Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Which statement by the nurse to the client accurately describes the ileal conduit?
A. This is always a temporary procedure that can always be reversed later
An ileal conduit is typically a permanent procedure for bladder cancer after cystectomy, as the bladder is removed. Reversibility is rare and depends on specific circumstances, not guaranteed. This statement is inaccurate, as it falsely suggests that ileal conduits are always temporary and reversible.
B. Urine is diverted into the sigmoid colon, where it is expelled through the rectum
Diverting urine to the sigmoid colon describes a ureterosigmoidostomy, not an ileal conduit. In an ileal conduit, urine is diverted through an ileal segment to an abdominal stoma, not the rectum. This statement is inaccurate, as it describes a different urinary diversion procedure.
C. Urine is diverted from the ureters to a stoma opening on the abdomen
An ileal conduit involves diverting urine from the ureters through a segment of ileum to a stoma on the abdomen, where urine is collected in an external pouch. This is the standard procedure for bladder cancer post-cystectomy, making this statement accurate and descriptive of the ileal conduit.
D. The diversion creates an opening in the bladder for urine to be eliminated
An ileal conduit does not create an opening in the bladder; the bladder is often removed in bladder cancer. Urine is diverted from the ureters to a stoma, bypassing the bladder. This statement is inaccurate, as it misrepresents the anatomical changes in an ileal conduit.
This question is an excerpt from Nurse Dive's nursing test bank - Pathophamacology Proctored Exam (Examplify). Take the full exam now
Full Explanation
Choice A reason: An ileal conduit is typically a permanent procedure for bladder cancer after cystectomy, as the bladder is removed. Reversibility is rare and depends on specific circumstances, not guaranteed. This statement is inaccurate, as it falsely suggests that ileal conduits are always temporary and reversible.
Choice B reason: Diverting urine to the sigmoid colon describes a ureterosigmoidostomy, not an ileal conduit. In an ileal conduit, urine is diverted through an ileal segment to an abdominal stoma, not the rectum. This statement is inaccurate, as it describes a different urinary diversion procedure.
Choice C reason: An ileal conduit involves diverting urine from the ureters through a segment of ileum to a stoma on the abdomen, where urine is collected in an external pouch. This is the standard procedure for bladder cancer post-cystectomy, making this statement accurate and descriptive of the ileal conduit.
Choice D reason: An ileal conduit does not create an opening in the bladder; the bladder is often removed in bladder cancer. Urine is diverted from the ureters to a stoma, bypassing the bladder. This statement is inaccurate, as it misrepresents the anatomical changes in an ileal conduit.
Similar Questions
A client with type 2 diabetes is prescribed glipizide, a sulfonylurea. The nurse should monitor the client for which of the following potential adverse effects?
A. Hypoglycemia
Glipizide, a sulfonylurea, stimulates insulin release from pancreatic beta cells by blocking ATP-sensitive potassium channels, increasing insulin secretion. This can cause hypoglycemia, especially if meals are skipped or with excessive dosing. Monitoring blood glucose is critical, as hypoglycemia can lead to symptoms like sweating, shakiness, or confusion, making this the primary adverse effect.
B. Hyperkalemia
Glipizide does not significantly affect potassium levels. Hyperkalemia is more associated with drugs like ACE inhibitors or potassium-sparing diuretics. Sulfonylureas primarily impact glucose metabolism, not electrolyte balance, making this an inaccurate adverse effect to monitor in patients taking glipizide.
C. Weight loss
Glipizide often causes weight gain, not weight loss, due to increased insulin levels promoting glucose uptake and fat storage. Weight loss is more associated with drugs like metformin or SGLT-2 inhibitors. This statement is inaccurate, as weight gain is a more likely concern with sulfonylureas.
D. Hypertension
Hypertension is not a common adverse effect of glipizide. Sulfonylureas primarily affect glucose metabolism, not blood pressure. While diabetes increases cardiovascular risk, glipizide does not directly cause hypertension, making this an inaccurate adverse effect to prioritize in monitoring for this medication.
Full Explanation
Choice A reason: Glipizide, a sulfonylurea, stimulates insulin release from pancreatic beta cells by blocking ATP-sensitive potassium channels, increasing insulin secretion. This can cause hypoglycemia, especially if meals are skipped or with excessive dosing. Monitoring blood glucose is critical, as hypoglycemia can lead to symptoms like sweating, shakiness, or confusion, making this the primary adverse effect.
Choice B reason: Glipizide does not significantly affect potassium levels. Hyperkalemia is more associated with drugs like ACE inhibitors or potassium-sparing diuretics. Sulfonylureas primarily impact glucose metabolism, not electrolyte balance, making this an inaccurate adverse effect to monitor in patients taking glipizide.
Choice C reason: Glipizide often causes weight gain, not weight loss, due to increased insulin levels promoting glucose uptake and fat storage. Weight loss is more associated with drugs like metformin or SGLT-2 inhibitors. This statement is inaccurate, as weight gain is a more likely concern with sulfonylureas.
Choice D reason: Hypertension is not a common adverse effect of glipizide. Sulfonylureas primarily affect glucose metabolism, not blood pressure. While diabetes increases cardiovascular risk, glipizide does not directly cause hypertension, making this an inaccurate adverse effect to prioritize in monitoring for this medication.
A client with type 2 diabetes who has been prescribed metformin. The client asks the nurse how the medication will affect their kidneys. What is the nurse’s most appropriate response?
