Chapter 44: Urinary Elimination Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. An assessment is completed by the nurse and a nursing diagnosis for the oriented adult female client is identified as Stress incontinence related to decreased pelvic muscle tone. An appropriate nursing intervention based on this diagnosis is to:

a.

Apply adult diapers

b.

Catheterize the client

c.

Administer Urecholine

d.

Teach Kegel exercises

ANS: d

d. 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.

a. The client is oriented and therefore could be taught Kegel exercises to improve pelvic floor muscle tone. Applying adult diapers does not improve the clients problem of incontinence and places the client at risk for skin breakdown.

b. Because bladder catheterization carries the risk of 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 nonpharmacologic intervention to reduce the clients stress incontinence.

c. Bethanechol (Urecholine) stimulates the parasympathetic nervous system to promote complete bladder emptying and is used primarily to treat urinary retention and possible overflow incontinence. Nonpharmacologic approaches should be attempted before pharmacological approaches are taken.

REF: Text Reference: p. 1367, Text Reference: p. 1368

2. A client in the hospital has an indwelling urinary catheter, and the nurse is instructing the nursing assistant in the appropriate care to provide. The nurse teaches the assistant to:

a.

Empty the drainage bag at least q8h

b.

Cleanse up the length of the catheter to the perineum

c.

Use clean technique to obtain a specimen for culture and sensitivity

d.

Place the drainage bag on the clients lap while transporting the client to testing

ANS: a

a. The urinary drainage bag should be emptied at least every 8 hours. If large outputs are noted, more frequent emptying will be required.

b. The perineum should be cleansed, and then down the catheter for a length of approximately 10 cm (4 inches).

c. Use sterile technique only to collect specimens from a closed drainage system.

d. 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 clients bladder for transport. It should not be placed on the clients lap.

REF: Text Reference: p. 1361

3. The nurse suspects that the client has a bladder infection based on the client exhibiting an early sign or symptom such as:

a.

Chills

b.

Hematuria

c.

Flank pain

d.

Incontinence

ANS: b

b. Irritation to bladder and urethral mucosa results in blood-tinged urine (hematuria). Hematuria is a sign of a bladder infection.

a. Chills are a more-systemic symptom associated with pyelonephritis.

c. Flank pain is a more-systemic symptom associated with pyelonephritis.

d. Incontinence is not a symptom of a bladder infection.

REF: Text Reference: p. 1328

4. The client has an indwelling catheter. The nurse should obtain a sterile urine specimen by:

a.

Disconnecting the catheter from the drainage tubing

b.

Withdrawing urine from a urinometer

c.

Opening the drainage bag and removing urine

d.

Using a needle to withdraw urine from the catheter port

ANS: d

d. A sterile specimen can be obtained through the special port found on the side of the indwelling catheter. The nurse clamps the tubing below the port, allowing fresh, uncontaminated urine to collect in the tube. After the nurse wipes the port with an antimicrobial swab, a sterile syringe needle is inserted, and at least 3 to 5 ml of urine is withdrawn. With sterile technique, the nurse transfers the urine to a sterile container.

a. The catheter should not be disconnected from the drainage tubing. The system should remain a closed system to prevent infection.

b. A urinometer is a device used to determine the specific gravity of urine. It is not a sterile device and should not be used for obtaining urine for a sterile urine specimen.

c. Urine should not be obtained from a drainage bag for a specimen, as the urine would not be fresh and would be contaminated from microorganisms in the drainage bag.

REF: Text Reference: p. 1335

5. Immediately after an intravenous pyelogram (IVP), the nurse should observe the client for which of the following?

a.

Infection in the urinary bladder

b.

An allergic reaction to the contrast material

c.

Urinary suppression caused by injury to kidney tissues

d.

Incontinence as a result of paralysis of the urinary sphincter

ANS: b

b. After an intravenous pyelogram (IVP), the nurse should encourage fluid intake to dilute and flush dye from the client and observe the client for late symptoms of allergy (rash, etc.).

a. No increased risk of infection of the urinary bladder occurs from an IVP. This would be more likely with an invasive procedure, such as an endoscopy (cystoscopy).

c. An IVP should not injure tissues of the kidney.

d. An IVP does not cause paralysis of the urinary sphincter.

REF: Text Reference: p. 1341

6. A client with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH). The nurse anticipates the client will exhibit:

a.

Hematuria

b.

An increased blood pressure.

c.

Dry mucous membranes

d.

