Chapter 41 - Urinary Elimination - Adaptive Quiz

The nurse determines that a female patient has a history of urinary tract infections. Which instructions does the nurse give the patient to prevent further episodes of urinary tract infections? Select all that apply. "Do not wear tight-fitting clothing." "Take baths rather than showers." "Take perfumed bubble baths." "Drink eight 8-ounce glasses of water per day." "Wipe the perineum from front to back after voiding."

-"Do not wear tight-fitting clothing." -"Drink eight 8-ounce glasses of water per day." -"Wipe the perineum from front to back after voiding." The nurse instructs the patient to refrain from wearing tight-fitting clothing because it may irritate the urethra and prevent ventilation of the perineal area. The nurse also instructs the patient to drink at least eight 8-ounce glasses of water per day to help flush out bacteria and maintain the fluid and electrolyte balance. The microorganisms in the anal area may contaminate the urethra; therefore the patient is instructed to wipe the perineal area from front to back after urination to prevent contamination of the urethra from fecal material. The patient should shower instead of bathing because it reduces the risk of infection. The nurse should also instruct the patient not to use perfumed bubble baths because they may cause inflammation and encourage bacterial growth.

The patient states that she "loses urine" every time she laughs or coughs. The nurse teaches the patient measures to regain urinary control. Which statement by the patient indicates the need for further teaching? "I will perform my Kegel exercises every day." "I joined Weight Watchers." "I drink two glasses of wine with dinner." "I have tried urinating every 3 hours."

-"I drink two glasses of wine with dinner." Alcohol is a bladder irritant. It increases urine production and causes uncontrolled bladder contractions. Kegel exercises should be performed every day to strengthen the bladder muscles. Losing weight decrease pressure on the bladder and helps strengthen bladder muscles. Following a toileting schedule keeps the bladder empty and decrease incontinent episodes.

A patient with hematuria is scheduled for cystoscopy. Which instruction does the nurse give to the patient after cystoscopy? "Increase your fluid intake." "Refrain from eating cereals." "Limit your potassium intake." "Do not consume citrus fruit."

-"Increase your fluid intake." The patient may have a burning sensation and an increased risk of urinary tract infections (UTIs) after cystoscopy; therefore the nurse instructs the patient to increase fluid intake. Increased fluid intake minimizes burning and prevents UTIs. Consumption of cereals, potassium, and citrus fruits do not cause a burning sensation or increase the risk of UTIs after cystoscopy.

Which instructions regarding bladder training should be included in the teaching plan for the family of a patient who is incontinent because of a stroke? "Use a Foley catheter at night to prevent accidents." "Offer the patient the commode or urinal every 1 to 2 hours." "Decrease the patient's oral fluid intake to 1 L per day." "Instruct the patient to hold the urine as long as possible to restore bladder tone."

-"Offer the patient the commode or urinal every 1 to 2 hours." To begin a bladder-training program, a nurse should teach the family to offer the patient the commode, bedpan, or urinal every 1 to 2 hours. When offered frequently enough, this prevents accidents and establishes a routine. Using a Foley catheter in a home setting increases the possibility of trauma or infections to the urethra and bladder. Decreasing the patient's fluid intake could cause secondary complications of dehydration and electrolyte imbalance. The patient is incontinent, so he or she is unable to hold the urine.

While assessing the results of a patient's serum creatinine test, the nurse finds that the patient has kidney damage. What would be the creatinine level in this patient? 0.5 mg/dL 0.9 mg/dL 1.2 mg/dL 1.6 mg/dL

-1.6 mg/dL Serum creatinine levels rise in cases of kidney damage. Normal values of creatinine are 0.6 to 1.2 mg/dL for women and 0.8 to 1.4 mg/dL for men. Therefore a creatinine level of 1.6 mg/dL indicates that the kidney is damaged. A value of 0.5 mg/dL is less than normal and may occur as a result of severe liver disease or a diet that is very low in protein. Values of 0.9 mg/dL and 1.2 mg/dL are normal and thus indicate proper functioning of the kidneys.

