Chapter 41 Elimination Questions

The nurse is placing an indwelling catheter in a female patient. She inserts the catheter into the vagina. What is the next action for the nurse to implement? a. collect a urine specimen and notify the 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 catherization ofthe patient

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What symptom is most likely to be exhibited by the patient who complains of voiding small amounts of urine in relation to his fluid intakes? a. nocturia b. polyuria c. anuria d. oliguria

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11. an average daily urine output is __________ mL.

1440 mL (minimum of 30 mL/hour)

6. The nurse is inserting an indwelling catheter into a male patient. While initially passing the catheter through the urethra, resistance is met. What action should the nurse take next? a. Notify the primary care provider to place a coudé 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. Coudé catheters may need to be placed using a metal wire introducer. Placement using an introducer typically is performed by a physician or the patient's urologist, to avoid damaging urethral tissue.

4. 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.

1. Which organism is responsible for the majority of urinary tract infections in female patients? a. Escherichia coli b. Nesseria gonorrhea 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 Escherichia coli, invade the urethra and multiply.

10. The nurse is caring for a patient who has urinary retention resulting from benign prostatic hyperplasia (BPH). The patient requires catheterization in order to drain the urine from his bladder. Which action will the nurse take to facilitate this procedure? a. Use a double-lumen Coudé catheter. b. Attach a leg bag to the catheter prior to insertion. c. Trim the pubic hair before cleaning the perineal area. d. Wait until the bladder is full to perform catheterization.

ANS: A A Coudé catheter is used when there is narrowing or constriction of the urethra, making insertion of a regular indwelling catheter difficult. The Coudé catheter has a special tip on the end that is designed to facilitate insertion of the catheter through the narrowed urethra caused by BPH. Trimming the pubic hair will not facilitate catheterization. Attaching a leg bag to the catheter prior to insertion is not needed because a bedside collection bag will usually be used at first.

19. The nurse is caring for a patient with a history of type I diabetes. Which assessment finding indicates to the nurse that the patient may not be compliant with his diabetic treatment regimen? a. The patient is always thirsty and frequently voids very large amounts of urine. b. The patient's urine is very concentrated with a dark amber color. c. The patient complains of throbbing flank pain and burning with urination. d. The patient has urinary hesitancy and difficulty initiating a stream of urine.

ANS: A A noncompliant diabetic patient will have elevated blood sugars that cause thirst and polyuria. Concentrated urine indicates dehydration. Throbbing flank pain and burning with urination are indicative of urinary tract infection. Urinary hesitancy and difficulty initiating urine stream are not indicative of elevated blood sugar levels.

8. The nurse is caring for a patient who has developed kidney failure. Which test finding leads the nurse to contact the nephrologist and arrange for emergency hemodialysis? a. Serum potassium level 7.4 mEq/L b. Serum creatinine level of 2.8 mg/dL c. Large amounts of protein in the urine d. 1500 mL of retained urine in the bladder

ANS: A Patients in renal failure often require dialysis once the serum potassium level exceeds 6.5 mEq/L. Critically high serum potassium levels can lead to lethal arrhythmias and must be corrected promptly. Patients with advanced renal failure may require emergency hemodialysis if the potassium level does not lower with other methods (insulin and 50% dextrose, kayexalate).

13. The nurse is caring for a patient who has just had an intravenous pyelography (IVP) completed. Which assessment is the nurse's highest priority after the patient returns from the test? a. Carefully calculate of the patient's intake and output. b. Monitor for discoloration of the patient's urine. c. Assess for possible iodine or shellfish allergies. d. Inquire if the patient has burning or pain with urination.

ANS: A The nurse must carefully monitor the patient's intake and output after IVP testing to ensure that the patient's kidneys were not damaged by the contrast dye. PO fluid intake should be encouraged to facilitate excretion of the contrast dye. Burning or pain with urination should not occur after IVP testing because there is no instrumentation of the urinary tract. Assessment of allergies must be done before the IVP is done because iodine-based contrast is used.

6. The nurse is caring for a patient who reports an urgent need to urinate but is unable to pass more than a few drops of urine on the toilet. Which is the priority assessment to be performed by the nurse? a. Bladder scan to determine the amount of urine in the bladder b. Auscultation to assess circulation through the right and left renal arteries c. Bimanual palpation to assess for possible enlargement of the kidneys d. Calculate the patient's intake and output to check for fluid volume deficit

ANS: A The patient with suspected urinary retention should have a bladder scan performed to determine the amount of urine in the bladder. If a significant amount of urine is found in the bladder, the physician may be notified to obtain an order for straight catheterization.

