Urinary Elimination
True or False: Use of an indwelling urinary catheter leads to the loss of bladder tone.
True
A woman informs the nurse that when she is experiencing stress it is difficult to void, and wonders why this happens. What is the nurse's best explanation? (a) "Stress causes the muscles to become tense." (b) "You require greater privacy to void." (c) "You might have a neurologic condition." (d) "What medications are you taking?"
a
When preparing to irrigate a Foley catheter, which is the appropriate initial nursing action? (a) Check health record for provider's order. (b) Gather equipment and supplies. (c) Assess urine characteristics. (d) Explain the procedure to the client.
a
A 75-year-old man was admitted to the hospital for altered mental status. He had been in his usual state of good health until this morning when a nurse at the long-term care facility where he lives noticed that he was confused. Shortly after being admitted to the hospital, he became combative and had to be restrained. His bed linens have to be changed frequently because of urinary incontinence. Which nursing diagnosis best describes this client's condition? (a) stress incontinence (b) urge urinary incontinence (c) functional incontinence (d) total urinary incontinence
c
A nurse is assessing a client who is complaining of difficulty urinating. Which assessment would be a priority? (a) Asking the client when he or she had last urinated (b) Determining any pain when palpating the lower abdomen (c) Palpating the bladder above the symphysis pubis (d) Obtaining the bladder scanner to check the urine volume
a
A client could experience increased urination when using which classification of medication? (a) Cholinergic agents (b) Analgesic medications (c) Central nervous system depressants (d) Stool softeners
a--Cholinergic agents stimulate the detrusor muscle, which causes more frequent urination.
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: (a) oliguria. (b) anuria. (c) nocturia. (d) polyuria.
a--Oliguria is a significant decrease in urine production.
The nurse measures a client's residual urine by catheterization after the client voids. Which condition would this test verify? (a) urinary tract infection (UTI) (b) urinary retention (c) urinary incontinence (d) urinary suppression
b
The nurse is reviewing the urinalysis of a client suspected of having a urinary tract infection. The potential diagnosis will be supported by the presence of: (a) protein. (b) calculi. (c) pus. (d) casts.
c
A client at the health care facility has been diagnosed with total urinary incontinence. How could the nurse describe the condition of the client? (a) loss of small amount of urine when intra-abdominal pressure rises (b) need to void is perceived frequently, with short-lived ability to sustain control of flow (c) loss of urine control because a toilet is not accessible (d) loss of urine without any identifiable pattern or warning
d
A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample? (a) before bedtime (b) afternoon (c) evening (d) first thing in the morning
d
An older adult woman tells the nurse that she has trouble controlling her urine. She states, "The urine starts dripping even before I feel like I have to go." The nurse interprets this as: (a) urge incontinence. (b) stress incontinence. (c) functional incontinence. (d) reflex incontinence.
d
A 57-year-old man is suffering from polyuria. What can cause polyuria? (a) diabetes insipidus (b) renal disease (c) urinary tract infection (d) renal calculi
a
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? (a) anuria (b) oliguria (c) nocturia (d) urinary retention
a
A client with frequent urinary tract infections (UTIs) has returned to the ambulatory clinic with symptoms of another UTI. Which information is essential for the nurse to review with the client as a strategy to decrease future risk of UTI? (a) Voiding before and after sexual intercourse (b) Wiping the perineal area from the rectal area to the urethra (c) Taking baths instead of showers (d) Wearing satin or silk underwear that hugs the skin tightly
a
A nurse is assisting a client with the use of a bedpan. The nurse understands that which statement about bedpans is true? (a) The largest part of a regular bedpan should be placed under the client's buttocks. (b) A regular bedpan is generally more comfortable for clients than a fracture bedpan. (c) A fracture bedpan is preferred for urination and a regular bedpan is preferred for defecation. (d) A fracture bedpan should be used only for clients who have fractures of the femur or lower spine.
a
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? (a) Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle. (b) Empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag. (c) Discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen. (d) Collect a urine specimen from the collection bag first thing in the morning, or a few hours after the client receives a diuretic.
