Urinary Elimination practice quiz

A student is collecting a sterile urine specimen from an indwelling catheter. How will the student correctly obtain the specimen?

Aspirate urine from the collection port When it is necessary to collect a urine specimen from a client with an indwelling catheter, it should always be obtained from the catheter itself using the special collection port. Pouring urine from the collection bag or aspirating from the collection bag can cause contamination from the collecting bag. A nurse should not remove the urinary catheter and ask the client to void.

A nurse is planning interventions for a client to assist in establishing a normal voiding pattern. Which nursing action should be included?

Assist the client to a normal voiding position when possible. Maintaining a normal voiding pattern would involve having privacy whenever possible, voiding once the urge is felt, and not waiting to urinate. Being in a normal voiding position is important for men and women. The client would not be scheduled to urinate; many people do not have a routine schedule, but void intermittently.

A client is preparing to give a clean-catch specimen. What action should the nurse have the client do first?

Clean each side of the urinary meatus with a separate wipe. A clean-catch specimen is collected in mid-stream. The nurse will first instruct to clean each side of the urinary meatus, release a small amount of urine, catch a sample, and then complete voiding

The nurse is collecting a clean-catch specimen from a client. Which nursing action is performed correctly in this procedure?

Position the container near the meatus, and collect at least 10 mL of urine. The container would be positioned near the meatus, collecting at least 10 mL of urine. There is no need to collect all of the urine until the bladder is empty. The first 10 mL of urine voided are discarded. This urine has potentially been contaminated because of its exposure to the urethra.

A nurse is caring for older adult clients in an assisted-living facility. Which effect of aging should the nurse consider when performing a urinary assessment?

Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection. Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection. The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night). Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination. Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weakness may interfere with voluntary control and the ability to reach a toilet in time. Individuals who view themselves as old, powerless, and neglected may cease to value voluntary control over urination, and simply find toileting too much bother no matter what the setting. Incontinence may be the result.

A nurse has catheterized a client to obtain urine for measuring postvoid residual (PVR) amount. The nurse obtains 40 mL of urine. What should the nurse do next?

Document this normal finding for postvoid residual. A postvoid residual (PVR) urine measures the amount of urine remaining in the bladder after voiding. It can be measured by catheterization or a bladder scan. A PVR of less than 50 mL indicates adequate bladder emptying. The nurse would document this normal finding for PVR. It is not necessary to palpate the abdomen as the bladder is empty.

A client who is a paraplegic as a result of an auto accident has incontinence. The nurse correctly recognizes that which type of incontinence is most likely?

Reflex An involuntary loss of urine that occurs at somewhat predictable intervals when a specific bladder volume is reached is called reflex incontinence. The person is unable to sense bladder fullness because of neurologic impairment, and the bladder simply empties when a certain degree of bladder stretch occurs. Bladder emptying occurs at the sacral reflex level because of impairment of the connection to the cerebrum that allows voluntary inhibition of voiding. Reflex incontinence is seen in clients with neurologic impairment, such as a spinal cord lesion, cerebrovascular accident, or brain tumor. The sudden, involuntary loss of small amounts (less than 50 mL) of urine that accompanies a sudden increase in intra-abdominal pressure is called stress incontinence, termed urge incontinence. The person with urge incontinence is unable simultaneously to perceive a full bladder and to hold urine until reaching the bathroom. Functional incontinence involves the inability or unwillingness of a person with normal bladder and sphincter control to reach the bathroom in time to void.

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. An ileal conduit involves a surgical resection of the small intestine, with transplantation of the ureters to the isolated segment of small bowel. Such diversions are usually permanent, and the client wears an external appliance to collect the urine because urine elimination from the stoma cannot be controlled voluntarily. Appliances are usually changed every 3 to 7 days, although they could be changed more often.

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. The nurse would ensure prescription is obtained, explain procedure to the client, use an antiseptic swab to cleanse the access port, then attach syringe and aspirate urine into the syringe. A specimen from the collecting receptacle (drainage bag) may not be fresh urine and could result in an inaccurate analysis. Always observe sterile technique while collecting a urine specimen from an indwelling catheter. Gather equipment, including a syringe, an antiseptic swab, a sterile specimen container, nonsterile gloves, and only tube tubing if needed; remember to unclamp the catheter after obtaining specimen to avoid reflux of urine into bladder.

