Chapter 36 Urinary Elimination
1.
During a visit to the pediatrician’s office, a parent inquiries about toilet training her daughter age 2 years. The nurse
informs the mother that one factor in determining toilet-training readiness is when …
A)
the child can recognize bladder fullness.
B)
the child can hold the urine for four to five hours.
C)
The child cannot control urination until seated on the toilet.
D)
The child ignores the desire to void.
Ans: A
Feedback:
Toilet training usually begins around ages 2 or 3 years. Toilet training should not begin until the child is able to hold urine
for two hours, recognize the feeling of bladder fullness, communicate the need to void, and control urination until seated on
the toilet.
2.
A client with urine retention related to a complete prostatic obstruction requires a urinary catheter to drain the bladder.
Which type of catheter is most appropriate for a client that has an obstructed urethra?
A)
Suprapubic catheter
B)
Indwelling urethral catheter
C)
Intermittent urethral catheter
D)
Straight catheter
Ans: A
Feedback:
A suprapubic catheter is used for long-term continuous drainage and is inserted through a small incision above the pubic area.
Suprapubic bladder drainage diverts urine from the urethra when injury, stricture, prostatic obstruction, or abdominal surgery
has compromised the flow of urine through the urethra.
3.
A patient has developed edema in her lower legs and feet, prompting her physician to prescribe furosemide (Lasix), a
diuretic medication. After the client has begun this new medication, what should the nurse anticipate?
A)
Increased output of dilute urine
B)
Increased urine concentration
C)
A risk of urinary tract infections
D)
Transient incontinence and increased urine production
Ans: A
Feedback:
Diuretics result in moderate to severe increases in the production of dilute urine. Concentration will decrease, not increase,
and there is no accompanying risk of urinary tract infections. For some clients, this sudden increase in urine output may
precipitate transient incontinence, but this remains an abnormal finding.
4.
A nurse is preparing to catheterize a female client. What will the nurse consider when comparing the anatomy of the
female urethra with that of the male urethra?
A)
Has different innervation
B)
No connection with bladder
C)
Shorter in length
D)
Longer in length
Ans: C
Feedback:
The anatomy of the urethra differs in males and females. The male urethra is about 51/2 to 61/4 inches (13.7 to 16.2 cm) long. The
female urethra is about 11/2 to 21/2 inches (3.7 to 6.2 cm) long. This difference is important in terms of catheterization and risk for
infection.
5.
Which of the following describes the term micturition?
A)
Emptying the bladder
B)
Catheterizing the bladder
C)
Collecting a urine specimen
D)
Experiencing total incontinence
Ans:
A
Feedback:
The process of emptying the bladder is known as urination, micturition, or voiding.
6.
A nurse working in a community pediatric clinic explains the process of toilet training to mothers of toddlers. Which is a
recommended guideline for initiating this training?
A)
The child should be able to hold urine for four hours.
B)
The child should be between 18 and 24 months old.
C)
The child should be able to communicate the need to void.
D)
The child does not need the desire to gain control of voiding.
Ans: C
Feedback:
Voluntary control of the urethral sphincters occurs between 18 and 24 months of age. However, many other factors are
required to achieve conscious control of bladder function, and toilet training usually begins at about 2 to 3 years of age. Toilet
training should not begin until the child is able to hold urine for two hours, recognize the feeling of bladder fullness,
communicate the need to void, and control urination until seated on the toilet. The child’s desire to gain control is also
important.
7.
A nurse is caring for older adult clients in an assisted-living facility. Which effect of aging should the nurse consider
when performing a urinary assessment?
A)
The diminished ability of the kidneys to concentrate urine may result in urinary tract infection.
B)
Increased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in frequency.
C)
Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract
infection.
D)
Neuromuscular problems may result in the client finding urinary control too much trouble, resulting in incontinence.
Ans: C
Feedback:
Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection.
The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night). Decreased
bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination.
Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weakness may interfere with
voluntary control and the ability to reach a toilet in time. Individuals who view themselves as old, powerless, and neglected
may cease to value voluntary control over urination, and simply find toileting too much bother no matter what the setting.
Incontinence may be the result.
8.
A nurse is assessing the urine output of a client with Parkinson’s disease who is on levodopa. Which of the following is
a common finding for a client on this medication?
A)
The urine may be brown or black.
B)
The urine may be blood-tinged.
C)
The urine may be green or blue-green.
D)
The urine may be orange or orange-red.
Ans: A
Feedback:
Levodopa (l-dopa), an antiparkinson drug, and injectable iron compounds can lead to brown or black urine. Anticoagulants
may cause hematuria (blood in the urine), leading to a pink or red color. Diuretics can lighten the color of urine to pale
yellow. Phenazopyridine (Pyridium), a urinary tract analgesic, can cause orange or orange-red urine.
9.
A client tells the nurse, “Every time I sneeze, I wet my pants.” What is this type of involuntary escape of urine called?
A)
Urinary incontinence
B)
Urinary incompetence
C)
Normal micturition
D)
Uncontrolled voiding
Ans: A
Feedback:
The process of emptying the bladder is termed micturition, voiding, or urination. Sometimes increased abdominal pressure,
such as occurs when sneezing or coughing, forces an involuntary escape of urine, especially in women because the urethra is
shorter. Any involuntary loss of urine that causes such a problem is referred to as urinary incontinence.
10.
During a health history interview, a male client tells the nurse that he does not feel that he completely empties his
bladder when he voids. He has been diagnosed with an enlarged prostate. What is the name of this symptom?
A)
Urinary incontinence
B)
Urinary retention
C)
Involuntary voiding
D)
Urinary frequency
Ans: B
Feedback:
Urinary retention occurs when urine is produced normally but is not excreted completely from the bladder. Factors
associated with urinary retention include medications, an enlarged prostate, or vaginal prolapse. Incontinence is
involuntary loss of urine from the bladder. Retention is an accumulation of urine in the bladder. Frequency is voiding more
often than usual.
11.
A nurse is assessing the urine on a newborn’s diaper. What would be a normal assessment finding?
A)
Scanty to no urine
B)
Highly concentrated urine
C)
Light in color and odorless
D)
Dark in color and odorous
Ans: C
Feedback:
Infants are born with little ability to concentrate urine. An infant’s urine is usually very light in color and without odor until
about 6 weeks of age, when the nephrons are able to control reabsorption of fluids and effectively concentrate urine. Infants
do not normally have scanty, highly concentrated, or dark and odorous urine.
12.
An older woman who is a resident of a long-term care facility has to get up and void several times during the night. This
can be the result of what physiologic change with normal aging?
A)
Diminished kidney ability to concentrate urine
B)
Increased bladder muscle tone causing urinary frequency
C)
Increased bladder contractility causing urinary stasis
D)
Decreased intake of fluids during daytime hours
Ans: A
Feedback:
Physiologic changes that accompany normal aging may affect urination in older adults. These changes include the
diminished ability to concentrate urine that may result in nocturia (voiding during the night). Aging does not result in
increased bladder muscle tone or increased bladder contractility. A decrease in fluid intake would not result in nocturia.
13.
After surgery, a postoperative client has not voided for eight hours. Where would the nurse assess the bladder for
distention?
A)
Between the symphysis pubis and the umbilicus
B)
Over the costovertebral region of the flank
C)
In the left lower quadrant of the abdomen
D)
Between ribs 11 and 12 and the umbilicus
Ans: A
Feedback:
When the bladder is distended with urine, it rises above the symphysis pubis and may reach to just below the umbilicus. The
other choices are anatomically incorrect for assessing a distended bladder.
14.
A nurse is delegating the collection of urinary output to an assistant. What should the nurse tell the assistant to do while
measuring the urine?
A)
Compare the amount of output with intake.
B)
Use a clean measuring cup for each voiding.
