CH 38: Urinary Elimination

d. "Let's explore structuring activities and toileting breaks."

A 70-year-old client confides to the nurse that she is "terribly embarrassed" that she has developed urinary incontinence over the past year. Which nursing response supports the client's self-esteem? a. "It would be best just to get some adult diapers." b. "Let me refer you to a urologist who can help you." c. "Don't worry, this is a normal condition for older adults." d. "Let's explore structuring activities and toileting breaks."

c. stress

A 70-year-old client who has four children and six grandchildren states that she "wets" herself when she sneezes or laughs. She reports that sometimes this also occurs when rising from a sitting to standing position. Which type of incontinence does the nurse anticipate? a. urge b. reflect c. stress d. total

d. one or both of the ureters are surgically implanted elsewhere The nurse should understand that in a urinary diversion, one or both of the ureters are surgically implanted elsewhere. This procedure is done for various life-threatening conditions. Incontinence is the inability to control either urinary or bowel elimination. Catheter care means the hygiene measures used to keep meatus and adjacent area of the catheter clean. In order to collect a catheter specimen, the nurse uses a catheter to collect a sample of urine in a sterile environment.

A client at a health care facility is being treated for cancer of the bladder. The health care provider uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion? a. inability to control either urinary or bowel elimination b. hygiene measures used to keep meatus and adjacent area of the catheter clean c. use of a catheter to collect urine in a sterile environment d. one or both of the ureters are surgically implanted elsewhere

d. cola-colored urine and fever

A client has been hospitalized for 5 days and the nurse is concerned the client is developing a urinary tract infection. Which assessment finding is consistent with a urinary tract infection? a. absence of sediment in the urine b. clear, pale, and yellow urine c. 1,200 ml/day urine output d. cola-colored urine and fever

a. functional incontinence Functional incontinence is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, or loss of memory or disorientation. Stress incontinence occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. Reflex incontinence is an emptying of the bladder without the sensation to void. Transient incontinence appears suddenly and lasts for 6 months or less.

A client in a long-term care facility becomes confused and disoriented at night and is incontinent during these periods of confusion due to the inability to find the commode. During the day, the client does not experience confusion and is continent. What type of incontinence is this client experiencing during the nighttime hours? a. functional incontinence b. transient incontinence c. stress incontinence d. reflex incontinence

c. Caffeine intake Fluids or food containing alcohol or caffeine, such as coffee, tea, cola, or chocolate, irritate the bladder and contain a diuretic that can increase urine output when ingested in large amounts. Blood pressure changes do not typically cause urgency, nor do most common vitamin supplements. Body weight affects urinary function, as with all body systems, but is not specifically linked to urgency.

A client is reporting bladder urgency. The nurse will assess which of the following? a. Blood pressure b. Body weight c. Caffeine intake d. Use of vitamin supplements

d. Nephron The functional unit of the kidney is called the nephron. Each kidney has more than 1 million nephrons, and each nephron is capable of forming urine. The nephron consists of the glomerulus, Bowman's capsule, proximal convoluted tubules, loop of Henle, distal tubule, and collecting duct. The glomerulus is a network of blood vessels, surrounded by Bowman's capsule, where urine formation begins. The tubules, loop of Henle, and collecting ducts are passageways that permit urine to flow to the renal pelvis and then to the ureters.

A client is suspected of having a disease process affecting the basic functional unit of the kidney. Which structure is most likely involved? a. Glomerulus b. Bowman's capsule c. Loop of Henle d. Nephron

d. stress Stress incontinence is associated with a raise in intra-abdominal pressure related to activities such as sneezing, coughing, or laughing. Urge incontinence takes place when there is a delay in accessing a toilet. Reflex incontinence takes place when a client automatically releases urine and cannot control it. Total incontinence takes place without a pattern or warning, and without client control.

A client reports to the nurse that after delivering an infant, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate? a. urge b. total c. reflex d. stress

a. anuria

A client with chronic kidney disease reports not being able to urinate for the past 24 hours. A bladder scan shows no urine in the bladder. How does the nurse document this data? a. anuria b. oliguria c. nocturia d. urinary retention

b. The client is dehydrated. The BUN test measures the amount of urea nitrogen in the blood. Urea, the major nitrogenous end-waste product of metabolism, is formed in the liver. The bloodstream carries urea from the liver to the kidneys for excretion. When the kidneys are diseased, they are unable to excrete urea adequately, and urea begins to accumulate in the blood, causing BUN to rise. Normal BUN is 8 to 25 mg/100 mL. Because other factors, such as high dietary intake of protein, fluid deficit, infection, gout, or excessive breakdown of protein stores, can also elevate BUN, it is not a highly sensitive indicator of impaired renal function.

