Bladder & Urethral Disorders—USE** Flashcards
1
Q
What are the most common symptoms of a UTI?
A
Urgency, frequency, low back pain, dysuria, suprapubic pain, cloudy urine, hematuria, fever/chills
2
Q
What are common antibiotics used for UTIs?
A
Amoxicillin, fosfomycin, levofloxacin, nitrofurantoin, sulfamethoxazole/trimethoprim
3
Q
What analgesic may be used for bladder pain during a UTI?
A
Phenazopyridine
4
Q
What urinary antiseptic is sometimes used for recurrent UTIs?
A
Methenamine
5
Q
What teaching is important for preventing UTIs?
A
Drink fluids, complete antibiotics, consider cranberry juice (not strongly evidence-based), hygiene practices
6
Q
What are the types of urinary incontinence?
A
Stress, reflex, functional, overflow, mixed, urge (OAB), transient, total
7
Q
What are common meds for urinary incontinence?
A
Oxybutynin (Ditropan)
Tolterodine (Detrol)
Phenoxybenzamine (Dibenzaline)
Bethanechol (Urecholine)
Tamulosin (Flomax)
Antidepressants: Amitriptyline, Nortriptyline
8
Q
What are nursing goals for incontinence?
A
Maintain continence, prevent skin breakdown, bladder training, reduce anxiety
9
Q
What meds are used to treat urinary retention?
A
Tamsulosin (Flomax) — relaxes smooth muscle
Bethanechol (Urecholine) — stimulates bladder contraction
10
Q
What are some causes of acute urinary retention?
A
Obstruction, anesthesia, anticholinergic meds (atropine, phenothiazines)
11
Q
What interventions are used for chronic retention?
A
Intermittent, indwelling, or suprapubic catheterization
12
Q
What is the Crede maneuver?
A
Manual pressure on the bladder to aid voiding
13
Q
What are common symptoms of bladder stones?
A
Hematuria, suprapubic pain, dark/cloudy urine, incomplete emptying, pain with voiding
14
Q
What are key diagnostics for bladder stones?
A
UA, spiral CT, KUB, cystoscopy, 24-hr urine for Ca/uric acid
15
Q
How are bladder stones treated?
A
Cystolitholapaxy, surgical incision, dietary changes
16
Q
What is important to monitor post-treatment?
A
I & O, temperature > 101 fever, gross Hematuria, filter urine for stone fragments
17
Q
What is the most common first symptom of bladder cancer?
A
Painless Hematuria
18
Q
What meds are used to treat bladder cancer intravesically?
A
Mitomycin (chemotherapeutic agent)
BCG (Bacillus Calmette-Guerin) — immunotherapy
Interferon alpha-2a — immune modulator
Topical antineoplastic agents
19
Q
What surgical options exist for bladder cancer?
A
Partial cysts to my, urinary diversion (continent/incontinent), neobladder
20
Q
What is a critical post-op nursing task after bladder surgery?
A
Monitor urine output—report <30 mL/hr immediately
21
Q
What are symptoms of urethral stricture?
A
Weak stream, hesitancy, retention, nocturnal, Hematuria, frequency, burning
22
Q
What treatments are used for urethral strictures?
A
Dilation, urethroplasty
23
Q
What are diagnostic tools for urethral stricture?
A
Cystoscopy, IVP, retrograde pyelogram, UA, culture & sensitivity
24
Q
What might progressive confusion and irritability indicate in a 90-year old with no prior dementia?
A
A possible UTI; older adults may show atypical symptoms like confusion
25
What should you teach a client with recurrent UTIs asking about prevention?
Stay hydrated, void after intercourse, avoid irritating products, possibly try cranberry juice, and take all antibiotics as prescribed
26
What is stress incontinence?
Leakage during activities that increase abdominal pressure (coughing, sneezing)
27
What is urge incontinence?
Sudden urge to void followed by involuntary loss of urine
28
What is overflow incontinence?
Bladder overfills and leaks without urge due to retention
29
What is functional incontinence?
Physical or cognitive impairment prevents timely toileting
30
What are signs of acute urinary retention?
Distended bladder, severe lower abdominal pain, inability to void, urgent need to urinate
31
What is the first step in managing acute urinary retention?
Immediate catheterization
32
What does a bladder scan do?
Measures post-void residual volume non-invasively
33
What condition often coexists with bladder stones in older adults?
Benign prostatic hyperplasia (BPH), causing urinary stasis
34
What diet modifications may help prevent recurrent stones?
Limiting foods high in calcium or uric acid, increasing fluid intake (unless contraindicated)
35
Name at least 4 risk factors for bladder cancer
Smoking
Environmental/occupational exposure
Chronic UTIs
Bladder stones
Pelvic radiation
36
What are late-stage symptoms of bladder cancer?
Pelvic/lower back pain, urinary retention, appetite/weight loss, weakness, leg swelling, bone pain
37
What lab test evaluates for bladder cancer cell presence in urine?
Urine cytology
38
What is a cystolitholapaxy?
A procedure to crush and wash out bladder stones via the urethra using a cystoscope
39
What is a neobladder?
A surgically created bladder from intestine allowing continent voiding after cystectomy
40
What is urethroplasty?
Surgical reconstruction or replacement of the urethra to relieve stricture
41
What is one of the most important signs to report post-op bladder surgery?
Urine output < 30mL/hour
42
What should you always assess in a client with a urinary catheter?
Catheter latency, I&O, urine color/clarity, signs of infection
43
When caring for a patient with urinary incontinence, what skin care principle is essential?
Keep skin clean and dry, use barrier creams, and reposition frequently
44
A 90 year old woman in a long-term care facility becomes increasingly confused, irritable, and refuses meals. She has no known dementia.
Which action should the nurse take first?
A. Offer a high-calorie nutritional supplement
B. Administer a sedative as ordered
C. Assess for urinary tract infection
D. Notify the physician of cognitive decline
C. Assess for urinary tract infection
Confusion in older adults is often a sign of UTI
45
A client with a history of UTIs is prescribed sulfamethoxazole/trimethoprim
What teaching should the nurse include?
A. Take the medication with food to reduce GI upset
B. Stop the medication once you feel better
C. Drink at least 8 glasses of water daily
D. Avoid sun exposure or use sunblock
E. You may take this with diary products
A. Take the medication with food to reduce GI upset
C. Drink at least 8 glasses of water daily
D. Avoid sun exposure or use sunblock
46
An 82 year old woman reports leaking urine when she coughs or laughs
What type of incontinence is she most likely experiencing?
A. Urge
B. Functional
C. Stress
D. Overflow
C. Stress
Stress incontinence is common during physical activity or pressure
47
An 82 year old woman reports leaking urine when she coughs or laughs
Which intervention is most appropriate?
A. Insert a urinary catheter
B. Recommend pelvic floor exercises
C. Restrict fluid intake
D. Encourage use of incontinence pads without further teaching
B. Recommend pelvic floor exercises
Kegel exercises strengthen pelvic muscles
48
A client is recovering from surgery under general anesthesia and has not voided for 8 hours despite fluid intake. Abdomen is destended.
Which prescription would the nurse expect?
A. Diuretics
B. Bladder irrigation
C. Straight catheterization
D. Bethanechol administration
C. Straight catheterization
Straight catheter is used for acute retention
49
A 67 year old male with a history of smoking presents with painless Hematuria?
Which diagnostic procedure is most definitive for bladder cancer?
A. Urinalysis
B. Bladder scan
C. Cystoscopy with biopsy
D. Intravenous pyelogram (IVP)
C. Cystoscopy with biopsy
This confirms bladder cancer
50
A 67 year old male with a history of smoking presents with painless Hematuria
The client begins intravesical BCG therapy. What teaching is most important?
A. This is a chemotherapy drug given through an IV
B. Expect frequent urination for 2 days
C. Disinfect the toilet with bleach after voiding for 6 hours post-treatment
D. Avoid all contact with other for 48 hours
C. Disinfection the toilet with bleach after voiding for 6 hours post-treatment
BCG is LIVE; prevent transmission via proper disposal
51
A client reports weak urinary stream and dribbling. Testing reveals a urethral stricture
Which intervention does the nurse anticipate?
A. Insertion of a suprapubic catheter
B. Immediate surgical removal of the bladder
C. Urethral dilation or urethroplasty
D. Intravenous antibiotics
C. Urethral dilation or urethroplasty
Urethral strictures are commonly managed with dilation or surgery
52
Which medications promote bladder emptying in a client with chronic urinary retention?
