Deck 54: Management of Patients With Urinary Disorders

Question 1

A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient?

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.

Answer 1

Drink liberal amounts of fluids.

Question 2

A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?

A) Stress incontinence
B) Reflex incontinence
C) Overflow incontinence
D) Functional incontinence

Answer 2

Stress incontinence

Question 3

A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient 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 into the urethra
D) Self-catheterizing every 2 hours at home

Answer 3

Using clean technique at home to catheterize

Question 4

A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patients 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

Question 5

The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patients health education, what nutritional guidelines should the nurse provide?

A) Restrict protein intake as ordered.
B) Increase intake of potassium-rich foods.
C) Follow a low-calcium diet.
D) Encourage intake of food containing oxalates.

Question 6

The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient?

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 physician about cloudy or foul-smelling urine.
D) Report any pink-tinged urine within 24 hours after the procedure.

Question 7

A female patients most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurses data analysis should be informed by what principle?

A) Most UTIs in female patients 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.

Question 8

The clinic nurse is preparing a plan of care for a patient 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 patient to perform pelvic floor muscle exercises.
C) Prepare the patient for an anterior vaginal repair procedure.
D) Provide information on periurethral bulking.

Question 9

The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patients bladder?

A) Insertion of a suprapubic catheter
B) Scheduling the patient 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

Question 10

The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately $50 \mathrm{~mL}$ of urine remaining in her bladder after voiding. What would be the nurses best response to this finding?

A) Perform a straight catheterization on this patient.
B) Avoid further interventions at this time, as this is an acceptable finding.
C) Place an indwelling urinary catheter.
D) Press on the patients bladder in an attempt to encourage complete emptying.

Question 11

The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day?

A) 1,250 mL
B) 2,000 mL
C) 2,750 mL
D) 3,500 mL

Question 12

A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patients urine output hourly and notifies the physician when the hourly output is less than what?

A) 30 mL
B) 50 mL
C) 100 mL
D) 125 mL

Question 13

The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient 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.

Question 14

The nurse is teaching a health class about UTIs to a group of older adults. 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 men older than 50 years of age 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.

Question 15

A patient 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 narrowest part of the stoma
C) The widest part of the stoma
D) Half the width of the stoma

Question 16

A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding?

A) Use a slipper bedpan.
B) Apply a cold compress to the perineum.
C) Have the patient lie in a supine position.
D) Provide privacy for the patient.

Question 17

A nurses colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurses 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.

Question 18

The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention?

A) The patients suprapubic region is dull on percussion.
B) The patient is uncharacteristically drowsy.
C) The patient claims to void large amounts of urine 2 to 3 times daily.
D) The patient takes a beta adrenergic blocker for the treatment of hypertension.

Question 19

A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patients post-procedure care?

A) Strain the patients urine following the procedure.
B) Administer a bolus of $500 \mathrm{~mL}$ normal saline following the procedure.
C) Monitor the patient for fluid overload following the procedure.
D) Insert a urinary catheter for 24 to 48 hours after the procedure.

Question 20

The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurses assessment reveals that the stoma is a dark purplish color. What is the nurses most appropriate response?

A) Document the presence of a healthy stoma.
B) Assess the patient 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.

Question 21

A patient 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?

A) Hydronephrosis
B) Nephritic syndrome
C) Pylonephritis
D) Nephrotoxicity

Question 22

The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply.

A) Dietary history
B) Family history of renal stones
C) Medication history
D) Surgical history
E) Vaccination history

Question 23

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 ordered.
B) Limit the use of indwelling urinary catheters.
C) Encourage frequent mobility and repositioning.
D) Toilet residents who are immobile on a scheduled basis.

Question 24

A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply.

A) Food cravings
B) Upper abdominal pain
C) Insatiable thirst
D) Uncharacteristic fatigue
E) New onset of confusion

Question 25

A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic?

A) The risk of developing a vaginal yeast infection as a consequent 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

Question 26

An adult patient has been hospitalized with pyelonephritis. The nurses review of the patients intake and output records reveals that the patient has been consuming between $3 \mathrm{~L}$ and $3.5 \mathrm{~L}$ of oral fluid each day since admission. How should the nurse best respond to this finding?

A) Supplement the patients fluid intake with a high-calorie diet.
B) Emphasize the need to limit intake to $2 \mathrm{~L}$ of fluid daily.
C) Obtain an order for a high-sodium diet to prevent dilutional hyponatremia.
D) Encourage the patient to continue this pattern of fluid intake.

Question 27

An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment?

