Chapter 55: Management of Patients With Urinary Disorders

A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? Through the bloodstream (hematogenous spread) By ascending infection (transurethral) Due to a fistula (direct extension) The result of urethra abrasion (sexual intercourse)

By ascending infection (transurethral) Explanation: The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Routes of Infection, p. 1617.

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."

"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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Monitoring and Managing Potential Complications, p. 1636.

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? 25 mL 50 mL 100 mL 150 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Bladder Emptying, p. 1554.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1644.

Which of the following is the most effective intravesical agent for recurrent bladder cancer? Bacillus Calmette-Guérin (BCG) Methotrexate Cisplatin Vinblastine

Bacillus Calmette-Guérin (BCG) Explanation: BCG is now considered the most effective intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances the body's immune response to cancer. Chemotherapy with a combination of methotrexate, 5-FU, vinblastine, doxorubicin (Adriamycin), and cisplatin has been effective in producing partial remission of transitional cell carcinoma of the bladder in some patients. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Medical Management, p. 1638.

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

Change in cognitive functioning Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-3, p. 1618.

As the nurse comes from morning report, the nurse is instructed to use a bladder scanner on a client following a client's attempt at urination. The client is able to void 300 mL. The client denies any pain on urination. The nurse scans 250 mL of remaining urine in the bladder. Which entry is most correct when documenting the intervention? Client voided 300 mL without dysuria Client voided 550 mL of urine for the daylight shift Client voided 300 mL with 250 mL residual volume Bladder scanning resulted in 250 mL

Client voided 300 mL with 250 mL residual volume Explanation: When documenting the results of using a bladder scanner, it is best to note the amount voided and then the residual urine remaining in the bladder. This documentation enables the analysis of the client's ability to empty the bladder.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1624.

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

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

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of: Anticipatory grieving Situational low self esteem Deficient knowledge: stoma care Disturbed body image

Disturbed body image Explanation: The client is exhibiting defining characteristics of disturbed body image. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Improving Body Image, p. 1645.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Controlling Odor, p. 1641.

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications? Reflex Iatrogenic Overflow Urge

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1624.

The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. Participate in strenuous exercises so that the tone of smooth muscle in the urinary tract can be strengthened to help propel calculi. Add calcium supplements to the diet to replace losses to renal calculi. 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. 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Educating Patients About Self-Care, p. 1636.

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)

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Medical Management, p. 1633.

A client is being treated for renal calculi and suspected hydronephrosis. Which measure should the nurse take to help maintain a record of the kidneys' function? Monitor the client's intake and output. Palpate for a thrill over the vascular access. Inspect the skin over the fistula or graft for signs of infection. Note the nailbeds and mobility of the fingers.

Monitor the client's intake and output. Explanation: Monitoring and recording the client's intake and output provides information about the kidneys' function. It also helps identify any arising complications such as hydronephrosis.

The nurse is caring for a client with a cystoscopy tube draining urine from the bladder. When reviewing the client's history prior to administering care, which is of most concern? Diagnostic studies reporting bladder stones Crusted drainage around the cystoscopy tube A white blood count of 12,000 cells/mm3 New diagnosis of urosepsis

New diagnosis of urosepsis Explanation: All of the options are typical risk factors for a client with a cystoscopy tube. The most concerning risk factor is of urosepsis, which is a serious systemic infection from microorganisms in the urinary tract invading the bloodstream.

Which finding is an early indicator of bladder cancer? Painless hematuria Occasional polyuria Nocturia Dysuria

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Clinical Manifestations, p. 1638.

Which term refers to inflammation of the renal pelvis? Pyelonephritis Cystitis Urethritis Interstitial nephritis

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1615.

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find? High specific gravity Slightly acidic pH Absent proteinuria Pyuria

Pyuria Explanation: The chief abnormality noted with the urinalysis is pyuria (combination of bacteria and leukocytes). Specific gravity would be low, pH would be slightly alkaline, and proteinuria would be minimal to mild. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 54-4, p. 1577.

Sympathomimetics have which of the following effects on the body? Relaxation of bladder wall Decrease of heart rate Constriction of bronchioles Constriction of pupils

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.

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

Risk for infection Explanation: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Interventional Procedures, p. 1634.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Medical Management, pp. 1569-1570.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Types of Urinary Incontinence, p. 1624.

Which of the following is the most common site of a nosocomial infection? Urinary tract Respiratory tract Gastrointestinal tract Skin

Urinary tract Explanation: The urinary tract is the most common site of nosocomial infection, accounting for greater than 3% of the total number reported by hospitals each year. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Introduction, p. 1616.

