Chapter 45 Urinary Elimination Answers 2

Test Bank 45-9 18. The nurse caring for a client in an extended care facility should provide which intervention in a bladder retraining program? 1. Providing negative reinforcement when the client is incontinent 2. Having the client wear adult diapers as a preventative measure 3. Putting the client on a q2h toilet schedule during the day 4. Promoting the intake of caffeine to stimulate voiding ANS: 3 A bladder retraining program includes initiating a toileting schedule on awakening, at least every 2 hours during the day and evening, before getting into bed, and every 4 hours at night. Negative reinforcement should not be used when the client is incontinent. However, positive reinforcement should be provided when continence is maintained. The client should be offered protective undergarments to contain urine and reduce the client’s embarrassment (not diapers). Tea, coffee, other caffeine drinks, and alcohol should be minimized. DIF: A REF: 1171 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 19. A 3-year-old child is visiting the pediatric clinic. The nurse suspects that the child has a urinary tract infection. An appropriate method for the nurse to implement in order to obtain a urine specimen from the child is to: 1. Use an indwelling catheter 2. Offer fluids 30 minutes in advance 3. Apply pressure over the urinary bladder 4. Place a diaper on the child and squeeze out the specimen ANS: 2 Offering the young child fluids 30 minutes before requesting a specimen may help. Because bladder catheterization carries the risk for UTI, blockage, and trauma to the urethra, it is preferable to rely on other measures for specimen collection. Applying pressure over the urinary bladder of a child with an intact nervous system will not help and may create more stress in the child. Squeezing urine from a child’s diaper is not an accurate method of obtaining a urine specimen to determine whether the child has a urinary tract infection. DIF: A REF: 1140 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 20. A urine sample is obtained from the client for a routine urinalysis. Upon reviewing the results of the test, the nurse notes that an expected finding of the urinalysis is: 1. pH 8.0 Test Bank 45-10 2. Specific gravity 1.018 3. Protein amounts to 12 mg/100 mL 4. White blood cells (WBCs) 5 to 8 per low-power field casts ANS: 2 The normal specific gravity of urine is 1.010 to 1.025. The normal urine pH is 4.6 to 8.0, with an average of 6.0. Protein is not normally found in the urine. The normal value for urine protein is 0, or up to 8 mg/100 mL. The number of WBCs is 0 to 4 per low-power field, and casts should be 0 in a normal urinalysis. DIF: A REF: 1140 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 21. The client is experiencing urinary retention, and the health care provider is contacted. The nurse anticipates a medication that will be ordered to promote emptying of the bladder is: 1. Oxybutynin chloride (Ditropan) 2. Bethanechol (Urecholine) 3. Propantheline (Pro-Banthine) 4. Nystatin (Mycostatin) ANS: 2 Cholinergic drugs, such as bethanechol (Urecholine), increase contraction of the bladder and improve emptying. Bethanechol stimulates parasympathetic nerves to increase bladder wall contraction and relax the sphincter. Oxybutynin chloride (Ditropan) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder), and thus reduces incontinence. Propantheline (Pro-Banthine) is an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally stimulates the bladder), and thus reduces incontinence. Nystatin (Mycostatin) is an antifungal agent. DIF: A REF: 1133 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 22. Which of the following actions by the nurse would indicate the need for remedial education in the removal of an indwelling catheter? 1. Draping the female client between the thighs 2. Obtaining a specimen before removal 3. Cutting the catheter to deflate the balloon 4. Checking the client’s output for 24 hours after removal ANS: 3 Test Bank 45-11 The nurse should not cut the catheter to deflate the balloon. The nurse inserts an empty, sterile syringe into the injection port. The nurse slowly withdraws all of the solution to deflate the balloon totally. The nurse then pulls the catheter out smoothly and slowly. The nurse positions the client in the same position as during catheterization. The nurse places a towel between a female client’s thighs or over a male client’s thighs. Some institutions recommend collecting a sterile urine specimen before removal of the catheter or sending the catheter tip for culture and sensitivity tests. The nurse should assess the client’s urinary function by noting the first voiding after catheter removal and documenting the time. DIF: A REF: 1165 OBJ: Comprehension TOP: Nursing Process: Evaluation MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 23. A condom catheter is to be used for an adult male client in the extended care facility. In the application of the condom catheter, the nurse employs appropriate technique when: 1. Using sterile gloves 2. Wrapping