Chapter 49: Management of Patients with Urinary Disorders Flashcards
(40 cards)
- A female client has been experiencing recurrent urinary tract infections. What health
education should the nurse provide to this client?
A. Bathe daily and keep the perineal region clean.
B. Avoid voiding immediately after sexual intercourse.
C. Drink liberal amounts of fluids.
D. Void at least every 6 to 8 hours.
ANS: C
Rationale: The client is encouraged to drink liberal amounts of fluids (water is the best
choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder
completely because this can significantly lower urine bacterial counts, reduce urinary
stasis, and prevent reinfection. The client should be encouraged to shower rather than bathe.
- A 42-year-old woman comes to the clinic reporting occasional urinary incontinence
when sneezing. The clinic nurse should recognize what type of incontinence?
A. Stress incontinence
B. Reflex incontinence
C. Overflow incontinence
D. Functional incontinence
ANS: A
Rationale: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure, such as a result of exertion, sneezing, coughing, or changing positions. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the client to reach the toilet in time for voiding.
- A nurse is caring for a female client whose urinary retention has not responded to
conservative treatment. When educating this client about self-catheterization, the nurse
should encourage what practice?
A. Assuming a supine position for self-catheterization
B. Using clean technique at home to catheterize
C. Inserting the catheter 1 to 2 inches (2.5 to 5 cm) into the urethra
D. Self-catheterizing every 2 hours at home
ANS: B
Rationale: The client may use a “clean” (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female client assumes a Fowler position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.
- A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this
client’s discharge education, what is the most plausible nursing diagnosis that the nurse
should address?
A. Impaired mobility related to limitations posed by the ileal conduit
B. Deficient knowledge related to care of the ileal conduit
C. Risk for deficient fluid volume related to urinary diversion
D. Risk for autonomic dysreflexia related to disruption of the sacral plexus
ANS: B
Rationale: The client will most likely require extensive teaching about the care and
maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.
- The nurse on a urology unit is working with a client who has been diagnosed with
calcium oxalate renal calculi. When planning this client’s health education, what
nutritional guidelines should the nurse provide?
A. Restrict protein intake as prescribed.
B. Increase intake of potassium-rich foods.
C. Follow a low-calcium diet.
D. Encourage intake of food containing oxalates.
ANS: A
Rationale: Protein is restricted to 60 g/day, while sodium is restricted to 3 to 4 g/day.
Low-calcium diets are generally not recommended except for true absorptive
hypercalciuria. The client should avoid intake of oxalate-containing foods and there is no need to increase potassium intake.
- The nurse is caring for a client who underwent percutaneous (endourologic) lithotripsy
earlier in the day. What instruction should the nurse give the client?
A. Limit oral fluid intake for 1 to 2 days.
B. Report the presence of fine, sand-like particles through the nephrostomy tube.
C. Notify the health care provider about cloudy or foul-smelling urine.
D. Report any pink-tinged urine within 24 hours after the procedure.
ANS: C
Rationale: The client should report the presence of foul-smelling or cloudy urine since this is suggestive of a urinary tract infection (UTI). Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand-like debris is normal due to residual stone products. Hematuria is common after lithotripsy.
- A female client’s most recent urinalysis results are suggestive of bacteriuria. When
assessing this client, the nurse’s data analysis should be informed by what principle?
A. Most UTIs in female clients are caused by viruses and do not cause obvious
symptoms.
B. A diagnosis of bacteriuria requires three consecutive positive results.
C. Urine contains varying levels of healthy bacterial flora.
D. Urine samples are frequently contaminated by bacteria normally present in the
urethral area.
ANS: D
Rationale: Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.
- The clinic nurse is preparing a plan of care for a client with a history of stress
incontinence. What role will the nurse have in implementing a behavioral therapy
approach?
A. Provide medication teaching related to pseudoephedrine sulfate.
B. Teach the client to perform pelvic floor muscle exercises.
C. Prepare the client for an anterior vaginal repair procedure.
D. Provide information on periurethral bulking.
ANS: B
Rationale: Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions have a behavioral approach.
