Chapter 29 Promoting Urinary Elimination

Alterations in Urinary Elimination Patterns

- Anuria - Dysuria - Incontinence - Nocturia - Oliguria - Polyuria

Function of the Urinary System (Bladder)

- Bladder stores urine and signals when it is full - Bladder empties when 250 to 400 mL of urine is present (under voluntary control) - Bladder can contain 1000 to 1800 mL of urine - Average urine output is 1000 to 1500 mL per day - Urethra carries urine from bladder sphincter to the meatus - Internal sphincter relaxes with micturition (urinating reflex) - The external sphincter is under voluntary control - At least 600 mL of urine must be excreted per day to remove waste products

Normal Urinary Elimination

- Infants void 5 to 40 times/day - Preschool children may void every 2 hours - Adults void 5 to 10 times per day - Males void 300 to 500 mL - Females void 250 mL The average output should be approximately 30 mL/hr

The Foley (retention catheter)

- Is the most common indwelling catheter; - It can remain in the bladder for an extended period. - Has two lumens, one to drain urine and one for inflation of the balloon holding the catheter in the bladder to prevent it from slipping out the urethra. - The balloon usually holds 5 to 10 mL of sterile water. - Is used for continuous drainage, particularly after surgery, and it also can be used for suprapubic (above the pubic bone) drainage.

Structure of the Urinary System

- Kidneys - Nephrons - Ureters - Urethra - Bladder

Factors Affecting Normal Urination

- Neurologic and muscle development - Alterations in spinal cord integrity - Fluid volume intake - Fluid loss in perspiration - Vomiting - Diarrhea - ADH secreted by the pituitary

Factors Interfering with Urinary Elimination

- Total loss of the kidney's ability to manufacture urine - Decreased kidney profusion - Blockage of the ureters - Disruption of the bladder by tumor or trauma - Infection - Neurologic damage to the nerves - Prostate surgery

Major types of urinary incontinence

-Stress - Urge - Overflow - Reflex - Functional - Transient

The urinary system is made up of which of the following structures? 1) Ureters, bladder, kidneys, urethra 2) Ureters, bladder, kidneys, prostate 3) Bladder, kidneys, urethra, urostomy 4) Urinometer, bladder, kidneys, urinary meatus

1) Ureters, bladder, kidneys, urethra

The patient had a resection of the prostate gland yesterday and has a three-way catheter for continuous irrigation. The draining urine is increasingly red. This means that the nurse needs to: 1. Notify the surgeon immediately. 2. Increase the rate of flow of the irrigation solution. 3. Increase his fluid intake to 4000 mL/24 hours. 4. Empty the drainage bag to prevent clotting.

1. Notify the surgeon immediately. Rationale: If the procedure was done yesterday, the fluid return should be progressively lighter in color. A dark red color indicates new bleeding; thus the primary care provider should be notified.

Brenda is making rounds on her post operative patient. She notices her patient's Foley has drained 90 mL in 3 hours. Which statement is correct? 1) This is a severe decrease in urine output. 2) This is an average amount of urine output. 3) This is a slightly above-average amount of urine output. 4) This is an excessive amount of urine for a postoperative patient.

2) This is an average amount of urine output.

Erin's patient will be going home with a catheter. All of the following are true regarding a Foley catheter except: 1) It is the most common type of indwelling catheter. 2) It has two lumens. 3) The balloon is inflated to 15 mL. 4) It may also be used for suprapubic drainage

3) The balloon is inflated to 15 mL.

The nurse is catheterizing a male patient. Resistance is met. The nurse should: 1. Apply more pressure with a twisting motion to insert the catheter. 2. Obtain a new sterile kit and try again with a sterile Coudé catheter. 3. Ask the patient to take a deep breath and slowly exhale as the catheter is inserted. 4. Discontinue the procedure and try again after the patient relaxes.

3. Ask the patient to take a deep breath and slowly exhale as the catheter is inserted. Rationale: Before taking the catheter out, the nurse should encourage the patient to relax and then gently try to move the catheter forward.

A nurse is caring for a patient who is incontinent. What is the priority action? 1. Help the patient void every 2 hours. 2. Decrease the fluid intake, especially in the evening. 3. Gather data to find the cause of incontinence. 4. Encourage expression of feelings of embarrassment.

3. Gather data to find the cause of incontinence. Rationale: First gather data about the cause of incontinence because this will guide the planning and the type of interventions.

