PrepU Chapter 55: Urinary

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 -Intermittent catheterizations -Exercises to promote sphincter control -Irrigating the urinary diversion

-Application of an ostomy pouch 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.

Which factor contributes to UTI in older adults? -Low incidence of chronic illness -Immunocompromise -Sporadic use of antimicrobial agents -Active lifestyle

-Immunocompromise Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, frequent use of antimicrobial agents, incomplete emptying of the bladder, and obstructed urine flow.

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? -Through the bloodstream (hematogenous spread) -By ascending infection (transurethral) -Due to a fistula (direct extension) -The result of urethra abrasion (sexual intercourse)

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

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? -Establishing a predetermined fluid intake pattern for the client -Encouraging the client to increase the time between voidings -Restricting fluid intake to reduce the need to void -Assessing present voiding patterns

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

-"This medication will relieve your pain." Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

Which information is important when teaching a client how to perform self-catheterization? -Peroxide is recommended for cleaning the urinary catheter. -Catheterization should occur every 4 to 6 hours and before bedtime. -The nurse uses nonsterile technique in the hospital setting. -The catheter is rinsed with sterile normal saline after being soaked in a cleaning solution.

-Catheterization should occur every 4 to 6 hours and before bedtime. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The catheter is rinsed with tap water after being soaked in a cleaning solution. Either antibacterial soap or povidone-iodine solution is recommended for cleaning urinary catheters at home. The nurse uses sterile technique in the hospital setting.

The nurse caring for a client after urinary diversion surgery monitors the client closely for peritonitis by assessing for which sign(s)? Select all that apply. -Leukocytosis -Abdominal distention -Hyperactive bowel sounds -Muscle flaccidity

-Leukocytosis -Abdominal distention The nurse should monitor the client for the following signs and symptoms of peritonitis: leukocytosis, abdominal pain and distention, absence of bowel sounds (paralytic ileus), fever, muscle rigidity, guarding, and nausea and vomiting.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? -Abnormalities in urine -Location of discomfort -Elevated calcium levels -Structural defects in the kidneys

-Location of discomfort The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

Which medication may be ordered to relieve discomfort associated with a urinary tract infection? -Nitrofurantoin -Phenazopyridine -Ciprofloxacin -Levofloxacin

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

Which term refers to inflammation of the renal pelvis? -Pyelonephritis -Cystitis -Urethritis -Interstitial nephritis

-Pyelonephritis 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.

Sympathomimetics have which of the following effects on the body? -Relaxation of bladder wall -Decrease of heart rate -Constriction of bronchioles -Constriction of pupils

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

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? -Determine the stone type. -Relieve any obstruction. -Relieve the pain. -Prevent nephron destruction.

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

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 oxalate -Low purine -High protein -High sodium

-Low purine 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.

Which metabolic defects are associated with stone formation? -Hyperparathyroidism -Hypoparathyroidism -Hypouricemia -Hyperthyroidism

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

Which medication may be ordered to relieve discomfort associated with a UTI? -Nitrofurantoin -Phenazopyridine -Ciprofloxacin -Levofloxacin

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

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? -Stoma ischemia -Postoperative pneumonia -Stoma retraction -Peritonitis

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

Which of the following is a cause of a calcium renal stone? -Excessive intake of vitamin D -Gout -Neurogenic bladder -Foreign bodies

-Excessive intake of vitamin D 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.

The nurse advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances? -Calcium -Uric acid -Struvite -Cystine

-Uric acid Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.

A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective? -Bactrim -Cipro -Macrodantin -Septra

-Cipro Ciprofloxacin (Cipro) is a fluoroquinolone used to treat UTIs. Co-trimoxazole (Bactrim, Septra) is a trimethoprim-sulfamethoxazole combination medication. Nitrofurantoin (Macrodantin, Furadantin) is an anti-infective urinary tract medication.

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. -Urinary retention -Deficient knowledge: management of urinary diversion -Disturbed body image -Risk for impaired skin integrity -Chronic pain

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

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

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

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? -Use tub baths as opposed to showers. -Drink coffee or tea to increase diuresis. -Drink liberal amount of fluids. -Void every 4 to 6 hours.

-Drink liberal amount of fluids. Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathe in a tub because bacteria in the bathwater may enter the urethra.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? -Straight catheterize the client every 4 to 6 hours. -Administer acetaminophen (Tylenol). -Teach client to increase fluid intake up to 3 liters per day. -Restrict fluid intake to 1 liter per day.

