Nokea
The nurse is caring for a client with chronic bladder infections and inflammation. The physician has ruled out several medical diagnoses and is considering interstitial cystitis. The nurse is most correct to anticipate which diagnostic test to confirm the disorder?
- A. A cystoscopy
- B. A voiding cystourethrogram
- C. A bladder biopsy
- D. A potassium sensitivity test
Correct Answer: C
Rationale: A bladder biopsy of the bladder mucosa reveals an inflammatory process with scarring and hemorrhagic areas and confirms the diagnosis. A cystoscopy reveals an inflamed bladder, bladder mucosa with pinpoint hemorrhages and a bladder capacity smaller than normal. A voiding cystourethogram demonstrates a small bladder capacity. A potassium sensitivity test reveals pain from the potassium instilled and is used in suggesting the presence of bladder inflammation and irritation.
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The nurse is caring for a 37-year-old female client with potential interstitial cystitis. Which question, asked by the nurse, is helpful in supporting the diagnosis?
- A. Have you noted any unusual vaginal drainage?
- B. Have you experienced hematuria with cramping?
- C. When was your last menstrual period?
- D. Do you drink alcoholic beverages on a frequent basis?
Correct Answer: C
Rationale: Although the cause of interstitial cystitis is unknown, there appears to be a connection with female hormones as a link between flare-ups prior to menstruation has been noted. Unusual vaginal drainage is a symptom of a sexually transmitted disease. Hematuria is a symptom of many urinary tract disorders and not helpful in specifically suggesting interstitial cystitis. Alcoholic beverage consumption is not an indicator.
The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction?
- A. The nursing assistant keeps the catheter and drainage bag together when moving the client
- B. The nursing assistant places the drainage bag on the client's abdomen for transport
- C. The nursing assistant places the drainage bag on the lower area of the wheelchair for transport
- D. The nursing assistant holds the drainage bag while the client moves to the wheelchair
Correct Answer: B
Rationale: The nurse would instruct the nursing assistant to maintain the drainage bag lower than the genital region to avoid a backflow of urine into the bladder. The nursing assistant is correct to move the catheter and drainage bag with the client to not put tension on the catheter, place the drainage bag on the lower area of the wheelchair, and hold the drainage bag while the client is in the process of moving.
The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of an early stage of malignant tumor of the bladder?
- A. Incontinence
- B. Dysuria
- C. Hematuria
- D. Frequency
Correct Answer: C
Rationale: The most common first symptom of a malignant tumor is painless hematuria. Most malignant tumors are vascular, thus, abnormal bleeding can be a first sign of abnormality. The client then has symptoms of incontinence (a later sign), dysuria, and frequency.
The licensed practical nurse is employed as a charge nurse at a long-term care facility. A resident is ordered a catheterization schedule of every 6 hours due to chronic urinary retention. The LPN reports daily catheterization amounts from the previous day ranging from 450 mL to 800 mL. Which nursing action is most correct?
- A. Continue the same order
- B. Obtain an order to decrease the frequency of the catheterizations
- C. Obtain an order to increase the frequency of the catheterizations
- D. Leave the catheterer in if obtaining a urine amount over 500 mL
Correct Answer: C
Rationale: The charge nurse realizes that if the volume of urine obtained via catheterization is more than 400 mL, the client should be catheterized more often. The LPN would call for a change in orders citing the urine volume as the rationale. Leaving the catheter in place is only completed if necessary.
The nurse is completing a plan of care for a client with chronic urinary incontinence. Which of the following outcomes is a priority?
- A. The client will decrease fluid intake to 1000 mL/day
- B. The client will use the bathroom every 30 minutes while awake
- C. The client will maintain perineal skin integrity
- D. The client will express feelings of acceptance related to condition
Correct Answer: C
Rationale: The nurse planning care would identify the priority outcome being to maintain skin integrity. Due to the urinary incontinence, perineal skin breakdown may occur due to the warm, moist environment. A skin barrier or moisture sealant is suggested. The nurse would not decrease fluid intake dramatically or tell the client to use the bathroom every 30 minutes in a chronic condition. It is important to accept those things that cannot be controlled.