The nurse instructs the client about the continent urinary diversion in the postoperative period and states that the stoma does not need a pouch. Which does the nurse use to explain the reason for the statement?
1. A gauze pad over the stoma collects draining urine.
2. All urine drains from the remaining healthy ureter.
3. Stoma has a muscular closure to prevent leakage.
4. Initially, a urinary diversion does not drain urine.
3
3. A continent urinary diversion has a muscular closure like a sphincter muscle pre-venting urine leakage. Clients perform self-catheterization every 4–6 hours to drain the urine from the internal reservoir created in surgery.
1. A gauze pad is unnecessary to collect urine.
2. Both ureters are usually diverted to the same diversion.
4. The continent urinary diversion drains urine immediately; in fact, the surgeon con-firms urine drainage from the diversion in the operating room.
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An older adult asks a nurse, "I hear a lot about limiting the amount of fat in my diet and eating a balanced diet. It is confusing. Can you help me understand what a balanced diet for me would be?" The nurse bases a response on which of the following?
a. 10-15% of total calories should be from fat, 30-40% from carbohydrates, and 35-75% from protein b. 20-35% of total calories should be from fat, 45-65% from carbohydrates, and 10-35% from protein c. 45-65% of total calories should be from fat, 20-35% from carbohydrates, and 10-35% from protein d. 20-35% of total calories should be from fat, 10-25% from carbohydrates, and 50-75% from protein
A patient has been taking psyllium [Metamucil] two to three times daily for several days. The patient complains of stomach pain but has not had a stool. What will the nurse do?
a. Ask the patient to drink a full glass of water. b. Give another dose of the psyllium. c. Request an order for a bisacodyl [Dulco-lax] suppository. d. Palpate the patient's abdomen and aus-cultate for bowel sounds.
The nurse is assessing a client who has undergone a transurethral resection of the prostate (TURP). Which assessment finding requires immediate action by the nurse?
a. Passing small blood clots after catheter removal b. Experiencing urinary frequency after ca-theter removal c. Having bright red drainage with multiple blood clots d. Having the urge to void continuously while the catheter is inserted
Your client is describing the pain in the back of his leg as burning, shooting pain with a level of 8 on a scale of 1 to 10. You know that this pain is likely _____ pain
1. nociceptive 2. visceral 3. neuropathic 4. somatic