C)
Tell the client to wash the urethra before voiding.
D)
Wear gloves when handling a client’s urine.
Ans: D
Feedback:
Gloves are required when handling urine to prevent exposure to pathogenic microorganisms or blood that may be
present in the urine. In addition, goggles are also worn if there is a concern of urine splashing.
15.
A nurse has instructed a client at the clinic about collecting a specimen for a routine urinalysis. The client makes the
following statements. Which one indicates a need for more teaching?
A)
“I need to tell you that I am having my menstrual period.”
B)
“I will void into the specimen bottle you gave me.”
C)
“I will keep the toilet paper in the specimen.”
D)
“I will be sure that no stool is included in my urine.”
Ans: C
Feedback:
Urine for a routine urinalysis does not have to be sterile. Ask the client to void into a clean receptacle and avoid
contamination with stool. Note on the request form if a woman is having her menstrual period. Instruct clients not to put toilet
paper into the urine because this makes analysis more difficult.
16.
A student is collecting a sterile urine specimen from an indwelling catheter. How will the student correctly obtain the
specimen?
A)
Pour urine from the collecting bag.
B)
Remove the catheter and ask the client to void.
C)
Aspirate urine from the collecting bag.
D)
Aspirate urine from the collection port.
Ans: D
Feedback:
When it is necessary to collect a urine specimen from a client with an indwelling catheter, it should always be obtained from
the catheter itself using the special collection port.
17.
A nurse is initiating a 24-hour urine collection for a client at home. What will be the first thing the nurse will ask the
client to do at the beginning of the specimen collection?
A)
Void and discard the urine.
B)
Begin the collection at a specific time.
C)
Add the first voiding to the specimen.
D)
Keep the urine warm during collection.
Ans: A
Feedback:
The collection is initiated at a specific time, but the client is asked to void at that time and discard the urine from the first
voiding. In most instances, a preservative is added to the collection bottle, or the collected urine is kept cold through
refrigeration or putting it on ice.
18.
An older adult woman has constant dribbling of urine. The associated discomfort, odor, and embarrassment may support
which of the following nursing diagnoses?
A)
Social Isolation
B)
Impaired Adjustment
C)
Defensive Coping
D)
Impaired Memory
Ans: A
Feedback:
Urinary incontinence is a special problem for older adults who may have decreasing control over micturition, or find it more
difficult to reach the toilet in time. The discomfort, odor, and embarrassment of urine-soaked clothing can greatly diminish a
person’s self-concept, causing him or her to feel like a social outcast.
19.
A male client who has had outpatient surgery is unable to void while lying supine. What can the nurse do to facilitate his
voiding?
A)
Assist him to a standing position.
B)
Tell him he has to void to be discharged.
C)
Pour cold water over his genitalia.
D)
Ask his wife to assist with the urinal.
Ans: A
Feedback:
Helping clients assume their usual voiding positions may be all that is necessary to resolve an inability to void. If male
clients cannot void lying down, encourage them to void while standing at the bedside unless this is contraindicated.
20.
A nurse is educating a client on the amount of water to drink each day. What is the recommended daily fluid intake for
adults?
A)
1 to 2 (4-oz) glasses per day
B)
5 to 6 (6-oz) glasses per day
C)
8 to 10 (8-oz) glasses per day
D)
16 to 20 (12-oz) glasses per day
Ans: C
Feedback:
Adults with no disease-related fluid restrictions should drink 2,000 to 2,400 mL (8 to 10 8-oz glasses) of fluid daily.
Monitor fluid intake for those that are high in caffeine, sodium, and sugar.
21.
A nurse is carrying out an order to remove an indwelling catheter. What is the first step of this skill?
A)
Deflate the balloon by aspirating the fluid.
B)
Ask the client to take several deep breaths.
C)
Tell the client burning may initially occur.
D)
Wash hands and put on gloves.
