Urinary Elimination

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Fundamentals of Nursing Chapter 37
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1

What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence?

It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters.

2

The nurse is attempting to insert a urinary catheter into a female client’s bladder and realizes the catheter has been inserted into the vagina. Which action is most appropriate?

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

3

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

4

The client is preparing to obtain a clean-catch midstream urine specimen. List in order the steps needed to complete the diagnostic test.

  • Provide instruction to the client.
  • Clean the area surrounding the urinary meatus with the provided cloth.
  • Void a small amount into stool.
  • Void into the provided collection device.
  • Secure the lid on the specimen container.
  • Submit collected specimen to the health care professional.
5

Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine?

  • 24-hour specimen
6

The nurse is preparing to insert an indwelling urinary catheter into a female client's bladder. The nurse has opened the sterile catheterization tray using sterile technique, donned sterile gloves and has opened all sterile supplies. Arrange the following steps in the correct order.

  • Clean each labial fold, then the area directly over the meatus.
  • Insert the lubricated catheter into the urethra.
  • Advance the catheter until there is a return of urine.
  • Inflate the balloon with the correct amount of sterile saline.
  • Discard used supplies
7

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.
8

The nurse has placed a urine collection bag on an infant. How often should the nurse check the bag to see if the infant has voided?

  • Every 15 minutes
9

The health care provider has prescribed an indwelling catheter for a client. When the nurse explains the procedure, the client refuses to allow placement of the catheter. Which action should the nurse take?

  • Ask the client why he or she does not want a catheter.
10

A nurse is the guest speaker at a women's club. Most of the women are older than 40 years of age and have asked the nurse to speak about health promotion topics. The nurse states that exercises may help with urinary urgency. Which exercise instruction will the nurse provide to the women?

  • Contract the pubic muscles for 3 seconds, then relax.
11

A sterile urine specimen for culture and sensitivity has been ordered for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen?

  • Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle.
12

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

blood

13

A woman is reporting bladder urgency. It is most important to assess:

  • caffeine intake.
14

A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a:

  • neurogenic bladder.
15

Use of an indwelling urinary catheter leads to the loss of bladder tone.

  • True
16

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?

  • Unless contraindicated, nurses should encourage clients to stand to use a urinal.
17

The nurse is inserting a urinary catheter into a 63-year-old male client and encounters resistance. What is the most likely cause of the resistance?

  • The client has an enlarged prostate.
18

The nurse educator is presenting a lecture on clients at risk for developing urinary tract infections (UTIs). Which response made by the staff nurse would indicate to the educator a need for further teaching?

  • “Having sexual relationships does not put a woman at risk for developing a UTI.”
19

The nurse is caring for a client with a prescription for a midstream urine specimen. The nurse would provide which information to the client?

  • “Void a small amount, stop, and discard it.”
20

The nurse is collecting data on a client with reflex incontinence. Which information would the nurse ask the client during the physical assessment?

  • “Do you have the sensation to urinate?”
21

The nurse measures a client’s residual urine by catheterization after the client voids. Which condition would this test verify?

  • urinary retention
22

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
23

The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate?

  • cloudy, foul odor
24

A client is preparing to give a clean-catch specimen. Which instruction will the nurse provide?

  • After the initial stream is initiated, collect the sample.
25

A client reports an episode of losing control of urination when a bathroom wasn’t close by. The client states, “I’m worried this means that I’m starting to lose control of my bladder.” What is the appropriate nursing response?

  • “Let’s review your medication history and whether you consume bladder irritants.”
26

A 70-year-old client who has four children and six grandchildren states that she “wets” herself when she sneezes or laughs. She reports that sometimes this also occurs when rising from a sitting to standing position. Which type of incontinence does the nurse anticipate?

stress. Stress incontinence is associated with a raise in intra-abdominal pressure related to activities such as sneezing, coughing, or laughing.

27

The parent of a 5-year-old child tells the nurse that on two occasions her son has lost control of urination when he had to wait to go to the bathroom at school. What is the appropriate nursing response?

