Chapter 045

Potter & Perry: Fundamentals of Nursing, 7th Edition
Test Bank
Chapter 45: Urinary Elimination
MULTIPLE CHOICE
1. The nurse determines that the nursing diagnosis stress urinary incontinence related to
decreased pelvic muscle tone is the most appropriate for an oriented adult female client.
A therapeutic nursing intervention based on this diagnosis is to:
1. Apply adult diapers
2. Catheterize the client
3. Administer Urecholine
4. Teach Kegel exercises
ANS: 4
Pelvic floor exercises, also known as Kegel exercises, improve the strength of pelvic
floor muscles and consist of repetitive contractions of muscle groups. These exercises
have demonstrated effectiveness in treating stress incontinence, overactive bladders, and
mixed causes of urinary continence. The client is oriented and therefore could be taught
Kegel exercises to improve pelvic floor muscle tone. Applying adult diapers does not
improve the clients problem of incontinence and places the client at risk for skin
breakdown. Because bladder catheterization carries the risk for urinary tract infection
(UTI), it is preferable to rely on other measures for management of incontinence. The
nurse can support the use of Kegel exercises as an inexpensive nonpharmacological
intervention to reduce the clients stress incontinence. Bethanechol (Urecholine)
stimulates the parasympathetic nervous system to promote complete bladder emptying
and is primarily used to treat urinary retention and possible overflow incontinence.
Nonpharmacological approaches should be attempted before pharmacological approaches
are taken.
DIF: A
REF: 1148
OBJ: Comprehension
TOP: Nursing Process: Planning
MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and
Comfort/Elimination
2. Which of the following statements should the nurse use to instruct the nursing assistant
caring for a client with an indwelling urinary catheter?
1. Empty the drainage bag at least every 8 hours.
2. Clean up the length of the catheter to the perineum.
3. Use clean technique to obtain a specimen for culture and sensitivity.
4. Place the drainage bag on the clients lap while transporting the client to testing.
ANS: 1
Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
45-2
The urinary drainage bag should be emptied at least every 8 hours. If large outputs are
noted, more frequent emptying will be required. The perineum should be cleansed and
then down the catheter for a length of approximately 10 cm (4 inches). Only use sterile
technique to collect specimens from a closed drainage system. Avoid raising the drainage
bag above the level of the bladder. If it becomes necessary to raise the bag during transfer
of the client to a bed or stretcher, clamp the tubing or empty the tubing contents to the
drainage bag first. The drainage bag can be attached to the wheelchair below the level of
the clients bladder for transport. It should not be placed on the clients lap.
DIF: A
REF: 1164
OBJ: Comprehension
TOP: Nursing Process: Implementation
Comfort/Elimination
3. The nurse suspects that the client has a bladder infection based on the client's exhibiting
an early sign or symptom such as:
1. Chills
2. Hematuria
3. Flank pain
4. Incontinence
ANS: 2
Irritation to the bladder and urethral mucosa results in blood-tinged urine (hematuria).
Hematuria is a sign of a bladder infection. Chills are a more systemic symptom
associated with pyelonephritis. Flank pain is a more systemic symptom associated with
pyelonephritis. Incontinence is not a symptom of a bladder infection.
DIF: A
REF: 1134
OBJ: Comprehension
TOP: Nursing Process: Assessment
Comfort/Elimination
4. When obtaining a sterile urine specimen from an indwelling urinary catheter the nurse
should:
1. Disconnect the catheter from the drainage tubing
2. Withdraw urine from a urinometer
3. Open the drainage bag and removing urine
4. Use a needle to withdraw urine from the catheter port
ANS: 4
Test Bank
45-3
A sterile specimen can be obtained through the special port found on the side of the
indwelling catheter. The nurse clamps the tubing below the port, allowing fresh,
uncontaminated urine to collect in the tube. After the nurse wipes the port with an
antimicrobial swab, a sterile syringe needle is inserted, and at least 3 to 5 mL of urine is
withdrawn. Using sterile technique, the nurse transfers the urine to a sterile container. The
catheter should not be disconnected from the drainage tubing. The system should remain
a closed system to prevent infection. A urinometer is a device used to determine the
specific gravity of urine. It is not a sterile device and should not be used for obtaining a
sterile urine specimen. Urine should not be obtained from a drainage bag for a specimen,
because the urine would not be fresh and would be contaminated from microorganisms in
the drainage bag.
DIF: A
REF: 1140
OBJ: Comprehension
Comfort/Elimination
5. Immediately after an intravenous pyelogram (IVP) the nurse should observe the client for
which of the following?
1. Infection in the urinary bladder
2. An allergic reaction to the contrast material
3. Urinary suppression caused by injury to kidney tissues
4. Incontinence as a result of paralysis of the urinary sphincter
ANS: 2
After an IVP the nurse should encourage fluid intake to dilute and flush dye from the
client and observe the client for late symptoms of allergy (e.g., rash). There is no
increased risk for infection of the urinary bladder from an IVP. This would be more likely
with an invasive procedure, such as an endoscopy (cystoscopy). An IVP should not injure
tissues of the kidney or cause paralysis of the urinary sphincter.
