When planning care for a client with right ureteral renal calculi, which of the following nursing diagnosis has the less priority of care while caring for this patient?
Impaired urinary elimination related to obstructed flow of urine.
Acute pain related to obstruction by the stone.
Risk for urinary sepsis related to urinary stasis.
Deficient knowledge related to need for prevention of recurrence of calculi.
The Correct Answer is D
Choice A rationale: Addressing the obstruction and restoring urinary flow is a priority to prevent complications.
Choice B rationale: Managing pain caused by the stone obstruction is essential for the client's comfort and well-being.
Choice C rationale: Preventing urinary stasis and subsequent infection is crucial to avoid sepsis.
Choice D rationale: Education about prevention, though important, might have a lower priority compared to addressing immediate complications like obstruction and pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: This is because removing a large amount of fluid from the abdominal cavity can cause a sudden decrease in intra-abdominal pressure, which can lead to hypovolemia and hypotension. The body compensates by increasing the heart rate to maintain cardiac output and perfusion.
Choice B rationale: This is not directly related to paracentesis and may indicate other conditions.
Choice C rationale: This is not directly related to paracentesis and may indicate other conditions.
Choice D rationale: This is not directly related to paracentesis and may indicate other conditions.
Correct Answer is B
Explanation
Choice A rationale: Rotating the neck to one side while observing the eyes moving to the opposite side is a procedure for testing for oculocephalic reflex or doll's eye
phenomenon, which indicates brainstem function.
Choice B rationale: This is the correct answer. Kernig's sign is a clinical sign that indicates meningitis, which is an inflammation of the membranes that cover the brain and spinal cord. To test for Kernig's sign, the nurse should flex the patient's hip to 90 degrees and then attempt to extend the knee. A positive Kernig's sign is when the patient
experiences pain in the lower back or hamstring, resists knee extension, or involuntarily flexes the opposite leg.
Choice C rationale: Stroking the lateral aspect of the sole of the patient's foot and observing for dorsiflexion of the big toe is a procedure for testing for Babinski's sign, which indicates upper motor neuron lesion or damage.
Choice D rationale: Passively flexing the patient's neck forward and observing for hip and knee flexion is a procedure for testing for Brudzinski's sign, which also indicates meningitis.
 |
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today