Nokea
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.
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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.
Examination of a client's bladder stones reveal that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
- A. Low oxalate
- B. Low purine
- C. High protein
- D. High sodium
Correct Answer: B
Rationale: A low-purine diet is used for uric acid stones, the benefits, however, are unknown. Clients with a history of calcium oxalate stone formation need a diet that is adequate in calcium and low in oxalate. Only clients who have type II absorptive hypercalciumâ??approximately half of the clientsâ??need to limit calcium intake. Usually, clients are told to increase their fluid intake significantly, consume a moderate protein intake, and limit sodium. Avoiding excessive protein intake is associated with lower urinary oxalate and lower uric acid levels. Reducing sodium intake can lower urinary calcium levels.
The best nursing action to remove urine from the bladder is to use a curve-tipped coud?© catheter
- A. Use a large catheter such as a 22 French
- B. Use a straight-tipped catheter
- C. Crec?º maneuver
Correct Answer: C
Rationale: The best nursing action to remove urine from the bladder is to use a curve-tipped coud?© catheter. The coud?© catheter has a curved tip to slide over the obstruction. Using a large catheter such as a 22 French would meet resistance and traumatize the urethral lining. A straight-tipped catheter also would meet the obstruction and not advance. Crec?º maneuver may eliminate a small amount of urine but does nothing to allow urine flow around the narrowing.
The nurse is caring for a 37-year-old female client with potential interstitial cystitis. Which question, asked by the nurse, is helpful in supporting the diagnosis?
- A. Have you noted any unusual vaginal drainage?
- B. Have you experienced hematuria with cramping?
- C. When was your last menstrual period?
- D. Do you drink alcoholic beverages on a frequent basis?
Correct Answer: C
Rationale: Although the cause of interstitial cystitis is unknown, there appears to be a connection with female hormones as a link between flare-ups prior to menstruation has been noted. Unusual vaginal drainage is a symptom of a sexually transmitted disease. Hematuria is a symptom of many urinary tract disorders and not helpful in specifically suggesting interstitial cystitis. Alcoholic beverage consumption is not an indicator.
The nurse is caring for several clients on a urinary medical unit. Which client is at an increased risk for bladder stones?
- A. The client with frequent urinary tract infections
- B. The client who is paraplegic
- C. The client with difficulty ambulating
- D. The client with abdominal surgery
Correct Answer: B
Rationale: The client who is immobile or who is paraplegic may also tend to form bladder stones. Clients with incomplete urinary elimination, urinary stasis, or concentrated urine are at higher risk for stone formation. There is not as strong correlation between infections, difficulty ambulating, and surgery.