Fundamentals PrepU Chapter 36: 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." "Discard your first urine and begin the collection after that." "Start collecting the urine with the next time you urinate." "Begin the collection when you first urinate in the morning."

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

The nurse is collecting data on a client with reflex incontinence. Which information would the nurse ask the client during the physical assessment? "Do you have the sensation to urinate?" "Do you dribble urine throughout the day?" "Do you leak urine with strain or coughing?" "Do you lose control of your urine all day?"

"Do you have the sensation to urinate?"

The nurse educator is presenting a lecture on clients at risk for developing urinary tract infections (UTIs). Which response made by the staff nurse would indicate to the educator a need for further teaching? -"Having sexual relationships does not put a woman at risk for developing a UTI." -"I will make sure to teach my clients with diabetes mellitus to control their glucose level to help prevent a UTI." -"A woman using an intrauterine device for contraceptive reason is at risk for developing a UTI." -"Due to the physiologic changes with aging, the elderly are at risk for developing a UTI."

"Having sexual relationships does not put a woman at risk for developing a UTI."

Several of the clients on a geriatric subacute medicine unit are experiencing urinary incontinence from differing causes. Which statement suggests that the client requires further education? "At home, I take my water pill in the morning so that I don't have to use the bathroom as much during the night." "I've made a point of scheduling when I drink water instead of waiting until I'm thirsty." "I know it's hard to get there, but I want to try to use the commode instead of wearing an adult diaper." "I make sure to limit how much I drink so that I don't have accidents."

"I make sure to limit how much I drink so that I don't have accidents."

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? "It would be best just to get some adult diapers." "Don't worry, this is a normal condition for older adults." "Let me refer you to a urologist who can help you." "Let's explore structuring activities and toileting breaks."

"Let's explore structuring activities and toileting breaks."

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? "Let's review the types of fluids that your child drinks in the morning." "This is extremely abnormal. You will need to see your son's pediatrician." "It would be appropriate to place your son in incontinence undergarments." "I would only worry about this if you were raising a daughter."

"Let's review the types of fluids that your child drinks in the morning."

A woman informs the nurse that when she is experiencing stress it is difficult to void, and wonders why this happens. What is the nurse's best explanation? "You might have a neurologic condition." "What medications are you taking?" "Stress causes the muscles to become tense." "You require greater privacy to void."

"Stress causes the muscles to become tense."

The nurse is caring for a client with a prescription for a midstream urine specimen. The nurse would provide which information to the client? "Void into the specimen hat in the toilet bowl." "Save all urine for the next 24 hours." "Void a small amount, stop, and discard it." "You will have a catheter put in to collect the urine."

"Void a small amount, stop, and discard it."

Three days post-surgery for breast reconstruction, the nurse assesses that the client is ambulating several times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action? Select all that apply. Perform, or allow client to perform, perineal hygiene at least once daily. Discontinue to catheter and report this to the healthcare provider. Contact the health care provider to ask for an order for catheter discontinuation. Ensure that the drainage bag is above the level of the bladder at all times. Delegate catheter discontinuation to the Unlicensed Assistive Personnel (UAP).

-Perform, or allow client to perform, perineal hygiene at least once daily. -Contact the health care provider to ask for an order for catheter discontinuation.

A client is preparing to give a clean-catch specimen. Which instruction will the nurse provide? Wait until the void is almost over to collect a specimen. After the initial stream is initiated, collect the sample. Collect the first urine expelled. Collect the entire urinary output.

After the initial stream is initiated, collect the sample.

A client with chronic kidney disease reports not being able to urinate for the past 24 hours. A bladder scan shows no urine in the bladder. How does the nurse document this data? Anuria Urinary Retention Oliguria Nocturia

Anuria

A nurse is assessing a client who is complaining of difficulty urinating. Which assessment would be a priority? Asking the client when he or she had last urinated Palpating the bladder above the symphysis pubis Determining any pain when palpating the lower abdomen Obtaining the bladder scanner to check the urine volume

Asking the client when he or she had last urinate

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? -Dehydration -Stasis -Infection -Blood

Blood

Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence? Boys may take longer for daytime continence than girls. Boys may walk by 1 year and should be continent by 3 years. Daytime continence is usually not achieved by boys until age 5. Incontinence after the age of 3 years is not normal.