  • “Let’s review the types of fluids that your child drinks in the morning.”
28

A client with chronic kidney disease reports not being able to urinate for the past 24 hours. A bladder scan shows no urine in the bladder. How does the nurse document this data?

Anuria.

Absence of urine for a 24-hour period reflects anuria.

29

The nurse is caring for a client with an indwelling urinary catheter secondary to neurogenic bladder. The nurse completes a prescription to obtain a urine specimen from the catheter. After reviewing the image, what is the most accurate narrative note the nurse would document to demonstrate the steps to obtain the urine specimen were performed appropriately?

  • Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well.
30

A male client informs the nurse that he is concerned about dribbling and incontinence of small amounts of urine after the removal of an indwelling urinary catheter. The nurse is aware that the catheter was in place for 3 weeks prior to being removed. Which is the nurse's best response to the client?

  • "It will take a little while for the bladder to reestablish control as the strength of the muscle improves, and an accident is not unusual."
31

A client has been n.p.o. 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?

  • dark amber

Urine may be dark amber or orange-brown if it is very concentrated secondary to a decreased fluid intake.

32

A client could experience increased urination when using which classification of medication?

Cholinergic agents

Cholinergic agents stimulate the detrusor muscle, which causes more frequent urination

33

A nurse is caring for a client with an external condom catheter. Which guideline should be implemented when applying and caring for this type of catheter?

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

Nursing care of a client with a condom catheter includes vigilant skin care to prevent excoriation. This includes removing the condom catheter daily, washing the penis with soap and water and drying carefully, and inspecting the skin for irritation. In hot and humid weather, more frequent changing may be required. In all cases, care must be taken to fasten the condom securely enough to prevent leakage, yet not so tightly as to constrict the blood vessels in the area. In addition, the tip of the tubing should be kept 1 to 2 in. (2.5 to 5 cm) beyond the tip of the penis to prevent irritation to the sensitive glans area.

34

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?

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

A deep breath helps to relax the perineal and abdominal muscles. The nurse should rotate the catheter slightly, because a drainage hole may be resting against the bladder wall, and raise the head of the client's bed to increase pressure in the bladder.

35

Which is true regarding the normal urination?

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

Urine output of less than 30 mL per hour may indicate inadequate blood flow to the kidneys. In adults, the average amount of urine per void is approximately 200 to 400 mL. Adults generally have a urine output of 1500 mL per day, while children, depending on age, have a urine output between 500 and 1500 mL per day. Urine output can vary greatly, depending on intake and fluid losses.

36

The nurse is caring for a client who has been experiencing nausea, vomiting, and diarrhea for 3 days. Which urine characteristics does the nurse anticipate?

strongly aromatic, dark amber

37

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.

  • Contact the health care provider to ask for an order for catheter discontinuation.
  • Perform, or all
38

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.

  • 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.
39

The nurse is caring for a postoperative client just returning from surgical insertion of a peritoneal dialysis catheter. Which are the nurse's priority assessments of the peritoneal dialysis catheter insertion site? Select all that apply.

  • Odor
  • Bleeding
  • Drainage
  • Pain
40

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?

  • Regular toileting routine
41

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

stress incontinence

The nurse should document the client's condition as stress incontinence following weakening of perineal and sphincter muscle tone secondary to giving birth. Reflex incontinence is caused by damage to motor and sensory tracts in the lower spinal cord secondary to trauma. Urge incontinence is caused by bladder irritation secondary to infection. Functional incontinence is caused by impaired mobility, impaired cognition, or an inability to communicate.

42

A client at a health care facility is being treated for cancer of the bladder. The physician uses a urinary diversion to help the client with urinary elimination. What describes a urinary diversion?

one or both of the ureters are surgically implanted elsewhere

This procedure is done for various life-threatening conditions.

43

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:

reflex incontinence

Reflex incontinence is caused by damage to motor and sensory tracts in the lower spinal cord secondary to trauma.

44

Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence?

Boys may take longer for daytime continence than girls.

Children in North American cultures usually achieve daytime urinary continence by 3 years of age; boys may take longer than girls. Nighttime continence may not occur until 4 or 5 years of age.

