Chapter 30. Urinary Elimination My Nursing Test Banks

Chapter 30. Urinary Elimination

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. What is the most significant change in kidney function that occurs with aging?

1)

Decreased glomerular filtration rate

2)

Proliferation of micro blood vessels to renal cortex

3)

Formation of urate crystals

4)

Increased renal mass

ANS: 1

Glomerular filtration rate is the amount of filtrate formed by the kidneys in 1 minute. Renal blood flow progressively decreases with aging primarily because of reduced blood supply through the micro blood vessels of the kidney. A decrease in glomerular filtration is the most important functional deficit caused by aging. Urate crystals are somewhat common in the newborn period. They might indicate that the infant is dehydrated. In older people, they result from too much uric acid in the blood, although this is not related to aging. Renal mass (weight) decreases over time, starting around age 30 to 40.

PTS:1DIFifficultREF:p. 1013

KEY:Nursing process: N/A | Client need: PHSI | Cognitive level: Recall

____ 2. While performing a physical assessment, the student nurse tells her instructor that she cannot palpate her patients bladder. Which statement by the instructor is best? You should:

1)

Try to palpate it again; it takes practice but you will locate it.

2)

Palpate the patients bladder only when it is distended by urine.

3)

Document this abnormal finding on the patients chart.

4)

Immediately notify the nurse assigned to the care of your patient.

ANS: 2

The bladder is not palpable unless it is distended by urine. It is not difficult to palpate the bladder when distended. The nurse should document her finding, but it is not an abnormal finding. It is not necessary to notify the nurse assigned to the patient.

PTS:1DIF:EasyREF:p. 1014

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Application

____ 3. Which urine specific gravity would be expected in a patient admitted with dehydration?

1)

1.002

2)

1.010

3)

1.025

4)

1.030

ANS: 4

Normal urine specific gravity ranges from 1.010 to 1.025. Specific gravity less than 1.010 indicates fluid volume excess, such as when the patient has fluid overload (too much IV fluid) or when the kidneys fail to concentrate urine. Specific gravity greater than 1.025 is a sign of deficient fluid volume that occurs, for example, as a result of blood loss or dehydration.

PTS:1DIF:ModerateREF:p. 1015

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Application

____ 4. Which medication class will the primary care provider most likely prescribe to increase urine output in the patient admitted with congestive heart failure?

1)

Thiazide diuretic

2)

Loop diuretic

3)

MAO inhibitor

4)

Anticholinergic

ANS: 2

A loop diuretic [e.g., Furosemide (Lasix)] increases urine elimination. It works by limiting the reabsorption of water in the renal tubules and is used to reduce congestion in the cardiopulmonary circulation. A thiazide diuretic is used to treat high blood pressure by reducing the amount of sodium and water in the blood vessels. An MAO inhibitor [e.g., phenelzine (Nardil)] is an antidepressant that is used after other medications have proven unsuccessful in lifting symptoms of serious depression. Anticholinergics [e.g., ipratropium (Atrovent)] relax smooth muscle in the airways. Also known as antispasmodics, they reduce airway constriction experienced by those with asthma, for example.

is a cholesterol-lowering drug. Although high cholesterol is a leading factor for heart disease, the medication is used to reduce cholesterol in the bloodnot to promote diuresis to reduce the demand on the heart and backflow into the lungs.

PTS:1DIF:ModerateREF:p. 1016; not stated directly in the text and requires critical thinking

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application

____ 5. The nurse identifies the nursing diagnosis Urinary Incontinence (Total) in an older adult patient admitted after a stroke. Urinary Incontinence places the patient at risk for which complication?

1)

Skin breakdown

2)

Urinary tract infection

3)

Bowel incontinence

4)

Renal calculi

ANS: 1

Urine contains ammonia, which may cause excoriation with prolonged contact with the skin. Bowel incontinence, not urinary incontinence, increases the patients risk for urinary tract infection. Immobility and high consumption of calcium-containing foods increase the risk for renal calculi.

PTS: 1 DIF: Moderate REF: p. 1021

KEY: Nursing process: Planning | Client need: PSI | Cognitive level: Application

____ 6. The nurse is caring for a patient who underwent a bowel resection 2 hours ago. His urine output for the past 2 hours totals 50 mL. Which action should the nurse take?

