Urinary Elimination Prep-U

A female client is asked to provide a specimen for a routine urinalysis. Which instructions should the nurse give the client?

"After cleansing the labia, urinate into the toilet first and then fill the container midstream."

The nurse is teaching an older adult female client who must provide a urine specimen. Which is the proper method to instruct the client to use to obtain a clean-catch urine specimen?

Catch the urine while holding the labia apart, after allowing the first urine to flow into the toilet.

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

Cholinergic agents

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?

"Let's review the types of fluids that your child drinks in the morning."

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?

"Let's review your medication history and whether you consume bladder irritants."

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

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

An older woman who is a resident of a long-term care facility has to get up and void several times during the night. This can be the result of what physiologic change with normal aging?

diminished ability of the kidneys to concentrate urine

A client is admitted to the health care facility reporting pain on urination that is secondary to a urinary tract infection (UTI). The nurse documents this finding as:

dysuria

Which of the following describes the term micturition?

emptying the bladder

Urinary elimination from an ileal conduit can be voluntarily controlled after the stoma heals from the initial surgery.

false

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

functional incontinence 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. Stress incontinence occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. Reflex incontinence is an emptying of the bladder without the sensation to void. Transient incontinence appears suddenly and lasts for 6 months or less.

A nurse is caring for an older adult client who has been prescribed a condom catheter. What are the common problems that a client can experience when using a condom catheter? Select all that apply.

may restrict the flow of blood to the skin and tissues may accumulate moisture beneath the sheath may lead to frequent leakage

A nurse at a health care facility provides continence training to a client. During the training, the nurse plans a trial schedule for voiding that correlates with the time when the client is usually incontinent. What is a possible reason for the nurse's action?

reduces potential for unintentional voiding Rationale: During the training, the nurse plans a trial schedule for voiding that correlates with the time when the client is usually incontinent so as to reduce the potential for accidental voiding or sustained urinary retention. Compiling a log of the client's urinary elimination pattern helps reveal the client's type of incontinence. Setting realistic, specific, short-term goals for the client prevents self-defeating consequences. Discouraging strict limitation of fluid intake ensures adequate urine volume.

An older adult client has constant dribbling of urine. The associated discomfort, odor, and embarrassment may support which nursing diagnosis?

social isolation Rationale: Impaired adjustment is associated with a client who cannot adjust or change to the situation. Defensive coping in this case would be denial of the urinary incontinence. Impaired memory is a diagnosis for a client who cannot remember he or she has urinary incontinence.

A nurse uses a catheter to collect a sterile urine specimen from a client at a health care facility. If a catheter is required temporarily, which type of catheter should the nurse use?

straight catheter

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

straight catheter

A nurse is caring for a client who has an infant age 4 months. The client informs the nurse that she has been experiencing a sudden loss of urine whenever she laughs; this is causing embarrassment to her. Which type of urinary incontinence is this client experiencing?

stress

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?

stress Rationale: Stress incontinence is associated with a raise in intra-abdominal pressure related to activities such as sneezing, coughing, or laughing. Urge incontinence takes place when there is a delay in accessing a toilet. Reflex incontinence takes place when a client automatically releases urine and cannot control it. Total incontinence takes place without a pattern or warning, and without client control.

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:

oliguria.

The nurse is caring for a male client with weakness who has been ordered to stay on bed rest for several days. Which method for urinary elimination does the nurse provide?

urinal

A client tells the nurse, "Every time I sneeze, I wet my pants." What is this type of involuntary escape of urine called?

urinary incontinence

The nurse measures a client's residual urine by catheterization after the client voids. Which condition would this test verify?

urinary retention

A nurse is providing education to a client who is scheduled for a cystoscopy as an outpatient procedure. Which description would the nurse include when discussing this procedure?

use of a flexible tube that is guided into the bladder Rationale: A cystoscope is a flexible tube that can be inserted into the urethra and guided into the bladder. A light at the end of the cystoscope allows the physician to look for abnormalities such as tumors, stones, or structural problems. Magnetic resonance imaging is a three- dimensional view of the urinary structures. Computed tomography is a specialized x-ray to assess kidney size and shape. Urodynamic studies involve measuring pressure and urine flow.

