Ch. 55: Mgmt of Pts w/ Urinary Disorders
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."
Correct response: "This medication will relieve your pain." Explanation: Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.
The nurse is giving discharge instructions to the client with uric acid renal calculi. Which statement by the client indicates the client understands the prescribed diet? "Chocolate, spinach, and strawberries are not allowed." "I should avoid raw fruits and vegetables." "I should limit my intake of meat and fish." "I will eliminate milk and other dairy products from my diet."
Correct response: "I should limit my intake of meat and fish." Explanation: A low-purine diet is prescribed for the client with uric acid renal calculi. Organ meats, shellfish, anchovies, asparagus, and mushrooms are foods high in purine.
Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? Incontinence Urinary retention Urgency Incomplete bladder emptying
Correct response: Incontinence Explanation: Incontinence is noted in clients diagnosed with Parkinson disease. Urinary retention is associated with spinal cord injury. Urgency is associated with an overactive bladder. Incomplete bladder emptying is associated with diabetes mellitus.
Which medication may be ordered to relieve discomfort associated with a UTI? Nitrofurantoin Phenazopyridine Ciprofloxacin Levofloxacin
Correct response: Phenazopyridine Explanation: Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.
Which finding is an early indicator of bladder cancer? Painless hematuria Occasional polyuria Nocturia Dysuria
Correct response: Painless hematuria Explanation: Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.
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.
Correct response: Strain the urine carefully for stone fragments. Explanation: The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.
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
Correct response: Uric acid Explanation: Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.
Which statement describing urinary incontinence in an older adult client is true? Urinary incontinence is a normal part of aging. Urinary incontinence isn't a disease. Urinary incontinence in the elderly population can't be treated. Urinary incontinence is a disease.
Correct response: Urinary incontinence isn't a disease. Explanation: 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.
The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include: proteinuria WBC 50 RBC 3 glucose trace
Correct response: WBC 50 Explanation: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.
The nurse caring for a client with a urinary diversion notices mucus around the stents and in the client's urine. Which is the appropriate nursing intervention? Contact the physician. Document the separation of the mucocutaneous junction. Remove the urinary stents. Document presence of mucus in the urine.
Correct response: Document presence of mucus in the urine. Explanation: The nurse should document the presence of mucus in the urine, as this is a normal finding in urinary diversions.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? "Take your temperature every 4 hours." "Increase your fluid intake to 2 to 3 L per day." "Apply an antibacterial dressing to the incision daily." "Be aware that your urine will be cherry-red for 5 to 7 days."
Correct response: "Increase your fluid intake to 2 to 3 L per day." Explanation: 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 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
Correct response: Urinary retention Explanation: Urinary retention and urinary incontinence are voiding dysfunctions, temporary or permanent alterations in the ability to urinate normally. Cystitis is an infectious disorder. Bladder stones and urethral stricture are obstructive disorders.
A client presents at the clinic with reports of urinary retention. What question should the nurse ask to obtain additional information about the client's report? "Have you had a fever and chills?" "How much fluid are you drinking?" "Do you get up at night to urinate?" "When did you last urinate?"
Correct response: "When did you last urinate?" Explanation: The nurse needs to determine the last time the client voided.
Which term refers to inflammation of the renal pelvis? Pyelonephritis Cystitis Urethritis Interstitial nephritis
Correct response: Pyelonephritis Explanation: Pyelonephritis is an upper urinary tract inflammation, which may be acute or chronic. Cystitis is inflammation of the urinary bladder. Urethritis is inflammation of the urethra. Interstitial nephritis is inflammation of the kidney.
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."
Correct response: "My urine will be eliminated through a stoma." Explanation: An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.
A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered? Rebound tenderness at McBurney's point An output of 200mL with each voiding Cloudy urine Urine with a specific gravity of 1.005-1.022
Correct response: Cloudy urine Explanation: The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise.
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
Correct response: Risk for infection Explanation: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.
Bladder retraining following removal of an indwelling catheter begins with encouraging the client to void immediately. advising the client to avoid urinating for at least 6 hours. performing straight catheterization after 4 hours. instructing the client to follow a 2- to 3-hour timed voiding schedule.
