Chapter 46: Urinary

Question 1

A nurse is teaching a patient about the urinary system. In which order will the nurse present the structures, following the flow of urine?

Answer 1

Kidney, ureters, bladder, urethra

Question 2

A nurse is reviewing urinary laboratory results. Which finding will cause the nurse to follow up?

Answer 2

Specific gravity of 1.036

Question 3

A patient is experiencing oliguria. Which action should the nurse perform first?

Answer 3

Assess for bladder distention.

Question 4

A patient requests the nurse’s help to the bedside commode and becomes frustrated when unable to void in front of the nurse. How should the nurse interpret the patient’s inability to void?

Answer 4

The patient can be anxious, making it difficult for abdominal and perineal muscles to relax enough to void

Question 5

The patient is having lower abdominal surgery and the nurse inserts an indwelling catheter. What is the rationale for the nurse’s action?

Answer 5

Anesthetics can decrease bladder contractility and cause urinary retention.

Question 6

The nurse, upon reviewing the history, discovers the patient has dysuria. Which assessment finding is consistent with dysuria?

Answer 6

Burning upon urination

Question 7

An 86-year-old patient is experiencing uncontrollable leakage of urine with a strong desire to void and even leaks on the way to the toilet. Which priority nursing diagnosis will the nurse include in the patient’s plan of care?

Answer 7

Urge urinary incontinence

Question 8

A patient has fallen several times in the past week when attempting to get to the bathroom. The patient gets up 3 or 4 times a night to urinate. Which recommendation by the nurse is most appropriate in correcting this urinary problem?

Answer 8

Limit fluid and caffeine intake before bed.

Question 9

A nurse is caring for a male patient with urinary retention. Which action should the nurse take first?

Answer 9

Assist to a standing position.

Question 10

Upon palpation, the nurse notices that the bladder is firm and distended; the patient expresses an urge to urinate. Which question is most appropriate?

Answer 10

“When was the last time you voided?”

Question 11

A nurse is planning care for a group of patients. Which task will the nurse assign to the nursing assistive personnel?

Answer 11

Obtaining a midstream urine specimen

Question 12

While receiving a shift report on a patient, the nurse is informed that the patient has urinary incontinence. Upon assessment, which finding will the nurse expect?

Answer 12

Reddened irritated skin on buttocks

Question 13

A nurse is inserting a catheter into a female patient. When the nurse inserts the catheter, no urine is obtained. The nurse suspects the catheter is not in the urethra. What should the nurse do?

Answer 13

Leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.

Question 14

A patient asks about treatment for stress urinary incontinence. Which is the nurse’s best response?

Answer 14

Perform pelvic floor exercises.

Question 15

The nurse suspects cystitis related to a lower urinary tract infection. Which clinical manifestation does the nurse expect the patient to report?

Answer 15

Frequency

Question 16

Which assessment question should the nurse ask if stress incontinence is suspected?

Answer 16

“Do you experience urine leakage when you cough or sneeze?”

Question 17

The patient has a catheter that must be irrigated. The nurse is using a needleless closed irrigation technique. In which order will the nurse perform the steps, starting with the first one?

1. Clean injection port.
2. Inject prescribed solution.
3. Twist needleless syringe into port.
4. Remove clamp and allow to drain.
5. Clamp catheter just below specimen port.
6. Draw up prescribed amount of sterile solution ordered.

Answer 17

6, 5, 1, 3, 2, 4

Question 18

To obtain a clean-voided urine specimen from a female patient, what should the nurse teach the patient to do?

Answer 18

Hold the labia apart while voiding into the specimen cup.

Question 19

A nurse is reviewing results from a urine specimen. What will the nurse expect to see in a patient with a urinary tract infection?

Answer 19

Bacteria

Question 20

The patient is taking phenazopyridine. When assessing the urine, what will the nurse expect?

Answer 20

Orange color

Question 21

Which clinical manifestation will the nurse expect to observe in a patient with excessive white blood cells present in the urine?

Answer 21

Fever with chills

Question 22

A patient has severe flank pain. The urinalysis reveals presence of calcium phosphate crystals. The nurse will anticipate an order for which diagnostic test?

Answer 22

Intravenous pyelogram

Question 23

A nurse is caring for a patient who just underwent an intravenous pyelography that revealed a renal calculus obstructing the left ureter. What is the nurse’s first priority in caring for this patient?

Answer 23

Monitor the patient for fever, rash, and difficulty breathing.

Question 24

Which statement by the patient about an upcoming contrast computed tomography (CT) scan indicates a need for further teaching?

Answer 24

“I will be anesthetized so that I lie perfectly still during the procedure.”

Question 25

The nurse is preparing to test a patient for postvoid residual with a bladder scan. Which action will the nurse take?

