Nokea
The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?
- A. Anticholinergic
- B. Diuretics
- C. Anticonvulsant
- D. Cholinergic
Correct Answer: A
Rationale: Pharmacologic agents that can improve bladder retention, emptying, and control include anticholinergic drugs. In this classification are medications such as Detrol, Ditropan, and Urecholine. Diuretics eliminate fluid from the body but do not affect the muscles of urinary elimination. Anticonvulsant and cholinergic medications also do not directly help with control.
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The nurse is caring for several clients on a urinary medical unit. Which client is at an increased risk for bladder stones?
- A. The client with frequent urinary tract infections
- B. The client who is paraplegic
- C. The client with difficulty ambulating
- D. The client with abdominal surgery
Correct Answer: B
Rationale: The client who is immobile or who is paraplegic may also tend to form bladder stones. Clients with incomplete urinary elimination, urinary stasis, or concentrated urine are at higher risk for stone formation. There is not as strong correlation between infections, difficulty ambulating, and surgery.
The nurse is caring for a client for whom an ileal conduit is created after a radical cystectomy. Which instructions would the nurse expect to include in the client's plan of care?
- A. Application of an ostomy pouch
- B. Intermitient catheterizations
- C. Exercises to promote sphincter control
- D. Irrigating the urinary diversion
Correct Answer: A
Rationale: An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermitient catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.
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.
The nurse is caring for a client diagnosed with bladder stones. The client is scheduled for a cystolitholapaxy. Which nursing action is most important to complete prior to the procedure?
- A. Strain all urine
- B. Maintain the intake and output
- C. Maintain 12 hours of nothing by mouth
- D. Make sure that the nurse has the consent signed
Correct Answer: A
Rationale: It is most important to strain all urine up to the time of the procedure. Should the client pass the stone, the procedure may be able to be cancelled. Maintaining intake and output is important in considering fluid balance. Most clients are ordered nothing by mouth after midnight for a morning procedure. The physician is responsible for explaining the procedure and obtaining the signatures on the consent.
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.