Ch 41 Urinary Elimination Review Questions

8. The nurse is assessing a patient with an indwelling catheter and finds that the catheter is not draining and the patient's bladder is distended. What action should the nurse take next? a. Notify the primary care provider. b. Assess the tubing for kinks and ensure downward flow. c. Change the catheter as soon as possible.

8. Answer: b The next action by the nurse should be to check the patency of the catheter tubing. At this point there is no need to aspirate any urine or call the primary care provider. The catheter should not be changed unless absolutely necessary, owing to the possibility of causing an infection.

A patient with a history of kidney stones is experiencing difficulty urinating and laboratory findings indicate the patient is in acute renal failure. What is the probable cause of this condition? a. Hypovolemia b. Cardiogenic shock c. Nephrotoxic substances d. Urethral obstruction

ANS: D Inadequate flow or complete obstruction by anything (such as stones or tumors) that blocks both ureters and the bladder, or obstructs the urethra, resulting in acute or chronic renal failure. With a history of kidney stones, it is most probably that one is moving down the urinary tract and got lodged, leading the patient to have difficulty urinating.

The patient is ordered an ultrasound of the kidneys. The nurse knows that prior to the test the patient will: a. be required to have a bowel cleansing enema. b. be checked for any allergies to shellfish. c. be required to drink a large amount of fluids before the test. d. have no pretest requirements.

ANS: D (debatable) An ultrasound scan may be performed to assess the size, shape, and location of the kidneys. Ultrasound studies may be safely conducted in patients who have allergies to contrast media, because no radiation or contrast dyes are used. No patient preparation such as fasting or sedation is required.

1. A patient with an indwelling catheter reports a need to void. What is the priority intervention for the nurse to perform? a. Check to see if the catheter is patent. b. Reassure the patient that it is not possible to void while catheterized. c. Catheterize the patient again with a larger gauge catheter. d. Notify the primary care provider.

1. Answer: a Checking the position and patency of the catheter first will determine whether the problem is mechanical or physiologic. At times, the end of the catheter may become lodged up against the side of the bladder, preventing the flow of urine into the tubing. Telling the patient that is impossible to void while catheterized is erroneous. Catheterizing the patient with a larger-gauge catheter is unnecessary at this point, as is contacting the primary care provider.

10. Which nursing intervention would be the highest priority when caring for a patient complaining of voiding small amounts of urine in relation to his fluid intake? a. Placing a disposable waterproof pad on the patient's bed before he goes to sleep. b. Documenting in the patient's electronic health record that he is complaining of anuria. c. Notifying the patient's primary care provider (PCP) of the need for intermittent catherization. d. Palpating the patient's bladder for distention before scanning for possible retention

10. Answer: d The highest priority nursing intervention for a patient experiencing oliguria (reduced urine volume) is to check the patient for bladder distention and retention. Placing a waterproof pad on the patient's bed at bedtime would be more appropriate if the patient was incontinent or experiencing nocturia (excessive urination at night). Documentation of anuria (excretion of 50-100 mL or less of urine each day) would be erroneous since the patient is complaining of repeatedly passing small amounts of urine. Notifying the primary care provider may be necessary, but only after the patient is assessed for distention and retention that is not resolved by other less invasive methods of relief.

2. Which nursing instruction is correct when a urine specimen is collected for culture and sensitivity testing from a patient without a urinary catheter? a. Tell the patient to void and pour the urine into a labeled specimen container. b. Ask the patient to void first into the toilet, stop midstream, and finish voiding into the sterile specimen container. c. Instruct the patient to discard the first void and collect the next void for the specimen. d. Have the patient keep all voided urine for 24 hours in a chilled, opaque collection container.

2. Answer: b Urine specimens for culture and sensitivity testing must be collected in sterile containers using the clean-catch, midstream method whenever possible. All voided urine specimens should be collected directly into the specimen container, not transferred to another, potentially contaminated receptacle. Discarding the entire first void and saving urine in a chilled, opaque container are both procedures for conducting a 24-hour urine collection.

3. A female patient has had frequent urinary tract infections. Which statement by the patient indicates that the nurse's teaching on prevention has been effective? a. "I will limit my fluid intake to 40 ounces per day." b. "I will use only organic bath bombs when bathing." c. "I will wait to wear my tight jeans until after my urine is clear." d. "I will wipe from the front to back after voiding."

3. Answer: d Wiping the female perineal area from front to back after voiding is crucial in the prevention of microorganisms, which lead to infection, being transferred from the rectum or vagina to the urethral meatus. Limiting fluid intake, using any type of bath bombs, and wearing tight-fitting clothing all may contribute to the promotion of urinary tract infections rather than their prevention.