Which daily urine output from a child weighing 10 kg would lead the nurse to conclude the child has oliguria? 100 mL 120 mL 140 mL 150 mL

-100 mL Normal urine output in children is 0.5 mL/kg per hour. Therefore the normal urine output per day for a child who weighs 10 kg is 0.5 mL × 10 kg × 24 hours = 120 mL per day. The nurse finds that the child has oliguria, which indicates that the urine volume of the child is less than 120 mL per day. The urine volumes of 120 mL per day, 140 mL per day, and 150 mL per day indicate adequate urine output for a child who weighs 10 kg.

A patient suffering from bladder cancer has surgery, and an orthotopic neobladder is placed in the patient. Which information would the nurse explain to this patient? The neobladder has to be catheterized frequently. A neobladder does not require a cutaneous urinary collection device. The urine drains continuously. You have to use a collection pouch at all times.

-A neobladder does not require a cutaneous urinary collection device. An orthotopic neobladder eliminates the need for a cutaneous urinary collection device and, in some cases, the need for intermittent catheterization. The bladder pouch needs to be catheterized frequently in case a continent urinary reservoir is created from a distal portion of the ileum and proximal portion of the colon. In an incontinent urinary diversion, the urine drains continuously and needs application of a collection pouch at all times.

The patient is incontinent, and a condom catheter is placed. The nurse would take which action? Secure the condom with tape. Change the condom every 48 hours. Assess the patient for skin irritation. Use sterile technique for placement.

-Assess the patient for skin irritation. Skin irritation can occur when the condom is twisted at the drainage tube attachment and obstructs urine drainage. The condom catheter has a self-adhesive film, so tape is not necessary and may damage the patient's skin. The condom catheter should be changed as needed. Sterile technique is not required for condom catheter placement.

A nurse, along with unlicensed assistive personnel (UAP), is catheterizing a patient with neurogenic bladder. Which duties are the responsibilities of the UAP? Select all that apply. Assist in positioning the patient Focus lighting Provide comfort measures Insert catheter into the urethral meatus Inflate the balloon fully as per the manufacturer's direction

-Assist in positioning the patient -Focus lighting -Provide comfort measures In some settings, UAPs may be permitted to insert a urinary catheter, but it is not routine practice. The UAP may assist with positioning the patient, focusing lighting, maintaining patient position, and providing comfort measures. Inserting the catheter into the urethral meatus and inflating the balloon of the catheter are skilled activities that should be performed by the nurse.

A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-catch urine specimen is markedly cloudy. Which factor might be the cause of these symptoms and findings? Bacteria Hypercalcemia Liver failure Uncontrolled diabetes

-Bacteria

Before the administration of prescribed metronidazole, the nurse explains that the patient's urine may be which color? Brown Blue Green Red

-Brown Some medications may affect urine color. Metronidazole causes tea-colored or brown urine. Cimetidine, indomethacin, and promethazine cause blue-green urine. Rifampin, warfarin, and phenazopyridine cause red urine.

Since removal of the patient's Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action would the nurse take first? Check for bladder distention. Encourage fluid intake. Obtain an order to recatheterize the patient. Document the amount of each voiding for 24 hours.

-Check for bladder distention. The patient may experience urinary retention after catheter removal. If amounts voided are small, checking for bladder distention is necessary. Fluids should not be encouraged or an order obtained for a new catheter until the reason for the minimal urine output has been determined. The nurse should document the patient's output, but this is not the priority action.

The nurse is caring for a patient who has undergone surgery for the placement of a suprapubic catheter. Which interventions does the nurse implement to reduce the risk of complications? Select all that apply. Check for drainage at the insertion site. Instruct the patient not to use any soap. Assess the patient for signs of infection. Have the patient apply lotion to the site. Instruct the patient to increase fluid intake.

-Check for drainage at the insertion site. -Assess the patient for signs of infection. -Instruct the patient to increase fluid intake. Redness and drainage are signs of infection; therefore checking for these signs helps assess the patient and prevent further complications. Increasing fluid intake keeps the patient hydrated and promotes urinary excretion. The patient should use soap and water to clean the site. The use of lotions and ointments is not useful in preventing infection and should be avoided.

The nurse notes that the patient's Foley catheter bag has been empty for 4 hours. Which action by the nurse is priority? Irrigate the Foley. Check for kinks in the tubing. Notify the health care provider. Assess the patient's intake.

-Check for kinks in the tubing. Kinks in tubing prevent flow of urine. To keep the drainage system patent, check for kinks or bends in the tubing. The Foley should not be irrigated or the health care provider notified until the line has been assessed for kinks or bends. The patient's intake can be assessed after the line has been checked.

