Chapter 46 Urinary Elimination-Fundamentals of Nursing

Chapter 46: Urinary Elimination
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MULTIPLE CHOICE ra




1. A nursing attendant is teaching a hospital client about the urinary system. In which ord
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er will the nursing attendant present the structures, following the flow of urine?
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Kidney, urethra, bladder, ureters ra ra ra




b. Kidney, ureters, bladder, urethra ra ra ra




c. Bladder, kidney, ureters, urethra ra ra ra




d. Bladder, kidney, urethra, ureters ra ra ra




ACCURATE ar



ANSWER:-B
The flow of urine follows these structures in this order: kidney, ureters, bladder, and urethra.
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DIF:Understand (comprehension) ra



OBJ:Explain the function and role of urinary system structures in urine formation and elimination.
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TOP:Teaching/Learning MSC: Health Promotion and Maintenance ra ra ra ra




2. A nursing attendant is reviewing urinary laboratory results. Which finding will cause th
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e nursing attendant to follow up? a. Protein level of 2 mg/100 mL
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b. Urine output of 80 mL/hr ra ra ra ra




c. Specific gravity of 1.036 ra ra ra




d. pH of 6.4 ra ra




ACCURATE ANSWER:-C ra



Dehydration, reduced renal blood flow, and increase in antidiuretic hormone secretion elevat
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e specific gravity. Normal specific gravity is 1.005 to 1.030. An output of 30 mL/hr or less for 2 or
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more hours would be cause for concern; 80 mL/hr is normal. The normal pH of urine is betwe
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en 4.6 and 8.0. Protein up to 8 mg/100 mL is acceptable; however, values in excess of this coul
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d indicate renal disease.
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DIF:Apply (application) ra



OBJ:Appraise nursing implications of common diagnostic tests of the urinary system.
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TOP:Implementation MSC: Reduction of Risk Potential ra ra ra




3. A hospital client is experiencing oliguria. Which action should the nursing attendant pe
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rform first?
a. Assess for bladder distention. ra ra ra




b. Request an order for diuretics. ra ra ra ra




c. Increase the hospital client ’s intravenous fluid rate. ra ra ra ra ra ra ra




d. Encourage the hospital client to drink caffeinated beverages. ra ra ra ra ra ra ra




ACCURATE ANSWER:-A ra



Oliguria is diminished urinary output in relation to fluid intake. The nursing attendant first s
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hould gather all assessment data to determine the potential cause of oliguria. It could be that
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the hospital client does not have adequate intake, or it could be that the bladder sphincter is
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not functioning and the hospital client is retaining water. Increasing fluids is effective if the h
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, ospital client does not have adequate intake or if dehydration occurs. Caffeine can work as a d
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iuretic but is not helpful if an underlying pathology is present. An order for diuretics can be o
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btained if the hospital client was retaining water, but this should not be the first action.
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DIF:Analyze (analysis) ra



OBJ:Demonstrate a physical assessment focused on urinary elimination. ra ra ra ra ra ra ra ar



TOP:Assessment MSC: Physiological Adaptation ra ra




4. A hospital client requests the nursing attendant ’s help to the bedside commode and be
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co
mes frustrated when unable to void in front of the nursing attendant . How should the
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nur sing attendant interpret the hospital client ’s inability to void?
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a. The hospital client can be anxious, making it difficult for abdominal and perineal
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muscles to relax enough to void. ra ra ra ra ra




b. The hospital client does not recognize the physiological signals that indicate a need to void.
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c. The hospital client is lonely and calling the nursing attendant in under false
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pretenses is a way to get attention. ra ra ra ra ra ra




d. The hospital client is not drinking enough fluids to produce adequate urine output.
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ACCURATE ANSWER:-A ra



Attempting to void in the presence of another can cause anxiety and tension in the muscles th
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at make voiding difficult. Anxiety can impact bladder emptying due to inadequate relaxation o
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f the pelvic floor muscles and urinary sphincter. The nursing attendant should give the hospit
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al client privacy and adequate time if appropriate. No evidence suggests that an underlying p
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hysiological (does not recognize signals or not drinking enough fluids) or psychological (lonel
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y) condition exists.
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DIF:Understand (comprehension) ra



