Homework Lance
1.An 80-year-old woman with a history of diabetes and arthritis has made an appointment with her health care provider for complaints of urinary incontinence (UI). The patient states that she has recently become incontinent of urine and thinks it is because of her age. What is the best response from the nurse?
a.
“That is not normal. You must have a UTI.”
b.
“You need to decrease your fluid intake so you don’t have to go to the bathroom as often.”
c.
“Are you having issues with walking to the bathroom or toileting?”
d.
“As you get older the sensations that your bladder is full become hypersensitive and cause a person to go to the bathroom more frequently.”
ANS: C
Functional UI is caused by factors that prohibit or interfere with a patient’s access to the toilet or other acceptable receptacle for urine. It is a significant problem for older adults who experience problems with mobility or the dexterity to manage their clothing and toileting behaviors. Functional UI may also be caused by poor motivation for continence, as seen in severe depression or by cognitive decline that has impaired the ability to sense and act upon the urge to void in an appropriate manner. Functional UI can be associated with underlying stress, urge, or mixed UI. In many cases functional incontinence is the direct result of caregivers not responding in a timely manner to requests for help with toileting.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 953-954 OBJ: Identify factors that commonly influence urinary elimination.
TOP:Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
2.At a recent staff meeting the staff educator discussed the importance of catheter care for the prevention of urinary tract infections (UTI). What percentage of health care–associated infections result from indwelling catheter use?
a.
10%
b.
60%
c.
70%
d.
80%
ANS: D
Eighty percent of health care–associated infections are associated with indwelling catheter use.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 953 OBJ: Discuss nursing measures to reduce urinary tract infections.
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
3.A 56-year-old patient, who has recently become postmenopausal, made an appointment with her health care provider for symptoms of an UTI. The patient has had three previously diagnosed UTIs in the past 4 months. She asks the nurse if this is a normal occurrence with postmenopausal women. What is the best response from the nurse?
a.
“Yes, because as women go through menopause, the lining of the urethra becomes more susceptible to infections.”
b.
“No, but why don’t you ask your health care provider for some antibiotics to keep on hand?”
c.
“Yes, and this must be frustrating because as we become older our body starts to cause us more problems.”
d.
“Yes, and this is why I’m not looking forward to going through menopause.”
ANS: A
There is a decrease in estrogenization of perineal tissue in women that increases the risk of urinary tract infection. The vaginal tissue of postmenopausal women may be dryer and less pink than in younger women. Health care providers would not give antibiotics to keep on hand. Nurses should not imply that a UTI is an expected problem of aging. Relaying what the nurse thinks about aging is not appropriate to voice to the patient.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 953 | 962 OBJ: Discuss nursing measures to reduce urinary tract infections.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
4.A mother has brought her 3-year-old child to the clinic for an annual well-child checkup. The mother tells the nurse that the child is in the process of being potty trained. The child will state that the need to go to the bathroom, but refuses to go on the toilet. What is the nurse’s best response?
a.
“This occurs because the child might be frightened of falling in the toilet.”
b.
“It is recommended that you try putting her in ‘time-out’ if she continues to refuse to sit on the toilet.”
c.
“Sometimes children at that age see urine and feces as part of themselves.”
d.
“Stop, your child is too young to worry about potty-training.”
ANS: C
When children begin to achieve bladder control and learn the appropriate skills, they sometimes resist urinating on the toilet. Children often associate their urine and feces as extensions of self, and they do not want to flush part of themselves away. The neurological system is not well developed until 2 to 3 years of age. Up until this time, the small child is not able to associate the sensations of filling and urge with urination. When the child recognizes feelings of urge, he or she can hold urine for 1 to 2 hours, and is able to communicate a need to eliminate, toilet training becomes successful. Fear of falling in the toilet may be a concern, but it is not the most appropriate answer for this question.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: 957 OBJ: Identify factors that commonly influence urinary elimination.
