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NUR243 - Medical-Surgical II > Chapter 50: Renal and Urologic Problems > Flashcards

Chapter 50: Renal and Urologic Problems Flashcards

UTI, incontience

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USMLE® Step 1 flashcards
1
Q

infections of the urinary tract

A

urinary tract infections

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2
Q

What is the most common pathogen that causes a UTI?

a. serratia
b. e. coli
c. staph aureus
d. streptococci

A

b. e. coli

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3
Q

T/F

The urinary tract above the urethra is normally sterile.

A

true

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4
Q

urine pH

A

6.0 - 7.5

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5
Q

The organisms that usually cause UTIs originate in the __________.

a. uterus
b. sphincter
c. urethra
d. perineum

A

d. perineum

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6
Q

What is the most common healthcare-associated infection?

A

UTI

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7
Q

What usually causes a patient to get a UTI when they are in the hospital?

A

the use of an indwelling catheter

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8
Q

CAUTI

A

catheter-associated urinary tract infection

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9
Q

Storage or emptying symptoms of a lower UTI?

  • painful urination (dysuria)
  • difficulty starting urine stream (hesitancy)
A

emptying symptoms

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10
Q

Storage or emptying symptoms of a lower UTI?

  • interruption of urinary stream while voiding (intermittency)
  • urine loss after completing voiding (postvoid dribbling)
A

emptying symptoms

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11
Q

Storage or emptying symptoms of a lower UTI?

  • inability to empty bladder (urinary retention)
A

emptying symptoms

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12
Q

Storage or emptying symptoms of a lower UTI?

  • involuntary or accidental urine loss or leakage (incontinence)
  • awakened by urge to void 2 or more times during sleep (nocturia)
A

storage symptoms

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13
Q

Storage or emptying symptoms of a lower UTI?

  • loss of urine during sleep (nocturnal enuresis)
  • sudden, strong urge, or intense desire to void immediately (urgency)
A

storage symptoms

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14
Q

Storage or emptying symptoms of a lower UTI?

urinating more than 8 times in 24 hours (urinary frequency)

A

storage symptoms

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15
Q

Lower or upper UTI?

symptoms are related to either bladder storage or bladder emptying

A

lower

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16
Q

Lower or upper UTI?

dysuria, frequency, urgency, and suprapubic discomfort or pressure

A

lower

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17
Q

Lower or upper UTI?

urine may have visible blood or sediment, giving it a cloudy appearance

A

lower

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18
Q

Lower or upper UTI?

typically causes fever, chills, and flank pain

A

upper

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19
Q

T/F

A UTI confined to the lower urinary tract does not usually have systemic manifestations.

A

true

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20
Q

Which age group are UTI manifestations often absent in?

a. neonates
b. adolescents
c. school-age
d. older adults

A

d. older adults

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21
Q

T/F

A reliable sign to tell if an older adult has a UTI is to take their temperature.

A

false; taking their temp is not a reliable sign

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22
Q

A 46-year-old female patient returns to the clinic with continued dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. Which action will the nurse plan to take?

a. Remind the patient about the need to drink 1000 mL of fluids daily.

b. Obtain a midstream urine specimen for culture and sensitivity testing.

c. Suggest that the patient use acetaminophen (Tylenol) to relieve symptoms.

d. Tell the patient to take the trimethoprim and sulfamethoxazole for 3 more days.

A

b. Obtain a midstream urine specimen for culture and sensitivity testing.

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23
Q

Which statement by a 22-year-old female patient with cystitis indicates to the nurse that instruction about preventing future urinary tract infections (UTIs) has been effective?

a. “I can use vaginal antiseptic sprays to reduce bacteria.”

b. “I will drink a quart of water or other fluids every day.”

c. “I will wash with soap and water before sexual intercourse.”

d. “I will empty my bladder every 3 to 4 hours during the day.”

A

d. “I will empty my bladder every 3 to 4 hours during the day.”