The nurse is teaching a client with recurrent urinary tract infections (UTIs) ways to decrease risk for additional UTIs. The nurse includes which information? Take tub baths instead of showers. Void immediately after sexual intercourse. Increase intake of coffee, tea, and colas. Void every 5 hours during the day.

Void immediately after sexual intercourse. Explanation: The nurse should instruct the client to void immediately after sexual intercourse to flush the urethra, expelling contaminants. Showers are encouraged, rather than tub baths, because bacteria in the bath water may enter the urethra. Coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants should be avoided. The client should be encouraged to void every 2 to 3 hours during the day and completely empty the bladder. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-5, p. 1621.

The nurse is caring for a client who has a type of urinary diversion that requires an external ostomy bag to collect the urine. This client has: an incontinent urinary diversion. a continent urinary diversion. a urethroplasty. a cystectomy.

an incontinent urinary diversion. Explanation: An incontinent urinary diversion requires an external ostomy bag to collect the urine. A continent urinary diversion is the creation of a reservoir within the body for urine collection. The reservoir is catheterized to drain urine. Urethroplasty is a surgical repair of the urethra. Cystectomy is a surgical removal of the bladder and is performed for large tumors that have penetrated the muscle wall. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1639.

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 contact the physician. change the pouching system. remove the urinary stents. apply Karaya powder.

contact the physician. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1646.

A client has a suspected bladder tumor. What is the most common first symptom of a malignant tumor of the bladder? painless hematuria fever dysuria 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.

Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply. Acute pyelonephritis Renal abscess Cystitis Urethritis Prostatitis

Acute pyelonephritis Renal abscess Upper UTIs include acute pyelonephritis, renal abscess, perineal abscess, chronic pyelonephritis, and interstitial nephritis. Lower UTIs include cystitis, urethritis, and prostatitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Upper Urinary Tract Infections, p. 1621.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Kidney, Ureter, and Bladder Studies, p. 1562.

Which of the following is a cause of a calcium renal stone? Excessive intake of vitamin D Gout Neurogenic bladder Foreign bodies

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Pathophysiology, p. 1632.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1645.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Urinary Retention, p. 1627.

A client who has a history of neurogenic bladder uses a permanent, indwelling catheter to facilitate urine elimination. What can this client consume to decrease the likelihood of bladder infection? cranberry juice increased protein red meat prune juice

cranberry juice Explanation: Cranberry juice or vitamin C may be recommended to keep the bacteria from adhering to the wall of the bladder and thus promoting their excretion and enhancing the effectiveness of drug therapy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1619.

Which metabolic defects are associated with stone formation? Hyperparathyroidism Hypoparathyroidism Hypouricemia Hyperthyroidism

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Pathophysiology, p. 1632.

A client is learning how to perform Kegel exercises. Which statement by the client indicates a need for additional teaching? "I need to sit or stand with my legs slightly apart." "I should draw in my muscles like when I'm moving my bowels." "I need to hold the position for at least 15 seconds." "I should repeat the sequence of exercises 3 to 4 times a day."

"I need to hold the position for at least 15 seconds." Explanation: When performing Kegel exercises, the client should hold the position of contraction for 5 to 10 seconds and then relax contraction for at least 10 seconds. The client should sit or stand with the legs slightly apart, draw in the muscles as when controlling voiding or defecating, and repeat the sequence of exercises 3 to 4 times per day. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-8, p. 1625.

A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate? "Use scented powders to disguise any odor." "Make sure to eat enough fiber to prevent constipation." "Try drinking coffee throughout the day." "Limit the number of times you urinate during the day."

"Make sure to eat enough fiber to prevent constipation." Explanation: Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-9, p. 1626.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Ileal conduit, p. 1639.

The nurse recognizes that test results that most likely indicate a urinary tract infection include: proteinuria WBC 50 RBC 3 glucose trace

WBC 50 Explanation: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Cellular Studies, p. 1618.

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

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

The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? Set up a routine schedule of every 4 hours to check for residual urine. Check for residual after the client reports the urge to void. Record the volume of urine obtained. Catheterize the client immediately after the client voids.

Catheterize the client immediately after the client voids. Explanation: To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Assessment and Diagnostic Findings, p. 1627.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-3, p. 1618

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

Cloudy urine Explanation: The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Assessing the Patient and the System, p. 1629.

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

Peritonitis Explanation: Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Collaborative Problems/Potential Complications, p. 1645.

The nurse recognizes that which risk factor does NOT predispose a client to the development of kidney stones? immobilization gout hyperparathyroidism hypoparathyroidism

hypoparathyroidism Explanation: Hypoparathyroidism is not a risk factor for the development of kidney stones. Immobilization, gout, and hyperparathyroidism are risk factors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1632.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Uric Acid Stones, p. 1633.

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

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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Types of Urinary Incontinence, p. 1623.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1631.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Pharmacologic Therapy, p. 1626.

The patient has been diagnosed with urge incontinence. What classification of medication does the nurse expect the patient will be placed on to help alleviate the symptoms? Antispasmodic agents Urinary analgesics Antibiotics Anticholinergic agents

Anticholinergic agents Explanation: Anticholinergic agents inhibit bladder contraction and are considered first line medications for urge incontinence. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Pharmacologic Therapy, p. 1626.

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 Milk at lunch Ginger ale at dinner time

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-5: Patient Education; Preventing Recurrent Urinary Tract Infections, p. 1621.

Which of the following is a potential cause of transient incontinence? Select all that apply. Delirium Restricted activity Infection of urinary tract Atrophic vaginitis Stool impaction

Delirium Restricted activity Infection of urinary tract Atrophic vaginitis Stool impaction Potential causes of transient incontinence include delirium, restricted activity, infection of the urinary tract, atrophic vaginitis, and stool impaction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-7, p. 1625.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Promoting Urinary Elimination, p. 1627.

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

Maintain skin and stomal integrity. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1640.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Acute Pharmacologic Therapy, p. 1619.

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

Uric acid Explanation: Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Uric Acid Stones, p. 1634.

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

urinary tract infection Explanation: Signs of a bladder infection include fever, chills, and suprapubic pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1617.

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

Deficient knowledge: management of urinary diversion Disturbed body image Risk for impaired skin integrity 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Preoperative Diagnosis, p. 1644.

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

Pyridium Explanation: The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Table 55-1, p. 1619.

A client is going to have a surgical procedure called a periurethral bulking to improve urinary control. Periurethral bulking is: placement of small amounts of collagen in urethral walls to aid the closing pressure. a procedure that increases storage capacity of the bladder. implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination. a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.

placement of small amounts of collagen in urethral walls to aid the closing pressure. Explanation: Periurethral bulking is the placement of small amounts of collagen in urethral walls to aid the closing pressure. Bladder augmentation is a procedure that increases storage capacity of the bladder. Implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination is one type of surgery done to improve urinary control. Anterior repair is a procedure that increases support to the bladder by tightening the vaginal wall under the urethra. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1626.

Which statement by the client who is performing self-catheterization indicates a need for further teaching? "I should perform self-catheterization every 4 to 6 hours." "I should lubricate the catheter before insertion." "I will need a sterile catheter kit each time I self-catheterize." "I will wash my catheter will hot soapy water."

"I will need a sterile catheter kit each time I self-catheterize." Explanation: Clients who self-catheterize use clean technique in the home setting. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Assisting With Intermittent Self-Catheterization, pp. 1631-1632.

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply. "I will never have another urinary stone again." "I need to take allopurinol." "Tylenol is best to control my pain." "I need to drink eight to ten glasses of water every day." "I'm so glad I don't have to make any changes in my diet."

"I will never have another urinary stone again." "I need to take allopurinol." "Tylenol is best to control my pain." "I'm so glad I don't have to make any changes in my diet." Nonsteroidal anti-inflammatory drugs are used to treat renal stone pain. Oxalate-containing foods should be avoided. Fluid intake should total 2 to 3 liters, if not contraindicated. Allopurinol (Zyloprim) is prescribed for uric acid stones. Recurrence of stones occurs in about half of individuals. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-12, p. 1633.

Which characteristic is seen with a healthy stoma? Painful Pink color No bleeding when cleansing the stoma Dry in appearance

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1640.

Which client is at highest risk for developing a hospital-acquired infection? A client with a laceration to the left hand A client who's taking prednisone (Deltasone) A client with an i1619 A client with Crohn's disease

A client with an i1619 Explanation: The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Nursing Management, p. 1629.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Uric Acid Stones, p. 1633.

An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client? Physical and environmental conditions History of allergies Occupational history Smoking habits

An 82-year-old client experiences urinary incontinence. Which factor should the nurse assess before beginning a bladder training program for this client? Physical and environmental conditions History of allergies Occupational history Smoking habits

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-8, p. 1625.

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

Drink liberal amount of fluids. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1620.