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
5.The nurse on a rehabilitation unit is caring for a 77-year-old patient who had undergone total knee replacement surgery. Since surgery, the patient has had several instances of urinary incontinence. The health care provider is contemplating the order of a Foley catheter. What is the nurse’s best response to this suggestion?
a.
“Perhaps you could order intermittent straight catheter insertions instead?”
b.
“I think it would be better to put a disposable undergarment on her.”
c.
“Could we try a toileting schedule before you order the Foley?”
d.
“I think that is a good idea; it will prevent skin breakdown.”
ANS: C
You are in a strategic position to serve as a patient advocate by suggesting noninvasive alternatives to catheterization use. For example, you may decrease the risk for UTI by suggesting the use of a bladder scanner to evaluate bladder urine volume without invasive instrumentation or implement a toileting schedule for the incontinent patient. Be aware of indications for catheter insertion and be prepared to advocate for the patient if the indications do not meet accepted guidelines.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF:975 | 977
OBJ: Discuss nursing measures to promote normal urination and to control incontinence.
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
6.The nurse is assessing a 76-year-old man in a nursing home with a diagnosis of UTI. The nurse notes that the patient is complaining of right flank pain. To assess for tenderness, the nurse should gently do which of the following?
a.
Auscultate the costovertebral angle.
b.
Palpate the tenth intercostal space.
c.
Percuss the costovertebral angle.
d.
Palpate the area above the ischial spine.
ANS: C
If the kidneys become infected or inflamed, flank pain typically develops. You assess for tenderness early in the disease by gently percussing the costovertebral angle (the angle formed by the spine and twelfth rib). Inflammation of the kidney results in pain on percussion.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:959
OBJ: Perform a beginning physical assessment related to urinary elimination.
TOP:Nursing Process: Assessment
MSC:Client Needs: Reduction of Risk Potential
7.A male patient has been admitted with a fever and malaise. The health care provider has ordered a clean catch midstream specimen for urinalysis on this patient. To collect the urine specimen, the nurse should instruct the patient to do which of the following?
a.
Return to bed to obtain the specimen using a straight catheter insertion.
b.
Use sterile gloves to cleanse his penis and collect the specimen in a sterile cup.
c.
Ask the patient to void into a cup or urine collection container.
d.
Cleanse his penis, begin his stream, and then void into a sterile cup.
ANS: D
Male patients should be instructed to retract the foreskin, if not circumcised, and cleanse the meatus in a circular motion moving from the center of the meatus to the outside. After cleansing, have the patient open the sterile urine cup and caution the patient to not touch the inside of the cup. To collect the specimen, instruct the patient to start voiding in the toilet or other receptacle, stop the stream, position the sterile cup to collect urine and then continue voiding into the cup. When finished, the lid should be put on the cup and the specimen processed per laboratory instruction. A simple urinalysis does not require a sterile urine specimen or sample. Obtaining the specimen from a straight catheter would occur if there was an issue with urinary retention or the patient is unable to void.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF:964
OBJ: Describe nursing implications of common diagnostic tests of the urinary system.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
8.The health care provider ordered a 24-hour urine specimen to test the renal function of a patient admitted with acute renal failure. The nurse has prepared all the necessary equipment and has asked the patient if he or she needs to void. The nurse knows that the 24-hour collection period will begin:
a.
after the first voided specimen is discarded.
b.
with the first morning voided specimen.
c.
after the second voided specimen is collected.
d.
as soon as the necessary equipment arrives.
ANS: A
In most 24-hour specimen collections, you will need to discard the first voided specimen and then start collecting urine in a special container that already has a preservative added. Depending on the test, the urine container may need to be kept cool by placing it in a container of ice. Patient education must include an explanation of the test, an emphasis on the need to collect all urine voided during the prescribed time period, and how to avoid contaminating the specimen with stool or toilet paper. Careful documentation of the start and stop time of the test, as requested by the laboratory, will improve testing accuracy. A 24-hour specimen can be started at any time after obtaining and discarding the first voided specimen.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF:964
OBJ: Describe nursing implications of common diagnostic tests of the urinary system.