17. The nurse is caring for a patient with an indwelling urinary catheter caused by severe prostate enlargement. Which is the priority nursing diagnosis for this patient? a. Risk for infection r/t indwelling urinary catheter b. Disturbed body image r/t presence of catheter c. Risk for contamination r/t potential leakage of urine on clothing d. Urinary retention r/t blockage of bladder outlet

ANS: A The presence of an indwelling urinary catheter puts the patient at high risk for urinary tract infection, and this is the highest priority diagnosis for the patient. Disturbed body image is not as important as the risk of infection. Risk for contamination does not relate to spillage of urine on clothing. Urinary retention was corrected by placement of the urinary catheter.

16. The nurse is caring for a patient with the nursing diagnosis of Urge urinary incontinence related to urinary tract infection. Which statement is appropriate for the "as evidenced by" portion of the patient's diagnosis? a. Sudden leakage of urine when patient is unable to get to the toilet in time. b. Continuous urine flow from the bladder regardless of attempts to use the toilet c. Leakage of urine from the bladder when the patient coughs, sneezes, or laughs d. Leakage of urine because the patient is unable to indicate need to use the toilet

ANS: A Urge urinary incontinence occurs when the patient has a sudden need to urinate but cannot get to the toilet in time. Continuous flow of urine is deemed total urinary incontinence. Leakage of urine when sneezing or coughing is stress incontinence. Functional incontinence occurs when the patient cannot indicate need to use the toilet.

MULTIPLE CHOICE 1. The nurse is caring for a patient who is recovering from septic shock. While in the ICU, the patient developed renal failure. Which type of renal failure did the patient most likely develop? a. Prerenal b. Renal c. Post-renal d. Mixed

ANS: A Vascular collapse and lack of blood flow to the kidneys from septic shock led to renal failure. The patient experienced prerenal failure because the cause was prior to the kidneys rather than damage to the kidneys itself or urinary structures.

1. The nurse is caring for an elderly patient whose dementia has become worse over the last 24 hours. The nurse suspects that the patient may have developed a urinary tract infection and obtains a urine sample. Which assessment findings prompt the nurse to contact the physician to obtain an order for urine culture and sensitivity testing? (Select all that apply.) a. Urinary dipstick testing is positive for nitrates. b. The urine appears cloudy with a foul odor. c. The urine is concentrated and dark amber in color. d. The urine smells faintly like nail polish remover. e. The patient is urinating more frequently than usual. f. The patient is normally continent but wet herself twice.

ANS: A, B, E, F Concentrated dark urine indicates dehydration rather than infection of the urinary tract. Urine that smells of nail polish remover contains ketones from high blood sugar. Urine that is cloudy with a foul odor and positive for nitrites is most likely due to urinary tract infection. Frequent urination and incontinence are signs of urinary tract infection in the elderly.

3. The nurse is working with a new nursing assistant who is providing care to patients with urinary difficulties. Which action by the nursing assistant indicates that additional teaching is required so that the assistant will learn to care for patients correctly? (Select all that apply.) a. The length of the urinary catheter is cleaned up to the patient's perineum. b. A urine sample is obtained from the drainage bag immediately after catheter insertion. c. A fresh condom catheter is applied every other day following careful perineal care. d. Zinc oxide barrier cream is applied liberally to the perineal area for incontinent patients. e. The catheter drainage bag is disconnected in order to put pants on the patient. f. Clean technique is used to obtain a urine specimen for culture and sensitivity from the catheter.

ANS: A, C, E, F The urinary catheter must be cleaned from the urinary meatus down toward the drainage bag rather than up toward the perineum. A fresh condom catheter must be applied daily. The catheter drainage bag should not be disconnected to put pants on the patient. The drainage bag can be threaded through the pants leg before putting pants on the patient. Sterile technique should be used to obtain samples from the catheter.

