Urinary Pattern
Meet the Client: Hunter Ellis
Hunter Ellis, a 76-year-old African American male, is a resident in a long-term care facility. He has been
unable to control the urge to void since experiencing a stroke 1 month ago. He is alert and oriented and has
no verbal deficits since his stroke.
Physiologic Integrity
1. Mr. Ellis states that prior to his stroke, he would get up five or six times during the
night to empty his bladder but that he was able to control the urge long enough to
make it to the bathroom. How should the nurse describe the urinary pattern that Mr.
Ellis is describing?
A. Dysuria
B. Frequency
C. Nocturia
D. Diureses
Rationale: This refers to frequently voiding at night. The incidence of nocturia
increases greatly in the older male client who has an enlarged prostate, or who may
possibly indicate an inability to concentrate urine because of poor blood flow to the
kidneys.
2. Since Mr. Ellis now voids spontaneously without recognizing the need to void, how
should the nurse document his current urinary pattern in the medical chart?
A. Polyuria
B. Incontinence
C. Retention
D. Oliguria
Rationale: Incontinence is the involuntary loss of urine. In the case of this client, it may
be the result of neurologic impairment secondary to the stroke.
Safe and Effective Care Environment
3. To help manage Mr. Ellis' incontinence, the nurse initiates a bladder training
program. Which instruction should the nurse provide to the unlicensed assistive
personnel (UAP) who will be helping care for Mr. Ellis?
A. Restrict oral fluids to 1,000 ml daily in evenly divided amounts.
B. Offer warm coffee, cocoa, or tea every 2 hours while awake.
C. Limit client socialization until voiding patterns are established.
D. Remind the client to void every 2 hours while awake.
Rationale: A toileting schedule is an effective means to retrain the bladder. Bladder
training should start with voiding every 2 hours in the daytime and every 4 hours at
Downloaded by Eric Wainaina ()
, night then be adapted to the individual needs. the call bell should be near the client so
that he can ring the bell for assistance to prevent the risk of falling.
4. After several weeks, the bladder training program is unsuccessful in stopping Mr.
Ellis' incontinence. Mr. Ellis appears withdrawn and states that he is frustrated at the
number of episodes that he is having.Which nursing diagnoses are appropriate for Mr.
Ellis?
A. Fluid volume deficit related to voiding patterns.
B. Fluid volume excess related to altered urination.
C. Risk for uremic syndrome related to unresolved incontinence.
D. Risk for impaired skin integrity related to urinary incontinence. E.
Ineffective coping related to inability to control urine leakage.
Rationale: The skin of the client with urinary incontinence is frequently exposed to
urine, which is irritating to the skin and places the client at risk for impaired skin
integrity. The nurse understands that the Braden Scale assessment should be
completed on this client and that every effort should be made to prevent the
development of pressure ulcers.
Rationale: Mr. Ellis’ withdrawn behavior and statements of frustration are evidence
that he may be having a difficult time dealing with his incontinence.
6. Following an episode of incontinence, the nurse washes the client's perineal area
with mild soap and water and applies a water-repellent ointment to the skin. Mr. Ellis'
wife is present and the nurse uses this opportunity to educate her about proper skin
care to prevent breakdown. Which of the following statements made by Mrs. Ellis
indicates that teaching has been effective?
a. "I should not apply lotions and ointments because it could increase the risk of skin
breakdown"
b. "Washing with mild soap and water followed by ointment can help to protect my
husband's skin"
c. "I should not use any type of soap on his buttocks or groin."
d. "I should massage any reddened areas if I notice them."
Rationale: Mild soap and warm water should be used to cleanse the skin followed by a
protective ointment. These water-repellant ointments help protect the skin from the
acidic effects of urine
7. The nursing staff continues with the bladder-training program, but Mr. Ellis'
incontinence shows little improvement. Since the bladder training has not been
successful, the nurse obtains a prescription to apply a condom catheter. Mr. Ellis is able
to ambulate with assistance.
In what order should the prescribed condom catheter be applied to Mr. Ellis? (Arrange
the options in the order they should be performed with the first action on top and the
last action on the bottom.)
