MEDSURG PrepU Ch. 55 Urinary D/o

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

a. "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 type of medication may be used to inhibit bladder contraction in a client with incontinence? a. Anticholinergic agent b. Estrogen hormone c. Tricyclic antidepressants d. Over-the-counter decongestant

a. Anticholinergic agent Anticholinergic agents are considered first-line medications for urge incontinence. Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular, and muscular integrity of the urethra. Tricyclic antidepressants decrease bladder contractions and increase bladder neck resistance. Stress incontinence may be treated using pseudoephedrine and phenylpropanolamine, ingredients found in over-the-counter decongestants.

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? a. Maintain skin and stomal integrity. b. Suggest a visit to a local ostomy group. c. Determine the client's ability to manage stoma care. d. Show photographs and drawings of the placement of the stoma.

a. 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.

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

a. 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.

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? a. Painless, gross hematuria b. Deep flank and abdominal pain c. Muscle spasm and abdominal rigidity over the flank d. Decreasing kidney function associated with fever and hematuria

a. Painless, gross hematuria Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.

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

b. 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.

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

b. Change in cognitive functioning The most common objective finding is a change in cognitive functioning, especially in those with dementia; these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

Which condition or laboratory result supports a diagnosis of pyelonephritis? a. Myoglobinuria b. Ketonuria c. Pyuria d. Low white blood cell (WBC) count

c. Pyuria Pyelonephritis is diagnosed by the presence of pyuria, leukocytosis, hematuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Myoglobinuria is seen with any disease process that destroys muscle. Ketonuria indicates a diabetic state. Because the client with pyelonephritis typically has signs of infection, the WBC count is more likely to be high rather than low.

A female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following? a. Interruption in the protective effect of glycosaminoglycan b. Disturbance in the normal bacterial flora of the vagina c. Reflux of urine from the urethra into the bladder d. Dysfunction of the bladder neck or urethra.

c. Reflux of urine from the urethra into the bladder With urethrovesical reflux, coughing, sneezing, or straining causes the bladder pressure to increase, which may force urine from the bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior portions of the urethra.

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

d. 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 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

d. 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 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? a. Stoma ischemia b. Postoperative pneumonia c. Stoma retraction d. Peritonitis

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

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? a. Acute pain b. Risk for infection c. Impaired urinary elimination d. Imbalanced nutrition: Less than body requirements

a. 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.

Which of the following accounts for the majority of ureteral injuries? a. Crashes, falls, and assaults b. Preexisting conditions c. Knife wounds d. Work injuries

a. Crashes, falls, and assaults Gunshot wounds account for 95% of ureteral injuries, which may range from contusions to complete transection. Unintentional injury to the ureter may occur during gynecologic or urologic surgery. Knife wounds and sports injuries do not account for the majority of ureteral injuries.

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? a. Calcium b. Uric acid c. Struvite d. Cystine

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

A female client who suffers from urethral strictures undergoes a dilation procedure and experiences a burning sensation while voiding. Which nursing instruction would be most helpful? a. Encourage a visit to a local ostomy support group. b. Advise cleansing of the perineum frequently. c. Urge the application of moisture sealants. d. Instruct the use of warm sitz baths.

d. Instruct the use of warm sitz baths. Taking warm sitz baths and non-narcotic analgesics can relieve the client's discomfort while voiding. A client may be advised to visit a local stoma support group following a urinary diversion procedure. The application of moisture sealants is useful with ostomy appliances. The encouragement of frequent cleaning and washing of the perineum will protect the skin, but may not relieve the client's discomfort.

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

d. 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.

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? a. Overflow b. Urge c. Reflex d. Stress

d. 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.

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

c. 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.

A client is admitted with nephrolithiasis. What symptoms does the nurse expect the client to experience? Select all that apply. a. Difficulty starting a urine stream b. Suprapubic pain c. Elevated temperature d. Constipation e. Hematuria

a. Difficulty starting a urine stream b. Suprapubic pain c. Elevated temperature e. Hematuria Symptoms of nephrolithiasis include hematuria, suprapubic pain, difficulty starting the urinary stream, symptoms of a bladder infection, and a feeling that the bladder is not completely empty. Diarrhea and abdominal discomfort are due to renointestinal reflexes and the anatomic proximity of the kidneys to the stomach, pancreas, and large intestine. Some clients may have few or no symptoms.

