Deck 46: Urinary Elimination

Question 1

An 86-year-old patient is experiencing uncontrollable leakage of urine with a strong desire to void and even leaks on the way to the toilet. Which priority nursing diagnosis will the nurse include in the patient's plan of care?

A) Functional urinary incontinence
B) Urge urinary incontinence
C) Impaired skin integrity
D) Urinary retention

Answer 1

Urge urinary incontinence

Question 2

A patient asks about treatment for stress urinary incontinence. Which is the nurse's best response?

A) Perform pelvic floor exercises.
B) Avoid voiding frequently.
C) Drink cranberry juice.
D) Wear an adult diaper.

Answer 2

Perform pelvic floor exercises.

Question 3

The patient has a catheter that must be irrigated. The nurse is using a needleless closed irrigation technique. In which order will the nurse perform the steps, starting with the first one?
1) Clean injection port.
2) Inject prescribed solution.
3) Twist needleless syringe into port.
4) Remove clamp and allow to drain.
5) Clamp catheter just below specimen port.
6) Draw up prescribed amount of sterile solution ordered

A) 3, 2, 6, 1, 5, 4
B) 5, 6, 1, 2, 3, 4
C) 1, 5, 6, 3, 2, 4
D) 6, 5, 1, 3, 2, 4

Answer 3

6, 5, 1, 3, 2, 4

Question 4

A nurse is planning care for a group of patients. Which task will the nurse assign to the nursing assistive personnel?

A) Obtaining a midstream urine specimen
B) Interpreting a bladder scan result
C) Inserting a straight catheter
D) Irrigating a catheter

Question 5

A nurse is inserting a catheter into a female patient. When the nurse inserts the catheter, no urine is obtained. The nurse suspects the catheter is not in the urethra. What should the nurse do?

A) Throw the catheter way and begin again.
B) Fill the balloon with the recommended sterile water.
C) Remove the catheter, wipe with alcohol, and reinsert after lubrication.
D) Leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.

Question 6

A nurse is reviewing results from a urine specimen. What will the nurse expect to see in a patient with a urinary tract infection?

A) Casts
B) Protein
C) Crystals
D) Bacteria

Question 7

Upon palpation, the nurse notices that the bladder is firm and distended; the patient expresses an urge to urinate. Which question is most appropriate?

A) "Does your urinary problem interfere with any activities?"
B) "Do you lose urine when you cough or sneeze?"
C) "When was the last time you voided?"
D) "Are you experiencing a fever or chills?"

Question 8

While receiving a shift report on a patient, the nurse is informed that the patient has urinary incontinence. Upon assessment, which finding will the nurse expect?

A) An indwelling Foley catheter
B) Reddened irritated skin on buttocks
C) Tiny blood clots in the patient's urine
D) Foul-smelling discharge indicative of infection

Question 9

The nurse suspects cystitis related to a lower urinary tract infection. Which clinical manifestation does the nurse expect the patient to report?

A) Dysuria
B) Flank pain
C) Frequency
D) Fever

Question 10

A patient is experiencing oliguria. Which action should the nurse perform first?

A) Assess for bladder distention.
B) Request an order for diuretics.
C) Increase the patient's intravenous fluid rate.
D) Encourage the patient to drink caffeinated beverages.

Question 11

A patient requests the nurse's help to the bedside commode and becomes frustrated when unable to void in front of the nurse. How should the nurse interpret the patient's inability to void?

A) The patient can be anxious, making it difficult for abdominal and perineal muscles to relax enough to void.
B) The patient does not recognize the physiological signals that indicate a need to void.
C) The patient is lonely, and calling the nurse in under false pretenses is a way to get attention.
D) The patient is not drinking enough fluids to produce adequate urine output.

Question 12

A nurse is teaching a patient about the urinary system. In which order will the nurse present the structures, following the flow of urine?

A) Kidney, urethra, bladder, ureters
B) Kidney, ureters, bladder, urethra
C) Bladder, kidney, ureters, urethra
D) Bladder, kidney, urethra, ureters

Question 13

To obtain a clean-voided urine specimen from a female patient, what should the nurse teach the patient to do?

A) Cleanse the urethral meatus from the area of most contamination to least.
B) Initiate the first part of the urine stream directly into the collection cup.
C) Drink fluids 5 minutes before collecting the urine specimen.
D) Hold the labia apart while voiding into the specimen cup.

Question 14

A nurse is caring for a male patient with urinary retention. Which action should the nurse take first?

A) Limit fluid intake.
B) Insert a urinary catheter.
C) Assist to a standing position.
D) Ask for a diuretic medication.

Question 15

Which assessment question should the nurse ask if stress incontinence is suspected?

A) "Do you think your bladder feels distended?"
B) "Do you empty your bladder completely when you void?"
C) "Do you experience urine leakage when you cough or sneeze?"
D) "Do your symptoms increase with consumption of alcohol or caffeine?"

