Chapter 37: Urinary Elimination

Which of the following is an accurate guideline to follow if there is not an immediate flow of urine after a catheter has been inserted?

Have the patient take a deep breath, which helps to relax the perineal and abdominal muscles.

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

Suprapubic catheter

Which type of incontinence is caused by an overactive detrusor muscle causing involuntary bladder contractions?

Urge

Which of the following statements about suprapubic catheters is true?

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

Several of the patients on a geriatric subacute medicine unit are experiencing urinary incontinence from differing causes. Which of the following statements suggests that the patient requires further teaching?

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

A nurse collects a clean-catch specimen from a client at a health care facility. Which of the following statements describes a clean-catch urine sample?

A sample of urine that is considered sterile

A client with a urinary tract infection is to be discharged from the healthcare facility. After teaching the client about measures to prevent urinary tract infections, the nurse determines that the teaching was successful when the client states which of the following?

"I need to void after sexual intercourse."

A patient informs the nurse that he is concerned about dribbling and incontinence of small amounts of urine after the removal of his indwelling urinary catheter. The nurse is aware that the catheter was in place for three weeks prior to being removed. Which of the following is the nurse's best response to the patient?

"It will take a little while for the bladder to re-establish control, and an accident is not unusual."

A woman informs the nurse that when she is experiencing stress it is difficult to void and wonders why this happens? The nurse explains

"Stress causes the muscles to become tense."

You are preparing to insert an indwelling urinary catheter into a 3-year-old child. Which of the following sizes of urinary catheters should you plan to use?

6 Fr

A nurse is caring for an elderly client at his home. The client has had a condom catheter applied. Which of the following describes a condom catheter?

A flexible sheath that is rolled around the penis

The nurse should recognize the possibility of maintaining a continuous bladder irrigation system when admitting which of these patients?

A patient who has undergone prostate resection surgery that morning

Upon admission, the patient informs the nurse of the medications he takes daily at home. When the nurse learns that the patient takes amitriptyline (Elavil), she anticipates the patient's urine may have which discoloration?

Blue-green

Which of the following statements 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 patient 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 patient does not experience confusion and is continent. What type of incontinence is this patient experiencing during the nighttime hours?

Functional incontinence

When a client is diagnosed with a urinary tract infection, the nurse anticipates that the client's urine will be

Cloudy with an offensive odor

A client at a health care facility has been diagnosed with polyuria. How would the nurse describe the client's condition in the medical record?

Greater than normal urinary volume

The micturition reflex is the

Act of bladder contraction and perceived need to void

An infant is born with spina bifida. She may have

Alterations in urinary elimination

The nurse has been closely monitoring a patient who has recently had her indwelling urinary catheter removed. In the six hours since the catheter was removed, the patient has yet to void. How should the nurse first respond to this assessment finding?

Assess the patient's bladder by palpation and bedside ultrasound.

Which of the following is an accurate step when caring for a hemodialysis access?

Auscultate over the site with a stethoscope to listen for a bruit or vibration.

Which of the following accurately describes a guideline when inserting an indwelling catheter?

Avoid irrigation unless needed to relieve an obstruction.

During his stay in the hospital, Mr. Wheeler has established a pattern of maintaining urinary continence during the day, but he is experiencing incontinence at night. What intervention should the nurse implement in Mr. Wheeler's care?

Condom catheter

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

Blood

A woman complains of bladder urgency. It is most important to assess

Caffeine intake

Use of which the following classification of medications can cause increased urination?

Cholinergic agents

A client is admitted to the healthcare facility with a diagnosis of stress incontinence. When reviewing the client's health record, which of the following would the nurse identify as a factor contributing to the client's condition?

Damage to the bladder neck

A client has been NPO after midnight for surgery. It is 11:00 AM and the nurse has asked her to void before being transferred to the surgical suite. The nurse should expect her urine to be

Dark amber

A nurse performs catheter irrigation for a client at a health care facility only after verifying that a medical order has been written. Why should the nurse take this precaution?

