1. A nurse is teaching a patient about the urinary system. In which order will the nurse present
the structures, following the flow of urine?
**Kidney, ureters, bladder, urethra
2. A nurse is reviewing urinary laborat
...
1. A nurse is teaching a patient about the urinary system. In which order will the nurse present
the structures, following the flow of urine?
**Kidney, ureters, bladder, urethra
2. A nurse is reviewing urinary laboratory results. Which finding will cause the nurse to follow
up?
**Specific gravity of 1.036
Dehydration, reduced renal blood flow, and increase in antidiuretic hormone secretion elevate
specific gravity. Normal specific gravity is 1.0053 to 1.030. An output of 30 mL/hr or less for 2
or more hours would be cause for concern; 80 mL/hr is normal. The normal pH of urine is
between 4.6 and 8.0. Protein up to 8 mg/100 mL is acceptable; however, values in excess of
this could indicate renal disease.
3. A patient is experiencing oliguria. Which action should the nurse perform first?
**Assess for bladder distention.
Oliguria is diminished urinary output in relation to fluid intake. It could be that the patient does
not have adequate intake, or it could be that the bladder sphincter is not functioning and the
patient is retaining water.
4. A patient requests the nurse’s help to the bedside commode and becomes frustrated when
unable to void in front of the nurse. How should the nurse interpret the patient’s inability to void?
**The patient can be anxious, making it difficult for abdominal and perineal muscles to
relax enough to void
5. The patient is having lower abdominal surgery and the nurse inserts an indwelling catheter.
What is the rationale for the nurse’s action?
**Anesthetics can decrease bladder contractility and cause urinary retention.
6. The nurse, upon reviewing the history, discovers the patient has dysuria. Which assessment
finding is consistent with dysuria?
**Burning upon urination
Dysuria - is burning or pain with urination. Hematuria - is blood in the urine. Urgency is an
immediate and strong desire to void that is not easily deferred. Nocturia - is awakening from
sleep due to urge to void.
7. An 86-year-old patient is experiencing uncontrollable leakage of urine with a strong desire to
void and even leaks on the way to the toilet. Which priority nursing diagnosis will the nurse
include in the patient’s plan of care?
**Urge urinary incontinence
Urge urinary incontinence - is the leakage of urine associated with a strong urge to void.
Urinary retention - is the inability to empty the bladder. Functional urinary incontinence - is
incontinence due to causes outside the urinary tract, such as mobility or cognitive impairments.
8. A patient has fallen several times in the past week when attempting to get to the bathroom.
The patient gets up 3 or 4 times a night to urinate. Which recommendation by the nurse is most
appropriate in correcting this urinary problem?
**Limit fluid and caffeine intake before bed.
Reducing fluids, especially caffeine and alcohol, before bedtime can reduce nocturia. To prevent
nocturia, suggest that the patient avoid drinking fluids 2 hours before bedtime.
9. A nurse is caring for a male patient with urinary retention. Which action should the nurse take
first?
**Assist to a standing position.
10. Upon palpation, the nurse notices that the bladder is firm and distended; the patient
expresses an urge to urinate. Which question is most appropriate?
**“When was the last time you voided?”
11. A nurse is planning care for a group of patients. Which task will the nurse assign to the
nursing assistive personnel?
**Obtaining a midstream urine specimen
12. While receiving a shift report on a patient, the nurse is informed that the patient has urinary
incontinence. Upon assessment, which finding will the nurse expect?
**Reddened irritated skin on buttocks
Urinary incontinence is uncontrolled urinary elimination; if the urine has prolonged contact with
the skin, skin breakdown can occur.
13. A nurse is inserting a catheter into a female patient. When the nurse inserts the catheter, no
urine is obtained. The nurse suspects the catheter is not in the urethra. What should the nurse
do?
**Leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.
The catheter should be left in place until the new, sterile catheter is inserted. The balloon should
not be filled since the catheter is in the vagina. The catheter must be sterile; using alcohol will
not make the catheter sterile.
14. A patient asks about treatment for stress urinary incontinence. Which is the nurse’s best
response?
**Perform pelvic floor exercises.
Poor muscle tone leads to an inability to control urine flow. The nurse should recommend pelvic
muscle strengthening exercises such as Kegel exercises; this solution best addresses the
patient’s problem.
15. The nurse suspects cystitis related to a lower urinary tract infection. Which clinical
manifestation does the nurse expect the patient to report?
**Frequency
Cystitis - is inflammation of the bladder; associated symptoms include hematuria, foul-smelling
cloudy urine, and urgency/frequency. Dysuria - is a common symptom of a lower urinary tract
infection (bladder). Flank pain, fever, and chills are all signs of pyelonephritis (upper urinary
tract).
16. Which assessment question should the nurse ask if stress incontinence is suspected?
**“Do you experience urine leakage when you cough or sneeze?”
Stress incontinence can be related to intraabdominal pressure causing urine leakage, as would
happen during coughing or sneezing.
17. The patient has a catheter that must be irrigated. The nurse is using a needleless closed
irrigation technique. In which order will the nurse perform the steps, starting with the first one?
Correct Order:
1. Draw up the prescribed amount of sterile solution ordered.
2. Clamp catheter just below specimen port.
3. Clean injection port.
4. Twist needleless syringe into port.
5. Inject prescribed solution.
6. Remove clamp and allow it to drain
18. To obtain a clean-voided urine specimen from a female patient, what should the nurse teach
the patient to do?
**Hold the labia apart while voiding into the specimen cup.
19. A nurse is reviewing results from a urine specimen. What will the nurse expect to see in a
patient with a urinary tract infection?
**Bacteria
Bacteria - in the urine along with other symptoms support a diagnosis of urinary tract infection.
Crystals - would be seen with renal stone formation. Casts - indicate renal disease. Protein -
indicates kidney function and damage to the glomerular membrane such as in
glomerulonephritis.
20. The patient is taking phenazopyridine. When assessing the urine, what will the nurse
expect?
**Orange color
21. Which clinical manifestation will the nurse expect to observe in a patient with excessive
white blood cells present in the urine?
**Fever with chills
22. A patient has severe flank pain. The urinalysis reveals the presence of calcium phosphate
crystals. The nurse will anticipate an order for which diagnostic test?
**Intravenous pyelogram
Flank pain and calcium phosphate crystals are associated with renal calculi. An intravenous
pyelogram - allows the provider to observe pathological problems such as obstruction of the
ureter. A cystoscopy - is used to detect bladder tumors and obstruction of the bladder outlet
and urethra. A bladder scan - measures the amount of urine in the bladder.
23. A nurse is caring for a patient who just underwent an intravenous pyelography that revealed
a renal calculus obstructing the left ureter. What is the nurse’s first priority in caring for this
patient?
**Monitor the patient for fever, rash, and difficulty breathing.
Assess for delayed hypersensitivity to the contrast media. Intravenous pyelography is performed
by administering iodine-based dye to view functionality of the urinary system. Therefore, the first
nursing priority is to assess the patient for an allergic reaction that could be life threatening. The
nurse should then encourage the patient to drink fluids to flush dye resulting from the procedure.
24. Which statement by the patient about an upcoming contrast computed tomography (CT)
scan indicates a need for further teaching?
**“I will be anesthetized so that I lie perfectly still during the procedure.”
Patients are not put under anesthesia for a CT scan; instead, the nurse should educate patients
about the need to lie perfectly still and about possible methods of overcoming feelings of
claustrophobia.
25. The nurse is preparing to test a patient for postvoid residual with a bladder scan. Which
action will the nurse take?
**Measure bladder within 10 minutes after the patient voids
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