Ch 58: Concepts of Care for Patients With Urinary Conditions (Evolve Questions)

The nurse is caring for a client who has a Foley catheter following gynecologic surgery. Which action by the assistive personnel (AP) requires nursing intervention?

A. Emptying the collection bag into a clean container.

B. Washing hands prior to emptying the Foley catheter.

C. Flushing the urine in the toilet after emptying the collection bag.

D. Placing the collection bag on the floor to prevent kinks in the tubing.

D

Although preventing kinks in the Foley catheter tubing is important, the nurse will need to intervene to prevent the collection bag from being placed on the floor (Choice D). The bag should be lower than the client's bladder, allowing the urine to flow through the tubing into the collection bag. Placing the collection bag on the floor could allow for urine to backflow into the tubing, creating a risk of infection. In addition, the port used to the empty the catheter needs to remain clean to avoid the potential for infection. The other actions are appropriate and do not require nursing intervention (Choices A, B, and C).

The nurse is teaching a 45-year-old female client health promotion to avoid recurrent cystitis. Which client statement indicates the need for additional teaching?

A. "I will drink at least 8 glasses of fluid during the daytime."

B. "After toileting, I will wipe from the front to the back."

C. "I will urinate before and after having intercourse."

D. "I will stop the amoxicillin when I have been symptom free for 2 days."

D

The client statement "I will stop the amoxicillin when I have been symptom free for 2 days" necessitates additional teaching. Amoxicillin is an antibiotic that is frequently used in the treatment of cystitis. The client will need to continue taking the antibiotic until all the medication is gone (Choice D). The symptoms may dissipate well before the course of antibiotic therapy is complete. Stopping the antibiotic can allow the infection to return. The other client statements are appropriate and do not indicate a need for additional teaching (Choices A, B, and C).

A 68-year-old female client presents to the primary care provider for an annual examination. Which assessment finding would alert the nurse to an increased risk for bladder cancer?

A. A 30-year occupation as a hairdresser

B. A recent colon cancer diagnosis in her sister

C. History of hypertension treated with beta blockers

D. Occasional urine leaking with sneezing or laughing

A

Exposure to toxins such as gasoline or diesel fuel or chemicals such as hair dye increases the risk for bladder cancer (Choice A). Bladder cancer does not appear to have a familial or genetic predisposition and is not associated with a relative's diagnosis of colon cancer (Choice B). A history of hypertension with treatment with beta blockers is not associated with an increased risk of bladder cancer (Choice C). Occasional urine leaking with sneezing is descriptive of stress incontinence and would not be a risk for bladder cancer (Choice D).

A 28-year-old female client states, "I don't know why I get cystitis every year. I don't drink much at work so I can avoid using the public toilet." Which of the following teachings by the nurse is most likely to reduce the risk for cystitis? Select all that apply.

A. Reinforce the choice to avoid using a public toilet.

B. Suggest intake of at least 2 to 3 L of fluid throughout the day.

C. Instruct to wipe the perineum from front to back after each toilet use.

D. Reinforce completion of the entire course of antibiotics as prescribed.

E. Instruct to empty the bladder immediately before intercourse.

B, C, D, E

An adequate intake of fluid can dilute the urine and increase the frequency of urination; both help to reduce the number of organisms in the bladder (Choice B). The client should wipe from front to back after toileting to avoid the spread of fecal material into the urinary tract (Choice C). Instructing the client to take the entire course of antibiotics as prescribed is important to eliminate the infection (Choice D). Stopping the medication before the entire course is complete can allow the infection to return or progress. Instructing the client to empty the bladder before and after intercourse can reduce the risk of cystitis (Choice E). Choice A is incorrect because using a public toilet, even sitting on the seat, does not lead to cystitis or a UTI.

A client is diagnosed with renal colic. What would the nurse do first?