a
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? (a) The birth can cause perineal swelling. (b) A neurogenic bladder results from local anesthesia. (c) A urinary tract infection results from the birth process. (d) Catheterization is necessary for 1 week.
a
The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate? (a) dehydration (b) hypovolemia (c) balanced fluids (d) renal failure
a
The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate? (a) cloudy, foul odor (b) light yellow, clear (c) clear, dark amber (d) strongly aromatic, amber
a
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: (a) deflate the balloon, insert the catheter further, and slowly attempt reinflation. (b) wait for 30 seconds, help the client to relax, and attempt inflation again. (c) stop, deflate the balloon, withdraw the catheter 0.75 to 1.5 in (2 to 4 cm), and slowly reinflate. (d) deflate the balloon, withdraw the catheter, and use a smaller sized catheter.
a
The nurse is preparing to catheterize a client who is incontinent of urine following bladder surgery. What fact should the nurse keep in mind when performing catheterization? (a) The bladder normally is a sterile cavity. (b) The external opening to the urethra should always be sterilized. (c) Pathogens introduced into the bladder remain in the bladder. (d) A normal bladder is as susceptible to infection as an injured one.
a
The nurse is teaching a client how to perform pelvic floor muscle exercises (Kegel exercises). Which teaching will the nurse include? (a) Tighten the internal muscles used to prevent or interrupt urination. (b) Keep muscles contracted for at least 30 seconds. (c) Relax muscles for at least 1 minute between contractions. (d) Perform these exercises 10 times daily for 1 month.
a
What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence? (a) It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. (b) The client can apply it himself with minimal supervision. (c) It can be left in place for a long period of time. (d) A sterile urine specimen can be obtained from the drainage bag tubing.
a
Which symptom will have a great impact on the extracellular fluid for water conservation? (a) Burns (b) Fracture (c) Small laceration (d) Pain
a
During a health history interview, a male client tells the nurse that he does not feel that he completely empties his bladder when he voids. The client has been diagnosed with an enlarged prostate. Which should the nurse include in the client education to encourage urination? Select all that apply. (a) Meditate while urinating (b) Do Kegel exercises 3 to 5 times per day (c) Try double voiding (d) Avoid antihistamines (e) Do not delay urination
a,b,c,d,e--Double voiding, urinating and then trying to go again a few moments later can be helpful. This will help to fully empty the bladder, lessen the feeling of constantly having to urinate, and maybe save another trip to the bathroom. The client should avoid antihistamines and decongestants. These medicines tighten the muscles around the urethra, making it harder to urinate.
Which assessment data, collected by the nurse, indicates that a client may have the nursing diagnosis of urge urinary incontinence? Select all that apply. (a) loses urine when a toilet is not readily available (b) urinates 20 times in 24 hours (c) wakes up to urinate at night, once weekly (d) experiences accidental loss of urine when there is an urgent need to urinate (e) can wait up to 30 minutes to urinate after the warning time
a,b,d
The nurse is caring for a client who had an arteriovenous (AV) graft surgically placed. The client is preparing for discharge. Which actions should the nurse teach the client to avoid? Select all that apply. (a) Having blood pressure measurements in the affected arm (b) Getting venipuncture in the affected arm (c) Getting an annual influenza vaccination (d) Carrying heavy items including purses or luggage with the affected arm (e) Sleeping with the affected arm under the head or body
a,b,d,e
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. (a) Contact the health care provider to ask for an order for catheter discontinuation. (b) Delegate catheter discontinuation to the Unlicensed Assistive Personnel (UAP). (c) Perform, or allow client to perform, perineal hygiene at least once daily. (d) Ensure that the drainage bag is above the level of the bladder at all times. (e) Discontinue to catheter and report this to the healthcare provider.
a,c
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. (a) Palpate for bladder distention. (b) Reposition the client in high-Fowler's position. (c) Check to make sure that the tubing is not kinked. (d) If return flow remains decreased, notify the health care provider. (e) Deflate and then reinflate the catheter balloon. (f) Remove the catheter.
a,c,d
A client in a long-term care facility becomes confused and disoriented at night and is incontinent during these periods of confusion due to the inability to find the commode. During the day, the client does not experience confusion and is continent. What type of incontinence is this client experiencing during the nighttime hours? (a) functional incontinence (b) transient incontinence (c) stress incontinence (d) reflex incontinence
a--Functional incontinence is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, or loss of memory or disorientation
A nurse is caring for a client with a hemodialysis access site. Which action should the nurse take? (a) Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration. (b) Administer an IV on the arm high above the access site. (c) Perform venipuncture below the access site to obtain a blood sample for laboratory testing. (d) Measure the client's blood pressure on the arm above the access site.
a--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.
