Nokea
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.
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The nurse is caring for a patient who is two days postoperative with an ileal conduit, and the patient will not look at the stoma or participate in care and insists that no one but the ostomy nurse specialist care for the stoma. Which of the following nursing diagnoses best reflects the data that the nurse has obtained?
- A. Anxiety related to threat to current status (effects of procedure on lifestyle)
- B. Disturbed body image related to alteration in self-perception
- C. Ineffective coping related to insufficient sense of control
- D. Ineffective denial related to ineffective coping strategies (denial of altered body function)
Correct Answer: B
Rationale: The patient's unwillingness to look at the stoma or participate in care indicates that disturbed body image is the best diagnosis. No data suggest that the impact on lifestyle is a concern for the patient, or that ineffective coping is a result of an insufficient sense of control. The patient's insistence that only the ostomy nurse care for the stoma indicates that denial is not present.
The home health nurse is teaching a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying. Which of the following patient statements indicates that the teaching has been effective?
- A. I will use a sterile catheter and gloves for each time I self-catheterize.
- B. I will clean the catheter carefully before and after each catheterization.
- C. I will need to buy seven new catheters weekly and use a new one every day.
- D. I will need to take prophylactic antibiotics to prevent any urinary tract infections.
Correct Answer: B
Rationale: Patients who are at home can use a clean technique for intermittent self-catheterization and change the catheter every 7 days. There is no need to use a new catheter every day, to use sterile catheters, or to take prophylactic antibiotics.
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.
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 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.