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24
Q

Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)?

a. Bladder distention

b. Foul-smelling urine

c. Suprapubic discomfort

d. Costovertebral tenderness

A

d. Costovertebral tenderness

25
Q

A 68-year-old patient admitted to the hospital with dehydration is confused and incontinent of urine. Which action would the nurse include in the plan of care?

a. Restrict fluids between meals and after the evening meal.

b. Insert an indwelling catheter until the symptoms have resolved.

c. Assist the patient to the bathroom every 2 hours during the day.

d. Apply absorbent adult incontinence diapers and pads over the bed linens.

A

c. Assist the patient to the bathroom every 2 hours during the day.

26
Q

A patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider?

a. Urinary urgency

b. Left-sided flank pain

c. Intermittent hematuria

d. Burning with urination

A

b. Left-sided flank pain

27
Q

Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)?

a. Low urine output

b. Bilateral flank pain

c. Nausea and vomiting

d. Burning on urination

A

d. Burning on urination

28
Q

T/F

UTIs are more common in men.

A

false; women

29
Q

Uncomplicated UTIs are treated with a short-term course of antibiotics, typically for ______ days.

A

3

30
Q

Complicated UTIs are treated with a long-term course of antibiotics, typically for ________ days.

A

7-14

31
Q

Which information about phenazopyridine will the nurse teach the patient with a urinary tract infection (UTI)?

a. Take the drug for at least 7 days.

b. The drug may cause photosensitivity.

c. The drug may change your urine color.

d. Take the drug before sexual intercourse.

A

c. The drug may change your urine color.

32
Q

Nursing staff on a hospital unit are reviewing rates of healthcare-associated infections (HAI) of the urinary tract. Which nursing action will be most helpful in decreasing the risk for urinary HAI in patients admitted to the hospital?

a. Testing the urine with a dipstick daily for nitrites

b. Avoiding unnecessary bladder catheterization

c. Encouraging adequate oral fluid and nutritional intake

d. Providing perineal hygiene to patients daily and as needed

A

b. Avoiding unnecessary bladder catheterization

33
Q

The nurse observes unlicensed assistive personnel (AP) taking the following actions when caring for a female patient with a urethral catheter. Which action requires that the nurse intervene?

a. Securing the catheter to the patient‘s upper inner thigh

b. Cleaning around the patient‘s urinary meatus with soap and water

c. Disconnecting the catheter from the drainage tube to obtain a specimen

d. Using an alcohol-based gel hand cleanser before performing catheter care

A

c. Disconnecting the catheter from the drainage tube to obtain a specimen

34
Q

The nurse teaches the female patient who has frequent UTIs to:

a. take tub baths with bubble baths
b. void before and after sexual intercourse
c. take prophylactic sulfonamides for the rest of her life
d. restrict fluid intake to prevent the need for frequent voiding

A

b. void before and after sexual intercourse

35
Q

A female patient with a suspected urinary tract infection is to provide a clean-catch urine specimen for culture and sensitivity testing. What would the nurse do to obtain the specimen?

a. Have the patient empty the bladder completely; then obtain the next urine specimen that the patient is able to void.

b. Tell the patient to clean the urethral area, void a small amount into the toilet, then void directly into a sterile container.

c. Insert a short sterile “mini” catheter attached to a collecting container into the urethra and bladder to obtain the specimen.

d. Clean the area around the patient‘s meatus with a povidone-iodine (Betadine) swab and then have the patient void into a sterile specimen cup.

A

b. Tell the patient to clean the urethral area, void a small amount into the toilet, then void directly into a sterile container.

36
Q

Name this type of incontinence.

loss of urine resulting from cognitive, functional, and environmental factors

a. incontinence after trauma or surgery
b. overflow incontinence
c. functional incontinence
d. stress incontinence

A

c. functional incontinence

37
Q

Name this type of incontinence.

CAUSES
- neurologic and/or muscular limitations
- cognitive problems
- psychologic issues
- environmental barriers

a. stress incontinence
b. functional incontinence
c. urge incontinence
d. overflow incontinence

A

b. functional incontinence

38
Q

Name this type of incontinence.