-Teach client to increase fluid intake up to 3 liters per day. The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

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-calcium diet -High-protein diet -Low-phosphorus diet -Low-purine diet

-Low-purine diet For uric acid stones, the patient is placed on a low-purine diet to reduce the excretion of uric acid in the urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided, and other proteins may be limited.

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? -Use clean technique during insertion -Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens -Place the catheter bag on the client's abdomen when moving the client -Perform meticulous perineal care daily with soap and water

-Perform meticulous perineal care daily with soap and water Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used when inserting a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's port to obtain specimens. The catheter bag must never be placed on the client's abdomen unless it is clamped because it may cause urine to flow back from the tubing into the bladder.

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

-The nursing assistant places the drainage bag on the client's abdomen for transport. 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? -Ileal conduit -Kock Pouch -Ureterosigmoidostomy -Indiana Pouch

-Ileal conduit 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.

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? -Encourage voiding immediately after catheter removal -Avoid drinking fluids for 6 hours -Perform straight catheterization every 4 hours -Implement a 2- to 3-hour voiding schedule

-Implement a 2- to 3-hour voiding schedule Immediately after the removal of the indwelling catheter, the client is placed on a voiding schedule, usually 2 to 3 hours. At the given time, the client is instructed to void. Immediate voiding is not usually encouraged.

Which instruction would be included in a teaching plan for a client diagnosed with a UTI? -Take tub baths as opposed to showers. -Drink coffee or tea to increase diuresis. -Drink liberal amount of fluids. -Void every 4 to 6 hours.

-Drink liberal amount of fluids. Clients diagnosed with a UTI should drink liberal amounts of fluids. They should void every 2 to 3 hours. Coffee and tea are urinary irritants. The client should shower instead of bathing in a tub because bacteria in the bath water may enter the urethra.

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 -Giving the client a glass of soda before bedtime -Taking the client to the bathroom twice per day -Consulting with a dietitian

-Encouraging intake of at least 2 L of fluid daily 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.

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? -Increased urine production due to metabolic conditions -Decreased pelvic muscle tone due to multiple pregnancies -Bladder irritation related to urinary tract infections -Obstruction due to fecal impaction or enlarged prostate

-Decreased pelvic muscle tone due to multiple pregnancies Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

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 -Ureter -Bladder -Urethra

-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. Which postoperative procedure should the nurse perform? -Determine the client's ability to manage stoma care -Show photographs and drawings of the placement of the stoma -Maintain skin and stoma integrity -Suggest a visit to a local ostomy group

-Maintain skin and stoma integrity The most important postoperative nursing management is to maintain skin and stoma integrity to avoid further complications, such as skin infections and urinary odor. Determining the client'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.

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? -Diagnostic studies reporting bladder stones -Crusted drainage around the cystoscopy tube -A white blood count of 12,000 cells/mm3 -New diagnosis of urosepsis

-New diagnosis of urosepsis 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.

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? -Use a clean technique during insertion -Use a sterile technique to disconnect the catheter from the tubing to obtain urine specimens -Place the catheter bag on the client's abdomen when moving the client -Perform meticulous perineal care daily with soap and water

-Perform meticulous perineal care daily with soap and water Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used when inserting a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's port to obtain specimens. The catheter bag must never be placed on the client's abdomen unless it is clamped because it may cause urine to flow back from the tubing into the bladder.

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. -For those patients who are incontinent, insert indwelling catheters. -Perform hand hygiene prior to patient care. -Assist the patients with frequent toileting. -Provide careful perineal care. -Encourage patients to wear briefs.

-Perform hand hygiene prior to patient care. -Assist the patients with frequent toileting. -Provide careful perineal care. In institutionalized older patients, such as those in long-term care facilities, infecting pathogens are often resistant to many antibiotics. Diligent hand hygiene, careful perineal care, and frequent toileting may decrease the incidence of UTIs.

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? -Urinary retention -Fever -Frequency -Painless hematuria

-Painless hematuria 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.

A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude? -The skin wasn't lubricated before the pouch was applied. -The pouch faceplate doesn't fit the stoma. -A skin barrier was applied properly. -Stoma dilation wasn't performed.