A nurse is carrying out an order to remove an indwelling catheter. What is the first step of this skill?

Wash hands and put on gloves. The first step of any skill involving body fluids is to wash hands and don gloves. All the steps listed are correct to remove a urinary catheter.

After surgery, a postoperative client has not voided for 8 hours. Where would the nurse assess the bladder for distention?

between the symphysis pubis and the umbilicus When the bladder is distended with urine, it rises above the symphysis pubis and may reach to just below the umbilicus. The other choices are anatomically incorrect for assessing a distended bladder.

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. If the client reports pain during balloon inflation, the nurse should stop inflation of balloon, which is most likely still in the client's urethra. The nurse should withdraw the solution from the balloon, insert the catheter an additional 0.5 to 1 in (1.25 to 2.5 cm), and slowly attempt to inflate the balloon again. Re-attempting inflation in the same location or after slight withdrawal could cause trauma to the client's urethra. It is not necessary to utilize a smaller gauge catheter.

A client reports frequently experiencing urine loss when moving from the wheelchair to bed. Which type of incontinence does the nurse anticipate?

functional Functional incontinence takes place when attempting to overcome obstacles, such as transferring from the wheelchair to the bed. Urge incontinence takes place when there is a delay in accessing a toilet. Reflex incontinence takes place when a client automatically releases urine and cannot control it. Total incontinence takes place without a pattern or warning, and without client control.

The nurse has entered a client's room to empty the client's urine collection bag at the end of a busy shift. The nurse realizes that the client's urine output is 75 mL over the past 8 hours. The nurse would recognize that the client is experiencing:

oliguria. Oliguria is a significant decrease in urine production. Anuria is an absence or near-absence of urine output. Nocturia is nighttime awakening to void. Polyuria is greatly increased urine production.

A nurse is preparing to catheterize a female client. What will the nurse consider when comparing the anatomy of the female urethra with that of the male urethra?

shorter in length The anatomy of the urethra differs in males and females. The male urethra is about 5½ to 6¼ inches (14 to 16 cm) long. The female urethra is about 1½ to 2½ inches (4 to 6 cm) long. This difference is important in terms of catheterization and risk for infection. The female anatomy does not have different innervation but it connects with the bladder similar to the male anatomy.

Upon assessment of the urine in a client's indwelling urinary catheter drain bag, the nurse notes the urine to be dark yellow. This assessment finding indicates:

the client is underhydrated. Conservation of fluid by the body during states of underhydration, fever, and diaphoresis results in the production of concentrated urine that is dark in color. A sign of overhydration would be very light or clear urine. Adequate fluid intake would correspond with pale yellow and clear urine. Signs of urinary tract infection include cloudy urine or urine containing blood or blood cells.

A client has been taught how to do Kegel exercises. What statement by the client indicates a need for further information?

"I will contract the muscles in my abdomen and thighs." Kegel exercises, or pelvic floor muscle training, are used to tone and strengthen the muscles that support the bladder. They can improve voluntary control of urination and thus improve or eliminate stress incontinence. The muscles to contract are the same ones used to stop urination midstream or control defecation. The client should not contract the muscles of the abdomen, inner thigh, or buttocks while doing Kegel exercises.

The nurse has an order to obtain a urine specimen from a client with an indwelling Foley catheter. Which supplies would the nurse need to gather? Select all that apply.

-10-mL (milliliter) syringe -Sterile specimen container -Antiseptic swab The nurse would need to gather a syringe, antiseptic swab, and sterile specimen container. The nurse would need clean, not sterile gloves, to perform the collection. The part of the tubing that connects to the catheter is where the specimen is collected from, and the nurse may need a clamp to allow a collection of urine within the tubing in case urine output is decreased.

The nurse is educating a client with an ileal conduit about the effects of food and fluid intake on the amount and quality of urine produced by the body. Which teaching points should the nurse include? Select all that apply.

