ATI SKILLS MODULE~URINARY
ELIMINATION EXAM QUESTIONS AND
ANSWERS
Urinary Elimination - Answer-is a precise system of filtration, reabsorption, and
excretion. These processes help fluid and electrolyte balance while filtering and
excreting water soluble wastes.
Primary organs involved in urinary elimination - Answer-Kidneys; with nephrons
performing most of the functions of filtration and elimination. Most adults produce
between 1,500 and 2,000 mL of urine per day.
Once urine is filtered it: - Answer-passes through ureters into the bladder (storage
reservoir for urine). Once urine collects in the bladder (150-200mL) it sends a signal to
the brain to indicate the need to urinate. Person then relaxes internal and external
sphincters located at bottom of the bladder and the urethra. Urine passes from the
bladder through uretha where it exits the body.
Factors that affect urinary elimination - Answer-surgery, immobility, medications, and
therapeutic diets.
Urinary diversions - Answer-temporary or permanent. A stoma for the drainage of urine.
Created for patients who have bladder cancer, radiation injury to the bladder, or chronic
urinary infections may require a diversion to drain urine from a diseased or
dysfunctional bladder.
Two types of urinary diversions - Answer-Continent urinary reservoir and Orthotopic
Neobladder
Continent Urinary Reservoir - Answer-It is created from a distal portion of the ileum and
proximal portion of the colon. The ureters are embedded in the reservoir. The reservoir
is situated under the abdominal wall and has a narrow ilieal segment brought out
through the abdominal wall to form a small stoma. The ileocecal valve creates a one
way valve in the pouch through which a catheter is inserted to empty the urine from the
pouch. Patients must be able to catheterize the pouch 4-6x a day for the rest of their
lives.
Orthotopic Neobladder - Answer-Uses an ileal pouch to replace the bladder.
Anatomically the pouch is in the same place as the bladder was before removal. This
allows patients to void normally.
, Nephrostomy - Answer-When patients need urinary drainage directly from one or both
kidneys. In this case a tube is placed directly into the renal pelvis to the abdominal
surface.
Ureterostomy - Answer-One or both ureters to the abdominal surface
What are the roles of a nurse when caring for a client with urinary diversions? - Answer-
Refer the client to an ostomy nurse
Train the client on management of urinary diversions.
Refer the client to ostomy associations for further support
Refer to client to United Ostomy Associations of America.
Factors affecting normal Urinary Elimination:
Age - Answer--full bladder control by 4-5 yrs of age
-enlargement of prostate after 40 yrs of age leads to urinary frequency, hesitancy,
retention, incontinence, and UTI's
-childbirth and gravity weaken pelvic floor, putting patients at risk for the prolapse of
bladder, leading to stress incontinence, which patients can manage with pelvic floor
(kegel) exercises.
Factors affecting normal Urinary Elimination:
Older adult patients - Answer--fewer nephrons
-loss of muscle tone of bladder (frequency occurs)
-inefficient emptying of the bladder (residual urine increases risk of UTI's)
-increase in nocturia (waking up to pee at night)
Factors affecting normal Urinary Elimination:
Pregancy - Answer--growing fetus compromises bladder space and compresses the
bladder
-there is a 30-50% increase in circulatory volume, which increases renal workload and
output
-hormone relaxin causes relaxation of sphincter
Factors affecting normal Urinary Elimination:
Diet - Answer--increase in sodium leads to decreased urination
-caffeine and alcohol intake lead to increased urination
Factors affecting normal Urinary Elimination: - Answer-Poor abdominal and pelvic
muscle tone.
Acute and chronic disorders.
Spinal chord injury.
Factors affecting normal Urinary Elimination:
Immobility - Answer-Incontinence is not associate with aging. It is a result of
neurological or mobility impairments.
ELIMINATION EXAM QUESTIONS AND
ANSWERS
Urinary Elimination - Answer-is a precise system of filtration, reabsorption, and
excretion. These processes help fluid and electrolyte balance while filtering and
excreting water soluble wastes.
Primary organs involved in urinary elimination - Answer-Kidneys; with nephrons
performing most of the functions of filtration and elimination. Most adults produce
between 1,500 and 2,000 mL of urine per day.
Once urine is filtered it: - Answer-passes through ureters into the bladder (storage
reservoir for urine). Once urine collects in the bladder (150-200mL) it sends a signal to
the brain to indicate the need to urinate. Person then relaxes internal and external
sphincters located at bottom of the bladder and the urethra. Urine passes from the
bladder through uretha where it exits the body.
Factors that affect urinary elimination - Answer-surgery, immobility, medications, and
therapeutic diets.
Urinary diversions - Answer-temporary or permanent. A stoma for the drainage of urine.
Created for patients who have bladder cancer, radiation injury to the bladder, or chronic
urinary infections may require a diversion to drain urine from a diseased or
dysfunctional bladder.
Two types of urinary diversions - Answer-Continent urinary reservoir and Orthotopic
Neobladder
Continent Urinary Reservoir - Answer-It is created from a distal portion of the ileum and
proximal portion of the colon. The ureters are embedded in the reservoir. The reservoir
is situated under the abdominal wall and has a narrow ilieal segment brought out
through the abdominal wall to form a small stoma. The ileocecal valve creates a one
way valve in the pouch through which a catheter is inserted to empty the urine from the
pouch. Patients must be able to catheterize the pouch 4-6x a day for the rest of their
lives.
Orthotopic Neobladder - Answer-Uses an ileal pouch to replace the bladder.
Anatomically the pouch is in the same place as the bladder was before removal. This
allows patients to void normally.
, Nephrostomy - Answer-When patients need urinary drainage directly from one or both
kidneys. In this case a tube is placed directly into the renal pelvis to the abdominal
surface.
Ureterostomy - Answer-One or both ureters to the abdominal surface
What are the roles of a nurse when caring for a client with urinary diversions? - Answer-
Refer the client to an ostomy nurse
Train the client on management of urinary diversions.
Refer the client to ostomy associations for further support
Refer to client to United Ostomy Associations of America.
Factors affecting normal Urinary Elimination:
Age - Answer--full bladder control by 4-5 yrs of age
-enlargement of prostate after 40 yrs of age leads to urinary frequency, hesitancy,
retention, incontinence, and UTI's
-childbirth and gravity weaken pelvic floor, putting patients at risk for the prolapse of
bladder, leading to stress incontinence, which patients can manage with pelvic floor
(kegel) exercises.
Factors affecting normal Urinary Elimination:
Older adult patients - Answer--fewer nephrons
-loss of muscle tone of bladder (frequency occurs)
-inefficient emptying of the bladder (residual urine increases risk of UTI's)
-increase in nocturia (waking up to pee at night)
Factors affecting normal Urinary Elimination:
Pregancy - Answer--growing fetus compromises bladder space and compresses the
bladder
-there is a 30-50% increase in circulatory volume, which increases renal workload and
output
-hormone relaxin causes relaxation of sphincter
Factors affecting normal Urinary Elimination:
Diet - Answer--increase in sodium leads to decreased urination
-caffeine and alcohol intake lead to increased urination
Factors affecting normal Urinary Elimination: - Answer-Poor abdominal and pelvic
muscle tone.
Acute and chronic disorders.
Spinal chord injury.
Factors affecting normal Urinary Elimination:
Immobility - Answer-Incontinence is not associate with aging. It is a result of
neurological or mobility impairments.
