EAQ Ch. 46 - Urinary Elimination and the Nursing Process

Alcohol is a bladder irritant. It increases urine production and causes uncontrolled bladder contractions

Yes

The nurse takes an order to obtain a post-void residual for a patient via catheterization. Which is the best method to obtain this measurement? 1 Intermittent catheterization 2 Long-term indwelling catheterization 3 Short-term indwelling catheterization 4 Medium-term indwelling catheterization

1 Intermittent catheterization Intermittent catheterization is used when evaluating the residual urine following urination. The investigation requires measurement of urine remaining in the bladder after voiding. Intermittent catheterization prevents the risk of infection. Long-term catheterization is done in patients with urinary retention. It may also be done for patients with recurrent episodes of urinary infections, skin breakdown, and terminal illness. Short-term catheterization is required for obstructive conditions, surgical repair of bladder and urethra, prevention of urethral obstruction, and bladder irrigation. There is no such thing as medium-term indwelling catheterization.

What instructions regarding bladder training should be included in the teaching plan for the family of a patient who is incontinent because of a stroke? 1 "Use an indwelling catheter at night to prevent accidents." 2 "Offer the patient the commode or urinal every 2 hours." 3 "Decrease the patient's oral fluid intake to 1 L per day." 4 "Instruct the patient to hold the urine as long as possible to restore bladder tone."

2 "Offer the patient the commode or urinal every 2 hours." To begin a bladder-training program, the nurse should teach the family to offer the patient the commode, bedpan, or urinal every 2 hours. Making this offer frequently enough prevents accidents and establishes a routine. Using an indwelling catheter in a home setting increases the possibility of trauma or infections to the urethra and bladder. Decreasing the patient's fluid intake could cause secondary complications of dehydration and electrolyte imbalance. The patient is incontinent so is unable to hold the urine.

The nurse notes that the patient's indwelling catheter bag has been empty for 4 hours. What is the priority action? 1 Irrigate the indwelling catheter. 2 Check for kinks in the tubing. 3 Notify the health care provider. 4 Assess the patient's intake

2 Check for kinks in the tubing. Kinks in tubing prevent flow of urine. To keep the drainage system patent, check for kinks or bends in the tubing.

A nurse is caring for a patient with an indwelling catheter. Which nursing action may increase the risk for a catheter-associated urinary tract infection? 1 Collecting specimens via a port in the tubing 2 Keeping the drainage bag above the level of the bladder 3 Allowing the patient to wear a leg bag while ambulating 4 Monitoring the drainage system to prevent backflow of urine

2 Keeping the drainage bag above the level of the bladder An indwelling catheter is attached to a urinary drainage bag to collect the continuous flow of urine. The nurse should always keep the drainage bag below the level of the patient's bladder to allow urine to drain down out of the bladder, because pooling of urine in the tubing may increase the risk of a catheter-associated urinary tract infection. Urine specimens for laboratory examinations should be collected via a special port in the tubing. The nurse should ensure that the urinary drainage bag does not touch the ground; patients may be allowed to wear a leg bag while ambulating. Backflow of urine from the tubing and bag into the bladder increases the risk of catheter-associated urinary tract infection; therefore, the nurse should monitor the system to prevent such an occurrence.

A patient tells a nurse, "I lose small amounts of urine while coughing, laughing, exercising, and walking but not at night while sleeping." Which of the nurse's responses is most appropriate? 1 "You may require intermittent catheterization." 2 "You should avoid caffeine, artificial sweeteners, and alcohol." 3 "I'll teach you pelvic muscle exercises that you can perform regularly to address the problem." 4 "You can perform urge-inhibition exercises to obtain relief from symptoms of urinary incontinence.

3 "I'll teach you pelvic muscle exercises that you can perform regularly to address the problem." Loss of a small volume of urine while coughing, laughing, exercising, and walking but not at night while sleeping, is characteristic of stress incontinence. This type of incontinence can be managed with pelvic muscle exercises. Overflow incontinence is associated with chronic retention of urine, and patients with this type of incontinence may require intermittent catheterization. Patients with urge incontinence may be instructed to avoid bladder irritants such as caffeine, artificial sweeteners, and alcohol. Urge-inhibition exercises may also help relieve symptoms associated with urge incontinence, not stress incontinence.

Which patient is most likely to exhibit symptoms such as dysuria, urgency, frequency, and nocturia? 1 A patient with kidney failure 2 A patient receiving diuretic therapy 3 A patient with a urinary tract infection 4 A patient with uncontrolled diabetes mellitus

3 A patient with a urinary tract infection Dysuria, urgency, frequency, and nocturia are symptoms that may be exhibited by patients with urinary tract infections. A patient with kidney failure may experience oliguria. Patients receiving diuretic therapy and those with uncontrolled diabetes mellitus may exhibit polyuria.

What should the nurse include in the plan of care for a patient with urge urinary continence? 1 Helping the patient learn efficient and safe toilet transfers 2 Helping the patient with leg-strengthening exercises 3 Helping the patient strengthen the pelvic floor muscles and learn fluid and food modifications 4 Helping the patient obtain assistive devices for the home that are covered by insurance

3 Helping the patient strengthen the pelvic floor muscles and learn fluid and food modifications While caring for a patient with urge urinary continence, the nurse should help the patient strengthen the pelvic floor muscles, learn techniques to inhibit the urinary urge, and learn fluid and food modifications. The other actions are the responsibilities of other health care professionals. It is the responsibility of an occupational therapist to help the patient learn efficient and safe toilet transfers. It is the responsibility of a physical therapist to help the patient with leg-strengthening exercises. A social worker should help the patient obtain assistive devices for the home that are covered by insurance.