Correct response: instructing the client to follow a 2- to 3-hour timed voiding schedule. Explanation: Immediately after the removal of the indwelling catheter, the client is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. At the given time interval, the client is instructed to void. Immediate voiding is not usually encouraged. If bladder ultrasound shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed to ensure complete bladder emptying.
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.
Correct response: Change the wafer and pouch. Explanation: 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.
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
Correct response: Peritonitis Explanation: 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 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
Correct response: Urinary calculi Explanation: Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.
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.
Correct response: notify the physician about cloudy or foul-smelling urine. Explanation: The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuria is common after lithotripsy.
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 Intermittent catheterizations Exercises to promote sphincter control Irrigating the urinary diversion
Correct response: Application of an ostomy pouch Explanation: 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.
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
Correct response: Away from skin folds Explanation: The nurse plans to have the stoma located away from skin folds and creases, bony prominences, the belt line, and the umbilicus. The stoma should be located in an area where the client can see and reach it.
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? Establishing a predetermined fluid intake pattern for the client Encouraging the client to increase the time between voidings Restricting fluid intake to reduce the need to void Assessing present voiding patterns
Correct response: Assessing present voiding patterns Explanation: 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.
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? Voiding at given intervals Prompted voiding Interval voiding Bladder retraining
Correct response: Bladder retraining Explanation: 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.
Which information is important when teaching a client how to perform self-catheterization? Peroxide is recommended for cleaning the urinary catheter. Catheterization should occur every 4 to 6 hours and before bedtime. The nurse uses nonsterile technique in the hospital setting. The catheter is rinsed with sterile normal saline after being soaked in a cleaning solution.
Correct response: Catheterization should occur every 4 to 6 hours and before bedtime. Explanation: The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The catheter is rinsed with tap water after being soaked in a cleaning solution. Either antibacterial soap or povidone-iodine solution is recommended for cleaning urinary catheters at home. The nurse uses sterile technique in the hospital setting.
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
Correct response: Change in cognitive functioning Explanation: 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.
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? type and size of the catheter to be used administration of cleansing enemas procedure for insertion of the catheter placement of the catheter
Correct response: type and size of the catheter to be used Explanation: 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.
The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence? Anticholinergic Diuretics Anticonvulsant Cholinergic
Correct response: Anticholinergic Explanation: Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic medications also do not directly help with control.
Sympathomimetics have which of the following effects on the body? Relaxation of bladder wall Decrease of heart rate Constriction of bronchioles Constriction of pupils
Correct response: Relaxation of bladder wall Explanation: Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.
The treatment of choice for a spinal cord-injured patient with impaired bladder emptying would include which of the following? Intermittent self-catheterization Indwelling catheterization Condom catheterization No catheterization is necessary
Correct response: Intermittent self-catheterization Explanation: Intermittent self-catheterization is the treatment of choice in patients with spinal cord injury and other neurologic disorders, such as multiple sclerosis (MS), when the ability to empty the bladder is impaired.
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
Correct response: Stress Explanation: 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 conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which factor as contributing to UTIs in older adults? Low incidence of chronic illness Immunocompromise Sporadic use of antimicrobial agents Active lifestyle
Correct response: Immunocompromise Explanation: Factors that contribute to UTIs in older adults include immunocompromise, cognitive impariment, high incidence of chronic illness, immobility, incomplete emptying of the bladder, obstructed flow of urine, and frequent use of antimicrobial agents.
The nurse is caring for an older client whose chart reveals that the client has a reversible cause of urinary incontinence. The nurse creates a plan of care for which condition? Asthma Bladder cancer Constipation Decreased progesterone levels
Correct response: Constipation Explanation: Constipation is a reversible cause of urinary incontinence in the older adult. Other reversible causes include acute urinary tract infection, infection elsewhere in the body, decreased fluid intake, a change in a chronic disease pattern, and decreased estrogen levels in menopausal woman. The other answers do not apply.
