Chapter 38: Urinary Elimination PrepU

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

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

The 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 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?

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

The parent of a 5-year-old child tells the nurse that on two occasions her son has lost control of urination when he 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."

The nurse is assessing a female client who states that they notice an involuntary loss of urine following a coughing episode. What would be the nurse's best reply?

"You are experiencing stress incontinence. Do you know how to do pelvic floor muscle (Kegel) exercises?"

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.

1. Clean each labial fold, then the area directly over the meatus. 2. Insert the lubricated catheter into the urethra. 3. Advance the catheter until there is a return of urine. 4. Inflate the balloon with the correct amount of sterile saline. 5. Discard used supplies.

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.

1. Provide instruction to the client. 2. Clean the area surrounding the urinary meatus with the provided cloth. 3. Void a small amount into toilet or bedpan. 4. Void into the provided collection device. 5. Secure the lid on the specimen container. 6. Submit collected specimen to the health care professional.

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.

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.

Which statement should the nurse convey to the parent of a 3-year-old boy 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 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.

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

Check health record for provider's order.

The UAP reports that a client on furosemide has voided 4000 mL in a 24-hour period. What is the appropriate nursing action?

Contact the health care provider to decrease furosemide.

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

Contract the pubic muscles for 3 seconds, then relax.

A female client is diagnosed with recurrent urinary tract infections (UTIs) and the nurse is providing education about preventative methods. What information is important for the nurse to give to the client to prevent another UTI? Select all that apply.

Drink two 8-oz glasses (480 mL) of water before and after sexual intercourse and void immediately after intercourse. Wear underwear with a cotton crotch. Avoid clothing that is tight and restrictive on the lower half of the body.

A 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)?

Ensure that the catheter is removed as soon as possible.

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.

What is an advantage of using an external condom catheter for a male 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 (Kegel) exercises will the nurse include?

Keep muscles contracted for at least 10 seconds.

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

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. Ensure that the drainage bag is above the level of the bladder at all times. Contact the health care provider to ask for an order for catheter discontinuation. Discontinue the catheter and report this to the health care provider. Delegate catheter discontinuation to the unlicensed assistive personnel (UAP). Perform, or allow client to perform, perineal hygiene at least once daily.

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

While providing care to a client admitted to the health care facility, the client states that she has "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

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.

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 difficulty voiding in the 8 hours since giving birth vaginally. What information should be provided to the client?It can be left in place for a long period of time. A sterile urine specimen can be obtained from the drainage bag tubing. The client can apply it himself with minimal supervision.

The birth can cause perineal swelling.

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.

The nurse caring for an older adult male client is determining whether the client can use a urinal to void. Which aspects of the client's medical history may contraindicate the use of a urinal?

The client is acutely confused and has been diagnosed with delirium.

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.

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.

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

Voiding before and after sexual intercourse

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

anuria

Absence of urine for a 24-hour period reflects

anuria

A 57-year-old client is suffering from polyuria. What can cause polyuria?

arginine vasopressin deficiency-D (central diabetes insipidus)

The nurse is caring for a client with weakness who is ambulatory but tires easily. Which method for urinary elimination does the nurse recommend?

bedside commode

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

blood

A 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

A client has been NPO (nothing by mouth) after midnight for surgery and the client has received no IV fluids. It is now 1300 and the nurse has asked the client to attempt to void before being transferred to the surgical suite. The nurse should expect the client's urine to be what color?

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 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?

functional

The nurse observes that a client frequently experiences urine loss when being transferred from a chair to the bed. Which type of incontinence does the nurse identify that the client is experiencing?

functional

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 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

A client at a health care facility is being treated for cancer of the bladder. The health care provider uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion?

one or both of the ureters are surgically implanted elsewhere

An older adult woman tells the nurse that she has trouble controlling her urine. She states, "The urine starts dripping even before I feel like I have to go." The nurse interprets this as:

reflex incontinence.

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?

stress

A nurse is caring for a client who has an infant age 4 months. The client informs the nurse that she has been experiencing a sudden loss of urine whenever she laughs; this is causing embarrassment to her. Which type of urinary incontinence is this client experiencing?

stress incontinence

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