Chapter 46 (Urinary Elimination)

What should the nurse teach a young woman with a history of urinary tract infections (UTIs) about UTI prevention? (Select all that apply.) 1. Maintain regular bowel elimination. 2. Limit water intake to 1 to 2 glasses a day. 3. Wear cotton underwear. 4. Cleanse the perineum from front to back. 5. Practice pelvic muscle exercise (Kegel) daily.

1, 3, 4

A patient is scheduled to have an intravenous pyelogram (IVP) the next morning. Which nursing measures should be implemented before the test? (Select all that apply.) 1. Ask the patient about any allergies and reactions. 2. Instruct the patient that a full bladder is required for the test. 3. Instruct the patient to save all urine in a special container. 4. Ensure that informed consent has been obtained. 5. Instruct the patient that facial flushing can occur when the contrast media is given.

1, 4, 5

An ambulatory elderly woman with dementia is incontinent of urine. She has poor short-term memory and has not been seen toileting independently. What is the best nursing intervention for this patient? 1. Recommend that she be evaluated for an overactive bladder (OAB) medication. 2. Establish a toileting schedule. 3. Recommend that she be evaluated for an indwelling catheter. 4. Start a bladder-retraining program.

2

There is no urine when a catheter is inserted 3 inches into a female's urethra. What should the nurse do next? 1. Remove the catheter and start all over with a new kit and catheter. 2. Leave the catheter there and start over with a new catheter. 3. Pull the catheter back and reinsert at a different angle. 4. Ask the patient to bear down and insert the catheter farther.

2

Which nursing intervention decreases the risk for catheter-associated urinary tract infection (CAUTI)? 1. Cleansing the urinary meatus 3 to 4 times daily with antiseptic solution 2. Hanging the urinary drainage bag below the level of the bladder 3 Emptying the urinary drainage bag daily 4. Irrigating the urinary catheter with sterile water

2

A postoperative patient with a three-way indwelling urinary catheter and continuous bladder irrigation (CBI) complains of lower abdominal pain and distention. What should be the nurse's initial intervention(s)? (Select all that apply.) 1. Increase the rate of the CBI. 2. Assess the patency of the drainage system. 3. Measure urine output. 4. Assess vital signs. 5. Administer ordered pain medication.

2, 3

Which nursing interventions should a nurse implement when removing an indwelling urinary catheter in an adult patient? (Select all that apply.) 1. Attach a 3-mL syringe to the inflation port. 2. Allow the balloon to drain into the syringe by gravity. 3. Initiate a voiding record/bladder diary. 4. Pull the catheter quickly. 5. Clamp the catheter before removal.

2, 3

What is a critical step when inserting an indwelling catheter into a male patient? 1. Slowly inflate the catheter balloon with sterile saline. 2. Secure the catheter drainage tubing to the bedsheets. 3. Advance the catheter to the bifurcation of the drainage and balloon ports. 4. Advance the catheter until urine flows, then insert ¼ inch more.

3

Which instruction should the nurse give the assistive personnel (AP) concerning a patient who has had an indwelling urinary catheter removed that day? 1. Limit oral fluid intake to avoid possible urinary incontinence. 2. Expect patient complaints of suprapubic fullness and discomfort. 3. Report the time and amount of first voiding. 4. Instruct patient to stay in bed and use a urinal or bedpan.

3

Place the following steps for insertion of an indwelling catheter in a female patient in appropriate order. 1. Insert and advance catheter. 2. Lubricate catheter. 3. Inflate catheter balloon. 4. Cleanse urethral meatus with antiseptic solution. 5. Drape patient with the sterile square and fenestrated drapes. 6. When urine appears, advance another 2.5 to 5 cm. 7. Prepare sterile field and supplies. 8. Gently pull catheter until resistance is felt. 9. Attach drainage tubing.

5, 7, 2, 4, 1, 6, 3, 8, 9

The nurse is preparing to apply an external catheter. Which action will the nurse take? A. Allow 1 to 2 inches of space between the tip of the penis and the end of the catheter. B. Spiral wrap the penile shaft using adhesive tape to secure the catheter. C. Twist the catheter before applying drainage tubing to the end of the catheter. D. Shave the pubic area before applying the catheter.

A. Allow 1 to 2 inches of space between the tip of the penis and the end of the catheter.

A patient is experiencing oliguria. Which action should the nurse perform first? A. Assess for bladder distention. B. Request an order for diuretics. C. Increase the patient's intravenous fluid rate. D. Encourage the patient to drink caffeinated beverages.

