Urinary Elimination Chapter 27

Question 1

Identify the major structures of the urinary system.

Answer 1

Answer:

The urinary system comprises the following major structures:

● Two kidneys

● Two ureters

● Bladder

● Urethra

Question 2

What are the functions of the kidneys?

Answer 2

Answer:

Kidneys have the following functions:

Primary functions

● The kidneys filter metabolic wastes, toxins, excess ions, and water from the bloodstream and excrete them as urine.

● The kidneys also help to regulate blood volume, blood pressure, electrolyte levels, and acid–base balance by selectively reabsorbing water and other substances.

Secondary functions

● Produce erythropoietin

● Secrete the enzyme rennin

● Activate vitamin D3 (calcitriol)

Question 3

Briefly describe how urine is formed.

Answer 3

Answer:

Urine is formed in the nephrons. The renal arteries bring blood to the kidneys and into the glomeruli. Blood pressure forces plasma, dissolved substances, and small proteins out of the porous glomeruli into the Bowman’s capsule to form a liquid called filtrate. The filtrate moves from Bowman’s capsule into the tubular network of the nephrons where 99% of the fluid is reabsorbed. About 1% of filtrate returns, as urine, to the collecting tubule, which transports it into the ureters.

Question 4

What role do the ureters, bladder, and urethra play in urinary elimination?

Answer 4

Answer:

The structures of the urinary system have the following roles:

● The ureters transport urine from the kidneys to the bladder.

● The bladder stores urine until it is excreted.

● The urethra transports urine from the urinary bladder to the body exterior.

Question 5

What quantity of urine in the bladder will stimulate the urge to void?

Answer 5

Approximately 200–450 mL of urine in adults (50–200 mL in children) are sufficient to stimulate the urination reflex. Less may be required in older adults.

Question 6

Identify at least three methods for determining whether hydration is adequate and urine output is within normal limits.

Answer 6

Answer:

Methods for determining if hydration is adequate and urination is normal include the following:

● The person voids 1,500 mL in a 24-hour period in five to six voids.

● An infant has 8–10 wet diapers per day.

● For most adults, pale to clear urine indicates adequate hydration.

Question 7

What common medications increase the amount of urine voided?

Answer 7

Answer:

Diuretics increase urine output.

Question 8

What types of medications are associated with urinary retention?

Answer 8

Answer:

Medications with anticholinergic effects may lead to urinary retention

Question 9

What types of conditions or surgeries are associated with a high incidence of altered urination?

Answer 9

Answer:

Patients with surgeries or pathology involving the genitourinary tract have a high incidence of altered urination.

Question 10

What should you discuss with your client when performing a nursing history focused on urinary elimination?

Answer 10

Answer:

The following items should be part of a nursing history focused on urinary elimination:

● Normal urination pattern

● Appearance of urine

● Changes in urination habits or urine appearance

● History of urination problems

● Use of urination aids

● Lifestyle questions

● Presence of urinary diversions,

Question 11

● What are the key elements of a physical assessment for a client with urination problems?

Answer 11

Answer:

Physical assessment for urinary elimination includes examination of the kidneys, bladder, urethra, and skin surrounding the genitals.

Question 12

How would you examine the kidney

Answer 12

by assessing for costovertebral angle tenderness (CVAT).

Question 13

How would you examine the bladder

Answer 13

Assess the bladder with inspection, palpation, and percussion.

● Begin the assessment by observing for swelling of the lower abdomen. Lightly palpate the lower abdomen to define the bladder margin. Observe the patient’s response to palpation, noting any signs of tenderness or discomfort.

● Next, percuss the area. A distended bladder that has risen into the abdomen produces a dull sound, as opposed to the normal tympanic sound of intestinal air.

● Correlate the findings with data about the client’s fluid intake and voiding.

Question 14

How would you examine the urethra

Answer 14

Assess the urethra by inspecting the urethral orifice. Look for erythema, discharge, swelling, or odor. These are all signs of infection, trauma, or inflammation.

Question 15

How would you examine the perineal area

Answer 15

Inspect the skin in the perineal area for signs of breakdown or irritation.

Question 16

Explain how to collect a clean-catch urine specimen.

