327 Chapter 28: Patients with Urinary Disorders Q's

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? A. "Apply an antibacterial dressing to the incision daily." B. "Be aware that your urine will be cherry-red for 5 to 7 days." C. "Take your temperature every 4 hours." D. "Increase your fluid intake to 2 to 3 L per day."

D. "Increase your fluid intake to 2 to 3 L per day." The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.

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 patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? A. An output of 200mL with each voiding B. Urine with a specific gravity of 1.005-1.022 C. Rebound tenderness at McBurney's point D. Cloudy urine

D. Cloudy urine The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise.

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? A. Cipro B. Macrodantin C. Bactrim D. Septra

A. 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.

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? A. Cipro B. Bactrim C. Nitrofurantoin D. Tetracycline

A. 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.

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

A. 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 obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? A. Hematuria B. Dysuria C. Frequency D. Incontinence

A. 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.

The nurse knows that which of the following body parts explains why cystitis is more common in women? A. The urethra B. The ureters C. The bladder D. The rectum

A. 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.

A gerontological nurse is aware of the high incidence and prevalence of urinary tract infections (UTIs) among older adults. Consequently, the nurse is implementing plans of care that attempt to reduce this risk. Which of the following actions present the greatest risk of UTIs for older adults? A. The use of indwelling urinary catheters B. The use of antibiotics for respiratory infections C. Restricting fluid in older adults with congestive heart failure (CHF) or renal disease D. Restricting older adults' mobility and levels of activity

A. The use of indwelling urinary catheters The use of indwelling urinary catheters presents a high risk of UTIs. Decreased fluid intake, the use of antibiotics, and immobility are also associated with these infections, but to a lesser extent.

The clinic nurse is teaching a young woman about preventing recurrent urinary tract infections. What information should the nurse include? A. Avoid voiding immediately after sexual intercourse. B. Drink liberal amounts of fluids. C. Void every 6 to 8 hours. D. Bathe daily.

B. Drink liberal amounts of fluids. The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather than bathe.

A nurse is providing care for a patient who has had an indwelling urinary catheter in place for the past several days. To reduce this patient's risk of developing a catheter-related infection, the nurse should: A. Empty the collection bag whenever the contents are ≥250 mL of urine. B. Ensure that the collection bag is always below the height of the patient's bladder. C. Clamp the collection tubing for 2 hours each day unless medically contraindicated. D. Swab the length of the tubing with chlorhexidine once per day.

B. Ensure that the collection bag is always below the height of the patient's bladder. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Bacteria enter the urinary drainage bag, multiply rapidly, and then migrate to the drainage tubing, catheter, and bladder. By keeping the drainage bag lower than the patient's bladder and not allowing urine to flow back into the bladder, this risk is minimized. Clamping, frequent emptying, and disinfecting do not necessarily reduce the patient's risk of developing an infection.

Which factor contributes to UTI in older adults? A. Sporadic use of antimicrobial agents B. Immunocompromise C. Active lifestyle D. Low incidence of chronic illness

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

B. urinary tract infection Signs of a bladder infection include fever, chills, and suprapubic pain.

Which objective symptom of a UTI is most common in older adults, especially those with dementia? A. Hematuria B. Back pain C. Change in cognitive functioning D. Incontinence

C. Change in cognitive functioning The most common objective finding is a change in cognitive functioning, especially in those with dementia, because 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.

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

C. Change the wafer and pouch. Whenever a leaking pouching system is noted, the nurse should change the wafer and pouch. Attempting to secure or patch the leak with tape and/or barrier paste can trap urine under the barrier or faceplate, which will compromise peristomal skin integrity. Emptying the pouch will not rectify the leaking.

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? A. High protein B. Low oxalate C. Low purine D. High sodium

C. Low purine A low-purine diet is used for uric acid stones, although the benefits are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

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. Suggestion to take tub baths instead of showers C. Need to urinate after engaging in sexual intercourse D. Importance of urinating every 4 to 6 hours while awake

C. 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.

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

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

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

C. Stress Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position. Reflex incontinence is the involuntary loss of urine because of hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.

Nursing management of the client with a urinary tract infection should include: A. Administering morphine sulfate B. Teaching the client to douche daily C. Instructing the client to limit fluid intake D. Discouraging caffeine intake

D. Discouraging caffeine intake Strategies for preventing urinary tract infection include proper perineal hygiene, increased fluid intake, avoiding urinary tract irritants (including caffeine), and establishing a frequent voiding regimen.

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

D. 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.

Patients with urolithiasis need to be encouraged to: A. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. B. Supplement their diet with calcium needed to replace losses to renal calculi. C. 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. D. Increase their fluid intake so that they can excrete up to 4 liters every day.

D. Increase their fluid intake so that they can excrete up to 4 liters every day. Fluids need to be increased up to 4 L/day to increase hydrostatic pressure within the urinary tract and thereby promote passage of the stone. This volume of fluid intake also helps prevent additional stone formation.

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. Uninhibited detrusor contractions. B. Compromised ligament and pelvic floor support of the urethra. C. A stricture or tumor in the bladder. D. Loss of motor control of the detrusor muscle.

D. 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 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? A. High-protein diet B. Low-phosphorus diet C. Low-calcium diet D. Low-purine diet

D. 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.

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. Show photographs and drawings of the placement of the stoma. B. Suggest a visit to a local ostomy group. C. Determine the client's ability to manage stoma care. D. Maintain skin and stomal integrity.

D. 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.

A 49-year-old man has been brought to the emergency department by his wife, who states that her husband is experiencing a repeat episode of kidneys stones. When planning interventions for this patient's immediate care, what problem is likely to be the priority? A. Fluid and electrolyte imbalance B. Decreased level of consciousness (LOC) C. Decreased cardiac output D. Pain

D. Pain Urinary stones are typically accompanied by severe pain, the treatment of which would be a nursing priority. Decreased LOC and cardiac output are unlikely. Fluid and electrolyte imbalances may occur, but not likely in the short term.

Sympathomimetics have which of the following effects on the body? A. Constriction of pupils B. Constriction of bronchioles C. Decrease of heart rate D. Relaxation of bladder wall

D. 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.

The nurse is assessing a client's new stoma and observes that the stoma color is now dark purple. The appropriate nursing intervention is to A. apply Karaya powder. B. remove the urinary stents. C. change the pouching system. D. contact the physician.

D. contact the physician. The appropriate nursing intervention when a newly created stoma is dark purple is to notify the physician. The physician or wound, ostomy, and continence (WOC) nurse will assess the stoma to determine whether it has superficial ischemia or is necrotic.