Urinary Elimination

URINARY ELIMINATION
1) If a stoma is dark or purple-blue it suggests:

A. Anemia
B. Ischemia
C. Compromised circulation
D. A and C
E. B and C

2) A continent ___ is a surgical alternative that uses a section of the intestine to create an
internal reservoire that holds urine. It uses an external stoma that must b e catheterized at
regular intervals to drain the urine that has collected in the reservoir.

Possible correct answers:

 Urostomy

3) When micturation is initiated the ______ contracts, the _____ relaxes, and urine enters
the posterior urethra. The muscles of the perineum and the _______ relax, the ______
contracts slightly, the _____ lowers, and micturation occurs.

A. Internal sphincter, detrusor muscle, external sphincter, abdominal muscles,

diaphragm
B. Detrusor muscle, external sphincter, internal sphincter, abdominal muscles,

diaphragm
C. Internal sphincter, detrusor muscle, external sphincter, diaphragm, abdominal

muscles
D. Detrusor muscle, diaphragm, internal sphincter, abdominal muscles, external

sphincter
E. Detrusor muscle, internal sphincter, external sphincter, abdominal muscles,

diaphragm

4) Blood in the urine, also known as _____, or pink or red coloured urine may be due to
taking what drug?

 hematuria, anticoagulants
 hematuria anticoagulants

5) True or False:
When collecting a urine sample, the first voided urine of the day is not collected because
it is considered not to be fresh urine.

 true

6) How many nephrons are in each kidney?

A. 1,000
B. 100,000
C. 1 million
D. 1 billion
E. None of the above

7) What type of medication can lighten the colour of urine to pale yellow?

 diuretics

8) Urine that appears cloudy or urine that has pus in it is called


 pyuria

9) Some antidepressants and B-complex vitamins can turn the urine ______


 green

10) Continuous and unpredicaable loss of urine, resulting from surger, physical
malformation, or trauma is known as what type of incontience?

 total
 total incontinence
11) What type of incontience is it when a patient has a broken leg which prevents them
from getting to the bathroom.

 functional
 functional incontinence

12) Awakening at night to urinate


 nocturia

13) When a patient leaks a bit of urine while laughing, it is called what kind of incontience?

 stress
 stress incontinence

14) Which of the following does not affect urination in older adults?

A. Medications
B. Decreased bladder contractility
C. Extent of ability in the kidneys
D. Motility problems

15) This type of catheter is used for long-term use and is surgically inserted through a small
incision above the pubic area; it is often used due to urethra injury or blockage occurs.

 suprapubic
 suprapubic catheter

16) Obtaining a specimen for routine uralysis requires ____ technique

A. Medical aseptic technique

B. Sterile technique
C. Surgical technique

17) In a Mitrofanoff procedure the bladder neck is closed and one end of the _____ is
brought to the skin surface and is used as a stoma; the other end is tunneled into
the bladder.

A. Appendix
B. Ileum
C. Stomach
D. Large intestine

18) Some causes of decreased muscles tone does not include which of the following:

A. Muscle atrophy
B. Exercise
C. Trauma
D. Foley catheter
E. Immobility

19) With micturation, the pressure within the bladder is _____ to the the pressure with the
bladder is filling.

A. Less than
B. Greater than
C. Equal to

20) A 24-hour output of less than _____ mL is called oliguria


 400

21) Phenazopyridine (Pyridium), a urinary tract analgesic, often used to treat UTIs,
can cause urine to turn what colour?

 orange
 orange-red

22) Which of the following is synonymous with a 24-hour output of less than 50 mL of urine?

A. Renal failure
B. Kidney shutdown
C. Anuria
D. All of the above
Unanswered Difficulty: Easy97% got this correct
23) Experiencing overflow incontiennce and functional incontinence is considere to be
what kind of incontience,

 mixed
 mixed incontinence

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p. 1507
24) The higher the number on the urometer the lower the urine concentration and specific
gravity.

A. True
B. False

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p. 1499
Unanswered Difficulty: Hard50% got this correct
25) Proteinuria is:

A. An indication of kidney disease
B. Defined by the presence of proteinin urine
C. Marked by the presence of sugar in urine
D. B and C
E. A and B

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p. 1491
26) ____ is the intentional or involuntary urination into bed or clothes that occurs after an
urge when contience should be prese t,


 enuresis

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p. 1489
27) Is it normal for mucus to appear in the urine of a patient with an ileal conduit?


 yes

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p. 1517
28) Difficulty during urination is known as____; while scanty or diminshed amount urine is
known as _____

A. Dysuria; Anuria
B. Anuria; Oliguria
C. Dysuria; Oliguria
D. Oliguria; Pyuria
E. Pyuria; Dysuria

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p. 1491
29) Diuresis is also known as

A. Glycosuria
B. Pyuria
C. Anuria
D. Oliguria
E. Polyuria

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p. 1491
30) A nurse can test urine for the presence of glucose, blood, protein, bilirubin, and bacteria.

A. True
B. False

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p. 1497
31) An indwelling catheter is usually preferred over suprapubic catheters for long-term
continous drainage.