Boys may take longer for daytime continence than girls.

The nurse is caring for a client who reports having cloudy, foul-smelling urine. Which other symptoms does the nurse anticipate that the client has? burning and frequency episodes of clear urine mixed with episodes of cloudy urine constipation and fluid overload difficulty starting the stream of urine

Burning and Frequency

A woman is reporting bladder urgency. It is most important to assess: weight. exercise. vitamin supplements. caffeine intake.

Caffeine intake

When preparing to irrigate a Foley catheter, which is the appropriate initial nursing action? Check health record for provider's order. Gather equipment and supplies. Assess urine characteristics. Explain the procedure to the client.

Check health record for provider's order.

A client could experience increased urination when using which classification of medication? Stool softeners Central nervous system depressants Cholinergic agents Analgesic medications

Cholinergic agents

When a client is diagnosed with a urinary tract infection, the nurse anticipates that the client's urine will be: light yellow with a faint ammonia odor. greenish with a strong ammonia odor. transparent with an aromatic odor. cloudy with an offensive odor.

Cloudy with an offensive odor

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 light yellow, clear strongly aromatic, amber clear, dark amber

Cloudy, foul odor

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? light yellow, clear strongly aromatic, amber clear, dark amber cloudy, foul odor

Cloudy, foul odor

During his stay in the hospital, a male client has established a pattern of maintaining urinary continence during the day, but he is experiencing incontinence at night. What intervention should the nurse implement in this client's care? condom catheter indwelling catheter toileting the client every 2 hours intermittent catheterization at bedtime

Condom Catheter

The nurse is performing data collection on an older adult client brought to the clinic by his daughter. Which finding collected would indicate to the nurse that the client may have a urinary tract infection (UTI)? Confusion Gender Frequency Nocturia

Confusion

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

Contact the health care provider to decrease furosemide -Voiding over 3000 mL/day is considered abnormal.

A client has been n.p.o. after midnight for surgery. It is 11 a.m. and the nurse has asked her to void before being transferred to the surgical suite. The nurse should expect her urine to be what color? Tea colored Colorless Dark amber Pale yellow

Dark amber

The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate? balanced fluids hypovolemia renal failure dehydration

Dehydration

The nursing assistant reports that a client on furosemide has voided 2000 mL in a 24-hour period. What is the appropriate nursing action? Increase IV fluids to compensate. Contact the healthcare provider to decrease furosemide. Document the finding as normal. Administer additional as needed (prn) dose of furosemide.

Document the finding as normal.

A nurse is caring for a client with an external condom catheter. What is a guideline for applying and caring for this type of catheter? Remove the catheter every 8 hours, or more often in humid weather. Fasten the condom securely enough to prevent leakage without constricting the blood vessels. Keep the tip of the tubing 2-3 inches (5 to 7.5 cm) beyond the tip of the penis. Wash the penis with antimicrobial soap and dry thoroughly.

Fasten the condom securely enough to prevent leakage without constricting the blood vessels.

A client reports that he is often unable to retain urine until he locates a toilet because his mobility is decreased. The nurse should recognize the characteristics of what type of incontinence? Urge Functional Stress Total

Functional Incontinence

The nurse is caring for a client with a history of renal insufficiency and type 2 diabetes. Which prescription, if noted in the client's chart, would alert the nurse to discuss with the health care practitioner? Urine dipstick four times a day Blueberry juice 10 oz by mouth (PO) daily Encourage fluids intake - 2 to 3 L per day Gentamicin 70 mg intramuscular (IM) every 8 hours

Gentamicin 70 mg intramuscular (IM) every 8 hours

A male client is being transferred to the hospital from a long-term care facility with a diagnosis of dehydration and urinary bladder infection. His skin is also excoriated from urinary incontinence. Which nursing diagnosis is most appropriate for this client? Impaired Skin Integrity related to functional incontinence Risk for Urinary Tract Infection related to dehydration Urinary Incontinence related to urinary tract infection Impaired Skin Integrity related to urinary bladder infection and dehydration

Impaired Skin Integrity related to urinary bladder infection and dehydration

A nurse drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance? indwelling urethral catheter intermittent urethral catheter retention catheter Foley catheter

Intermittent urethral catheter

What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence? It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. A sterile urine specimen can be obtained from the drainage bag tubing. The client can apply it himself with minimal supervision. It can be left in place for a long period of time.

