Elimination

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe?

Loperamide Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.

Which instructions given to a client with renal calculi would be most beneficial? Select all that apply.

"Substitute lemon juice for tea." "Drink plenty of water." Rationale: Renal calculi is the formation of kidney stones. Drinking plenty of water will keep the body hydrated and prevent further formation of stones. Tea contains caffeine, a diuretic, which causes dehydration. Therefore the client must be advised to replace tea with lemon juice. Spinach is rich in oxalates. Consuming spinach soup may aggravate the problem, due to the formation of oxalate crystals. Excessive consumption of proteins may precipitate uric acid stones. Therefore the use of proteins should not be encouraged. Foods rich in omega-3-fatty acids are beneficial in maintaining good health. However, the use of omega-3-fatty acids, specifically in the treatment, mitigation, or prevention of kidney stones, is not justified.

A client with urge incontinence is receiving oxybutynin 30 mg orally twice a day. Each tablet contains 5 mg. How many tablets will the nurse administer in each dose?

6 tablets

A client complains of nocturia, bladder pain, urinary frequency, urgency, and dribbling at the end of urination. On physical examination, the nurse finds a smooth, firm, and enlarged prostate. The digital rectal examination report indicates enlargement of prostate tissue surrounding the urethra. Which condition does the nurse suspect in the client?

Benign prostatic hyperplasia (BPH) Rationale: BPH is a benign enlargement of the prostate gland caused by excessive accumulation of dihydrotestosterone in the prostate cells, which can stimulate cell growth and overgrowth of prostate tissue surrounding the urethra. The clinical manifestations of BPH include nocturia, bladder pain, urinary frequency, urgency, and dribbling at the end of urination. Presence of fever, chills, back pain, and perineal pain, along with acute urinary symptoms such as dysuria, urinary frequency, urgency, and cloudy urine indicates prostatitis, which involves inflammation of the prostate gland. Tightness of the foreskin of the penis resulting in the inability to pull it forward from a retracted position and preventing normal return over the glans indicates paraphimosis. Symptoms of prostate cancer include dysuria, hesitancy, urinary urgency, and leaking or dribbling.

A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result will the nurse check to confirm the diagnosis?

Biopsy of prostatic tissue Rationale: A definitive diagnosis of the cellular changes associated with benign prostatic hyperplasia (BPH) is made by biopsy, with subsequent microscopic evaluation. Palpation of the prostate gland through rectal examination is not a definitive diagnosis; this only reveals size and configuration of the prostate. The serum phosphatase level will provide information for prostatic cancer; a definitive diagnosis cannot be made with this test for BPH. A sample of prostatic fluid helps to diagnosis prostatitis.

A client is scheduled for discharge following surgery. The medical record indicates that the client has not had a bowel movement since before surgery, which was 4 days ago. During the hospital stay, the client received a stool softener daily and an oral laxative the day before discharge. Which one of the prescribed medications should the nurse administer to ensure a bowel movement prior to discharge?

Bisacodyl 10-mg suppository Rationale: A bisacodyl suppository should produce results before the client leaves the facility. The client already had an oral laxative the previous day, which was not effective at the time of discharge. The client already had stool softeners daily, which were not effective at the time of discharge.

A nurse is caring for an elderly client with dementia who has developed dehydration as a result of vomiting and diarrhea. Which assessment best reflects the fluid balance of this client?

Blood lab results Rationale: Blood lab results provide objective data about fluid and electrolyte status as well as about hemoglobin and hematocrit. Skin turgor is not a reliable indicator of hydration status for the elderly client because it is generally decreased with age. Intake and output results provide data only about fluid balance, but do not present a comprehensive picture of the client's fluid and electrolyte status; therefore this is not the best answer. The client's report about fluid intake is subjective data in general and not reliable because this client has dementia and therefore has memory problems.

After the surgical creation of an ileostomy, a client is transferred to a rehabilitation unit. The client asks for help in selecting breakfast. What should the nurse encourage the client to eat or drink?

Cream of wheat and bananas Low-residue foods will not increase motility (cream of wheat and bananas). Caffeine in the coffee and the fiber in the oranges will increase motility and should be avoided. Wheat cereal contains roughage and should be avoided. Toast and the vegetables in a western omelet are high in residue; also, the omelet is fried, which should be avoided

The urinalysis report of a client reveals pH to be 6, turbidity-cloudy, specific gravity of 1.02, and 0.7 mg/dL of proteins. What does the primary healthcare provider infer from the findings?

Infection Rationale: Cloudy urine indicates infection, sedimentation, or high levels of protein in the urine. Therefore the primary healthcare provider concludes that the client has an infection. Increased amounts of proteins in the urine indicate glomerular disorders. The normal levels of protein in the urine range between 0-0.8 mg/dL. Since the client's report shows 0.7 mg/dL of urinary proteins, this is normal. Changes in the pH of urine indicate acid-base imbalance. The average pH of urine is 6. Therefore the client's urinary pH is normal. Decreased kidney perfusion is characterized by increased specific gravity of the urine. The normal specific gravity of urine ranges between 1.000-1.040. The client's urine has a specific gravity of 1.02, which is a normal value.

A nurse is preparing to administer an oil-retention enema and understands that it works primarily by doing what?

Lubricating the sigmoid colon and rectum Rationale: The primary purpose of an oil-retention enema is to lubricate the sigmoid colon and rectum. Secondary benefits of an oil-retention enema include stimulating the urge to defecate and softening feces. An oil-retention enema does not dissolve feces.

A male client reports dysuria, nocturia, and difficulty starting the urinary stream. A cystoscopy and biopsy of the prostate gland have been scheduled. After the procedure the client reports an inability to void. Which action should the nurse take?

Palpate above the pubic symphysis. Rationale: A full bladder is palpable with urinary retention and distention, which are common problems after a cystoscopy because of urethral edema. More conservative nursing methods, such as running water or placing a warm cloth over the perineum, should be attempted to precipitate voiding; catheterization carries a risk of infection and is used as the last resort. Fluids dilute the urine and reduce the chance of infection after cystoscopy and should not be limited. Although urinary retention can occur, it is not expected; the nurse must assess the extent of bladder distention and discomfort.

A client with severe Crohn disease develops a small bowel obstruction. Which clinical finding should the nurse expect the client to report?

Projectile vomiting Rationale: Nausea and vomiting, accompanied by diffuse abdominal pain, commonly occur in clients with small bowel obstruction; the vomiting may be projectile and may contain bile or fecal material. Hematemesis is associated more closely with peptic ulcer disease. Bleeding with defecation is associated with hemorrhoids and anal fissures. Pain in the left lower quadrant is associated with diverticulitis. Pain associated with a small bowel obstruction usually is more diffuse.

While reviewing the result of an intravenous pyelogram, the nurse discovers that the client has a shortened urethra. The client also complains of urinary incontinence. Which nursing intervention is beneficial for the client?

Providing thorough perineal care after each voiding Rationale: Weakened urinary sphincters and shortened urethras are age-related physiologic changes in older adults. Because a shortened urethra has an increased potential for bladder infections, the nurse should provide thorough perineal care after each voiding. Encouraging the client to use the toilet or bedpan every two hours will help to avoid overflow urinary incontinence. Responding quickly to the client's indication of the need to void will help to alleviate urinary stress incontinence episodes. Providing privacy, assistance, and voiding stimulants over the perineum will help to initiate voiding in the client.

During an interview, the nurse discovers that the spouse of a debilitated, chronically constipated client digitally removes stool from the client's rectum. Which response to disimpaction is the nurse attempting to prevent by presenting other strategies to regulate the client's bowel movements?

Slowing of the heart Rationale: Disimpaction can cause vagal stimulation, which slows the heart. The vagus is the principal nerve of the parasympathetic portion of the autonomic nervous system. Increased pulse rate is an action of the sympathetic nervous system. Stimulation of the sympathetic nervous system dilates bronchioles in the lungs; the vagus nerve constricts them. Vagus nerve stimulation increases gastric secretions.

A nurse is caring for a 3-month-old infant with severe diarrhea following antibiotic therapy. After the effects of dehydration are stabilized, the healthcare provider prescribes Lactobacillus granules. What explanation does the nurse give to the infant's parents about the reason for giving lactobacilli?

The flora that inhabit a healthy gastrointestinal tract must be recolonized. Rationale: Lactobacilli are part of the flora in the healthy gastrointestinal tract. The purpose of administering lactobacilli granules is to help recolonize the normal gastrointestinal flora that were destroyed with antibiotic therapy. The other options are not the actions of lactobacilli granules.

A child is admitted to the hospital with diarrhea and is prescribed antidiarrheal medications. Which nursing actions indicate that the nurse is skilled in safe drug administration to pediatric clients? Select all that apply.

The nurse promotes fluid and electrolyte balance. The nurse calculates the drug dose according to the age. Rationale: The nurse should calculate the dose according to the age of the child to ensure accurate dosing. Diarrhea causes rapid loss of fluid volume and electrolytes through the stools; therefore, the nurse should promote fluid and electrolyte balance by ensuring the appropriate intake of fluids. The nurse should assess the child for the presence of eating disorders such as bulimia and anorexia to check for the abuse of laxatives. The nurse should not recommend the long-term use of antidiarrheal medications because they cause toxic effects. The nurse should measure the amount of diarrhea by the number of stools every 24 hours and not for 48 hours.