the adhesive tape securely around the base of the penis 3. Leaving a 1- to 2-inch space between the tip of the penis and the end of the catheter 4. Taping the tubing tightly to the thigh and attaching the drainage bag to the bed frame ANS: 3 A 1- to 2-inch space should be left between the tip of the penis and the end of the catheter. Nonsterile gloves are worn to apply a condom catheter. Standard adhesive tape should never be used to secure a condom catheter because it does not expand with change in penis size and is painful to remove. The tubing of a condom catheter is not taped tightly to the thigh. The drainage bag is attached to the lower bed frame. DIF: A REF: 1169 OBJ: Comprehension TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 24. Urinary elimination may be altered with different pathophysiological conditions. For the client with diabetes mellitus, the nurse anticipates that an initial urinary sign or symptom will be: 1. Urgency 2. Dysuria 3. Hematuria 4. Polyuria ANS: 4 Test Bank 45-12 An initial urinary symptom of diabetes mellitus is polyuria. Urgency is not a symptom of diabetes mellitus. Urgency may be caused by a full bladder, bladder irritation from infection, incompetent urethral sphincter, or psychological stress. Dysuria is not a symptom of diabetes mellitus. Dysuria may be caused by bladder inflammation, trauma, or inflammation of the urethral sphincter. Hematuria is not a symptom of diabetes mellitus. Hematuria may be a symptom of neoplasms of the bladder or kidney, glomerular disease, infection of the kidney or bladder, trauma to urinary structures, calculi, or bleeding disorders. DIF: A REF: 1138 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 25. The nurse is assessing a client admitted with complaints related to chronic kidney dysfunction. The nurse recognizes that this client is most likely to present with which of the resulting symptoms? 1. Anemia 2. Hypotension 3. Diabetes mellitus 4. Clinical depression ANS: 1 Clients with chronic alterations in kidney function cannot produce sufficient quantities of the hormone erythropoietin; therefore they are prone to anemia. Diabetes mellitus may be a cause of the renal dysfunction, and the client may or may not be depressed. Hypertension, not hypotension, is a typical outcome of kidney dysfunction. DIF: C REF: 1138 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 26. Which of the following statements made by a client experiencing chronic kidney dysfunction reflects the best understanding of the most common physiological effect this disorder can have on the body? 1. “I’m tested regularly for anemia.” 2. “My diet is restricted because of this problem.” 3. “Diabetes runs in my family, so I get tested regularly.” 4. “I can get really depressed if I think about this too much.” ANS: 1 Clients with chronic alterations in kidney function cannot produce sufficient quantities of the hormone erythropoietin; therefore they are prone to anemia. The remaining options deal with nonphysiological events or conditions that are more causes of the dysfunction, not effects. Test Bank 45-13 DIF: C REF: 1130 OBJ: Analysis TOP: Nursing Process: Evaluation MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 27. Which of the following clients is at greatest risk for developing a renal infection? 1. A 27-year-old male 2. A 16-year-old male 3. A 9-year-old female 4. A 45-year-old female ANS: 3 The short length of the urethra predisposes women and girls to infection. It is easy for bacteria to enter the urethra from the perineal area. The 9-year-old female has the shortest urethra and so has the greatest risk. DIF: A REF: 1131 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 28. Which of the following clients will most benefit from client/parent education regarding the prevention of renal infections via proper hygiene habits? 1. Males ages 35 to 65 2. Males ages 3 to 16 3. Females ages 3 to 12 4. Females ages 20 to 50 ANS: 3 The 3- to 12-year-old female has the shortest urethra and so has the greatest need. The short length of the urethra predisposes women and girls to infection. It is easy for bacteria to enter the urethra from the perineal area. DIF: C REF: 1131 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 29. The nurse is interviewing a client with a history of benign prostatic hypertrophy (BPH). In light of this diagnosis, the nurse should include information regarding which of the following in order to assess the chronic effects of this renal disorder? 1. Number of times he usually urinates in a 24-hour period 2. What medications he is currently taking for the condition 3. The results of his latest prostate-specific antigen (PSA) testing 4. Whether he usually experiences a complete emptying of his bladder ANS: 4 Test Bank 45-14 If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time the micturition reflex changes, causing bladder overactivity, and can cause the bladder to not completely empty. The remaining options focus on the impact the condition has on daily living and the monitoring necessary to determine the presence of prostate cancer. DIF: C REF: 1138 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 30. Which of the following statements made by a client with benign prostatic hypertrophy (BPH) during an admissions interview reflects the best understanding of the long-term effects of this condition? 