Chapter 46: Urinary Elimination (Nursing Skills Related to Urinary Elimination)

What is the minimum length of an intermittent catheter that should be inserted through the urethral meatus in a female patient? Record your answer using a whole number.

5 cm Rationale: The minimum insertion length of an intermittent catheter is 5 cm (2 inches). Pg. 1136

What is the minimum length of an intermittent catheter that should be inserted through the urethral meatus in a male patient? Record your answer using a whole number.

5 cm Rationale: The minimum length of insertion of an intermittent catheter is 17 cm (7 inches). Pg. 1136

Within what duration of voiding should the scan measurement be performed for measuring residual bladder volume? Record your answer using a whole number.

10 minutes Rationale: The scan measurement should be done within 10 minutes of voiding. Pg. 1123

What size (in French scale) urinary catheter should the nurse use for a 17-year-old girl? Write your answer using a whole number.

12 French Rationale: The nurse should use a 12 French (Fr) scale size of urinary catheter for a 17-year-old girl. Pg. 1120

The nurse is caring for a patient who has an indwelling urinary catheter. Which action by the nurse increases the risk for patient complications?

*A. Allowing the drainage bag to get full before emptying* B. Keeping the urinary drainage system closed C. Preventing urine backflow from the tubing and bag into the bladder D. Performing perineal hygiene after each bowel movement Rationale: The nurse should not allow the drainage bag to get full before emptying. An overfull drainage bag creates tension and undue pressure on the catheter, which may induce trauma to the urethra or urinary meatus. The nurse should maintain a closed urinary drainage system that does not permit any channels for entry of pathogens. The nurse should make sure that there is no urine backflow from the tubing and bag into the bladder. The nurse should perform perineal hygiene after each bowel movement. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Pg. 1122

The patient has to provide a urine sample. Which actions should the nurse perform? Select all that apply.

*A. Instruct patient to obtain a midstream sample.* B. Instruct patient to obtain a last-stream sample. C. Instruct patient to obtain a sample at the beginning of urination. *D. Transport specimen to the laboratory within 15-30 minutes.* *E. Refrigerate specimen if it does not reach the laboratory within 30 minutes.* Rationale: The nurse should collect a midstream urine sample as that is free from urethral and dermal contaminants. Because bacteria grow quickly in urine, the specimen should be transported to the laboratory within 15 to 30 minutes. Urine not received by the laboratory within 30 minutes should be refrigerated to prevent bacteria from growing. However, refrigeration should not exceed 2 hours. Last-stream samples usually contain dermal contaminants. Initial-stream samples contain urethral contaminants. Test-Taking Tip: Knowing one correct response to a multiple-response question can help immensely, so don't panic if you are sure of only one response. In this case, knowing a midstream sample is needed helps you eliminate the two incorrect choices. Pg. 1130

The nurse, along with an nursing assistive person (NAP), is catheterizing a patient with a neurogenic bladder. What are the responsibilities of the NAP? Select all that apply.

*A. Maintain the privacy of the patient.* *B. Provide perineal care.* *C. Assist in the positioning of the patient.* D. Insert catheter into the urethral meatus. E. Inflate the balloon fully as per the manufacturer's direction. Rationale: Nursing assistive personnel (NAP) are responsible for maintaining the privacy of the patient. The NAP also provide perineal care before and after the procedure, and are responsible for assisting the nurse in positioning the patient for catheterization. Inserting the catheter into the urethral meatus and inflating the balloon of the catheter are skilled activities that should be performed by the nurse. Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously. Pg. 1140

A nursing instructor asks the nursing assistive person (NAP) to explain the skills of perineal care for a patient with an indwelling catheter. Which statement if made by the NAP indicates a need for further learning?

A. "A female patient should be placed in dorsal recumbent position." B. "A catheter should be grasped with two fingers to stabilize it near the meatus." *C. "A catheter should be cleaned using a vertical motion moving towards the meatus."* "D. A waterproof pad should be placed under the patient while performing perineal care." Rationale: The nursing assistive person (NAP) should clean the catheter using a circular motion directed upwards/away from the meatus. A female patient is placed in dorsal recumbent positioning. The catheter is grasped with two fingers to stabilize it near the meatus. A waterproof pad is placed under the patient to protect bed linens from soiling. Pg. 1140

What should the nurse teach a patient who has altered urinary elimination about maintaining a healthy bladder?

A. "Drink ample fluids before bed time." B. "Drink three to four glasses of water daily." *C. "Avoid drinking tea, coffee, or chocolate drinks."* D. "Limit fluid intake if there is urinary incontinence." Rationale: The nurse should teach the patient to avoid beverages that contain tea, coffee, or chocolate. Drinking fluids before bed time should be avoided because of the risk of nocturia. A patient should be advised to drink six to eight glasses of water a day. Fluid intake should not be limited even if there is urinary incontinence. Pg. 1118

A nursing instructor asks a nursing student to explain the evaluation phase of a patient who underwent urinary catheterization due to compromised bladder function. Which statement if made by the student indicates a need for further education?

A. "During the evaluation phase,the nurse reassesses the patient's urination pattern." B. "During the evaluation phase, the nurse asks the patient if expectations are being met." *C. "During the evaluation phase, the nurse explains the procedure and the importance of the catheter to the patient."* D. "During the evaluation phase, the nurse asks the patient about any permanent change in elimination Rationale: During the planning phase (not the evaluation phase) of the nursing process, the nurse explains the surgical procedure and the importance of the catheter to the patient. During the evaluation phase, the nurse reassesses the patient's urination pattern, asks the patient if the expectations are being met, and asks the patient about any permanent change in elimination. Test-Taking Tip: If you can eliminate any responses as incorrect based on your knowledge, you will not be guessing randomly but will be exercising "informed guessing." Pg. 1132

A nursing instructor asks a nursing student to elaborate on nursing interventions for a patient experiencing stress urinary incontinence related to a weakened pelvic musculature. Which statement if made by the student indicates a need for further learning?

