Ch 45 Urinary Elimination
An obese client reports leaking urine while coughing. What management strategies should be included in the client's treatment plan? Select all that apply.
Kegel exercises Weight Control Measures
The nurse directs the NAP to remove a Foley catheter The nurse directs the NAP to remove a Foley catheter at 1300. The nurse would check if the client has voided by:
1700. The client may experience urinary retention after removal of the catheter. If 4 hours after Foley removal have elapsed without voiding, it may be necessary to reinsert the Foley.
A 55-year-old man is admitted to the hospital with urinary retention. The health care provider orders catheterization for the client. When setting up the supplies for catheterization, which size catheter should the nurse select for this client?
18 fr
A nurse is documenting the removal of a urinary drainage catheter from a client. If the catheter is removed at 9:00 AM, what time is the client due to void?
1:00 pm (4 hours later)
An elderly client has undergone a radical retropubic prostatectomy and will need an indwelling catheter. Which balloon size is most appropriate for this client?
30 mL to provide hemostasis to the prostatic bed
A nurse works in a renal care unit. Which client would require a long-term indwelling catheter?
A client with terminal illness requiring frequent changes of the bed linen Long-term indwelling catheterization is used in clients who have a permanent condition and cannot be managed with intermittent or short-term catheterization. The client who has a terminal illness and requires frequent changes of bed linens should be catheterized long term. Frequent changes of linen may be uncomfortable and painful for the client. The client who underwent a surgical repair of the bladder would need a short-term catheter until the recovery happens. A client with prostate enlargement would also require a short-term catheterization until the enlargement is treated. A client who requires an assessment of residual urine volume would require an intermittent catheterization. Text Reference - p. 1061
The nurse is preparing to administer erythropoietin to a client who presents with a deficiency. The nurse knows that the client needs this medication because of dysfunction in which organ?
Kidney Kidneys produce erythropoietin. Clients 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.
An older adult presents with urinary frequency due to cystitis. What nursing instructions are helpful to this client? Select all that apply
Advise intake of cranberry juice. Encourage client to increase fluid intake. Discourage intake of coffee, tea, cola, and alcohol.
The client states that she "loses urine" every time she laughs or coughs. The nurse teaches the client measures to regain urinary control. The nurse recognizes the need for further teaching when the client states:
Alcohol is a bladder irritant. It increases urine production and causes uncontrolled bladder contractions.
A client suffering from bladder cancer is operated on, and an orthotopic neobladder is placed in the client. What should the nurse explain to this client?
An orthotopic neobladder is placed at the same position as the normal bladder, and the client is able to void normally. The bladder pouch needs to be catheterized frequently in case a continent urinary reservoir is created from a distal portion of the ileum and proximal portion of the colon. In an incontinent urinary diversion, the urine drains continuously and needs application of a collection pouch at all times. Text Reference - p. 1047
What measures should the nurse emphasize to prevent urinary infection in females? Select all that apply.
Proper hand washing Wiping from front to back after voiding and defecation Adequate fluid intake
The client is incontinent, and a condom catheter is placed. The nurse should take which action?
Assess the client for skin irritation.
The nurse is teaching a group of licensed vocational/practical nurses (LVNs/LPNs) about the pathogenesis of urinary infections. Which information pertaining to catheter-associated urinary tract infection (CAUTI) should the nurse include in the teaching? Select all that apply.
Bacteria inhabit the vagina. Bacteria inhabit the distal urethra in men and women. Escherichia coli is the common causative organism. Catheter-associated urinary infection is caused by bacteria that inhabit the vagina in women and by bacteria that inhabit the distal urethra in men and women. The common organism responsible for CAUTI is Escherichia coli. The infection is ascending in nature, as bacteria cause infection as they ascend the urinary tract. Bacteria from the colon are the main causes of urinary infections.
Since removal of the client's Foley catheter, the client has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first?
Check for bladder distention.
The nurse notes that the client's Foley catheter bag has been empty for 4 hours. The priority action would be to:
Check for kinks in the tubing.
The nurse assesses that the client has a full bladder, and the client states that he or she is having difficulty voiding. The nurse would teach the client to:
Crede's Method (pressure on bladder)
A female client reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is:
Cystitis
The client's urine specific gravity is 1.05. The urine tests positive for ketone bodies. What could be the possible causes? Select all that apply.
