Urinary Elimination: Chapter 36

The nurse is teaching the Crede maneuver to a client who has difficulty urinating. Which nursing teaching is appropriate? "Attempt to void as soon as you awake from sleep." "Bend forward and apply pressure over your bladder." "Visualize an ocean or a river as you sit on the toilet." "Run water from your faucet while you are attempting to urinate."

"Bend forward and apply pressure over your bladder." Explanation: The Crede maneuver involves the act of bending forward and applying hand pressure over the bladder. Other answers do not reflect this maneuver.

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine? 24-hour specimen Intermittent specimen Random specimen Clean-catch specimen

24-hour specimen A 24-hour urine specimen is required for accurate measurement of the kidney's excretion of substances that the kidney does not excrete at the same rate throughout the day. A clean-catch or midstream-voided specimen is used when a specimen relatively free from microorganisms is required. Random urine specimen collection is used when sterile urine is not required.

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." "You will have a catheter put in to collect the urine." "Void a small amount, stop, and discard it."

"Void a small amount, stop, and discard it." When collecting a midstream urine specimen, the client voids a small amount, stop, and discards it; the first small amount helps to flush away organisms near the urinary meatus. The midstream urine specimen is a sterile specimen so it is not collected in the hat in the toilet bowl. The client will not need to be catheterized. It is a one-time specimen, so urine will not be collected for 24 hours.

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. Collect the entire urinary output. Collect the first urine expelled. After the initial stream is initiated, collect the sample.

After the initial stream is initiated, collect the sample. Explanation: A clean-catch specimen is collected in mid-stream. It is not reasonable, nor necessary, to collect the entire urinary output. It is not correct to collect the first urine expelled or to wait until the void is almost over.

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. 4 Clean each labial fold, then the area directly over the meatus. 2 Insert the lubricated catheter into the urethra. 5 Advance the catheter until there is a return of urine. 1 Inflate the balloon with the correct amount of sterile saline. 3 Discard used supplies

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.

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 Intermittent urethral catheters, or straight catheters, are used to drain the bladder for shorter periods. If a catheter is to remain in place for continuous drainage, an indwelling urethral catheter is used. Indwelling catheters are also called retention or Foley catheters. A suprapubic catheter is used for long-term continuous drainage. This type of catheter is inserted surgically through a small incision above the pubic area.

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? reflect total stress urge

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.

The nurse is changing a stoma appliance on an ileal conduit. Which nursing action is recommended procedure? Select all that apply. Apply faceplate by using firm, even pressure for approximately 60 seconds. Clean skin around stoma with alcohol on a gauze pad. Gently remove the appliance, starting at the top and keeping the abdominal skin taut. Remove appliance faceplate by pulling appliance from skin rather than pushing. Make sure skin around stoma is thoroughly dry by patting it dry. Apply a silicone-based adhesive remover by spraying or wiping as needed.

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. Explanation: The nurse would gently remove the appliance, starting at the top and keeping the abdominal skin taut. This method would prevent excessive damage to skin and tissue of the client. The nurse would apply a silicone-based adhesive remover by spraying or wiping as needed. The adhesive remover helps to prevent skin and tissue damage. The nurse would make sure skin around the stoma is thoroughly dry by patting it dry. Moist skin does not hold adhesives well, possibly causing skin and tissue damage. The nurse would not remove the appliance faceplate by pulling the appliance from the skin rather than pushing. The nurse would not clean the skin around the stoma with alcohol. Alcohol is drying to the skin, possibly causing skin or tissue damage. The nurse would not hold the faceplate firmly in place for 60 seconds when placing it. Pressure for 30 seconds is sufficient.

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

It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. The catheter is not in the bladder, so urine in the tubing is not sterile.

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

Kidney dysfunction Explanation: Kidney dysfunction could be a possible cause for the clients' 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.

The client is preparing to obtain a clean-catch midstream urine specimen. List in order the steps needed to complete the diagnostic test. 1 Void into the provided collection device. 2 Secure the lid on the specimen container. 3 Void a small amount into stool. 4 Provide instruction to the client. 5 Submit collected specimen to the health care professional. 6 Clean the area surrounding the urinary meatus with the provided cloth.

