Question 1

The nurse measures the urine output of a patient who requires a bedpan to void.Which action should the nurse take first? Put on gloves and:

Accepted Answer

First,the nurse should put on gloves and have the patient void directly into the bedpan.Next,she should pour the urine into a graduated container,place the measuring device on a flat surface,and read the amount at eye level.She should observe the urine for color,clarity,and odor.Then,if no specimen is required,she should discard the urine in the toilet and clean the container and bedpan.Finally,she should record the amount of urine voided on the patient's intake and output record.

Question 2

The nurse is caring for a patient who underwent a bowel resection 2 hours ago.His urine output for the past 2 hours totals 50 mL.Which action should the nurse take?

Accepted Answer

The amount of 50 mL in 2 hours is not normal output.The kidneys typically produce 60 mL of urine per hour.Therefore,the nurse should notify the provider when the patient shows diminished urine output (oliguria).Patients who undergo abdominal surgery commonly require increased infusions of IV fluid during the immediate postoperative period.The nurse cannot provide increased IV fluids without a provider's order.The nurse should not administer any medications before the scheduled time without a prescription.The provider may hold the patient's scheduled dose of diuretic if he determines that the patient is experiencing deficient fluid volume.

Question 3

Which urine specific gravity would be expected in a patient admitted with dehydration?

Accepted Answer

Normal urine specific gravity ranges from 1.010 to 1.025.Specific gravity less than 1.010 indicates fluid volume excess,such as when the patient has fluid overload (too much IV fluid)or when the kidneys fail to concentrate urine.Specific gravity greater than 1.025 is a sign of deficient fluid volume that occurs,for example,as a result of blood loss or dehydration.

Question 4

Which outcome is appropriate for the patient who underwent urinary diversion surgery and creation of an ileal conduit for invasive bladder cancer?

Accepted Answer

The most appropriate outcome for this patient is "The patient will perform urostomy self-care" by a specific date.The patient with an ileal conduit is unable to resume a "normal" urination pattern; urine,along with mucus,drains continuously from the stoma site,so the urine will not be clear.Also,the phrase "sufficient volume" is too vague for an outcome statement.The patient with a continent urostomy inserts a catheter into the stoma to drain urine.

Question 5

Which daily urine output is within normal limits for a newborn weighing 8 pounds?

Accepted Answer

A newborn weighing 8 pounds (3.6 kg)should produce 15 to 60 mL of urine per kilogram per day.If the newborn produces 50 mL/kg/day and weighs 3.6 kg,he will produce a total of 180 mL in 24 hours.The other options are not within normal limits and require further assessment.

Question 6

A patient is admitted with high BUN and creatinine levels,low blood pH,and elevated serum potassium level.Based on these laboratory findings the nurse suspects which diagnosis?

Accepted Answer

Elevated BUN,creatinine,and serum potassium levels and low blood pH are signs of renal failure.Cystitis is an infection of the bladder and would not result in abnormal renal function.Renal calculi typically produce blood in the urine but do not lead to marked renal dysfunction and failure.Enuresis is involuntary urination,particularly common in children,and does not produce renal dysfunction.The cause of enuresis is often emotional,developmental,or trauma related.

Question 7

Which action should the nurse take when beginning bladder training using scheduled voiding?

Accepted Answer

The nurse should offer the patient the bedpan or assist the patient to the bathroom every 2 hours while she is awake.You would encourage the patient to get up once during the night to void but awakening the patient every 2 hours would lead to fatigue.If the patient adheres to the schedule,the voiding interval should be increased by 15 to 30 minutes each week.Simply asking the patient about the urge to void does not help to manage bladder emptying.

Question 8

A mother tells the nurse at an annual well child checkup that her 6-year-old son occasionally "wets himself." Which response by the nurse is appropriate?

Accepted Answer

The nurse should explain that occasional wetting is normal in children during the early school years.The mother should handle the situation calmly and avoid punishing the child.Medications are occasionally prescribed for nocturnal enuresis when the child is older and not sleeping at home,but not for occasional daytime wetting.

Question 9

The nurse identifies the nursing diagnosis Urinary Incontinence (Total)in an older adult patient admitted after a stroke.Urinary Incontinence places the patient at risk for which complication?

Accepted Answer

Urine contains ammonia,which may cause excoriation with prolonged contact with the skin.Bowel incontinence,not urinary incontinence,increases the patient's risk for urinary tract infection.Immobility and high consumption of calcium-containing foods increase the risk for renal calculi.

Question 10

A patient who sustained a spinal cord injury will perform intermittent self-catheterization after discharge.After discharge teaching,which statement by the patient would indicate correct understanding of the procedure?

Accepted Answer

The nurse should inform the patient that clean technique can be used after discharge.The patient should wash his hands before the procedure,then wash the reusable catheter in soap and water,and rinse and store it in a clean,dry place.It is not necessary for the patient to use a new catheter for each catheterization.The patient should use a straight catheter; therefore,a balloon is not inflated after insertion.Straight catheters are removed immediately after use.

Question 11

A patient is prescribed furosemide (Lasix),a loop diuretic,for treatment of congestive heart failure.The patient is at risk for which electrolyte imbalance associated with use of this drug?