Dehydration Starvation Diabetes Mellitus
What bone-related changes should a nurse expect to see in a client with chronic renal failure?
Demineralization A client with chronic renal failure cannot make sufficient amounts of active vitamin D. As a result, these clients are at risk of demineralization of the bone due to impaired calcium absorption in the intestine. The client with chronic renal failure will be hypocalcemic due to impaired calcium and phosphorus metabolism; therefore, there will not be calcification in the bones. Bone density will decrease due to demineralization. Chronic renal failure does not cause bone marrow hyperplasia.
Which term describes leakage of urine despite voluntary control of urination?
Dribbling **Incontinence is for involuntary control
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. The nursing assessment reveals that the client is obese, has had three pregnancies, and has already gone through menopause. The nurse understands that she is at increased risk of developing urinary tract infection. What nursing interventions are helpful to prevent a urinary tract infection in the client? Select all that apply.
Emphasize wearing cotton underwear. Promote complete emptying of bladder by double voiding. Emphasize the importance of perineal hygiene. Cotton underwear absorbs the moisture and helps to keep the skin on the perineal area dry. Residual urine in bladder promotes bacterial growth. Complete voiding reduces the risk of developing a urinary tract infection which may be achieved by double voiding. Perineal hygiene is important in preventing a urinary tract infection. The urethral meatus should be cleaned after each void or bowel movement. Adequate fluid intake helps to flush the microorganisms from the urinary tract, and prevent infection. Catheterization increases the risk of bladder infections, and should be avoided.
A 55-year-old man is admitted to the hospital with urinary retention. The client is catheterized to relieve retention. What actions are necessary to prevent infection in the client? Select all that apply.
Ensure a closed drainage system. Monitor the patency of the catheter. Ensure that the spigot does not touch any contaminated surfaces. Follow good hand hygiene techniques.
A nurse works in a dialysis unit. Which clinical situations require dialysis? Select all that apply.
Failed conservative management in correcting renal failure Worsening of uremic syndrome related to end stage renal disease Severe electrolyte disturbance which cannot be easily corrected
A nurse is reviewing the laboratory reports of a client. The urine report shows presence of large proteins in the urine. What is the most probable cause of proteinuria?
Glomerular injury The glomerular capillaries filter water, glucose, amino acids, urea, creatinine, and major electrolytes from the blood. Large proteins do not normally get filtered because of the size of protein molecules. However, if the glomeruli are injured, the large proteins may pass into the urine. The presence of white blood cells in the urine indicates infection of the urinary tract. The presence of ketones in urine may be due to excess ingestion of aspirin and starvation.
A client who presents with dribbling of urine is diagnosed with stress incontinence. What else should the nurse include in the assessment of this client? Select all that apply.
Height and weight Menopausal status Number of live births
A 55-year-old man is admitted to the hospital with urinary retention. What interventions should the nurse perform to stimulate the micturition reflex? Select all that apply.
Help the client to relax and void in a standing position. Tell the client to run water while trying to void. Pour warm water over the client's perineum. Helping the client relax and stimulate the micturition reflex can relieve urinary retention. Assuming a normal position of voiding also helps in micturition. The client should stand up and void. The sound of running water may stimulate micturition through suggestion. Pouring warm water over the client's perineum creates a sensation of urination and helps to stimulate the micturition reflex. Stroking the inner, not outer, thigh stimulates sensory nerves and helps in voiding. Catheterization relieves retention but does not stimulate the micturition reflex.
A client with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the client that he or she is at risk for: Select all that apply.
Infection Reflux Urine
The client has to provide a urine sample. What actions should the nurse perform? Select all that apply.
Instruct client to obtain a midstream sample. Specimen should be transported to the laboratory within 15-30 minutes. Specimen might require refrigeration if it does not reach the laboratory within 30 minutes. The nurse should collect a midstream urine sample because it is free from urethral and dermal contaminants. As 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 sample usually contains dermal contaminants. Initial stream sample contains urethral contaminants.
The nurse receives a prescription to obtain a post-void residual for a client via catheterization. What is the best way to obtain this measurement?
Intermittent catheterization
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 client about her disorder? Select all that apply.
It occurs due to weakness of muscles around the urethra. It is called stress incontinence. It occurs when the intra-abdominal pressure exceeds urethral resistance. 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 intra-abdominal 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.
