Chapter 38 Urinary Elimination

The nurse has an order to obtain a 24-hour urine specimen from a client. Which instruction would be accurate for collection of the specimen?

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

A nurse is carrying out a prescription to remove an indwelling catheter. Which explanation should the nurse use with the client prior to removing an indwelling catheter?

"I am going to remove the catheter after withdrawing the fluid from the balloon." To remove an indwelling catheter, the nurse must withdraw the fluid from the balloon before removing the tubing. If the nurse cuts the tubing, there is no certainty that the full amount of water is removed from the balloon. There is no need for the client to hold the breath or to worry about intense burning under normal circumstances.

A school nurse is educating a class of middle school students on how to promote urinary system health. Which statement by one of the students indicates understanding?

"I will wipe from front to back after going to the toilet." Teaching about measures to promote urinary system health is a major nursing responsibility. Measures include drying the perineal area after urination or defecation from the front to the back (or from urethra to rectum). Wearing tight pants can trap microorganisms. Drinking water will has no bearing on how long microorganisms stay in the body. Children should always inform parents of any symptoms of illness, but this does not address how to promote urinary health.

A 70-year-old client confides to the nurse that they are "terribly embarrassed" that they have developed urinary incontinence over the past year. Which nursing response supports the client's self-esteem?

"Let's explore structuring activities and toileting breaks." The nurse will promote the client's self-esteem by exploring ways in which the client can verbalize feelings, maintain dignity, and become empowered to participate in self-care. Telling the client to get adult undergarments (referring to these as "diapers" is not therapeutic), sending them to a urologist, and telling them not to worry discounts the client's concern.

The parent of a 5-year-old child tells the nurse that on two occasions their child has lost control of urination when they 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." 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 health care provider without taking a history, and it is impractical to simply recommend incontinence undergarments.

A female client is diagnosed with a urinary tract infection (UTI) and states this is their second one in the last 6 months. In teaching the client about health promotion, the nurse would include which statement?

"Try to urinate immediately after sexual intercourse." The female client who has repeated UTIs needs health promotion teaching to avoid reoccurrence of these. Urinating immediately after sexual intercourse and drinking an adequate amount of water (eight 8 to 10 oz glasses per day) are important in prevention of UTIs. Showers (rather than tub baths) and cleaning the perineal area from front to back are also measures to help prevent UTIs.

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.

A client has not voided for 8 hours after surgery. Which finding indicates the client has a distended bladder?

A bulge between the symphysis pubis and the umbilicus When the bladder is distended with urine, it rises above the symphysis pubis and may reach to just below the umbilicus. The other choices are anatomically incorrect for assessing a distended bladder.

A nurse is assessing a client who is reporting difficulty urinating. Which assessment would be a priority?

Asking the client when they had last urinated In assessing the bladder, the nurse would first determine when the client last urinated. Once this information is known, the nurse would then want to palpate the bladder and lower abdomen. If unable to determine bladder fullness, the nurse would want to obtain the bladder scanner, if available, in order to assess urine volume in the bladder.

A nurse is collecting a sterile urine specimen from an indwelling catheter. How will the nurse correctly obtain the specimen? Pour urine from the collecting bag. Remove the catheter and ask the client to void. Aspirate urine from the collection port. Aspirate urine from the collecting bag.

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

The nurse is teaching an older adult female client who must provide a urine specimen. Which is the proper method to instruct a female client to obtain a clean-catch urine specimen?

Catch the urine while holding the labia apart, after allowing the first urine to flow into the toilet. The client should first perform hand hygiene, then separate the labia minora and cleanse the perineum with commercially prepared aseptic swabs, starting in front of the urethral meatus and moving the swab toward the rectum. The client should repeat this cleansing process three times with different cotton balls or swabs, then begin to urinate while continuing to hold the labia apart. Next, the client should allow the first urine to flow into the toilet, and then hold the specimen container under the urine stream and collect urine. Then, the client should remove the specimen container, release the hand from the labia, seal the container tightly, and finish voiding. The client then performs hand hygiene again.

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.

The nurse is preparing to irrigate a Foley catheter. What is the nurse's initial action?

Check electronic health record for medical order. The nurse will first check for an order to irrigate the Foley catheter. The other steps can be taken after it has been confirmed that an order for irrigation exists.

When preparing to irrigate a Foley catheter, which is the appropriate initial nursing action?