A client admitted to the hospital with chronic renal failure suddenly develops the following signs and symptoms: left arm arteriovenous (AV) fistula has weak thrill and bruit; BP 88/40 mm Hg; stated feels dizzy. Which action would the nurse implement first? (a) Notify the primary care provider. (b) Change to supine position. (c) Instruct to not get out of bed. (d) Examine that clothing is not constrictive on arm.
b
A client has burning upon urination. The urinalysis indicates pyuria. Which is the next action the nurse will take? (a) Monitor vital signs (b) Contact the health care provider (c) Encourage fluids (d) Instruct on proper wiping technique
b
A parent asks the nurse when his 18-month-old daughter will be ready for toilet training. Which statement best answers the parent's question regarding toilet training? (a) "Your child will tell you when there is a sensation of bladder fullness." (b) "One signal of preparedness is when your child is dry for at least 2 hours." (c) "Your child should be at least 2 years old before you start toilet training." (d) "Girls typically take longer than boys to be ready for toilet training."
b
The health care provider has prescribed an indwelling catheter for a client. When the nurse explains the procedure, the client refuses to allow placement of the catheter. Which action should the nurse take? (a) Inform the client that the health care provider will be contacted. (b) Ask the client why he or she does not want a catheter. (c) Gather appropriate supplies to teach the client to perform straight catheterization. (d) Continue to place the indwelling catheter because it has been prescribed.
b
The nurse has an order to obtain a 24-hour urine specimen from a client. Which instruction would be accurate for collection of the specimen? (a) "Begin the collection when you first urinate in the morning." (b) "Discard your first urine and begin the collection after that." (c) "Start collecting the urine with the next time you urinate." (d) "You will need to have a catheter inserted for this collection."
b
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? (a) Cleansed access port with warm soap and water, syringe attached and aspirated 10 mL of urine and placed in specimen container. (b) Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. (c) 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. (d) Gathered supplies, checked prescription, collected urine from access port and notified health care provider at the completion of the procedure.
b
The nurse is caring for a client with weakness who is ambulatory but tires easily. Which method for urinary elimination does the nurse recommend? (a) fracture pan (b) bedside commode (c) bedpan (d) regular bathroom
b
The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises (Kegel exercises) will the nurse include? (a) Loosen the internal muscles used to prevent or interrupt urination. (b) Keep muscles contracted for at least 10 seconds. (c) Relax muscles for at least 5 minutes between Kegels. (d) Perform these exercises two times daily for a week.
b
Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence? (a) Incontinence after the age of 3 years is not normal. (b) Boys may take longer for daytime continence than girls. (c) Boys may walk by 1 year and should be continent by 3 years. (d) Daytime continence is usually not achieved by boys until age 5.
b
Which urinary care teaching will the nurse provide to a young adult female client? (a) Wipe from the back to the front. (b) Refrain from douching unless ordered by a health care provider. (c) If you do not feel like voiding, still strain to make sure the bladder is empty. (d) Drink water more frequently in the morning and evening to facilitate hydration.
b
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? (a) Moist perineal skin (b) Reddened perineal skin (c) Presence of smegma (d) Absence of discharge
b
When planning care for a client with a Foley catheter, which actions should the nurse include? Select all that apply. (a) Use powder or lotion in the perineal area. (b) Encourage fluid intake, unless contraindicated. (c) Record volume and character of the urine. (d) Maintain a closed urinary catheter system. (e) Change the indwelling catheter regularly.
b,c,d
The nurse is reviewing the chart of an older adult client who exhibits signs of confusion. Which laboratory value would indicate to the nurse that intervention is needed? (a) Blood urea nitrogen (BUN) - 7 mg/dL (19.6 mmol/L) (b) Urine culture sensitivity - 100,000/mL (c) Hemoglobin - 40% (0.40) (d) Magnesium - 2.5 mEq/L (2.5 mmol/L
b--100,000 organisms per milliliter in a urine culture and sensitivity specimen is positive of a urinary tract infection. BUN, hemoglobin, and magnesium are all within the normal ranges.