The nurse is teaching a client with Parkinson's disease about the prescribed medication levodopa (Dopar). What should the nurse include in the teaching related to the urinary system?
It turns the urine brown or black.
An older male client states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this client is to:
Kegel exercises
The nurse understands that urinary tract infections (UTIs) in women are eight times more common than in men. What are the reasons for this? Select all that apply.
Lack of antibacterial substances in vaginal secretions. Failure to wipe from front to back after voiding or defecating. The urethra lies closer to the anus than it does in males. The urethra is shorter than it is in males.
The nurse is reviewing the urinalysis report for a client. Which finding indicates possible glomerular injury?
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 health care provider instructs the nurse to insert an indwelling urinary catheter in a client for 3 weeks. What type of catheter is the best choice for this client to prevent infection and promote comfort?
Latex --- 3 weeks
A client is being assessed for a possible urinary tract infection (UTI). Before sending a urinalysis specimen to the laboratory, a nurse collects a small amount of urine to perform a dipstick test. If the client has a UTI, which component should be detected in the urine?
Leukocytes
A known diabetic client is on amitriptyline (Elavil) for pain. The client has been recently diagnosed with Parkinson's disease and is put on levodopa (Dopar). The client complains of brownish discoloration of urine. What could be the reason for this urine color?
Levodopa can cause brownish or blackish discoloration of urine due to its chemical composition. Diabetes can cause kidney problems and result in hematuria, in which urine could be red. Amitriptyline causes bluish or greenish discoloration of urine. Parkinson's disease is not associated with a change in urine color.
To minimize the client experiencing nocturia, the nurse would teach him or her to:
Limit fluids before bedtime. (2 hours)
A client reports a burning sensation and pain while passing urine, as well as fever and chills. What should the nurse include in the assessment?
Look for presence of blood in the urine Pain and a burning sensation during urination are symptoms of a lower urinary tract infection. Irritation to the bladder mucosa by bacteria frequently causes hematuria (blood in the urine), so presence of blood in the urine is another sign of a urinary tract infection. Urinary tract infections are not contagious, so asking if any other family members are sick will not help. Assessing the client's height and weight is important, but not relevant to a urinary tract infection. Whether or not the client has a history of hypertension is irrelevant to urinary tract infections.
A nurse, along with nursing assistive personnel (NAP), is catheterizing a client with neurogenic bladder. What are the responsibilities of the NAP? Select all that apply.
Maintain the privacy of the client. Provide perineal care. Assist in the positioning of the client. The nursing assistive personnel (NAP) are responsible for maintaining the privacy of the client. The NAP also provide perineal care before and after the procedure, and is responsible for assisting the nurse in positioning the client 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.
What are the pre-test and post-test procedures should a nurse follow while managing a client who is scheduled for a cystoscopy? Select all that apply.
Monitor intake and output. Inform the client that he may have voiding difficulty post procedure. Inform the client that he may pass red-tinged urine post procedure. Fluid intake and urine output should be monitored post cystoscopy to determine obstruction or trauma to the urinary system. After the procedure, the client may have difficulty voiding or have red or pink urine because of trauma to the urethral or bladder mucosa. Fluids should be encouraged to promote urine formation and prevent infection. Cystoscopy can be used as a therapeutic procedure and may have untoward effects.
The client is to have an intravenous pyelogram (IVP). Which of the following apply to this procedure? Select all that apply.
Note any allergies. Encourage fluids after the procedure. The dye used in the procedure is iodine based. Assessing for history of any allergies can predict allergy to the dye used. Fluid intake dilutes and flushes the dye from the client.
A client complains of passing only a little amount of urine despite a normal fluid intake. What should the nurse record this as?
Oliguria Oliguria is the decrease in urine output in spite of normal intake. It often occurs when fluid loss through other means such as sweating, diarrhea, or vomiting increases. Pain or burning during urination is called dysuria. Excessive output of urine is known as polyuria and blood tinged urine is called hematuria.
A client with a bladder disorder is advised to get a urinary diversion. The client wishes to have the type of urinary diversion that allows normal voiding. Which type of urinary diversion suits the client's requirement?
Orthotopic neobladder using an ileal pouch Orthotopic neobladder of the ileal pouch is the diversion procedure that allows the client to have normal voiding. Nephrostomy tubes need urinary drainage directly from the renal pelvis. Incontinent urinary diversion is associated with continuous urinary drainage without the client's voluntary control. A radical cystectomy with an ileal conduit forms a stoma on the abdominal wall and necessitates life-long wearing of a stoma appliance and a drainage bag.
A nurse is conducting a health awareness program for a group of immunocompromised clients. Which fruit juice can make the bladder more susceptible to infections in these clients?
Pineapple (because it is citrus)
A client complains that he is not able to pass urine completely. Even after voiding, the client does not feel that the bladder is empty. What tests can be done to assess the postvoid residual (PVR) in the client?
Portable noninvasive bladder ultrasound device Postvoid residual can be assessed using a portable noninvasive bladder ultrasound device. It helps to determine the amount of urine left in the bladder after voiding. A cystoscopy helps to visualize the structures of the urinary tract. An x-ray of the abdomen may show the condition of abdominal organs, but is not helpful in determining the residual urine left in the bladder. An intravenous pyelogram may help to determine the function of the kidneys, but does not help in determining postvoid residual.
Which intervention is most appropriate for a client with functional urinary incontinence?
Provide normal fluid intake and establish a toilet schedule. (Habit training!) For physiologic health, a client needs to maintain normal fluid intake. A toileting schedule based on the client's elimination patterns can help reduce episodes of incontinence. Catheters are used as a last choice because of infection potential and body self-image issues. Fluid intake should be kept at normal levels; there is no need to increase it. Restricting the fluid intake may cause dehydration.
What are the roles of a nurse when caring for a client with urinary diversions? Select all that apply.
Refer the client to an ostomy nurse. Train the client on management of urinary diversions. Refer the client to ostomy associations for further support. Refer to client to United Ostomy Associations of America. Clients with urinary diversions require special care, and should be referred to an ostomy nurse. The ostomy nurse provides all the information about ostomy care, and educates the client about ostomy care. The client must be trained to properly manage the diversion and become independent, as it is a long-term condition. In addition, they should be referred to the United Ostomy Associations of America for more information. This organization provides information about support groups to enhance coping and adaptation to lifestyle and body image changes. The ostomy nurse assists the client and family members with matters pertaining to all aspects of care. Care must be taken not to pull on tubing, especially in a nephrostomy, since it can cause tissue and organ damage and infection.
A client is advised to undergo dialysis. What is an indication for dialysis?
Renal failure refractory to conservative management
client is advised to undergo dialysis. Which conditions are the indications for dialysis? Select all that apply.
Renal failure that does not respond to conservative therapy Worsening or uremic symptoms associated with renal failure Severe electrolyte and fluid imbalance
The nurse understands that hypertension can be caused by an impaired renin-angiotensin mechanism. Which statements accurately describe the renin-angiotensin mechanism? Select all that apply.
Renin is secreted by the juxtaglomerular apparatus. Angiotensin II causes peripheral vasoconstriction. Angiotensin II causes aldosterone secretion in the adrenal cortex. Renin is secreted in the juxtaglomerular apparatus of the kidneys in response to a drop in blood pressure. Angiotensin II has two functions. It causes peripheral vasoconstriction, which in turn increases blood pressure. It is also involved in secreting aldosterone from the adrenal cortex of the adrenal gland. Aldosterone also raises the blood pressure by causing water retention. Angiotensinogen is produced in the liver in response to renin production, not the lungs. The converting enzyme responsible for conversion of angiotensin I to angiotensin II is present in the lungs, not in the liver.
A nurse notices pus in the catheter of a client who had an indwelling catheter inserted four days ago. What nursing measure is appropriate for this client?
Replace with new one
client reports having the urge to void but urine starts leaking before she reaches the bathroom. Which treatment strategies would be helpful for the client? Select all that apply.
Scheduled toileting Absorbent products Clothing modification
The nurse who works in a medical surgical unit observes that women have a higher incidence of urinary tract infections than men. Why is this? Select all that apply.
Shortened urethra Absence of prostatic secretions Proximity of urethral meatus to anus
A male client returned from the operating room 6 hours ago with a cast on his right arm. He has not yet voided. Which action would be the most beneficial in assisting the client to void?
Suggest he stand at the bedside.
The nurse is teaching kidney function to a group of nursing students. Which of the following statements apply to kidney function? Select all that apply.
