Med/Surg Chp 55

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 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?

urinary urgency

A client presents at the clinic with complaints of urinary retention. What question should the nurse ask to obtain additional information about the client's complaint?

when did you last urinate

The nurse is participating in a bladder retraining program for a patient who had an indwelling catheter for 2 weeks. The nurse knows that, during this process, straight catheterization, after catheter-free intervals, can be discontinued when residual urine is:

<100mL

Which client is at highest risk for developing a hospital-acquired infection?

A client with an indwelling urinary catheter

A client is prescribed amitriptyline, an antidepressant for incontinence. The nurse understands that this drug is an effective treatment because it:

Increases bladder neck resistance.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?

Increasing fluid intake to 3 L/day

The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone?

Ketoralac (Toradol)

A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to:

Loss of motor control of the detrusor muscle.

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?

Low purine

After teaching a group of students about malignant bladder tumors, the instructor determines that the teaching was successful when the students identify which of the following clients as having the greatest risk for developing a malignant bladder tumor?

History of cigarette smoking

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs?

I should take at least 1,000 mg of vitamin C each day."

Which of the following is a factor contributing to UTI in older adults?

Immunocompromise

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 is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which of the following should the nurse include?

Implementing a 2- to 3-hour voiding schedule

Which type of voiding dysfunction is seen in patients diagnosed with Parkinson's disease?

Incontinence

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the student 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

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply.

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

Which of the following is a potential cause of transient incontinence? Select all that apply.

Delirium • Restricted activity • Infection of urinary tract • Atrophic vaginitis • Stool impaction

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of:

Disturbed body image

Which of the following terms is used to refer to inflammation of the renal pelvis?

Pyelonephritis

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

Pyridium

Sympathomimetics have which of the following effects on the body?

Relaxation of bladder wall

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

Risk for infection

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

Void regularly, 5 to 8 times a day

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

Susan Hopkins, a 32-year-old administrative assistant, is being seen by a physician with the urology practice where you practice nursing. She has a history of neurogenic bladder and uses a permanent, indwelling catheter to facilitate urine elimination. What can Mrs. Hopkins consume to decrease the likelihood of bladder infection?

cranberry juice

A urinary diversion procedure follows a cystectomy and is performed to divert urine to another collecting system. In addition to the use with bladder tumors, it is also used for extensive pelvic malignancies and severe traumatic injury to the bladder. The type of urinary diversion that requires an external ostomy bag to collect the urine is called a

cutaneous urinary diversion.

Which finding is an early indicator of bladder cancer?

Painless hematuria

A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following?

By ascending infection (transurethral)

The most common presenting objective symptoms of a UTI in older adults, especially in those with dementia, include which of the following?

Change in cognitive functioning

The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include?

Change in cognitive functioning

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

A client undergoes surgery for removing a malignant tumor followed by a urinary diversion procedure. Which of the following postoperative procedures is the most important for the nurse to perform?

Maintain skin and stomal integrity

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

A physician orders cystoscopy and random biopsies of the bladder for a client who reports painless hematuria. Test results reveal carcinoma in situ in several bladder regions. To treat bladder cancer, the client will have a series of intravesical instillations of bacillus Calmette-Guérin (BCG), administered 1 week apart. When teaching the client about BCG, the nurse should mention that this drug commonly causes:

hematuria.

All of the following are risk factors toward the development of kidney stones except

hypoparathyroidism.

Bladder retraining following removal of an indwelling catheter begins with

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

A patient who has been treated with uric acid for stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient?

low purine diet

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal?

relieve the pain

A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply.

• Suspend the drainage bag off the floor. • Wash the perineal area with soap and water at least twice daily. • Empty the collection bag at least every 8 hours to reduce bacterial growth.

Which of the following medications maybe ordered to relieve discomfort associated with a urinary tract infection?

Phenazopyridine (Pyridium)

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

The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small amounts of urine. The appropriate nursing intervention is which of the following?

Change wafer and pouch.

Which of the following would be included in a teaching plan for a patient diagnosed with a urinary tract infection?

Drink liberal amount of fluids

Which of the following would be included in a teaching plan for a patient diagnosed with a UTI?

Drink liberal amount of fluids.

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.

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

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

Excessive intake of vitamin D

Patients with urolithiasis need to be encouraged to:

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

A patient undergoes surgery for removing a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which of the following?

Maintain skin and stomal integrity.

A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage?

Milk

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."

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

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

Painless gross hematuria

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:

help the client cope with the anxiety associated with changes in body image.

The nurse is conducting a community education program on urinary incontinence. The nurse determines that the participants understand the teaching when they identify which of the following as risk factors for urinary incontinence?

sedatives

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. Which of the following should the nurse inquire about with the physician before catheterization?

type and size of catheter

Ms. Simpson, age 72 years, is being seen in the clinic with a suspected bladder tumor. These tumors occur more frequently in men than women and usually affect clients 50 years of age and older. Use of tobacco products is the leading cause of bladder cancer. You are asking Ms. Simpson about symptoms that she has had that brought her to the clinic. What is the most common first symptom of a malignant tumor of the bladder?

Painless hematuria

A female client is undergoing a bladder training program as treatment for urinary incontinence. Which of the following techniques would be the most appropriate suggestion?

Performing Kegel exercises.

A male patient, who is 82 years of age, suffers from urinary incontinence. Which of the following factors should the nurse assess before beginning a bladder training program for the patient?

Physical and environmental conditions

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?

Stress

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 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 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