A. True
B. False

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This is false because suprapubic catheters are often preferred over indwelling urethral
catheters for long-term urinary drainage, because suprapubic catheteres are associated
with decreased risk of contamination with organisms from fecal material, elimination of
damage to the urethra, a higher rate of patient satisfaction, and a lower risk of catheter-
associated urinary tract infection.
32) When higher nerve centers develop early in life, the _____ control of micturation
develops.

 voluntary

33) When assessing a patient's urine, check all of the following, but do not note:

A. Colour of urine
B. Odour of urine
C. Sugar in urine
D. Clarity of urine
E. Sediment in urine

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p. 1492

34) The technique that requires a sampe obtained by catheterizing the patient's bladder or by
use of an foley catheter is a:

A. Sterile specimen
B. Routine uralysis specimen
C. Clean-catch specimen
D. Midstream specimen
E. Catheter specimen
35) Patients can be taught to insert and remove intermittent catheterse themselves

A. True
B. False

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p. 1509
36) Surgery is the first line of therapy for urinary incontience

A. True
B. False

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Noninvasive, low-risk vehavioural interventions are the first line of therapy. (p. 1507)
37) Which of the following is used as a manual bladder compression technique?

A. Kegel's maneuver
B. Crede's maneuver
C. Gravity's maneuver
D. All of the above

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p. 1503
Difficulty: Easy98% got this correct

38) As one ages is there an increase or decrease in the sensation of thirst?


39) Weakening of which muscles is a common cause of urinary incontinence.

 pelvic floor

 pelvic
 pelvic floor muscles
40) One of the key functions of the kidneys is to help maintain the _____ and _____ of body
fluids.

 composition volume, volume composition, composition, volume, volume,
composition

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p. 1485
41) The surgical creation of an alternate route for excretion of urine is called

 urinary diversion


42) _____ is the amount of urine rematining in the bladder immediately after voiding, which
can be measured by catheterization or use of portable ultrasound device.

 postvoid residual
 PVR

43) Catheter lumens are graded on a:

A. Credes (C) scale
B. French (F) scale
C. Kegel (K) scale
D. All of the above

44) The kidneys are located on either side of the ______ column, behind the ______, in the
_____ abdominal cavity.


 vertebral, peritoneum, upper, vertebral peritoneum upper

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p. 1485
45) One should apply lubricant to a catheter before inserting it into a male patient.

A. True
B. False

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Applying lubricant to the catheter before inserting it in a male patient is no longer
recommended. Currently, the recommendation is to gently insert the tip of a syringe
prefilled with lubricant into the male urethra before inserting the catheter. (p. 1513 -
1514)
46) A clean-catch specimen of urine is collected during _____


 midstream

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(p. 1492)

47) _____ is a delay or difficulty in initiating voiding.

 hesitancy
 hesitency
48) _____ are infections acquired in the hospital. The most common cause of which is
______

 nosocomial infections, catheterization
 nosocomial infections catheters

 nosocomial infections catheter
 nosocomial infections catheterization
 nosocomial infection catheters

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p. 1507
49) What is the most common organismal cause of urinary tract infections?

A. Staphylococcus aureus
B. Being sexually active
C. Diabetes mellitus
D. Escherichia coli
E. A and C

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p. 1504
50) What are the three types of wastes that are characteristics of urine?

 organic, inorganic, liquid, organic wastes, inorganic wastes, liquid wastes,

organic wastes inorganic wastes liquid wastes, organic inorganic liquid

51) The device used to create an image of the patient's bladder and calculate urine volume
present in the bladder is called a _____ scanner.


 bedside

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p. 1492
52) For long-term use in an adult, a ___F to ___F catheter is commonly used

 12, 14
 12 14
 12F 14F
 12F, 14F

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p. 1511
53) Voiding is largely a(n) voluntary/involuntary reflex?


 involuntary

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Voiding is largely an involuntary reflect act but its control can be learned (p. 1488)
54) Those who urinate frequently/infrequently usually have more/less urinary tract
infections and kidney disorders.

 frequently less
 frequently, less
 infrequently, more
 infrequently more

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p. 1488
55) _____ in the bladder are stimulated as the urine collects, eventually causing the desire
to void.


 stretch receptors

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p. 1488

56) The involuntary losso fo urine that occurs soon after feeling an urgent need to void is
called:

A. Mixed incontience
B. Stress incontinence
C. Over-flow incontience
D. Urge incontinence
57) What type of incontinence appears suddenly and lasts for 6 months or less.

 transient incontinence
 transient

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p. 1505
58) The presence of sugar in the urine is known as

 glycosuria

59) _____ is a measure of the density of urine compared with the density of water.

 specific gravity

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p. 1498
60) Can the bladder be palpated when empty? Percussed?

 no no

 no. no.
 no, no

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p. 1491
61) Give the two names of the catheter used to drain the bladder for short periods of time (5
to 10 minutes)

 intermittent catheter, straight catheter
 straight, intermittent

 straight catheter, intermittent catheter
 intermittent, straight
 intermittent straight

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p. 1509
62) What type of catheter is used for continuous drainage through the urethra?

A. Indwelling urethral catheter
B. Retention catheter
C. Foley catheter
D. All of the above

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p. 1509
63) Diuretics are commonly used in the treatment of:

A. Low blood pressure
B. High blood pressure
C. Low blood sugar
D. High blood sugar

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p. 1490
64) Caffeine-containing beverages, such as soda, coffee, and tea, have a ____ effect

 diuretic
 diuretics

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p. 1489
65) A culture and sensitivity (C&S) is considered positive if it shows at least 10,000
organisms per mL of urine.