A low serum sodium level

ANS: c

c. Alcohol inhibits the release of antidiuretic hormone (ADH), resulting in increased water loss in urine. The client may show signs of decreased fluid volume (dehydration), including dry mucous membranes.

a. The effects of excessive alcohol intake and reduced ADH will not cause hematuria.

b. Having decreased antidiuretic hormone will lead to increased urine production. The client may exhibit a decreased blood pressure because of decreased fluid volume.

d. Having decreased ADH will lead to increased urine production. The client may exhibit an increased serum sodium level with dehydration.

REF: Text Reference: p. 1327

7. A client is going to have a cystoscopy. Which of the following reflects the correct information that should be taught before the procedure?

a.

Are you allergic to iodine?

b.

There will be no need to have a special consent form.

c.

You will need to have fluids restricted the evening before the cystoscopy.

d.

You will probably be given sedatives before the procedure.

ANS: d

d. Although this procedure may be accomplished by using local anesthesia, it is more commonly performed by using general anesthesia or conscious sedation to avoid unnecessary anxiety and trauma for the client.

a. A cystoscopy involves direct visualization. No contrast dye is used; therefore the nurse does not need to ask if the client is allergic to iodine.

b. A signed consent form is obtained.

c. Fluids are not restricted before or after the procedure. The flushing action helps remove bacteria from the urethra.

REF: Text Reference: p. 1341

8. 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?

a.

Increase fluid intake to 3500 ml

b.

Insert indwelling Foley catheter

c.

Rinse the perineum with warm water

d.

Apply firm pressure over the bladder 

ANS: c

c. The nurse can pour warm water over the clients perineum and create the urge to urinate.

a. 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 clients fluid intake to 3500 ml is excessive.

b. Because bladder catheterization carries the risk of UTI, it should be avoided if possible. The nurse should try other noninvasive measures to promote urination before calling the physician for an order to insert a Foley catheter.

d. 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 clients uterus at this time.

REF: Text Reference: p. 1343

9. The nurse is visiting the client who has a nursing diagnosis of Alteration in urinary elimination, retention. On assessment, the nurse anticipates that this client will exhibit:

a.

Severe flank pain and hematuria

b.

Pain and burning on urination

c.

A loss of the urge to void

d.

A feeling of pressure and voiding of small amounts

ANS: d

d. With urinary retention, urine continues to collect in the bladder, stretching its walls and causing feelings of pressure, discomfort, tenderness over the symphysis pubis, restlessness, and diaphoresis. The sphincter temporarily opens to allow a small volume of urine (25 to 60 ml) to escape, with no real relief of discomfort.

a. Severe flank pain and hematuria are supporting data for an upper UTI (pyelonephritis).

b. Pain and burning on urination are symptoms of a lower UTI (such as a bladder infection).

c. Supportive data for reflex incontinence would include a loss of the urge to void.

REF: Text Reference: p. 1328

10. 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 to obtain a clean-voided urine specimen? 

a.

Apply sterile gloves for the procedure.

b.

Restrict fluids before the specimen collection.

c.

Place the specimen in a clean urinalysis container.

d.

Collect the specimen after the initial stream of urine has passed.

ANS: d

d. To collect a clean-voided specimen, the nurse should collect the specimen (30 to 60 ml) after the initial stream of urine has passed.

a. Nonsterile gloves are adequate.

b. Fluids are encouraged so the client will be more likely to be able to void.

c. The specimen should be collected in a sterile container and then placed into a plastic specimen bag.

REF: Text Reference: p. 1337

11. The nurse is aware that clients with chronic alterations in kidney function have insufficient amounts of:

a.

Vitamin A

b.

Vitamin D

c.

Vitamin E

d.

Vitamin K

ANS: b

b. The kidneys play a role in calcium and phosphate regulation by producing a substance that converts vitamin D into its active form. Clients with chronic alterations in kidney function do not make sufficient amounts of the active vitamin D.

a. Clients with chronic alterations in kidney function do not suffer from an insufficient amount of vitamin A.

c. Clients with chronic alterations in kidney function do not suffer from an insufficient amount of vitamin E.

d. Clients with chronic alterations in kidney function do not suffer from an insufficient amount of vitamin K.

REF: Text Reference: p. 1324

12. In an assessment of a client with reflex incontinence, the nurse expects to find that the client has:

a.

A constant dribbling of urine

b.

An uncontrollable loss of urine when coughing or sneezing

c.

No urge to void and an unawareness of bladder filling

d.

An immediate urge to void but not enough time to reach the bathroom

ANS: c

c. The nurse expects to find the client with reflex incontinence to have no urge to void and an unawareness of bladder filling.

a. A constant dribbling of urine may be seen with overflow incontinence.

b. Stress incontinence occurs when the client is unable to control loss of urine when coughing or sneezing.

d. Functional incontinence is seen when an immediate urge to void is felt, but not enough time to get to the bathroom.

