PrepU: Ch. 38: Urinary Elimination

During data collection, the client expresses concern over a change in the color of the urine from tea-colored to green since beginning a new medication. Which appropriate question would the nurse ask this client? - "Are you taking any B-complex vitamins?" - "Are you taking phenazopyridine?" - "Are you taking levodopa?" - "Are you taking a diuretic?"

"Are you taking any B-complex vitamins?"

The nurse has an order to obtain a 24-hour urine specimen from a client. Which instruction would be accurate for collection of the specimen? - "Begin the collection when you first urinate in the morning." - "You will need to have a catheter inserted for this collection." - "Start collecting the urine with the next time you urinate." - "Discard your first urine and begin the collection after that."

"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? - "I will use clean gloves to handle the catheter and other equipment." - "The client will be placed in a reclining position with knees bent." - "Washing hands before and after the procedure is important." - "I will place a bath blanket over the client to provide privacy."

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

The parent of a 5-year-old child tells the nurse that on two occasions her son has lost control of urination when he had to wait to go to the bathroom at school. What is the appropriate nursing response? - "I would only worry about this if you were raising a daughter." - "Let's review the types of fluids that your child drinks in the morning." - "It would be appropriate to place your son in incontinence undergarments." - "This is extremely abnormal. You will need to see your son's pediatrician."

"Let's review the types of fluids that your child drinks in the morning."

A client states that urinary incontinence has become a problem and asks the nurse how to help control or alleviate this problem. Which statement by the nurse would be accurate? - "You need to decrease your daily fluid intake to help with this." - "Performing pelvic floor muscle (Kegel) exercises can help with muscle strengthening." - "It is best to have an indwelling catheter inserted to prevent incontinence." - "Coffee and diet sodas are not factors with being incontinent of urine."

"Performing pelvic floor muscle (Kegel) exercises can help with muscle strengthening."

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. - Avoid clothing that is tight and restrictive on the lower half of the body. - Drink two 8-oz glasses (480 mL) of water before and after sexual intercourse and void immediately after intercourse. - Dry the perineal area after urination or defecation from the back to the front. - Wear underwear with a cotton crotch. - Take baths instead of showers.

- Avoid clothing that is tight and restrictive on the lower half of the body. - 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.

When planning care for a client with a Foley catheter, which actions should the nurse include? Select all that apply. - Encourage fluid intake, unless contraindicated. - Maintain a closed urinary catheter system. - Change the indwelling catheter regularly. - Record volume and character of the urine. - Use powder or lotion in the perineal area.

- Encourage fluid intake, unless contraindicated. - Maintain a closed urinary catheter system. - Record volume and character of the urine.

Three days post-surgery for breast reconstruction, the nurse assesses that the client is ambulating several times daily. The health care provider has not yet written an order to discontinue the client's urinary catheter. What is the appropriate nursing action? Select all that apply. - Discontinue to catheter and report this to the healthcare provider. - Delegate catheter discontinuation to the Unlicensed Assistive Personnel (UAP). - Perform, or allow client to perform, perineal hygiene at least once daily. - Ensure that the drainage bag is above the level of the bladder at all times. - Contact the health care provider to ask for an order for catheter discontinuation.

- Perform, or allow client to perform, perineal hygiene at least once daily. - Contact the health care provider to ask for an order for catheter discontinuation.

The client is preparing to obtain a clean-catch midstream urine specimen. Place in order the steps needed to complete the diagnostic test. Use all options. - Submit collected specimen to the health care professional. - Void a small amount into toilet or bedpan. - Provide instruction to the client. - Void into the provided collection device. - Secure the lid on the specimen container. - Clean the area surrounding the urinary meatus with the provided cloth.

- Provide instruction to the client. - Clean the area surrounding the urinary meatus with the provided cloth. - Void a small amount into toilet or bedpan. - Void into the provided collection device. - Secure the lid on the specimen container. - Submit collected specimen to the health care professional.

