Chapter 46: Urinary Elimination (including evolve questions)

Which of the following clients presents with an increased risk for urinary incontinence? (Select all that apply.) 1. The 74-year-old diagnosed with parkinsonism 5 years ago 2. The 25-year-old with Crohn's disease diagnosed 4 years ago 3. The 62-year-old Alzheimer's disease client diagnosed 8 years ago 4. The 34-year-old mother of two diagnosed with multiple sclerosis 8 years ago 5. The 73-year-old diagnosed with benign prostatic hyperplasia (BPH) 6 years ago 6. The 69-year-old client diagnosed with type 2 diabetes 9 years ago

ANS: 1, 3, 4, 5, 6 Many diseases and conditions affect the ability to micturate. Diabetes mellitus and multiple sclerosis cause changes in nerve functions that can lead to possible loss of bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder contractions. Older men often suffer from BPH, which makes them prone to urinary retention and incontinence. Some clients with cognitive impairments, such as Alzheimer's disease, lose the ability to sense a full bladder or are unable to recall the procedure for voiding. Diseases that slow or hinder physical activity interfere with the ability to void. Degenerative joint disease and parkinsonism are examples of conditions that make it difficult to reach and use toilet facilities. Crohn's disease is gastrointestinal in nature and does not directly affect micturition.

1 A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is: 1Cystitis. 2Hematuria. 3Pyelonephritis. 4Dysuria.

1. Answer: 1. Urine is cloudy in cystitis because of bacterial and white cells.

10 The nurse is planning to remove a Foley catheter at 1300. The nurse would check if the patient has voided by: 1 1400. 2 1600 3 1700. 4 2300.

10. Answer: 3. The patient may experience urinary retention after removal of the catheter. If 4 hours after Foley removal have elapsed without voiding, it may be necessary to reinsert the Foley.

12 The patient is to have an intravenous pyelogram (IVP). Which of the following apply to this procedure? (Select all that apply.) 1Note any allergies. 2Monitor intake and output. 3Provide for perineal hygiene. 4Assess vital signs. 5Encourage fluids after the procedure.

12. Answer: 1, 5. The dye used in the procedure is iodine based. Assessing for history of any allergies can predict allergy to the dye used. Fluid intake dilutes and flushes the dye from the patient.

2 A male patient returned from the operating room 6 hours ago with a cast on his right arm. He has not yet voided. Which action would be the most beneficial in assisting the patient to void? 1Suggest he stand at the bedside 2Stay with the patient 3Give him the urinal to use in bed 4Tell him that, if he doesn't urinate, he will be catheterized

2. Answer: 1. A man voids more easily in the standing position.

6 To minimize the patient experiencing nocturia, the nurse would teach him or her to: 1Perform perineal hygiene after urinating. 2Set up a toileting schedule. 3Double void. 4Limit fluids before bedtime.

6. Answer: 4. With nocturia the patient has to get up during the night to urinate. Limiting fluids 2 hours before bedtime minimizes nocturia.

7 A patient with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the patient that he or she is at risk for: (Select all that apply.) 1Infection. 2Retention. 3Stagnant urine. 4Reflux of urine.

7. Answer: 1, 4. Urine in the bag and tubing becomes a medium for bacteria, and infection is likely to develop if urine flows back into the bladder.

What best describes measurement of post-void residual (PVR)? A. Bladder scan the patient immediately after voiding. B. Catheterize the patient 30 minutes after voiding. C. Bladder scan the patient when they report a strong urge to void. D. Catheterize the patient with a 16 Fr/10 mL catheter

A. Bladder scan the patient immediately after voiding. A PVR or post void residual is the measurement of urine in the bladder within 15 minutes of normal voiding. It would not be a true measurement of PVR if the bladder was full, or if after 30 minutes of voiding. A 16 Fr/10 mL catheter and would not be appropriate to use when catheterizing for PVR.

When a person as a fever or diaphoresis, how would the urine output be described? A. Decreased and highly concentrated B. Decreased and highly dilute C. Increased and concentrated D. Increased and dilute

A. Decreased and highly concentrated Fever and diaphoresis cause the kidneys to conserve body fluids, Thus, the urine is concentrated and decreased in amount.

Which of the following statements made by a client experiencing chronic kidney dysfunction reflects the best understanding of the most common physiological effect this disorder can have on the body? 1. "I'm tested regularly for anemia." 2. "My diet is restricted because of this problem." 3. "Diabetes runs in my family, so I get tested regularly." 4. "I can get really depressed if I think about this too much."

ANS: 1 Clients with chronic alterations in kidney function cannot produce sufficient quantities of the hormone erythropoietin; therefore they are prone to anemia. The remaining options deal with nonphysiological events or conditions that are more causes of the dysfunction, not effects.

A 45-year-old female client has been hospitalized for severe abdominal pain. The health care provider has ordered a PCA pump for the client to help control the pain. It has been determined that the pain is due to cholelithiasis and the client is scheduled for a cholecystectomy later that day. The client returns to the unit postoperatively with a Foley catheter anchored. The nurse notes that the client's urine output has decreased. The nurse knows that this is most likely due to: 1. Stress response 2. Preoperative NPO status 3. Kidney failure 4. Post-operative urinary retention

ANS: 1 The stress response releases an increased amount of ADH, which increases water reabsorption. Stress also elevates the level of aldosterone, causing retention of sodium and water. Both of these substances reduce urine output in an effort to maintain circulatory fluid volume. Although the client was NPO postoperatively, she had a pain pump, which indicates that she had a running IV with fluids. It is not indicated that the client had kidney failure, and since the client had an anchored urinary catheter, she would not have urinary retention.

Immediately after an intravenous pyelogram (IVP) the nurse should observe the client for which of the following? 1. Infection in the urinary bladder 2. An allergic reaction to the contrast material 3. Urinary suppression caused by injury to kidney tissues 4. Incontinence as a result of paralysis of the urinary sphincter

ANS: 2 After an IVP the nurse should encourage fluid intake to dilute and flush dye from the client and observe the client for late symptoms of allergy (e.g., rash). There is no increased risk for infection of the urinary bladder from an IVP. This would be more likely with an invasive procedure, such as an endoscopy (cystoscopy). An IVP should not injure tissues of the kidney or cause paralysis of the urinary sphincter.

The client is experiencing urinary retention, and the health care provider is contacted. The nurse anticipates a medication that will be ordered to promote emptying of the bladder is: 1. Oxybutynin chloride (Ditropan) 2. Bethanechol (Urecholine) 3. Propantheline (Pro-Banthine) 4. Nystatin (Mycostatin)

ANS: 2 Cholinergic drugs, such as bethanechol (Urecholine), increase contraction of the bladder and improve emptying. Bethanechol stimulates parasympathetic nerves to increase bladder wall contraction and relax the sphincter. Oxybutynin chloride (Ditropan) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder), and thus reduces incontinence. Propantheline (Pro-Banthine) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder), and thus reduces incontinence. Nystatin (Mycostatin) is an antifungal agent.

The nurse suspects that the client has a bladder infection based on the client's exhibiting an early sign or symptom such as: 1. Chills 2. Hematuria 3. Flank pain 4. Incontinence

ANS: 2 Irritation to the bladder and urethral mucosa results in blood-tinged urine (hematuria). Hematuria is a sign of a bladder infection. Chills are a more systemic symptom associated with pyelonephritis. Flank pain is a more systemic symptom associated with pyelonephritis. Incontinence is not a symptom of a bladder infection

A 3-year-old child is visiting the pediatric clinic. The nurse suspects that the child has a urinary tract infection. An appropriate method for the nurse to implement in order to obtain a urine specimen from the child is to: 1. Use an indwelling catheter 2. Offer fluids 30 minutes in advance 3. Apply pressure over the urinary bladder 4. Place a diaper on the child and squeeze out the specimen

ANS: 2 Offering the young child fluids 30 minutes before requesting a specimen may help. Because bladder catheterization carries the risk for UTI, blockage, and trauma to the urethra, it is preferable to rely on other measures for specimen collection. Applying pressure over the urinary bladder of a child with an intact nervous system will not help and may create more stress in the child. Squeezing urine from a child's diaper is not an accurate method of obtaining a urine specimen to determine whether the child has a urinary tract infection.

The nurse knows that which of the following clients is most at risk for a bone fracture: 1. 44-year-old female with rheumatoid arthritis 2. 64-year-old male with Cushing's disease 3. 53-year-old female with chronic alterations in renal function 4. 60-year-old male with cirrhosis of the liver

ANS: 2 The kidneys affect calcium and phosphate regulation by producing a substance that converts vitamin D into its active form. Clients with chronic alterations in kidney function do not make sufficient amounts of the active vitamin D. They are prone to develop renal bone disease resulting from the demineralization of bone caused by impaired calcium absorption.

The nurse is aware that clients with chronic alterations in kidney function suffer from insufficient amounts of: 1. Vitamin A 2. Vitamin D 3. Vitamin E 4. Vitamin K

ANS: 2 The kidneys play a role in calcium and phosphate regulation by producing a substance that converts vitamin D into its active form. Clients with chronic alterations in kidney function do not make sufficient amounts of the active vitamin D. Clients with chronic alterations in kidney function do not suffer from an insufficient amount of vitamin A, vitamin E, or vitamin K.

A urine sample is obtained from the client for a routine urinalysis. Upon reviewing the results of the test, the nurse notes that an expected finding of the urinalysis is: 1. pH 8.0 2. Specific gravity 1.018 3. Protein amounts to 12 mg/100 mL 4. White blood cells (WBCs) 5 to 8 per low-power field casts

ANS: 2 The normal specific gravity of urine is 1.010 to 1.025. The normal urine pH is 4.6 to 8.0, with an average of 6.0. Protein is not normally found in the urine. The normal value for urine protein is 0, or up to 8 mg/100 mL. The number of WBCs is 0 to 4 per low-power field, and casts should be 0 in a normal urinalysis.

A condom catheter is to be used for an adult male client in the extended care facility. In the application of the condom catheter, the nurse employs appropriate technique when: 1. Using sterile gloves 2. Wrapping the adhesive tape securely around the base of the penis 3. Leaving a 1- to 2-inch space between the tip of the penis and the end of the catheter 4. Taping the tubing tightly to the thigh and attaching the drainage bag to the bed frame

ANS: 3 A 1- to 2-inch space should be left between the tip of the penis and the end of the catheter. Nonsterile gloves are worn to apply a condom catheter. Standard adhesive tape should never be used to secure a condom catheter because it does not expand with change in penis size and is painful to remove. The tubing of a condom catheter is not taped tightly to the thigh. The drainage bag is attached to the lower bed frame.

