While assessing a client following lithotripsy with stent insertion, which data indicates to the nurse that the procedure was successful?
Stone fragments are collected when straining the client's urine.
Client denies urinary frequency, urgency, or dysuria.
Urine is pale pink with no observable blood clots.
Serum creatinine and blood urea nitrogen (BUN) levels are within normal limits.
The Correct Answer is A
A. This directly indicates that the lithotripsy procedure was successful in breaking down the stone into smaller fragments that can be passed through the urinary tract.
B. While the absence of these symptoms is a positive sign, it does not directly confirm the success of the lithotripsy procedure. These symptoms can be present even if the stone has been broken down.
C. Pale pink urine is expected after lithotripsy due to minor bleeding. The absence of blood clots is also a good sign, but it doesn't definitively confirm the procedure's success.
D. Serum creatinine and blood urea nitrogen (BUN) levels are within normal limits. These lab values are important indicators of kidney function but do not directly relate to the success of the lithotripsy procedure itself.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Chips and pretzels are high in sodium, which can contribute to fluid retention and exacerbate symptoms of CVI. While reducing sodium intake can help manage fluid retention and swelling, it is not the most direct action for promoting circulation itself. It’s more of an adjunctive measure that can support overall management of CVI but does not directly improve venous circulation.
B. Mountain biking is an intense physical activity that may not be suitable for all clients with chronic venous insufficiency, especially if they have significant symptoms or mobility issues. High-impact exercises can potentially exacerbate symptoms or lead to injury. Low-impact activities are generally recommended to improve circulation and manage CVI.
C. Elevating the lower extremities is a highly effective measure for promoting circulation in clients with chronic venous insufficiency. It helps reduce venous pressure and promotes the return of blood to the heart, thereby alleviating swelling and discomfort. This action is directly beneficial in managing CVI.
D. Restricting fluid intake to water alone does not directly address the underlying issues of venous insufficiency. While managing overall fluid intake can be part of a comprehensive plan to prevent excessive fluid retention, it is not the most direct or effective action for promoting circulation compared to elevating the legs.
Correct Answer is A
Explanation
A. Administering an incorrect dose of insulin can lead to hypoglycemia, a serious complication. Discarding the incorrectly dialed dose ensures patient safety. Directly addresses the error and prevents potential harm.
B. This option is inefficient and increases the risk of error. It's unnecessary to use both a pen and a syringe for a single dose. Does not address the immediate issue of the incorrect dose.
C. Administering more insulin than prescribed is dangerous and can lead to hypoglycemia. Wasting the remainder doesn't address the core issue of the incorrect dose. Increases the risk of hypoglycemia.
D. Insulin pens are designed to be precise. Dialing down to the correct dose after an error can compromise the accuracy of the dose. Does not ensure accurate dosing.
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