Chapter 37

The nurse has an order to obtain a 24-hour urine specimen from a client. Which instruction would be accurate for collection of the specimen? "Begin the collection when you first urinate in the morning." "Discard your first urine and begin the collection after that." "Start collecting the urine with the next time you urinate." "You will need to have a catheter inserted for this collection."

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

The experienced nurse is observing a new nurse who is preparing to catheterize a female client. Which statement by the new nurse requires immediate intervention by the experienced nurse? "I will place a bath blanket over the client to provide privacy." "The client will be placed in a reclining position with knees bent." "I will use clean gloves to handle the catheter and other equipment." "Washing hands before and after the procedure is important."

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

A 70-year-old client confides to the nurse that she is "terribly embarrassed" that she has developed urinary incontinence over the past year. Which nursing response supports the client's self-esteem? "It would be best just to get some adult diapers." "Let me refer you to a urologist who can help you." "Don't worry, this is a normal condition for older adults." "Let's explore structuring activities and toileting breaks."

"Let's explore structuring activities and toileting breaks." TAKE ANOTHER QUIZ

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

24-hr specimen

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 renal failure. What is an accurate step when caring for the client's hemodialysis access? Percuss the site to feel for a thrill or vibration. Auscultate over the site with a stethoscope to listen for a bruit. Use the affected arm if an IV must be started to avoid impairment of both arms. If a thrill is not palpable and/or a bruit is not detectable, assess for these signs in the other arm.

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

The nurse is caring for a 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 sexual intercourse. Try soaking in bubble baths in the evenings. Wipe the perineal area from back to front. Decrease fluid intake to decrease urination.

Be sure to urinate after sexual intercourse.

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

Boys may take longer for daytime continence than girls.

The nurse is teaching an older adult female client who must provide a urine specimen. Which is the proper method to instruct the client to use 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. Catch the urine while holding the labia apart, then cleanse each side of the labia with prepared aseptic swabs. Catch the urine while holding the labia apart, after cleansing. Fill the specimen cup. Catch the urine in the cup after cleansing the perineum.

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

Which is true regarding the normal urination? Catheterized clients should drain a minimum of 30 mL of urine per hour. In adults, the average amount of urine per void is 500 mL. Urinary output does not vary all that much between adults and children. In adults, the amount of urine voided typically does not depend on fluid intake and losses.

Catheterized clients should drain a minimum of 30 mL of urine per hour.

When preparing to irrigate a Foley catheter, which is the appropriate initial nursing action? Check health record for provider's order. Gather equipment and supplies. Assess urine characteristics. Explain the procedure to the client.

Check health record for provider's order.

A client could experience increased urination when using which classification of medication? Cholinergic agents Analgesic medications Central nervous system depressants Stool softeners

Cholinergic agents

The nurse is preparing to insert an indwelling urinary catheter into a female 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. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Clean each labial fold, then the area directly over the meatus. 2Insert the lubricated catheter into the urethra. 3Advance the catheter until there is a return of urine. 4Inflate the balloon with the correct amount of sterile saline. 5Discard used supplies.

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.

Three days post-surgery for breast reconstruction, the nurse assesses that 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? Select all that apply. Contact the health care provider to ask for an order for catheter discontinuation. Delegate catheter discontinuation to the Unlicensed Assistive Personnel (UAP). Perform, or allow client to perform, perineal hygiene at least once daily. Ensure that the drainage bag is above the level of the bladder at all times. Discontinue to catheter and report this to the healthcare provide

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.

A nurse is the guest speaker at a women's club. Most of the women are older than 40 years of age and have asked the nurse to speak about health promotion topics. The nurse states that exercises may help with urinary urgency. Which exercise instruction will the nurse provide to the women?

Contract the pubic muscles for 3 seconds, then relax.

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. Encourage the client to confide in family members and tell them about the accidents. Inform the client that this is not normal and make a referral to a urologist. Tell the client that this happens to all people when they get older.

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

A client is prescribed an indwelling urinary catheter for 2 days prior to surgery. Which action should the nurse take to decrease the occurrence of health care-associated infection (HAI) for this client? Encourage fluid intake. Maintain the urinary catheter until discharge. Request a straight catheter from the health care provider. Irrigate the catheter twice per day.

Encourage fluid intake.

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? Have the client drink 8 ounces of water every 15 minutes for 1 hour. Wipe off some of the ultrasound gel and rescan. Ensure proper positioning of the scanner head and rescan. Place the client on either side and rescan.

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 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 female 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. Immediately remove the catheter from the vagina, contact the health care provider, and anticipate a prescription for prophylactic antibiotics. Ask the client to bear down until the catheter is expelled. Remove the catheter from the vagina and attempt to insert it into the bladder.

