Urinary Elimination

A nurse is delegating the collection of urinary output to an unlicensed assistive personnel (UAP). What should the nurse tell the UAP to do while measuring the urine?

Wear gloves when handling a client's urine.

A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample?

first thing in the morning

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."

A client is diagnosed with frequent urinary tract infections. What would be an appropriate question for the nurse to ask the client?

"How frequently do you urinate each day?"

A client has been taught how to do Kegel exercises. What statement by the client indicates a need for further information?

"I will contract the muscles in my abdomen and thighs."

The experienced nurse is observing a new nurse who is preparing to catheterize a female client. Which statement by the new nurse requires immediate intervention by the experienced nurse?

"I will use clean gloves to handle the catheter and other equipment."

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."

A parent asks the nurse when his 18-month-old daughter will be ready for toilet training. Which statement best answers the parent's question regarding toilet training?

"One signal of preparedness is when your child is dry for at least 2 hours."

The nurse has an order to obtain a urine specimen from a client with an indwelling Foley catheter. Which supplies would the nurse need to gather? Select all that apply.

10-mL (milliliter) syringe Sterile specimen container Antiseptic swab The nurse would need to gather a syringe, antiseptic swab, and sterile specimen container. The nurse would need clean, not sterile gloves, to perform the collection. The part of the tubing that connects to the catheter is where the specimen is collected from, and the nurse may need a clamp to allow a collection of urine within the tubing in case urine output is decreased.

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

24-hour specimen

A student is collecting a sterile urine specimen from an indwelling catheter. How will the student correctly obtain the specimen?

Aspirate urine from the collection port. When it is necessary to collect a urine specimen from a client with an indwelling catheter, it should always be obtained from the catheter itself using the special collection port. Pouring urine from the collection bag or aspirating from the collection bag can cause contamination from the collecting bag. A nurse should not remove the urinary catheter and ask the client to void.

A nurse is caring for a client with a hemodialysis access site. Which action should the nurse take?

Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration.

What accurately describes a practice guideline that the nurse should follow when inserting an indwelling catheter?

Avoid irrigation unless needed to relieve an obstruction.

A client is preparing to give a clean-catch specimen. Which instruction will the nurse provide?

After the initial stream is initiated, collect the sample.

A client is suspected of having a disease process affecting the functional unit of the kidney. Which stucture is most likely involved?

Nephron

A nurse is carrying out an order to remove an indwelling catheter. What is the first step of this skill?

Wash hands and put on gloves

Use of an indwelling urinary catheter leads to the loss of bladder tone.

True

A nurse is educating a client on the amount of water to drink each day. What is the recommended daily fluid intake for adults?

Eight to ten 8-oz (2,000 to 2,400 mL) glasses per day

A nurse is assisting a client with the use of a bedpan. The nurse understands that which statement about bedpans is true?

The largest part of a regular bedpan should be placed under the client's buttocks.

A nurse is assessing the freshly voided urine of a client. What characteristics of the urine would indicate a urinary problem? Select all that apply.

The urine smells like ammonia. There is pus in the urine. The urine is cloudy.

During the well-child checkup for 2-year-old twins (one boy, one girl), their mother asks the nurse about preparing to toilet train the children. What information can be provided to the parent? Select all that apply.

Daytime incontinence is not a concern while toilet training Children who are able to remain dry for a few hours at a time may be signaling readiness for toilet training. Children old enough to undress themselves will have increased abilities to toilet train.

A nurse is caring for older adult clients in an assisted-living facility. Which effect of aging should the nurse consider when performing a urinary assessment?

Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection.

A client admitted to the hospital with chronic renal failure suddenly develops the following signs and symptoms: left arm arteriovenous (AV) fistula has weak thrill and bruit; BP 88/40 mm Hg; stated feels dizzy. Which action would the nurse implement first?

Change to supine position.

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.

A client is preparing to give a clean-catch specimen. What action should the nurse have the client do first?

Clean each side of the urinary meatus with a separate wipe. A clean-catch specimen is collected in mid-stream. The nurse will first instruct to clean each side of the urinary meatus, release a small amount of urine, catch a sample, and then complete voiding.

A nurse has catheterized a client to obtain urine for measuring postvoid residual (PVR) amount. The nurse obtains 40 mL of urine. What should the nurse do next?

Document this normal finding for postvoid residual.