Answer 25

Measure bladder within 10 minutes after the patient voids.

Question 26

A nurse is watching a nursing assistive personnel (NAP) perform a postvoid bladder scan on a female with a previous hysterectomy. Which action will require the nurse to follow up?

Answer 26

Sets the scanner to female

Question 27

A female patient is having difficulty voiding in a bedpan but states that her bladder feels full. To stimulate micturition, which nursing intervention should the nurse try first?

Answer 27

Utilizing the power of suggestion by turning on the faucet and letting the water run.

Question 28

A nurse is caring for an 8-year-old patient who is embarrassed about urinating in bed at night. Which intervention should the nurse suggest to reduce the frequency of this occurrence?

Answer 28

“Drink your nightly glass of milk earlier in the evening.”

Question 29

A nurse is inserting an indwelling urinary catheter for a male patient. Which action will the nurse take?

Answer 29

Cleanse the meatus with circular strokes beginning at the meatus and working outward.

Question 30

The nurse will anticipate inserting a Coudé catheter for which patient?

Answer 30

A 56-year-old male admitted for bladder irrigation

Question 31

A nurse is evaluating a nursing assistive personnel’s (NAP) care for a patient with an indwelling catheter. Which action by the NAP will cause the nurse to intervene?

Answer 31

Placing the drainage bag on the side rail of the patient’s bed

Question 32

A nurse is caring for a patient with a continent urinary reservoir. Which action will the nurse take?

Answer 32

Teach the patient how to self-cath the pouch.

Question 33

The nurse is preparing to apply an external catheter. Which action will the nurse take?

Answer 33

Allow 1 to 2 inches of space between the tip of the penis and the end of the catheter.

Question 34

A nurse is caring for a hospitalized patient with a urinary catheter. Which nursing action best prevents the patient from acquiring an infection?

Answer 34

Maintaining a closed urinary drainage system

Question 35

A nurse is providing care to a patient with an indwelling catheter. Which practice indicates the nurse is following guidelines for avoiding catheter-associated urinary tract infection (CAUTI)?

Answer 35

Drapes the urinary drainage tubing with no dependent loops

Question 36

A nurse is providing care to a group of patients. Which patient will the nurse see first?

Answer 36

A patient with reflex incontinence with elevated blood pressure and pulse rate

Question 37

To reduce patient discomfort during a closed intermittent catheter irrigation, what should the nurse do?

Answer 37

Use room temperature irrigation solution.

Question 38

Which observation by the nurse best indicates that a continuous bladder irrigation for a patient following genitourinary surgery is effective?

Answer 38

Bright red urine turns pink in the tubing

Question 39

The nurse anticipates a suprapubic catheter for which patient?

Answer 39

A patient with a urethral stricture

Question 40

Which nursing actions will the nurse implement when collecting a urine specimen from a patient? (Select all that apply.)

a. Growing urine cultures for up to 12 hours
b. Labeling all specimens with date, time, and initials
c. Allowing the patient adequate time and privacy to void
d. Wearing gown, gloves, and mask for all specimen handling
e. Transporting specimens to the laboratory in a timely manner
f. Collecting the specimen from the drainage bag of an indwelling catheter

Answer 40

B, C, E

Question 41

The nurse is obtaining a 24-hour urine specimen collection from the patient. Which actions should the nurse take? (Select all that apply.)

a. Keeping the urine collection container on ice when indicated
b. Withholding all patient medications for the day
c. Irrigating the sample as needed with sterile solution
d. Testing the urine sample with a reagent strip by dipping it in the urine
e. Asking the patient to void and discarding that urine to start the collection

Answer 41

A,E

Question 42

Which findings should the nurse follow up on after removal of a catheter from a patient? (Select all that apply.)

a. Increasing fluid intake
b. Dribbling of urine
c. Voiding in small amounts
d. Voiding within 6 hours of catheter removal
e. Burning with the first couple of times voiding

Answer 42

B, C

Question 43

A nurse administers an antimuscarinic to a patient. Which findings indicate the patient is having therapeutic effects from this medication? (Select all that apply.)

a. Decrease in dysuria
b. Decrease in urgency
c. Decrease in frequency
d. Decrease in prostate size
e. Decrease in bladder infection

Answer 43

B,C

Question 44

The nurse is using different toileting schedules. Which principles will the nurse keep in mind when planning care? (Select all that apply.)

a. Habit training uses a bladder diary.
b. Timed voiding is based upon the patient’s urge to void.
c. Prompted voiding includes asking patients if they are wet or dry.
d. Elevation of feet in patients with edema can decrease nighttime voiding.
e. Bladder retraining teaches patients to follow the urge to void as quickly as possible.

Answer 44

A,C