Ch 27 Caring for Clients with Urinary Disorders

14. A client who has an allergy to sulfa drugs is given a prescription for Amoxil to treat a urinary tract infection. Which of these actions should the nurse take? a. Tell the client to take the medication as ordered. b. Consult with the health care provider about administering an antihistamine drug 30 minutes prior to each dose of the antimicrobial. c. Tell the client to hold the prescription, and inform the health care provider of the allergy. d. Ask the pharmacist to verify use of this medicine.

ANS: A Antibiotic education for clients should include taking the medication as ordered until the course is completed.

9. Which of these aspects should a nurse include when teaching a client who has nocturnal enuresis? a. limiting fluid intake after 6:00 P.M. b. attaching an external condom c. reducing fluid intake volume each day d. attempting to void every 2 hours when awake

ANS: A Incontinence during sleep is called nocturnal enuresis. Treatment includes limiting fluid intake after 6:00 P.M.

2. A client who has an enlarged prostate gland tells the nurse he feels like his bladder is not completely empty after voiding, and his health care provider requests a check for residual urine. Which of these nursing actions is correct? a. Catheterize him immediately after he voids, and record the amount obtained. b. Have him measure his voidings in sequentially numbered containers and record the amount and time of each voiding. c. Insert a retention catheter, and connect it to a bedside collection unit. d. Keep an accurate intake and output (I&O), and subtract and record the difference between the intake and the output for each 8-hour shift.

ANS: A The distended bladder can be palpated above the symphysis. The nurse should check for residual urine when the client does void. The way to check for residual urine is by catheterization.

5. What is the MOST common cause of urge incontinence? a. an irritated bladder due to infection or very concentrated urine b. excessive intake of fluids c. loss of perineal muscle tone due to trauma or aging d. use of alpha-antagonist medications

ANS: A Urge incontinence occurs when a person is unable to suppress the sudden urge or need to urinate. An irritated bladder is often the cause.

6. The client with urge incontinence is BEST treated by which approach? a. encouraging a fluid intake of 3,000 mL/day b. restricting fluid intake to 1,000 mL/day c. strengthening the perineal muscles with Kegel exercises d. taking anticholinergic medications as ordered

ANS: A Urge incontinence occurs when a person is unable to suppress the sudden urge or need to urinate. An irritated bladder is often the cause. Treatment often includes encouraging a fluid intake of 3,000 mL/day.

1. The nurse explains to the client that several causes of incontinence are reversible. Which of the following should be included? (Select all that apply.) a. restricted mobility b. polyuria c. infections d. delirium e. nocturia f. increased calcium intake

ANS: A, B, C, D Several causes of incontinence are reversible or correctable. Remember DRIP: delirium, restriction of mobility, infection, polyuria.

8. A client who has multiple sclerosis develops total urinary incontinence. What initial treatment should the nurse tell the client to expect? a. anticholinergic medications b. indwelling catheter to a collection bag c. intermittent self-catheterization of the urinary bladder d. surgery to create a permanent ileal conduit

ANS: B A blocked urethra or bladder weakness may prevent normal emptying. When no urine is retained in the bladder, it is termed total incontinence. Treatment includes an indwelling catheter attached to a collection bag.

20. Which nursing intervention is indicated for a client who had intravesical chemotherapy today? a. Ambulate in the hall each hour. b. Change positions every 15 minutes for several hours. c. Observe strict bed rest for 24 hours. d. Turn and reposition every 2 to 3 hours.

ANS: B Nursing interventions for a client receiving intravesical chemotherapy include changing positions every 15 minutes for several hours to ensure all surface areas receive contact.

10. Which of these normal changes occurring in the urinary system with aging may contribute to an older adult female client developing cystitis? a. decreased bladder capacity b. weakening of bladder and perineal muscles resulting in the inability to empty the bladder c. development of stress incontinence d. decreased renal function

ANS: B Cystitis, inflammation of the urinary bladder, is more common in females because of their short urethra, which allows bacteria to ascend from the vagina or rectum. Bacteria may descend from an infected kidney. Bacteria in the bladder multiply, causing redness and swelling of the wall of the bladder, which in turn causes increased urinary frequency, dysuria, pyuria, hematuria, and sometimes burning and urgency. The normal changes occurring in the urinary system with aging, such as weakening of bladder and perineal muscles that results in the inability to empty the bladder, may increase risk of developing cystitis in older females.

3. A 60-year-old female client states that whenever she coughs, sneezes, or laughs there is leakage of urine. The nurse explains to the client that the incontinence this client experiencing is: a. overflow b. stress c. total d. urge

ANS: B Stress incontinence, the most common type, is a leakage of urine when a person does anything that strains the abdomen such as coughing, laughing, jogging, dancing, sneezing, lifting, making a quick movement, or even walking.

16. A client who has urolithiasis asks the nurse what causes this condition to develop. Which of the following factors will the nurse explain predisposes the development of calculi? a. thyroid disorders b. recurrent urinary tract infections (UITs) c. increased physical activity d. eating a high protein diet

ANS: B The reasons stones form have not yet been identified but individuals who are immobile, have hyperparathryoidism, or have recurrent UTIs are predisposed to urolithiasis.

2. Risk factors for the development of bladder cancer include which of the below? (select all that apply.) a. high fluid consumption b. genetics c. smoking d. chronic bladder inflammation e. working with paint products f. birth defects of the bladder

ANS: B, C, D, E, F There are several risk factors for the development of bladder cancer. The main risk factor is cigarette smoking. Individuals who smoke nicotine products have twice the risk of developing bladder cancer as do nonsmokers. The carcinogens from the cigarette smoke enter into the bloodstream and are filtered by the liver and sent to the kidneys for excretion. The carcinogens then accumulate in the bladder as the urine awaits excretion. Other risk factors include working with dyes, rubber, leather, or paint products; arsenic in drinking water; genetics; bladder birth defects; low fluid consumption; chemotherapy and radiation therapy; and chronic bladder inflammation.

