Chapter 22: Urinary elimination

39. A nurse is caring for a client with an indwelling urinary catheter. A urine specimen for culture and sensitivity is prescribed. What should the nurse do when collecting this specimen? 1. Place the urine specimen in a sterile urine container. 2. Obtain the urine specimen from the hourly urine chamber of the collection bag. 3. Collect the urine specimen from the drainage port at the bottom of the collection bag. 4. Take the urine specimen directly from the distal end of the catheter after separating it from the tubing.

1

5. A nurse is caring for a client who has a urinary retention catheter. A urine culture and sensitivity is prescribed. Which step ensures that the collected specimen is sterile? 1. Swab the specimen port with an antiseptic swab. 2. Don sterile gloves when obtaining the specimen. 3. Use a urinalysis container to collect the specimen. 4. Collect the specimen early in the morning before breakfast.

1

A nurse is caring for an older adult female who says, "Why am I always getting bladder infections?" How should the nurse respond? 1. "Women have a shorter urethra than men do, and that makes women more susceptible than men to bladder infections." 2. "Older adults may experience retained urine, which becomes more acidic and promotes the development of bladder infections." 3. "It is hard for women to cleanse the urinary meatus, which increases the risk of bladder infections." 4. "Infrequent sexual intercourse predisposes women nurse is caring for an older adult female who says, to bladder infections."

1

21. Which of the following is essential to ensure reliable bedside dipstick testing of urine? Select all that apply. 1. Use the correct reagent. 2. Ensure adequate lighting. 3. Ensure that the kit is not past the expiration date. 4. Avoid delegating the procedure to another nursing team member. 5. Read the test results immediately after removing the test strip from the urine.

1,2,3

3. A nurse identifies that a client may be experiencing urinary retention. Which clinical indicators support this inference? Select all that apply. 1. Voiding small amounts of urine several times hourly 2. Abdominal palpation indicating bladder distention 3. Tenderness over the symphysis pubis on palpation 4. Dysuria on voiding 5. Blood-tinged urine

1,2,3

28. A nurse is caring for a client who has an indwelling urinary catheter. Which nursing actions are important to include in this client's plan of care? Select all that apply. 1. Obtain the vital signs routinely. 2. Cleanse the perineal area several times a day. 3. Monitor the tubing for kinks and obstructions. 4. Assess the urine for color, cloudiness, and volume. 5. Attach the drainage collection bag to the bed railing. 6. Position the drainage bag above the level of the bladder.

1,2,3,4

11. A client reports signs and symptoms associated with urge incontinence. Which actions should the nurse teach the client to employ to gain better bladder control? Select all that apply. 1. Practice Kegel exercises. 2. Avoid lifting heavy objects. 3. Avoid products with caffeine. 4. Attend a bladder retraining program. 5. Use the Credé maneuver when voiding. 6. Urinate immediately when feeling the sensation to void.

1,2,3,4,6

19. A nurse is caring for a group of clients with a variety of urinary retention catheters. Which of the follow- ing nursing interventions are common to all types of urinary catheters? Select all that apply. 1. Provide perineal care three times a day and when- ever necessary. 2. Position the collection container below the level of the pelvis. 3. Ensure that the balloon is filled with sterile saline. 4. Hang the collection bag on the frame of the bed. 5. Tape the collection tubing to the inner thigh

1,2,4

25. A nurse is caring for a client with a diagnosis of UTI. Which clinical indicators identified during a nursing assessment support this medical diagnosis? Select all that apply. 1. Dysuria 2. Hematuria 3. Urinary retention 4. Urgent sensation to void 5. Distended suprapubic area

1,2,4

9. A client with a history of urinary tract infections asks the nurse for suggestions to limit their occurrence. Which should the nurse encourage the client to ingest to inhibit the growth of microorganisms that can cause a bladder infection? Select all that apply. 1. Eggs 2. Meats 3. Apple juice 4. Whole-grain breads 5. Concentrated cranberry juice

1,2,4,5

. A home-care nurse is caring for a cognitively intact woman who has arthritis that affects her hands, hips, and knees and slows her mobility. The client tells the nurse about having a few episodes of urinary incontinence that were upsetting. The nurse identifies that the client is experiencing functional incontinence. Which nursing interventions in the plan of care are specific to limiting episodes of incontinence in this client? Select all that apply. 1. Encourage wearing clothing with Velcro closures instead of buttons and zippers. 2. Suggest purchasing a lift chair if economics permit. 3. Encourage avoiding products with caffeine. 4. Teach to position a commode nearby. 5. Teach the client Kegel exercises. 6. Suggest voiding every 2 hours

1,2,4,6

34. A nurse is caring for a client with a history of experiencing residual urine after voiding. The nurse uses a bladder ultrasound scanner (BUS) to detect the amount of urine that remains in the bladder after the client voids. Which actions should the nurse implement that are essential to this test? Select all that apply. 1. Repeat the measurement several times. 2. Provide perineal hygiene before the procedure is initiated. 3. Position the client in the supine position for the duration of the procedure. 4. Explain that no discomfort will be experienced as the transducer is moved on the surface of the skin. 5. Place the scan head on the abdomen, midline four inches above the pubic bone, aiming the scan head toward the coccyx.