A. Prepare the client for lithotripsy.

B. Encourage oral intake of fluids.

C. Administer opioids as ordered.

D. Strain the urine and send for urinalysis.

C

Renal colic is severe flank pain caused by kidney stones. The pain can be most severe when the stone is moving or the ureter is obstructed. The first nursing action is to provide pain relief by administering opioids as ordered (Choice C). The client may require lithotripsy if the stone is too large to pass on its own; however, pain relief should occur first (Choice A). Renal colic is usually very severe and the client will likely be diaphoretic and nauseated. Providing oral fluids can occur once the pain has been controlled (Choice B). The urine should be strained and sent for urinalysis; however, this can occur after the client has received pain medication (Choice D).

The nurse is performing catheter care. Which nursing action demonstrates proper aseptic technique?

A. Applying Betadine ointment to the perineal area after catheterization

B. Irrigating the catheter daily

C. Positioning the collection bag below the height of the bladder

D. Sending a urine specimen to the laboratory for testing

C

Proper aseptic technique during catheter care involves positioning the collection bag below the height of the bladder. Urine collection bags must be kept below the level of the bladder at all times. Elevating the collection bag above the bladder causes reflux of pathogens from the bag into the urinary tract. Applying antiseptic solutions or antibiotic ointments to the perineal area of catheterized clients has not demonstrated any beneficial effect. A closed system of irrigation must be maintained by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract, so routine catheter irrigation would be avoided. Sending a urine specimen to the laboratory is not indicated for asepsis.

The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client statement indicates that the teaching was effective?

A. "I must avoid drinking carbonated beverages."

B. "I need to douche vaginally once a week."

C. "I need to drink 2½ L of fluid every day."

D. "I will not drink fluids after 8 p.m. each evening."

C

Teaching an older female about interventions to decrease the risk for cystitis is effective when the client says, “I need to drink 2½ L of fluid every day.” Drinking this much fluid each day flushes out the urinary system and helps reduce the risk for cystitis. Avoiding carbonated beverages is not necessary to reduce the risk for cystitis. Douching is not a healthy behavior because it removes beneficial organisms as well as the harmful ones. Avoiding fluids after 8:00 p.m. would help prevent nocturia but not cystitis. It is recommended that clients with incontinence problems limit their late-night fluid intake to 120 mL.

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include?

A. "For the best effect, perform all of your exercises while you are seated on the toilet."

B. "Limit your exercises to 5 minutes twice a day, or you may injure yourself."

C. "Results should be visible to you within 72 hours."

D. "You are exercising correct muscles if you can stop urine flow in midstream."

D

The nurse is telling the client about pelvic muscle exercises and says, "You are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used. Pelvic muscle exercises can be performed anywhere and would be performed at least 10 times daily to improve and maintain pelvic muscle strength. Noticeable results in pelvic muscle strength take several weeks.

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which client statement indicates that teaching was effective?

A. "I am so relieved that I can continue eating my fried fish meals every week."

B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore."

C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe."

D. "I will no longer be able to have red wine with my dinner."

D

Teaching about low purine diets to a client with urolithiasis consisting of uric acid is effective when the client says, “I will no longer be able to have red wine with my dinner.” Nutrition therapy depends on the type of stone formed. When stones consist of uric acid (urate), the client needs to decrease intake of purine sources such as organ meats, poultry, fish, gravies, red wines, and sardines. Reduction of urinary purine content may help prevent these stones from forming. Avoiding oxalate sources such as spinach, black tea, and rhubarb is appropriate when the stones consist of calcium oxalate.

The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification?

A. "A small-lumen catheter will help prevent injury to my urethra."

B. "I will use a new, sterile catheter each time I do the procedure."

C. "My family members can be taught to help me if I need it."

D. "Proper handwashing before I start the procedure is very important."

B

The client with a neurogenic bladder who needs to self-catheterize for bladder emptying requires further clarification when the client says, "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and reused. With proper handwashing and cleaning of the catheter, no increase in bacterial complications has been shown. Catheters are replaced when they show signs of deteriorating. The smallest lumen possible and the use of a lubricant help reduce urethral trauma to this sensitive mucous tissue. Research shows that family members in the home can be taught to perform straight catheterizations using a clean (rather than a sterile) catheter with good outcomes. Proper handwashing is extremely important in reducing the risk for infection in clients who use intermittent self-catheterization and is a principle that must be stressed.

