Deck 45: Urinary Elimination

Question 1

A postpartum client has been unable to void since her delivery of her baby this morning.Which of the following nursing measures would be beneficial for the client initially?
1) Increase fluid intake to 3500 mL.
2) Insert indwelling Foley catheter.
3) Rinse the perineum with warm water.
4) Apply firm pressure over the bladder.

Answer 1

3
The nurse can pour warm water over the client's perineum and create the sensation to urinate.A client with normal renal function who does not have heart or kidney disease should drink 2000 to 2500 mL of fluid daily.Increasing the client's fluid intake to 3500 mL is excessive.Because bladder catheterization carries the risk for UTI,it should be avoided if possible.The nurse should try other noninvasive measures to promote urination before calling the health care provider for an order to insert a Foley catheter.The nurse should not apply firm pressure over the bladder of a postpartum woman with an intact nervous system.The nurse could create more damage by exerting force on the client's uterus at this time.

Question 2

Which of the following statements should the nurse use to instruct the nursing assistant caring for a client with an indwelling urinary catheter?
1) Empty the drainage bag at least every 8 hours.
2) Clean up the length of the catheter to the perineum.
3) Use clean technique to obtain a specimen for culture and sensitivity.
4) Place the drainage bag on the client's lap while transporting the client to testing.

Answer 2

1
The urinary drainage bag should be emptied at least every 8 hours.If large outputs are noted,more frequent emptying will be required.The perineum should be cleansed and then down the catheter for a length of approximately 10 cm (4 inches).Only use sterile technique to collect specimens from a closed drainage system.Avoid raising the drainage bag above the level of the bladder.If it becomes necessary to raise the bag during transfer of the client to a bed or stretcher,clamp the tubing or empty the tubing contents to the drainage bag first.The drainage bag can be attached to the wheelchair below the level of the client's bladder for transport.It should not be placed on the client's lap.

Question 3

The nurse determines that the nursing diagnosis stress urinary incontinence related to decreased pelvic muscle tone is the most appropriate for an oriented adult female client.A therapeutic nursing intervention based on this diagnosis is to:
1) Apply adult diapers
2) Catheterize the client
3) Administer Urecholine
4) Teach Kegel exercises

Answer 3

4
Pelvic floor exercises,also known as Kegel exercises,improve the strength of pelvic floor muscles and consist of repetitive contractions of muscle groups.These exercises have demonstrated effectiveness in treating stress incontinence,overactive bladders,and mixed causes of urinary continence.The client is oriented and therefore could be taught Kegel exercises to improve pelvic floor muscle tone.Applying adult diapers does not improve the client's problem of incontinence and places the client at risk for skin breakdown.Because bladder catheterization carries the risk for urinary tract infection (UTI),it is preferable to rely on other measures for management of incontinence.The nurse can support the use of Kegel exercises as an inexpensive nonpharmacological intervention to reduce the client's stress incontinence.Bethanechol (Urecholine)stimulates the parasympathetic nervous system to promote complete bladder emptying and is primarily used to treat urinary retention and possible overflow incontinence.Nonpharmacological approaches should be attempted before pharmacological approaches are taken.

Question 4

A client is going to have a cystoscopy.Which of the following reflects the correct information that should be taught before the procedure?
1) "Are you allergic to iodine?"
2) "There will be no need to have a special consent form."
3) "You will need to have fluids restricted the evening before the cystoscopy."
4) "You will probably be given sedatives before the procedure."

Question 5

A urine sample is obtained from the client for a routine urinalysis.Upon reviewing the results of the test,the nurse notes that an expected finding of the urinalysis is:
1) pH 8.0
2) Specific gravity 1.018
3) Protein amounts to 12 mg/100 mL
4) White blood cells (WBCs)5 to 8 per low-power field casts

Question 6

The nurse is working with a client who has a urinary diversion.Included in the plan of care for this client is instruction that:
1) Special clothing will need to be ordered in order to fit around the diversion
2) A stomal bag will only need to be worn at night
3) A reduction in physical activity will be planned
4) Special skin care is a priority

Question 7

A 3-year-old child is visiting the pediatric clinic.The nurse suspects that the child has a urinary tract infection.An appropriate method for the nurse to implement in order to obtain a urine specimen from the child is to:
1) Use an indwelling catheter
2) Offer fluids 30 minutes in advance
3) Apply pressure over the urinary bladder
4) Place a diaper on the child and squeeze out the specimen

Question 8

The client is experiencing urinary retention,and the health care provider is contacted.The nurse anticipates a medication that will be ordered to promote emptying of the bladder is:
1) Oxybutynin chloride (Ditropan)
2) Bethanechol (Urecholine)
3) Propantheline (Pro-Banthine)
4) Nystatin (Mycostatin)

Question 9

A timed urine specimen collection is ordered.The test will need to be restarted if which of the following occurs?
1) The client voids in the toilet.
2) The urine specimen is kept cold .
3) The first voided urine is discarded.
4) The preservative is placed in the collection container.

Question 10

In an assessment of a client with reflex incontinence the nurse expects to find that the client has:
1) A constant dribbling of urine
2) An uncontrollable loss of urine when coughing or sneezing
3) No urge to void and an unawareness of bladder filling
4) An immediate urge to void but not enough time to reach the bathroom

Question 11

The unit manager is evaluating the care of a new nursing staff member.Which of the following is an appropriate technique for the nurse to implement in order to obtain a clean-voided urine specimen?
1) Apply sterile gloves for the procedure.
2) Restrict fluids before the specimen collection.
3) Place the specimen in a clean urinalysis container.
4) Collect the specimen after the initial stream of urine has passed.

Question 12

The nurse is aware that clients with chronic alterations in kidney function suffer from insufficient amounts of:
1) Vitamin A
2) Vitamin D
3) Vitamin E
4) Vitamin K

Question 13

When calculating the daily intake and output,the nurse anticipates that the urinary output for an average adult should be:
1) 800 to 1000 mL/day
2) 1000 to 1200 mL/day
3) 1500 to 1600 mL/day
4) 2000 to 2300 mL/day

Question 14

Immediately after an intravenous pyelogram (IVP)the nurse should observe the client for which of the following?
1) Infection in the urinary bladder
2) An allergic reaction to the contrast material
3) Urinary suppression caused by injury to kidney tissues
4) Incontinence as a result of paralysis of the urinary sphincter

Question 15

The nurse is visiting the client who has a nursing diagnosis of urinary retention.Upon assessment the nurse anticipates that this client will exhibit:
1) Severe flank pain and hematuria
2) Pain and burning on urination
3) A loss of the urge to void
4) A feeling of pressure and voiding of small amounts

Question 16

The nurse caring for a client in an extended care facility should provide which intervention in a bladder retraining program?
1) Providing negative reinforcement when the client is incontinent
2) Having the client wear adult diapers as a preventative measure
3) Putting the client on a q2h toilet schedule during the day
4) Promoting the intake of caffeine to stimulate voiding

Question 17

The nurse suspects that the client has a bladder infection based on the client's exhibiting an early sign or symptom such as:
1) Chills
2) Hematuria
3) Flank pain
4) Incontinence

Question 18

Which of the following actions by the nurse would indicate the need for remedial education in the removal of an indwelling catheter?
1) Draping the female client between the thighs
2) Obtaining a specimen before removal
3) Cutting the catheter to deflate the balloon
4) Checking the client's output for 24 hours after removal

Question 19

A client with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH).The nurse anticipates the client will exhibit:
1) Hematuria
2) An increased blood pressure
3) Dry mucous membranes
4) A low serum sodium level

Question 20

When obtaining a sterile urine specimen from an indwelling urinary catheter the nurse should:
1) Disconnect the catheter from the drainage tubing
2) Withdraw urine from a urinometer
3) Open the drainage bag and removing urine
4) Use a needle to withdraw urine from the catheter port

Question 21

The nurse is caring for a 23-year-old male client who is in the ICU with second and third degree burns over 40 percent of his body.One of the first symptoms that the client is having organ failure is that the urine output is less than:
1) 30 mL/hour
2) 40 mL/hour
3) 50 mL/hour
4) 60 mL/hour

Question 22

The nurse is discussing signs and symptoms of both upper and lower urinary tract infections with a client who has a history of both.Which of the following statements by the client reflects the best understanding of the differing symptomatology?
1) "When I get cloudy urine,I figure I have an infection."
2) "Burning when I urinate is usually the first symptom I notice."
3) "I have a big problem when I feel like I have the flu but with back pain too."
4) "When I see blood in my urine,I know I need to call my health care provider."