1)

Do nothing; this is normal postoperative urine output.

2)

Increase the infusion rate of the patients IV fluids.

3)

Notify the provider about the patients oliguria.

4)

Administer the patients routine diuretic dose early.

ANS: 3

50 mL in 2 hours is not normal output. The kidneys typically produce 60 mL of urine per hour. Therefore, the nurse should notify the provider when the patient shows diminished urine output (oliguria). Patients who undergo abdominal surgery commonly require increased infusions of IV fluid during the immediate postoperative period. The nurse cannot provide increased IV fluids without a providers order. The nurse should not administer any medications before the scheduled time without a prescription. The provider may hold the patients scheduled dose of diuretic if he determines that the patient is experiencing deficient fluid volume.

PTS: 1 DIF: Difficult REF: p. 1025

KEY: Nursing process: Interventions | Client need: PSI| Cognitive level: Application

____ 7. The nurse measures the urine output of a patient who requires a bedpan to void. Which action should the nurse take first? Put on gloves and:

1)

Have the patient void directly into the bedpan.

2)

Pour the urine into a graduated container.

3)

Read the volume with the container on a flat surface at eye level.

4)

Observe the color and clarity of the urine in the bedpan.

ANS: 1

First, the nurse should put on gloves and have the patient void directly into the bedpan. Next, she should pour the urine into a graduated container, place the measuring device on a flat surface, and read the amount at eye level. She should observe the urine for color, clarity, and odor. Then, if no specimen is required, she should discard the urine in the toilet and clean the container and bedpan. Finally, she should record the amount of urine voided on the patients intake and output record.

PTS: 1 DIF: Easy REF: p. 1041

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

____ 8. The nurse instructs a woman about providing a clean-catch urine specimen. Which of the following statements indicates that the patient correctly understands the procedure?

1)

I will be sure to urinate into the hat you placed on the toilet seat.

2)

I will wipe my genital area from front to back before I collect the specimen midstream.

3)

I will need to lie still while you put in a urinary catheter to obtain the specimen.

4)

I will collect my urine each time I urinate for the next 24 hours.

ANS: 2

To obtain a clean-catch urine specimen, the nurse should instruct the patient to cleanse the genital area from front to back and collect the specimen midstream. This follows the principle of going from clean to dirty. The nurse should have the ambulatory patient void into a hat (container for collecting the urine of an ambulatory patient) when monitoring urinary output, but not when obtaining a clean-catch urine specimen. A urinary catheter is required for a sterile urine specimen, not a clean-catch specimen. A 24-hour urine collection may be necessary to evaluate some disorders, but a clean-catch specimen is a one-time collection.

PTS: 1 DIF: Moderate REF: pp. 1043-1044

KEY: Nursing process: Evaluation | Client need: SECE | Cognitive level: Analysis

____ 9. What position should the patient assume before the nurse inserts an indwelling urinary catheter?

1)

Modified Trendelenburg

2)

Prone

3)

Dorsal recumbent

4)

Semi-Fowlers

ANS: 3

The nurse should have the patient lie supine with knees flexed, feet flat on the bed (dorsal recumbent position). If the patient is unable to assume this position, the nurse should help the patient to a side-lying position. Modified Trendelenburg position is used for central venous catheter insertion. Prone position is sometimes used to improve oxygenation in patients with adult respiratory distress syndrome. Semi-Fowlers position is used to prevent aspiration in those receiving enteral feedings.

PTS: 1 DIF: Easy REF: p. 1031

KEY: Nursing process: Interventions | Client need: Physiological Integrity | Cognitive level: Application

____ 10. A patient complains that she passes urine whenever she sneezes or coughs. How should the nurse document this complaint in the patients healthcare record?

1)

Transient incontinence

2)

Overflow incontinence

3)

Urge incontinence

4)

Stress incontinence

ANS: 4

Stress incontinence is an involuntary loss of urine that occurs with increased intra-abdominal pressure. Activities that typically produce the symptom include sneezing, coughing, laughing, lifting, and exercise. Transient incontinence is a short-term incontinence that is expected to resolve spontaneously. It is typically caused by urinary tract infection or medications, such as diuretics. Overflow incontinence is the loss of urine when the bladder becomes distended; it is commonly associated with fecal impaction, enlarged prostate, and neurological conditions. Urge incontinence is the involuntary loss of urine associated with a strong urge to void.

