Nokea
The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer?
- A. Smoking cessation
- B. Reduction of alcohol intake
- C. Maintenance of a diet high in vitamins and nutrients
- D. Vitamin D supplementation
Correct Answer: A
Rationale: People who smoke develop bladder cancer twice as often as those who do not smoke. High alcohol intake and low vitamin intake are not noted to contribute to bladder cancer.
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A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the patients cardiopulmonary status is stable, what aspect of care should the nurse prioritize?
- A. IV fluid administration
- B. Insertion of an indwelling urinary catheter
- C. Pain management
- D. Assisting with aspiration of the stone
Correct Answer: C
Rationale: The patient with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the patients need for IV fluids or for catheterization. Kidney stones cannot be aspirated.
The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patients bladder?
- A. Insertion of a suprapubic catheter
- B. Scheduling the patient immediately for a prostatectomy
- C. Application of warm compresses to the perineum to assist with relaxation
- D. Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours
Correct Answer: A
Rationale: When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.
The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention?
- A. The patients suprapubic region is dull on percussion.
- B. The patient is uncharacteristically drowsy.
- C. The patient claims to void large amounts of urine 2 to 3 times daily.
- D. The patient takes a beta adrenergic blocker for the treatment of hypertension.
Correct Answer: A
Rationale: Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.
A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice?
- A. Assuming a supine position for self-catheterization
- B. Using clean technique at home to catheterize
- C. Inserting the catheter 1 to 2 inches into the urethra
- D. Self-catheterizing every 2 hours at home
Correct Answer: B
Rationale: The patient may use a clean (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female patient assumes a Fowlers position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter7.5 \mathrm{~cm}$ ( 3 inches) into the urethra, in a downward and backward direction.
The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day?
- A. $1,250 \mathrm{~mL}$
- B. $2,000 \mathrm{~mL}$
- C. $2,750 \mathrm{~mL}$
- D. $3,500 \mathrm{~mL}$
Correct Answer: B
Rationale: Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output exceeding2 \mathrm{~L}$ a day is advisable.