Urinary Elimination Flashcards
A new graduate nurse and their preceptor must collect several urine specimens for laboratory testing. Which techniques for urine collection by the graduate nurse are performed incorrectly, requiring the preceptor to intervene? Select all that apply.
a. Catheterizing a patient to collect a sterile urine sample for routine urinalysis
b. Collecting a clean-catch urine specimen in the morning and storing it at room temperature until an afternoon pick-up
c. Collecting a sterile urine specimen from the collection bag of a patient’s indwelling catheter
d. Collecting about 3 mL of urine from a patient’s indwelling catheter to send for a urine culture
e. Planning to collect a sterile specimen from a patient with a urinary diversion by catheterizing the stoma
f. Discarding the first urine of the day when performing a 24-hour urine specimen collection on a patient
a, b, c
A urine culture requires about 3 mL of urine, whereas routine urinalysis requires at least 10 mL of urine. The preferred method of collecting a sterile urine specimen from a urinary diversion is to catheterize the stoma. For a 24-hour urine specimen, the nurse should discard the first voiding, then collect all urine voided for the next 24 hours. A sterile urine specimen is not required for a routine urinalysis. Urine chemistry is altered after urine stands at room temperature for a long period of time. A specimen from the collection drainage bag may not be fresh urine and could result in an inaccurate analysis.
A nurse caring for older adults in an extended-care facility performs regular assessments of the patients’ urinary functioning. Which patients would the nurse identify as at risk for urinary retention? Select all that apply.
a. Patient who is diagnosed with an enlarged prostate
b. Patient who is on bedrest
c. Patient who is diagnosed with vaginal prolapse
d. Older adult patient with dementia
e. Patient who is taking antihistamines to treat allergies
f. Patient who has difficulty walking to the bathroom
a, c, e
Urinary retention occurs when urine is produced normally but is not excreted completely from the bladder. Factors associated with urinary retention include medications such as antihistamines, an enlarged prostate, or vaginal prolapse. Being on bedrest, having dementia, and having difficulty walking to the bathroom may place patients at risk for urinary incontinence.
A nurse in the gynecology clinic is preparing an educational brochure to teach patients how to prevent UTIs. Which teaching points would the nurse include? Select all that apply.
a. Wear underwear with a cotton crotch.
b. Take baths rather than showers.
c. Drink of six to eight 8-oz glasses of liquid per day.
d. Urinate before and after intercourse.
e. After defecation, dry the perineal area from the front to the back.
f. Observe the urine for color, amount, odor, and frequency.
a, c, e, f
It is recommended that a healthy adult drink six to eight 8-oz glasses of fluid daily, dry the perineal area after urination or defecation from the front to the back, and observe the urine for color, amount, odor, and frequency. It is also recommended to wear underwear with a cotton crotch, take showers rather than baths, and drink two glasses of water before and after sexual intercourse and void immediately after intercourse. Observing urine characteristics will not prevent a UTI; however, this observation may help a patient notice an infection.
A patient who has pneumonia has had a fever for 3 days. What characteristics would the nurse anticipate related to the patient’s urine output?
a. Decreased amount and highly concentrated
b. Decreased amount and very pale like water
c. Increased amount and very concentrated
d. Increased amount and dilute appearing
a
Fever and diaphoresis cause the kidneys to conserve body fluids. Thus, the urine is concentrated and decreased in amount.
The health care provider has ordered an indwelling catheter to be inserted to relieve urinary retention in a male patient with prostate enlargement. What consideration will the nurse keep in mind when performing this procedure?
a. The male urethra is more vulnerable to injury during insertion.
b. In the hospital, a clean technique is used for catheter insertion.
c. The catheter is inserted 2 to 3 inches into the meatus.
d. Since it uses a closed system, the risk for UTI is absent.
a
Because of the length of the male urethra and need to insert the catheter 6 to 8 inches, it is more prone to injury. The nurse inserts the catheter for a female patient 2 to 3 inches. This procedure requires surgical asepsis to prevent introducing bacteria into the urinary tract. The presence of an indwelling catheter places the patient at risk for a UTI.