Accepted Answer

Furosemide is a loop diuretic,which causes potassium to pass into the urine.This drug increases the risk for hypokalemia (low potassium); it does not cause hypocalcemia (low calcium in the blood),hypomagnesemia (low blood magnesium),or hypophosphatemia (low blood phosphorous).

Question 12

What position should the patient assume before the nurse inserts an indwelling urinary catheter?

Accepted Answer

The nurse should have the patient lie supine with knees flexed,feet flat on the bed (dorsal recumbent position).If the patient is unable to assume this position,the nurse should help the patient to a side-lying position.Modified Trendelenburg position is used for central venous catheter insertion.Prone position is sometimes used to improve oxygenation in patients with adult respiratory distress syndrome.Semi-Fowler's position is used to prevent aspiration in those receiving enteral feedings.

Question 13

The nurse instructs a woman about providing a clean-catch urine specimen.Which of the following statements indicates that the patient correctly understands the procedure?

Accepted Answer

To obtain a clean-catch urine specimen,the nurse should instruct the patient to cleanse the genital area from front to back and collect the specimen midstream.This follows the principle of going from "clean" to "dirty." The nurse should have the ambulatory patient void into a "hat" (container for collecting the urine of an ambulatory patient)when monitoring urinary output,but not when obtaining a clean-catch urine specimen.A urinary catheter is required for a sterile urine specimen,not a clean-catch specimen.A 24-hour urine collection may be necessary to evaluate some disorders but a clean-catch specimen is a one-time collection.

Question 14

Which task can the nurse safely delegate to the nursing assistive personnel?

Accepted Answer

The nurse can safely delegate indwelling urinary catheter care to nursing assistive personnel who are adequately trained to do so.Palpating the bladder,administering continuous bladder irrigation,and obtaining the patient's history and physical assessment involve the critical-thinking skills of a professional nurse.

Question 15

A patient complains that she passes urine whenever she sneezes or coughs.How should the nurse document this complaint in the patient's healthcare record?

Accepted Answer

Stress incontinence is an involuntary loss of urine that occurs with increased intra-abdominal pressure.Activities that typically produce the symptom include sneezing,coughing,laughing,lifting,and exercise.Transient incontinence is a short-term incontinence that is expected to resolve spontaneously.It is typically caused by urinary tract infection or medications,such as diuretics.Overflow incontinence is the loss of urine when the bladder becomes distended; it is commonly associated with fecal impaction,enlarged prostate,and neurological conditions.Urge incontinence is the involuntary loss of urine associated with a strong urge to void.

Question 16

The nurse notes that a patient's indwelling urinary catheter tubing contains sediment and crusting at the meatus.Which action should the nurse take?

Accepted Answer

The catheter needs to be changed when sediment collects in the tubing or catheter and crusting at the meatus occurs.It is not necessary to notify the provider immediately.The nurse should not flush the catheter tubing.The patient should be encouraged to consume fluids that increase urine acidity to prevent urinary tract infection; however,it will not help clear the catheter tubing of sediment.

Question 17

While performing a physical assessment,the student nurse tells her instructor that she cannot palpate her patient's bladder.Which statement by the instructor is best?

Accepted Answer

The bladder is not palpable unless it is distended by urine.It is not difficult to palpate the bladder when distended.The nurse should document her finding,but it is not an abnormal finding.It is not necessary to notify the nurse assigned to the patient.

Question 18

The student nurse asks the provider if she will prescribe an indwelling urinary catheter for a hospitalized patient who is incontinent.The provider explains that catheters should be utilized only when absolutely necessary because:

Accepted Answer

Indwelling urinary catheters should not be routinely used for hospitalized patients with incontinence because they are the leading cause of healthcare-acquired infection (nosocomial).The cost of an indwelling urinary catheter should not deter its use if necessary.Latex-free catheters are available for patients with or at risk for latex allergy.Insertion may be somewhat uncomfortable,but it should not be painful.

Question 19

Which intervention should the nurse take first to promote micturation in a patient who is having difficulty voiding?

Accepted Answer

The nurse should perform independent nursing measures such as pouring warm water over the patient's perineum before notifying the provider.If nursing measures fail,the nurse should notify the provider.The provider may order an indwelling urinary catheter or a straight catheter to relieve the patient's urinary retention.

Question 20

The surgeon orders hourly urine output measurement for a patient after abdominal surgery.The patient's urine output has been greater than 60 mL/hour for the past 2 hours.Suddenly,the patient's urine output drops to almost nothing.What should the nurse do first?

Accepted Answer

If the patient's urinary output suddenly ceases,the nurse should irrigate the urinary catheter to assess whether the catheter is blocked.If no blockage is detected,the nurse should notify the surgeon.The surgeon may request that the catheter be changed if irrigation does not help or if the tubing is not kinked.However,the nurse should not change a catheter in the immediate postoperative period without consulting with the surgeon.The surgeon may prescribe an IV fluid bolus if the patient is suspected to have a deficient fluid volume.

Quiz 28: Urinary Elimination