Chapter 40, Bowel Elimination/Chapter 41, Urinary Elimination

A nurse is preparing an enema. Which enema helps to treat local infections? 1. Isotonic enema 2. Medication enema 3. Carminative enema 4. Oil-retention enema

2. Medication enema Medication enemas may contain antibiotics that help to treat local infections. Isotonic enemas expand the colon to promote peristalsis. Carminative enemas stimulate peristalsis and provide relief from gastric distention. Oil-retention enemas lubricate the rectum and colon to make the feces softer and easier to pass.

6. The nurse is inserting an indwelling catheter into a male patient. While initially passing the catheter through the urethra, resistance is met. What action should the nurse take next? a. Notify the primary care provider to place a coudé catheter. b. Straighten the penis and attempt to progress the catheter again. c. Remove the catheter and insert one with a smaller lumen. d. Inflate the balloon and wait for urine passage.

ANS: A Coudé catheters are a special type of double-lumen, indwelling catheters that are slightly stiff and bent at the end, allowing the catheter to pass more easily through a partially constricted urethra. They are used mostly in men experiencing prostate enlargement or BPH. Coudé catheters may need to be placed using a metal wire introducer. Placement using an introducer typically is performed by a physician or the patient's urologist, to avoid damaging urethral tissue.

4. Nursing interventions for the patient who suffers from stress incontinence include a. kegel exercises. b. surgical interventions. c. bowel retraining. d. intermittent catheterization.

ANS: A Kegel exercises also are known as pelvic floor exercises. They improve muscle tone in the pelvic floor, which helps to prevent stress incontinence.

7. The nursing instructor is teaching information about constipation in the elderly. Which statement from the student indicates a need for further instruction on this topic? a. Patients receiving tube feedings often experience constipation. b. Poor fluid intake and inability to eat a high-fiber diet often cause constipation. c. Patients with impaired mobility may experience constipation. d. Medications commonly taken by elders often contribute to constipation.

ANS: A Patients on tube feedings often experience diarrhea, not constipation.

2. A patient with a history of diarrhea is seen in the clinic. Which nursing intervention is most essential to include in this patient's plan of care? a. Weighing the patient daily b. Encouraging a diet high in fiber c. Decreasing the patient's fluid intake d. Instructing the patient to increase protein in the diet

ANS: A The patient with diarrhea is susceptible to dehydration. Checking the patient's weight daily will monitor fluid status.

Which organism is responsible for the majority of urinary tract infections in female patients? a Escherichia coli b. Nesseria gonorrhea c. Candida albicans d. Haemophilus influenza

ANS: A Urinary tract infections (UTIs) are the result of bacteria in the urine. Infection occurs when bacteria from the digestive tract, usually Escherichia coli, invade the urethra and multiply.

1. Prior to discharge, the nurse teaches the patient the proper techniques for applying an ostomy pouch. When evaluating the teaching, the nurse observes the patient apply a new ostomy pouch without cleansing the skin underneath. What action(s) should the nurse implement following this patient's return demonstration? (Select all that apply.) a. Repeat the demonstration to show the patient how to clean the ostomy site. b. Document that the patient performed the initial return demonstration accurately and safely. c. Offer positive reinforcement regarding the need to cleanse the site to prevent skin breakdown below the appliance. d. Discharge the patient with written instructions and illustrations that demonstrate the correct procedure. e. Notify the health care provider that a repeat demonstration of the ostomy appliance procedure is needed.

ANS: A, C, D The initial return demonstration was not performed accurately, and since it is the nurse's responsibility to complete the needed teaching, the health care provider does not need to be notified. Discomfort and damage to the skin can result from not washing the site; therefore, the nurse should repeat the demonstration, emphasizing the importance of cleansing. Positive reinforcement and the provision of written instructions are valuable teaching strategies.

5. Average urine pH is a. 4 b. 6 c. 7 d. 9

ANS: B Urine normally is slightly acidic, with an average pH of 6. Urine with a pH of 4 is very acidic. A pH of 7 is neutral, and a pH of 9 is very alkaline.

1. To best determine the patient's competency in changing an ostomy appliance, what should the nurse ask the patient to do? a. Verbalize the procedure. b. Identify the supplies needed. c. Perform the procedure. d. List the steps in the procedure.

ANS: C Repeat performance is the best way to ensure competency.