Answer 16

Answer:

To collect a clean-catch specimen, the client must cleanse the genitalia before voiding and collect the sample in midstream.

Question 17

You are caring for a patient on a hospital unit from 0700 to 1200. Based on the following information, calculate the I&O and comment on your findings.

Receiving IV fluid at 125 mL/hr

0800 breakfast—4 oz juice, toast, scrambled eggs, 8 oz coffee

0930—3 oz water

0700 to 1200—wound drainage: 360 mL

0700 to 1200—urine output per indwelling catheter: 180 mL

Answer 17

Answer:

● Intake. The patient’s fluid intake is 1075 mL in 5 hours; this includes IV fluid and oral fluid.

● Output. The patient’s fluid output is 540 mL in 5 hours; this includes urine and wound drainage.

● Comments. There is a +535 mL balance, although the urine output is low at an average of 36 mL/hr

Question 18

Identify activities that promote normal urination patterns.

Answer 18

Answer:

The following activities promote normal urination patterns:

● Provide privacy.

● Assist with positioning.

● Position the patient in his preferred position whenever possible

● Provide a bedpan, urinal, or bedside commode if the patient cannot ambulate to the bathroom.

● Facilitate toileting routines; determine the patient’s usual voiding pattern and assist him to the toilet at these times and upon request.

● Promote adequate fluids and nutrition; encourage an intake of 10 large glasses of water daily for patients without health concerns that limit their fluid intake. Encourage more water for those who are engaging in prolonged exercise or exposed to a hot, humid environment.

● Assist with perineal hygiene if the patient cannot provide self-care.

Question 19

Describe the difference between a catheter used for straight catheterization and one used for ongoing drainage.

Answer 19

Answer:

The catheters have the following differences:

● A straight catheter has a single lumen and is inserted for brief periods for immediate drainage of the bladder (e.g., to obtain a sterile urine specimen, to measure post-void residual volume, or to relieve temporary bladder distention).

● An indwelling catheter (Foley or retention catheter) is used for continuous bladder drainage and may have two or three lumens. The first lumen drains urine, the second lumen is used to inflate the balloon that holds the catheter in place, and a third lumen may be used for bladder irrigation.

Question 20

Why is intermittent catheterization preferred for patients who must be catheterized over lengthy periods of time?

Answer 20

Answer:

For patients who must be catheterized over lengthy periods of time, intermittent catheterization is preferred because it carries a substantially lower risk of infection than an indwelling catheter.

Question 21

What actions should you take before inserting a catheter?

Answer 21

Answer:

The following actions should be taken before inserting a catheter:

● Verify the order

● Gather appropriate supplies

● Explain the procedure to the patient

● Answer any questions the patient may have

● Provide privacy

Question 22

When caring for a client with an indwelling catheter you notice sandy particles around the urethral meatus. What should you do?

Answer 22

Answer:

Sandy particles are signs of encrustation and indicate the catheter should be replaced. Provide perineal care to the patient and obtain an order for replacement of the catheter from the primary care provider.

Question 23

How often should the urine collection bag be emptied?

Answer 23

Answer:

Empty the urine collection bag at least every 8 hours, or more often if it is full, to make it more convenient for the patient to ambulate.

Question 24

A _________________________ is an instrument that is used to measure the specific gravity of urine.

Answer 24

Answer:

refractometer

Question 25

Percussion of the _________________________ that results in pain or discomfort could indicate the presence of an inflammatory process in the kidney.

Answer 25

Answer:

costovertebral angle

Question 26

_________________________ is the application of gentle, manual pressure over the bladder to promote bladder emptying.

Answer 26

Answer:

Credé’s maneuver

Question 27

A/an _________________________ is a type of urinary diversion that involves implanting the ureters into a small segment of the small intestine, which is then brought to the abdominal wall, where a stoma is created.

Answer 27

Answer:

ileal conduit

Question 28

If a child is experiencing involuntary urination after the age of 5 or 6, he may have a condition known as _________________________.

Answer 28

Answer:

enuresis

Question 29

The nurse notes that there has only been 100 mL of urine output from his patient’s Foley catheter in 6 hours. The nurse should first do which of the following?