The nurse caring for a client in an extended care facility should provide which intervention in a bladder retraining program? 1. Providing negative reinforcement when the client is incontinent 2. Having the client wear adult diapers as a preventative measure 3. Putting the client on a q2h toilet schedule during the day 4. Promoting the intake of caffeine to stimulate voiding

ANS: 3 A bladder retraining program includes initiating a toileting schedule on awakening, at least every 2 hours during the day and evening, before getting into bed, and every 4 hours at night. Negative reinforcement should not be used when the client is incontinent. However, positive reinforcement should be provided when continence is maintained. The client should be offered protective undergarments to contain urine and reduce the client's embarrassment (not diapers). Tea, coffee, other caffeine drinks, and alcohol should be minimized.

The nurse is discussing urinary elimination alterations with a group of middle-age adults. The nurse appropriately shares with the group that whereas men experience urinary frequency as a result of prostate enlargement, the female: 1. Is more affected if she has experienced multiple pregnancies 2. Does not usually experience urinary problems until much later in life 3. Experiences an increased risk for urinary tract infections related to menopause 4. Appears to have less risk for kidney infections because of gradually declining estrogen levels

ANS: 3 Aging often impairs micturition. In the male, prostate enlargement usually begins during the 40s and continues throughout life, resulting in urinary frequency and possible urinary retention. In women, changes in the urethral mucosa associated with loss of estrogen during and after menopause contribute to increased susceptibility to UTIs. Although pregnancies may affect urinary continence, decreased estrogen levels do not protect against kidney infections.

A client with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH). The nurse anticipates the client will exhibit: 1. Hematuria 2. An increased blood pressure 3. Dry mucous membranes 4. A low serum sodium level

ANS: 3 Alcohol inhibits the release of ADH, resulting in increased water loss in urine. The client may show signs of decreased fluid volume (dehydration), including dry mucous membranes. The effects of excessive alcohol intake and reduced antidiuretic hormone will not cause hematuria. Having decreased levels of antidiuretic hormone will lead to increased urine production. The client may exhibit a decreased blood pressure resulting from decreased fluid volume and an increased serum sodium level with dehydration.

Which of the following would indicate that the clinician performing the catheterization of a female client was competent? 1. Keeping both hands sterile throughout the procedure 2. Reinserting the catheter if it was misplaced initially in the vagina 3. Inflating the balloon to test it before catheter insertion 4. Advancing the catheter 7 to 8 inches

ANS: 3 Before inserting the indwelling catheter, the balloon should be tested by injecting the fluid from the prefilled syringe into the balloon port. The dominant hand is kept sterile throughout the procedure. The nondominant hand is not kept sterile because it touches the client. If the catheter is misplaced, it should be left in the vagina as a landmark indicating where not to insert, and another sterile catheter should be inserted into the urethra. The catheter should be advanced 2 to 3 inches in the female client.

The nurse is discussing signs and symptoms of both upper and lower urinary tract infections with a client who has a history of both. Which of the following statements by the client reflects the best understanding of the differing symptomatology? 1. "When I get cloudy urine, I figure I have an infection." 2. "Burning when I urinate is usually the first symptom I notice." 3. "I have a big problem when I feel like I have the flu but with back pain too." 4. "When I see blood in my urine, I know I need to call my health care provider."

ANS: 3 Clients with lower UTIs have pain or burning during urination (dysuria) as urine flows over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the infection worsens. An irritated bladder (cystitis) causes a frequent and urgent sensation of the need to void. Irritation to bladder and urethral mucosa results in blood-tinged urine (hematuria). The urine appears concentrated and cloudy because of the presence of WBCs or bacteria. If infection spreads to the upper urinary tract (kidneys—pyelonephritis, a serious renal condition), flank pain, tenderness, fever, and chills are common. The remaining options identify general symptoms that are not condition specific.

Which of the following clients is at greatest risk for developing a renal infection? 1. A 27-year-old male 2. A 16-year-old male 3. A 9-year-old female 4. A 45-year-old female

ANS: 3 The short length of the urethra predisposes women and girls to infection. It is easy for bacteria to enter the urethra from the perineal area. The 9-year-old female has the shortest urethra and so has the greatest risk.

A client is going to have a cystoscopy. Which of the following reflects the correct information that should be taught before the procedure? 1. "Are you allergic to iodine?" 2. "There will be no need to have a special consent form." 3. "You will need to have fluids restricted the evening before the cystoscopy." 4. "You will probably be given sedatives before the procedure."

ANS: 4 Although this procedure may be accomplished using local anesthesia, it is more commonly performed using general anesthesia or conscious sedation to avoid unnecessary anxiety and trauma for the client. A cystoscopy involves direct visualization. No contrast dye is used; therefore the nurse does not need to ask if the client is allergic to iodine. A signed consent form is obtained. Fluids are not restricted before or after the procedure. The flushing action helps remove bacteria from the urethra.

Urinary elimination may be altered with different pathophysiological conditions. For the client with diabetes mellitus, the nurse anticipates that an initial urinary sign or symptom will be: 1. Urgency 2. Dysuria 3. Hematuria 4. Polyuria

ANS: 4 An initial urinary symptom of diabetes mellitus is polyuria. Urgency is not a symptom of diabetes mellitus. Urgency may be caused by a full bladder, bladder irritation from infection, incompetent urethral sphincter, or psychological stress. Dysuria is not a symptom of diabetes mellitus. Dysuria may be caused by bladder inflammation, trauma, or inflammation of the urethral sphincter. Hematuria is not a symptom of diabetes mellitus. Hematuria may be a symptom of neoplasms of the bladder or kidney, glomerular disease, infection of the kidney or bladder, trauma to urinary structures, calculi, or bleeding disorders.

The nurse is interviewing a client with a history of benign prostatic hypertrophy (BPH). In light of this diagnosis, the nurse should include information regarding which of the following in order to assess the chronic effects of this renal disorder? 1. Number of times he usually urinates in a 24-hour period 2. What medications he is currently taking for the condition 3. The results of his latest prostate-specific antigen (PSA) testing 4. Whether he usually experiences a complete emptying of his bladder

ANS: 4 If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time the micturition reflex changes, causing bladder overactivity, and can cause the bladder to not completely empty. The remaining options focus on the impact the condition has on daily living and the monitoring necessary to determine the presence of prostate cancer.

The nurse recognizes that a client recovering from anesthesia required for surgical repair of a fractured ulna is likely to experience difficulty urinating primarily because of: 1. The impaired cognitive state the client will experience as the effects of the anesthesia wear off 2. The decreased volume of orally ingested fluids before, during, and after the surgical procedure 3. The length of time the client was under the effects of general anesthesia required for the surgical procedure 4. The effects of the anesthetic on the nerves and muscles controlling the relaxation of the urinary bladder

ANS: 4 Medications, including anesthesia, interfere with both the production and the characteristics of urine and affect the act of urination. The remaining options may affect urination but not to the extent of the anesthetic effects.

A 46-year-old male client with chronic renal problems is in the hospital for a nephrostomy. The nurse understands that this is the surgical insertion of a tube that will drain urine from the client's: 1. Bladder 2. Urethra 3. Ureters 4. Renal pelvis

ANS: 4 Some clients have a need for urinary drainage directly from one or both kidneys. In this case a tube placed directly into the renal pelvis. This procedure is called a nephrostomy

The nurse is working with a client who has a urinary diversion. Included in the plan of care for this client is instruction that: 1. Special clothing will need to be ordered in order to fit around the diversion 2. A stomal bag will only need to be worn at night 3. A reduction in physical activity will be planned 4. Special skin care is a priority

ANS: 4 Special skin care is a priority in caring for a client with a urinary diversion. Local irritation and skin breakdown occur when urine comes in contact with the skin for long period. Special clothing is not necessary for the client with a urinary diversion, but the client must wear a stomal pouch continuously because there is no sphincter control for regulation of urine flow. There is no need to plan for a reduction in activity.

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? 1. Apply sterile gloves for the procedure. 2. Restrict fluids before the specimen collection. 3. Place the specimen in a clean urinalysis container. 4. Collect the specimen after the initial stream of urine has passed.

ANS: 4 To collect a clean-voided specimen, the nurse should collect the specimen (30 to 60 mL) after the initial stream of urine has passed. Nonsterile gloves are adequate. Fluids are encouraged so the client will be more likely to be able to void. The specimen should be collected in a sterile container and then placed into a plastic specimen bag.

A 46-year-old client has had kidney disease for the past 10 years. His kidneys are no longer functioning. The nurse knows that which of the following offers the client the potential for restoration of normal kidney function? 1. Lasix therapy 2. Hemodialysis 3. Peritoneal dialysis 4. Kidney transplant

ANS: 4 Unlike the other treatments, successful organ transplantation offers the client the potential for restoration of normal kidney function.

Which of the following nursing interventions is most specific for a client being monitored for possible urinary retention? 1. Measuring urine output with each urination 2. Monitoring the color and clarity of urine with each voiding 3. Collecting a urine sample for a culture and sensitivity test 4. Asking the cognizant client to report each time he or she urinates

ANS: 4 With retention the client may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine. Be aware of the volume and frequency of voiding to assess this condition in the client. The alert, oriented client can be asked to notify the nurse each time micturition occurs. The remaining options are more generalized or specific for a urinary tract infection.

The nurse is visiting the client who has a nursing diagnosis of urinary retention. Upon assessment the nurse anticipates that this client will exhibit: 1. Severe flank pain and hematuria 2. Pain and burning on urination 3. A loss of the urge to void 4. A feeling of pressure and voiding of small amounts

ANS: 4 With urinary retention, urine continues to collect in the bladder, stretching its walls and causing feelings of pressure, discomfort, tenderness over the symphysis pubis, restlessness, and diaphoresis. The sphincter temporarily opens to allow a small volume of urine (25 to 60 mL) to escape, with no real relief of discomfort. Severe flank pain and hematuria are supporting data for an upper urinary tract infection (pyelonephritis). Pain and burning on urination are symptoms of a lower urinary tract infection (such as a bladder infection). Supportive data for reflex incontinence would include a loss of the urge to void.

26. A nurse anticipates urodynamic testing for a patient with which symptom? a. Involuntary urine leakage b. Severe flank pain c. Presence of blood in urine d. Dysuria

ANS: A Urodynamic testing evaluates the muscle function of the bladder and is used to look for the cause of urinary incontinence. Severe flank pain indicates renal calculi; CT scan or IVP would be a more efficient diagnostic test. Blood indicates trauma to the urethral or bladder mucosa. Pain on elimination may warrant cultures to check for infection.