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

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

Cholinergic agents Cholinergic agents stimulate the detrusor muscle, which causes more frequent urination. Analgesics act to relieve pain. Central nervous system depressants are medicines that include sedatives, tranquilizers, and hypnotics. These drugs can slow brain activity, making them useful for treating anxiety, panic, acute stress reactions, and sleep disorders. Stool softeners makes bowel movements softer and easier to pass.

Urinalysis and urine culture testing have been ordered for a client who has an indwelling urinary catheter. The nurse observes that there is currently no urine in the client's catheter tube. What should the nurse do?

Clamp the tube below to access the port to allow urine to accumulate. If there is not sufficient urine for collection, the nurse should clamp the tubing below the access port for up to 30 minutes. Increased fluid intake will not cause urine to accumulate in the tubing. Similarly, repositioning is unlikely to resolve the problem. Aspirating from an air-filled catheter tube may draw a contaminated sample from tubing distal to the access port.

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

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

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

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

Three days after surgery for breast reconstruction, the client is ambulating several 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(s)? Select all that apply.

Contact the health care provider to ask for an order for catheter discontinuation. Perform, or allow client to perform, perineal hygiene at least once daily. The nurse should advocate for catheter discontinuation to prevent a catheter-associated urinary tract infection (CAUTI), and still perform or encourage the client to perform daily perineal care. Discontinuation of the catheter should not take place until the nurse has received an order, and delegation should take place only if appropriate based on the unlicensed assistive personnel's (UAP's) qualification and the nurse's ongoing appropriate supervision. The drainage bag should never remain above the level of the bladder; it should be below the level of the bladder.

A nurse has been asked to speak about health promotion topics for a group of women older than 40 years of age. The nurse states that exercises may help with urinary urgency. Which exercise instruction will the nurse provide to the group?

Contract the pubic muscles for 3 seconds, then relax. Pelvic floor muscle (Kegel) exercises, strengthen the pubococcygeal muscles and effectively promote urinary control. The nurse should inform the women to locate the muscles used to start and stop urinating. Then contract those muscles and relax them repeatedly. Strengthening the abdominal muscles will not help with urinary control. Squatting, jumping, and performing leg lifts will help to strengthen the quadriceps and hamstrings.

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

Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection. Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection. The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night). Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination. Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weakness may interfere with voluntary control and the ability to reach a toilet in time. Individuals who view themselves as old, powerless, and neglected may cease to value voluntary control over urination, and simply find toileting too much bother no matter what the setting. Incontinence may be the result.

An older adult client informs the nurse that they are experiencing urinary incontinence. The client has no other health problems, and states, "I don't want anybody to know about this problem." How will the nurse promote the client's self-esteem?

Discuss the use of protective undergarments to avoid embarrassment from incontinence. The nurse will promote the client's self-esteem by openly discussing adult undergarments. The client has no other health problems, and can benefit by learning how to self-manage this concern. Encouraging the client to tell family members does not support the client's desire to refrain from telling others about this issue. The client does not need referral to a urologist at this time. Reassuring the client that others have this concern is nontherapeutic and does not directly meet the client's concern.

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

Document this normal finding for postvoid residual. A postvoid residual (PVR) urine measures the amount of urine remaining in the bladder after voiding. It can be measured by catheterization or a bladder scan. A PVR of less than 50 mL indicates adequate bladder emptying. The nurse would document this normal finding for PVR. It is not necessary to palpate the abdomen as the bladder is empty.

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

Encourage fluid intake, unless contraindicated. Record volume and character of the urine. Maintain a closed urinary catheter system. The client with a Foley catheter should maintain a closed drainage system to prevent introduction of pathogens into the system, and should have the urinary output monitored closely to determine adequate volume. The client can have natural irrigation of the catheter with an increased intake of fluid, if not contraindicated, which also reduces potential for infection. The character of the urine should also be monitored to determine any signs of urinary tract infection. The indwelling catheter should not be changed regularly but only as needed. Powder or lotion should not be used in the perineal area, but the area should be cleansed daily (or after each bowel movement).

The nurse is preparing a client for a cystoscopy procedure. Which intervention would be part of the preparation for this?

Having the client sign a consent form for the procedure The client would sign a consent form for the procedure since it is invasive. This would be completed after the procedural health care provider had explained the purpose, risks, and benefits of the procedure. The client would not be maintained NPO (nothing by mouth) or have a catheter inserted for this procedure. The procedure is usually painless, so the client would not be told to expect pain as a normal part of the procedure.