-The pouch faceplate doesn't fit the stoma. If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

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

-"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.

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

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

Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? -Overflow -Urge -Reflex -Stress

-Stress Stress incontinence may occur with sneezing, coughing, or changing position. Overflow incontinence refers to the involuntary loss of urine associated with overdistention of the bladder. Urge incontinence refers to involuntary loss of urine associated with urgency. Reflex incontinence refers to the involuntary loss of urine due to involuntary urethral relaxation in the absence of normal sensations.

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? -Urge incontinence -Functional incontinence -Stress incontinence -Iatrogenic incontinence

-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).

Which statement describing urinary incontinence in an older adult client is true? -Urinary incontinence is a normal part of aging. -Urinary incontinence isn't a disease. -Urinary incontinence in the elderly population can't be treated. -Urinary incontinence is a disease.

-Urinary incontinence isn't a disease. Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, including diuretics, hypnotics, sedatives, anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

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 -Risk for infection -Impaired urinary elimination -Imbalanced nutrition: Less than body requirements

-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.

Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what? -Voiding at given intervals -Prompted voiding -Interval voiding -Bladder retraining

-Bladder retraining Bladder retraining includes a timed voiding schedule and urinary urge inhibition exercises. These exercises involve delaying voiding to help the patient stay dry for a set period of time. When one time interval is reached, another is set. The time is usually increased by 10 to 15 minutes, until an acceptable voiding interval is achieved.

Patients with urolithiasis need to be encouraged to: -Increase their fluid intake so that they can excrete 2.5 to 4 liters every day. -Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. -Supplement their diet with calcium needed to replace losses to renal calculi. -Limit their voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system.

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

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

-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.

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 as well as an antifungal for the yeast infection she will probably have. -Take the antibiotic for 3 days as prescribed. -Understand that if the infection reoccurs, the dose will be higher next time. -Be sure to take the medication with grapefruit juice.

-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. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.

A patient has a suprapubic catheter inserted postoperatively. What would be the advantages of the suprapubic catheter versus a urethral catheter? Select all that apply. -The suprapubic catheter can be kept in longer than a urethral catheter. -The patient can void sooner than with a urethral catheter. -The suprapubic catheter allows for more mobility. -The patient is not at risk for a UTI with a suprapubic catheter. -The suprapubic catheter permits measurement of residual urine without urethral instrumentation.

-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. 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 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 -The bladder -The rectum -The ureters

-The urethra 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.

Which is the procedure of choice for men with recurrent or complicated UTIs? -Transrectal ultrasonography -IV urogram -CT -MRI

-Transrectal ultrasonography A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs.

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? -Stress -Urge -Overflow -Functional

-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 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? -Acute glomerulonephritis -Ureteral stricture -Urinary calculi -Renal cell carcinoma

-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.

Which of the following is a strategy to promote urinary continence? -Void regularly, 5 to 8 times a day -Take diuretics after 4 PM -Use caffeine in moderation -Implement a low fiber diet

-Void regularly, 5 to 8 times a day Strategies to promote urinary continence include increasing awareness of the amount and timing of all fluid intake; avoid taking diuretics after 4 PM; avoiding bladder irritants, such as caffeine, alcohol, and aspartame (NutraSweet); taking steps to avoid constipation by drinking adequate fluids, eating a well-balanced diet high in fiber, exercising regularly, and taking stool softeners if recommended; and voiding regularly, 5 to 8 times a day (about every 2 to 3 hours).

The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include: -proteinuria -WBC 50 -RBC 3 -glucose trace

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

Which risk factors predispose a client to the development of kidney stones? Select all that apply. -immobilization. -gout. -hyperparathyroidism. -hypoparathyroidism.

-immobilization. -gout. -hyperparathyroidism. Hypoparathyroidism is not a risk factor for the development of kidney stones. Immobilization, gout, and hyperparathyroidism are risk factors.

A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: -limit oral fluid intake for 1 to 2 weeks. -report the presence of fine, sandlike particles through the nephrostomy tube. -notify the physician about cloudy or foul-smelling urine. -report bright pink urine within 24 hours after the procedure.

-notify the physician about cloudy or foul-smelling urine. The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy.

A client has a suspected bladder tumor. What is the most common first symptom of a malignant tumor of the bladder? -painless hematuria -fever -dysuria -urgency

-painless hematuria 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.