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The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient?
- A. Limit oral fluid intake for 1 to 2 days.
- B. Report the presence of fine, sand like particles through the nephrostomy tube.
- C. Notify the physician about cloudy or foul-smelling urine.
- D. Report any pink-tinged urine within 24 hours after the procedure.
Correct Answer: C
Rationale: The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.
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Resection of a patients bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following?
- A. Remain NPO for 12 hours prior to the treatment.
- B. Hold the solution in the bladder for 2 hours before voiding.
- C. Drink the intravesical solution quickly and on an empty stomach.
- D. Avoid acidic foods and beverages until the full cycle of treatment is complete.
Correct Answer: B
Rationale: The patient is allowed to eat and drink before the instillation procedure. Once the bladder is full, the patient must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.
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 female patients most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurses data analysis should be informed by what principle?
- A. Most UTIs in female patients are caused by viruses and do not cause obvious symptoms.
- B. A diagnosis of bacteriuria requires three consecutive positive results.
- C. Urine contains varying levels of healthy bacterial flora.
- D. Urine samples are frequently contaminated by bacteria normally present in the urethral area.
Correct Answer: D
Rationale: Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding10^5$ colonies/ \mathrm{mL}$ of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.
The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurses assessment reveals that the stoma is a dark purplish color. What is the nurses most appropriate response?
- A. Document the presence of a healthy stoma.
- B. Assess the patient for further signs and symptoms of infection.
- C. Inform the primary care provider that the vascular supply may be compromised.
- D. Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.
Correct Answer: C
Rationale: A healthy stoma is pink or red. A change from this normal color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma.
A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patients post-procedure care?
- A. Strain the patients urine following the procedure.
- B. Administer a bolus of500 \mathrm{~mL}$ normal saline following the procedure.
- C. Monitor the patient for fluid overload following the procedure.
- D. Insert a urinary catheter for 24 to 48 hours after the procedure.
Correct Answer: A
Rationale: Following ESWL, the nurse should strain the patients urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.