46 urinary elimination

Question 1

1. A patient is scheduled to have an intravenous pyelogram (IVP) the next morning. Which nursing measures should be implemented before the test? (Select all that apply.)

Answer 1

1. Ask the patient about any allergies and reactions.
2. Ensure that informed consent has been obtained.
3. Instruct the patient that facial flushing can occur when the contrast media is given.

Question 2

2. What is a critical step when inserting an indwelling catheter into a male patient?

Answer 2

3. Advance the catheter to the bifurcation of the drainage and balloon ports.

Question 3

3. Which instruction should the nurse give the assistive personnel (AP) concerning a patient who has had an indwelling urinary catheter removed that day?

Answer 3

3. Report the time and amount of first voiding.

Question 4

4. A postoperative patient with a three-way indwelling urinary catheter and continuous bladder irrigation (CBI) complains of lower abdominal pain and distention. What should be the nurse’s initial intervention(s)? (Select all that apply.)

Answer 4

2. Assess the patency of the drainage system.

3. Measure urine output.

Question 5

5. An ambulatory elderly woman with dementia is incontinent of urine. She has poor short-term memory and has not been seen toileting independently. What is the best nursing intervention for this patient?

Answer 5

2. Establish a toileting schedule.

Question 6

6. What should the nurse teach a young woman with a history of urinary tract infections (UTIs) about UTI prevention? (Select all that apply.)

Answer 6

1. Maintain regular bowel elimination.
2. Wear cotton underwear.
3. Cleanse the perineum from front to back.

Question 7

7. Place the following steps for insertion of an indwelling catheter in a female patient in appropriate order.

Answer 7

5. Drape patient with the sterile square and fenestrated drapes.
6. Prepare sterile field and supplies.
7. Lubricate catheter.
8. Cleanse urethral meatus with antiseptic solution.
9. Insert and advance catheter.
10. When urine appears, advance another 2.5 to 5 cm.
11. Inflate catheter balloon.
12. Gently pull catheter until resistance is felt.
13. Attach drainage tubing.

Question 8

8. Which nursing interventions should a nurse implement when removing an indwelling urinary catheter in an adult patient? (Select all that apply.)

Answer 8

2. Allow the balloon to drain into the syringe by gravity.

3. Initiate a voiding record/bladder diary.

Question 9

9. Which nursing intervention decreases the risk for catheter-associated urinary tract infection (CAUTI)?

Answer 9

2. Hanging the urinary drainage bag below the level of the bladder

Question 10

10. There is no urine when a catheter is inserted 3 inches into a female’s urethra. What should the nurse do next?

Answer 10

2. Leave the catheter there and start over with a new catheter.

Question 11

A patient has a standard creatinine clearance test ordered. Which information would the nurse include when teaching a patient about the test?

Answer 11

Correct

It is a 24-hour urine collection.
The creatinine clearance test is timed. It should last for exactly the required period (standard is 24 hours) to ensure an accurate representation of the patient’s kidney function.
Incorrect

All urine must be collected during the designated time period once the test starts.
Once the collection starts, no urine should be discarded. It is crucial that all urine is collected, or the collection must begin again for another 24-hour period.

Question 12

Which potential cause of kidney failure is prerenal?

Answer 12

Low cardiac output
Prerenal problems occur before reaching the kidneys. A good example is low cardiac output, which can damage the kidney by creating insufficient blood flow to the kidney for adequate function.

Question 13

Place the spread of a urinary tract infection in ascending anatomical order.

Answer 13

Contamination of the urinary meatus by a pathogen
Spread to the urethra, causing urethritis
Spread to the urinary bladder, causing cystitis
Spread to the ureters, causing ureteritis (rare)
Spread to the kidneys, causing pyelonephritis

Urinary tract infections begin locally with contamination of the urinary meatus. The pathogen then colonizes in the urethra and slowly ascends the lower urinary tract. It can spread to the upper urinary tract if not adequately treated.

Question 14

A urinalysis is performed for a patient with suspected dehydration. The nurse recognizes that which urinalysis result correlates with fluid volume deficit?

Answer 14

Elevated specific gravity
Specific gravity measures urine concentration, which reflects hydration status. A high specific gravity occurs with dehydration.

Question 15

Match the urinary function diagnostic test with its description.

Answer 15

High-frequency sound waves used to visualize anatomic structures
Ultrasound
Invasive internal exam of the urethra and bladder with lighted device
Cystoscopy
Detailed x-ray cross-sectional images of the urinary system
Computed tomography (CT)
X-ray using contrast medium to visualize kidneys, ureters, and bladder
Intravenous pyelogram

Question 16

Match the urinary pattern alteration to its corresponding cue.

Answer 16

Urine output <50 to 100 mL/24 hrs  
Anuria 
Urine output <400 mL/24 hrs  
Oliguria 
Urine output >2500 mL/24 hrs  
Polyuria 
Excessive urination at night  
Nocturia

Question 17

Which conditions are general risk factors for developing urinary incontinence?

Answer 17

Older age
The muscle tone of the bladder, urethra, and pelvic floor decreases with age, increasing the risk of urinary incontinence.
Correct

Immobility
Immobility is a significant risk factor for developing incontinence. Functional incontinence refers to a lack of urine control related to a physical limitation rather than any abnormality of the urinary tract. The physical limitation delays the person’s ability to use the toilet and incontinence occurs.
Correct

Pregnancy
Pregnancy is a risk factor for urinary incontinence because of increased abdominal pressure and relaxation of the urethral sphincters secondary to the pregnancy hormone relaxin.

Question 18

The nurse provides education about fluid intake to a patient worried about recurrent urinary tract infections (UTIs). Which statement by the patient indicates that teaching was successful?

Answer 18

High fluid intake flushes out my urinary system and reduces my chances of getting a UTI.”
Increased fluid intake increases volume and frequency of urination, which helps prevent urinary stagnation and bacteria colonization, preventing UTI. Increased fluid intake also helps prevent the formation of renal calculi.

Question 19

A sterile urine sample via catheterization is prescribed for a patient who is temporarily unable to provide a clean catch sample. Which type of urinary catheter will the nurse use to obtain the sample?

Answer 19

Straight catheter

Straight catheters are designed for single-use “in-and-out” catheterization and are ideal for sterile sample collection.

Question 20

The nurse recognizes which physiologic connection between Kegel exercises and improved urinary continence?

Answer 20

Urethral sphincter tone increases.
Pelvic floor muscle exercises like Kegels tone the urinary and anal sphincters and support musculature, which improves voluntary control of urine flow.

Question 21

Which rationale would the nurse recognize for placing a patient in the high-Fowler position to facilitate urination in a bedpan?

Answer 21

Increases intraabdominal pressure

The high-Fowler position increases intraabdominal pressure and helps voiding.

Question 22

The UAP is assisting the nurse in the care of a patient with an indwelling urinary catheter. Which instruction would the nurse provide to the UAP to prevent urine from flowing back into the sterile bladder?

Answer 22

Hang the patient’s urine collection bag below the patient’s mattress on a nonmovable part of the bed frame.
This action would keep the urine collection bag below the level of the bladder and prevent urine from flowing back into the bladder.

Question 23

A nurse is caring for a patient with continuous urinary bladder irrigation. Which cue indicates a complication of urinary bladder irrigation and warrants further investigation and action by the nurse?

Answer 23

Decrease in hourly catheter output
A decrease in hourly catheter output indicates a complication and warrants immediate further investigation by the nurse. Possible causes include an obstruction such as a blood or mucus clot in the drainage tubing, a decrease in patient urine output, or an obstruction of the bladder irrigation input system.

Question 24

Which evaluation outcome indicates that a male patient with urinary incontinence using a condom catheter is improving?

Answer 24

Previously macerated perineal skin shows signs of healing.

Healing is an indication of improvement.

Question 25

Which equipment would the nurse use to collect a nonsterile urine sample from an ambulatory hospitalized female patient with limited manual dexterity?

Answer 25

Urine hat A urine hat is ideal for collecting a nonsterile urine sample from an ambulatory hospitalized patient with limited manual dexterity. A urine hat is placed in the front of the patient’s toilet before voiding.

Question 26

The nurse is evaluating the effectiveness of teaching a patient to independently collect a clean catch midstream urine sample for a suspected urinary tract infection (UTI). Which action by the patient indicates that further teaching is needed?

Answer 26

Grasps the rim of the specimen cup with the forefinger inside the cup and the thumb outside the cup By touching the inside of the cup, the patient has contaminated the specimen through the introduction of external microorganisms. The nurse recognizes that further teaching is needed.

Question 27

The nurse caring for an adult patient with a urine output of 350 mL in the past 24 hours is evaluating the previously selected hypothesis of Impaired Kidney Function. Which new cues in the patient chart indicate a need to begin the clinical judgment process again and create a new hypothesis?

Answer 27

Serum creatinine level within expected range Serum creatinine within the expected range does not support a hypothesis of Impaired Kidney Function and suggests the need to create a new hypothesis. Serum creatinine levels are typically elevated with impaired kidney function. Correct Specific gravity of urine above the expected range Higher-than-expected specific gravity of urine neither specifically supports nor contradicts a hypothesis of Impaired Kidney Function, although typically specific gravity of urine is decreased in kidney function. Elevated specific gravity indicates concentrated urine, which is common with dehydration. A better hypothesis for this cue in combination with other cues presented (low urine output) would be Dehydration or fluid volume deficit rather than Impaired Kidney Function. Correct Urinalysis negative for protein Urinalysis negative for protein does not support a hypothesis of Impaired Kidney Function and suggests the need to create a new hypothesis. The presence of protein in urine suggests impaired kidney function. Correct Serum blood urea nitrogen (BUN)/creatinine ratio within expected range Serum BUN/creatinine ratio within the expected range does not support a hypothesis of Impaired Kidney Function and suggests the need to create a new hypothesis. High BUN/creatinine ratios occur suddenly in acute kidney failure.

Question 28

Which solutions would the nurse generate for a hypothesis of Impaired Kidney Function?

Answer 28

Monitor serum creatinine and blood urea nitrogen (BUN) level. Serum creatinine and BUN monitoring is a solution the nurse would generate for a hypothesis of Impaired Kidney Function. Increasing serum BUN and creatinine levels are indicators of worsening kidney function. Assess for swelling in extremities. The nurse would generate the solution of assessing for swelling in the extremities. Kidney impairment can cause fluid buildup in the blood if kidneys are not filtering and regulating fluid, electrolytes, and protein correctly. Swelling in extremities can lead to circulatory problems such as blood clots. Monitor for cardiac arrhythmia. Monitoring for arrhythmias is a solution the nurse would generate. Impaired Kidney Function results in serum electrolyte imbalances including alterations in potassium, which may cause dangerous cardiac arrhythmias.

Question 29

Which cues support the hypothesis of Urinary Retention?

Answer 29

Bladder palpable after voiding A palpable bladder after voiding suggests inadequate emptying of the bladder and supports the hypothesis of Urinary Retention. Correct Urinary frequency Urinary frequency supports the hypothesis of Urinary Retention because a continually near-full bladder frequently stimulates the urge to void. Diagnosis of prostate enlargement Prostate enlargement may cause urinary retention because of the obstruction of the ureter by the enlarged prostate. This cue supports the hypothesis of Urinary Retention.

Question 30

During assessment of a pregnant patient, the nurse recognizes the cues of urinary frequency and small volume urine leakage as supportive of the hypothesis of Urinary Incontinence. Knowledge of which physiologic process provides the rationale for this hypothesis?

Answer 30

A hormone causes relaxation of urethral sphincters. The nurse knows that the hormone relaxin is released during pregnancy to allow for pelvic joint relaxation, which facilitates the passage of the baby at birth. This same hormone causes the relaxation of the urethral sphincters, contributing to Urinary Incontinence.

Question 31

A patient involved in a motor vehicle accident is transferred to your facility. Multiple patient problem hypotheses are generated. Which hypothesis is the highest priority?

