Nur 203 GU
The nurse measures the urine output of a PT who requires bedpan to void. Which action should the nurse take first. Put gloves on and: a) Have the PT void directly onto the bedpan b) Pour the urine into a graduated container c) Read the volume with the container on a flat surface at eye level d) Observe the color and clarity of the urine in the bedpan
Answer: A First, the nurse should put on gloves and have the patient void directly into the bedpan. Next, she should pour the urine into a graduated container, place the measuring device on a flat surface, and read the amount at eye level. She should observe the urine for color, clarity, and odor. Then, if no specimen is required, she should discard the urine in the toilet and clean the container and bedpan. Finally, she should record the amount of urine voided on the patient's intake and output record.
The surgeon orders hourly urine output measurement for a PT after abdominal surgery, The PT's urine output has been greater than 60 mL/hr for the past 2 hours. Suddenly, the PT's urine output drops to almost nothing. What should the nurse do first? a) Irrigate the catheter with 30 mL of sterile solution. b) Replace the PT's indwelling urinary catheter. c) Infuse 500 mL of normal saline solution IV over 1 hour d) Notify the surgeon immediately.
Answer: A If the patient's urinary output suddenly ceases, the nurse should irrigate the urinary catheter to assess whether the catheter is blocked. If no blockage is detected, the nurse should notify the surgeon. The surgeon may request that the catheter be changed if irrigation does not help or if the tubing is not kinked. However, the nurse should not change a catheter in the immediate postoperative period without consulting with the surgeon. The surgeon may prescribe an IV fluid bolus if the patient is suspected to have a deficient fluid volume.
The nurse is planning care for a renal patient who is prescribed a diuretic medication. In planning care, what is the most appropriate time of day to administer this med? a) in the morning b) in the afternoon c) in the evening before bedtime d) After meals
Answer: A In planning care or teaching patients about diuretic medications, the nurse should administer and teach for these medications to be taken in the morning. Diuretics increase urine output and when taken at night can cause nocturia, leading to interrupted sleep. This is especially important for the elderly, as there may be associated safety risks with frequent arising for urination during the night. Diuretic medication generally does not cause nausea or GI upset; therefore, it is not necessary to take the medication with a full stomach.
The student nurse asks the provider if she will prescribe an indwelling urinary catheter for a hospitalized PT who is incontinent. The provider explains that catheters should be utilized only when absolutely necessary because: a) They are leading cause of nosocomial infection b) They are too expensive for routine use. c) They contain latex, increasing the risk for allergies d) Insertion is painful for most patients.
Answer: A Indwelling urinary catheters should not be routinely used for hospitalized patients with incontinence because they are the leading cause of healthcare-acquired infection (nosocomial). The cost of an indwelling urinary catheter should not deter its use if necessary. Latex-free catheters are available for patients with or at risk for latex allergy. Insertion may be somewhat uncomfortable, but it should not be painful.
The nurse has received a prescription to obtain urinalysis and microscopic analysis. When is the ideal time of the day for the nurse to collect this specimen? a) In the morning b) in the evening before bedtime c) Before a meal d) After the PT drinks 1 L of water
Answer: A The ideal time of the day to collect a urinalysis and microscopic analysis is first thing in the morning when a patient awakens and first urinates. The urine is generally more concentrated because it has been sitting in the bladder all or most of the night and, therefore, contains relatively higher levels of cellular elements and urine components, such as protein or microscopic blood, if present. Although collecting urine in the evening or before a meal may be more convenient for some patients, this timing is more difficult to accurately interpret because the concentration might be affected by the fluid intake throughout the day. Likewise, collecting a urine sample after the patient drinks a liter of water would yield a diluted specimen, thus providing an inaccurate view of the patient's urinary status.
A mother tells the nurse at an annual well child checkup that her 6-year-old son occasionally "wets himself." Which response by the nurse is appropriate? a) Explain that occasional wetting is normal in children of this age. b) Tell the mother to restrict her child's activities to avoid wetting. c) Suggest "time-out" to reinforce of staying dry. d) Inform the mother that medication is commonly used to control wetting.
Answer: A The nurse should explain that occasional wetting is normal in children during the early school years. The mother should handle the situation calmly and avoid punishing the child. Medications are occasionally prescribed for nocturnal enuresis when the child is older and not sleeping at home, but not for occasional daytime wetting.