A. Instruct the patient to drink two glasses of water.

B. Notify the doctor immediately.

C. Irrigate the Foley catheter with 30 mL of sterile saline.

D. Assess the catheter tubing and the patient’s abdomen.

Answer 29

Answer:

D. Assess the catheter tubing and the patient’s abdomen

Rationale:

The nurse should first determine whether urine is being retained in the bladder. This can be accomplished through palpation of the bladder and/or checking the catheter tubing for kinks.

Question 30

Mrs. Sanchez is awaiting surgery for a right hip fracture. The nurse suspects that Mrs. Sanchez has a urinary tract infection and anticipates that the physician will order which of the following?

A. Freshly voided urine specimen in the morning

B. Clean-catch specimen

C. Sterile urine specimen

D. 24-hour urine collection

Answer 30

Answer:

C. Sterile urine specimen

Rationale:

For most patients, a clean-catch specimen would be ordered. However, because Mrs. Sanchez would need to use a “fracture pan,” it is very likely that the specimen would be contaminated during collection. As a result, a straight catheterization will be needed.

Question 31

A patient’s urine specific gravity has been reported at 1.035. Which of the following nursing actions would be appropriate?

A. Start an IV of normal saline at 150 mL per hour.

B. Encourage the patient to increase fluid intake.

C. Insert a straight catheter to assess for urinary retention.

D. Obtain an order for fluid restriction from the physician.

Answer 31

Answer:

B. Encourage the patient to increase fluid intake

Rationale:

A specific gravity of 1.035 would indicate concentrated urine, indicating the possibility of dehydration. Starting an IV of normal saline is not an independent nursing action.

Question 32

The nurse knows that the patient has understood teaching related to urinary incontinence when the patient states which of the following?

A. “I’ll just get those disposable pads because there is nothing to be done.”

B. “I’ll limit my fluid intake so that I won’t dribble so much.”

C. “I will do my Kegel exercises every day.”

D. “I’m going to have surgery, and the doctor will make a Kock pouch.”

Answer 32

Answer:

C. “I will do my Kegel exercises every day.”

Rationale:

Kegel exercises help to strengthen the pelvic floor muscles and help to prevent and treat some types of incontinence. You would not want the patient to decrease fluid intake unless excessive (> 3,000 mL) because this would lead to concentrated urine and risk for UTI. A Kock pouch is created when the bladder is removed.

Question 33

The nurse should call the physician immediately if a patient’s urostomy stoma is red in color.

Answer 33

Answer:

False

Rationale:

This is a normal finding.

Question 34

It is important for the nurse to assess the results of the serum blood urea nitrogen and serum creatinine lab tests for the patient receiving certain chemotherapy agents.

Answer 34

Answer:

True

Rationale:

Chemotherapy agents can also be nephrotoxic.

Question 35

Escherichia coli is an intestinal bacterium that is frequently responsible for urinary tract infections.

Answer 35

Answer:

True

Question 36

1.When inserting an indwelling urinary catheter in a male patient, the nurse cleanses the penis with an antiseptic wash. Which step should she take next?

1) Gently insert the tip of the prefilled syringe into the urethra to instill the lubricant.
2) Ask the patient to bear down as though trying to void.
3) Slowly insert the end of the catheter into the urinary meatus.
4) Insert the catheter about 7 to 9 inches (17 to 22.5 cm) or until urine flows.

Answer 36

Answer:

1) Gently insert the tip of the prefilled syringe into the urethra to instill the lubricant.

Rationale:

The steps of the procedure for inserting an indwelling urinary catheter are as follows. The nurse should gently insert the tip of the prefilled syringe into the urethra and instill the lubricant. Then the nurse should ask the patient to bear down as though trying to void, as she slowly inserts the end of the catheter into the meatus. She should continue to insert the catheter about 7 to 9 inches (17 to 22.5 cm) or until urine flows. When urine appears, she should advance the catheter 1 to 2 inches (2.5 to 5 cm) more. She should hold the catheter securely with her dominant hand while the urine flows. After urine flows, she should stabilize the catheter’s position in the urethra and use the other hand to pick up the saline-filled syringe and inflate the catheter balloon.

Question 37

2.The nurse is obtaining the history of a newly admitted patient. Which element in the patient’s history places the patient at risk for urinary tract infection?