4. Which discharge instruction should the nurse provide to the patient following a colonoscopy? a. Some discomfort and bleeding is normal postprocedure. b. Return to the emergency room if you experience mild abdominal cramping. c. Do not drive or operate heavy machinery for 12 hours postprocedure. d. Return to your normal bowel pattern immediately postprocedure.

ANS: C Since sedation is given for the procedure, the patient should not drive or operate heavy machinery.

6. What should be included in teaching for a patient who will be discharged with a prescription for a laxative? a. Calling the health care provider if nausea, vomiting, or abdominal pain occurs b. Continuing use of laxatives to encourage bowel evacuation c. Adding regular exercise, sufficient fluids, and regular defecation habits to his or her routine d. Knowing the difference between laxatives and cathartics

ANS: C The patient who is discharged on laxatives should still be instructed on the nonpharmacological methods to decrease constipation and promote normal bowel patterns. Laxatives are contraindicated in patients with nausea, vomiting, or undiagnosed abdominal pain. Ongoing use of laxatives is associated with harmful side effects, such as an increase in constipation and impaction, predisposition to colorectal cancer, dependency, and electrolyte imbalance and should not be encouraged. Knowing the difference between laxatives and cathartics will not help the patient in this case.

3. The patient is ordered an ultrasound to determine the size, shape, and location of the kidneys. The nurse knows that prior to the test the patient will a. be required to have a bowel cleansing enema. b. be checked for any allergies to shellfish. c. be required to drink a large amount of fluids before the test. d. have no pretest requirements.

ANS: D An ultrasound scan may be performed to assess the size, shape, and location of the kidneys. Ultrasound studies may be safely conducted in patients who have allergies to contrast media, because no radiation or contrast dyes are used. No patient preparation such as fasting or sedation is required.

2. A patient is experiencing acute renal failure. What is the most common cause of this critical illness? a. Hypovolemia b. Cardiogenic shock c. Nephrotoxic substances d. Urethral obstruction

ANS: D Inadequate flow or complete obstruction by anything (such as stones or tumors) that blocks both ureters and the bladder, or obstructs the urethra, can lead to an anuric state, resulting in acute or chronic renal failure.

5. Select the most appropriate goal for a patient experiencing diarrhea related to antibiotic use: a. The patient will return to previous elimination pattern. b. The patient will increase intake of grains, rice, and cereals. c. The patient will discontinue antibiotic use and contact the health care provider. d. The patient will increase fluid intake.

ANS: D The patient will increase fluid intake since diarrhea can lead to dehydration.

3. A patient is scheduled for an upper GI series. Which information is most important to obtain from him before the procedure? a. Allergy to lasix b. Last bowel movement c. Time the enema was administered d. Any difficulty swallowing

ANS: D The patient will need to drink barium for this x-ray; therefore, swallowing ability should be assessed prior to the start of the procedure

A patient with an indwelling catheter reports a need to void. What is the priority intervention for the nurse to perform? a. Check to see if the catheter is patent. b. Reassure the patient that it is not possible to void while catheterized. c. Catheterize the patient again with a larger-gauge catheter. d. Notify the primary care provider (PCP).

Answer: a Checking the position and patency of the catheter first will determine whether the problem is mechanical or physiologic in nature. At times, the end of the catheter may become lodged up against the side of the bladder preventing the flow of urine into the tubing. Telling the patient that is impossible to void while catheterized is erroneous. Catheterizing the patient with a larger-gauge catheter is unnecessary at this point, as is contacting the PCP.

The teaching plan for a patient with diarrhea should include which intervention? a. Drinking at least eight glasses of fluid each day b. Eating foods low in sodium and potassium c. Limiting the amount of soluble fiber in the diet d. Eliminating whole-wheat and whole-grain breads and cereal

Answer: a Diarrhea is associated with high risk for dehydration, so the patient should increase the fluid intake. The patient may need increased sodium and potassium intake owing to loss of these electrolytes in the frequent stools. Fiber will add bulk and help to form the stools so should be increased. Whole-grain products contain fiber.

A patient is being discharged from the hospital with a new ileostomy. The patient expresses concern about caring for the ostomy. Before hospital discharge, it is most important for the nurse to coordinate with which member of the health care team? a. Home care nurse b. Wound ostomy continence nurse c. Registered dietitian d. Primary care provider

Answer: b The wound ostomy continence nurse (WOCN) is the most important person to contact to schedule teaching sessions and follow-up care. This nurse specialist is certified in the treatment of patients who have a bowel or bladder diversion. Although team input is important, the contribution of the WOCN is paramount to help the patient achieve competence and comfort with self-care before discharge.