Which action should the nurse take when beginning bladder training using scheduled voiding? a) Offer PT a bedpan every 2 hours while she is awake. b) Increase voiding interval by 30 to 60 minutes each week. c) Frequently ask the PT if she has urge to void. d) Increase the frequency b/t voiding even if urine leakage occurs.
Answer: A The nurse should offer the patient the bedpan or assist the patient to the bathroom every 2 hours while she is awake. You would encourage the patient to get up once during the night to void but awakening the patient every 2 hours would lead to fatigue. If the patient adheres to the schedule, the voiding interval should be increased by 15 to 30 minutes each week. Simply asking the patient about the urge to void does not help to manage bladder emptying.
The nurse identifies the nursing diagnosis Urinary Incontinence (Total) is an older adult patient admitted after a stroke. Urinary Incontinence places the patient at risk for which complication? a) Skin Breakdown b) Urinary Tract Infection c) Bowel Incontinence d) Renal Calculi
Answer: A Urine contains ammonia. which may cause excoriation with prolonged contact with the skin. Bowel Incontinence, not urinary, increases the patient's risk for UTI. Immobility and high consumption of calcium-containing foods increase teh risk for renal calculi.
The nurse would expect which of the following signs of symptoms for a PT with a suspected UTI? Select all that apply: a) Urinary frequency b) Urinary urgency c) Polyuria d) Abdominal Pain e) Proteinuria
Answer: A, B Signs and symptoms of urinary tract infections include urinary frequency, urgency, foul-smelling urine, pyuria, dysuria, hematuria, bladder spasms, edema, chills, fever, back pain, and nausea and vomiting. Polyuria is indicative of diabetes mellitus, not UTI. Patients do not usually complain of abdominal pain with UTI. Pain if present is retroperitoneal, back, or lower groin. Hematuria, rather than proteinuria, occurs with UTI.
Which of the following task(s) may be delegated to a CNA? Select all that apply: a) Measuring/Recording I&O b) Performing a bedside dipstick urine test c) Applying condom catheter to male PT d) Assessing PT's ability to collect urine specimen e) Determining which type of catheter to insert
Answer: A, B, C Measuring and recording intake and output, performing a bedside dipstick urine test, and applying a condom catheter to a male patient are all tasks that can be delegated to a certified nursing assistant (CNA) trained in these procedures. A CNA cannot assess a patient's urinary and cognitive status to determine ability to collect a specimen, as this is the responsibility of the registered nurse. A CNA cannot determine which catheter type is most appropriate for a patient. This judgment would be made by the registered nurse or prescribed for specific patient needs.
The nurse is preparing a young adult, female PT for IVP. What are the priority actions by the nurse prior to this procedure? Select all that apply. a) Obtain informed consent prior to procedure. b) Ask whether PT has allergy to shellfish. c) Check lab results for serum BUN and creatinine. d) Encourage increased fluid intake prior to procedure e) Determine whether PT has had a barium enema in the past 4 days.
Answer: A, B, C, E An intravenous pyelogram (IVP) uses radiopaque contrast medium to visualize the kidneys, ureters, bladder, and renal pelvis. This test evaluates renal function by analyzing flow of contrast over time. Priority nursing care prior to the procedure includes the following: • Obtaining a history of allergies, most specifically allergies to shellfish because the dye used is iodine based • Ensuring a baseline BUN and creatinine level have been performed, as this test is contraindicated for patients who are in renal failure • Ensuring that a signed consent form is on the chart because this is an invasive procedure The nurse would not increase fluid intake prior to the procedure, but would instruct and maintain the patient on NPO status for 8 hours prior to the test. Postprocedure patients are encouraged to increase fluid intake, and the nurse will monitor for any possible reaction to the dye, such as rash, nausea, or hives. It is appropriate to inquire about a barium enema because barium contrast material and medication containing bismuth (e.g., Pepto-Bismol) in the 4 days prior to the test can affect the results.
The nurse is caring for a PT with suspected kidney dysfunction. In reviewing the PT's home med list, the nurse is most alerted to which meds? Select all that apply. a) Aspirin b) Gentamicin c) Estrogen d) Ibuprofen e) Insulin
Answer: A, B, D In caring for patients with kidney disease, the nurse is most alerted to medications that can be nephrotoxic. These medications include gentamicin and high-dose or long-term use of aspirin and ibuprofen. Estrogen is used to improve the blood flow to and thickness in urethral tissues. Estrogen is not FDA approved for treatment of stress incontinence, although it may be prescribed for other reasons. The nurse should not have concern regarding the use of insulin with respect to potential for kidney dysfunction.
