Chapter 34: Management of Clients with Urinary Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 34: Management of Clients with Urinary Disorders

MULTIPLE CHOICE

1. In a client with a history of frequent urinary tract infections (UTIs), the nurse would note the need for further teaching when the client says I

a.

am on an oral contraceptive.

b.

often take baths instead of showers.

c.

use unscented tampons during my period.

d.

use a water-soluble lubricant for intercourse.

ANS: B

Women who experience frequent UTIs are encouraged to shower rather than take a tub bath and to avoid bubble baths, salts, and scented feminine hygiene products.

DIF: Evaluation/Evaluating REF: pp. 731-732 OBJ: Evaluation

MSC: Health Promotion and Maintenance Disease Prevention

2. For a client with a history of recurrent UTIs who is prescribed an acid-ash diet, the nurse would advise the client to include

a.

alcohol.

b.

carbonated beverages.

c.

coffee.

d.

cranberry juice.

ANS: D

Acid-ash items include cranberry juice and vitamin C. The nurse should advise the client to avoid coffee and alcohol because these liquids may irritate the bladder lining.

DIF: Application/Applying REF: p. 731 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

3. In caring for a client with interstitial cystitis, the nurse would focus significant nursing interventions on

a.

administering antibiotics.

b.

providing emotional support.

c.

teaching about an acid-ash diet.

d.

teaching preventive measures.

ANS: B

The major nursing responsibility associated with interstitial cystitis is supporting the client through diagnosis and treatment. Because the cause of this syndrome is unclear, few nursing interventions are aimed at prevention.

DIF: Application/Applying REF: p. 735 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

4. For a client experiencing urinary incontinence, in the initial plan of care the nurse would include

a.

encouraging the client to void frequently.

b.

limiting fluid intake.

c.

teaching Kegel exercises.

d.

using adult diapers to prevent accidents.

ANS: C

Kegel exercises have long been the technique of choice for reducing urinary incontinence. Many clients self-limit fluids thinking that will help prevent accidents. Adequate fluid intake and urine production are both needed to stimulate the micturition reflex. If not contraindicated, encourage the client to drink 0.5 ml/pound of body weight daily. The frequency of voiding depends on the clients past habits, best assessed with a voiding diary. The client may need to void as often as every 30 minutes at the start of a bladder training program, but the timing is gradually increased to help increase bladder capacity. Adult diapers should be a last resort when other methods of maintaining continence have failed.

DIF: Application/Applying REF: pp. 764, 766, 767

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

5. In teaching a client who requires a condom catheter for control of incontinence how to properly apply the system, the nurse stresses that part of the correct method for applying the device is to

a.

apply the condom close to the end of the penis.

b.

attach the device with tape wrapped around the shaft of the penis.

c.

fasten the sheath with elastic tape applied in a spiral manner.

d.

retract the foreskin before application.

ANS: C

When rolling the condom sheath over the penis, one must take care to allow at least 1.5 cm between the distal end of the penis and the internal end of the sheath to reduce skin irritation, ensuring the foreskin is over the glans. Only elastic tape should be used to allow for expansion or erection. The tape is applied in a spiral manner only to avoid reduced circulation.

DIF: Application/Applying REF: pp. 768-769 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

6. The nurse explains to a client who is receiving oxybutynin (Ditropan) for control of urinary incontinence that the drugs effect is

a.

decreasing bladder contractility.

b.

increasing serotonin in the CNS, leading to bladder wall relaxation.

c.

promoting relaxation of the bladder outlet.

d.

reducing intra-abdominal pressure.

ANS: B

Oxybutynin works by increasing the volume in the bladder that can be tolerated before an involuntary bladder contraction occurs, by decreasing the strength of the involuntary bladder contraction, and by increasing the total bladder capacity. Tricyclic antidepressants are sometimes prescribed for overactive bladder and interstitial cystitis. They are the drugs that increase synaptic serotonin levels in the CNS, resulting in bladder wall relaxation.

DIF: Comprehension/Understanding REF: p. 767 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

7. For a client experiencing urinary retention with overflow, the factor in the clients history that would prompt the nurse to question an order for a cholinergic medication is

a.

bladder outlet obstruction.

b.

diabetes mellitus.

c.

frequent UTIs.

d.

multiple pregnancies.

ANS: A

Cholinergic medications and antispasmodics are contraindicated in clients with bladder outlet obstruction or a weak detrusor muscle. Giving these medications could lead to ureterovesical reflux or ruptured bladder.