The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures?

A. "If I restrict my oral intake of fluids, the adjustment will be easier."

B. "I must go to the restroom more often because my urine will be excreted through my anus."

C. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag."

D. "I will have to drain my pouch with a catheter."

D

The client who is scheduled for a neobladder and Kock pouch correctly understands the procedure when the client says, "I will have to drain my pouch with a catheter." A neobladder is a type of continent reservoir created from an intestinal graft to store urine and replace the surgically removed bladder. A Kock pouch is also a continent reservoir with a Penrose drain and a plastic Medena catheter in the stoma. The drain removes lymphatic fluid or other secretions. The catheter ensures urine drainage so that incisions can heal. For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter. Urine is not excreted through the anus. Fluids would not be restricted. A neobladder does not require the use of an ostomy bag.

Which nursing intervention or practice is effective in helping to prevent urinary tract infection (UTI) in hospitalized clients?

A. Encouraging fluid intake

B. Irrigating all catheters daily with sterile saline

C. Recommending that catheters be placed in all clients

D. Reevaluating the need for indwelling catheters

D

The nursing intervention that is effective in helping to prevent UTIs in hospitalized clients is reevaluating the need for indwelling catheters. Studies have shown that this intervention is the best way to prevent UTIs in the hospital setting. Encouraging fluids, although it is a valuable practice for clients with catheters, will not prevent the occurrence of UTIs in the hospital setting. In some clients, their conditions do not permit an increase in fluids, such as those with heart failure and kidney failure. Irrigating catheters daily is contraindicated, because any time a closed system is opened, bacteria may be introduced. Placing catheters in all clients is unnecessary and unrealistic. This practice would place more clients at risk for the development of UTI.

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows understanding of the teaching?

A. "I need to be drinking at least 1.5 to 2.5 L of fluids every day."

B. "It is a good idea for me to reduce germs by taking a tub bath daily."

C. "Trying to get to the bathroom to urinate every 6 hours is important for me."

D. "Urinating 1000 mL on a daily basis is a good amount for me."

A

The client who shows a correct understanding of avoiding UTIs says, "I need to be drinking at least 1.5 to 2.5 L of fluids every day." To reduce the number of UTIs, clients need to be drinking a minimum of 1.5 to 2.5 L of fluid (mostly water) each day. Showers, rather than tub baths, are recommended for women who have recurrent UTIs. Urinating every 3 to 4 hours is ideal for reducing the occurrence of UTI. This is advisable rather than waiting until the bladder is full to urinate. Urinary output needs to be at least 1.5 L daily. Ensuring this amount "out" is a good indicator that the client is drinking an adequate amount of fluid.

An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond?

A. "Don't worry about it. You need them."

B. "Shop at night, when stores are less crowded."

C. "Tell everyone that they are for your husband."

D. "That is tough. What do you think might help?"

D

When an older women says to the nurse, "I am so embarrassed about buying adult diapers for myself," the nurse says "That is tough. What do you think might help?" Stating that the situation is tough acknowledges the client's concerns, and asking the client to think about what might help assists the client to think of methods to solve her problem. Telling the client not to worry is dismissive of the client's concerns. Telling the client to shop at night does not empower the client, and it reaffirms the client's embarrassment. Suggesting to the client that she tell everyone they are for her husband also does not empower the client. Rather, it suggests to the client that telling untruths is acceptable.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for post procedure home care?

A. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach."

