Ch. 30 - Urine

The nurse just finished inserting an indwelling urinary catheter into a client and is sitting down to document the procedure. Which information should the nurse include in the medical record? Select all that apply. 1. Catheter size 2. Provision of privacy 3. Date and time of insertion 4. Projected date of removal 5. Amount of saline in balloon 6. Color, clarity, and amount of urine return

1. Catheter size 3. Date and time of insertion 5. Amount of saline in balloon 6. Color, clarity, and amount of urine return

Which physiological factors can place an 83-year-old client at risk for acute kidney injury? Select all that apply. 1. Decline in glomerular function 2. Loss of urinary sphincter control 3. Arteriosclerotic blood vessel changes 4. Decreased abdominal muscle control 5. Consumption of large quantities of caffeine

1. Decline in glomerular function 3. Arteriosclerotic blood vessel changes 4. Decreased abdominal muscle control

Which interventions should the nurse instruct the client to perform to decrease the incidence of urinary incontinence? Select all that apply. 1. Eliminate caffeine from the diet. 2. Limit the intake of fluids. 3. Stop smoking. 4. Lose weight. 5. Increase the use of artificial sweeteners.

1. Eliminate caffeine from the diet. 3. Stop smoking. 4. Lose weight.

Which are urinary symptoms that may occur as a result of the aging process? Select all that apply. 1. Leakage of urine 2. Decreased frequency of urination 3. Decreased volume of urine 4. Nocturnal frequency of urine 5. Bladder infections

1. Leakage of urine 4. Nocturnal frequency of urine 5. Bladder infections

Which health history information should be obtained before a nurse places an indwelling catheter? Select all that apply. 1. Any allergies 2. History of bladder surgery 3. History of heart disease 4. Any problems with constipation 5. Number of pregnancies

1. Any allergies 2. History of bladder surgery Allergies to iodine and latex will require alterations to normal indwelling catheter insertion procedure. History of bladder disease may require a smaller lumen catheter or alteration in the procedure.

A client has been having severe diarrhea and fever for the past few days with decreased urinary output. Which would be the expected effect on the urine specific gravity? 1. An increase in specific gravity 2. A decrease in specific gravity 3. No change in specific gravity of urine 4. Unable to determine with the information provided

1. An increase in specific gravity Specific gravity increases with dehydration or fluid loss.

A urine specimen is obtained by a client cleaning the exterior meatus, then beginning to void, then collecting the urine sample midstream. Which type of specimen does this describe? 1. Freshly voided specimen 2. Clean-catch specimen 3. Sterile urine specimen 4. 24-hour specimen

2. Clean-catch specimen

Which factors place female clients at higher risk for urinary tract infections? Select all that apply. 1. Pregnancy 2. Menopause 3. Sexual activity 4. Prostate enlargement 5. Longer urethral length

1. Pregnancy 2. Menopause 3. Sexual activity Pregnancy breaks the tone of the pelvic floor. Pregnancy can increase a female client's risk for urinary tract infections due to pressure on the bladder and hormonal changes. Menopause causes decreased normal flora as well as drying of the vaginal mucosa. Perineal pathogens can enter the urinary tract during sexual intercourse.

Which are goals of nursing care for a client with an indwelling urinary catheter? Select all that apply. 1. Prevent infection. 2. Maintain skin integrity. 3. Prevent the client from ambulating. 4. Keep the catheter in as long as possible. 5. Maintain the free flow of urine.

1. Prevent infection. 2. Maintain skin integrity. 5. Maintain the free flow of urine.

The home health nurse just removed an indwelling urinary catheter from a client per the health-care provider's order. Which instructions should the nurse provide the client? Select all that apply. 1. Report any pain or burning upon urination. 2. Increase oral fluid intake to promote urine production. 3. Contact the health-care provider if unable to urinate 8 hours after catheter removal. 4. Notify the health-care provider after the first void with color and amount of urine. 5. Discard the first urine sample after removing the catheter and then collect the urine in a jug for the next 24 hours.

