneuver to remove urine from the bladder. C) Insert a coudé catheter to remove urine from the bladder. D) Use a straight-tipped catheter to remove urine from the bladder.

Ans: CFeedback:The best nursing action to remove urine from the bladder is to use a curve-tipped coudé catheter. The coudé catheter has a curved tip to slide over the obstruction. Using a large catheter such as a 22 French would meet resistance and trauma to the urethral lining. A straight-tipped catheter also would meet the obstruction and not advance. The Credé's maneuver may eliminate a small amount of urine but does nothing to allow urine flow around the narrowing.

The licensed practical nurse is employed as a charge nurse at a long-term care facility. A resident is ordered a catheterization schedule of every 6 hours due to chronic urinary retention. The LPN reports daily catheterization amounts from the previous day ranging from 450 mL to 800 mL. Which nursing action is most correct? A) Continue the same order. B) Obtain an order to decrease the frequency of the catheterizations. C) Obtain an order to increase the frequency of the catheterizations. D) Leave the catheter in if obtaining a urine amount over 500 mL.

Ans: CFeedback:The charge nurse realizes that if the volume of urine obtained via catheterization is more than 400 mL, the client should be catheterized more often. The LPN would call for a change in orders citing the urine volume as the rationale. Leaving the catheter in place is only completed if necessary.

The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? A) Diagnostic studies reporting bladder stones B) Crusted drainage around the cystoscopy tube C) A white blood count of 12,000 cells/mm3 D) New diagnosis of urosepsis

Ans: D Feedback: All of the options are typical risk factors for a client with a cystoscopy tube. The most concerning risk factor is of urosepsis, which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream.

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? A) Need to wear underwear made from synthetic material B) Importance of urinating every 4 to 6 hours while awake C) Suggestion to take tub baths instead of showers D) Need to urinate after engaging in sexual intercourse

Ans: D Feedback: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.

The nurse is caring for a client who has chronic urinary retention and discussing the options. When discussing care, which intervention is considered first? A) Completing clean intermittent catheterization B) Inserting a cystostomy tube C) Applying a condom catheter D) Using the Credé's maneuver

Ans: D Feedback: When considering interventions, begin with the least invasive. The Credé's maneuver or manual voiding is completed by pressing on the bladder to further expel urine. This procedure requires no invasive measures that would increase the risk of infection. Intermittent catheterization is an invasive procedure but would remove all urine from the bladder. The most invasive is placing an indwelling catheter surgically through the abdominal wall. A condom catheter is used for males who are incontinent.

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) Fever C) Frequency D) Painless hematuria

Ans: DFeedback: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 to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? A) Set up a routine schedule of every 4 hours to check for residual urine. B) Check for residual after the client reports the urge to void. C) Record the volume of urine obtained. D) Catheterize the client immediately after the client voids.

Ans: DFeedback:To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.