Chapter 43

1. The nurse is caring for a man diagnosed with prostatitis. What symptom should the nurse expect when collecting data from the patient? a. Dysuria b. Polyuria c. Hematuria d. Glycosuria

1. ANS: A The most common symptoms are the same ones that occur with any urinary tract infection (UTI): complaints of urgency, frequency, hesitancy, and dysuria. Because of the location and role of the prostate gland, the patient may complain of low back, perineal, and post-ejaculation pain; he may also have a fever and chills. B. D. Polyuria and glycosuria are symptoms of diabetes mellitus. C. Hematuria is not common with prostatitis but may signal a more serious disorder.

10. A patient is discharged home after a prostatectomy. Two days later, he calls the nurse and says his bleeding has increased. The nurse asks what he has been doing since discharge. Which activity reported by the patient indicates the need for teaching by the nurse? a. The patient took an opioid for pain. b. The patient raked leaves in the yard. c. The patient took a walk around the block. d. The patient has been sitting in a recliner watching television.

10. ANS: B Activity can increase bleeding, and raking is strenuous. A. C. D. Sitting, walking, and taking an opioid should not increase bleeding.

11. The nurse is assisting with teaching a patient who will be discharged with a catheter after a prostatectomy. Which patient statement indicates the need for further teaching? a. I should call you if the bleeding increases. b. I need to wash around the meatus with soap and water each day. c. I should keep the drainage bag below the level of my bladder at all times. d. Applying antibiotic ointment to the meatus twice a day will prevent skin breakdown.

11. ANS: D B. The meatus should be washed with soap and water, but antibiotic ointment is usually not necessary. C. The bag must be kept below the level of the bladder to prevent return of urine to the bladder, which may increase risk of infection. A. Bleeding should be reported.

12. A male client comes into the emergency department experiencing a painful prolonged erection. What term should the nurse use to document this patients problem? a. Orchitis b. Priapism c. Paraphimosis d. Peyronies disease

12. ANS: B Priapism is a painful erection that lasts too long. D. Peyronies disease often gives the penis a curved or crooked look when it is erect. D. Paraphimosis occurs when the uncircumcised foreskin is pulled back, during intercourse or bathing, and not immediately replaced in a forward position. This causes constriction of the dorsal veins, which leads to edema and pain. A. Orchitis is a rare inflammation or infection of the testes.

13. The nurse is bathing an older male patient who has never been circumcised. What is proper care of the uncircumcised penis? a. Do not retract the foreskin; leave it in its natural position at all times. b. Use alcohol and a cotton swab to clean gently underneath the foreskin. c. Retract the foreskin, wash with soap and water, and replace the foreskin to its original position. d. Retract the foreskin, wash with soap and water, and leave the foreskin retracted to prevent collection of debris.

13. ANS: C Care of the male patient who has never been circumcised includes pulling the foreskin back carefully, wash with mild soap and water, and replace the foreskin to its normal position. D. Leaving the foreskin retracted can impair circulation. A. It must be retracted for adequate hygiene and then replaced. B. Alcohol is not necessary and may be irritating.

14. A patient is diagnosed with excessive fluid in the scrotal sac. What term should the nurse use when discussing the health problem with the patient? a. Orchitis b. Hydrocele c. Varicocele d. Epididymitis

14. ANS: B A hydrocele is a collection of fluid in the scrotal sac. D. Epididymitis is inflammation or infection of the epididymis that may be caused by bacteria, viruses, parasites, chemicals, or trauma. C. A varicocele is a condition sometimes called varicose veins of the scrotum. A. Orchitis is a rare inflammation or infection of the testes.

15. The nurse is providing care for a patient admitted with epididymitis. Which intervention is most appropriate? a. Frequent ambulation b. Pressure to the scrotum c. Elevation of the scrotum d. Warm packs to the scrotum

15. ANS: C Depending on the severity of the pain, the patient may be placed on bedrest with the scrotum elevated, possibly on ice packs, and also given analgesics. B. Pressure would increase pain. A. Ambulation might be painful. D. Warm packs will not reduce the pain of the health problem

16. A 30-year-old male patient has just received a diagnosis of testicular cancer. He appears sad and states, I always wanted to have children. Now it will be impossible. What nursing intervention would be most helpful? a. Contact pastoral care to counsel the patient. b. Provide the patient with literature about adoption. c. Inform the patient that children will be out of the question. d. Tell the patient that it may be possible to deposit sperm in a sperm bank before treatment is begun.