Question 16

A patient has fallen several times in the past week when attempting to get to the bathroom. The patient gets up 3 or 4 times a night to urinate. Which recommendation by the nurse is most appropriate in correcting this urinary problem?

A) Limit fluid and caffeine intake before bed.
B) Leave the bathroom light on to illuminate a pathway.
C) Practice Kegel exercises to strengthen bladder muscles.
D) Clear the path to the bathroom of all obstacles before bedtime.

Question 17

The nurse, upon reviewing the history, discovers the patient has dysuria. Which assessment finding is consistent with dysuria?

A) Blood in the urine
B) Burning upon urination
C) Immediate, strong desire to void
D) Awakes from sleep due to urge to void

Question 18

The patient is having lower abdominal surgery and the nurse inserts an indwelling catheter. What is the rationale for the nurse's action?

A) The patient may void uncontrollably during the procedure.
B) Local trauma sometimes promotes excessive urine incontinence.
C) Anesthetics can decrease bladder contractility and cause urinary retention.
D) The patient will not interrupt the procedure by asking to go to the bathroom.

Question 19

The patient is taking phenazopyridine. When assessing the urine, what will the nurse expect?

A) Red color
B) Orange color
C) Dark amber color
D) Intense yellow color

Question 20

A nurse is reviewing urinary laboratory results. Which finding will cause the nurse to follow up?

A) Protein level of 2 mg/100 mL
B) Urine output of 80 mL/hr
C) Specific gravity of 1.036
D) pH of 6.4

Question 21

A nurse is providing care to a group of patients. Which patient will the nurse see first?

A) A patient who is dribbling small amounts on the way to the bathroom and has a diagnosis of urge incontinence
B) A patient with reflex incontinence with elevated blood pressure and pulse rate
C) A patient with an indwelling catheter that has stool on the catheter tubing
D) A patient who has just voided and needs a postvoid residual test

Question 22

The nurse is preparing to test a patient for postvoid residual with a bladder scan. Which action will the nurse take?

A) Measure bladder before the patient voids.
B) Measure bladder within 10 minutes after the patient voids.
C) Measure bladder with head of bed raised to 60 degrees.
D) Measure bladder with head of bed raised to 90 degrees.

Question 23

A nurse is watching a nursing assistive personnel (NAP) perform a postvoid bladder scan on a female with a previous hysterectomy. Which action will require the nurse to follow up?

A) Palpates the patient's symphysis pubis
B) Wipes scanner head with alcohol pad
C) Applies a generous amount of gel
D) Sets the scanner to female

Question 24

A nurse is caring for a hospitalized patient with a urinary catheter. Which nursing action best prevents the patient from acquiring an infection?

A) Maintaining a closed urinary drainage system
B) Inserting the catheter using strict clean technique
C) Disconnecting and replacing the catheter drainage bag once per shift
D) Fully inflating the catheter's balloon according to the manufacturer's recommendation

Question 25

The nurse is preparing to apply an external catheter. Which action will the nurse take?

A) Allow 1 to 2 inches of space between the tip of the penis and the end of the catheter.
B) Spiral wrap the penile shaft using adhesive tape to secure the catheter.
C) Twist the catheter before applying drainage tubing to the end of the catheter.
D) Shave the pubic area before applying the catheter.

Question 26

The nurse will anticipate inserting a Coudé catheter for which patient?

A) An 8-year-old male undergoing anesthesia for a tonsillectomy
B) A 24-year-old female who is going into labor
C) A 56-year-old male admitted for bladder irrigation
D) An 86-year-old female admitted for a urinary tract infection

Question 27

A nurse is evaluating a nursing assistive personnel's (NAP) care for a patient with an indwelling catheter. Which action by the NAP will cause the nurse to intervene?

A) Emptying the drainage bag when half full
B) Kinking the catheter tubing to obtain a urine specimen
C) Placing the drainage bag on the side rail of the patient's bed
D) Securing the catheter tubing to the patient's thigh

Question 28

To reduce patient discomfort during a closed intermittent catheter irrigation, what should the nurse do?

A) Use room temperature irrigation solution.
B) Administer the solution as quickly as possible.
C) Allow the solution to sit in the bladder for at least 1 hour.
D) Raise the bag of the irrigation solution at least 12 inches above the bladder.

Question 29

A nurse is providing care to a patient with an indwelling catheter. Which practice indicates the nurse is following guidelines for avoiding catheter-associated urinary tract infection (CAUTI)?

A) Drapes the urinary drainage tubing with no dependent loops
B) Washes the drainage tube toward the meatus with soap and water
C) Places the urinary drainage bag gently on the floor below the patient
D) Allows the spigot to touch the receptacle when emptying the drainage bag

Question 30

Which clinical manifestation will the nurse expect to observe in a patient with excessive white blood cells present in the urine?

