Care Management Chapter 38 Lippincott

A client at a health care facility has been diagnosed with polyuria. Which question should the nurse ask the client to determine the cause?

"Have you ever had an elevated blood sugar level?"

The experienced nurse is observing a new nurse who is preparing to catheterize a client. Which statement by the new nurse requires immediate intervention by the experienced nurse?

"I will use clean gloves to handle the catheter and other equipment."

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

"Let's explore structuring activities and toileting breaks."

The parent of a 5-year-old child tells the nurse that on two occasions their child has lost control of urination when they had to wait to go to the bathroom at school. What is the appropriate nursing response?

"Let's review the types of fluids that your child drinks in the morning."

A client reports an episode of losing control of urination when a bathroom was not close by. The client states, "I am worried this means that I am starting to lose control of my bladder." What is the appropriate nursing response?

"Let's review your medication history and whether you consume bladder irritants."

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine?

24 hour specimen

A urinary catheter has been placed in a client with a bladder neck obstruction that led to urinary retention. Which intervention will the nurse prioritize to minimize the client's risk for catheter-associated urinary tract infection (CAUTI)?

Advocate for removal of the catheter as soon as it becomes unnecessary.

The health care provider has prescribed an indwelling catheter for a client. When the nurse explains the procedure, the client refuses to allow placement of the catheter. Which action should the nurse take next?

Ask the client why they do not want a catheter.

A nurse is caring for a client with a hemodialysis access site. Which action should the nurse take?

Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration.

The nurse is caring for a client who has a history of acute kidney injury. What is an accurate step when caring for the client's hemodialysis access?

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

The nurse is caring for a female client with frequent urinary tract infections (UTIs). What does the nurse include in the client's teaching plan to decrease the incidence of UTIs?

Be sure to urinate after you have sexual intercourse.

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

Catch the urine while holding the labia apart, after allowing the first urine to flow into the toilet.

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

Cholinergic agents

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

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

A client is preparing to give a clean-catch urine specimen. Which instruction will the nurse provide?

Collect the sample after allowing initial urine to flow into the toilet.

A client has burning upon urination. The urinalysis indicates pyuria. Which is the next action the nurse will take?

Contact the health care provider

Three days after surgery for breast reconstruction, the client is ambulating several times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action(s)? Select all that apply.

Contact the health care provider to ask for an order for catheter discontinuation. Perform, or allow client to perform, perineal hygiene at least once daily.

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

Discuss the use of protective undergarments to avoid embarrassment from incontinence.

The nurse is performing a portable bladder ultrasound on a client who has palpable bladder distention. The scanner reveals little urine in the bladder. What should the nurse do next?

Ensure proper positioning of the scanner head and rescan.

A nurse is caring for a client with an external condom catheter. Which guideline should be implemented when applying and caring for this type of catheter?

Fasten the condom securely enough to prevent leakage without constricting blood flow.

The nurse is caring for a client with a history of renal insufficiency and type 2 diabetes. Which prescription, if noted in the client's chart, would alert the nurse to discuss with the health care practitioner?

Gentamicin 70 mg intramuscular (IM) every 8 hours

What is an advantage of using an external condom catheter for a client who has frequent episodes of urinary incontinence?

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

The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises (Kegel exercises) will the nurse include?

Keep muscles contracted for at least 10 seconds.

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

Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.

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

Male children may take longer for daytime continence than female children.

During a health history interview, a client tells the nurse that they do not feel they completely empty their bladder when they void. The client has been diagnosed with an enlarged prostate. Which should the nurse include in the client education to encourage urination? Select all that apply.

Meditate while urinating. Do pelvic floor muscle (Kegel) exercises 3 to 5 times per day. Try double voiding. Avoid antihistamines. Do not delay urination.

The nurse assesses redness, drainage, and odor to the area around a client's peritoneal dialysis catheter. Palpation of the abdomen causes the client pain. Which intervention is the priority?

Notifying the health care provider of the assessment findings.