A. True
B. False

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A C&S would be considered positive if it showed at least 100,000 organisms per mL
66) Anuria is a 24-hour urine output that is less than ____ mL


 50

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p. 1491
67) Bacteria in the urine is called


 bacteriuria

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p. 1505
68) True or False:
Urinary incontinence is untreatable.


 false

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p. 1507
69) True or False:
Most people void during sleeping hours

 false

70) When the bladder fills to about ____ to ____ mL (in an adult) a person feels the diesire to
void.

150 250, 150, 250

71) Overflow incontience is:

A. Continuous and unpredicaable loss of urine, resulting from surger, physical

malformation, or trauma.
B. The involuntary loss of urine that occurs soon after feeling an urgency to void
C. Urine loss caused by the inability to reach the toilet
D. Experiencing emptying of the bladder without the sensation of the need to void
E. The involunary loss of urine associated with overdistension of the bladder

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p. 1507
72) An antiparkinson drug and injectable iron compounds can turn urine into which two
colours?

 brown and black
 black and brown

 brown black
 black brown
 brown, black

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p. 1490
73) What is it called when urine is produced normally but is not excreted completely from
the bladder?


 urinary retention

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p. 1488
74) Drugs known to be ______ are capable of causing kidney damage


 nephrotoxic

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p. 1490
75) The basic structural and functional unit of the kidney is


 nephron, nephrons

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p. 1485
76) Pain during urination


 dysuria

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p. 1491
77) The first voided urine of the day is usually ____ concentrated than other urine excreted
during the day.

A. More
B. Less
C. Equally

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p. 1488
78) A bladder irrigationi (through the catheter) rinses out the bladder and can also instill
medication that acts directly on the _____ ____.


 bladder wall

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p. 1514
79) According to the textbook, to pee is also known as

A. Micturation
B. Urination
C. Voiding
D. All of the above

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p. 1488
80) Normally, the kidneys _____ be palpated, generally requring ______ palpation.

A. Can't; electronic
B. Can; light
C. Can; superficial
D. Can; deep
E. Can; electronic

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p. 1491
81) A _____ _____ is a cutaneous urinary diversion. It involves a surgical resection of the
small intestine, with transplantation of the ureters to the isolated segment of small
bowel. This separated section of th esmall intestine is then brought to the This diversion
requires external appliances to collect the urine.

 ileal conduit

82) An involuntary loss of urine related to an incrase in intra-abdominal pressure is called
______ incontinence.

83) Any involuntary loss of urine is known as


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

2. Answer: 1, 2, 4, and 5
3. Answer: 2. Check the penis for adequate circulation 30 min after applying
4. Answer: 1. Leaves the catheter in place and gets a new sterile catheter
5. Answer: 3. “Soaking in a warm tub bath may ease the irritation associated with the
catheter”
6. Answer: 4. urge urinary incontinence
7. Answer: 2, 4
8. Answer: 2. Kock pouch
9. Answer: 3. Crede’s maneuver: apply gentle manual pressure to the lower abdomen
10. Answer: 2, 5
11. Answer: 3. Prostate enlargement
12. Answer: 2. Graduate
13. Answer: 2. Urinary tract infection
14. Answer: 3. Positioning a bedside commode near the bed
Answer: 1. Use a sterile specimen container.
16. Answer: 2 and 4
17. Answer: 1. Check to see whether the catheter is patent
18. Answer: 1. Discard the first voiding
19. Answer: 2, 3, and 4
20. Answer: 1, 4, and 5

1. If obstructed, which component of the urination system would cause peristaltic waves?
a. Kidney
b. Ureters
c. Bladder
d. Urethra
ANS: B
2. When reviewing laboratory results, the nurse should immediately notify the health care
provider about which finding?
a. Glomerular filtration rate of 20 mL/min
b. Urine output of 80 mL/hr
c. pH of 6.4
d. Protein level of 2 mg/100 mL
ANS: A
3. A patient is experiencing oliguria. Which action should the nurse perform first?
a. Increase the patient's intravenous fluid rate.
b. Encourage the patient to drink caffeinated beverages.
c. Assess for bladder distention.
d. Request an order for diuretics.
ANS: C
4. A patient requests the nurse's assistance to the bedside commode and becomes frustrated when
unable to void in front of the nurse.
The nurse understands the patient's inability to void because

a. Anxiety can make it difficult for abdominal and perineal muscles to relax enough
to void.
b. The patient does not recognize the physiological signals that indicate a need to
void.
c. The patient is lonely, and calling the nurse in under false pretenses is a way to get
attention.
d. The patient is not drinking enough fluids to produce adequate urine output.
ANS: A
5. The nurse knows that indwelling catheters are placed before a cesarean because
a. The patient may void uncontrollably during the procedure.
b. A full bladder can cause the mother's heart rate to drop.
c. Spinal anesthetics can temporarily disable urethral sphincters.
d. The patient will not interrupt the procedure by asking to go to the bathroom.
ANS: C
6. The nurse knows that urinary tract infection (UTI) is the most common health care-associated
infection because
a. Catheterization procedures are performed more frequently than indicated.
b. Escherichia coli pathogens are transmitted during surgical or catheterization
procedures.
C.Perineal care is often neglected by nursing staff.
D.Bedpans and urinals are not stored properly and transmit infection.
ANS: B
urinary tract, so they are unlikely to be the primary cause of UTI.
7. An 86-year-old patient tells the nurse that she is experiencing uncontrollable leakage of urine.
Which nursing diagnosis should the
nurse include in the patient's plan of care?

