Chapter 36: Urinary Elimination Supplement

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? A.) cloudy, foul odor B.) light yellow, clear C.) clear, dark amber D.) strongly aromatic, amber

A.) cloudy, foul odor 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 nurse is caring for an elderly client in a long-term care setting. The client normally has a condom catheter applied overnight. Which of the following describes a condom catheter? A) A flexible sheath that is rolled around the penis. B) A bag attached by adhesive backing to the skin around the genitals. C) A urine drainage tube inserted but not left in place. D) A urine drainage tube that is left in place over a period of time.

Ans: A Feedback: A condom catheter is a flexible sheath that is rolled around the penis. A urinary bag (U-bag) is a bag attached by adhesive backing to the skin surrounding the genitals. A straight catheter is a urine drainage tube inserted but not left in place; a retention catheter is a urine drainage tube that is left in place over a period of time.

A 69-year-old man had a transurethral resection of the prostate early this morning and now has continuous bladder irrigation running. What is the primary goal of this form of irrigation? A) The client's catheter will remain patent and free of blood clots. B) The client's urinary output will be medium-amber to dark-amber in color. C) The client's bladder will contain between 100 and 300 ml of urine at all times. D) The client will maintain a normal cycle of bladder filling and urine elimination.

Ans: A Feedback: Continuous irrigations is intended to keep a catheter patent after prostate or other urologic surgery in which blood clots and tissue debris collect within the bladder and catheter. Because of the client's recent surgery and the volume of solution being instilled, the output will not be amber-colored. As well, bladder contents will be scant because of the continuous drainage. This intervention temporarily precludes normal bladder filling.

The nurse is caring for a client who has a urostomy. Which of the following should the nurse use to maintain the client's peristomal skin? A) Tampons B) Skin barrier products C) Antibiotic powder D) Skin tape

Ans: A Feedback: In order to maintain the integrity of the peristomal skin, skin barrier products are used, and sometimes antibiotic or steroid ointment is applied. The nurse should use a tampon when changing the urinary appliance. When changing the appliance, it may help to place a tampon within the stoma to absorb urine temporarily while the skin is cleansed and prepared for another appliance. However, this only applies during an appliance change. Antibiotics are not used in powder form. Skin tape is not an actual product.

The nurse is caring for an 18-year-old female client with a urinary tract infection. Which of the following is a factor that most affects the pattern of urine elimination in this client? A) Integrity of the client's spinal cord B) Diminished capacity of the client's bladder C) Degenerative changes in the client's cerebral cortex D) Relaxation of the client's pelvic floor muscle tone

Ans: A Feedback: Patterns of urinary elimination depend on the integrity of the spinal cord as well as physiologic, emotional, and social factors. Diminished bladder capacity, relaxation of pelvic floor muscle tone, and degenerative changes in the cerebral cortex are age-related changes that increase the risk of incontinence and lead to urinary urgency, respectively, in older adults.

A client at a health care facility is describing signs and symptoms that include polyuria. The nurse should recognize what aspect of this client's condition? A) Greater than normal urinary volume B) Inadequate elimination of urine C) Absence of urine D) Difficult or uncomfortable voiding

Ans: A Feedback: Polyuria means greater than normal urinary elimination. It may accompany minor dietary variations. For example, consuming higher than normal amounts of fluids, especially those with mild diuretic effects (e.g., coffee, tea), or taking certain medications actually can increase urination. Oliguria is inadequate elimination of urine. Anuria means the absence of urine. Dysuria is difficult or uncomfortable voiding.

A postsurgical client has been admitted to the unit with an indwelling urinary catheter that was inserted in the operating room and which is scheduled for removal the following morning. How can the nurse best avoid backflow or urine into the client's bladder and subsequent infection? A) Ensure that the collection bag is always lower than the client's bladder. B) Irrigate the catheter if clots or pus are visible in the tubing or collection bag. C) Ensure that the contents of the collection bag do not exceed 50% of capacity. D) Position the client in a high Fowler's position unless contraindicated.

Ans: A Feedback: The nurse always positions the drainage system lower than the bladder to avoid backflow of urine. High Fowler's positioning, catheter irrigation, and frequent emptying do not necessarily prevent the backflow of urine into the client's bladder.

When collecting a urine sample from a client for examination, the nurse notes that the sample appears dark amber in color. Which of the following could cause this variation in color of the urine? A) Dehydration B) Infection C) Urinary stasis D) Presence of blood

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

A nurse performs catheter irrigation for a client at a health care facility only after verifying that a medical order has been written. Why should the nurse take this precaution? A) To comply with medical directives B) To demonstrate legal limits of nursing C) To provide baseline for assessing outcome of procedure D) To provide an opportunity for health teaching

Ans: B Feedback: Before performing the catheter irrigation, the nurse checks the client's record to verify that a medical order has been written as this demonstrates the legal limit of nursing. The nurse needs to verify the irrigation solution prescribed in order to comply with the medical directives. In order to provide a baseline for assessing the outcome, the nurse should assess the characteristics of the urine. The nurse determines how much the client understands about catheter teaching as it provides an opportunity for health teaching.