A. Oxybutynin
B. Tamsulosin
C. Bethanechol
D.Tolterodine
C. Bethanechol
Stimulates bladder contraction
53
A client with overactive bladder is prescribed Tolterodine. Which teaching is essential?
A. This may cause urinary retention
B. Take this with grapefruit juice
C. Report dry mouth immediately
D. Expect frequent bowel movements
A. This may cause urinary retention
Anticholinergic meds like Tolterodine can cause retention
54
A 32 year old client with acute pyelonephritis is preparing for discharge. What should be a key focus of discharge teaching?
A. Low-sodium diet
B. Use of anticholinergic
C. Recurrent infection prevention
D. Intermittent catheterization
C. Recurrent infection prevention
Preventing recurrent infections is essential to avoid chronic kidney damage
55
A client returns from the OR after a nephrectomy. Two hours later, they become increasingly sedated, hypotension, and have a urine output of 20 mL/hour. What is the nurse’s best action?
A. Monitor vital signs for another hour
B. Elevate the head of the bed
C. Assess for internal bleeding and notify provider
D. Administer pain medication
C. Assess for internal bleeding and notify provider
-These are signs of potential hemorrhagic shock post-surgery
56
Which signs suggest dialysis disequilibrium in a client receiving hemodialysis? (Select all that apply)
A. Confusion
B. Headache
C. Bleeding gums
D. Nausea
E. Muscle twitching
A. Confusion
B. Headache
D. Nausea
Due to rapid cerebral fluid shifts
57
Which integumentary symptom is associated with chronic renal failure?
A. Cherry-red lips
B. Petechiae
C. Gray-bronze skin
D. Cyanotic nail beds
C. Gray-bronze skin
A gray-bronze color is linked to uremia and toxin buildup
58
A client with ESRD has lab results: Calcium 7.5 mg/dL, Postassium 6.4 mEq/L, Phosphate 5.0 mg/dL.
What symptoms does the nurse expect? (Select all that apply)
A. Irritability
B. Dysrhythmias
C. Constipation
D. Nausea
E. Hypotension
A. Irritability
B. Dysrhythmias
D. Nausea
E. Hypotension
Reflect electrolyte imbalance and risk of cardia instability
59
What instructions should be included in teaching for a client performing peritoneal dialysis at home? (Select all that apply)
A. Clean catheter with soap and water
B. Use antiseptic like povidone-iodine
C. Keep supplies away from pets and children
D. Wash hands before handling the catheter
E. Secure the catheter below the belt line
B. Use antiseptic like povidone-iodine
C. Keep supplies away from pets and children
D. Wash hands before handling the catheter
Aseptic technique is vital to prevent peritonitis
60
What is the priority in managing a client with a nephrostomy tube?
A. Clamp the tube hourly
B. Flush the tube with sterile saline
C. Maintain continuous urine drainage
D. Irrigate the tube daily
C. Maintain continuous urine drainage
To prevent hydronephrosis and preserve kidney function
61
A client post-kidney transplant has a urine output of 20 ml/hour. What is the nurse’s priority action?
A. Reposition the client
B. Monitor hourly for trends
C. Notify the healthcare provider
D. Reassess in 2 hours
C. Notify the healthcare provider
Output less than 30 an hr may indicate rejection or obstruction
62
Why does a client with ESRD develop anemia?