1. “I usually get up 3 to 4 times a night to urinate.” 2. “My health care provider prescribed some medication that has helped.” 3. “At least I can usually empty my bladder; I really hate that feeling of being full.” 4. “The prostate specific antigen (PSA) results have stayed stable for the last 3 tests.” ANS: 3 If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time the micturition reflex changes, causing bladder overactivity, and can cause the bladder to not completely empty. The remaining options focus on the impact the condition has on daily living and the monitoring of the client for prostate cancer. DIF: C REF: 1138 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 31. The nurse realizes that a postsurgical client who underwent a left knee replacement is most likely to experience which of the following urinary complications? 1. Dysuria 2. Bladder spasms 3. A bladder infection 4. Burning on urination ANS: 1 Medications including anesthesia interfere with both the production and the characteristics of urine and affect the act of urination. Difficulty with urination is a common complication of general anesthesia. The remaining options are not directly connected to postsurgical complications. DIF: C REF: 1138 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination Test Bank 45-15 32. The nurse recognizes that a client recovering from anesthesia required for surgical repair of a fractured ulna is likely to experience difficulty urinating primarily because of: 1. The impaired cognitive state the client will experience as the effects of the anesthesia wear off 2. The decreased volume of orally ingested fluids before, during, and after the surgical procedure 3. The length of time the client was under the effects of general anesthesia required for the surgical procedure 4. The effects of the anesthetic on the nerves and muscles controlling the relaxation of the urinary bladder ANS: 4 Medications, including anesthesia, interfere with both the production and the characteristics of urine and affect the act of urination. The remaining options may affect urination but not to the extent of the anesthetic effects. DIF: C REF: 1138 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 33. A 70-year-old client is discussing his recent difficulty in initiating his flow of urine while on a cross-country bus tour with a senior citizens’ group. Which of the following assessment questions is directed toward the most likely cause of the problem? 1. “Did the bus stop frequently so you could get up and walk around?” 2. “Did you drink plenty of water while you were on the trip?” 3. “Do you find using public restrooms unsettling?” 4. “Do you have any chronic urinary problems?” ANS: 3 Attempting to void in a public restroom sometimes results in a temporary inability to void. Although the remaining options may affect urination, this situation strongly suggests an emotional cause. DIF: C REF: 1132 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 34. Which of the following nursing interventions is most specific for a client being monitored for possible urinary retention? 1. Measuring urine output with each urination 2. Monitoring the color and clarity of urine with each voiding 3. Collecting a urine sample for a culture and sensitivity test 4. Asking the cognizant client to report each time he or she urinates ANS: 4 Test Bank 45-16 With retention the client may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine. Be aware of the volume and frequency of voiding to assess this condition in the client. The alert, oriented client can be asked to notify the nurse each time micturition occurs. The remaining options are more generalized or specific for a urinary tract infection. DIF: C REF: 1138 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 35. The nurse is caring for an older adult who is recovering from hip replacement surgery. The client shares with the nurse that he has been using the urinal “a lot but I feel like my bladder isn’t empty.” Which of the following statements by the nurse shows the best understanding of the appropriate initial intervention for this particular client? 1. “I’ll call your primary care provider and let her know you are having this problem.” 2. “I have the ancillary personnel measure your output, so please don’t empty your urinal yourself.” 