Demonstrates legal limits of nursing

A nurse is caring for a client at a health care facility who experiences urinary urgency. Which of the following is a possible cause of the client's condition?

Diminished bladder capacity

A patient 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 patient to follow?

Drink two glasses of water before and after sexual intercourse.

A client is admitted to the healthcare facility with complaints of pain on urination that is secondary to a urinary tract infection (UTI). The nurse documents this finding as which of the following?

Dysuria

A nurse is caring for a client who is being treated for bladder infection. The client complains to the nurse that he has been having difficulty voiding and feels uncomfortable. How should the nurse document the client's condition?

Dysuria

A client at a health care facility complains to the nurse that when traveling, he is unable to retain urine until he locates a toilet. How should the nurse document this incontinence in the client?

Functional

A nurse is caring for a patient with an external condom catheter. Which of the following 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.

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

Incontinence

A patient has developed edema in her lower legs and feet, prompting her physician to prescribe furosemide (Lasix), a diuretic medication. After the patient has begun this new medication, what should the nurse anticipate?

Increased output of dilute urine

A nurse drains the bladder of a patient by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance?

Intermittent urethral catheter

Which of the following is an advantage of using a condom catheter for a male patient who has frequent episodes of urinary incontinence?

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

You are attempting to insert a urinary catheter into a female patient's bladder and realize the catheter has been inserted into the vagina. Which of the following actions 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 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

The nurse collects a urine sample from a client for urinalysis. Which of the following 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

A nurse prepares a patient with an ileal conduit to be discharged to his home. Which of the following is a normal finding following this procedure?

Mucus in the urine is a normal finding.

A patient is suspected of having a disease process affecting the functional unit of the kidney. The nurse correctly recognizes which of the following stuctures is most likely involved?

Nephron

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

A nurse is caring for a client diagnosed with congestive heart failure. Which of the following would the nurse most likely assess?

Nocturia

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

Oliguria

Which of the following is a recommended guideline when catheterizing the female urinary bladder?

Once urine drains, advance the catheter another 2 to 3 inches.

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. Which of the following describes a urinary diversion?

One or both of the ureters are surgically implanted elsewhere

You are preparing to insert an indwelling urinary catheter into a female patient's bladder. Arrange the following steps in the correct order.

Open sterile catheterization tray using sterile technique. Don sterile gloves. Open all sterile supplies. Clean each labial fold, then the area directly over the meatus. Slowly insert the lubricated catheter into the urethra. Advance the catheter until there is a return of urine.

A client has a urinary tract infection. The client is told to take phenazopryridine (Pyridium) to decrease urinary discomfort. The client should be instructed that her urine will turn

Orange

An older adult woman tells the nurse that she has trouble controlling her urine. She states, "The urine starts dripping even before I feel like I have to go." The nurse interprets this as which of the following?

Overflow incontinence

You are the guest speaker at a women's club. Most of the women are over the age of 40 years. The women have asked you to speak on health promotion topics. In the area of urinary urgency, you instruct the women to

Perform Kegel exercises

You are preparing to assess a patient's postvoid residual using a bladder scanner. Arrange the following steps in the correct order.

Press the appropriate gender button. Position scanner head with directional arrow pointing to the head. Press scanner head onto the skin 1 to 1.5 inches above the symphysis pubis. Aim scanner head toward coccyx and activate scan. Verify screen crossbars fall within bladder image. Observe and record the volume measurement on the screen.

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?

Purge air from the tubing

The nurse is reviewing the urinalysis of a client suspected of having a urinary tract infection. The presence of which of the following will support the potential diagnosis?

Pus

A laboratory test of a client's urine indicates the presence of pus in the urine. Which of the following terms is used to describe this type of urine?

Pyuria

Which of the following terms is most closely associated with an acute urinary tract infection?

Pyuria

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 meatal skin

A nurse is preparing a discharge teaching plan for a patient being sent home with a peritoneal dialysis catheter in place. Which of the following is a recommended guideline that should be included in the instructions?

The catheter exit site should be cleansed after showering.