a. Urinary retention
b. Hesitancy
c. Urgency
d. Urinary incontinence
ANS: D
8. A patient has fallen several times in the past week when attempting to get to the bathroom.
The patient informs the nurse that he gets up 3 or 4 times a night to urinate. Which
recommendation by the nurse is most appropriate in correcting this urinary problem?
a. Clear the path to the bathroom of all obstacles before bed.
b. Leave the bathroom light on to illuminate a pathway.
c. Limit fluid and caffeine intake before bed.
d. Practice Kegel exercises to strengthen bladder muscles.
ANS: C
9. When caring for a patient with urinary retention, the nurse would anticipate an order for
a. Limited fluid intake.
b. A urinary catheter.
c. Diuretic medication.
d. A renal angiogram.
ANS: B
10. Upon palpation, the nurse notices that the bladder is firm and distended; the patient expresses
an urge to urinate. The nurse should
follow up by asking
a. "When was the last time you voided?"
b. "Do you lose urine when you cough or sneeze?"
c. "Have you noticed any change in your urination patterns?"
d. "Do you have a fever or chills?"
ANS: A
1. P.
TRICYCLIC (ANTIDEPRESSANTS) The risk of urinary retention is
AND ANTIHISTAMINES ARE increased with medications having
EXAMPLES OF SUCH DRUGS. anticholinergic effects. Name a few
Answer:P
You said:You gave no answer
2. H.
ADH RELEASE IS SUPPRESSED. When fluid intake increases
Answer:H
3. F.
NEUROLOGIC IMPAIRMENT, People at risk for urinary retention
SUCH AS SPINAL CORD INJURY include:
OR BRAIN LESIONS..
POSTOPERATIVE CLIENTS MAY
EXPERIENCE TEMPORARY
URINARY RETENTION UNTIL
EDEMA SUBSIDES AND SPINAL
ANESTHESIA WEARS OFF.
Answer:F
4. D.
KINKED OR PLUGGED Obstruction can also occur when clients
have catheters or nephrostomy tubes in
place that become
Answer:D
5. C.
DECREASED FLUID INTAKE Urine may be dark amber or orange-
brown if it is very concentrated
secondary to
Answer:C
6. K.
CLIENT SHOULD BATHE AT Absorbent Products:
LEAST DAILY. EACH TIME Need to change the protective pads or
PRODUCT IS CHANGED, briefs frequently to avoid odor and to
PERINEAL AREA SHOULD BE prevent skin irritation from prolonged
CLEANSED & EXAMINED FOR exposure to moisture
IRRITATION.
Answer:K
7. T.
MEN/WOMEN FIND IT DIFFICULT Body position and voiding
WHEN NOT IN NATURAL
POSITION. THIS ALTERS VOIDING
PATTERN, SO VOIDING BECOMES
MORE FREQUENT, BUT WITH
LESS VOLUME.
Answer:T
8. B.
THIS "WATER SAVING" TO When a person loses a great deal of
REGULATE CONCENTRATION OF body fluid, the kidneys increase
SOLUTES IN THE ECF RESULTS IN reabsorption of water from the
DECREASED URINE OUTPUT. glomerular filtrate to maintain proper
osmolarity of the ECF.
Answer:B
9. S.
BLADDER The drainage collection bag and tubing
should remain below the level of the
______ to maintain proper drainage and
to prevent pooling or backflow.
Answer:S
10. O.
TUMORS, OR TUMORS THAT Structural abnormalities can cause
PRESS AGAINST THE URINARY urinary obstruction
TRACT, RENAL STONES, AND
PROSTATIC ENLARGEMENT.
Answer:O
11. I.
INADEQUATE BLOOD FLOW TO Urine output of less than 30mL/hour
THE KIDNEYS may indicate:
Answer:I
12. Q.
URGENCY. URGENCY IMPLIES A ________ is the subjective feeling of
STRONG MICTURITION REFLEX being unable to delay voiding
CAUSED BY INFLAMMATION OR voluntarily.
INFECTION OF THE URETHRA OR
BLADDER; INCOMPETENT
URETHRAL SPHINCTER, WEAK
PERINEAL MUSCLE CONTROL, OR
PSYCHOLOGICAL STRESS.
Answer:Q
13. A.
GROWING UTERUS CAN EXERT Urinary elimination & pregnancy
PRESSURE ON THE BLADDER, A
COMMON CAUSE OF URINARY
FREQUENCY IN PREGNANT
WOMEN.
COMPRESSION OF THE BLADDER