B. "Do not share your toilet with family members for the next 24 hours."

C. "Please be sure to stand when you are urinating."

D. "Underwear worn during the procedure and for 12 hours afterward should be discarded."

B

The nurse tells the client who is being treated for bladder cancer and had a live virus compound instilled into his bladder not to share his toilet with family members for the next 24 hours. The toilet must not be shared for 24 hours following this procedure because others using the toilet could be infected with the live virus that was instilled into the client. If only one toilet is available in the household, teach the client to flush the toilet after use and to follow this by adding 1 cup (236 mL) of undiluted bleach to the bowl water. The bowl is then flushed after 15 minutes, and the seat and flat surfaces of the toilet are wiped with a cloth containing a solution of 10% liquid bleach. The client must sit while urinating for at least 24 hours postprocedure to prevent splashing of the contaminated urine out of the commode, where it could be toxic for anyone who comes in contact with it. Underwear or other clothing that has come into contact with urine during the 24 hours after instillation must be washed separately from other clothing in a solution of 10% liquid bleach. It does not need to be discarded.

Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN?

A. A 42 year old with painless hematuria who needs an admission assessment

B. A 46 year old scheduled for cystectomy who needs help in selecting a stoma site

C. A 48 year old receiving intravesical chemotherapy for bladder cancer

D. A 55 year old with incontinence who has intermittent catheterization ordered

D

The nurse manager assigns a 55-year-old client with incontinence who has intermittent catheterization prescribed to the experienced LPN/LVN. Admission assessments and intravesical chemotherapy would be done by an RN. Preoperative preparation for cystectomy and stoma site selection would be done by an RN and either a Certified Wound, Ostomy, and Continence Nurse or an enterostomal therapy nurse.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (assistive personnel [AP])?

A. Assisting the client in developing a schedule for when to take prescribed antibiotics

B. Inserting a straight catheter as necessary if the client is unable to empty the bladder

C. Teaching the client how to use the Credé maneuver to empty the bladder more fully

D. Using a bladder scanner to check residual bladder volume after the client voids

D

The home health RN delegates the task of using a bladder scanner to check residual bladder volume after the client voids, to the AP. Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (AP) who has been trained and evaluated in this skill. Assisting the client in developing a schedule for when to take prescribed antibiotics, inserting a straight catheter, and teaching the client to use the Credé maneuver all require more education and are in the legal scope of practice of the LPN/LVN or RN.

A client who is admitted with urolithiasis reports “spasms of intense flank pain, nausea, and severe dizziness.” Which intervention does the nurse implement first?

A. Administer morphine sulfate as prescribed.

B. Begin an infusion of metoclopramide as prescribed.

C. Obtain a urine specimen for urinalysis as prescribed.

D. Infuse 0.9% normal saline at 100 mL/hr as prescribed.

A

The intervention the nurse implements first for a client admitted with urolithiasis who reports “spasms of intense flank pain, nausea, and severe dizziness” is to administer morphine sulfate. Morphine administered intravenously will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension. An infusion of metoclopramide (Reglan) 10 mg IV would be begun after the client’s pain is controlled. A urine specimen for urinalysis would be obtained and an infusion of 0.9% normal saline at 100 mL/hr would be started after the client’s pain is controlled.

The nurse receives the change-of-shift report on four clients. Which client will the nurse assess first?

A. A 26 year old admitted 2 days ago with urosepsis with an oral temperature of 99.4°F (37.4°C)

B. A 28 year old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours

C. A 32 year old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy

D. A 40 year old with noninfectious urethritis who is reporting “burning” and has estrogen cream prescribed

B

After change-of-shift report, the nurse will first assess the 28 year old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours. Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client who has been receiving morphine sulfate may be oversedated and may not be aware of any discomfort caused by bladder distention. The 26 year old admitted with urosepsis and slight fever, the 32 year old scheduled for cystoscopy, and the 40 year old with noninfectious urethritis are not at immediate risk for complications or deterioration.

A client with cognitive impairment has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan?

A. Bladder training

B. Credé method

C. Habit training

D. Kegel exercises

C

Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis. Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with their own training.