Provide instruction to the client. Clean the area surrounding the urinary meatus with the provided cloth. Void a small amount into stool. Void into the provided collection device. Secure the lid on the specimen container. Submit collected specimen to the health care professional. Explanation: A clean-catch urine specimen is used to obtain a specimen that is clean in nature. The procedure is not sterile. The process requires the nurse to provide the needed education to the client. The client will begin by cleaning the area surrounding the meatus with a provided wipe. The client will void into the stool and discard. The client will next void into the provided specimen container. Once the specimen container is filled the client may finish voiding in the stool and discard. The specimen will need to be secured and submitted to the health care professional.

A client who had an open hysterectomy 2 days ago is ambulating around the unit four 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? Discontinue the catheter and document in the electronic health record. Maintain the drainage bag above the bladder when the client ambulates. Request an order for catheter discontinuation from the health care provider. Delegate catheter discontinuation to the unlicensed assistive personnel (UAP).

Request an order for catheter discontinuation from the health care provider. The nurse should contact the health care provider to advocate for catheter discontinuation to prevent a catheter-associated urinary tract infection (CAUTI). Discontinuation of the catheter should not take place until the nurse has received an order from the provider. Delegation should take place only if appropriate based on the UAP's qualification and the nurse's ongoing appropriate supervision. The drainage bag must remain above the level of the bladder.

A nurse is collecting a urine specimen for urinalysis. Which factors should the nurse consider when performing this procedure? Select all that apply. Strict aseptic technique must be used when collecting and handling urine specimens. Sterile urine specimens may be obtained by catheterizing the client's bladder. A clean-catch specimen of urine may be collected in midstream. A sterile urine specimen is required for a routine urinalysis. Urine should be left standing at room temperature for a 24-hour period before being sent to the laboratory. If a woman is menstruating, a urine specimen cannot be obtained for urinalysis.

Sterile urine specimens may be obtained by catheterizing the client's bladder. Strict aseptic technique must be used when collecting and handling urine specimens. A clean-catch specimen of urine may be collected in midstream. Explanation: The nurse would realize that a sterile urine specimen must be obtained by catheterizing the client's bladder. The nurse would use strict aseptic technique when collecting and handling urine specimens. The nurse would realize that a clean-catch specimen of urine would be collected midstream. The nurse would realize that a sterile specimen is not required for a routine urinalysis. The nurse would realize that a menstruating woman can give a specimen for urinalysis, but this fact should be documented on the lab slip. The nurse would realize that urine cannot be left at room temperature for a 24-hour period before being sent to the laboratory.

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? Urge incontinence Reflex incontinence Stress incontinence Functional incontinence

Stress incontinence Explanation: The nurse should document the client's condition as stress incontinence following weakening of perineal and sphincter muscle tone secondary to giving birth. Reflex incontinence is caused by damage to motor and sensory tracts in the lower spinal cord secondary to trauma. Urge incontinence is caused by bladder irritation secondary to infection. Functional incontinence is caused by impaired mobility, impaired cognition, or an inability to communicate.

Which is not true of urine color? The color of urine ranges from light yellow to amber. The appearance of urine streaked with blood is always abnormal. Medications can alter urine's color. Someone's state of hydration affects the color.

The appearance of urine streaked with blood is always abnormal. Urine may appear cloudy, dark reddish-brown, or streaked with blood when a woman is menstruating.

The nurse is preparing to provide education to a client concerning prescribed medications to manage incontinence. The prescribed medication is oxybutynin. What information can be provided? The medication will increase the amount of fluids retained by the body, thereby lessening the incidence of incontinence. The medication will reduce the amount of urine being produced by the body, thereby lessening incontinence. The medication will help to stimulate contraction of muscles involved in voiding, thereby lessening incontinence. The medication will be used to reduce overactivity of muscles involved in voiding, thereby lessening incontinence.