Ans: D
Feedback:
Although all the steps listed are correct, the first step of any skill involving body fluids is to wash hands and don gloves. A
22.
nurse has catheterized a client to obtain urine for measuring postvoid residual (PVR) amount. The nurse obtains 40
mL of urine. What should the nurse do next?
A)
Report this abnormal finding to the physician.
B)
Perform another catheterization to verify the amount.
C)
Document this normal finding for postvoid residual.
D)
Palpate the abdomen for a distended bladder.
Ans: C
Feedback:
A postvoid residual (PVR) urine measures the amount of urine remaining in the bladder after voiding. It can be measured
by catheterization or a bladder scan. A PVR of less than 50 mL indicates adequate bladder emptying. The nurse would
document this normal finding for PVR.
23.
A nurse is inserting an indwelling urethral catheter. What type of supplies will the nurse need for this procedure?
A)
A clean catheter and rubber gloves
B)
A sterile catheterization kit or tray
C)
Solutions to sterilize the urethra
D)
Solutions to sterilize the vagina
Ans: B
Feedback:
The bladder is a sterile environment. The urethra and vagina cannot be sterilized. The equipment used for catheterization is
usually prepackaged in a sterile disposable kit or tray.
24.
A client has been taught how to do Kegel exercises. What statement by the client indicates a need for further
information?
A)
“I understand these will help me control stress incontinence.”
B)
“I know this is also called pelvic floor muscle training.”
C)
“I will do these 30 to 80 times a day for two months.”
D)
“I will contract the muscles in my abdomen and thighs.”
Ans: D
Feedback:
Kegel exercises, or pelvic floor muscle training, are used to tone and strengthen the muscles that support the bladder. They
can improve voluntary control of urination and thus improve or eliminate stress incontinence. The muscles to contract are
the same ones used to stop urination midstream or control defecation. The client should not contract the muscles of the
abdomen, inner thigh, or buttocks while doing Kegel exercises.
25.
A man with urinary incontinence tells the nurse he wears adult diapers for protection. What risks should the nurse
discuss with this client?
A)
Public embarrassment
B)
Skin breakdown and UTI
C)
Inability to control urine
D)
Odor and leakage
Ans: B
Feedback:
Clients frequently turn to absorbent products for protection when they are incontinent of urine and if they have not had this
condition properly diagnosed and treated. When used improperly, such products may cause skin breakdown and place the
client at risk for a UTI.
26.
A school nurse is educating a class of middle-school girls on how to promote urinary system health. Which of the
following statements by one of the girls indicates a need for more information?
A)
“I will take showers rather than baths.”
B)
“I will wear underpants with cotton crotches.”
C)
“I will tell my parents if I have burning or pain.”
D)
“I will wipe back to front after going to the toilet.”
Ans: D
Feedback:
Teaching about measures to promote urinary system health is a major nursing responsibility. Measures include drying the
perineal area after urination or defecation from the front to the back (or from urethra to rectum).
27.
A client is taking diuretics. What should the nurse teach the client about his urine?
A)
Urinary output will be decreased.
B)
Urinary output will be increased.
C)
Urine will be a pale-yellow color.
D)
Urine may be brown or black.
Ans: C
Feedback:
Certain drugs cause the urine to change color. Diuretics can lighten the color of urine to pale yellow. The nurse should
inform the client about this side effect of the medication.
28.
A nurse is preparing a client for an invasive diagnostic procedure of the urinary system. What statement by the nurse
would help reduce the client’s anxiety?
A)
“We do these procedures every day, so you don’t need to worry.”
B)
“I have had this done to me, and it only hurt for a little while.”
C)
“Why are you so worried? Do you think you have a tumor?”
D)
“Let me explain to you what they do during this procedure.”
Ans: D
Feedback:
Various diagnostic procedures, typically performed in a hospital operating room or outpatient facility, are used to study the
urinary system. Nurses are responsible for preparing the client and giving aftercare. Explaining the procedure helps reduce the
client’s anxiety.
29.