The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which factor is contributing to UTIs in older adults? Low incidence of chronic illness Immunocompromise Sporadic use of antimicrobial agents Active lifestyle

Immunocompromise Explanation: Factors that contribute to UTIs in older adults include immunocompromise, cognitive impairment, high incidence of chronic illness, immobility, incomplete emptying of the bladder, obstructed flow of urine, and frequent use of antimicrobial agents. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-3, p. 1618.

The nurse is assisting in the development of a protocol for bladder retraining following removal of an indwelling catheter. Which item should the nurse include? Encourage voiding immediately after catheter removal Avoid drinking fluids for 6 hours Perform straight catheterization every 4 hours Implement a 2- to 3-hour voiding schedule

Implement a 2- to 3-hour voiding schedule Explanation: Immediately after the removal of the indwelling catheter, the client is placed on a voiding schedule, usually 2 to 3 hours. At the given time, the client is instructed to void. Immediate voiding is not usually encouraged. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1631.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Monitoring and Managing Potential Complications, p. 1636.

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

Monitor urine output hourly and report output less than 30 mL/hr. Explanation: In the immediate postoperative period, urine volumes are monitored hourly. Throughout the patient's hospitalization, the nurse monitors closely for complications, reports signs and symptoms of them promptly, and intervenes quickly to prevent their progression. If urinary drainage stops or decreases to less than 30 mL/hour, or if the client complains of back pain, the nurse needs to notify the physician immediately. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Nursing Management, pp. 1639-1640.

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.

Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care. 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-5, p. 1621.

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

Stress Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1623.

The nurse provides care for a client who is prescribed bladder retraining following urinary catheterization. urinate bladder scan defecate urinary catheterization drink laboratory testing

The nurse should first ask the client to urinate then perform the prescribed bladder scan 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.

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 urethra The bladder The rectum The ureters

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Lower Urinary Tract Infections, p. 1616.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Types of Urinary Incontinence, p. 1624.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1627.

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."

"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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Uric Acid Stones, p. 1634.

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."

"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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Table 55-1, p. 1619.

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?"

"When did you last urinate?" Explanation: The nurse needs to determine the last time the client voided. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Promoting Urinary Elimination, p. 1627.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Nursing Interventions, p. 1636.

The nurse is caring for a client with an ileal conduit is created 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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Ileal Conduit, p. 1639.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Ileal conduit, p. 1639.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Table 55-8, p. 1625.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1631.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1641.

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

Diabetes mellitus Explanation: Increased urinary glucose levels create an infection-prone environment in the urinary tract. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Urine Cultures, p. 1618.

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

Discouraging caffeine intake Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-8, p. 1625.

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection? Use tub baths as opposed to showers. Drink coffee or tea to increase diuresis. Drink liberal amount of fluids. Void every 4 to 6 hours.

Drink liberal amount of fluids. Explanation: 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 bathe in a tub because bacteria in the bathwater may enter the urethra. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1620.

A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply. Empty the collection bag at least every 8 hours to reduce bacterial growth. Disconnect the tubing to collect urine samples. Suspend the drainage bag off the floor. Wash the perineal area with soap and water at least twice daily. Irrigate the catheter every 24 hours.

Empty the collection bag at least every 8 hours to reduce bacterial growth. Suspend the drainage bag off the floor. Wash the perineal area with soap and water at least twice daily. Never disconnect the tubing to collect samples, irrigate, or ambulate the patient since this will allow bacteria to enter the closed system. Drainage systems should have an aspiration or puncture port from which a specimen can be obtained. The drainage system should not be disconnected. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-10, p. 1630.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-9, p. 1626.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Ileal Conduit, p. 1639.

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

Immunocompromise Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-3, p. 1618.

Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease? Incontinence Urinary retention Urgency Incomplete bladder emptying

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Table 55-2, p. 1623.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Nursing Management, p. 1622.

A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of: Permanent distention Infection Consistent pain Daily and painful spasms

Infection Explanation: Infection is caused by an increased urinary bacterial count that results from incomplete and delayed emptying of the bladder. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Gerontologic Considerations, p. 1617.

A client is recovering from the creation of an ileal conduit with stents. Which action(s) will the nurse take if the conduit and stents stop draining urine? Select all that apply. Change the collection bag. Insert a catheter through the stoma. Apply external pressure around the stoma. Remove the skin barrier around the stoma. Irrigate the stents with 5 to 10 mL sterile normal saline.