Question 23

The nurse is interviewing a client with a history of benign prostatic hypertrophy (BPH).In light of this diagnosis,the nurse should include information regarding which of the following in order to assess the chronic effects of this renal disorder?
1) Number of times he usually urinates in a 24-hour period
2) What medications he is currently taking for the condition
3) The results of his latest prostate-specific antigen (PSA)testing
4) Whether he usually experiences a complete emptying of his bladder

Question 24

The nurse is assessing a client admitted with complaints related to chronic kidney dysfunction.The nurse recognizes that this client is most likely to present with which of the resulting symptoms?
1) Anemia
2) Hypotension
3) Diabetes mellitus
4) Clinical depression

Question 25

The nurse is caring for a 19-year-old male client with a fractured left femur whose leg was pinned 36 hours ago and is now in traction.Which of the following stressors is mostly likely the cause of this client's difficulty related to starting urine flow?
1) Pain related to the fracture and its repair
2) Anxiety regarding the serious nature of the injury
3) The inability to stand in order to facilitate urination
4) Poor fluid intake in the accident and ensuing surgery

Question 26

Urinary elimination may be altered with different pathophysiological conditions.For the client with diabetes mellitus,the nurse anticipates that an initial urinary sign or symptom will be:
1) Urgency
2) Dysuria
3) Hematuria
4) Polyuria

Question 27

Which of the following statements made by a client experiencing chronic kidney dysfunction reflects the best understanding of the most common physiological effect this disorder can have on the body?
1) "I'm tested regularly for anemia."
2) "My diet is restricted because of this problem."
3) "Diabetes runs in my family,so I get tested regularly."
4) "I can get really depressed if I think about this too much."

Question 28

Which of the following clients will most benefit from client/parent education regarding the prevention of renal infections via proper hygiene habits?
1) Males ages 35 to 65
2) Males ages 3 to 16
3) Females ages 3 to 12
4) Females ages 20 to 50

Question 29

The nurse is discussing urinary elimination alterations with a group of middle-age adults.The nurse appropriately shares with the group that whereas men experience urinary frequency as a result of prostate enlargement,the female:
1) Is more affected if she has experienced multiple pregnancies
2) Does not usually experience urinary problems until much later in life
3) Experiences an increased risk for urinary tract infections related to menopause
4) Appears to have less risk for kidney infections because of gradually declining estrogen levels

Question 30

Which of the following statements made by an older adult with a history of urinary tract infections shows the best understanding of interventions that minimize the risk for developing such infections?
1) "I drink 8 ounces of cranberry juice a day to discourage bacterial growth in my bladder."
2) "Whenever I feel an infection coming on,I immediately call my health care provider."
3) "I told the nurses I didn't want a urinary catheter unless I absolutely had to have one."
4) "Whenever I can,I avoid drinking after 8 PM because I usually go to bed about 11 PM."

Question 31

The nurse recognizes that a client recovering from anesthesia required for surgical repair of a fractured ulna is likely to experience difficulty urinating primarily because of:
1) The impaired cognitive state the client will experience as the effects of the anesthesia wear off
2) The decreased volume of orally ingested fluids before,during,and after the surgical procedure
3) The length of time the client was under the effects of general anesthesia required for the surgical procedure
4) The effects of the anesthetic on the nerves and muscles controlling the relaxation of the urinary bladder

Question 32

The nurse realizes that a postsurgical client who underwent a left knee replacement is most likely to experience which of the following urinary complications?
1) Dysuria
2) Bladder spasms
3) A bladder infection
4) Burning on urination

Question 33

A 33-year-old female client in her first trimester of pregnancy complains to the nurse on her prenatal visit that she is needs to urinate more frequently and is concerned about having a urinary tract infection.Which of the following statements would be most appropriate for the nurse to make?
1) Are you having any burning or pain when you urinate?
2) Your uterus is pushing up against your bladder which causes you to have to go more frequently
3) Later in your pregnancy as the baby gets bigger it will be a lot worse
4) It is normal for you to have to urinate more frequently because you are eliminating for two now

Question 34

Which of the following nursing interventions is most specific for a client being monitored for possible urinary retention?
1) Measuring urine output with each urination
2) Monitoring the color and clarity of urine with each voiding
3) Collecting a urine sample for a culture and sensitivity test
4) Asking the cognizant client to report each time he or she urinates