2. The nurse is caring for a male patient who will be performing intermittent self-catheterization at home. Which actions by the patient indicate the need for additional teaching about this procedure? (Select all that apply.) a. Patency of the balloon is tested prior to insertion of the catheter. b. The catheter is inserted another 2 inches after urine is seen in the tubing. c. The catheter is carefully secured to the leg to prevent accidental removal. d. The foreskin is returned to its natural position after the catheter is removed. e. Catheterization is performed regularly before the bladder becomes distended. f. Water-soluble lubricant is generously applied along the length of the catheter.

ANS: A, C, F Only 5 to 8 inches of the catheter tip are covered with water-soluble lubricant. Patency of the balloon is only checked when indwelling catheters are inserted. Intermittent catheters need not be secured to the patient's leg because they will be removed after the bladder is drained.

5. 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. Urine with a pH of 4 is very acidic. A pH of 7 is neutral, and a pH of 9 is very alkaline.

20. The nurse is caring for a patient who is to undergo computed tomography (CT) of the kidneys and ureters. Which assessment finding by the nurse must be reported to the physician and radiologist before the patient has the procedure? a. The patient is allergic to bananas and latex. b. The patient thinks that she might be pregnant. c. The patient has a family history of bladder cancer. d. The patient currently has a urinary tract infection.

ANS: B CT requires exposure to radiation similar to an x-ray, so the patient's physician and radiologist should be notified promptly of the possibility of pregnancy. The other conditions do not preclude CT scan examination for the patient.

7. The nurse is caring for a seriously ill patient whose laboratory results show a serum creatinine level of 3.5 mg/dL and a serum BUN of 35 mg/dL. Which conclusion can the nurse draw from these test results? a. The patient is severely dehydrated. b. The patient's kidneys have been damaged. c. The patient has a urinary tract infection. d. The patient has developed a renal calculus.

ANS: B Elevated BUN and creatinine are found in laboratory test results when the kidneys have been damaged and are unable to sufficiently clear metabolic wastes from the bloodstream. A dehydrated patient may have an elevated BUN, but the serum creatinine should be normal. Urinary tract infection and kidney stone (renal calculus) would not cause elevated BUN and creatinine levels.

9. The nurse is caring for a patient who will undergo ultrasound testing of the bladder and kidneys the next morning. Which instruction will the nurse provide to the patient about the test? a. "A small IV will be inserted into your arm to inject the contrast dye." b. "You will need to drink lots of water but not use the toilet." c. "You should not have anything to eat or drink after midnight." d. "You will receive a cleansing enema before you have the test."

ANS: B No preparation is needed for kidney and bladder ultrasound other than having the patient drink lots of fluid beforehand. The patient is instructed not to use the toilet so that the bladder will be filled and easy to visualize. No contrast dye, enemas, or fasting is required.

15. The nurse is caring for a patient who had prostate surgery the previous day. The patient has had significantly decreased urine output over the last shift despite ample oral and IV fluid intake. The patient's urine from the indwelling catheter is cherry red with occasional small clots. What is the appropriate action of the nurse? a. Remove the urinary catheter and replace it with a new one b. Gently irrigate the catheter using warmed sterile normal saline c. Send a sample of the patient's urine to the laboratory for analysis d. Call the physician and obtain an order for kidney and bladder ultrasound

ANS: B The patient most likely has decreased urine output caused by clot formation that is blocking urine from draining through the catheter. The catheter should be gently irrigated using sterile technique and warmed sterile saline to loosen clots and facilitate urinary drainage. The catheter should not be removed. Ultrasound and urinalysis are not necessary.

3. The nurse is caring for a patient who is experiencing stress incontinence. Which goal is the most important for this patient? a. The patient will carefully complete a voiding diary for the duration of 2 weeks. b. The patient will not experience involuntary urination during coughing or sneezing. c. The patient will be able to recognize and effectively manage perineal dermatitis. d. The patient will demonstrate how to appropriately use urinary incontinence products.

ANS: B The patient with stress incontinence experiences loss of urine when coughing, sneezing, laughing, or exercising. The highest priority goal for this patient is to not experience incontinence at all and remain continent through all daily activities. If the patient remains continent, perineal dermatitis will not be a problem and urinary incontinence products will not be needed.

21. The nurse is caring for a patient with a history of incontinence and poor perineal hygiene practices. The patient has had four urinary tract infections in the past year. Which is the priority goal for the nursing diagnosis of Ineffective therapeutic regimen management? a. The patient will be provided with educational materials about risks of urosepsis. b. The patient will allow family members to assist with daily bathing and perineal care. c. The patient will clearly state why she refuses to provide adequate care for herself. d. Regular home care nursing visits and follow-up telephone contact will be arranged.

