URINARY ELIMINATION

What discharge instructions should the nurse provide a 20-year-old client being discharged with a urinary tract infection (UTI)?​ Select all that apply. A. Drink at least 2 liters of water per day​. B. Wipe front to back. C. Void after sex. D. Empty the bladder every 5 hours. E. Wear latex, rayon underwear.

A, B & C Rationale: Drinking plenty of water (at least eight, 8-ounce glasses which equals about 2 liters), wiping from front to back, voiding after sex, wearing absorbent, breathable underwear, and emptying the bladder every 3-4 hours are correct discharge instructions for this client.

After the healthcare provider obtains a fresh urine specimen, what is the maximum time it can be stored at room temperature? A. Less than 24 hours B. Less than 2 hours C. Less than 48 hours D. Between 4-8 hours

B Rationale: Urine should be refrigerated immediately if possible (0-2 hours). Bacterial growth in a urine specimen if it sits at room temperature can alter some laboratory results. Sending the specimen to the laboratory quickly can ensure proper storage is used and lab results are most accurate.

The healthcare provider ordered a urine culture for a client. Which item would a nurse need for a urine specimen collection from an existing indwelling urinary catheter? A. Sterile gloves B. Container of ice C. Clean collection cup D. 10 mL syringe

D Rationale: A 5 mL to 10 mL syringe would be used to access a port on an indwelling catheter. A sterile collection cup is used for a client without an indwelling catheter. Sterile gloves would be needed if the client was being catheterized. A container of ice is needed for testing when multiple collections are done over a period of time.

A group of nurses traveling on a mission trip have arrived at a clinic where they will be providing care for the villagers. The clinic is focused on urinary health. It is important that assessments are done quickly and that the care is organized.​ While working in the urinary health clinic, which tasks can be delegated to an unlicensed assistive personnel (UAP)? Select all that apply. A. Obtain vital signs from a client who reports hematuria. B. Instruct the client to collect a clean-catch urine specimen. C. Perform perineal care for a client with urinary incontinence. D. Palpate the bladder of a client with urinary retention. E. Educate a female client with recurrent urinary tract infections about prevention strategies.

A & C Rationale: Performing perineal care and obtaining vital signs can be delegated to the UAP. The nurse may not delegate to the UAP evaluation, assessment, or teaching.

A group of nurses traveling on a mission trip have arrived at a clinic where they will be providing care to the villagers. The clinic is focused on urinary health. It is important that assessments are done quickly and that the care is organized. Which statement by Gigi indicates that she understands the bladder retraining program? Select all that apply. A. "I will not void every time urgency occurs." B. "I know the goal is to increase the time between voidings." C. "I will take slow, deep breaths to relax while suppressing urgency." D. "I no longer need to keep a diary of voiding and leaking." E. "I will perform muscle exercises to suppress urgency."

A, B, C & E Rationale: Bladder retaining is a behavior therapy designed to help clients control urinary urgency and frequency. Clients are taught techniques to suppress urgency, such as taking slow, deep breaths to relax and performing pelvic muscle exercises in quick succession. The goal is to gradually increase the interval between voiding. The toileting schedule should be based on a diary of voiding and leaking.

The nurse is caring for a client with an indwelling catheter. The client voices spasm-like pain at the catheter insertion site. Which signs or symptoms are an indication of a urinary tract infection? Select all that apply. A. Dark urine B. Crystalluria C. Cramping D. Feeling the need to void even though a catheter is present E. Pain at the catheter insertion site F. Positive McBurney's sign

A, D & E Rationale: Pain, concentrated urine, and feeling a need to void are signs and symptoms of a urinary tract infection.​ Deep tenderness at McBurney's point, known as McBurney's sign, is a sign of acute appendicitis. ​Crystalluria is cloudy urine and is often considered a benign condition and one of the side effects of sulfonamides and penicillin medications. The spasm-like pain voiced by the client is most likely related to urethral irritation and should not be interpreted as cramping, which is not a typical symptom of catheter-associate urinary tract infection (CAUTI).

Frank has a recent orthotopic neobladder reconstruction. What would be an appropriate topic for the nurse to teach Frank? A. How to apply an urostomy pouch B. Intermittent catheterization C. Valsalva maneuver D. Peristomal skin care

C Rationale:Clients with a neobladder can control their voiding using the Valsalva maneuver. There is no stoma. Other continent urinary diversions have a stoma and require self-catheterization. An urostomy (or ileal conduit) drains into an external pouch.

Jonathan Deoso (preferred pronouns: he/him/his) is a 62-year-old client who presents to the clinic with bladder incontinence. He reports bladder distention and constant dribbling of urine. Even after urinating, he states he still feels the urge to urinate. Which type of incontinence is this client most likely experiencing? A. Reflex incontinence B. Urge incontinence C. Functional incontinence D. Stress incontinence

A Rationale: Overflow incontinence, also called reflex incontinence or underactive bladder, occurs when the bladder muscle fails to contract and the bladder becomes overdistended. When the bladder reaches maximum capacity, some urine must leak out to prevent bladder rupture. Bladder distention causes constant dribbling of urine. When urine is released, bladder emptying feels incomplete.

