Urinary Elimination

Which patient has the highest risk for falls? 1. 68-Year-old patient with urge incontinence and mild left hemiparesis 2. 58-Year-old patient who frequently exercises and has stress incontinence 3. 70-Year-old patient with overflow incontinence and diabetic polyuria 4. 62-Year-old patient with decreased manual dexterity and function incontinence

Answer 1: Patients with urge incontinence frequently rush to the bathroom. In addition, even mild one-sided weakness can create problems with balance.

An older patient is trying to control episodes of incontinence by decreasing fluid intake. Which suggestion is the most helpful to the patient? 1. Drink 2 liters of fluid every day unless your provider says otherwise 2. Consume fluids early in the day and reduce fluid intake after 7:00 pm 3. Divide total fluid into small portions spread throughout the day 4. Restrict fluid intake until alternative methods are tried and successful

Answer 2: Avoiding fluids after 7:00 pm helps to decrease incontinence at night, and this is a specific suggestion that helps the patient to gain some control. Drinking 2 liters per day is correct, but this is less helpful, because it does not address the issue of incontinence. Dividing the fluid into small portions is a strategy for patients who must be on fluid restriction for medical conditions, such as end-stage renal failure. Decreasing total fluid intake makes the urine more concentrated and irritating, and incontinence may worsen. Interventions, such as Kegel exercise, environmental modification, or bladder training are preferable to decreasing fluid intake.

For a patient experiencing urinary retention, which assessment is the nurse most likely to perform? 1. Assess patient's ability to safely ambulate to the bathroom 2. Inspect the skin for signs of maceration or irritation 3. Gentle palpation of the area over the symphysis pubis 4. Assess and monitor laboratory values, especially electrolytes

Answer 3: Severe urinary retention can cause bladder distention, and the nurse would gently palpate the bladder area.

Which hospitalized client is at highest risk for catheter associated urinary tract infection (CAUTI)? 1. client with diabetes mellitus 2. client who had one course of antibiotic therapy 3. client with a family history of UTIs 4. client with a urinary calculus

Answer: 1 Clients who are immunosuppressed, have diabetes mellitus, or have undergone multiple courses of antibiotic therapy are prone to bacterial, fungal, and parasitic infections. Taking one course of antibiotic therapy or having a family history of UTIs does not make a client at high risk for development of a CAUTI. A predisposing factor for a UTI is ongoing problems of urinary calculi; one calculus would not place a client at high risk.

A nurse is caring for an elderly male client who complains that he can't pass urine. A bladder scan reveals 600 ml of urine present in the bladder. The nurse attempts to place the indwelling catheter the physician ordered, but resistance prevents the nurse from placing it. A serum prostate-specific antigen (PSA) test indicates a level of 29 g/L. The physician places an indwelling catheter and the urine specimen returns positive for nitrites, leukocytes, and bacteriuria. Which conditions should the nurse suspect? Select all that apply. 1. prostate problems 2. urinary tract infection (UTI) 3. acute renal failure 4. vitamin K deficiency 5. liver failure

Answer: 1, 2 An elevated PSA level and lower urinary tract symptoms may indicate a prostate problem. A urine specimen positive for leukocytes, nitrites, and bacteriuria indicates UTI. The client's signs and symptoms don't indicate acute renal failure, liver failure, or a vitamin K deficiency.

A client has been prescribed allopurinol for renal calculi that are caused by high uric acid levels. Which symptoms indicate the client is experiencing adverse effect of this drug? Select all that apply. 1. nausea 2. rash 3. constipation 4. flushed skin 5. bone marrow depression

Answer: 1, 2, 5 Common adverse effects of allopurinol include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.

The nurse is caring for a client with a cystectomy and ileal conduit (urostomy) for prior bladder cancer. Which statements by the client would indicate that teaching has been effective? Select all that apply. 1. "I understand that I will need to consume adequate amounts of fluids each day." 2. "It is important to observe the color and odor of my urine." 3. "This ostomy pouch is temporary until my surgery can be reversed." 4. "I should eat a diet high in protein and carbohydrates." 5. "Redness around the stoma should be reported to my physician."

Answer: 1, 2, 5 Teaching regarding care of the ostomy is important to maintain a healthy environment. The increased intake of fluids will keep the urine dilute and will help flush out bacteria. Observing the color and amount of urine will help determine whether output is adequate. Reporting redness will identify early symptoms of an infection. "This ostomy pouch is temporary until my surgery can be reversed" and "I should eat a diet high in protein and carbohydrates" are incorrect because an ileal conduit is permanent--the bladder has been removed. Furthermore, a diet high in protein is not recommended for problems with the urinary system because it can damage the kidneys.