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 urinary bladder infection and dehydration

A nurse will use a bladder scanner to assess a client with urinary frequency. How should the nurse best prepare the client for this procedure?

Position the client in a supine position.

The nurse is educating a client with an ileal conduit about the effects of food and fluid intake on the amount and quality of urine produced by the body. Which teaching points should the nurse include? Select all that apply.

Dehydration leads to increased fluid reabsorption by the kidneys, leading to decreased and concentrated urine production. Fluid overload leads to excretion of a large quantity of dilute urine. Consumption of caffeine-containing beverages (cola, coffee, and tea) leads to increased urine production due to their diuretic effect. Ingestion of certain foods, such as asparagus, onions, and beets, may lead to alterations in the odor or color of urine.

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 adult clients have a decrease in bladder contraction, which can lead to decreased urination or urinary retention. If there is a decrease in bladder muscle tone, this may lead to frequent urination instead. Older adult clients can have a decreased ability to concentrate urine, which causes nocturia (urination during the night). Older adult clients also can feel powerless, which can cause incontinence.

A nurse who is right-handed is inserting a woman's indwelling urinary catheter. The nurse will use cotton balls and antiseptic solution to cleanse the woman's meatus and perineum. Which of the nurse's actions is most appropriate?

Use her left hand to spread the woman's labia and keep them spread until the catheter is inserted.

A nurse is collecting a routine urinalysis on a client presenting to the emergency room with abdominal pain. What nursing action is important in the collection of this specimen?

Obtain a nonsterile specimen and send it to the lab. A sterile urine specimen is not required for a routine urinalysis. Obtain and label the specimen and send it to the laboratory for examination. Do not leave the urine standing at room temperature for a long period of time before sending it to the laboratory, because this may alter both the appearance and chemistry of the urine.

The nurse is caring for a client diagnosed with a urinary tract infection. The primary care provider orders include an antibiotic, an antipyretic, and a urine culture and sensitivity, and urine specimen for nitrates. Which actions should the nurse take? Select all that apply.

Obtain the urine specimens before beginning the ordered antibiotic. Instruct the client on the midstream urine collection process. Place the collected specimen with proper label in a biohazard bag and send it to the lab after collection.

A client reports frequently experiencing urine loss when moving from the wheelchair to bed. Which type of incontinence does the nurse anticipate?

functional Functional incontinence takes place when attempting to overcome obstacles, such as transferring from the wheelchair to the bed. Urge incontinence takes place when there is a delay in accessing a toilet. Reflex incontinence takes place when a client automatically releases urine and cannot control it. Total incontinence takes place without a pattern or warning, and without client control.

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?

intermittent urethral 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?

loss of urine without any identifiable pattern or warning

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

neurogenic bladder.

The nurse is preparing a client for an intravenous pyelogram. Which nursing actions are performed correctly? Select all that apply.

Withhold food or fluids 12 hours before testing. Give an enema the day of the examination. Obtain client's allergy history. Give a laxative the evening before the examination.

The nurse has entered a client's room to empty the client's urine collection bag at the end of a busy shift. The nurse realizes that the client's urine output is 75 mL over the past 8 hours. The nurse would recognize that the client is experiencing:

oliguria.

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

The nurse is attempting to insert a urinary catheter into a female client's bladder and realizes the catheter has been inserted into the vagina. Which action is most appropriate?

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

A client with an emergently placed central venous catheter (CVC) is to have emergent hemodialysis. Upon assessment of the CVC the nurse visualizes redness, drainage, and odor to the area around the CVC. Palpation of the surrounding skin causes the client pain. Which intervention is the priority?

Notifying the health care provider of the assessment findings

The nurse is inserting a urinary catheter into a 63-year-old male client and encounters resistance. What is the most likely cause of the resistance?

The client has an enlarged prostate.

A client's BUN test results are significantly elevated. When reviewing the client's history, which finding is consistent with BUN elevation other than renal compromise?

The client is dehydrated.

The nurse is inserting a urinary catheter into a female client and has begun to inflate the balloon, an action that has caused the client to wince and cry out in pain. Consequently, the nurse should:

deflate the balloon, insert the catheter further, and slowly attempt reinflation.

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

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

straight catheter

A nurse prepares a client with a recently created ileal conduit to be discharged from the hospital. Which is an expected assessment finding?

Mucus in the urine is a normal finding. 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 planning interventions for a client to assist in establishing a normal voiding pattern. Which nursing action should be included?