Which of the following are considered normal processes and changes in the urinary system that occur with aging in older adults? Select all that apply: a) The number of functional nephrons decreases with age b) The volume of urine that the bladder can hold lessens with age c) Increased pelvic floor muscle tone contributes to incontinence d) Loss of bladder elasticity leads to urinary retention e) Prostate enlargement causes urinary incontinence.
Answer: A, B, D The size and functioning of the kidneys begin to decrease at about age 50, and by age 80 only about two-thirds of the functioning nephrons remain. This results in a decline in glomerular filtration rate (GFR), which affects the ability to dilute and concentrate urine, but does not normally create problems unless an illness alters fluid balance. Additionally, the volume of urine within the bladder decreases because of a loss of elasticity in the bladder wall; thus, older adults need to urinate more frequently, especially during the night. Loss of elasticity and muscle tone also decrease the ability of the bladder to empty completely, leading to urinary retention. Pelvic floor muscle tone decreases, rather than increases, contributing to incontinence. Prostate enlargement causes urinary frequency and hesitancy, not incontinence.
The nurse educator is preparing a teaching plan on preventing urinary tract infections for a group of female college students. What information will the nurse include in the plan? Select all that apply. a) Empty the bladder soon after sexual intercourse. b) Urinate when you first feel the urge to void. c) Wear appropriate underwear, including nylon or synthetic garments. d) Wipe perineum area from back to front after voiding. e) Use tampons instead of sanitary napkins while menstruating.
Answer: A, B, E All age groups are at risk for urinary tract infections (UTIs). Prevention measures include increasing fluid intake, primarily water, and urinating when the urge to void is first felt. To reduce the risk of UTI, the nurse would teach the client the following: • Urinating after having intercourse to flush away bacteria that might have entered the urethra is appropriate teaching for college students. • Because bacteria can multiply in stagnant urine, women should urinate when they feel the urge to void, and not make a habit of postponing urination. • Tampons are advised during the menstrual period rather than sanitary pads because they keep the urethral opening drier than a sanitary pad, thereby limiting bacterial overgrowth. Cotton underwear is better than nylon or other synthetic fabrics, which are unbreathable fabrics. With such fabrics, moisture builds up, creating an ideal environment for microbial growth. Women should always wipe from front to back (cleaner to dirtier) after urination or defecation to help prevent transferring bacteria from the rectum and vagina to the urethra. Bacteria and other microorganisms grow well in a warm, moist environment.
A client has just voided 50 mL, yet reports that his bladder still feels full. The nurses's next actions should include which of the following? Select all that apply: a) Palpating the bladder height b) Obtaining a clean catch urine specimen c) performing a bladder scan d) Asking the PT about recent voiding history e) Inserting a straight catheter to measure residual urine.
Answer: A, C, D The nurse should palpate the bladder for distention to validate the client's statement. A bladder scan will yield a more accurate measurement of the postvoid residual urine, so it would be appropriate at this time. A detailed history of the client's recent voiding patterns will assist the nurse in determining the appropriate nursing diagnosis and developing a plan of care. A clean-catch urine specimen may be necessary if further assessment shows the potential of a urinary tract infection, but is not indicated at this time. Inserting a straight catheter to measure residual urine is an invasive procedure with the risk of introducing microorganisms into the bladder. It is usually unnecessary if the nurse has access to a portable bladder scanner.
Which daily urine output is within normal limits for a newborn weighing 8 pounds? a) 288 mL b) 180 mL c) 36 mL d) 18 mL
Answer: B A newborn weighing 8 pounds (3.6 kg) should produce 15 to 60 mL of urine per kilogram per day. If the newborn produces 50 mL/kg/day and weighs 3.6 kg, he will produce a total of 180 mL in 24 hours. The other options are not within normal limits and require further assessment.