A. "I should instruct the patient to avoid tea and coffee." B. "I should teach the patient to take in adequate water and fluid." C. "I should advise the patient to perform pelvic muscle exercises." *D. "I should encourage the patient to increase intraabdominal pressure."* Rationale: A patient experiencing stress urinary incontinence related to a weakened pelvic musculature should be instructed to decrease (not increase) intraabdominal pressure. The patient should avoid tea, coffee and other bladder irritants. The patient should also have an adequate intake of fluid to stay hydrated and perform pelvic muscle exercises. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Pg. 1117

What is the correct amount space allowed between the tip of the penis and the end of the catheter while placing a condom catheter on a patient?

A. 1.5 to 3 cm *B. 2.5 to 5 cm* C. 3.5 to 5 cm D. 4.5 to 6 cm Rationale: While placing a condom catheter on the patient, the nurse should allow a space of 2.5 to 5 cm (1 to 2 inches) between the tip of the penis and the end of the catheter. Pg. 1125

What is the normal pH range of urine?

A. 2.6 to 4 B. 3.6 to 5 *C. 4.6 to 8* D. 4.6 to 9 Rationale: The normal pH of the urine ranges from 4.6 to 8. Pg. 1113

A patient complains of diminished urinary output. The nurse finds that the patient also has diminished fluid intake. What is the medical term for this condition?

A. Dysuria *B. Oliguria* C. Polyuria D. Nocturia Rationale: Oliguria is the medical term used for low urinary output in relation to the fluid intake. Dysuria is pain or discomfort associated with voiding. Polyuria is a term for the voiding excessive amounts of urine. Nocturia is the condition of awakening from sleep because of the urge to void. Pg. 1110

What nursing intervention is the nurse least likely to provide to a patient diagnosed with stress urinary incontinence related to a weakened pelvic musculature?

A. Encouraging the patient to lose weight *B. Reinforcing teaching related to type 2 diabetes* C. Advising the patient to maintain adequate hydration D. Instructing the patient to avoid caffeine and other bladder irritants Rationale: If a patient is diagnosed with stress urinary incontinence related to a weakened pelvic musculature, the nurse is least likely to reinforce teaching related to type 2 diabetes. This type of teaching is needed in cases where there is risk of infection due to diabetes. A patient who has stress urinary incontinence related to a weakened pelvic musculature should be encouraged to lose weight and maintain adequate hydration. The nurse should also instruct the patient to avoid caffeine and other bladder irritants. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Pg. 1117

What nursing intervention should the nurse provide to a patient who has wet skin due to urinary incontinence and is at risk for impaired skin integrity?

A. Encouraging the patient to lose weight B. Advising the patient to maintain adequate hydration C. Using pictures to teach the patient about pelvic anatomy *D. Teaching the patient to apply a moisture barrier product as needed* Rationale: A patient who is at risk for impaired skin integrity due to having wet skin caused by incontinence or old age should be taught to apply moisture barrier products as needed. A patient who has stress urinary incontinence related to a weakened pelvic musculature should be encouraged to lose weight and maintain adequate hydration. The nurse should use pictures to teach a patient who has deficient knowledge pertaining to urinary incontinence about pelvic anatomy. Pg. 1117

What skill is the nurse least likely to perform during the physical assessment of a patient with urinary elimination problems?

A. Palpating the lower abdomen to assess for bladder fullness B. Percussing the costovertebral angle to assess for tenderness C. Auscultating the kidney to detect the presence of a renal artery bruit *D. Positioning the female patient into a supine position to examine the genitalia* Rationale: To examine a female patient, the nurse should place the patient in dorsal recumbent position to allow for full exposure of the genitalia. Bladder fullness can be assessed via gentle palpation of the lower abdomen. A full bladder feels like a smooth and rounded mass. To discern if the kidneys are infected or inflamed, percussion of the costovertebral angle is done. Auscultation of the renal artery is also done to detect the presence of a bruit, which may arise because of turbulent blood flow through a narrowed artery. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Pg. 1110

A female patient requires an indwelling catheter. What body position should the patient be placed in?

A. Supine position B. Fowler's position C. Semi-sitting position *D. Dorsal recumbent position* Rationale: For placing an indwelling catheter in a female patient, the nurse should have the patient in dorsal recumbent position. A male patient who requires an indwelling catheter should be in supine or Fowler's position. Semi-sitting position is the preferred position for a patient to void for collecting urine specimens. Pg. 1140

Which statement is true regarding the use of a bladder scanner to measure residual bladder volume?

A. The patient is placed in the dorsal recumbent position. B. The scan measurement should be performed within 20 minutes of voiding. *C. Women who have had a hysterectomy should be designated as male.* D. Ultrasound gel is applied to the midline abdomen about 2.5 to 4 cm below the symphysis pubis. Rationale: Women who have had a hysterectomy should be designated as male when setting the gender designation according to the manufacturer's guidelines. The patient is placed in a supine position, not dorsal recumbent. The scan measurement is conducted within 10 minutes of voiding, not 20. Ultrasound gel is applied to the midline abdomen about 2.5 to 4 cm above, not below, the symphysis pubis. Pg. 1123