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

d. Bladder biopsy A biopsy of the bladder mucosa which reveals an inflammatory process with scarring and hemorrhagic areas confirms the diagnosis. A cystoscopy would reveal a markedly inflamed bladder with pinpoint hemorrhage and a bladder capacity that is smaller than normal. A voiding cystourethrogram demonstrates a small bladder capacity. Urine culture would be negative.

Which metabolic defects are associated with stone formation? a. Hyperparathyroidism b. Hypoparathyroidism c. Hypouricemia d. Hyperthyroidism

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

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

a. 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 educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? a. Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. b. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. c. Add calcium supplements to the diet to replace losses to renal calculi. d. 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.

a. Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. A patient who has shown a tendency to form stones should drink enough fluid to excrete greater than 2,000 mL (preferably 3,000 to 4,000 mL) of urine every 24 hours.

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: a. renal calculi. b. hematuria. c. delayed ejaculation. d. impotence.

b. hematuria. Intravesical instillation of BCG commonly causes hematuria. Other common adverse effects of BCG include urinary frequency and dysuria. Less commonly, BCG causes cystitis, urinary urgency, urinary incontinence, urinary tract infection, abdominal cramps or pain, decreased bladder capacity, tissue in urine, local infection, renal toxicity, and genital pain. BCG isn't associated with renal calculi, delayed ejaculation, or impotence.

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? a. Voiding at given intervals b. Prompted voiding c. Interval voiding d. Bladder retraining

d. 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.

What is true about extracorporeal shock wave lithotripsy (ESWL)? Select all that apply. a. ESWL is a high-energy blast of pressure. b. ESWL is a ureteroscopic approach. c. ESWL is done while the patient is undergoing a percutaneous nephrolithotomy. d. Stones are shattered into smaller particles that are passed from the urinary tract.

a. ESWL is a high-energy blast of pressure. d. Stones are shattered into smaller particles that are passed from the urinary tract. Stones are shattered into smaller particles that are passed from the urinary tract. ESWL is a high-energy blast of pressure. ESWL is not a ureteroscopic approach. ESWL is not done while the patient is undergoing a percutaneous nephrolithotomy.

A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence? a. Encouraging intake of at least 2 L of fluid daily b. Giving the client a glass of soda before bedtime c. Taking the client to the bathroom twice per day d. Consulting with a dietitian

a. 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.

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? a. type and size of the catheter to be used b. administration of cleansing enemas c. procedure for insertion of the catheter d. placement of the catheter

a. type and size of the catheter to be used Before catheterization, the nurse should inquire about the type and size of the catheter to be used and if the catheter should be removed or retained in place after the bladder is empty.

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

b. 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 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.

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? a. The skin wasn't lubricated before the pouch was applied. b. The pouch faceplate doesn't fit the stoma. c. A skin barrier was applied properly. d. Stoma dilation wasn't performed.

b. 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.

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

b. 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 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? a. "I should wipe from back to front." b. "I should take a tub bath at least 3 times per week." c. "I should take at least 1,000 mg of vitamin C each day." d. "I should limit my fluid intake to limit my trips to the bathroom."

c. "I should take at least 1,000 mg of vitamin C each day." The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTI.

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: a. Compromised ligament and pelvic floor support of the urethra. b. Uninhibited detrusor contractions. c. Loss of motor control of the detrusor muscle. d. A stricture or tumor in the bladder.

c. Loss of motor control of the detrusor muscle. Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void. These patients also experience hyperreflexia in the absence of normal sensations associated with voiding.

A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care? a. Turn the patient every 2 hours around the clock. b. Administer pain medication every 2 hours. c. Monitor urine output hourly and report output less than 30 mL/hr. d. Clean the stoma with soap and water after the patient voids.

c. Monitor urine output hourly and report output less than 30 mL/hr. In the immediate postop period, urine volumes are monitored hourly. Throughout the pt's hospitalization, the nurse monitors closely for complications, reports signs and symptoms of them promptly, and intervenes quickly to prevent their progression. If urinary drainage stops or decreases to less than 30 mL/hour, or if the client complains of back pain, the nurse needs to notify the physician immediately.

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

c. Strain the urine carefully for stone fragments. The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical analysis.

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

d. 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.

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

d. 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.