The nurse is placing an indwelling catheter in a female patient. She inserts the catheter into the vagina. What is the next action for the nurse to implement? a. Collect a urine specimen and notify the PCP. b. Leave the catheter in place and insert a new catheter into the urethra. c. Remove the catheter from the vagina and place it into the urethra. d. Ask another nurse to attempt the catheterization of the patient.

Answer: b By leaving the first catheter in place in the vagina, the nurse can more accurately identify the urethra for insertion of the new catheter. This prevents misplacing the new catheter into the vagina during the second catheterization attempt. The catheter that was placed in the vagina is no longer sterile, so it should not be reused and should be discarded after the new catheter is properly placed. It is impossible to get a urine sample from the catheter placed in the vagina. Only after experiencing difficulty with proper placement of the new catheter may the nurse wish to ask for assistance from another nurse.

A patient is scheduled for an intravenous pyelogram (IVP). Which piece of data would be most important to know before the procedure is carried out? a. Urinalysis showing negative results on testing for sugar and acetone b. History of allergies c. History of a recent thyroid scan d. Frequency of urination

Answer: b Contraindications tor IVP include an allergy to iodine, which is similar in nature to the contrast material injected during the intravenous pyelogram. Knowing this information would be critical to providing safe patient care. Frequency of urination may be an indication to perform an IVP; however, this is not critical to know before performing an IVP. The results of a urinalysis and history of a recent thyroid scan would not affect a scheduled IVP.

A 40-year-old patient complains of 4 days of frequent loose stools with abdominal cramping. What is the priority nursing diagnosis for this patient? a. Altered Skin Integrity b. Risk for Imbalanced Fluid Volume c. Acute Pain d. Self-Care Deficit: Toileting

Answer: b Diarrhea can cause dehydration with loss of fluids and electrolytes. There is no statement of problems with the skin, although this patient may be at risk for skin breakdown if the diarrhea continues. In addition, no self-care deficit is stated for this patient. Although the patient has experienced cramping and the pain needs to be addressed, the main consideration would be correction of any fluid and electrolyte problems, followed by determination of the cause of the diarrhea.

The nurse is assessing a patient with an indwelling catheter and finds that the catheter is not draining and the patient's bladder is distended. What action should the nurse take next? a. Notify the primary care provider (PCP). b. Assess the tubing for kinks and ensure downward flow. c. Change the catheter as soon as possible. d. Aspirate the stagnant urine in the catheter for culture.

Answer: b The next action by the nurse should be to check the patency of the catheter tubing. At this point there is no need to aspirate any urine or call the PCP. The catheter should not be changed unless absolutely necessary, owing to the possibility of causing an infection.

Which nursing instruction is correct when a urine specimen is collected for culture and sensitivity testing from a patient without a urinary catheter? a. Tell the patient to void and pour the urine into a labeled specimen container. b. Ask the patient to void first into the toilet, stop midstream, and finish voiding into the sterile specimen container. c. Instruct the patient to discard the first void and collect the next void for the specimen. d. Have the patient keep all voided urine for 24 hours in a chilled, opaque collection container.

Answer: b Urine specimens for culture and sensitivity testing must be collected in sterile containers using the clean-catch, midstream method whenever possible. All voided urine specimens should be collected directly into the specimen container, not transferred from another potentially contaminated vessel. Discarding the entire first void and saving urine in a chilled, opaque container are both procedures for conducting a 24-hour urine collection.

Which nursing intervention is included for a patient experiencing diarrhea? a. Limiting fluid intake to 1000 mL/day b. Administering a cathartic suppository c. Increasing fiber in the diet d. Limiting exercise

Answer: c Fiber is encouraged in patients with diarrhea to add bulk to the stools. Fluid intake and exercise should be encouraged. Cathartics would not be used because they are strong laxatives used to soften the stool and evacuate the bowels.

A patient is scheduled for a colonoscopy. After preprocedure teaching by the nurse, the patient demonstrates understanding when he makes which statement? a. "I can have coffee the morning of the procedure." b. "I should drink a red sports drink the day before to stay hydrated." c. "I should drink clear liquids for 2 days before the procedure." d. "I will be able to drive home immediately after the procedure."

Answer: c The patient will be on a clear liquid diet for 1 to 3 days before the procedure. The patient should not eat or drink anything immediately before the procedure. Drinks with red or purple dye are contraindicated because they could interfere with the exam findings. Patients are given medications during the procedure that alter the sensorium and therefore need to have someone else drive them home.

