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A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patients post-procedure care?
- A. Strain the patients urine following the procedure.
- B. Administer a bolus of500 \mathrm{~mL}$ normal saline following the procedure.
- C. Monitor the patient for fluid overload following the procedure.
- D. Insert a urinary catheter for 24 to 48 hours after the procedure.
Correct Answer: A
Rationale: Following ESWL, the nurse should strain the patients urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.
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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.
The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day?
- A. $1,250 \mathrm{~mL}$
- B. $2,000 \mathrm{~mL}$
- C. $2,750 \mathrm{~mL}$
- D. $3,500 \mathrm{~mL}$
Correct Answer: B
Rationale: Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output exceeding2 \mathrm{~L}$ a day is advisable.
A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patients high risk for urinary retention and should implement what intervention in the patients plan of care?
- A. Relaxation techniques
- B. Sodium restriction
- C. Lower abdominal massage
- D. Double voiding
Correct Answer: D
Rationale: To enhance emptying of a flaccid bladder, the patient may be taught to double void. After each voiding, the patient is instructed to remain on the toilet, relax for 1 to 2 minutes, and then attempt to void again in an effort to further empty the bladder. Relaxation does not affect the neurologic etiology of a flaccid bladder. Sodium restriction and massage are similarly ineffective.
The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patients health education, what nutritional guidelines should the nurse provide?
- A. Restrict protein intake as ordered.
- B. Increase intake of potassium-rich foods.
- C. Follow a low-calcium diet.
- D. Encourage intake of food containing oxalates.
Correct Answer: A
Rationale: Protein is restricted to60 \mathrm{~g} / \mathrm{d}$, while sodium is restricted to 3 to4 \mathrm{~g} / \mathrm{d}$. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalatecontaining foods and there is no need to increase potassium intake.
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.