BY THE UTERUS MAY ALSO LEAD
TO OBSTRUCTION OF URINARY
FLOW AND INCOMPLETE
EMPTYING OF THE BLADDER.
UTI'S ARE MORE COMMON

DURING PREGNANCY BECAUSE
OF THE HORMONALLY RELATED
CHANGES IN THE URINARY
TRACT.
TRAUMA FROM VAGINAL

DELIVERY CAUSES SWELLING IN
THE PERINEAL AREA, WHICH
CAN OBSTRUCT THE FLOW OF
URINE AND CAUSE URINARY
RETENTION DURING THE EARLY
POSTPARTUM PERIOD.
Answer:A
14. J.
ANTIBACTERIAL PROPERTIES OF Men are less susceptible to lower UTI's
PROSTATIC SECRETIONS. because of the longer length of the male
urethra and also because of
the_________
Answer:J
15. R.
THE NEPHRON The functional unit of the kidney is
called:
Answer:R
16. E.
ZINC OXIDE If perineal skin is reddened or fragile,
apply a barrier cream (often with ____
____ as the active ingredient or non-
sting barrier film.
Answer:E
17. G.
SOME PEOPLE CAN NOT RELAX Privacy and urination
MUSCLES, PROVIDE AS MUCH
PRIVACY FOR ELIMINATION AS
POSSIBLE.
Answer:G
18. M.
REABSORB MORE WATER, THUS Release of ADH causes the kidney to
PRODUCING A MORE
CONCENTRATED URINE.
Answer:M
19. L.
LEG BAGS SHOULD BE CLEANED Leg bags:
DAILY, USING A DILUTE (1:10)
BLEACH SOLUTION.
Answer:L
20. N.
VOID 6-8 X PER DAY How often per day do people void, and
1200-1500ML IN 24HOURS how much fluid in 24 hour period?
MINIMUM OF 200ML AND NO
MORE THAN 500ML PER VOID.
Answer:N
1. What is the most common cause of urinary incontinence in an elderly patient?

a. Functional
b. Infection
c. Drugs
d. Dementia
e. Constipation
2. All the following are common side effects of bladder relaxant medication except:
a. Urinary retention
b. Constipation
c. Blurry vision
d. Diaphoresis
e. Gastroesophageal reflux
3. Which is true regarding the normal control of urine storage?
a. The intravesicular pressure increases to a threshold pressure as the bladder slowly fills.
b. Reflex activation of the parasympathetic innervation of the detrusor during filling prevents
bladder contraction and facilitates storage.
c. Both the internal and external sphincters must remain closed during filling for continence.
d. Pelvic nerve afferents monitor the bladder volume.
e. Sensory urgency is associated with an acontractile bladder.
4. Which of the following statement
5. All the following are associated with an increased incidence of urinary incontinence except:
a. Age
b. Obesity
c. Chronic cough
d. Indwelling catheter
e. Peripheral nerve injury
6. Which of the following is true of urge incontinence?
a. Increased innervation and control of bladder function resulting in involuntary bladder
contraction
b. Decreased innervation and control of bladder function resulting in involuntary bladder
contraction
c. Decreased innervation and loss of bladder control resulting in voluntary bladder contraction
d. Decreased innervation and loss of bladder control resulting in bladder atrophy
e. Increased innervation and control of bladder function resulting in bladder spasm
Answer Key — Post-test Questions 1. — b 2. — e 3. — d 4. — b 5. — d 6. — a
 . You're assessing your patients during morning rounding. Which patient below is at
MOST risk for developing a urinary tract infection?*
o A. A 25 year old patient who finished a regime of antibiotics for strep throat
10 weeks ago.
o B. A 55 year old female who is post-opt day 7 from hip surgery.
o C. A 68 year old male who is experiencing nausea and vomiting.
o D. A 87 year old female with Alzheimer’s disease who is experiencing bowel

incontinence.
 2. A 36 year old female, who is 29 weeks pregnant, reports she is experiencing burning
when voiding. The physician orders a urinalysis. Which statement by the patient demonstrates
she understands how to collect the specimen?*
o A. "I’ll hold the cup firmly against the urethra while collecting the sample."
o B. "I will cleanse back to front with the antiseptic wipe before peeing in the
cup."
o C. "First, I will pee a small amount of urine in the toilet and then collect the
rest in the cup."
o D. "I will be sure to drink a lot of fluids to keep the urine diluted before
peeing into the cup."
 3. During a head-to-toe assessment on a patient with a possible urinary tract infection,

you perform costovertebral angle percussion. The costovertebral angle is found?*
o A. between the bottom of the 12th rib and spine
o B. between the right upper quadrant and umbilicus
o C. between the sternal notch and angle of Louis
o D. between the ischial spine and umbilicus
 4. A 76 year old female is admitted due to a recent fall. The patient is confused and
agitated. The family members report that this is not normal behavior for the patient. They explain
that the patient is very active in the community and cares for herself. Based on the information
you have gathered about the patient, which physician's order takes priority?*
o A. "Collect a urinalysis"
o B. "Collect a T3 and T4 level"
o C. "Insert a Foley Catheter"
o D. "Keep patient NPO"

 5. The physician orders a urine culture on your patient in room 5505 with a urinary tract
infection. In addition, the patient is ordered to start IV Bactrim
(Sulfamethoxazole/Trimethoprim). How will you proceed with following this order?*
o A. First, hang the antibiotic, and then collect the urine culture.
o B. First, hang the antibiotic and when the antibiotic is finished infusing
collect the urine culture.
o C. First, collect the urine culture, and then hang the antibiotic.
o D. First, collect the urine culture and then hold the dose of the antibiotic until
the urine culture is back from the lab.
 6. A patient with a urinary tract infection is taking Bactrim

