Nokea
The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply.
- A. Dietary history
- B. Family history of renal stones
- C. Medication history
- D. Surgical history
- E. Vaccination history
Correct Answer: A,B,C
Rationale: Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to stone formation. When caring for a patient with renal stones it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones.
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A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the patients admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply.
- A. Diarrhea
- B. High fever
- C. Hematuria
- D. Urinary frequency
- E. Acute pain
Correct Answer: C,D,E
Rationale: Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia. Often, the patient has a desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteral colic. Diarrhea is not associated with this presentation and a fever is usually absent due to the noninfectious nature of the health problem.
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.
A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurses most appropriate response?
- A. Report this finding promptly to the primary care provider.
- B. Obtain a sterile urine sample and send it for culture.
- C. Obtain a urine sample and check it for\mathrm{pH}$.
- D. Reassure the patient that this is an expected phenomenon.
Correct Answer: D
Rationale: Because mucous membrane is used in forming the conduit, the patient may excrete a large amount of mucus mixed with urine. This causes anxiety in many patients. To help relieve this anxiety, the nurse reassures the patient that this is a normal occurrence after an ileal conduit procedure. Urine testing for culture or\mathrm{pH}$ is not required.
A nurses colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurses management of urinary incontinence in older adults?
- A. Diuretics should be promptly discontinued when an older adult experiences incontinence.
- B. Restricting fluid intake is recommended for older adults experiencing incontinence.
- C. Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence.
- D. Urinary incontinence is not considered a normal consequence of aging.
Correct Answer: D
Rationale: Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.
A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patients urine output hourly and notifies the physician when the hourly output is less than what?
- A. $30 \mathrm{~mL}$
- B. $50 \mathrm{~mL}$
- C. $100 \mathrm{~mL}$
- D. $125 \mathrm{~mL}$
Correct Answer: A
Rationale: A urine output below30 \mathrm{~mL} / \mathrm{hr}$ may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis.