Nokea
A patient who has had a transurethral resection with fulguration for bladder cancer 3 days previously calls the nurse at the urology clinic. Which of the following information given by the patient is most important to report to the health care provider?
- A. The patient is using opioids for pain.
- B. The patient has noticed clots in the urine.
- C. The patient is very anxious about the cancer.
- D. The patient is taking a 15-minute sitz bath twice a day.
Correct Answer: B
Rationale: Clots in the urine are not expected and require further follow-up. Sitz baths two to three times a day, use of opioids for pain, and anxiety are typical after this procedure.
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The nurse is obtaining the health history for a patient who smokes two packs of cigarettes daily. Which of the following conditions should the nurse include in the teaching plan that the patient is at an increased risk for developing?
- A. Kidney stones
- B. Bladder cancer
- C. Bladder infection
- D. Interstitial cystitis
Correct Answer: B
Rationale: Cigarette smoking is a risk factor for bladder cancer. The patient's risk for developing interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by quitting smoking.
The nurse is caring for a patient who is two days postoperative with an ileal conduit, and the patient will not look at the stoma or participate in care and insists that no one but the ostomy nurse specialist care for the stoma. Which of the following nursing diagnoses best reflects the data that the nurse has obtained?
- A. Anxiety related to threat to current status (effects of procedure on lifestyle)
- B. Disturbed body image related to alteration in self-perception
- C. Ineffective coping related to insufficient sense of control
- D. Ineffective denial related to ineffective coping strategies (denial of altered body function)
Correct Answer: B
Rationale: The patient's unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best diagnosis. No data suggest that the impact on lifestyle is a concern for the patient, or that ineffective coping is a result of an insufficient sense of control. The patient's insistence that only the ostomy nurse care for the stoma indicates that denial is not present.
The nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy. Which of the following findings is most important to report?
- A. Blood in urine
- B. Left flank pain
- C. Left flank bruising
- D. Drop in urine output
Correct Answer: D
Rationale: A drop in urine output after lithotripsy may indicate obstruction or renal damage, which is a critical complication requiring immediate reporting. Hematuria, left flank pain, and bruising are common post-lithotripsy findings and are less urgent unless severe or persistent.
Which of the following actions should the nurse teach to a patient to help prevent the recurrence of renal calculi?
- A. Use a filter to strain all urine.
- B. Avoid dietary sources of calcium.
- C. Drink diuretic fluids such as coffee.
- D. Have 2000-3000 ml of fluid a day.
Correct Answer: D
Rationale: A fluid intake of 2000-2200 ml daily is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
The nurse is caring for a patient with benign prostatic hyperplasia who has chills, fever, and is vomiting. Which of the following findings by the nurse is most helpful in determining whether the patient has an upper urinary tract infection (UTI)?
- A. Suprapubic pain
- B. Bladder distention
- C. Foul-smelling urine
- D. Costovertebral tenderness
Correct Answer: D
Rationale: Costovertebral tenderness is characteristic of pyelonephritis. The other symptoms are characteristic of lower UTI and are likely to be present if the patient also has an upper UTI.