A nurse is caring for a patient with an enlarged prostate who has had an indwelling catheter for several weeks. A prescription for continuous bladder irrigation (CBI) is written after the patient developed hematuria post cystoscopy. The nurse teaches the patient the purpose of CBI is to prevent what situation?
a. Catheter infection due to long-term use
b. Need to flush the catheter of organisms post procedure
c. Blood clots that could block the catheter
d. Need for increased fluid intake
c
Post procedure continuous bladder irrigation, in the presence of hematuria, prevents stasis of blood and clot formation potentially obstructing urine output. In the absence of hematuria, clots or debris, natural irrigation of the catheter through increased fluid intake by the patient is preferred. It is preferable to avoid catheter irrigation unless necessary to relieve or prevent obstruction (Gould et al., 2009; SUNA, 2015).
A nurse is caring for a patient who has a urinary diversion (urostomy) after cystectomy (removal of the bladder) to treat bladder cancer. What interventions are indicated for this patient? Select all that apply.
a. Measuring the patient’s fluid intake and output
b. Keeping the skin around the stoma moist
c. Emptying the appliance frequently
d. Reporting any mucus in the urine to the primary care provider
e. Encouraging the patient to look away when changing the appliance
f. Monitoring the return of intestinal function and peristalsis
a, c, f
Urinary diversion involves the surgical creation of an alternate route for excretion of urine. When caring for a patient with a urinary diversion, the nurse should measure the patient’s fluid intake and output to monitor fluid balance, change the appliance frequently, monitor the return of intestinal function and peristalsis, keep the skin around the stoma dry, watch for mucus in the urine as a normal finding, and encourage the patient to participate in care and look at the stoma.
A nurse is changing the stoma appliance on a patient’s ileal conduit. Which finding requires the nurse to follow up with the provider?
a. Stoma is moist.
b. Skin around the stoma is irritated.
c. Urine is leaking from the stoma.
d. Stoma is a purple-black color.
d
The stoma should appear pink to red, shiny, and moist; a dark brown or purple-blue stoma may reflect compromised circulation. The nurse contacts the health care provider immediately. A urostomy is incontinent; urine leakage is expected.
A postoperative patient is having difficulty voiding and reports suprapubic pressure. What action can the nurse take to promote voiding?
a. Pouring cold water over the patient’s fingers and perineum
b. Assist the patient to void as soon as they feel the urge.
c. Assessing bladder residual using the bladder scanner
d. Recommending an indwelling catheter
b
Factors associated with urinary retention include medications, an enlarged prostate, and vaginal prolapse. Assist the patient to void when the patient first feels the urge. Assessing for residual urine will not promote voiding; rather, it will determine the volume of urine in the bladder. Cold water would cause the patient to tighten their muscles.
A nurse caring for a patient who just began hemodialysis assesses the patient’s AV fistula. Nursing documentation includes: “5/10/25 0930 AV fistula in the right forearm negative for thrill and bruit. Patient denies pain and tenderness.” Which finding is essential for the nurse report to the health care provider?
a. Thrill and bruit are absent.
b. Area is without redness or swelling.
c. Patient denies pain and tenderness.
d. Trace edema of the fingers is present.
a
The nurse palpates and auscultates over the access site, feeling for a thrill or vibration and listening for the bruit or swishing sound. Presence of the thrill and bruit are normal findings, indicating patency of the access. Decreased or absent thrill and/or bruit indicates a that there is an issue with the patency of the access, which could be a result of narrowing or clotting of the access, resulting in poor blood flow. No report of pain, redness, or swelling is a normal finding. A trace of edema is not a priority.
A nurse is caring for an alert, ambulatory, older adult with urinary frequency who has difficulty making it to the bathroom in time. Which nursing intervention is most appropriate to include in the care plan for this patient?
a. Explaining that incontinence is an expected occurrence with aging
b. Asking the patient’s family/caregivers to purchase incontinence pads for the patient
c. Teaching the patient how to perform PFMT exercises at regular intervals
d. Inserting an indwelling catheter to prevent skin breakdown
c
Pelvic floor exercises (Kegel exercises) may help a patient regain control of the micturition. Incontinence is not a normal consequence of aging. Using absorbent products may remove motivation from the patient and caregiver to seek evaluation and treatment of the incontinence; they should be used only after careful evaluation by a health care provider. Due to risk for infection, an indwelling catheter is the last choice of treatment.