The nurse is caring for a patient who reports deep amber urine and increased odor. While reviewing the laboratory results, the nurse finds that the blood urea nitrogen (BUN) level is 25 mg/dL and the urine specific gravity is high. Which condition does the nurse suspect in this patient? Hepatitis Dehydration Diabetes mellitus Urinary tract infection

-Dehydration The normal color of urine is pale yellow to amber. The urine may be deep amber due to dehydration or low fluid intake. The odor of the urine increases with dehydration because a larger amount of waste is excreted in a smaller amount of urine. Because of the dehydration, there is a decreased amount of water and the nitrogenous waste products are more concentrated, making the BUN elevated. Decreased urine output means the urine will contain greater amounts of solid materials, and thus the specific gravity will increase. The urine of a patient with hepatitis will resemble the color of tea. BUN levels are also decreased in hepatitis. BUN levels increase in cases of diabetes mellitus, but the urine will have a fruity odor. In a patient with a urinary tract infection, the urine will be cloudy with a foul smell. STUDY TIP: If a patient is dehydrated, the body conserves fluid by concentrating the urine, which produces the deep amber color as well as the increased specific gravity finding.

The patient's urine specific gravity is 1.05. The urine tests positive for ketone bodies. Which conditions could be the possible causes? Select all that apply. Diabetes mellitus 2 Dilute urine A diet low in sugars and carbohydrates Overhydration Starvation

-Diabetes mellitus -A diet low in sugars and carbohydrates -Starvation The presence of ketones in the urine (ketonuria) indicates that fat has broken down for energy. Ketones are normally not passed in the urine. Large amounts of ketones in the urine may indicate diabetic ketoacidosis. A diet low in sugars and carbohydrates, prolonged fasting or starvation, and vomiting also may be associated with ketonuria. A high specific gravity and presence of ketone bodies do not indicate urine dilution or overhydration. STUDY TIP: The more concentrated the urine, the higher its specific gravity. The specific gravity of distilled water is 1.000, and normal urine may range from 1.005 to 1.030. Therefore a specific gravity of 1.050 is high, indicating the urine is more concentrated than normal, or lower in water content than normal. A dilute urine would have a lower-than-normal specific gravity. You also know the patient is not overhydrated. Thus the choices "Dilute urine" and "Overhydration" can be eliminated.

The nurse finds that a patient's urine has a sweet fruity odor. Which condition does the nurse suspect in this patient? Dehydration Diabetes mellitus Urinary infection Enlarged prostate

-Diabetes mellitus Uncontrolled diabetes may cause a sweet fruity odor in urine. Deep amber-colored urine is observed in cases of dehydration. A foul odor is an indication of a urinary infection. Red or pink urine color is observed in cases of an enlarged prostate.

Which description of anuria is accurate? Painful urination Reduced volume of urine Failure to excrete urine Excessive urination at night

-Failure to excrete urine Anuria is the failure of the kidneys to excrete urine. Dysuria is the term for painful urination. A reduced volume of urine is called oliguria. Excessive urination at night is called nocturia. STUDY TIP: The prefixes a- and an- mean "no," "not," or "without." Anuria's literal meaning is "without urination." Think of (or look up in a dictionary) other terms that begin with this prefix, such as anhydrous ("without water"), to help you recall the meaning of anuria. Acute anuria is life threatening and requires emergent investigation.

Which functions are true of kidneys? Select all that apply. Filter liquid waste from the blood Balance electrolytes in the blood Regulate blood volume and pressure Synthesize vitamin D to help control calcium levels Synthesize vitamin A to help control calcium levels

-Filter liquid waste from the blood -Balance electrolytes in the blood -Regulate blood volume and pressure -Synthesize vitamin D to help control calcium levels The kidneys are the major excretory organs of the body. The two kidneys are located bilaterally below the ribs toward the middle of the back. They filter liquid waste from the blood, balance electrolytes in the blood, regulate blood volume and pressure, produce erythropoietin for red blood cell formation, synthesize vitamin D to help control calcium levels, and maintain the acid-base balance of the extracellular fluid. The kidneys do not synthesize vitamin A.