TOP:Nursing Process: Implementation
MSC:Client Needs: Physiologic Integrity: Reduction of Risk Potential
9.A 34-year-old patient is being seen in the ED for complaints of severe flank pain lasting for 2 days. The ED physician suspects that the patient has hydroureter. Which of the following tests would the nurse expect the health care provider to order?
a.
KUB (kidney, ureter, bladder) radiography
b.
IVP (intravenous pyelogram)
c.
Endoscopy
d.
Ultrasound renal bladder
ANS: D
Health care providers use the x-ray examination to determine the size, shape, and location of the kidneys, ureters, and bladder structures. It is also useful in visualizing calculi (stones) or tumors in these organs. Common uses of endoscopy include: microscopic hematuria, detect/obtain specimens from bladder tumors, and obstruction of the bladder outlet and urethra. Common uses for IVP include: detect and measure urinary calculi, tumors, hematuria, and obstruction of the urinary tract. Doing an ultrasound renal bladder would detect masses, obstruction, the presence of hydronephrosis or hydroureter, abnormalities in the bladder wall, calculi, and measure postvoid residual.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF:966 | 967
OBJ: Describe nursing implications of common diagnostic tests of the urinary system.
TOP:Nursing Process: Assessment
MSC:Client Needs: Physiologic Integrity: Reduction of Risk Potential
10.A 57-year-old woman has been incontinent of urine for the past 2 months. Her health care provider has scheduled her to have a test to check for stress urinary incontinence. For which of the following tests should the nurse prepare the patient?
a.
Abdominal radiograph
b.
Intravenous pyelogram
c.
Endoscopy
d.
Ultrasound renal bladder
ANS: D
Ultrasound renal bladder common uses: detect masses, obstruction, presence of hydronephrosis or hydroureter, abnormalities in the bladder wall, calculi, and measure postvoid residual. Common uses of endoscopy include: microscopic hematuria, detect/obtain specimens from bladder tumors, and obstruction of the bladder outlet and urethra. Common uses for IVP include: detect and measure urinary calculi, tumors, hematuria, and obstruction of the urinary tract. Abdominal roentgenogram (plain film; kidney, ureter, bladder [KUB] or flat plate) are commonly used to detect and measure the size of urinary calculi.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF:966 | 967
OBJ: Describe nursing implications of common diagnostic tests of the urinary system.
TOP:Nursing Process: Assessment
MSC:Client Needs: Physiologic Integrity: Reduction of Risk Potential
11.The nurse is caring for a 45-year-old patient with a suspicious tumor in the bladder. The health care provider has ordered a procedure to identify the tumor tissue. Which test is done to collect tissue specimens?
a.
Abdominal radiograph
b.
Intravenous pyelogram
c.
Endoscopy/cystoscopy
d.
Ultrasound renal bladder
ANS: C
Common uses of endoscopy include: microscopic hematuria, detect/obtain specimens from bladder tumors, and obstruction of the bladder outlet and urethra. Common uses for IVP include: detect and measure urinary calculi, tumors, hematuria, and obstruction of the urinary tract. Abdominal roentgenogram (plain film; kidney, ureter, bladder [KUB] or flat plate) are commonly used to detect and measure the size of urinary calculi. Ultrasound renal bladder common uses: detect masses, obstruction, presence of hydronephrosis or hydroureter, abnormalities bladder wall, calculi, and measure postvoid residual.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF:966 | 967
OBJ: Describe nursing implications of common diagnostic tests of the urinary system.
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
12.A patient has just been diagnosed with diabetes mellitus. The patient voices concerns about possible kidney disease in the future. The patient asks, “In which part of the kidney is urine produced?” The nurse’s response is that urine is formed in the:
a.
ureter.
b.
bladder
c.
nephron.
d.
glomerulus.