Assist the client to a normal voiding position when possible.

The nurse is preparing to insert an indwelling urinary catheter into a female client's bladder. The nurse has opened the sterile catheterization tray using sterile technique, donned sterile gloves and has opened all sterile supplies. Arrange the following steps in the correct order.

Clean each labial fold, then the area directly over the meatus. Insert the lubricated catheter into the urethra. Advance the catheter until there is a return of urine. Inflate the balloon with the correct amount of sterile saline. Discard used supplies.

After surgery, a postoperative client has not voided for 8 hours. Where would the nurse assess the bladder for distention?

between the symphysis pubis and the umbilicus

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

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

A 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 flexible sheath that is rolled around the penis

A woman is reporting bladder urgency. It is most important to assess:

caffeine intake.

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?

stress

A nurse maintaining continuous bladder irrigation on a client notes that hourly drainage is less than amount of irrigation being given. Which interventions would be appropriate in this situation? Select all that apply.

Palpate for bladder distention. Check to make sure that the tubing is not kinked. If return flow remains decreased, notify the health care provider.

The nurse is collecting a clean-catch specimen from a client. Which nursing action is performed correctly in this procedure?

Position the container near the meatus, and collect at least 10 mL of urine.

A client who is a paraplegic as a result of an auto accident has incontinence. The nurse correctly recognizes that which type of incontinence is most likely?

Reflex

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?

The client will have to wear an external appliance to collect urine.

Upon assessment of the urine in a client's indwelling urinary catheter drain bag, the nurse notes the urine to be dark yellow. This assessment finding indicates:

the client is underhydrated.

Which symptom will have a great impact on the extracellular fluid for water conservation?

Burns The water saving, to regulate the concentration of solutes in the ECF, results in decreased urine output. Increased loss of body fluids can occur with vomiting, diarrhea, excessive diaphoresis secondary to fever or exercise, excessive wound drainage, extensive burns, or blood loss from trauma or surgery.

A client with frequent urinary tract infections (UTIs) has returned to the ambulatory clinic with symptoms of another UTI. The nurse reviews measures to follow to promote health and decrease the risk of contracting a UTI. Which measure is appropriate for the client to follow?

Drink two glasses of water before and after sexual intercourse.

When planning care for a client with a Foley catheter, which actions should the nurse include? Select all that apply.

Encourage fluid intake, unless contraindicated. Record volume and character of the urine. Maintain a closed urinary catheter system.

The nurse is changing a stoma appliance on an ileal conduit. Which nursing action is recommended procedure? Select all that apply.

Gently remove the appliance, starting at the top and keeping the abdominal skin taut. Apply a silicone-based adhesive remover by spraying or wiping as needed. Make sure skin around stoma is thoroughly dry by patting it dry.

The nurse is caring for a male client who has a urinary obstruction and is not a candidate for surgery. Which intervention will the nurse prepare the client for?

Insertion of a urologic stent The nurse would expect the health care provider would insert a urologic stent for this male client. Urologic stents relieve urinary obstructions and provide a path for the flow of urine. The other options are not appropriate for this client.

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.

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.

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?

Reddened perineal skin

A nurse is caring for an older adult client who has been prescribed a condom catheter. What potential problems related to the use of a condom catheter should the nurse monitor in the client? Select all that apply.

Restricted blood flow to the glans tissue Excoriation of the skin in the glans area Kinks in tubing that encourage backflow of urine

The nurse is teaching a client how to perform pelvic floor muscle exercises (Kegel exercises). Which teaching will the nurse include?

Tighten the internal muscles used to prevent or interrupt urination. 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 three to four times daily for 2 weeks to 1 month. The client should not be instructed to keep muscles contracted for at least 30 seconds, relax muscles for at least 1 minute between exercises, nor perform these exercises 10 times daily for 1 month.

The nurse is caring for a client with an indwelling urinary catheter secondary to neurogenic bladder. The nurse completes a prescription to obtain a urine specimen from the catheter. After reviewing the image, what is the most accurate narrative note the nurse would document to demonstrate the steps to obtain the urine specimen were performed appropriately?

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

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?

Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle.

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

dark brown, cloudy

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

one or both of the ureters are surgically implanted elsewhere

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?

stress

The school nurse is caring for a student who experienced a seizure in the classroom. The student was noted to lose a large amount of urine during the seizure. Which type of incontinence does the nurse anticipate the client may have experienced?

total