ANS: B The priority for this patient is to improve personal hygiene and perineal care in order to reduce the risk of future urinary tract infections. The patient's agreement to allow family members to assist with bathing and perineal care will greatly reduce this risk. Providing educational materials about the risk of urosepsis and regular follow-up care are interventions rather than patient goals. The patient may not be refusing to adequately care for herself, so this should not be a goal.

4. The nurse is caring for a patient who is to complete a 24-hour urine collection to measure creatinine clearance. Which tasks related to this test may be delegated to the nursing assistant? (Select all that apply.) a. Teaching the patient about sterile specimen collection b. Keeping the urine collection container cool on ice c. Dumping the urine from the patient's first void d. Restricting the patient's oral fluid intake during the test e. Transporting the specimen to the laboratory for testing f. Reminding the patient not to put toilet paper in the urine

ANS: B, C, E, F The nurse assistant can help the nurse by keeping the urine collection container cool on ice, dumping the urine from the patient's first void, and reminding the patient not to put toilet tissue in the urine specimen. The nurse assistant can also transport the specimen to the laboratory after the urine has been collected for 24 hours. Fluid intake should be encouraged during the test. Teaching the patient about the testing procedure is done by the nurse, although creatinine clearance testing does not require sterile technique.

11. The nurse is caring for an incontinent male patient who has a deep decubitus ulcer on his sacrum. Which intervention will best manage the patient's urinary incontinence and facilitate healing of the ulcer? a. Use of disposable absorbable incontinence briefs b. Daily application of perineal barrier cream containing zinc oxide c. Careful perineal care and application of a condom catheter d. Insertion of a single-lumen straight urinary catheter

ANS: C Condom catheters allow for collection of urine in the incontinent patient without the infection risks of an indwelling catheter. The condom catheter is applied to the outside of the penis like a condom instead of being inserted into the urethra. Careful perineal care is performed prior to application of the condom catheter and regularly thereafter. Use of disposable briefs or perineal barrier cream will not facilitate healing of the sacral ulcer. A single-lumen straight urinary catheter is used to drain the bladder to relieve urinary retention or to obtain a urine sample for testing. A straight catheter is not used for management of incontinence.

14. The nurse is caring for a patient with benign prostatic hypertrophy who states that he feels a constant urge to urinate but cannot pass more than 30 to 60 mL of urine into the toilet at a time. The nurse performs a bladder scan and finds that there are 1100 mL of urine in the patient's bladder. What is the priority nursing diagnosis for this patient? a. Alteration in comfort r/t continual urge to urinate b. Overflow urinary incontinence r/t over-distention of the bladder c. Urinary retention r/t obstruction of urinary bladder outlet d. Toileting self-care deficit r/t inability to pass urine into the toilet

ANS: C The patient has acute urinary retention with overflow as evidenced by 1100 mL of urine in the bladder and frequent passage of small amounts of urine. The priority nursing diagnosis is thus urinary retention r/t obstruction of urinary bladder outlet. Urinary retention is the cause of the patient's discomfort and drainage of the bladder will result in relief of the patient's symptoms. The patient is able to get himself on and off the toilet so toileting self-care deficit is not a problem. Overflow urinary incontinence is not applicable because the patient is passing the urine into the toilet.

5. The nurse is caring for a patient who recently underwent ileal conduit surgery. Which nursing diagnosis is the highest priority for this patient? a. Ineffective sexuality pattern related to changed body structure b. Social isolation related to potential for accidental leakage of urine c. Knowledge deficit related to care and maintenance of ostomy appliance d. Disturbed body image related to presence of stoma and appliance

ANS: C The patient with a new ileal conduit needs to learn how to care for the urinary stoma and appliance prior to discharge from the hospital. If the appliance is not used and applied correctly, the patient may experience urinary leakage and significant skin breakdown from exposure to urine. The other diagnoses are less important than the patient's knowledge deficit about ostomy care.

2. The nurse is caring for a patient with diabetes insipidus. The patient has constant severe thirst, drinks fluids continuously, and voids 3 to 4 L of clear yellow urine daily. Which term will the nurse use in the record to describe this patient's urinary output? a. Anuria b. Oliguria c. Polyuria d. Enuresis

ANS: C Urinary output greater than 2500 mL/day is polyuria. Insufficient urine output is oliguria, whereas absence of urine is anuria. Enuresis is commonly known as "bedwetting" at night.