ANS: D
One percent of the glomerular filtrate is excreted as urine. The ureter is attached to the kidney pelvis and carries urinary wastes into the bladder. The kidneys are reddish-brown, bean-shaped organs that filter the blood waste products. The nephrons remove waste products from the blood and regulate water and electrolyte concentrations in body fluids. The bladder is a hollow, distensible, muscular organ that holds urine.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF:952
OBJ: Explain the structures of the urinary system, including function and role in urine formation and elimination. TOP: Nursing Process: Assessment
MSC:Client Needs: Physiological Integrity
13.A nurse suspects that a patient may be experiencing urinary retention. What should the nurse expect to find on assessment of this patient?
a.
Spasms and difficulty urinating
b.
Pain in the umbilical region
c.
Large amounts of voided cloudy urine
d.
Small amounts of urine voided 2 to 3 times per hour
ANS: D
The patient is only able to partially empty the bladder. Because of a distended bladder, the patient experiences pressure, discomfort, and tenderness over the suprapubic area. Urinary output is also an indicator of bladder function. Patients who have not voided for longer than 3 to 6 hours, and have had fluid intake recorded should be evaluated for urinary retention. In some patients just helping them to a normal position to void prompts voiding.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF:963
OBJ:Discuss common alterations associated with urinary elimination.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
14.A patient with congestive heart failure reports experiencing increased urination when taking the prescribed medication. The nurse explains that which of the following is true?
a.
The patient is probably taking a diuretic.
b.
The patient is probably taking an anticholinergic.
c.
The patient is probably taking an antispasmodic.
d.
The patient probably has a UTI.
ANS: A
Diuretics increase urinary output by preventing resorption of water and certain electrolytes. Some drugs change the color of urine (e.g., phenazopyridine, orange; riboflavin, intense yellow). Anticholinergics (e.g., atropine, overactive bladder [OAB] agents) may increase the risk for urinary retention by inhibiting bladder contractility. Hypnotics and sedatives (e.g., analgesics, antianxiety agents) may reduce the ability to recognize and act on the urge to void.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 954 OBJ: Identify factors that commonly influence urination.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
15.A patient calls the office to tell you that his or her urine has changed to an orange color. The best response of the nurse is which of the following?
a.
“Did you recently start a new prescription for Pyridium?”
b.
“Did you recently drink a lot of cranberry juice?”
c.
“Have you noticed any blood on the tissue when you wipe yourself?”
d.
“Please make an appointment with the office right away.”
ANS: A
Various medications and foods change the color of urine. For example, patients taking phenazopyridine, a urinary analgesic, void urine that is bright orange. Eating beets, rhubarb, and blackberries causes red urine. The kidneys excrete special dyes used in IV diagnostic studies, which discolor the urine. Patients with liver disease who have high concentrations of bilirubin (urobilinogen) often have dark amber urine. Report unexpected color changes to the health care provider.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 964 OBJ: Describe characteristics of normal and abnormal urine.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
16.A 20-year-old female college student who suffers from frequent UTIs visits the student health clinic. The student asks how to decrease the frequency of UTIs. What is the nurse’s most appropriate response?
a.
“Drink at least 6 to 8 glasses of water daily.”
b.
“Increase your fluid intake by drinking caffeinated beverages.”
c.
“Cleanse the perineal area from anus to urethral meatus.”
d.
“Take an over-the-counter urinary tract cleanser.”
ANS: A
Drinking 6 to 8 glasses of water a day is recommended. Spread it out evenly throughout the day. Avoid or limit drinking beverages that contain caffeine (coffee, tea, chocolate drinks, and soft drinks). To avoid UTIs and contamination, women should cleanse themselves from the meatus toward the rectum. Proper hand washing and perineal care will greatly reduce the incidence of UTIs.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 970 OBJ: Discuss nursing measures to reduce urinary tract infections.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
17.The nurse is caring for a patient from a long-term care facility who has a Foley catheter. The urine in the bag is dark yellow and has a cloudy appearance and a strong odor. According to the transfer sheet, the Foley was placed 5 weeks before the hospital admission. What should the nurse do?
a.