The nurse must perform a bladder irrigation to instill medication. During the procedure, the tube will have to be clamped. What is the best rationale for clamping the tubing? 1. Follows the standard procedure 2. Ensures that sterility of the system is maintained 3. Prevents the solution from going directly into the bag 4. Prevents urine from being drawn back into the catheter

3. Prevents the solution from going directly into the bag Rationale: The tube must be clamped below the insertion port or the medication will flow directly downward into the drainage bag, rather than into the bladder.

Bruce's patient needs a condom catheter. This type of catheter is used when: 1) The patient cannot void. 2) A man or woman has bladder surgery. 3) A female is incontinent. 4) A male is incontinent.

4) A male is incontinent.

Erin's patient has been complaining of burning when she urinates. Her doctor ordered a urinalysis, which shows pyuria. These results indicate: 1) There is an increased amount of protein. 2) Liver disease or an obstruction of the bile duct. 3) There is blood in the urine. 4) There is pus in the urine.

4) There is pus in the urine.

Which statement by the patient indicates an understanding of how to perform the clean catch method for a urine specimen? 1. "I should clean my genital area first, pee into the cup, and then clean myself." 2. "I should fill the cup completely and save it in the refrigerator." 3. "I should keep the contents of the kit sterile at all times." 4. "I should clean myself first, pee a little into the toilet, and then pee into the cup."

4. "I should clean myself first, pee a little into the toilet, and then pee into the cup. Rationale: Cleaning the genital area, voiding into the toilet, and voiding into the cup is the correct sequence.

A 24-hour urine specimen is ordered for a patient. The nursing assistant discards some of the urine that should have been saved. Which is the most appropriate nursing action? 1. Verbally reprimand the nursing assistant. 2. Make a note to extend the urine collection period. 3. Continue the urine collection and label the specimen. 4. Notify the charge nurse and restart the test.

4. Notify the charge nurse and restart the test. Rationale: If some of the urine has been discarded, the test will have to be started over.

A male patient is admitted with urinary retention. There is an order to insert an indwelling urinary catheter. He attempts to void and passes 100 mL of urine. Before catheterization, the nurse should: 1. Use a condom catheter with a leg bag. 2. Wait 2 hours and have the patient try to void again. 3. Have the patient drink two to three glasses of water. 4. Perform a bladder scan to determine the amount of urine retained.

4. Perform a bladder scan to determine the amount of urine retained. Rationale: Performing a bladder scan to measure retained urine is the best action because the patient has been admitted for urinary retention.

The nurse has just collected a midstream urine specimen from a patient. Which urine characteristic would be of the greatest concern? 1. Urine smells slightly of ammonia. 2. Urine is dilute. 3. Urine is slightly cloudy. 4. Urine is dark brown.

4. Urine is dark brown. Rationale: Dark brown urine could be a sign of bleeding, which could be caused by trauma or disease. Dark brown urine could also be caused by release of myoglobin, which can cause kidney damage. The other findings are expected characteristics of a normal urine sample.

Condom Catheter

A condom catheter consists of a condom with a tube attached to the distal end that is attached to a drainage bag. It is used to provide continuous urine drainage for the male in a noninvasive manner. Read the directions that come with the specific catheter.

The average hourly urine output in mL for an adult is: A. 30 B. 60 C. 90 D. 120

A. 30

Urine remaining in the bladder after voiding is known as: A. Urinary retention. B. Pyuria. C. Urethral stricture. D. Hematuria.

A. Urinary retention.

The nurse can assist a patient who needs to void but cannot begin the urinary stream by: a. Running water in a nearby sink. b. Pouring cool water over the perineum. c. Inserting an indwelling catheter. d. Distracting the patient with conversation.

a. Running water in a nearby sink.

An adult male patient who cannot void has an order to have a urinary catheter inserted. Which size catheter would be most appropriate to use? a. 12 French b. 16 French c. 18 French d. 22 French

c. 18 French The average sized urinary catheter used for an adult male is 18 to 20 French.

The normal urine pH is: A. 2 to 4 B. 5 to 7 C. 7.35 to 7.45 D. 7.5 to 8.4

B. 5 to 7

Cloudy urine may indicate the presence of: A. Ketones. B. Bacteria. C. Ammonia. D. Vitamins.

B. Bacteria.

Where should the catheter drainage bag be kept in relation to the level of the bladder? A. Above B. Below. C. Even with. D. In front of.

B. Below.

A catheter that uses an inflated balloon to maintain placement in the bladder is referred to as which type of catheter? A. Straight. B. Retention. C. Irrigation. D. Condom.

