2821 Lecture | PrepU | Chapter 38: Urinary Elimination

The nurse has an order to obtain a 24-hour urine specimen from a client. Which instruction would be accurate for collection of the specimen? "You will need to have a catheter inserted for this collection." "Begin the collection when you first urinate in the morning." "Discard your first urine and begin the collection after that." "Start collecting the urine with the next time you urinate."

"Discard your first urine and begin the collection after that."

Which statement should the nurse convey to the parent of a 3-year-old male child who has not achieved urinary continence? Incontinence after the age of 3 years is not normal. Male children may take longer for daytime continence than female children. Male children may walk by 1 year and should be continent by 3 years. Daytime continence is usually not achieved by male children until age 5.

Male children may take longer for daytime continence than female children.

The nurse is choosing a collection device to collect urine from a nonambulatory male client. What would be the nurse's best choice? Urinal Bedpan Specimen hat Large urine collection bag

Urinal

A sterile urine specimen for culture and sensitivity has been prescribed for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen? Withdraw several milliliters of urine from the port on the collection tubing, using aseptic technique. Empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag. Discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen. Collect a urine specimen from the collection bag first thing in the morning, or a few hours after the client receives a diuretic.

Withdraw several milliliters of urine from the port on the collection tubing, using aseptic technique.

When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. What could cause this variation in color of the urine?

blood Explanation:A reddish-brown urine sample is indicative of the presence of blood. The urine appears dark amber in color due to dehydration. Infection and stasis would cause the urine to appear cloudy.

A client at a health care facility is being treated for cancer of the bladder. The health care provider uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion? inability to control either urinary or bowel elimination hygiene measures used to keep the meatus and adjacent area of the catheter clean use of a catheter to collect urine in a sterile environment one or both of the ureters are surgically implanted elsewhere

one or both of the ureters are surgically implanted elsewhere

A client reports to the nurse that after delivering an infant, they lose small amounts of urine each time they sneeze or laugh hard. Which type of incontinence does the nurse anticipate? total urge reflex stress

stress

The nurse is caring for a client who has been experiencing nausea, vomiting, and diarrhea for 3 days. Which urine characteristics does the nurse anticipate?

strongly aromatic, dark amber Explanation:The nurse anticipates that the client may be dehydrated, which is characterized by strongly aromatic, dark amber urine. The other characteristics are not associated with dehydration.

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine?

24-hour specimen Explanation:A 24-hour urine specimen is required for accurate measurement of the kidney's excretion of substances that the kidney does not excrete at the same rate throughout the day. A clean-catch or midstream-voided specimen is used when a specimen relatively free from microorganisms is required. Random urine specimen collection is used when sterile urine is not required.

Which is true regarding the normal urination? A. Catheterized clients should drain a minimum of 30 mL of urine per hour. B. Urinary output does not vary all that much between adults and children. C. In adults, the average amount of urine per void is 500 mL. D. In adults, the amount of urine voided typically does not depend on fluid intake and losses.

A. Catheterized clients should drain a minimum of 30 mL of urine per hour.

The nurse is caring for a client who has a history of acute kidney injury. What is an accurate step when caring for the client's hemodialysis access? Percuss the site to feel for a thrill or vibration. Auscultate over the site with a stethoscope to listen for a bruit. Use the affected arm if an IV must be started to avoid impairment of both arms. If a thrill is not palpable and/or a bruit is not detectable, assess for these signs in the other arm.

Auscultate over the site with a stethoscope to listen for a bruit.

A nurse is caring for a client who is catheterized following surgery of the prostate. When caring for the client, the nurse performs a continuous irrigation of the catheter. Which intervention should the nurse perform when providing continuous irrigation? A. Place the sterile solution on the bed. B. Prime the tubing with the solution. C. Clean around the urinary meatus. D. Empty the balloon with a syringe.

B. Prime the tubing with the solution. When providing continuous irrigation, the nurse must prime the tubing with the irrigation solution to ensure that no air enters the system. The nurse should hang the sterile irrigating solution from an IV pole, rather than place it on the bed, to allow it to flow freely. The nurse empties the balloon with a syringe and also cleans the urinary meatus when removing the catheter—not when irrigating the catheter.

The nurse is caring for a client with an indwelling urinary catheter. The nurse completes a prescription to obtain a urine specimen from catheter. After reviewing image, what is the most accurate note to document to demonstrate the steps to obtain the urine specimen were performed appropriately? A. "Obtained urine specimen from urinary drainage bag using a syringe, client expressed no discomfort during or after the procedure, verified prescription & cleansed access port." B. "Cleansed access port with warm soap & water, syringe attached, aspirated 10 mL of urine & placed in specimen container." C. "Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well." D. "Gathered supplies, checked prescription, collected urine from access port & notified health care provider at the completion of the procedure."

