QUIZLET Ch. 55 (MED SURG) URINARY DISORDERS

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction? "Take your temperature every 4 hours." "Increase your fluid intake to 2 to 3 L per day." "Be aware that your urine will be cherry-red for 5 to 7 days." "Apply an antibacterial dressing to the incision daily."

"Increase your fluid intake to 2 to 3 L per day." Rationale: Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system

A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program? Encouraging the client to increase the time between voidings Assessing present voiding patterns Restricting fluid intake to reduce the need to void Establishing a predetermined fluid intake pattern for the client

Assessing present voiding patterns Rationale: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding.

Behavioral interventions for urinary incontinence can be coordinated by a nurse. A comprehensive program that incorporates timed voiding and urinary urge inhibition is referred to as what? Bladder retraining Interval voiding Voiding at given intervals Prompted voiding

Bladder retraining

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? Empty the pouch. Change the wafer and pouch. Secure or patch it with tape. Secure or patch it with barrier paste.

Change the wafer and pouch.

The clinic nurse is teaching a young woman about preventing recurrent urinary tract infections. What information should the nurse include? Avoid voiding immediately after sexual intercourse. Void every 6 to 8 hours. Bathe daily. Drink liberal amounts of fluids.

Drink liberal amounts of fluids.

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 Perform straight catheterization every 4 hours Implement a 2- to 3-hour voiding schedule Avoid drinking fluids for 6 hours

Implement a 2- to 3-hour voiding schedule rationale: 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.

A client undergoes surgery to remove a malignant tumor followed by a urinary diversion procedure. Which postoperative procedure is the most important for the nurse to perform? Maintain skin and stomal integrity. Suggest a visit to a local ostomy group. Determine the client's ability to manage stoma care. Show photographs and drawings of the placement of the stoma.

Maintain skin and stomal integrity.

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

Relaxation of bladder wall rationale: Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.

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

Pyelonephritis Rationale: - 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 Septra Bactrim Levaquin

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

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 retention urinary tract infection urinary incontinence urethral strictures

urinary tract infection rationale: Signs of a bladder infection include fever, chills, and suprapubic pain.

The nurse is conducting discharge teaching for a client who was admitted with a kidney stone. The nurse includes which instruction as a measure to prevent additional kidney stones? Increase protein intake. Adhere to a low-calcium diet. Avoid drinking water before bedtime. Avoid drinking tea.

Avoid drinking tea. rationale: - The nurse should teach the client to avoid tea and other oxalate-containing foods, such as spinach, strawberries, rhubarb, peanuts, and wheat bran. - The client should restrict protein intake to 60 g/day and should drink two glasses of water at bedtime. - Low-calcium diets are generally not recommended.

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

Iatrogenic rationale: - Latrogenic 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.

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 Muscle spasm and abdominal rigidity over the flank Deep flank and abdominal pain Decreasing kidney function associated with fever and hematuria

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

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

Teach client to increase fluid intake up to 3 liters per day. rationale: The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

Which statement describing urinary incontinence in an older adult client is true? Urinary incontinence is a normal part of aging. Urinary incontinence is a disease. Urinary incontinence isn't a disease. Urinary incontinence in the elderly population can't be treated.

Urinary incontinence isn't a disease.

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 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. assess whether the client is a good candidate for surgery.

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

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. Take the antibiotic as well as an antifungal for the yeast infection she will probably have. Be sure to take the medication with grapefruit juice. Understand that if the infection reoccurs, the dose will be higher next time.

Take the antibiotic for 3 days as prescribed.

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 need to drink eight to ten glasses of water every day." "I'm so glad I don't have to make any changes in my diet." "I will never have another urinary stone again." "Tylenol is best to control my pain." "I need to take allopurinol."

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

Which nursing diagnosis is appropriate for the client with a new ileal conduit? Select all that apply. Risk for impaired skin integrity Disturbed body image Deficient knowledge: management of urinary diversion Urinary retention Chronic pain

Change in cognitive functioning rationale: especially in those with dementia, because these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

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

Excessive intake of vitamin D Rationale: 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.

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? Bladder Ureter Urethra Kidney

Kidney

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens Use clean technique during insertion Perform meticulous perineal care daily with soap and water Place the catheter bag on the client's abdomen when moving the client

Perform meticulous perineal care daily with soap and water

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

painless hematuria rationale: 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.

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: Uninhibited detrusor contractions. Loss of motor control of the detrusor muscle. A stricture or tumor in the bladder. Compromised ligament and pelvic floor support of the urethra.

Loss of motor control of the detrusor muscle. Rationale: 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.

Which medication may be ordered to relieve discomfort associated with a UTI? cystectomy urinary diversion topical application of an antineoplastic drug resection and fulguration

- topical application of an antineoplastic drug - resection and fulguration rationale: Small, superficial tumors may be removed by cutting (resecting) or coagulation (fulguration) with a transurethral resectoscope. Topical application of an antineoplastic drug may be used after resection and fulguration of a tumor. Cystectomy is a surgical removal of the bladder and is performed for large tumors that have penetrated the muscle wall. Urinary diversion is performed after a cystectomy.

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? Ginger ale at dinner time Fruit juice midmorning Milk at lunch Coffee in the morning

Coffee in the morning Rationale: - 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.

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 Rationale: Increased urinary glucose levels create an infection-prone environment in the urinary tract.

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? Clean the stoma with soap and water after the patient voids. Monitor urine output hourly and report output less than 30 mL/hr. 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. rationale: 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.

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? If risk for chronic pyelonephritis is likely Shows damage to the kidneys Reveals causative microorganisms Detects calculi, cysts, or tumors

Detects calculi, cysts, or tumors Rationale: - 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.

The nurse is educating a patient with urolithiasis about preventive measures to avoid another occurrence. What should the patient be encouraged to do? 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. 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. Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. SUBMIT ANSWER

Increase fluid intake so that the patient can excrete 2,500 to 4,000 mL every day, which will help prevent additional stone formation. rationale: 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

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? High protein High sodium Low purine Low oxalate

Low purine Rationale: - 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 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."

- "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." rationale: - Nonsteroidal anti-inflammatory drugs are used to treat renal stone pain. - Oxalate-containing foods should be avoided. - Fluid intake should total 2 to 3 liters, if not contraindicated. - Allopurinol (Zyloprim) is prescribed for uric acid stones. - Recurrence of stones occurs in about half of individuals.

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 Colonization of the patient's urethra from bloodborne pathogens Proliferation of normal microbiotic flora Ingested microorganisms

Fecal contamination from the patient's perineum

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? Reflux of urine from the urethra into the bladder Interruption in the protective effect of glycosaminoglycan Dysfunction of the bladder neck or urethra. Disturbance in the normal bacterial flora of the vagina

Reflux of urine from the urethra into the bladder rationale: 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.