ATI Specific Content Chapters

A nurse is teaching a client who has multiple sclerosis and has a new prescription for glatiramer acetate. Which of the following statements indicates that the client understands the teaching? "I will ask my partner to give the injection in the same spot each time." "I will avoid going to the store when it is crowded." "I will see relief of my symptoms in about 1 week." "I will exercise rigorously while taking this medication."

"I will avoid going to the store when it is crowded." (Clients who are prescribed this medication are instructed to avoid crowds and individuals who have infection)

A nurse is providing discharge teaching to a client who has chronic kidney disease (CKD). Which of the following statements by the client indicates an understanding of the teaching? "I will consume foods that are high in protein." "I will decrease my intake of foods that are high in phosphorus." "I will limit my intake of foods that are high in iron." "I will add salt to the foods I consume."

"I will decrease my intake of foods that are high in phosphorus." (A client who has CKD should limit their intake of foods that are high in phosphorus to prevent bone damage)

A nurse is planning care for a group of clients. Which of the following clients should the nurse plan to monitor for signs of nephrotoxicity? A client who is receiving gentamicin for the treatment of a wound infection A client who is receiving digoxin for the treatment of heart failure A client who is receiving methylprednisolone for the treatment of severe asthma A client who is receiving propranolol for the treatment of hypertension

A client who is receiving gentamicin for the treatment of a wound infection (Aminoglycoside antibiotics can damage the cells of the proximal renal tubules, causing acute tubular necrosis. The nurse should plan to monitor this client for nephrotoxicity and acute kidney injury.)

A nurse is caring for a client who is in balanced suspension skeletal traction and reports intermittent muscle spasms. Which of the following actions should the nurse take first? Reposition the client. Check the position of the weights and ropes. Administer a muscle relaxant. Provide distraction.

Check the position of the weights and ropes. (The first action the nurse should take when using the nursing process is to assess the client. The nurse should first check the position of the weights and ropes to investigate the cause of the muscle spasms. The weights might be too heavy, or the nurse might need to realign the client.)

A nurse is caring for a client who has a history of status epilepticus and requires seizure precautions. Which of the following actions should the nurse take? A) Assess hourly for a spike in blood pressure. B) Keep the client on bed rest. C) Keep a padded tongue blade at the bedside. D) Establish IV access.

D) Establish IV access.

A nurse is caring for a client who has a retinal detachment. Which of the following findings should the nurse expect? Photophobia Complete vision loss Flashes of bright light Cloudiness of the lens

Flashes of bright light (The nurse should expect a client who has a retinal detachment to see flashes of bright light or floating dark spots in the affected eye as the retinal layers separate.)

A nurse is caring for a client who has advancing amyotrophic lateral sclerosis. Which of the following interventions is the nurse's priority? Provide frequent rest periods throughout the day. Administer pain medication on a regular schedule. Monitor pulse oximetry findings. Administer baclofen for spasticity.

Monitor pulse oximetry findings. (The greatest risk to the client is respiratory compromise due to progressive paralysis of respiratory muscles. Therefore, the priority intervention is to monitor the client's oxygen saturation to identify respiratory compromise as soon as possible)

A nurse in a women's health clinic is caring for a client who reports urinary urgency and dysuria. Which of the following additional findings should the nurse identify as an indication of a urinary tract infection (UTI)? Vaginal discharge Pyuria Glucosuria Elevated creatine kinase-MB

Pyuria (The nurse should identify pyuria, or white blood cells in the urine, as a common manifestation of a UTI.)

*A nurse is assessing a client who has a head injury following a motor-vehicle crash. The nurse should identify that which of the following findings indicates increasing intracranial pressure? Restlessness Dizziness Hypotension Fever

Restlessness (Behavioral changes, such as restlessness and irritability, are early manifestations of increased intracranial pressure.)

A nurse is assessing a client who has rheumatoid arthritis. Which of the following findings should the nurse expect? Unilateral joint involvement Ulnar deviation Fractures of the spine Decreased sedimentation rate

Ulnar deviation (A client who has rheumatoid arthritis can experience inflammation in the hand joints that can make them susceptible to deformity from daily use. Ulnar deviation, or lateral deviation of the fingers, can occur from opening jars and other similar motions.)

