Nokea
A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?
- A. Stress incontinence
- B. Reflex incontinence
- C. Overflow incontinence
- D. Functional incontinence
Correct Answer: A
Rationale: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. 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 patient to reach the toilet in time for voiding.
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A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?
- A. Hydronephrosis
- B. Nephritic syndrome
- C. Pylonephritis
- D. Nephrotoxicity
Correct Answer: A
Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.
A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patients urine output hourly and notifies the physician when the hourly output is less than what?
- A. $30 \mathrm{~mL}$
- B. $50 \mathrm{~mL}$
- C. $100 \mathrm{~mL}$
- D. $125 \mathrm{~mL}$
Correct Answer: A
Rationale: A urine output below30 \mathrm{~mL} / \mathrm{hr}$ may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis.
Resection of a patients bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following?
- A. Remain NPO for 12 hours prior to the treatment.
- B. Hold the solution in the bladder for 2 hours before voiding.
- C. Drink the intravesical solution quickly and on an empty stomach.
- D. Avoid acidic foods and beverages until the full cycle of treatment is complete.
Correct Answer: B
Rationale: The patient is allowed to eat and drink before the instillation procedure. Once the bladder is full, the patient must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.
A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurses best response?
- A. Inform the patient that urgency and occasional incontinence are expected for the first few weeks post-removal.
- B. Obtain an order for a loop diuretic in order to enhance urine output and bladder function.
- C. Inform the patient that this is not unexpected in the short term and scan the patients bladder following each void.
- D. Obtain an order to reinsert the patients urinary catheter and attempt removal in 24 to 48 hours.
Correct Answer: C
Rationale: Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule, usually every 2 to 3 hours. At the given time interval, the patient is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely, straight catheterization may be performed. An indwelling catheter would not be reinserted to resolve the problem and diuretics would not be beneficial. Ongoing incontinence is not an expected finding after catheter removal.
A patient has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of disturbed body image. How can the nurse best address the effects of this urinary diversion on the patients body image?
- A. Emphasize that the diversion is an integral part of successful cancer treatment.
- B. Encourage the patient to speak openly and frankly about the diversion.
- C. Allow the patient to initiate the process of providing care for the diversion.
- D. Provide the patient with detailed written materials about the diversion at the time of discharge.
Correct Answer: B
Rationale: Allowing the patient to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the patient is hesitant. Provision of educational materials is rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role of the diversion in cancer treatment does not directly address the patients body image.