1.

The nurse recognizes that urinary elimination changes may occur even in healthy older adults because
of which of the following?

1. The bladder distends and its capacity increases

2. Older adults ignore the need to void
3. Urine becomes more concentrated
4. The amount of urine retained after voiding increases

2. During assessment of the client with urinary incontinence, the nurse is most likely to assess for which
of the following? Select all that apply.

1. Perineal skin irritation

2. Fluid intake of less than 1,500 mL/d
3. History of antihistamine intake
4. Hx of UTI
5. A fecal impaction

3. Which action represents the appropriate nursing management of a client wearing a condom catheter?

1. Ensure that the tip of the penis fits snugly against the end of the condom
2. Check the penis for adequate circulation 30 min after applying
3. Change the condom every 8 hours
4. Tape the collecting tube to the lower abdomen.

4. The catheter slips into the vagina during a straight catheterization of a female client. The nurse does
which action?

1. Leaves the catheter in place and gets a new sterile catheter

2. Leaves the catheter in place and asks another nurse to attempt the procedure
3. Removes the catheter and redirects it to the urinary meatus
4. Removes the catheter, wipes it with a sterile gauze, and redirects it to the urinary meatus

5. Which statement indicates a need for further teaching of a home care client with a long term
indwelling catheter?

1. “I will keep the collecting bag below the level of the bladder at all times”
2. “Intake of cranberry juice may help decrease the risk of infection”
3. “Soaking in a warm tub bath may ease the irritation associated with the catheter”
4. “I should use clean tech. when emptying the collecting bag”

6. During shift report, the nurse learns that an older female client is unable to maintain continence after
she senses the urge to void and becomes incontinent on the way to the bathroom. Which nursing
diagnosis is most appropriate?

1. stress urinary incontinence

2. reflex urinary incontinence
3. functional urinary incontinence
4. urge urinary incontinence
7. A female client has a urinary tract infection. Which teaching points by the nurse should be helpful to
the client? Select all that apply.

1. Limit fluids to avoid the burning sensation on urination

2. Review symptoms of UTI with the client
3. Wipe the perineal area from back to front
4. Wear cotton underclothes
5. Take baths rather than showers

8. The nurse will need to assess the client’s performance of clean intermittent self catheterization (CISC)
for a client with which urinary diversion?

1. Ileal conduit
2. Kock pouch
3. Neobladder
4. Vesicostomy

9. Which focus is the nurse most likely to teach for a client with a flaccid bladder?

1. Habit training: attempt voiding at specific time periods

2. Bladder training: delay voiding according to a pre-schedule timetable
3. Crede’s maneuver: apply gentle manual pressure to the lower abdomen
4. Kegel exercises: contract the pelvic muscles

10. Which of the following behaviors indicates that the client on a bladder training program has met the
expected outcomes? Select all that apply.

1. Voids each time there is an urge

2. Practices slow, deep breathing until the urge decreases
3. Uses adult diapers, for “just in case”
4. Drinks citrus juices and carbonated beverages
5. Performs pelvic muscle exercises

11. A nurse has identified that the patient has overflow incontinence. What is a major factor that
contributes to this clinical manifestation?

1. Coughing
2. Mobility deficits
3. Prostate enlargement
4. Urinary tract infection

12. A nurse must measure the intake and output (I&O) for a patient who has a urinary retention
catheter. Which equipment is most appropriate to use to accurately measure urine output from a
urinary retention catheter?

1. Urinal
2. Graduate
3. Large syringe
4. Urine collection bag

13. A patient’s urine is cloudy, is amber, and has an unpleasant odor. What problem may this
information indicate that requires the nurse to make a focused assessment?

1. Urinary retention
2. Urinary tract infection
3. Ketone bodies in the urine
4. High urinary calcium level

14. A nurse is caring for a debilitated female patient with nocturia. Which nursing intervention is the
priority when planning to meet this patient’s needs?

1. Encouraging the use of bladder training exercises

2. Providing assistance with toileting every four hours
3. Positioning a bedside commode near the bed
4. Teaching the avoidance of fluid after 5 PM

15. A practitioner uses a urine specimen for culture and sensitivity via a straight catheter for a patient.
What should the nurse do when collecting this urine specimen?

1. Use a sterile specimen container.

2. Collect urine from the catheter port.
3. Inflate the balloon with 10 mL of sterile water.
4. Have the patient void before collecting the specimen.

16. A nurse in a provider’s office is assessing a client who reports losing control of urine when ever she
coughs, laughs, or sneezes. The client relates a history of three vaginal births, but no serious accidents or
illnesses. Which of the following interventions are appropriate for helping to control or eliminate the
clients incontinence? Select all that apply.

1. Limit total daily fluid intake

2. Decrease or avoid caffeine
3. Increase the intake of calcium supplements
4. Avoid the intake of alcohol
5. Use Crede maneuver

17. A client who has an indwelling catheter reports I need to urinate. Which of the following
interventions should the nurse perform?