The nurse is reviewing the lab report of a patient. The presence of which substance in the urine hints at the possibility of an abnormality? Protein: 6 Glucose: ++ Red blood cells: 2 White blood cells: 4

-Glucose: ++ A normal urinalysis should not be positive for glucose, as glucose undergoes complete reabsorption. The presence of protein in the urine is acceptable under 8 mg/100 mL. The presence of 2 red cells is acceptable, but there should not be any more than this. A white cell of count 4 is acceptable and does not indicate abnormality.

The patient has to provide a urine sample. Which actions should the nurse perform? Select all that apply. Instruct patient to obtain a midstream sample. Instruct patient to obtain a last-stream sample. Instruct patient to obtain a sample at the beginning of urination. Use a sterile specimen cup. Take care not to contaminate the specimen.

-Instruct patient to obtain a midstream sample. -Use a sterile specimen cup. -Take care not to contaminate the specimen. For culture and sensitivity testing, urine is collected by the clean-catch, or midstream, method using a sterile specimen cup. Specimens also can be obtained by performing straight catheterization using sterile technique or by removal of a specimen from the tubing of an indwelling catheter or urinary diversion collection bag. Care needs to be taken to ensure that the specimen is not contaminated. Last-stream samples usually contain dermal contaminants. Initial-stream samples contain urethral contaminants.

An obese patient reports leaking urine while coughing. Which management strategies would be included in the patient's treatment plan? Select all that apply. Adequate fluid intake Kegel exercises Heavy weightlifting Weight-control measures Caffeinated beverages

-Kegel exercises -Weight-control measures The patient's symptoms are suggestive of stress incontinence of urine (ICNP) associated with increased intra-abdominal pressure and weak pelvic musculature due to obesity. Kegel exercises should be taught to the patient to strengthen the pelvic muscles. Weight-control measures should be instituted to help the patient lose weight and maintain a healthy weight. Maintaining fluid intake is helpful for patients who are at risk for infection, not for stress incontinence. Lifting heavy weights can put pressure on the bladder and worsen incontinence. The intake of caffeinated beverages should be avoided by a patient suffering from stress incontinence. Caffeine irritates the bladder mucosa and can cause bladder spasms, worsening the incontinence.

The nurse is preparing to administer erythropoietin to a patient who presents with a deficiency. The nurse knows that the patient needs this medication because of dysfunction in which organ? Liver Bone Kidney Spleen

-Kidney Kidneys produce erythropoietin. Patients with chronic renal failure require exogenous erythropoietin supplementation for red blood cell production. The liver, bones, and spleen are not involved in the synthesis of erythropoietin.

A patient reports pink-colored urine. During the assessment, the nurse finds that the patient has abdominal distension and feels discomfort during percussion. The patient's medical reports show an increased ratio of blood urea nitrogen to creatinine, along with the presence of glucose in the urine. How would the nurse interpret these patient findings? Kidney disease Signs of cirrhosis of the liver Indomethacin use Promethazine use

-Kidney disease The color of normal urine varies from pale yellow to amber. Pink urine indicates either the presence of blood in the urine or kidney disease. Normally, the abdomen is not distended and it is free of swelling and bruises. Abdominal distension may occur due to additional fluid retention because of the kidney disease. The patient should not feel pain or discomfort with percussion. Discomfort during percussion is a symptom of kidney disease. An increased ratio of blood urea nitrogen to creatinine is a symptom of kidney disease. Normal urine has very little to no glucose. The presence of glucose in the urine can also indicate kidney disease. A decreased ratio of blood urea nitrogen to creatinine indicates cirrhosis of the liver. Indomethacin and promethazine cause blue-green urine and do not affect the ratio of blood urea nitrogen to creatinine.

The nurse is reviewing the urinalysis report for a patient. Which finding indicates possible glomerular injury? White blood cells Casts Large proteins Glucose

-Large proteins The presence of large proteins in the urine is suggestive of glomerular injury, as they are not normally able to filter through the glomerulus. White blood cells and casts can indicate a urinary tract infection. Glucose in the urine may be indicative of diabetes mellitus. STUDY TIP: Proteins are large molecules, so they are not normally filtered by the kidney into the urine. The filtering apparatus does not normally let them pass; you could think of it as trying to force a goldfish through a window screen. When large proteins are in the urine, it means there is damage (think of it as holes in the screen) to the filtering apparatus, the glomerulus.

