chapter 59 med surg
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?
Change the wafer and pouch.
The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program?
Medication usage
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.
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
A client who is diagnosed with calcium oxalate stones is instructed to limit calcium intake. The client is instructed to consume ______ mg of calcium per day, or less, as part of dietary treatment.
1000
A client who was involved in an MVA which resulted in paraplegia is working toward living at home. The client is currently developing an individualized CIC schedule, preferring not to wear a leg bag. What is the maximum amount of urine the client should allow to collect before catheterization?
350 mL
A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
Assessing present voiding patterns
Which of the following is the most effective intravesical agent for recurrent bladder cancer?
Bacillus Calmette-Guérin (BCG)
A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered?
Cloudy urine
Nursing management of the client with a urinary tract infection should include:
Discouraging caffeine intake
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:
Disturbed body image
The nurse caring for a client with a urinary diversion notices mucus around the stents and in the client's urine. Which is the appropriate nursing intervention?
Document presence of mucus in the urine.
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.
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.
Which finding is an early indicator of bladder cancer?
Painless hematuria
The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply
Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care.
Which nursing intervention should the nurse caring for the client with pyelonephritis implement?
Teach client to increase fluid intake up to 3 liters per day.
When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?
The client keeps the drainage bag below the bladder at all times.
John Ericsson, a 57-year-old railroad worker, is a client on the hospital unit where you practice nursing. As a result of trauma, Mr. Ericsson has developed urinary incontinence and is beginning bladder training to regain control over his urine elimination. Why is the catheter being clamped and unclamped?
To promote normal bladder function
A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. Which of the following should the nurse inquire about with the physician before catheterization?
Type and size of the catheter to be used
A client who has had a urinary diversion procedure is going to be discharged. What information would the nurse include when instructing the client on care of the stoma and collection pouch? Select all that apply.
When changing the adhesive wafer (to which the urostomy collection bag is attached), remove all remaining adhesive before applying a new wafer. Drain the continent urostomy four times a day or as directed by the physician. Wash the urinary collection pouch thoroughly after changing.
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.
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
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:
help the client cope with the anxiety associated with changes in body image.
A client has developed urinary incontinence and is beginning bladder training to regain control over urine elimination. The catheter would be clamped and unclamped to:
promote normal bladder function.
A client has been admitted to the renal unit with acute pyelonephritis, and is undergoing parenteral antibiotic treatment. What would be a significant aspect of this client's discharge education?
recurring infection prevention
A 60-year-old woman has begun a course of oral antibiotics for the treatment of a urinary tract infection (UTI). The patient's nurse should recognize that the causative microorganisms most likely originated from:
Fecal contamination from the patient's perineum
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?
"My urine will be eliminated through a stoma."
A patient has been diagnosed with a UTI and is prescribed an antibiotic. What first-line fluoroquinolone antibacterial agent for UTIs has been found to be significantly effective?
Cipro
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?
Implement a 2- to 3-hour voiding schedule
A 17-year-old high school student is returning to the medical-surgical unit following an appendectomy. She reports the need to urinate and cannot do so. What type of procedure will you perform to resolve her difficulty?
Intermittent catheterization under sterile conditions
A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action?
Maintain skin and stomal integrity.
A nurse is teaching a client how to do Kegel exercises. Place in order from first to last the correct steps in performing these exercises.
Sit or stand with legs slightly apart. Draw in perivaginal muscles and anal sphincter as when controlling voiding or defecating. Hold position of contraction for 5 seconds (count or time with a watch). Relax contraction for at least 10 seconds. Repeat exercises 5 to 6 times, increasing slowly to 25 times.
Which of the following nursing actions is most important in caring for the client following lithotripsy?
Strain the urine carefully for stone fragments.
Which of the following is a strategy to promote urinary continence?
Void regularly, 5 to 8 times a day
Which instruction would be included in a teaching plan for a client diagnosed with a UTI?
Drink liberal amount of fluids.
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?
Monitor urine output hourly and report output less than 30 mL/hr.
A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point should the nurse include?
Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.
Which statement describing urinary incontinence in an older adult client is true?
Urinary incontinence isn't a disease.
A 32-year-old client has a history of neurogenic bladder and presents with fever, burning, and discharge at her catheter insertion site. What would you suspect is the problem?
Urinary tract infection
The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement?
Void immediately after sexual intercourse.
What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia?
Change in cognitive functioning
Which objective symptom of a UTI is most common in older adults, especially those with dementia?
Change in cognitive functioning
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
A client regularly recognizes the sensation of needing to void but cannot control voiding in time to reach a toilet. How would the nurse document this type of incontinence?
Urge
Patricia O'Connor, a 17-year-old high school student, is returning to the medical-surgical unit where you practice nursing from surgery. She has just undergone an appendectomy. She reports the need to urinate and cannot do so. What is your response to her situation as ordered by the physician?
Intermittent catheterization
A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?
Pyridium
The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do?
Take the antibiotic for 3 days as prescribed.