1. Check to see whether the catheter is patent

2. Reassure the client that it is not possible for her to urinate
3. Re-catheterize the bladder with a larger gauge catheter
4. Collect a urine specimen for analysis

18. A provider prescribes a 24 hour urine collection for a client. Which of the following actions should
the nurse take?
1. Discard the first voiding
2. Keep all voidings in a container at room temperature
3. Ask the client to urinate and pour the urine into a specimen container
4. Ask the client to urinate into the toilet, stop midstream, and finish urinating into the specimen
container

19. A nurse is preparing to initiate a bladder training program for a client who has a voiding disorder.
Which of the following actions should the nurse take? Select all that apply.

1. Establish a schedule of voiding prior to meal times

2. Have the client record voiding times
3. Gradually increase the voiding intervals
4. Reminded client to hold urine until next scheduled voiding time
5. Provide a sterile container for voiding

20. A nurse educator on a medical unit is reviewing factors that increase the risk of urinary tract
infections with a group of assistive personnel. Which of the following should be included in the review?
Select all that apply.

1. Having sexual intercourse on a frequent basis

2. Lowering of testosterone levels
3. Wiping from front to back
4. The location of the vagina in relation to the anus
5. Undergoing frequent catheterization

Answers and Rationale

1. Answer: 4. The amount of urine retained after voiding increases

The capacity of the bladder may decrease with age but the muscle is weaker and can cause urine to be
retained (Option 4). Older adults don’t ignore the urge to void and may have difficulty getting to the
toilet in time (Option 2). The kidney becomes less able to concentrate urine with age (Option3).

2. Answer: 1, 2, 4, and 5

The perineum may become irritated by the frequent contact with urine (Opt1). Normal fluid intake is at
least 1,500 mL/d and clients often decrease their intake to try to minimize urine leakage (Opt2). UTIs can
contribute to incontinence (Opt4). A fecal impaction can compress the urethra, which results in sm.
amts of urine leakage (Opt5). Antihistamines can cause urinary retention rather than urinary
incontinence (Opt3).

3. Answer: 2. Check the penis for adequate circulation 30 min after applying

The penis and condom should be checked 1/2 hour after application to ensure that it’s not too tight. A 1
in. space should be left btw the penis and the end of the condom (opt1). The condom is changed every
24h (opt3) and the tubing is taped to the leg or attached to a leg bag. An indwelling catheter is taped to
the lower abdomen or upper thigh (opt4).
4. Answer: 1. Leaves the catheter in place and gets a new sterile catheter

The catheter in the vagina is contaminated and can’t be reused.If left in place, it may help avoid
mistaking the vaginal opening for the urinary meatus. A single failure to catheterize the meatus doesn’t
indicate that another nurse is needed although sometimes a second nurse can assist in visualization of
the meatus (opt2).

5. Answer: 3. “Soaking in a warm tub bath may ease the irritation associated with the catheter”

Soaking in a bathtub can increase the risk of exposure to bacteria. The bag should be below the level of
the bladder to promote proper drainage (opt1). Intake of cranberry juice creates an environment
nonconducive to infection (opt2). Clean technique is appropriate for touching the exterior portions of
the system (opt4).

6. Answer: 4. urge urinary incontinence

The key phrase is “the urge to void” option one occurs when the client coughs, sneezes, or jars the body,
resulting in accidental loss of urine. Option two occurs with involuntary loss of urine at somewhat
predictable intervals when a specific bladder volume is reached. Option three is involuntary loss of urine
related to impaired function.

7. Answer: 2, 4

Option two validates the diagnosis. Cotton underwear promotes appropriate exposure to air, resulting
in decreased bacterial growth (opt4). Increased fluids decrease concentration and irritation (opt1). The
client should wipe the perineal area from front to back to prevent spread of bacteria from the rectal
area to the urethra (opt3). Showers reduce exposure of area to bacteria (opt5).

8. Answer: 2. Kock pouch

The ileal conduit and vesicostomy (opt1,4) are in continent urinary diversions, and clients are required
to use an external ostomy appliance to contain the urine. Clients with a neobladder can control their
voiding (opt3).

9. Answer: 3. Crede’s maneuver: apply gentle manual pressure to the lower abdomen

Because the bladder muscles will not contract to increase the intra-bladder pressure to promote
urination, the process is initiated manually. Options one, two, and four: to promote continence bladder
contractions are required for habit training, bladder training, and increasing the tone of the pelvic
muscles.

10. Answer: 2, 5

It is important for the client to inhibit the urge to void sensation when a premature urge is experienced.
Some clients may need diapers; this is not the best indicator of a successful program (opt3). Citrus juices
may irritate the bladder (opt4). Carbonated beverages increase diuresis and the risk of incontinence
(opt4).
11. Answer: 3. Prostate enlargement

An enlarged prostate compresses the urethra and interferes with the outflow of urine, resulting in
urinary retention. With urinary retention, the pressure within the bladder builds until the external
urethral sphincter temporarily opens to allow a small volume (25-60mL) of urine to escape (overflow
incontinence). Coughing, which raises the intro abdominal pressure, is related to stress incontinence,
not overflow incontinence (opt1). Mobility deficits, such as spinal cord injuries, are related to reflex
incontinence, not overflow incontinence (opt2). Urinary tract infections are related to urge
incontinence, not overflow incontinence (opt4).