16. ANS: D If a diagnosis of cancer has been made, provide emotional support for the patient. If the patient wants to have children, he should be encouraged to make deposits in a sperm bank before any surgery or treatment is started. A. Pastoral care may be helpful if the patient wishes, but they will not be able to inform the patient about sperm bank donations. B. Providing adoption literature is inappropriate at this time. C. Having children is possible even with the diagnosis of testicular cancer.

17. The nurse is teaching a male patient the early warning signs of testicular cancer. What should this instruction include? a. Skin of scrotal sac red in color b. Small painless lump on the testicle c. Presence of rugae on the scrotal sac d. Skin of scrotal sac cooler in temperature

17. ANS: B Early warning signs of cancer can include a small, usually painless lump on the testicle. The patient may also notice that the scrotum is swollen and feels heavy. Some tumors produce hormones that cause breast enlargement and tenderness. A. The skin of the scrotal sac is not red in color with testicular cancer. C. D. Rugae on the scrotal sac and cooler in temperature are normal findings.

18. A male patient is experiencing erectile dysfunction. For which medication classification should the nurse assess if the patient is prescribed? a. NSAIDs b. Antibiotics c. Antidiabetics d. Antihypertensives

18. ANS: D Antihypertensive agents often affect the autonomic nervous system and affect erection. A, B, C, Antibiotics, antidiabetics, and NSAIDs do not commonly cause erectile dysfunction.

19. A patient has just received a new prescription for a transurethral suppository for erectile dysfunction. What instructions should the nurse provide about this medication? a. Urinate before you insert the suppository into your urethra. b. Remove the suppository after you are finished having intercourse. c. Lubricate the suppository well, and insert it into your rectum before intercourse. d. Insert the suppository into the urethra at least 2 hours before anticipated intercourse.

19. ANS: A The patient is instructed to urinate before use of the suppository. C. A tiny pellet (microsuppository) is inserted into the urethra using a specialized single-dose applicator. The medication usually begins to work in 5 to 10 minutes, and the effects last for approximately 30 to 60 minutes. D. Two hours is too long to insert before having intercourse. B. The suppository will be absorbed and is not removable.

2. The nurse is assisting with teaching a 56-year-old office manager who reports engaging in a variety of activities. Which one should the nurse explain most likely increased his risk for developing prostatitis? a. Sitting for long periods in his office b. Bowling once a week with the office team c. Drinking three to four martinis each night after work d. Having sexual intercourse with his wife once a week

2. ANS: C Ways to prevent the development of prostatitis are regular and complete emptying of the bladder to prevent urinary tract infection, avoiding excess alcohol, and avoiding certain high-risk sexual practices. A. Sitting may play a role in infertility but not necessarily prostatitis. D. Sexual intercourse with a spouse is not high risk. B. Bowling and other exercise are not risk factors.

20. A patient is using a suction device and penile ring to treat erectile dysfunction. What instructions must the patient receive to prevent tissue damage? a. Loosen the penile ring before having intercourse. b. Remove the penile ring as soon as an erection occurs. c. Remove the penile ring within 15 to 20 minutes of putting it on. d. Leave the penile ring on no more than an hour after intercourse.

20. ANS: C Suction devices are another nonsurgical treatment option. This is an external cylinder vacuum device that fits over the penis and draws the blood up into the corporeal bodies, causing an erection. A penile ring is then slipped onto the base of the penis. Once the cylinder is removed, sexual intercourse can begin. Special care must be taken to remove the penile ring within 15 to 20 minutes to prevent tissue damage. A. B. Removing or loosening the ring as soon as the erection occurs risks losing the erection. D. An hour can cause circulatory impairment and tissue damage.

21. The nurse is assisting with a urology clinic intake assessment on a patient who reports erectile dysfunction. He has tried several treatments without success. He states, Im pretty useless to my wife now. I might as well become a monk. Which nursing diagnosis should take priority in guiding the nurses care? a. Anxiety related to uncertain future b. Powerlessness related to inability to fulfill role functions c. Noncompliance related to use of treatments for erectile dysfunction d. Knowledge Deficit related to lack of knowledge about treatments for erectile dysfunction

21. ANS: B The patients comment shows powerlessness. A. C. D. There is no evidence of knowledge deficit, anxiety, or noncompliance in the data provided.