The nurse is caring for a PT who has an indwelling urinary catheter inserted for the past 5 days. In reviewing and revising the plan of care, what is the most important nursing diagnosis for this PT? a) Disturbed Body Image b) Risk for Infection c) Risk for Impaired Skin Integrity d) Risk for Decreased Urine Output
Answer: B Anyone who has an indwelling catheter is at risk for infection. Indwelling catheters pose several risks: Failing to maintain a closed drainage system increases the risk for infection by allowing bacteria to enter the catheter, the catheter provides a pathway for bacteria to migrate up into the urinary system, the catheter irritates the mucosal lining of the urethra, which then creates a portal of entry for microbes. The longer the catheter remains indwelling, the higher the risk there is for the patient to develop a UTI. Although the patient may be embarrassed about having a catheter, a body image diagnosis (Disturbed Body Image) is rarely given priority over a basic need, such as remaining infection free. There are no data in the scenario to suggest actual Disturbed Body Image. A long-term indwelling catheter can cause irritation to mucous membranes, and sometimes to surrounding skin (Risk for Impaired Skin Integrity). Although the catheter may be a risk factor for Impaired Skin Integrity, that is less common and of a lower priority than Risk for Infection. Decreased urine output is primarily a problem of fluid intake or kidney function. Inserting a catheter does nothing to increase fluid intake, nor does it stimulate the kidneys to produce more urine. Therefore, it is not a risk factor for decreased urine output. If the patient had actual (instead of risk for) decreased urine output, a catheter might be inserted to relieve bladder pressure. However the appropriate diagnosis would then be Urinary Retention—an actual rather than a risk diagnosis.
A patient is prescribed Lasix, a loop diuretic, for treatment of CHF. The PT is at risk for which electrolyte imbalance associated with use of this drug? a) Hypocalcemia b) Hypokalemia c) Hypomagnesesmia d) Hypophosphatemia
Answer: B Furosemide is a loop diuretic, which causes potassium to pass into the urine. This drug increases the risk for hypokalemia (low potassium); it does not cause hypocalcemia (low calcium in the blood), hypomagnesemia (low blood magnesium), or hypophosphatemia (low blood phosphorous).
Which of the following statements best describes how normal voluntary urination occurs? a) The detrusor muscle relaxes to pass urine thru the urethra. b) The external urethral sphincter contracts to force urine out of the bladder. c) Stretch receptors send sensory impulse to the voiding reflex center. d) Voluntary control of the internal urethral sphincter leads to bladder emptying.
Answer: B Micturition (passing urine) occurs when the contracted detrusor muscle pushes stored urine through the relaxed internal urethral sphincter into the urethra. The detrusor muscle must contract, not relax, to pass urine through the urethra. Stretch receptors do send sensory impulses to the voiding reflex center; however, this only is a precursor to voiding. Voiding does not occur at that time. The internal urethral sphincter is not under voluntary control.
While performing a physical assessment, the student nurse tells her instructor that she cannot palpate her patient's bladder. Which statement by the instructor is best? a) "Try to palpate again; it takes practice but you will locate it." b) Palpate the patient's bladder only when it is distended by urine. c) "Document this abnormal finding on the patient's chart." d) "Immediately notify the nurse assigned to the care of your patient."
Answer: B The bladder is not palpable unless it is distended by urine. It is not difficult to palpate the bladder when distended. The nurse should document her finding, but it is not an abnormal finding. It is not necessary to notify the nurse assigned to the patient.
Which outcome is appropriate for the patient who underwent urinary diversion surgery and creation of an ileal conduit for invasive bladder cancer? a) Patient will resume his normal urination pattern by (target date) b) Patient will perform urostomy self-care by (target date). c) Patient will perform self-catheterization by (target date). d) Patient's urine will remain clear with sufficient volume.
Answer: B The most appropriate outcome for this patient is "The patient will perform urostomy self-care" by a specific date. The patient with an ileal conduit is unable to resume a "normal" urination pattern; urine, along with mucus, drains continuously from the stoma site, so the urine will not be clear. Also, the phrase "sufficient volume" is too vague for an outcome statement. The patient with a continent urostomy inserts a catheter into the stoma to drain urine.
A patient who sustained a spinal cord injury will perform intermittent self-catheterization after discharge. After discharge teaching, which statement by the patient would indicate correct understanding of the procedure? a) I will need to replace the catheter weekly. b) I can use clean, rather than sterile, technique at home. c) I will remember to inflate the catheter balloon after insertion. d) I will dispose of the catheter after use and a get a new one each time.
Answer: B The nurse should inform the patient that clean technique can be used after discharge. The patient should wash his hands before the procedure, then wash the reusable catheter in soap and water, and rinse and store it in a clean, dry place. It is not necessary for the patient to use a new catheter for each catheterization. The patient should use a straight catheter; therefore, a balloon is not inflated after insertion. Straight catheters are removed immediately after use.