A) Reduced urine specific gravity
B) Increased blood pressure
C) Abnormal blood sugar
D) Fever with chills

Question 31

Which observation by the nurse best indicates that a continuous bladder irrigation for a patient following genitourinary surgery is effective?

A) Output that is smaller than the amount instilled
B) Blood clots or sediment in the drainage bag
C) Bright red urine turns pink in the tubing
D) Bladder distention with tenderness

Question 32

A patient has severe flank pain. The urinalysis reveals presence of calcium phosphate crystals. The nurse will anticipate an order for which diagnostic test?

A) Intravenous pyelogram
B) Mid-stream urinalysis
C) Bladder scan
D) Cystoscopy

Question 33

A nurse is caring for a patient who just underwent an intravenous pyelography that revealed a renal calculus obstructing the left ureter. What is the nurse's first priority in caring for this patient?

A) Turn the patient on the right side to alleviate pressure on the left kidney.
B) Encourage the patient to increase fluid intake to flush the obstruction.
C) Monitor the patient for fever, rash, and difficulty breathing.
D) Administer narcotic medications to the patient for pain.

Question 34

A nurse is caring for a patient with a continent urinary reservoir. Which action will the nurse take?

A) Teach the patient how to self-cath the pouch.
B) Teach the patient how to perform Kegel exercises.
C) Teach the patient how to change the collection pouch.
D) Teach the patient how to void using the Valsalva technique.

Question 35

A female patient is having difficulty voiding in a bedpan but states that her bladder feels full. To stimulate micturition, which nursing intervention should the nurse try first?

A) Exiting the room and informing the patient that the nurse will return in 30 minutes to check on the patient's progress.
B) Utilizing the power of suggestion by turning on the faucet and letting the water run.
C) Obtaining an order for a Foley catheter.
D) Administering diuretic medication.

Question 36

Which statement by the patient about an upcoming contrast computed tomography (CT) scan indicates a need for further teaching?

A) "I will follow the food and drink restrictions as directed before the test is scheduled."
B) "I will be anesthetized so that I lie perfectly still during the procedure."
C) "I will complete my bowel prep program the night before the scan."
D) "I will be drinking a lot of fluid after the test is over."

Question 37

A nurse is caring for an 8-year-old patient who is embarrassed about urinating in bed at night. Which intervention should the nurse suggest to reduce the frequency of this occurrence?

A) "Set your alarm clock to wake you every 2 hours, so you can get up to void."
B) "Line your bedding with plastic sheets to protect your mattress."
C) "Drink your nightly glass of milk earlier in the evening."
D) "Empty your bladder completely before going to bed."

Question 38

Which nursing actions will the nurse implement when collecting a urine specimen from a patient? (Select all that apply.)

A) Growing urine cultures for up to 12 hours
B) Labeling all specimens with date, time, and initials
C) Allowing the patient adequate time and privacy to void
D) Wearing gown, gloves, and mask for all specimen handling
E) Transporting specimens to the laboratory in a timely manner
F) Collecting the specimen from the drainage bag of an indwelling catheter

Question 39

A nurse is inserting an indwelling urinary catheter for a male patient. Which action will the nurse take?

A) Hold the shaft of the penis at a 60-degree angle.
B) Hold the shaft of the penis with the dominant hand.
C) Cleanse the meatus 3 times with the same cotton ball from clean to dirty.
D) Cleanse the meatus with circular strokes beginning at the meatus and working outward.

Question 40

The nurse anticipates a suprapubic catheter for which patient?

A) A patient with recent prostatectomy
B) A patient with a urethral stricture
C) A patient with an appendectomy
D) A patient with menopause

Question 41

A nurse administers an antimuscarinic to a patient. Which findings indicate the patient is having therapeutic effects from this medication? (Select all that apply.)

A) Decrease in dysuria
B) Decrease in urgency
C) Decrease in frequency
D) Decrease in prostate size
E) Decrease in bladder infection

Question 42

The nurse is using different toileting schedules. Which principles will the nurse keep in mind when planning care? (Select all that apply.)

A) Habit training uses a bladder diary.
B) Timed voiding is based upon the patient's urge to void.
C) Prompted voiding includes asking patients if they are wet or dry.
D) Elevation of feet in patients with edema can decrease nighttime voiding.
E) Bladder retraining teaches patients to follow the urge to void as quickly as possible.

Question 43

The nurse is obtaining a 24-hour urine specimen collection from the patient. Which actions should the nurse take? (Select all that apply.)

A) Keeping the urine collection container on ice when indicated
B) Withholding all patient medications for the day
C) Irrigating the sample as needed with sterile solution
D) Testing the urine sample with a reagent strip by dipping it in the urine
E) Asking the patient to void and discarding that urine to start the collection

Question 44

Which findings should the nurse follow up on after removal of a catheter from a patient? (Select all that apply.)

A) Increasing fluid intake
B) Dribbling of urine
C) Voiding in small amounts
D) Voiding within 6 hours of catheter removal
E) Burning with the first couple of times voiding