Which statement indicates a need for further teaching of a home care client with a long-term indwelling catheter? A. "Soaking in a warm tub bath may ease the irritation associated with the catheter." B. "Intake of cranberry juice may help decrease the risk of infection." C. "I will keep the collecting bag below the level of the bladder at all times." D. "I should use clean technique when emptying the collection bag."

A Rationale: Soaking in a bathtub can increase the risk of exposure to bacteria. The bag should be below the level of the bladder to promote proper drainage. Intake of cranberry juice creates an environment non-conducive to infection. Clean technique is appropriate for touching the exterior portions of the system.

The nurse receives the following bedside report from the previous shift:​ This is Ms. Sullivan. She is an 80-year-old typically independent female admitted for shortness of breath. She has rales bilaterally and is saturating 87% currently on a 5 L nasal cannula. Her most recent blood pressure is 168/89 and her heart rate is irregular and 110 beats per minute. She does not have a fever. This morning, she was able to ambulate with assistance to the bedside commode, but her shortness of breath has worsened and she can hardly complete a sentence without catching her breath. The healthcare provider ordered placement of an indwelling catheter and furosemide 40 mg IV every 6 hours, along with potassium chloride protocol and cardiac monitoring.​ The previous nurse says she does not understand why the healthcare provider ordered an indwelling catheter. What would be an appropriate response? A. "It seems as though her condition is deteriorating and that strict intake and output should be calculated. A urinary catheter is appropriate in this situation, despite her risk." B. "Placing a urinary catheter is fine. I'm sure we will need to send frequent urine specimens to the lab." C. "A bedpan should be fine. She was able to use the bedside commode before." D. "We can just add extra layers of incontinence pads to the bed and avoid a catheter. She's at a higher risk for a catheter-associated urinary tract infection (CAUTI) because of her age."

A Rationale: The nurse recognizes that the client's condition is declining as evidenced by her increased shortness of breath and inability to complete a sentence. This best response answers the question by identifying the reason for strict input and output. Exerting her energy to get to a bedside commode or lying flat to position herself on a bedpan would be detrimental to her respiratory status. The healthcare provider has ordered large doses of a diuretic. Maintaining accurate intake and output is important in a client with fluid volume overload. Laying incontinence pads beneath the client increases the risk of skin breakdown significantly and does not allow for accurate measurement of urine output. The need for frequent urine specimen collection is not an indication for an indwelling urinary catheter due to the increased risk of infection.

A client who has an indwelling catheter reports a need to urinate. Which intervention should the nurse perform? A. Check to see whether the catheter is patent. B. Collect a urine specimen for analysis. C. Re-catheterize the bladder with a larger gauge catheter. D. Reassure the client that it is not possible for them to urinate.

A Rationale: A clogged or kinked catheter causes the bladder to fill and stimulates the need to urinate. Reassuring the client that it is not possible to urinate is a non-therapeutic response because it diminishes the client's concern. There are less invasive approaches the nurse can take before replacing the catheter. Although it may become necessary to collect a urine specimen, there is a simpler approach the nurse can take to assess and possibly resolve the client's problem.

Kristina, an active mother of three children, is seen in the clinic and reports leaking urine when she coughs and laughs. One of the recommendations from the primary healthcare provider is Kegel exercises. Kristina asks the nurse why she should perform these exercises. ​What is the nurse's best response? A. "Kegel exercises will strengthen your pelvic floor muscles​." B. "Kegel exercises will allow you to pass urine easier​." C. "Kegel exercises will strengthen your ureters." D. "Kegel exercises will strengthen your bladder."

A Rationale: Kegel exercises strengthen the pelvic floor muscles. To perform Kegel exercises correctly, pretend you have to urinate and then hold it. Relax and tighten the muscles that control urine flow. Consistent Kegel exercises can improve incontinence in three to six weeks.

The nurse is unable to send the random urinalysis specimen immediately to the laboratory. What is the appropriate action for the nurse to take? A. Refrigerate the urine specimen. B. Keep the specimen warm at 98.6 degrees. C. Store the urine specimen at room temperature. D. Add a preservative and keep at the bedside.

A Rationale: The nurse should place the urine specimen on ice or in a refrigerator designated for specimens. Never place specimens in a refrigerator where food items are stored. Keeping the specimen cool inhibits bacteria growth in the specimen. Preservatives are not used in random urinalysis specimens but may be used in timed specimens.

James is a 90-year-old male client who reports getting up four to five times per night to empty his bladder and struggles to control his bladder long enough to get to the bathroom in time. ​ James is experiencing which urinary patterns? Select all that apply. A. Nocturia B. Polyuria C. Oliguria D. Urgency E. Dysuria

A & D Rationale: James often wakes up in the middle of the night to void (nocturia). His sense of urgency places him at risk of not making it to the bathroom in time.