OBJ:Identify factors that commonly impact urinary elimination. ra ra ra ra ra ra



TOP:Evaluation MSC: Basic Care and Comfort ra ra ra ra




5. The hospital client is having lower abdominal surgery and the nursing attendant inserts
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a n indwelling catheter. What is the rationale for the nursing attendant ’s action? a.
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The hospital client may void uncontrollably during the procedure.
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b. Local trauma sometimes promotes excessive urine incontinence.
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c. Anesthetics can decrease bladder contractility and cause urinary retention. ra ra ra ra ra ra ra ra




d. The hospital client will not interrupt the procedure by asking to go to the bathroom.
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ACCURATE ANSWER:-C ra



Anesthetic agents and other agents given during surgery can decrease bladder contractility a
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nd/or sensation of bladder fullness, causing urinary retention. Local trauma during lower abd
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ominal and pelvic surgery sometimes obstructs urine flow, requiring temporary use of an indwe
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lling urinary catheter. The hospital client is more likely to retain urine rather than experience
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uncontrollable voiding.
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DIF:Understand (comprehension) ra



OBJ:Identify factors that commonly impact urinary elimination. ra ra ra ra ra ra ar



TOP:Evaluation MSC: Reduction of Risk Potential ra ra ra ra




6. The nursing attendant , upon reviewing the history, discovers the hospital client
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s dysuria. Which assessment finding is consistent with dysuria? a. Blood in the urine
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b. Burning upon urination ra ra

, c. Immediate, strong desire to void ra ra ra ra




d. Awakes from sleep due to urge to void ra ra ra ra ra ra ra




ACCURATE ANSWER:-B ra



Dysuria is burning or pain with urination. Hematuria is blood in the urine. Urgency is an im
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mediate and strong desire to void that is not easily deferred. Nocturia is awakening form sleep
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due to urge to void. ra ra ra ra




DIF:Understand (comprehension) ra



OBJ:Compare and contrast common alterations associated with urinary elimination. ra ra ra ra ra ra ra ra ar



TOP:Assessment MSC: Physiological Adaptation ra ra




7. An 86-year- ra



old hospital client is experiencing uncontrollable leakage of urine with a strong desire to voi
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d and even leaks on the way to the toilet. Which priority nursing diagnosis will the nursing
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attendant include in the hospital client ’s plan of care? a. Functional urinary incontinence
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b. Urge urinary incontinence ra ra




c. Impaired skin integrity ra ra




d. Urinary retention ra




ACCURATE ANSWER:-B ra




Urge urinary incontinence is the leakage of urine associated with a strong urge to void. Hospital
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client s leak urine on the way to or at the toilet and rush or hurry to the toilet. Urinary retenti
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on is the inability to empty the bladder. Functional urinary incontinence is incontinence due to c
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auses outside the urinary tract, such as mobility or cognitive impairments. While Impaired sk
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in integrity can occur, it is not the priority at this time, and there is no data to support this dia
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gnosis.
DIF:Analyze (analysis) ra



OBJ:Select nursing diagnoses associated with alterations in urinary elimination.
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TOP:Diagnosis MSC: Management of Care ra ra ra




8. A hospital client has fallen several times in the past week when attempting to get to the
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rbathroom. The hospital client gets up 3 or 4 times a night to urinate. Which recommen
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dation by the nursing attendant is most appropriate in correcting this urinary problem
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?
a. Limit fluid and caffeine intake before bed.
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b. Leave the bathroom light on to illuminate a pathway.
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c. Practice Kegel exercises to strengthen bladder muscles. ra ra ra ra ra ra




d. Clear the path to the bathroom of all obstacles before bedtime.
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ACCURATE ANSWER:-A ra



Reducing fluids, especially caffeine and alcohol, before bedtime can reduce nocturia. To prev
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ent nocturia, suggest that the hospital client avoid drinking fluids 2 hours before bedtime. C
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learing a path to the bathroom, illuminating the path, or shortening the distance to the bathro
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om may reduce falls but will not correct the urination problem. Kegel exercises are useful if a
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hospital client is experiencing stress incontinence.
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DIF:Apply (application) ra



OBJ:Discuss nursing interventions to promote normal urinary elimination. TO
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P:Implementation MSC:
Health Promotion and Maintenance ra ra ra