HIT 3 Test 4 Urinary Disorders C 55

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

A client presents at the clinic with complaints of urinary retention. What question should the nurse ask to obtain additional information about the client's complaint?

"When did you last urinate?" Explanation: The nurse needs to determine the last time the client voided.

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 Explanation: 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 participating in a bladder retraining program for a patient who had an indwelling catheter for 2 weeks. The nurse knows that, during this process, straight catheterization, after catheter-free intervals, can be discontinued when residual urine is:

<100 mL Explanation: Residual urine greater than 100 mL is considered diagnostic of urinary retention. Refer to Box 28-9 in the text.

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 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.

After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the student have understood the material when they identify which of the following as a cause of stress incontinence?

Decreased pelvic muscle tone due to multiple pregnancies Explanation: 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 employed in an urologist office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?

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.

The most common presenting objective symptoms of a urinary tract infection in older adults, especially in those with dementia, include?

Change in cognitive functioning Explanation: The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these patients 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.

The nurse is caring for a client who is describing urinary symptoms of needing to go to the bathroom with little notice. When the nurse is documenting these symptoms, which medical term will the nurse document?

Urinary urgency Explanation: The nurse would document urinary urgency. Urinary frequency is urinating more frequently than normal often times due to inadequate emptying of the bladder. Urinary incontinence is the involuntary loss of urine. Urinary stasis is a stoppage or diminution of flow.

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

WBC 50 Explanation: Increased white blood cell occurs in all clients with a UTI and indicates an infectious process is occurring.

The nurse working with a patient after an ileal conduit notices that the pouching system is leaking small amounts of urine. The appropriate nursing intervention is which of the following?

Change wafer and pouch. Explanation: Whenever the nurse notes a leaking pouching system, the nurse should change the wafer and pouch. Attempting to secure or patch the leak with tape and/or barrier paste will trap urine under the barrier or faceplate, which will compromise peristomal skin integrity. Emptying the pouch will not rectify the leaking.

Which of the following would be included in a teaching plan for a patient diagnosed with a UTI?

Drink liberal amount of fluids. Explanation: Patients 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 patient should shower instead of bathing in a tub because bacteria in the bath water may enter the urethra.

A male patient, who is 82 years of age, suffers from urinary incontinence. Which of the following factors should the nurse assess before beginning a bladder training program for the patient?

Physical and environmental conditions Explanation: It is essential to assess the patient'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 patient. It is not so essential to assess the patient's history of allergy, occupation, and smoking habits before beginning a bladder training program.

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 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.

Urinary tract infections increase with age and disability. The nurse is aware that the elderly often fail to exhibit the typical symptoms of a UTI. Therefore, a urine culture and sensitivity should be obtained. What bacteria would the nurse expect to find to help confirm the diagnosis of a UTI?

Escherichia coli Explanation: Escherichia coli is the most common organism found in urinary tract infections, especially in the elderly. It is responsible for more than 50% of infections (based on research studies).

Which of the following is a cause of a calcium renal stone?

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.

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?

History of cigarette smoking Explanation: 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.

The nurse is conducting a community education program on UTIs. The nurse determines that the participants understand the teaching when they identify which of the following as a contributing factor for UTIs in older adults?

Immunocompromise Explanation: Factors that contribute to UTIs in older adults include immunocompromise, high incidence of chronic illness, immobility, and frequent use of antimicrobial agents.

Which type of voiding dysfunction is seen in patients diagnosed with Parkinson's disease?

Incontinence Explanation: Incontinence is noted in patients diagnosed with Parkinson's 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 undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. 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. 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.

Which finding is an early indicator of bladder cancer?

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.

Which of the following medications may be ordered to relieve discomfort associated with a UTI?

Phenazopyridine (Pyridium) Explanation: Pyridium is a urinary analgesic ordered to relieve discomfort associated with UTIs. Furadantin, Cipro, and Levaquin are antibiotics.

Which of the following is a characteristic of a normal stoma?

Pink color Explanation: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.

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. 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.

During a rectal examination, which finding is evidence of a urethral injury?

The presence of a boggy mass Explanation: When the urethra is ruptured, a hematoma or collection of blood separates the two sections of the urethra. This condition may feel like a boggy mass on rectal examination. Because of the rupture and hematoma, the prostate becomes high riding. A palpable prostate gland usually indicates a nonurethral injury. Absent sphincter tone would refer to a spinal cord injury. The presence of blood (a positive Hemoccult) would probably correlate with GI bleeding or a colon injury.

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 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.

Which of the following is the procedure of choice for men with recurrent or complicated urinary tract infections (UTIs)?

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

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 Explanation: Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an over distended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.

The nurse advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances?

Uric acid Explanation: Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.

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. 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.

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'm so glad I don't have to make any changes in my diet."

Which of the following terms is used to refer to inflammation of the renal pelvis?

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.

A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?

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

Sympathomimetics have which of the following effects on the body?

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

The nurse advises the patient with chronic pyelonephritis that he should:

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.

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 urinate after engaging in sexual intercourse Explanation: 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.

A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?

Increasing fluid intake to 3 L/day Explanation: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

A client undergoes surgery for removing a malignant tumor followed by a urinary diversion procedure. Which of the following postoperative procedures is the most important for the nurse to perform?

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.

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. 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.

Bladder retraining following removal of an indwelling catheter begins with

instructing the patient to follow a 2 to 3 hour timed voiding schedule. Explanation: Immediately after the removal of the indwelling catheter, the patient is placed on a timed voiding schedule, usually 2 to 3 hours. At the given time interval, the patient is instructed to void. Immediate voiding is not usually encouraged. The patient is commonly placed on a timed voiding schedule, usually within 2 to 3 hours. Immediately after the removal of the indwelling catheter, the patient is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. If bladder ultrasound scanning shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed for complete bladder emptying.

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

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

A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply.

• Suspend the drainage bag off the floor. • Wash the perineal area with soap and water at least twice daily. • Empty the collection bag at least every 8 hours to reduce bacterial growth.

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, reducing swelling and facilitating passage of the stone?

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.

Which nursing diagnosis is appropriate for a client with renal calculi?

Risk for infection Explanation: Infection can occur with renal calculi from urine stasis caused by obstruction. Ineffective tissue perfusion (renal) and Decreased cardiac output aren't appropriate for this client, and retention of urine, rather than incontinence, usually occurs.

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 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.

Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?

Low purine Explanation: 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.

The nurse is conducting a community education program on urinary incontinence. The nurse determines that the participants understand the teaching when they identify which of the following as risk factors for urinary incontinence?

Sedatives Explanation: Use of sedatives, diuretics, hypnotics, and opioids are risk factors for urinary incontinence. Additional risk factors include high-impact exercises, a BMI greater than 40, and vaginal birth delivery.