The nurse is assessing a client with urinary incontinence. Which items should be included as part of the nursing assessment? Select all that apply. A. Bladder distention B. Perineal irritation C. Signs of infection D. Fluid intake E. Constipation

A, B, C, & D Rationale: The nurse should assess for any irritation caused by urine. Normal fluid intake should be at least 1,500 mL/day. Clients with incontinence sometimes decrease intake to decrease incontinence. Incontinence can increase the risk of urinary tract infection (UTI). Bladder distention is a sign of retention but can cause overflow. Assessing for constipation is not needed.

The family of a client with incontinence is coming to visit this afternoon. To provide the best care for the client, the nurse will perform which nursing actions? Select all that apply. A. Change the sheets according to protocol and ensure they are clean and dry. B. Limit the oral intake of the client to reduce the chance that they will need to void later today. C. Encourage the client to talk about some of their favorite things. D. Insert a urinary catheter to reduce the chances that the client is sitting on wet pads or linens. E. Apply a skin barrier to protect the client's skin from any excess moisture.

A, C & E Rationale: Ensuring the client has dry and clean sheets is always important for skin care and well-being. Speaking to the client about their favorite things supports their emotional state and helps their mind stay active. A skin barrier can be beneficial to reduce skin breakdown. Limiting the client's fluid intake is not in their best interest. Inserting a catheter to decrease the nurse's workload is contraindicated.

The client is diagnosed with a urinary tract infection. When planning care for this client, which nursing actions are most appropriate? Select all that apply. A. Encourage increased fluid intake to flush bacteria from the urinary tract. B. Teach the client to clean the perineum daily and use a vaginal deodorant spray to mask the odor. C. Ask the client to void every 2 hours while awake. D. Remind the client to avoid caffeinated beverages and other bladder irritants. E. Instruct the client to wipe the perineum from front to back after voiding or defecating.

A, C, D & E Rationale: The nurse should include the following in the plan of care: Encourage increased fluid intake to flush bacteria from the urinary tract. Ask the client to void every 2 hours while awake. Remind the client to avoid caffeinated beverages and other bladder irritants. Instruct the client to wipe the perineum from front to back after voiding or defecating. The perineum should be cleaned after each voiding or bowel movement. Deodorant sprays should be avoided as they disrupt the normal pH and may encourage bacterial growth.

When inserting an indwelling urinary catheter into a male client, which actions should the nurse take? Select all that apply. A. Secure catheter tubing to the upper thigh. B. Gently insert the tip of a syringe containing lubricant into the urethra. C. Insert the catheter 7-9 inches or until urine begins to flow. D. Clean the penis with an antiseptic wash. E. Apply sterile gloves and use aseptic technique. F. Inflate catheter balloon after inserting the catheter.

A, C, D, E & F Rationale: When inserting an indwelling urinary catheter into a male client, the nurse should: Clean the penis with an antiseptic wash. Insert the catheter 7-9 inches or until urine begins to flow. Apply sterile gloves and use aseptic technique. Inflate the catheter balloon after inserting the catheter. Secure catheter tubing to the upper thigh. The catheter tip should be dipped into lubricant prior to insertion. The lubricant syringe should not be inserted into the urethra.

Which factors related to client care and urinary catheters are important? Select all that apply. A. Provide privacy for clients in the bathroom if they are not at risk of falling. B. All adults above the age of 75 will require a Foley catheter if in a long-term care facility. C. Output should be measured and output below 60 mL/hour should be immediately shared with the provider. D. An extreme increase or decrease in urine volume could indicate a problem with the client's status. E. Urine volume is measured using receptacles with volume-measurement markings.

A, D & E Rationale: Assess for any extreme increase or decrease in urine volume. Urine output less than 30 mL per hour for more than two consecutive hours or excessive urine output (polyuria) is a cause for concern and should prompt further assessment and notification of the healthcare provider. After a client voids in a bedside commode, bedpan, or urinal, or when urine is emptied from a catheter drainage bag, urine can be measured using a graduated measuring container. For clients who void in a toilet, a urine hat can be used. Privacy may help a client relax and urinate. While there are competing tensions between client privacy and safety when it comes to toileting, the bathroom is an important place for staff to provide supervision and assistance due to the difficulty clients may have with transferring and managing clothing, as well as multiple hard surfaces that can cause injury in the event of a fall.

Which statements are correct information the nurse should share with a home care client with a long-term indwelling catheter? Select all that apply. A. "Use of cranberry supplements may help decrease the risk of infection." B. "You should use clean technique when emptying the collection bag." C. "Soaking in a warm tub bath may ease the irritation associated with the catheter." D. "The collecting bag should be below the level of the bladder at all times." E. "Due to Medicare costs, it's okay to reuse a catheter if you have a way to sterilize it at home, so you can save money."

A. B & D Rationale: The bag should be below the level of the bladder to promote proper drainage. Clean technique is appropriate for touching the exterior portions of the system.​ Intake of cranberry supplements creates an environment non-conducive to infection. Nurses have used cranberry juice to treat urinary tract infections for decades. Research now supports the use of cranberry supplements to prevent urinary tract infections because cranberry molecules bind with the iron that bacteria need to grow and reproduce and substances in cranberry block the adherence of bacteria to the walls of the bladder. Taking a tub bath with an indwelling catheter increases the chance of infection, and you should not reuse a catheter.