A. Assess for bladder distention.

A nurse is caring for a patient with a continent urinary reservoir. Which action will the nurse teach the patient? A. Catheterizing the pouch B. Preforming Kegel exercises C. Changing the collection pouch D. To avoid using the Valsalva technique

A. Catheterizing the pouch

A nurse is providing care to a patient with an indwelling catheter. Which practice indicates the nurse is following guidelines for avoiding catheter-associated urinary tract infection (CAUTI)? A. Drapes the urinary drainage tubing with no dependent loops. B. Washes the drainage tube toward the meatus with soap and water. C. Places the urinary drainage bag gently on the floor below the patient. D. Allows the spigot to touch the receptacle when emptying the drainage bag.

A. Drapes the urinary drainage tubing with no dependent loops.

The nurse is using different toileting schedules. Which principles will the nurse keep in mind when planning care? (Select all that apply.) A. Habit training uses a bladder diary. B. Timed voiding is based upon the patient's urge to void. C. Prompted voiding includes asking patients if they are wet or dry. D. Elevation of feet in patients with edema can decrease nighttime voiding. E. Bladder retraining teaches patients to follow the urge to void as quickly as possible.

A. Habit training uses a bladder diary. C. Prompted voiding includes asking patients if they are wet or dry.

A patient reports severe flank pain. The urinalysis reveals presence of calcium phosphate crystals. The nurse will anticipate an order for which diagnostic test? A. Intravenous pyelogram B. Mid-stream urinalysis C. Bladder scan D. Cystoscopy

A. Intravenous pyelogram

The nurse is obtaining a 24-hour urine specimen collection from the patient. Which actions should the nurse take? (Select all that apply.) A. Keeping the urine collection container on ice when indicated B. Withholding all patient medications for the day C. Irrigating the sample as needed with sterile solution D. Testing the urine sample with a reagent strip by dipping it in the urine E. Asking the patient to void and discarding that urine to start the collection

A. Keeping the urine collection container on ice when indicated E. Asking the patient to void and discarding that urine to start the collection

A patient has fallen several times in the past week when attempting to get to the bathroom. The patient gets up 3 or 4 times a night to urinate. Which recommendation by the nurse is most appropriate in correcting this urinary problem? A. Limit fluid and caffeine intake before bed. B. Leave the bathroom light on to illuminate a pathway. C. Practice Kegel exercises to strengthen bladder muscles. D. Clear the path to the bathroom of all obstacles before bedtime.

A. Limit fluid and caffeine intake before bed.

A nurse is caring for a hospitalized patient with a urinary catheter. Which nursing action best prevents the patient from acquiring an infection? A. Maintaining a closed urinary drainage system B. Inserting the catheter using strict clean technique C. Disconnecting and replacing the catheter drainage bag once per shift D. Fully inflating the catheter's balloon according to the manufacturer's recommendation

A. Maintaining a closed urinary drainage system

A nurse is planning care for a group of patients. Which task will the nurse assign to the nursing assistive personnel (AP)? A. Obtaining a midstream urine specimen B. Interpreting a bladder scan result C. Inserting a straight catheter D. Irrigating a catheter

A. Obtaining a midstream urine specimen

A patient asks about treatment for stress urinary incontinence. Which is the nurse's best response? A. Perform pelvic floor exercises. B. Avoid voiding frequently. C. Drink cranberry juice. D. Wear an adult diaper.

A. Perform pelvic floor exercises.

A patient requests the nurse's help to the bedside commode and becomes frustrated when unable to void in front of the nurse. How should the nurse interpret the patient's inability to void? A. The patient can be anxious, making it difficult for abdominal and perineal muscles to relax enough to void. B. The patient does not recognize the physiological signals that indicate a need to void. C. The patient is lonely and calling the nurse in under false pretenses is a way to get attention. D. The patient is not drinking enough fluids to produce adequate urine output.

A. The patient can be anxious, making it difficult for abdominal and perineal muscles to relax enough to void.

To reduce patient discomfort during a closed intermittent catheter irrigation, what should the nurse do? A. Use room temperature irrigation solution. B. Administer the solution as quickly as possible. C. Allow the solution to sit in the bladder for at least 1 hour. D. Raise the bag of the irrigation solution at least 12 inches above the bladder.

A. Use room temperature irrigation solution.

Which statement by the patient about an upcoming contrast computed tomography (CT) scan indicates a need for further teaching? A. "I will follow the food and drink restrictions as directed before the test is scheduled." B. "I will be anesthetized so that I lie perfectly still during the procedure." C. "I will complete my bowel prep program the night before the scan." D. "I will be drinking a lot of fluid after the test is over."