A client's BUN test results are significantly elevated. When reviewing the client's history, which finding is consistent with BUN elevation other than renal compromise? a. The client is on a low protein diet. b. The client is dehydrated. c. The client has a history of osteoarthritis. d. The client is lactose intolerant.

a. Assist the client to a standing position. Helping clients assume their usual voiding positions may be all that is necessary to resolve an inability to void. If male clients cannot void lying down, the nurse will encourage them to void while standing at the bedside, unless this is contraindicated. While running water often helps relax clients so voiding can occur, it is not addressing the clients true need. Telling the client that he needs to void prior to discharge is putting stress on performing the activity, which is counterproductive. Asking the spouse to assist with holding the urinal may also make the client uncomfortable.

A male client who has had outpatient surgery is unable to void while lying supine. Which intervention would be most effective in assisting the client to urinate? a. Assist the client to a standing position. b. Tell the client he has to void to be discharged. c. Run water in a nearby sink. d. Ask the spouse to assist with the urinal.

b. intermittent urethral catheter

A nurse drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance? a. indwelling urethral catheter b. intermittent urethral catheter c. Foley catheter d. retention catheter

a. Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration.

A nurse is caring for a client with a hemodialysis access site. Which action should the nurse take? a. Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration. b. Administer an IV on the arm high above the access site. c. Perform venipuncture below the access site to obtain a blood sample for laboratory testing. d. Measure the client's blood pressure on the arm above the access site.

c. Fasten the condom securely enough to prevent leakage without constricting blood flow.

A nurse is caring for a client with an external condom catheter. Which guideline should be implemented when applying and caring for this type of catheter? a. Remove the catheter every 8 hours, or more often in humid weather. b. Wipe the penis thoroughly with an alcohol swab and dry thoroughly before application. c. Fasten the condom securely enough to prevent leakage without constricting blood flow. d. Ensure the tip of the tubing is touching the tip of the client's penis.

c. Prepare for a rush of a large amount of urine.

A nurse is preparing to catheterize a female client with an overdistended bladder. Which action should the nurse take? a. Use a straight catheter. b. Insert one catheter to drain and another for continuous use. c. Prepare for a rush of a large amount of urine. d. Insert a larger catheter than indicated for long-term use.

b. Wearing gloves when handling the urine

A nurse is preparing to measure a client's urine output. Which interventions would be of highest priority? a. Using an appropriate measuring container b. Wearing gloves when handling the urine c. Measuring the urine container at eye level d. Noting the color and clarity of the urine

b. appearance c. pH e. casts

A nurse is reviewing the results of a client's routine urinalysis, which are as follows: - Straw color - Cloudy appearance - pH 3.5 - Urine specific gravity: 1.020 - Positive for casts Which result(s) alerts the nurse to a potential concern? Select all that apply a. color b. appearance c. pH d. specific gravity e. casts

d. Contract the pubic muscles for 3 seconds, then relax.

A nurse is the guest speaker at a women's club. Most of the women are older than 40 years of age and have asked the nurse to speak about health promotion topics. The nurse states that exercises may help with urinary urgency. Which exercise instruction will the nurse provide to the women? a. Contract abdominal muscles 10 times per day. b. Squat down and then jump up to a standing position. c. Lie on the floor, raise, then lower your legs 20 times per day. d. Contract the pubic muscles for 3 seconds, then relax.

d. "I will wipe from front to back after going to the toilet."

A school nurse is educating a class of middle school students on how to promote urinary system health. Which statement by one of the students indicates understanding? a. "I will drink more water to make sure germs do not stay in my body." b. "I will wear tight pants to prevent germs from entering." c. "I will tell my parents if I have any symptoms like burning or pain." d. "I will wipe from front to back after going to the toilet."

a. Withdraw several milliliters of urine from the port on the collection tubing, using aseptic technique.

A sterile urine specimen for culture and sensitivity has been prescribed for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen? a. Withdraw several milliliters of urine from the port on the collection tubing, using aseptic technique. b. Empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag. c. Discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen. d. Collect a urine specimen from the collection bag first thing in the morning, or a few hours after the client receives a diuretic.

b. Stress

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence? a. Urge b. Stress c. Overflow d. Functional

d. Notifying the health care provider of the assessment findings. The assessment is indicative of peritonitis or infection associated with the peritoneal dialysis catheter. The health care provider may request laboratory studies, but these cannot be obtained until a prescription is received. Flushing the catheter does not address the likely infection. Sitting the client up may aggravate the pain. The nurse should attempt to keep the client in the most comfortable position possible until a prescription is received from the health care provider.