A nurse is caring for an elderly patient who is receiving treatment for urinary incontinence. After reviewing the patient's prescription, the nurse knows to observe the patient for cognitive impairment. Which medication is the patient most likely taking? 1 Atropine 2 Diuretics 3 Oxybutynin 4 Phenazopyridine

3 Oxybutynin Antimuscarinic agents such as oxybutynin are used to treat different types of urinary incontinence. These drugs may cause cognitive impairment in older adults. Anticholinergics, such as atropine, inhibit bladder contractility, thereby increasing the risk for urinary retention. Diuretics increase urinary output by preventing the resorption of water and certain electrolytes. Phenazopyridine is a urinary analgesic that may be prescribed to patients with painful urination associated with urinary tract infections; patients who take drugs with phenazopyridine will void orange urine.

Which intervention is most appropriate for a patient with functional urinary incontinence? 1 Insert an indwelling catheter. 2 Increase fluid intake to flush the kidneys. 3 Provide normal fluid intake and establish a toilet schedule. 4 Restrict fluid intake to decrease the episodes of incontinence

3 Provide normal fluid intake and establish a toilet schedule. For physiological health, a patient must maintain normal fluid intake. A toileting schedule based on the patient's elimination patterns can help reduce episodes of incontinence. Catheters are used as a last choice, because of the potential for infection and body self-image issues. Fluid intake should be kept at normal levels; there is no need to increase it. Restricting the fluid intake may cause dehydration.

While caring for a female patient with altered urinary elimination, the nurse instructs the patient to assume a squatting position when voiding. What is the reason behind this recommendation? 1 To prevent infections 2 To promote normal micturition 3 To promote complete bladder emptying 4 To help relieve stress urinary incontinence

3 To promote complete bladder emptying The squatting position facilitates complete bladder emptying in female patients. To prevent infections, the nurse promotes adequate fluid intake and perineal hygiene and instructs patients to void at regular intervals. To promote normal micturition, the nurse may instruct the patient to drink adequate amounts of fluid. To help relieve stress urinary incontinence, the nurse may provide pelvic muscle training.

A nurse is assessing the severity of a patient's urinary elimination problem. Which question is most appropriate? 1 "Does your urinary problem restrict you from doing your usual activities?" 2 "Do you dribble urine before voiding, after voiding, or at other times?" 3 "Have you been hospitalized or have you received a diagnosis of a new medical problem recently?" 4 "How often are you awakened with the urge to void while you are sleeping?"

4 "How often are you awakened with the urge to void while you are sleeping?" To assess the severity of a patient's urinary elimination problem, the nurse may ask the patient about the frequency of being awakened at night with the urge to void. To assess the effects of the patient's urinary elimination problem, the nurse may ask whether the urinary problem interferes with the patient's usual activities. To assess signs and symptoms, the nurse may ask whether the patient dribbles urine before voiding, after voiding, or at other times. To determine any predisposing factors, the nurse may ask whether the patient recently has been hospitalized or received a diagnosis of a new medical problem.

Which of a student nurse's statements regarding urinary incontinence requires correction? 1 "Urinary incontinence is common in older adults." 2 "Urge incontinence and stress incontinence are common forms of urinary incontinence." 3 "Urinary incontinence is characterized by any involuntary loss of urine." 4 "Mixed incontinence is a combination of stress and functional incontinence."

4 "Mixed incontinence is a combination of stress and functional incontinence." Mixed incontinence is a combination of stress and urge, not functional, incontinence. Urinary incontinence is common in older adults. Urge incontinence and stress incontinence are common forms of urinary incontinence that are characterized by any involuntary loss of urine.

A nurse is assisting the primary health care provider in assessing a patient with altered urinary elimination. After assessing the patient, the primary health care provider suspects that the patient has an obstruction of the ureters. Which diagnostic test does the nurse expect the patient to undergo? 1 Cystoscopy 2 Abdominal roentgenogram 3 Ultrasound of the urinary bladder 4 Axial computed tomographic scan

4 Axial computed tomographic scan An axial computed tomographic scan is commonly used to identify anatomic abnormalities, renal tumors and cysts, calculi, and obstruction of the ureters. Cystoscopy is an invasive procedure used to detect bladder tumors and obstruction of the bladder outlet and urethra. An abdominal roentgenogram is commonly ordered to detect and measure the size of urinary calculi. An ultrasound scan of the urinary bladder is helpful in the measurement of the post void residual volume.

A patient is being assessed for a possible urinary tract infection (UTI). Before sending a urinalysis specimen to the laboratory, the nurse collects a small amount of urine to perform a dipstick test. If the patient has a UTI, which component should be detected in the urine? 1 Protein 2 Glucose 3 Ketones 4 Leukocytes

4 Leukocytes A dipstick test is performed in the healthcare provider's office to test for different components. In this case, the health care provider tests white blood cells, or leukocytes, which indicate an infection. Protein is detected in patients with nephropathy. Glucose is detected in patients with diabetes mellitus. Ketones are detected in patients with poorly controlled diabetes, starvation, and dehydration.

The patient is incontinent, and a condom catheter is placed. Which action should the nurse take? 1 Shave the pubic area prior to application. 2 Ensure foreskin is in retracted position. 3 Assess the patient for skin irritation. 4 Use sterile technique for placement

Assess Patient for skin irritation The nurse should assess the patient for skin irritation, which can occur when the condom is twisted at the drainage tube attachment and obstructs urine drainage. Skin should not be shaved prior to condom application; however, hair can be clipped at the base of the penis as necessary. If patient is uncircumcised, ensure that the foreskin is in the normal nonretracted position. Hand hygiene and glove application is adequate for this procedure.