Chapter 49: Management of Patients with Urinary Disorders
The nurse is encouraging the client with recurrent urinary tract infections to increase fluid intake to 8 large glasses of fluids daily. Which beverage would the nurse discourage for this client? Coffee in the morning Fruit juice midmorning Ginger ale at dinner time Milk at lunch
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 counted toward the daily fluid total.
Which medication may be ordered to relieve discomfort associated with a UTI? Levofloxacin Ciprofloxacin Nitrofurantoin Phenazopyridine
Phenazopyridine Explanation: Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.
Which characteristic is seen with a healthy stoma? Dry in appearance Pink color Painful No bleeding when cleansing the stoma
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 client has a suspected bladder cancer. What is the most common first symptom of a malignant tumor of the bladder? painless hematuria dysuria fever urgency
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.
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 procedure for insertion of the catheter administration of cleansing enemas placement of the catheter
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 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."
"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 nurse catheterized an elderly client and confirmed the presence of residual urine. What residual urine volume would be considered abnormal for an elderly client? 150 mL 100 mL 50 mL 25 mL
150 mL Explanation: Residual urine volume of more than 50-100 mL is considered normal for an elderly client. Amounts of less than 100 are within a normal range for a middle-aged person.
Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? Low purine High protein Low oxalate High sodium
Low purine Explanation: 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—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.
Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis? Risk for deficient knowledge: self-catherization Risk for infection Risk for fluid volume excess Risk for altered urinary elimination
Risk for infection Explanation: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.
A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client? Remind the client that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. Remind the client that occasional febrile episodes are expected following ESWL. Tell the client to report to the ED for further assessment. Tell the client to monitor his temperature for the next 24 hours and then contact his urologist's office.
Tell the client to report to the ED for further assessment. Explanation: Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.
A client asks the nurse why cystitis is more common in women than in men. Which of the following body parts will the nurse include in the answer? The ureters The rectum The bladder The urethra
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.
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? Functional Urge Overflow Stress
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.
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? Cystine Calcium Struvite Uric acid
Uric acid Explanation: Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.
The nurse recognizes that test results that most likely indicate a urinary tract infection include: RBC 3 glucose trace WBC 50 proteinuria
WBC 50 Explanation: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.
The nurse is caring for a client recovering from extracorporeal shock wave lithotripsy (ESWL). Which client statement(s) indicates that teaching about self-care has been effective? Select all that apply. "The bruise on my back is from the treatment." "Blood in my urine should go away by day 4 or 5." "I may expect to experience some pain and discomfort." "I will take my temperature every day." "I need to increase my intake of fluids every day."
"I will take my temperature every day." "I may expect to experience some pain and discomfort." "The bruise on my back is from the treatment." "I need to increase my intake of fluids every day." "Blood in my urine should go away by day 4 or 5." Explanation: The client recovering from extracorporeal shock wave lithotripsy (ESWL) should receive instructions for home care. These instructions are to include measuring the temperature every day and reporting any elevations. Although ESWL usually does not cause damage to tissue, it can cause discomfort and pain. The client should also understand that the bruise on the back is from the treatment. Fluids should be increased to assist with the passage of stone fragments. The client should expect hematuria that should clear within 4 to 5 days after the procedure.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? "Be aware that your urine will be cherry-red for 5 to 7 days." "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."
"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 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 Assessing present voiding patterns Restricting fluid intake to reduce the need to void
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.
Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Overflow Urge Iatrogenic Reflex
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.
Patients with urolithiasis need to be encouraged to: Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. Increase their fluid intake so that they can excrete up to 4 liters every day. 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. Supplement their diet with calcium needed to replace losses to renal calculi.
Increase their fluid intake so that they can excrete up to 4 liters every day. Explanation: 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.
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? Elevated calcium levels Abnormalities in urine Structural defects in the kidneys Location of discomfort
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.
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? Maintain skin and stomal integrity. Suggest a visit to a local ostomy group. Determine the client's ability to manage stoma care. Show pictures and drawings of placement of the stoma.
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.
A client has developed urinary incontinence after having a urinary catheter in place for a few weeks. What is the initial nursing intervention the nurse should use to start the client with bladder training? Place client on a timed voiding schedule. Perform straight catheterizations at specific times each day. Instruct the client to drink more fluids at night for a full bladder in the morning. Immediately after voiding, perform a bladder scan.
Place client on a timed voiding schedule. Explanation: Placing the client on a timed voiding schedule after a catheter removal will promote bladder muscle retraining. The nurse should do a bladder scan immediately after voiding, but this is not the initial action. The nurse does not need to complete urinary catheterization at specific intervals for initial bladder training. The client needs to limit fluids at night.