PTS:1DIF:ModerateREF:p. 1018

KEY: Nursing process: Diagnosis | Client need: PSI | Cognitive level: Analysis

____ 11. Which outcome is appropriate for the patient who underwent urinary diversion surgery and creation of an ileal conduit for invasive bladder cancer?

1)

Patient will resume his normal urination pattern by (target date).

2)

Patient will perform urostomy self-care by (target date).

3)

Patient will perform self-catheterization by (target date).

4)

Patients urine will remain clear with sufficient volume.

ANS: 2

The most appropriate outcome for this patient is the patient will perform urostomy self-care by a specific date. The patient with an ileal conduit is unable to resume a normal urination pattern; urine, along with mucus, drains continuously from the stoma site, so the urine will not be clear. Also, the phrase sufficient volume is too vague for an outcome statement. The patient with a continent urostomy inserts a catheter into the stoma to drain urine.

PTS:1DIF:ModerateREF:p. 1039

KEY: Nursing process: Planning | Client need: PSI | Cognitive level: Application

____ 12. Which intervention should the nurse take first to promote micturition in a patient who is having difficulty voiding?

1)

Insert an indwelling urinary catheter.

2)

Notify the provider immediately.

3)

Insert an intermittent, straight catheter.

4)

Pour warm water over the patients perineum.

ANS: 4

The nurse should perform independent nursing measures, such as pouring warm water over the patients perineum before notifying the provider. If nursing measures fail, the nurse should notify the provider. The provider may order an indwelling urinary catheter or a straight catheter to relieve the patients urinary retention.

PTS:1DIF:ModerateREF:p. 1028

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Analysis

____ 13. The student nurse asks the provider if she will prescribe an indwelling urinary catheter for a hospitalized patient who is incontinent. The provider explains that catheters should be utilized only when absolutely necessary because:

1)

They are the leading cause of nosocomial infection.

2)

They are too expensive for routine use.

3)

They contain latex, increasing the risk for allergies.

4)

Insertion is painful for most patients.

ANS: 1

Indwelling urinary catheters should not be routinely used for hospitalized patients with incontinence because they are the leading cause of healthcare-acquired infection (nosocomial). The cost of an indwelling urinary catheter should not deter its use if necessary. Latex-free catheters are available for patients with or at risk for latex allergy. Insertion may be somewhat uncomfortable, but it should not be painful.

PTS:1DIF:ModerateREF:p. 1028

KEY: Nursing process: Planning | Client need: PSI | Cognitive level: Application

____ 14. A patient who sustained a spinal cord injury will perform intermittent self-catheterization after discharge. After discharge teaching, which statement by the patient would indicate correct understanding of the procedure?

1)

I will need to replace the catheter weekly.

2)

I can use clean, rather than sterile, technique at home.

3)

I will remember to inflate the catheter balloon after insertion.

4)

I will dispose of the catheter after use and get a new one each time.

ANS: 2

The nurse should inform the patient that clean technique can be used after discharge. The patient should wash his hands before the procedure, then wash the reusable catheter in soap and water, and rinse and store it in a clean, dry place. It is not necessary for the patient to use a new catheter for each catheterization. The patient should use a straight catheter; therefore, a balloon is not inflated after insertion. Straight catheters are removed immediately after use.

PTS: 1 DIF: Moderate REF: p. 1029

KEY: Nursing process: Evaluation | Client need: PSI | Cognitive level: Application

____ 15. The nurse notes that a patients indwelling urinary catheter tubing contains sediment and crusting at the meatus. Which action should the nurse take?

1)

Notify the provider immediately.

2)

Flush the catheter tubing with saline solution.

3)

Replace the indwelling urinary catheter.

4)

Encourage fluids that increase urine acidity.

ANS: 3

The catheter needs to be changed when sediment collects in the tubing or catheter and crusting at the meatus occurs. It is not necessary to notify the provider immediately. The nurse should not flush the catheter tubing. The patient should be encouraged to consume fluids that increase urine acidity to prevent urinary tract infection; however, it will not help clear the catheter tubing of sediment.