9. When caring for a patient with urinary retention, the nurse would anticipate an order for a. Limited fluid intake. b. A urinary catheter. c. Diuretic medication. d. A renal angiogram.

ANS: B A urinary catheter would relieve urinary retention. Reducing fluids would reduce the amount of urine produced but would not alleviate the urine retention. Diuretic medication would increase urine production and may worsen the discomfort caused by urine retention. A renal angiogram is an inappropriate diagnostic test for urinary retention.

13. Which nursing diagnosis related to alternations in urinary function in an older adult should be a nurse's first priority? a. Self-care deficit related to decreased mobility b. Risk of infection c. Anxiety related to urinary frequency d. Impaired self-esteem related to lack of independence

ANS: B Older adults often experience poor muscle tone, which leads to an inability of the bladder to fully empty. Residual urine greatly increases the risk of infection. Following Maslow's hierarchy of needs, physical health risks should be addressed before emotional/cognitive risks such as anxiety and self-esteem. Decreased mobility can lead to self-care deficit; the nurse's priority concern for this diagnosis would be infection, because the elderly person must rely on others for basic hygiene.

11. Which of the following is the primary function of the kidney? a. Metabolizing and excreting medications b. Maintaining fluid and electrolyte balance c. Storing and excreting urine d. Filtering blood cells and proteins

ANS: B The main purpose of the kidney is to maintain fluid and electrolyte balance by filtering waste products and regulating pressures. The kidneys filter the byproducts of medication metabolism. The bladder stores and excretes urine. The kidneys help to maintain red blood cell volume by producing erythropoietin.

27. A patient is having difficulty voiding in a bedpan but states that she feels her bladder is full. To stimulation micturition, which nursing intervention should the nurse try first? a. Exiting the room and informing the patient that the nurse will return in 30 minutes to check on the patient's progress b. Utilizing the power of suggestion by turning on the faucet and letting the water run c. Obtaining an order for a Foley catheter d. Administering diuretic medication

ANS: B To stimulate micturition, the nurse should attempt noninvasive procedures first. Running warm water or stroking the inner aspect of the upper thigh promotes sensory perception that leads to urination. A patient should not be left alone on a bedpan for 30 minutes because this could cause skin breakdown. Catheterization places the patient at increased risk of infection and should not be the first intervention attempted. Diuretics are useful if the patient is not producing urine, but they do not stimulate micturition.

1. If obstructed, which component of the urination system would cause peristaltic waves? a. Kidney b. Ureters c. Bladder d. Urethra

ANS: B Ureters drain urine from the kidneys into the bladder; if they become obstructed, peristaltic waves attempt to push the obstruction into the bladder. The kidney, bladder, and urethra do not produce peristaltic waves. Obstruction of both bladder and urethra typically does not occur.

5. The nurse knows that indwelling catheters are placed before a cesarean because a. The patient may void uncontrollably during the procedure. b. A full bladder can cause the mother's heart rate to drop. c. Spinal anesthetics can temporarily disable urethral sphincters. d. The patient will not interrupt the procedure by asking to go to the bathroom.

ANS: C Spinal anesthetics may cause urinary retention due to the inability to sense or carry out the need to void. The patient is more likely to retain urine, rather than experience uncontrollable voiding. With spinal anesthesia, the patient will not be able to ambulate during the procedure. A full bladder has no impact on the pulse rate of the mother.

22. The nurse would anticipate an order for which diagnostic test for a patient who has severe flank pain and calcium phosphate crystals revealed on urinalysis? a. Renal ultrasound b. Bladder scan c. KUB x-ray d. Intravenous pyelogram

ANS: D Flank pain and calcium phosphate crystals are associated with renal calculi. An intravenous pyelogram allows the provider to observe pathological problems such as obstruction of the ureter. A renal ultrasound is performed to identify gross structures. A bladder scan measures the amount of urine in the bladder. A KUB x-ray shows size, shape, symmetry, and location of the kidneys.

Which of the following is the correct order for insertion of an indwelling catheter in a female patient? 1. Insert and advance catheter. 2. Lubricate catheter. 3. Inflate catheter balloon. 4. Cleanse urethral meatus. 5. Drape the patient with the sterile square and fenestrated drapes. 6. When urine appears advance another 2.5 to 5 cm. 7. Prepare sterile field and supplies. 8. Gently pull catheter until resistance is felt. 9. Attach drainage tubing. A. 7, 5, 2, 1, 4, 6, 3, 8, 9 B. 5, 7, 2, 4, 1, 6, 3, 8, 9 C. 5, 7, 1, 2, 4, 6, 3, 9, 8 D. 5, 7, 2, 1, 4, 3, 6, 8, 9

B. 5, 7, 2, 4, 1, 6, 3, 8, 9

Data must be collected to evaluate the effectiveness of a plan to reduce urinary incontinence in an older adult patient. Of the information below, which is the least important for the evaluation process? A. The incontinence pattern B. State of physical mobility C. Medications being taken D. Age of patient

D. Age of patient Incontinence is not a natural consequence of the aging process. All the other factors are necessary information for the plan of care.

Mrs. Grayson is a 55-year-old woman who has had problems with stress incontinence for the past 2 years. She has not spoken to anyone about her problems because she is embarrassed. She finally confides to her health care practitioner that the problem is causing her to avoid social situations and she would like help to regain urinary control. Mrs. Grayson weighs 200 pounds, and her height is 5 feet 1 inch. She has been referred to a continence specialist. A plan of care was developed after a thorough assessment of her urinary pattern and symptoms. 1She has recently begun Kegel exercises to attempt improvement in her urinary control. She doesn't see any improvement. She has been trying to deal with the problem by using an absorbent pad in her underwear, but she feels as though everyone knows her problem. What additional teaching does Mrs. Grayson need?

1. Teach Mrs. Grayson supportive measures to reduce intraabdominal pressure such as losing weight and avoiding heavy lifting. Other measures that will help her include initiating a bladder and habit training program, maintaining a toileting schedule, having her use double voiding, and encouraging her to reduce caffeinated beverages from her diet.

11 The postoperative patient has difficulty voiding after surgery and is feeling "uncomfortable" in the lower abdomen. Which action should the nurse implement first? 1Encourage fluid intake 2Administer pain medication 3Catheterize the patient 4Turn on the bathroom faucet as he tries to void

11. Answer: 4. The sound of running water helps many patients to void through the power of suggestion.

13 The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to: 1Use the double-voiding technique. 2Perform Kegel exercises. 3Use Credé's method. 4Keep a voiding diary.

13. Answer: 3. With this method pressure is put on the suprapubic area with each attempted void. The maneuver promotes bladder emptying by relaxing the urethral sphincter.

14 The patient states that she "loses urine" every time she laughs or coughs. The nurse teaches the patient measures to regain urinary control. The nurse recognizes the need for further teaching when the patient states: 1"I will perform my Kegel exercises every day." 2"I joined weight watchers." 3"I drink two glasses of wine with dinner." 4"I have tried urinating every 3 hours."

14. Answer: 3. Alcohol is a bladder irritant. It increases urine production and causes uncontrolled bladder contractions.

15 The nurse notes that the patient's Foley catheter bag has been empty for 4 hours. The priority action would be to: 1Irrigate the Foley. 2Check for kinks in the tubing. 3Notify the health care provider. 4Assess the patient's intake. Answers: 1. 1; 2. 1; 3. 1, 2, 3, 4, 5; 4. 4; 5. 1; 6. 4; 7. 1, 4; 8. 3; 9. 1320 mL; 10. 3; 11. 4; 12. 1, 5; 13. 3; 14. 3; 15. 2.

15. Answer: 2. Kinks in tubing prevent flow of urine. To keep the drainage system patent, check for kinks or bends in the tubing.

2Two months after your first encounter with Mrs. Grayson, she has been seen by her primary health care provider for burning on urination with increased frequency and urgency. She has also noted blood in her urine for a week. What is Mrs. Grayson experiencing and what can you teach her to minimize her symptoms?

2. Mrs. Grayson is experiencing urinary tract infection (UTI). Residual or retained urine in her bladder causes the urine to become more alkaline and is an ideal site for microorganism growth. Encourage Mrs. Grayson to increase her fluid intake to 2200 to 2700 mL/day. Teach her to empty her bladder completely. Ensure that she continues to use good perineal hygiene.

3 Elimination changes that result from inability of the bladder to empty properly may cause which of the following? (Select all that apply.) 1Incontinence 2Frequency 3Urgency 4Urinary retention 5Urinary tract infection

3. Answer: 1, 2, 3, 4, 5. Any condition resulting in urinary retention increases the risk for urinary tract infection. As retention progresses, retention with overflow develops. Pressure in the bladder builds to a point at which the external urethral sphincter is unable to hold back urine. With retention the patient may void small amounts of urine 2 to 3 times an hour and have urgency. He or she may continually dribble urine. Urinary retention results from inability of the bladder to empty.

3Mrs. Grayson says she is not satisfied with her current state of urinary control and has decided on a more permanent solution to her stress incontinence. She opts for a minimally invasive procedure that will provide support for the urethra. She will be going home with an indwelling catheter. She asks how to care for the catheter while she is home. She does not want another urinary tract infection. What do you tell her about measures at home to remain infection free?

3. Strategies to teach Mrs. Grayson to prevent infection include maintaining good hand hygiene, cleaning from front to back of perineum, performing catheter care, taking care not to raise bag higher than bladder (preventing reflux of urine). Instruct Mrs. Grayson to maintain an adequate fluid intake and a closed urinary drainage system. Also tell Mrs. Grayson to prevent kinks in catheter tubing.

4 An older male patient states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this patient is to: 1Help him stand to void. 2Place a condom catheter. 3Have him practice Credé's method. 4Initiate Kegel exercises.

4. Answer: 4. Kegel exercises strengthen pelvic floor muscles and are effective in urine control in patients with urge incontinence and difficulty starting and stopping urination.

5 Since removal of the patient's Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first? 1Check for bladder distention 2Encourage fluid intake 3Obtain an order to recatheterize the patient 4Document the amount of each voiding for 24 hours

5. Answer: 1. The patient may experience urinary retention after catheter removal. If amounts voided are small, checking for bladder distention is necessary.

8 The patient is incontinent, and a condom catheter is placed. The nurse should take which action? 1Secure the condom with adhesive tape 2Change the condom every 48 hours 3Assess the patient for skin irritation 4Use sterile technique for placement

8. Answer: 3. Skin irritation can occur when the condom is twisted at the drainage tube attachment and obstructs urine drainage.