DIF: A
REF: 1145
OBJ: Comprehension
Comfort/Elimination
6. A client with an excessive alcohol intake has a reduced amount of antidiuretic hormone
(ADH). The nurse anticipates the client will exhibit:
1. Hematuria
2. An increased blood pressure
3. Dry mucous membranes
4. A low serum sodium level
ANS: 3
Test Bank
45-4
Alcohol inhibits the release of ADH, resulting in increased water loss in urine. The client
may show signs of decreased fluid volume (dehydration), including dry mucous
membranes. The effects of excessive alcohol intake and reduced antidiuretic hormone
will not cause hematuria. Having decreased levels of antidiuretic hormone will lead to
increased urine production. The client may exhibit a decreased blood pressure resulting
from decreased fluid volume and an increased serum sodium level with dehydration.
DIF: A
REF: 1133
OBJ: Comprehension
Comfort/Elimination
7. A client is going to have a cystoscopy. Which of the following reflects the correct
information that should be taught before the procedure?
1. Are you allergic to iodine?
2. There will be no need to have a special consent form.
3. You will need to have fluids restricted the evening before the cystoscopy.
4. You will probably be given sedatives before the procedure.
ANS: 4
Although this procedure may be accomplished using local anesthesia, it is more
commonly performed using general anesthesia or conscious sedation to avoid
unnecessary anxiety and trauma for the client. A cystoscopy involves direct visualization.
No contrast dye is used; therefore the nurse does not need to ask if the client is allergic to
iodine. A signed consent form is obtained. Fluids are not restricted before or after the
procedure. The flushing action helps remove bacteria from the urethra.
DIF: A
REF: 1146
OBJ: Comprehension
Comfort/Elimination
8. A postpartum client has been unable to void since her delivery of her baby this morning.
Which of the following nursing measures would be beneficial for the client initially?
1. Increase fluid intake to 3500 mL.
2. Insert indwelling Foley catheter.
3. Rinse the perineum with warm water.
4. Apply firm pressure over the bladder.
ANS: 3
Test Bank
45-5
The nurse can pour warm water over the clients perineum and create the sensation to
urinate. A client with normal renal function who does not have heart or kidney disease
should drink 2000 to 2500 mL of fluid daily. Increasing the clients fluid intake to 3500
mL is excessive. Because bladder catheterization carries the risk for UTI, it should be
avoided if possible. The nurse should try other noninvasive measures to promote
urination before calling the health care provider for an order to insert a Foley catheter.
The nurse should not apply firm pressure over the bladder of a postpartum woman with
an intact nervous system. The nurse could create more damage by exerting force on the
clients uterus at this time.
DIF: C
REF: 1149
OBJ: Analysis
Comfort/Elimination
9. The nurse is visiting the client who has a nursing diagnosis of urinary retention. Upon
assessment the nurse anticipates that this client will exhibit:
1. Severe flank pain and hematuria
2. Pain and burning on urination
3. A loss of the urge to void
4. A feeling of pressure and voiding of small amounts
ANS: 4
With urinary retention, urine continues to collect in the bladder, stretching its walls and
causing feelings of pressure, discomfort, tenderness over the symphysis pubis,
restlessness, and diaphoresis. The sphincter temporarily opens to allow a small volume of
urine (25 to 60 mL) to escape, with no real relief of discomfort. Severe flank pain and
hematuria are supporting data for an upper urinary tract infection (pyelonephritis). Pain
and burning on urination are symptoms of a lower urinary tract infection (such as a
bladder infection). Supportive data for reflex incontinence would include a loss of the
urge to void.
DIF: A
REF: 1146
OBJ: Comprehension
Comfort/Elimination
10. The unit manager is evaluating the care of a new nursing staff member. Which of the
following is an appropriate technique for the nurse to implement in order to obtain a
clean-voided urine specimen?
1. Apply sterile gloves for the procedure.
2. Restrict fluids before the specimen collection.
3. Place the specimen in a clean urinalysis container.
4. Collect the specimen after the initial stream of urine has passed.
ANS: 4
Test Bank
45-6
To collect a clean-voided specimen, the nurse should collect the specimen (30 to 60 mL)
after the initial stream of urine has passed. Nonsterile gloves are adequate. Fluids are
encouraged so the client will be more likely to be able to void. The specimen should be
collected in a sterile container and then placed into a plastic specimen bag.
DIF: A
REF: 1142
OBJ: Comprehension
Comfort/Elimination
11. The nurse is aware that clients with chronic alterations in kidney function suffer from
insufficient amounts of:
1. Vitamin A
2. Vitamin D
3. Vitamin E
4. Vitamin K
ANS: 2
The kidneys play a role in calcium and phosphate regulation by producing a substance
that converts vitamin D into its active form. Clients with chronic alterations in kidney
function do not make sufficient amounts of the active vitamin D. Clients with chronic
alterations in kidney function do not suffer from an insufficient amount of vitamin A,
vitamin E, or vitamin K.
DIF: A
REF: 1131
OBJ: Comprehension
Comfort/Elimination
12. In an assessment of a client with reflex incontinence the nurse expects to find that the
client has:
1. A constant dribbling of urine
2. An uncontrollable loss of urine when coughing or sneezing
3. No urge to void and an unawareness of bladder filling
4. An immediate urge to void but not enough time to reach the bathroom
ANS: 3
The nurse expects to find the client with reflex incontinence to have no urge to void and
an unawareness of bladder filling. A constant dribbling of urine may be seen with
overflow incontinence. With stress incontinence the client is unable to control loss of
urine when coughing or sneezing. Functional incontinence is seen when there is an
immediate urge to void but not enough time to get to the bathroom.