PTS:1DIF:ModerateREF:p. 1031

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

____ 16. The surgeon orders hourly urine output measurement for a patient after abdominal surgery. The patients urine output has been greater than 60 mL/hour for the past 2 hours. Suddenly the patients urine output drops to almost nothing. What should the nurse do first?

1)

Irrigate the catheter with 30 mL of sterile solution.

2)

Replace the patients indwelling urinary catheter.

3)

Infuse 500 mL of normal saline solution IV over 1 hour.

4)

Notify the surgeon immediately.

ANS: 1

If the patients urinary output suddenly ceases, the nurse should irrigate the urinary catheter to assess whether the catheter is blocked. If no blockage is detected, the nurse should notify the surgeon. The surgeon may request that the catheter be changed if irrigation does not help or if the tubing is not kinked. However, the nurse should not change a catheter in the immediate postoperative period without consulting with the surgeon. The surgeon may prescribe an IV fluid bolus if the patient is suspected to have a deficient fluid volume.

PTS:1DIFifficultREF:p. 1058

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Analysis

____ 17. A patient is admitted with high BUN and creatinine levels, low blood pH, and elevated serum potassium level. Based on these laboratory findings the nurse suspects which diagnosis?

1)

Cystitis

2)

Renal calculi

3)

Enuresis

4)

Renal failure

ANS: 4

Elevated BUN, creatinine, and serum potassium levels and low blood pH are signs of renal failure. Cystitis is an infection of the bladder and would not result in abnormal renal function. Renal calculi typically produce blood in the urine but do not lead to marked renal dysfunction and failure. Enuresis is involuntary urination, particularly common in children, and does not produce renal dysfunction. The cause of enuresis is often emotional, developmental, or trauma related.

PTS:1DIFifficultREF:p. 1023

KEY: Nursing process: Diagnosis | Client need: PSI | Cognitive level: Analysis

____ 18. A mother tells the nurse at an annual well-child checkup that her 6-year-old son occasionally wets himself. Which response by the nurse is appropriate?

1)

Explain that occasional wetting is normal in children of this age.

2)

Tell the mother to restrict her childs activities to avoid wetting.

3)

Suggest time out to reinforce the importance of staying dry.

4)

Inform the mother that medication is commonly used to control wetting.

ANS: 1

The nurse should explain that occasional wetting is normal in children during the early school years. The mother should handle the situation calmly and avoid punishing the child. Medications are occasionally prescribed for nocturnal enuresis when the child is older and not sleeping at home, but not for occasional daytime wetting.

PTS:1DIF:ModerateREF:pp. 1038-1039

KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Application

____ 19. Which task can the nurse safely delegate to the nursing assistive personnel?

1)

Palpating the bladder of a patient who is unable to void

2)

Administering a continuous bladder irrigation

3)

Providing indwelling urinary catheter care

4)

Obtaining the patients history and physical assessment

ANS: 3

The nurse can safely delegate indwelling urinary catheter care to nursing assistive personnel who are adequately trained to do so. Palpating the bladder, administering continuous bladder irrigation, and obtaining the patients history and physical assessment involve the critical thinking skills of a professional nurse.

PTS:1DIF:Moderate

REF: p. 1048, 1058; not directly stated in text

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Analysis

____ 20. Which action should the nurse take when beginning bladder training using scheduled voiding?

1)

Offer the patient a bedpan every 2 hours while she is awake.

2)

Increase the voiding interval by 30 to 60 minutes each week.

3)

Frequently ask the patient if she has the urge to void.

4)

Increase the frequency between voiding even if urine leakage occurs.

ANS: 1

The nurse should offer the patient the bedpan or assist the patient to the bathroom every 2 hours while she is awake. You would encourage the patient to get up once during the night to void, but awakening the patient every 2 hours would lead to fatigue. If the patient adheres to the schedule, the voiding interval should be increased by 15 to 30 minutes each week. Simply asking the patient about the urge to void does not help to manage bladder emptying.

PTS:1DIF:ModerateREF:p. 1033

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

____ 21. A patient is prescribed furosemide (Lasix), a loop diuretic, for treatment of congestive heart failure. The patient is at risk for which electrolyte imbalance associated with use of this drug?