The medication will be used to reduce overactivity of muscles involved in voiding, thereby lessening incontinence. Explanation: Oxybutynin (an antispasmodic) may be used to treat urinary urgency and frequency caused by overactive detrusor muscle activity.

The nurse is assessing a female client who states that she notices an involuntary loss of urine following a coughing episode. What would be the nurse's best reply? "You are experiencing stress incontinence. Do you know how to do Kegel exercises?" "You are experiencing total incontinence. Have you had any surgeries or trauma that may be causing this?" "You are experiencing reflex incontinence. Have you had a spinal cord injury in the past?" "You are experiencing transient incontinence. Have you been administered diuretics or IV fluids lately?"

"You are experiencing stress incontinence. Do you know how to do Kegel exercises?" Explanation: Stress incontinence occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. This commonly occurs during coughing, sneezing, laughing, or other physical activities. Childbirth, menopause, obesity, or straining from chronic constipation can also result in urine loss. Pelvic floor muscle training (PFMT) can improve voluntary control of urination and significantly reduce or eliminate problems with stress incontinence by strengthening perineal and abdominal muscle tone (Huebner et al., 2011). PFMT, more commonly called Kegel exercises, targets the inner muscles that lie under and support the bladder. These muscles can be toned, strengthened, and actually made larger by a regular routine of tightening and relaxing. Transient incontinence appears suddenly and lasts for 6 months or less. It is usually caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment (e.g., use of diuretics, IV fluid administration). Total incontinence is a continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation. Urination cannot be controlled due to an anatomic abnormality.

The nurse has an order to obtain a 24-hour urine from a client. Which of the following instructions 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." "Begin the collection when you first urinate in the morning." "Start collecting the urine with the next time you urinate."

"Discard your first urine and begin the collection after that." Explanation: The nurse would give the instructions to the client that the first urine would be discarded and collections of urine begin after that point. The urine is then collected for 24 hours and may need to be placed on ice or refrigerated. When the 24 hours is completed, the client would need to be asked to void, and the specimen collection is completed.

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? "I know it's hard to get there, but I want to try to use the commode instead of wearing an adult diaper." "I've made a point of scheduling when I drink water instead of waiting until I'm thirsty." "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 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." Explanation: Limiting fluid intake is not a healthy practice, and clients should be encouraged not to use fluid restriction as an incontinence management strategy. Promoting fluid intake is beneficial for most clients who do not possess a contraindication, and it is appropriate and useful to take diuretics in the morning to avoid nocturia. Even though it may involve work for both the client and the nurse, clients who want to use a bathroom or commode rather than an adult absorbent brief should be encouraged to do so.

What accurately describes a guideline when inserting an indwelling catheter? Use clean technique when inserting a catheter. Maintain an open system whenever possible. Avoid irrigation unless needed to relieve an obstruction. Use the largest appropriate-sized catheter.

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

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 Blood Infection

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.

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

Boys may take longer for daytime continence than girls. Explanation: Children in North American cultures usually achieve daytime urinary continence by 3 years of age; boys may take longer than girls. Nighttime continence may not occur until 4 or 5 years of age.

Which is true regarding the normal urination? In adults, the average amount of urine per void is 500 mL. Catheterized clients should drain a minimum of 30 mL of urine per hour. In adults, the amount of urine voided typically does not depend on fluid intake and losses. Urinary output does not vary all that much between adults and children.

Catheterized clients should drain a minimum of 30 mL of urine per hour. Explanation: Urine output of less than 30 mL per hour may indicate inadequate blood flow to the kidneys. In adults, the average amount of urine per void is approximately 200 to 400 mL. Adults generally have a urine output of 1500 mL per day, while children, depending on age, have a urine output between 500 and 1500 mL per day. Urine output can vary greatly, depending on intake and fluid losses.