REF: Text Reference: p. 1349

13. In determining the clients urinary status, the nurse anticipates that the urinary output for an average adult should be:

a.

800 to 1000 ml per day

b.

1000 to 1200 ml per day

c.

1500 to 1700 ml per day

d.

2000 to 2300 ml per day

ANS: c

c. Although output does depend on intake, the normal adult urine output is 1500 to 1600 ml/day.

a. This is not the urinary output for an average adult.

b. This is not the urinary output for an average adult.

d. This is not the urinary output for an average adult.

REF: Text Reference: p. 1324

14. A timed urine specimen collection is ordered. The test will need to be restarted if the following occurs:

a.

The client voids in the toilet

b.

The urine specimen is kept cold

c.

The first voided urine is discarded

d.

The preservative is placed in the collection container

ANS: a

a. Missed specimens make the whole collection inaccurate. The test must be restarted.

b. The urine specimen is kept in a collection container, which may contain preservatives, or the urine may be kept in a collection container on ice. The urine specimen being kept cold is not a reason to restart a timed urine collection.

c. This is correct. The timed period begins after the client urinates. The first voided urine is discarded, and then the time for collection begins.

d. The urine specimen is kept in a collection container, which may contain preservatives.

REF: Text Reference: p. 1335

15. The nurse is working with a client who has a urinary diversion. Included in the plan of care for this client is instruction that:

a.

Special clothing will need to be ordered to fit around the diversion

b.

A stomal bag will need to be worn only at night

c.

A reduction in physical activity will be planned

d.

Special skin care is a priority

ANS: d

d. Special skin care is a priority in caring for a client with a urinary diversion. Local irritation and skin breakdown occur when urine comes in contact with the skin for long periods.

a. Special clothing is not necessary for the client with a urinary diversion.

b. The client with a urinary diversion must wear a stomal pouch continuously because no sphincter control exists for regulation of urine flow.

c. No need is found to plan for a reduction in activity.

REF: Text Reference: p. 1329

16. The nursing instructor is evaluating the student during the catheterization of a female client. The instructor determines that the student has implemented appropriate technique when observed:

a.

Keeping both hands sterile throughout the procedure

b.

Reinserting the catheter if it was misplaced initially in the vagina

c.

Inflating the balloon to test it before catheter insertion

d.

Advancing the catheter 7 to 8 inches

ANS: c

c. Before inserting the indwelling catheter, the balloon should be tested by injecting the fluid from the prefilled syringe into the balloon port.

a. The dominant hand is kept sterile throughout the procedure. The nondominant hand is not kept sterile, as it touches the client.

b. If the catheter is misplaced, it should be left in the vagina as a landmark indicating where not to insert, and another sterile catheter should be inserted into the urethra.

d. The catheter should be advanced 2 to 3 inches in the female client.

REF: Text Reference: p. 1353

17. A client is receiving closed catheter irrigation. During the shift, 950 ml of normal saline irrigant is instilled, and a total of 1725 ml is found in the drainage bag. The clients urinary output is calculated by the nurse to be:

a.

775 ml

b.

950 ml

c.

1725 ml

d.

2675 ml

ANS: a

a. The amount of fluid used to irrigate the bladder and catheter should be subtracted from the total output to determine an accurate urinary output. 1725 ml 950 ml = 775 ml.

b. This is not the correct calculation of the clients urinary output.

c. This is not the correct calculation of the clients urinary output.

d. This is not the correct calculation of the clients urinary output.

REF: Text Reference: p. 1365

18. A bladder-retraining program for a client in an extended care facility should include:

a.

Providing negative reinforcement when the client is incontinent

b.

Having the client wear adult diapers as a preventive measure

c.

Putting the client on a q2h toilet schedule during the day

d.

Promoting the intake of caffeine to stimulate voiding

ANS: c

c. A bladder-retraining program includes initiating a toileting schedule on awakening, at least every 2 hours during the day and evening, before getting into bed, and every 4 hours at night.

a. Negative reinforcement should not be used when the client is incontinent. However, positive reinforcement should be provided when continence is maintained.

b. The client should be offered protective undergarments to contain urine and reduce the clients embarrassment (not diapers).

d. Tea, coffee, other caffeine drinks, and alcohol should be minimized.

REF: Text Reference: p. 1368

19. 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 to obtain a urine specimen from the child is to:

a.

Use an indwelling catheter

b.

Offer fluids 30 minutes in advance

c.

Apply pressure over the urinary bladder

d.

