Hinkle 49 Flashcards
Week 8
A female client has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this client?
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.
C
The client is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The client should be encouraged to shower rather than bathe.
A 42-year-old woman comes to the clinic reporting occasional urinary incontinence when sneezing. The clinic nurse should recognize what type of incontinence?
A. Stress incontinence
B. Reflex incontinence
C. Overflow incontinence
D. Functional incontinence
A
Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure, such as a result of exertion, sneezing, coughing, or changing positions. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the client to reach the toilet in time for voiding.
A nurse is caring for a female client whose urinary retention has not responded to conservative treatment. When educating this client 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 (2.5 to 5 cm) into the urethra
D. Self-catheterizing every 2 hours at home
B
The client may use a “clean” (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female client assumes a Fowler position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.
A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this client’s 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
B
The client will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.
The nurse on a urology unit is working with a client who has been diagnosed with calcium oxalate renal calculi. When planning this client’s health education, what nutritional guidelines should the nurse provide?
A. Restrict protein intake as prescribed.
B. Increase intake of potassium-rich foods.
C. Follow a low-calcium diet.
D. Encourage intake of food containing oxalates.
A
Protein is restricted to 60 g/day, while sodium is restricted to 3 to 4 g/day. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The client should avoid intake of oxalate-containing foods and there is no need to increase potassium intake.
The nurse is caring for a client who underwent percutaneous (endourologic) lithotripsy earlier in the day. What instruction should the nurse give the client?
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 health care provider about cloudy or foul-smelling urine.
D. Report any pink-tinged urine within 24 hours after the procedure.
C
The client should report the presence of foul-smelling or cloudy urine since this is suggestive of a urinary tract infection (UTI). Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand-like debris is normal due to residual stone products. Hematuria is common after lithotripsy.
A female client’s most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse’s data analysis should be informed by what principle?
A. Most UTIs in female clients 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.
D
Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.
The clinic nurse is preparing a plan of care for a client 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 client to perform pelvic floor muscle exercises.
C. Prepare the client for an anterior vaginal repair procedure.
D. Provide information on periurethral bulking.
B
Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions have a behavioral approach.
The nurse and urologist have both been unsuccessful in catheterizing a client with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the health care provider will use to drain the client’s bladder?
A. Insertion of a suprapubic catheter
B. Scheduling the client 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
A
When the client cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.
The nurse has implemented a bladder retraining program for an older adult client. The nurse places the client on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the client typically has approximately 50 mL of urine remaining in the bladder after voiding. What would be the nurse’s best response to this finding?
A. Perform a straight catheterization on this client.
B. Avoid further interventions at this time, as this is an acceptable finding.
C. Place an indwelling urinary catheter.
D. Press on the client’s bladder in an attempt to encourage complete emptying.
B
In adults older than 60 years of age, 50 to 100 mL of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted.
The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day?
A. 1,250 mL
B. 2,000 mL
C. 2,750 mL
D. 3,500 mL
B
Unless contraindicated by kidney injury or hydronephrosis, clients with renal stones should drink at least eight 8-oz (250 mL) glasses of water daily or have IV fluids
A client with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the client’s urine output hourly and notifies the health care provider when the hourly output is less than what amount?
A. 30 mL
B. 50 mL
C. 100 mL
D. 125 mL
A
A urine output below 0.5 mL/kg/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis.
The nurse is caring for a client with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a client 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.
C
To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.
The nurse is teaching a health class of older adults about urinary tract infections (UTI)s. 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 older men 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.
B
The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging, resulting in increased incidence. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs.
A client 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 length, then double it
C. The widest part of the stoma
D. Half the width of the stoma
C
The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage.
A client being treated in the hospital has been experiencing occasional urinary retention. What voiding trigger technique would help this client?
A. Using a bedpan instead of a commode
B. Dipping the client’s hands in warm water
C. Performing a bladder scan after voiding
D. Encouraging male clients to use a urinal in bed
B
Dipping the client’s hands in warm water is a urinary trigger technique that helps encourage clients to start voiding. Other trigger techniques include turning on the faucet while the client is attempting to void and stroking the abdomen or inner thighs. Using a commode instead of a bedpan is a nursing measure to encourage normal voiding patterns. Encouraging a male client to use a urinal while standing is more natural and comfortable and is also linked to voiding patterns. Bladder scanning after voiding will assess whether the client is retaining urine but is not a trigger technique.