B. "I will be anesthetized so that I lie perfectly still during the procedure."

The nurse anticipates a suprapubic catheter for which patient? A. A patient with recent prostatectomy B. A patient with a urethral stricture C. A patient with an appendectomy D. A patient with menopause

B. A patient with a urethral stricture

A nurse is providing care to a group of patients. Which patient will the nurse see first? A. A patient who is dribbling urine and has a diagnosis of urge incontinence B. A patient with reflex incontinence with elevated blood pressure and pulse rate C. A patient with an indwelling catheter that has stool on the catheter tubing D. A patient who has just voided and needs a postvoid residual test

B. A patient with reflex incontinence with elevated blood pressure and pulse rate

The nurse, upon reviewing the history, discovers the patient has dysuria. Which assessment finding is consistent with dysuria? A. Blood in the urine B. Burning upon urination C. Immediate, strong desire to void D. Awakes from sleep due to urge to void

B. Burning upon urination

Which findings should the nurse follow up on after removal of a catheter from a patient? (Select all that apply.) A. Increasing fluid intake B. Dribbling of urine C. Voiding in small amounts D. Voiding within 6 hours of catheter removal E. Burning with the first couple of times voiding

B. Dribbling of urine C. Voiding in small amounts

A nurse is teaching a patient about the urinary system. In which order will the nurse present the structures, following the flow of urine? A. Kidney, urethra, bladder, ureters B. Kidney, ureters, bladder, urethra C. Bladder, kidney, ureters, urethra D. Bladder, kidney, urethra, ureters

B. Kidney, ureters, bladder, urethra

Which nursing actions will the nurse implement when collecting a urine specimen from a patient? (Select all that apply.) A. Growing urine cultures for up to 12 hours B. Labeling all specimens with date, time, and initials C. Allowing the patient adequate time and privacy to void D. Wearing gown, gloves, and mask for all specimen handling E. Transporting specimens to the laboratory in a timely manner F. Collecting the specimen from the drainage bag of an indwelling catheter

B. Labeling all specimens with date, time, and initials C. Allowing the patient adequate time and privacy to void E. Transporting specimens to the laboratory in a timely manner

The nurse is preparing to test a patient for postvoid residual with a bladder scan. Which action will the nurse take? A. Measure bladder before the patient voids. B. Measure bladder within 15 minutes after the patient voids. C. Measure bladder with head of bed raised to 60 degrees. D. Measure bladder with head of bed raised to 90 degrees.

B. Measure bladder within 15 minutes after the patient voids.

The patient is prescribed phenazopyridine. When assessing the urine, what will the nurse expect? A. Red color B. Orange color C. Dark amber color D. Intense yellow color

B. Orange color

While receiving a shift report on a female patient, the nurse is informed that the patient has been experiencing urinary incontinence. Upon assessment, which finding will the nurse expect? A. An indwelling Foley catheter B. Reddened irritated skin on buttocks C. Tiny blood clots in the patient's urine D. Foul-smelling discharge indicative of infection

B. Reddened irritated skin on buttocks

An 86-year-old patient is experiencing uncontrollable leakage of urine with a strong desire to void and even leaks on the way to the toilet. Which priority nursing diagnosis will the nurse include in the patient's plan of care? A. Functional urinary incontinence B. Urge urinary incontinence C. Impaired skin integrity D. Urinary retention

B. Urge urinary incontinence

A nurse administers an antimuscarinic to a patient. A decrease in which findings indicate the patient is having therapeutic effects from this medication? (Select all that apply.) A. Dysuria B. Urgency C. Frequency D. Prostate size E. Bladder infection

B. Urgency C. Frequency

A female patient is having difficulty voiding in a bedpan but states that her bladder feels full. To stimulate micturition, which nursing intervention should the nurse try first? A. Exiting the room and informing the patient that the nurse will return in 30 minutes to check on the patient's progress B. Utilizing the power of suggestion by turning on the faucet and letting the water run C. Obtaining an order for a Foley catheter D. Administering diuretic medication

B. Utilizing the power of suggestion by turning on the faucet and letting the water run

Which assessment question should the nurse ask if stress incontinence is suspected? A. "Do you think your bladder feels distended?" B. "Do you empty your bladder completely when you void?" C. "Do you experience urine leakage when you cough or sneeze?" D. "Do your symptoms increase with consumption of alcohol or caffeine?"

C. "Do you experience urine leakage when you cough or sneeze?"

A nurse is caring for an 8-year-old patient who is embarrassed about urinating in bed at night. Which intervention should the nurse suggest to reduce the frequency of this occurrence? A. "Set your alarm clock to wake you every 2 hours, so you can get up to void." B. "Line your bedding with plastic sheets to protect your mattress." C. "Drink your nightly glass of milk earlier in the evening." D. "Empty your bladder completely before going to bed."

C. "Drink your nightly glass of milk earlier in the evening."

Upon palpation, the nurse notices that the bladder is firm and distended; the patient expresses an urge to urinate. Which question is most appropriate? A. "Does your urinary problem interfere with any activities?" B. "Do you lose urine when you cough or sneeze?" C. "When was the last time you voided?" D. "Are you experiencing a fever or chills?"