DIF: A
REF: 1152
OBJ: Comprehension
Comfort/Elimination
Test Bank
45-7
13. When calculating the daily intake and output, the nurse anticipates that the urinary output
for an average adult should be:
1. 800 to 1000 mL/day
2. 1000 to 1200 mL/day
3. 1500 to 1600 mL/day
4. 2000 to 2300 mL/day
ANS: 3
Although output does depend on intake, the normal adult urine output is 1500 to 1600
mL/day.
DIF: A
REF: 1130
OBJ: Comprehension
Comfort/Elimination
14. A timed urine specimen collection is ordered. The test will need to be restarted if which
of the following occurs?
1. The client voids in the toilet.
2. The urine specimen is kept cold .
3. The first voided urine is discarded.
4. The preservative is placed in the collection container.
ANS: 1
Missed specimens make the whole collection inaccurate, causing the test to need to be
restarted. The urine specimen is kept in a collection container, which may contain
preservatives, or the urine may be kept in a collection container on ice. The timed period
begins after the client urinates. The first voided urine is discarded, and then the time for
collection begins.
DIF: A
REF: 1140
OBJ: Comprehension
Comfort/Elimination
15. The nurse is working with a client who has a urinary diversion. Included in the plan of
care for this client is instruction that:
1. Special clothing will need to be ordered in order to fit around the diversion
2. A stomal bag will only need to be worn at night
3. A reduction in physical activity will be planned
4. Special skin care is a priority
ANS: 4
Test Bank
45-8
Special skin care is a priority in caring for a client with a urinary diversion. Local
irritation and skin breakdown occur when urine comes in contact with the skin for long
period. Special clothing is not necessary for the client with a urinary diversion, but the
client must wear a stomal pouch continuously because there is no sphincter control for
regulation of urine flow. There is no need to plan for a reduction in activity.
DIF: A
REF: 1134
OBJ: Comprehension
Comfort/Elimination
16. Which of the following would indicate that the clinician performing the catheterization of
a female client was competent?
1. Keeping both hands sterile throughout the procedure
2. Reinserting the catheter if it was misplaced initially in the vagina
3. Inflating the balloon to test it before catheter insertion
4. Advancing the catheter 7 to 8 inches
ANS: 3
Before inserting the indwelling catheter, the balloon should be tested by injecting the
fluid from the prefilled syringe into the balloon port. The dominant hand is kept sterile
throughout the procedure. The nondominant hand is not kept sterile because it touches the
client. If the catheter is misplaced, it should be left in the vagina as a landmark indicating
where not to insert, and another sterile catheter should be inserted into the urethra. The
catheter should be advanced 2 to 3 inches in the female client.
DIF: A
REF: 1159
OBJ: Comprehension
TOP: Nursing Process: Evaluation
Comfort/Elimination
17. The nurse caring for a client who is receiving closed catheter irrigation instills 950 mL of
normal saline irrigant during the shift. There is a total of 1725 mL in the drainage bag.
The nurse calculates the clients urinary output for the shift to be:
1. 775 mL
2. 950 mL
3. 1725 mL
4. 2675 mL
ANS: 1
The amount of fluid used to irrigate the bladder and catheter should be subtracted from
the total output to determine an accurate urinary output. 1725 mL 950 mL = 775 mL.
DIF: A
REF: 1168
OBJ: Comprehension
Comfort/Elimination
Test Bank
45-9
18. The nurse caring for a client in an extended care facility should provide which
intervention in a bladder retraining program?
1. Providing negative reinforcement when the client is incontinent
2. Having the client wear adult diapers as a preventative measure
3. Putting the client on a q2h toilet schedule during the day
4. Promoting the intake of caffeine to stimulate voiding
ANS: 3
A bladder retraining program includes initiating a toileting schedule on awakening, at
least every 2 hours during the day and evening, before getting into bed, and every 4 hours
at night. Negative reinforcement should not be used when the client is incontinent.
However, positive reinforcement should be provided when continence is maintained. The
client should be offered protective undergarments to contain urine and reduce the clients
embarrassment (not diapers). Tea, coffee, other caffeine drinks, and alcohol should be
minimized.
DIF: A
REF: 1171
OBJ: Comprehension
Comfort/Elimination
19. A 3-year-old child is visiting the pediatric clinic. The nurse suspects that the child has a
urinary tract infection. An appropriate method for the nurse to implement in order to
obtain a urine specimen from the child is to:
1. Use an indwelling catheter
2. Offer fluids 30 minutes in advance
3. Apply pressure over the urinary bladder
4. Place a diaper on the child and squeeze out the specimen
ANS: 2
Offering the young child fluids 30 minutes before requesting a specimen may help.
Because bladder catheterization carries the risk for UTI, blockage, and trauma to the
urethra, it is preferable to rely on other measures for specimen collection. Applying
pressure over the urinary bladder of a child with an intact nervous system will not help
and may create more stress in the child. Squeezing urine from a childs diaper is not an
accurate method of obtaining a urine specimen to determine whether the child has a
urinary tract infection.