A patient is being assessed for a possible urinary tract infection (UTI). Before sending a urinalysis specimen to the laboratory, the nurse collects a small amount of urine to perform a dipstick test. If the patient has a UTI, which component would be detected in the urine? Protein Glucose Ketones Leukocytes

-Leukocytes A dipstick test is performed in the health care provider's office to test for different components. In this case, the health care provider tests for white blood cells or leukocytes, which indicate an infection. Protein is detected in patients with nephropathy. Glucose is detected in patients with diabetes mellitus. Ketones are detected in patients with poorly controlled diabetes, starvation, and dehydration.

Which information would the nurse teach the patient to minimize episodes of nocturia? Perform perineal hygiene after urinating. Set up a toileting schedule. Double void. Limit fluids before bedtime.

-Limit fluids before bedtime. The patient with nocturia has to get up during the night to urinate. Limiting fluids 2 hours before bedtime minimizes nocturia. Performing perineal hygiene after urinating does not prevent nocturia. Setting up a toileting schedule and double voiding do not minimize episodes of nocturia.

Which symptom is characteristic of stress incontinence? A sudden urge to void Loss of urine when coughing Constant dribbling of urine Inability to reach the toilet

-Loss of urine when coughing Loss of urine control during activities such as coughing that increase intraabdominal pressure indicates stress incontinence. A sudden urge to void indicates urge incontinence. A constant dribbling of urine indicates overflow incontinence. The inability to reach the toilet in time indicates functional incontinence.

A patient is scheduled for an x-ray of the kidney, ureter, and bladder. Which preliminary preparations would this patient take? No preparation is required for x-ray. Bowel preparation is done with magnesium citrate. Light sedatives are provided the previous night. Fasting is required before examination.

-No preparation is required for x-ray. For getting an x-ray of kidney, ureter, and bladder there is no specific preliminary preparation that needs to be done. Bowel preparation with magnesium citrate is required for barium enema, colonoscopy, and flexible sigmoidoscopy. Light sedation is required for upper endoscopy, colonoscopy, sigmoidoscopy, and computed tomography scan. The patient needs to fast before the examination for certain procedures. Such procedures include barium swallow, upper endoscopy, barium enema, ultrasound, computed tomography, and magnetic resonance imaging.

The nurse assesses that a patient's urinary output is 25 mL per hour. Which nursing intervention is the priority for this patient? Give the patient intravenous fluids. Monitor the patient's potassium levels. Notify the health care provider. Have the patient increase fluid intake.

-Notify the health care provider. Normal urine output in adults is 60 mL per hour. Urine output of less than 30 mL per hour indicates decreased renal perfusion; the nurse reports this to the health care provider immediately to identify the cause and prevent complications. Intravenous fluids help maintain the fluid and electrolyte balance if the cause of the decrease in urine output is determined to be decreased intake of fluids. Potassium levels increase during renal failure; therefore the nurse should monitor the potassium levels and start dialysis accordingly. Increased intake of fluids is useful if the cause of the patient's low urine output is decreased fluid intake. STUDY TIP: To help you recall that normal urine output in adults is 60 mL/hour, connect that rate with a common highway speed limit of 60 MILES per hour.

A patient with acute renal failure has low blood pressure with pale, clammy, and cool skin. The nurse determines that the patient's urine volume is less than 400 mL per day and the serum potassium level is 7.5 mEq/L. Which condition does the nurse suspect in this patient? Anuria Oliguria Dysuria Nocturia

-Oliguria Normal urine output is about 2500 mL per day. The patient's urine output is less than 400 mL per day, which indicates oliguria (a condition in which the patient has reduced urine output). Low blood pressure and pale, clammy, and cool skin occur as a result of acute renal failure and oliguria; potassium retention also may occur. Anuria is the absence of urine excretion. Dysuria is painful urination. Nocturia is excessive urination at night.