3. The patient is ordered an ultrasound to determine the size, shape, and location 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 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.

2. A patient is experiencing acute renal failure. What is the most common cause of this critical illness? 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, can lead to an anuric state, resulting in acute or chronic renal failure.

12. The nurse is caring for a patient who has urinary frequency. Which nursing diagnosis is the highest priority for this patient? a. Risk for compromised human dignity r/t occasional incontinence b. Risk-prone health behavior r/t living alone at home with nocturia c. Risk for contamination r/t urine contact with perineal area skin d. Risk for falls r/t hurried trips to the bathroom during the day and night

ANS: D Risk for falls is the highest priority diagnosis for this patient because rushing to the bathroom can lead to loss of balance and serious injury. Walking to the bathroom at night is even more dangerous because of low lighting conditions and sleepiness. Living alone with a history of nocturia does not demonstrate risk-prone health behavior. Risk for impaired skin integrity would be appropriate for the patient's potential skin breakdown caused by incontinence and skin contact with urine.

4. The nurse is caring for a postoperative patient whose urinary catheter was removed 8 hours previously. The patient has not been able to void since the catheter was removed and now reports suprapubic pain. What is the priority action of the nurse? a. Encourage oral fluid intake and administer a diuretic. b. Obtain a urine sample to test for culture and sensitivity. c. Carefully calculate the patient's daily intake and output. d. Obtain an order to straight-catheterize the patient.

ANS: D The patient who has not voided for 8 hours after urinary catheter removal and is complaining of suprapubic pain has acute urinary retention. The physician should be notified to obtain an order for straight catheterization to drain the bladder. A urine sample for culture and sensitivity is not ordered. Encouraging fluid intake and administering a diuretic will increase the amount of urine in the bladder and make the patient even more uncomfortable.

18. The preceptor is watching a nursing student care for a male patient who requires a condom catheter. Which action by the nursing student indicates that the procedure is performed correctly? a. Sterile gloves are donned before touching the catheter. b. Adhesive tape is applied securely around the base of the penis. c. Water-soluble lubricant is applied to the end of the catheter. d. The foreskin is returned to its natural position before the catheter is applied.

ANS: D The patient's penis should be cleaned with soap and water with the foreskin retracted prior to condom catheter application. The foreskin should then be returned to its natural position before the catheter is applied. Adhesive tape should never be applied around the base of the penis because circulation may be compromised. Sterile gloves and lubricant are not needed.

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 (PCP).

Answer: a Checking the position and patency of the catheter first will determine whether the problem is mechanical or physiologic in nature. 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 PCP.

9. The nurse is placing an indwelling catheter in a female patient. She inserts the catheter into the vagina. What is the next action for the nurse to implement? a. Collect a urine specimen and notify the 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.

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. It is impossible to get a urine sample from the catheter placed in the vagina. Only after experiencing difficulty with proper placement of the new catheter may the nurse wish to ask for assistance from another nurse.

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 showing negative results on testing for sugar and acetone b. History of allergies c. History of a recent thyroid scan d. Frequency of urination

Answer: b Contraindications tor IVP include an allergy to iodine, which is similar in nature to the contrast material injected during the intravenous pyelogram. 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.

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

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 to relax the patient, this is not the primary concern.

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 (PCP). b. Assess the tubing for kinks and ensure downward flow. c. Change the catheter as soon as possible. d. Aspirate the stagnant urine in the catheter for culture.

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 PCP. The catheter should not be changed unless absolutely necessary, owing to the possibility of causing an infection.

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.

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 from another potentially contaminated vessel. Discarding the entire first void and saving urine in a chilled, opaque container are both procedures for conducting a 24-hour urine collection.

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.

Answer: c The peristomal area can 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 or firm pressure is needed for their application.

10. What symptom is most likely to be exhibited by the patient who complains of voiding small amounts of urine in relation to his fluid intake? a. Nocturia b. Polyuria c. Anuria d. Oliguria

Answer: d Oliguria is reduced urine volume. Nocturia is excessive urination at night. Polyuria is an excessive amount of urine excreted each day, and anuria is excretion of 50 to 100 mL or less of urine each day.

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 bubble bath 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."

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 bubble bath, and wearing tight-fitting clothing all may contribute to the promotion of urinary tract infections, rather than their prevention.

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 (Pyridium) b. A diet that includes a large amount of beets or blackberries c. An enlarged prostate or kidney stones d. High concentrations of bilirubin secondary to liver disease e. Increased carbohydrate intake

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.

25.What blood tests are used to evaluate renal function?

BUN-- blood urea nitrogen creatinine

14. cautious monitoring by the nurse of the patient with a renal disorder includes:

Cautious monitoring of the patient includes strict I&Os and daily weights, along with assessment of vital signs, neurologic status, and overall condition

15. Dysuria is often associated with:

Dysuria is associated with bladder or UTI, cystitis, STDs, yeast infection, kidney or bladder stones, prostatic enlargements, malignancy, allergic or irritant reaction to soaps, vaginal lubes, spermicides, contraceptive foams and sponges, tampons, and toilet paper.

12. What factors can influence urinary output?

Factors that influence urinary output include psychosocial factors, food and fluid intake, surgical and diagnostic procedures, pathologic conditions, and urinary tract infections

17. identify at least three factors that may contribute to urinary retention

Vaginal childbirth, infections of the brain or spinal cord, diabetes, stroke, neurologic disorders, heavy metal poisoning, pelvic injury or trauma, prostate enlargement, infection, surgery

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 (pyridium) b. a diet that includes a large amount of beets or blackberries c. an enlarged prostate or kidney stones d. high concentrations of bilirubin secondary to liver disease e. increased carbohydrate intake

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.

48. A patient is going to have an IVP. Which of the following reflects the most critical assessment question for this patient before the procedure? a. "are you allergic to iodine?" b. "did you remove all metal?" c. "have you had this procedure before?" d. "when did you last have a procedure that required sedatives?"

a. "are you allergic to iodine."

57. A patient is receiving closed catheter irrigation. During the shift, 950 mL of normal saline irrigant aare instilled, and there is a total of 1725 mL in the drainage bag. The patient's urinary output is calculated by the nurse to be: a. 775 mL b. 950 mL c. 1725 mL d. 2675 mL

a. 775 mL

65. Which of the following urinary diversions requires that the patient has a stoma created? a. Ileal conduit b. Kock pouch c. Mainz pouch d. Ileal neobladder

a. Ileal conduit

26. Diagnostic testing may be done to evaluate the status of the urinary system. a. What preparation is necessary for an intravenous pyelogram (IVP)? b. pregnant women should not have tests with:

a. NPO 8 to 12 hours before and may need a laxative or enema to empty the bowels b. the use of radiographs and contrast dyes are contraindicated for pregnant patients

52. In an assessment of a patient with overflow incontinence, the nurse expects to find that the patient has: a. a constant dribbling of urine b. no urge to void and an unawareness of bladder filling c. an uncontrollable loss of urine when coughing and sneezing d. an immediate urge to void but not enough time to reach the bathroom

a. a constant dribbling of urine

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 present 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 PCP

a. check to see if the catheter is present checking the position and patency of the catheter first will determine whether the problem is mechanical or physiologic in nature. At times, the end of the catheter may become lodged up against the side of the bladder preventing the flow of urine into tubing. Telling the patient that is impossible to void while catheterized is erroneous. Catheterizing the patient with a large gauge catheter is unnecessary at this point, as is contacting the PCP.

19.Indicate how the following influence urinary elimination: a. dehydration b. diuretics c. paraplegia d. renal calculi

a. dehydration-- reduced urinary output b. diuretics-- increase urinary output and loss of electrolytes c. paraplegia-- loss of sensation and muscle control to the lower part of the body with resultant urinary retention

44. A patient in the hospital has an indwelling urinary catheter, and the nurse is instructing the nursing assistant in the appropriate care to provide. The nurse teaches the assistant to : a. empty the drainage bag when 2/3 full b. cleanse up the length of the catheter to the perineum c. open the drainage system to obtain a specimen for culture and sensitivity d. place the drainage bag on the patient's lap while transporting the patient to testing

a. empty the drainage bag when 2/3 full

13. For a patient with anuria or oliguria, dialysis may be indicated. a. describe the difference between hemodialysis and peritoneal dialysis b. what is the goal of dialysis

a. hemodialysis takes the patient's blood and has it flow through the filters of a machine and ultrafiltrate. Peritoneal dialysis uses the abdominal cavity as the membrane for exchange of fluid and molecules. b. The goal of dialysis is to remove toxins and maintain fluid, electrolyte, and acid-base balance