DIF: A
REF: 1140
OBJ: Comprehension
Comfort/Elimination
20. A urine sample is obtained from the client for a routine urinalysis. Upon reviewing the
results of the test, the nurse notes that an expected finding of the urinalysis is:
1. pH 8.0
Test Bank
45-10
2. Specific gravity 1.018

3. Protein amounts to 12 mg/100 mL
4. White blood cells (WBCs) 5 to 8 per low-power field casts
ANS: 2
The normal specific gravity of urine is 1.010 to 1.025. The normal urine pH is 4.6 to 8.0,
with an average of 6.0. Protein is not normally found in the urine. The normal value for
urine protein is 0, or up to 8 mg/100 mL. The number of WBCs is 0 to 4 per low-power
field, and casts should be 0 in a normal urinalysis.
DIF: A
REF: 1140
OBJ: Comprehension
Comfort/Elimination
21. The client is experiencing urinary retention, and the health care provider is contacted. The
nurse anticipates a medication that will be ordered to promote emptying of the bladder is:
1. Oxybutynin chloride (Ditropan)
2. Bethanechol (Urecholine)
3. Propantheline (Pro-Banthine)
4. Nystatin (Mycostatin)
ANS: 2
Cholinergic drugs, such as bethanechol (Urecholine), increase contraction of the bladder
and improve emptying. Bethanechol stimulates parasympathetic nerves to increase
bladder wall contraction and relax the sphincter. Oxybutynin chloride (Ditropan) is an
anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally
stimulates the bladder), and thus reduces incontinence. Propantheline (Pro-Banthine) is
an anticholinergic drug that depresses the neurotransmitter acetylcholine (which normally
stimulates the bladder), and thus reduces incontinence. Nystatin (Mycostatin) is an
antifungal agent.
DIF: A
REF: 1133
OBJ: Comprehension
Comfort/Elimination
22. Which of the following actions by the nurse would indicate the need for remedial
education in the removal of an indwelling catheter?
1. Draping the female client between the thighs
2. Obtaining a specimen before removal
3. Cutting the catheter to deflate the balloon
4. Checking the clients output for 24 hours after removal
ANS: 3
Test Bank
45-11
The nurse should not cut the catheter to deflate the balloon. The nurse inserts an empty,
sterile syringe into the injection port. The nurse slowly withdraws all of the solution to
deflate the balloon totally. The nurse then pulls the catheter out smoothly and slowly. The
nurse positions the client in the same position as during catheterization. The nurse places
a towel between a female clients thighs or over a male clients thighs. Some institutions
recommend collecting a sterile urine specimen before removal of the catheter or sending
the catheter tip for culture and sensitivity tests. The nurse should assess the clients
urinary function by noting the first voiding after catheter removal and documenting the
time.
DIF: A
REF: 1165
OBJ: Comprehension
Comfort/Elimination
23. A condom catheter is to be used for an adult male client in the extended care facility. In
the application of the condom catheter, the nurse employs appropriate technique when:
1. Using sterile gloves
2. Wrapping the adhesive tape securely around the base of the penis
3. Leaving a 1- to 2-inch space between the tip of the penis and the end of the catheter
4. Taping the tubing tightly to the thigh and attaching the drainage bag to the bed
frame
ANS: 3
A 1- to 2-inch space should be left between the tip of the penis and the end of the
catheter. Nonsterile gloves are worn to apply a condom catheter. Standard adhesive tape
should never be used to secure a condom catheter because it does not expand with change
in penis size and is painful to remove. The tubing of a condom catheter is not taped
tightly to the thigh. The drainage bag is attached to the lower bed frame.
DIF: A
REF: 1169
OBJ: Comprehension
Comfort/Elimination
24. Urinary elimination may be altered with different pathophysiological conditions. For the
client with diabetes mellitus, the nurse anticipates that an initial urinary sign or symptom
will be:
1. Urgency
2. Dysuria
3. Hematuria
4. Polyuria
ANS: 4
Test Bank
45-12
An initial urinary symptom of diabetes mellitus is polyuria. Urgency is not a symptom of

diabetes mellitus. Urgency may be caused by a full bladder, bladder irritation from
infection, incompetent urethral sphincter, or psychological stress. Dysuria is not a
symptom of diabetes mellitus. Dysuria may be caused by bladder inflammation, trauma,
or inflammation of the urethral sphincter. Hematuria is not a symptom of diabetes
mellitus. Hematuria may be a symptom of neoplasms of the bladder or kidney,
glomerular disease, infection of the kidney or bladder, trauma to urinary structures,
calculi, or bleeding disorders.
DIF: A
REF: 1138
OBJ: Comprehension
Comfort/Elimination
25. The nurse is assessing a client admitted with complaints related to chronic kidney
dysfunction. The nurse recognizes that this client is most likely to present with which of
the resulting symptoms?
1. Anemia
2. Hypotension
3. Diabetes mellitus
4. Clinical depression
ANS: 1
Clients with chronic alterations in kidney function cannot produce sufficient quantities of
the hormone erythropoietin; therefore they are prone to anemia. Diabetes mellitus may be
a cause of the renal dysfunction, and the client may or may not be depressed.
Hypertension, not hypotension, is a typical outcome of kidney dysfunction.
DIF: C
REF: 1138
OBJ: Analysis
Comfort/Elimination
26. Which of the following statements made by a client experiencing chronic kidney
dysfunction reflects the best understanding of the most common physiological effect this
disorder can have on the body?
