Urinary Elimination

Question 1

A person’s _ depend on social culture, personal habits, and physical abilities. In North America, most people are accustomed to privacy and clean (even decorative) surroundings while they urinate.

Answer 1

urinary habits

Question 2

Each nephron has a _, a tuft of capillaries surrounded by Bowman’s capsule.

Answer 2

glomerulus

Question 3

At the junction between the ureter and the bladder, a flaplike fold of mucous membrane acts as a valve to prevent _ (backflow) of urine up the ureters.

Answer 3

reflux

Question 4

The _ (vesicle) is a hollow, muscular organ that serves as a reservoir for urine and as the organ of excretion.

Answer 4

urinary bladder

Question 5

The smooth muscle layers are collectively called the _. The _ allows the bladder to expand as it fills with urine, and to contract to release urine to the outside of the body during voiding.

Answer 5

detrusor muscle

Question 6

The _ at the base of the bladder is a triangular area marked by the ureter openings at the posterior corners and the opening of the urethra at the anterior inferior corner.

Answer 6

trigone

Question 7

The _ extends from the bladder to the urinary meatus (opening).

Answer 7

urethra

Question 8

The vagina, urethra, and rectum pass through the _, which consists of sheets of muscles and ligaments that provide support to the viscera of the pelvis.

Answer 8

pelvic floor

Question 9

_, _, and _ all refer to the process of emptying the urinary bladder.

Answer 9

Micturition, voiding, and urination

Question 10

Urination occurs when the adult bladder contains between _ and _ mL of urine. In children, a considerably smaller volume, _ to _ mL, stimulates these nerves.

Answer 10

250 and 450

50 to 200 mL

Question 11

Factors Affecting Voiding

Answer 11

Developmental Factors
Psychosocial Factors
Fluid and Food Intake
Medications
Muscle Tone
Pathologic Conditions
Surgical and Diagnostic Procedures

Question 12

_, which is defined as the involuntary passing of urine when control should be established (about 5 years of age), can be a problem for some school-age children.

Answer 12

Enuresis

Question 13

_, or bed-wetting, is the involuntary passing of urine during sleep.

Answer 13

Nocturnal enuresis

Question 14

This explains the need for older adults to arise during the night to void (_) and the retention of residual urine, predisposing the older adult to bladder infections.

Answer 14

nocturnal frequency

Question 15

_ (e.g., chlorothiazide and furosemide) increase urine formation by preventing the reabsorption of water and electrolytes from the tubules of the kidney into the bloodstream.

Answer 15

Diuretics

Question 16

_ (or _) refers to the production of abnormally large amounts of urine by the kidneys, often several liters more than the client’s usual daily output.

Answer 16

Polyuria (or diuresis)

Question 17

Polyuria can follow excessive fluid intake, a condition known as _, or may be associated with diseases such as diabetes mellitus, diabetes insipidus, and chronic nephritis.

Answer 17

polydipsia

Question 18

The terms _ and _ are used to describe decreased urinary output.

Answer 18

oliguria and anuria

Question 19

_ is low urine output, usually less than 500 mL a day or 30 mL an hour for an adult.

Answer 19

Oliguria

Question 20

_ refers to a lack of urine production.

Answer 20

Anuria

Question 21

This filtering is done through the use of _, a technique by which fluids and molecules pass through a semipermeable membrane according to the rules of osmosis.

Answer 21

renal dialysis

Question 22

_ is voiding at frequent intervals, that is, more than four to six times per day

Answer 22

Urinary frequency

Question 23

_ is voiding two or more times at night.

Answer 23

Nocturia

Question 24

_ is the sudden, strong desire to void.

Answer 24

Urgency

Question 25

_ means voiding that is either painful or difficult.

Answer 25

Dysuria

Question 26

Often, _ (a delay and difficulty in initiating voiding) is associated with dysuria.

Answer 26

urinary hesitancy

Question 27

_ is involuntary urination in children beyond the age when voluntary bladder control is normally acquired, usually 4 or 5 years of age.

Answer 27

Enuresis

Question 28

_, or involuntary leakage of urine or loss of bladder control, is a health symptom, not a disease. It is only normal in infants.

Answer 28

Urinary incontinence (UI)

Question 29

_ occurs because of weak pelvic floor muscles and/or urethral hypermobility, causing urine leakage with such activities as laughing, coughing, sneezing, or any body movement that puts pressure on the bladder.

Answer 29

Stress urinary incontinence (SUI)

Question 30

This type of incontinence is described as an urgent need to void and the inability to stop micturition (passage of urine)

Answer 30

Urge Urinary Incontinence

Question 31

_ is diagnosed when symptoms of both stress UI and urgency UI are present.