A nurse is administering continuous closed bladder irrigation to a client. After performing this intervention, the nurse observes that the irrigation solution is not flowing at the prescribed rate. Which actions should the nurse take? Select all that apply. - Encourage the client to drink a glass of water. - Raise the bag 3 to 6 in (7.5 to 15 cm). - Open the clamp all the way. - Increase the speed at which the plunger in the syringe is being pushed. - Have the client stand, so that gravity can assist the irrigation process. - Check the tubing for kinks or pressure points.

- Raise the bag 3 to 6 in (7.5 to 15 cm). - Open the clamp all the way. - Check the tubing for kinks or pressure points.

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? - Gathered supplies, checked prescription, collected urine from access port and notified health care provider at the completion of the procedure. - 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 proc

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

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

Checking that the client has signed a consent form for the procedure

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

Cholinergic agents

For which client will the nurse plan interventions addressing a neurogenic bladder? - 4-year old child who has not successfully been toilet trained - Client recovering from a stroke - Client with weak pelvic floor muscles - Client being treated for pyelonephritis

Client recovering from a stroke

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 - Total - Stress

Functional

The nurse has inserted a client's urinary catheter as ordered, but there has been no immediate flow of urine. What is the nurse's most appropriate action? - Advance the catheter slightly, because a drainage hole may be resting against the bladder wall. - Leave the catheter in place and reassess in 30 minutes. - Have the client take a deep breath to relax the perineal and abdominal muscles. - Lower the head of the client's bed to increase pressure in the bladder area.

Have the client take a deep breath to relax the perineal and abdominal muscles.

A nurse drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance? - Intermittent urethral catheter - Foley catheter - Indwelling urethral catheter - Retention catheter

Intermittent urethral catheter

The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle (Kegel) exercises will the nurse include? - Perform these exercises two times daily for a week. - Loosen the internal muscles used to prevent or interrupt urination. - Keep muscles contracted for at least 10 seconds. - Relax muscles for at least 5 minutes between repetitions.

Keep muscles contracted for at least 10 seconds.

The nurse is attempting to insert a urinary catheter into a female client's bladder and realizes the catheter has been inserted into the vagina. Which action is most appropriate? - Ask the client to bear down until the catheter is expelled. - Immediately remove the catheter from the vagina, contact the health care provider, and anticipate a prescription for prophylactic antibiotics. - Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. - Remove the catheter from the vagina and attempt to insert it into the bladder.

Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter.

A client is suspected of having a disease process affecting the basic functional unit of the kidney. Which structure is likely involved? - Bowman capsule - Loop of Henle - Glomerulus - Nephron

Nephron

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? - Obtaining laboratory studies - Notifying the health care provider of the assessment findings - Checking for blood return in the CVC - Placing the client as N.P.O. status

Notifying the health care provider of the assessment findings

A client at a health care facility is being treated for cancer of the bladder. The health care provider uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion? - One or both of the ureters are surgically implanted elsewhere - Hygiene measures used to keep meatus and adjacent area of the catheter clean - Inability to control either urinary or bowel elimination - Use of a catheter to collect urine in a sterile environment

One or both of the ureters are surgically implanted elsewhere

While providing care to a client admitted to the health care facility, the client states that she has "a burning sensation when urinating." After further questioning, the nurse inspects the client's perineal area. Which sign/symptom would the nurse document as an abnormal finding? - Reddened perineal skin - Presence of smegma - Absence of discharge - Moist perineal skin

Reddened perineal skin

An older adult woman tells the nurse that she has trouble controlling her urine. She states, "The urine starts dripping even before I feel like I have to go." The nurse interprets this as: - Functional incontinence - Urge incontinence - Reflex incontinence - Stress incontinence

Reflex incontinence

Which urinary care teaching will the nurse provide to a young adult female client? - Refrain from douching unless ordered by a health care provider. - Wipe from the back to the front. -If you do not feel like voiding, still strain to make sure the bladder is empty. - 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? - Fluid restriction - Regular toileting routine - Indwelling catheterization - Encouraging the client to stay close to home

Regular toileting routine

Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)? - Straight catheter - Foley catheter - Indwelling urethral catheter - Suprapubic catheter

Straight catheter

A client reports to the nurse that after delivering an infant, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate? - Reflex - Total - Stress - Urge

Stress

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence? - Functional - Urge - Overflow - Stress

Stress

A nurse is caring for a client who has an infant age 4 months. The client informs the nurse that she has been experiencing a sudden loss of urine whenever she laughs; this is causing embarrassment to her. Which type of urinary incontinence is this client experiencing? - Stress incontinence - Functional incontinence - Reflex incontinence - Urge incontinence

Stress incontinence

The nurse is caring for a client who has been experiencing difficulty voiding in the 8 hours since giving birth vaginally. What information should be provided to the client? - The birth can cause perineal swelling. - A neurogenic bladder results from local anesthesia. - Catheterization is likely necessary for 5 to 7 days. - A urinary tract infection can result from the birth process.

The birth can cause perineal swelling.

The nurse is inserting a urinary catheter into a 63-year-old male client and encounters resistance. What is the most likely cause of the resistance? - The nurse failed to deflate the retention balloon after pretesting it for integrity. - The client has an occult abscess in the urethra. - The client has an enlarged prostate. - The diameter of the catheter is too large.

The client has an enlarged prostate.

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 is acutely confused and has been diagnosed with delirium. - The client has had urinary catheters in place repeatedly during previous admissions. - The client has a history of benign prostatic hyperplasia (BPH; prostate enlargement). - The client was treated for kidney stones a few months earlier.

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. - A dressing should always be worn over the site to avoid leaking. - The client may bathe rather than shower, provided the site is covered with gauze. - 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 caring for a client who has just undergone surgery to create an ileal conduit for urinary elimination via a stoma. Which fact about this procedure should the nurse mention to the client? - This urinary diversion is only temporary. - The client will have to wear an external appliance to collect urine. - Urination can be voluntarily controlled after the stoma heals from the initial surgery. - The client will need to change the urinary pouch every 4 hours.

The client will have to wear an external appliance to collect urine.

A nurse who is right-handed is inserting a woman's indwelling urinary catheter. The nurse will use cotton balls and antiseptic solution to cleanse the woman's meatus and perineum. Which of the nurse's actions is most appropriate? - Insert the catheter with her left hand while supporting the woman with her right hand. - Perform hand hygiene between cleansing the woman's labia and inserting the catheter. - Use her left hand to spread the woman's labia and keep them spread until the catheter is inserted. - Grasp a cotton ball with forceps in her left hand and spread the woman's labia with her right hand.

Use her left hand to spread the woman's labia and keep them spread until the catheter is inserted.

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

24-hour specimen

The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate? - Clear, dark amber - Light yellow, clear - Cloudy, foul odor - Strongly aromatic, amber

Cloudy, foul odor

A client is prescribed an indwelling urinary catheter for 2 days prior to surgery. Which action should the nurse take to decrease the occurrence of health care-associated infection (HAI) for this client? - Irrigate the catheter twice per day. - Maintain the urinary catheter until discharge. - Encourage fluid intake. - Request a straight catheter from the health care provider.

Encourage fluid intake.

