Urinary Elimination

Question 1

Which component of the urination system would cause peristaltic waves

Answer 1

Ureters

Rationale: uterers drain urine from the kidneys into the bladder. The kidney, bladder, and urethra do not produce peristaltic waves

Question 2

A patient requests the nurse assistance to the bedside commode and becomes frustrated when unable to void in front of the nurse. The nurse understand that patients inability to void because

Answer 2

Anxiety can make it difficult for abdominal and perineal muscles to relax enough to void

Question 3

The nurse knows that in dwelling catheters are placed before a cesarean because

Answer 3

Spinal anesthetics can temporarily disable urethral sphincters

Rationale: spinal anesthetics may cause urinary retention due to the inability to sense or carry out the need to void.

Question 4

The nurse knows that UTI is the most common health care associated infection because

Answer 4

E. coli pathogens are transmitted during surgical of catherization

Rationale: E. coli is the leading pathogen causing UTI; this pathogen enters during procedures. Sterile technique is imperative to prevent the spread of infection

Question 5

A 86 year old patient tells the nurse that she is experiencing uncontrollable leakage of urine. Which nursing diagnosis should the nurse include in the patients plan of care

Answer 5

Urinary incontinence

Rationale: age related changes such as loss of pelvic muscle tone can cause involuntary loss of urine

Question 6

When caring for a patient with urinary retention, the nurse would anticipate an order for

Answer 6

Urinary Catheter

Rationale: a catheter would relieve urinary retention. Reducing fluids would reduce the amount of urine produced but would not alleviate the urine retention

Question 7

Upon palpation, the nurse notices that the bladder is firm and distended; the patient expresses an urge to urinate. The nurse should follow up by asking

Answer 7

“ when was the last time your voided”

Rationale: the nurse should first determine the source of discomfort.

Question 8

Which of the following is the primary function of the kidney

Answer 8

Maintaining fluid and electrolyte balance

Rationale: the main purpose of the kidney is to maintain fluid and electrolyte balance by filtering waste products and regulating pressures

Question 9

While receiving a shift report on a patient, the nurse is informed that the patient has urinary incontinence. Upon assessment, the nurse would expect to find

Answer 9

Reddened irritated skin on the buttocks

Rationale: if the urine has prolonged contact with the skin, skin breakdown can occur. Urinary incontinence is uncontrolled urinary elimination

Question 10

Which nursing diagnosis repeated to alternations in urinary function in an older adult should be a nurses first priority

Answer 10

Risk of infection

Rationale: older adults experience poor muscle tone, which leads to an inability of the bladder to fully empty. Residual greatly increases the risk of infection.

Question 11

A patient asks about treatment for urge urinary incontinence. The nurses best repose is to advise the patient to

Answer 11

Perform pelvic floor exercise

Rationale: poor muscle tone leads to an inability to control urine flow. The nurse should recommend pelvic muscle strengthening exercises

Question 12

The nurse suspects that a urinary tract infection has progressed to cystitis when the patient complains of which symptom

Answer 12

Frequency

Rationale: cystitis is inflammation of the bladder; associated symptoms include hematuria(blood in urine) and urgency

Question 13

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

Answer 13

“ do you experience urine leakage when you cough or sneeze”

Rationale: stress incontinence can be related to intra-abdominal pressure causing urine leakage

Question 14

When establishing a diagnosis of altered urinary elimination, the nurse should first

Answer 14

Discuss causes and solution to problems related to micturition(urination)

Question 15

To obtain a clean voided urine specimen for a female patient, the nurse should teach the patient to

Answer 15

Hold the labia apart while voiding into the specimen cup

Rationale: this reduce bacteria levels in the specimen. Should be cleansed from the area least contaminated to the greatest (front to back)

Question 16

When viewing a urine specimen under a microscope, what would the nurse expect to see in a patient with a UTI

Answer 16

Bacteria

Question 17

The nurse would expect the urine of a patient with uncontrolled diabetes mellitus to be

Answer 17

Sweet smelling

Rationale: incomplete fat metabolism and buildup ketones give urine a sweet or fruity odor.

Question 18

What signs and symptoms would the nurse expect to observe in a patient with excessive white blood cells present in the urine

Answer 18

Fever and chills

Rationale: the presence of white blood cells indicates a UTI

Question 19

The nurse would anticipate an order for which diagnostic test for a patient who has severe flank pain and calcium phosphate crystals

Answer 19

Intravenous pyelogram

Rationale: flank pain and calcium phosphate crystals are associated with rank calculi. An intravenous pyelogram allows the provider to observe pathological problems such as obstruction to the ureter.