22. A male patient has infertility caused by an endocrine problem. For which type of problem should the nurse plan care for this patient? a. Testicular b. Pretesticular c. Post-testicular d. Chronic testicular

22. ANS: B Endocrine problems are pretesticular, because hormones affect testicular function. A. Testicular problems occur in the testes. C. Post-testicular problems are usually the result of surgery or injury along the pathway from the testes to the outside of the mans body. D. Chronic testicular is not a category of testicular health problems.

23. The nurse is assisting a 28-year-old man who is undergoing testing for infertility. He says, I cant believe I have to stop wearing tight jeans. What on earth could that have to do with anything? Which response by the nurse is best? a. Tight jeans do not cause infertility. That is an old wives tale. b. The pressure on your scrotum from tight jeans can damage your testes. c. Its not the tight jeans, but the way they make you sit that causes the problem. d. Tight jeans hold your scrotum too close to your body, where the heat can inhibit sperm production.

23. ANS: D Excessive use of hot tubs and saunas, wearing tight jeans, and long-haul truck driving have all been identified as raising the temperature level in the scrotum to the extent that sperm production is decreased. A. Tight jeans can affect fertility. B. Pressure on the scrotum from tight jeans is not identified as causing scrotal damage. C. Sitting in tight jeans is not the cause of infertility.

24. The nurse is reviewing the medical records for a couple who have been trying to conceive. How long must a couple attempt to conceive unsuccessfully before they are considered infertile? a. 1 year b. 2 years c. 3 months d. 6 months

24. ANS: A A couple is considered infertile if they have been unsuccessful at becoming pregnant after at least 1 year of unprotected intercourse. B. C. D. 2 years, 3 months or 6 months are inaccurate lengths of time that a couple needs to engage in unprotected intercourse before being identified as infertile.

33. The nurse is collecting a medication history from a man with erectile dysfunction. For what medication classes and lifestyle substances should the nurse assess because they can cause erectile dysfunction? (Select all that apply.) a. Alcohol b. Caffeine c. Antibiotics d. Antihistamines e. Beta-blocking agents f. Oral hypoglycemic agents

33. ANS: A, B, D, E Beta blockers, alcohol, antihistamines, and caffeine can all contribute to erectile dysfunction. C. F. Antibiotics and oral hypoglycemics do not; however, diabetes can contribute to the development of erectile dysfunction.

25. The nurse is caring for a patient in the emergency department in a hypertensive crisis. He states he stopped taking his blood pressure medicine because it made him impotent. What should be the nurses first response? a. No, it is a myth that blood pressure medications cause erectile dysfunction. You should see a urologist to look for other causes. b. You are right; blood pressure medications can cause erectile dysfunction. You should consider seeing a urologist for treatment. c. No, blood pressure medications do not usually cause erectile dysfunction; it is the high blood pressure that can cause the problem. You need to be careful to take your medications to keep it under control. d. Yes, blood pressure medications can cause erectile dysfunction, but there are many different classes of drugs for high blood pressure. Lets ask your physician what might work better for you.

25. ANS: D Some classes of medications for hypertension can cause erectile dysfunction. Some men have been known to stop taking their blood pressure medication and risk a stroke or heart attack because the medication interfered with their sexual activity. Talking with the physician about other options should take place first. A. B. If a change in medication does not help, then a referral to a urologist might be in order. C. High blood pressure does not cause erectile dysfunction.

26. A male patient has a curved penis. What term should the nurse use to document this observation? a. Priapism b. Phimosis c. Paraphimosis d. Peyronies disease

26. ANS: D Peyronies disease often gives the penis a curved or crooked look when it is erect. A. Priapism is a painful erection that lasts too long. B. Phimosis is the term used to describe a condition in which the foreskin of an uncircumcised male becomes so tight it is difficult or impossible to pull back, away from the head of the penis. C. Paraphimosis occurs when the uncircumcised foreskin is pulled back, during intercourse or bathing, and not immediately replaced in a forward position. This causes constriction of the dorsal veins, which leads to edema and pain.

27. The nurse is reviewing the male reproductive system with a couple being evaluated for infertility. What concentration of sperm should the nurse instruct this couple as being needed for normal conception to occur? a. 5 million sperm per mL of semen b. 10 million sperm per mL of semen c. 15 million sperm per mL of semen d. 20 million sperm per mL of semen

27. ANS: D A number of conditions must be present in the man for conception to occur. Normal healthy sperm in a concentration of at least 20 million per milliliter of semen are needed. A. B. C. Less than 20 million sperm per mL of semen would not support conception.