The nurse is assigned the care of a patient for whom a cleansing enema has been ordered. What information is most important for the nurse to know before administration of the enema? a. The proper way to position the patient b. Signs and symptoms of intolerance to the procedure c. Vital signs before the procedure d. History of surgery of the anus or rectum

Answer: d The most important item in preadministration assessment data is a history of surgery to the anus or rectum, which may contraindicate enema administration. The nurse needs to know the proper patient position for an enema and must observe for signs of intolerance to the procedure, but these are done during the procedure. Vital signs are not routinely obtained before an enema.

While performing an abdominal assessment on an unconscious patient, the nurse notes presence of an ostomy. The fecal output is liquid in consistency, with a pungent odor, and the stoma is located in the upper right quadrant of the abdomen. What type of ostomy does the patient have? a. Descending colostomy b. Ureterostomy c. Ileostomy d. Ascending colostomy

Answer: d An ascending colostomy meets the description of fecal output of liquid consistency and with a pungent odor, as well as location of the stoma in the upper right quadrant of the abdomen. Descending colostomies produce increasingly formed stool. An ileostomy will produce liquid stool but with less odor because enzyme activity is not present. Ureterostomies drain urine, not stool.

The nurse knows that the teaching for a patient who was recently diagnosed with constipation has been effective if the patient's meal request specifies which food choice? a. Hot dog on a bun b. Grilled chicken c. Tuna sandwich on white bread d. Spinach salad with dressing

Answer: d Green leafy vegetables are high in fiber. None of the other options are high in fiber but could be modified by using whole-grain products.

What symptom is most likely to be exhibited by the patient who complains of voiding small amounts of urine in relation to his fluid intake? a. Nocturia b. Polyuria c. Anuria d. Oliguria

Answer: d Oliguria is reduced urine volume. Nocturia is excessive urination at night. Polyuria is an excessive amount of urine excreted each day, and anuria is excretion of 50 to 100 mL or less of urine each day.

A female patient has had frequent urinary tract infections. Which statement by the patient indicates that the nurse's teaching on prevention has been effective? a. "I will limit my fluid intake to 40 ounces per day." b. "I will use bubble bath when bathing." c. "I will wait to wear my tight jeans until after my urine is clear." d. "I will wipe from the front to back after voiding."

Answer: d Wiping the female perineal area from front to back after voiding is crucial in the prevention of microorganisms, which lead to infection, being transferred from the rectum or vagina to the urethral meatus. Limiting fluid intake, using bubble bath, and wearing tight-fitting clothing all may contribute to the promotion of urinary tract infections, rather than their prevention.

When emptying a patient's catheter drainage bag, the nurse notes that the urine appears to be discolored. The nurse understands that what factors may change the color of urine? (Select all that apply.) a. Taking the urinary tract analgesic phenazopyridine (Pyridium) b. A diet that includes a large amount of beets or blackberries c. An enlarged prostate or kidney stones d. High concentrations of bilirubin secondary to liver disease e. Increased carbohydrate intake

Answers: a, b, c, d Urine may appear orange when a patient is taking phenazopyridine. Urine can appear red or pink with a diet including beets or blackberries and if blood is present in the urine, which may be secondary to an enlarged prostate or kidney stones. Urine often has a brownish appearance when liver disease such as hepatitis or cirrhosis is present.

3. To prevent constipation in an inactive patient, which early interventions should the nurse implement? (Select all that apply.) a. Stool softener administration b. Enema administration c. Increasing the fiber in the diet d. Increasing physical activity e. Increasing fluid intake

Answers: a, c, d, e Administering stool softeners, increasing the fiber and fluids in the diet, and increasing physical activity are all early interventions to prevent constipation. Although used to treat constipation, an enema would not be an early intervention for prevention.

When administering a cleansing enema, which techniques should the nurse use? (Select all that apply.) a. Assist the patient to a left side-lying (Sims) position. b. Perform hand hygiene and apply sterile gloves. c. Add room-temperature solution to enema bag. d. Lubricate 2 to 4 cm (1 to 2 inches) of tip of rectal tube with lubricating jelly. e. Raise container, release clamps, and allow solution to flow to fill tubing. f. Hang solution bag 45 to 60 cm (18 to 21 inches) above anus and instill rapidly. g. Clamp tubing after solution is instilled.