45

The nurse is caring for a client who has been experiencing difficulty voiding since her vaginal birth. The client voices concern to the nurse. What information should be provided to the client?

  • The birth can cause perineal swelling.
46

A nurse is preparing to measure a client’s urine output. Which interventions would be of highest priority?

Wearing gloves when handling the urine

All of these interventions would be important to ensure safety in handling the client's urine and obtaining an accurate output. However, safety with handling body fluids would be a priority for the nurse to decrease risk of exposure to pathogens or blood that may be in the client’s urine.

47

The nurse is choosing a collection device to collect urine from a nonambulatory male client? What would be the nurse’s best choice?

Urinal

A urinal is the best choice to collect urine from a nonambulatory male client

A specimen hat is for a commode. A bedpan is not the best choice for a male client. A large urine collection bag would be used with an indwelling catheter.

48

A client reports to the nurse that after delivering a baby, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate?

stress. Stress incontinence is associated with a raise in intra-abdominal pressure related to activities such as sneezing, coughing, or laughing.

49

The nurse is preparing to irrigate a Foley catheter. What is the nurse’s initial action?

Check electronic health record for medical order.

The nurse will first check for an order to irrigate the Foley catheter. The other steps can be taken after it has been confirmed that an order for irrigation exists.

50

The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate?

dehydration.

The nurse anticipates that the client may be dehydrated, which is characterized by strongly aromatic, dark amber urine.

51

A 70-year-old client confides to the nurse that she is “terribly embarrassed” that she has developed urinary incontinence over the past year. Which nursing response supports the client’s self-esteem?

“Let’s explore structuring activities and toileting breaks.”

The nurse will promote the client’s self-esteem by exploring ways in which the client can verbalize feelings, maintain dignity, and become empowered to participate in self-care.

52

The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises (Kegel exercises) will the nurse include?

Keep muscles contracted for at least 10 seconds.

Kegel exercises should be performed by tightening the internal muscles used to prevent or interrupt urination for 10 seconds, followed by a period of 10 seconds of relaxation. The client should be instructed to perform this regimen 3-4 times daily for 2 weeks to 1 month.

53

A client with a history of advanced liver disease comes to the emergency department (ED) with dehydration. White blood cell count shows elevation in bands and neutrophils. When preparing to catheterize the client, what color urine does the nurse anticipate will drain?

dark brown, cloudy.

The client with advanced liver disease is expected to have dark brown or dark amber urine; infection may be represented by cloudy urine.

54

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.

Clients should avoid baths and public pools as well as wearing tight clothes and belts around the exit site. Once the site is healed, some health care providers do not require clients to wear a dressing unless the site is leaking.

55

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?

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

The nurse should auscultate over the access site with the bell of the stethoscope, listening for a bruit or vibration, and palpate over the access site, feeling for a thrill or vibration. If these are not present, the health care provider should be notified at once.

56

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. A client who is acutely confused is likely unable to manipulate a urinal effectively.

57

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.

The scanner head should be repositioned, and the bladder should be rescanned before assuming that the bladder is truly empty.

58

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?

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

An ileal conduit involves a surgical resection of the small intestine, with transplantation of the ureters to the isolated segment of small bowel. Such diversions are usually permanent, and the client wears an external appliance to collect the urine because urine elimination from the stoma cannot be controlled voluntarily. Appliances are usually changed every 3 to 7 days, although they could be changed more often.

59

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

The assessment is indicative of hospital-acquired catheter infection associated with the CVC. The medical provider may request laboratory studies, but these cannot be obtained until a prescription is received.

60

Upon assessment of the urine in a client's indwelling urinary catheter drain bag, the nurse notes the urine to be dark yellow. Which next step should the nurse implement?

Encourage fluid intake.

Conservation of fluid by the body during states of underhydration, fever, and diaphoresis results in the production of concentrated urine that is dark in color. A sign of overhydration would be very light or clear urine. Adequate fluid intake would correspond with pale yellow and clear urine. Signs of urinary tract infection include cloudy urine or urine containing blood or blood cells.