A client is complaining that their bladder still feels full even after voiding 60 mL. What should the nurse's next action be? A. Give the client medication for the discomfort. B. Perform a bladder scan. C. Have the client try to void in one hour. D. Get a urine specimen.

B Rationale: A bladder scan will get an accurate measurement of the post-void residual volume. Getting a urine specimen, telling the client to void in an hour, or medicating the client are not appropriate for retention.

A client who was admitted to the hospital for seizures, developed delirium on the fourth day. ​What type of incontinence would this client likely experience?​ A. Stress incontinence​ B. Functional incontinence ​ C. Reflex incontinence D. Urge incontinence​

B Rationale: Functional incontinence is related to causes outside the urinary tract and is often associated with cognitive dysfunction and immobility. Stress incontinence is due to increased pressure in the abdomen. Reflex incontinence is commonly due to a spinal injury. Urge incontinence is the strong sense of an urge to urinate.

The nurse is caring for several clients. Which client is most at risk for developing a urinary tract infection? A. An older adult client who is experiencing nausea and vomiting. B. An older adult client with Alzheimer's disease who is experiencing fecal incontinence. C. A young adult client who is taking antibiotics to treat pharyngitis. D. A middle-adult client who is 7 days postoperative from hip replacement surgery.

B Rationale: An older adult client with Alzheimer's disease who is also experiencing fecal incontinence is most at risk for developing a urinary tract infection (UTI). Fecal incontinence increases the risk of a UTI. Also, clients with Alzheimer's disease may experience bladder retention due to the inability to communicate the need to void which increases the amount of time the urine is left in the bladder. A middle-adult client with hip replacement, and an older adult with nausea/vomiting, and a young adult taking antibiotics are at less risk for developing a UTI.

Which urinalysis result could indicate infection? A. Negative for ketones B. Presence of leukocyte esterase C. Presence of a red blood cell D. Dark yellow color

B Rationale: Presence of leukocyte esterase is an indicator of infection. One red blood cell and no ketones is considered normal. A dark yellow color may indicate dehydration.

A client has a kidney infection and asks why a urine culture is needed. What is the nurse's best response? A. "It is used for researching causes of kidney infections in other people."​ B. "We need to identify the type of bacteria causing the infection." C. "It is used to determine the chemicals in your urine." D. "We want to know if the infection is resistant to treatment."

B Rationale: The best response is that a urine culture is used to detect and identify bacteria and yeast in the urine. A urinalysis is for determining chemicals. A sensitivity test can be run on the culture to see if it is drug resistant, but that is not the main purpose. The data is not collected for research unless it is part of a research study.

Cassandra Johnson (preferred pronouns: she/her) is a 36-year-old client who is 29 weeks pregnant. She presents to the clinic with burning from urination. The healthcare provider prescribes a urinalysis with culture. Which statement made by the client demonstrates an understanding of how to collect the specimen? A. "I'll hold the collection cup firmly against the urethra while collecting the urine sample." B. "I will release a small amount of urine into the toilet, then collect the remaining urine in the collection cup." C. "I will be sure to drink plenty of fluid to dilute my urine before collecting the urine sample." D. "I will cleanse the labia from back to front with an antiseptic wipe before collecting urine in the cup."

B Rationale: When collecting a urine specimen, it is important to avoid contaminating the sample; therefore, the client should collect the urine sample during mid-stream. The client should release a small amount of urine into the toilet, then collect the remaining urine in the collection cup. The cup should be placed a few inches away from the urethra, and prior to voiding the client should use an antiseptic wipe to cleanse the labia from front to back. It is best to collect the sample when the bladder has been full for 2-3 hours, therefore the urine is concentrated, not diluted.

When caring for clients with urinary catheters, when is it important for a nurse to wash their hands? Select all that apply. A. Immediately after applying hand sanitizer B. Before, after, and between direct client contact C. Before putting on sterile gloves D. Before inserting the urinary catheter E. After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings (even if gloves are worn) F. After contact with surfaces or objects in the client's room

B, C, D, E & F Rationale: Nurses should wash their hands: before, after, and between direct client contact (e.g., taking a pulse, lifting a client) before putting on sterile gloves before inserting invasive devices, such as a peripheral vascular catheter or urinary catheter after contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings (even if gloves are worn) when moving from a contaminated to a clean body site during care after contact with surfaces or objects in the client's room (e.g., overbed table, intravenous (IV) pump). Washing hands after applying hand sanitizer would be redundant and therefore unnecessary.

Which factors can affect urinary elimination? Select all that apply. A. Constipation B. Body position C. Pelvic muscle tone D. Age E. Medications F. Hydration status G. Renal calculi

B, C, D, E, F & G Rationale: Poor pelvic muscle tone can lead to urinary incontinence, while renal calculi (kidney stones) impact the flow of urine. Body position impacts the ability to empty the bladder. Age and medication often impair the ability to effectively control the bladder. Hydration status relates to the frequency of urination and the kidneys' ability to process and eliminate waste. Constipation does not affect urinary elimination but may be affected by some of the same problems.