Answers: a, e, g The patient should be assisted to the left side-lying (Sims) position. The container release clamps must be released and the solution allowed to flow for fill the tubing. After the solution is instilled, the tubing should be clamped. Gloves for this procedure do not need to be sterile. Solution should be warmed to slightly warmer than body temperature (or 100° to 105° F) to prevent cramping. The tip of the rectal tube should be lubricated 6 to 8 cm (3 to 4 inches). If the enema bag is hung too high and the solution is instilled too rapidly, cramping may occur.

The nurse is educating a group of women about measures to reduce the risk of urinary infections. What should the nurse include in the teaching? 1. Decrease fluid intake. 2. Wash hands frequently. 3. Urinate every 8 hours. 4. Wipe from back to front after defecation.

Correct 2. Wash hands frequently. Inadequate handwashing predisposes patients to urinary infections; therefore, frequent handwashing reduces this risk. The nurse should tell patients to increase their fluid intake, not decrease it, to prevent urinary tract infections. Patients should also be taught to empty their bladder as soon as they feel the urge. The longer urine sits in the bladder, the more bacteria can grow and lead to an infection. Wiping has to be done from front to back after defecation to prevent contamination from fecal bacteria.

The nurse is reviewing the urinalysis report for a patient. Which finding indicates possible glomerular injury? 1. White blood cells 2. Casts 3. Large proteins 4. Glucose

Correct 3. Large proteins The presence of large proteins in the urine is suggestive of glomerular injury, as they are not normally able to filter through the glomerulus. White blood cells and casts can indicate a urinary tract infection. Glucose in the urine may be indicative of diabetes mellitus.

A primary healthcare provider prescribes a normal saline enema for a patient. What does the nurse understand about the effects of this enema? Select all that apply. A. It can aid in the removal of impacted feces. B. It will distend the colon. C. It will stimulate peristalsis. D. It will irritate the colonic mucosa. E. It will lubricate the colonic mucosa.

Correct A, B, C A normal saline enema is a cleansing enema. The normal saline used as enema solution aids in the removal of impacted feces and distends the colon, thereby stimulating peristalsis. A soapsuds enema irritates the colonic mucosa, which stimulates peristalsis. An oil retention enema lubricates the colonic mucosa and facilitates easy passage of stools.

A stool culture is used to: Select all that apply. A. Detect parasites. B. Help determine the cause of diarrhea. C. Verify that a previous pathogenic bacterial infection has been resolved. D. Detect blood in the stool.

Correct A, B, C A stool culture is used along with other tests to detect parasites in the stool and to help determine the cause of diarrhea. Stool cultures are ordered if the patient complains of diarrhea for several days or when blood or mucus is noted in loose stools. Stool culture may be performed if the history suggests that the patient may have consumed food contaminated with bacteria associated with undercooked meat or raw eggs, or the same food that has made others ill. Recent travel outside the United States may suggest possible food contamination. If the patient has had a previous pathogenic bacterial infection of the GI tract that has been treated or resolved, additional stool cultures may be performed to verify that the pathogenic bacteria are no longer detectable. Testing for the presence of blood in the feces is performed using a fecal occult blood test.

A nurse, along with unlicensed assistive personnel (UAP), is catheterizing a patient with neurogenic bladder. What are the responsibilities of the UAP? Select all that apply. A. Focus lighting. B. Provide comfort measures. C. Assist in positioning the patient. D. Insert catheter into the urethral meatus. E. Inflate the balloon fully as per the manufacturer's direction.

Correct A, B, C In some settings, UAPs may be permitted to insert a urinary catheter, but it is not routine practice. The UAP may assist with positioning the patient, focusing lighting, maintaining patient position, and providing comfort measures. Inserting the catheter into the urethral meatus and inflating the balloon of the catheter are skilled activities that should be performed by the nurse

Which foods does the nurse teach the patient to refrain from eating to prevent flatulence? Select all that apply. A. Beans B. Spicy foods C. Fresh fruit D. Cauliflower E. Whole grains

Correct A, B, D Beans, spicy foods, and cauliflower are gas-producing foods and should be eliminated from the patient's diet to reduce flatulence. Fresh fruits and whole grains are highly nutritious and are not gas-producing foods; therefore, these foods may be included in the patient's diet.