DIF: Analysis/Analyzing REF: p. 760 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

8. A client with urinary incontinence is scheduled for surgery. The client states This will fix my incontinence. The nurse should assess this client for the presence of

a.

an anatomic defect.

b.

an infection.

c.

pyelonephritis.

d.

the presence of residual urine.

ANS: A

Surgery should be performed in the incontinent client only when a structural or anatomic defect is found.

DIF: Comprehension/Understanding REF: pp. 769-770 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

9. To determine if a client has an initial manifestation typically seen in clients with bladder neoplasm, the nurse would ask

a.

Do you have pain when you urinate?

b.

Do you produce larger amounts of urine than you have in the past?

c.

Have you noticed any blood in your urine?

d.

Have you noticed that you urinate more frequently than you used to?

ANS: C

Painless gross hematuria is most frequently the first manifestation of bladder cancer, occurring in 85% of all cases.

DIF: Comprehension/Understanding REF: p. 737 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. An enterostomal therapist would suggest that the location for a urinary stoma is the

a.

lower abdominal quadrants.

b.

pubic area.

c.

rib margins.

d.

umbilical area.

ANS: A

The main criterion for stomal placement is that the site allows the faceplate of the drainage appliance to bind securely to the abdominal surface as well as be clearly visible to the client. This means that the surgeon must avoid the umbilicus, rib margins, pubis, iliac crests, and any pre-existing scars, wrinkles, or crevices.

DIF: Application/Applying REF: p. 743 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

11. When the nurse notes that the ureteral catheter is no longer draining urine, the most appropriate action would be to

a.

clamp the urethral catheter to promote drainage from the ureteral catheter.

b.

do nothing, since this is a normal occurrence in the first 24 hours.

c.

irrigate the ureteral catheter with 30 ml of sterile saline.

d.

notify the physician immediately.

ANS: D

When ureteral stents or catheters are placed, patency is very important to prevent hydronephrosis and pyelonephritis. Urine production and drainage should be constant, so this client is at risk of complications unless the nurse acts quickly. Because there is no mucus present, irrigation is not usually needed unless specifically ordered and then only in amounts of 5-10 ml.

DIF: Application/Applying REF: pp. 744, 745 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

12. A client is being rehabilitated after surgery to create a Kock pouch. The nurse should include which information in the clients teaching plan?

a.

Care of a suprapubic catheter

b.

Self-catheterization technique

c.

Technique for applying a permanent pouch

d.

Technique for irrigating a ureteral catheter

ANS: B

Postoperative care for the client with a Kock or Indiana pouch is similar to that of any client with a urinary diversion, except there is no external drainage bag. The client performs catheterization using the same principles as for clean, intermittent urinary self-catheterization.

DIF: Application/Applying REF: p. 747 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

13. Noting that the clients stoma is red and moist 8 hours after urinary diversion surgery, the nurse would

a.

continue to make hourly assessments of the stoma.

b.

notify the surgeon immediately.

c.

remove the pouch and reapply it correctly.

d.

remove the pouch to expose the stoma to air.

ANS: A

The nurse should inspect the stoma every hour for the first 24 hours after surgery. The stoma should be red and moist.

DIF: Application/Applying REF: p. 744 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

14. The nurse would realize that additional teaching is needed when the client with a ureteroileostomy says I

a.

am going shopping for new clothing that will better accommodate the pouch.

b.

will change the pouch when it begins to leak.

c.

wont drink too much so the amount of urine I make will be less.

d.

am going to cut down on eating dairy products.

ANS: C

The client with a ureteroileostomy should maintain a daily fluid intake of at least 3 L (3 quarts) unless there is another reason why the client should not have this amount of fluid. These clients are at high risk of developing kidney stones and pyelonephritis, and maintaining a high intake and normal urine output will help prevent these complications.

DIF: Evaluation/Evaluating REF: pp. 729, 741, 752-753

OBJ: Evaluation

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

15. Nursing care for a client with urinary bladder calculi should include

a.

checking for abdominal distention.

b.

collecting a 24-hour urine specimen for calcium.

c.

encouraging fluid intake up to 4000 ml/day.

d.

maintaining bed rest.

ANS: C

The nurse should encourage the client to increase fluid intake to 3 to 4 L daily (unless contraindicated) to ensure a urine output of 2.5 to 3 L/day.

DIF: Application/Applying REF: pp. 752-753 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

16. The nurse reinforces explanations that the procedure for lithotripsy involves

a.

capturing of stones via a scope.

b.

dissolution of stones with medication.

c.

fragmenting of stones by shock waves.

d.

surgical removal of stones.

ANS: C

Extracorporeal shock wave lithotripsy (ESWL) uses high-energy shock waves transmitted through water to the stone. These shock waves cause the stones to rupture into small fragments that can be passed or retrieved endoscopically.