The nurse is planning to initiate a bladder retraining program for a client who has a voiding disorder. Which actions should the nurse take? Select all that apply. A. Establish a schedule of voiding prior to meal times. B. Teach the client to inhibit the urge to void by performing pelvic muscle exercises. C. Provide a sterile container for voiding. D. Gradually increase the interval between voiding. E. Base toileting schedule on diary of voiding and leaking.

B, D & E Rationale: Bladder retaining is a behavior therapy designed to help clients control urinary urgency and frequency. Clients are taught techniques to suppress urgency, such as taking slow, deep breaths to relax and performing pelvic muscle exercises in quick succession. The goal is to gradually increase the interval between voiding. The toileting schedule should be based on a diary of voiding and leaking. ​Mealtimes may not be regular and the intervals may be longer than every four hours. A sterile container is not used for bladder retraining. It is used for specimen collection and testing.

The nurse is providing discharge education to a female client who is recovering from a urinary tract infection. Which information should the nurse provide? Select all that apply. A. If possible, stand while urinating. B. Urinate after sexual intercourse. C. Wipe the perineum from back to front after defecation and urination. D. Void as soon as possible when the urge occurs. E. Drink adequate amounts of fluid daily.

B, D & E Rationale: Urinating after sexual intercourse rids the lower urinary tract of any bacteria that may be present. Clients should void as soon as possible when the urge occurs. Urinary retention can lead to urinary tract infection (UTI). To avoid UTIs, clients should drink approximately 2300 mL of fluid daily to flush out solutes or particles that collect in the urinary system and decrease bladder irritability. The close proximity of the female urethra to the anus increases the risk for UTI. The perineum should be wiped from front to back after defecation and urination. Female clients should void while in the squatting position. Male clients void more easily in a standing position.

A male client is on a 24-hour timed urine study and will collect urine at home. What supplies will the nurse need to gather so the client can complete this study? Select all that apply. A. Antiseptic wipes B. Ice packs C. Indwelling catheter D. Urinal E. Collection vessel

B, D & E Rationale: The nurse should provide the client with a collection vessel, urinal, and ice packs. The client will first void in the urinal and then transfer the urine to the collection vessel. The collection vessel will hold the urine. The client will dump the urine from the urinal into the collection vessel. This prevents cross-contamination of the larger collection vessel. Ice packs will be used to keep the urine cool. Antiseptic wipes are not required because this urine collection does not require any special preparation. An indwelling catheter is not required for this specimen.

In addition to incontinence, the client reports nocturia. When planning care for this client, which nursing action is most appropriate? A. Avoiding non-steroidal anti-inflammatory medications (NSAIDs) B. Avoiding fluid intake after 5 p.m. daily C. Bladder retraining and pelvic muscle exercises D. Teaching intermittent self-catheterization

C Rationale: Bladder retaining and pelvic muscle exercises would be most beneficial in the care of this client. Clients should not avoid fluid intake but should ensure adequate fluid intake daily. Intermittent self-catheterization may be necessary to treat reflex incontinence, not urge incontinence. Bladder irritants such as alcohol and caffeine should be avoided, not NSAIDs.

After urine collection, the client hands the specimen to the nurse, who notes that the urine is cloudy and amber-colored with a foul odor. Which medical diagnosis does the nurse anticipate? A. Fecal impaction B. Renal Failure C. Urinary tract infection D. Stress incontinence

C Rationale: Symptoms of a urinary tract infection include cloudy and concentrated urine (amber-colored) as well as a foul odor. These symptoms alone do not reflect stress incontinence, renal failure, or fecal impaction.

A group of nurses traveling on a mission trip have arrived at a clinic where they will be providing care for the villagers. The clinic is focused on urinary health. It is important that assessments are done quickly and that the care is organized. The nurses reflect on the last client to receive home care during their visit. The client was an older adult with multiple sclerosis and an indwelling urinary catheter draining dark amber-colored urine with a foul odor. The vital signs were as follows: T 100.9 °F (38.3 °C), HR 105, RR 20, BP 125/78. The client was unsure about the current date and time or when the catheter was inserted. Which action taken by the nurses was most appropriate in the care of this client? A. Tell the client to increase fluid intake to at least 3000 mL daily. B. Document the findings as normal for client age and medical history. C. Notify the healthcare provider and recommend removal of the indwelling catheter. D. Reorient the client and provide perineal cleaning and catheter care.

C Rationale: The client has symptoms associated with urinary tract infection, including elevated temperature and pulse, dark-amber-colored urine with a foul odor, and confusion. The nurse should notify the healthcare provider and recommend removal of the indwelling catheter. The assessment findings are not normal. Reorientation, increasing fluid intake, and cleaning will not resolve a urinary tract infection.

