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The nurse has tested the\mathrm{pH}$ of urine from a patients newly created ileal conduit and obtained a result of 6.8. What is the nurses best response to this assessment finding?
- A. Obtain an order to increase the patients dose of ascorbic acid.
- B. Administer IV sodium bicarbonate as ordered.
- C. Encourage the patient to drink at least500 \mathrm{~mL}$ of water and retest in 3 hours.
- D. Irrigate the ileal conduit with a dilute citric acid solution as ordered.
Correct Answer: A
Rationale: Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine\mathrm{pH}$ is kept below 6.5 by administration of ascorbic acid by mouth. An increased\mathrm{pH}$ may suggest a need to increase ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, nor by increasing fluid intake.
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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 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.
A patient has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of disturbed body image. How can the nurse best address the effects of this urinary diversion on the patients body image?
- A. Emphasize that the diversion is an integral part of successful cancer treatment.
- B. Encourage the patient to speak openly and frankly about the diversion.
- C. Allow the patient to initiate the process of providing care for the diversion.
- D. Provide the patient with detailed written materials about the diversion at the time of discharge.
Correct Answer: B
Rationale: Allowing the patient to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the patient is hesitant. Provision of educational materials is rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role of the diversion in cancer treatment does not directly address the patients body image.
A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of101.1 \mathrm{~F}(38.4 \mathrm{C})$. How should the nurse best respond to the patient?
- A. Remind the patient that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence.
- B. Remind the patient that occasional febrile episodes are expected following ESWL.
- C. Tell the patient to report to the ED for further assessment.
- D. Tell the patient to monitor his temperature for the next 24 hours and then contact his urologists office.
Correct Answer: C
Rationale: Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.
An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment?
- A. Reviewing the patients 24-hour food recall for changes in diet
- B. Assessing for recent contact with individuals who have UTIs
- C. Assessing for changes in the patients level of psychosocial stress
- D. Reviewing the patients medication administration record for recent changes
Correct Answer: D
Rationale: Many medications affect urinary continence in addition to causing other unwanted or unexpected effects. Stress and dietary changes could potentially affect the patients continence, but medications are more frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result from contact with infected individuals.