Prep-U Chap 37 Urinary Elimination

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." -"Start collecting the urine with the next time you urinate." -"Begin the collection when you first urinate in the morning." -"You will need to have a catheter inserted for this collection."

"Discard your first urine and begin the collection after that."

The experienced nurse is observing a new nurse who is preparing to catheterize a female client. Which statement by the new nurse requires immediate intervention by the experienced nurse? -"The client will be placed in a reclining position with knees bent." -"I will place a bath blanket over the client to provide privacy." -"I will use clean gloves to handle the catheter and other equipment." -"Washing hands before and after the procedure is important."

"I will use clean gloves to handle the catheter and other equipment."

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? -"Don't worry, this is a normal condition for older adults." -"Let me refer you to a urologist who can help you." -"Let's explore structuring activities and toileting breaks." -"It would be best just to get some adult diapers."

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

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? -"I agree; please make an appointment with your health care provider." -"I suggest that you invest in incontinence undergarments." -"This only happened one time, so it is nothing to worry about." -"Let's review your medication history and whether you consume bladder irritants."

"This only happened one time, so it is nothing to worry about."

A female client is diagnosed with recurrent urinary tract infections (UTIs) and the nurse is providing education about preventative methods. What information is important for the nurse to give to the client to prevent another UTI? Select all that apply. -Take baths instead of showers. -Dry the perineal area after urination or defecation from the back to the front. -Drink two 8-oz glasses (480 mL) of water before and after sexual intercourse and void immediately after intercourse. -Avoid clothing that is tight and restrictive on the lower half of the body. -Wear underwear with a cotton crotch.

-Drink two 8-oz glasses (480 mL) of water before and after sexual intercourse and void immediately after intercourse. -Wear underwear with a cotton crotch. -Avoid clothing that is tight and restrictive on the lower half of the body.

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine? -24-hour specimen -intermittent specimen -Clean-catch specimen -Random specimen

24-hour specimen

+A nurse is assessing a client who is complaining of difficulty urinating. Which assessment would be a priority? -Obtaining the bladder scanner to check the urine volume -Determining any pain when palpating the lower abdomen -Palpating the bladder above the symphysis pubis -Asking the client when he or she had last urinated

Asking the client when he or she had last urinated

The nurse is caring for a client who has a history of renal failure. What is an accurate step when caring for the client's hemodialysis access? -Percuss the site to feel for a thrill or vibration. -Auscultate over the site with a stethoscope to listen for a bruit. -Use the affected arm if an IV must be started to avoid impairment of both arms. -If a thrill is not palpable and/or a bruit is not detectable, assess for these signs in the other arm.

Auscultate over the site with a stethoscope to listen for a bruit

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 pressure -Intake and output -Blood sugar -Frequency of urine

Blood sugar

Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence? -Incontinence after the age of 3 years is not normal. -Boys may walk by 1 year and should be continent by 3 years. -Boys may take longer for daytime continence than girls. -Daytime continence is usually not achieved by boys until age 5.

Boys may take longer for daytime continence than girls.

The nurse is teaching an older adult female client who must provide a urine specimen. Which is the proper method to instruct the client to use to obtain a clean-catch urine specimen? -Catch the urine while holding the labia apart, after cleansing. Fill the specimen cup. -Catch the urine in the cup after cleansing the perineum. -Catch the urine while holding the labia apart, after allowing the first urine to flow into the toilet. -Catch the urine while holding the labia apart, then cleanse each side of the labia with prepared aseptic swabs.

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

Which is true regarding the normal urination? -Urinary output does not vary all that much between adults and children. -In adults, the average amount of urine per void is 500 mL. -Catheterized clients should drain a minimum of 30 mL of urine per hour. -In adults, the amount of urine voided typically does not depend on fluid intake and losses.

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

The nurse is preparing to irrigate a Foley catheter. What is the nurse's initial action? -Check electronic health record for medical order. -Gather equipment and supplies. -Assess urine characteristics. -Explain the procedure to the client.

Check electronic health record for medical order.

When preparing to irrigate a Foley catheter, which is the appropriate initial nursing action? -Assess urine characteristics. -Gather equipment and supplies. -Check health record for provider's order. -Explain the procedure to the client.

Check health record for provider's order.

A client could experience increased urination when using which classification of medication? -Stool softeners -Analgesic medications -Central nervous system depressants -Cholinergic agents

Cholinergic agents

Urinalysis and urine culture testing have been ordered for a client who has an indwelling urinary catheter. The nurse observes that there is currently no urine in the client's catheter tube. What should the nurse do? -Encourage the client to increase fluid intake for the next couple of hours. -Attach a syringe to the access port and aspirate until a sample is obtained. -Reposition the client supine. -Clamp the tube below to access the port to allow urine to accumulate.

Clamp the tube below to access the port to allow urine to accumulate.