Contact the health care provider for an order to change the catheter and provide an update on the appearance of the urine.
b.
Request an order for a urine for culture and sensitivity but do not change the catheter; the catheter can remain in place for another week per protocol.
c.
Contact the health care provider for an order to remove the catheter.
d.
Do nothing; the catheter can remain in place for another week per protocol.
ANS: A
For patients requiring long-term catheterization, catheter changes should be individualized, not routine. In many cases, catheters need to be changed every 4 to 6 weeks. Long-term catheters should be changed for leaking, blockage, and before obtaining a sterile specimen for urine culture. Long-term catheterization should be avoided because of its association with urinary tract infection. Make every attempt to remove catheters as soon as the patient can void.
PTS:1DIF:Cognitive Level: Analyzing (Analysis)
REF: 973 OBJ: Identify factors that commonly influence urinary elimination.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
18.A patient is scheduled for an intravenous pyelogram (IVP). What should the nurse do for this diagnostic examination?
a.
Make no special preparations before the examination.
b.
Push oral fluids before the examination.
c.
Have the patient fast after the procedure.
d.
Assess the patient for an allergy to iodine before the examination.
ANS: D
Patients need to be assessed for iodine or shellfish allergies before the test because the contrast media is iodine based. Before an IVP procedure, bowel preparation is required. The patient is NPO for at least 4 hours before the procedure. After the procedure the patient is encouraged to push fluids to reduce the nephrotoxic effects of the contrast material.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:966
OBJ: Describe nursing implications of common diagnostic tests of the urinary system.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
19.A patient with a Foley catheter needs a urine sample for culture and sensitivity. What is the most appropriate action for the nurse to take?
a.
Disconnect the drainage tube from the catheter.
b.
Open the drainage bag and withdraw urine.
c.
Withdraw urine from the closed system drainage bag.
d.
Insert a sterile blunt cannula in the catheter port to withdraw urine.
ANS: D
Disconnecting the drainage tube from the catheter breaches sterile technique and can cause introduction of bacteria into the system. Because urine in the drainage bag can rapidly grow bacteria, never take a urine sample from the drainage bag.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:964
OBJ: Describe nursing implications of common diagnostic tests of the urinary system.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
MULTIPLE RESPONSE
1.Patients with urinary incontinence are unable to completely empty their bladder. The nurse can assist a patient to void by using which of the following methods? (Select all that apply.)
a.
Completing manual bladder compression
b.
Having the patient assume the normal position for voiding
c.
Telling the patient to void only when he or she has the urge
d.
Pressing down on the right and left flanks of the patient
e.
Running water in the sink
ANS: A, B, E
To promote relaxation and stimulate bladder contractions, use sensory stimuli (e.g., turning on running water, putting a patient’s hand in a pan of warm water, or stroking the female patient’s inner thigh) and providing privacy. A strategy to promote relaxation and stimulate bladder contractions is to help patients assume the normal position for voiding. Encourage patients to attempt voiding according to the clock, not urge.
PTS:1DIF:Cognitive Level: Applying (Application)
REF:971
OBJ: Discuss nursing measures to promote normal urination and to control incontinence.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
OTHER
1.A patient needs to have a Foley catheter inserted. Place the following steps into the correct order for this procedure. (Separate letters by a comma and space as follows: A, B, C, D.)
a.Apply sterile gloves.
b.Open the catheterization kit.
c.Wash the perineal area with soap and water.
d.Position the patient.
e.Drape the perineum.
f. Clean the urethra.
ANS:
D, C, B, A, E, F
Positioning permits visualization of the perineal structures. Washing reduces microorganisms. The catheterization kit contains materials necessary to insert the catheter. Apply sterile gloves to prevent infection, drape the perineum, and clean urethra with antiseptic solution to prevent infection.
PTS:1DIF:Cognitive Level: Applying (Application)
REF: 979-983 OBJ: Apply or insert an external or indwelling catheter.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
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