1. Im tested regularly for anemia.
2. My diet is restricted because of this problem.
3. Diabetes runs in my family, so I get tested regularly.
4. I can get really depressed if I think about this too much.
ANS: 1
Clients with chronic alterations in kidney function cannot produce sufficient quantities of
the hormone erythropoietin; therefore they are prone to anemia. The remaining options
deal with nonphysiological events or conditions that are more causes of the dysfunction,
not effects.
Test Bank
45-13
DIF: C
REF: 1130
OBJ: Analysis
Comfort/Elimination
27. Which of the following clients is at greatest risk for developing a renal infection?
1. A 27-year-old male
2. A 16-year-old male
3. A 9-year-old female
4. A 45-year-old female
ANS: 3
The short length of the urethra predisposes women and girls to infection. It is easy for
bacteria to enter the urethra from the perineal area. The 9-year-old female has the shortest
urethra and so has the greatest risk.
DIF: A
REF: 1131
OBJ: Analysis
Comfort/Elimination
28. Which of the following clients will most benefit from client/parent education regarding
the prevention of renal infections via proper hygiene habits?
1. Males ages 35 to 65
2. Males ages 3 to 16
3. Females ages 3 to 12
4. Females ages 20 to 50
ANS: 3
The 3- to 12-year-old female has the shortest urethra and so has the greatest need. The
short length of the urethra predisposes women and girls to infection. It is easy for bacteria
to enter the urethra from the perineal area.
DIF: C
REF: 1131
OBJ: Analysis
Comfort/Elimination
29. The nurse is interviewing a client with a history of benign prostatic hypertrophy (BPH).
In light of this diagnosis, the nurse should include information regarding which of the
following in order to assess the chronic effects of this renal disorder?
1. Number of times he usually urinates in a 24-hour period
2. What medications he is currently taking for the condition
3. The results of his latest prostate-specific antigen (PSA) testing
4. Whether he usually experiences a complete emptying of his bladder
ANS: 4
Test Bank
45-14
If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time
the micturition reflex changes, causing bladder overactivity, and can cause the bladder to
not completely empty. The remaining options focus on the impact the condition has on
daily living and the monitoring necessary to determine the presence of prostate cancer.
DIF: C
REF: 1138
OBJ: Analysis
Comfort/Elimination
30. Which of the following statements made by a client with benign prostatic hypertrophy
(BPH) during an admissions interview reflects the best understanding of the long-term
effects of this condition?
1. I usually get up 3 to 4 times a night to urinate.
2. My health care provider prescribed some medication that has helped.
3. At least I can usually empty my bladder; I really hate that feeling of being full.
4. The prostate specific antigen (PSA) results have stayed stable for the last 3 tests.
ANS: 3
If a chronic obstruction such as prostate enlargement hinders bladder emptying, over time
the micturition reflex changes, causing bladder overactivity, and can cause the bladder to
not completely empty. The remaining options focus on the impact the condition has on
daily living and the monitoring of the client for prostate cancer.
DIF: C
REF: 1138
OBJ: Analysis
Comfort/Elimination
31. The nurse realizes that a postsurgical client who underwent a left knee replacement is
most likely to experience which of the following urinary complications?
1. Dysuria
2. Bladder spasms
3. A bladder infection
4. Burning on urination
ANS: 1
Medications including anesthesia interfere with both the production and the
characteristics of urine and affect the act of urination. Difficulty with urination is a
common complication of general anesthesia. The remaining options are not directly
connected to postsurgical complications.
DIF: C
REF: 1138
OBJ: Analysis
Comfort/Elimination
Test Bank
45-15
32. The nurse recognizes that a client recovering from anesthesia required for surgical repair
of a fractured ulna is likely to experience difficulty urinating primarily because of:
1. The impaired cognitive state the client will experience as the effects of the
anesthesia wear off
2. The decreased volume of orally ingested fluids before, during, and after the
surgical procedure
3. The length of time the client was under the effects of general anesthesia required
for the surgical procedure
4. The effects of the anesthetic on the nerves and muscles controlling the relaxation of
the urinary bladder
ANS: 4
Medications, including anesthesia, interfere with both the production and the
characteristics of urine and affect the act of urination. The remaining options may affect
urination but not to the extent of the anesthetic effects.
DIF: C
REF: 1138
OBJ: Analysis
Comfort/Elimination
33. A 70-year-old client is discussing his recent difficulty in initiating his flow of urine while
on a cross-country bus tour with a senior citizens group. Which of the following
assessment questions is directed toward the most likely cause of the problem?
1. Did the bus stop frequently so you could get up and walk around?
2. Did you drink plenty of water while you were on the trip?
3. Do you find using public restrooms unsettling?
4. Do you have any chronic urinary problems?
ANS: 3
Attempting to void in a public restroom sometimes results in a temporary inability to
void. Although the remaining options may affect urination, this situation strongly
suggests an emotional cause.
DIF: C
REF: 1132
OBJ: Analysis
Comfort/Elimination
34. Which of the following nursing interventions is most specific for a client being monitored
for possible urinary retention?