A client with urinary incontinence is prescribed incontinence briefs. Which factors should be included in the client education the nurse provides?

"Cleanse the skin each time you change the briefs."

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." Rationale: Limiting fluid intake is not a healthy practice, and clients should be encouraged not to use fluid restriction as an incontinence management strategy. Promoting fluid intake is beneficial for most clients who do not possess a contraindication, and it is appropriate and useful to take diuretics in the morning to avoid nocturia. Even though it may involve work for both the client and the nurse, clients who want to use a bathroom or commode rather than an adult absorbent brief should be encouraged to do so.

A client has been taught how to do Kegel exercises. What statement by the client indicates a need for further information?

"I will contract the muscles in my abdomen and thighs."

The experienced nurse is observing a new nurse who is preparing to catheterize a female client. Which statement by the new nurse requires immediate intervention by the experienced nurse?

"I will use clean gloves to handle the catheter and other equipment." Rationale: Sterile gloves are required for catheterization

A school nurse is educating a class of female middle school students on how to promote urinary system health. Which statement by one of the girls indicates understanding?

"I will wipe from front to back after going to the toilet."

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

24-hour specimen Rationale: A clean-catch or midstream-voided specimen is used when a specimen relatively free from microorganisms is required. Random urine specimen collection is used when sterile urine is not required.

A male client informs the nurse that he is concerned about dribbling and incontinence of small amounts of urine after the removal of an indwelling urinary catheter. The nurse is aware that the catheter was in place for 3 weeks prior to being removed. Which is the nurse's best response to the client?

"It will take a little while for the bladder to reestablish control as the strength of the muscle improves, and an accident is not unusual."

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?

"Let's explore structuring activities and toileting breaks."

The nurse is preparing to insert an indwelling urinary catheter into a 3-year-old child. Which size of urinary catheter should the nurse plan to use?

6 Fr

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.

1. Clean each labial fold, then the area directly over the meatus. 2. Insert the lubricated catheter into the urethra. 3. Advance the catheter until there is a return of urine. 4. Inflate the balloon with the correct amount of sterile saline. 5. Discard used supplies.

A client with a new urostomy requires teaching by the nurse. The nurse will construct the plan of care and education based upon which primary nursing diagnosis? Select all that apply.

1. risk for impaired skin integrity 2. risk for infection 3. situational low self-esteem

When caring for a client at the health care facility, the nurse has to record the client's urinary volume. Which amount would indicate a normal urinary volume?

2,000 mL/day Rationale: A urinary volume of 2,000 mL/day is considered normal. A client's urination volume is normal if it is between 500 and 3,000 mL/day and considered average at 1,200 mL/day. Urination volume is considered abnormal if it is less than 400 mL/day or greater than 3,000 mL/day.

A client has just returned from surgery with a Foley catheter in place. The nurse anticipates that the catheter will be removed within what time frame after the operation?

24 hours

A male client who has had outpatient surgery is unable to void while lying supine. Which intervention would be most effective in assisting the client to urinate?

Assist the client to a standing position.

A client has not voided for 8 hours after surgery. Which finding indicates the client has a distended bladder?

A bulge between the symphysis pubis and the umbilicus

A client is preparing to give a clean-catch specimen. Which instruction will the nurse provide?

After the initial stream is initiated, collect the sample. Rationale: A clean-catch specimen is collected in mid-stream. It is not reasonable, nor necessary, to collect the entire urinary output. It is not correct to collect the first urine expelled or to wait until the void is almost over.

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?

Ask the client why he or she does not want a catheter.

A student is collecting a sterile urine specimen from an indwelling catheter. How will the student correctly obtain the specimen?

Aspirate urine from the collection port.

What accurately describes a practice guideline that the nurse should follow when inserting an indwelling catheter?

Avoid irrigation unless needed to relieve an obstruction.

