Ch. 36- Urinary Elimination

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?

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

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 an UTI." During sexual intercourse, bacteria from the perineal area may travel into the urethra and urinary bladder. The spermicide used with the diaphragm (IUD) decreases the vagina's normally protective flora. The glucose in the urine acts an excellent medium for bacteria to proliferate in the client with diabetes mellitus. The elderly are predisposed to development of UTI due to the physiological changes associated with aging.

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

"How frequently do you urinate each day?" The client with frequent urinary tract infections may have infrequent urination, which can lead to stagnation of urine in the bladder; this potentially leads to growth of bacteria. Taking blood pressure medication, being on a special diet, or having bowel movements do not increase the risk for urinary tract infections.

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

The healthcare provider has ordered a Foley catheter for a 48-year-old male client who is in traction with leg fractures. The client refuses, stating "I don't want something placed internally into me." What is the appropriate nursing response?

"Let me talk to your healthcare provider about a condom catheter." The nurse will support the client's autonomy by investigating other options like a condom catheter. It is nontherapeutic to discount the client's concern, or to tell the client that this is the only catheterization option. The client clearly cannot ambulate with leg fractures.

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?

"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.

A parent asks the nurse when an 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." A child is typically 2-3 years old before beginning toilet training, although this does depend on the culture. The child signals readiness by staying dry for longer periods; usually at least 2 hours. The child may feel a sensation of bladder fullness, but is not necessarily able to express this. Boys may take longer to be ready for toilet training instead of girls.

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?

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

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

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.

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. 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?

Catheterized clients should drain a minimum of 30 mL of urine per hour. 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.

A client could experience increased urination when using which classification of medication?

Cholinergic agents Explanation: Cholinergic agents stimulate the detrusor muscle, which causes more frequent urination.

To promote drainage of a client's Foley catheter, which intervention would be most important for the nurse to implement?

Confirming the catheter tubing is not lying under the client The measure that directly relates to proper drainage of the catheter is being sure that the catheter tubing is free and clear of any obstructions, such as being under the client. The drainage bag should also be lower than the client's bladder. The drainage bag should not be on the floor to prevent infection. The nurse would secure the catheter after insertion to prevent pulling of the catheter, which can cause irritation. The nurse would also ensure the balloon on the catheter is properly inflated to prevent movement of the catheter, which can also cause irritation.

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

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. Measures to decrease the risk for a UTI include drinking ten 8-ounce glasses of water daily; observing for signs and symptoms of a UTI; drying the perineal from the urethra toward the rectum; drinking two glasses of water before and after sexual intercourse; showering rather than bathing; wearing cotton underwear; avoiding tight, constricting clothing; and drinking cranberry or blueberry juice daily.

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?

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

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?

Functional Explanation: 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 client in a long-term care facility becomes confused and disoriented at night and is incontinent during these periods of confusion due to the inability to find the commode. During the day, the client does not experience confusion and is continent. What type of incontinence is this client experiencing during the nighttime hours?

Functional incontinence Functional incontinence is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, or loss of memory or disorientation. Stress incontinence occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. Reflex incontinence is an emptying of the bladder without the sensation to void. Transient incontinence appears suddenly and lasts for 6 months or less.

A client who visits a health care facility for a routine assessment reports to the nurse that he is unable to control his urinary elimination. This has resulted in him soiling his clothes and has led to a lot of embarrassment. How should the nurse document the client's condition?

Incontinence 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.

The nurse is caring for a male patient who has a urinary obstruction and is not a candidate for surgery. What intervention would the nurse expect the health care provider to perform?

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 the 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 catheter is not in the bladder, so urine in the tubing is not sterile.

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?

Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. 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 nurse assesses the urine of a patient who is using a bedpan and finds that it is a dark brown color. What medication might be causing this effect?

Levodopa Levodopa and injectable iron compounds can cause brown or black urine. Phenazopyridine can cause orange or orange-red urine. Amitriptyline can cause green or blue-green urine, and diuretics can lighten the color of urine to pale yellow.

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

Nephron

Because of the older adult's inability to concentrate urine as a physiologic change, the nurse should assess the client for which condition?

Nocturia The older adult has many physiologic changes that can relate to urination, and one of these is the inability of the kidneys to concentrate urine. This can lead to nocturia, or urination during the night. With clients who have an intact urinary tract, the kidneys concentrate urine during the night so that a person does not have to get up frequently to urinate. Incontinence can be caused by many factors for an elderly person including a decrease in bladder tone or a feeling of powerlessness. Urinary stasis or retention can be caused by a decrease in the bladder's contractability.

