Chapter 55: Management of Patients With Urinary Disorders

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

1

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

1

The nurse is assisting in the preoperative planning for stoma placement in a client scheduled for urinary diversion surgery. Where should the nurse plan for the stoma to be located? Over a bony prominence Away from skin folds At the belt line At the umbilicus

1

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

1

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. Suggest a visit to a local ostomy group. Determine the client's ability to manage stoma care. Show photographs and drawings of the placement of the stoma.

1

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

4

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."

1

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

1

A client who has a history of neurogenic bladder presents with fever, burning, and suprapubic pain. What would the nurse suspect is the problem? urinary tract infection urinary incontinence urinary retention urethral strictures

1

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 Fruit juice midmorning Milk at lunch Ginger ale at dinner time

1

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.

2,3,4

The nurse is preparing to assess a client's new stoma. Which finding would the nurse include in the documentation of a healthy stoma? Pain Pink color Black color Dry in appearance

2

The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. Add calcium supplements to the diet to replace losses to renal calculi. Limit voiding to every 6 to 8 hours so that increased volume can increase hydrostatic pressure, which will help push stones along the urinary system.

1

Which finding is an early indicator of bladder cancer? Painless hematuria Occasional polyuria Nocturia Dysuria1

1

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? Cystitis Bladder stones Urinary retention Urethral stricture

3

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.

3

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

4

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

4

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.

3

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia? Incontinence Change in cognitive functioning Hematuria Back pain

2

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

3

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

1

A client is being treated for a malignant bladder tumor. What would be included in treatment of a small tumor? Select all that apply. resection and fulguration topical application of an antineoplastic drug cystectomy urinary diversion

1,2

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

2

Which of the following nursing actions is most important in caring for the client following lithotripsy? Monitor the continuous bladder irrigation. Administer allopurinol (Zyloprim). Strain the urine carefully for stone fragments. Notify the physician of hematuria.

3

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

3

A client is suspected of having interstitial cystitis. Which diagnostic test would the nurse anticipate as being used to confirm the diagnosis? Cystoscopy Voiding cystourethrogram Urine culture Bladder biopsy

4

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

4

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)

2

Examination of a client's bladder stones reveals 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

2

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

2

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? Hyperuricemia Pancreatitis Diabetes mellitus Hyperparathyroidism

3

Which laboratory value supports a diagnosis of pyelonephritis? Myoglobinuria Ketonuria Pyuria Low white blood cell (WBC) count

3

What is true about extracorporeal shock wave lithotripsy (ESWL)? Select all that apply. Stones are shattered into smaller particles that are passed from the urinary tract. ESWL is administered with the client in a water bath or surrounded by a soft cushion while under light anesthesia or sedation. ESWL is a ureteroscopic approach. ESWL is done while the patient is undergoing a percutaneous nephrolithotomy.

1,2

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

2

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

3

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.

2

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? Secure or patch it with tape. Empty the pouch. Change the wafer and pouch. Secure or patch it with barrier paste.

3

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."

2

The nurse is evaluating the effectiveness of discharge teaching for the client with an ileal conduit. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. "I might notice a strong urine odor if I eat eggs, cheese, or asparagus." "I cannot wait until I can have surgery to get rid of this ostomy." "I will need to change the appliance every day." "I will need to monitor the skin around my ostomy for irritation." "I will need to catheterize myself every 2 to 3 hours."

2,3,5

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? Shows damage to the kidneys If risk for chronic pyelonephritis is likely Reveals causative microorganisms Detects calculi, cysts, or tumors

4

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

4

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.

2

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.

3

The nurse has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply. Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Drink caffeinated beverages twice a day to increase urination. Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder Bathe in warm water to soak the affected area.

1,3,4

A client postoperatively reports to the nurse the need to urinate, but is unable to void. What should the nurse expect the healthcare provider to order? Select all that apply. Complete a straight catheterization. Place an indwelling catheterization. Schedule a suprapubic catheter insertion. Perform a bladder scan. Ambulate the client.

1,4

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an IV infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output? It's a normal finding caused by blood loss during surgery. It's a normal finding associated with the client's nothing-by-mouth status. It's an abnormal finding that requires further assessment. It's an abnormal finding that will correct itself when the client ambulates.

3

Which nursing diagnosis is appropriate for a client with renal calculi? Ineffective tissue perfusion (renal) Functional urinary incontinence Risk for infection Decreased cardiac output

3

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 medication has caused permanent damage to the bladder sphincter and will require surgical correction. Relaxation of the supporting ligaments has occurred and the patient will need to perform pelvic floor exercises to strengthen them. The patient will require a medication regimen to decrease the overactivity of the bladder. When the medication is discontinued or changed, the incontinence will resolve.

4