A male client in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take first? A. Question the client about urinary tract infection (UTI) risk factors. B. Teach correct midstream urine collection. C. Ask the client about current medications. D. Notify the client's healthcare provider.

C Rationale: The first action the nurse should take is to ask the client about current medications as a red-orange color in the urine is normal with some over-the-counter (OTC) medications, such as phenazopyridine (Pyridium). Then the nurse would teach the client how to correctly perform a midstream urine collection. Contacting the healthcare provider and asking the client's history about UTI risk factors are not necessary.

A clean void urine is ordered. The 16-year-old client asks the nurse why they should wipe the urinary meatus from front to back. What rationale will the nurse give the client? A. It allows visualization of the urinary meatus prior to voiding. B. It is personal preference. C. It prevents contamination of the urine specimen with stool. D. It sterilizes the urinary meatus.

C Rationale: Wiping from front to back in a linear motion will prevent cross-contamination of the urinary meatus. Wiping back to front can introduce fecal matter and contaminate the urinary meatus, thus contaminating the urine sample. It will not help visualize or sterilize the urinary meatus. It is not a personal preference.

A group of nurses traveling on a mission trip have arrived at a clinic where they will be providing care for the villagers. The clinic is focused on urinary health. It is important that assessments are done quickly and that the care is organized. While conducting a home visit, the nurse suspects that a client has a urinary tract infection. Which action taken by the nurse is most appropriate? A. Administer the first dose of antibiotics, wait one hour, then collect a urine specimen. B. Administer the first dose of antibiotics then collect a urine specimen. C. Collect a urine specimen then administer the first dose of antibiotics. D. Collect a urine specimen and hold antibiotic treatment until the results are available.

C Rationale: If a urinary tract infection is suspected, a urine culture should be performed before starting antibiotic medication. Antibiotic medication may alter the results of a urine culture. However, medication should be started immediately after collecting the specimen as a delay in treatment could result in worsening infection.

During a client's urinary bladder catheterization, the bladder is emptied gradually. Completely emptying an over-distended bladder at one time may cause which condition? A. Abdominal cramping B. Atrophy of bladder musculature C. Possible shock D. Renal failure

C Rationale: Rapid emptying of an over-distended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 mL at one time was the standard of practice, but this is no longer thought to be necessary as long as the over-distended bladder is emptied slowly.

Greg is on bed rest with limited mobility and needs assistance with voiding. He is otherwise healthy. What is the best method for the nurse to provide? A. Insert an indwelling catheter. B. Position Greg so he can use a bedpan. C. Give Greg a urinal to use. D. Place a condom catheter.

C Rationale: The nurse should give Greg a urinal to use. He is on bed rest and it would be the most appropriate thing to use. A bedpan would be used for females. If the client can use a urinal, catheters are not appropriate due to the increased risk and cost.

The healthcare provider ordered a 12-hour timed urine study at 06:00. The order was received by the nurse at 06:30. The client voided at 08:00. When will the nurse end the collection time for this order? A. 06:00 B. 08:00 C. 20:00 D. 06:30

C Rationale: The timed test is always started after the first void. If the client first voids at 08:00, then 12 hours later would be 20:00.

The nurse's note from the previous shift noted that the client's reagent test may indicate uncontrolled diabetes. Which chemicals on the reagent test result may suggest this? Select all that apply. A. Protein B. Bilirubin C. Ketones D. Glucose E. Nitrates

C & D Rationale: A reagents test that is positive for ketones and glucose suggests uncontrolled diabetes. High protein levels may indicate renal dysfunction. Bilirubin may be a sign of liver damage or disease. Nitrates may be a sign of infection.​

Paul is a 22-year-old male who suffered major abdominal trauma as a result of a motor vehicle accident. He has an ureterostomy which he cares for independently. Which nursing diagnoses could apply to Paul? Select all that apply. A. Urinary incontinence: urge B. Urinary retention C. Risk for disturbed body image D. Risk for impaired skin E. Self-care deficit

C & D Rationale: Considering the client is young with a new ureterostomy, he would be at risk for disturbed body image. Skin care is important around the stoma, so he would also be at risk for impaired skin. The client would not have any retention or urge incontinence since the ureterostomy freely drains without sensation or control from the client. Self-care deficit is not applicable if the client is successfully caring for the ureterostomy.

A client has just voided 50 mL but reports that their bladder still feels full. What should the nurse's next actions be? Select all that apply. A. Ask the client about their recent voiding history. B. Obtain a clean-catch urine specimen. C. Perform a bladder scan. D. Encourage the client to consume cranberry juice daily. E. Insert a straight catheter to measure residual urine. F. Palpate the bladder height.

C & F Rationale: The nurse should palpate the bladder for distention. A bladder scan will yield a more accurate measurement of the post-void residual urine. A detailed history of the client's recent voiding patterns will assist the nurse in determining the appropriate nursing diagnosis and developing a plan of care. A clean-catch urine specimen may be necessary if further assessment shows the potential of a urinary tract infection. Cranberry juice is sometimes used in an effort to prevent urinary tract infection, although there is conflicting research to support this action. Inserting a straight catheter to measure residual urine is an invasive procedure with the risk of introducing microorganisms into the bladder and is usually unnecessary if the nurse has access to a portable bladder scanner.

