Chapter 38 Urinary Elimination

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? -Functional -Urge -Overflow -Stress

-STRESS Stress incontinence is caused by pelvic floor muscle weakness or urethral hypermobility. Urge incontinence is caused by an overactive detrusor muscle causing involuntary bladder contraction. Overflow incontinence occurs when the bladder muscle distends and urine is forced out. Functional incontinence occurs when a physical or psychological impairment impedes continence despite a competent urinary system.

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine? 24-hour specimen random specimen clean-catch specimen intermittent specimen

24-HOUR SPECIMEN -A 24-hour urine specimen is required for accurate measurement of the kidney's excretion of substances that the kidney does not excrete at the same rate throughout the day. A clean-catch or midstream-voided specimen is used when a specimen relatively free from microorganisms is required. Random urine specimen collection is used when sterile urine is not required.

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? -urinary retention -nocturia -anuria -oliguria

ANURIA -Absence of urine for a 24-hour period reflects anuria.

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. Measure the client's blood pressure on the arm above the access site. Administer an IV on the arm high above the access site. Perform venipuncture below the access site to obtain a blood sample for laboratory testing.

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

A nurse is caring for a client with a hemodialysis access site. Which action should the nurse take? Perform venipuncture below the access site to obtain a blood sample for laboratory testing. Measure the client's blood pressure on the arm above the access site. Administer an IV on the arm high above the access site. Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration.

Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration. -The nurse should auscultate over the hemodialysis access site with the bell of a stethoscope, listening for a bruit or vibration, to assess the patency of the access. The nurse should not measure the client's blood pressure, perform a venipuncture, or start an IV on the access arm, as doing so could lead to infection or clotting of the graft or fistula.

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 regular bathroom bed pan fracture pan

BEDSIDE COMMODE -The client with weakness who tires easily may benefit from a bedside commode. Because the client is ambulatory, a bed pan or fracture pan is not needed. Ambulating to the regular bathroom may increase the risk for falls.

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. Incontinence after the age of 3 years is not normal. Daytime continence is usually not achieved by boys until age 5. Boys may walk by 1 year and should be continent by 3 years.

BOYS MAY TAKE LONGER FOR DAYTIME CONTINENCE THAN GIRLS Children in North American cultures usually achieve daytime urinary continence by 3 years of age; boys may take longer than girls. Nighttime continence may not occur until 4 or 5 years of age.

Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence? Incontinence after the age of 3 years is not normal. Boys may take longer for daytime continence than girls. Daytime continence is usually not achieved by boys until age 5. Boys may walk by 1 year and should be continent by 3 years.

Boys may take longer for daytime continence than girls. - Children in North American cultures usually achieve daytime urinary continence by 3 years of age; boys may take longer than girls. Nighttime continence may not occur until 4 or 5 years of age.

A woman is reporting bladder urgency. It is most important to assess: vitamin supplements. weight. exercise. caffeine intake.

CAFFEINE INTAKE

A woman is reporting bladder urgency. It is most important to assess: exercise. vitamin supplements. caffeine intake. weight.

CAFFEINE INTAKE -Fluids or food containing alcohol or caffeine, such as coffee, tea, cola, or chocolate, irritate the bladder and contain a diuretic that can increase urine output when ingested in large amounts.

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? Squat down and then jump up to a standing position. Lie on the floor, raise, then lower your legs 20 times per day. Contract abdominal muscles 10 times per day. Contract the pubic muscles for 3 seconds, then relax.

Contract the pubic muscles for 3 seconds, then relax. -Pelvic floor exercises, or Kegel exercises, strengthen the pubococcygeal muscles and effectively promote urinary control. The nurse should inform the women to locate the muscles used to start and stop urinating. Then contract those muscles and relax them repeatedly. Strengthening the abdominal muscles will not help with urinary control. Squatting, jumping, and performing leg lifts will help to strengthen the quadriceps and hamstrings.

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? clear, light yellow aromatic, green reddish-brown, clear dark brown, cloudy

DARK BROWN, CLOUDY -The client with advanced liver disease is expected to have dark brown or dark amber urine; infection may be represented by cloudy urine. Other answers are incorrect.

The nurse is preparing to place a Foley catheter for a female client who will soon have surgery. Into what position will the nurse place the client? semi-Fowler's lithotomy supine dorsal recumbent

DORSAL RECUMBENT -The appropriate position for a female client who will have a Foley catheter placed is the dorsal recumbent position. Other answers are incorrect.

A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample? afternoon before bedtime first thing in the morning evening

FIRST THING IN THE MORNING -While the specimen can be collected at any time during the day, the first urine voided in the morning is preferred. The first urine is usually more concentrated because the client does not usually consume fluid during the night and the effects of diet and activity are minimized.

A nurse prepares a client with a recently created ileal conduit to be discharged from the hospital. Which is an expected assessment finding? Stoma is flush with the abdominal surface. Mucus in the urine is a normal finding. Stoma is fully stable. Stoma is pale to light pink in color.