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

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

Levodopa

A nurse is maintaining a client's continuous bladder irrigation. When appraising the effectiveness of this therapy, the nurse should prioritize what assessment? Calculating the flow rate of urinary output Monitoring the characteristics of the urinary output Assessing PVR using a bladder scanner Palpating the client's bladder region

Monitoring the characteristics of the urinary output

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

Nephron

A client with an emergently placed central venous catheter (CVC) is to have emergent hemodialysis. Upon assessment of the CVC the nurse visualizes redness, drainage, and odor to the area around the CVC. Palpation of the surrounding skin causes the client pain. Which intervention is the priority?

Notifying the health care provider of the assessment findings

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

Position the patient in a supine position

Which urinary care teaching will the nurse provide to a young adult female client? Wipe from the back to the front. Refrain from douching unless ordered by a health care provider. If you do not feel like voiding, still strain to make sure the bladder is empty. Drink water more frequently in the morning and evening to facilitate hydration.

Refrain from douching unless ordered by a health care provider.

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? Encouraging the client to stay close to home Fluid restriction Indwelling catheterization Regular toileting routine

Regular toileting routine

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 informs the nurse that it is difficult to void when experiencing stress, and asks why this happens. Which response by the nurse is appropriate?

Stress causes muscles to become tense

The clinic nurse is collecting data from a female client with frequent, recurrent urinary tract infections who was discharged from the hospital. Which data collection would indicate to the nurse that the client is adhering to discharge instructions? The client drinks eight 8-oz glasses of cranberry juice daily. The client soaks in the bathtub daily for perineal care. Since the client is symptom-free, she no longer takes the prescribed antibiotics. The client drinks two glasses of water before and after sexual intercourse.

The client drinks two glasses of water before and after sexual intercourse.

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 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.

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 may bathe rather than shower, provided the site is covered with gauze. A dressing should always be worn over the site to avoid leaking. Sterile technique must be observed by the client in the home setting. The client should avoid wearing tight clothes or belts near the site.

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.

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? This urinary diversion is only temporary. The client will need to change the urinary pouch every 4 hours. The client will have to wear an external appliance to collect urine. Urination can be voluntarily controlled after the stoma heals from the initial surgery.

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

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

Urinal TAKE ANOTHER QUIZ

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

Use her left hand to spread the woman'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? Using an appropriate measuring container Wearing gloves when handling the urine Measuring the urine container at eye level Noting the color and clarity of the urine

Wearing gloves when handling the urine

A woman is reporting bladder urgency. It is most important to 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

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 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 light yellow, clear clear, dark amber strongly aromatic, amber

cloudy, foul odor

A client has been NPO. after midnight for surgery. It is 11 a.m. and the nurse has asked her to void before being transferred to the surgical suite. The nurse should expect her urine to be what color? pale yellow colorless dark amber tea colored

dark amber

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 57-year-old man is suffering from polyuria. What can cause polyuria? diabetes insipidus renal disease urinary tract infection renal calculi

diabetes insipidus

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 reports that he is often unable to retain urine until he locates a toilet because his mobility is decreased. The nurse should recognize the characteristics of what type of incontinence? stress urge functional total

functional

A male client is being transferred to the hospital from a long-term care facility with a diagnosis of dehydration and urinary bladder infection. His skin is also excoriated from urinary incontinence. Which nursing diagnosis is most appropriate for this client? Impaired Skin Integrity related to functional incontinence Urinary Incontinence related to urinary tract infection Impaired Skin Integrity related to urinary bladder infection and dehydration Risk for Urinary Tract Infection related to dehydration

impaired skin integrity related to urinary bladder infection and dehydration

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 drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance? indwelling urethral catheter intermittent urethral catheter Foley catheter retention catheter

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 a health care facility is being treated for cancer of the bladder. The physician uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion? inability to control either urinary or bowel elimination hygiene measures used to keep meatus and adjacent area of the catheter clean use of a catheter to collect urine in a sterile environment one or both of the ureters are surgically implanted elsewhere

one or both of the ureters are surgically implanted elsewhere TAKE ANOTHER QUIZ

The nurse is caring for an older adult client who has had a condom catheter applied. Which intervention will the nurse include in the care of this client? Perform thorough skin care daily. Change the condom catheter every other day. Make sure the condom sheath is secured tightly to the penis. Ensure the tubing is flush to the tip of the penis.

perform skin care daily

A 70-year-old client who has four children and six grandchildren states that she "wets" herself when she sneezes or laughs. She reports that sometimes this also occurs when rising from a sitting to standing position. Which type of incontinence does the nurse anticipate?

stress

A nurse is assessing a client who is complaining of difficulty urinating. Which assessment would be a priority? Asking the client when he or she had last urinated Determining any pain when palpating the lower abdomen Palpating the bladder above the symphysis pubis Obtaining the bladder scanner to check the urine volume

Asking the client when he or she had last urinated

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

Check electronic health record for medical order.

