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The nurse is caring for a patient with renal calculi, gross hematuria, and severe colicky left flank pain. Which of the following actions is priority at this time?
- A. Encourage oral fluid intake.
- B. Administer prescribed analgesics.
- C. Monitor temperature every 4 hours.
- D. Give antiemetics as needed for nausea.
Correct Answer: B
Rationale: Although all of the nursing actions may be used for patients with renal lithiasis, the patient's presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.
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The nurse is obtaining the health history for a patient who smokes two packs of cigarettes daily. Which of the following conditions should the nurse include in the teaching plan that the patient is at an increased risk for developing?
- A. Kidney stones
- B. Bladder cancer
- C. Bladder infection
- D. Interstitial cystitis
Correct Answer: B
Rationale: Cigarette smoking is a risk factor for bladder cancer. The patient's risk for developing interstitial cystitis, urinary tract infection (UTI), or kidney stones will not be reduced by quitting smoking.
Which of the following actions should the nurse teach to a patient to help prevent the recurrence of renal calculi?
- A. Use a filter to strain all urine.
- B. Avoid dietary sources of calcium.
- C. Drink diuretic fluids such as coffee.
- D. Have 2000-3000 ml of fluid a day.
Correct Answer: D
Rationale: A fluid intake of 2000-2200 ml daily is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.
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.
Which of the following nursing actions is most helpful in decreasing the risk for hospital-acquired infection (HAI) of the urinary tract in patients admitted to the hospital?
- A. Avoid unnecessary catheterizations
- B. Encourage adequate oral fluid intake.
- C. Test urine with a dipstick daily for nitrites.
- D. Provide thorough perineal hygiene to patients.
Correct Answer: A
Rationale: Since catheterization bypasses many of the protective mechanisms that prevent urinary tract infection (UTI), avoidance of catheterization is the most effective means of reducing HAI. The other actions will also be helpful, but are not as useful as decreasing urinary catheter use.
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.