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. Measure the height of the edge of the bladder below the symphysis pubis. Retract the foreskin of an uncircumcised male client to visualize the meatus. The nurse assess the client's urine for color, odor, clarity, and the presence of any sediment. Place male clients in the dorsal recumbent position for good visualization of the meatus. Inspect the urethral orifice for any signs of inflammation, discharge, or foul odor. If using a bedside scanner, place the client in a supine position.

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

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

It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. The external condom catheter is not in the bladder. It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters which are placed in the bladder. Because it is not sterile, a sterile urine specimen cannot be obtained. Often, the client does not place the external condom catheter by themself. The catheter is changed every day and the skin of the penis is assessed.

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

Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. Leaving the catheter in place as a marker assists in the correct placement of the second catheter into the bladder. It is not necessary to contact the health care provider. The vagina is not sterile, so insertion of a sterile catheter poses little risk for infection. Asking the client to bear down is not necessary because the catheter is not typically completely inserted. Removing the catheter from the vagina and attempting to insert it into the bladder will cause cross-contamination.

A nurse assesses the urine of a client 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.

The nurse is catheterizing a male urinary bladder, and urine leaks out of the meatus around the catheter. Which actions would the nurse perform next? Select all that apply.

Make sure the smallest sized catheter with a 10-mL balloon is used. Consider an evaluation for urinary tract infection. Ensure that the correct amount of solution was used to inflate the balloon. The nurse would make sure the smallest sized catheter with a 10-mL balloon is used for the procedure. Large catheters cause bladder and urethral irritation and trauma. Large, balloon-fill volumes occupy more space inside the bladder and put added weight on the base of the bladder. Irritation of the bladder wall and detrusor muscle can cause leakage. If leakage persists, consider an evaluation for urinary tract infection. Ensure that the correct amount of solution was used to inflate the balloon. Underfilling the balloon can cause the catheter to dislodge into the urethra. The nurse would not increase the size of the indwelling catheter. The nurse would not have a need to assess the client for diarrhea. The nurse would not attempt to push the catheter further into the bladder if underfill is suspected. This could cause trauma to the urethra or bladder.

Which statement should the nurse convey to the parent of a 3-year-old male child who has not achieved urinary continence?

Male children may take longer for daytime continence than female children. Children in North American cultures usually achieve daytime urinary continence by 3 years of age; male children may take longer than female children. Nighttime continence may not occur until 4 or 5 years of age.

A client with an emergently placed central venous catheter (CVC) is to have emergent hemodialysis. Upon assessment of the CVC the nurse visualizes redness, drainage, and odor to the area around the CVC. Palpation of the surrounding skin causes the client pain. Which intervention is the priority? Notifying the health care provider of the assessment findings Obtaining laboratory studies Checking for blood return in the CVC Placing the client as N.P.O. status

Notifying the health care provider of the assessment findings The assessment is indicative of hospital-acquired catheter infection associated with the CVC. The medical provider may request laboratory studies, but these cannot be obtained until a prescription is received. There is no indication to withhold oral food or fluids from the client at this time. Checking for blood return is not indicated and access to the CVC used for hemodialysis should not be attempted without a prescription to do so from the health care provider.

The nurse assesses redness, drainage, and odor to the area around a client's peritoneal dialysis catheter. Palpation of the abdomen causes the client pain. Which intervention is the priority? Sitting the client up in a greater than a 40-degree angle. Obtaining laboratory studies. Flushing the catheter with 15 - 20 mL of normal saline Notifying the health care provider of the assessment findings.

Notifying the health care provider of the assessment findings. The assessment is indicative of peritonitis or infection associated with the peritoneal dialysis catheter. The health care provider may request laboratory studies, but these cannot be obtained until a prescription is received. Flushing the catheter does not address the likely infection. Sitting the client up may aggravate the pain. The nurse should attempt to keep the client in the most comfortable position possible until a prescription is received from the health care provider.

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

Position the client in a supine position. Portable bladder scanner results are most accurate when the client is in the supine position during the scanning. The procedure is painless, so there is no specific need to administer analgesia. Diuretics are not given in anticipation of the procedure and it is unnecessary to rest prior to scanning.

A nurse is caring for a client who is catheterized following surgery of the prostate. When caring for the client, the nurse performs a continuous irrigation of the catheter. Which intervention 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—not when irrigating the catheter.

The client is preparing to obtain a clean-catch midstream urine specimen. Place in order the steps needed to complete the diagnostic test. Use all options.

Provide instruction to the client. Clean the area surrounding the urinary meatus with the provided cloth. Void a small amount into toilet or bedpan. Void into the provided collection device. Secure the lid on the specimen container. Submit collected specimen to the health care professional. 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 toilet or bedpan 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 toilet or bedpan and discard. The specimen will need to be secured and submitted to the health care professional.