Which of the following is a cause of a calcium renal stone? Excessive intake of vitamin D Gout Neurogenic bladder Foreign bodies
Correct response: Excessive intake of vitamin D Explanation: Potential causes of calcium renal stones include excessive intake of vitamin D, hypercalcemia, hyperparathyroidism, excessive intake of milk and alkali, and renal tubular acidosis. Gout is associated with uric acid. Struvite stones are associated with neurogenic bladder and foreign bodies.
Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Reflex Iatrogenic Overflow Urge
Correct response: Iatrogenic Explanation: Iatrogenic incontinence is the involuntary loss of urine due to extrinsic medical factors, predominantly medications. Reflex incontinence is the involuntary loss of urine due to 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.
A patient informs the nurse that every time she sneezes or coughs, she urinates in her pants. What type of incontinence does the nurse recognize the patient is experiencing? Urge incontinence Functional incontinence Stress incontinence Iatrogenic incontinence
Correct response: Stress incontinence Explanation: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position (Meiner, 2011; Miller, 2012).
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.
Correct response: Take the antibiotic for 3 days as prescribed. Explanation: The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.
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
Correct response: The urethra Explanation: 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.
Which metabolic defects are associated with stone formation? Hyperparathyroidism Hypoparathyroidism Hypouricemia Hyperthyroidism
Correct response: Hyperparathyroidism Explanation: Metabolic defects such as hyperparathyroidism and hyperuricemia (gout) are associated with stone formation. Hypoparathyroidism, hyperthyroidism, and hypouricemia are not associated with stone formation.
Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. Urinary retention Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity Chronic pain
Correct response: Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity Explanation: 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.
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? Incontinence Dysuria Hematuria Frequency
Correct response: Hematuria Explanation: 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 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
Correct response: Urge Explanation: Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an over distended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. Which postoperative procedure should the nurse perform? Determine the client's ability to manage stoma care Show photographs and drawings of the placement of the stoma Maintain skin and stoma integrity Suggest a visit to a local ostomy group
Correct response: Maintain skin and stoma integrity Explanation: The most important postoperative nursing management is to maintain skin and stoma integrity to avoid further complications, such as skin infections and urinary odor. Determining the client's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the preoperative procedure.
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? Kidney Ureter Bladder Urethra
Correct response: Kidney Explanation: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.
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
Correct response: Urge Explanation: Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an overdistended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.
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
Correct response: Location of discomfort Explanation: The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.
The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest? A low-sodium diet A low-purine diet A diet high in fruits and vegetables A diet high in calcium
Correct response: A low-purine diet Explanation: The nurse would suggest a low-purine diet. Foods to avoid are anchovies, animal organs and sardines. The other options do not lower the uric acids levels.
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? Low-calcium diet High-protein diet Low-phosphorus diet Low-purine diet
Correct response: Low-purine diet Explanation: 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.
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
Correct response: Perform meticulous perineal care daily with soap and water Explanation: 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 medication may be ordered to relieve discomfort associated with a urinary tract infection? Nitrofurantoin Phenazopyridine Ciprofloxacin Levofloxacin
Correct response: Phenazopyridine Explanation: Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.
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
Correct response: Acute pain Explanation: 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.
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
Correct response: Coffee in the morning Explanation: The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and countered toward the daily fluid total.
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
Correct response: Detects calculi, cysts, or tumors Explanation: 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.
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
Correct response: Diabetes mellitus Explanation: Increased urinary glucose levels create an infection-prone environment in the urinary tract.
Which of the following would be least appropriate to suggest to a client with a urinary diversion to control odor? Avoid foods such as buttermilk or yogurt. Eat plenty of cheese and eggs. Avoid pouches with carbon filters. Add a few drops of diluted white vinegar to the pouch.
Correct response: Eat plenty of cheese and eggs. Explanation: To help control odor, the client should use pouches with carbon filters or other odor barriers or add a few drops of liquid deodorizer or diluted white vinegar to the pouch. Foods such as cranberry juice, yogurt or buttermilk may help to decrease odor while foods such as asparagus, cheese, and eggs may impart an odor to the urine.
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
Correct response: Encouraging intake of at least 2 L of fluid daily Explanation: 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.
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? Ileal conduit Kock Pouch Ureterosigmoidostomy Indiana Pouch
Correct response: Ileal conduit Explanation: 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 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.