A patient has constipation. What are the signs and symptoms of constipation? Select all that apply. A. Abdominal pressure B. Abdominal distention C. Stoma "budding" D. Loose feces E. Abdominal cramping

Correct A, B, E Constipation is a condition in which the patient has difficulty in passing bowel movements. Constipation causes abdominal pressure, abdominal distention, and abdominal cramping. Accumulation of stool increases abdominal pressure, which causes stomach distention and abdominal cramping. Constipation does not cause stoma "budding"; "budding" in a stoma is normal. Loose feces are a sign of diarrhea; hard feces is a sign of constipation.

What are the reasons for the presence of ketones in a patient's urine? Select all that apply. A. Vomiting B. Prolonged fasting C. A diet high in sugars D. A diet adequate in proteins E. A diet low in carbohydrates

Correct A, B, E Ketonuria is the presence of ketones in the urine. It indicates the breakdown of fat for energy. Vomiting and prolonged fasting decreases glucose levels in the body and leads to the breakdown of fat to supply energy. A diet low in carbohydrates makes the body use other sources of energy, such as fats. A diet high in sugars does not cause ketonuria due to the presence of high glucose levels for energy; a diet low in sugars can lead to ketonuria. A diet adequate in proteins will not lead to ketonuria.

A nurse is teaching a group of people regarding colon cancer. Which factors should the nurse list as warning signs of colon cancer? Select all that apply. A. Rectal bleeding B. Obesity and inactivity C. Change in bowel habits D. Older than 50 years of age E. Having a family history of colon cancer

Correct A, C A change in bowel habits and rectal bleeding are both warning signs of colon cancer. Obesity, inactivity, older than 50 years, and a family history of colon cancer are all risk factors of developing colon cancer.

Which foods may alter the results of a patient's fecal occult blood test? Select all that apply. A. Carrots B. Cereals C. Red meat D. Grapefruit E. Milk products

Correct A, C, D A fecal occult blood test is done to determine the presence of microscopic or invisible blood in the stools. Carrots and red meat should be avoided. Grapefruit is rich in vitamin C and may lead to a false-negative result. Cereals and milk products do not alter the results of a fecal occult blood test.

A nurse is caring for a patient admitted with diarrhea. What could be the possible causes of diarrhea in the patient? Select all that apply. A. Use of opioid drugs B. Use of antibiotics C. Food allergies D. Psychological stress E. Hypothyroidism

Correct B, C, D Use of antibiotics may cause diarrhea by disrupting the normal flora of the intestine. Food allergies and psychological stress cause increased peristalsis resulting in diarrhea. Use of opioid drugs and hypothyroidism cause constipation by decreasing peristalsis.

A nurse is teaching a patient about healthy bowel habits. What information should be included in the teaching? Select all that apply. A. Laxatives should be used regularly. B. Dietary fibers should be an essential component of the diet. C. Fluid intake should be at least 6 to 8 glasses of water per day. D. Physical exercise should be avoided to prevent constipation. E. Stress management techniques should be practiced.

Correct B, C, E Consuming dietary fiber increases the bulk of stool and helps in better bowel elimination. Maintaining adequate fluid intake increases the water content of the stool and prevents it from hardening, and permits easy passage through the rectum and anus. Stress can cause constipation; therefore, the patient should be instructed to practice stress management techniques. Laxatives should not be used regularly, as the bowel becomes habituated to laxative use. Physical activity helps prevent constipation by facilitating bowel movements.

A nurse suspects a patient has a fecal impaction. Which findings would be consistent for a fecal impaction? Select all that apply. A. Fatigue B. Malaise C. Cramping D. Rectal pain E. Loss of appetite

Correct C, D, E An impaction refers to the presence of a hard fecal mass in the rectum or colon that cannot be expelled easily. Impactions may cause electrolyte disturbances, resulting in cramps. Rectal pain occurs because of the repeated attempts to defecate and pressure from the mass. Loss of appetite is a symptom of impaction due to the inability to defecate. Fatigue and malaise are symptoms of diarrhea.

A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in small amounts and is more frequent when she coughs. What should the nurse teach the patient about her disorder? Select all that apply. A. It occurs due to local irritation. B. It occurs due to nervous system disorders. C. It occurs due to weakness of muscles around the urethra. D. It is called stress incontinence. E. It occurs when the intraabdominal pressure exceeds urethral resistance.

Correct C, D, E Involuntary voiding of urine on coughing occurs due to weakness of muscles around the urethra. It is also called stress incontinence. Stress incontinence occurs in older women when intraabdominal pressure exceeds urethral resistance. Involuntary voiding occurs only when abdominal pressure rises above the urethral pressure. Local irritating factors and nervous system disorders usually lead to urge incontinence.