- The nurse and urologist have both been unsuccessful in catheterizing a client with a
prostatic obstruction and a full bladder. What approach does the nurse anticipate the
health care provider will use to drain the client’s bladder?
A. Insertion of a suprapubic catheter
B. Scheduling the client immediately for a prostatectomy
C. Application of warm compresses to the perineum to assist with relaxation
D. Medication administration to relax the bladder muscles and reattempting
catheterization in 6 hours
ANS: A
Rationale: When the client cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.
- The nurse has implemented a bladder retraining program for an older adult client.
The nurse places the client on a timed voiding schedule and performs an ultrasonic
bladder scan after each void. The nurse notes that the client typically has approximately
50 mL of urine remaining in the bladder after voiding. What would be the nurse’s best
response to this finding?
A. Perform a straight catheterization on this client.
B. Avoid further interventions at this time, as this is an acceptable finding.
C. Place an indwelling urinary catheter.
D. Press on the client’s bladder in an attempt to encourage complete emptying.
ANS: B
Rationale: In adults older than 60 years of age, 50 to 100 mL of residual urine may
remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted.
- The nurse is caring for a client recently diagnosed with renal calculi. The nurse should
instruct the client to increase fluid intake to a level where the client produces at least how
much urine each day?
A. 1,250 mL
B. 2,000 mL
C. 2,750 mL
D. 3,500 mL
ANS: B
Rationale: Unless contraindicated by kidney injury or hydronephrosis, clients with renal
stones should drink at least eight 8-oz (250 mL) glasses of water daily or have IV
fluids prescribed to keep the urine dilute. Urine output exceeding 2 L a day is advisable.
- A client with cancer of the bladder has just returned to the unit from the PACU after
surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the
client’s urine output hourly and notifies the health care provider when the hourly output
is less than what amount?
A. 30 mL
B. 50 mL
C. 100 mL
D. 125 mL
ANS: A
Rationale: A urine output below 0.5 mL/kg/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis.
- The nurse is caring for a client with an indwelling urinary catheter. The nurse is aware
that what nursing action helps prevent infection in a client with an indwelling catheter?
A. Vigorously clean the meatus area daily.
B. Apply powder to the perineal area twice daily.
C. Empty the drainage bag at least every 8 hours.
D. Irrigate the catheter every 8 hours with normal saline.
ANS: C
Rationale: To reduce the risk of bacterial proliferation, the nurse should empty the
collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become
contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.
- The nurse is teaching a health class of older adults about urinary tract infections
(UTI)s. What characteristic of UTIs should the nurse cite?
A. Men over age 65 are equally prone to UTIs as women, but are more often
asymptomatic.
B. The prevalence of UTIs in older men approaches that of women in the same age
group.
C. Men of all ages are less prone to UTIs, but typically experience more severe
symptoms.
D. The prevalence of UTIs in men cannot be reliably measured, as men generally
do not report UTIs.
ANS: B
Rationale: The antibacterial activity of the prostatic secretions that protect men from
bacterial colonization of the urethra and bladder decreases with aging, resulting in
increased incidence. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs.
- A client has been admitted to the postsurgical unit following the creation of an ileal
conduit. What should the nurse measure to determine the size of the appliance needed?
A. The circumference of the stoma
B. The length, then double it
C. The widest part of the stoma
D. Half the width of the stoma
ANS: C
Rationale: The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage.
- A client being treated in the hospital has been experiencing occasional urinary
retention. What voiding trigger technique would help this client?
A. Using a bedpan instead of a commode
B. Dipping the client’s hands in warm water
C. Performing a bladder scan after voiding
D. Encouraging male clients to use a urinal in bed
ANS: B
Rationale: Dipping the client’s hands in warm water is a urinary trigger technique that helps encourage clients to start voiding. Other trigger techniques include turning on the faucet while the client is attempting to void and stroking the abdomen or inner thighs. Using a commode instead of a bedpan is a nursing measure to encourage normal voiding patterns. Encouraging a male client to use a urinal while standing is more natural and comfortable and is also linked to voiding patterns. Bladder scanning after voiding will
assess whether the client is retaining urine but is not a trigger technique.
- A nurse’s colleague has applied an incontinence pad to an older adult client who has
experienced occasional episodes of functional incontinence. What principle should guide
the nurse’s management of urinary incontinence in older adults?