It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.

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

Keep muscles contracted for at least 10 seconds.

The nurse is attempting to insert a urinary catheter into a female client's bladder and realize the catheter has been inserted into the vagina. Which action is most appropriate? Remove the catheter from the vagina and attempt to insert it into the bladder. Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. Ask the client to bear down until the catheter is expelled. Immediately remove the catheter from the vagina, contact the primary care provider and anticipate an order for prophylactic antibiotics.

Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.

A client at the health care facility has been diagnosed with total urinary incontinence. How could the nurse describe the condition of the client? -Need to void is perceived frequently, with short-lived ability to sustain control of flow -Loss of urine control because a toilet is not accessible -Loss of urine without any identifiable pattern or warning -Loss of small amount of urine when intra-abdominal pressure rises

Loss of urine without any identifiable pattern or warning

A client is suspected of having a disease process affecting the functional unit of the kidney. Which stucture is most likely involved? Nephron Bowman's capsule Loop of Henle Glomerulus

Nephron

An older adult client is experiencing urinary retention. What age-related physiologic change does the nurse discuss with the client that may be a contributing factor? Older adults may have a decrease in contraction of the bladder. Older adults can have a decrease in bladder muscle tone. Older adults have a decreased ability to concentrate urine. Older adults who have limited support can feel powerless.

Older adults may have a decrease in contraction of the bladder.

A nurse is the guest speaker at a women's club. Most of the women are over the age of 40 years. The women have asked the nurse to speak on health promotion topics. In the area of urinary urgency, the nurse will instruct the women to: increase caffeine daily. take an antispasmodic. perform Kegel exercises. limit fluid intake.

Perform Kegel exercises

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? Place the sterile solution on the bed. Empty the balloon with a syringe. Prime the tubing with the solution. Clean around the urinary meatus.

Prime the tubing with the solution.

The nurse is reviewing the urinalysis of a client suspected of having a urinary tract infection. The potential diagnosis will be supported by the presence of: pus. calculi. casts. protein.

Pus

While providing care to a client admitted to the health care facility, the client states that she has "a burning sensation when urinating." After further questioning, the nurse inspects the client's perineal area. Which sign/symptom would the nurse document as an abnormal finding? Moist perineal skin Absence of discharge Reddened perineal skin Presence of smegma

Reddened perineal skin

The health care provider requests an indwelling urinary catheter to be inserted into a woman who has had a total hip replacement and is on strict bed rest. When inserting the catheter, the nurse would place the client in which position? Sims Supine Semi-Fowler Dorsal recumbent

Sims

Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)? Foley catheter suprapubic catheter straight catheter indwelling urethral catheter

Straight Catheter

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? total stress reflect urge

Stress

A client reports to the nurse that after delivering a baby, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate? total urge reflex stress

Stress

Which type of incontinence is caused by pelvic floor muscle weakness? Stress Functional Overflow Urge

Stress

A nurse is caring for a client who has an infant age 4 months. The client informs the nurse that she has been experiencing a sudden loss of urine whenever she laughs; this is causing embarrassment to her. Which type of urinary incontinence is this client experiencing? Functional incontinence Urge incontinence Reflex incontinence Stress incontinence

Stress Incontinence

A client reports to the nurse that after delivering a baby, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate? total stress reflex urge

Stress incontinence

The nurse is caring for a client who has been experiencing difficulty voiding since her vaginal birth. The client voices concern to the nurse. What information should be provided to the client? A neurogenic bladder results from local anesthesia. The birth can cause perineal swelling. A urinary tract infection results from the birth process. Catheterization is necessary for 1 week.

The birth can cause perineal swelling.

The nurse is providing education to a client who is being discharged to home with an indwelling urinary catheter in place. What information is important for the nurse to discuss with the client? Empty the catheter bag every few days when it is full. Restrict daily fluid intake. The catheter can be connected to a smaller leg bag for ambulation. Clamp the catheter tubing daily for 2 hours and then release the clamp at night.