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 client is suspected of having a disease process affecting the functional unit of the kidney. Which structure is most likely involved? Glomerulus Nephron Bowman's capsule Loop of Henle

NEPHRON -The functional unit of the kidney is called the nephron. Each kidney has more than 1 million nephrons, and each nephron is capable of forming urine. The nephron consists of the glomerulus, Bowman's capsule, proximal convoluted tubules, loop of Henle, distal tubule, and collecting duct. The glomerulus is a network of blood vessels, surrounded by Bowman's capsule, where urine formation begins. The tubules, loop of Henle, and collecting ducts are passageways that permit urine to flow to the renal pelvis and then to the ureters.

A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a: cystocele. overactive bladder. neurogenic bladder. enuresis.

NEUROGENIC BLADDER -Neurologic injury after a stroke or spinal cord injury can disrupt normal patterns of urinary elimination. This condition is called neurogenic bladder. A cystocele is a herniation of the urinary bladder. Enuresis is the clinical term for bedwetting. An overactive bladder is the term used when a person has increased urinary urge, increased urinary frequency, or both

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? Flushing the catheter with 15 - 20 mL of normal saline Obtaining laboratory studies. Notifying the health care provider of the assessment findings. Sitting the client up in a greater than a 40-degree angle.

NOTIFYING THE HEALTH CARE PROVIDER OF THE ASSESSMENT FINDINGS -The assessment is indicative of peritonitis or infection associated with the peritoneal dialysis catheter. The health care provider may request laboratory studies, but these cannot be obtained until a prescription is received. Flushing the catheter does not address the likely infection. Sitting the client up may aggravate the pain. The nurse should attempt to keep the client in the most comfortable position possible until a prescription is received from the health care provider.

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? Sitting the client up in a greater than a 40-degree angle. Flushing the catheter with 15 - 20 mL of normal saline Notifying the health care provider of the assessment findings. Obtaining laboratory studies.

NOTIFYING THE HEALTH CARE PROVIDER OF THE ASSESSMENTS FINDINGS The assessment is indicative of peritonitis or infection associated with the peritoneal dialysis catheter. The health care provider may request laboratory studies, but these cannot be obtained until a prescription is received. Flushing the catheter does not address the likely infection. Sitting the client up may aggravate the pain. The nurse should attempt to keep the client in the most comfortable position possible until a prescription is received from the health care provider.

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. Ensure the tubing is flush to the tip of the penis. Make sure the condom sheath is secured tightly to the penis. Change the condom catheter every other day.

PERFORM THOROUGH SKIN CARE DAILY -Clients with condom catheters (also known as urinary sheaths), require thorough skin care daily to prevent skin breakdown. The condom sheath should be changed daily, not every other day. The condom sheath should be secured in place, but should not be tight on the penis for risk of reduced blood flow/damage. Drainage tubing should be 1 to 2 in (2.5 to 5 cm) from the tip of the penis to prevent urine irritating the glans.

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? Assess the client's need for analgesia. Have the client rest for 15 minutes before the assessment. Position the client in a supine position. Administer a diuretic, as ordered.

POSITION THE CLIENT IN A SUPINE POSITION -Portable bladder scanner results are most accurate when the client is in the supine position during the scanning. The procedure is painless, so there is no specific need to administer analgesia. Diuretics are not given in anticipation of the procedure and it is unnecessary to rest prior to scanning.

A nurse is caring for a client who is catheterized following surgery of the prostate. When caring for the client, the nurse performs a continuous irrigation of the catheter. Which intervention should the nurse perform when providing continuous irrigation? Place the sterile solution on the bed. Clean around the urinary meatus. Prime the tubing with the solution. Empty the balloon with a syringe.

PRIME THE TUBING WITH THE SOLUTION -When providing continuous irrigation, the nurse must prime the tubing with the irrigation solution to ensure that no air enters the system. The nurse should hang the sterile irrigating solution from an IV pole, rather than place it on the bed, to allow it to flow freely. The nurse empties the balloon with a syringe and also cleans the urinary meatus when removing the catheter—not when irrigating the catheter.

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? Moist perineal skin Presence of smegma Reddened perineal skin Absence of discharge

REDDENED PERINEAL SKIN -The presence of reddened perineal skin is an abnormal finding. The healthy skin should be moist and noninflamed with no discharge present. Smegma (an accumulation of white, odorous secretions from sebaceous glands found under the labia minora in women and under the foreskin in men) is considered a normal finding.

Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)? -indwelling urethral catheter -straight catheter -suprapubic catheter -Foley catheter

STRAIGHT CATHETER -Intermittent urethral catheters, or straight catheters, are used to drain the bladder for shorter periods. If a catheter is to remain in place for continuous drainage, an indwelling urethral catheter is used. Indwelling catheters are also called retention or Foley catheters. A suprapubic catheter is used for long-term continuous drainage. This type of catheter is inserted surgically through a small incision above the pubic area.