A. Diuretics should be promptly discontinued when an older adult experiences
incontinence.
B. Restricting fluid intake is recommended for older adults experiencing
incontinence.
C. Urinary catheterization is a first-line treatment for incontinence in older adults
with incontinence.
D. Urinary incontinence is not considered a normal consequence of aging.
ANS: D
Rationale: Nursing management is based on the premise that incontinence is not
inevitable with illness or aging and that it is often reversible and treatable. Diuretics
cannot always be safely discontinued. Fluid restriction and catheterization are not
considered to be safe, first-line interventions for the treatment of incontinence.
- The nurse is working with a client whose health history includes occasional episodes
of urinary retention. What assessment finding would suggest that the client is currently
retaining urine?
A. The client’s suprapubic region is dull on percussion.
B. The client is uncharacteristically drowsy.
C. The client claims to void large amounts of urine two to three times daily.
D. The client takes a beta adrenergic blocker for the treatment of hypertension.
ANS: A
Rationale: Dullness on percussion of the suprapubic region is suggestive of urinary
retention. Clients retaining urine are typically restless, not drowsy. A client experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.
- A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy
(ESWL). What should the nurse include in the client’s postprocedure care?
A. Strain the client’s urine following the procedure.
B. Administer a bolus of 500 mL normal saline following the procedure.
C. Monitor the client for fluid overload following the procedure.
D. Insert a urinary catheter for 24 to 48 hours after the procedure.
ANS: A
Rationale: Following ESWL, the nurse should strain the client’s urine for gravel or sand.
There is no need to administer an IV bolus after the procedure and there is not a
heightened risk of fluid overload. Catheter insertion is not normally indicated following
ESWL.
- The nurse is caring for a client who has undergone creation of a urinary diversion.
Forty-eight hours postoperatively, the nurse’s assessment reveals that the stoma is a
dark purplish color. What is the nurse’s most appropriate response?
A. Document the presence of a healthy stoma.
B. Assess the client for further signs and symptoms of infection.
C. Inform the primary care provider that the vascular supply may be compromised.
D. Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy
appliance around the stoma may be too loose.
ANS: C
Rationale: A healthy stoma is pink or red. A change from this color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma.
- A client is undergoing diagnostic testing for a suspected urinary obstruction. The
nurse should know that incomplete emptying of the bladder due to bladder outlet
obstruction can cause what issue?
A. Hydronephrosis
B. Nephritic syndrome
C. Pyelonephritis
D. Nephrotoxicity
ANS: A
Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the
renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.
- The nurse is assessing a client admitted with renal stones. During the admission
assessment, what parameters should the nurse address? Select all that apply.
A. Dietary history
B. Family history of renal stones
C. Medication history
D. Surgical history
E. Vaccination history
ANS: A, B, C
Rationale: Dietary and medication histories and family history of renal stones are
obtained to identify factors predisposing the client to stone formation. When caring for a client with renal stones, it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones.
- A nurse who provides care in a long-term care facility is aware of the high incidence
and prevalence of urinary tract infections among older adults. What action has the
greatest potential to prevent UTIs in this population?
A. Administer prophylactic antibiotics as prescribed.
B. Limit the use of indwelling urinary catheters.
C. Encourage frequent mobility and repositioning.
D. Toilet residents who are immobile on a scheduled basis.
ANS: B
Rationale: When indwelling catheters are used, the risk of UTI increases dramatically.
Limiting their use significantly reduces an older adult’s risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally given. Mobility does not have a direct effect on UTI risk.
- A female client has been prescribed a course of antibiotics for the treatment of a UTI.
When providing health education for the client, the nurse should address what topic?
A. The risk of developing a vaginal yeast infection as a consequence of antibiotic
therapy
B. The need to expect a heavy menstrual period following the course of antibiotics
C. The risk of developing antibiotic resistance after the course of antibiotics
D. The need to undergo a series of three urine cultures after the antibiotics have
been completed
ANS: A
Rationale: Yeast vaginitis occurs in many clients treated with antimicrobial agents that affect vaginal flora. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.