B. Retention.

A pouch collecting urine from a stoma is known as a: A. Foley kit. B. Urostomy. C. Malecot. D. Catheter bag.

B. Urostomy.

Changes Occurring with Aging

Decrease in the number of functioning nephrons Decrease in filtration rate Decreased bladder tone—nocturia Decreased bladder emptying, increased residual Enlargement of prostate—urethral obstruction Incontinence is not a normal part of aging

Finding of excess sugar in the urine is also known as: A. Polyuria. B. Anuria. C. Glycosuria. D. Ketonuria.

C. Glycosuria.

When irrigating a urinary drainage system, which is the best practice to follow? A. Apply suction. B. Clamp tube after 30 minutes. C. Use aseptic technique. D. Perform the Credé maneuver.

C. Use aseptic technique.

Types of Urinary Catheters

Catheter types ➢ Robinson ➢ Foley ➢ Suprapubic ➢ Coudé ➢ Alcock ➢ de Pezzer ➢ Malecot ➢ Condom

Characteristics of Normal Urine

Color ➢ Straw-colored or amber Clarity ➢ Transparent or only slightly cloudy Odor ➢ Faintly like ammonia Specific gravity ➢ Normal range is 1.010 to 1.030 pH ➢ Slightly acid, ranging from 5.5 to 7.0

Cystitis

Cystitis ➢ Inflammation of the bladder ➢ May be caused by irritation of highly concentrated urine, pathogenic bacteria, injury, or instillation of an irritating substance ➢ Symptoms: frequency, urgency, dysuria, burning, malaise, foul-smelling urine, slight temperature elevation

Frequent urinary urgency and burning during urination are common symptoms of: A. Colitis. B. Ascites. C. Ileitis. D. Cystitis.

D. Cystitis.

Oliguria

Decreased urine output less than 400 mL in 24 hours

A nurse should notify the physician if: a. 24-hour urine output is 720 mL. b. 24-hour urine output is 1000 mL. c. 24-hour urine output is 800 mL. d. 24-hour urine output is 700 mL.

d. 24-hour urine output is 700 mL. Average hourly urine output is 30 mL, therefore 700 mL in a 24-hour period is abnormal because it averages to less than 30 mL/hour. The remaining options reflect urine output within normal range for a 24-hour period.

Polyuria

Excessive urination (>1500 mL in 24 hours)

Abnormalities Found in Urine

Glycosuria ➢ Glucose in the urine Proteinuria ➢ Protein in the urine Hematuria ➢ Blood in the urine Pyuria ➢ Pus in the urine Ketonuria ➢ Ketones in the urine

Incontinence

Involuntary release of urine

Urinary Elimination

Is a precise system of filtration, reabsorption, and excretion. These processes help fluid and electrolyte balance while filtering and excreting water-soluble wastes.

Function of the Urinary System (Kidneys)

Kidneys ➢ Filter blood through the nephrons ➢ Metabolic waste and excess water are extracted ➢ Regulate electrolytes by excreting excess amounts and help with acid-base balance by retaining hydrogen ions and bicarbonate ➢ Tubules secrete, excrete, or reabsorb electrolytes, water, and other substances Kidneys manufacture approximately 1.5 L of urine in 24 hours - Urine production related to various factors - Ureters carry urine from kidneys to the bladder

Kidneys and Nephrons

Kidneys ➢ Two bean-shaped organs 6 cm wide x 12 cm long ➢ Located at level of L1 on either side of the spine • Each kidney contains approximately 1 million nephrons Nephrons ➢ Inside each nephron is a glomerulus consisting of a cluster of capillaries surrounded by Bowman's capsule and a system of tubules ➢ Nephrons are the working units of the kidney

Anuria

Less than 100 mL of urine output in 24 hours

Incontinence

Loss of normal bladder control Body image disturbance, Increased risk for impaired skin integrity, Increased risk for infection May be temporary or permanent May be corrected by surgery May be helped by performing Kegel exercises

Urinary stress incontinence

Loss of small amounts of urine from increased abdominal pressure without bladder muscle contraction with laughing, sneezing, or lifting. Can occur in females due to weak pelvic floor muscles following childbirth or menopause, and in males due to alterations in the urethra following a prostatectomy

Urine Specimens

Normal voided specimen ➢ Send to the laboratory within 5 to 10 minutes. Urine standing for more than 15 minutes changes characteristics Urinalysis: Random non-sterile specimen Midstream (clean-catch) specimen for culture and sensitivity Specimen from an indwelling catheter Sterile catheterized specimen 24-hour specimen: Timed urine specimens, collect urine for 24 hrs, discard the first voiding, refrigerate. Strained specimen