A patient is scheduled for a plain film x-ray of the kidney, ureter, and bladder. What preliminary preparations should this patient take 1. No preparation is required in plain film. 2. Bowel preparation is done with magnesium citrate. 3. Light sedatives are provided the previous night. 4. Fasting is required before examination.

Correct 1. No preparation is required in plain film. For getting a plain film of kidney, ureter, and bladder there is no specific preliminary preparation that needs to be done. Bowel preparation with magnesium citrate is required for barium enema, colonoscopy, and flexible sigmoidoscopy. Light sedation is required for upper endoscopy, colonoscopy, sigmoidoscopy, and for computed tomography scan. The patient needs to fast before the examination for certain procedures. Such procedures include barium swallow, upper endoscopy, barium enema, ultrasound, computed tomography, and magnetic resonance imaging.

A patient is scheduled for a plain film x-ray of the kidney, ureter, and bladder. What preliminary preparations should this patient take? 1. No preparation is required in plain film. 2. Bowel preparation is done with magnesium citrate. 3. Light sedatives are provided the previous night. 4. Fasting is required before examination.

Correct 1. No preparation is required in plain film. For getting a plain film of kidney, ureter, and bladder there is no specific preliminary preparation that needs to be done. Bowel preparation with magnesium citrate is required for barium enema, colonoscopy, and flexible sigmoidoscopy. Light sedation is required for upper endoscopy, colonoscopy, sigmoidoscopy, and for computed tomography scan. The patient needs to fast before the examination for certain procedures. Such procedures include barium swallow, upper endoscopy, barium enema, ultrasound, computed tomography, and magnetic resonance imaging.

A nurse is caring for a patient who has a colostomy. When assessing the color of the stoma, which color indicates the stoma is healthy? 1. Reddish pink 2. Purple 3. Blue 4. Brown 5. Black

Correct 1. Reddish pink A normal stoma should be moist, reddish pink, and "budding" slightly above skin level. A stoma that is purple, blue, brown, or black in color may have a compromised circulation.

Which diagnostic examination is the safest way to assess the urinary system in pregnant women? 1. Cystoscopy 2. An ultrasound examination 3. An intravenous pyelogram 4. A computed tomographic scan

Correct 2. An ultrasound examination An ultrasound examination helps to assess the kidneys. It is safe to perform in pregnant women because no radiation or contrast dyes are used. Anesthesia must be administered to a patient before performing cystoscopy; therefore, the patient notifies the primary healthcare provider before undergoing the procedure. An intravenous pyelogram may expose the patient to low amounts of radiation that can affect the fetus during the pregnancy. A computed tomographic scan may cause a teratogenic effect in the fetus due to the radiation used in the process.

The nurse is reviewing the lab report of a patient. The presence of what substance in the urine hints at the possibility of an abnormality? 1. Protein - 6 2. Glucose ++ 3. Red blood cells - 2 4. White blood cells - 4

Correct 2. Glucose ++ A normal urinalysis should not be positive for glucose, as glucose undergoes complete reabsorption. The presence of protein in the urine is acceptable under 8 mg/100 mL. The presence of 2 red cells is acceptable, but there should not be any more than this. A white cell of count 4 is acceptable and does not indicate abnormality.

A patient has stress incontinence. What is a characteristic of stress incontinence? 1. A sudden urge to void 2. Loss of urine when coughing 3. Constant dribbling of urine 4. Inability to reach the toilet

Correct 2. Loss of urine when coughing Loss of urine control during activities such as coughing that increase intra-abdominal pressure indicates stress incontinence. A sudden urge to void indicates urge incontinence. A constant dribbling of urine indicates overflow incontinence. The inability to reach the toilet in time indicates functional incontinence.

The nurse is teaching a group of staff members about abnormal urination patterns. Which statement made by a staff member indicates effective learning? 1. "Anuria is painful urination." 2. "Anuria is reduced volume of urine." 3. "Anuria is the failure to excrete urine." 4. "Anuria is excessive urination at night."

Correct 3. "Anuria is the failure to excrete urine." Anuria is the failure of the kidneys to excrete urine. Dysuria is the term for painful urination. A reduced volume of urine is called oliguria. Excessive urination at night is called nocturia.