DIF: Comprehension/Understanding REF: p. 756 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Therapeutic Procedures

17. A client has an autonomous neurogenic bladder. The nurse plans care for this client understanding that the client

a.

cannot perceive bladder fullness or initiate or maintain urination.

b.

feels no bladder-filling sensation but empties the bladder reflexively.

c.

feels the sensation of the bladder filling but cannot initiate micturition.

d.

has a temporary problem with initiating micturition.

ANS: A

The client with an autonomous neurogenic bladder can neither perceive bladder fullness nor initiate or maintain urination without some type of assistance (e.g., applying external pressure on the abdomen). Clients with motor paralytic bladders can feel the bladder filling, even to the point of pain, but cannot initiate micturition. This condition can be temporary if a bacterial or viral infection is the cause. Reflex neurogenic bladder causes the client to be unable to feel bladder filling, and bladder emptying is done reflexively, although it may be incomplete.

DIF: Application/Applying REF: pp. 771-772 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

18. During a bladder training program for a client with spinal cord injury using intermittent catheterization, the client suddenly complains of a throbbing headache. Noting that the clients blood pressure is elevated, the priority action by the nurse is to

a.

catheterize the client.

b.

limit fluids for the remainder of the day.

c.

notify the physician immediately.

d.

place the client flat in bed.

ANS: A

Autonomic dysreflexia is a potentially life-threatening complication that can affect spinal cordinjured clients. The most frequent cause is bladder distention or feces in the rectum. Nursing interventions involve removing the triggering stimuli by reestablishing urine flow or by removing fecal impaction, if necessary. The nurse would catheterize the client, monitor the clients vital signs every 5 minutes, raise the head of the bed to a semi-Fowler position, and notify the physician. Catheterizing the client takes priority over notifying the physician because it addresses the manifestations directly and may remove the irritating stimulus, potentially preventing serious complications.

DIF: Analysis/Analyzing REF: p. 772 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

19. A nurse working on a rehabilitation unit is caring for several clients with neurogenic bladder. The client who probably should not be a candidate for intermittent catheterization teaching is the

a.

15-year-old client who cannot understand sterile technique.

b.

26-year-old paraplegic client.

c.

26-year-old woman with an active sex life.

d.

35-year-old man with an erratic work schedule.

ANS: D

Catheterization must be carried out at specified intervals throughout the day until bedtime. A client who is incapable of adhering to this schedule is not an appropriate candidate for the program. Intermittent self-catheterization is done with clean, not sterile, technique. Having paraplegia or an active sex life would not interfere with the program.

DIF: Comprehension/Understanding REF: p. 773 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

20. The nurse teaching self-catheterization technique should include the importance of

a.

catheterizing every 3 to 4 hours.

b.

drinking at least 500 ml of fluid before catheterization.

c.

sterile technique.

d.

using the Cred maneuver before catheterization.

ANS: A

Authorities recommend that clean (rather than sterile) technique be used for catheterization outside health care facilities. The average interval for adults is every 3 to 4 hours, although the client usually starts at intervals of 2 to 3 hours. Sterile technique is not used.

DIF: Application/Applying REF: p. 773 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

21. The nurse who is teaching methods of micturition stimulation would stress that the method that may have genitourinary risks is

a.

the Cred maneuver.

b.

the Valsalva maneuver.

c.

trigger stimulation.

d.

vagal stimulation.

ANS: A

The Cred maneuver involves the client placing his or her fingers over the bladder and pressing downward slowly toward the symphysis pubis, as though milking the urine out of the urinary system. Complications include causing urinary reflux into the ureters.

DIF: Application/Applying REF: p. 773 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

22. The nurse caring for a man with a mega-ureter should assess for the potential problem of

a.

impotence.

b.

incontinence.

c.

scrotal swelling.

d.

urine reflux.

ANS: D

Abnormal dilation of the ureter (mega-ureter) is characterized by dilation and pouching of the ureteral wall just adjacent to the vesicoureteral junction. Mega-ureter causes problems because of refluxing or obstructive effects.

DIF: Application/Applying REF: p. 776 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

23. After reading the order to irrigate ureteral catheter with 50 ml of sterile saline solution, the nurse should

a.

call the surgeon to clarify.

b.

irrigate as ordered.

c.

question the order relative to the use of sterile saline.

d.

warn the client that there will be some discomfort.

ANS: A

Ureteral catheters should be irrigated only with specific orders and then only with 5 to 10 ml of sterile normal saline.

DIF: Analysis/Analyzing REF: p. 745 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Error Prevention

24. A nurse is caring for a client with an indwelling Foley catheter. Which intervention takes highest priority?

a.

