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The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patients bladder?
- A. Insertion of a suprapubic catheter
- B. Scheduling the patient immediately for a prostatectomy
- C. Application of warm compresses to the perineum to assist with relaxation
- D. Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours
Correct Answer: A
Rationale: When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.
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A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patients discharge education, what is the most plausible nursing diagnosis that the nurse should address?
- A. Impaired mobility related to limitations posed by the ileal conduit
- B. Deficient knowledge related to care of the ileal conduit
- C. Risk for deficient fluid volume related to urinary diversion
- D. Risk for autonomic dysreflexia related to disruption of the sacral plexus
Correct Answer: B
Rationale: The patient will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.
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.
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 patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding?
- A. Use a slipper bedpan.
- B. Apply a cold compress to the perineum.
- C. Have the patient lie in a supine position.
- D. Provide privacy for the patient.
Correct Answer: D
Rationale: Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the patient with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.
The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurses assessment reveals that the stoma is a dark purplish color. What is the nurses most appropriate response?
- A. Document the presence of a healthy stoma.
- B. Assess the patient for further signs and symptoms of infection.
- C. Inform the primary care provider that the vascular supply may be compromised.
- D. Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.
Correct Answer: C
Rationale: A healthy stoma is pink or red. A change from this normal color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma.