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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Correct Answer is B

Explanation

A. Driving the client to the nearest medical facility is not appropriate; professional emergency medical services are needed.

B. Notifying emergency management services ensures that the client receives professional medical evaluation and care immediately.

C. Providing water to test the gag reflex is not appropriate in an emergency situation and could pose a choking risk.

D. Performing carotid massage is not recommended and could worsen the condition; it is not a standard emergency procedure.

A. Radiofrequency catheter ablation B. Defibrillation C. CPR D. Elective cardioversion

Correct Answer is B

Explanation

A. Radiofrequency catheter ablation is incorrect. This is a long-term treatment for arrhythmias but not for immediate management of VT.

B. Defibrillation is correct. Defibrillation is used for pulseless ventricular tachycardia or ventricular fibrillation to restore a normal heart rhythm.

C. CPR is incorrect. CPR is performed if the patient is unresponsive and pulseless, not as the first-line intervention for VT.

D. Elective cardioversion is incorrect. Elective cardioversion is used for stable arrhythmias such as atrial fibrillation, not for immediate VT treatment.

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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

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