12. A client is to be treated for suspected cystitis. Which of these orders should the nurse implement first? a. Administer urinary antimicrobial medication. b. Administer urinary tract analgesics. c. Obtain a urine specimen for culture and sensitivity (C&S). d. Start an IV fluid at 100 mL/h.

ANS: C A urinary antimicrobial medication is given after a urinary specimen has been sent for C&S. Clients are usually asked to drink 3 to 4 liters of noncaffeinated fluid each day. Cranberry juice is especially beneficial, as it is believed to prevent bacteria from sticking to the wall of the bladder. Cystitis may lead to pyelonephritis.

11. A client has developed a nosocomial cystitis. Which of these organisms MOST commonly causes cystitis? a. Candida albicans b. Clostridium c. Escherichia coli d. Streptococcus aureus

ANS: C Most urinary tract infections are caused by Escherichia coli, but some are caused by Candida albicans.

19. What are the only early warning signs of bladder cancer? a. dysuria and urgency b. gradual-onset oliguria and proteinuria c. increased urinary frequency and painless, intermittent hematuria d. sudden onset anuria after cystitis

ANS: C Urinary bladder tumors may also obstruct the flow of urine. When the urinary bladder is completely removed, a urinary diversion is necessary. The only early warning signs of bladder cancer is an increased urinary frequency and painless, intermittent hematuria.

4. What is the goal of surgery to treat stress urinary incontinence? a. to close the urethra enough to prevent urine from leaking out b. to inject collagen into the tissues surrounding the urethra c. to perform the Kegel procedure d. to restore and reconstruct the support of the pelvic floor muscles

ANS: D Urinary incontinence is the involuntary loss of urine from the bladder. Although this is a physiologic problem, it also affects the client's emotional, psychological, and social well-being. All types of incontinence such as stress, urge, overflow, total, and nocturnal enuresis can be treated with the goal of restoring and reconstructing the support of the pelvic floor muscles.

21. A nurse observes that a client's ileal conduit stoma is dark bluish in the immediate postoperative period. Which of these actions should the nurse take? a. Chart the observation. b. Have the client assume a semi-Fowler's position. c. Remove the pouch, and make the pouch opening larger. d. Notify the health care provider immediately.

ANS: D A dark bluish color in a client's ileal conduit stoma in the immediate postoperative period could indicate a lack of blood supply, and the health care provider should be notified immediately.

1. A client with urinary retention may be treated by all of the following methods. Which method is preferred when the client is in acute distress? a. antispasmodics b. surgery c. urinary analgesics d. urinary catheterization

ANS: D A person who is unable to void when there is an urge to void has urinary retention. This condition creates urinary stasis and increases the possibility of infection. The urine may overflow the bladder's capacity, causing incontinence. The client may experience discomfort, anxiety, frequency of urination, and voiding of small amounts. The distended bladder can be palpated above the symphysis. The nurse should check for residual urine when the client does void. The way to check for residual urine is by catheterization.

17. Extracorporeal shock wave lithotripsy (ESWL) is administered to a client to treat urolithiasis. Which of these aspects should the client anticipate following this treatment? a. IV fluids for 72 hours b. remaining NPO for 12 hours c. normal skin appearance d. bloody urine for one to two days

ANS: D ESWL is a method of crushing a calculus at any place in the urinary system with ultrasonic waves. Nursing interventions post-procedure include teaching the client to anticipate bloody urine for one to two days.

15. Which of these statements should the nurse include for clients who have frequent urinary tract infections, to prevent recurrence? a. "Clean the perineum back to front." b. "Wear incontinence control products to prevent accidents." c. "Douche regularly with pleasantly scented products." d. "Void more frequently, especially after sexual intercourse."

ANS: D Teaching for clients with frequent urinary tract infections to prevent recurrence should include cleaning the perineum front to back; wearing cotton undergarments; voiding more frequently, especially after sexual intercourse; and changing incontinence control products frequently to prevent infection.

18. Following treatment for renal calculi that were primarily calcium in composition, which of these dietary modifications would assist a client in preventing recurrence? a. Avoid anchovies, sardines, and organ meats. b. Eat foods such as broccoli, asparagus, chocolate, tea, and spinach. c. Avoid cereals, cranberries, plums, eggs, and meats. d. Eat foods high in calcium such as milk, broccoli, and cheese.

ANS: D Teaching for renal calculi that were primarily calcium in composition should include educating the client dietary modifications to assist with preventing recurrence, such as limiting foods high in calcium such as milk, broccoli, and cheese.

13. A client who has cystitis complains of extreme dysuria, and Pyridium has been prescribed. Which of these aspects should the nurse include in client teaching? a. "Drink at least 3 liters of water and 3 liters of cranberry juice per day." b. "Reduce the amount of whole grains and meats in your diet." c. "Expect your urine to appear more concentrated." d. "This medicine turns your urine red-orange and can stain clothes and toilets."

ANS: D The client should be instructed that a reddish-orange discoloration of urine may occur. The client should also be instructed that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of GI upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

7. To assess a client who is experiencing symptoms of overflow incontinence, the nurse will focus on which area? a. amount of caffeinated beverages consumed daily b. use of diuretics c. evidence of edema d. presence of diabetes

ANS: D When the bladder becomes so full and distended that urine leaks out, it is called overflow incontinence. Clients with high risk for overflow incontinence are those with diabetes.