Nokea
A patient who had a cystoscopy the previous day calls the urology clinic and gives the nurse all the following information. Which of the following patient statements should be reported immediately to the health care provider?
- A. My urine still looks pink.
- B. My IV site is still bruised.
- C. I have a temperature of 38.3°C (100.9°F).
- D. I did not sleep well last night.
Correct Answer: C
Rationale: The patient's elevated temperature may indicate a bladder infection, a possible complication of cystoscopy. The health care provider should be notified so that antibiotic therapy can be started. Pink-tinged urine is expected after a cystoscopy. The insomnia and bruising should be discussed further with the patient but do not indicate a need to notify the health care provider.
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The nurse is preparing a patient with a decreased glomerular filtration rate for an intravenous pyelogram (IVP). Which of the following actions should be included in the plan of care?
- A. Monitor the urine output after the procedure.
- B. Assist with monitored anesthesia care (MAC).
- C. Give oral contrast solution before the procedure.
- D. Insert a large size urinary catheter before the IVP.
Correct Answer: A
Rationale: Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient's urine output. MAC sedation and retention catheterization are not required for the procedure. The contrast medium is given intravenously, not orally.
The nurse is caring for a patient following an intravenous pyelogram (IVP) and obtains all of the following assessment data. Which of the following findings require immediate action by the nurse?
- A. The heart rate is 58 beats/minute.
- B. The respiratory rate is 38 breaths/minute.
- C. The patient complains of a dry mouth.
- D. The urine output is 400 mL in the first 2 hours.
Correct Answer: B
Rationale: The increased respiratory rate indicates that the patient may be experiencing an allergic reaction (anaphylactic reaction) to the contrast medium used during the procedure. The nurse should immediately assess the patient's oxygen saturation and breath sounds. The other data are not unusual findings following an IVP.
The nurse is assessing a patient's urinary system and is unable to palpate either kidney. Which of the following actions should the nurse take next?
- A. Obtain a urine specimen to check for hematuria
- B. Document the information on the assessment form.
- C. Ask the patient about any history of recent sore throat.
- D. Ask the health care provider about scheduling a renal ultrasound.
Correct Answer: B
Rationale: The kidneys are protected by the abdominal organs, ribs, and muscles of the back and may not be palpable under normal circumstances, so no action except to document the assessment information is needed. Asking about a recent sore throat, checking for hematuria, or obtaining a renal ultrasound may be appropriate when assessing for renal problems for some patients, but there is nothing in the question stem to indicate that they are appropriate for this patient.
The health care provider orders a clean-catch urine specimen for culture and sensitivity testing for a patient with a suspected urinary tract infection (UTI). Which of the following actions should the nurse implement to obtain the specimen?
- A. Teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup.
- B. Have the patient empty the bladder completely, and then obtain the next urine specimen that the patient is able to void.
- C. Insert a short, small 'mini' catheter attached to a collecting container into the urethra and bladder to obtain the specimen.
- D. Clean the area around the meatus with a povidone-iodine swab, and then have the patient void into a sterile container.
Correct Answer: A
Rationale: Teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup best describes the technique for obtaining a clean-catch specimen. The answer beginning, 'insert a short, small, 'mini' catheter attached to a collecting container' describes a technique that would result in a sterile specimen, but a health care provider's order for a catheterized specimen would be required. Using povidone-iodine before obtaining the specimen is not necessary and might result in suppressing the growth of some bacteria. And the technique described in the answer beginning 'have the patient empty the bladder completely' would not result in a sterile specimen.
The nurse is caring for a patient with an elevated blood urea nitrogen (BUN) and serum creatinine who is scheduled for a renal arteriogram. Which of the following bowel preparation prescriptions should the nurse question?
- A. Fleet enema
- B. Tap-water enema
- C. Bisacodyl tablets
- D. Castor oil
Correct Answer: A
Rationale: High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure. The other medications for bowel evacuation are more appropriate.