TREATMENT
- Modifying the environment or care plan to facilitate regular, easy access to toilet and promote patient safety
- Includes better lighting, ambulatory assistance equipment, clothing alterations, timed voiding, different toileting equipment

a. Functional Incontinence
b. Stress Incontinence
c. Urge Incontinence
d. Incontinence After Trauma or Surgery

A

a. Functional Incontinence

39
Q

Name this type of incontinence.

  • In women, vesicovaginal or urethrovaginal fistula may occur
  • In men, inadequate urethral sphincter function, can lead to stress, urge, overflow, or mixed UI

a. Incontinence After Trauma or Surgery
b. Functional Incontinence
c. Reflex Incontinence
d. Stress Incontinence

A

a. Incontinence After Trauma or Surgery

40
Q

Name this type of incontinence.

CAUSES
- Fistulas may occur as a complication of pregnancy and delivery of baby, after hysterectomy or invasive cancer of cervix, or after radiation therapy
- Incontinence is a postoperative complication of radical prostatectomy, and rarely transurethral resection of the prostate

a. Overflow Incontinence
b. Stress Incontinence
c. Functional Incontinence
d. Incontinence After Trauma or Surgery

A

d. Incontinence After Trauma or Surgery

41
Q

Name this type of incontinence.

TREATMENT
- External condom catheter
- Penile clamp
- Sling surgery (male)
- Surgery to correct fistula
- Periurethral balloons

a. Functional Incontinence
b. Urge Incontinence
c. Incontinence After Trauma or Surgery
d. Overflow Incontinence

A

c. Incontinence After Trauma or Surgery

42
Q

Name this type of incontinence.

  • Occurs when pressure of urine in overfull bladder overcomes sphincter control and/or detrusor underactivity
  • Leakage of small amounts of urine is frequent or continual throughout day and night
  • Concurrent incomplete bladder emptying
  • Bladder can stay distended and is usually palpable

a. Reflex Incontinence
b. Stress Incontinence
c. Urge Incontinence
d. Overflow Incontinence

A

d. Overflow Incontinence

43
Q

Name this type of incontinence.

CAUSES

  • Caused by bladder or urethral outlet obstruction (bladder neck obstruction, urethral stricture, pelvic organ prolapse) or by underactive detrusor muscle caused by myogenic or neurogenic factors (e.g., herniated disc, diabetic neuropathy)
  • May occur after pelvic floor surgery
  • Neurogenic bladder (flaccid type)

a. Reflex Incontinence
b. Overflow Incontinence
c. Stress Incontinence
d. Urge Incontinence

A

b. Overflow Incontinence

44
Q

Name this type of incontinence.

TREATMENT
- Urinary catheterization to decompress bladder
- α-Adrenergic blockers
- 5α-Reductase inhibitors
- Bethanechol to enhance bladder contractions
- Intermittent catheterization
- Intravaginal device, such as a pessary, to support prolapse
- Surgery to correct underlying problem

a. Overflow Incontinence
b. Reflex Incontinence
c. Functional Incontinence
d. Urge Incontinence

A

a. Overflow Incontinence

45
Q

Name this type of incontinence.

  • Condition occurs with no warning, periodic involuntary urination
  • Urination can be frequent, large in volume, and occurs equally during day and night

a. Urge Incontinence
b. Reflex Incontinence
c. Incontinence After Trauma or Surgery
d. Functional Incontinence

A

b. Reflex Incontinence

46
Q

Name this type of incontinence.

CAUSES
- CNS problems, including, multiple sclerosis, brain tumors, CVA, Parkinson disease, spinal cord injuries

a. Reflex Incontinence
b. Stress Incontinence
c. Urge Incontinence
d. Incontinence After Trauma or Surgery

A

a. Reflex Incontinence

47
Q

Name this type of incontinence.