A nurse is caring for a client who is being treated for bladder infection. The client complains to the nurse that he has
been having difficulty voiding and feels uncomfortable. How should the nurse document the client’s condition?
A)
Anuria
B)
Oliguria
C)
Polyuria
D)
Dysuria
Ans: D
Feedback:
The nurse could document the client’s condition as dysuria, which is difficulty or discomfort when voiding. Dysuria is a
common symptom of trauma to the urethra or bladder infection. Anuria means absence of urine or a volume of 100 mL or
less in 24 hours. Oliguria indicates inadequate elimination of urine. Polyuria is the term used to indicate greater than normal
urinary volume, and may accompany minor dietary variations.
30.
A nurse uses a catheter to collect a sterile urine specimen from a client at a health care facility. If a catheter is required
temporarily, which type of catheter should the nurse use?
A)
Condom catheter
B)
Urinary bag
C)
Straight catheter
D)
Retention catheter
Ans: C
Feedback:
The nurse should use a straight catheter to collect a sterile urine specimen from the client. A straight catheter is a urine
drainage tube inserted but not left in place. It drains urine temporarily or provides a sterile urine specimen. Condom
catheters are helpful for clients with urinary incontinence receiving care at home, because they are easy to apply. A urinary
bag is more often used to collect urine specimens from infants. A retention catheter, also called an indwelling catheter, is
left in place for a period of time.
31.
A client with a urinary tract infection is to be discharged from the health care facility. After teaching the client about
measures to prevent urinary tract infections, the nurse determines that the education was successful when the client
states which of the following?
A)
“I should take frequent bubble baths.”
B)
“I need to void after sexual intercourse.”
C)
“I should wipe from back to front after going to the bathroom.”
D)
“I need to wear pants that are snug fitting.”
Ans: B
Feedback:
The client’s statement about voiding after sexual intercourse to prevent urinary tract infection is accurate. Taking frequent
bubble baths, wiping the perineum from back to front, and wearing snug fitting pants increases the risk of urinary tract
infection. The client should avoid taking frequent bubble baths, using harsh soaps, and wearing tight-fitting pants because
they can irritate the urethra. The client also should always wipe from front to back after urinary or fecal elimination.
32.
A client is admitted to the health care facility with complaints of pain on urination that is secondary to a urinary tract
infection (UTI). The nurse documents this finding as which of the following?
A)
Polyuria
B)
Dysuria
C)
Nocturia
D)
Hematuria
Ans: B
Feedback:
Dysuria means painful voiding. Pain is often associated with UTIs and is felt as a burning sensation during urination.
Polyuria is the formation and excretion of excessive amounts of urine in the absence of a concurrent increase in fluid
intake. Voiding during normal sleeping hours is called nocturia. Hematuria refers to blood in the urine.
33.
What is the micturition reflex?
A)
The process of filtration beginning with the glomerulus
B)
The act of bladder contraction and perceived need to void
C)
The reabsorption of the substances the body wants to retain
D)
The secretion of electrolytes that are harmful to the body
Ans: B
Feedback:
Several words are used to describe the process of excreting urine from the body, including urination, voiding, and
micturition.
34.
A nurse is using a bladder scanner to assess the bladder volume of a client with urinary frequency. In which of the
following positions would the nurse place the client?
A)
Supine
B)
Sims’
C)
High Fowler’s
D)
Dorsal recumbent
Ans: A
Feedback:
Portable bladder ultrasound devices are accurate, reliable, and noninvasive devices used to assess bladder volume.
Results are most accurate when the client is in the supine position during the scanning.
35.
The home health nurse is caring for an older adult woman living alone at home who is incontinent of urine and changes
her adult diaper daily. Which of the following nursing diagnoses is the most appropriate for this client?
A)
Risk for activity intolerance
B)
Risk for impaired skin integrity
C)
Risk for infection
D)
Risk for falls
Ans: B
Feedback:
A client who is incontinent, utilizes adult diapers, and only changes them daily is at Risk for Impaired Skin Integrity in the
genital and perineal area.