Answer 31

Mixed incontinence

Question 32

This is “continuous involuntary leakage or dribbling of urine that occurs with incomplete bladder emptying” (Scemons, 2013, p. 55).

Answer 32

Overflow Incontinence

Question 33

An impaired neurologic function can interfere with the normal mechanisms of urine elimination, resulting in a _.

Answer 33

neurogenic bladder

Question 34

When emptying of the bladder is impaired, urine accumulates and the bladder becomes overdistended, a condition known as _.

Answer 34

urinary retention

Question 35

Urea, the end product of protein metabolism, is measured as _.

Answer 35

blood urea nitrogen (BUN)

Question 36

The _ uses 24-hour urine and serum creatinine levels to determine the glomerular filtration rate, a sensitive indicator of renal function.

Answer 36

creatinine clearance test

Question 37

_, which requires that the client postpone voiding, resist or inhibit the sensation of urgency, and void according to a timetable rather than according to the urge to void.

Answer 37

Bladder retraining

Question 38

_, also referred to as scheduled toileting, attempts to keep clients dry by having them void at regular intervals, such as every 2 to 4 hours.

Answer 38

Habit training

Question 39

Clients who have a flaccid bladder (weak, soft, and lax bladder muscles) may use manual pressure on the bladder to promote bladder emptying. This is known as _ or _.

Answer 39

Credé’s maneuver
Credé’s method

Question 40

A _ is a “urinary tract infection that occurs while an indwelling catheter is in place or within 48 hours of its removal” (Seckel, 2013, p. 63)

Answer 40

catheter- associated urinary tract infection (CAUTI)

Question 41

An _ is a flushing or washing-out with a specified solution.

Answer 41

irrigation

Question 42

A _ is inserted surgically through the abdominal wall above the symphysis pubis into the urinary bladder.

Answer 42

suprapubic catheter

Question 43

A_ is when one or both of the ureters may be brought directly to the side of the abdomen to form small stomas.

Answer 43

ureterostomy

Question 44

A _ may be formed when the bladder is left intact but voiding through the urethra is not possible (e.g., due to an obstruction or a neurogenic bladder).

Answer 44

vesicostomy

Question 45

A _ diverts urine from the kidney via a catheter inserted into the renal pelvis to a nephrostomy tube and bag

Answer 45

nephrostomy

Question 46

The most common incontinent urinary diversion is the _ or _.

Answer 46

ileal conduit
ileal loop

Question 47

The nurse recognizes that urinary elimination changes may occur even in healthy older adults because of which of the following?
1. The bladder distends and its capacity increases.
2. Older adults ignore the need to void.
3. Urine becomes more concentrated.
4. The amount of urine retained after voiding increases.

Answer 47

Answer: 4. Rationale: The capacity of the bladder may decrease with age but the muscle is weaker and can cause urine to be retained (option 4). Older adults do not ignore the urge to void and may have difficulty in getting to the toilet in time (option 2). The kidney becomes less able to concentrate urine with age (option 3). Cognitive Level: Remembering. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 48-2.

Question 48

During assessment of the client with urinary incontinence, the nurse is most likely to assess for which of the following? Select all that apply.
1. Perineal skin irritation
2. Fluid intake of less than 1,500 mL/day
3. History of antihistamine intake 4. History of frequent urinary tract infections
5. A fecal impaction

Answer 48

Answer: 1, 2, 4, and 5. Rationale: The perineum may become irritated by the frequent contact with urine (option 1). Normal fluid intake is at least 1,500 mL/day and clients often decrease their intake to try to minimize urine leakage (option 2). UTIs can contribute to incontinence (option 4). A fecal impaction can compress the urethra, which can result in small amounts of urine leakage (option 5). Antihistamines can cause urinary retention rather than incontinence (option 3).

Question 49

Which action represents the appropriate nursing management of a client wearing a condom catheter
1. Ensure that the tip of the penis fits snugly against the end of the condom.
2. Check the penis for adequate circulation 30 minutes after applying.
3. Change the condom every 8 hours.
4. Tape the collecting tubing to the lower abdomen.

Answer 49

Answer: 2. Rationale: The penis and condom should be checked one-half hour after application to ensure that it is not too tight. A 1-in. space should be left between the penis and the end of the condom (option 1). The condom is changed every 24 hours (option 3), and the tubing is taped to the leg or attached to a leg bag (option 4). An indwelling catheter is secured to the lower abdomen or upper thigh. Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation. Learning Outcome: 48-10a.