Downloaded by Eric Wainaina ()
Meet the Client: Hunter Ellis
Hunter Ellis, a 76-year-old African American male, is a resident in a long-term care facility. He has been
unable to control the urge to void since experiencing a stroke 1 month ago. He is alert and oriented and has
no verbal deficits since his stroke.
Physiologic Integrity
1. Mr. Ellis states that prior to his stroke, he would get up five or six times during the
night to empty his bladder but that he was able to control the urge long enough to
make it to the bathroom. How should the nurse describe the urinary pattern that Mr.
Ellis is describing?
A. Dysuria
B. Frequency
C. Nocturia
D. Diureses
Rationale: This refers to frequently voiding at night. The incidence of nocturia
increases greatly in the older male client who has an enlarged prostate, or who may
possibly indicate an inability to concentrate urine because of poor blood flow to the
kidneys.
2. Since Mr. Ellis now voids spontaneously without recognizing the need to void, how
should the nurse document his current urinary pattern in the medical chart?
A. Polyuria
B. Incontinence
C. Retention
D. Oliguria
Rationale: Incontinence is the involuntary loss of urine. In the case of this client, it may
be the result of neurologic impairment secondary to the stroke.
Safe and Effective Care Environment
3. To help manage Mr. Ellis' incontinence, the nurse initiates a bladder training
program. Which instruction should the nurse provide to the unlicensed assistive
personnel (UAP) who will be helping care for Mr. Ellis?
A. Restrict oral fluids to 1,000 ml daily in evenly divided amounts.
B. Offer warm coffee, cocoa, or tea every 2 hours while awake.
C. Limit client socialization until voiding patterns are established.
D. Remind the client to void every 2 hours while awake.
Rationale: A toileting schedule is an effective means to retrain the bladder. Bladder
training should start with voiding every 2 hours in the daytime and every 4 hours at
Downloaded by Eric Wainaina ()
, night then be adapted to the individual needs. the call bell should be near the client so
that he can ring the bell for assistance to prevent the risk of falling.
4. After several weeks, the bladder training program is unsuccessful in stopping Mr.
Ellis' incontinence. Mr. Ellis appears withdrawn and states that he is frustrated at the
number of episodes that he is having.Which nursing diagnoses are appropriate for Mr.
Ellis?
A. Fluid volume deficit related to voiding patterns.
B. Fluid volume excess related to altered urination.
C. Risk for uremic syndrome related to unresolved incontinence.
D. Risk for impaired skin integrity related to urinary incontinence. E.
Ineffective coping related to inability to control urine leakage.
Rationale: The skin of the client with urinary incontinence is frequently exposed to
urine, which is irritating to the skin and places the client at risk for impaired skin
integrity. The nurse understands that the Braden Scale assessment should be
completed on this client and that every effort should be made to prevent the
development of pressure ulcers.
Rationale: Mr. Ellis’ withdrawn behavior and statements of frustration are evidence
that he may be having a difficult time dealing with his incontinence.
6. Following an episode of incontinence, the nurse washes the client's perineal area
with mild soap and water and applies a water-repellent ointment to the skin. Mr. Ellis'
wife is present and the nurse uses this opportunity to educate her about proper skin
care to prevent breakdown. Which of the following statements made by Mrs. Ellis
indicates that teaching has been effective?
a. "I should not apply lotions and ointments because it could increase the risk of skin
breakdown"
b. "Washing with mild soap and water followed by ointment can help to protect my
husband's skin"
c. "I should not use any type of soap on his buttocks or groin."
d. "I should massage any reddened areas if I notice them."
Rationale: Mild soap and warm water should be used to cleanse the skin followed by a
protective ointment. These water-repellant ointments help protect the skin from the
acidic effects of urine
7. The nursing staff continues with the bladder-training program, but Mr. Ellis'
incontinence shows little improvement. Since the bladder training has not been
successful, the nurse obtains a prescription to apply a condom catheter. Mr. Ellis is able
to ambulate with assistance.
In what order should the prescribed condom catheter be applied to Mr. Ellis? (Arrange
the options in the order they should be performed with the first action on top and the
last action on the bottom.)
Downloaded by Eric Wainaina ()