The nurse instructs a woman about providing a clean-catch urine specimen. Which of the following statements indicates that the patient correctly understands the procedure? a) I will be sure to urinate into the 'hat' you placed on the toilet seat b) I will wipe my genital area from front to back before I collect the specimen midstream c) I will need to lie still while you put in a urinary catheter to obtain the specimen. d) I will collect my urine each time I urinate for the next 24 hours.
Answer: B To obtain a clean-catch urine specimen, the nurse should instruct the patient to cleanse the genital area from front to back and collect the specimen midstream. This follows the principle of going from "clean" to "dirty." The nurse should have the ambulatory patient void into a "hat" (container for collecting the urine of an ambulatory patient) when monitoring urinary output, but not when obtaining a clean-catch urine specimen. A urinary catheter is required for a sterile urine specimen, not a clean-catch specimen. A 24-hour urine collection may be necessary to evaluate some disorders but a clean-catch specimen is a one-time collection.
Which of the following is/are appropriate goal(s) for a PT with urinary incontinence? Select all that apply: a) increase intake of citrus fruits b) Maintain daily oral fluids to 8 to 10 glasses per day c) Limit daily caffeine intake to less than 100 mg d) Engage in high-impact, aerobic exercise. e) Restrict fluid intake thru the day.
Answer: B, C The nurse should encourage lifestyle changes such as maintaining daily oral fluid intake to 8 to 10 glasses per day. Citrus is considered a bladder irritant; intake should be reduced or eliminated. Caffeine also irritates the bladder; intake should be limited to less than 100 mg per day. High-impact exercise can be associated with stress incontinence for those with weakened pelvic muscles that support the bladder and urethra, so it should not be a goal for this patient. The patient with incontinence needs to drink adequate fluids and not limit fluids. Adequate fluid intake is important to maintain dilute urine, which is less irritating to the bladder; to maintain systemic hydration; and to reduce the risk for constipation, which can contribute to urinary incontinence
What type of indwelling catheter is most suitable for long-term use? a) Silver-alloy catheter b) PVC Catheter c) Silicone catheter d) Triple-lumen catheter
Answer: C Silicone catheters are used primarily for long-term catheterization, as they cause less tissue irritation and prevent encrustation. Silver-alloy coated catheters are used to reduce the risk of catheter-associated urinary tract infections rather than for their suitability for long-term use. Polyvinyl chloride (PVC) catheters are more rigid, less comfortable for indwelling use, and more commonly used for intermittent self-catheterization. A triple-lumen catheter is inserted when the patient requires irrigation of the bladder.
Which urinary system structure is considered the functional unit responsible for filtration and water absorption? a) Collecting duct b) Ureter c) Nephron d) Tubular System
Answer: C The nephron is the basic structural and functional unit of the kidney. The collecting duct, ureter, and tubular system are all incorrect because they are not the basic structural and functional unit, but are merely a part of it. Each nephron consists of a Bowman's capsule, enclosing a glomerulus (responsible for most of filtering), a series of filtrating tubules and a collecting duct. Together, these structures act as a microscopic filter, controlling the excretion and retention of fluids and solutes according to the body's moment-by-moment needs.
The nurse is inserting an indewelling urinary catheter for a female PT. Upon insertion of the catheter the nurse accidentally touches the PT's leg and bed sheet with the tip of the catheter. What is the most appropriate action by the nurse? a) Cleanse the tip of the catheter with povidone iodine before proceeding with insertion. b) Cleanse the tip of the catheter with alcohol before proceeding with insertion. c) Obtain a new catheter and reinsert it using sterile technique. d) Continue with the procedre as the nurse only lightly touched the surfaces.
Answer: C Insertion of an indwelling urinary catheter is a sterile procedure for all patients. If the catheter upon insertion touches the labia or vagina (female), unsterile bed linens, or any part of the patient's body, it is contaminated. The nurse must obtain and insert a new, sterile catheter. Cleansing a catheter with povidone-iodine (Betadine) or alcohol is not acceptable, as this does not sterilize the catheter. The nurse should not continue the procedure without obtaining a new catheter.
The nurse is caring for a PT who underwent a bowel resection 2 hours ago. His urine output for the past 2 hours totals 50 mL. Which action should the nurse take? a) Do nothing; this is normal postoperative urine output. b) Increase the infusion rate of the PT's IV fluids. c) Notify the provider about the PT's oliguria. d) Administer the PT's routine diuretic dose early.