A nurse is caring for a patient who is taking phenazopyridine (a urinary tract analgesic) for a UTI. The patient states, “My urine was bright orange-red today; I think I’m bleeding. Something is terribly wrong.” How will the nurse best respond?
a. “The medication causes a red-orange tinge to the urine; it is expected.”
b. “I will test your urine for blood.”
c. “This may be the result of an injury to your bladder.”
d. “I’ll hold the medication and let the provider know you are allergic to the drug.”
a
Phenazopyridine, a urinary tract analgesic, can cause orange or orange-red urine; the nurse educates the patient to expect this change.
A nurse is caring for a male patient who had a urinary sheath applied following hip surgery. What nursing interventions are appropriate to include when caring for this patient? Select all that apply.
a. Preventing the tubing from kinking to maintain free urinary drainage
b. Changing the sheath weekly and provide hygiene
c. Fastening the sheath tightly to prevent the possibility of leakage
d. Having the patient maintain bedrest to prevent the sheath from slipping off
e. Leaving 1 to 2 inches (2.5 to 5 cm) beyond the tip of the penis
f. Ensuring the device does not restrict blood flow.
a, e, f
Maintaining free urinary drainage is a nursing priority. Institute measures to prevent the tubing from becoming kinked and urine from backing up in the tubing. The catheter should be allowed to drain freely through tubing that is not kinked. Nursing care of a patient with a urinary sheath includes skin care to prevent excoriation. Remove the condom daily and wash the penis with soap and water, and dry it carefully. Care must be taken to fasten the sheath securely enough to prevent leakage, yet not so tightly as to constrict the blood vessels in the area. The tip of the tubing should extend 1 to 2 inches (2.5 to 5 cm) beyond the tip of the penis to prevent irritation to the sensitive glans area. Confining a patient to bedrest increases the risk for hazards of immobility.
A nurse receives a prescription to catheterize a patient following surgery. What nursing action reflects correct technique?
a. Planning to use different equipment for catheterization of male versus female patients
b. Selecting the smallest appropriate size indwelling urinary catheter
c. Sterilizing the equipment prior to insertion
d. Avoiding filling the balloon with sterile water to prevent pressure on tissues
b
The smallest appropriate indwelling urinary catheter should be selected to aid in prevention of CAUTIs in the adult hospitalized patient (ANA, 2014; SUNA, 2015). The equipment used for catheterization is usually prepackaged in a sterile, disposable tray and is the same for both male and female patients. Most kits already contain a standard-sized catheter. Catheters are graded on the French (F) scale according to lumen size, with 12 to 16Fr gauge commonly used (Bardsley, 2015a; Beauchemin et al., 2018; Newman, 2013). A 14F, 5-mL or 10-mL balloon is usually appropriate, unless ordered otherwise (ANA, 2014).
A nurse in the emergency room is teaching a patient how to collect a midstream urine specimen. What instructions will the nurse give the patient? Select all that apply.
a. Wash your hands with soap and water.
b. Open the container and place the lid face down on the counter.
c. Separate your labia and wipe with the antiseptic towelettes in the kit.
d. Without letting go of the labia, void a small amount into the toilet or collection hat.
e. Lean the collection container against the urinary opening and void into the container.
f. Void an ounce, then remove the container and finish voiding in the toilet.
a, c, d, e
The nurse gives these instructions to collect the midstream/clean-catch urine specimen: Wash your hands with soap and water. Open the collection cup, and place the lid face up; do not touch the inside. Separate the labia and cleanse the urinary opening with soap and water or towelettes included in the kit. Void about 1 oz. (30 mL) into the toilet, then move the collection cup close to the urinary opening and void about 1 oz (no less than 2 teaspoons) into the container. Pass the remainder of the urine into the toilet. Without touching the inside of the lid, close the cup and return it to the nurse.