A client has burning upon urination. The urinalysis indicates pyuria. Which is the next action the nurse will take? -Instruct on proper wiping technique -Contact the health care provider -Encourage fluids -Monitor vital signs

Contact the health care provider

+The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate? -renal failure -dehydration -balanced fluids -hypovolemia

Dehydration

An older adult client informs the nurse that they are experiencing urinary incontinence. The client has no other health problems, and states, "I don't want anybody to know about this problem." How will the nurse promote the client's self-esteem? -Tell the client that this happens to all people when they get older. -Inform the client that this is not normal and make a referral to a urologist. -Encourage the client to confide in family members and tell them about the accidents. -Discuss the use of protective undergarments to avoid embarrassment from incontinence.

Discuss the use of protective undergarments to avoid embarrassment from incontinence.

+The nurse is performing a portable bladder ultrasound on a client who has palpable bladder distention. The scanner reveals little urine in the bladder. What should the nurse do next? -Ensure proper positioning of the scanner head and rescan. -Have the client drink 8 ounces of water every 15 minutes for 1 hour. -Wipe off some of the ultrasound gel and rescan. -Place the client on either side and rescan.

Ensure proper positioning of the scanner head and rescan.

A client reports frequently experiencing urine loss when moving from the wheelchair to bed. Which type of incontinence does the nurse anticipate? -functional -reflex -total -urge

Functional

+The nurse is preparing a client for a cystoscopy procedure. Which intervention would be part of the preparation for this? -Maintaining the client without liquids before the procedure -Having the client sign a consent form for the procedure -Inserting a Foley catheter the morning of the procedure -Explaining to the client that the procedure will be painful

Having the client sign a consent form for the procedure

A nurse is caring for a female client with an indwelling urinary catheter. Which action should the nurse take into consideration to reduce the client's risk of developing a urinary tract infection (UTI)? -Irrigate the catheter with sterile water once per shift. -Administer prophylactic antibiotics, as ordered. -Ensure that the catheter is removed as soon as possible. -Use clean technique when inserting the catheter.

Irrigate the catheter with sterile water once per shift.

+A nurse is caring for a female client who is unable to transfer to a commode. The nurse is assisting the client with positioning on a bedpan. Which statement should guide the nurse's action? -Bedpans should not be used if the client needs to defecate. -Many clients find it embarrassing or degrading to use a bedpan. -Incorrect placement of a bedpan has been linked to development of UTIs. -The bed should be lowered to the lowest height before placing the bedpan.

Many clients find it embarrassing or degrading to use a bedpan.

+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 -Checking for blood return in the CVC -Obtaining laboratory studies -Placing the client as N.P.O. status

Notifying the health care provider of the assessment findings

A client has been NPO. after midnight for surgery. It is 11 a.m. and the nurse has asked her to void before being transferred to the surgical suite. The nurse should expect her urine to be what color? -tea colored -dark amber -pale yellow -colorless

Pale yellow

The nurse is reviewing the urinalysis of a client suspected of having a urinary tract infection. The potential diagnosis will be supported by the presence of: -calculi. -pus. -casts. -protein.

Pus

Which urinary care teaching will the nurse provide to a young adult female client? -If you do not feel like voiding, still strain to make sure the bladder is empty. -Refrain from douching unless ordered by a health care provider. -Wipe from the back to the front. -Drink water more frequently in the morning and evening to facilitate hydration.

Refrain from douching unless ordered by a health care provider.

A client who visits a health care facility for a routine assessment reports to the nurse being unable to control urinary elimination. This has resulted in the client soiling clothes and has led to a lot of embarrassment. Which nursing intervention will be appropriate to use with this client? -Indwelling catheterization -Encouraging the client to stay close to home -Fluid restriction -Regular toileting routine

Regular toileting routine

+The nurse is engaged in collecting a urine specimen for a routine urinalysis from a client with an indwelling catheter. What nursing action has the greatest impact on the accuracy of the testing results? -Selecting this particular specimen port site -Using a syringe that holds at least 10 ml -Positioning the client as shown -Wearing gloves for the procedure

Selecting this particular specimen port site

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? -Reflex -stress -urge -total

Stress

The clinic nurse is collecting data from a female client with frequent, recurrent urinary tract infections who was discharged from the hospital. Which data collection would indicate to the nurse that the client is adhering to discharge instructions? -The client drinks eight 8-oz glasses of cranberry juice daily. -The client soaks in the bathtub daily for perineal care. -Since the client is symptom-free, she no longer takes the prescribed antibiotics. -The client drinks two glasses of water before and after sexual intercourse.

The client drinks two glasses of water before and after sexual intercourse.

+The nurse caring for an older adult male client is determining whether the client can use a urinal to void. Which aspects of the client's medical history may contraindicate the use of a urinal? -The client was treated for kidney stones a few months earlier. -The client has a history of benign prostatic hyperplasia (BPH; prostate enlargement). -The client is acutely confused and has been diagnosed with delirium. -The client has had urinary catheters in place repeatedly during previous admissions.