The health care provider notifies a client of a diagnosis of glycosuria. Which additional assessment information will the nurse obtain from the client next?

Blood sugar

Which is true regarding the normal urination?

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

A client has burning upon urination. The urinalysis indicates pyuria. Which is the next action the nurse will take?

Contact the health care provider

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.

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

A nurse is caring for older adult clients in an assisted-living facility. Which effect of aging should the nurse consider when performing a urinary assessment?

Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection.

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 nurse has catheterized a client to obtain urine for measuring postvoid residual (PVR) amount. The nurse obtains 40 mL of urine. What should the nurse do next?

Document this normal finding for postvoid residual. A postvoid residual (PVR) urine measures the amount of urine remaining in the bladder after voiding. It can be measured by catheterization or a bladder scan. A PVR of less than 50 mL indicates adequate bladder emptying. The nurse would document this normal finding for PVR. It is not necessary to palpate the abdomen as the bladder is empty.

A client with frequent UTIs has returned to the ambulatory clinic with symptoms of another UTI. The nurse reviews measures to follow to promote health and decrease the risk of contracting a UTI. Which measure is appropriate for the client to follow?

Drink two glasses of water before and after sexual intercourse.

A home care client has an indwelling catheter connected to a leg bag. What can the nurse recommend to help prevent development of a urinary tract infection?

Empty the leg bag at regular intervals.

A client is prescribed an indwelling urinary catheter prior to surgery. Which action should the nurse take to decrease the occurrence of health care-associated infection (HAI) for this client

Encourage fluid intake.

A nurse caring for a client with a nephrostomy tube finds that the urine output from the tube has decreased and notifies the physician. The physician writes an order for the tube to be irrigated. Which would be most appropriate for the nurse to do when irrigating a nephrostomy tube?

Irrigate with sterile saline. Rationale: The nurse should use sterile saline for irrigation, as tap water may damage the kidneys. Irrigation of a nephrostomy must be done using strict asepsis, not a clean technique, and no more than 10 mL of sterile saline should be instilled. It is important never to clamp a nephrostomy tube because doing so would cause the backup of urine that could result in renal damage.

A home care nurse visits a client diagnosed with depression who informs the nurse that he has been prescribed amitriptyline. What would the nurse include when educating the client about the effects of this medication?

It causes urine to turn blue-green.

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. Rationale: The external condom catheter is not in the bladder. It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters which are placed in the bladder. Because it is not sterile, a sterile urine specimen cannot be obtained. Often, the client does not place the external condom catheter by himself. The catheter is changed every day and the skin of the penis is assessed.

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?

Keep muscles contracted for at least 10 seconds. Rationale: Kegel exercises should be performed by tightening the internal muscles used to prevent or interrupt urination for 10 seconds, followed by a period of 10 seconds of relaxation. The client should be instructed to perform this regimen 3-4 times daily for 2 weeks to 1 month.

A client who visits a health care facility for a routine assessment reports to the nurse being unable to control urinary elimination. This has resulted in the client soiling clothes and has led to a lot of embarrassment. Which nursing intervention will be appropriate to use with this client?

Regular toileting routine

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 a prescription to discontinue the client's urinary catheter. What is the appropriate nursing action?

Request a prescription for catheter discontinuation from the health care provider.

A nurse is using a bladder scanner to assess the bladder volume of a client with urinary frequency. In which position would the nurse place the client?

Supine

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?

The bladder normally is a sterile cavity.

A nurse working in a community pediatric clinic explains the process of toilet training to mothers of toddlers. What is a recommended guideline for initiating this training?

The child should be able to communicate the need to void.

A client is prescribed a diuretic for swelling of the lower extremities. What would the nurse teach the client about the effect of the medication on the client's urinary output?

The client's urinary output will be increased.

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

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

True

A nurse is assisting a client with the use of a urinal. The nurse recognizes that which statement about the use of a urinal is true?

Unless contraindicated, nurses should encourage clients to stand to use a urinal.