The nurse is assessing a client with a urinary sheath catheter. After removing the catheter, the nurse observes a break in skin integrity on the penis. What actions by the nurse would be appropriate at this time? Select all that apply. Allow the skin to be open to air as much as possible Arrange for a consult with a wound nurse Wash the area with soap and water and apply the catheter Insert an indwelling catheter instead Do not reapply the urinary sheath

Do not reapply the urinary sheath Allow the skin to be open to air as much as possible Arrange for a consult with a wound nurse Explanation: If the nurse finds a break in skin integrity when assessing the client's penis, the should not reapply the external urinary sheath. The nurse should allow the skin to be open to air as much as possible. If the facility has a wound, ostomy, and continence nurse, a consult should be arranged. An indwelling catheter should be used as a last resort due to the increased risk of urinary tract infection.

A home care nurse visits a client diagnosed with depression who informs the nurse that he has been prescribed amitriptyline. What would the nurse include when educating the client about the effects of this medication? It causes urinary retention. It decreases glomerular filtrate rate. It decreases sensation of bladder fullness. It causes urine to turn blue-green.

It causes urine to turn blue-green. Explanation: The nurse should inform the client that amitriptyline turns the urine blue-green. The risk of urinary retention is increased with medications that have anticholinergic effects. Tricyclic antidepressants and antihistamines are examples of such drugs. Narcotics can decrease the sensation of bladder fullness and the glomerular filtration rate.

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? Immediately remove the catheter from the vagina, contact the primary care provider and anticipate an order for prophylactic antibiotics. Ask the client to bear down until the catheter is expelled. 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.

Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. Explanation: Start the procedure over and attempt to place the new catheter directly above misplaced catheter. Once the new catheter is correctly in place, remove the catheter in the vaginal orifice. Never remove a catheter from the vagina and insert it in the urethra as this action can cause cross-contamination.

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

Nephron Explanation: The functional unit of the kidney is called the nephron. Each kidney has more than 1 million nephrons, and each nephron is capable of forming urine. The nephron consists of the glomerulus, Bowman's capsule, proximal convoluted tubules, loop of Henle, distal tubule, and collecting duct. The glomerulus is a network of blood vessels, surrounded by Bowman's capsule, where urine formation begins. The tubules, loop of Henle, and collecting ducts are passageways that permit urine to flow to the renal pelvis and then to the ureters.

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

Stress Explanation: Stress incontinence is caused by pelvic floor muscle weakness. Urge incontinence is the inability to suppress urination after sensing the need to do so; many physical and psychological issues can be related to this problem. Overflow incontinence is related to overdistention, or overflow, of the bladder. Causes of functional incontinence include environmental barriers, physical limitations, memory loss, and disorientation.

What is the micturition reflex? The reabsorption of the substances the body wants to retain. The secretion of electrolytes that are harmful to the body. The act of bladder contraction and perceived need to void. The process of filtration beginning with the glomerulus.

The act of bladder contraction and perceived need to void. Several words are used to describe the process of excreting urine from the body, including urination, voiding, and micturition.

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 urinary tract infection results from the birth process. A neurogenic bladder results from local anesthesia. The birth can cause perineal swelling. Catheterization is necessary for 1 week.

The birth can cause perineal swelling. The birth can cause perineal swelling. Explanation: Trauma from vaginal birth causes swelling in the perineal area, which can obstruct the flow of urine and cause urinary retention during the early postpartum period.

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? A) Restrict daily fluid intake. Empty the catheter bag every few days when it is full. 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. Educational points related to an indwelling urinary catheter include instructions on connecting the catheter to a smaller leg bag for ambulation; maintaining adequate fluid intake; keeping the catheter free of kinks (avoid clamping the catheter tubing); emptying the drainage bag at regular intervals; and avoiding a full drainage bag that may lead to reflux of 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. Discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen. Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle. 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. Explanation: When it is necessary to collect a urine specimen from a client with an indwelling catheter, it should be obtained from the catheter itself using the special port for specimens. A specimen from the collecting receptacle (drainage bag) may not be fresh urine and could result in an inaccurate analysis. A client's catheter would not be removed for the sole purpose of obtaining a urine specimen.

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 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 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 (or indwelling) catheter is a urine drainage tube that is left in place over a period of time.