C. "When was the last time you voided?"

The nurse will anticipate inserting a Coudé catheter for which patient? A. An 8-year-old male undergoing anesthesia for a tonsillectomy B. A 24-year-old female who is going into labor C. A 56-year-old male admitted for bladder irrigation D. An 86-year-old female admitted for a urinary tract infection

C. A 56-year-old male admitted for bladder irrigation

The patient is having lower abdominal surgery and the nurse inserts an indwelling catheter. What is the rationale for the nurse's action? A. The patient may void uncontrollably during the procedure. B. Local trauma sometimes promotes excessive urine incontinence. C. Anesthetics can decrease bladder contractility and cause urinary retention. D. The patient will not interrupt the procedure by asking to go to the bathroom.

C. Anesthetics can decrease bladder contractility and cause urinary retention.

A nurse is caring for a male patient experiencing urinary retention. Which action should the nurse take first? A. Limit fluid intake. B. Insert a urinary catheter. C. Assist to a standing position. D. Ask for a diuretic medication.

C. Assist to a standing position.

Which observation by the nurse best indicates that a continuous bladder irrigation for a patient following genitourinary surgery is effective? A. Output that is smaller than the amount instilled B. Blood clots or sediment in the drainage bag C. Bright red urine turns pink in the tubing D. Bladder distention with tenderness

C. Bright red urine turns pink in the tubing

The nurse suspects cystitis related to a lower urinary tract infection. Which clinical manifestation does the nurse expect the patient to report? A. Dysuria B. Flank pain C. Frequency D. Fever

C. Frequency

A nurse is caring for a patient who just underwent an intravenous pyelography that revealed a renal calculus obstructing the left ureter. What is the nurse's first priority in caring for this patient? A. Turn the patient on the right side to alleviate pressure on the left kidney. B. Encourage the patient to increase fluid intake to flush the obstruction. C. Monitor the patient for fever, rash, and difficulty breathing. D. Administer narcotic medications to the patient for pain.

C. Monitor the patient for fever, rash, and difficulty breathing.

A nurse is evaluating a nursing assistive personnel's (AP) care for a patient with an indwelling catheter. Which action by the AP will cause the nurse to intervene? A. Emptying the drainage bag when half full B. Kinking the catheter tubing to obtain a urine specimen C. Placing the drainage bag on the side rail of the patient's bed D. Securing the catheter tubing to the patient's thigh

C. Placing the drainage bag on the side rail of the patient's bed

A nurse is reviewing urinary laboratory results. Which finding will cause the nurse to follow up? A. Protein level of 2 mg/100 mL B. Urine output of 80 mL/hr C. Specific gravity of 1.036 D. pH of 6.4

C. Specific gravity of 1.036

A nurse is reviewing results from a urine specimen. What will the nurse expect to see in a patient with a urinary tract infection? A. Casts B. Protein C. Crystals D. Bacteria

D. Bacteria

A nurse is inserting an indwelling urinary catheter for a male patient. Which action will the nurse take? A. Hold the shaft of the penis at a 60-degree angle. B. Hold the shaft of the penis with the dominant hand. C. Cleanse the meatus 3 times with the same cotton ball from clean to dirty. D. Cleanse the meatus with circular strokes beginning at the meatus and working outward.

D. Cleanse the meatus with circular strokes beginning at the meatus and working outward.

Which clinical manifestation will the nurse expect to observe in a patient with excessive white blood cells present in the urine? A. Reduced urine specific gravity B. Increased blood pressure C. Abnormal blood sugar D. Fever with chills

D. Fever with chills

To obtain a clean-voided urine specimen from a female patient, what should the nurse teach the patient to do? A. Cleanse the urethral meatus from the area of most contamination to least. B. Initiate the first part of the urine stream directly into the collection cup. C. Drink fluids 5 minutes before collecting the urine specimen. D. Hold the labia apart while voiding into the specimen cup.

D. Hold the labia apart while voiding into the specimen cup.

A nurse is inserting a catheter into a female patient. When the nurse inserts the catheter, no urine is obtained. The nurse suspects the catheter is not in the urethra. What should the nurse do? A. Throw the catheter way and begin again. B. Fill the balloon with the recommended sterile water. C. Remove the catheter, wipe with alcohol, and reinsert after lubrication. D. Leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.

D. Leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.

A nurse is watching a nursing assistive personnel (AP) perform a postvoid bladder scan on a female with a previous hysterectomy. Which action will require the nurse to follow up? A. Palpates the patient's symphysis pubis. B. Wipes scanner head with alcohol pad. C. Applies a generous amount of gel. D. Sets the scanner to female.

D. Sets the scanner to female.