After a clean void, a client gives the nurse the collection cup with 1 mL of urine for urinalysis. What would be the nurse's best response? A. "Thank you. This is enough for the sample." B. "We need at least 50 mL so you will have to try again tomorrow." C. "We don't need that much urine for the test." D. "Let's have you drink some water and try again in a while."

D Rationale: At least 10 mL is needed for an accurate urinalysis, so 1 mL may limit the extent of testing. The client can be given fluids and try again when the bladder is full. It should be noted that the amount of urine needed for other urine tests, such as drug screening, may differ.

A client has missed her period by two days and is concerned she may be pregnant. The client tells the nurse at the clinic that she wants to take an at-home pregnancy test. Which statement by the client needs to be addressed by the nurse? A. "The test may rarely give me a false-negative or false-positive result." B. "The pregnancy test detects a hormone." C. "An in-home pregnancy test is usually very accurate." D. "I should take the pregnancy test now."

D Rationale: It is best to wait for one to two weeks after a missed period for accurate results as there can be false negatives and false positives. The test detects the hCG hormone. An in-home pregnancy test is usually very accurate but may rarely give a false-positive or false-negative result.

The catheter slips into the vagina during a straight catheterization of a client. Which action should the nurse perform next? A. Remove the catheter. Wipe it with sterile gauze and redirect it to the urinary meatus. B. Remove the catheter and redirect it to the urinary meatus. C. Leave the catheter in place and ask another nurse to attempt the procedure. D. Leave the catheter in place and restart the procedure with a new sterile catheter.

D Rationale: The catheter in the vagina is contaminated and cannot be reused. If left in place, it may help avoid mistaking the vaginal opening for the urinary meatus with a new attempt using a new sterile kit. A single failure to catheterize the meatus does not indicate that another nurse is needed, although sometimes a second nurse can assist in visualization of the meatus. Removing and redirecting increases the chance of infection.

When planning care for this client, which is likely to be the focus of education? A. Need for a prostatectomy B. Care for an indwelling urinary catheter C. Use of a pessary device D. Bladder compression (Credé method)

D Rationale: The focus of education is most likely to be bladder compression (Credé method). Although an enlarged prostate may cause reflex incontinence, a prostatectomy may not be needed. Pessary devices are used for female clients. While intermittent self-catheterization may be necessary, an indwelling urinary catheter is not needed.

What is the primary reason for taping an indwelling catheter laterally to the thigh of a male client? A. Prevent the catheter from kinking in the urethra B. Allow the client to turn without kinking the catheter C. Prevent accidental catheter removal D. Eliminate pressure at the penoscrotal angle

D Rationale: The primary reason for taping an indwelling catheter is to prevent pressure at the penoscrotal angle. Prolonged pressure at the penoscrotal angle can cause a ureterocutaneous fistula. Taping the catheter tubing can prevent kinking, allow the client to turn, and prevent accidental removal; however, these are not the most important reasons to secure the tubing to the male client's thigh.

A client has a ureteral catheter in place after renal surgery. What is the priority nursing action when caring for this client's ureteral catheter? A. Ensure that the catheter drains at least 30 mL an hour. B. Irrigate the catheter with 30 mL of normal saline every 8 hours. C. Clamp the catheter every 2 hours for 30 minutes. D. Ensure that the catheter is draining freely.

D Rationale: The ureteral catheter should drain freely without bleeding at the site. Because an ureteral catheter may come from only one kidney, it may drain less than 30 cc an hour. Little or no drainage for several hours may indicate a need to contact a healthcare provider. Many surgeons have specific criteria regarding catheter drainage and when to notify them. Clamping or irrigating a catheter should not be done except when ordered specifically by the provider.

Which action represents the appropriate nursing management of a client wearing a condom catheter? A. Ensure that the tip of the penis fits snugly against the end of the condom. B. Tape the collecting tube to the lower abdomen. C. Change the condom every 8 hours. D. Check the penis for adequate circulation 20 minutes after applying.

D Rationale: The penis and condom should be checked 20 minutes after application to ensure that the condom is not too tight. A 1-inch space should be left between the penis and the end of the condom. The condom is changed every 24 hours and the tubing is taped to the leg or attached to a leg bag.

The nurse clamped the indwelling catheter for a clean void urine specimen. A nursing student asked for the rationale. What should be the nurse's response? A. "This measures your actual output." B. "This is hospital policy." C. "This is to assess the function of the catheter balloon." D. "This is to obtain the freshest urine possible."

D Rationale: To obtain a clean void urine from a client with an indwelling catheter, always collect the freshest urine. The nurse is unable to determine how long the urine has been in the leg bag and should not be used. Hospital policy and assessing the function of the catheter are not reasons for clamping. It should be noted that clamping should only be a few minutes in order to prevent pooling of urine in the bladder.