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? difficulty starting the stream of urine constipation and fluid overload burning and frequency episodes of clear urine mixed with episodes of cloudy urine

burning and frequency Explanation: The nurse anticipates that the client has a urinary tract infection (UTI), which is characterized by cloudy, foul-smelling urine, burning, and frequency. Difficulty starting a urine stream is associated with benign prostatic hypertrophy; UTI's are not characterized by intermittent clear urine, nor by constipation and fluid overload. Dehydration is more likely.

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

caffeine intake. Explanation: Fluids or food containing alcohol or caffeine, such as coffee, tea, cola, or chocolate, irritate the bladder and contain a diuretic that can increase urine output when ingested in large amounts.

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 cloudy, foul odor clear, dark amber

cloudy, foul odor Explanation: 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 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? aromatic, green dark brown, cloudy clear, light yellow reddish-brown, clear

dark brown, cloudy The client with advanced liver disease is expected to have dark brown or dark amber urine; infection may be represented by cloudy urine. Other answers are incorrect.

A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample? before bedtime afternoon evening first thing in the morning

first thing in the morning While the specimen can be collected at any time during the day, the first urine voided in the morning is preferred. The first urine is usually more concentrated because the client does not usually consume fluid during the night and the effects of diet and activity are minimized.

The nurse observes that a client frequently experiences urine loss when being transferred from a chair to the bed. Which type of incontinence does the nurse identify that the client is experiencing? total functional reflex urge

functional Functional incontinence takes place when attempting to overcome obstacles, such as transferring from the wheelchair to the bed. Other types of incontinence have different causative factors.

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? Foley catheter indwelling urethral catheter retention catheter intermittent urethral catheter

intermittent urethral catheter Explanation: An intermittent urethral catheter (straight catheter) is a catheter inserted through the urethra into the bladder to drain urine for a short period of time (5 to 10 minutes). With an indwelling urethral catheter (retention or Foley catheters), a catheter (tube) is inserted through the urethra into the bladder for continuous drainage of urine; a balloon is then inflated to ensure that the catheter remains in the bladder once it is inserted.

A patient has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this patient is related to a A) Cystocele B) Enuresis C) Overactive bladder D) Neurogenic bladder

neurogenic bladder. Neurologic injury after a stroke or spinal cord injury can disrupt normal patterns of urinary elimination. This condition is called neurogenic bladder. A cystocele is a herniation of the urinary bladder. Enuresis is the clinical term for bedwetting. An overactive bladder is the term used when a person has increased urinary urge, increased urinary frequency, or both.

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: anuria oliguria nocturia polyuria

oliguria Explanation: Oliguria is a significant decrease in urine production. Anuria is an absence or near-absence of urine output. Nocturia is nighttime awakening to void. Polyuria is greatly increased urine production.

The nurse is caring for a client who reports developing urinary incontinence over the past 4 weeks. When taking a history, the nurse will ask if the client has been placed recently on what kind of medication that may contribute to this condition? sleeping pills stool softeners antihistamines hormone patch

sleeping pills Explanation: The nurse anticipates that medications for hypertension, diuretics, antidepressants, and sleeping pills may contribute to urinary incontinence. Other answers are incorrect.

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 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.

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? urinal regular bathroom bedside commode fracture pan

urinal Explanation: The client with weakness who has been ordered to stay on bed rest will benefit from use of a urinal. The client should not be moved to the bedside commode or regular bathroom. A fracture pan may be useful for bowel movements.

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." 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.

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? Nocturia Oliguria Urinary Retention Anuria

Anuria Explanation: Absence of urine for a 24-hour period reflects anuria.

The nurse is preparing to catheterize a client who is incontinent of urine following bladder surgery. What fact should the nurse keep in mind when performing catheterization? The external opening to the urethra should always be sterilized. A normal bladder is as susceptible to infection as an injured one. Pathogens introduced into the bladder remain in the bladder. The bladder normally is a sterile cavity.

