GU prep U

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.

In assessing the appropriateness of removing a suprapubic catheter, the nurse recognizes that the client's residual urine must be less than which amount? 30 mL 50 mL 100 mL 400 mL

100 mL Residual urine less than 100 mL indicates that the suprapubic catheter can be discontinued. If the client complains of discomfort or pain, however, the suprapubic catheter is usually left in place until the client can void successfully.

The nurse is encouraging the client with recurrent urinary tract infections to increase his fluid intake to 8 large glasses of fluids daily. The client states he frequently drinks water and all of the following. Which of the following would the nurse discourage for this client? Coffee in the morning Fruit juice midmorning Milk at lunch Ginger ale at dinner time

Coffee in the morning The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and countered toward the daily fluid total.

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? - Shows damage to the kidneys - If risk for chronic pyelonephritis is likely - Reveals causative microorganisms - Detects calculi, cysts, or tumors

Detects calculi, cysts, or tumors Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? Hyperuricemia Pancreatitis Diabetes mellitus Hyperparathyroidism

Diabetes mellitus Increased urinary glucose levels create an infection-prone environment in the urinary tract.

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 The most important postoperative nursing management is to maintain skin and stoma integrity to avoid further complications, such as skin infections and urinary odor. Determining the client's ability to manage stoma care, showing photographs, and suggesting a visit to a local ostomy group would be a part of the preoperative procedure.

A nurse has been asked to speak to a local women's group about preventing cystitis. Which of the following would the nurse include in the presentation? - Need to wear underwear made from synthetic material - Importance of urinating every 4 to 6 hours while awake - Suggestion to take tub baths instead of showers - Need to urinate after engaging in sexual intercourse

Need to urinate after engaging in sexual intercourse Measures to prevent cystitis include voiding after sexual intercourse, wearing cotton underwear, urinating every 2 to 3 hours while awake, and taking showers instead of tub baths.

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 Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used when inserting a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's port to obtain specimens. The catheter bag must never be placed on the client's abdomen unless it is clamped because it may cause urine to flow back from the tubing into the bladder.

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

Pyelonephritis 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.

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 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 caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections? The urethra The bladder The rectum The ureters

The urethra

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

Urinary tract

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." 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.

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 The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.

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." An ileal conduit is a non-continent urinary diversion whereby the ureters drain into an isolated section of ileum. A stoma is created at one end of the ileum, exiting through the abdominal wall.

A 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 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.

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 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.

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 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.

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 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. 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.

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 Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.

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

Phenazopyridine Phenazopyridine is a urinary analgesic ordered to relieve discomfort associated with UTIs. Nitrofurantoin, ciprofloxacin, and levofloxacin are antibiotics.

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 Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi. The client would be at risk for infection.

Which of the following nursing actions is most important in caring for the client following lithotripsy? - Monitor the continuous bladder irrigation. - Administer allopurinol (Zyloprim). - Strain the urine carefully for stone fragments. - Notify the physician of hematuria.

Strain the urine carefully for stone fragments.

Which is the procedure of choice for men with recurrent or complicated UTIs? Transrectal ultrasonography IV urogram CT MRI

Transrectal ultrasonography A transrectal ultrasonography is the procedure of choice for men with recurrent or complicated UTIs.

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

WBC 50

Which risk factors predispose a client to the development of kidney stones? Select all that apply. immobilization. gout. hyperparathyroidism. hypoparathyroidism.

immobilization Hypoparathyroidism is not a risk factor for the development of kidney stones. Immobilization, gout, and hyperparathyroidism are risk factors.

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. - prevent bladder distention. - promote urine production. - prevent urinary retention.

promote normal bladder function. The clamping and unclamping of the catheter begins to reestablish normal bladder function and capacity.

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. 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.