12. Answer: 2. Graduate

A graduate is a collection container with volume markings usually at 25 mL increments that promote
accurate measurements of urine volume. Although urinals have volume markings on the side, usually
they occur in 100 mL increments that do not promote accurate measurements (opt1). Option 3 is
impractical. A large syringe is used to obtain a sterile specimen from a retention catheter (Foley
catheter). A urine collection bag is flexible and balloons outward as urine collects. In addition, the
volume markings are at 100 mL increments that do not promote accurate measurements (opt4).

13. Answer: 2. Urinary tract infection

The urine appears concentrated (amber)and cloudy because of the presence of bacteria, white blood
cells, and red blood cells. The unpleasant odor is caused by pus in the urine (pyuria). These clinical
manifestations do not reflect urinary retention. Urinary retention is evidenced by supra pubic distention
and lack of voiding or small, frequent voiding (overflow incontinence) (opt1). These clinical
manifestations do not reflect Ketone bodies in the urine. A reagent strip dipped in urine will measure
the presence of Ketone bodies (opt3). These clinical manifestations do not reflect excessive calcium in
the urine. Urine calcium levels are measured by assessing a 24 hour urine specimen (opt4).

14. Answer: 3. Positioning a bedside commode near the bed

The use of a commode requires less energy than using a bedpan and is safer than walking to the
bathroom. Sitting on the commode uses gravity to empty the bladder fully and thus prevent urinary
stasis. Although option 1 should be done, it is not the priority. Option 2 may be too often or not often
enough for the patient. Care should be individualized for the patient. Fluids may be decreased during
the last two hours before bedtime, but they should not be avoided completely after 5 PM (opt4). Some
fluid intake is necessary for adequate renal perfusion.

15. Answer: 1. Use a sterile specimen container.

A culture attempts to identify the microorganisms present in the urine, and a sensitivity study identifies
the antibiotics that are effective against the isolated micro organisms. A sterile specimen container is
used to prevent contamination of the specimen by micro organisms outside the body (exogenous). The
urine from straight catheter flows directly into the specimen container. Collecting a urine specimen from
a catheter port is necessary when the patient has a urinary retention catheter (opt2). A straight catheter
has a single lumen for draining urine from the bladder. A straight catheter does not remain in the
bladder and therefore does not have a 2nd lumen for water to be inserted into a balloon (opt3). This
may result in no urine left in the bladder for the straight catheter to collect. A minimum of 3 mL of urine
is necessary for a specimen for urine culture and sensitivity (opt4).

16. Answer: 2 and 4

Caffeine and alcohol are bladder irritants and can worsen stress incontinence. Alcohol is a bladder
irritant and can worsen stress incontinence. Because stress incontinence results from weak pelvic
muscles and other structures, limiting fluid will not resolve the problem (opt1). Calcium has no effect on
stress incontinence (opt3). The Crede maneuver helps manage reflex incontinence, not stress
incontinence (opt5).

17. Answer: 1. Check to see whether the catheter is patent

A clogged or kinked catheter causes the bladder to fill and stimulates the need to urinate. Reassuring
the client that is not possible to urinate is a non-therapeutic response because it diminishes the client’s
concern (opt2). There are less invasive approaches the nurse can take before replacing the catheter
(opt3). Although it may become necessary to collect a urine specimen, there is a simpler approach the
nurse can take to assess and possibly resolve the client’s problem (opt4).

18. Answer: 1. Discard the first voiding

The nurse should discard the first voiding of the 24 hour urine specimen, and note the time. The nurse
should collect all voidings after that and keep them in a refrigerated container (opt2). For a urinalysis,
the nurse should ask the client to urinate and pour the urine into a specimen container (opt3). For a
culture, the nurse should ask the client to urinate first into the toilet, then stop midstream, and finish
urinating in the specimen container (opt4).

19. Answer: 2, 3, and 4

Ask the client to keep track of voiding times is an appropriate nursing action. Gradually increasing the
voiding interval is an appropriate nursing action. The client should be reminded to hold urine until the
next scheduled voiding time. Bladder training involves voiding at scheduled in frequent intervals and
gradually increasing these intervals to four hours. Mealtimes are not regular, and the intervals may be
longer than every four hours (opt1). A sterile container is not used in a bladder training program (opt5).

20. Answer: 1, 4, and 5

Having sexual intercourse on a frequent basis is a factor that increases the risk of UTI in both males and
females. The close proximity of the female urethra to the anus is a factor that increases the risk of UTIs.
Undergoing frequent catheterization and the use of indwelling catheters are risk factors for UTIs. The
decrease in estrogen levels during menopause increases a woman’s susceptibility to UTIs (opt2). Wiping
from front to back decreases a woman’s risk of UTIs (opt3).