Answer 31

Impaired Airway Clearance Hypotheses about life-threatening issues such as alterations in airway, breathing, and/or circulation always have top priority. Impaired Airway Clearance is a life-threatening alteration in breathing.

Question 32

Match the solution to the expected patient outcome.

Answer 32

Fewer urine leakage episodes within 48 hours -Incontinence trigger education Decreased residual urine volume after void within one day -Bladder emptying technique education No urinary tract infections (UTIs) one month from hospital discharge -Education about UTI prevention No perineal redness two weeks from hospital discharge -Skin care barrier cream use training

Question 33

Place the anatomic structures in the order through which urine passes as it moves from the kidneys to the exterior of the body.

Answer 33

``` Renal pelvis Ureter Bladder Internal urethral sphincter External urethral sphincter Urinary meatus ``` As urine flows from the kidney to the exterior of the body, it passes through the renal pelvis of the kidney and down the ureter to be stored in the bladder. It exits the bladder by way of the internal urethral sphincter at the neck of the bladder, travels through the urethra (which passes through the prostate [in males] and pelvic floor muscles [in males and females]), goes through the external urethral sphincter, and exits the body from the urinary meatus at the distal end of the ureter.

Question 34

A patient newly diagnosed with kidney disease is learning about basic kidney functions during a patient education session. Which statements would the nurse include?

Answer 34

The kidneys regulate electrolytes and fluid in the blood. Electrolyte and fluid regulation are primary functions of the kidneys. This happens through filtration, reabsorption, and secretion. The kidneys help maintain the body’s red blood cell count. Erythropoietin is a hormone produced by the kidneys that is necessary for formation of red blood cells. Correct The kidneys help regulate blood pH. The kidneys regulate acid-base balance of the body (pH balance) by reabsorption of bicarbonate (buffer) and excretion of hydrogen ions (acid).

Question 35

The nurse recognizes which findings as normal in a urine specimen from a healthy adult?

Answer 35

Creatinine Some creatinine is expected in normal urine from a healthy adult. Creatinine is a nitrogenous waste filtered and excreted by the kidneys. Correct Electrolytes Some electrolytes are expected in normal urine. Kidneys regulate and excrete electrolytes such as sodium and potassium to maintain homeostasis in the body. Ammonia Some ammonia is expected in normal urine from a healthy adult. Ammonia is a nitrogenous waste filtered and excreted by the kidneys. Urea Some urea is expected in normal urine from a healthy adult. Urea is a nitrogenous waste filtered and excreted by the kidneys.

Question 36

Which process is directly affected by nephron damage?

Answer 36

Regulation of blood components Nephrons filter and regulate circulating blood, flushing undesirable components out of the body in urine. Nephron damage will affect the regulation of blood components.

Question 37

Urinary continence depends on adequate muscle tone of which structures?

Answer 37

Bladder Urinary continence depends on the muscle tone of the urinary bladder, both urethral sphincters, and the pelvic floor. Urethral sphincters Urinary continence depends on the muscle tone of the urinary bladder, both urethral sphincters, and the pelvic floor. Correct Pelvic floor Urinary continence depends on the muscle tone of the urinary bladder, both urethral sphincters, and the pelvic floor.

Question 38

The nurse is caring for a patient who has developed urinary retention. While reviewing the patient’s medications, the nurse recognizes which medication type as known to contribute to the risk of developing urinary retention?

Answer 38

Drugs that act on the autonomic nervous system Drugs that act on the autonomic nervous system may cause urinary retention because they interfere with neurologic signaling such as sphincter and detrusor muscle function. These types of drugs are sometimes prescribed to treat urinary incontinence.

Question 39

Which alterations in urinary function are typical with certain surgical and diagnostic procedures?

Answer 39

Temporary urine retention with anesthesia Anesthesia effects can dull awareness of the need to urinate, causing urinary retention. Changes in urine color with procedures causing bleeding If the procedure involving the urinary tract causes bleeding, it is often noticed as pink or red urine. Urinary retention with procedures causing urethral swelling Tissue damage of or near a ureter during a procedure can cause swelling, which may obstruct the ureter, causing urine retention.