(Sulfamethoxazole/Trimethoprim). As the nurse you know it is important that the patient
consumes 2.5 to 3 L of fluid per day to prevent which of the following complications?*
o A. Brown urine
o B. Crystalluria
o C. Renal Stenosis
o D. Renal Calculi
 7. You’re providing discharge teaching to a female patient on how to prevent urinary

tract infections. Which statement is INCORRECT?*
o A. "Void immediately after sexual intercourse."
o B. "Avoid wearing tight fitting underwear."
o C. "Try to void every 2-3 hours."
o D. "Use scented sanitary napkins or tampons during menstruation."
 8. A patient, who is having spasms and burning while urinating due to a UTI, is
prescribed "Pyridium" (Phenazopyridine). Which option below is a normal side effect of this
drug?*
o A. Hematuria
o B. Crystalluria
o C. Urethra mucous
o D. Orange colored urine
 9. You're caring for a patient with an indwelling catheter. The patient complains of spasm
like pain at the catheter insertion site. Which of the following options below are other signs and
symptoms the patient could experience or the nurse could observe if a urinary tract infection was
present? SELECT-ALL-THAT-APPLY:*
o A. Increased WBC
o B. Crystalluria
o C. Positive McBurney's Sign
o D. Feeling the need to void even though a catheter is present
o E. Dark and cloudy urine
o F. Cramping
 10. On your nursing care plan for a patient with a urinary tract infection, which of the
following would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY:*
o A. Encourage voiding every 2-3 hours while awake.
o B. Restrict fluid intake to 1-2 liters per day.
o C. Monitor intake and output daily.
o D. The patient verbalizes the importance of using vaginal sprays to decrease
reoccurrence of urinary tract infections prior to discharge home.
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Urinary Tract Infection NCLEX Question Quiz
1. You’re assessing your patients during morning rounding. Which patient below is at MOST
risk for developing a urinary tract infection?
A. A 25 year old patient who finished a regime of antibiotics for strep throat 10 weeks ago.
B. A 55 year old female who is post-opt day 7 from hip surgery.
C. A 68 year old male who is experiencing nausea and vomiting.

D. A 87 year old female with Alzheimer’s disease who is experiencing bowel incontinence.
2. A 36 year old female, who is 29 weeks pregnant, reports she is experiencing burning when
voiding. The physician orders a urinalysis. Which statement by the patient demonstrates she
understands how to collect the specimen?
A. “I’ll hold the cup firmly against the urethra while collecting the sample.”
B. “I will cleanse back to front with the antiseptic wipe before peeing in the cup.”
C. “First, I will pee a small amount of urine in the toilet and then collect the rest in the cup.”
D. “I will be sure to drink a lot of fluids to keep the urine diluted before peeing into the cup.”
3. During a head-to-toe assessment on a patient with a possible urinary tract infection, you
perform costovertebral angle percussion. The costovertebral angle is found?
A. between the bottom of the 12th rib and spine
B. between the right upper quadrant and umbilicus
C. between the sternal notch and angle of Louis
D. between the ischial spine and umbilicus
4. A 76 year old female is admitted due to a recent fall. The patient is confused and agitated. The
family members report that this is not normal behavior for the patient. They explain that the
patient is very active in the community and cares for herself. Based on the information you have
gathered about the patient, which physician’s order takes priority?
A. “Collect a urinalysis”
B. “Collect a T3 and T4 level”
C. “Insert a Foley Catheter”
D. “Keep patient NPO”
5. The physician orders a urine culture on your patient in room 5505 with a urinary tract
infection. In addition, the patient is ordered to start IV Bactrim
(Sulfamethoxazole/Trimethoprim). How will you proceed with following this order?
A. First, hang the antibiotic, and then collect the urine culture.
B. First, hang the antibiotic and when the antibiotic is finished infusing collect the urine culture.
C. First, collect the urine culture, and then hang the antibiotic.
D. First, collect the urine culture and then hold the dose of the antibiotic until the urine culture is
back from the lab.
6. A patient with a urinary tract infection is taking Bactrim (Sulfamethoxazole/Trimethoprim).

As the nurse you know it is important that the patient consumes 2.5 to 3 L of fluid per day to
prevent which of the following complications?
A. Brown urine
B. Crystalluria
C. Renal Stenosis
D. Renal Calculi
7. You’re providing discharge teaching to a female patient on how to prevent urinary tract
infections. Which statement is INCORRECT?
A. “Void immediately after sexual intercourse.”
B. “Avoid wearing tight fitting underwear.”
C. “Try to void every 2-3 hours”
D. “Use scented sanitary napkins or tampons during menstruation.”
8. A patient, who is having spasms and burning while urinating due to a UTI, is prescribed
“Pyridium” (Phenazopyridine). Which option below is a normal side effect of this drug?
A. Hematuria
B. Crystalluria
C. Urethra mucous
D. Orange colored urine
9. You’re caring for a patient with an indwelling catheter. The patient complains of spasm like
pain at the catheter insertion site. Which of the following options below are other signs and
symptoms the patient could experience or the nurse could observe if a urinary tract infection was
present? SELECT-ALL-THAT-APPLY:
A. Increased WBC
B. Crystalluria
C. Positive McBurney’s Sign