Administer antispasmotics for bladder spasms.

b.

Provide meticulous perineal care.

c.

Provide privacy when assessing the catheters patency.

d.

Record accurate I&O.

ANS: B

Privacy and accurate I&O are important components in the care plan for any client with an indwelling Foley catheter. However, to prevent nosocomial urinary tract infections secondary to catheter use, the nurse should provide meticulous perineal care, maintain the closed drainage system, and only use the catheter for as long as absolutely necessary. Do not use a Foley catheter for nurse convenience.

DIF: Application/Applying REF: p. 731 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Therapeutic Procedures

25. A male client has come to the clinic with complaints of urethritis and urinary frequency with burning. The nurse should assess this client for the presence of

a.

a sexually transmitted disease.

b.

chronic urinary tract infections.

c.

congenital bladder defects.

d.

reflux and distended bladder.

ANS: A

Urethritis is commonly associated with sexually transmitted diseases; in fact, the most common causes are chlamydia and gonorrhea.

DIF: Application/Applying REF: pp. 732-733 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

26. An elderly client who lives at home is brought to the clinic by her daughter. The daughter states that the client no longer goes out to shop for herself and so is not eating right. The daughter is worried about the client losing weight and seeming depressed. The client appears slightly dehydrated. The nurse should assess the client for

a.

dementia.

b.

elder abuse.

c.

incontinence.

d.

medication misuse.

ANS: C

People with incontinence often try to isolate themselves and limit their fluid intake in order to lessen the chances of having an accident. While all four options are valid assessment points, because so many elderly suffer from incontinence that would be the likely place to start.

DIF: Analysis/Analyzing REF: pp. 762, 767 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

27. A client has interstitial cystitis and has had several treatments with instillation of oxychlorosene (Clorpactin) into the bladder. The client is crying and verbalizing frustration with the frequent treatments that seem to do no good. The best response by the nurse is

a.

Do you get upset easily with other problems?

b.

Im concerned that this doesnt seem to be helping you.

c.

Lets ask the doctor when you can expect to see some results.

d.

You seem upset. I can sit with you for a few minutes.

ANS: D

Instillation of various agents into the bladder can be one treatment option for interstitial cystitis. However, the treatment is lengthy; it sometimes requires 3 treatments weekly for 2-4 months before any noticeable improvement occurs. Clients easily become frustrated and the nurses best response is to offer support.

DIF: Analysis/Analyzing REF: pp. 734-735 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Interactions

28. A client is having intravesical BCG instillation for bladder cancer. Safety precautions the nurse should implement include

a.

disinfect the toilet and urine containers with bleach.

b.

limit time giving direct client care to 30 minutes per 8-hour shift.

c.

not allowing visitors into the room during the instillation.

d.

wearing a gown and gloves when entering the room.

ANS: A

BCG instillation is very toxic and all toilets and urine containers used by the client during the instillation and for 6 hours afterwards need to be disinfected with bleach

DIF: Application/Applying REF: p. 739 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Handling Hazardous and Infectious Materials

29. A male client is scheduled for radical bladder surgery for advanced cancer. He appears very anxious and is making sexually inappropriate jokes to the nursing staff. The most appropriate nursing diagnosis for this client is

a.

Fear related to threat to biologic integrity

b.

Impaired coping related to poorly-developed coping mechanisms

c.

Knowledge deficit related to amount of pre-operative education needed

d.

Risk for Disturbed body image related to possible sexual dysfunction

ANS: D

Radical bladder surgery may cause problems with sexual function, including impotence in men. This makes risk for disturbed body image the most appropriate diagnosis for this client, although the others might be appropriate also.

DIF: Analysis/Analyzing REF: p. 744 OBJ: Diagnosis

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

MULTIPLE RESPONSE

1. A nurse in a long-term care facility has several residents who are incontinent. Which of the following actions can this nurse delegate to the unlicensed assistive personnel? (Select all that apply.)

a.

Assist residents with exercises to strengthen pelvic muscles.

b.

Assist the resident to the bathroom on a set schedule.

c.

Increase the time interval for bathroom trips as the resident becomes continent.

d.

Measure intake and output and report cloudy urine.

e.

Teach residents how to do Kegel exercises to strengthen pelvic muscles.

ANS: A, B, C, D

Unlicensed personnel can do all of the above options, except for teaching residents how to do Kegel exercises. Only the nurse can do teaching; however, an unlicensed assistive person can assist the client with doing the exercises by encouraging and reminding the client who has already been taught the technique.

DIF: Analysis/Analyzing REF: p. 769 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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