The nurse is teaching a class about cancer prevention. Which interventions will the nurse include that can prevent bladder cancer? (Select all that apply.)

A. Drinking 2½ L of fluid a day

B. Showering after working with or around chemicals

C. Stopping the use of tobacco

D. Using pelvic floor muscle exercises

E. Wearing gloves and a mask when working around chemicals and fumes

B, C, E

The interventions that are helpful in preventing bladder cancer are: showering after working with or around chemicals, stopping the use of tobacco, and wearing gloves and a mask when working around chemical and fumes. Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. Bathing after exposure to them is advisable. Tobacco use is one of the highest, if not the highest, risk factor in the development of bladder cancer. Increasing fluid intake is helpful for some urinary problems such as urinary tract infection, but no correlation has been noted between fluid intake and bladder cancer risk. Using pelvic floor muscle strengthening (Kegel) exercises is helpful with certain types of incontinence, but no data show that these exercises prevent bladder cancer.

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). What signs and symptoms will the nurse include in the teaching? (Select all that apply.)

A. Dysuria

B. Enuresis

C. Frequency

D. Nocturia

E. Urgency

A, C, D, E

The signs and symptoms of UTI include: dysuria (pain or burning with urination), frequency, nocturia (frequent urinating at night), and urgency (having the urge to urinate quickly). Enuresis (bed-wetting) is not a sign of a UTI.

An older adult client diagnosed with urge incontinence is prescribed oxybutynin. Which side effects will the nurse tell the client to expect? (Select all that apply.)

A. Dry mouth

B. Increased blood pressure

C. Constipation

D. Increased intraocular pressure

E. Reddish-orange urine color

A, C, D

Urge incontinence is the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate. Side effects of oxybutynin prescribed for urge incontinence include: dry mouth, constipation, and increased intraocular pressure with the potential to make glaucoma worse. Oxybutynin is an anticholinergic/antispasmodic medication. Alpha-adrenergic agonists and beta blockers, which may be prescribed for urinary incontinence, may cause an increase in blood pressure. Phenazopyridine, a bladder analgesic used to decrease urinary pain, causes the urine to be a reddish-orange color.

A client diagnosed with urge incontinence is started on tolterodine. What interventions will the nurse suggest to alleviate the side effects of this drug? (Select all that apply.)

A. Take the drug at bedtime.

B. Encourage increased fluids.

C. Increase fiber intake.

D. Limit the intake of dairy products.

E. Use hard candy for dry mouth.

B, C, E

Interventions the nurse suggests to alleviate the side effects of tolterodine include: encouraging increased fluids, increasing fiber intake, and using hard candy for dry mouth. Anticholinergics cause constipation. Increasing fluids and fiber intake will help with this problem. Anticholinergics also cause extreme dry mouth, which can be alleviated with using hard candy to moisten the mouth. Taking the drug at night and limiting dairy products will not have an effect on the complications encountered with propantheline.

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (Select all that apply.)

A. “Be certain to wear sunscreen and protective clothing.”

B. “Drink at least 3 L of fluids every day.”

C. “Take this drug with 8 ounces (236 mL) of water.”

D. “Try to urinate frequently to keep your bladder empty.”

E. “You will need to take all of these drugs to get the benefits.”

A, B, C, E

The nurse tells the client with a UTI who is taking trimethoprim/sulfamethoxazole to be certain to wear sunscreen protection clothing, drink at least 3 L of fluid every day, take the drug with 8 ounces (236 mL) of water, and take all of these drugs to get the benefits. Wearing sunscreen and protective clothing is important while taking trimethoprim/sulfamethoxazole, because increased sensitivity to the sun can lead to severe sunburn. Sulfamethoxazole can form crystals that precipitate in the kidney tubules, so fluid intake prevents this complication. Clients must be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon, to prevent bacterial resistance and infection recurrence. Emptying the bladder is important, but not keeping it empty. The client would be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.