Types of Incontinence: Overflow, Functional and Nocturnal Enuresis

Overflow incontinence: Poor contractility of the detrusor muscle of the bladder and obstruction of the urethra may be related to prostate enlargement in the male, pelvic surgery, constipation, medication, pregnancy or genital prolapse or abnormality in the female. Functional incontinence: Caused by cognitive inability to recognize the urge to urinate, extreme depression, or dementia. Inability to reach the bathroom because of protective devices, side rails, or physical impairment can also result in this type of incontinence. Nocturnal enuresis: Involuntary loss of urine at night, which can be due to an overactive bladder, medication, or sleep apnea.

Dysuria

Painful or difficult urination; may be from infection or trauma

Assessment

Patients should be assessed for: ➢ Usual pattern of elimination ➢ Incidences of incontinence, frequent urination ➢ Burning on urination ➢ Sense of urgency ➢ Times of day for elimination ➢ Total daily fluid intake

Type of Urinary Specimens

Specimen types ➢ Routine ➢ Midstream/Clean-catch ➢ Indwelling catheter ➢ Sterile ➢ 24-hour ➢ Straining

Ureters, Bladder and Urethra

Ureters ➢ Hollow tubes that carry urine from the kidneys to the bladder ➢ Each ureter is 25 to 30 cm long Bladder ➢ Hollow muscular organ located in lower pelvis that stores urine Urethra ➢ Carries urine from bladder to meatus; flow controlled by urinary sphincter ➢ Meatus—conducts urine to outside the body

Types of Incontinence: Urgency, Stress and Mixed

Urgency incontinence: Involuntary loss of urine in response to a strong sensation of need to empty the bladder (urinary urgency). Stress incontinence: Urethral sphincter failure that is often associated with increased intra-abdominal pressure, as occurs with sneezing, laughing, coughing, and aerobic exercise. Mixed incontinence: A combination of different types such as stress and urgency incontinence.

Nocturia

When a person has to get up more than twice in the night to void

A male patient who suffered a spinal cord injury is learning to perform self-urinary catheterization before being discharged to home. The statement made by the patient that indicates more instruction is needed is: a. "It is a sterile procedure." b. "The catheter should be pinched before it is withdrawn." c. "The penis is lifted to a 60- to 90-degree angle for catheter insertion." d. "The procedure is done sitting on the toilet."

a. "It is a sterile procedure."

A nurse is caring for a patient with prostate enlargement who has an indwelling catheter. As the nurse is attaching a portion of the catheter to the patient's abdomen, the patient asks why this is being done. The correct response is: a. "Taping the catheter to your abdomen will prevent pulling on the meatus." b. "The catheter can't be pulled out if it is taped to your abdomen." c. "Taping it in this way enhances the draining of your bladder." d. "This will prevent the Foley cat

a. "Taping the catheter to your abdomen will prevent pulling on the meatus."

A patient who underwent prostate surgery is admitted to the surgical unit with a catheter that is used to provide continuous irrigation. The nurse recognizes this catheter is a(n): a. Alcock. b. Malecot. c. Coudé catheter. d. De Pezzer catheter.

a. Alcock. An Alcock catheter is used for bladder irrigation following prostate surgery.

A nurse is teaching a client about diagnostic urinary testing. Which of the following should the nurse include in the teaching about cystometric testing? a. Cystometric testing measures bladder capacity, pressure, and final capacity when the urge to urinate begins b. Cystometric testing measures urine speed and volume c. Cystometric testing measures bladder pressure when urinary leakage occurs d. Cystometric testing measures electrical activity of the muscles and nerves of the bladder and sphincters

a. Cystometric testing measures bladder capacity, pressure, and final capacity when the urge to urinate begins Cystometric testing involves measuring bladder capacity, the pressure of the bladder during filling, and the final capacity when the urge to urinate begins.

A nurse is preparing to collect a urine sample for urinalysis using a reagent strip. The nurse should identify that the reagent strip can detect substances that are consistent with which of the following conditions? a. Diabetes b. Colon cancer c. Pancreatitis d. Pregnancy

a. Diabetes Urine concentration, protein, glucose, ketones, bilirubin, leukocytes, nitrites, and blood can also be tested with a urinalysis.