A male client is being transferred to the hospital from a long-term care facility with a diagnosis of dehydration and urinary bladder infection. The client's skin is also excoriated from urinary incontinence. Which nursing concern is most appropriate for the nurse to include in this client's care plan? - Altered skin integrity related to functional incontinence - Altered skin integrity related to urinary bladder infection and dehydration - Urinary tract infection risk related to dehydration - Urinary incontinence related to urinary tract infection

Altered skin integrity related to urinary bladder infection and dehydration

A nurse has received an order to insert a urinary catheter into a female client. In preparation, the nurse asks if she has ever had an indwelling catheter and, if so, why and for how long. The nurse has performed which action? - Assessed for the most appropriate size of catheter to insert - Assessed the possibility that the client has urethral strictures - Assessed the client's risk of hemorrhage during insertion - Gauged the client's risk of developing a urinary tract infection

Assessed the possibility that the client has urethral strictures

A nurse is caring for a client with a hemodialysis access site. Which action should the nurse take? - Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration. - Measure the client's blood pressure on the arm above the access site. - Perform venipuncture below the access site to obtain a blood sample for laboratory testing. - Administer an IV on the arm high above the access site.

Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration.

The nurse is caring for a client who has a history of acute kidney injury. What is an accurate step when caring for the client's hemodialysis access? - 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. - Percuss the site to feel for a thrill or vibration. - 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.

When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. What could cause this variation in color of the urine? - Infection - Blood - Stasis - Dehydration

Blood

The health care provider notifies a client of a diagnosis of glycosuria. Which assessment information will the nurse obtain from the client next? - Frequency of urine - Blood pressure - Blood sugar - Intake and output

Blood sugar

A nurse has been asked to speak about health promotion topics for a group of women older than 40 years of age. The nurse states that exercises may help with urinary urgency. Which exercise instruction will the nurse provide to the group? - Lie on the floor, raise, then lower your legs 20 times per day. - Contract the pubic muscles for 3 seconds, then relax. - Squat down and then jump up to a standing position. - Contract abdominal muscles 10 times per day.

Contract the pubic muscles for 3 seconds, then relax.

A client is reporting bladder urgency. Which will the nurse assess? - Caffeine intake - Blood pressure - Use of vitamin supplements - Body weight

Caffeine intake

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? - In adults, the average amount of urine per void is 500 mL. - 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. - Urinary output does not vary all that much between adults and children.

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

A client admitted to the hospital with chronic kidney injury suddenly develops the following signs and symptoms: left arm arteriovenous (AV) fistula has weak thrill and bruit; blood pressure 88/40 mm Hg; states feeling dizzy. Which action will the nurse implement first? - Notify the primary health care provider. - Change to supine position. - Instruct to not get out of bed. - Examine that clothing is not constrictive on arm.

Change to supine position.

A nurse assessing an older adult client finds that the client has had four urinary tract infections in the past year. Which physiologic change of aging would the nurse suspect is the cause? - Decreased bladder muscle tone - Neurologic weakness - Decreased bladder contractility - Diminished ability to concentrate urine

Decreased bladder contractility

The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate? - Hypovolemia - Kidney injury - Balanced fluids - Dehydration

Dehydration

A 57-year-old man is suffering from polyuria. What can cause polyuria? - Diabetes insipidus - Urinary tract infection - Renal calculi - Renal disease

Diabetes insipidus

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? - 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. - Inform the client that this is not normal and make a referral to a urologist. - Tell the client that this happens to all people when they get older.

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? - Have the client drink 8 ounces of water every 15 minutes for 1 hour. - Ensure proper positioning of the scanner head and rescan. - Place the client on either side and rescan. - Wipe off some of the ultrasound gel and rescan.

Ensure proper positioning of the scanner head and rescan.

A nurse is caring for a client with an external condom catheter. Which guideline should be implemented when applying and caring for this type of catheter? - Remove the catheter every 8 hours, or more often in humid weather. - Ensure the tip of the tubing is touching the tip of the client's penis. - Fasten the condom securely enough to prevent leakage without constricting blood flow. - Wipe the penis thoroughly with an alcohol swab and dry thoroughly before application.

Fasten the condom securely enough to prevent leakage without constricting blood flow.

A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample? - First thing in the morning - Evening - Afternoon - Before bedtime

First thing in the morning

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 - Stress incontinence - Overflow incontinence - Functional incontinence

Total incontinence

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

Urinal