1) Hypertension
2) Hypothyroidism
3) Diabetes mellitus
4) Hormonal contraceptive use

Answer 37

Answer:

3) Diabetes mellitus

Rationale:

Diabetes mellitus places the patient at risk for urinary tract infection because glucose in the urine provides a medium favorable for bacterial growth. Hypertension, hypothyroidism, and hormonal contraceptive use are not directly related to an increased risk for urinary tract infection.

Question 38

3.A patient who underwent surgery for removal of a pituitary tumor develops a condition in which the kidneys are unable to conserve water and the quantity of urine voided increases. Which urine specific gravity would the nurse expect to find in the patient with this disorder?

1) 1.001
2) 1.010
3) 1.025
4) 1.030

Answer 38

Answer:

1) 1.001

Rationale:

The patient with diabetes insipidus would have a low specific gravity, such as 1.001. This indicates dilute urine that results from poor concentrating ability of the kidneys. Normal urine specific gravity ranges from 1.010 to 1.025. A specific gravity of 1.030 indicates concentrated urine or deficient fluid volume (dehydration).

Question 39

4.Which blood level is commonly tested to help assess kidney function?

1) Hemoglobin
2) Potassium
3) Sodium
4) Creatinine

Answer 39

Answer:

4) Creatinine

Rationale:

The nurse would examine laboratory results for blood urea nitrogen and creatinine to assess kidney function. Hemoglobin, potassium, and sodium levels can be affected by kidney disease, but they do not directly assess kidney function.

Question 40

5.A patient is admitted with pyelonephritis. Which anatomic structure is affected by this disorder?

1) Kidneys
2) Bladder
3) Urethra
4) Prostate gland

Answer 40

Answer:

1) Kidneys

Rationale:

Pyelonephritis is an infection of the kidneys. Cystitis is an infection involving the bladder. An infection of the urethra is known as urethritis. Prostatitis is an infection involving the prostate gland.

Question 41

6.The parent of a 7-year-old son brings the child to the pediatric care provider to discuss her child’s nighttime bedwetting. She reports he has never achieved consistent dryness at night. What is the nurse’s best response to the mother’s concern?

1) “We’ll start medication right away to control it.”
2) “Family history is not associated with bedwetting.”
3) “We will look for a urinary tract infection.”
4) “Wait it out. Your son will likely outgrow it.”

Answer 41

Answer:

4) “Wait it out. Your son will likely outgrow it.”

Rationale:

Based on the history, the nurse understands the condition is nocturnal enuresis because the child has not yet achieved dryness at night at an age where continence would be expected. Nocturnal en uresis is most common among boys. Ninety-five percent of children outgrow it by age 10. Nighttime bedwetting runs in families. So if one parent was a bedwetter, then the chances the child will also have trouble with achieving continence at night will be likely. Pharmacologic intervention can be useful for older children, particularly when the child is not sleeping at home. However, prior to age 8 or 10, medication is not indicated.

Question 42

7.The nurse is teaching an older female patient how to manage stress incontinence at home. She instructs her to contract her pelvic floor muscles for at least 10 seconds followed by a brief period of relaxation. What is this intervention called?

1) Prompted voiding
2) Crede technique
3) Valsalva maneuver
4) Kegel exercises

Answer 42

Answer:

4) Kegel exercises

Rationale:

Kegel exercises strengthen the pelvic floor muscles that support the uterus, bladder, and bowel. Doing Kegel exercises regularly can reduce urinary incontinence. These exercises involve tightening and relaxing the muscles around the vaginal area. Prompted voiding is a part of a bladder training program where the person learns to void based on a schedule, rather than empty the bladder. The Crede technique is applying manual pressure with your hands to the top portion of the bladder to initiate a urine flow. The Valsalva is the maneuver in which a person tries to exhale forcibly with a closed glottis (the windpipe) so that no air exits through the mouth or nose, for example, in strenuous coughing, straining during a bowel movement, or lifting a heavy weight.

Question 43

Urge inccontence

Answer 43

Overactive bladder, strong urge to void with involuntary urine loss

Question 44

Stress incontinence

Answer 44

Less than 50 ml loss of urine r/t increased intrabdominal pressure

Ex pregnancy