D. Feeling the need to void even though a catheter is present
E. Dark and cloudy urine
F. Cramping
10. On your nursing care plan for a patient with a urinary tract infection, which of the following
would be appropriate nursing interventions? SELECT-ALL-THAT-APPLY:
A. Encourage voiding every 2-3 hours while awake.
B. Restrict fluid intake to 1-2 liters per day.
C. Monitor intake and output daily.
D. The patient verbalizes the importance of using vaginal sprays to decrease reoccurrence of
urinary tract infections prior to discharge home.
Answer Key:
1. D
2. C
3. A
4. A
5. C
6. B
7. D
8. D
9. A, D, E, F
10 A, C
Question 1
The right answer was maintain fluid balance.
Question 2
The right answer was primarily concerned with human response, while medical diagnoses are
primarily concerned with pathology.
Question 3
The right answer was medicate the patient for pain.
Question 4
The right answer was practice good dental hygiene and report gum swelling or bleeding.
Question 5
The right answer was atelectasis.
Question 6
The right answer was discuss community resources with the spouse and offer to make referrals.
Question 7
The right answer was inform the neurosurgeon of the patient's status.
Question 8
The right answer was informs staff members regularly of how well they are performing their
jobs.
Question 9
The right answer was sensory deprivation.
Question 10
The right answer was measure the patient's blood pressure and pulse readings.
Question 11
The right answer was Sodium and water retention
Question 12
The right answer was paternalism.
Question 13
The right answer was "There is no peak time for Lantus."
Question 14
The right answer was Reassessment and audit
Question 15
The right answer was Signaling the need for immediate investigation and response
Question 16
The right answer was Rediscovering or developing satisfaction in one's relationship with a
significant other
Question 17
The right answer was direct the discussion and validation of emotion, without false reassurance.
Question 18
The right answer was a process analysis.
Question 19
The right answer was ambulating 50 feet without experiencing dyspnea.
Question 20
The right answer was Watson
Question 21
The right answer was "There is no standardization among the manufacturers of herbs in this
country."
Question 22
The right answer was low in fiber, and high in protein and calories.
Question 23
The right answer was independent use of upper extremities and efficient cough.
Question 24
The right answer was obtaining a computed tomography scan of the head without contrast.
Question 25
The right answer was select an activity for improvement.
1. The main goal of treatment for acute glomerulonephritis is to:
encourage activity.
encourage high protein intake.
maintain fluid balance.
teach intermittent urinary catheterization.
2. Nursing diagnoses mostly differ from medical diagnoses in that they are:
dependent upon medical diagnoses for the direction of appropriate interventions.

primarily concerned with caring, while medical diagnoses are primarily concerned with
curing.
primarily concerned with human response, while medical diagnoses are primarily concerned
with pathology.
primarily concerned with psychosocial parameters, while medical diagnoses are primarily
concerned with physiologic parameters.
3. A patient who received spinal anesthesia four hours ago during surgery is transferred to the
surgical unit and, after one and a half hours, now reports severe incisional pain. The patient's
blood pressure is 170/90 mm Hg, pulse is 108 beats/min, temperature is 99oF (37.2oC), and
respirations are 30 breaths/min. The patient's skin is pale, and the surgical dressing is dry and
intact. The most appropriate nursing intervention is to:
medicate the patient for pain.
place the patient in a high Fowler position and administer oxygen.
place the patient in a reverse Trendelenburg position and open the IV line.
report the findings to the provider.
4. To prevent a common, adverse effect of prolonged use of phenytoin sodium (Dilantin),

patients taking the drug are instructed to:
avoid crowds and obtain an annual influenza vaccination.

drink at least 2 L of fluids daily, including 8 to 10 glasses of water.
eat a potassium-rich, low sodium diet.
practice good dental hygiene and report gum swelling or bleeding.
5. The most common, preventable complication of abdominal surgery is:
atelectasis.
fluid and electrolyte imbalance.
thrombophlebitis.
urinary retention.
6. A 78-year-old patient is scheduled for transition to home after treatment for heart disease. The
patient's spouse, who has chronic obstructive pulmonary disease, plans to care for the patient at
home. The spouse says that their grown children, who live nearby, will help. The best approach
to discharge planning is to:
arrange nursing home placement for the couple.

consult the spouse's healthcare provider about the spouse's ability to care for the patient.
contact the children to ascertain their commitment to help.
discuss community resources with the spouse and offer to make referrals.
7. During an assessment of a patient who sustained a head injury 24 hours ago, the medical-
surgical nurse notes the development of slurred speech and disorientation to time and place. The
nurse's initial action is to:
continue the hourly neurologic assessments.

inform the neurosurgeon of the patient's status.
prepare the patient for emergency surgery.
recheck the patient's neurologic status in 15 minutes.
8. For the evaluation feedback process to be effective, a manager:
conducts weekly meetings with staff members.

considers staff members' interests and abilities when delegating tasks.
informs staff members regularly of how well they are performing their jobs.
provides goals for staff members to meet.
9. An 80-year-old patient is placed in isolation when infected with methicillin-

resistant Staphylococcus aureus. The patient was alert and oriented on admission, but is now
having visual hallucinations and can follow only simple directions. The medical-surgical nurse
recognizes that the changes in the patient's mental status are related to:
a fluid and electrolyte imbalance.

a stimulating environment.
sensory deprivation.
sundowning.
10. To prepare a patient on the unit for a bronchoscopic procedure, a medical-surgical nurse
administers the IV sedative. The medical-surgical nurse then instructs the licensed practical
nurse to:
educate the patient about the pending procedure.

give the patient small sips of water only.
measure the patient's blood pressure and pulse readings.
take the patient to the bathroom one more time.
11. Which physiological response is often associated with surgery-related stress?
Bronchial constriction
Decreased cortisol levels
Peripheral vasodilation
Sodium and water retention
12. A patient's family does not know the patient's end-of-life care preferences, but assumes that
they know what is best for the patient under the circumstances. This assumption reflects:
justice.
paternalism.
pragmatism.
veracity.
13. Which statement by a patient with diabetes mellitus indicates an understanding of the
medication insulin glargine (Lantus)?
"Lantus causes weight loss."