Which complication does the nurse monitor for in a pregnant patient who is taking prenatal vitamin tablets with iron? 1. Diarrhea 2. Flatulence 3. Constipation 4. Incontinence

Correct 3. Constipation Prenatal vitamins are rich in iron and interfere with bowel function. Iron slows down intestinal peristalsis and increases absorption of water in the colon, resulting in constipation. Diarrhea occurs due to an increase in intestinal peristalsis. Vitamins high in iron do not increase the production of gases leading to flatulence or cause fecal incontinence.

A patient with abdominal discomfort has presence of bowel sounds that are loud, high-pitched, and rushing. What pattern of the bowel sounds should the nurse record? 1. Normal 2. Hypoactive 3. Hyperactive 4. Tympanic note

Correct 3. Hyperactive Hyperactive bowel sounds tend to be loud, high-pitched, and rushing; they are commonly heard with diarrhea or inflammatory disorders. Normal bowel sounds occur every 5-15 seconds and last for one to a few seconds. Hypoactive sounds will be fewer than 5 sounds per minute. Tympanic note is not an auscultation finding; instead it is a percussion finding.

The nurse is preparing to administer erythropoietin to a patient who presents with a deficiency. The nurse knows that the patient needs this medication because of dysfunction in which organ? 1. Liver 2. Bone 3. Kidney 4. Spleen

Correct 3. Kidney Kidneys produce erythropoietin. Patients with chronic renal failure require exogenous erythropoietin supplementation for red blood cell production. The liver, bones, and spleen are not involved in the synthesis of erythropoietin.

A patient with a bladder disorder is advised to get a urinary diversion. The patient wishes to have the type of urinary diversion that allows normal voiding. Which type of urinary diversion suits the patient's requirement? 1. Ileal conduit 2. Indiana pouch 3. Orthotopic neobladder 4. Mainz pouch

Correct 3. Orthotopic neobladder Orthotopic neobladder is the diversion procedure that allows the patient to have normal voiding. In the case of an ileal conduit, urine drains through a stoma into a collection bag. Incontinent urinary diversion is associated with continuous urinary drainage without the patient's voluntary control. For cutaneous continent diversions (Kock pouch, Mainz pouch, Indiana pouch), a collection reservoir is surgically created using a segment of the intestine; the patient then needs to catheterize the reservoir through a cutaneous stoma every 4 to 6 hours to drain stored urine.

To minimize the patient's episodes of nocturia, the nurse would teach him or her to: 1. Perform perineal hygiene after urinating. 2. Set up a toileting schedule. 3. Double void. 4. Limit fluids before bedtime.

Correct 4. Limit fluids before bedtime. The patient with nocturia has to get up during the night to urinate. Limiting fluids 2 hours before bedtime minimizes nocturia.

A nurse is preparing to administer a continuous bladder irrigation. Which type of catheter is useful for this type of bladder irrigation? 1. Foley catheter 2. Coudé catheter 3. Straight catheter 4. Triple-lumen catheter

Correct 4 Triple-lumen catheter Triple-lumen catheters have one lumen to introduce sterile irrigation fluid, one to drain the urine, and the third lumen to fill the retention balloon at the tip of the catheter. A Foley catheter has two lumens; one for draining urine and the other for filling a balloon. Coudé catheters are a special type of double-lumen catheter with a curved tip for use in patients with enlarged prostate glands. Straight catheters have only one lumen to drain the urine.

An indwelling catheter is ordered for a postoperative patient who is unable to void. What is the primary concern of the nurse performing the procedure? a. Teaching deep-breathing techniques b. Maintaining strict aseptic technique c. Medicating the patient for pain before the procedure d. Positioning the patient for comfort during the procedure

It is most important to maintain strict aseptic technique while inserting an indwelling catheter to try to prevent a urinary tract infection. It is not necessary to medicate patients before urinary catheterization. Although comfortable positioning and deep breathing may help to relax the patient, this is not the primary concern.

What self-care measure is most important for the nurse to include in the teaching plan for a patient who will be discharged with a urostomy? a. Change the appliance before going to bed. b. Cut the wafer 1 inch larger than the stoma. c. Cleanse the peristomal skin with mild soap and water. d. Use firm pressure to attach the wafer to the skin.

The peristomal area can be washed by the patient using warm water and mild soap as needed and routinely at bath time. The collection device typically has a face plate to ensure a good fit and prevent leakage of urine. These appliances are changed less frequently than before bed each night, and neither a widely cut wafer or firm pressure is needed for their application.