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? Bactrim Cipro Macrodantin Septra

Cipro Ciprofloxacin (Cipro) is a fluoroquinolone used to treat UTIs. Co-trimoxazole (Bactrim, Septra) is a trimethoprim-sulfamethoxazole combination medication. Nitrofurantoin (Macrodantin, Furadantin) is an anti-infective urinary tract medication.

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) Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac (Toradol) are effective in treating renal stone pain because they provide specific pain relief. They also inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone.

A 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 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.

The nurse is preparing to assess a client's new stoma. Which finding would the nurse include in the documentation of a healthy stoma? - Pain - Pink color - Black color - Dry in appearance

Pink color Characteristics of a healthy stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. A black, purple, or brown color may indicate that the vascular supply may be compromised, which may require surgical intervention.

A female patient visits her primary health care provider with a complaint of frequency of urination and incontinence when she sneezes. The health care provider suspects the patient is experiencing cystitis. The nurse knows that this is most likely due to which of the following? - Interruption in the protective effect of glycosaminoglycan - Disturbance in the normal bacterial flora of the vagina - Reflux of urine from the urethra into the bladder - Dysfunction of the bladder neck or urethra.

Reflux of urine from the urethra into the bladder With urethrovesical reflux, coughing, sneezing, or straining causes the bladder pressure to increase, which may force urine from the bladder into the urethra. When the pressure returns to normal, the urine flows back into the bladder, bringing into the bladder bacteria from the anterior portions of the urethra.

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

- Urinary retention - Deficient knowledge: management of urinary diversion - Disturbed body image

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 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.

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 The nurse should observe for signs and symptoms of UTI: cloudy malodorous urine, hematuria, fever, chills, anorexia, and malaise

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

Hyperparathyroidism Metabolic defects such as hyperparathyroidism and hyperuricemia (gout) are associated with stone formation. Hypoparathyroidism, hyperthyroidism, and hypouricemia are not associated with stone formation.

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. 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.

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

Iatrogenic 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.

The nurse is conducting a history and assessment related to a client's incontinence. Which element should the nurse include in the assessment before beginning a bladder training program? - Medication usage - History of allergies - Occupational history - Smoking habits

Medication usage It is essential to assess the client's physical and environmental conditions before beginning a bladder training program, because the patient may not be able to reach the bathroom in time. During the bladder training program, a change in environment may be an effective suggestion for the client. It is not so essential to assess the client's history of allergy, occupation, and smoking habits before beginning a bladder training program.

A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal? Determine the stone type. Relieve any obstruction. Relieve the pain. Prevent nephron destruction.

Relieve the pain. The immediate objective is to relieve pain, which can be incapacitating depending on the location of the stone.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? - Straight catheterize the client every 4 to 6 hours. - Administer acetaminophen (Tylenol). - Teach client to increase fluid intake up to 3 liters per day. - Restrict fluid intake to 1 liter per day.

Teach client to increase fluid intake up to 3 liters per day.

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 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.

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

stress 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.

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 signs of a bladder infection include fever, chills, and suprapubic pain.

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." Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.

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?"

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

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 Infection is caused by an increased urinary bacterial count that results from incomplete and delayed emptying of the bladder.

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 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.

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 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.

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) The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.

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. 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.

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

Incontinence 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.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence? - Increased urine production due to metabolic conditions - Decreased pelvic muscle tone due to multiple pregnancies - Bladder irritation related to urinary tract infections - Obstruction due to fecal impaction or enlarged prostate

Decreased pelvic muscle tone due to multiple pregnancies Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease. Transient incontinence is due to increased urine production related to metabolic conditions. Urge incontinence is due to bladder irritation related to urinary tract infections, bladder tumors, radiation therapy, enlarged prostate, or neurologic dysfunction. Overflow incontinence is due to obstruction from fecal impaction or enlarged prostate.

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. 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.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs? - "I should wipe from back to front." - "I should take a tub bath at least 3 times per week." - "I should take at least 1,000 mg of vitamin C each day." - "I should limit my fluid intake to limit my trips to the bathroom."