"Lantus is used only at night."
"The duration of Lantus is six hours."
"There is no peak time for Lantus."
14. Which action occurs primarily during the evaluation phase of the nursing process?
Data collection
Decision-making and judgment
Priority-setting and expected outcomes
Reassessment and audit
15. Which action best describes a sentinel event alert?
Documenting the breakdown in communication during a shift report

Indicating that a community or institution is unsafe
Recording the harm done when a medication error occurs
Signaling the need for immediate investigation and response
16. Which is primarily a developmental task of middle age?
Learning and acquiring new skills and information

Rediscovering or developing satisfaction in one's relationship with a significant other
Relying strongly upon spiritual beliefs
Risk taking and its perceived consequences
17. A medical-surgical nurse, who is caring for a patient with a new diagnosis of cancer,
observes the patient becoming angry with the physicians and nursing staff. The best approach to
diffuse the emotionally charged discussion is to:
allow the patient and family members time to be alone.

arrange time for the patient to speak with another patient with cancer.
direct the discussion and validation of emotion, without false reassurance.
request a consultation from a social worker on the oncology unit.
18. It is hospital policy to assess and record a patient's pulse before administering digoxin
(Lanoxin). By auditing the nursing records to determine the frequency of compliance with this
policy, the quality assessment and improvement committee is conducting:
a process analysis.
a quality analysis.
a system analysis.
an outcome analysis.
19. The nursing diagnosis for a patient with a myocardial infarction is activity intolerance. The
plan of care includes the patient outcome criterion of:
agreeing to discontinue smoking.

ambulating 50 feet without experiencing dyspnea.
experiencing no dyspnea on exertion.
tolerating activity well.
20. A nursing department in an acute care setting decides to redesign its nursing practice based
on a theoretical framework. The feedback from patients, families, and staff reflects that caring is
a key element. Which theorist best supports this concept?
Erikson
Maslow
Rogers
Watson
21. Which statement by a patient demonstrates an accurate understanding about herbal

supplements?
"Herbs may interact with prescribed medications but not other herbs."
"Most herbs have been tested and found to be safe and therapeutic."
"The Food and Drug Administration regulates herbs and allows advertising."
"There is no standardization among the manufacturers of herbs in this country."
22. For a patient with Crohn's disease, the medical-surgical nurse recommends a diet that is:
high in fiber, and low in protein and calories.
high in potassium.
low in fiber, and high in protein and calories.
low in potassium.
23. When examining a patient who is paralyzed below the T4 level, the medical-surgical nurse
expects to find:
flaccidity of the upper extremities.

hyperreflexia and spasticity of the upper extremities.
impaired diaphragmatic function requiring ventilator support.
independent use of upper extremities and efficient cough.
24. After completing a thorough neurological and physical assessment of a patient who is
admitted for a suspected stroke, a medical-surgical nurse anticipates the next step in the
immediate care of this patient to include:
administering tissue plasminogen activator.

obtaining a computed tomography scan of the head without contrast.
obtaining a neurosurgical consultation.
preparing for carotid Doppler ultrasonography.
25. The first step in applying the quality improvement process to an activity in a clinical setting
is to:
assemble a team to review and revise the activity.

collect data to measure the status of the activity.
select an activity for improvement.
set a measurable standard for the activity.

Urinary Elimination

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URINARY ELIMINATION

1) If a stoma is dark or purple-blue it suggests:

6) How many nephrons are in each kidney?

E. None of the above

8) Urine that appears cloudy or urine that has pus in it is called

12) Awakening at night to urinate

14) Which of the following does not affect urination in older adults?

B. Decreased bladder contractility

C. Extent of ability in the kidneys

E. None of the above

16) Obtaining a specimen for routine uralysis requires ____ technique

A. Medical aseptic technique

20) A 24-hour output of less than _____ mL is called oliguria

A. An indication of kidney disease

B. Defined by the presence of proteinin urine

C. Marked by the presence of sugar in urine

D. All of the above

E. None of the above

A. Credes (C) scale

B. French (F) scale

C. Kegel (K) scale

D. All of the above

E. None of the above

B. Being sexually active

A. Indwelling urethral catheter

D. All of the above

E. None of the above

A. Low blood pressure

B. High blood pressure

C. Low blood sugar

D. High blood sugar

E. None of the above

C. Urine loss caused by the inability to reach the toilet

E. The involunary loss of urine associated with overdistension of the bladder

D. All of the above

E. None of the above

83) Any involuntary loss of urine is known as

1. Perineal skin irritation

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

1. stress urinary incontinence

1. Habit training: attempt voiding at specific time periods

1. Encouraging the use of bladder training exercises

1. Use a sterile specimen container.

1. Check to see whether the catheter is patent

1. Discard the first voiding

1. Having sexual intercourse on a frequent basis

Answers and Rationale

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

6. Answer: 4. urge urinary incontinence

8. Answer: 2. Kock pouch

11. Answer: 3. Prostate enlargement

12. Answer: 2. Graduate

13. Answer: 2. Urinary tract infection

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

Answer: 1. Use a sterile specimen container.

16. Answer: 2 and 4

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

18. Answer: 1. Discard the first voiding

19. Answer: 2, 3, and 4

20. Answer: 1, 4, and 5

The nurse understands the patient's inability to void because

nurse include in the patient's plan of care?