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

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

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

Refrain from douching unless ordered by a health care provider.

The nurse completes the task of changing the dressing of a recent surgically inserted peritoneal dialysis catheter. The nurse has applied antibiotic ointment as prescribed, covered the site with 4 × 4 gauze, and labeled the dressing with the date, time of change, and initials of the nurse performing the task. Prior to leaving the client's bedside, the nurse should complete which task next?

Secure the tubing of the peritoneal dialysis catheter to the client's abdomen.

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

The birth can cause perineal swelling.

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

The client should avoid wearing tight clothes or belts near the site.

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

The client will have to wear an external appliance to collect urine.

The nurse is caring for a client with a Foley catheter in place who has a prescription for a sterile urine specimen for culture and sensitivity. The nurse implements which techniques to obtain the prescribed urine specimen? Select all that apply.

The nurse uses a syringe to withdraw urine from the port. The nurse dons clean gloves and cleanses the port with aseptic solution.

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

Use their left hand to spread the client's labia and keep them spread until the catheter is inserted.

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

Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well.

A nurse is preparing to measure a client's urine output. Which interventions would be of highest priority?

Wearing gloves when handling the urine

A sterile urine specimen for culture and sensitivity has been prescribed for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen?

Withdraw several milliliters of urine from the port on the collection tubing, using aseptic technique.

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

anuria

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

blood

The health care provider notifies a client of a diagnosis of glycosuria. Which assessment information will the nurse obtain from the client next?

blood sugar

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

caffeine intake

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

checking that the client has signed a consent form for the procedure

For which client will the nurse plan interventions addressing a neurogenic bladder?

client recovering from a stroke

The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate?

cloudy, foul odor

The nurse is caring for an older adult client suspected of having a urinary tract infection. The nurse will perform what assessment specifically associated with the development of this condition in the older adult?

cognitive assessment

A client with a history of advanced liver disease comes to the emergency department (ED) with dehydration. White blood cell count shows elevation in bands and neutrophils. When preparing to catheterize the client, what color urine does the nurse anticipate will drain?

dark brown, cloudy

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

dehydration

A nurse notes that the volume of the client's urinary elimination is less than 300 ml/day. Which nursing intervention will be appropriate to use with this client?

evaluating fluid intake

A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample?

first thing in the morning

A client in a long-term care facility becomes confused and disoriented at night and is incontinent during these periods of confusion due to the inability to find the commode. During the day, the client does not experience confusion and is continent. What type of incontinence is this client experiencing during the nighttime hours?

functional incontinence

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

intermittent urethral catheter

A nurse assesses the urine of a client who is using a bedpan and finds that it is a dark brown color. What medication might be causing this effect?

levodopa

A client at the health care facility has been diagnosed with total urinary incontinence. How will the nurse describe the condition of the client?

loss of urine without any identifiable pattern or warning

A client is suspected of having a disease process affecting the basic functional unit of the kidney. Which structure is likely involved?

nephron

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

reddened perineal skin

A client who visits a health care facility for a routine assessment reports to the nurse being unable to control urinary elimination. This has resulted in the client soiling clothes and has led to a lot of embarrassment. Which nursing intervention will be appropriate to use with this client?

regular toileting routine

Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)?

straight catheter

A 70-year-old client who has four children and six grandchildren states that they "wet" themself when they sneeze or laugh. They report that sometimes this also occurs when rising from a sitting to standing position. Which type of incontinence does the nurse anticipate?

stress

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

stress

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence?

stress

The nurse is caring for a client who has been experiencing nausea, vomiting, and diarrhea for 3 days. Which urine characteristics does the nurse anticipate?

strongly aromatic, dark amber

The nurse is inserting a urinary catheter into a 63-year-old male client and encounters resistance. What is the most likely cause of the resistance?

the client has an enlarged prostate

A client's blood urea nitrogen (BUN) test results are significantly elevated. When reviewing the client's history, which finding is consistent with BUN elevation other than renal compromise?

the client is dehydrated

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

urinal