9 After a transurethral prostatectomy a patient returns to his room with a triple-lumen indwelling catheter and continuous bladder irrigation. The irrigation is normal saline at 150 mL/hr. The nurse empties the drainage bag for a total of 2520 mL after an 8-hour period. How much of the total is urine output? __________________________________

9. Answer: 1320 mL. The output is determined by calculating the amount of irrigation solution and subtracting that from the total output: 150 × 8 = 1200. Total output is 2520. 2520 − 1200 = 1320 urine output.

A patient is scheduled to have an intravenous pyelogram (IVP) the next morning. Which nursing measures should be implemented prior to the test? (Select all that apply.) A. Ask the patient about any allergies and reactions. B. Instruct the patient that a full bladder is required for the test. C. Instruct the patient to save all urine in a special container. D. Ensure that informed consent has been obtained. E. Explain that the test includes instrumentation of the urinary tract.

A. Ask the patient about any allergies and reactions. D. Ensure that informed consent has been obtained. An intravenous pyelogram (IVP) involves intravenous injection of an iodine based contrast media. Patients that have had a previous hypersensitivity reaction to contrast media in the past are at high risk for another reaction. Informed consent is required. There is no need for a full bladder such as with a pelvic ultrasound or to save any urine for testing. There is no instrumentation of the urinary tract such as with a cystoscopy.

What should the nurse teach a young woman with a history of urinary tract infections about UTI prevention? (Select all that apply.) A. Keep the bowels regular. B. Limit water intake to 1-2 glasses a day C. Wear cotton underwear D. Cleanse the perineum from front to back. E. Practice pelvic muscle exercise (Kegel) daily.

A. Keep the bowels regular. C. Wear cotton underwear D. Cleanse the perineum from front to back. All are interventions that lead to healthy bladder habits. Adequate hydration will ensure that the bladder is regularly flushed out and will help prevent a UTI. Pelvic muscle exercises promote pelvic health but not necessarily prevent UTI.

Which of the following is a nursing priority when caring for a male patient with a condom catheter? A. Preventing the tubing from kinking to maintain free urinary drainage B. Not removing the catheter for any reason C. Fastening the condom tightly to prevent the possible ability of leakage D. Maintaining bed rest at all times to prevent the catheter from slipping off

A. Preventing the tubing from kinking to maintain free urinary drainage The catheter should be allowed to drain freely through toothing that is not kink. It also should be removed daily to prevent skin excoriation and should not be fastened too tightly for restriction of blood vessels in the area is likely. Confining a patient to bed rest increases the risk for other hazards related to immobility.

The doctor has ordered an indwelling catheter inserted in a hospitalized male patient. The nurse is aware of which of the following considerations? A. The male urethra is more vulnerable to injury during insertion B. In the hospital, a clean technique is used for catheter insertion C. The catheter is inserted 2" to 3" into the meatus D. Since it uses a closed system, the risk for urinary infection is absent

A. The male urethra is more vulnerable to injury during insertion Because of its length the male urethra is more prone to injury and requires that the catheter be inserted 6" to 8". This procedure requires surgical asepsis to prevent introducing bacteria into the urinary tract. The placement of an indwelling catheter has a risk of UTI.

The nurse is caring for a 23-year-old male client who is in the ICU with second and third degree burns over 40 percent of his body. One of the first symptoms that the client is having organ failure is that the urine output is less than: 1. 30 mL/hour 2. 40 mL/hour 3. 50 mL/hour 4. 60 mL/hour

ANS: 1 An output of less than 30 mL/hr indicates possible renal alterations.

The nurse is assessing a client admitted with complaints related to chronic kidney dysfunction. The nurse recognizes that this client is most likely to present with which of the resulting symptoms? 1. Anemia 2. Hypotension 3. Diabetes mellitus 4. Clinical depression

ANS: 1 Clients with chronic alterations in kidney function cannot produce sufficient quantities of the hormone erythropoietin; therefore they are prone to anemia. Diabetes mellitus may be a cause of the renal dysfunction, and the client may or may not be depressed. Hypertension, not hypotension, is a typical outcome of kidney dysfunction.

A 33-year-old female client in her first trimester of pregnancy complains to the nurse on her prenatal visit that she is needs to urinate more frequently and is concerned about having a urinary tract infection. Which of the following statements would be most appropriate for the nurse to make? 1. Are you having any burning or pain when you urinate? 2. Your uterus is pushing up against your bladder which causes you to have to go more frequently 3. Later in your pregnancy as the baby gets bigger it will be a lot worse 4. It is normal for you to have to urinate more frequently because you are eliminating for two now

ANS: 1 In a pregnant woman the developing fetus pushes against the bladder, reducing the bladder's capacity and causing a feeling of fullness. This effect is more likely to occur in the first and third trimesters. Since the client expressed concern regarding a UTI, the nurse should make further assessments to explore that possibility.

47. A 34-year-old diabetic female client had a spontaneous vaginal birth of a 37-week 6.2 kg infant. The nurse caring for the client post-partum understands that due to the traumatic birth the client is at increased risk for: 1. Acute urinary retention 2. Hematuria 3. Kidney failure 4. Enuresis

ANS: 1 In acute retention key signs are bladder distention and absence of urine output over several hours. The client under the influence of anesthetics or analgesics often feels only pressure, but the alert client has severe pain as the bladder distends beyond its normal capacity. In severe urinary retention the bladder holds as much as 2000 to 3000 mL of urine. Retention occurs as a result of urethral obstruction, surgical or childbirth trauma, alterations in motor and sensory innervation of the bladder, medication side effects, or anxiety.

Which of the following statements made by an older adult with a history of urinary tract infections shows the best understanding of interventions that minimize the risk for developing such infections? 1. "I drink 8 ounces of cranberry juice a day to discourage bacterial growth in my bladder." 2. "Whenever I feel an infection coming on, I immediately call my health care provider." 3. "I told the nurses I didn't want a urinary catheter unless I absolutely had to have one." 4. "Whenever I can, I avoid drinking after 8 PM because I usually go to bed about 11 PM."

ANS: 1 Make fluids such as cranberry juice available as part of the client's fluid intake. Cranberry juice discourages bacterial adherence to the bladder wall. The remaining options either have less impact on a daily basis or are more related to early detection rather than prevention.

The nurse realizes that a postsurgical client who underwent a left knee replacement is most likely to experience which of the following urinary complications? 1. Dysuria 2. Bladder spasms 3. A bladder infection 4. Burning on urination

ANS: 1 Medications including anesthesia interfere with both the production and the characteristics of urine and affect the act of urination. Difficulty with urination is a common complication of general anesthesia. The remaining options are not directly connected to postsurgical complications.

A timed urine specimen collection is ordered. The test will need to be restarted if which of the following occurs? 1. The client voids in the toilet. 2. The urine specimen is kept cold . 3. The first voided urine is discarded. 4. The preservative is placed in the collection container.

ANS: 1 Missed specimens make the whole collection inaccurate, causing the test to need to be restarted. The urine specimen is kept in a collection container, which may contain preservatives, or the urine may be kept in a collection container on ice. The timed period begins after the client urinates. The first voided urine is discarded, and then the time for collection begins.

A 73-year-old female client with Parkinson's syndrome was prescribed levodopa when other therapies had failed. The client is alarmed that her urine has become dark brown and is concern. The nurse explains to the client that one of the side effects of this medication is that it may cause: 1. Her urine to become dark brown or black 2. Heart failure 3. Kidney failure 4. Hair loss

ANS: 1 Some medications change the color of urine. Phenazopyridine (Pyridium) colors the urine a bright orange to rust; amitriptyline causes a green or blue discoloration, whereas levodopa discolors the urine to brown or black.

The nurse caring for a client who is receiving closed catheter irrigation instills 950 mL of normal saline irrigant during the shift. There is a total of 1725 mL in the drainage bag. The nurse calculates the client's urinary output for the shift to be: 1. 775 mL 2. 950 mL 3. 1725 mL 4. 2675 mL

ANS: 1 The amount of fluid used to irrigate the bladder and catheter should be subtracted from the total output to determine an accurate urinary output. 1725 mL 950 mL = 775 mL.

Which of the following statements should the nurse use to instruct the nursing assistant caring for a client with an indwelling urinary catheter? 1. Empty the drainage bag at least every 8 hours. 2. Clean up the length of the catheter to the perineum. 3. Use clean technique to obtain a specimen for culture and sensitivity. 4. Place the drainage bag on the client's lap while transporting the client to testing.

ANS: 1 The urinary drainage bag should be emptied at least every 8 hours. If large outputs are noted, more frequent emptying will be required. The perineum should be cleansed and then down the catheter for a length of approximately 10 cm (4 inches). Only use sterile technique to collect specimens from a closed drainage system. Avoid raising the drainage bag above the level of the bladder. If it becomes necessary to raise the bag during transfer of the client to a bed or stretcher, clamp the tubing or empty the tubing contents to the drainage bag first. The drainage bag can be attached to the wheelchair below the level of the client's bladder for transport. It should not be placed on the client's lap.

Which of the following symptomatology is reflective of a lower urinary tract infection? (Select all that apply.) 1. Chills and fever 2. Nausea and vomiting 3. Frequency or urgency 4. Cloudy or blood-tinged urine 5. Pelvic tenderness or flank pain 6. Burning or pain when voiding

ANS: 1, 2, 3, 4, 6 Clients with lower UTIs have pain or burning during urination (dysuria) as urine flows over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the infection worsens. An irritated bladder (cystitis) causes a frequent and urgent sensation of the need to void. Irritation to bladder and urethral mucosa results in blood-tinged urine (hematuria). The urine appears concentrated and cloudy because of the presence of white blood cells (WBCs) or bacteria. If infection spreads to the upper urinary tract (kidneys—pyelonephritis, a serious renal condition), flank pain, tenderness, fever, and chills are common.

The nurse is discussing a middle-age adult male client's report of nocturia. The client has diabetes that is managed with diet and exercise as well as hypertension that is currently well-controlled with medication. The nurse should include which of the following as possible causes for his frequent urination at night? (Select all that apply.) 1. An enlarged prostate gland 2. Poorly controlled blood glucose 3. Drinking a cup of tea before bed 4. Possible side effect of his medication 5. Taking his diuretic too close to bedtime 6. Consuming too many liquids during the day

ANS: 1, 2, 3, 5 Excessive fluid intake before bed (especially coffee or alcohol), renal disease, the aging process, prostate enlargement, poorly controlled diabetes, and diuretic medication therapy scheduled late in the day can cause nocturia. If taken appropriately, his medications are not likely a cause.