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

Urinal A specimen hat is for a commode. A bedpan is not the best choice for a male client. A large urine collection bag would be used with an indwelling catheter.

A nurse is initiating a 24-hour urine collection for a client at home. What will be the first thing the nurse will ask the client to do at the beginning of the specimen collection?

Void and discard the urine. Rationale: The collection is initiated at a specific time, but the client is asked to void at that time and discard the urine from the first voiding. In most instances, a preservative is added to the collection bottle, the collected urine is kept cold through refrigeration, or it is kept on ice.

A nurse is delegating the collection of urinary output to an unlicensed assistive personnel (UAP). What should the nurse tell the UAP to do while measuring the urine?

Wear gloves when handling a client's urine.

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 nurse is inserting an indwelling urethral catheter. What type of supplies will the nurse need for this procedure?

a sterile catheterization kit or tray The bladder is a sterile environment. The urethra and vagina cannot be sterilized. The equipment used for catheterization is usually prepackaged in a sterile disposable kit or tray. Within the sterile disposable kit or tray, there is sterile solution to clean the vagina for placement of the catheter into the urethra. A clean catheter and rubber gloves are not used to catheterize a client.

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 caring for a client with weakness who is ambulatory but tires easily. Which method for urinary elimination does the nurse recommend?

bedside commode Rationale: The client with weakness who tires easily may benefit from a bedside commode. Because the client is ambulatory, a bedpan or fracture pan is not needed. Ambulating to the regular bathroom may increase the risk for falls.

The nurse is caring for a client who reports having cloudy, foul-smelling urine. Which other symptoms does the nurse anticipate that the client has?

burning and frequency Rationale: The nurse anticipates that the client has a urinary tract infection (UTI), which is characterized by cloudy, foul-smelling urine, burning, and frequency. Difficulty starting a urine stream is associated with benign prostatic hypertrophy; UTIs are not characterized by intermittent clear urine, nor by constipation and fluid overload. Dehydration is more likely.

During his stay in the hospital, a male client has established a pattern of maintaining urinary continence during the day, but he is experiencing incontinence at night. What intervention should the nurse implement in this client's care?

condom catheter

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

A client has developed edema in her lower legs and feet, prompting her physician to prescribe furosemide, a diuretic medication. After the client has begun this new medication, what should the nurse anticipate?

increased output of dilute urine

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 Rationale: An intermittent urethral catheter (straight catheter) is a catheter inserted through the urethra into the bladder to drain urine for a short period of time (5 to 10 minutes). With an indwelling urethral catheter (retention or Foley catheters), a catheter (tube) is inserted through the urethra into the bladder for continuous drainage of urine; a balloon is then inflated to ensure that the catheter remains in the bladder once it is inserted.

A nurse is assessing the urine on a newborn's diaper. What would be a normal assessment finding?

light in color and odorless

Which term is most closely associated with an acute urinary tract infection?

pyuria

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. What would would the nurse document as an abnormal finding?

reddened meatal skin Rationale: Smegma, an accumulation of white, odorous secretions from sebaceous glands found under the labia minora in women and under the foreskin in men, is normal and is not a discharge from the urinary meatus.

An older adult woman living alone at home is incontinent of urine. Which nursing diagnosis would be appropriate for a plan of care?

risk for impaired skin integrity

The nurse is planning care for a client with a newly placed urostomy. For what priority problems will the nurse address and provide interventions? Select all that apply.

situational low self-esteem risk for infection

A client with urine retention related to a complete prostatic obstruction requires a urinary catheter to drain the bladder. Which type of catheter is most appropriate for a client that has an obstructed urethra?

suprapubic catheter

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 Rationale: The nurse would discard the first void of the day. The bladder has collected urine that has been produced by the kidneys overnight. The first voided urine of the day is usually more concentrated than other urine excreted during the day. Because the first urine of the day is not fresh, but rather an accumulation of a number of hours of kidney output, this urine may or may not be used as a specimen for certain tests.

A client is brought to the emergency department (ED) after a seizure. Which type of incontinence does the nurse anticipate the client may have experienced?

total