The kidneys produce several substances vital for maintenance of blood pressure. The kidneys produce several substances vital to bone mineralization. A nephron is a functional unit of the kidney and helps in urine formation. The kidneys filter waste products of metabolism and excrete them in the urine.
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. The nursing assessment reveals that the client is obese, has had three pregnancies, and has already gone through menopause. What nursing interventions would be helpful to this client in reducing incontinence? Select all that apply.
Teach the client Kegel exercises Advise the client to avoid caffeinated drinks. Stress the importance of losing weight. Kegel exercises increase the strength of muscles around the urethra and help to reduce stress incontinence. Losing weight helps to reduce stress incontinence. Cough is a reflex activity and is difficult to control voluntarily. Caffeinated drinks have a diuretic effect and increase stress incontinence. Lifting heavy weights increases abdominal pressure and thus increases incontinence; therefore, it should be avoided.
A client with renal failure is advised to undergo peritoneal dialysis. Which statement holds true for peritoneal dialysis?
The peritoneum functions as a semipermeable membrane. There are two types of dialysis: peritoneal and hemodialysis. In peritoneal dialysis, the peritoneum functions as a semipermeable membrane to remove accumulated wastes and toxins. In hemodialysis, the dialysate fluid is pumped through one side of the artificial semipermeable membrane. The client's blood is pumped through the other side. The client's blood becomes clean through osmosis, diffusion, and ultrafiltration. The clean blood is then returned to the body through specially placed devices, graft, fistula, or catheter. Text Reference - p. 1045
The postoperative client has difficulty voiding after surgery and is feeling "uncomfortable" in the lower abdomen. Which action should the nurse implement first?
Turn on bathroom water
A client is prescribed a uroflowmetry diagnostic test. The nurse knows this test determines which urinary abnormality?
Urinary incontinence Uroflowmetry (urodynamic testing) is the investigation that assesses bladder muscle function and evaluates the causes of urinary incontinence. Bladder cancer is diagnosed by cystoscopy, which allows the health care provider to visualize the bladder wall and biopsy the tumor. Ultrasound helps to identify structural abnormalities in the bladder. Intravenous pyelogram (IVP) helps to diagnose stones in the urinary tract.
An elderly male client has been admitted to the hospital for a urinary tract infection. Which of the following physiological changes in the urinary system should the nurse teach the client about? Select all that apply.
Urinary retention increases risk of urinary infection. Prostate enlargement may lead to urinary retention. Ineffective bladder contraction leads to urinary retention. Urinary retention increases risk for bacterial growth and development of urinary infection. Prostate enlargement may lead to urinary retention by obstructing the flow of urine. Because the bladder cannot contract effectively, an older adult often retains urine after voiding. The older adult often experiences nocturia. Prostate enlargement increases urinary frequency due to incomplete voiding.
A diabetic client's urine tests positive for glucose. What is the minimum level the nurse would expect the client's blood glucose to be at?
Urine will be positive for glucose when the glucose level is above the normal reabsorbtive capacity of the kidneys, which corresponds to 180 mg/100 ml of blood. Therefore, the urine will be positive for blood glucose above a concentration of 180 mg/100ml. Concentrations of 155 mg, 165 mg, and 175 mg are within the normal absorptive capacity of the kidney. Hence, the urine will be negative for glucose in these situations.
A nurse is caring for a client with urinary incontinence. What actions should the nurse perform to promote comfort for the client? Select all that apply.
Use absorbent pads. Catheterize the client with orders from the health care provider. Change dressings and linens when wet.
The nurse is educating a group of women about measures to reduce the risk of urinary tract infections. What should the nurse include in the teaching?
Wash hands frequently
What instructions regarding bladder training should be included in the teaching plan for the family of a client who is incontinent because of a stroke?
What instructions regarding bladder training should be included in the teaching plan for the family of a client who is incontinent because of a stroke? To begin a bladder-training program, a nurse should teach the family to offer the client the commode, bedpan, or urinal every 2 hours. When offered frequently enough, this prevents accidents and establishes a routine. Using a Foley catheter in a home setting increases the possibility of trauma or infections to the urethra and bladder. Decreasing the client's fluid intake could cause secondary complications of dehydration and electrolyte imbalance. The client is incontinent, so he or she is unable to hold the urine.
The nurse is reviewing the lab report of a client. The presence of what substance in the urine hints at the possibility of an abnormality?
glucose ++