3. “I’m going to ask that you please use your call bell and notify me or the ancillary staff each time you void.” 4. “I suggest that we try limiting the amount of fluids you are drinking for a few hours and see if that helps.” ANS: 3 With retention the client may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine. Be aware of the volume and frequency of voiding to assess this condition in the client. The alert, oriented client can be asked to notify the nurse each time micturition occurs. The notification of the primary care provider is not the initial intervention. Although measuring the urine output is not inappropriate, it is not specific to this client’s complaint. Restricting fluids is neither appropriate nor likely to affect the problem. DIF: C REF: 1138 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 36. The nurse is discussing signs and symptoms of both upper and lower urinary tract infections with a client who has a history of both. Which of the following statements by the client reflects the best understanding of the differing symptomatology? 1. “When I get cloudy urine, I figure I have an infection.” 2. “Burning when I urinate is usually the first symptom I notice.” 3. “I have a big problem when I feel like I have the flu but with back pain too.” 4. “When I see blood in my urine, I know I need to call my health care provider.” ANS: 3 Test Bank 45-17 Clients with lower UTIs have pain or burning during urination (dysuria) as urine flows over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the infection worsens. An irritated bladder (cystitis) causes a frequent and urgent sensation of the need to void. Irritation to bladder and urethral mucosa results in blood-tinged urine (hematuria). The urine appears concentrated and cloudy because of the presence of WBCs or bacteria. If infection spreads to the upper urinary tract (kidneys— pyelonephritis, a serious renal condition), flank pain, tenderness, fever, and chills are common. The remaining options identify general symptoms that are not condition specific. DIF: C REF: 1134 OBJ: Analysis TOP: Nursing Process: Evaluation MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination 37. The nurse is discussing urinary elimination alterations with a group of middle-age adults. The nurse appropriately shares with the group that whereas men experience urinary frequency as a result of prostate enlargement, the female: 1. Is more affected if she has experienced multiple pregnancies 2. Does not usually experience urinary problems until much later in life 3. Experiences an increased risk for urinary tract infections related to menopause 4. Appears to have less risk for kidney infections because of gradually declining estrogen levels ANS: 3 Aging often impairs micturition. In the male, prostate enlargement usually begins during the 40s and continues throughout life, resulting in urinary frequency and possible urinary retention. In women, changes in the urethral mucosa associated with loss of estrogen during and after menopause contribute to increased susceptibility to UTIs. Although pregnancies may affect urinary continence, decreased estrogen levels do not protect against kidney infections. DIF: C REF: 1134 OBJ: Analysis TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 38. The nurse is caring for a 19-year-old male client with a fractured left femur whose leg was pinned 36 hours ago and is now in traction. Which of the following stressors is mostly likely the cause of this client’s difficulty related to starting urine flow? 1. Pain related to the fracture and its repair 2. Anxiety regarding the serious nature of the injury 3. The inability to stand in order to facilitate urination 4. Poor fluid intake in the accident and ensuing surgery ANS: 3 Test Bank 45-18 Some men who cannot stand to urinate become overly distressed. Although the other options may have some effect, the primary cause is most likely the emotional stress of not being able to assume the usual position for male urination. DIF: C REF: 1151 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 39. Which of the following statements made by an older adult with a history of urinary tract infections shows the best understanding of interventions that minimize the risk for developing such infections? 1. “I drink 8 ounces of cranberry juice a day to discourage bacterial growth in my bladder.” 2. “Whenever I feel an infection coming on, I immediately call my health care provider.” 3. “I told the nurses I didn’t want a urinary catheter unless I absolutely had to have one.” 4. “Whenever I can, I avoid drinking after 8 PM because I usually go to bed about 11 PM.” ANS: 1 Make fluids such as cranberry juice available as part of the client’s fluid intake. Cranberry juice discourages bacterial adherence to the bladder wall. The remaining options either have less impact on a daily basis or are more related to early detection rather than prevention. DIF: C REF: 1150 OBJ: Analysis TOP: Nursing Process: Evaluation MSC: NCLEX® test plan designation: Physiological Integrity/Basic Care and Comfort/Elimination 40. The nurse is caring for a 23-year-old male client who is in the ICU with second and third degree burns over 40 percent of his body. One of the first symptoms that the client is having organ failure is that the urine output is less than: 1. 30 mL/hour 2. 40 mL/hour 3. 50 mL/hour 4. 60 mL/hour ANS: 1 An output of less than 30 mL/hr indicates possible renal alterations. DIF: B REF: 1134 OBJ: Application TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation Physiological Integrity/Basic Care and Comfort/Elimination