The bladder normally is a sterile cavity. Explanation: The bladder is normally a sterile cavity. It is not possible to sterilize a part of the human body, only disinfect it. Pathogens introduced into the bladder have the ability to enter other parts of the body, including the blood stream. An injured bladder is much more susceptible to infection than a normal bladder.

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 client is on a low protein diet. The client has a history of osteoarthritis. The client is lactose intolerant.

The client is dehydrated. Explanation: The BUN test measures the amount of urea nitrogen in the blood. Urea, the major nitrogenous end-waste product of metabolism, is formed in the liver. The bloodstream carries urea from the liver to the kidneys for excretion. When the kidneys are diseased, they are unable to excrete urea adequately, and urea begins to accumulate in the blood, causing BUN to rise. Normal BUN is 8 to 25 mg/100 mL. Because other factors, such as high dietary intake of protein, fluid deficit, infection, gout, or excessive breakdown of protein stores, can also elevate BUN, it is not a highly sensitive indicator of impaired renal function.

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

dehydration Explanation: The nurse anticipates that the client may be dehydrated, which is characterized by strongly aromatic, dark amber urine. The symptoms are not associated with hypervolemia, balanced fluids, nor renal failure.

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

one or both of the ureters are surgically implanted elsewhere Explanation: 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.

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

the first voiding of the day Explanation: The nurse would discard the first void of the day. The bladder has collected urine that has been produced by the kidneys overnight. The first voided urine of the day is usually more concentrated than other urine excreted during the day. Because the first urine of the day is not fresh, but rather an accumulation of a number of hours of kidney output, this urine may or may not be used as a specimen for certain tests. The other options would be appropriate to use for urine tests.

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

True

The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice? Specimen hat Large urine collection bag Urinal Bedpan

Urinal Explanation: A urinal is the best choice to collect urine from a nonambulatory male client. A specimen hat is for a commode. A bedpan is not the best choice for a male client. A large urine collection bag would be used with an indwelling catheter.

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

Check health record for provider's order. Explanation: The nurse will first check for an order to irrigate the Foley catheter. The other steps can be taken after the order is confirmed.

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

Contact the health care provider to decrease furosemide. Explanation: 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 is caring for an elderly client who has been prescribed a condom catheter. What potential problems related to the use of condom catheter should the nurse monitor in the client? Select all that apply. Inability to control urinary elimination Excoriation of the skin in the glans area Restricted blood flow to the glans tissue Frequent urinary tract infection Kinks in tubing that encourages backflow of urine

Correct response: Restricted blood flow to the glans tissue Excoriation of the skin in the glans area Kinks in tubing that encourages backflow of urine Explanation: A potential problem that can occur with the use of condom catheters is the restriction of blood flow to the skin and tissues of the penis if the sheath is applied too tightly. Another potential problem is the tendency of moisture to accumulate beneath the sheath leading to skin breakdown or excoriation, especially the skin around the glans. A retention catheter, not a condom catheter, could lead to urinary tract infection. Use of a condom catheter does not lead to the inability to control urinary elimination. Care must be taken to fasten the condom securely enough to prevent leakage. Monitor for kinks in the tubing since this may cause backflow of urine.

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? Dark amber Tea colored Pale yellow Colorless

Dark amber Urine may be dark amber or orange-brown if it is very concentrated secondary to a decreased fluid intake. Urine is lighter than normal if it is diluted. Foods or drugs can also alter the color of urine. Tea-colored or very dark urine is a sign of dehydration.

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

Keep muscles contracted for at least 10 seconds. Explanation: 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 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. 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.

Fasten the condom securely enough to prevent leakage without constricting the blood vessels. Explanation: Nursing care of a client with an external condom catheter includes vigilant skin care to prevent excoriation. This includes removing the condom catheter daily, washing the penis with soap and water and drying carefully, and inspecting the skin for irritation. In hot and humid weather, more frequent changing may be required. In all cases, care must be taken to fasten the condom securely enough to prevent leakage, yet not so tightly as to constrict the blood vessels in the area. In addition, the tip of the tubing should be kept 1-2 inches (2.5 to 5 cm) beyond the tip of the penis to prevent irritation to the sensitive glans area.