1)

Hypocalcemia

2)

Hypokalemia

3)

Hypomagnesemia

4)

Hypophosphatemia

ANS: 2

Furosemide is a loop diuretic, which causes potassium to pass into the urine. This drug increases the risk for hypokalemia (low potassium); it does not cause hypocalcemia (low calcium in the blood), hypomagnesemia (low blood magnesium), or hypophosphatemia (low blood phosphorous).

PTS:1DIF:ModerateREF:p. 1016, not stated directly in the text and requires critical thinking

KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Comprehension

____ 22. Which daily urine output is within normal limits for a newborn weighing 8 pounds?

1)

288 mL

2)

180 mL

3)

36 mL

4)

18 mL

ANS: 2

A newborn weighing 8 pounds (3.6 kg) should produce 15 to 60 mL of urine per kilogram per day. If the newborn produces 50 mL/kg/day and weighs 3.6 kg, he will produce a total of 180 mL in 24 hours. The other options are not within normal limits and require further assessment.

PTS:1DIFifficultREF:p. 1015

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Analysis

____ 23. The nurse is teaching an older female patient how to manage urge incontinence at home. What is the first-line approach to reducing involuntary leakage of urine?

1)

Insertion of a pessary

2)

Intermittent self-catheterization

3)

Bladder training

4)

Anticholinergic medication

ANS: 3

The goal of bladder training is to enable the patient to hold increasingly greater volumes of urine in the bladder and to increase the interval between voiding. This involves patient teaching, scheduled voiding, and self-monitoring using a voiding diary. In addition to teaching the mechanisms of urination, teach distraction and relaxation strategies to help inhibit the urge to void. Other techniques include deep breathing and guided imagery.

A pessary is an incontinence device that is inserted into the vagina to reduce organ prolapse or pressure on the bladder. Clean, intermittent self-catheterization is a good option for managing incontinence that is resistant to conservative measure, such as bladder training, Kegel exercises, lifestyle modification, and medication. Anticholinergic medication can be highly effective for improving urinary incontinence. However, more conservative measures, such as timed voiding and Kegel exercises, are recommended first.

PTS:1DIF:ModerateREF:p. 1033

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

____ 24. What is the best technique for obtaining a sterile urine specimen from an indwelling urinary catheter?

1)

Use antiseptic wipes to cleanse the meatus prior to obtaining the sample.

2)

Briefly disconnect the catheter from the drainage tube to obtain the sample.

3)

Withdraw urine through the port using a needleless access device.

4)

Obtain the urine specimen directly from the collection bag.

ANS: 3

To obtain a specimen from an indwelling catheter, insert the needleless access device with a 20- or 30-mL syringe into the specimen port, and aspirate to withdraw the amount of urine you need. Wiping the meatus with an antiseptic material helps to minimize contamination for a clean-catch voided specimen, not a sample collected from a closed system such as an indwelling catheter system. Never disconnect the catheter from the drainage tube to obtain a sample. Interrupting the system creates a portal of entry for pathogens, thereby increasing the risk of contamination. Do not take the specimen from the collection bag because that urine may be several hours old.

PTS: 1 DIF: Moderate REF: p. 1024

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Which of the following is/are an appropriate goal(s) for a patient with urinary incontinence? Choose all that apply.

1)

Increase the intake of citrus fruits.

2)

Maintain daily oral fluids to 8 to 10 servings per day.

3)

Limit daily caffeine intake to less than 100 mg.

4)

Engage in high-impact, aerobic exercise.

ANS: 2, 3

The nurse should encourage lifestyle changes such as limiting caffeine intake to fewer than 100 mg per day; limiting intake of alcohol, artificial sweeteners, spicy foods, and citrus fruit; and maintaining daily oral fluid intake to 8 to 10 servings per day. High-impact exercise can be associated with stress incontinence for those with weakened pelvic muscles that support the bladder and urethra.

PTS:1DIF:ModerateREF:p. 1033

KEY: Nursing process: Planning | Client need: PSI | Cognitive level: Application

True/False

Indicate whether the statement is true or false.

____ 1. Nurses should obtain information about urinary control from all female patients.

ANS: T

All women, especially older women and those who have experienced childbirth, should be screened for different types of urinary incontinence.

PTS:1DIF:Moderate

REF: p. 1017; implied from the information under Urinary Incontinence

KEY: Nursing process: Assessment | Client need: PSI | Cognitive level: Comprehension

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