A patient with a bladder disorder is advised to get a urinary diversion. The patient wishes to have the type of urinary diversion that allows normal voiding. Which type of urinary diversion suits the patient's requirement? 1Ileal conduit Indiana pouch Orthotopic neobladder Mainz pouch

-Orthotopic neobladder Orthotopic neobladder is the diversion procedure that allows the patient to have normal voiding. In the case of an ileal conduit, urine drains through a stoma into a collection bag. Incontinent urinary diversion is associated with continuous urinary drainage without the patient's voluntary control. For cutaneous continent diversions (Kock pouch, Indiana pouch, Mainz pouch), a collection reservoir is surgically created using a segment of the intestine; the patient then needs to catheterize the reservoir through a cutaneous stoma every 4 to 6 hours to drain stored urine.

Which measures would the nurse emphasize to prevent urinary tract infections in females? Select all that apply. Proper handwashing Use of indwelling catheters Frequent sexual intercourse Wiping from front to back after voiding and defecation Adequate fluid intake

-Proper handwashing -Wiping from front to back after voiding and defecation -Adequate fluid intake Proper handwashing may prevent spread of microorganisms. Wiping from front to back after voiding and defecation prevents the entry of microorganisms to the urinary system. Adequate fluid intake promotes urine formation and prevents bacterial growth. Indwelling urinary catheters serve as a port of entry for microorganisms and increase the risk of infection. Frequent sexual intercourse increases the risk of infection by introduction of microorganisms into the genital area.

The patient suffering from urinary incontinence is admitted to the hospital. How can the nurse help the patient manage incontinence? Select all that apply. Provide low-set chairs. Provide a bedside commode. Provide information about continence care. Keep the bed raised well above the floor. Provide clothes that can be easily opened.

-Provide a bedside commode. -Provide information about continence care. -Provide clothes that can be easily opened. Incontinence can be due the inability to reach the toilet on time when the bladder is full. A bedside commode helps the patient reach the toilet in time. The nurse should provide resources for information about continence care, patient education, and treatment available at various supportive care centers. This information would help the patient learn about the problem and the correct ways to manage it. Some patients may find it difficult to unbutton or unzip. This delay can result in urinary incontinence. Low-set chairs and beds raised well above the floor may prevent the patient from reaching the toilet in time.

Which intervention is most appropriate for a patient with functional urinary incontinence? Insert an indwelling catheter. Increase fluid intake to "flush" the kidneys. Provide normal fluid intake and establish a toilet schedule. Restrict fluid intake to decrease the episodes of incontinence.

-Provide normal fluid intake and establish a toilet schedule. For physiologic health, a patient needs to maintain normal fluid intake. A toileting schedule based on the patient's elimination patterns can help reduce episodes of incontinence. Catheters are used as a last choice because of infection potential and body self-image issues. Fluid intake should be kept at normal levels; there is no need to increase it. Restricting fluid intake may cause dehydration.

The nurse is caring for a patient with a urinary obstruction that prevents the flow of urine. While analyzing the microscopic urinalysis, the nurse notes the presence of crystals in the urine. Which patient condition does the nurse infer from these findings? Infection Renal calculi Dehydration Kidney damage

-Renal calculi The presence of crystals in urine shows renal calculi (stones), which may obstruct the flow of urine. Therefore catheters called stents may be placed in the ureters to prevent the obstruction of the flow of urine. The presence of bacteria in the urine indicates infection. Increased specific gravity and an increased ratio of blood urea nitrogen to creatinine may indicate dehydration. The presence of proteins and glucose in the urine indicates kidney damage.

A patient is advised to undergo dialysis. Which condition is an indication for dialysis? Urinary tract infection Prostate enlargement Renal failure refractory to conservative management Incontinence due to spinal cord injury

-Renal failure refractory to conservative management Dialysis is a method of cleaning the blood of waste products and metabolic toxins through the process of diffusion, osmosis, and ultrafiltration. It is needed in patients who have renal failure that does not respond to conservative therapies such as dietary management and medications. Urinary tract infections are managed by increasing the fluid intake and antibiotic therapy. Prostate enlargement can be surgically treated. The patient with incontinence caused by spinal cord injury is managed by catheterization.

The nurse notes that a patient's urine is orange. Which drug history does the nurse check for in the patient's medical record? Rifampin Cimetidine Metronidazole Promethazine

-Rifampin Normal urine has a pale yellow to an amber color. Many medications may affect urine color. Rifampin causes red-colored urine. Cimetidine causes blue-green urine. Metronidazole causes the urine to turn brown or tea-colored. Promethazine causes blue-green urine.