The nurse is caring for a client with type 1 diabetes who has been diagnosed with end-stage renal disease (ESRD). The nurse regularly assesses the client for which of the following? (Select all that apply.) 1. Nausea 2. Polyuria 3. Lethargy 4. Vomiting 5. Confusion 6. Headache

ANS: 1, 3, 4, 5, 6 Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease (ESRD). Eventually the client has symptoms resulting from uremic syndrome. An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, oliguria, nausea, vomiting, headache, drowsiness, coma, and convulsions characterize this syndrome.

The nurse is caring for a 56-year-old female client with renal failure who regularly undergoes peritoneal dialysis. The nurse understands that this client is most at risk for: 1. Pulmonary embolism 2. Electrolyte imbalances 3. Polyuria 4. Urinary incontinence

ANS: 2 Peritoneal dialysis is an indirect method of cleansing the blood of waste products using osmosis and diffusion with the peritoneum functioning as a semipermeable membrane. This method removes excess fluid and waste products from the bloodstream when a sterile electrolyte solution (dialysate) is instilled into the peritoneal cavity by gravity via a surgically placed catheter. The dialysate remains in the cavity for a prescribed time interval and then is drained out by gravity, taking accumulated wastes and excess fluid and electrolytes with it. This places the client at risk for electrolyte imbalances.

When calculating the daily intake and output, the nurse anticipates that the urinary output for an average adult should be: 1. 800 to 1000 mL/day 2. 1000 to 1200 mL/day 3. 1500 to 1600 mL/day 4. 2000 to 2300 mL/day

ANS: 3 Although output does depend on intake, the normal adult urine output is 1500 to 1600 mL/day.

A 70-year-old client is discussing his recent difficulty in initiating his flow of urine while on a cross-country bus tour with a senior citizens' group. Which of the following assessment questions is directed toward the most likely cause of the problem? 1. "Did the bus stop frequently so you could get up and walk around?" 2. "Did you drink plenty of water while you were on the trip?" 3. "Do you find using public restrooms unsettling?" 4. "Do you have any chronic urinary problems?"

ANS: 3 Attempting to void in a public restroom sometimes results in a temporary inability to void. Although the remaining options may affect urination, this situation strongly suggests an emotional cause.

Which of the following statements made by a client with benign prostatic hypertrophy (BPH) during an admissions interview reflects the best understanding of the long-term effects of this condition? 1. "I usually get up 3 to 4 times a night to urinate." 2. "My health care provider prescribed some medication that has helped." 3. "At least I can usually empty my bladder; I really hate that feeling of being full." 4. "The prostate specific antigen (PSA) results have stayed stable for the last 3 tests."

ANS: 3 If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time the micturition reflex changes, causing bladder overactivity, and can cause the bladder to not completely empty. The remaining options focus on the impact the condition has on daily living and the monitoring of the client for prostate cancer.

The nurse is caring for a 19-year-old male client with a fractured left femur whose leg was pinned 36 hours ago and is now in traction. Which of the following stressors is mostly likely the cause of this client's difficulty related to starting urine flow? 1. Pain related to the fracture and its repair 2. Anxiety regarding the serious nature of the injury 3. The inability to stand in order to facilitate urination 4. Poor fluid intake in the accident and ensuing surgery

ANS: 3 Some men who cannot stand to urinate become overly distressed. Although the other options may have some effect, the primary cause is most likely the emotional stress of not being able to assume the usual position for male urination.

Which of the following clients will most benefit from client/parent education regarding the prevention of renal infections via proper hygiene habits? 1. Males ages 35 to 65 2. Males ages 3 to 16 3. Females ages 3 to 12 4. Females ages 20 to 50

ANS: 3 The 3- to 12-year-old female has the shortest urethra and so has the greatest need. The short length of the urethra predisposes women and girls to infection. It is easy for bacteria to enter the urethra from the perineal area.

A postpartum client has been unable to void since her delivery of her baby this morning. Which of the following nursing measures would be beneficial for the client initially? 1. Increase fluid intake to 3500 mL. 2. Insert indwelling Foley catheter. 3. Rinse the perineum with warm water. 4. Apply firm pressure over the bladder.

ANS: 3 The nurse can pour warm water over the client's perineum and create the sensation to urinate. A client with normal renal function who does not have heart or kidney disease should drink 2000 to 2500 mL of fluid daily. Increasing the client's fluid intake to 3500 mL is excessive. Because bladder catheterization carries the risk for UTI, it should be avoided if possible. The nurse should try other noninvasive measures to promote urination before calling the health care provider for an order to insert a Foley catheter. The nurse should not apply firm pressure over the bladder of a postpartum woman with an intact nervous system. The nurse could create more damage by exerting force on the client's uterus at this time.

In an assessment of a client with reflex incontinence the nurse expects to find that the client has: 1. A constant dribbling of urine 2. An uncontrollable loss of urine when coughing or sneezing 3. No urge to void and an unawareness of bladder filling 4. An immediate urge to void but not enough time to reach the bathroom

ANS: 3 The nurse expects to find the client with reflex incontinence to have no urge to void and an unawareness of bladder filling. A constant dribbling of urine may be seen with overflow incontinence. With stress incontinence the client is unable to control loss of urine when coughing or sneezing. Functional incontinence is seen when there is an immediate urge to void but not enough time to get to the bathroom.

Which of the following actions by the nurse would indicate the need for remedial education in the removal of an indwelling catheter? 1. Draping the female client between the thighs 2. Obtaining a specimen before removal 3. Cutting the catheter to deflate the balloon 4. Checking the client's output for 24 hours after removal

ANS: 3 The nurse should not cut the catheter to deflate the balloon. The nurse inserts an empty, sterile syringe into the injection port. The nurse slowly withdraws all of the solution to deflate the balloon totally. The nurse then pulls the catheter out smoothly and slowly. The nurse positions the client in the same position as during catheterization. The nurse places a towel between a female client's thighs or over a male client's thighs. Some institutions recommend collecting a sterile urine specimen before removal of the catheter or sending the catheter tip for culture and sensitivity tests. The nurse should assess the client's urinary function by noting the first voiding after catheter removal and documenting the time.

The nurse is caring for an older adult who is recovering from hip replacement surgery. The client shares with the nurse that he has been using the urinal "a lot but I feel like my bladder isn't empty." Which of the following statements by the nurse shows the best understanding of the appropriate initial intervention for this particular client? 1. "I'll call your primary care provider and let her know you are having this problem." 2. "I have the ancillary personnel measure your output, so please don't empty your urinal yourself." 3. "I'm going to ask that you please use your call bell and notify me or the ancillary staff each time you void." 4. "I suggest that we try limiting the amount of fluids you are drinking for a few hours and see if that helps.".

ANS: 3 With retention the client may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine. Be aware of the volume and frequency of voiding to assess this condition in the client. The alert, oriented client can be asked to notify the nurse each time micturition occurs. The notification of the primary care provider is not the initial intervention. Although measuring the urine output is not inappropriate, it is not specific to this client's complaint. Restricting fluids is neither appropriate nor likely to affect the problem.

When obtaining a sterile urine specimen from an indwelling urinary catheter the nurse should: 1. Disconnect the catheter from the drainage tubing 2. Withdraw urine from a urinometer 3. Open the drainage bag and removing urine 4. Use a needle to withdraw urine from the catheter port

ANS: 4 A sterile specimen can be obtained through the special port found on the side of the indwelling catheter. The nurse clamps the tubing below the port, allowing fresh, uncontaminated urine to collect in the tube. After the nurse wipes the port with an antimicrobial swab, a sterile syringe needle is inserted, and at least 3 to 5 mL of urine is withdrawn. Using sterile technique, the nurse transfers the urine to a sterile container. The catheter should not be disconnected from the drainage tubing. The system should remain a closed system to prevent infection. A urinometer is a device used to determine the specific gravity of urine. It is not a sterile device and should not be used for obtaining a sterile urine specimen. Urine should not be obtained from a drainage bag for a specimen, because the urine would not be fresh and would be contaminated from microorganisms in the drainage bag.

The nurse determines that the nursing diagnosis stress urinary incontinence related to decreased pelvic muscle tone is the most appropriate for an oriented adult female client. A therapeutic nursing intervention based on this diagnosis is to: 1. Apply adult diapers 2. Catheterize the client 3. Administer Urecholine 4. Teach Kegel exercises.

ANS: 4 Pelvic floor exercises, also known as Kegel exercises, improve the strength of pelvic floor muscles and consist of repetitive contractions of muscle groups. These exercises have demonstrated effectiveness in treating stress incontinence, overactive bladders, and mixed causes of urinary continence. The client is oriented and therefore could be taught Kegel exercises to improve pelvic floor muscle tone. Applying adult diapers does not improve the client's problem of incontinence and places the client at risk for skin breakdown. Because bladder catheterization carries the risk for urinary tract infection (UTI), it is preferable to rely on other measures for management of incontinence. The nurse can support the use of Kegel exercises as an inexpensive nonpharmacological intervention to reduce the client's stress incontinence. Bethanechol (Urecholine) stimulates the parasympathetic nervous system to promote complete bladder emptying and is primarily used to treat urinary retention and possible overflow incontinence. Nonpharmacological approaches should be attempted before pharmacological approaches are taken

4. A patient requests the nurse's assistance to the bedside commode and becomes frustrated when unable to void in front of the nurse. The nurse understands the patient's inability to void because a. Anxiety can make it difficult for abdominal and perineal muscles to relax enough to void. b. The patient does not recognize the physiological signals that indicate a need to void. c. The patient is lonely, and calling the nurse in under false pretenses is a way to get attention. d. The patient is not drinking enough fluids to produce adequate urine output.

ANS: A Attempting to void in the presence of another can cause anxiety and tension in the muscles that make voiding difficult. The nurse should give the patient privacy and adequate time if appropriate. No evidence suggests that an underlying physiological or psychological condition exists.

19. When viewing a urine specimen under a microscope, what would the nurse expect to see in a patient with a urinary tract infection? a. Bacteria b. Casts c. Crystals d. Protein

ANS: A Bacteria indicate a urinary tract infection. Crystals would be seen with renal stone formation. Casts indicate renal alterations. Protein is not visible under a microscope and indicates renal disease.

28. A nurse is caring for an 8-year-old patient who is embarrassed about urinating in his bed at night. Which intervention should the nurse suggest to reduce the frequency of this occurrence? a. "Drink your nightly glass of milk earlier in the evening." b. "Set your alarm clock to wake you every 2 hours, so you can get up to void." c. "Line your bedding with plastic sheets to protect your mattress." d. "Empty your bladder completely before going to bed."

ANS: A Nightly incontinence and nocturia are often resolved by limiting fluid intake 2 hours before bedtime. Setting the alarm clock to wake does not correct the physiological problem, nor does lining the bedding with plastic sheets. Emptying the bladder may help with early nighttime urination, but will not affect urine produced throughout the night from late-night fluid intake.