A nurse is providing information to a client about what may happen if their urinary tract infection (UTI) is not treated. Which of the following statements by the client indicates an understanding of the information? a. I can develop a kidney infection called pyelonephritis b. I might have urinary retention c. I might become incontinent d. I can develop functional incontinence

a. I can develop a kidney infection called pyelonephritis

A nurse is caring for a female client who has a prescription for a clean catch urine specimen. Which of the following statements by the client demonstrates an understanding of how to provide a urine specimen? a. I need to wipe from front to back with a sanitary wipe b. I should place the urine sample cup in the refrigerator c. I will begin the urination process in the specimen cup d. I will urinate in the urine tray for the nurse to collect

a. I need to wipe from front to back with a sanitary wipe Female clients should be instructed to use sanitary wipes to clean the genital area from front to back.

Nurses in a long-term care facility are developing a prevention program to eliminate catheter acquired infections (CAUTI). The rationale for this program includes which of the following? a. Medicaid will no longer reimburse for this complication. b. CAUTIs are considered an indicator of adequate care. c. CAUTIs result in 45% of hospital-acquired infections every year. d. Nursing interventions have been proven to have little or no effect on the number of urinary infections.

a. Medicaid will no longer reimburse for this complication.

A female patient has had a knee replacement and is experiencing difficulty voiding. What should the nurse recommend? a. Pour warm water over the perineum while patient attempts to void. b. Catheterize the patient to avoid problems. c. Use Crede's maneuver per nursing order. d. Use a sitz bath per nursing order.

a. Pour warm water over the perineum while patient attempts to void. Warm water may help patients to initiate the voiding reflex. Catheterization is used after other techniques have been unsuccessful. A physician order is needed for use of Crede's maneuver and/or a sitz bath.

A nurse is collecting a voided specimen for urinalysis. The nurse should a. Tell the patient that only about 1.5 inches of urine is needed. b. Tell the patient to use sterile technique. c. Tell the patient it is necessary to fill the container. d. Send the urine to the laboratory within 20 minutes.

a. Tell the patient that only about 1.5 inches of urine is needed. When collecting a voided specimen for urinalysis, it is not necessary to fill the container with urine; only about 1.5 inches of urine is needed. Send the urine within 5 to 10 minutes. Sterile technique is not needed.

A nurse is caring for a group of clients who are at risk for an alteration in urinary elimination. Which of the following groups should the nurse identify as being at an increased risk? (select all that apply) a. Uncircumcised infants b. School-aged children c. Middle adults d. Older adults e. Young adults

a. Uncircumcised infants b. School-aged children d. Older adults

A nurse irrigating a patient's indwelling urinary catheter should instill normal saline as ordered, and then: a. Unclamp the tubing and lower the collection bag. b. Massage the patient's bladder. c. Ask the patient to take a deep breath and hold it. d. Keep the tubing clamped for 30 to 45 minutes.

a. Unclamp the tubing and lower the collection bag.

A nurse is cleansing the perineal area of a female patient who is having a urinary catheter inserted. The nurse should use the last povidone iodine-soaked cotton ball to cleanse downward over the: a. Urinary meatus. b. Left labia. c. Right labia. d. Perirectal area.

a. Urinary meatus.

A nurse is planning care for a client who has an order for urinalysis. Which of the following tests should the nurse anticipate being ordered if the presence of white blood cells is detected on the urinalysis? a. Urine culture b. Bladder scan c. 24-hour urine d. Stool culture

a. Urine culture

What are the functions of the urinary structures for elimination? (Select all that apply.) a. Waste products are diluted with water and excreted as urine. b. The urethra carries urine from the kidneys to the bladder. c. A bladder can hold 2500 mL of urine. d. Urine output is related to the amount of fluid intake.

a. Waste products are diluted with water and excreted as urine. d. Urine output is related to the amount of fluid intake. Urine output is related to fluid intake and can vary considerably. Waste products are excreted as urine. Ureters carry urine from the kidneys to the bladder. A bladder can hold 1000 to 1800 mL of urine.

The nurse is admitting a patient with suspected urolithiasis. An appropriate nursing intervention in the care of such a patient would be to: a. Place a sieve over the commode. b. Obtain an order for indwelling urinary catheter. c. Place a graduated cylinder near the commode. d. Attach a urinary leg bag.

a. place a sieve over the commode. When a patient is suspected of having urolithiasis (a urinary stone), the urine is strained through a fine sieve.

The nurse caring for a severely dehydrated patient who has a Foley catheter in place assesses the patient to confirm adequate urine perfusion by the urine output of: a. 15 mL. b. 30 mL. c. 45 mL. d. 60 mL.

b. 30 mL.