A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in small amounts and is more frequent when she coughs. The nursing assessment reveals that the patient is obese, has had three pregnancies, and has already gone through menopause. Which nursing interventions would be helpful to this patient in reducing incontinence? Select all that apply. Advise the patient to suppress cough. Teach the patient Kegel exercises. Advise the patient to avoid caffeinated drinks. Stress the importance of losing weight. Encourage lifting heavy weights to increase muscle strength.

-Teach the patient Kegel exercises. -Advise the patient to avoid caffeinated drinks. -Stress the importance of losing weight. Kegel exercises increase the strength of muscles around the urethra and help reduce stress incontinence. Losing weight helps reduce stress incontinence. Caffeinated drinks have a diuretic effect and increase stress incontinence. Cough is a reflex activity and is difficult to control voluntarily. Lifting heavy weights increases abdominal pressure and thus increases incontinence; therefore it should be avoided.

A patient with renal failure is advised to undergo peritoneal dialysis. Which statement holds true for peritoneal dialysis? The abdominal cavity functions as a dialyzing membrane. The dialysate fluid is pumped through one side of a semipermeable membrane. The processes of diffusion, osmosis, and ultrafiltration clean the patient's blood. The blood is returned to the body through a specially placed vascular access device.

-The abdominal cavity functions as a dialyzing membrane. There are two types of dialysis: peritoneal dialysis and hemodialysis. In peritoneal dialysis, the abdominal cavity functions as the dialyzing membrane through which fluid and molecules are exchanged and toxic substances are removed from the body. In hemodialysis, the dialysate fluid is pumped through one side of the artificial semipermeable membrane. The patient's blood is pumped through the other side. The patient's blood becomes clean through osmosis, diffusion, and ultrafiltration. The clean blood is then returned to the body through specially placed devices, graft, fistula, or catheter.

A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in small amounts and is more frequent when she coughs. Which information would the nurse teach the patient about her disorder? Select all that apply. It is the result of local irritation. It occurs due to nervous system disorders. The leakage occurs due to weakness of muscles around the urethra. This condition is called stress incontinence. It occurs when the intraabdominal pressure exceeds urethral resistance.

-The leakage occurs due to weakness of muscles around the urethra. -This condition is called stress incontinence. -It occurs when the intraabdominal pressure exceeds urethral resistance. Involuntary voiding of urine on coughing occurs due to weakness of muscles around the urethra. It is also called stress incontinence. Stress incontinence occurs in older women when intraabdominal pressure exceeds urethral resistance. Involuntary voiding occurs only when abdominal pressure rises above the urethral pressure. Local irritating factors and nervous system disorders usually lead to urge incontinence.

A patient is scheduled for a cystoscopy. Which information would the nurse give to this patient about cystoscopy? Select all that apply. The patient may have difficulty voiding after the test. The urine output will increase after the test. The patient should limit the intake of fluids before the test. The urine will be straw-colored after the test. The exam takes 2 to 3 hours to perform.

-The patient may have difficulty voiding after the test. -The patient should limit the intake of fluids before the test. Cystoscopy involves visualization of urinary structures through a scope inserted into the urinary tract. It may cause tissue edema, and as a result the patient may have difficulty voiding after the test. The patient should take nothing by mouth 8 to 12 hours before the test in case general anesthesia needs to be administered. Because of edema, the urine output may decrease, not increase. The urine may be red or pink in color after the test because of local injury. The entire examination may take up to 45 minutes.

A nurse is preparing to administer a continuous bladder irrigation. Which type of catheter is useful for this type of bladder irrigation? Foley catheter Coudé catheter Straight catheter Triple-lumen catheter

-Triple-lumen catheter Triple-lumen catheters have one lumen to introduce sterile irrigation fluid, one to drain the urine, and the third lumen to fill the retention balloon at the tip of the catheter. A Foley catheter has two lumens: one for draining urine and the other for filling a balloon. Coudé catheters are a special type of double-lumen catheter with a curved tip for use in patients with enlarged prostate glands. Straight catheters have only one lumen to drain the urine.

The postoperative patient has difficulty voiding after surgery and is feeling "uncomfortable" in the lower abdomen. Which action should the nurse implement first? Encourage fluid intake. Administer pain medication. Catheterize the patient. Turn on the bathroom faucet as the patient tries to void.