1. Measuring urine output with each urination
2. Monitoring the color and clarity of urine with each voiding
3. Collecting a urine sample for a culture and sensitivity test
4. Asking the cognizant client to report each time he or she urinates
ANS: 4
Test Bank
45-16
With retention the client may void small amounts of urine 2 or 3 times an hour with no
real relief of discomfort or may continually dribble urine. Be aware of the volume and
frequency of voiding to assess this condition in the client. The alert, oriented client can be
asked to notify the nurse each time micturition occurs. The remaining options are more
generalized or specific for a urinary tract infection.
DIF: C
REF: 1138
OBJ: Analysis
Comfort/Elimination
35. The nurse is caring for an older adult who is recovering from hip replacement surgery.
The client shares with the nurse that he has been using the urinal a lot but I feel like my
bladder isnt empty. Which of the following statements by the nurse shows the best
understanding of the appropriate initial intervention for this particular client?
1. Ill call your primary care provider and let her know you are having this problem.
2. I have the ancillary personnel measure your output, so please dont empty your
urinal yourself.
3. Im going to ask that you please use your call bell and notify me or the ancillary
staff each time you void.
4. I suggest that we try limiting the amount of fluids you are drinking for a few hours
and see if that helps.
ANS: 3
With retention the client may void small amounts of urine 2 or 3 times an hour with no
real relief of discomfort or may continually dribble urine. Be aware of the volume and
frequency of voiding to assess this condition in the client. The alert, oriented client can be
asked to notify the nurse each time micturition occurs. The notification of the primary
care provider is not the initial intervention. Although measuring the urine output is not
inappropriate, it is not specific to this clients complaint. Restricting fluids is neither
appropriate nor likely to affect the problem.
DIF: C
REF: 1138
OBJ: Analysis
Comfort/Elimination
36. The nurse is discussing signs and symptoms of both upper and lower urinary tract
infections with a client who has a history of both. Which of the following statements by
the client reflects the best understanding of the differing symptomatology?
1. When I get cloudy urine, I figure I have an infection.
2. Burning when I urinate is usually the first symptom I notice.
3. I have a big problem when I feel like I have the flu but with back pain too.
4. When I see blood in my urine, I know I need to call my health care provider.
ANS: 3
Test Bank
45-17
Clients with lower UTIs have pain or burning during urination (dysuria) as urine flows
over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the
infection worsens. An irritated bladder (cystitis) causes a frequent and urgent sensation of
the need to void. Irritation to bladder and urethral mucosa results in blood-tinged urine
(hematuria). The urine appears concentrated and cloudy because of the presence of
WBCs or bacteria. If infection spreads to the upper urinary tract (kidneys
pyelonephritis, a serious renal condition), flank pain, tenderness, fever, and chills are
common. The remaining options identify general symptoms that are not condition
specific.
DIF: C
REF: 1134
OBJ: Analysis
MSC: NCLEX test plan designation Physiological Integrity/Basic Care and
Comfort/Elimination
37. The nurse is discussing urinary elimination alterations with a group of middle-age adults.
The nurse appropriately shares with the group that whereas men experience urinary
frequency as a result of prostate enlargement, the female:
1. Is more affected if she has experienced multiple pregnancies
2. Does not usually experience urinary problems until much later in life
3. Experiences an increased risk for urinary tract infections related to menopause
4. Appears to have less risk for kidney infections because of gradually declining
estrogen levels
ANS: 3
Aging often impairs micturition. In the male, prostate enlargement usually begins during
the 40s and continues throughout life, resulting in urinary frequency and possible urinary
retention. In women, changes in the urethral mucosa associated with loss of estrogen
during and after menopause contribute to increased susceptibility to UTIs. Although
pregnancies may affect urinary continence, decreased estrogen levels do not protect
against kidney infections.
DIF: C
REF: 1134
OBJ: Analysis
Comfort/Elimination
38. The nurse is caring for a 19-year-old male client with a fractured left femur whose leg
was pinned 36 hours ago and is now in traction. Which of the following stressors is
mostly likely the cause of this clients difficulty related to starting urine flow?
1. Pain related to the fracture and its repair
2. Anxiety regarding the serious nature of the injury
3. The inability to stand in order to facilitate urination
4. Poor fluid intake in the accident and ensuing surgery
ANS: 3
Test Bank
45-18
Some men who cannot stand to urinate become overly distressed. Although the other
options may have some effect, the primary cause is most likely the emotional stress of not
being able to assume the usual position for male urination.
DIF: C
REF: 1151
OBJ: Analysis
Comfort/Elimination
39. Which of the following statements made by an older adult with a history of urinary tract
infections shows the best understanding of interventions that minimize the risk for
developing such infections?
1. I drink 8 ounces of cranberry juice a day to discourage bacterial growth in my
bladder.
2. Whenever I feel an infection coming on, I immediately call my health care
provider.
3. I told the nurses I didnt want a urinary catheter unless I absolutely had to have
one.
4. Whenever I can, I avoid drinking after 8 PM because I usually go to bed about 11
PM.
ANS: 1
Make fluids such as cranberry juice available as part of the clients fluid intake.
Cranberry juice discourages bacterial adherence to the bladder wall. The remaining
options either have less impact on a daily basis or are more related to early detection
rather than prevention.