The nurse is caring for a client with bladder cancer with an ileal conduit. What is a characteristic of the urine in the ostomy immediately postoperatively? Select all that apply. 1. mucus threads in the urine 2. dysuria 3. urinary output > 30 mL per hour 4. gross hematuria 5. anuria

Answer: 1, 3 The nurse will expect to see urine output from an ileal conduit as mucus threads in the urine and urinary output > 30 mL per hour. The client will not have painful urination and gross hematuria. The client should have continuous urination, not absence of urine (anuria).

A client is scheduled to undergo weekly intravesical chemotherapy for bladder cancer for 8 weeks. Which statement indicates that the client understands how to manage the urine as a biohazard? 1. "I'll void into a bedpan and then empty the urine into the toilet." 2. "I can disinfect the urine and toilet with bleach for 6 hours following a treatment." 3. "It's important to clean the bathroom daily with disinfectant wipes." 4. "I should use a separate bathroom from the rest of the family for the next 8 weeks."

Answer: 2 After intravesical chemotherapy, the client must treat the urine as a biohazard; this involves disinfecting the urine and the toilet with household bleach for 6 hours following a treatment. It is not necessary to use a bedpan and then empty the urine in the toilet; the client can use the toilet, but must disinfect the urine with bleach. The bathroom does not need to be cleaned daily with disinfectant wipes. The client does not need to use a separate bathroom as long as the client's urine is disinfected with bleach.

A client with prostate cancer is treated with a luteinizing hormone-releasing hormone agonist and antagonist goserelin. What symptom should the nurse instruct the client to expect while receiving this treatment? 1. tenderness of the scrotum 2. flushing 3. loss of pubic hair 4. decreased blood pressure

Answer: 2 Goserelin is used to decrease testosterone production in men to slow or stop the production of cancer cells. A common side effect is flushing or hot flashes. Changes in blood pressure, tenderness of the scrotum, and dramatic changes in secondary sexual characteristics should not occur.

A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is present for their first day on the unit. An agency nurse and an experienced nurse are also present on the unit. The charge nurse should assign the new graduate to the care of: 1. a client who had an ileal conduit 3 days ago, an elderly client with a urinary tract infection (UTI), and an adolescent with kidney stones. 2. an elderly client with bladder cancer awaiting surgery, an elderly client who had a prostatectomy and bladder irrigation 2 days ago, and an elderly client with renal insufficiency. 3. a middle-age client who had a kidney transplant 3 days ago, an elderly client in acute renal failure, and an elderly client with urinary sepsis. 4. an elderly client just admitted for acute stroke, a young adult client with suspected kidney stones, and a middle-age client with suspected pyelonephritis.

Answer: 2 The charge nurse should assign the new nurse to the elderly client newly diagnosed with bladder cancer awaiting surgery, the elderly client who recently had a prostatectomy with bladder irrigation, and the elderly client with renal insufficiency. These clients have conditions common to the genitourinary floor. The charge nurse should assign the agency nurse to the client who had an ileal conduit, the older adult client with a UTI, and the adolescent with kidney stones. Their conditions have lesser acuity. The charge nurse should assign the experienced nurse to the most acute clients: the middle-age kidney-transplant recipient, the older adult client in acute renal failure, the older adult client with urinary sepsis, the older adult client just admitted for acute stroke, the young adult client with suspected kidney stones, and the middle-age client with suspected pyelonephritis.

The nurse is caring for a client with urinary calculi of unknown origin. Which interventions would be appropriate for this client? Select all that apply. 1. Restrict fluid. 2. Strain urine. 3. Medicate for pain. 4. Decrease calcium intake. 5. Administer allopurinol.

Answer: 2, 3 Strain the urine to obtain the stone and send it for analysis, which will assist the healthcare provider in determining the correct course of treatment to prevent a recurrence. Urinary calculi are very painful and require pain medication. Client needs to increase fluid to flush out the stone. It is not appropriate to decrease calcium until it is determined that the stone consists of calcium. Allopurinol would only be ordered if the stone consisted of uric acid.

