A nurse is planning postoperative care for a client who is scheduled for an ileal conduit procedure. The nurse should include which of the following in the client's plan of care? (Select all that apply).

Educate the client that hematuria is expected following the procedure.

Notify the provider immediately if mucus is present in the urine.

Monitor hourly urine output.

Apply skin barrier around the stoma site.

Maintain the client on a fluid restriction.

Answer and Explanation

Correct Answer : A,C,D

A. Hematuria is commonly expected following an ileal conduit procedure due to the surgical intervention in the urinary tract.
B. Mucus in the urine is a normal finding after an ileal conduit procedure because the ileum secretes mucus naturally; it does not require immediate notification of the provider unless there are other concerning symptoms.
C. Monitoring hourly urine output is crucial to ensure the patency of the urinary system and to detect any early signs of complications such as obstruction or leakage.
D. Applying a skin barrier around the stoma site is essential to protect the skin from the corrosive effects of urine and to prevent skin breakdown.
E. Fluid restriction is not typically required unless specifically indicated by the provider for other medical reasons; maintaining adequate hydration is important for the client's recovery and to ensure proper urine production.

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Free Nursing Study Resources

Correct Answer is ["100"]

Explanation

- First, calculate the total volume to be infused over the desired time frame: 50 mL over 30 minutes.

- To find the rate in mL/hr, multiply the volume by 2 (since 30 minutes is half an hour), resulting in 100 mL/hr.

- Therefore, the nurse should set the IV pump to deliver 100 mL/hr to administer clindamycin 300 mg over 30 minutes.

A. "Wear an eye patch on the right eye at all times." B. "Plan to relax in a hot tub spa each day." C. "Engage in a vigorous exercise program." D. "Implement a schedule to include periods of rest."

Correct Answer is D

Explanation

A. "Wear an eye patch on the right eye at all times.": This is not appropriate as wearing an eye patch continuously can cause strain on the other eye. It is generally recommended to alternate the eye patch between eyes to manage diplopia (double vision).
B. "Plan to relax in a hot tub spa each day.": This is inappropriate as heat can exacerbate MS symptoms, leading to increased fatigue and other symptoms.
C. "Engage in a vigorous exercise program.": This is inappropriate because vigorous exercise can cause excessive fatigue in individuals with MS. A moderate, well-balanced exercise program is more beneficial.
D. "Implement a schedule to include periods of rest.": This is appropriate as incorporating periods of rest helps manage fatigue, which is a common symptom in MS. It allows the client to balance activity and rest to avoid exacerbation of symptoms.

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A nurse is planning postoperative care for a client who is scheduled for an ileal conduit procedure. The nurse should include which of the following in the client's plan of care? (Select all that apply).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["100"]

Explanation

A nurse is presenting discharge instructions to a client who has multiple sclerosis (MS). The client reports symptoms of diplopia, dysmetria, and sensory change. Which of the following nursing statements are appropriate?

Correct Answer is D

Explanation

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