Question 35

The nurse knows that which of the following clients is most at risk for a bone fracture:
1) 44-year-old female with rheumatoid arthritis
2) 64-year-old male with Cushing's disease
3) 53-year-old female with chronic alterations in renal function
4) 60-year-old male with cirrhosis of the liver

Question 36

The nurse is caring for an older adult who is recovering from hip replacement surgery.The client shares with the nurse that he has been using the urinal "a lot but I feel like my bladder isn't empty." Which of the following statements by the nurse shows the best understanding of the appropriate initial intervention for this particular client?
1) "I'll call your primary care provider and let her know you are having this problem."
2) "I have the ancillary personnel measure your output,so please don't empty your urinal yourself."
3) "I'm going to ask that you please use your call bell and notify me or the ancillary staff each time you void."
4) "I suggest that we try limiting the amount of fluids you are drinking for a few hours and see if that helps."

Question 37

Which of the following clients is at greatest risk for developing a renal infection?
1) A 27-year-old male
2) A 16-year-old male
3) A 9-year-old female
4) A 45-year-old female

Question 38

A 70-year-old client is discussing his recent difficulty in initiating his flow of urine while on a cross-country bus tour with a senior citizens' group.Which of the following assessment questions is directed toward the most likely cause of the problem?
1) "Did the bus stop frequently so you could get up and walk around?"
2) "Did you drink plenty of water while you were on the trip?"
3) "Do you find using public restrooms unsettling?"
4) "Do you have any chronic urinary problems?"

Question 39

Which of the following statements made by a client with benign prostatic hypertrophy (BPH)during an admissions interview reflects the best understanding of the long-term effects of this condition?
1) "I usually get up 3 to 4 times a night to urinate."
2) "My health care provider prescribed some medication that has helped."
3) "At least I can usually empty my bladder;I really hate that feeling of being full."
4) "The prostate specific antigen (PSA)results have stayed stable for the last 3 tests."

Question 40

A condom catheter is to be used for an adult male client in the extended care facility.In the application of the condom catheter,the nurse employs appropriate technique when:
1) Using sterile gloves
2) Wrapping the adhesive tape securely around the base of the penis
3) Leaving a 1- to 2-inch space between the tip of the penis and the end of the catheter
4) Taping the tubing tightly to the thigh and attaching the drainage bag to the bed frame

Question 41

A 73-year-old female client with Parkinson's syndrome was prescribed levodopa when other therapies had failed.The client is alarmed that her urine has become dark brown and is concern.The nurse explains to the client that one of the side effects of this medication is that it may cause:
1) Her urine to become dark brown or black
2) Heart failure
3) Kidney failure
4) Hair loss

Question 42

A 34-year-old diabetic female client had a spontaneous vaginal birth of a 37-week 6.2 kg infant.The nurse caring for the client post-partum understands that due to the traumatic birth the client is at increased risk for:
1) Acute urinary retention
2) Hematuria
3) Kidney failure
4) Enuresis

Question 43

A 46-year-old client has had kidney disease for the past 10 years.His kidneys are no longer functioning.The nurse knows that which of the following offers the client the potential for restoration of normal kidney function?
1) Lasix therapy
2) Hemodialysis
3) Peritoneal dialysis
4) Kidney transplant

Question 44

A 45-year-old female client has been hospitalized for severe abdominal pain.The health care provider has ordered a PCA pump for the client to help control the pain.It has been determined that the pain is due to cholelithiasis and the client is scheduled for a cholecystectomy later that day.The client returns to the unit postoperatively with a Foley catheter anchored.The nurse notes that the client's urine output has decreased.The nurse knows that this is most likely due to:
1) Stress response
2) Preoperative NPO status
3) Kidney failure
4) Post-operative urinary retention

Question 45

The nurse is caring for a 56-year-old female client with renal failure who regularly undergoes peritoneal dialysis.The nurse understands that this client is most at risk for:
1) Pulmonary embolism
2) Electrolyte imbalances
3) Polyuria
4) Urinary incontinence

Question 46

A 46-year-old male client with chronic renal problems is in the hospital for a nephrostomy.The nurse understands that this is the surgical insertion of a tube that will drain urine from the client's:
1) Bladder
2) Urethra
3) Ureters
4) Renal pelvis