2. When reviewing laboratory results, the nurse should immediately notify the health care provider about which finding? a. Glomerular filtration rate of 20 mL/min b. Urine output of 80 mL/hr c. pH of 6.4 d. Protein level of 2 mg/100 mL

ANS: A Normal glomerular filtration rate should be around 125 mL/min; a severe decrease in renal perfusion could indicate a life-threatening problem such as shock or dehydration. Normal urine output is 1000 to 2000 mL/day; an output of 30 mL/hr or less for 2 or more hours would be cause for concern. The normal pH of urine is between 4.6 and 8.0. Protein up to 8 mg/100 mL is acceptable; however, values in excess of this could indicate renal disease.

14. A patient asks about treatment for urge urinary incontinence. The nurse's best response is to advise the patient to a. Perform pelvic floor exercises. b. Drink cranberry juice. c. Avoid voiding frequently. d. Wear an adult diaper.

ANS: A Poor muscle tone leads to an inability to control urine flow. The nurse should recommend pelvic muscle strengthening exercises such as Kegel exercises; this solution best addresses the patient's problem. Drinking cranberry juice is a preventative measure for urinary tract infection. The nurse should not encourage the patient to reduce voiding; residual urine in the bladder increases the risk of infection. Wearing an adult diaper could be considered if attempts to correct the root of the problem fail. DIF: Analyze REF: 1056 OBJ: Identify nursing diagnoses appropriate for patients with alterations in urinary elimination.

38. Which observation by the nurse best indicates that bladder irrigation for urinary retention has been effective? a. Recording an output that is larger than the amount instilled b. Presence of blood clots or sediment in the drainage bag c. Reduction in discomfort from bladder distention d. Visualizing clear urinary catheter tubing

ANS: A Recording an output that is greater than what was irrigated into the bladder shows progress that the bladder is draining urine. The other observations do not objectively measure the increase in urine output.

21. What signs and symptoms would the nurse expect to observe in a patient with excessive white blood cells present in the urine? a. Fever and chills b. Difficulty holding in urine c. Increased blood pressure d. Abnormal blood sugar

ANS: A The presence of white blood cells in urine indicates a urinary tract infection. Difficulty with urinary elimination indicates blockage or renal damage. Increased blood pressure is associated with renal disease or damage and some medications. Abnormal blood sugars would be seen in someone with ketones in the urine, as this finding indicates diabetes.

10. Upon palpation, the nurse notices that the bladder is firm and distended; the patient expresses an urge to urinate. The nurse should follow up by asking a. "When was the last time you voided?" b. "Do you lose urine when you cough or sneeze?" c. "Have you noticed any change in your urination patterns?" d. "Do you have a fever or chills?"

ANS: A To obtain an accurate assessment, the nurse should first determine the source of the discomfort. Urinary retention causes the bladder to be firm and distended. Further assessment to determine the pathology of the condition can be performed later. Questions concerning fever and chills, changing urination patterns, and losing urine during coughing or sneezing focus on specific pathological conditions.

39. The nurse anticipates urinary diversion from the kidneys to a site other than the bladder for which patient? a. A 12-year-old female with severe abdominal trauma b. A 24-year-old male with severe genital warts around the urethra c. A 50-year-old male with recent prostatectomy d. A 75-year-old female with end-stage renal disease

ANS: A Urinary diversion would be needed in a patient with abdominal trauma who might have injury to the urinary system. Genital warts are not needed for urinary diversion. Patients with a prostatectomy may require intermittent catheterization after the procedure. End-stage renal disease would not be affected by rerouting the flow of urine.

37. To reduce patient discomfort during closed catheter irrigation, the nurse should a. Use room temperature irrigation solution. b. Administer the solution as quickly as possible. c. Allow the solution to sit in the bladder for at least 1 hour. d. Raise the bag of irrigation solution at least 12 inches above the bladder.

ANS: A Using cold solutions, instilling solutions too quickly, and prolonging filling of the bladder can cause discomfort and cramping. To reduce this, ensure that the solution is at room temperature, lower the solution bag so it instills slowly, and drain the bladder fully after an ordered amount of time.

2. The nurse properly obtains a 24-hour urine specimen collection by (Select all that apply.) a. Asking the patient to void and to discard the first sample. b. Keeping the urine collection container on ice. c. Withholding all patient medications for the day. d. Asking the patient to notify the staff before and after every void.

ANS: A, B When obtaining a 24-hour urine specimen, it is important to keep the urine in cool condition. The patient should be asked to void and to discard the urine before the procedure begins. Medications do not need to be held unless indicated by the provider. If properly educated about the collection procedure, the patient can maintain autonomy and perform the procedure alone, taking care to maintain the integrity of the solution.

3. Which of the following are indications for irrigating a urinary catheter? (Select all that apply.) a. Sediment occluding within the tubing b. Blood clots in the bladder following surgery c. Rupture of the catheter balloon d. Bladder infection e. Presence of renal calculi

ANS: A, B, D Catheter irrigation is used to flush and remove blockage that may be impeding the catheter from properly draining the bladder. Irrigation is used to remove blood clots in the bladder following surgery. For patients with bladder infection, an antibiotic irrigation is often ordered. A ruptured catheter balloon will involve extensive follow-up and possible surgery to remove the particles. Renal calculi obstruct the ureters and therefore the flow of urine before it reaches the bladder.

29. Many individuals have difficulty voiding in a bedpan or urinal while lying in bed because they a. Are embarrassed that they will urinate on the bedding. b. Would feel more comfortable assuming a normal voiding position. c. Feel they are losing their independence by asking the nursing staff to help. d. Are worried about acquiring a urinary tract infection.

ANS: B Assuming a normal voiding position helps patients relax and be able to void; lying in bed is not the typical position in which people void. Men usually are most comfortable when standing; women are more comfortable when sitting and squatting. Embarrassment at using the bedpan and worrying about a urinary tract infection are not related to the lying-in-bed position. Fear of loss of independence is not related to use of the bedpan or urinal.

6. The nurse knows that urinary tract infection (UTI) is the most common health care-associated infection because a. Catheterization procedures are performed more frequently than indicated. b. Escherichia coli pathogens are transmitted during surgical or catheterization procedures. C.Perineal care is often neglected by nursing staff. D.Bedpans and urinals are not stored properly and transmit infection.

ANS: B E. coli is the leading pathogen causing UTIs; this pathogen enters during procedures. Sterile technique is imperative to prevent the spread of infection. Frequent catheterizations can place a patient at high risk for UTI; however, infection is caused by bacteria, not by the procedure itself. Perineal care is important, and buildup of bacteria can lead to infection, but this is not the greatest cause. Bedpans and urinals may become bacteria ridden and should be cleaned frequently. Bedpans and urinals are not inserted into the urinary tract, so they are unlikely to be the primary cause of UTI.

34. When caring for a hospitalized patient with a urinary catheter, which nursing action best prevents the patient from acquiring an infection? a. Inserting the catheter using strict clean technique b. Performing hand hygiene before and after providing perineal care c. Fully inflating the catheter's balloon according to the manufacturer's recommendation d. Disconnecting and replacing the catheter drainage bag once per shift

ANS: B Hand hygiene helps prevent infection in patients with a urinary catheter. A catheter should be inserted in the hospital setting using sterile technique. Inflating the balloon fully prevents dislodgement and trauma, not infection. Disconnecting the drainage bag from the catheter creates a break in the system and an open portal of entry and increases risk of infection. DIF: Apply REF: 1048 OBJ: Discuss nursing measures

33. The nurse would question an order to insert a urinary catheter on which patient? a. A 26-year-old patient with a recent spinal cord injury at T2 b. A 30-year-old patient requiring drug screening for employment c. A 40-year-old patient undergoing bladder repair surgery d. An 86-year-old patient requiring monitoring of urinary output for renal failure

ANS: B Urinary catheterization places the patient at increased risk for infection and should be performed only when necessary. Urine can be obtained via clean-catch technique for a drug screening or urinalysis. Spinal cord injury, surgery, and renal failure wi h critical t intake and output monitoring are all appropriate reasons for catheterization.

While receiving a shift report on a patient, the nurse is informed that the patient has urinary incontinence. Upon assessment, the nurse would expect to find a. An indwelling Foley catheter. b. Reddened irritated skin on the buttocks. c. Tiny blood clots in the patient's urine. d. Foul-smelling discharge indicative of a UTI.

ANS: B Urinary incontinence is uncontrolled urinary elimination; if the urine has prolonged contact with the skin, skin breakdown can occur. An indwelling Foley catheter is a solution for urine retention. Blood clots and foul-smelling discharge are often signs of infection.

36. A nurse is providing education to a patient being treated for a urinary tract infection. Which of the following statements by the patient indicates an understanding? a. "Since I'm taking medication, I do not need to worry about proper hygiene." b. "I should drink 15 to 20 glasses of fluid a day to help flush the bacteria out." c. "My medication may discolor my urine; this should resolve once the medication is stopped." d. "I should not have sexual intercourse until the infection has resolved."

ANS: C Some anti-infective medications turn urine colors; this is normal and will dissipate as the medication leaves the system. Even if the patient is on medication, hygiene is important to prevent spread or reinfection. Fluid intake should be increased to help flush out bacteria; however, 15 to 20 glasses is too much. Sexual intercourse is allowed with a urinary tract infection, as long as good hygiene and safe practices are used.

5. The nurse understands that peritoneal dialysis and hemodialysis use which processes to clean the patient's blood? (Select all that apply.) a. Gravity b. Osmosis c. Diffusion d. Filtration

ANS: B, C Osmosis and diffusion are the two processes used to clean the patient's blood in both types of dialysis. In peritoneal dialysis, osmosis and dialysis occur across the semi-permeable peritoneal membrane. In hemodialysis, osmosis and dialysis occur through the filter membrane on the artificial kidney. In peritoneal dialysis, the dialysate flows by gravity out of the abdomen.Gravity has no effect on cleansing of the blood. Filtration is the process that occurs in the glomerulus as blood flows through the kidney.

4. Which of the following symptoms are most closely associated with uremic syndrome? (Select all that apply.) a. Fever b. Nausea and vomiting c. Headache d. Altered mental status e. Dysuria

ANS: B, C, D Uremic syndrome is associated with end-stage renal disease. Signs and symptoms include headache, altered mental status, coma, seizures, nausea, vomiting, and pericarditis.

1. Which nursing actions are acceptable when collecting a urine specimen? (Select all that apply.) a. Growing urine cultures for up to 12 hours b. Labeling all specimens with date, time, and initials c. Wearing gown, gloves, and mask for all specimen handling d. Allowing the patient adequate time and privacy to void e. Squeezing urine from diapers into a urine specimen cup f. Transporting specimens to the laboratory in a timely fashion g. Placing a plastic bag over the child's urethra to catch urine

ANS: B, D, F, G All specimens should be labeled appropriately and processed in a timely fashion. Allow patients time and privacy to void. Children may have difficulty voiding; attaching a plastic bag gives the child more time and freedom to void. Urine cultures can take up to 48 hours to develop. Gown, gloves, and mask are not necessary for specimen handling unless otherwise indicated. Urine should not be squeezed from diapers.

30. The nurse would anticipate inserting a Coudé catheter for which patient? a. An 8-year-old male undergoing anesthesia for a tonsillectomy b. A 24-year-old female who is going into labor c. A 56-year-old male admitted for bladder irrigation d. An 86-year-old female admitted for a urinary tract infection.

ANS: C A Coudé catheter has a curved tip that is used for patients with enlarged prostates. This would be indicated for a middle-aged male who needs bladder irrigation. Coudé catheters are not indicated for children or women.

15. The nurse suspects that a urinary tract infection has progressed to cystitis when the patient complains of which symptom? a. Dysuria b. Flank pain c. Frequency d. Fever and chills

ANS: C Cystitis is inflammation of the bladder; associated symptoms include hematuria and urgency/frequency. Dysuria is a commo n symptom of a lower urinary tract infection. Flank pain, fever, and chills are all signs of pyelonephritis.

32. A nurse notifies the provider immediately if a patient with an indwelling catheter a. Complains of discomfort upon insertion of the catheter. b. Places the drainage bag higher than the waist while ambulating. c. Has not collected any urine in the drainage bag for 2 hours. d. Is incontinent of stool and contaminates the external portion of the catheter. ANS: C

ANS: C If the patient has not produced urine in 2 hours, the physician needs to be notified immediately because this could indicate renal failure. Discomfort upon catheter insertion is unpleasant but unavoidable. The nurse is responsible for maintaining the integrity of the catheter by ensuring that the drainage bag is below the patient's bladder. Stool left on the catheter can cause infection and should be removed as soon as it is noticed. The nurse should ensure that frequent perineal care is being provided.

20. The nurse would expect the urine of a patient with uncontrolled diabetes mellitus to be a. Cloudy. b. Discolored. c. Sweet smelling. d. Painful.

ANS: C Incomplete fat metabolism and buildup of ketones give urine a sweet or fruity odor. Cloudy urine may indicate infection or renal failure. Discolored urine may result from various medications. Painful urination indicates an alteration in urinary elimination.

24. Which statement by the patient about an upcoming computed tomography (CT) scan indicates a need for further teaching? a. "I'm allergic to shrimp, so I should monitor myself for an allergic reaction." b. "I will complete my bowel prep program the night before the scan." c. "I will be anesthetized so that I lie perfectly still during the procedure." d. "I will ask the technician to play music to ease my anxiety."

ANS: C Patients are not put under anesthesia for a CT scan; instead the nurse should educate patients about the need to lie perfectly still and about possible methods of overcoming feelings of claustrophobia. The other options are correct. Patients need to be assessed for an allergy to shellfish if receiving contrast for the CT. Bowel cleansing is often performed before CT. Listening to music will help the patient relax and remain still during the examination.

31. The nurse knows that which indwelling catheter procedure places the patient at greatest risk for acquiring a urinary tract infection? a. Emptying the drainage bag every 8 hours or when half full b. Kinking the catheter tubing to obtain a urine specimen c. Placing the drainage bag on the side rail of the patient's bed d. Failing to secure the catheter tubing to the patient's thigh

ANS: C Placing the drainage bag on the side rail of the bed could allow the bag to be raised above the level of the bladder and urine to flow back into the bladder. The urine in the drainage bag is a medium for bacteria; allowing it to reenter the bladder can cause infection. The drainage bag should be emptied and output recorded every 8 hours or when needed. Urine specimens are obtained by temporarily kinking the tubing; a prolonged kink could lead to bladder distention. Failure to secure the catheter to the patient's thigh places the patient at risk for tissue injury from catheter dislodgment.

8. A patient has fallen several times in the past week when attempting to get to the bathroom. The patient informs the nurse that he gets up 3 or 4 times a night to urinate. Which recommendation by the nurse is most appropriate in correcting this urinary problem? a. Clear the path to the bathroom of all obstacles before bed. b. Leave the bathroom light on to illuminate a pathway. c. Limit fluid and caffeine intake before bed. d. Practice Kegel exercises to strengthen bladder muscles.

ANS: C Reducing fluids, especially caffeine and alcohol, before bedtime can reduce nocturia. Clearing a path to the restroom or illuminating the path, or shortening the distance to the restroom, may reduce falls but will not correct the urination problem. Kegel exercises are useful if a patient is experiencing incontinence.

16. Which assessment question should the nurse ask if stress incontinence is suspected? a. "Does your bladder feel distended?" b. "Do you empty your bladder completely when you void?" c. "Do you experience urine leakage when you cough or sneeze?" d. "Do your symptoms increase with consumption of alcohol or caffeine?"

ANS: C Stress incontinence can be related to intra-abdominal pressure causing urine leakage, as would happen during coughing or sneezing. Asking the patient about the fullness of his bladder would rule out retention and overflow. An inability to void completely can refer to urge incontinence. Physiological causes and medications can effect elimination, but this is not related to stress incontinence.

3. A patient is experiencing oliguria. Which action should the nurse perform first? a. Increase the patient's intravenous fluid rate. b. Encourage the patient to drink caffeinated beverages. c. Assess for bladder distention. d. Request an order for diuretics.

ANS: C The nurse first should gather all assessment data to determine the potential cause of oliguria. It could be that the patient does not have adequate intake, or it could be that the bladder sphincter is not functioning and the patient is retaining water. Increasing fluids is effective if the patient does not have adequate intake, or if dehydration occurs. Caffeine can work as a diuretic but is not helpful if an underlying pathology is present. An order for diuretics can be obtained if the patient was retaining water, but this should not be

18. To obtain a clean-voided urine specimen for a female patient, the nurse should teach the patient to a. Cleanse the urethral meatus from the area of most contamination to least. b. Initiate the first part of the urine stream directly into the collection cup. c. Hold the labia apart while voiding into the specimen cup. d. Drink fluids 5 minutes before collecting the urine specimen.

ANS: C The patient should hold the labia apart to reduce bacterial levels in the specimen. The urethral meatus should be cleansed from the area of least contamination to greatest contamination (or front-to-back). The initial steam flushes out microorganisms in the urethra and prevents bacterial transmission in the specimen. Drink fluids 30 to 60 minutes before giving a specimen.

7. An 86-year-old patient tells the nurse that she is experiencing uncontrollable leakage of urine. Which nursing diagnosis should the nurse include in the patient's plan of care? a. Urinary retention b. Hesitancy c. Urgency d. Urinary incontinence

ANS: D Age-related changes such as loss of pelvic muscle tone can cause involuntary loss of urine known as Urinary incontinence. Urinary retention is the inability to empty the bladder. Hesitancy occurs as difficulty initiating urination. Urgency is the feeling of the need to void immediately.

25. The nurse anticipates preparing a patient who is allergic to shellfish for an arteriogram by a. Obtaining baseline vital signs after the start of the procedure. b. Monitoring the extremity for neurocirculatory function. c. Keeping the patient on bed rest for the prescribed time. d. Administering an antihistamine medication to the patient.

ANS: D Before the procedure is begun, the nurse should assess the patient for food and other allergies and should administer an antihistamine, because a contrast iodine-based dye is used for the procedure. Baseline vitals should be obtained before the start of the procedure and frequently thereafter. The procedure site is monitored and the patient kept on bed rest after the procedure is complete.

35. An 86-year-old patient asks the nurse what lifestyle changes will reduce the chance of a urinary tract infection. Which response is accurate? a. Urinary tract infections are unavoidable in the elderly because of a weakened immune system. b. Decreasing fluid intake will decrease the amount of urine with bacteria produced. c. Making sure to cleanse the perineal area from back to front after voiding will reduce the chance of infection. d. Increasing consumption of acidic foods such as cranberry juice will reduce the chance of infection.

ANS: D Cranberry juice and other acidic foods decrease adherence of bacteria to the bladder wall. Urinary tract infections are avoidable in the elderly population with proper knowledge and hygiene. Perineal skin should be cleansed from front to back to avoid spreading fecal matter to the urethra. Increasing fluids will help to flush bacteria, thus preventing them from residing in the bladder for prolonged periods of time.

A patient has a nursing diagnosis of impaired urinary elimination related to maturational enuresis. You recognize that your patient is which of the following? A. An older adult that is 65 years of age is incontinent B. A child older than four years of age who has an voluntary urination C. A 12 month old child who is in voluntary urination D. A patient with neurological damage resulting in bladder dysfunction

B. A child older than four years of age who has an voluntary urination Maturational enuresis is in voluntary urination after an age when continence should be present. A 12 month old child is not expected to be continent, and incontinence and neurological damage are not maturational problems.

23. A nurse is caring for a patient who just underwent intravenous pyelography that revealed a renal calculus obstructing the left ureter. What is the nurse's first priority in caring for this patient? a. Turn the patient on the right side to alleviate pressure on the left kidney. b. Encourage the patient to increase fluid intake to flush the obstruction. c. Administer narcotic medications to alleviate pain. d. Monitor the patient for fever, rash, and difficulty breathing.

ANS: D Intravenous pyelography is performed by administering iodine-based dye to view functionality of the urinary system. Many individuals are allergic to shellfish; therefore, the first nursing priority is to assess the patient for an allergic reaction that could be life threatening. The nurse should then encourage the patient to drink fluids to flush dye resulting from the procedure. Narcotics can be administered but are not the first priority. Turning the patient on the side will not affect patient safety.

17. When establishing a diagnosis of altered urinary elimination, the nurse should first a. Establish normal voiding patterns for the patient. b. Encourage the patient to flush kidneys by drinking excessive fluids. c. Monitor patients' voiding attempts by assisting them with every attempt. d. Discuss causes and solutions to problems related to micturition.

ANS: D The nurse should assess first to determine cause, then should discuss and create goals with the patient, so nurse and patient can work in tandem to normalize voiding. The nurse should incorporate the patient's input into creating a plan of care for the patient. Drinking excessive fluid will not help and may worsen alterations in urinary elimination. The nurse does not need to monitor every void attempt by the patient; instead the nurse should provide patient education. The nurse asks the patient about normal voiding patterns, but establishing voiding patterns is a later intervention.

Which nursing interventions should the nurse implement when removing an indwelling urinary catheter in an adult patient? (Select all that apply.) A. Attach a 3 mL syringe to the inflation port B. Allow the balloon to drain into the syringe by gravity. C. Initiate a voiding record/bladder diary D. Pull catheter quickly E. Clamp the catheter prior to removal.

B. Allow the balloon to drain into the syringe by gravity. C. Initiate a voiding record/bladder diary By allowing the balloon to drain by gravity the development of creases or ridges in the balloon may be avoided and thus minimize trauma to the urethra during withdrawal. All patients who have a catheter removed should have their voiding monitored. The best way to do this is with a voiding record or bladder diary. The size syringe used to deflate the balloon is dictated by the size of the balloon. In the adult patient balloon sizes are either 10 mLs or 30 mLs. Catheters should be pulled out slowly and smoothly. There is no evidence to support clamping catheters prior to removal.

The NAP reports to the nurse that a patient's catheter drainage bag has been empty for 4 hours. What is a priority nursing intervention? A. Implement the "as needed" order to irrigate the catheter. B. Assess the catheter and drainage tubing for obvious occlusion. C. Notify the health care provider immediately. D. Assess the vital signs and intake and output record.

B. Assess the catheter and drainage tubing for obvious occlusion. The priority nursing intervention is to ensure that there is not an occlusion in the catheter or drainage tubing.

A post-operative patient with a three-way indwelling urinary catheter and continuous bladder irrigation (CBI) complains of lower abdominal pain and distention. What should be the nurse's initial intervention? A. Increase the rate of the CBI B. Assess the intake and output C. Decrease the rate of the CBI D. Assess vital signs

B. Assess the intake and output An appropriate first action would be to assess the patency of the drainage system. Urine output in the drainage bag should be more than the volume of the irritant solution infused. If the system is not draining urine and irritant, the irritant should be stopped immediately, the catheter may be occluded and the bladder distended.

What nursing intervention decreases the risk for catheter associated urinary tract infection (CAUTI)? A. Cleanse the urinary meatus 3-4 times daily with antiseptic solution. B. Hang the urinary drainage bag below the level with the bladder. C. Empty the urinary drainage bag daily. D. Irrigate the urinary catheter with sterile water.

B. Hang the urinary drainage bag below the level with the bladder. Evidenced based interventions shown to decrease the risk for CAUTI include ensuring that there is a free flow of urine from the catheter to the drainage bag.

There is no urine when a catheter is inserted into a female's urethra. What should the nurse do next? A. Remove the catheter and start all over with a new kit and catheter. B. Leave the catheter there and start over with a new catheter. C. Pull the catheter back and re-insert at a different angle. D. Ask the patient to bear down and insert the catheter further.

B. Leave the catheter there and start over with a new catheter. The catheter may be in the vagina, leave the catheter in the vagina as landmark indicating where not to insert, and insert another sterile catheter. Pulling the catheter back and re-inserting is poor technique increasing the risk for CAUTI.

When collecting a urine specimen for routine urinalysis from a patient, the nurse must keep in mind which of the following? A. A sterile specimen is required for collection B. Results may be altered if a sample is left standing at room temperature for a long time C. The external meatus requires cleaning with antiseptic soap and water before voiding D. A clean-catch midstream specimen is necessary

B. Results may be altered if a sample is left standing at room temperature for a long time Urine chemistry it altered after urine stands at room temperature for a long period of time. For a routine urinalysis, a clean specimen is adequate. The external meatus does not need to be cleaned with an antiseptic, as is required for a clean-catch midstream specimen.

Which of the following terms notes a patient's inability to void even though the kidneys are producing urine that enters the bladder? A. Urgency B. Retention C. Oliguria D. Dysuria

B. Retention Urgency is a strong desire to void. Oliguria is scanty or greatly diminished amount of urine voided in a given time. Dysuria is difficulty urinating.

An ambulatory elderly woman with dementia is incontinent of urine. She has poor short term memory and has not been seen toileting independently. What is the best nursing intervention for this patient? A. Recommend she be evaluated for an OAB medication. B. Start a scheduled toileting program. C. Recommend she be evaluated for an indwelling catheter. D. Start a bladder retraining program

B. Start a scheduled toileting program. The first nursing intervention for any patient with incontinence, who is able to toilet, is to assist them with toilet access. This patient is not cognitively intact so a bladder retraining program is not appropriate for her. It is not clear in this case that she has OAB and a catheter is never a good solution for incontinence.

What is a critical step when inserting an indwelling catheter into a male patient? A. Slowly inflate the catheter balloon with sterile saline. B. Secure the catheter drainage tubing to the bed sheets C. Advance the catheter to the bifurcation of the drainage and balloon ports. D. Advance the catheter until urine flows, then insert ¼ inch more.

C. Advance the catheter to the bifurcation of the drainage and balloon ports. Advancing the catheter to the bifurcation avoids inflating the catheter balloon in the prostatic urethra causing trauma and pain. Catheter balloons are never inflated with saline. Securing the catheter drainage tubing to the bed sheets increases the risk for accidental pulling or tension on the catheter. The advancement of the catheter until flows and then inserting ¼ inch more is not unique to the male patient.

Which nursing assessment question would best indicate that an incontinent man with a history of prostate enlargement might not be emptying his bladder adequately? A. Do you leak urine when you cough or sneeze? B. Do you need help getting to the toilet? C. Do you dribble urine constantly? D. Does it burn when you pass your urine?

C. Do you dribble urine constantly? Incontinence characterized by constant dribbling of urine is associated with incontinence associated with urinary retention. . The other options point to stress incontinence, functional incontinence or a UTI.

Nursing care for a patient with an indwelling catheter includes which of the following: A. Irrigation of the catheter with a 30 mL of normal saline solution every 4 hours B. Disconnecting and reconnecting the drainage system quickly to obtain a urine sample C. Encourage a generous fluid intake if not contraindicated by the patient D. Telling the patient that burning and irritation are normal, subsiding within a few days

C. Encourage a generous fluid intake if not contraindicated by the patient A generous fluid intake promotes healthy urinary tract function. Irrigation may introduce bacteria into the urinary tract and is not routinely ordered. The drainage system should never be disconnected to obtain a sample, this could allow bacteria to enter into the urinary tract. Burning and irritation may indicate that an infection is present and should never be disregarded.

Mrs. Jones is an alert, ambulatory, older nursing home resident, who frequently has difficulty making it to the bathroom in time. The nurse planning her care is aware of which of the following? A. Incontinence is to be expected and a woman of Mrs. Jones age. B. One of every 10 nursing home residents is incontinent C. Keagle exercises performed at regular intervals throughout the day may be helpful D. An indwelling catheter should be inserted as soon as possible

C. Keagle exercises performed at regular intervals throughout the day mayb e helpful Keagle exercises may help a patient regain control of the micturition process. Incontinence is not a normal consequence of aging, and at least half of nursing home residents may be incontinent. An indwelling catheter is the last choice of treatment.

When assessing a patient's first voided urine of the day, which finding should be reported to the health care provider? A. Pale yellow urine B. Slightly cloudy urine C. Light pink urine D. Dark amber urine

C. Light pink urine Light pink urine indicates the presence of blood in the urine, which is never a normal finding. First voided urine can normally be slightly cloudy and darker in color. Pale yellow urine indicates normal finding.

A patient taking Phenazopyridine (pyridium, a urinary track analgesic) should be cautioned that her urine may change to what color? A. Pale yellow B. Green C. Orange red D. Brown

C. Orange red Pyridium is noted for turning the urine orange red, and the patient needs to be aware of this.

What instructions should the nurse give the NAP concerning a patient who has had an indwelling urinary catheter removed that day? A. Limit oral fluid intake to avoid possible urinary incontinence. B. Expect patient complaints of suprapubic fullness and discomfort. C. Report the time and amount of first voiding. D. Instruct patient to stay in bed and use a urinal or bedpan.

C. Report the time and amount of first voiding. In order to adequately assess bladder function after a catheter is removed; voiding frequency and amount should be monitored. Unless contraindicated, fluids should be encouraged. To promote normal micturition, patients should be placed in as normal a posture for voiding as possible. Suprapubic tenderness and pain are possible indicators of urinary retention and/or a UTI.

Mr. Bales is 60 years old and alert. He is timid and reluctant to talk about his urinary retention problem. Which part of this plan could create stress for Mr. Bales and possibly increase his inability to urinate? A. Assisting him in assuming his normal voiding position B. Pulling curtains around him to provide privacy during voiding C. Staying with him while voiding D. Offering a urinal or a regular schedule

C. Staying with him while voiding Mr. Bales will probably be embarrassed if the nurse remains with him as he attempts to void and is more likely to have difficulty voiding.

Which nursing intervention minimizes the risk for trauma and infection when applying an external/condom catheter? A. Leave a gap of 3-5 inches between the tip of the penis and drainage tube B. Shave the pubic area so that hair does not adhere C. Wash with soap and water prior to applying the condom type catheter. D. Apply tape to the condom sheath to keep it securely in place.

C. Wash with soap and water prior to applying the condom type catheter. Hygiene minimizes skin irritation. There needs to be 2.5 to 5 cm (1 to 2 inches) of space between tip of the glans penis and the end of the catheter. Excess space may cause pooling of urine causing excessive exposure to urine. Shaving the pubic area increases the risk for skin irritation. The condom should be secure but not tight. Application of tape is contraindicated because it could interfere with circulation increasing risk for necrosis of the penis.

Which of the following would the nurse incorporate into the teaching plan for a patient to promote healthy urinary function? A. Drinking more then 2,000 mL per day will cause fluid retention B. The healthy adult should drink four to six 8 oz glasses of water per day C. Children need fewer reminds to drink because of a greater thirst sensitivity D. Caffeine-containing beverages should be monitored to prevent excess intake

D. Caffeine-containing beverages should be monitored to prevent excess intake Caffeine intake should be limited because it is irritating to the bladder mucosa. It is recommend that the healthy adult drink eight to ten 8 oz glasses of water. Unless a disease process is present.

Mr. Chang, a hospitalized patient with diabetes mellitus, has developed a UTI. He is 80 years old and has an indwelling catheter in place. Which factor is most likely the cause of the UTI? A. The close proximity of the male genitalia to the rectum B. Decreased immunity C. A high urine glucose level D. The indwelling urinary catheter

D. The indwelling urinary catheter Most UTI in hospitalized patients are caused by the presence of indwelling catheters. Additionally, although less significant, causes of UTI include a decrease in immunity in elder people with the presence of glucose in the urine, as in diabetes.