A client has burning upon urination. The urinalysis indicates pyuria. Which is the next action the nurse will take? Monitor vital signs Contact the health care provider Encourage fluids Instruct on proper wiping technique

Contact the health care provider

The nurse is assessing a client with a urinary sheath catheter. After removing the catheter, the nurse observes a break in skin integrity on the penis. What actions by the nurse would be appropriate at this time? Select all that apply. Do not reapply the urinary sheath Allow the skin to be open to air as much as possible Wash the area with soap and water and apply the catheter Arrange for a consult with a wound nurse Insert an indwelling catheter instead

Do not reapply the urinary sheath Allow the skin to be open to air as much as possible Arrange for a consult with a wound nurse

nurse is caring for a female client with an indwelling urinary catheter. Which action should the nurse take into consideration to reduce the client's risk of developing a urinary tract infection (UTI)? Use clean technique when inserting the catheter. Ensure that the catheter is removed as soon as possible. Irrigate the catheter with sterile water once per shift. Administer prophylactic antibiotics, as ordered.

Ensure that the catheter is removed as soon as possible.

The nurse is caring for a client who has been experiencing difficulty voiding since her vaginal birth. The client voices concern to the nurse. What information should be provided to the client? The birth can cause perineal swelling. A neurogenic bladder results from local anesthesia. A urinary tract infection results from the birth process. Catheterization is necessary for 1 week.

The birth can cause perineal swelling.

The nurse is assessing a client's bladder volume using an ultrasound bladder scanner. Which nursing actions are performed correctly? Select all that apply.

The nurse gently palpates the client's symphysis pubis. The nurse places a generous amount of ultrasound gel or gel pad midline on the client's abdomen, about 1 to 1.5 in (2.5 to 4 cm) above the symphysis pubis. The nurse aims the scanner head toward the bladder (points the scanner head slightly downward toward the coccyx). The nurse adjusts the scanner head to center the bladder image on the crossbars.

The nurse is assessing a client's bladder volume using an ultrasound bladder scanner. Which nursing actions are performed correctly? Select all that apply. The nurse gently palpates the client's symphysis pubis. The nurse places a generous amount of ultrasound gel or gel pad midline on the client's abdomen, about 1 to 1.5 in (2.5 to 4 cm) above the symphysis pubis. The nurse places the scanner head on the gel or gel pad, with the directional icon on the scanner head pointed away from the client's head. The nurse aims the scanner head toward the bladder (points the scanner head slightly downward toward the coccyx). The nurse adjusts the scanner head to center the bladder image on the crossbars. The nurse presses and holds the END button until it beeps 3 times and then reads the volume measurement on the screen.

The nurse gently palpates the client's symphysis pubis. The nurse places a generous amount of ultrasound gel or gel pad midline on the client's abdomen, about 1 to 1.5 in (2.5 to 4 cm) above the symphysis pubis. The nurse aims the scanner head toward the bladder (points the scanner head slightly downward toward the coccyx). The nurse adjusts the scanner head to center the bladder image on the crossbars.

The nurse instructs the client about the clean catch urine specimen. Which statement made by the client indicates a need for further teaching from the nurse? "I will: urinate directly into the specimen cup, filling it to the top and then cap it without touching the inside of the lid." use three wipes provided; one to clean each side of the urinary meatus, and one in the middle from front to back." wash my hands before collecting the clean catch urine specimen." keep the labia spread after cleaning and during collection of the specimen."

The nurse instructs the client about the clean catch urine specimen. Which statement made by the client indicates a need for further teaching from the nurse? "I will: urinate directly into the specimen cup, filling it to the top and then cap it without touching the inside of the lid." use three wipes provided; one to clean each side of the urinary meatus, and one in the middle from front to back." wash my hands before collecting the clean catch urine specimen." keep the labia spread after cleaning and during collection of the specimen."

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? Cleansed access port with warm soap and water, syringe attached and aspirated 10 mL of urine and placed in specimen container. Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. Obtained urine specimen from urinary drainage bag using a syringe, client expressed no discomfort during or after the procedure, verified prescription and cleansed access port. Gathered supplies, checked prescription, collected urine from access port and notified health care provider at the completion of the procedure.

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

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.

The nurse is caring for an older adult client suspected of having a urinary tract infection. The nurse should assess for what finding specifically associated with the development of this condition in the older adult? High fever Dysuria Acute confusion Nausea

acute confusion

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

Which symptom will have a great impact on the extracellular fluid for water conservation?

burns

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 explaining to the client that the procedure will be painful maintaining the client without liquids before the procedure inserting a Foley catheter the morning of the procedure

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

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 inserting a urinary catheter into a female client and has begun to inflate the balloon, an action that has caused the client to wince and cry out in pain. Consequently, the nurse should: deflate the balloon, insert the catheter further, and slowly attempt reinflation. wait for 30 seconds, help the client to relax, and attempt inflation again. stop, deflate the balloon, withdraw the catheter 0.75 to 1.5 in (2 to 4 cm), and slowly reinflate. deflate the balloon, withdraw the catheter, and use a smaller sized catheter.

deflate the balloon, insert the catheter further, and slowly attempt reinflation.

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

perineal

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

straight catheter

A client reports to the nurse that after delivering an infant, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate? urge total reflex stress

stress