A. Blood loss through dialysis
B. Uremic suppression of bone marrow
C. Decreased erythropoietin production
D. Vitamin B12 deficiency
C. Decreased erythropoietin production
Erythropoietin is reduced in ESRD, leading to decreased RBCs
63
What are hallmarks of symptoms of acute glomerulonephritis? (Select all that apply)
A. Cola-colored urine
B. Anasarca
C. Polyuria
D. Proteinura
E. Decreased BUN
A. Cola-colored urine
B. Anasarca
D. Proteinura
These are classic signs of glomerular inflammation and damage
64
UTI: Acute pain related to inflammation of bladder mucosa as evidenced by dysuria, urgency, and suprapubic pain
Goal: Client will verbalize relief from pain within 48 hours of initiating treatment
Interventions:
Assess pain (location, intensity, frequency): establishes baseline & monitors response to therapy
Encourage increased fluid intake (unless contraindicated): promotes urinary dilation & flushing of bacteria
Administer prescribed antibiotics & analgesics (phenazopyridine): treats infection & relieves urinary discomfort
Teach client to wipe front to back, avoid irritating products: Prevents recurrence by reducing introduction of bacteria
Evaluation: Reports pain decreased & no longer has urgency or burning with urination
65
Urinary Incontinence: Impaired urinary elimination related to decreased sphincter control as evidenced by involuntary leakage of urine
Goal: Client will regain improved urinary control within 2 weeks of intimating bladder training program
Intervention:
Initiate bladder training schedule & document voiding patterns: helps reestablish normal voiding intervals
Teach pelvic floor (Kegel) exercises: strengthens muscles to support continence
Apply skin barrier products & monitor for breakdown: prevents incontinence-associated dermatitis
Administer anticholinergic meds as prescribed (oxybutynin): decreases bladder spasms & urgency
Evaluation: client reports fewer episodes of incontinence & improved confidence
66
Urinary Retention: related to obstruction or neurogenic bladder as evidenced by distended bladder and low urinary output
Goal: Client will resume complete bladder emptying within 48 hours
Interventions:
Assess bladder size & perform bladder scan post-void: identifies retained urine volume
Facilitate voiding with running water, privacy, or warm water techniques: stimulates urination reflex
Administer Bethanechol or Tamsulosin as ordered: promotes fetus or contraction or urethral relaxation
Catheterization as needed for acute retention: relieves pressure & prevents kidney damage
Evaluation: client voids effectively without catheterization and reports relief from fullness
67
Bladder stones: risk for infection related to urinary stasis and stone irritation
Goal: client will remain free of UTI symptoms throughout hospitalization
Interventions:
Monitor temperature & urine characteristics: detects signs of infection early
Encourage increased fluid intake: dilutes urine and aids stone passage
Filter all urine & send stones for lab analysis: identifies stone composition to guide dietary treatment
Administer analgesics & antispasmodics as prescribed: provides symptoms relief & promotes relaxation of urinary tract
Evaluation: client demonstrates understanding of prevention strategies and remains a febrile
68
Bladder Cancer: Risk for deficient fluid volume related to Hematuria and potential urinary diversion
Goal: client will maintain adequate fluid balance post-surgery
Interventions:
Monitor intake and output closely, especially if diversion present: early detection of fluid imbalance
Inspect urine for blood, clots, or decrease in flow: indicates obstruction or hemorrhage
Provide emotional support and include client in ostomy care teaching: supports adaptation to body image changes
Administer intravesical therapy safely: prevents recurrence; safety to avoid exposure
Evaluation: Maintains normal fluid volume and demonstrates independences in diversion care
69
Acute Glomerulonephritis: excess fluid volume related to impaired renal function as evidenced by edema and weight gain
Goal: Client will exhibit reduced edema and stable weight within 5 days
Interventions:
Daily weights & monitor peripheral edema: assesses effectiveness of treatment
Restrict sodium & fluids per order: reduces fluid overload
Monitor vital signs & lung sounds: detects hypertension or pulmonary edema
Administer diuretics & antihypertensives as prescribed: controls fluid and blood pressure
Evaluation: edema decreases, lung sounds remain clear, and weight stabilizes
70
What is a urinary tract infection (UTI)?
Infection within the urinary system caused by a bacteria, virus, or fungus
71
What are the risk factors for UTIs?
Most common in women due to a shorter urethra and its proximity to the rectum, indwelling catheters, overuse of antibiotics, hormone changes (pregnancy), diabetes mellitus, and environmental factors (feminine products, detergents, soaps)
72
What is ureterolithiasis?
Stones found in the ureter
73
What are bladder calculi?
Stones found in the bladder
74
What is the most common type of renal calculi?
Calcium stones
75
What causes uric acid stones?
Excess uric acid in the urine (acidic urine)
76
What are the signs and symptoms of renal calculi?
Flank/abdominal pain, Hematuria, pyuria, nausea, vomiting, fever
77
What is extracorporeal shock wave lithotripsy (ESWL)?
A noninvasive procedure that sends shock waves to break up the stone
78
What is percutaneous nephrolithotomy?
Invasive procedure that removes the stone through an incision made on the back
79
What is urethral stent placement?
Invasive procedure where a stent is inserted to allow urine and/or stones to pass from the bladder to the ureters
80
What causes struvite stones?
Bacteria that causes ammonia-rich urine and an alkaline environment
81
What causes cystine stones?
Excess cystine in the urine due to a rare genetic disorder affecting renal absorption of cystine