The nurse mentor is observing a novice nurse preparing to insert an indwelling catheter for a female client with urinary retention. The mentor would intervene if which action by the novice nurse is noted? (a) The novice nurse asks the client to take a deep breath when resistance was met during insertion of the catheter. (b) The novice nurse selects an 18 French Foley catheter to insert. (c) The novice nurse places a trash receptacle within easy reach. (d) The novice nurse assists the client to a dorsal recumbent position with knees flexed, feet about 2 ft (0.6 m) apart.
b--A 14F to 16F catheter should be used when catheterizing an adult client
A nurse is preparing to measure a client's urine output. Which interventions would be of highest priority? (a) Using an appropriate measuring container (b) Wearing gloves when handling the urine (c) Measuring the urine container at eye level (d) Noting the color and clarity of the urine
b--All of these interventions would be important to ensure safety in handling the client's urine and obtaining an accurate output. However, safety with handling body fluids would be a priority for the nurse to decrease risk of exposure to pathogens or blood that may be in the client's urine.
A client reports an episode of losing control of urination when a bathroom wasn't close by. The client states, "I'm worried this means that I'm starting to lose control of my bladder." What is the appropriate nursing response? (a) "I agree; please make an appointment with your health care provider." (b) "This only happened one time, so it is nothing to worry about." (c) "Let's review your medication history and whether you consume bladder irritants." (d) "I suggest that you invest in incontinence undergarments."
c
A client with an emergently placed central venous catheter (CVC) is to have emergent hemodialysis. Upon assessment of the CVC the nurse visualizes redness, drainage, and odor to the area around the CVC. Palpation of the surrounding skin causes the client pain. Which intervention is the priority? (a) Checking for blood return in the CVC (b) Placing the client as N.P.O. status (c) Notifying the health care provider of the assessment findings (d) Obtaining laboratory studies
c
A male client 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 client? (a) Impaired Skin Integrity related to functional incontinence (b) Urinary Incontinence related to urinary tract infection (c) Impaired Skin Integrity related to urinary bladder infection and dehydration (d) Risk for Urinary Tract Infection related to dehydration
c
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? (a) This urinary diversion is only temporary. (b) The client will need to change the urinary pouch every 4 hours. (c) The client will have to wear an external appliance to collect urine. (d) Urination can be voluntarily controlled after the stoma heals from the initial surgery.
c
A nurse is caring for a client with an external condom catheter. Which guideline should be implemented when applying and caring for this type of catheter? (a) Remove the catheter every 8 hours, or more often in humid weather. (b) Wipe the penis thoroughly with an alcohol swab and dry thoroughly before application. (c) Fasten the condom securely enough to prevent leakage without constricting blood flow. (d) Ensure the tip of the tubing is touching the tip of the client's penis.
c
The nurse educator is presenting a lecture on clients at risk for developing urinary tract infections (UTIs). Which response made by the staff nurse would indicate to the educator a need for further teaching? (a) "A woman using an intrauterine device for contraceptive reason is at risk for developing a UTI." (b) "I will make sure to teach my clients with diabetes mellitus to control their glucose level to help prevent a UTI." (c) "Having sexual relationships does not put a woman at risk for developing a UTI." (d) "Due to the physiologic changes with aging, the elderly are at risk for developing a UTI."
c
The nurse is caring for a client with concerns of urinary incontinence. A review of the client's data collection reveals the client has a history of spinal surgery and states, "I urinate all the time and cannot predict when I will urinate." This data collection would suggest to the nurse that this client is experiencing which type of urinary incontinence? (a) Stress incontinence (b) Functional incontinence (c) Total incontinence (d) Overflow incontinence
c
The nurse is caring for a hospitalized 3-year-old child. The mother expresses concern, stating, "My child was toilet trained for three months. Since being here, she is no longer toilet trained. I cannot understand this." What appropriate response would the nurse provide to the mother? (a) "It is unusual for a child this age to be toilet trained." (b) "Since she is so young, you can retrain her again when she gets home." (c) "It is not unusual for children to regress when hospitalized; it should be short lived." (d) "Since she is wetting her underwear, she probably was not fully toilet trained yet."