Sympathomimetics have which of the following effects on the body? Relaxation of bladder wall Constriction of pupils Constriction of bronchioles Decrease of heart rate
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.
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? Urinary retention Cystitis Bladder stones Urethral stricture
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 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
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.
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? Prompted voiding Interval voiding Voiding at given intervals Bladder retraining
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 medication may be ordered to relieve discomfort associated with a urinary tract infection? Levofloxacin Nitrofurantoin Ciprofloxacin Phenazopyridine
Phenazopyridine Explanation: Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.
The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do? Take the antibiotic for 3 days as prescribed. Understand that if the infection reoccurs, the dose will be higher next time. Be sure to take the medication with grapefruit juice. Take the antibiotic as well as an antifungal for the yeast infection she will probably have.
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.
A client has developed urinary incontinence after having a urinary catheter in place for a few weeks. What is the initial nursing intervention the nurse should use to start the client with bladder training? Immediately after voiding, perform a bladder scan. Place client on a timed voiding schedule. Perform straight catheterizations at specific times each day. Instruct the client to drink more fluids at night for a full bladder in the morning.
Place client on a timed voiding schedule. Explanation: Placing the client on a timed voiding schedule after a catheter removal will promote bladder muscle retraining. The nurse should do a bladder scan immediately after voiding, but this is not the initial action. The nurse does not need to complete urinary catheterization at specific intervals for initial bladder training. The client needs to limit fluids at night.
A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs? "I should wipe from back to front." "I should limit my fluid intake to limit my trips to the bathroom." "I should take a tub bath at least 3 times per week." "I should take at least 1,000 mg of vitamin C each day."
"I should take at least 1,000 mg of vitamin C each day." Explanation: 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.
The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? 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. Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. Add calcium supplements to the diet to replace losses to renal calculi. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi.
Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. Explanation: 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 (Meschi et al., 2011).
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. Perform hand hygiene prior to patient care. Encourage patients to wear briefs. For those patients who are incontinent, insert indwelling catheters. Provide careful perineal care. Assist the patients with frequent toileting.
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.
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? Prevent nephron destruction. Relieve any obstruction. Relieve the pain. Determine the stone type.
Relieve the pain. Explanation: The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.
A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief? Encourage frequent ambulation. Restrict the client's sodium intake. Encourage deep-breathing exercises. Encourage the client to void every 2 to 3 hours.
Encourage frequent ambulation. Explanation: When a client with urinary calculi complains of excruciating pain, the client should be encouraged to ambulate. This is because the supine position increases colic, while ambulation relieves it. Also, adequate fluid intake should be suggested to promote the passage of stones and to prevent urinary stasis, or the formation of new stones. The client should be encouraged to void when there is a risk of infection related to urinary stasis. The suggestion for restricting sodium intake is offered to a client with chronic glomerulonephritis, not urinary calculi. The nurse should promote deep-breathing exercises to provide relief to a client recovering from surgery who has an ineffective breathing pattern.
When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? The client clamps the catheter drainage tubing while visiting with the family. The client sets the drainage bag on the floor while sitting down. The client loops the drainage tubing below its point of entry into the drainage bag. The client keeps the drainage bag below the bladder at all times.
The client keeps the drainage bag below the bladder at all times. Explanation: To maintain effective drainage, the client should keep the drainage bag below the bladder; doing so allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because the bag could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.
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? Urinary calculi Acute glomerulonephritis Ureteral stricture Renal cell carcinoma
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.
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 places the drainage bag on the client's abdomen for transport. The nursing assistant keeps the catheter and drainage bag together when moving the client. 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.
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.
The nurse provides care for a client who is prescribed bladder retraining following urinary catheterization. Complete the following sentence by choosing from the lists of options. The nurse should first ask the client to_____Select..._______ then perform the prescribed _____Select..._________ Select #1: - defecate -urinate -drink select #2: - urinary cathorization - laboratory testing - bladder scan
urinate... bladder scan... Explanation: Postcatheterization detrusor instability can be managed with the implementation of bladder retraining with the client. When implementing bladder retraining for a client who experiences postcatheterization detrusor instability, the nurse first asks the client to urinate.Once the client voids, the nurse then performs the prescribed bladder scan. Bladder retraining involves urination, not defecation. The client is instructed to drink a measured amount of fluid from 8 am to 10 pm with the implementation of bladder retraining to avoid bladder overdistention; however, the client is not instructed to drink at specific times during this process. After the client is asked to void, urinary catheterization is not performed unless the bladder scan indicates a residual greater than 300 ml. Laboratory testing is not completed as part of bladder retaining; however, the nurse should measure the volumes of urine voided and palpate the bladder at repeated intervals to assess for distention.