Care for an indwelling urinary catheter should include which intervention? A. Lay the drainage bag on the floor to allow for maximum drainage through gravity. B. Insert the catheter using clean technique. C. Keep the drainage bag on the bed with the client. D. Remove obvious encrustations from the external catheter surface by washing it gently with soap and water.

D Rationale: Vigorous cleaning of the meatus while the catheter is in place is not recommended, but the area can be gently washed with soap and water to remove obvious encrustations from the external catheter surface. Insert the catheter using sterile (not clean) technique. To avoid the backflow of contaminated urine into the bladder and an increased chance of infection, do not raise the collection bag above the level of the client's bladder. To prevent contamination of the closed system, never let the drainage bag touch the floor; hang it on the bed in a dependent position.

Sally Jones (preferred pronouns: she/her) is a 68-year-old client who presents to the clinic with bladder incontinence. She reports a sudden loss of large amounts of urine for no reason after feeling an urge to void. Which type of incontinence is this client most likely experiencing? A. Reflex incontinence B. Stress incontinence C. Functional incontinence D. Urge incontinence

D Rationale: urge incontinence is more common in older females. This is the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate. Normally, when the bladder is full, contraction of the bladder muscle signals the brain to urinate. Continent adults override that signal and relax the bladder muscle until a place to toilet is located. However, with urge incontinence, the client cannot suppress the signal and the strong urge to void causes urine to leak. Urinary urgency and frequency are present, as well as nocturia. A large amount of urine can be lost with each occurrence.

A group of nurses traveling on a mission trip have arrived at a clinic where they will be providing care for the villagers. The clinic is focused on urinary health. It is important that assessments are done quickly and that the care is organized. Gig reports losing control of urine when she coughs, laughs, or sneezes. Which information should the nurse provide to control or eliminate the client's incontinence? Select all that apply. A. Teach bladder compression (Crede method). B. Use intermittent catheterization. C. Limit total daily fluid intake. D. Avoid the intake of alcohol. E. Decrease or avoid caffeine consumption. F. Instructions about bladder retraining.

D, E & F Rationale: Stress incontinence is the most common type of urinary incontinence in younger females and is characterized by the inability to retain urine when laughing, coughing, sneezing, jogging, or lifting. The client cannot tighten the urethra enough to overcome the increased bladder pressure caused by contraction of the detrusor muscle within the bladder walls. A small amount of urine is lost with exertion. Avoiding bladder irritants (alcohol, caffeine) and bladder training can resolve issues. Intermittent catheterization and bladder compression are not necessary to resolve stress incontinence. Clients should not limit fluid intake.

The nurse is caring for a 75-year-old uncircumcised male client who needs assistance with a urine specimen collection. Place the tasks in the correct order for collecting a urine specimen, from first to last. A. Don gloves B. Collect the midstream of urine C. Replace the foreskin D. Document the urine collection E. Retract the foreskin and clean the urinary meatus F. Wash hands G. Open the container H. Label the specimen at the bedside

F, A, G, E, B, C, H , D Rationale: Washing hands and donning gloves are the first two steps in the process. These steps ensure personal protection and prevent cross-contamination. Open the container to prepare the collection cup for the sample. Retracting the foreskin and cleaning the urinary meatus prevent contamination of the specimen. Once the foreskin is cleaned, it must stay retracted. One hand may have to keep the foreskin retracted; therefore, the specimen cup should be opened first. Collecting mid-stream urine flushes the urethra of bacteria. It is important for the provider to remember to replace the foreskin to the original position after the sample has been collected. Failure to reposition the foreskin can result in decreased circulation in the area and increase the risk for complications. Label the specimen at the bedside per facility policy. Document the urine collection per facility policy. In a client who requires more assistance or is unable to urinate when asked, a different collection method (straight catheterization) may be more appropriate.

The nurse is preparing to collect a clean void urine specimen from a client who can void unassisted. Which supplies are needed? Select all that apply. A. Gloves B. Indwelling catheter C. Clean specimen cup D. Antiseptic wipes E. Sterile specimen cup

A, D & E Rationale: A sterile specimen cup, gloves, and antiseptic wipes are required for this procedure. The clean specimen container would only be appropriate if the nurse was going to perform a urinalysis via urine test strip and testing for infection or bacteria is not necessary. An indwelling catheter is not needed if the client can void unassisted.

A provider prescribes a urine specimen for culture and sensitivity via a straight catheter for a client. What should the nurse do when collecting this urine specimen? A. Use a sterile specimen container. B. Inflate the balloon with 10 mL of sterile water. C. Have the client void before collecting the specimen. D. Collect urine from the catheter port.

A Rationale: A culture attempts to identify the microorganisms present in the urine and a sensitivity study identifies the antibiotics that are effective against the isolated microorganisms. A sterile specimen container is used to prevent contamination of the specimen by microorganisms outside the body (exogenous). The urine from a straight catheter flows directly into the specimen container; there is no collection port or balloon on a straight catheter. A minimum of 3 mL of urine is necessary for a specimen for urine culture and sensitivity, so the client should not void prior to collection.