Correct response: Increase fluids to 3 to 4 L/24 hours to dilute the urine. Explanation: Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination, and prevent dehydration. A balanced diet would be recommended but there is no need to restrict sodium or calcium.
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? Encourage a visit to a local ostomy support group. Advise cleansing of the perineum frequently. Urge the application of moisture sealants. Instruct the use of warm sitz baths.
Correct response: Instruct the use of warm sitz baths. Explanation: 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.
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, thereby reducing swelling and facilitating passage of the stone? Morphine sulfate Aspirin Ketoralac (Toradol) Meperidine (Demerol)
Correct response: Ketoralac (Toradol) Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac (Toradol) are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.
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: Compromised ligament and pelvic floor support of the urethra. Uninhibited detrusor contractions. Loss of motor control of the detrusor muscle. A stricture or tumor in the bladder.
Correct response: Loss of motor control of the detrusor muscle. Explanation: 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.
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
Correct response: Low purine Explanation: 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 client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action? Determine the client's ability to manage stoma care. Show pictures and drawings of placement of the stoma. Maintain skin and stomal integrity. Suggest a visit to a local ostomy group.
Correct response: Maintain skin and stomal integrity. Explanation: The most important postoperative nursing management is to maintain skin and stomal integrity to avoid further complications, such as skin infections and urinary odor. Determining the client's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the preoperative procedure.
The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program? Medication usage History of allergies Occupational history Smoking habits
Correct response: Medication usage Explanation: It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the patient may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.
A client is treated for renal calculi and suspected hydronephrosis. Therefore, the nurse should maintain a record of the kidney's function. Which measure can the nurse take to help achieve the objective? Note the nail beds and mobility of the fingers Monitor the patient's intake and output Palpate for a thrill over the vascular access Inspect the skin over the fistula or graft for signs of infection
Correct response: Monitor the patient's intake and output Explanation: Monitoring and recording the client's intake and output provides information about how the kidneys are functioning and helps to identify any arising complications, such as hydronephrosis. Noting the nail beds and mobility of the fingers, palpating for a thrill over the vascular access, and inspecting the skin over the fistula or graft for signs of infection are nursing interventions to provide care to a client undergoing hemodialysis.
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom? Urinary retention Fever Frequency Painless hematuria
Correct response: Painless hematuria Explanation: The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.
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 Deep flank and abdominal pain Muscle spasm and abdominal rigidity over the flank Decreasing kidney function associated with fever and hematuria
Correct response: Painless, gross hematuria Explanation: Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.
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.
Correct response: Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care. Explanation: In institutionalized older patients, such as those in long-term care facilities, infecting pathogens are often resistant to many antibiotics. Diligent hand hygiene, careful perineal care, and frequent toileting may decrease the incidence of UTIs.
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use clean technique during insertion Use 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
Correct response: Perform meticulous perineal care daily with soap and water Explanation: 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 characteristic is seen with a healthy stoma? Painful Pink color No bleeding when cleansing the stoma Dry in appearance
Correct response: Pink color Explanation: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.
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
Correct response: Pyridium Explanation: The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.
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.
Correct response: Relieve the pain. Explanation: The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.
Which nursing intervention should the nurse caring for the client with pyelonephritis implement? Straight catheterize the client every 4 to 6 hours. Administer acetaminophen (Tylenol). Teach client to increase fluid intake up to 3 liters per day. Restrict fluid intake to 1 liter per day.
Correct response: Teach client to increase fluid intake up to 3 liters per day. Explanation: The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.
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.
Correct response: The nursing assistant places the drainage bag on the client's abdomen for transport. Explanation: The nurse would instruct the nursing assistant to maintain the drainage bag lower than the genital region to avoid a backflow of urine into the bladder. The nursing assistant is correct to move the catheter and drainage bag with the client to not put tension on the catheter, place the drainage bag on the lower area of the wheelchair, and hold the drainage bag while the client is in the process of moving.
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? The skin wasn't lubricated before the pouch was applied. The pouch faceplate doesn't fit the stoma. A skin barrier was applied properly. Stoma dilation wasn't performed.
Correct response: The pouch faceplate doesn't fit the stoma. Explanation: 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.
