Ch. 37 Urinary
A nurse is administering continuous closed bladder irrigation to a client. After performing this intervention, the nurse observes that the irrigation solution is not flowing at the prescribed rate. Which actions should the nurse take? Select all that apply.
Raise the bag 3 to 6 in (7.5 to 15 cm). Check the tubing for kinks or pressure points. Open the clamp all the way.
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?
Reddened perineal skin
The nurse is caring for a client who has been experiencing difficulty voiding since her vaginal birth. The client voices concern to the nurse. What information should be provided to the client?
The birth can cause perineal swelling.
A client at a health care facility is being treated for cancer of the bladder. The physician uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion?
one or both of the ureters are surgically implanted elsewhere
A nurse is the guest speaker at a women's club. Most of the women are over the age of 40 years. The women have asked the nurse to speak on health promotion topics. In the area of urinary urgency, the nurse will instruct the women to:
perform Kegel exercises.
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 incontinence
The nurse is caring for a client who has been experiencing nausea, vomiting, and diarrhea for 3 days. Which urine characteristics does the nurse anticipate?
strongly aromatic, dark amber
The nurse measures a client's residual urine by catheterization after the client voids. Which condition would this test verify?
urinary retention
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 caring for an older adult client at his home. The client has had a condom catheter applied. Which describes a condom catheter?
a flexible sheath that is rolled around the penis
A nurse collects a clean-catch specimen from a client at a health care facility. Which statement describes a clean-catch urine sample?
a sample of urine that is considered sterile
The nurse is caring for a client who reports having cloudy, foul-smelling urine. Which assessment question should the nurse ask the client?
"Are you experiencing burning and frequency?"
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."
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?
"Let me talk to your health care provider about a condom catheter."
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."
Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine?
24-hour specimen
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 nurse is caring for a client with a hemodialysis access site. Which action should the nurse take?
Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration.
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
The nurse is preparing to insert an indwelling urinary catheter into a female client's bladder. The nurse has opened the sterile catheterization tray using sterile technique, donned sterile gloves and has opened all sterile supplies. Arrange the following steps in the correct order.
Clean each labial fold, then the area directly over the meatus. Insert the lubricated catheter into the urethra. Advance the catheter until there is a return of urine. Inflate the balloon with the correct amount of sterile saline. Discard used supplies.
A client has burning upon urination. The urinalysis indicates pyuria. Which is the next action the nurse will take?
Contact the health care provider
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?
Fasten the condom securely enough to prevent leakage without constricting blood flow.
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.
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.
The nurse is attempting to insert a urinary catheter into a female client's bladder and realizes the catheter has been inserted into the vagina. Which action is most appropriate?
Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.
A client is suspected of having a disease process affecting the functional unit of the kidney. Which stucture is most likely involved?
Nephron
Which statement should be included in the nurse's education plan for older adults regarding urinary elimination?
Nocturia and urinary retention are more common in older adults.
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?
Notifying the health care provider of the assessment findings
A client who undergoes peritoneal dialysis is admitted to the hospital after an elective total-knee arthroplasty. Upon assessment the nurse visualizes redness, drainage, and odor to the area around the peritoneal dialysis catheter. Palpation of the abdomen causes the client pain. Which intervention is the priority?
Notifying the health care provider of the assessment findings.
A nurse will use a bladder scanner to assess a client with urinary frequency. How should the nurse best prepare the client for this procedure?
Position the client in a supine position.
The nurse completes the task of changing the dressing of a recent surgically inserted peritoneal dialysis catheter. The nurse has applied antibiotic ointment as prescribed, covered the site with 4 × 4 gauze, and labeled the dressing with the date, time of change, and initials of the nurse performing the task. Prior to leaving the client's bedside, the nurse should complete which task next?
Secure the tubing of the peritoneal dialysis catheter to the client's abdomen.
A nurse is collecting a urine specimen for urinalysis. Which factors should the nurse consider when performing this procedure? Select all that apply.
Sterile urine specimens may be obtained by catheterizing the client's bladder. Strict aseptic technique must be used when collecting and handling urine specimens. A clean-catch specimen of urine may be collected in midstream.
Use of an indwelling urinary catheter leads to the loss of bladder tone.
True
The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse's best choice?
Urinal
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?
Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well.
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?
Voiding before and after sexual intercourse
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
During data collection, the client expresses concern over a change in the color of the urine from tea-colored to green since beginning a new medication. Which appropriate question would the nurse ask this client?
