Nokea
A patient has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed?
- A. The circumference of the stoma
- B. The narrowest part of the stoma
- C. The widest part of the stoma
- D. Half the width of the stoma
Correct Answer: C
Rationale: The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than1.6 \mathrm{~mm}$ (1 / 8$ inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage.
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A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?
- A. Stress incontinence
- B. Reflex incontinence
- C. Overflow incontinence
- D. Functional incontinence
Correct Answer: A
Rationale: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to reach the toilet in time for voiding.
The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite?
- A. Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic.
- B. The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group.
- C. Men of all ages are less prone to UTIs, but typically experience more severe symptoms.
- D. The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.
Correct Answer: B
Rationale: The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age approaches that of women in the same age group. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs.
A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply.
- A. Food cravings
- B. Upper abdominal pain
- C. Insatiable thirst
- D. Uncharacteristic fatigue
- E. New onset of confusion
Correct Answer: D,E
Rationale: The most common subjective presenting symptom of UTI in older adults is generalized fatigue. The most common objective finding is a change in cognitive functioning. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none is directly suggestive of a UTI.
The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a patient how to manage her new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices?
- A. Empty the collection bag when it is between one-half and two-thirds full.
- B. Limit fluid intake to prevent production of large volumes of dilute urine.
- C. Reinforce the appliance with tape if small leaks are detected.
- D. Avoid using moisturizing soaps and body washes when cleaning the peristomal area.
Correct Answer: D
Rationale: The patient is instructed to avoid moisturizing soaps and body washes when cleaning the area because they interfere with the adhesion of the pouch. To maintain skin integrity, a skin barrier or leaking pouch is never patched with tape to prevent accumulation of urine under the skin barrier or faceplate. Fluids should be encouraged, not limited, and the collection bag should not be allowed to become more than one-third full.
An adult patient has been hospitalized with pyelonephritis. The nurses review of the patients intake and output records reveals that the patient has been consuming between3 \mathrm{~L}$ and3.5 \mathrm{~L}$ of oral fluid each day since admission. How should the nurse best respond to this finding?
- A. Supplement the patients fluid intake with a high-calorie diet.
- B. Emphasize the need to limit intake to2 \mathrm{~L}$ of fluid daily.
- C. Obtain an order for a high-sodium diet to prevent dilutional hyponatremia.
- D. Encourage the patient to continue this pattern of fluid intake.
Correct Answer: D
Rationale: Unless contraindicated, 3 to4 \mathrm{~L}$ of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. No need to supplement this fluid intake with additional calories or sodium.