Insert a catheter through the stoma. Irrigate the stents with 5 to 10 mL sterile normal saline. If urine output drops below 0.5 mL/kg/hr, the client may be experiencing dehydration or an obstruction in the ileal conduit. A catheter can be inserted through the stoma to monitor for possible stasis or residual urine from a constricted stoma. If the ureteral stents are not draining, careful irrigation with 5 to 10 mL of sterile normal saline may be performed. Changing the collection bag will not improve the urine flow. Pressure should not be applied around the stoma. Removing the skin barrier around the stoma will not improve the urine flow.

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 TAKE ANOTHER QUIZ

Painless, gross hematuria Explanation: Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Clinical Manifestations, p. 1638.

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an IV infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output? It's a normal finding caused by blood loss during surgery. It's a normal finding associated with the client's nothing-by-mouth status. It's an abnormal finding that requires further assessment. It's an abnormal finding that will correct itself when the client ambulates.

It's an abnormal finding that requires further assessment. Explanation: The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Evaluation, pp. 1620-1621.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Pathophysiology, p. 1632.

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

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 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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Urinary Retention, p. 1627.

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 oxalate Low purine High protein 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Uric Acid Stones, p. 1633.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1645.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1620.

The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client? Suprapubic cystostomy tube Permanent drainage with a urethral catheter Clean intermittent catheterization Credé voiding procedure

Permanent drainage with a urethral catheter Explanation: Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones, renal diseases, bladder infections, and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Credé voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-4, p. 1621.

Which medication may be ordered to relieve discomfort associated with a urinary tract infection? Nitrofurantoin Phenazopyridine Ciprofloxacin Levofloxacin

Phenazopyridine Explanation: Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with a UTI. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Table 55-1, p. 1619.

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? Physical and environmental conditions History of allergies Occupational history Smoking habits

Physical and environmental conditions 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1628.

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. Instruct the client to drink more fluids at night for a full bladder in the morning. Place client on a timed voiding schedule. Perform straight catheterizations at specific times each day.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1631.

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

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 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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Indwelling Catheters, p. 1629.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Providing Stoma and Skin Care, p. 1640.

The nurse is assessing the client's ileal conduit stoma in the clinic. Which assessment finding would be of greatest concern to the nurse? The urine has an ammonia odor. Yellow urine is draining from the stoma. The skin surrounding the stoma is red. The stoma is dusky red.

The stoma is dusky red. Explanation: A dusky red color indicates the blood supply of the stoma is compromised and suggests superficial necrosis of the stoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Providing Stoma and Skin Care, p. 1640.

Which of the following is the procedure of choice for men with recurrent or complicated urinary tract infections (UTIs)? Transrectal ultrasonography IV urogram Computed tomography (CT) scan Magnetic resonance imaging (MRI)

Transrectal ultrasonography Explanation: A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Other Studies, p. 1618.

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

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Clinical Manifestations, p. 1574.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Urinary Incontinence, p. 1623.

Which of the following is a strategy to promote urinary continence? Void regularly, 5 to 8 times a day Take diuretics after 4 PM Use caffeine in moderation Implement a low fiber diet

Void regularly, 5 to 8 times a day Explanation: Strategies to promote urinary continence include increasing awareness of the amount and timing of all fluid intake; avoid taking diuretics after 4 PM; avoiding bladder irritants, such as caffeine, alcohol, and aspartame (NutraSweet); taking steps to avoid constipation by drinking adequate fluids, eating a well-balanced diet high in fiber, exercising regularly, and taking stool softeners if recommended; and voiding regularly, 5 to 8 times a day (about every 2 to 3 hours). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Chart 55-9, p. 1626.

A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to: assess whether the client is a good candidate for surgery. help the client cope with the anxiety associated with changes in body image. assess suicidal risk postoperatively. evaluate the client's need for mental health intervention. TAKE ANOTHER QUIZ

help the client cope with the anxiety associated with changes in body image. Explanation: Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the client at risk for suicide. Although evaluating the need for mental health intervention is always important, this client displays no behavioral changes that suggest intervention is necessary at this time. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Improving Body Image, p. 1645.

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.

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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, Interventional Procedures, p. 1634.

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. Before catheterization, the nurse would discuss with the physician information about insertion of a nasogastric tube. placement of IV and central venous pressure lines. the type and size of the catheter to be used. administering cleansing enemas.

the 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 whether the catheter should be removed or retained in place after the bladder is empty. Inserting a nasogastric tube, administering enemas, and placing IV lines are measures taken during preoperative and postoperative preparation in the case of surgery. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 55: Management of Patients With Urinary Disorders, p. 1627.