The nurse assesses redness, drainage, and odor to the area around a client's peritoneal dialysis catheter. Palpation of the abdomen causes the client pain. Which intervention is the priority? a. Flushing the catheter with 15 - 20 mL of normal saline b. Obtaining laboratory studies. c. Sitting the client up in a greater than a 40-degree angle. d. Notifying the health care provider of the assessment findings.

d. The client is acutely confused and has been diagnosed with delirium.

The nurse caring for an older adult male client is determining whether the client can use a urinal to void. Which aspects of the client's medical history may contraindicate the use of a urinal? a. The client was treated for kidney stones a few months earlier. b. The client has a history of benign prostatic hyperplasia (BPH; prostate enlargement). c. The client has had urinary catheters in place repeatedly during previous admissions. d. The client is acutely confused and has been diagnosed with delirium.

a. Do not reapply the urinary sheath b. Allow the skin to be open to air as much as possible d. Arrange for a consult with a wound nurse

The nurse is assessing a client with a urinary sheath catheter. After removing the catheter, the nurse observes a break in skin integrity on the penis. What actions by the nurse would be appropriate at this time? Select all that apply. a. Do not reapply the urinary sheath b. Allow the skin to be open to air as much as possible c. Wash the area with soap and water and apply the catheter d. Arrange for a consult with a wound nurse e. Insert an indwelling catheter instead

a. Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. Leaving the catheter in place as a marker assists in the correct placement of the second catheter into the bladder. It is not necessary to contact the health care provider. The vagina is not sterile, so insertion of a sterile catheter poses little risk for infection. Asking the client to bear down is not necessary because the catheter is not typically completely inserted. Removing the catheter from the vagina and attempting to insert it into the bladder will cause cross-contamination.

The nurse is attempting to insert a urinary catheter into a female client's bladder and realizes the catheter has been inserted into the vagina. Which action is most appropriate? a. Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. b. Immediately remove the catheter from the vagina, contact the health care provider, and anticipate a prescription for prophylactic antibiotics. c. Ask the client to bear down until the catheter is expelled. d. Remove the catheter from the vagina and attempt to insert it into the bladder.

a. The birth can cause perineal swelling.

The nurse is caring for a client who has been experiencing difficulty voiding in the eight hours since her vaginal birth. What information should be provided to the client? a. The birth can cause perineal swelling. b. A neurogenic bladder results from local anesthesia c. A urinary tract infection can result from the birth process d. Catheterization is likely necessary for five to seven days

d. strongly aromatic, dark amber

The nurse is caring for a client who has been experiencing nausea, vomiting, and diarrhea for 3 days. Which urine characteristics does the nurse anticipate? a. cloudy, foul odor b. light yellow, clear c. clear, colorless d. strongly aromatic, dark amber

a. cloudy, foul odor

The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate? a. cloudy, foul odor b. light yellow, clear c. clear, dark amber d. strongly aromatic, amber

b. Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well.

The nurse is caring for a client with an indwelling urinary catheter secondary to neurogenic bladder. The nurse completes a prescription to obtain a urine specimen from the catheter. What is the most accurate narrative note the nurse would document to demonstrate the steps to obtain the urine specimen were performed appropriately? a. Cleansed access port with warm soap and water, syringe attached and aspirated 10 mL of urine and placed in specimen container. b. Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. c. Obtained urine specimen from urinary drainage bag using a syringe, client expressed no discomfort during or after the procedure, verified prescription and cleansed access port. d. Gathered supplies, checked prescription, collected urine from access port and notified health care provider at the completion of the procedure.

c. Total incontinence

The nurse is caring for a client with concerns of urinary incontinence. A review of the client's data collection reveals the client has a history of spinal surgery and states, "I urinate all the time and cannot predict when I will urinate." This data collection would suggest to the nurse that this client is experiencing which type of urinary incontinence? a. Stress incontinence b. Functional incontinence c. Total incontinence d. Overflow incontinence

d. Urinal

The nurse is choosing a collection device to collect urine from a non-ambulatory male client. What would be the nurse's best choice? a. Specimen hat b. Large urine collection bag c. Bedpan d. Urinal

c. Ensure proper positioning of the scanner head and rescan.