DIF: C
REF: 1150
OBJ: Analysis
Comfort/Elimination
40. The nurse is caring for a 23-year-old male client who is in the ICU with second and third
degree burns over 40 percent of his body. One of the first symptoms that the client is
having organ failure is that the urine output is less than:
1. 30 mL/hour
2. 40 mL/hour
3. 50 mL/hour
4. 60 mL/hour
ANS: 1
An output of less than 30 mL/hr indicates possible renal alterations.
DIF: B
REF: 1134
OBJ: Application
Comfort/Elimination
Test Bank
45-19
41. The nurse knows that which of the following clients is most at risk for a bone fracture:
1. 44-year-old female with rheumatoid arthritis
2. 64-year-old male with Cushings disease
3. 53-year-old female with chronic alterations in renal function
4. 60-year-old male with cirrhosis of the liver
ANS: 2
The kidneys affect calcium and phosphate regulation by producing a substance that
converts vitamin D into its active form. Clients with chronic alterations in kidney
function do not make sufficient amounts of the active vitamin D. They are prone to
develop renal bone disease resulting from the demineralization of bone caused by
impaired calcium absorption.
DIF: A
REF: 1132
OBJ: Comprehension
Comfort/Elimination
42. A 33-year-old female client in her first trimester of pregnancy complains to the nurse on
her prenatal visit that she is needs to urinate more frequently and is concerned about
having a urinary tract infection. Which of the following statements would be most
appropriate for the nurse to make?
1. Are you having any burning or pain when you urinate?
2. Your uterus is pushing up against your bladder which causes you to have to go
more frequently
3. Later in your pregnancy as the baby gets bigger it will be a lot worse
4. It is normal for you to have to urinate more frequently because you are eliminating
for two now
ANS: 1
In a pregnant woman the developing fetus pushes against the bladder, reducing the
bladders capacity and causing a feeling of fullness. This effect is more likely to occur in
the first and third trimesters. Since the client expressed concern regarding a UTI, the
nurse should make further assessments to explore that possibility.
DIF: A
REF: 1134
OBJ: Comprehension
Comfort/Elimination
43. The nurse is caring for a 56-year-old female client with renal failure who regularly
undergoes peritoneal dialysis. The nurse understands that this client is most at risk for:
1. Pulmonary embolism
2. Electrolyte imbalances
3. Polyuria
4. Urinary incontinence
Test Bank
45-20
ANS: 2
Peritoneal dialysis is an indirect method of cleansing the blood of waste products using
osmosis and diffusion with the peritoneum functioning as a semipermeable membrane.
This method removes excess fluid and waste products from the bloodstream when a
sterile electrolyte solution (dialysate) is instilled into the peritoneal cavity by gravity via a
surgically placed catheter. The dialysate remains in the cavity for a prescribed time
interval and then is drained out by gravity, taking accumulated wastes and excess fluid
and electrolytes with it. This places the client at risk for electrolyte imbalances.
DIF: A
REF: 1138
OBJ: Comprehension
Comfort/Elimination
44. A 46-year-old client has had kidney disease for the past 10 years. His kidneys are no
longer functioning. The nurse knows that which of the following offers the client the
potential for restoration of normal kidney function?
1. Lasix therapy
2. Hemodialysis
3. Peritoneal dialysis
4. Kidney transplant
ANS: 4
Unlike the other treatments, successful organ transplantation offers the client the potential
for restoration of normal kidney function.
DIF: C
REF: 1130
OBJ: Analysis
Comfort/Elimination
45. A 45-year-old female client has been hospitalized for severe abdominal pain. The health
care provider has ordered a PCA pump for the client to help control the pain. It has been
determined that the pain is due to cholelithiasis and the client is scheduled for a
cholecystectomy later that day. The client returns to the unit postoperatively with a Foley
catheter anchored. The nurse notes that the clients urine output has decreased. The nurse
knows that this is most likely due to:
1. Stress response
2. Preoperative NPO status
3. Kidney failure
4. Post-operative urinary retention
ANS: 1
Test Bank
45-21
The stress response releases an increased amount of ADH, which increases water
reabsorption. Stress also elevates the level of aldosterone, causing retention of sodium
and water. Both of these substances reduce urine output in an effort to maintain
circulatory fluid volume. Although the client was NPO postoperatively, she had a pain
pump, which indicates that she had a running IV with fluids. It is not indicated that the
client had kidney failure, and since the client had an anchored urinary catheter, she would
not have urinary retention.
DIF: A
REF: 1131
OBJ: Comprehension
Comfort/Elimination
46. A 73-year-old female client with Parkinsons syndrome was prescribed levodopa when
other therapies had failed. The client is alarmed that her urine has become dark brown
and is concern. The nurse explains to the client that one of the side effects of this
medication is that it may cause:
1. Her urine to become dark brown or black
2. Heart failure
3. Kidney failure
4. Hair loss
ANS: 1
Some medications change the color of urine. Phenazopyridine (Pyridium) colors the urine
a bright orange to rust; amitriptyline causes a green or blue discoloration, whereas
levodopa discolors the urine to brown or black.