1. Report any pain or burning upon urination. 2. Increase oral fluid intake to promote urine production. 3. Contact the health-care provider if unable to urinate 8 hours after catheter removal.

A nurse is caring for an elderly client who has nearly fallen twice while getting out of bed to go to the bathroom. The nurse has instructed the client not to get up without assistance. The client tells the nurse about feeling a need to get to the bathroom when the urge to void occurs and feeling a need to rush. Which strategy should the nurse utilize to minimize the client's risk of falling? 1. Obtain an order for an indwelling catheter. 2. Check on the client every 2 hours and offer toileting assistance. 3. Require that a family member stay with the client. 4. Obtain an order for restraints to prevent injury.

2. Check on the client every 2 hours and offer toileting assistance.

The nurse is reviewing the laboratory data for a client admitted with acute kidney injury. Which values would the nurse expect to see elevated? Select all that apply. 1. Sodium 2. Creatinine 3. Red blood cells (RBC) 4. Blood urea nitrogen (BUN) 5. Glomerular filtration rate (GFR)

2. Creatinine 4. Blood urea nitrogen (BUN) The creatinine level would be increased in a client with acute kidney injury, as the kidney cannot filter nitrogenous waste products. The BUN is increased due to a buildup of nitrogenous waste products that happens in acute kidney injury.

Which are measures a nurse can take to help prevent urinary tract infection in clients with an indwelling catheter? Select all that apply. 1. Disconnect the tubing regularly. 2. Empty the collection bag at least every 8 hours. 3. Regularly check connections. 4. Provide perineal care when the area becomes soiled. 5. Keep the collection bag below the level of the bladder. 6. Provide open irrigation as needed.

2. Empty the collection bag at least every 8 hours. 3. Regularly check connections. 4. Provide perineal care when the area becomes soiled. 5. Keep the collection bag below the level of the bladder.

When the nurse is inserting a catheter into a male client, resistance is met. What is the first action should the nurse take? 1. Remove the catheter and discard. 2. Hold the catheter firmly until resistance eases. 3. Push the catheter forcefully until it advances. 4. Remove the catheter and try inserting it again.

2. Hold the catheter firmly until resistance eases. Test Taking Tip: When inserting an indwelling catheter into a male client, it is common to feel resistance at the prostatic sphincter.

Which condition in older men can result in impaired flow of urine from the bladder into the urethra? 1. Renal calculi 2. Prostatic hypertrophy 3. Cardiovascular disorders 4. Stroke

2. Prostatic hypertrophy Prostatic hypertrophy is an enlarged prostate, and it can impair flow of urine out of the bladder.

A nurse is inserting an indwelling catheter into a client. She begins to inflate the balloon, she feels resistance, and the client complains of discomfort. Which action should the nurse take? 1. Remove the catheter and discard it. 2. Notify the physician and document that the client refused a catheter. 3. Deflate the balloon and advance the catheter about an inch before attempting again. 4. Leave the catheter in place without inflating the balloon.

3. Deflate the balloon and advance the catheter about an inch before attempting again.

A client presents to the emergency department with nausea and vomiting for 2 days. The client states he or she has not urinated at all for the past 8 hours. Which is the most likely cause of his lack of urine output? 1. Impaired renal function 2. Renal calculi 3. Dehydration 4. Prostatic hypertrophy

3. Dehydration The history of nausea and vomiting indicate that the client is likely to have a decreased fluid intake.

A nurse is placing an indwelling catheter in an obese female client and realizes that the catheter is in the vagina rather than the urinary meatus. Which action should the nurse take? 1. Remove the catheter from the vagina and again try to place the catheter. 2. Adjust the client's position or lighting and attempt again with the same catheter. 3. Discard the catheter, adjust the client's position and lighting, and try again with a new catheter. 4. Discard the catheter and ask another nurse to try to place the catheter.

