Nokea
The nurse is caring for a patient who has had left-sided extracorporeal shock wave lithotripsy. Which of the following findings is most important to report?
- A. Blood in urine
- B. Left flank pain
- C. Left flank bruising
- D. Drop in urine output
Correct Answer: D
Rationale: A drop in urine output after lithotripsy may indicate obstruction or renal damage, which is a critical complication requiring immediate reporting. Hematuria, left flank pain, and bruising are common post-lithotripsy findings and are less urgent unless severe or persistent.
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The nurse is caring for a patient who has bladder cancer and had a cystectomy with creation of an Indiana pouch. Which of the following topics should the nurse include in patient teaching?
- A. Application of ostomy appliances
- B. Catheterization technique and schedule
- C. Analgesic use before emptying the pouch
- D. Use of barrier products for skin protection
Correct Answer: B
Rationale: The Indiana pouch enables the patient to self-catheterize every 4-6 hours. There is no need for an ostomy device or barrier products. Catheterization of the pouch is not painful.
The nurse is caring for a young adult female patient who is diagnosed with polycystic kidney disease. Which of the following information should the nurse include in teaching at this time?
- A. Importance of genetic counselling
- B. Complications of renal transplantation
- C. Methods for treating persistent and severe pain
- D. Differences between hemodialysis and peritoneal dialysis
Correct Answer: A
Rationale: Because a young female patient may be considering having children, the nurse should include information about genetic counselling when teaching the patient. The well-managed patient will not need to choose between hemodialysis and peritoneal dialysis or know about the effects of transplantation for many years. There is no indication that the patient has persistent pain.
The nurse is caring for a patient with nephrotic syndrome who develops flank pain. Which of the following medication classifications should the nurse anticipate including in the patient teaching plan?
- A. Antibiotics
- B. Anticoagulants
- C. Corticosteroids
- D. Antihypertensives
Correct Answer: B
Rationale: Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis.
The nurse is caring for a patient who had a nephrectomy after having massive trauma to the kidney. Which of the following assessment findings obtained postoperatively is most important to communicate to the surgeon?
- A. Blood pressure is 102/58.
- B. Incisional pain level is 8/10.
- C. Urine output is 20 ml/hour for 2 hours.
- D. Crackles are heard at both lung bases.
Correct Answer: C
Rationale: Because the urine output should be at least 0.5 ml/kg/hour, a 20 ml output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life-threatening as decreased renal perfusion.
The nurse is caring for a patient whose renal calculus is analyzed as being very high in uric acid. To prevent recurrence of stones, which of the following foods should the nurse teach the patient to avoid eating?
- A. Milk and dairy products
- B. Legumes and dried fruits
- C. Organ meats and sardines
- D. Spinach, chocolate, and tea
Correct Answer: C
Rationale: Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.