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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Keeping the leg in a dependent position can increase swelling; the leg should be elevated to reduce swelling.
B. Applying ice to the affected area is recommended to reduce swelling and pain after arthroscopic knee surgery.
C. Active range of motion exercises might be recommended, but this depends on the surgeon’s instructions and typically starts after the initial recovery period.
D. Bedrest for 24 hours is not usually required; gentle movement and following specific rehabilitation protocols are encouraged.
Correct Answer is ["100"]
Explanation
- Total volume to infuse: 200 mL
- Time for infusion: 2 hours
- The IV pump rate is calculated as: (Total Volume / Time) = Rate
- So, the calculation would be: (200 mL / 2 hr) = 100 mL/hr
- The nurse should set the IV pump to deliver 100 mL/hr.
Answer= 100
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