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The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client?
- A. Supurapubic cystostomy tube
- B. Permanent drainage with a urethral catheterer
- C. Clean intermittent catheterization
- D. Cred?© voiding procedure
Correct Answer: B
Rationale: Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones; renal diseases; bladder infections; and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream. Clean intermittent catheterization has the fewest complications and is the preferred treatment for urinary retention. The Cred?© voiding procedure is used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.
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The nurse is caring for a client diagnosed with bladder cancer and requiring a cystectomy. The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. In gathering information for the client, which urinary diversion would the nurse select?
- A. Ileal conduit
- B. Kock Pouch
- C. Ureterosigmoidostomy
- D. Indiana Pouch
Correct Answer: A
Rationale: When the physician is discussing a stoma, the nurse recognizes that the client will have an ileal conduit which is a cutaneous urinary diversion. Both the Kock Pouch and Indiana Pouch are continent urinary diversions. The ureterosigmoidostomy connects with the rectum for urinary drainage.
The licensed practical nurse is employed as a charge nurse at a long-term care facility. A resident is ordered a catheterization schedule of every 6 hours due to chronic urinary retention. The LPN reports daily catheterization amounts from the previous day ranging from 450 mL to 800 mL. Which nursing action is most correct?
- A. Continue the same order
- B. Obtain an order to decrease the frequency of the catheterizations
- C. Obtain an order to increase the frequency of the catheterizations
- D. Leave the catheterer in if obtaining a urine amount over 500 mL
Correct Answer: C
Rationale: The charge nurse realizes that if the volume of urine obtained via catheterization is more than 400 mL, the client should be catheterized more often. The LPN would call for a change in orders citing the urine volume as the rationale. Leaving the catheter in place is only completed if necessary.
The nurse is caring for a client with chronic bladder infections and inflammation. The physician has ruled out several medical diagnoses and is considering interstitial cystitis. The nurse is most correct to anticipate which diagnostic test to confirm the disorder?
- A. A cystoscopy
- B. A voiding cystourethrogram
- C. A bladder biopsy
- D. A potassium sensitivity test
Correct Answer: C
Rationale: A bladder biopsy of the bladder mucosa reveals an inflammatory process with scarring and hemorrhagic areas and confirms the diagnosis. A cystoscopy reveals an inflamed bladder, bladder mucosa with pinpoint hemorrhages and a bladder capacity smaller than normal. A voiding cystourethogram demonstrates a small bladder capacity. A potassium sensitivity test reveals pain from the potassium instilled and is used in suggesting the presence of bladder inflammation and irritation.
The nurse is caring for a client diagnosed with bladder stones. The client is scheduled for a cystolitholapaxy. Which nursing action is most important to complete prior to the procedure?
- A. Strain all urine
- B. Maintain the intake and output
- C. Maintain 12 hours of nothing by mouth
- D. Make sure that the nurse has the consent signed
Correct Answer: A
Rationale: It is most important to strain all urine up to the time of the procedure. Should the client pass the stone, the procedure may be able to be cancelled. Maintaining intake and output is important in considering fluid balance. Most clients are ordered nothing by mouth after midnight for a morning procedure. The physician is responsible for explaining the procedure and obtaining the signatures on the consent.
The nurse observes a client's uric acid level of 9.3 mg/dL. When teaching the client about ways to decrease the uric acid level, which diet would the nurse suggest?
- A. A low-sodium diet
- B. A low-purine diet
- C. A diet high in fruits and vegetables
- D. A diet high in calcium
Correct Answer: B
Rationale: The nurse would suggest a low-purine diet. Foods to avoid are anchovies, animal organs, and sardines. The other options do not lower the uric acid levels.