"Are you taking any B-complex vitamins?"
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?
"Discard your first urine and begin the collection after that."
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?
"Having sexual relationships does not put a woman at risk for developing a UTI."
A client is diagnosed with frequent urinary tract infections. What would be an appropriate question for the nurse to ask the client?
"How frequently do you urinate each day?"
The nurse is providing instructions to a client with kidney stones on measures to help prevent urinary tract infections (UTIs). Which statement made by the client would indicate to the nurse that further teaching is necessary? Select all that apply.
"I will drink 10 ounces of cranberry juice every day." "I will bathe in the bathtub rather than take a shower."
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?
"It is not unusual for children to regress when hospitalized; it should be short lived."
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."
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?
"Stress causes the muscles to become tense."
A female client is diagnosed with a urinary tract infection (UTI) and states this is her second one in the last 6 months. In teaching the client about health promotion, the nurse would include which statement?
"Try to urinate immediately after sexual intercourse."
The nurse is caring for a client with a prescription for a midstream urine specimen. The nurse would provide which information to the client?
"Void a small amount, stop, and discard it."
The nurse is assessing a female client who states that she notices an involuntary loss of urine following a coughing episode. What would be the nurse's best reply?
"You are experiencing stress incontinence. Do you know how to do Kegel exercises?"
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.
Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence?
Boys may take longer for daytime continence than girls.
Which symptom will have a great impact on the extracellular fluid for water conservation?
Burns
The nurse is caring for a male client who has a urinary obstruction and is not a candidate for surgery. Which intervention will the nurse prepare the client for?
Insertion of a urologic stent
The nurse is catheterizing a male urinary bladder, and urine leaks out of the meatus around the catheter. Which actions would the nurse perform next? Select all that apply.
Make sure the smallest sized catheter with a 10-mL balloon is used. Consider an evaluation for urinary tract infection. Ensure that the correct amount of solution was used to inflate the balloon.
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.
The nurse is inserting a urinary catheter into a 63-year-old male client and encounters resistance. What is the most likely cause of the resistance?
The client has an enlarged prostate.
A client's BUN test results are significantly elevated. When reviewing the client's history, which finding is consistent with BUN elevation other than renal compromise?
The client is dehydrated.
The nurse is assessing a client's bladder volume using an ultrasound bladder scanner. Which nursing actions are performed correctly? Select all that apply.
The nurse gently palpates the client's symphysis pubis. The nurse places a generous amount of ultrasound gel or gel pad midline on the client's abdomen, about 1 to 1.5 in (2.5 to 4 cm) above the symphysis pubis. The nurse aims the scanner head toward the bladder (points the scanner head slightly downward toward the coccyx). The nurse adjusts the scanner head to center the bladder image on the crossbars.
A nurse who is right-handed is inserting a woman's indwelling urinary catheter. The nurse will use cotton balls and antiseptic solution to cleanse the woman's meatus and perineum. Which of the nurse's actions is most appropriate?
Use her left hand to spread the woman's labia and keep them spread until the catheter is inserted.
The nurse is caring for a group of clients on the acute care unit. Which clients does the nurse identify that would benefit from urinary catheterization? Select all that apply.
a client in septic shock that is unresponsive a confused client that requires a sterile urine specimen to be obtained a client with an enlarged prostate that is unable to void
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
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
A woman is reporting bladder urgency. It is most important to assess:
caffeine intake.
When a client is diagnosed with a urinary tract infection, the nurse anticipates that the client's urine will be:
cloudy with an offensive odor.
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?
cloudy, foul odor
A client with a history of advanced liver disease comes to the emergency department (ED) with dehydration. White blood cell count shows elevation in bands and neutrophils. When preparing to catheterize the client, what color urine does the nurse anticipate will drain?
dark brown, cloudy
The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate?
dehydration
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?
functional incontinence
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
A client at the health care facility has been diagnosed with total urinary incontinence. How could the nurse describe the condition of the client?
loss of urine without any identifiable pattern or warning
A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a:
neurogenic bladder.
A 70-year-old client who has four children and six grandchildren states that she "wets" herself when she sneezes or laughs. She reports that sometimes this also occurs when rising from a sitting to standing position. Which type of incontinence does the nurse anticipate?
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
The nurse should instruct the female client who has experienced two urinary tract infections within the past year to:
void following sexual intercourse.