-Dehydration leads to increased fluid reabsorption by the kidneys, leading to decreased and concentrated urine production. -Fluid overload leads to excretion of a large quantity of dilute urine. -Consumption of caffeine-containing beverages (cola, coffee, and tea) leads to increased urine production due to their diuretic effect. -Ingestion of certain foods, such as asparagus, onions, and beets, may lead to alterations in the odor or color of urine. Dehydration leads to increased fluid reabsorption by the kidneys, leading to decreased and concentrated urine production. Fluid overload leads to excretion of a large quantity of dilute urine. Consumption of caffeine-containing beverages (cola, coffee, and tea) leads to increased urine production due to their diuretic effect. Consumption of alcoholic beverages leads to increased urine production due to their inhibition of antidiuretic hormone release. Ingestion of foods and beverages high in sodium content leads to decreased urine formation due to sodium and water reabsorption and retention. Ingestion of certain foods, such as asparagus, onions, and beets, may lead to alterations in the odor or color of urine.

When planning care for a client with a Foley catheter, which actions should the nurse include? Select all that apply.

-Encourage fluid intake, unless contraindicated. -Record volume and character of the urine. -Maintain a closed urinary catheter system. The client with a Foley catheter should maintain a closed drainage system to prevent introduction of pathogens into the system, and should have the urinary output monitored closely to determine adequate volume. The client can have natural irrigation of the catheter with an increased intake of fluid, if not contraindicated, which also reduces potential for infection. The character of the urine should also be monitored to determine any signs of urinary tract infection. The indwelling catheter should not be changed regularly but only as needed. Powder or lotion should not be used in the perineal area, but the area should be cleansed daily (or after each bowel movement).

The nurse is changing a stoma appliance on an ileal conduit. Which nursing action is recommended procedure? Select all that apply.

-Gently remove the appliance, starting at the top and keeping the abdominal skin taut. -Apply a silicone-based adhesive remover by spraying or wiping as needed. -Make sure skin around stoma is thoroughly dry by patting it dry. The nurse would gently remove the appliance, starting at the top and keeping the abdominal skin taut. This method would prevent excessive damage to skin and tissue of the client. The nurse would apply a silicone-based adhesive remover by spraying or wiping as needed. The adhesive remover helps to prevent skin and tissue damage. The nurse would make sure skin around the stoma is thoroughly dry by patting it dry. Moist skin does not hold adhesives well, possibly causing skin and tissue damage. The nurse would not remove the appliance faceplate by pulling the appliance from the skin rather than pushing. The nurse would not clean the skin around the stoma with alcohol. Alcohol is drying to the skin, possibly causing skin or tissue damage. The nurse would not hold the faceplate firmly in place for 60 seconds when placing it. Pressure for 30 seconds is sufficient.

A nurse maintaining continuous bladder irrigation on a client notes that hourly drainage is less than amount of irrigation being given. Which interventions would be appropriate in this situation? Select all that apply.

-Palpate for bladder distention. -Check to make sure that the tubing is not kinked. -If return flow remains decreased, notify the health care provider. The nurse should palpate for bladder distention; if the client is lying supine, roll the client onto his or her side to help increase the amount of drainage. The nurse should also check to make sure that the tubing is not kinked and, if return flow remains decreased, notify the health care provider. Irrigation would likely be attempted before removal. The balloon is not deflated and reinflated to resolve this problem.

A nurse is caring for an older adult client who has been prescribed a condom catheter. What potential problems related to the use of a condom catheter should the nurse monitor in the client? Select all that apply.

-Restricted blood flow to the glans tissue -Excoriation of the skin in the glans area -Kinks in tubing that encourage backflow of urine A potential problem that can occur with the use of condom catheters is the restriction of blood flow to the skin and tissues of the penis if the sheath is applied too tightly. Another potential problem is the tendency of moisture to accumulate beneath the sheath leading to skin breakdown or excoriation, especially the skin around the glans. A retention catheter, not a condom catheter, could lead to urinary tract infection. Use of a condom catheter does not lead to the inability to control urinary elimination. Care must be taken to fasten the condom securely enough to prevent leakage. Monitor for kinks in the tubing since this may encourage backflow of urine.

A nurse is assessing the freshly voided urine of a client. What characteristics of the urine would indicate a urinary problem? Select all that apply.

