Nokea
Which intervention should you delegate to the nursing assistant for a patient with cystitis?
- A. Show the patient how to secure a clean-catch urine sample.
- B. Check the patient's urine for color, odor, and sediment.
- C. Review the nursing care plan and add nursing interventions.
- D. Provide the patient with a clean-catch urine sample container.
Correct Answer: C
Rationale: Reviewing the nursing care plan and adding nursing interventions can be delegated to the nursing assistant as it does not involve any complex medical procedures or decision-making.
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Which characteristic is more likely with acute pyelonephritis than with a lower UTI?
- A. Fever
- B. Dysuria
- C. Urgency
- D. Frequency
Correct Answer: A
Rationale: The correct answer is A because fever is more commonly associated with acute pyelonephritis, which is an infection of the renal parenchyma, compared to lower UTIs that primarily affect the bladder and urethra. Dysuria, urgency, and frequency can occur in both types of UTIs but may be more severe in acute pyelonephritis.
Water intoxication may result from absorption of excessive bladder irrigation solution after surgery. Which of the following symptoms might indicate water intoxication is developing?
- A. Confusion and restlessness
- B. Increased serum sodium concentration
- C. Cool, clammy skin
- D. Marked peripheral edema
Correct Answer: A
Rationale: Confusion and restlessness are common symptoms of water intoxication. Monitoring for these signs is crucial in detecting and managing water intoxication promptly to prevent further complications.
The male patient is admitted with a diagnosis of benign prostatic hyperplasia (BPH). What urination characteristics should the nurse expect to assess in this patient?
- A. Oliguria
- B. Hesitancy
- C. Hematuria
- D. Pneumaturia
Correct Answer: B
Rationale: The correct answer is B because hesitancy is a common urination characteristic in patients with benign prostatic hyperplasia. Oliguria, hematuria, and pneumaturia are not typically associated with BPH.
An important point to remember when assisting urosto-mates with a pouch change is to
- A. scrub the peristomal skin with a deodorant soap
- B. cut the pouch opening approximately 3 mm larger than the stoma
- C. dry the skin thoroughly with alcohol wipes
- D. place aspirin in the bottom of the pouch to absorb odors
Correct Answer: B
Rationale: When assisting urosto-mates with a pouch change, it is important to cut the pouch opening approximately 3 mm larger than the stoma to prevent irritation and ensure a proper fit. This allows for a better seal and reduces the risk of leakage or skin damage. Scrubbing the peristomal skin with a deodorant soap, drying the skin with alcohol wipes, or placing aspirin in the pouch are not recommended practices and may lead to complications.
What information should be taught to a patient taking oxybutynin chloride (Ditropan) for incontinence?
- A. Drink fluids or use hard candy when you experience a dry mouth.
- B. Be sure to notify your physician if you experience a heart rate of less than 60 per minute.
- C. Take the medication on an empty stomach for better absorption.
- D. Avoid all citrus fruits and juices while on this medication.
Correct Answer: B
Rationale: It is important to monitor heart rate, as oxybutynin can cause cardiac side effects.