While providing care to a client admitted to the health care facility, the client states that they have "a burning sensation when urinating." After further questioning, the nurse inspects the client's perineal area. Which sign/symptom would the nurse document as an abnormal finding? Reddened perineal skin Presence of smegma Absence of discharge Moist perineal skin

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 females and under the foreskin in males) is considered a normal finding.

Which urinary care teaching will the nurse provide to a young adult female client?

Refrain from douching unless ordered by a health care provider. Douching is not recommended unless ordered by the health care provider. Female clients should be taught to wipe from the urinary area towards the rectum to decrease the risk for introducing pathogens into the urethra. Straining is not appropriate. Water should be consumed throughout the day, not just in the morning and evening.

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

Repeat the irrigation. If the tubing was not clamped before introducing the irrigation solution, the nurse should repeat the irrigation. If the tubing is not clamped, the irrigation solution will drain into the urinary drainage bag and not enter the catheter. There is no immediate need to contact the health care provider or to change the catheter.

The health care provider requests an indwelling urinary catheter to be inserted into a female client who has had a total hip replacement and is on strict bed rest. When inserting the catheter, the nurse would place the client in which position?

Sims The Sims, or side-lying, position is especially used for clients who have limited hip mobility because it permits excellent visualization of the urinary meatus. Usually, female clients are placed in a dorsal recumbent position for catheterization, and male clients are put in a supine or semi-Fowler position.

The nurse is caring for a client who has been experiencing difficulty voiding in the 8 hours since giving birth vaginally. What information should be provided to the client?

The birth can cause perineal swelling. 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 effects of anesthesia do not constitute a neurogenic bladder. Catheterization may be necessary in the short term, but 5 to 7 days would normally be excessive and create a risk for infection. Birth does not normally cause a urinary tract infection, whose effects would not evident at this early stage postpartum.

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. Enlargement of the prostate gland is commonly seen in males over age 50 and may interfere with urinary catheterization. The client does not have an occult abscess in the urethra as the nurse was able to pass some of the catheter and then had resistance. The resistance is not caused by the balloon as this inflation had not occurred. The diameter of the catheter is not too large.

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

The client should avoid wearing tight clothes or belts near the site. Clients should avoid baths and public pools as well as wearing tight clothes and belts around the exit site. Once the site is healed, some health care providers do not require clients to wear a dressing unless the site is leaking. Clean technique is sometimes allowed in the home.

A nurse is caring for a client who has just undergone surgery to create an ileal conduit for urinary elimination via a stoma. Which fact about this procedure should the nurse mention to the client?

The client will have to wear an external appliance to collect urine. An ileal conduit involves a surgical resection of the small intestine, with transplantation of the ureters to the isolated segment of small bowel. Such diversions are usually permanent, and the client wears an external appliance to collect the urine because urine elimination from the stoma cannot be controlled voluntarily. Appliances are usually changed every 3 to 7 days, although they could be changed more often.

A nurse is caring for a client who has urinary incontinence associated with a flaccid neurogenic bladder.

The nurse will implement in-and-out catheterization because the client has reflex urinary incontinence. The client has the type of injury that can result in reflex urinary incontinence. With this type of urinary dysfunction, it is necessary to perform in-and-out catheterization at regular intervals. Medications may also be prescribed to relax the sphincters. A flaccid neurogenic bladder can cause involuntary incontinence associated with a specific bladder volume that can occur at slightly predicatable intervals. Other causes may include spinal cord injury, brain tumor, or a cerebrovascular accident. When the volume of urine reaches a certain point it overcomes the sphincter, this is known as reflex urinary incontinence. A timed voiding schedule is used for those with urge urinary incontinence. This type of incontinence is associated with an overactive detrusor muscle, bladder dysfunction, or the affects of diuretics, caffeine, or alcohol. Pelvic floor muscle (Kegel) exercises are used to reduce the negative urinary effects associated with stress incontinence. Stress incontinence is caused by increased or high abdominal pressure. It can also be a complication associated with prostate cancer. Routine toileting can either be used with functional or total urinary incontinence. The functional type of incontinence is associated with altered environment combined with physiological deficits such as cognition, neurovascular or mobility. Excellent skin care is a necessary whenever a client has total urinary incontinence that keeps the perineal skin moist at most times. This type of incontinence can be caused by some form of impairment to the spinal cord or as a result of severe cognitive deficits.