The nurse is performing a portable bladder ultrasound on a client who has palpable bladder distention. The scanner reveals little urine in the bladder. What should the nurse do next? a. Have the client drink 8 ounces of water every 15 minutes for 1 hour. b. Wipe off some of the ultrasound gel and rescan. c. Ensure proper positioning of the scanner head and rescan. d. Place the client on either side and rescan.

b. 1, 2, 5, 3, 4, 6 Press the appropriate gender button. Position the scanner head with directional arrow pointing to the head. Press scanner head onto the skin 1 to 1.5 inches (2.5 to 3.75 cm) above the symphysis pubis. Aim the scanner head toward the coccyx and activate the scan. Verify that screen crossbars fall within the bladder image. Observe and record the volume measurement on the screen.

The nurse is preparing to assess a client's postvoid residual using a bladder scanner. Place the following steps in the correct order. Use all options. 1. Press the appropriate gender button. 2. Position the scanner head with directional arrow pointing to the head. 3. Aim the scanner head toward the coccyx and activate the scan. 4. Verify that screen crossbars fall within the bladder image. 5. Press scanner head onto the skin 1 to 1.5 inches (2.5 to 3.75 cm) above the symphysis pubis. 6. Observe and record the volume measurement on the screen. a. 5, 1, 2, 6, 4, 3 b. 1, 2, 5, 3, 4, 6 c. 1, 2, 6, 5, 3, 4 d. 4, 2, 1, 6, 5, 3

a. The bladder normally is a sterile cavity.

The nurse is preparing to catheterize a client who is incontinent of urine following bladder surgery. What fact should the nurse keep in mind when performing catheterization? a. The bladder normally is a sterile cavity. b. The external opening to the urethra should always be sterilized. c. Pathogens introduced into the bladder remain in the bladder. d. A normal bladder is as susceptible to infection as an injured one.

b. Keep muscles contracted for at least 10 seconds.

The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises (Kegel exercises) will the nurse include? a. Loosen the internal muscles used to prevent or interrupt urination. b. Keep muscles contracted for at least 10 seconds. c. Relax muscles for at least 5 minutes between Kegels. d. Perform these exercises two times daily for a week.

a. Contact the health care provider to ask for an order for catheter discontinuation. c. Perform, or allow client to perform, perineal hygiene at least once daily.

Three days post-surgery for breast reconstruction, the nurse assesses that the client is ambulating several times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action? Select all that apply. a. Contact the health care provider to ask for an order for catheter discontinuation. b. Delegate catheter discontinuation to the Unlicensed Assistive Personnel (UAP). c. Perform, or allow client to perform, perineal hygiene at least once daily. d. Ensure that the drainage bag is above the level of the bladder at all times. e. Discontinue to catheter and report this to the healthcare provider.

a. True

Use of an indwelling urinary catheter leads to the loss of bladder tone. a. True b. False

a. It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.

What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence? a. It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. b. The client can apply it himself with minimal supervision. c. It can be left in place for a long period of time. d. A sterile urine specimen can be obtained from the drainage bag tubing.

d. blood A reddish-brown urine sample is indicative of the presence of blood. The urine appears dark amber in color due to dehydration. Infection and stasis would cause the urine to appear cloudy.

When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. What could cause this variation in color of the urine? a. dehydration b. infection c. stasis d. blood

a. 24-hour specimen A 24-hour urine specimen is required for accurate measurement of the kidney's excretion of substances that the kidney does not excrete at the same rate throughout the day. A clean-catch or midstream-voided specimen is used when a specimen relatively free from microorganisms is required. Random urine specimen collection is used when sterile urine is not required.

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine? a. 24-hour specimen b. clean-catch specimen c. random specimen d. intermittent specimen

b. Refrain from douching unless ordered by a health care provider. Douching is not recommended unless ordered by the health care provider. Female clients should be taught to wipe from the urinary area towards the rectum to decrease the risk for introducing pathogens into the urethra. Straining is not appropriate. Water should be consumed throughout the day, not just in the morning and evening.

Which urinary care teaching will the nurse provide to a young adult female client? a. Wipe from the back to the front. b. Refrain from douching unless ordered by a health care provider. c. If you do not feel like voiding, still strain to make sure the bladder is empty. d. Drink water more frequently in the morning and evening to facilitate hydration.

a. A bulge between the symphysis pubis and the umbilicus

client has not voided for 8 hours after surgery. Which finding indicates the client has a distended bladder? a. A bulge between the symphysis pubis and the umbilicus b. A bulge over the costovertebral region of the flank c. A bulge in the left lower quadrant of the abdomen d. A bulge between ribs 11 and 12 and the umbilicus