-Turn on the bathroom faucet as the patient tries to void. The sound of running water helps many patients void through the power of suggestion. Encouraging fluid intake, administering pain medications, and catheterizing the patient are effective measures, but it may be helpful to provide sensory stimuli that will help the patient relax, as this is a less invasive approach to take initially.

A patient complains that he is not able to pass urine completely. Even after voiding, the patient does not feel that the bladder is empty. Which test can be done to determine the extent of urinary retention in the patient? Ultrasound Cystoscopy X-ray of the abdomen Intravenous pyelogram (IVP)

-Ultrasound A bladder scan can be conducted by the nurse with handheld ultrasound equipment to quickly determine the extent of urinary retention. A cystoscopy helps visualize the structures of the urinary tract. An x-ray of the abdomen may show the condition of abdominal organs, but is not helpful in determining the residual urine left in the bladder. An intravenous pyelogram may help determine the function of the kidneys, but does not help in determining the extent of urinary retention.

Which diagnostic examination is the safest way to assess the urinary system in pregnant women? Cystoscopy Ultrasound examination Intravenous pyelogram Computed tomographic scan

-Ultrasound examination An ultrasound examination helps assess the kidneys. It is safe to perform in pregnant women because no radiation or contrast dyes are used. Anesthesia must be administered to a patient before performing cystoscopy; therefore the patient notifies the health care provider before undergoing the procedure. An intravenous pyelogram may expose the patient to low amounts of radiation that can affect the fetus during the pregnancy. A computed tomographic scan may cause a teratogenic effect in the fetus due to the radiation used in the process.

The nurse is reviewing laboratory results for a patient and notices the urine tested positive for ketones. Which underlying factors may lead to the presence of urinary ketone bodies? Select all that apply. Epilepsy Uncontrolled diabetes mellitus A diet low in sugars and carbohydrates Hyperthyroidism Starvation

-Uncontrolled diabetes mellitus -A diet low in sugars and carbohydrates -Starvation Ketones are produced as a byproduct when the body uses fat for energy production. Large amounts of ketones in the urine may indicate diabetic ketoacidosis. A diet low in sugars and carbohydrates, prolonged fasting or starvation, and vomiting also may be associated with ketonuria. Epilepsy and hyperthyroidism are not associated with the presence of ketone bodies in urine. Epilepsy is a disease that affects the nervous system, and hyperthyroidism affects the endocrine system.

A patient has recently undergone surgery. Which complication does the nurse expect as a result of anesthesia? Nocturia Hematuria Urine retention Temporary incontinence

-Urine retention Anesthesia decreases the awareness of the need to void and results in urine retention. Anesthetic agents do not stimulate bladder activity at night and are not responsible for causing nocturia. Anesthetic agents do not cause irritation or inflammation of the mucosa, so they do not lead to hematuria. Constipation can cause temporary incontinence because it results in the impaction of stool and interferes with bladder emptying.

The nurse is evaluating an unlicensed assistive personnel (UAP) member who is helping a patient use a bedpan. Which action by the UAP indicates a need for correction? Using a cold bedpan Cleaning out the bedpan after every use Putting the patient in a high Fowler's position Placing a small pillow under the patient's back

-Using a cold bedpan A patient who is unable to ambulate to the bathroom may use a bedpan for urination. The UAP should warm the bedpan before use because a cold bedpan contracts the perineal muscles and inhibits voiding. Cleaning the bedpan after every use helps prevent infection. A high Fowler's position increases intraabdominal pressure and stimulates voiding from a more natural position. Placing a small pillow behind the patient's back while voiding helps make the patient comfortable.

The nurse is educating a group of women about measures to reduce the risk of urinary tract infections. Which instruction would the nurse include in the teaching? Decrease fluid intake. Wash hands frequently. Urinate every 8 hours. Wipe from back to front after defecation.

-Wash hands frequently. Inadequate handwashing predisposes patients to urinary infections; therefore frequent handwashing reduces this risk. The nurse should tell patients to increase their fluid intake, not decrease it, to prevent urinary tract infections. Patients should also be taught to empty their bladders as soon as they feel the urge. The longer urine sits in the bladder, the more bacteria can grow and lead to an infection. Wiping has to be done from front to back after defecation to prevent contamination from fecal bacteria.