TREATMENT
- Treat underlying cause
- Intermittent self-catheterization
- Behavioral therapy including bladder training, pelvic floor muscle exercises
- Certain medications may be useful: anticholinergics, Ɓ3-adrenergic agonist, tricyclic antidepressants, topical estrogen (women)

a. Functional Incontinence
b. Incontinence After Trauma or Surgery
c. Reflex Incontinence
d. Stress Incontinence

A

c. Reflex Incontinence

48
Q

Name this type of incontinence.

  • Sudden increase in intraabdominal pressure causes involuntary passage of urine
  • Can occur during coughing, laughing, sneezing, or physical activities, such as heavy lifting, exercising
  • Leakage usually is in small amounts and may not be daily

a. Functional Incontinence
b. Overflow Incontinence
c. Urge Incontinence
d. Stress Incontinence

A

d. Stress Incontinence

49
Q

Name this type of incontinence.

CAUSES
- Most common in women with relaxed pelvic floor musculature (from delivery, use of instrumentation during vaginal delivery, or multiple pregnancies)
- Structures of female urethra atrophy when estrogen decreases
- Prostate surgery for BPH or prostate cancer

a. Overflow Incontinence
b. Stress Incontinence
c. Incontinence After Trauma or Surgery
d. Urge Incontinence

A

b. Stress Incontinence

50
Q

Name this type of incontinence.

TREATMENT
- Pelvic floor muscle exercises (e.g., Kegel exercises), weight loss if obese, topical estrogen products, transurethral bulking agents, surgery
- Continence pessary. Use of duloxetine may be of aid

a. Urge Incontinence
b. Functional Incontinence
c. Reflex Incontinence
d. Stress Incontinence

A

d. Stress Incontinence

51
Q

Name this type of incontinence.

  • Often referred to as overactive bladder
  • Occurs randomly when urgency precedes involuntary urination
  • Leakage is periodic but can be frequent and varies in amount
  • Nocturnal frequency and incontinence are common

a. Reflex Incontinence
b. Urge Incontinence
c. Incontinence After Trauma or Surgery
d. Functional Incontinence

A

b. Urge Incontinence

52
Q

Name this type of incontinence.

CAUSES
- Caused by uncontrolled contraction or overactive detrusor muscle
- Bladder escapes central inhibition and contracts reflexively
- Conditions include:
- CNS problems (e.g., stroke, Alzheimer disease, brain tumor, Parkinson disease)
- Bladder disorders (e.g., cancer, radiation effects, interstitial cystitis)

a. Urge Incontinence
b. Reflex Incontinence
c. Incontinence After Trauma or Surgery
d. Stress Incontinence

A

a. Urge Incontinence

53
Q

Name this type of incontinence.

TREATMENT
- Treat underlying cause
- Biobehavioral interventions (bladder retraining with urge suppression, decrease in diet irritants, bowel regularity, pelvic floor muscle exercises)
- Anticholinergic drugs
- Vaginal estrogen creams
- Containment devices (e.g., external condom catheters)
- Absorbent products

a. Overflow Incontinence
b. Incontinence After Trauma or Surgery
c. Urge Incontinence
d. Reflex Incontinence

A

c. Urge Incontinence

54
Q

occurs when bladder pressure exceeds urethral closure pressure

A

incontinence

55
Q

T/F

Anything that interferes with internal and/or external urethral sphincter control can result in urinary incontinence.

A

true

56
Q

the combination of stress and urge incontinence

A

mixed incontinence

57
Q

A 55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is appropriate to include in the care plan?

a. Place a commode at the patient‘s bedside.

b. Assist the patient to the bathroom every 3 hours.

c. Demonstrate how to perform the Credé maneuver.

d. Teach the patient how to perform Kegel exercises.

A

d. Teach the patient how to perform Kegel exercises.

58
Q

Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours. Which nursing action is the priority?

a. Encourage the patient to drink more fluids.

b. Plan to monitor the patient‘s intake and output.

c. Use an ultrasound scanner to check the post-voiding residual volume.

d. Reassure the patient that urinary problems are common after rectal surgery.

A

c. Use an ultrasound scanner to check the post-voiding residual volume.

NUR243 - Medical-Surgical II (19 decks)

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