The nurse is collecting data on a client with a urinary tract infection (UTI). Which statements should the nurse expect the client to make? Select all that apply. 1. "I urinate large amounts." 2. "I need to urinate frequently." 3. "It burns when I urinate." 4. "My urine smells sweet." 5. "I need to urinate urgently."

Answer: 2, 3, 5 Typical data collection findings for a client with a UTI include urinary frequency, burning on urination, and urinary urgency. The client with a UTI typically reports frequent voiding in small amounts, not large amounts. The client with a UTI complains of foul-smelling, not sweet-smelling, urine.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about? 1. chronic, excessive acetaminophen use. 2. recent streptococcal infection. 3. childhood asthma. 4. family history of pernicious anemia.

Answer: 2. A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.

In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. What additional sign should the nurse assess? 1. nephritis 2. referred pain 3. urine retention 4. additional stone formation

Answer: 2. The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and to the testicles in male clients. Nausea, vomiting, abdominal cramping, and diarrhea may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of pain described in this situation is unlikely to be caused by additional stone formation.

A nurse is caring for a chronically malnourished homeless client who was admitted with severe diarrhea for 2 days. What does the nurse determine is a priority potential problem? 1. hypervolemia 2. renal calculi 3. albumin level of 4.3 g/dL 4. hypoparathyroidism

Answer: 2. Although hypervolemia is a possibility if the client is rehydrated too quickly, the question is asking what could result from the client's admitting condition. Clients who are malnourished and/or have diarrhea tend to have lower pH (acidic) urine levels, putting them at higher risk of renal calculi. The albumin level is normal. Hypoparathyroidism is not caused by diarrhea.

Which finding in the client's history would be the least likely to have predisposed the client to renal calculi? 1. having had several urinary tract infections in the past 2 years 2. having taken large doses of vitamin C over the past several years 3. drinking less than the recommended amount of milk 4. having been on prolonged bed rest after an accident the previous year

Answer: 3. A high, rather than low, milk intake predisposes to renal calculi formation, owing to the calcium in milk. Recurrent urinary tract infections are implicated in stone formation as certain bacteria promote stone formation. High daily doses of vitamins C are a risk factor because they can increase the citric acid level. Prolonged immobility is a risk factor for renal calculi because it causes calcium to be released into the bloodstream.

Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateral crackles and observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcal glomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take? 1. Encourage activity as tolerated. 2. Provide a high-protein, fluid-monitored diet. 3. Monitor patient blood pressure. 4. Place the client on a sheepskin, and monitor for increasing edema.

Answer: 3. Blood pressure control is a priority assessment in clients with poststreptococcal glomerulonephritis. The blood pressure can be increased for up to 6 weeks after treatment. The nurse must provide a low-protein diet during the acute phase. The nurse must also closely monitor the client's fluid intake and output. Clients should be placed on bed rest to control hypertension and workload on the kidney. Although providing comfort measures (such as placing the client on a sheepskin) are important, this action isn't a priority.

An older woman has begun to stay in her apartment, avoiding socializing with her peers in the independent living center. She states that she cannot wait when she needs to urinate. She is afraid that she will have an accident. It is most appropriate for the nurse to: 1. Tell her not to worry because many of the other ladies have the same problem. 2. Suggest that she begin to wear an adult incontinence garment when she goes out. 3. Recommend that she restrict her fluid intake so the problem does not occur as often. 4. Provide encouragement and discuss Kegel exercises and other approaches to cope with incontinence.

Correct answer: 4 Older adults may hesitate to discuss incontinence problems with the physician or nurse because they are embarrassed or because they think that incontinence is simply a problem of aging that they must endure. Therefore the topic must be introduced in a sensitive manner by caregivers. In some cases, incontinence is curable using surgery, medications, or other treatments. In other cases, it can be better managed, thus allowing the older person a more normal lifestyle.

Your patient Mrs. F. has been diagnosed with urge urinary incontinence. Which of the following are appropriate nursing interventions? (Select all that apply.) 1. Avoid placing throw rugs in her room 2. Offer her a cup of tea to reduce detrusor muscle spasms 3. Place her close to the restroom, and remind her of its location 4. Secure her pants with safety pins to keep them secure

Correct answers: 1, 3 A person with urge UI is at particular risk of falls from rushing to the bathroom; therefore environmental hazards need to be minimized. Caffeine should be avoided, as it stimulates the bladder. Clothing should be easy to maneuver for quick removal, and it is helpful if bathrooms are situated close by and the person with urge incontinence is aware of their location.