Question 50

The catheter slips into the vagina during a straight catheterization of a female client. The nurse does which action?
1. Leaves the catheter in place and gets a new sterile catheter.
2. Leaves the catheter in place and asks another nurse to attempt the procedure.
3. Removes the catheter and redirects it to the urinary meatus.
4. Removes the catheter, wipes it with a sterile gauze, and redirects it to the urinary meatus.

Answer 50

Answer: 1. Rationale: The catheter in the vagina is contaminated and cannot be reused. If left in place, it may help avoid mistaking the vaginal opening for the urinary meatus. A single failure to catheterize the meatus does not indicate that another nurse is needed although sometimes a second nurse can assist in visualizing the meatus (option 2). Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation. Learning Outcome: 48-10b.

Question 51

Which statement indicates a need for further teaching of the home care client with a long-term indwelling catheter?
1. “I will keep the collecting bag below the level of the bladder at all times.” 2. “Intake of cranberry juice may help decrease the risk of infection.” 3. “Soaking in a warm tub bath may ease the irritation associated with the catheter.”
4. “I should use clean technique when emptying the collecting bag.”

Answer 51

Answer: 3. Rationale: Soaking in a bathtub can increase the risk of exposure to bacteria. The bag should be below the level of the bladder to promote proper drainage (option 1). Intake of cranberry juice creates an environment that inhibits infection (option 2). Clean technique is appropriate for touching the exterior portions of the system (option 4). Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Evaluation. Learning Outcome: 48-7.

Question 52

During shift report, the nurse learns that an older female client is unable to maintain continence after she senses the urge to void and becomes incontinent on the way to the bathroom. Which nursing diagnosis is most appropriate?
1. Stress Urinary Incontinence
2. Reflex Urinary Incontinence
3. Functional Urinary Incontinence
4. Urge Urinary Incontinence

Answer 52

Answer: 4. Rationale: The key phrase is “the urge to void.” Option 1 occurs when the client coughs, sneezes, or jars the body, resulting in accidental loss of urine. Option 2 occurs with involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached. Option 3 is involuntary loss of urine related to impaired function. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Diagnosis. Learning Outcome: 48-6.

Question 53

A female client has a urinary tract infection (UTI). Which teaching points by the nurse would be helpful to the client? Select all that apply.
1. Limit fluids to avoid the burning sensation on urination.
2. Review symptoms of UTI with the client.
3. Wipe the perineal area from back to front.
4. Wear cotton underclothes.
5. Take baths rather than showers.

Answer 53

Answer: 2 and 4. Rationale: Option 2 validates the diagnosis. Cotton underwear promotes appropriate exposure to air, resulting in decreased bacterial growth (option 4). Increased fluids decrease concentration and irritation (option 1). The client should wipe the perineal area from front to back to prevent spread of bacteria from the rectal area to the urethra (option 3). Showers reduce exposure of area to bacteria (option 5). Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 48-7.

Question 54

The nurse will need to assess the client’s performance of clean intermittent self-catheterization (CISC) for a client with which urinary diversion?
1. Ileal conduit
2. Kock pouch
3. Neobladder
4. Vesicostomy

Answer 54

Answer: 2. Rationale: The ileal conduit and vesicostomy (options 1 and 4) are incontinent urinary diversions, and clients are required to use an external ostomy appliance to contain the urine. Clients with a neobladder can control their voiding (option 3). Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Assessment. Learning Outcome: 48-9.

Question 55

Which focus is the nurse most likely to teach for a client with a flaccid bladder?
1. Habit training: Attempt voiding at specific time periods.
2. Bladder training: Delay voiding according to a preschedule timetable.
3. Credé’s maneuver: Apply gentle manual pressure to the lower abdomen.
4. Kegel exercises: Contract the pelvic muscles.

Answer 55

Answer: 3. Rationale: Because the bladder muscles will not contract to increase the intrabladder pressure to promote urination, the process is initiated manually. Options 1, 2, and 4: To promote continence, bladder contractions are required for habit training, bladder training, and increasing the tone of the pelvic muscles. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 48-9.

Question 56

Which of the following behaviors indicates that the client on a bladder training program has met the expected outcomes? Select all that apply.
1. Voids each time there is an urge.
2. Practices slow, deep breathing until the urge decreases.
3. Uses adult diapers, for “just in case.” 4. Drinks citrus juices and carbonated beverages.
5. Performs pelvic muscle exercises.

Answer 56

Answer: 2 and 5. Rationale: It is important for the client to inhibit the urge-to-void sensation when a premature urge is experienced. Some clients may need diapers; this is not the BEST indicator of a successful program (option 3). Citrus juices may irritate the bladder (option 4). Carbonated beverages increase diuresis and the risk of incontinence (option 4). Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Evaluation. Learning Outcome: 48-6.