H & C Prep U Ch 55: Management of Patients With Urinary Disorders

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

"I should limit my intake of meat and fish."

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 take at least 1,000 mg of vitamin C each day."

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."

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

"When did you last urinate?"

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-purine diet

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

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence

Anticholinergic

Which type of medication may be used to inhibit bladder contraction in a client with incontinence

Anticholinergic agent

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

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

By ascending infection (transurethral)

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

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

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 has been asked to provide health information to a female patient diagnosed with a urinary tract infection. What appropriate instructions will the nurse provide? Select all that apply

Cleanse around the perineum and urethral meatus after each bowel movement to reduce pathogens. Drink liberal amounts of fluid to flush out bacteria. Void every 2-3 hours to prevent overdistention of the bladder

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

Diabetes mellitus

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply

Disturbed body image Risk for impaired skin integrity Deficient knowledge: management of urinary diversion

A male client who is admitted with the diagnosis of urinary calculi complains of excruciating pain. The pain is suspected to be caused by increased pressure in the renal pelvis. Which measure would be most appropriate to provide pain relief

Encourage frequent ambulation.

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

Hematuria

Which metabolic defects are associated with stone formation

Hyperparathyroidism

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications

Iatrogenic

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

Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing

Stress

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.

Patients with urolithiasis need to be encouraged to

Increase their fluid intake so that they can excrete 2.5 to 4 liters every day.

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following

Location of discomfort

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 purine

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-purine diet

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 reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom

Painless hematuria

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

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection

Perform meticulous perineal care daily with soap and water

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

Urge

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

Peritonitis

Which medication may be ordered to relieve discomfort associated with a UTI

Phenazopyridine

Which medication may be ordered to relieve discomfort associated with a urinary tract infection

Phenazopyridine

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

Which of the following nursing actions is most important in caring for the client following lithotripsy

Strain the urine carefully for stone fragments.

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 reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find

Pyuria

Which laboratory value supports a diagnosis of pyelonephritis

Pyuria

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis

Risk for infection

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.

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.

The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction

The nursing assistant places the drainage bag on the client's abdomen for transport.

The 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 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

Uric acid

A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage

milk

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

notify the physician about cloudy or foul-smelling urine.

The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include

WBC 50

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 a suspected bladder tumor. What is the most common first symptom of a malignant tumor of the bladder

painless hematuria

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 being treated for a malignant bladder tumor. What would be included in treatment of a small tumor? Select all that apply

• resection and fulguration • topical application of an antineoplastic drug

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

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 an abnormal finding that requires further assessment.

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

Ketoralac (Toradol)

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

When the medication is discontinued or changed, the incontinence will resolve.