When attempting to catheterize a male patient, there is resistance to catheter insertion. The nurse's initial intervention should be to: a. Withdraw the catheter and start over. b. Ask the patient to take a deep breath. c. Ask the patient to bear down and hold his breath. d. Ask that the patient lie on the right side.

b. Ask the patient to take a deep breath.

A nurse is caring for a client who reports occasionally having dark, tea-colored urine at home. The nurse identifies that which of the following activities can contribute to this finding? a. Attending yoga class b. Consuming alcohol c. Drinking 2,000 mL of fluid a day d. Consuming fish for dinner

b. Consuming alcohol Dark urine is a sign of urine concentration and can be a sign of dehydration. Certain beverages, however, can increase urine production. Alcohol and caffeinated beverages such as cola, coffee, and tea all increase urine production and can be dehydrating if not balanced with water consumption.

Catheterization is an appropriate intervention in which situation? a. Hematuria noted on urinalysis b. Dilation of urethral stricture c. Urinary tract infection (UTI) d. Bladder scan reveals 150 mL of residual urine

b. Dilation of urethral stricture Catheterization is an appropriate intervention for dilation of a urethral stricture. Catheterization is not an appropriate intervention for hematuria, for UTI, or for 150 mL of residual urine in the bladder.

A nurse is reinforcing teaching with a client about foods that can irritate the bladder. Which of the following foods should the nurse identify as being irritant? a. Milk b. Oranges c. Nuts d. Bananas

b. Oranges

A nurse is assessing a client who has an indwelling urinary catheter and determines that the catheter is in place and functioning properly. The nurse should expect which of the following findings? a. Dark yellow, cloudy urine b. Pale yellow, clear urine c. Urine with a strong odor d. Urine with a slight red tint

b. Pale yellow, clear urine

Which age-related change in the urinary system should a nurse expect? a. Increased red blood cells (RBCs) in the urine b. Reduced rate of renal filtration c. Episodes of incontinence d. Increased bladder tone

b. Reduced rate of renal filtration Reduced rate of renal filtration occurs with aging and may lead to a decrease in renal function. The bladder tone decreases with aging. Incontinence is not a normal part of aging. Increased RBCs is not an age-related change.

A nurse instructing a female patient on obtaining a clean catch urine specimen should stress: a. To spread the labia apart and clean the center area first. b. To catch the middle portion of urine after voiding a small amount into the toilet. c. To carefully collect the urine in the container as soon as the urine stream starts. d. To fill the urine cup to the brim to ensure an adequate sample.

b. To catch the middle portion of urine after voiding a small amount into the toilet.

A nurse is assessing a client who has stress incontinence. Which of the following findings should the nurse expect with this client? a. Urine leakage prior to reaching the toilet b. Urine leakage following coughing c. Urine leakage as a result of nerve damage d. Urine leakage due to not reaching the toilet in time from a physical impairment

b. Urine leakage following coughing Stress incontinence is a leakage of urine when the client engages in coughing, sneezing, laughing, or physical activity due to increased pressure on the bladder.

An adult patient has an order to have his urinary catheter irrigated with normal saline. The nurse plans to draw up how much solution into the sterile irrigation syringe? a. 1 to 20 mL b. 20 to 30 mL c. 30 to 40 mL d. 50 to 60 mL

c. 30 to 40 mL The appropriate amount of solution to draw into the syringe for irrigation is 30 to 40 mL in an adult patient, which provides effective irrigation without risking over distention of the bladder.

To prevent changes in the chemical characteristics of urine, a nurse sends a sample of fresh urine to the laboratory for urinalysis within at least: a. 1 to 2 minutes. b. 3 to 5 minutes. c. 5 to 10 minutes. d. 20 to 30 minutes.

c. 5 to 10 minutes.

A nurse is documenting the removal of a urinary drainage catheter from an assigned patient. If the catheter is removed at 9:00 AM, the nurse recognizes that the patient is due to void by: a. 11:00 AM. b. 12 noon. c. 5:00 PM. d. 9:00 PM.

c. 5:00 PM. Documentation of removal of a urinary catheter should include the time the patient is due to void, which is within 8 hours.

A nurse is teaching a newly licensed nurse about urinary retention. Which go the following clients should the nurse include as having an increased risk for this condition? a. A client who has an enlarges uterus b. A client who experiences frequent urinary tract infections c. A client who has an enlarged prostate d. a client who has chronic hypertension

c. A client who has an enlarged prostate A client who has an enlarged prostate is more likely to experience urinary retention.

