Nokea
Which of the following findings by the nurse for a patient admitted with glomerulonephritis indicates that treatment has been effective?
- A. The patient denies pain with voiding.
- B. The urine dipstick is negative for nitrites.
- C. Peripheral and periorbital edema is resolved.
- D. The antistreptolysin-O (ASO) titre is decreased.
Correct Answer: C
Rationale: Since edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Antibodies to streptococcus will persist after a streptococcal infection. Nitrites will be negative and the patient will not experience dysuria since the patient does not have a urinary tract infection.
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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.
The nurse is caring for a patient who has a history of functional urinary incontinence. Which of the following nursing actions should be included in the plan of care?
- A. Place a bedside commode near the patient's bed.
- B. Demonstrate the use of the Credé manoeuvre to the patient.
- C. Use an ultrasound scanner to check postvoiding residuals.
- D. Teach the use of Kegel exercises to strengthen the pelvic floor.
Correct Answer: A
Rationale: Modifications in the environment make it easier to avoid functional incontinence. Checking for residual urine and performing the Credé manoeuvre are interventions for overflow incontinence. Kegel exercises are useful for stress incontinence.
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.
The nurse is caring for a patient who has had an ureterolithotomy with a left ureteral catheter and a urethral catheter in place. Which of the following actions should the nurse include in the plan of care?
- A. Provide education about home care for both catheters
- B. Apply continuous steady tension to the ureteral catheter.
- C. Clamp the ureteral catheter unless output from
- D. Call the health care provider if the ureteral catheter output drops suddenly.
Correct Answer: D
Rationale: The health care provider should be notified if the ureteral catheter output decreases since obstruction of this catheter may result in an increase in pressure in the renal pelvis. Tension on the ureteral catheter should be avoided in order to prevent catheter displacement. To avoid pressure in the renal pelvis, the catheter is not clamped. Since the patient is not usually discharged with a ureteral catheter in place, patient teaching about both catheters is not needed.
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.