28. An older male patient is upset to learn about the diagnosis of benign prostatic hyperplasia. What should the nurse explain to the patient about this health problem? a. This health problem is a precursor to prostate cancer. b. 75% of men over the age of 70 have this health problem. c. 50% of men with this health problem need the prostate removed. d. 25% of men with this health problem will have erectile dysfunction.

28. ANS: B Enlargement of the prostate gland is a normal process in older men. It begins at about age 50 and happens in 75% of men older than age 70. A. This health problem does not lead to prostate cancer. C. D. Men with this health problem do not need to have the prostate gland removed and erectile dysfunction is not associated with this health problem.

29. The mother is upset to learn that her sons testes have not descended into the scrotum. At what age should the mother consider surgery for her sons health problem? a. 1 b. 2 c. 3 d. 4

29. ANS: A The testicles normally drop down (descend) into the scrotum in the last 1 to 2 months before the boy is born. Often, undescended testicles descend into the scrotum on their own in the first few months of life. If they do not descend by that time, surgery should be done to correct the problem, typically before age 1. B. C. D. Waiting to perform surgery after the age 1 increases the risk for infertility.

3. The nurse is caring for a patient with prostatitis. Which manifestation should the nurse attend to immediately? a. Shaking chills b. Inability to urinate c. Fever 101F (38.3C) d. Low back pain rated 9 on a 0-to-10 scale

3. ANS: B All of the symptoms provided are physiological, so the nurse needs to look at which could be life or health threatening. Inability to urinate could lead to a ruptured bladder or other serious complications and must be attended to first. A. C. D. Priorities after urination would include pain, fever, and chills.

30. The treatment provided to a patient with prostatitis is being evaluated. What information should the nurse use to determine that treatment has been successful? a. No evidence of erectile dysfunction b. Stabilized hemoglobin and hematocrit levels c. Clean catch urine specimen absent of bacteria d. Prostate specific antigen level within normal limits

30. ANS: C A clean urine culture with absence of all symptoms of prostatitis is the desired outcome. A. Erectile dysfunction is not associated with prostatitis. B. Hemoglobin and hematocrit levels are not affected by prostatitis. D. Prostate specific antigen is used to determine the presence of prostate cancer.

31. A patient is being treated for prostatitis. What instructions should the nurse provide to help this patient? (Select all that apply.) a. Avoid tub baths. b. Empty your bladder frequently. c. Avoid products that contain caffeine. d. Try to increase the amount of fiber in your diet. e. Increase your fluid intake to nearly 3000 mL/day. f. Take your antibiotics until your symptoms have completely resolved.

31. ANS: B, C, E B. Encourage the patient to empty his bladder every 2 to 3 hours even if he does not feel the urge to urinate. A. Sitz baths should be encouraged, not avoided. E. Fluids such as water and cranberry juice should be encouraged up to 2500 to 3000 mL per day unless contraindicated by heart failure or other chronic illness. C. Bladder irritants in the form of caffeine products (e.g., coffee, tea, cola, and chocolate), citrus juices, and alcohol should be taken in very limited amounts. D. Fiber does not affect urinary elimination. F. Antibiotics should always be taken until they are gone unless otherwise instructed by the physician.

32. The nurse is collecting admission data from a patient recently diagnosed with benign prostatic hyperplasia. Which symptoms should the nurse expect the patient to report? (Select all that apply.) a. Low back pain b. Dribbling after urination c. Difficulty initiating an erection d. Difficulty maintaining an erection e. Difficulty starting the urine stream

32. ANS: B, E Symptoms related to obstruction include decrease in the size or force of the urinary stream, difficulty in starting a stream, dribbling after urination is thought to be completed, urinary retention, and a feeling that the bladder is not empty. The patient may also experience overflow incontinence or an interrupted stream, where the urine stops midstream and then starts again. A. Pain may be related to cancer. C. D. Prostate hyperplasia does not affect erections.