A. Metformin is generally safe for the kidneys but requires monitoring in case of renal impairment
Metformin is safe for kidneys in patients with normal renal function but is excreted renally, requiring monitoring in chronic kidney disease (CKD). Reduced glomerular filtration rate (GFR) can lead to metformin accumulation, increasing lactic acidosis risk. Regular renal function tests (e.g., creatinine, GFR) are needed, making this statement accurate.
B. Metformin is nephrotoxic and can directly damage your kidneys over time
Metformin is not nephrotoxic; it does not directly damage kidneys. Its primary risk in renal impairment is lactic acidosis due to reduced clearance, not direct toxicity. This statement is inaccurate, as metformin is generally renal-safe when monitored appropriately in patients with adequate kidney function.
C. Metformin increases the risk of kidney stones due to changes in urine composition
Metformin does not increase kidney stone risk. It lowers blood glucose by reducing hepatic gluconeogenesis and improving insulin sensitivity, without altering urinary composition linked to stones. Kidney stones are more associated with conditions like hyperuricemia or dehydration, making this statement inaccurate for metformin’s effects.
D. Metformin has no effect on the kidneys and does not require monitoring
Metformin requires renal function monitoring, as it is cleared by the kidneys. In renal impairment, accumulation can cause lactic acidosis, a rare but serious complication. This statement is inaccurate, as monitoring (e.g., eGFR) is essential to ensure safe use, especially in patients with kidney disease risk.
Full Explanation
Choice A reason: Metformin is safe for kidneys in patients with normal renal function but is excreted renally, requiring monitoring in chronic kidney disease (CKD). Reduced glomerular filtration rate (GFR) can lead to metformin accumulation, increasing lactic acidosis risk. Regular renal function tests (e.g., creatinine, GFR) are needed, making this statement accurate.
Choice B reason: Metformin is not nephrotoxic; it does not directly damage kidneys. Its primary risk in renal impairment is lactic acidosis due to reduced clearance, not direct toxicity. This statement is inaccurate, as metformin is generally renal-safe when monitored appropriately in patients with adequate kidney function.
Choice C reason: Metformin does not increase kidney stone risk. It lowers blood glucose by reducing hepatic gluconeogenesis and improving insulin sensitivity, without altering urinary composition linked to stones. Kidney stones are more associated with conditions like hyperuricemia or dehydration, making this statement inaccurate for metformin’s effects.
Choice D reason: Metformin requires renal function monitoring, as it is cleared by the kidneys. In renal impairment, accumulation can cause lactic acidosis, a rare but serious complication. This statement is inaccurate, as monitoring (e.g., eGFR) is essential to ensure safe use, especially in patients with kidney disease risk.
Which client is at greatest risk for osteoporosis?
A. A 30-year-old male who drinks alcohol occasionally with a BMI of 25
A 30-year-old male with occasional alcohol use and normal BMI (25) has minimal osteoporosis risk. Alcohol in moderation and normal weight do not significantly reduce bone density. Peak bone mass is typically preserved at this age, making him less at risk compared to glucocorticoid users.
B. A 22-year-old female who recently had a baby
A 22-year-old female post-pregnancy may experience temporary bone density loss due to calcium demands during pregnancy and lactation, but young age and ongoing bone remodeling reduce long-term osteoporosis risk. Recovery is likely with adequate nutrition, making her less at risk than the glucocorticoid-treated patient.
C. A 40-year-old male taking glucocorticoids for inflammatory bowel disease
Glucocorticoids, used for inflammatory bowel disease, significantly increase osteoporosis risk by inhibiting osteoblast activity, reducing calcium absorption, and increasing bone resorption. This 40-year-old male faces accelerated bone loss, especially with chronic use, making him the highest risk among the options due to medication-induced bone density reduction.
D. A 35-year-old female who recently began running marathons
A 35-year-old female running marathons engages in weight-bearing exercise, which promotes bone density through mechanical stress and osteoblast stimulation. This reduces osteoporosis risk compared to glucocorticoid use, as exercise enhances bone remodeling and strength, making her less likely to develop osteoporosis than the male on steroids.
Full Explanation
Choice A reason: A 30-year-old male with occasional alcohol use and normal BMI (25) has minimal osteoporosis risk. Alcohol in moderation and normal weight do not significantly reduce bone density. Peak bone mass is typically preserved at this age, making him less at risk compared to glucocorticoid users.
Choice B reason: A 22-year-old female post-pregnancy may experience temporary bone density loss due to calcium demands during pregnancy and lactation, but young age and ongoing bone remodeling reduce long-term osteoporosis risk. Recovery is likely with adequate nutrition, making her less at risk than the glucocorticoid-treated patient.
Choice C reason: Glucocorticoids, used for inflammatory bowel disease, significantly increase osteoporosis risk by inhibiting osteoblast activity, reducing calcium absorption, and increasing bone resorption. This 40-year-old male faces accelerated bone loss, especially with chronic use, making him the highest risk among the options due to medication-induced bone density reduction.
Choice D reason: A 35-year-old female running marathons engages in weight-bearing exercise, which promotes bone density through mechanical stress and osteoblast stimulation. This reduces osteoporosis risk compared to glucocorticoid use, as exercise enhances bone remodeling and strength, making her less likely to develop osteoporosis than the male on steroids.