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MULTIPLE CHOICE
ANS: C
Females at any age are more susceptible to cystitis than men
because of the shorter urethra in women. Postmenopausal
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 pregnant would not have a risk potential as high as
the older woman who is not using hormone replacement therapy.
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.
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.
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
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.
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.
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.
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.
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 inquire about removing the catheter. All
other questions might be appropriate, but because of client
safety, this question takes priority.
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.
ANS: B
The shock waves from lithotripsy can cause bleeding into the
tissues through which the waves pass. Application 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.
ANS: A
Although all interventions are or might be important, obtaining a
urine sample for urinalysis takes priority. Often urinary tract
infection (UTI) symptoms in older adults are atypical, and a UTI
may present with new onset of confusion or falling. The urine
sample should be obtained before starting antibiotics. Dietary
requirements and gait training should be implemented after
obtaining the urine sample.
ANS: D
The greatest risk factor for bladder cancer is a long history of
tobacco use. The other factors would not necessarily contribute
to the development of this specific type of cancer.
DIF: Remembering/Knowledge REF: 1388
KEY: Urothelial cancer| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care
Environment: Management of Care
ANS: C
A pale or cyanotic stoma indicates impaired circulation to the
stoma and must be treated to prevent necrosis. Blood-tinged
urine and serous sanguineous drainage are expected after this
type of surgery. Oxygen saturation of 92% on room air is at the
low limit of normal.
ANS: A
Smoking is known to be a factor that greatly increases the risk of
bladder cancer. Alcohol use, recreational drug use, and
prescription drug use (except medications that contain
phenacetin) are not known to increase the risk of developing
bladder cancer.
ANS: D
The goal for the client who is scheduled to undergo a procedure
such as an ileal conduit is to have a positive self-image and a
positive attitude about his or her body. Discussing the procedure
candidly with someone who has undergone the same procedure
will foster such feelings, especially when the current client has
an opportunity to ask questions and voice concerns to someone
with first-hand knowledge. Medications for anxiety will not
promote a positive self-image and a positive attitude, nor will
discussing the procedure once more with the physician or
hearing the nurse’s opinion.
ANS: A
The client should use a second form of birth control because
penicillin seems to reduce the effectiveness of estrogen-
containing contraceptives. She should not experience increased
menstrual bleeding, an irregular heartbeat, or blood in her urine
while taking the medication.
ANS: D
Functional urinary incontinence occurs as the result of problems
not related to the client’s bladder, such as trouble ambulating or
difficulty accessing the toilet. One goal is that the client will be
able to manage his or her clothing independently. Elastic
waistband slacks that are easy to pull down can help the client
get on the toilet in time to void. The other instructions do not
relate to functional urinary incontinence.
ANS: B
Some types of incontinence are treated with anticholinergic
medications such as propantheline (Pro-Banthine).
Anticholinergic side effects include dry mouth, constipation, and
urinary retention. The nurse needs to assess the client’s
medication list to determine whether the client is taking an
anticholinergic medication. If he or she is taking anticholinergics,
the nurse should further assess the client’s manifestations to
determine if they are related to a simple side effect or an
overdose. The other questions are not as helpful to understanding
the current situation.
ANS: B
Exercise therapy and electrical stimulation are used for clients
with stress incontinence related to childbirth or low levels of
estrogen after menopause. Exercise therapy increases pelvic
wall strength; it does not improve ambulation. Physical therapy
and a bedside commode would be appropriate interventions for
the client who has difficulty ambulating. Habit training is the
type of bladder training that will be most effective with
cognitively impaired clients. Bladder training can be used only
with a client who is alert, aware, and able to resist the urge to
urinate.
ANS: A
There is a strong association between family history and stone
formation and recurrence. Nephrolithiasis is associated with
many genetic variations; therefore, the nurse should ask whether
other family members have also had renal stones. The other
questions do not refer to renal calculi but instead are questions
that should be asked of a client with a urinary tract infection.
ANS: B
The most common manifestation of urethral stricture after a
urologic procedure is obstruction of urine flow. This rarely causes
pain and has no impact on blood pressure. The client may
experience overflow incontinence with the involuntary loss of
urine when the bladder is distended. Blood in the urine is not a
manifestation of the obstruction of urine flow.
