Nokea
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.
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The nurse is encouraging the client with recurrent urinary tract infections to increase fluid intake to 8 large glasses of fluids daily. Which beverage would the nurse discourage for this client?
- A. Coffee in the morning
- B. Fruit juice midmorning
- C. Milk at lunch
- D. Ginger ale at dinner time
Correct Answer: A
Rationale: The nurse would discourage drinking coffee. Coffee, tea, alcohol, and colas are urinary tract irritants. Fruit juice, milk, and ginger ale are appropriate for drinking and counted toward the daily fluid total.
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 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.
The nurse is caring for a client for whom an ileal conduit is created after a radical cystectomy. Which instructions would the nurse expect to include in the client's plan of care?
- A. Application of an ostomy pouch
- B. Intermitient catheterizations
- C. Exercises to promote sphincter control
- D. Irrigating the urinary diversion
Correct Answer: A
Rationale: An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermitient catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.
A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
- A. Urinary retention
- B. Fever
- C. Frequency
- D. Painless hematuria
Correct Answer: D
Rationale: The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.