A client in a health care facility has had a urinary catheter in situ for the past several days.The client's nurse has amended the client's plan of care to reflect the use of the device. What nursing diagnosis is a priority in this aspect of the client's care? A) Risk for deficient fluid volume B) Risk for infection C) Risk for impaired mobility D) Risk for acute pain

Ans: B Feedback: Indwelling urinary catheters pose a high risk of infection; this risk must be addressed by providing meticulous nursing care. Catheters do not result in fluid volume deficit. The risk of infection is more likely a threat to the client than risks for pain and impaired mobility.

A laboratory test of a client's urine indicates the presence of pus in the urine. Which of the following health problems should the nurse document? A) Hematuria B) Pyuria C) Glycosuria D) Ketonuria

Ans: B Feedback: The term ìpyuriaî refers to the presence of pus in the urine. Hematuria is the presence of blood in the urine, glycosuria is the presence of glucose in the urine, and ketonuria indicates that the urine contains ketones.

A nurse is caring for a male client whose prostatic hypertrophy has resulted in impaired urinary elimination. The nurse is aware of the vital importance of maintaining healthy urinary production and elimination because the functions of the urinary system include which of the following? A) Mobilizing glucose for distribution to body cells B) Eliminating the waste products of cellular metabolism C) Maintaining osmotic pressure within the bladder D) Eliminating undigestible components of the diet

Ans: B Feedback: Urinary elimination is the process of releasing excess fluid and metabolic wastes. Undigestible products are primarily excreted by the GI system, not the GU system. The urinary system does not distribute glucose and the maintenance of osmotic pressure in the bladder is not a primary role of this body system.

An elderly client has been experiencing urinary hesitancy and this has resulted in the client's bladder become overdistended with urine. What intervention should the nurse attempt before resorting to the insertion of a urinary catheter? A) Increase the client's intake of low-pH fluids in order to stimulate bladder function. B) Encourage the client to perform some vigorous exercise. C) Run water from the tap in the client's room to stimulate the urge to void. D) Position the client in a side-lying position.

Ans: C Feedback: General measures to promote urination include using stimuli such as running water from a tap to initiate voiding. A side-lying position does not stimulate voiding. Similarly, acidic fluids and exercise do not stimulate normal urinary function.

A nurse notes that a client's urine output is less than 300 ml over the past 24 hours. Which of the following could be the possible cause for the client's decreased output? A) Diuretic medication B) Endocrine disease C) Kidney dysfunction D) Liver disease

Ans: C Feedback: Kidney dysfunction could be a possible cause for the low volume of urination by the client. Diuretic medication and endocrine disease would increase the volume of urination. Liver disease would cause the urine to appear brown in color.

A nurse is caring for an older adult client at a health care facility who experiences urinary urgency. Which of the following is a possible cause of the client's condition? A) Impaired mobility B) Metabolic dysfunction C) Diminished bladder capacity D) Antibiotic therapy

Ans: C Feedback: Older adults are likely to experience urinary urgency and frequency because of normal physiologic changes such as diminished bladder capacity and degenerative changes in the cerebral cortex. Impaired mobility could lead to functional incontinence. Antibiotics and metabolic problems do not increase the risk for urinary incontinence.

A client at a health care facility complains to the nurse that when going about his day he is often unable to hold his urine while he tries to locate a toilet. How should the nurse document this incontinence in the client? A) Stress B) Urge C) Functional D) Total

Ans: C Feedback: The nurse should document the client's condition as functional incontinence when the client is unable to retain urine for some time after getting an urge to void. Stress incontinence can result in the loss of small amounts of urine when intra-abdominal pressure rises. Urge incontinence is the need to void perceived frequently with a short-lived ability to sustain control of flow. Total incontinence is the loss of urine without any identifiable pattern.

A nurse uses a catheter to collect a sterile urine specimen from a client at a health care facility. The catheter will be removed immediately after the specimen is obtained. Which type of catheter should the nurse use? A) Condom catheter B) Urinary bag C) Straight catheter D) Retention catheter

Ans: C Feedback: The nurse should use a straight catheter to collect a sterile urine specimen from the client. A straight catheter is a urine drainage tube inserted but not left in place. It drains urine temporarily or provides a sterile urine specimen. Condom catheters are helpful for clients with urinary incontinence receiving care at home because they are easy to apply. A urinary bag is more often used to collect urine specimens from infants. A retention catheter, also called an indwelling catheter, is left in place for a period of time.

A nurse collects a clean-catch specimen from a client at a health care facility. Which of the following statements describes a clean-catch urine sample? A) A sample of fresh urine collected in a clean container. B) A sample of urine collected in a sterile room environment. C) A sample of urine collected over a period of 24 hours. D) A sample of urine that is considered sterile.

Ans: D Feedback: A clean-catch specimen is a sample of urine that is considered sterile. A clean-catch specimen is preferred to a randomly voided specimen. This method of collection is preferred when a urine specimen is needed during a client's menstrual cycle. A void specimen is a sample of fresh urine collected in a clean container. A catheter specimen is a sample of urine collected in a sterile environment using a catheter. A 24-hour specimen is a sample of urine collected over a 24-hour period.

A nurse at a health care facility provides continence training to a client. During the training, the nurse plans a trial schedule for voiding that correlates with the time when the client is usually incontinent. Which of the following is a possible reason for the nurse's action? A) Reveals the client's type of incontinence B) Prevents self-defeating consequences C) Ensures adequate urine volume D) Reduces potential for accidental voiding

Ans: D Feedback: During the training, the nurse plans a trial schedule for voiding that correlates with the time when the client is usually incontinent so as to reduce the potential for accidental voiding or sustained urinary retention. Compiling a log of the client's urinary elimination pattern helps reveal the client's type of incontinence. Setting realistic, specific, short-term goals for the client prevents self-defeating consequences. Discouraging strict limitation of fluid intake ensures adequate urine volume.

A client who visits a health care facility for a routine assessment complains to the nurse that he is unable to control his urinary elimination. This has resulted in him soiling his clothes and has led to significant embarrassment. How should the nurse document the client's condition? A) Albuminuria B) Nocturia C) Dysuria D) Incontinence

Ans: D Feedback: The nurse should document the client's condition as urinary incontinence. Incontinence is the inability to control either urinary or bowel elimination and is abnormal after a person is toilet-trained. Albuminuria is urine containing excessive protein. Dysuria is difficult or uncomfortable voiding.

A client at a health care facility is being treated for cancer of the bladder. The physician has established a urinary diversion to help the client with urinary elimination. Which of the following describes a urinary diversion? A) Inability to control either urinary or bowel elimination B) Hygiene measures used to keep meatus and adjacent area of the catheter clean C) Use of a catheter to collect urine in a sterile environment D) Surgical implantation of one or both of the ureters

Ans: D Feedback: 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.

A nurse is caring for a 65-year-old male client who is postoperative day 1 following a total hip replacement. Which of the following should the nurse use in order to assist the client to eliminate urine? A) Commode B) Raised toilet C) Bedpan D) Fracture pan

Ans: D Feedback: The nurse should use a fracture pan to assist a client with a musculoskeletal disorder to eliminate urine. A fracture pan, a modified version of a conventional bedpan, is flat on the sitting end rather than rounded. Clients with musculoskeletal disorders who cannot elevate their hips and sit on a bedpan in the usual manner use a fracture pan. Clients who are weak or cannot walk to the bathroom may need a commode. Clients confined to bed use a urinal or bedpan.

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? A.) Loosen the internal muscles used to prevent or interrupt urination. B.) Keep muscles contracted for at least 10 seconds. C.) Relax muscles for at least 5 minutes between Kegels. D.) Perform these exercises two times daily for a week.

B.) Keep muscles contracted for at least 10 seconds. 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.

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.) Empty the balloon with a syringe. D.) Clean around the urinary meatus.

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.

A client reports an episode of losing control of urination when a bathroom wasn't close by. The client states, "I'm worried this means that I'm starting to lose control of my bladder." What is the appropriate nursing response? A.) "I agree; please make an appointment with your healthcare provider." B.) "This only happened one time, so it is nothing to worry about." C.) "Let's review your medication history and whether you consume bladder irritants." D.) "I suggest that you invest in incontinence undergarments."

C.) "Let's review your medication history and whether you consume bladder irritants." Urge incontinence can be aggravated by bladder irritants such as caffeine or alcohol, and can take place if diuretics are taking in the morning. The nurse will start by reviewing these factors. The nurse should not discount this as an isolated event without further assessment. It is too soon to refer the client to the healthcare provider, or to recommend incontinence undergarments.

The UAP reports that a client on furosemide has voided 4000 mL in a 24-hour period. What is the appropriate nursing action? A.) Document the finding as normal. B.) Increase IV fluids. C.) Contact the health care provider to decrease furosemide. D.) Administer an additional dose of furosemide.

C.) Contact the health care provider to decrease furosemide. Voiding over 3000 mL/day is considered abnormal. The client may benefit from a reduction in the amount of furosemide that is prescribed. Therefore, it is appropriate to contact the healthcare provider to decrease furosemide. Documenting the finding as normal, increasing IV fluids, and administering an additional dose of furosemide are not appropriate nursing actions.

A nurse notes that the volume of the client's urinary elimination is less than 50 mL/day. What could be the possible cause for the low volume of urination by the client? A.) Diuretic medication B.) Endocrine disease C.) Kidney dysfunction D.) Liver disease

C.) Kidney dysfunction Kidney dysfunction could be a possible cause for the client's low volume of urination. Diuretic medication and endocrine disease would increase the volume of urination. Liver disease would cause the urine to appear brown in color.

A 70-year-old client who has four children and six grandchildren states that she "wets" herself when she sneezes or laughs. She reports that sometimes this also occurs when rising from a sitting to standing position. Which type of incontinence does the nurse anticipate? A.) urge B.) reflect C.) stress D.) total

C.) stress Stress incontinence is associated with a raise in intra-abdominal pressure related to activities such as sneezing, coughing, or laughing. Other types of incontinence have different causative factors.

A 70-year-old client confides to the nurse that she is "terribly embarrassed" that she has developed urinary incontinence over the past year. Which nursing response supports the client's self-esteem? A.) "It would be best just to get some adult diapers." B.) "Let me refer you to a urologist who can help you." C.) "Don't worry, this is a normal condition for older adults." D.) "Let's explore structuring activities and toileting breaks."

D.) "Let's explore structuring activities and toileting breaks." The nurse will promote the client's self-esteem by exploring ways in which the client can verbalize feelings, maintain dignity, and become empowered to participate in self-care. Telling the client to get adult undergarments (referring to these as "diapers" is not therapeutic), sending her to a urologist, and telling her not to worry discounts the client's concern.

The parent of a 5-year-old child tells the nurse that on two occasions her son has lost control of urination when he had to wait to go to the bathroom at school. What is the appropriate nursing response? A.) "This is extremely abnormal. You will need to see your son's pediatrician." B.) "I would only worry about this if you were raising a daughter." C.) "It would be appropriate to place your son in incontinence undergarments." D.) "Let's review the types of fluids that your child drinks in the morning."

D.) "Let's review the types of fluids that your child drinks in the morning." Bladder irritants such as caffeine can cause urge incontinence; it is appropriate to determine whether the child is consuming fluids that contain caffeine. The child's urge incontinence is not extremely abnormal, and this physiological response is not related to gender. It is too soon to refer the client to the healthcare provider without taking a history, and it is impractical to simply recommend incontinence undergarments.

What accurately describes a practice guideline that the nurse should follow when inserting an indwelling catheter? A.) Use clean technique when inserting a catheter. B.) Maintain an open system whenever possible. C.) Use the largest appropriate-sized catheter in order to prevent leakage. D.) Avoid irrigation unless needed to relieve an obstruction.

D.) Avoid irrigation unless needed to relieve an obstruction. Irrigation should be avoided to prevent infection unless there is an obstruction. A closed system should be maintained using sterile technique. The smallest appropriate-sized catheter should be used.

The nurse has placed a urine collection bag on an infant. How often should the nurse check the bag to see if the infant has voided? -Every 15 minutes -Every 30 minutes -Every 45 minutes -Every 60 minutes

Every 15 minutes Explanation: The nurse should check the bag every 15 minutes. An infant does not have voluntary control over the bladder, so voiding occurs when the bladder is full. Checking the bag too frequently is not necessary. If the length of time is too long, the bag may overfill with urine and become unattached. The nurse should make sure the bag is secured in place.

A nurse prepares a client with a recently created ileal conduit to be discharged from the hospital. Which is an expected assessment finding? -Stoma is pale to light pink in color. -Stoma is fully stable. -Stoma is flush with the abdominal surface. -Mucus in the urine is a normal finding.

Mucus in the urine is a normal finding. Explanation: The isolated segment of small intestine continues to produce mucus (seen in the urine), as part of its normal functioning. The stoma should be dark pink to red and moist. The size of the stoma usually stabilizes within 6 to 8 weeks. Most stomas protrude 0.5 inch to 1 inch (1.25 to 2.5 cm) from the abdominal surface.

A nurse is caring for a client who has just undergone surgery to create an ileal conduit for urinary elimination via a stoma. Which fact about this procedure should the nurse mention to the client? - This urinary diversion is only temporary. -The client will need to change the urinary pouch every 4 hours. -The client will have to wear an external appliance to collect urine. -Urination can be voluntarily controlled after the stoma heals from the initial surgery.

The client will have to wear an external appliance to collect urine. Explanation: An ileal conduit involves a surgical resection of the small intestine, with transplantation of the ureters to the isolated segment of small bowel. Such diversions are usually permanent, and the client wears an external appliance to collect the urine because urine elimination from the stoma cannot be controlled voluntarily. Appliances are usually changed every 3 to 7 days, although they could be changed more often.