A nurse would modify the urine collection technique when a urine sample is needed from an infant by: a. Placing the infant on a bedpan after removing the diaper. b. Removing the diaper after the infant voids and send the diaper to the laboratory. c. Attaching a bag with adhesive backing to the skin surrounding the genitals. d. Applying a very small condom catheter.

c. Attaching a bag with adhesive backing to the skin surrounding the genitals.

The nurse is aware that in the older adult, a urinary infection may cause the patient to: a. Run an exceptionally high temperature. b. Have foul urine and diarrhea. c. Become disoriented and confused. d. Become irritable.

c. Become disoriented and confused.

A nurse is caring for a client with suspected dehydration. For which of the following findings should the nurse monitor this client? a. Oral temperature of 36.4 degrees C (97.5 degrees F) b. Light yellow urine c. Dry mucous membranes d. Diaphoresis

c. Dry mucous membranes Dehydration is a decrease in fluid volume leading to a negative fluid balance. Dry mucous membranes or a dry mouth are manifestations of dehydration.

Which bacterium is most often responsible for cystitis? a. Pseudomonas. b. Enterococcus c. Escherichia coli d. Proteus

c. Escherichia coli Escherichia coli is often the bacterium responsible for cystitis, especially in females. Proteus, Pseudomonas, and Enterococcus may cause cystitis but are not considered the most common causes.

A patient has been ordered to have a 24-hour urine collection as part of a diagnostic workup. The action taken to perform this procedure correctly is to: a. Continue the collection if the patient accidentally voids directly into the toilet. b. Obtain a container and put it in a warm water bath in the bathroom. c. Have the patient void at the beginning of the collection and throw it away. d. Have the patient void for the last time a few hours before the collection ends.

c. Have the patient void at the beginning of the collection and throw it away. The patient's bladder should be empty when the test begins; for this reason, the urine obtained at the start time is discarded and the urine collected should be stored on ice during the 24-hour period.

A nurse is observing a nursing assistant offering a bedpan to a patient. The nurse will intervene if the nursing assistant: a. Closes the bedside curtain. b. Dons clean gloves. c. Keeps the head of the bed flat after placing the bedpan. d. Asks the patient to bend his knees and press down with his feet.

c. Keeps the head of the bed flat after placing the bedpan.

A patient is being assessed for a possible urinary tract infection in the outpatient clinic. Before sending a urinalysis specimen to the laboratory, the nurse collects a small amount of urine in order to perform a dipstick test in order to detect: a. Protein. b. Glucose. c. Leukocytes. d. Ketones.

c. Leucocytes A dipstick test is performed to test for different components and, in this case, for white blood cells or leukocytes, which indicate an infection. The accurate timing of the reading is essential to the accuracy of the result.

When intermittently catheterizing an elderly female patient, the nurse may a. Pre-medicate elderly patients for relaxation purposes. b. Approach the meatus only from the front. c. Position the patient on her side. d. Position the patient prone.

c. Position the patient on her side. In the elderly female, the urinary meatus is sometimes found just inside the opening of the vagina. If the patient has difficulty with the dorsal recumbent position, place her on her side with the knees flexed and upper leg supported by pillows, then approach the meatus from the rear. Prone position is not appropriate for catheterization. Pre-medication is not an appropriate intervention unless there is significant discomfort with the procedure.

A nurse is caring for a client who is receiving antibiotic treatment for a urinary tract infection and is experiencing diarrhea. Which of the following should the nurse identify as a potential cause of the diarrhea? a. The antibiotic dose is not correct, and the provider should be alerted b. The antibiotic interferes with the client's ability to absorb nutrients c. The antibiotic eliminates the healthy gastrointestinal bacteria, allowing harmful bacteria to grow d. The antibiotic decreases a client's immunity level, resulting in diarrhea

c. The antibiotic eliminates the healthy gastrointestinal bacteria, allowing harmful bacteria to grow

A nurse is caring for a client who has a stone in the right ureter that is obstructing the flow of urine. Which of the following urinary diversions should the nurse anticipate the client will need? a. Urostomy b. Continent cutaneous reservoir c. Ureteral stent d. Neobladder

c. Ureteral stent Ureteral stent placement allows the passage of urine when a ureter is blocked from either a stone, mass, scar tissue, inflammation, or infection.

A patient has just had a urinary drainage catheter removed. The nurse plans to measure intake and output for this patient for another: a. 1 to 2 hours. b. 4 to 6 hours. c. 6 to 8 hours. d. 12 to 24 hours.

d. 12 to 24 hours.

