Nokea
The nurse is preparing a patient for an intravenous pyelogram (IVP) and obtains the following information. Which information has the most immediate implications for the patient's care?
- A. The patient describes allergies to shellfish and penicillin.
- B. The patient has not had anything to eat or drink for 8 hours.
- C. The patient complains of costovertebral angle (CVA) tenderness.
- D. The patient used a bisacodyl tablet the previous night.
Correct Answer: A
Rationale: Iodine-based contrast dye is used during IVP and for many computed tomography (CT) scans. The nurse will need to notify the health care provider before the procedures so that the patient can receive medications such as antihistamines or corticosteroids before the procedures are started. The other information also is important to note and document but does not have immediate implications for the patient's care during the procedures.
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The nurse is admitting an older-adult patient with benign prostatic hyperplasia. Which of the following actions should be included in the nursing plan of care?
- A. Limit fluid intake to no more than 1500 mL/day.
- B. Leave a light on in the bathroom during the night
- C. Pad the patient's bed to accommodate overflow incontinence.
- D. Ask the patient to use a urinal so that all urine can be measured.
Correct Answer: B
Rationale: The patient's age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patient's output is necessary or that the patient has overflow incontinence.
The nurse is caring for a patient with an elevated blood urea nitrogen (BUN) and serum creatinine who is scheduled for a renal arteriogram. Which of the following bowel preparation prescriptions should the nurse question?
- A. Fleet enema
- B. Tap-water enema
- C. Bisacodyl tablets
- D. Castor oil
Correct Answer: A
Rationale: High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure. The other medications for bowel evacuation are more appropriate.
Which of the following actions should the nurse plan to take first when admitting a patient who has a history of neurogenic bladder as a result of a spinal cord injury?
- A. Ask about the usual urinary pattern and any measures used for bladder control.
- B. Assist the patient to the toilet at scheduled times to help ensure bladder emptying.
- C. Check the patient for urinary incontinence every 2 hours to maintain skin integrity.
- D. Use intermittent catheterization on a regular schedule to avoid the risk of infection.
Correct Answer: A
Rationale: Before planning any interventions, the nurse should complete the assessment and determine the patient's normal bladder pattern and the usual measures used by the patient at home. All the other responses may be appropriate, but until the assessment is complete, an individualized plan for the patient cannot be developed.
A patient's urine dipstick indicates a small amount of protein in the urine. Which of the following actions should the nurse take next?
- A. Check which medications the patient is currently taking.
- B. Obtain a clean-catch urine specimen for culture and sensitivity testing.
- C. Ask the patient about any family history of persistent renal failure.
- D. Send a urine specimen to the laboratory to test for ketones and glucose.
Correct Answer: A
Rationale: Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings. The other actions by the nurse may be appropriate, but checking for medications that may affect the dipstick accuracy should be done first.
The nurse is preparing a patient for a cystoscopy. Which of the following information should the nurse include in patient teaching about the procedure?
- A. NPO for 8 hours to prevent nausea and vomiting.
- B. Strict bed rest for about 4-6 hours.
- C. Request prescribed opioids as necessary for pain.
- D. May experience blood-tinged urine and urinary frequency.
Correct Answer: D
Rationale: Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires opioids for relief is not expected. A good fluid intake is encouraged after this procedure. Bed rest is not required following cystoscopy.