Nokea
A client is being discharged after lithotripsy for a urinary calculus. Which statements should the nurse include in the discharge teaching? (Select all that apply.)
- A. Finish the prescribed antibiotic even if you are feeling better.
- B. Drink at least 3 liters of fluid each day.
- C. The bruising on your back may take several weeks to resolve.
- D. All of the above
Correct Answer: D
Rationale: After lithotripsy for a urinary calculus, it is important for the client to complete the prescribed antibiotic course to prevent urinary tract infections. Drinking at least 3 liters of fluid daily helps dilute stone-forming crystals, prevent dehydration, and promote urine flow. Bruising on the back may occur after the procedure and can take several weeks to resolve. Additionally, the client may experience blood in the urine for several days post-procedure. Reporting any pain, fever, chills, or urination difficulties to the healthcare provider is essential, as these symptoms could indicate infection or stone formation. Choice D is correct as all the statements are appropriate for the client's discharge teaching. Choices A, B, and C are individually correct based on the rationale provided, making D the correct answer.
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The nurse is caring for a patient who will receive 10% calcium gluconate to treat a serum potassium level of 5.9 mEq/L. The nurse performs a drug history prior to beginning the infusion. Which drug taken by the patient would cause concern?
- A. Digitalis
- B. Hydrochlorothiazide
- C. Hydrocortisone
- D. Vitamin D
Correct Answer: A
Rationale: Calcium gluconate is administered to treat hyperkalemia by reducing myocardial irritability. When given to a patient taking digitalis, it can lead to digitalis toxicity. Digitalis and calcium gluconate both affect cardiac function, and their concomitant use can potentiate adverse effects. Hydrochlorothiazide, Hydrocortisone, and Vitamin D may impact potassium levels, but they do not interact with calcium gluconate in a way that would cause concern for toxicity.
A client with bladder cancer who underwent a complete cystectomy with ileal conduit is being assessed by a nurse. Which assessment finding should prompt the nurse to urgently contact the healthcare provider?
- A. The ileostomy is draining blood-tinged urine.
- B. There is serous sanguineous drainage on the surgical dressing.
- C. The ileostomy stoma appears pale and cyanotic.
- D. Oxygen saturations are 92% on room air.
Correct Answer: C
Rationale: A pale or cyanotic appearance of the ileostomy stoma indicates compromised circulation, which can lead to necrosis if not promptly addressed. On the other hand, blood-tinged urine and serous sanguineous drainage are common following a complete cystectomy with ileal conduit. These findings do not typically indicate an urgent issue. An oxygen saturation of 92% on room air is slightly below the normal range but does not warrant urgent healthcare provider contact unless accompanied by significant respiratory distress or other concerning symptoms.
Why is lactated Ringer's solution given to a patient experiencing vomiting and diarrhea?
- A. To increase interstitial and intracellular hydration
- B. To maintain plasma volume over time
- C. To pull water from the interstitial space into the extracellular fluid
- D. To replace water and electrolytes
Correct Answer: D
Rationale: Lactated Ringer's solution is an isotonic solution commonly used to replace water and electrolytes lost due to conditions like vomiting and diarrhea. It helps to restore fluid balance by replacing the lost volume and electrolytes. Option A is incorrect because hypotonic fluids, not lactated Ringer's solution, increase interstitial and intracellular hydration. Option B is incorrect as colloidal solutions, not lactated Ringer's solution, are used to maintain plasma volume over time. Option C is incorrect as hypertonic solutions, not lactated Ringer's solution, pull water from the interstitial space into the extracellular fluid.
A client has undergone renal angiography via the right femoral artery. The nurse determines that the client is experiencing a complication of the procedure upon noting:
- A. Urine output of 40 mL/hr
- B. Blood pressure of 118/76 mm Hg
- C. Respiratory rate of 18 breaths/min
- D. Pallor and coolness of the right leg
Correct Answer: D
Rationale: Pallor and coolness of the right leg indicate a potential vascular complication following renal angiography, such as hemorrhage, thrombosis, or embolism. These signs suggest impaired circulation in the affected limb. Urine output, blood pressure, and respiratory rate are not typically associated with complications of renal angiography. Complications of this procedure mainly involve allergic reactions to the dye, dye-induced renal damage, and various vascular issues.
A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?
- A. Decreased calcium levels
- B. Increased phosphorus levels
- C. No adventitious sounds in the lungs
- D. Increased edema in the legs
Correct Answer: C
Rationale: The absence of adventitious sounds upon auscultation of the lungs is a key indicator that the client's fluid balance is stable. Adventitious sounds, such as crackles or wheezes, are typically heard in conditions of fluid overload, indicating that the body is retaining excess fluid. Choices A and B, decreased calcium levels and increased phosphorus levels, are common laboratory findings associated with chronic kidney disease (CKD) and are not directly related to fluid balance. Increased edema in the legs is a sign of fluid imbalance, suggesting fluid retention in the tissues, which would not indicate stable fluid balance in a client with CKD on fluid restrictions.