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You are working in a urologist's office. When you return from lunch, you have the following phone messages. Which one requires immediate attention?

Mr. Smith, who has multiple sclerosis, has been managing his urinary retention with intermittent catheterization for several years. He has been depressed lately after losing his job and admitted at his last visit to having thoughts of self-harm. He left a message saying he had chills, fatigue, and an oral temperature of 103°F.

Ms. Jones, who has had urinary frequency and urgency for many years, started on Ditropan at her last office visit. She left a message saying her urinary frequency has improved, but her mouth was very dry.

Mr. Jones, a new patient expressing concerns over embarrassing symptoms of incontinence.

Ms. Smith, who is 18 years old, called to cancel her afternoon appointment for her initial incontinence evaluation. Her message said her symptoms weren't that bad and she would call to reschedule.

Answer and Explanation

The Correct Answer is A

Choice A reason: Mr. Smith requires immediate attention due to his multiple sclerosis and severe symptoms of chills, fatigue, and a high fever (103°F). These symptoms could indicate a severe infection such as a urinary tract infection (UTI) or even sepsis, which can be life-threatening, especially in individuals with a compromised immune system or chronic conditions like multiple sclerosis.
Choice B reason: Ms. Jones's dry mouth is a common side effect of Ditropan (oxybutynin), which is used to treat urinary frequency and urgency. While it is uncomfortable, it is not an emergency and can be addressed at the next visit or over a phone consultation.
Choice C reason: Mr. Jones, being a new patient with incontinence concerns, does not present an immediate emergency. This issue, while significant for his quality of life, can be managed through a scheduled appointment.
Choice D reason: Ms. Smith's decision to cancel her appointment due to her symptoms not being severe does not require immediate attention. She can be rescheduled for a later date without risk to her health.

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Correct Answer is B

Explanation

Choice A reason: Wearing an external collection bag is typically associated with other types of urinary diversions, such as an ileal conduit, not a neobladder.
Choice B reason: A neobladder involves the creation of an internal pouch from a segment of the intestine that stores urine and allows for more natural urination, similar to the function of a natural bladder. This option provides the ability to void through the urethra.
Choice C reason: While some initial incontinence can occur after neobladder surgery, the goal is to eventually have voluntary control over urination with time and practice.
Choice D reason: Having a stoma located in the abdomen is characteristic of an ileal conduit or urostomy, not a neobladder. The neobladder is designed to avoid the need for an external stoma.

A. Serum creatinine 6 mg/dL B. Serum potassium 4.5 mEq/L C. Hemoglobin 16 g/dL D. BUN 15 mg/dL

Correct Answer is A

Explanation

Choice A reason: A serum creatinine level of 6 mg/dL is significantly elevated and indicates impaired kidney function, which is a hallmark of acute kidney injury (AKI). Normal creatinine levels are typically around 0.6 to 1.2 mg/dL for adults, so this level suggests severe kidney impairment.
Choice B reason: A serum potassium level of 4.5 mEq/L is within the normal range (3.5-5.0 mEq/L) and does not indicate acute kidney injury. Elevated potassium can be seen in AKI but is not the most specific indicator without other abnormal values.
Choice C reason: A hemoglobin level of 16 g/dL is within the normal range for adults (approximately 13.8 to 17.2 g/dL for men and 12.1 to 15.1 g/dL for women). It does not indicate acute kidney injury.
Choice D reason: A BUN level of 15 mg/dL is within the normal range (7-20 mg/dL) and does not indicate acute kidney injury on its own. Elevated BUN in conjunction with elevated creatinine would be more indicative of AKI.

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You are working in a urologist's office. When you return from lunch, you have the following phone messages. Which one requires immediate attention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who is preoperative for a neobladder urinary diversion. Which of the following statements should the nurse make?

Correct Answer is B

Explanation

A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?

Correct Answer is A

Explanation

You arrive for your morning shift on the urology unit, and the night nurse gives a report on the following patients who will be under your care. Which one would you see first?

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