ANS: C
The nurse should accept and acknowledge the client’s concerns,
and assist the client to learn techniques that will allow control of
urinary incontinence. The nurse should not diminish the client’s
concerns with the use of pads or stating statistics about the
occurrence of incontinence.
ANS: C
Pregnant clients with a urinary tract infection require prompt and
aggressive treatment because cystitis can lead to acute
pyelonephritis during pregnancy. The nurse should encourage the
client to make an appointment and have the infection treated.
Burning pain when urinating does not indicate the start of labor
or weakening of pelvic muscles.
MULTIPLE RESPONSE
ANS: A, B, D
Fluid intake, estrogen levels, and immune suppression all can
increase the chance of recurrent cystitis. Family history is
usually insignificant, and cranberry juice, not grapefruit or
orange juice, has been found to increase the acidic pH and
reduce the risk for bacterial cystitis.
ANS: A, C, F
The key points in self-catheterization include washing hands,
using lubricants, and maintaining a regular schedule to avoid
distention and retention of urine that leads to bacterial growth. A
smaller rather than a larger lumen catheter is preferred. The
client needs to catheterize more often than every 12 hours. Self-
catheterization in the home is a clean procedure.
ANS: B, E
Clients who suffer from stress incontinence have weak pelvic
floor muscles or urethral sphincter and cannot tighten their
urethra sufficiently to overcome the increased detrusor pressure.
Stress incontinence is common after childbirth, when the pelvic
muscles are stretched and weakened from pregnancy and
delivery. Urge incontinence occurs in people who cannot
suppress the contraction signal from the detrusor muscle.
Abnormal detrusor contractions may be a result of neurologic
abnormalities including dementia, or may occur with no known
abnormality. Post-void residual is associated with reflex
incontinence, not with urge incontinence or stress incontinence.
Management of urge incontinence includes decreasing fluid
intake, especially in the evening hours.
ANS: B, E
Clients who are severely immunocompromised or who have
diabetes mellitus are more prone to fungal UTIs. The nurse
should assess for these factors by asking about medical history,
current medical problems, and the current medication list. A
physical examination and a post-void residual may be needed, but
not until further information is obtained indicating that these
examinations are necessary. Travel to foreign countries probably
would not be important because, even if exposed, the client
needs some degree of compromised immunity to develop a fungal
UTI.
ANS: A, B, D
Stress incontinence is a loss of urine with physical exertion,
coughing, sneezing, or exercising. Urge incontinence presents
with an abrupt and strong urge to void and usually has a large
amount of urine released with each occurrence. Overflow
incontinence occurs with bladder distention and results in a
constant dribbling of urine. Functional incontinence is the
leakage of urine caused by factors other than a disorder of the
lower urinary tract. Reflex incontinence results from abnormal
detrusor contractions from a neurologic abnormality.
ANS: A, B, E
Clients with calcium phosphate urinary stones should be taught
to limit the intake of foods high in animal protein, sodium, and
calcium. Clients with calcium oxalate stones should avoid
spinach, black tea, and rhubarb. Clients with uric acid stones
should avoid red wine.
ANS: A, B, C
The client should be taught to finish the prescribed antibiotic to
ensure that he or she does not get a urinary tract infection. The
client should drink at least 3 liters of fluid daily to dilute
potential stone-forming crystals, prevent dehydration, and
promote urine flow. After lithotripsy, the client should expect
bruising that may take several weeks to resolve. The client
should also experience blood in the urine for several days. The
client should report any pain, fever, chills, or difficulty with
urination to the provider as these may signal the beginning of an
infection or the formation of another stone.
ANS: A, B, E
The client should be taught that the muscles used to start and
stop urination are pelvic muscles, and that pelvic muscles can be
strengthened by contracting and relaxing them. The client should
tighten pelvic muscles for a slow count of 10 and then relax the
muscles for a slow count of 10, and perform this exercise 15
times while in lying-down, sitting-up, and standing positions. The
client should begin to notice improvement in control of urine
after several weeks of exercising the pelvic muscles.