Chapter 18: Urinary Elimination

Chapter 18: Urinary Elimination

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is preparing to insert an indwelling urinary catheter into a female patient who is having major open heart surgery and will be in the intensive care unit after surgery. Which statement about the purpose of the catheter by the patient best indicates that teaching by the nurse was effective?

a.	“An empty bladder always helps prevent bladder infections.”
b.	“The catheter drains residual urine from a urinary obstruction.”
c.	“The catheter prevents urinary infections.”
d.	“The catheter will allow us to monitor your urine output status closely after surgery.”

 

 

ANS:  D

During acute illness, a patient may require urinary catheterization for close monitoring of urine output or to facilitate bladder emptying when bladder function is compromised. An empty bladder does help prevent bladder infections by decreasing the risk of residual urine; however, a bladder infection is not as immediate a threat to the patient as fluid and electrolyte imbalance. A urinary catheter drains urine from an obstruction, but this is not this patient’s problem. The catheter does not prevent urinary infections.

 

DIF:    Cognitive Level: Analyze                REF:   Page 470

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Evaluation

 

2. The nurse inserts an indwelling urinary catheter into an adult patient who has been unable to void. Which assessment finding would the nurse expect?

a.	The patient complains of burning.
b.	The urine output exceeds 30 mL/hr.
c.	The patient develops a fever.
d.	The urine is yellow and blood tinged.

 

 

ANS:  B

The nurse expects the catheter to drain more than 30 mL/hr of urine as an indication of adequate urine output because it has been a while since the patient voided. A patient complaint of burning or the development of a fever would be unexpected findings and warrant further assessment. Blood-tinged urine would also be an unexpected finding and warrant further assessment.

 

DIF:    Cognitive Level: Comprehend          REF:   Page 478

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Assessment

 

3. The nurse evaluates the effectiveness of the patient’s intermittent urinary catheterization for residual urine. Which of the following requires follow-up nursing intervention?

a.	The patient is passing urine in the bathroom.
b.	The urine is clear yellow and without odor.
c.	The bladder is nonpalpable above the pubic bone.
d.	The patient complains of frequency and urgency.

 

 

ANS:  D

Patient complaints of frequency and urgency are consistent with clinical indicators of a bladder infection, which indicates that the intermittent catheterization has been ineffective. Follow-up nursing interventions include increasing patient fluids to dilute and flush out urinary pathogens and collaborating with the provider for potential alterations to the therapeutic regimen, including urine culture and sensitivity. If the patient passes urine in the bathroom, he or she has enough bladder control to reach the bathroom before urinating, which is consistent with clinical indicators of normal urinary function. Normal urine is clear, yellow, and without strong odors and indicates that intermittent urinary catheterization is effective therapy. A nonpalpable bladder indicates an empty bladder and effective intermittent urinary catheterization.

 

DIF:    Cognitive Level: Apply                   REF:   Page 489

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Evaluation

 

4. In which position would the nurse place a female patient when preparing to insert a urinary catheter?

a.	Prone
b.	Supine
c.	High-Fowler’s
d.	Dorsal recumbent

 

 

ANS:  D

The nurse assists the female patient to the dorsal recumbent position for insertion of a urinary catheter because this position exposes the perineum adequately to visualize the urinary meatus and maintain aseptic technique during the procedure. Positioning the patient on her stomach, flat in bed, or sitting upright impairs the nurse’s ability to expose the perineum, visualize the urinary meatus, maintain aseptic technique, and drain urine from the bladder.

 

DIF:    Cognitive Level: Remember            REF:   Page 480

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation

 

5. Which technique should the nurse use to cleanse the perineum of a female patient during urinary catheter insertion?

a.	Rinse the perineum with warm antiseptic solution.
b.	Swab the perineum 3 times from the anus to the urinary meatus.
c.	Use the nondominant hand to keep the labia spread apart continuously.
d.	Use the nondominant hand to cleanse from the urinary meatus to the rectum.

 

 

ANS:  C

The nurse uses the nondominant hand to spread apart the labia and maintain the position until the catheter is in place; once the nurse contaminates the nondominant hand by touching the perineum, he or she cannot use that hand to manipulate sterile equipment. Rinsing the perineum is impractical and not necessary. To prevent infection, the nurse uses the dominant hand to cleanse from the urinary meatus to the rectum in one motion.

 

DIF:    Cognitive Level: Remember            REF:   Page 482

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation