MBAA 60|MBAA604 Chapter 66: Care of Patients with Urinary Problems

Chapter 66: Care of Patients with Urinary Problems Chapter 66: Care of Patients with Urinary Problems MULTIPLE CHOICE 1. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis? a. A 36-year-old female who has never been pregnant b. A 42-year-old male who is prescribed cyclophosphamide c. A 58-year-old female who is not taking estrogen replacement d. A 77-year-old male with mild congestive heart failure ANS: C Females at any age are more susceptible to cystitis than men because of the shorter urethra in women. Post- menopausal women who are not on hormone replacement therapy are at increased risk for bacterial cystitis because of changes in the cells of the urethra and vagina. The middle-aged woman who has never been preg- nant would not have a risk potential as high as the older woman who is not using hormone replacement therapy. DIF: Understanding/Comprehension REF: 1367 KEY: Cystitis| health screening MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 2. A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a “shift to the left” in a client’s white blood cell count. Which action should the nurse take? a. Request that the laboratory perform a differential analysis on the white blood cells. b. Notify the provider and start an intravenous line for parenteral antibiotics. c. Collaborate with the unlicensed assistive personnel (UAP) to strain the client’s urine for renal calculi. d. Assess the client for a potential allergic reaction and anaphylactic shock. ANS: B An increase in band cells creates a “shift to the left.” A left shift most commonly occurs with urosepsis and is seen rarely with uncomplicated urinary tract infections. The nurse will be administering antibiotics, most likely via IV, so he or she should notify the provider and prepare to give the antibiotics. The shift to the left is part of a differential white blood cell count. The nurse would not need to strain urine for stones. Allergic reactions are associated with elevated eosinophil cells, not band cells. DIF: Applying/Application REF: 1370 KEY: Cystitis| assessment/diagnostic examination MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. A nurse cares for a postmenopausal client who has had two episodes of bacterial urethritis in the last 6 months. The client asks, “I never have urinary tract infections. Why is this happening now?” How should the nurse respond? a. “Your immune system becomes less effective as you age.” b. “Low estrogen levels can make the tissue more susceptible to infection.” c. “You should be more careful with your personal hygiene in this area.” d. “It is likely that you have an untreated sexually transmitted disease.” ANS: B Low estrogen levels decrease moisture and secretions in the perineal area and cause other tissue changes, predisposing it to the development of infection. Urethritis is most common in postmenopausal women for this reason. Although immune function does decrease with aging and sexually transmitted diseases are a known cause of urethritis, the most likely reason in this client is low estrogen levels. Personal hygiene usually does not contribute to this disease process. DIF: Applying/Application REF: 1367 KEY: Cystitis| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 4. After teaching a client with bacterial cystitis who is prescribed phenazopyridine (Pyridium), the nurse assess- es the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching? a. “I will not take this drug with food or milk.” b. “If I think I am pregnant, I will stop the drug.” c. “An orange color in my urine should not alarm me.” d. “I will drink two glasses of cranberry juice daily.” ANS: C Phenazopyridine discolors urine, most commonly to a deep reddish orange. Many clients think they have blood in their urine when they see this. In addition, the urine can permanently stain clothing. Phenazopyridine is safe to take if the client is pregnant. There are no dietary restrictions or needs while taking this medication. DIF: Applying/Application REF: 1372 KEY: Cystitis| medication safety MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 5. After teaching a client who has stress incontinence, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional teaching? a. “I will limit my total intake of fluids.” b. “I must avoid drinking alcoholic beverages.” c. “I must avoid drinking caffeinated beverages.” d. “I shall try to lose about 10% of my body weight.” ANS: A Limiting fluids concentrates urine and can irritate tissues, leading to increased incontinence. Many people try to manage incontinence by limiting fluids. Alcoholic and caffeinated beverages are bladder stimulants. Obesity increases intra-abdominal pressure, causing incontinence. DIF: Applying/Application REF: 1380 KEY: Cystitis| hydration MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 6. A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program? a. A 78-year-old female who is confused b. A 65-year-old male with diabetes mellitus c. A 52-year-old female with kidney failure d. A 47-year-old male with arthritis ANS: A For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from another type of bladder training. DIF: Applying/Application REF: 1380 KEY: Urinary incontinence| health screening MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 7. After delegating care to an unlicensed assistive personnel (UAP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the UAP’s understanding. Which action indicates the UAP needs ad- ditional teaching? a. Toileting the client after breakfast b. Changing the client’s incontinence brief when wet c. Encouraging the client to drink fluids d. Recording the client’s incontinence episodes ANS: B Habit training is undermined by the use of absorbent incontinence briefs or pads. The nurse should re-educate the UAP on the technique of habit training. The UAP should continue to toilet the client after meals, encourage the client to drink fluids, and record incontinent episodes. DIF: Applying/Application REF: 1381 KEY: Urinary incontinence| delegation| supervision| unlicensed assistive personnel (UAP) MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 8. A nurse plans care for a client with overflow incontinence. Which intervention should the nurse include in this client’s plan of care to assist with elimination? a. Stroke the medial aspect of the thigh. b. Use intermittent catheterization. c. Provide digital anal stimulation. d. Use the Valsalva maneuver. ANS: D In clients with overflow incontinence, the voiding reflex arc is not intact. Mechanical pressure, such as that achieved through the Valsalva maneuver (holding the breath and bearing down as if to defecate), can initiate voiding. Stroking the medial aspect of the thigh or providing digital anal stimulation requires the reflex arc to be intact to initiate elimination. Due to the high risk for infection, intermittent catheterization should only be implemented when other interventions are not successful. DIF: Applying/Application REF: 1381 KEY: Urinary incontinence MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 9. A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should the nurse ask the primary health care provider? a. “Do you want daily weights on this client?” b. “Will the client be able to return home?” c. “Can we discontinue the indwelling catheter?” d. “Should we get another chest x-ray today?” ANS: C An indwelling catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse should in- quire about removing the catheter. All other questions might be appropriate, but because of client safety, this question takes priority. DIF: Applying/Application REF: 1368 KEY: Infection control MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 10. After teaching a client with a history of renal calculi, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching? a. “I should drink at least 3 liters of fluid every day.” b. “I will eliminate all dairy or sources of calcium from my diet.” c. “Aspirin and aspirin-containing products can lead to stones.” d. “The doctor can give me antibiotics at the first sign of a stone.” ANS: A Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse should encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone. DIF: Applying/Application REF: 1384 KEY: Urolithiasis| hydration MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance 11. A nurse cares for a client who has kidney stones from secondary hyperoxaluria. Which medication should the nurse anticipate administering? a. Phenazopyridine (Pyridium) b. Propantheline (Pro-Banthine) c. Tolterodine (Detrol LA) d. Allopurinol (Zyloprim) ANS: D Stones caused by secondary hyperoxaluria respond to allopurinol (Zyloprim). Phenazopyridine is given to clients with urinary tract infections. Propantheline is an anticholinergic. Tolterodine is an anticholinergic with smooth muscle relaxant properties. DIF: Applying/Application REF: 1386 KEY: Urolithiasis| medications MSC: Integrated Process: Nursing Process: Planning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client’s right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results. ANS: B The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Applica- tion of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh- frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the client’s position will not decrease bleeding. ...............Continued**