A nurse is caring for a client who is catheterized following a surgery of the prostate. When caring for the client, the nurse performs a continuous irrigation of the catheter. Which of the following interventions should the nurse perform when providing continuous irrigation?

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 and not when irrigating the catheter.

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 of the following would the nurse document as an abnormal finding?

Reddened perineal skin The presence of reddened perineal skin is an abnormal finding. The healthy skin should be moist and noninflamed with no discharge present. Smegma, an accumulation of white, odorous secretions from sebaceous glands found under the labia minora in women and under the foreskin in men, is considered a normal finding.

A nurse is performing an intermittent closed catheter irrigation on a client and realizes that the tubing was not clamped before introducing the irrigation solution. What would be the nurse's response to this situation?

Repeat the irrigation.

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?

Stress incontinence

Which is not true of urine 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 catheterize a client who is incontinent of urine following bladder surgery. What fact should the nurse keep in mind when performing catheterization?

The bladder normally is a sterile cavity. 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.

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?

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

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 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 device must be programmed for the gender of the client by pushing the correct button on the device. The device must be programmed for the gender of the client by pushing the correct button on the device. If a female client has had a hysterectomy, the male button is pushed. A postvoid residual (PVR) volume less than 50 mL indicates adequate bladder emptying. A PVR of greater than 150 mL is often recommended as the guideline for catheterization, because residual urine volumes of greater than 150 mL have been associated with the development of urinary tract infections.

A nurse is collecting a routine urinalysis on a client presenting to the emergency room with abdominal pain. Which of the following is true regarding this specimen?

The nurse will obtain a nonsterile specimen and send it to the lab.

The nursing student who is learning skills during campus lab identifies which of the following statements about bedpans to be true?

The rounded shelf of a regular bedpan should be placed under the client's buttocks. The only true statement is that the rounded shelf of the regular bedpan should be placed under the client's buttocks. Very thin and older adult clients may prefer the fracture bedpan. Both types of bedpans can be used for either urination or defecation. A fracture bedpan can be used for any client.

Which statements about suprapubic catheters is true?

They are often preferred over an indwelling urethral catheter for long-term urinary drainage. Suprapubic catheters are associated with: decreased risk of contamination with organisms from fecal material; elimination of damage to the urethra; a higher rate of client satisfaction; and a lower risk of catheter-associated urinary tract infections

The nurse is caring for a client with concerns of urinary incontinence. A review of the client's data collection reveals the client has a history of spinal surgery and states, "I urinate all the time and cannot predict when I will urinate." This data collection would suggest to the nurse that this client is experiencing which type of urinary incontinence?

Total incontinence Total incontinence may be the result of surgery, trauma, or physical malformation; the client has continuous and unpredictable loss of urine. Stress incontinence is related to an increase in intra-abdominal pressure; and commonly occurs during activities, such as coughing and sneezing. Overflow incontinence is associated with overdistention and overflow of the bladder; and the signal to empty the bladder is lost, the bladder fills, and the client dribbles urine. Functional incontinence occurs because the client is unable to reach the toilet.

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

True

The nurse is observing the unlicensed assistive personnel (UAP) assist the client with the bedpan. The nurse would intervene if which action, by the UAP, is noted?

UAP positions the bedpan so the client's buttocks rest on the shallow end of the regular bedpan. It is important to place the bedpan in the proper position to prevent spills onto the bed, ensure client comfort, and prevent injury to the skin from a misplaced bedpan. Therefore, the UAP should position the bedpan so the client's buttocks rest on the rounded shelf of the regular bedpan. Applying powder to the rim of the bedpan helps keep the bedpan from sticking to the client's skin and makes it easier to remove, unless it is contraindicated. The nurse uses less energy when placing the hand closest to the client palm up, under the lower back, and assisting with client lifting. A waterproof pad protects the bed from bedpan spillage.

Which statement about the use of a urinal is true?

Unless contraindicated, nurses should encourage clients to stand to use a urinal. A urinal should not be left in place for extended periods of time, because pressure and irritation to the client's skin can result.

The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice?

Urinal

The nurse is reviewing the chart of an elderly client who exhibits signs of confusion. Which laboratory value would indicate to the nurse that intervention is needed?

Urine culture & sensitivity - 100,000/mL 100,000 organisms per milliliter in an urine culture and sensitivity specimen is positive of a urinary tract infection. BUN, hemoglobin, and magnesium are all within the normal ranges.

A nurse is inserting a catheter into a female urinary bladder. Which nursing action is performed correctly?

