A nurse is planning care for a client who has renal stones and a urinary catheter in place.
Which of the following interventions should the nurse include in the plan of care?
Maintain the client on bed rest.
Strain the client's urine through a mesh filter.
Encourage fluid intake of 1500 mL/day.
Clamp the urinary catheter every 2 hr.
The Correct Answer is B
a. Maintain the client on bed rest: While rest may be indicated in some cases, it is not a specific intervention for managing renal stones with a urinary catheter.
b. Strain the client's urine through a mesh filter: Straining urine is essential to collect any stones that may have passed, allowing for analysis and identification.
c. Encourage fluid intake of 1500 mL/day: Adequate fluid intake is crucial to prevent stone formation, but the amount may vary depending on the client's specific needs and condition.
d. Clamp the urinary catheter every 2 hr: Clamping the urinary catheter is not a standard
intervention for managing renal stones. Straining the urine for stone collection is a more relevant intervention.
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Related Questions
Correct Answer is B
Explanation
a. Rest in a supine position: Resting in a supine position may compromise lung expansion, and an upright position is often recommended for clients with emphysema to improve ventilation.
b. Breathe in through her nose and out through pursed lips: This technique helps maintain
positive airway pressure, preventing premature airway collapse, and can improve gas exchange in clients with emphysema.
c. Limit fluid intake throughout the day: Adequate hydration is important for maintaining
respiratory secretions in a liquefied state and is generally encouraged for clients with respiratory conditions.
d. Consume a low-protein diet: A low-protein diet is not specifically indicated for improving gas exchange in clients with emphysema. Nutrition recommendations may focus on a well-balanced diet to support overall health.
Correct Answer is D
Explanation
a. Decrease the IV fluid infusion rate and limit oral fluid intake: The client's BUN and creatinine levels are not significantly elevated, and limiting fluid intake may exacerbate dehydration.
Decreasing the IV fluid rate may not be indicated without further assessment.
b. Collect a urine specimen for culture and sensitivity: While obtaining a urine specimen is
important, the priority in this case is to evaluate the urine output for amount and specific gravity to assess renal function and fluid balance.
c. Continue routine care because the results are within the expected reference range: The elevated BUN, along with nausea and vomiting, suggests the need for further assessment rather than
continuing routine care without adjustments.
d. Evaluate urine output for amount and urine for specific gravity: This is the correct action to assess renal function and fluid balance. Monitoring urine output and specific gravity will help determine if the client's kidneys are effectively concentrating urine and adequately excreting waste products.
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