1,3,4

33. A 24-hour urine test is prescribed. Which actions should be implemented by the nurse when conduct- ing this test? Select all that apply. 1. Have the client void one last time at the end of the 24 hours and add it to the volume being collected. 2. Have the client void one last time at the end of the 24 hours and discard this urine. 3. Collect the first voiding and then add subsequent voidings for the next 24 hours. 4. Discard the first voiding and then collect the urine for the next 24 hours. 5. Store the collected urine during the 24 hours in a collection container.

1,4,5

1. A hospitalized 70-year-old adult had a computed tomography (CT) scan with contrast at 11 a.m. The client has an IV running at 125 mL per hour and ingested 50% of lunch with an 8-oz cup of coffee and 4 oz of soup at 12 noon. The nurse is going on a break at 1 p.m. and provides the following information to the nurse accepting responsibility for the client. Which information about the client is of most concern to the nurse accepting responsibility for the client? 1. Presence of slight nausea 2. Urine output 100 mL at 12:45 3. Blood pressure 148/84 mm Hg 4. Medicated for a mild headache

2

23. A nurse is caring for a client who is having urine collected for a 24-hour urine test. During the afternoon of the testing period, the client forgets and accidentally voids into the toilet but tells the nurse right away. What should the nurse do next? 1. Start the test again in the morning. 2. Identify the time and begin a new test. 3. Add the time since the previous voiding to the end of the test. 4. Notify the delay of the test to the primary health- care provider.

2

31. A postoperative client has an indwelling catheter that has not drained urine in 2 hours. What should the nurse do first? 1. Ask the primary health-care provider for a prescription to irrigate the catheter. 2. Milk the tubing to dislodge any mucus or sediment in the catheter. 3. Palpate the client's suprapubic area to assess for distention. 4. Recognize the client's status is within expected limits.

2

32. A nurse is caring for a client receiving continuous bladder irrigation (CBI) after prostate surgery. Which nursing action is essential when caring for this client? 1. Check the volume of the client's output every hour to ensure tube patency. 2. Increase the irrigation solution flow rate until the return flow is pink and free from clots. 3. Irrigate the double-lumen catheter according to the primary health-care provider's prescription. 4. Turn the client from side to side to promote output, which helps to minimize clot formation in the urine.

2

A nurse receives a prescription to collect a clean-catch urine. What specific techniques should the nurse use that are different from those used to obtain urine for a urinalysis? Select all that apply. 1. The urine specimen should be sent to the laboratory as soon as possible after it is obtained. 2. The urine should be collected in the middle of a free-flowing stream of urine. 3. The urinary meatus must be cleansed three times with an antiseptic swab. 4. The urine specimen should be obtained first thing in the morning. 5. The urine specimen should be collected in a sterile container.

2,3,5

13. A nurse is caring for a female client who has a history of frequent urinary tract infections. What should the nurse teach the client to do? Select all that apply. 1. Wear nylon underwear. 2. Avoid artificial sweeteners. 3. Void before having intercourse. 4. Take a bubble bath rather than showering. 5. Urinate when the urge to urinate is perceived. 6. Encourage the intake of concentrated cranberry juice daily

2,5,6

10. Which nursing intervention is most effective when assisting a client to completely empty the bladder? 1. Place the client's hands in warm water. 2. Place a warm, wet washcloth over the genital area. 3. Encourage the client to wait a minute and attempt to urinate again. 4. Turn a faucet on in the client's room to produce sounds of flowing water.

3

16. A nurse is caring for a postoperative client with a urinary retention catheter. The nurse reviews the surgeon's prescriptions, reviews the last nursing progress note, and performs a physical assessment of the client. Which action should the nurse perform first? 1. Ambulate the client in the room. 2. Encourage coughing and deep breathing. 3. Empty the client's urine collection chamber hourly. 4. Turn off the compression device during ankle pumping exercises.

3

27. A straight catheterization is prescribed for a client who has urinary retention. The draining volume reaches 750 mL without completely emptying the bladder. What alternative does the nurse have to help prevent bladder spasms? 1. Remove the catheter and reinsert a retention catheter. 2. Continue the complete emptying of the client's bladder. 3. Release the remaining urine in the bladder slowly over 20 minutes. 4. Take the catheter out and then recatheterize the client in 20 minutes.

3

24. A nurse is assessing a client with the diagnosis of urinary tract infection (UTI). Which clinical indicators identified by the nurse support this medical diagnosis? Select all that apply. 1. Sweet, fruity odor to the urine 2. Dark amber color of urine 3. Blood-tinged urine 4. Cloudy urine 5. Foamy urine

3,4

29. A nurse receives a prescription to initiate continuous bladder irrigation. Which catheter should the nurse choose to perform the procedure correctly? 1. Straight catheter 2. Indwelling catheter 3. Triple-lumen catheter 4. Double-lumen catheter

3

18. A nurse is caring for a 3-week-old infant. Which assessment regarding the number of diapers the infant soils daily should cause concern? 1. 7 2. 8 3. 9 4. 10

1

35. A nurse is caring for a client who is scheduled for a cystoscopy. Which information should the nurse include when telling the client about what to expect after the procedure? 1. Urinary retention may occur after the procedure. 2. Urine may be dark red initially after the procedure. 3. Bedrest is necessary for several days after the procedure. 4. A clear liquid diet generally is prescribed for a few days after the procedure.

1

7. While all of the following clinical manifestations are important to report to a primary health-care provider, which is most important? 1. Anuria 2. Dysuria 3. Polyuria 4. Nocturia

1

22. A client's specific gravity is 1.032. For what additional clinical indicators should the nurse assess the client? Select all that apply. 1. Weight loss 2. Hypertension 3. Peripheral edema 4. Decreased skin turgor 5. Rapid, weak pulse rat

1,4,5

15. A nurse is caring for a group of clients. Which client should cause a concern about potential urinary retention? 1. The client who is immobile in bed 2. The client who just had a retention catheter removed 3. The client who is disoriented to time, place, and person 4. The client who just was placed on a fluid restricted diet

2

26. A nurse is assessing a client and is concerned that the client may be experiencing urinary retention. Which clinical indicators support this conclusion? Select all that apply. 1. Blood-tinged urine 2. Amber-colored urine 3. Reports of abdominal pressure 4. Lower abdominal distention on palpation 5. Voiding small amounts of urine at a time

3,4,5

17. A female client is scheduled for thoracic surgery and is told by the surgeon that a urinary catheter will be placed in the bladder in the operating room. After the surgeon leaves, the client asks the nurse, "Why am I going to have a tube in my bladder when I am having surgery in my chest?" Which response by the nurse is appropriate? 1. "It is more convenient to control urine flow rather than having to clean a client after being incontinent." 2. "We want clients to rest after your type of surgery. You will not be burdened with having to use a bedpan." 3. "A urinary catheter enables us to easily secure a urine specimen for laboratory tests that generally are prescribed after surgery." 4. "Hourly urine production is monitored with a urinary catheter. It is an effective way to assess kidney and circulatory function."

4

2. A nurse is assisting a female client who is experiencing numerous daily episodes of urge incontinence to gain better control of urination. Which outcome reflects achievement of a goal associated with this client's urge incontinence? 1. Urinates every two hours while remaining dry between voiding 2. Wears an adult incontinence brief only when venturing outside the home 3. Empties the bladder every time before leaving the house, limiting incontinence 4. Uses deep, slow breathing until the sensation to void subsides, increasing intervals between voiding

4

37. A nurse is obtaining a health history from a client. The client states that she is embarrassed about episodes of incontinence when she sneezes or exercises and that she no longer attends an exercise program for this reason. She now walks several miles a day to lose the 50 lb she gained when pregnant with her fifth child. Based on this information, which nursing intervention will best help the client to address the underlying cause of her lack of urine control? 1. Teach the client foods to avoid that irritate the bladder mucosa. 2. Encourage the client to return to her exercise class. 3. Have the client prepare a toileting schedule. 4. Teach the client Kegel exercises.

4

38. The nurse is caring for an older adult who is receiving oxybutynin to reduce the occurrence of bladder spasms related to a UTI. For which side effects should the nurse assess the client? Select all that apply. 1. Dizziness 2. Diaphoresis 3. Gastric irritation 4. Urinary retention 5. Orange-colored urine

4

8. A client reports concern about not having urinated in several hours, having the sensation of the need to void, and having moderate abdominal distention. What should the nurse do first? 1. Encourage the client to drink more fluid. 2. Stroke the inner aspect of the client's thigh. 3. Pour warm water over the client's perineal area. 4. Have the client assume an upright position for voiding.

4