Answer: C The amount of 50 mL in 2 hours is not normal output. The kidneys typically produce 60 mL of urine per hour. Therefore, the nurse should notify the provider when the patient shows diminished urine output (oliguria). Patients who undergo abdominal surgery commonly require increased infusions of IV fluid during the immediate postoperative period. The nurse cannot provide increased IV fluids without a provider's order. The nurse should not administer any medications before the scheduled time without a prescription. The provider may hold the patient's scheduled dose of diuretic if he determines that the patient is experiencing deficient fluid volume.
The nurse notes that a PT's indwelling urinary catheter tubing contains sediment at the meatus. Which action should the nurse take? a) notify the provider immediately b) Flush the catheter tubing with saline solution. c) Replace the indwelling urinary catheter. d) Encourage fluids that increase urine acidity.
Answer: C The catheter needs to be changed when sediment collects in the tubing or catheter and crusting at the meatus occurs. It is not necessary to notify the provider immediately. The nurse should not flush the catheter tubing. The patient should be encouraged to consume fluids that increase urine acidity to prevent urinary tract infection; however, it will not help clear the catheter tubing of sediment.
The nurse is teaching an older female PT how to manage urge incontinence at home. What is the first-line approach to reducing involuntary leakage of urine? a) Insertion of a pessary b) Intermittent self-catheterization c) Bladder training d) Anticholinergic medication
Answer: C The goal of bladder training is to enable the patient to hold increasingly greater volumes of urine in the bladder and to increase the interval between voiding. This involves patient teaching, scheduled voiding, and self-monitoring using a voiding diary. In addition to teaching the mechanisms of urination, teach distraction and relaxation strategies to help inhibit the urge to void. Other techniques include deep breathing and guided imagery. A pessary is an incontinence device that is inserted into the vagina to reduce organ prolapse or pressure on the bladder. Clean intermittent self-catheterization is a good option for managing incontinence that is resistant to conservative measure, such as bladder training, Kegel exercises, lifestyle modification, and medication. Anticholinergic medication can be highly effective for improving urinary incontinence. However, more conservative measures, such as timed voiding and Kegel exercises, are recommended first.
Which task can the nurse safely delegate to the NAP? a) Palpating the bladder of a PT who is unable to void. b) Administering a continous bladder irrigation c) Providing indwelling urinary catheter care d) Obtaining the PT's history and physical assessment.
Answer: C The nurse can safely delegate indwelling urinary catheter care to nursing assistive personnel who are adequately trained to do so. Palpating the bladder, administering continuous bladder irrigation, and obtaining the patient's history and physical assessment involve the critical-thinking skills of a professional nurse.
What position should the patient assume before the nurse inserts an indwelling urinary catheter? a) Modified Trendelenburg b) Prone c) Dorsal Recumbent d) Semi-Fowler's
Answer: C The nurse should have the patient lie supine with knees flexed, feet flat on the bed (dorsal recumbent position). If the patient is unable to assume this position, the nurse should help the patient to a side-lying position. Modified Trendelenburg position is used for central venous catheter insertion. Prone position is sometimes used to improve oxygenation in patients with adult respiratory distress syndrome. Semi-Fowler's position is used to prevent aspiration in those receiving enteral feedings.
What is the best technique for obtaining sterile urine specimen from an indwelling urinary catheter? a) Use antiseptic wipes to cleanse the meatus prior to obtaining the sample. b) Briefly disconnect the catheter from the drainage tube to obtain sample. c) Withdraw urine thru the port using a needleless access device. d) Obtain the urine specimen directly from the collection bag.
Answer: C To obtain a specimen from an indwelling catheter, insert the needleless access device with a 20- or 30-mL syringe into the specimen port, and aspirate to withdraw the amount of urine you need. Wiping the meatus with an antiseptic material helps to minimize contamination for a clean-catch voided specimen, not a sample collected from a closed system such as an indwelling catheter system. Never disconnect the catheter from the drainage tube to obtain a sample. Interrupting the system creates a portal of entry for pathogens, thereby increasing the risk of contamination. Do not take the specimen from the collection bag because that urine may be several hours old.
The nurse is teaching a female PT with stress incontinence how to perform pelvic floor muscle exercises. Which of the following statements indicates that the PT understands the procedure? a) I will practice by stopping and starting my urine flow. b) I will hold each contraction for 20 seconds. c) I will perform 30 to 45 contractions each morning. d) I will keep the contraction and relaxation times equal.
Answer: D Contraction and relaxation times should be equal. For example, the patient should hold the contraction for 5 seconds, and then relax for 5 seconds. The patient should be cautioned against doing pelvic floor muscle exercises (PFMEs) while actually urinating, because that can cause backflow of urine. Each contraction should be held for 5 to 10 seconds; 20-second contractions are too long. A recommended routine is to perform 10 to 15 PFMEs three times a day. The exercises should not be done all at one time.
A PT is admitted with high BUN and creatinine levels, low blood pH, and elevated serum potassium level. Based on these lab findings the nurse suspects which diagnosis? a) Cystitis b) Renal Calculi c) Enuresis d) Renal Failure
Answer: D Elevated BUN, creatinine, and serum potassium levels and low blood pH are signs of renal failure. Cystitis is an infection of the bladder and would not result in abnormal renal function. Renal calculi typically produce blood in the urine but do not lead to marked renal dysfunction and failure. Enuresis is involuntary urination, particularly common in children, and does not produce renal dysfunction. The cause of enuresis is often emotional, developmental, or trauma related.
A PT's catheter bag is empty 2 hours after it was last drained. The nurse's first action is to: a) irrigate the catheter b) Perform bladder scan c) Replace the catheter d) Check for kinks or compression
Answer: D Kinks or compression of the catheter or tubing may impede flow of urine into the bag. If there are no kinks or compression, assessment for urinary retention by performing a bladder scan may be appropriate. Irrigating the catheter and replacing the catheter are more invasive interventions that increase the patient's risk for infection. These options may be considered after a full assessment is completed and no other, simpler cause is identified.
Which urine specific gravity would be expected in a patient admitted with dehydration? a) 1.002 b) 1.010 c) 1.021 d) 1.030
Answer: D Normal urine specific gravity ranges from 1.010 to 1.025. Specific gravity less than 1.010 indicates fluid volume excess, such as when the patient has fluid overload or when the kidneys fail to concentrate urine. Specific gravity greater 1.025 is a sign of deficient fluid volume that occurs, for example, as a result of blood loss or dehydraation.
The nurse is seeing a 20-year-old client with a UTI at the women's health clinic. The client says to the nurse, "It seems to me more women get UTI's than men. Why is this?" What is the best response by the nurse? a) Because women are usually more sexually active than men, they are at higher risk for infections. b) Men have a prostate gland that protects them against UTIs. c) The female urethra is longer than a male making women more prone to infections. d) Hormone changes during pregnancy and pressure of the uterus on the bladder can make women more prone to UTIs.
Answer: D Some pregnant women are more prone to UTI because of hormonal changes and because of pressure of the uterus on the bladder. In women, the urethra is about 3 to 4 cm (1.5 in.) long and is anchored to the anterior wall of the vagina. Because the female urethra is so short, women are especially prone to urinary tract infections from microorganisms ascending from the vagina and rectum. In men, the urethra extends about 20 cm (8 in.). There is no evidence to support that women are more sexually active than men, thus rendering them more prone to urinary tract infections. The prostate gland in males is not related to occurrence of infection unless the prostate is enlarged.
A patient complains that she passes urine whenever she sneezes or coughs. How should the nurse document this complaint in the patient's healthcare record? a) Transient Incontinence b) Overflow Incontinence c) Urge Incontinence d) Stress incontinence
Answer: D Stress incontinence is an involuntary loss of urine that occurs with increased intra-abdominal pressure. Activities that typically produce the symptom include sneezing, coughing, laughing, lifting, and exercise. Transient incontinence is a short-term incontinence that is expected to resolve spontaneously. It is typically caused by urinary tract infection or medications, such as diuretics. Overflow incontinence is the loss of urine when the bladder becomes distended; it is commonly associated with fecal impaction, enlarged prostate, and neurological conditions. Urge incontinence is the involuntary loss of urine associated with a strong urge to void.
Which intervention should the nurse take first to promote micturation in a PT who is having difficulty voiding? a) Insert indwelling urinary catheter b) Notify the provider immediately c) Insert an intermittent, straight catheter d) Pour warm water of the patient's perineum.
Answer: D The nurse should perform independent nursing measures such as pouring warm water over the patient's perineum before notifying the provider. If nursing measures fail, the nurse should notify the provider. The provider may order an indwelling urinary catheter or a straight catheter to relieve the patient's urinary retention.