Use dominant hand to inflate the catheter balloon, and inject entire volume of sterile water supplied in prefilled syringe. The nurse would use the dominant hand to inflate the catheter balloon, and inject the entire volume of sterile water supplied in the prefilled syringe. The nurse would not hold the catheter 12 inches from the tip. This would result in the nurse having little control over the tip of the catheter and the catheter could easily become contaminated. The nurse would not cleanse the perineal area with a gauze pad and alcohol. Iodine swabs are used to clean the perineal area prior to catheter insertion. The nurse would assist the client into the supine position, not the prone position for the procedure.

A nurse is preparing to measure a client's urine output. Which of the following interventions would be of highest priority?

Wearing gloves when handling the urine All of these interventions would be important to ensure safety in handling the client's urine and obtaining an accurate output. However, safety with handling body fluids would be a priority for the nurse to decrease risk of exposure to pathogens or blood that may be in the client's 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?

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

The nurse is caring for a client with weakness who is ambulatory but tires easily. Which method for urinary elimination does the nurse recommend?

bedside commode

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

caffeine intake.

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 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.

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 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 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.

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 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.

The nurse collects a urine sample from a client for urinalysis. What would the nurse document as a normal characteristic?

light yellow color

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 The nurse could describe the client's condition as the loss of urine without any identifiable pattern or warning. Stress incontinence can be described as loss of a small amount of urine when intra-abdominal pressure rises. Urge incontinence can be described as the need to void being perceived frequently with a short-lived ability to sustain control of flow. Functional urinary incontinence can be described as the loss of control over urination because a toilet is not accessible.

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 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.

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

straight catheter

A physician orders a long-term continuous drainage system to monitor a chronically ill client. What type of catheter would best suit this client's needs?

suprapubic catheter Suprapubic catheters are recommended for long-term continuous drainage because they are associated with a decreased risk of contamination with organisms from fecal material, the elimination of damage to the urethra, a higher rate of client satisfactions, and a lower risk of UTIs.

The doctor has ordered the collection of a fresh urine sample for a particular examination. Which urine sample would the nurse discard?

the first voiding of the day 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.

The nurse measures a client's residual urine by catheterization after the client voids. Which condition would this test verify?

urinary retention

The nurse is providing instructions to a client with kidney stones on measures to help prevent urinary tract infections (UTIs). Which statement made by the client, would indicate to the nurse that further teaching is necessary? (Select all that apply.)

• "I will drink 10 ounces of cranberry juice every day." • "I will bathe in the bath tub rather than take a shower." Even though cranberry juice is encouraged to prevent bacteria from adhering to the urinary bladder wall, it is not recommended for the client with kidney stones. The client should take showers instead of bathing in the bathtub to prevent UTIs. Drinking 8 to 10, 8-oz glasses of water daily, notifying the health care provider of any signs of infection, such as foul urine odor, and wearing underwear with a cotton crotch are measures to prevent UTIs.

Which situation warrants urinary catheterization? Select all that apply.

• A client is in septic shock and highly unstable. • A sterile urine specimen is needed from an acutely confused client. • A client with an enlarged prostate is unable to void.

A nurse is performing a physical assessment of a client's urinary system. Which nursing actions are appropriate during this assessment? Select all that apply.

• If using a bedside scanner, the nurse places the client in a supine position. • The nurse inspects the urethral orifice for any signs of inflammation, discharge, or foul odor. • The nurse assess the client's urine for color, odor, clarity, and the presence of any sediment. • The nurse retracts the foreskin of an uncircumcised male client to visualize the meatus.

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

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

The nurse is assessing a client's bladder volume using an ultrasound bladder scanner. Which nursing actions are performed correctly? Select all that apply.

• The nurse gently palpates the client's symphysis pubis. • The nurse places a generous amount of ultrasound gel or gel pad midline on the client's abdomen, about 1 to 1.5 inches above the symphysis pubis. • The nurse aims the scanner head toward the bladder (points the scanner head slightly downward toward the coccyx). • The nurse adjusts the scanner head to center the bladder image on the crossbars.

The nurse is caring for a client who reports urinary incontinence over the past 2 months. In reviewing the electronic health record, which new prescriptions will the nurse look for that may be related to the concern? (Select all that apply.)

• diuretics • antihypertensives • antidepressants • sleeping pills The nurse anticipates that medications for hypertension, diuretics, antidepressants, and sleeping pills may contribute to urinary incontinence. Stool softeners are not associated with urinary incontinence.

A client with a new urostomy requires teaching by the nurse. The nurse will construct the plan of care and education based upon which primary nursing diagnosis? (Select all that apply.)

• risk for impaired skin integrity • risk for Infection • situational Low Self-Esteem