A patient with a history of cystitis had surgery 24 hours ago and is now unable to void. A bladder scan indicates that he has approximately 400 mL of retained urine. The nurse anticipates that the least invasive intervention the primary care provider will order would be: a. Inserting an indwelling Foley catheter. b. Monitoring intake and output. c. Obtaining a midstream specimen. d. Applying Credé maneuver to the bladder.

d. Applying Credé maneuver to the bladder.

A nurse is educating a group of elderly patients in an assisted-living facility about urinary incontinence. Information offered during the encounter may include a. Indwelling Foley catheters are recommended for management of all types of incontinence. b. Avoidance of Kegel exercises. c. Wear adult diapers day and night to prevent leakage. d. Condom catheters may be used by males.

d. Condom catheters may be used by males. Condom catheters are appropriate for males if used correctly. Kegel exercises are recommended and may greatly reduce or stop incontinence. Adult diapers are not to be worn 24 hours a day as a result of an increased risk of skin breakdown. Indwelling Foley catheters are not appropriate for all types of incontinence, and the risks associated with trauma and infection may outweigh the benefits

A nurse is educating a client who has paraplegia about urinary catheter use. Which of the following catheter types should the nurse include in the teaching to help facilitate urinary elimination for this client? a. Suprapubic catheter b. Indwelling catheter c. Condom catheter d. Intermittent catheter

d. Intermittent catheter Clients who have paraplegia will often utilize intermittent catheters in conjunction with bladder training to avoid urinary accidents due to the lack of bladder sensation from paralysis.

An older adult male patient needs to have a condom catheter applied. An appropriate technique is to: a. Shave the perineal area before beginning. b. Apply povidone iodine to the penis before catheter application. c. Apply an adhesive strip in a circle around the base of the penis. d. Leave 1 to 2 inches between the tip of the penis and the drainage part of the catheter.

d. Leave 1 to 2 inches between the tip of the penis and the drainage part of the catheter.

A nurse is caring for an older adult client who is experiencing urinary leakage. Which of the following is an expected age-related change that can contribute to this occurrence? a. Reduce blood supply b. Loss of kidney tissue c. Loss of nephrons d. Loss of bladder tone

d. Loss of bladder tone With advancing age, there is a loss of bladder tone, which can lead to issues such as urinary leakage, incontinence, or retention.

When the patient who has an order to be out of bed complains of feeling too weak to walk to the bathroom, the nurse assists the patient with urination elimination by: a. Acquiring a walker so that the patient can go to the bathroom. b. Using a fracture bedpan and keep the patient flat. c. Obtaining a raised toilet seat. d. Placing a commode at the bedside.

d. Placing a commode at the bedside.

A nurse is evaluating a client's bladder training program. Which of the following statements by the client indicates the bladder training was successful? a. The client has accidents daily b. The client voids a small amount when visit the bathroom c. The client continues to visit the bathroom every hour d. The client experiences less than one urinary accident per week

d. The client experiences less than one urinary accident per week

A nurse is providing postoperative instructions for a client who had a kidney stone removal and placement of nephrostomy tube. Which of the following statements by the client indicates an understanding of the instructions? a. This tube will keep my ureters open in case of another stone b. This tube will remain permanently because I can't empty my bladder c. This tube goes directly into my bladder d. The tube is only temporary

d. The tube is only temporary This type of diversion is usually temporary and is removed once the kidney has healed.

A nurse is reviewing the primary function of the urinary tract with a group of newly licensed nurses. Which of the following information should the nurse include? a. The urinary tract regulates the production of red blood cells b. The urinary tract produces hormones for blood pressure regulation c. The urinary tract keeps the bones strong d. The urinary tract eliminates waste and excess fluid from the body

d. The urinary tract eliminates waste and excess fluid from the body

A nurse is reinforcing instructions about Kegel exercises with a female patient. An appropriate instruction is to: a. Do the exercises 12 times each day. b. Hold each muscle contraction for a count of 3 seconds. c. Tighten the abdominal muscles. d. Tighten the pelvic muscles.

d. Tighten the pelvic muscles.

To help reduce a patient's risk of recurrent cystitis, the nurse teaches the patient to: a. Eat citrus fruits to alkalinize the urine. b. Always wipe the perineal area from back to front. c. Take long, warm bubble baths. d. Wear cotton underwear and avoid nylon or constrictive clothing.

d. Wear cotton underwear and avoid nylon or constrictive clothing.