"I should take at least 1,000 mg of vitamin C each day." The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTI.

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 Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diuretic and may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder? Incontinence Dysuria Hematuria Frequency

Hematuria The most common first symptom of a malignant tumor is hematuria. Most malignant tumors are vascular; thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of incontinence (a later sign), dysuria and frequency.

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. 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).

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.

help the client cope with the anxiety associated with changes in body image. 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.

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 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.

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. 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.

Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet? - Low oxalate - Low purine - High protein - High sodium

Low purine A low-purine diet is used for uric acid stones, although the benefits are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciuria—approximately half of the clients—need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.

A 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

Painless, gross hematuria Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.

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. 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.

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 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.

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 The nurse plans to have the stoma located away from skin folds and creases, bony prominences, the belt line, and the umbilicus. The stoma should be located in an area where the client can see and reach it.

A client 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." 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.

After teaching a group of students about malignant bladder tumors, the instructor determines that the teaching was successful when the students identify which of the following clients as having the greatest risk for developing a malignant bladder tumor? Client with a history of untreated gonorrhea Client with a history of bladder inflammation Client with a history of cigarette smoking Client with a history of a sexually transmitted disease

Client with a history of cigarette smoking Environmental and occupational health hazards are associated with bladder tumors. Therefore, the client who smokes is at the greatest risk for a malignant tumor. The client with a history of untreated gonorrhea is most vulnerable to urethral strictures, while the client with a history of bladder inflammation may be vulnerable to interstitial cystitis. Finally, the client with sexually transmitted disease may be vulnerable to acquiring urethritis.

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. 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.

When caring for a client with an uncomplicated mild urinary tract infection (UTI), the nurse knows that recent studies have shown which drug to be a good choice for short-course (e.g., 3-day) therapy? Levofloxacin Trimethoprim-sulfamethoxazole Nitrofurantoin Ciprofloxacin

Levofloxacin Levofloxacin, a fluoroquinolone, is a good choice for short-course therapy of uncomplicated mild to moderate UTI. Clinical trial data show high client compliance with the 3-day regimen (95.6%) and a high eradication rate for all pathogens (96.4%). Trimethoprim-sulfamethoxazole (TMP-SMZ) and nitrofurantoin are commonly used to treat complicated UTIs, such as pyelonephritis. Ciprofloxacin is also a good choice for treatment of a complicated UTI. Recent studies have found ciprofloxacin to be significantly more effective than TMP-SMZ in community-based clients and in nursing home residents.

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. 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.

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. 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.

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. 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.

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. The trend is toward a shortened course of antibiotic therapy for uncomplicated UTIs, because most cases are cured after 3 days of treatment. Regardless of the regimen prescribed, the patient is instructed to take all doses prescribed, even if relief of symptoms occurs promptly. Although brief pharmacologic treatment of UTIs for 3 days is usually adequate in women, infection recurs in about 20% of women treated for uncomplicated UTIs.

A client 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 Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

A 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. 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

A patient taking an alpha-adrenergic medication for the treatment of hypertension is having a problem with incontinence. What does the nurse tell the patient? - The medication has caused permanent damage to the bladder sphincter and will require surgical correction. - Relaxation of the supporting ligaments has occurred and the patient will need to perform pelvic floor exercises to strengthen them. - The patient will require a medication regimen to decrease the overactivity of the bladder. - When the medication is discontinued or changed, the incontinence will resolve.

When the medication is discontinued or changed, the incontinence will resolve. Iatrogenic incontinence refers to the involuntary loss of urine due to extrinsic medical factors, predominantly medications. One such example is the use of alpha-adrenergic agents to decrease blood pressure. In some people with an intact urinary system, these agents adversely affect the alpha receptors responsible for bladder neck closing pressure; the bladder neck relaxes to the point of incontinence with a minimal increase in intra-abdominal pressure, thus mimicking stress incontinence. As soon as the medication is discontinued, the apparent incontinence resolves.