A nurse at a health care facility provides continence training to a client. During the training, the nurse plans a trial schedule for voiding that correlates with the time when the client is usually incontinent. Which of the following is a possible reason for the nurse's action?

Reduces potential for accidental voiding

A nurse is performing an intermittent closed catheter irrigation on a patient 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.

The physician orders an indwelling urinary catheter to be inserted into a woman who has had a total hip replacement and is on strict bedrest. When inserting the catheter, the nurse would place the client in which position?

Side-lying position

A nurse uses a catheter to collect a sterile urine specimen from a client at a health care facility. If a catheter is required temporarily, which type of catheter should the nurse use?

Straight catheter

Which type of incontinence is caused by pelvic floor muscle weakness?

Stress

A nurse is caring for a client who has a 4-month-old infant. 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

On what factor is the effectiveness of continuous bladder irrigation based?

The characteristics of the urine

A nurse is examining the urine specimen of a dehydrated client. Which of the following is a characteristic odor of the urine voided by a dehydrated client?

Strong

A nurse is using a bladder scanner to assess the bladder volume of a patient with urinary frequency. In which of the following positions would the nurse place the patient?

Supine

A patient with urine retention related to a complete prostatic obstruction requires a urinary catheter to drain the bladder. Which type of catheter is most appropriate for a patient that has an obstructed urethra?

Suprapubic catheter

A nurse assessing the access site of a hemodialysis catheter cannot palpate a thrill or hear a bruit. What is the most likely cause of this emergency situation?

The access may be clotting off.

The nurse is providing teaching to a patient who is being discharged to home with an indwelling urinary catheter in place. What information is important for the nurse to discuss with the patient?

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

During a visit to the pediatrician's office, a parent inquires about toilet training her 2-year-old daughter. The nurse informs the mother that one factor in determining toilet-training readiness is when:

The child can recognize bladder fullness.

The nurse is caring for a patient who has been experiencing difficulty voiding since her vaginal birth. The patient voices concern to the nurse. What information should be provided to the patient?

The delivery can cause perineal swelling

A nurse uses a portable bladder ultrasound device to assess bladder volume for a patient who is unable to void. Which of the following accurately states information needed to interpret the results?

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

Which of the following statements about bedpans is true?

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

A routine urinalysis has been ordered on a patient presenting to the emergency room with abdominal pain. What basic information does the nurse need to know to obtain this specimen?

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

You are inserting a urinary catheter into a 63-year-old male patient and encounter resistance. Which of the following is the most likely cause of the resistance?

The patient has an enlarged prostate.

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

The patient is underhydrated.

Urinary catheterization is the most common cause of hospital acquired infection.

True

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

True

Which of the following statements about the use of a urinal is true?

Unless contraindicated, nurses should encourage patients to stand to use a urinal.

A nurse catheterizing a male patient asks if he had an indwelling catheter previously and if so, why and for how long? The nurse uses this information to asses for which of the following conditions?

Urethral strictures

A sterile urine specimen for culture and sensitivity has been ordered for a patient 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.

The home care nurse is caring for a patient with an ileal conduit. Upon assessment of the patient's stoma, the nurse recognizes a normal stoma site as appearing:

dark pink and moist.

A nurse is caring for an elderly client who has been prescribed a condom catheter. Which of the following are the common problems that a client can experience when using a condom catheter? Select all that apply.

• May restrict the flow of blood to the skin and tissues • May accumulate moisture beneath the sheath • May lead to frequent leakage

Which of the following situations warrant urinary catheterization? Select all that apply.

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

Which of the following statements accurately describe the effects of food and fluid intake on the amount and quality of urine produced by the body? 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.

A nurse is caring for an elderly patient who is incontinent. Which of the following effects of aging might contribute to urinary alterations? Select all that apply.

• Diminished ability of kidneys to concentrate urine may result in nocturia. • Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine. • Decreased bladder contractility may lead to urine retention and stasis. • Neuromuscular problems may interfere with voluntary control of urination.

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

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