24. What are the expected characteristics of urine? Select all that apply. a. pale yellow color b. cloudy c. fruity color d. pH=6 e. protein present f. no glucose

a. pale yellow color d. pH=6 f. no glucose

54. A timed urine specimen collection is ordered. The test will need to be restarted if the: a. patient voids in the toilet b. urine specimen is kept cold c. first voided urine is discarded d. preservative is placed in the collection container

a. patient voids in the toilet

23. Identify what the following can do to the appearance of a patient's urine: a. beets and blackberries b. warfarin c. liver failure

a. pink or red b. orange c. brown or tea color

16. Which of the following individuals may be more prone to episodes of urinary incontinence? Select all that apply. a. women b. men c. school aged children d. older adults e. pregnant women

a. women d. older adults e. pregnant women

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

b. ask the patient to void first into the toilet, stop midstream, and finish voiding into the sterile specimen container Urine specimen 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 from another potentially contaminated vessel. Discarding the entire first void and saving usine in a chilled, opaque container are both procedures for conducting a 24 hour urine collection

The nurse assessing a patient withan indwelling catheter and finds that the catheter is not draining and the patient's bladderis distended. What action should the nurse take next? a. notify the PCP b. assess the tubing for kinks and ensure downward flow c. change the catheter as soon as possible d. aspirate the stagnant urine in the catheter for culture

b. assess the tubing for kinks and ensure downward flow The next action by the nurse should be to check the patency ofthe catheter tubing. At this point there is no need to aspirate any urine or call the PCP. The catheter should not be changed unless absolutely necessary, owing to the possibility of causing an infection.

55. The nurse is working with a patient who has an incontinent urinary diversion. Included in the plan of care for this patient is instruction that: a. special clothing is necessary b. careful skin care is a priority c. a stoma bag will only need to be worn at night d. a strict reduction in physical activity will be planned

b. careful skin care is a priority

45. The nurse suspects that the patient has a bladder infection on the basis of the patient exhibiting: a. nausea b. hematuria c. flank pain d. incontinence

b. hematuria

A patient is scheduled for an intravenous pyelogram. Which piece of data would be most important to know before the procedure is carried out? a. urinalysis showing negative results on testing for sugar and acetone b. history of allergies c. history of recent thyroid scan d. frequency of urination

b. history of allergies Contraindications for IVP include an allergy to iodine, which is similiar in nature to the contrast material injected during intravenous pyelogram. 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 scheduled IVP.

An indwelling catheter is ordered for a postoperative patient who is unable to void. What is the primary concern of the nurse preforming 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

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

63. Urinary elimination may be altered with different pathophysiological conditions. For the patient with diabetes mellitus, the nurse anticipates that an initial urinary sign or symptom will be which of the following? a. urgency b. polyuria c. dysuria d. hematuria

b. polyuria

59. A sample is obtained from the patient for a routine urinalysis. After reviewing the results of the test, the nurse notes that an expected finding of the urinalysis is: a. pH 8.0 b. specific gravity 1.018 c. protein amounts to 12 mg/100mL d. WBCs of 5 to 8 per low-power field casts

b. specific gravity 1.018

53. In determining the patient's urinary status, the nurse anticipates that the urinary output for an average adult should be approximately: a. 400 mL/day b. 800 mL/day c. 1400 mL/day d. 2000 mL/day

c. 1400mL/day

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 water 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

c. cleanse the peristomal skin with mild soap and water The peristomal area can 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 water or firm pressure is needed for their application.

60. An order is written for the patient's indwelling urinary catheterization to be discontinued. The unit manager is observing the new staff nurse provide care to this patient and implement the prescriber's order. The unit manager determines that further instruction is required for the new staff nurse in catheter removal if he is observed: a. draping the female patient b. obtaining a specimen before removal c. cutting the catheter to deflate the balloon d. checking the patient's output carefully for 6 to 8 hours after removal

c. cutting the catheter to deflate the balloon

47. A patient with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH). The nurse anticipates the patient will exhibit: a. hematuria b. an increased blood pressure c. dry mucous membranes d. a low serum sodium level

c. dry mucous membranesq

56. The nursing instructor is evaluating the student during the catheterization of a female patient. The instructor determines that the student has implemented appropriate technique when observed: a. keeping both hands sterile throughout the procedure b. reinserting the catheter if it was misplaced initially in the vagina c. inflating the balloon to test it before catheter insertion d. advancing the catheter 7 to 8 inches

c. inflating the balloon to test it before catheter insertion

61. A condom catheter is to be used for an adult male patient in the extended care facility. In the application of the condom catheter, the nurse employs appropriate technique when: a. using sterile gloves b. wrapping adhesive tape securely around the base of the penis c. leaving a 1 to 2 inch space between the tip of the penis and the end of the catheter d. taping the tubing tightly to the thigh and attaching the drainage bag to the side rail

c. leaving a 1 to 2 inch space between the tip of the penis and the end of the catheter

58. A toileting program for a patient in an extended care facility should include which of the following? a. providing negative reinforcement when the patient is incontinent b. having the patient wear adult diapers as a preventative measure c. putting the patient on a q2h toilet schedule during the day d. promoting the intake of caffeine to stimulate voiding

c. putting the patient on a q2h toilet schedule during the day

49. A postpartum patient has been unable to void since her delivery of her baby this morning. Which of the following nursing measures would be beneficial for the patient initially? a. increase fluid intake to 3500 mL b. insert an indwelling catheter c. rinse the perineum with warm water d. apply firm pressure over the bladder

c. rinse the perineum with warm water

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 bubble bath when bathing c. I will wait to wear my tight jeans until after my urine is clear d. I will wipe from front to back after voiding

d. I will wipe from the front to back after voiding Wiping the female patient 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 bubble bath, and wearing tight-fitting clothing all may contribute to the promotion of urinary tract infections rather than prevention of.

50. The nurse is visiting the patient who has a nursing diagnosis of Alteration in urinary elimination, retention. On assessment, the nurse anticipates that this patient will exhibit: a. a loss of the urge to void b. severe flank pain and hematuria c. pain and burning on urination d. a feeling of pressure and voiding of small amounts

d. a feeling of pressure and voiding of small amounts

51. The unit manager is evaluating the care of a new nursing staff member. Which of the following is an appropriate technique for the nurse to implement in order to obtain a clean-voided urine specimen? a. apply sterile gloves for the procedure b. restrict fluids before the specimen collection c. place the specimen in a clean urinalysis container d. collect the specimen after the initial stream of urine has passed

d. collect the specimen after the initial stream of urine has passed

64. The nurse recognizes that postrenal failure is associated with: a. renal damage b. low cardiac output c. vascular collapse d. functional obstruction

d. functional obstruction

62. The patient has a suprapubic catheter in place. Which of the following is correct for this type of catheterization? a. irrigation is required for urine to drain b. the catheter is secured with adhesive tape c. lotions or creams are used around the site to protect the skin d. it is usually placed 4 to 5 cm above the symphysis pubis

d. it is usually placed 4 to 5 cm above the symphysis pubis

22. Indicate the expected findings from the physical assessment of the urinary system. Select all that apply. a. distention over the suprapubic area b. bruit heard over the left renal artery c. discomfort on percussion of the kidney d. soft abdomen e. bilateral ecchymosis to the lower abdominal quadrants f. absence of indentation and scarring

d. soft abdomen f. absence of indentation and scarring

43. An assessment is completed by the nurse, and a nursing diagnosis for the oriented adult female patient is identified as Stress incontinence related to decreased pelvic muscle tone. An appropriate nursing intervention based on this diagnosis is to: a. apply adult diapers b. catheterize the patient c. administer urecholine d. teach kegel exercises

d. teach kegel exercises

46. The patient has an indwelling catheter. The nurse should obtain a sterile urine specimen by: a. disconnecting the catheter from the drainage tubing b. inserting a needle into the catheter tubing c. opening the drainage bag and removing urine d. using a syringe to withdraw urine from the catheter port

d. using a syringe to withdraw urine from the catheter port

21. What specific aspects of the physical assessment are conducted to determine renal and bladder status?

inspect the abdomen for color, contour, symmetry and distention. The renal arteries should be auscultated. Palpation and percussion of the bladder are performed

18. the patient with an enlarged prostate may exhibit which signs and symptoms?

urinary frequency, hesitancy, retention, and a feeling of bladder fullness, pressure, or pain