DIF: C
REF: 1134
OBJ: Analysis
Comfort/Elimination
47. A 34-year-old diabetic female client had a spontaneous vaginal birth of a 37-week 6.2 kg
infant. The nurse caring for the client post-partum understands that due to the traumatic
birth the client is at increased risk for:
1. Acute urinary retention
2. Hematuria
3. Kidney failure
4. Enuresis
ANS: 1
Test Bank
45-22
In acute retention key signs are bladder distention and absence of urine output over
several hours. The client under the influence of anesthetics or analgesics often feels only
pressure, but the alert client has severe pain as the bladder distends beyond its normal
capacity. In severe urinary retention the bladder holds as much as 2000 to 3000 mL of
urine. Retention occurs as a result of urethral obstruction, surgical or childbirth trauma,
alterations in motor and sensory innervation of the bladder, medication side effects, or
anxiety.
DIF: C
REF: 1132
OBJ: Analysis
Comfort/Elimination
48. A 46-year-old male client with chronic renal problems is in the hospital for a
nephrostomy. The nurse understands that this is the surgical insertion of a tube that will
drain urine from the clients:
1. Bladder
2. Urethra
3. Ureters
4. Renal pelvis
ANS: 4
Some clients have a need for urinary drainage directly from one or both kidneys. In this
case a tube placed directly into the renal pelvis. This procedure is called a nephrostomy.
DIF: A
REF: 1132
OBJ: Knowledge
Comfort/Elimination
MULTIPLE RESPONSE
1. Which of the following clients presents with an increased risk for urinary incontinence?
(Select all that apply.)
1. The 74-year-old diagnosed with parkinsonism 5 years ago
2. The 25-year-old with Crohns disease diagnosed 4 years ago
3. The 62-year-old Alzheimers disease client diagnosed 8 years ago
4. The 34-year-old mother of two diagnosed with multiple sclerosis 8 years ago
5. The 73-year-old diagnosed with benign prostatic hyperplasia (BPH) 6 years ago
6. The 69-year-old client diagnosed with type 2 diabetes 9 years ago
ANS: 1, 3, 4, 5, 6
Test Bank
45-23
Many diseases and conditions affect the ability to micturate. Diabetes mellitus and
multiple sclerosis cause changes in nerve functions that can lead to possible loss of
bladder tone, reduced sensation of bladder fullness, or inability to inhibit bladder
contractions. Older men often suffer from BPH, which makes them prone to urinary
retention and incontinence. Some clients with cognitive impairments, such as
Alzheimers disease, lose the ability to sense a full bladder or are unable to recall the
procedure for voiding. Diseases that slow or hinder physical activity interfere with the
ability to void. Degenerative joint disease and parkinsonism are examples of conditions
that make it difficult to reach and use toilet facilities. Crohns disease is gastrointestinal in
nature and does not directly affect micturition.
DIF: C
REF: 1133
OBJ: Analysis
Comfort/Elimination
2. The nurse is caring for a client with type 1 diabetes who has been diagnosed with endstage renal disease (ESRD). The nurse regularly assesses the client for which of the
following? (Select all that apply.)
1. Nausea
2. Polyuria
3. Lethargy
4. Vomiting
5. Confusion
6. Headache
ANS: 1, 3, 4, 5, 6
Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease
(ESRD). Eventually the client has symptoms resulting from uremic syndrome. An
increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities,
oliguria, nausea, vomiting, headache, drowsiness, coma, and convulsions characterize
this syndrome.
DIF: A
REF: 1133
OBJ: Comprehension
Comfort/Elimination
3. Which of the following symptomatology is reflective of a lower urinary tract infection?
(Select all that apply.)
1. Chills and fever
2. Nausea and vomiting
3. Frequency or urgency
4. Cloudy or blood-tinged urine
5. Pelvic tenderness or flank pain
6. Burning or pain when voiding
Test Bank
45-24
ANS: 1, 2, 3, 4, 6
Clients with lower UTIs have pain or burning during urination (dysuria) as urine flows
over inflamed tissues. Fever, chills, nausea, vomiting, and malaise develop as the
infection worsens. An irritated bladder (cystitis) causes a frequent and urgent sensation of
the need to void. Irritation to bladder and urethral mucosa results in blood-tinged urine
(hematuria). The urine appears concentrated and cloudy because of the presence of white
blood cells (WBCs) or bacteria. If infection spreads to the upper urinary tract (kidneys
pyelonephritis, a serious renal condition), flank pain, tenderness, fever, and chills are
common.
DIF: A
REF: 1133
OBJ: Comprehension
Comfort/Elimination
4. The nurse is discussing a middle-age adult male clients report of nocturia. The client has
diabetes that is managed with diet and exercise as well as hypertension that is currently
well-controlled with medication. The nurse should include which of the following as
possible causes for his frequent urination at night? (Select all that apply.)
1. An enlarged prostate gland
2. Poorly controlled blood glucose
3. Drinking a cup of tea before bed
4. Possible side effect of his medication
5. Taking his diuretic too close to bedtime
6. Consuming too many liquids during the day
ANS: 1, 2, 3, 5
Excessive fluid intake before bed (especially coffee or alcohol), renal disease, the aging
process, prostate enlargement, poorly controlled diabetes, and diuretic medication therapy
scheduled late in the day can cause nocturia. If taken appropriately, his medications are
not likely a cause.
DIF: C
REF: 1135
OBJ: Analysis
Comfort/Elimination

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Potter & Perry: Fundamentals of Nursing, 7th Edition

2. Specific gravity 1.018

An initial urinary symptom of diabetes mellitus is polyuria. Urgency is not a symptom of

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