The client is acutely confused and has been diagnosed with delirium

A nurse is preparing a discharge teaching plan for a client being sent home with a peritoneal dialysis catheter in place. Which guideline should be included in the instructions? -The client should avoid wearing tight clothes or belts near the site. -The client may bathe rather than shower, provided the site is covered with gauze. -A dressing should always be worn over the site to avoid leaking. -Sterile technique must be observed by the client in the home setting.

The client should avoid wearing tight clothes or belts near the site.

+A nurse is assisting a client with the use of a bedpan. The nurse understands that which statement about bedpans is true? -A fracture bedpan should be used only for clients who have fractures of the femur or lower spine. -A fracture bedpan is preferred for urination and a regular bedpan is preferred for defecation. -The largest part of a regular bedpan should be placed under the client's buttocks. -A regular bedpan is generally more comfortable for clients than a fracture bedpan.

The largest part of a regular bedpan should be placed under the client's buttocks.

The nurse is assessing a client with an older arteriovenous (AV) graft for hemodialysis access in the left arm. The client reports significant pain to the distal left arm. Capillary refill in the left hand is greater than 4 seconds. Which should the nurse assess before contacting the health care provider? -Pedal pulses -Temperature -Respiratory rate -Thrill and bruit

Thrill and bruit

The nurse is teaching a client how to perform pelvic floor muscle exercises (Kegel exercises). Which teaching will the nurse include? -Keep muscles contracted for at least 30 seconds. -Tighten the internal muscles used to prevent or interrupt urination. -Perform these exercises 10 times daily for 1 month. -Relax muscles for at least 1 minute between contractions.

Tighten the internal muscles used to prevent or interrupt urination.

The nurse is caring for a client with concerns of urinary incontinence. A review of the client's data collection reveals the client has a history of spinal surgery and states, "I urinate all the time and cannot predict when I will urinate." This data collection would suggest to the nurse that this client is experiencing which type of urinary incontinence? -Total incontinence -Functional incontinence -Stress incontinence -Overflow incontinence

Total incontinence

A nurse is assisting a client with the use of a urinal. The nurse recognizes that which statement about the use of a urinal is true? -Both male and female clients commonly void into a urinal in the bathroom to facilitate measurement of urinary output. -Unless contraindicated, nurses should encourage clients to stand to use a urinal. -Urinals must be replaced every 24 hours to reduce the risk of infection. -If nocturnal incontinence is anticipated, a urinal can be placed between the legs while the client is asleep.

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

The nurse is choosing a collection device to collect urine from a nonambulatory male client. What would be the nurse's best choice? -Urinal -Specimen hat -Bedpan -Large urine collection bag

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? -Cleansed access port with warm soap and water, syringe attached and aspirated 10 mL of urine and placed in specimen container. -Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. -Obtained urine specimen from urinary drainage bag using a syringe, client expressed no discomfort during or after the procedure, verified prescription and cleansed access port. -Gathered supplies, checked prescription, collected urine from access port and notified health care provider at the completion of the procedure.

Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well.

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 urine drainage tube inserted but not left in place -a bag attached by adhesive backing to the skin around the genitals -a flexible sheath that is rolled around the penis -a urine drainage tube that is left in place over a period of time

a flexible sheath that is rolled around the penis

A 57-year-old man is suffering from polyuria. What can cause polyuria? -urinary tract infection -renal disease -diabetes insipidus -renal calculi

diabetes insipidus

The nurse is preparing to place a Foley catheter for a female client who will soon have surgery. Into what position will the nurse place the client? -semi-Fowler's -supine -lithotomy -dorsal recumbent

dorsal recumbent

A client reports that he is often unable to retain urine until he locates a toilet because his mobility is decreased. The nurse should recognize the characteristics of what type of incontinence? -functional -urge -stress -total

functional

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? -retention catheter -Foley catheter -intermittent urethral catheter -indwelling urethral catheter

intermittent urethral catheter

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? -hygiene measures used to keep meatus and adjacent area of the catheter clean -inability to control either urinary or bowel elimination -one or both of the ureters are surgically implanted elsewhere -use of a catheter to collect urine in a sterile environment

one or both of the ureters are surgically implanted elsewhere

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? -urge incontinence -stress incontinence -functional incontinence -reflex incontinence

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? -clear, colorless -strongly aromatic, dark amber -cloudy, foul odor -light yellow, clear

strongly aromatic, dark amber

The nurse instructs the client about the clean catch urine specimen. Which statement made by the client indicates a need for further teaching from the nurse? "I will: -urinate directly into the specimen cup, filling it to the top and then cap it without touching the inside of the lid." -use three wipes provided; one to clean each side of the urinary meatus, and one in the middle from front to back." -keep the labia spread after cleaning and during collection of the specimen." -wash my hands before collecting the clean catch urine specimen."

urinate directly into the specimen cup, filling it to the top and then cap it without touching the inside of the lid."