-The urine smells like ammonia. -There is pus in the urine. -The urine is cloudy. The urine specimen that would indicate a urinary problem would possibly smell like ammonia, have pus visible in the sample, and be cloudy in nature. A normal urine sample would be amber colored, translucent, and have a pH around 6.0.

The nurse is preparing a client for an intravenous pyelogram. Which nursing actions are performed correctly? Select all that apply.

-Withhold food or fluids 12 hours before testing. -Give an enema the day of the examination. -Obtain client's allergy history. -Give a laxative the evening before the examination. The nurse would expect to withhold or limit foods before testing, give an enema the day of the examination, obtain the client's allergy history, and give a laxative the evening before the examination. The nurse would have the client void before the test. The nurse would not restrict fluids and foods immediately after the examination.

A client with frequent urinary tract infections (UTIs) has returned to the ambulatory clinic with symptoms of another UTI. The nurse reviews measures to follow to promote health and decrease the risk of contracting a UTI. Which measure is appropriate for the client to follow?

Drink two glasses of water before and after sexual intercourse. Measures to decrease the risk for a UTI include drinking ten 8-ounce glasses of water daily; observing for signs and symptoms of a UTI; drying the perineal from the urethra toward the rectum; drinking two glasses of water before and after sexual intercourse; showering rather than bathing; wearing cotton underwear; avoiding tight, constricting clothing; and drinking cranberry or blueberry juice daily. Drinking two glasses of water encourages urination before and after sexual intercourse which can cleanse the urethra of any bacteria caused by the intercourse.

A nurse is educating a client on the amount of water to drink each day. What is the recommended daily fluid intake for adults?

Eight to ten 8-oz (2,000 to 2,400 mL) glasses per day Adults with no disease-related fluid restrictions should drink eight to ten 8-oz glasses (2,000 to 2,400 mL) of fluid daily. The client should drink be mostly water and monitor intake of fluids that are high in caffeine, sodium, and sugar.

A nurse prepares a client with a recently created ileal conduit to be discharged from the hospital. Which is an expected assessment finding?

Mucus in the urine is a normal finding. The isolated segment of small intestine continues to produce mucus (seen in the urine), as part of its normal functioning. The stoma should be dark pink to red and moist. The size of the stoma usually stabilizes within 6 to 8 weeks. Most stomas protrude 0.5 inch to 1 inch (1.25 to 2.5 cm) from the abdominal surface.

A nurse is collecting a routine urinalysis on a client presenting to the emergency room with abdominal pain. What nursing action is important in the collection of this specimen?

Obtain a nonsterile specimen and send it to the lab. A sterile urine specimen is not required for a routine urinalysis. Obtain and label the specimen and send it to the laboratory for examination. Do not leave the urine standing at room temperature for a long period of time before sending it to the laboratory, because this may alter both the appearance and chemistry of the urine.

An older adult client is experiencing urinary retention. What age-related physiologic change does the nurse discuss with the client that may be a contributing factor?

Older adults may have a decrease in contraction of the bladder. Older adult clients have a decrease in bladder contraction, which can lead to decreased urination or urinary retention. If there is a decrease in bladder muscle tone, this may lead to frequent urination instead. Older adult clients can have a decreased ability to concentrate urine, which causes nocturia (urination during the night). Older adult clients also can feel powerless, which can cause incontinence.

A nurse is delegating the collection of urinary output to an unlicensed assistive personnel (UAP). What should the nurse tell the UAP to do while measuring the urine?

Wear gloves when handling a client's urine Gloves are required when handling urine to prevent exposure to pathogenic microorganisms or blood that may be present in the urine. In addition, goggles are also worn if there is a concern of urine splashing. The UAP should measure and record the amount of urine. A clean measuring cup should be used to measure the amount of the urine. The UAP does not need to instruct the client to wash the urethra before voiding. This is completed if a clean catch specimen is needed.

A sterile urine specimen for culture and sensitivity has been ordered 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 a syringe and needle. When it is necessary to collect a urine specimen from a client with an indwelling catheter, it should be obtained from the catheter itself using the special port for specimens. A specimen from the collecting receptacle (drainage bag) may not be fresh urine and could result in an inaccurate analysis. A client's catheter would not be removed for the sole purpose of obtaining a urine specimen. Collection of a specimen does not need to happen in the morning or after a diuretic.