The catheter can be connected to a smaller leg bag for ambulation

The clinic nurse is collecting data from a female client with frequent, recurrent urinary tract infections who was discharged from the hospital. Which data collection would indicate to the nurse that the client is adhering to discharge instructions? The client soaks in the bathtub daily for perineal care. The client drinks two glasses of water before and after sexual intercourse. Since the client is symptom-free, she no longer takes the prescribed antibiotics. The client drinks eight 8-oz glasses of cranberry juice daily.

The client drinks two glasses of water before and after sexual intercourse.

A nurse uses a portable bladder ultrasound device to assess bladder volume for a client who is unable to void. Which statement accurately details information needed to interpret the results? The scan is contraindicated for a female who had a hysterectomy. A postvoid residual (PVR) volume of less than 150 mL is often recommended as the guideline for catheterization, because this has been associated with the development of urinary tract infections. The device must be programmed for the gender of the client by pushing the correct button on the device. A postvoid residual (PVR) volume more than 50 mL indicates adequate bladder emptying.

The device must be programmed for the gender of the client by pushing the correct button on the device.

Which statements about suprapubic catheters is true? Inadvertent dislodgement can permanently damage the urethra. They are often preferred over an indwelling urethral catheter for long-term urinary drainage. They are surgically inserted through a small incision above the umbilicus. They drain urine directly from the ureters.

They are often preferred over an indwelling urethral catheter for long-term urinary drainage.

The nurse is teaching a client how to perform pelvic floor muscle exercises (Kegel exercises). Which teaching will the nurse include? Perform these exercises 10 times daily for 1 month. Relax muscles for at least 1 minute between Kegels. Keep muscles contracted for at least 30 seconds. Tighten the internal muscles used to prevent or interrupt urination.

Tighten the internal muscles used to prevent or interrupt urination.

A client is brought to the emergency department (ED) after a seizure. Which type of incontinence does the nurse anticipate the client may have experienced? reflex total urge stress

Total Incontinence

True or False: Use of an indwelling urinary catheter leads to the loss of bladder tone.

True

The nurse is caring for a male client with weakness who has been ordered to stay on bed rest for several days. Which method for urinary elimination does the nurse provide? fracture pan bedside commode regular bathroom urinal

Urinal

The nurse is caring for a male client with weakness who has been ordered to stay on bed rest for several days. Which method for urinary elimination does the nurse provide? fracture pan regular bathroom bedside commode urinal

Urinal

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

The nurse measures a client's residual urine by catheterization after the client voids. Which condition would this test verify? urinary suppression urinary retention urinary tract infection (UTI) urinary incontinence

Urinary retention

A nurse is preparing to measure a client's urine output. Which interventions would be of highest priority? Noting the color and clarity of the urine Measuring the urine container at eye level Using an appropriate measuring container Wearing gloves when handling the urine

Wearing gloves when handling the urine

A sterile urine specimen for culture and sensitivity has been ordered for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen? Empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag. Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle. 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 a syringe and needle.

A nurse is caring for an older adult client at his home. The client has had a condom catheter applied. Which describes a condom catheter? a bag attached by adhesive backing to the skin around the genitals a urine drainage tube inserted but not left in place a urine drainage tube that is left in place over a period of time a flexible sheath that is rolled around the penis

a flexible sheath that is rolled around the penis

An infant is born with spina bifida. She may have: renal failure. alterations in urinary elimination. excessive loss of sodium in the urine. increased urine production.

alterations in urinary elimination

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? clear, light yellow dark brown, cloudy aromatic, green reddish-brown, clear

dark brown, cloudy

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? use of a catheter to collect urine in a sterile environment one or both of the ureters are surgically implanted elsewhere inability to control either urinary or bowel elimination hygiene measures used to keep meatus and adjacent area of the catheter clean.

one or both of the ureters are surgically implanted elsewhere

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? clear, colorless cloudy, foul odor strongly aromatic, dark amber light yellow, clear

strongly aromatic, dark amber

The doctor has ordered the collection of a fresh urine sample for a particular examination. Which urine sample would the nurse discard? the bedtime voiding the sample collected immediately after lunch the first voiding of the day the voiding collected at 4 p.m.

the first voiding of the day