4. A patient is scheduled for an intravenous pyelogram (IVP). Which piece of data would be most important to know before the procedure is carried out? a. Urinalysis negative for sugar and acetone b. History of allergies c. History of a recent thyroid scan d. Frequency of urination

4. Answer: b Contraindications for intravenous pyelogram (IVP) include an allergy to iodine, which is similar to the contrast material injected during the IVP. Knowing this information would be critical to providing safe patient care. Frequency of urination may be an indication to perform an IVP; however, this is not critical to know before performing an IVP. The results of a urinalysis and history of a recent thyroid scan would not affect a scheduled IVP.

5. When emptying a patient's catheter drainage bag, the nurse notes that the urine appears to be discolored. The nurse understands that what factors may change the color of urine? (Select all that apply.) a. Taking the urinary tract analgesic phenazopyridine b. A diet that includes a large number of beets or blackberries c. An enlarged prostate or kidney stones d. High concentrations of bilirubin secondary to liver disease e. Increased carbohydrate intake

5. Answers: a, b, c, d Urine may appear orange when a patient is taking phenazopyridine. Urine can appear red or pink with a diet including beets or blackberries and if blood is present in the urine, which may be secondary to an enlarged prostate or kidney stones. Urine often has a brownish appearance when liver disease such as hepatitis or cirrhosis is present. Carbohydrate intake does not typically cause urine to be discolored.

6. What self-care measure is most important for the nurse to include in the teaching plan for a patient who will be discharged with a urostomy? a. Change the appliance before going to bed. b. Cut the wafer 1 inch larger than the stoma. c. Cleanse the peristomal skin with mild soap and water. d. Use firm pressure to attach the wafer to the skin.

6. Answer: c The peristomal area should be washed by the patient using warm water and mild soap as needed and routinely at bath time. The collection device typically has a face plate to ensure a good fit and prevent leakage of urine. These appliances are changed less frequently than before bed each night, and neither a widely cut wafer nor firm pressure is needed for their application.

7. An indwelling catheter is ordered for a postoperative patient who is unable to void. What is the primary concern of the nurse performing the procedure? a. Teaching deep-breathing techniques b. Maintaining strict aseptic technique c. Medicating the patient for pain before the procedure d. Positioning the patient for comfort during the procedure

7. Answer: b It is most important to maintain strict aseptic technique while inserting an indwelling catheter, to try to prevent a urinary tract infection. It is not necessary to medicate patients before urinary catheterization. Although comfortable positioning and deep breathing may help relax the patient, this is not the primary concern.

9. The nurse is placing an indwelling catheter in a female patient. The nurse accidentally inserts the catheter into the vagina. What is the next action for the nurse to implement? a. Collect a urine specimen and notify the primary care provider (PCP). b. Leave the catheter in place and insert a new catheter into the urethra. c. Remove the catheter from the vagina and place it into the urethra. d. Ask another nurse to attempt the catheterization of the patient.

9. Answer: b By leaving the first catheter in place in the vagina, the nurse can more accurately identify the urethra for insertion of the new catheter. This prevents misplacing the new catheter into the vagina during the second catheterization attempt. The catheter that was placed in the vagina is no longer sterile, so it should not be reused and should be discarded after the new catheter is properly placed into the bladder. It is impossible to get a urine sample from the catheter placed in the vagina. Only after having trouble with proper placement of the new catheter may the nurse wish to ask for assistance from another nurse.

The nurse is inserting an indwelling catheter into a male patient. While initially passing the catheter through the urethra, resistance is met. What action would the nurse take next? a. Withdraw the catheter and obtain a coude catheter. b. Straighten the penis and attempt to progress the catheter again. c. Remove the catheter and insert one with a smaller lumen. d. Inflate the balloon and wait for urine passage.

ANS: A Coudé catheters are a special type of double-lumen, indwelling catheters that are slightly stiff and bent at the end, allowing the catheter to pass more easily through a partially constricted urethra. They are used mostly in men experiencing prostate enlargement or BPH. The nurse would not continue trying to advance the catheter, try one with a smaller lumen, or inflate the balloon before the catheter was properly inserted.

Nursing interventions for the patient who suffers from stress incontinence include: a. Kegel exercises. b. surgical interventions. c. bowel retraining. d. intermittent catheterization.

ANS: A Kegel exercises also are known as pelvic floor exercises. They improve muscle tone in the pelvic floor, which helps to prevent stress incontinence.

Which organism is responsible for the majority of urinary tract infections in female patients? a. Escherichia coli b. Neisseria gonorrhoeae c. Candida albicans d. Haemophilus influenza

ANS: A Urinary tract infections (UTIs) are the result of bacteria in the urine. Infection occurs when bacteria from the digestive tract, usually E. coli, invade the urethra and multiply. N. gonorrhoeae causes gonorrhea. C. albicans causes yeast infections. H. influenza causes influenza.

Average urine pH is: a. 4. b. 6. c. 7. d. 9.

ANS: B Urine normally is slightly acidic, with an average pH of 6.