A nurse working in a community pediatric clinic explains the process of toilet training to parents of toddlers. What is a recommended guideline for initiating this training?

The toddler should be able to communicate the need to void. Voluntary control of the urethral sphincters occurs between 18 and 24 months of age. However, many other factors are required to achieve conscious control of bladder function, and toilet training usually begins at about 2 to 3 years of age. Toilet training should not begin until the toddler is able to hold urine for 2 hours, recognize the feeling of bladder fullness, communicate the need to void, and control urination until seated on the toilet. The toddler's desire to gain control is also important.

A nurse is assessing the urine output of a client with Parkinson disease who is on levodopa. Which sign is a common finding for a client on this medication?

The urine may be brown or black. Levodopa, an antiparkinsonian drug, and injectable iron compounds can lead to brown or black urine. Anticoagulants may cause hematuria (blood in the urine), leading to a pink or red color. Diuretics can lighten the color of urine to pale yellow. Phenazopyridine, a urinary tract analgesic, can cause orange or orange-red urine.

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, whereby 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.

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

Urinal A urinal is the best choice to collect urine from a nonambulatory male client. If the client is on strict bed rest or confined to bed due to weakness or disability, the client must be positioned in bed in as close to an upright position as feasible. In most instances, the client is able to place and hold the urinal themself. If they are unable to do so, the nurse should hold the urinal in place while the client urinates or place the urinal and leave the client alone for a few moments. A bedpan is not the best choice for a male client, who tends to prefer the bottle-like shape of the urinal, although female clients tend to prefer the shape of a bedpan. A specimen hat is for a commode. A large urine collection bag would be used with an indwelling catheter.

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

Use their left hand to spread the client's labia and keep them spread until the catheter is inserted. Using the thumb and one finger of the nondominant hand, the nurse should spread the client's labia and identify the meatus. The nurse should be prepared to maintain separation of labia with one hand until the catheter is inserted and urine is flowing well and continuously. The nurse does not let go of the labia to perform hand hygiene after cleansing. The catheter is inserted with the dominant hand.

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

Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. The nurse would ensure prescription is obtained, explain procedure to the client, use an antiseptic swab to cleanse the access port, then attach syringe and aspirate urine into the syringe. A specimen from the collecting receptacle (drainage bag) may not be fresh urine and could result in an inaccurate analysis. Always observe sterile technique while collecting a urine specimen from an indwelling catheter. Gather equipment, including a syringe, an antiseptic swab, a sterile specimen container, nonsterile gloves, and only tube tubing if needed; remember to unclamp the catheter after obtaining specimen to avoid reflux of urine into bladder.

A client with frequent urinary tract infections (UTIs) has returned to the ambulatory clinic with symptoms of another UTI. Which information is essential for the nurse to review with the client as a strategy to decrease future risk of UTI?

Voiding 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; voiding 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 preparing to measure a client's urine output. Which 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.

During a visit to the pediatrician's office, a parent inquires about toilet training the 2-year-old child. Which toilet training readiness factor should the nurse include in teaching the parent about toilet training?

When your child can recognize bladder fullness. Toilet training usually begins around ages 2 or 3 years. Toilet training should not begin until the child is able to hold urine for 2 hours, recognizes the feeling of bladder fullness, communicates the need to void, and controls urination until seated on the toilet.

A client with chronic kidney disease reports not being able to urinate for the past 24 hours. A bladder scan shows no urine in the bladder. How does the nurse document this data?

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

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

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

A client is reporting bladder urgency. Which will the nurse assess?

caffeine intake 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. Blood pressure changes do not typically cause urgency, nor do most common vitamin supplements. Body weight affects urinary function, as with all body systems, but is not specifically linked to urgency.

The nurse is preparing a client for a cystoscopy procedure. Which intervention would be part of the preparation?

checking that the client has signed a consent form for the procedure The client would sign a consent form for the procedure since it is invasive. This would be completed by the procedural health care provider after explaining the purpose, risks, and benefits of the procedure. The will check that this consent is signed before the procedure beings. The client does not need to have fluids withheld nor have a catheter inserted for this procedure. The procedure is usually painless, so the client would not be told to expect pain as a normal part of the procedure.

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 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. If the client reports pain during balloon inflation, the nurse should stop inflation of balloon, which is most likely still in the client's urethra. The nurse should withdraw the solution from the balloon, insert the catheter an additional 0.5 to 1 in (1.25 to 2.5 cm), and slowly attempt to inflate the balloon again. Re-attempting inflation in the same location or after slight withdrawal could cause trauma to the client's urethra. It is not necessary to utilize a smaller gauge catheter.