34. A patient is prescribed tamsulosin (Flomax) for treatment of benign prostatic hypertrophy. What instructions should be provided to this patient? (Select all that apply.) a. Dizziness may occur. b. Chew or crush tablets. c. Avoid unnecessary sunlight. d. Avoid the use of heavy machinery. e. Dry mouth and gastrointestinal upset may occur. f. Be careful when going from a sitting to a standing position.

34. ANS: A, D, E, F Warn patients that dizziness may occur with onset of use, so be careful when moving to a standing position. Monitor blood pressure and pulse. Use caution with driving or use of heavy machinery. Dry mouth may occur. B. Do not crush or chew tablets. C. Sunlight does not affect tamsulosin.

35. The nurse is reviewing a patients prescribed medications. Which medications are used to treat cancer by suppressing or blocking testosterone? (Select all that apply.) a. Leuprolide (Lupron) b. Finasteride (Proscar) c. Dutasteride (Avodart) d. Diethylstilbesterol (DES) e. Goserelin (Zoladex)

35. ANS: A, D, E Leuprolide, goserelin, and DES suppress hormone function. B. C. Finasteride and dutasteride are alpha-reductase inhibitors that inhibit the enzyme responsible for formation of potent androgen from testosterone.

36. The nurse is providing care for a patient diagnosed with bacterial prostatitis who is being treated on an outpatient basis with oral antibiotic therapy. In addition to the medication, which interventions should the nurse include in discharge teaching? (Select all that apply.) a. Bedrest b. Stool softeners c. Warm sitz baths d. Anti-inflammatory agents e. Self-catheterization every 2 hours

36. ANS: B, C, D Acute bacterial prostatitis is usually treated medically with antibiotic therapy. Other forms of treatment may include anti-inflammatory agents, stool softeners, warm sitz baths, prostatic massage, and dietary changes, such as decreasing spicy foods and alcohol. A. E. Bedrest and self-catheterization are not necessary.

37. The nurse is assisting with the preparation of materials for a patient who is at risk for prostatitis. What should the nurse include in this teaching? (Select all that apply.) a. Practice safe sex b. Ensure good personal hygiene c. Avoid urinary catheterizations d. Avoid excessive intake of citrus juices e. Avoid excessive intake of animal products

37. ANS: A, B, C, D The nurse should teach the avoidance of risk factors such as urinary catheterization, poor hygiene, risky sexual practices, and excessive intake of bladder irritants such as alcohol, caffeine, or citrus juices. Avoiding risk factors is important to resolving or preventing prostatitis. E. Excessive intake of animal products is not a risk factor for prostatitis.

38. A male patient explains that manifestations of benign prostatic hyperplasia (BPH) have been occurring for several years. For which adverse effects of this health problem should the nurse consider when planning this patients caring? (Select all that apply.) a. Urosepsis b. Bladder cancer c. Renal insufficiency d. Evidence of hydronephrosis e. Recurrent urinary tract infections

38. ANS: A, C, D, E When BPH is untreated and obstruction is prolonged, serious complications can occur. Urine that sits in the bladder for too long can back up into the kidneys, causing hydronephrosis, renal insufficiency, or urosepsis; it can also damage the bladder walls, leading to bladder dysfunction and recurrent urinary tract infections. B. Bladder cancer is not an adverse effect of untreated benign prostatic hyperplasia.

39. The HCP suggests that a patient with benign prostatic hyperplasia have an invasive procedure to reduce the symptoms of the disorder. For which procedures should the nurse prepare materials for the patient? (Select all that apply.) a. Lithotripsy b. Prostatic stents c. Transurethral needle ablation d. Transurethral microwave therapy e. High intensity focused ultrasound

39. ANS: B, C, D, E Nonsurgical invasive treatments are available to help treat benign prostatic hyperplasia. These include transurethral microwave therapy (TUMT), which involves heat applied directly to the gland to inhibit growth, transurethral needle ablation (TUNA), and high intensity focused ultrasound (HIFU) which uses radio or sound waves to destroy parts of the gland. Prostatic stents may be used to open the passageway for urine to flow more freely. A. Lithotripsy is a procedure to break up kidney stones.

4. A patient diagnosed with benign prostatic hyperplasia is prescribed the alpha-blocking medication terazosin (Hytrin) to reduce symptoms. For which side effect should the nurse monitor this patient? a. Dry mouth b. Headaches c. Hypotension d. Urinary frequency

4. ANS: C Alpha-blocking medications dilate vessels, so the nurse should monitor the patient for hypotension. A. B. D. Headache, dry mouth, and urinary frequency are also possible but are not life or health threatening.