C. "Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well."

A nurse is performing a physical assessment of a client's urinary system. Which nursing actions are appropriate during this assessment? Select all that apply. If using a bedside scanner, place the client in a supine position. Measure the height of the edge of the bladder below the symphysis pubis. Inspect the urethral orifice for any signs of inflammation, discharge, or foul odor. Place male clients in the dorsal recumbent position for good visualization of the meatus. Retract the foreskin of an uncircumcised male client to visualize the meatus. The nurse assess the client's urine for color, odor, clarity, and the presence of any sediment.

If using a bedside scanner, place the client in a supine position Inspect the urethral orifice for any signs of inflammation, discharge, or foul odor. Retract the foreskin of an uncircumcised male client to visualize the meatus. The nurse assess the client's urine for color, odor, clarity, and the presence of any sediment..

The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises (Kegel exercises) will the nurse include? How long should pelvic muscles be contracted?

Keep muscles contracted for at least 10 seconds. Explanation:Kegel exercises should be performed by tightening the internal muscles used to prevent or interrupt urination for 10 seconds, followed by a period of 10 seconds of relaxation. The client should be instructed to perform this regimen 3-4 times daily for 2 weeks to 1 month.

The nurse caring for an older adult male client is determining whether the client can use a urinal to void. Which aspects of the client's medical history may contraindicate the use of a urinal? The client has had urinary catheters in place repeatedly during previous admissions. The client is acutely confused and has been diagnosed with delirium. The client was treated for kidney stones a few months earlier. The client has a history of benign prostatic hyperplasia (BPH; prostate enlargement).

The client is acutely confused and has been diagnosed with delirium. A client who is acutely confused is likely unable to manipulate a urinal effectively. Kidney stones, BPH, and previous catheterizations do not preclude the use of a urinal.

The nurse is caring for a client with concerns of urinary incontinence. A review of the client's data collection reveals the client has a history of spinal surgery and states, "I urinate all the time and cannot predict when I will urinate." This data collection would suggest to the nurse that this client is experiencing which type of urinary incontinence?

Total incontinence Explanation:Total incontinence may be the result of surgery, trauma, or physical malformation; the client has continuous and unpredictable loss of urine. Stress incontinence is related to an increase in intra-abdominal pressure and commonly occurs during activities such as coughing and sneezing. Overflow incontinence is associated with overdistention and overflow of the bladder, whereby the signal to empty the bladder is lost, the bladder fills, and the client dribbles urine. Functional incontinence occurs because the client is unable to reach the toilet.

The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice?

Urinal

The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate?

cloudy, foul odor Explanation:The nurse anticipates that the client has an infection, which is characterized by cloudy, foul-smelling urine. Urine is normally light yellow and clear. Dark amber urine that is strongly aromatic could indicate dehydration, but would not create the symptoms noted.

A client with a history of advanced liver disease comes to the emergency department (ED) with dehydration. White blood cell count shows elevation in bands and neutrophils. When preparing to catheterize the client, what color urine does the nurse anticipate will drain?

dark brown, cloudy Explanation:The client with advanced liver disease is expected to have dark brown or dark amber urine; infection may be represented by cloudy urine. Other answers are incorrect.

A client in a long-term care facility becomes confused and disoriented at night and is incontinent during these periods of confusion due to the inability to find the commode. During the day, the client does not experience confusion and is continent. What type of incontinence is this client experiencing during the nighttime hours?

functional incontinence Explanation:Functional incontinence is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, or loss of memory or disorientation. Stress incontinence occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. Reflex incontinence is an emptying of the bladder without the sensation to void. Transient incontinence appears suddenly and lasts for 6 months or less.

A client at the health care facility has been diagnosed with total urinary incontinence. How will the nurse describe the condition of the client? loss of large amount of urine when intra-abdominal pressure rises need to void is perceived frequently, with short-lived ability to sustain control of flow loss of bladder control as a result of adverse medication effects or psychological stress loss of urine without any identifiable pattern or warning

loss of urine without any identifiable pattern or warning

A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a:

neurogenic bladder. Explanation:Neurologic injury after a stroke or spinal cord injury can disrupt normal patterns of urinary elimination. This condition is called neurogenic bladder. A cystocele is a herniation of the urinary bladder. Enuresis is the clinical term for bedwetting. An overactive bladder is the term used when a person has increased urinary urge, increased urinary frequency, or both.

A client at a health care facility is being treated for cancer of the bladder. The physician uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion?

one or both of the ureters are surgically implanted elsewhere Explanation:The nurse should understand that in a urinary diversion, one or both of the ureters are surgically implanted elsewhere. This procedure is done for various life-threatening conditions. Incontinence is the inability to control either urinary or bowel elimination. Catheter care means the hygiene measures used to keep meatus and adjacent area of the catheter clean. In order to collect a catheter specimen, the nurse uses a catheter to collect a sample of urine in a sterile environment.