3. Discard the catheter, adjust the client's position and lighting, and try again with a new catheter.

What is the purpose of using a drape when inserting a catheter? 1. Reduces the risk of infection 2. Improves lighting for the procedure 3. Provides privacy for the client 4. Helps regulate temperature

3. Provides privacy for the client

When inserting an indwelling catheter, which level of asepsis is used? 1. Medical asepsis 2. Disinfection 3. Surgical asepsis 4. Low level asepsis

3. Surgical asepsis

Which type of catheter should a client who is receiving a continuous irrigation have? 1. Single-lumen catheter 2. Double-lumen catheter 3. Triple-lumen catheter 4. Quad-lumen catheter

3. Triple-lumen catheter A triple-lumen catheter provides one lumen for injecting the balloon, one lumen for irrigation, and one lumen for the solution and urine to flow out of the bladder.

A client presents to the emergency room with vomiting and diarrhea. The client is dehydrated. Which hormone does the nurse expect to be secreted by the posterior pituitary gland to reduce water loss? 1. Renin 2. Aldosterone 3. Erythropoietin 4. Antidiuretic hormone (ADH)

4. Antidiuretic hormone (ADH)

The nurse has an order to obtain a urine specimen for a culture and sensitivity test from a client with an indwelling urinary catheter. Which procedure is accurate for obtaining the specimen? 1. Obtaining the specimen from the drainage bag 2. Disconnecting the tubing and obtaining the specimen 3. Inserting a new indwelling urinary catheter to obtain a sterile urine specimen 4. Clamping the tubing and withdrawing a fresh specimen from the tubing aseptically

4. Clamping the tubing and withdrawing a fresh specimen from the tubing aseptically

What anatomical feature makes women more prone to urinary tract infections than men? 1. Increased width of the pelvic bones 2. Proximity of the urethra to the vagina and anus 3. Larger bladder 4. Decreased length of the ureters

2. Proximity of the urethra to the vagina and anus

Which functions of the kidney are considered secondary functions? Select all that apply. 1. Acid-base balance 2. Renin production 3. Water reabsorption 4. Vitamin D activation 5. Erythropoietin secretion

2. Renin production 4. Vitamin D activation 5. Erythropoietin secretion

Which piece of information is most important for the nurse to obtain prior to removing an indwelling urinary catheter? 1. Date of insertion 2. Type of catheter material 3. Amount of saline in balloon 4. Allergy to betadine or shellfish

3. Amount of saline in balloon This allows the nurse to use the correct syringe size and to ensure the nurse removes all of the saline before pulling the catheter out.

The nurse calculates urinary output for a client admitted with dehydration and determines the client's output is 800 mL/day. Which nursing intervention is most appropriate for the nurse to perform first? 1. Notify the health-care provider. 2. Document the finding as normal. 3. Assess the urine color and clarity. 4. Insert an indwelling urinary catheter.

3. Assess the urine color and clarity. The normal daily urine output should be a minimum of 1200 mL. This client is at risk for urinary dysfunction due to low output. However, the nurse needs to obtain more information prior to contacting the health-care provider. The nurse needs more information prior to notifying the health-care provider. Therefore, the nurse should assess the color and clarity of the urine first.

The nurse is assessing the urinalysis results for a client with an indwelling urinary catheter. Which findings indicate the presence of a urinary tract infection? Select all that apply. 1. Glucose 2. Ketones 3. Bacteria 4. Bilirubin 5. Hemoglobin 6. Leukocyte esterase

3. Bacteria 5. Hemoglobin 6. Leukocyte esterase GLUCOSE would be present in the urinalysis for a client with diabetes mellitus. It does not indicate a urinary tract infection. A client with impaired carbohydrate metabolism such as uncontrolled type 1 diabetes mellitus would have KETONES in the urine. This finding would not show the presence of infection. A client with liver disease, not a urinary tract infection, would have BILIRUBIN in the urine.

Which is an advantage of intermittent catheterization over indwelling catheters? 1. Convenience to the client 2. Decreased risk of infection 3. Can be removed immediately and client can void normally 4. Convenient for the nurse

3. Can be removed immediately and client can void normally