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? urge total reflect stress

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? Overflow Urge Stress Functional

STRESS

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 - Stress incontinence is associated with a raise in intra-abdominal pressure related to activities such as sneezing, coughing, or laughing. 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 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. Catheterization is necessary for 1 week. A urinary tract infection results from the birth process.

THE BIRTH CAN CAUSE PERINEAL SWELLING -Trauma from vaginal birth causes swelling in the perineal area, which can obstruct the flow of urine and cause urinary retention during the early postpartum period.

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 nurse failed to deflate the retention balloon after pretesting it for integrity. -The client has an enlarged prostate. -The client has an occult abscess in the urethra. -The diameter of the catheter is too large.

THE CLIENT HAS AN ENLARGED PROSTATE -Enlargement of the prostate gland is commonly seen in men over age 50 and may interfere with urinary catheterization. The client does not have an occult abscess in the urethra as the nurse was able to pass some of the catheter and then had resistance. The resistance is not caused by the balloon as this inflation had not occurred. The diameter of the catheter is not too large.

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 on a low protein diet. The client is lactose intolerant. The client has a history of osteoarthritis. The client is dehydrated.

THE CLIENT IS DEHYDRATED

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. The client is on a low protein diet. The client is lactose intolerant. The client has a history of osteoarthritis.

THE CLIENT IS DEHYDRATED -The BUN test measures the amount of urea nitrogen in the blood. Urea, the major nitrogenous end-waste product of metabolism, is formed in the liver. The bloodstream carries urea from the liver to the kidneys for excretion. When the kidneys are diseased, they are unable to excrete urea adequately, and urea begins to accumulate in the blood, causing BUN to rise. Normal BUN is 8 to 25 mg/100 mL. Because other factors, such as high dietary intake of protein, fluid deficit, infection, gout, or excessive breakdown of protein stores, can also elevate BUN, it is not a highly sensitive indicator of impaired renal function.

Use of an indwelling urinary catheter leads to the loss of bladder tone. True False

TRUE

Use of an indwelling urinary catheter leads to the loss of bladder tone. True False

TRUE -People with indwelling urinary catheters lose bladder tone because the bladder muscle is not being stretched by the bladder filling with urine. During prolonged periods of immobility, decreased bladder and sphincter tone can result in poor urinary control and urinary stasis. Other causes of decreased muscle tone include childbearing, muscle atrophy due to decreased estrogen levels as seen with menopause, and damage to muscles from trauma.

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. -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.

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? Perform hand hygiene between cleansing the woman's labia and inserting the catheter. Use her left hand to spread the woman's labia and keep them spread until the catheter is inserted. Grasp a cotton ball with forceps in her left hand and spread the woman's labia with her right hand. Insert the catheter with her left hand while supporting the woman with her right hand.

Use her left hand to spread the woman's labia and keep them spread until the catheter is -Using the thumb and one finger of the nondominant hand, the nurse should spread the client's labia and identify the meatus. The nurse should be prepared to maintain separation of labia with one hand until the catheter is inserted and urine is flowing well and continuously. The nurse does not let go of the labia to perform hand hygiene after cleansing. The catheter is inserted with the dominant hand.

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? 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. 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.

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. 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. Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. 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. - 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 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? Collect a urine specimen from the collection bag first thing in the morning, or a few hours after the client receives a diuretic. Empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag. Withdraw several milliliters of urine from the port on the collection tubing, using aseptic technique. Discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen.

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

A nurse collects a clean-catch specimen from a client at a health care facility. Which statement describes a clean-catch urine sample? a sample of urine that is considered sterile a sample of urine collected over a period of 24 hours a sample of urine collected in a sterile environment a sample of fresh urine collected in a clean container

a sample of urine that is considered sterile -A clean-catch specimen is a sample of urine that is considered sterile. A clean-catch specimen is preferred to a randomly voided specimen. This method of collection is preferred when a urine specimen is needed during a client's menstrual cycle. A void specimen is a sample of fresh urine collected in a clean container. A catheter specimen is a sample of urine collected in a sterile environment using a catheter. A 24-hour specimen is a sample of urine collected over a 24-hour period

A client states that urinary incontinence has become a problem and asks the nurse how to help control or alleviate this problem. Which statement by the nurse would be accurate? "Coffee and diet sodas are not factors with being incontinent of urine." "You need to decrease your daily fluid intake to help with this." "Performing Kegel exercises can help with muscle strengthening." "It is best to have a Foley catheter inserted to prevent incontinence."

"Performing Kegel exercises can help with muscle strengthening." -The client with urinary incontinence may benefit from performing Kegel exercises several times daily to help tone pelvic floor muscles. The client would want to avoid caffeine, alcohol, and artificial sweeteners, as these increase the risk of incontinence. The daily recommended fluid intake would be 1500 to 2000 mL to prevent dehydration; fluid intake may be limited at night to decrease nocturia. A Foley catheter would not be routinely placed for this, but would instead be a last resort for incontinence.