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

dehydration The nurse anticipates that the client may be dehydrated, which is characterized by strongly aromatic, dark amber urine. The symptoms are not associated with hypovolemia, balanced fluids, nor kidney injury.

An older adult resident of a long-term care facility has to get up and void several times during the night. This can be the result of what physiologic change with normal aging? increased bladder contractility causing urinary stasis increased bladder muscle tone causing urinary frequency decreased intake of fluids during daytime hours diminished ability of the kidneys to concentrate urine

diminished ability of the kidneys to concentrate urine Physiologic changes that accompany normal aging may affect urination in older adults. These changes include the diminished ability of the kidneys to concentrate urine, which may result in nocturia (voiding during the night). Aging does not result in increased bladder muscle tone or increased bladder contractility. A decrease in fluid intake would not result in nocturia.

A client is admitted to the health care facility reporting pain on urination that is secondary to a urinary tract infection (UTI). The nurse documents this finding as:

dysuria Dysuria means painful voiding. Pain is often associated with UTIs and is felt as a burning sensation during urination. Polyuria is the formation and excretion of excessive amounts of urine in the absence of a concurrent increase in fluid intake. Voiding during normal sleeping hours is called nocturia. Hematuria refers to blood in the urine.

A nurse is caring for a client who is being treated for bladder infection. The client reports having difficulty voiding and feeling uncomfortable. How should the nurse document the client's condition?

dysuria The nurse could document the client's condition as dysuria, which is difficulty or discomfort when voiding. Dysuria is a common symptom of trauma to the urethra or bladder infection. Anuria means absence of urine or a volume of 100 mL or less in 24 hours. Oliguria indicates inadequate elimination of urine. Polyuria is the term used to indicate greater than normal urinary volume, and may accompany minor dietary variations.

Which of the following describes the term micturition?

emptying the bladder The process of emptying the bladder is known as urination, micturition, or voiding. Catheterizing the bladder is when a urinary catheter is placed inside the urethra. Collecting a urine specimen can be by clean catch or by use of a urinary catheter. Incontinence is when a client voids on oneself.

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

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

A client reports that they are often unable to retain urine until they locate a toilet because their mobility is decreased. The nurse should recognize the characteristics of what type of incontinence?

functional 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 has developed edema in the lower legs and feet, prompting her health care provider to prescribe furosemide, a diuretic medication. After the client has begun this new medication, what should the nurse anticipate?

increased output of dilute urine Diuretics result in moderate to severe increases in the production of dilute urine. Concentration will decrease, not increase, and there is no accompanying risk of urinary tract infections. For some clients, this sudden increase in urine output may precipitate transient incontinence, but this remains an abnormal finding.

A client is suspected of having a disease process affecting the basic functional unit of the kidney. Which structure is likely involved? Bowman capsule glomerulus loop of Henle nephron

nephron 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.

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 The nurse should use a straight catheter to collect a sterile urine specimen from the client. A straight catheter is a urine drainage tube inserted but not left in place. It drains urine temporarily or provides a sterile urine specimen. Condom catheters are helpful for clients with urinary incontinence receiving care at home because they are easy to apply. A urinary bag is more often used to collect urine specimens from infants. A retention catheter, also called an indwelling catheter, is left in place for a period of time.

A client reports to the nurse that after delivering an infant, they lose small amounts of urine each time they sneeze or laugh hard. Which type of incontinence does the nurse anticipate? urge total stress reflex

stress Stress incontinence is associated with a raise in intra-abdominal pressure related to activities such as sneezing, coughing, or laughing. Urge incontinence takes place when there is a delay in accessing a toilet. Reflex incontinence takes place when a client automatically releases urine and cannot control it. Total incontinence takes place without a pattern or warning, and without client control.

A nurse is caring for a client who gave birth 4 months ago. The client informs the nurse that they have been experiencing a sudden loss of urine whenever they laugh; this is causing embarrassment to them. Which type of urinary incontinence is this client experiencing?

stress incontinence 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.

A client 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 client that has an obstructed urethra?

suprapubic catheter A suprapubic catheter is used for long-term continuous drainage and is inserted through a small incision above the pubic area. Suprapubic bladder drainage diverts urine from the urethra when injury, stricture, prostatic obstruction, or abdominal surgery has compromised the flow of urine through the urethra. An indwelling urethral catheter, straight, and intermittent urethral catheter is placed in the urethra.