A nurse is collecting data on a client who is two days postoperative following creation of an ileal conduit. The nurse should report which of the following findings?

Urine in the drainage appliance

Feces in the drainage appliance

Mild edema of the stoma

Redness of the stoma

Answer and Explanation

The Correct Answer is B

a. Urine in the drainage appliance: The presence of urine in the drainage appliance is expected in a client with an ileal conduit, as this is the route for urine to exit the body.

b. Feces in the drainage appliance: An ileal conduit is created for urinary diversion, and feces

should not be present in the drainage appliance. This finding could indicate a complication and should be reported.

c. Mild edema of the stoma: Mild edema of the stoma may be expected in the early postoperative period and may not require immediate reporting unless it worsens.

d. Redness of the stoma: Some redness is normal around a stoma, and it may not require immediate reporting unless there are signs of infection or worsening inflammation.

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Free Nursing Study Resources

Correct Answer is A

Explanation

a. A sensory warning that a seizure is imminent: An aura is a subjective sensation or warning that a seizure is about to occur. It can manifest as visual, auditory, or other sensory experiences.

b. A brief loss of consciousness accompanied by staring: This describes an absence seizure, not an aura. Absence seizures are characterized by a brief loss of consciousness without convulsions.

c. A continuous seizure state in which seizures occur in rapid succession: This describes status epilepticus, not an aura. Status epilepticus is a medical emergency characterized by prolonged or rapidly recurring seizures.

d. A period of sleepiness following the seizure during which arousal is difficult: This describes the postictal state, not an aura. The postictal state is a period of altered consciousness or

sleepiness that may follow a seizure.

A. Blood glucose 150 mg/dL B. Urine specific gravity 1.035 C. Weight loss of 3% of total body weight. D. Potassium 2.5 mEq/L

Correct Answer is D

Explanation

a. Blood glucose 150 mg/dL: While elevated blood glucose may be a concern, potassium levels are more critical in the context of acute gastroenteritis, which can lead to fluid and electrolyte

imbalances.

b. Urine specific gravity 1.035: Elevated urine specific gravity indicates concentrated urine and possible dehydration. However, the low potassium level takes precedence as it can lead to

serious cardiac complications.

c. Weight loss of 3% of total body weight: Weight loss is a concern, but the immediate risk of hypokalemia (low potassium) takes priority.

d. Potassium 2.5 mEq/L: This low potassium level is a critical finding that requires prompt attention, as it can lead to cardiac dysrhythmias and other serious complications.

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A nurse is collecting data on a client who is two days postoperative following creation of an ileal conduit. The nurse should report which of the following findings?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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