PrepU ch. 36: Urinary Elimination

Several of the clients on a geriatric subacute medicine unit are experiencing urinary incontinence from differing causes. Which statement suggests that the client requires further education?

"I make sure to limit how much I drink so that I don't have accidents."

A nurse is caring for a client who is catheterized following a surgery of the prostate. When caring for the client, the nurse performs a continuous irrigation of the catheter. Which of the following interventions should the nurse perform when providing continuous irrigation?

Prime the tubing with the solution

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 of the following would the nurse document as an abnormal finding?

Reddened perineal skin

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine?

24-hour specimen

The doctor has ordered the collection of a fresh urine sample for a particular examination. Which urine sample would the nurse discard?

The first voiding of the day

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

Contact the health care provider to decrease furosemide.

What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence?

It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.

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

Anuria

The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises will the nurse include?

Keep muscles contracted for at least 10 seconds

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

Blood

Which is true regarding the normal urination?

Catheterized clients should drain a minimum of 30 mL of urine per hour.

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

Check health record for provider's order

A client could experience increased urination when using which classification of medication?

Cholinergic agents

The nurse is preparing to insert an indwelling urinary catheter into a female client's bladder. The nurse has opened the sterile catheterization tray using sterile technique, donned sterile gloves and has opened all sterile supplies. Arrange the following steps in the correct order.

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

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?

Dark brown, cloudy

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

The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate?

Dehydration

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

Diabetes insipidus

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

Discard your first urine and begin the collection after that

The nurse is caring for a client with urinary incontinence who has a prescription for a postvoid residual (PVR) collection. 45 mL of amber urine is returned via PVR. Which appropriate action would the nurse take with this data collection?

Document the finding

The nursing assistant reports that a client on furosemide has voided 2000 mL in a 24-hour period. What is the appropriate nursing action?

Document the finding as normal.

a urinalysis has been ordered for a client. When is the best time for the client to provide a sample?

First thing in the morning

A client reports that he is often unable to retain urine until he locates a toilet because his mobility is decreased. The nurse should recognize the characteristics of what type of incontinence?

Functional

A male patient is being transferred to the hospital from a long-term care facility with a diagnosis of dehydration and urinary bladder infection. His skin is also excoriated from urinary incontinence. Which nursing diagnosis is most appropriate for this patient?

Impaired skin integrity related to urinary bladder infection and dehydration

A nurse drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance?

Intermittent urethral catheter

The nurse is attempting to insert a urinary catheter into a female client's bladder and realize the catheter has been inserted into the vagina. Which action is most appropriate?

Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.

A client is suspected of having a disease process affecting the functional unit of the kidney. Which structure is most likely involved?

Nephron

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

Neurogenic bladder

Which statement should be included in the nurse's education plan for older adults regarding urinary elimination?

Nocturia and urinary retention are more common in older adults

Three days post-surgery for breast reconstruction, the nurse assesses that the client is ambulating several times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action? Select all that apply.

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

A client who had an open hysterectomy 2 days ago is ambulating around the unit four times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action?

Request an order for catheter discontinuation from the health care provider.

A nurse is caring for an elderly client who has been prescribed a condom catheter. What potential problems related to the use of 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

Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)?

Straight catheter

The nurse is caring for a client who has been experiencing nausea, vomiting, and diarrhea for 3 days. Which urine characteristics does the nurse anticipate?

Strongly aromatic, dark amber

What is the micturition reflex?

The act of bladder contraction and perceived need to void.

Which is not true of urine color?

The appearance of urine streaked with blood is always abnormal

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

The nurse is providing education to a client who is being discharged to home with an indwelling urinary catheter in place. What information is important for the nurse to discuss with the client?

The catheter can be connected to a smaller leg bag for ambulation.

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.

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 nurse is teaching a client how to perform pelvic floor muscle exercises (Kegel exercises). Which teaching will the nurse include?

Tighten the internal muscles used to prevent or interrupt urination

The school nurse is caring for a student who experienced a seizure in the classroom. The student was noted to lose a large amount of urine during the seizure. Which type of incontinence does the nurse anticipate the client may have experienced?

Total

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

True

The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice?

Urinal

An infant is born with spina bifida. She may have:

alterations in urinary elimination

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?

dorsal recumbent

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

one or both of the ureters are surgically implanted elsewhere