Place a diaper on the child and squeeze out the specimen

ANS: b

b. Offering a young child fluids 30 minutes before requesting a specimen may help.

a. Because bladder catheterization carries the risk of UTI, blockage, and trauma to the urethra, it is preferable to rely on other measures for specimen collection.

c. Applying pressure over the urinary bladder of a child with an intact nervous system will not help and may create more stress in the child.

d. Squeezing urine from a childs diaper is not an accurate method of obtaining a urine specimen to determine whether the child has a UTI.

REF: Text Reference: p. 1335

20. A sample is obtained from the client for a routine urinalysis. On reviewing the results of the test, the nurse notes that an expected finding of the urinalysis is:

a.

pH, 8.0

b.

Specific gravity, a.018

c.

Protein amounts to 12 mg per 100 ml

d.

White blood cell count of five to eight per low-power field casts

ANS: b

b. The normal specific gravity of urine is a.01 to a.025.

a. The normal urine pH is d.6 to 8.0, with an average of 6.0.

c. Protein is not normally found in the urine. The normal value for urine protein is none, or up to 8 mg/100ml.

d. The number of WBCs is 0 to 4 per low-power field and casts should be none in a normal urinalysis.

REF: Text Reference: p. 1339

21. The client is experiencing urinary retention, and the physician is contacted. The nurse anticipates that a medication that will be ordered to promote emptying of the bladder is:

a.

Oxybutynin chloride (Ditropan)

b.

Bethanechol (Urecholine)

c.

Propantheline (Pro-banthine)

d.

Nystatin (Mycostatin)

ANS: b

b. Cholinergic drugs, such as bethanechol (Urecholine), increase contraction of the bladder and improve emptying. Bethanechol (Urecholine) stimulates parasympathetic nerves to increase bladder-wall contraction and relax the sphincter.

a. Oxybutynin chloride (Ditropan) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder) and thus reduces incontinence.

c. Propantheline (Pro-banthine) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder), and thus, reduces incontinence.

d. Nystatin (Mycostatin) is an antifungal agent.

REF: Text Reference: p. 1348

22. An order is written for the clients indwelling urinary catheterization to be discontinued. While observing the new staff nurse provide care to this client and implement the prescribers order, the unit manager determines that further instruction is required for the new nurse in catheter removal if he is observed:

a.

Draping the female client between the thighs

b.

Obtaining a specimen before removal

c.

Cutting the catheter to deflate the balloon

d.

Checking the clients output for 24 hours after removal

ANS: c

c. The nurse should not cut the catheter to deflate the balloon. The nurse inserts an empty, sterile syringe into the injection port. The nurse slowly withdraws all of the solution to deflate the balloon totally. The nurse then pulls the catheter out smoothly and slowly.

a. The nurse positions the client in the same position as during catheterization. The nurse places a towel between a female clients thighs or over a male clients thighs.

b. Some institutions recommend collecting a sterile urine specimen before removal of the catheter or sending the catheter tip for culture and sensitivity tests.

d. The nurse assesses the clients urinary function by noting the first voiding after catheter removal and documenting the time and amount of voiding for the next 24 hours.

REF: Text Reference: p. 1361, Text Reference: p. 1365

23. 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 uses appropriate technique when:

a.

Using sterile gloves

b.

Wrapping the adhesive tape securely around the base of the penis

c.

Leaving a 1 to 2 inch space between the tip of the penis and the end of the catheter

d.

Taping the tubing tightly to the thigh and attaching the drainage bag to the bed frame

ANS: c

c. A 1- to 2-inch space should be left between the tip of the penis and the end of the catheter.

a. Nonsterile gloves are worn to apply a condom catheter.

b. Standard adhesive tape should never be used to secure a condom catheter because it does not expand with change in penis size and is painful to remove.

d. The tubing of a condom catheter is not taped tightly to the thigh. The drainage bag is attached to the lower bed frame.

REF: Text Reference: p. 1366

24. Urinary elimination may be altered with different pathophysiologic conditions. For the client with diabetes mellitus, the nurse anticipates that an initial urinary sign or symptom will be:

a.

Urgency

b.

Dysuria

c.

Hematuria

d.

Polyuria

ANS: d

d. An initial urinary symptom of diabetes mellitus is polyuria.

a. Urgency is not a symptom of diabetes mellitus. Urgency may be caused by a full bladder, bladder irritation from infection, incompetent urethral sphincter, or psychological stress.

b. Dysuria is not a symptom of diabetes mellitus. Dysuria may be caused by bladder inflammation, trauma, or inflammation of the urethral sphincter.

c. Hematuria is not a symptom of diabetes mellitus. Hematuria may be a symptom of neoplasms of the bladder or kidney, glomerular disease, infection of the kidney or bladder, trauma to urinary structures, calculi, or bleeding disorders.

REF: Text Reference: p. 1333

Copyright 2005 by Mosby, Inc. All rights reserved.

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