Question 20

A nurse is caring for a patient who just underwent intravenous pyelography that reveled a renal calculus obstructing the left ureter. What is the nurses first priority in caring for this patient

Answer 20

Monitor the patient for fever, rash, and difficulty breathing

Rationale: intravenous pyelography is performed by administering iodine based dye to view functionality of the urinary system. Many individuals are allergic to shellfish, therefore, the first nursing priority is to assess the patient for an allergic reaction

Question 21

The nurse anticipates preparing a patient who is allergic to shellfish for an arteriogram by

Answer 21

Administering an antihistamine medication to the patient

Rationale: the nurse should asses the patient for food and other allergies and should administer an antihistamine, because a contrast iodine based dye is used for the procedure

Question 22

A nurse anticipates urodynamic testing for a patient with which symptom

Answer 22

Involuntary urine leakage

Rationale: urodynamic testing evaluates the muscle function of the bladder and is used to look for the cause of urinary incontinence.

Question 23

The nurse would anticipate inserting a coude catheter for which patient

Answer 23

A 56 year old male admitted for bladder irrigation

Rationale: a coude catheter has a curved top that is used for patients with enlarged prostates.

Question 24

The nurse knows that which indwelling catheter procedure places that patient at greatest risk for acquiring a UTI

Answer 24

Placing the drainage bag on the side rail of the patients bed

Rationale: placing the drainage bag on the side rail of the bed could allow the bag to be raised above the level of the bladder and urine to flow back into the bladder. Allowing it to re enter the bladder can cause infection.

Question 25

A nurse notifies the provider immediately if a patient with an indwelling catheter

Answer 25

Has not collected any urine in the drainage bag for 2 hours

Rationale: physician needs to be notified immediately because this could indicate renal failure.

Question 26

The nurse would question an order to insert a urinary catheter on which patient

Answer 26

A 30 year old patient requiring drug screening for employment

Rationale: this should only be performed if necessary because the patient is at risk for infection due to catherization

Question 27

When caring got a hospitalized patient with a urinary catheter, which nursing action best prevents the patient from acquiring an infection

Answer 27

Performing hand hygiene before and after providing perineal care

Rationale: hand hygiene helps prevent infection in patients with a urinary catheter. Should be inserted using sterile technique

Question 28

A nurse is providing education to a patient being treated for a UTI. Which of the following statements by the patient indicated an understanding

Answer 28

My medication may discolor my urine, this should resolve once the medication is stopped

Rationale: some anti-infective medications turn urine colors

Question 29

To reduce patient discomfort during closed catheter irrigation, the nurse should

Answer 29

Use room temperature irrigation solution

Rationale: using cold solutions, instilling solutions too quickly, and prolonging filling of the bladder can cause discomfort and cramping

Question 30

Which observation by the nurse best indicated that bladder irrigation for urinary retention has been effective

Answer 30

Recording an output that is larger then the amount instilled

Rationale: recording an output that is greater then what was irrigated into the bladder shouts proceed that the bladder is draining urine.

Question 31

The nurse anticipates urinary diversion from the kidneys to a site other than the bladder for which patient

Answer 31

A 12 year old female with severe abdominal trauma

Rationale:urinary diversion is a surgical procedure to reroute urine flow from its normal pathway. This would be needed in a patient with abdominal trauma who might have injury to the urinary system

Question 32

Which nursing actions are acceptable when collecting a urine specimen

Answer 32

Labeling all specimens with date, time, initials
Allowing the patient adequate time and privacy to void
Transporting specimens to the laboratory in a timely fashion
Placing a plastic bag over the child’s urethra to catch urine- children may have difficulty voiding so attaching a plastic bag gives the child more time and freedom to void

Question 33

The nurse properly obtains a 24 hour urine specimen collection by

Answer 33

Asking a patient to void and to discard the first sample
Keeping the urine collection container on ice

Rationale: when obtaining 24 hour urine specimen, it is important to keep the urine in cool condition.

Question 34

Which of the following are indicators for irrigating a urinary catheter

Answer 34

Sediment occluding within the tubing
Blood clots in the bladder following surgery
Bladder infection

Rationale: catheter irrigation is used to flush and remove blockage that may be impending the catheter from properly draining the bladder. Irrigation is used to remove blood clots in the bladder following surgery

Question 35

Which of the following symptoms are most closely associated with uremic syndrome

Answer 35

Nausea and vomiting
Headache
Altered mental status

Rationale: uremic syndrome is associated with end stage renal disease. Signs and symptoms include headache, altered mental status, coma, seizures, nausea, vomiting, and pericarditis

Question 36

The nurse understand that peritoneal dialysis and hemodialysis use which processes to clean that patients blood

Answer 36

Osmosis
Diffusion

Rationale: osmosis and diffusion are two processes used to clean the patients blood in both types of dialysis.