c
The nurse is caring for an older adult client suspected of having a urinary tract infection. The nurse should assess for what finding specifically associated with the development of this condition in the older adult? (a) High fever (b) Dysuria (c) Acute confusion (d) Nausea
c
The nurse is collecting a clean-catch specimen from a client. Which nursing action is performed correctly in this procedure? (a) Don sterile gloves (b) Collect the first 10 mL of urine voided in the sterile specimen container. (c) Position the container near the meatus, and collect at least 10 mL of urine. (d) Continue collecting the urine in the container until the bladder is empty.
c
The nurse is performing a portable bladder ultrasound on a client who has palpable bladder distention. The scanner reveals little urine in the bladder. What should the nurse do next? (a) Have the client drink 8 ounces of water every 15 minutes for 1 hour. (b) Wipe off some of the ultrasound gel and rescan. (c) Ensure proper positioning of the scanner head and rescan. (d) Place the client on either side and rescan.
c
A female client is diagnosed with recurrent urinary tract infections (UTIs) and the nurse is providing education about preventative methods. What information is important for the nurse to give to the client to prevent another UTI? Select all that apply. (a) Dry the perineal area after urination or defecation from the back to the front. (b) Take baths instead of showers. (c) Drink two 8-oz glasses (480 mL) of water before and after sexual intercourse and void immediately after intercourse. (d) Wear underwear with a cotton crotch. (e) Avoid clothing that is tight and restrictive on the lower half of the body.
c,d,e
A 70-year-old client confides to the nurse that she is "terribly embarrassed" that she has developed urinary incontinence over the past year. Which nursing response supports the client's self-esteem? (a) "It would be best just to get some adult diapers." (b) "Let me refer you to a urologist who can help you." (c) "Don't worry, this is a normal condition for older adults." (d) "Let's explore structuring activities and toileting breaks."
d
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? (a) inability to control either urinary or bowel elimination (b) hygiene measures used to keep meatus and adjacent area of the catheter clean (c) use of a catheter to collect urine in a sterile environment (d) one or both of the ureters are surgically implanted elsewhere
d
A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a: (a) cystocele. (b) enuresis. (c) overactive bladder. (d) neurogenic bladder.
d
A client reports to the nurse that after delivering a baby, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate? (a) urge (b) total (c) reflex (d) stress
d
The health care provider has prescribed an indwelling catheter for a 48-year-old male client who is in traction with leg fractures. Which information will the nurse give the client when he states not wanting the indwelling catheter? (a) "This is the only option for catheterization." (b) "This is what your health care provider has prescribed." (c) "Indwelling catheters do not hurt, and I will be careful placing it." (d) "Let me talk to your health care provider about a condom catheter."
d
The nurse caring for an older adult male client is determining whether the client can use a urinal to void. Which aspects of the client's medical history may contraindicate the use of a urinal? (a) The client was treated for kidney stones a few months earlier. (b) The client has a history of benign prostatic hyperplasia (BPH; prostate enlargement). (c) The client has had urinary catheters in place repeatedly during previous admissions. (d) The client is acutely confused and has been diagnosed with delirium.
d
The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice? (a) Specimen hat (b) Large urine collection bag (c) Bedpan (d) Urinal
d
The parent of a 5-year-old child tells the nurse that on two occasions her son has lost control of urination when he had to wait to go to the bathroom at school. What is the appropriate nursing response? (a) "This is extremely abnormal. You will need to see your son's pediatrician." (b) "I would only worry about this if you were raising a daughter." (c) "It would be appropriate to place your son in incontinence undergarments." (d) "Let's review the types of fluids that your child drinks in the morning."
d
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? (a) dehydration (b) infection (c) stasis (d) blood
d
Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)? (a) Foley catheter (b) suprapubic catheter (c) indwelling urethral catheter (d) straight catheter
d