40. The nurse reviews care orders written by the HCP for a patient recovering from a transurethral resection of the prostate. These orders include bladder irrigation, antispasmodic medication, and intravenous antibiotics every 6 hours. For which potential complications are these orders specifically addressing? (Select all that apply.) a. Infection b. Blood clots c. Bladder spasms d. Urinary retention e. Nausea and vomiting

40. ANS: A, B, C Complications associated with prostate surgery depend on the type and extent of the procedure performed. The main medical complications include clot formation, bladder spasms, and infection. D. E. Bladder irrigation, antispasmodic medication and intravenous antibiotics are not prescribed to prevent urinary retention or nausea and vomiting.

5. A 70-year-old male arrives in the emergency department and says, I haven't urinated in 24 hours. I feel like I have to go, but I cant. What care should the nurse anticipate providing first? a. STAT administration of IV fluids b. Emergency preparation for a cystoscopy c. STAT insertion of an indwelling catheter d. Emergency preparation for an intravenous pyelogram (IVP)

5. ANS: C First, the patient must be assisted to empty his bladder to avoid rupture or other complications. A. IV fluids will further add to his need to urinate. B. D. Preparation for tests would wait until he is safe from immediate harm.

6. The nurse is providing pre-operative care for an 80-year-old patient who is scheduled to have prostate surgery. The patient says, I know a man who was impotent after this surgery. Will that happen to me? Which response by the nurse is most appropriate? a. There are many treatments available if it does occur. b. Most men your age learn to deal with erectile dysfunction if it does occur. c. Impotence should not be a problem; sperm production is not affected by this surgery. d. Some prostate surgery can cause erectile dysfunction. Ill ask your surgeon to explain the risks to you.

6. ANS: D Some types of prostate procedures can lead to erectile dysfunction. The physician needs to address this risk with the patient. A. B. C. It is inappropriate for the nurse to talk about treatments, because it is not known from the information given if the patient is having a high-risk procedure. There is no reason to alarm the patient unnecessarily.

7. A patient who has just returned from a transurethral resection of the prostate (TURP) asks the nurse why he needs a urinary catheter. What is the correct explanation? a. The catheter keeps your bladder empty to reduce risk for infection. It is important to leave it in for at least 72 hours. b. The catheter is keeping pressure on the area to prevent bleeding. We will remove it when the risk for bleeding has passed. c. We can take the catheter out when you are able to urinate on your own. Ill ask the physician if we can remove it later today. d. The catheter is being used to irrigate your bladder with antibiotics. It is important to continue this until you can take antibiotics orally.

7. ANS: B As the tissue is removed during TURP, bleeding occurs. A Foley catheter is left in place with 30 to 60 mL of sterile water inflating the balloon. The balloon is overfilled and may be secured tightly to the leg or abdomen to tamponade (compress) the prostate area and stop the bleeding. D. Irrigation solution generally flows continuously; manual irrigation may be done for the first 24 hours to help maintain catheter patency by removing clots and chips. C. The health care provider (HCP) will remove the Foley catheter after the danger of hemorrhage has passed. A. Antibiotics are not routine.

8. The nurse is caring for a patient with continuous bladder irrigation after a transurethral resection of the prostate (TURP). Which assessment finding should take priority? a. Pink-tinged urine b. 10-mL urine output in an hour c. Patient report of bladder spasms d. Leakage of small amounts of urine around the catheter

8. ANS: D 10 mL in an hour is not normal and signifies either a kidney problem or, more likely, an obstructed catheter. A, C, and D are all common after TURP and are easily treated.

9. The nurse has just removed an indwelling catheter from a patient following transurethral resection of the prostate. What action by the nurse is most important? a. Monitor vital signs. b. Watch for bladder spasms. c. Offer the urinal every 15 minutes. d. Collect serial samples of urine to monitor for color.

9. ANS: D Serial urine samples may be collected after the Foley catheter has been removed. To do this, each time the patient urinates, save some of the urine in a transparent cup, and make sure to line up the cups in order (usually on a shelf in the bathroom). This way the nurse or physician can see whether the urine is becoming progressively less bloody and clearer with each void. A. Vital signs are always important but are not specific to removing a catheter. B. Bladder spasms are more likely early while the catheter is in place. D. Offering the urinal every 15 minutes is not necessary.