A) Reviewing the patients 24-hour food recall for changes in diet
B) Assessing for recent contact with individuals who have UTIs
C) Assessing for changes in the patients level of psychosocial stress
D) Reviewing the patients medication administration record for recent changes

Question 28

A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment?

A) Clearly explain the potential benefits of pelvic floor muscle exercises.
B) Ensure the patient knows that surgery will be required if the exercises are unsuccessful.
C) Arrange for biofeedback when the patient is learning to perform the exercises.
D) Contact the patient weekly to ensure that she is performing the exercises consistently.

Question 29

A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patients high risk for urinary retention and should implement what intervention in the patients plan of care?

A) Relaxation techniques
B) Sodium restriction
C) Lower abdominal massage
D) Double voiding

Question 30

A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patients plan of care?

A) Impaired physical mobility related to presence of an indwelling urinary catheter
B) Risk for infection related to presence of an indwelling urinary catheter
C) Toileting self-care deficit related to urinary catheterization
D) Disturbed body image related to urinary catheterization

Question 31

A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurses best response?

A) Inform the patient that urgency and occasional incontinence are expected for the first few weeks post-removal.
B) Obtain an order for a loop diuretic in order to enhance urine output and bladder function.
C) Inform the patient that this is not unexpected in the short term and scan the patients bladder following each void.
D) Obtain an order to reinsert the patients urinary catheter and attempt removal in 24 to 48 hours.

Question 32

A nurse on a busy medical unit provides care for many patients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which patient?

A) A patient whose diagnosis of chronic kidney disease requires a fluid restriction
B) A patient who has Alzheimers disease and who is acutely agitated
C) A patient who is on bed rest following a recent episode of venous thromboembolism
D) A patient who has decreased mobility following a transmetatarsal amputation

Question 33

A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the patients admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply.

A) Diarrhea
B) High fever
C) Hematuria
D) Urinary frequency
E) Acute pain

Question 34

A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the patients cardiopulmonary status is stable, what aspect of care should the nurse prioritize?

A) IV fluid administration
B) Insertion of an indwelling urinary catheter
C) Pain management
D) Assisting with aspiration of the stone

Question 35

A patient has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the patients discharge education accordingly. What preventative measure should the nurse encourage the patient to adopt?

A) Increasing intake of protein from plant sources
B) Increasing fluid intake
C) Adopting a high-calcium diet
D) Eating several small meals each day

Question 36

A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology
Unit where he was treated, telling the nurse that he has a temperature of 101.1F (38.4C). How should the nurse best respond to the patient?

A) Remind the patient that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence.
B) Remind the patient that occasional febrile episodes are expected following ESWL.
C) Tell the patient to report to the ED for further assessment.
D) Tell the patient to monitor his temperature for the next 24 hours and then contact his urologists office.

Question 37

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?

A) Smoking cessation
B) Reduction of alcohol intake
C) Maintenance of a diet high in vitamins and nutrients
D) Vitamin D supplementation

Question 38

Resection of a patients bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following?

A) Remain NPO for 12 hours prior to the treatment.
B) Hold the solution in the bladder for 2 hours before voiding.
C) Drink the intravesical solution quickly and on an empty stomach.
D) Avoid acidic foods and beverages until the full cycle of treatment is complete.

Question 39

The nurse has tested the $\mathrm{pH}$ of urine from a patients newly created ileal conduit and obtained a result of 6.8. What is the nurses best response to this assessment finding?

A) Obtain an order to increase the patients dose of ascorbic acid.
B) Administer IV sodium bicarbonate as ordered.
C) Encourage the patient to drink at least $500 \mathrm{~mL}$ of water and retest in 3 hours.
D) Irrigate the ileal conduit with a dilute citric acid solution as ordered.

Question 40

A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurses most appropriate response?

A) Report this finding promptly to the primary care provider.
B) Obtain a sterile urine sample and send it for culture.
C) Obtain a urine sample and check it for $\mathrm{pH}$ .
D) Reassure the patient that this is an expected phenomenon.

Question 41

The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a patient how to manage her new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices?

A) Empty the collection bag when it is between one-half and two-thirds full.
B) Limit fluid intake to prevent production of large volumes of dilute urine.
C) Reinforce the appliance with tape if small leaks are detected.
D) Avoid using moisturizing soaps and body washes when cleaning the peristomal area.

Question 42

A patient has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of disturbed body image. How can the nurse best address the effects of this urinary diversion on the patients body image?

A) Emphasize that the diversion is an integral part of successful cancer treatment.
B) Encourage the patient to speak openly and frankly about the diversion.
C) Allow the patient to initiate the process of providing care for the diversion.
D) Provide the patient with detailed written materials about the diversion at the time of discharge.