A nurse is caring for a client immediately following a kidney transplant. The nurse should identify which of the following findings as a possible indication of a delay in functioning of the transplanted kidney? Blood pressure 110/58 mm Hg Incisional tenderness Pink and bloody urine Urine output 30 mL/2 hr

Urine output 30 mL/2 hr (The client should have a minimum urine output of 30 mL/hr. Following a renal transplant, the nurse should monitor for a decrease in the hourly urine output as an indication that the kidney is not functioning adequately.)

A nurse is planning care for a client following a lumbar puncture. Which of the following actions should the nurse plan to take? A) Apply a pressure dressing to the site for 8 hr. B) Restrict the client's fluid intake for 24 hr. C) Ensure that the client lies flat for up to 12 hr. D) Inform the client that neck stiffness is an expected outcome of the procedure.

Ensure that the client lies flat for up to 12 hr. (The client should lie flat for up to 12 hr to prevent cerebrospinal fluid leakage from the puncture site, which can cause a headache.)

A nurse is providing teaching to a client who has chronic kidney disease (CKD). Which of the following statements by the client indicates an understanding of the teaching? "I will check my blood pressure once per week." "I will take a magnesium antacid if I get constipated." "I will weigh myself every morning." "I will use a salt substitute in my diet."

I will weigh myself every morning." (Clients who have CKD should weigh themselves every morning at the same time to monitor fluid balance. The client should void prior to weighing if able, wear similar clothing when obtaining weight, and use the same set of scales each time.)

A nurse is planning care for a client who has chronic kidney disease and a potassium level of 7.3 mEq/L. Which of the following interventions should the nurse plan to take? Initiate an IV infusion of lactated Ringer's solution. Give spironolactone 50 mg PO BID. Infuse regular insulin in dextrose 10% in water. Administer supplemental phosphorus.

Infuse regular insulin in dextrose 10% in water. (The nurses should infuse regular insulin in dextrose 10% to 20% in water to a client who has hyperkalemia. The administration of insulin will drive the potassium from the extracellular fluid into the intracellular fluid to decrease the serum potassium level. The dextrose in the solution will counter the insulin to prevent hypoglycemia from occurring.)

A nurse is teaching an assistive personnel (AP) about providing care to a client following a total hip arthroplasty. Which of the following instructions should the nurse include? Avoid applying antiembolism stockings to the affected leg. Have the client lean forward when moving from a sitting to a standing position. Discourage the client from sitting in a wheelchair with the back reclined. Place an abductor pillow between the client's legs when turning the client.

Place an abductor pillow between the client's legs when turning the client. (The nurse should inform the AP that a client who had a total hip arthroplasty should maintain the hip in abduction following surgery to reduce the risk of dislocating the affected hip. The AP should place an abductor pillow between the client's legs when turning the client to keep the hips in abduction.)

A nurse is caring for a client who has nephrotic syndrome and has been taking prednisone for 3 days. Which of the following findings should the nurse report to the provider as an adverse effect of prednisone? Sore throat Frequent stools Hearing loss Tremors

Sore throat (Glucocorticoids depress the immune system and increase the client's risk for infection. The nurse should recognize a sore throat as an indication of infection and report this finding to the provider.)

A nurse is preparing to assess a client who received hemodialysis 1 hr ago. Which of the following assessments should the nurse perform first? Potassium level Body weight Creatinine level Vital signs

Vital signs (When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority information to assess is the client's vital signs. After hemodialysis, the client is at risk for hemodynamic instability, which includes hypotension, dysrhythmia, and hemorrhage.)

A nurse is teaching a client who has Parkinson's disease and is prescribed carbidopa-levodopa. Which of the following client statements indicates an understanding of the teaching? "I should expect an increase in my blood pressure while taking this medication." "I should take this medication 2 hours after meals to increase absorption." "I should expect that this medication can cause me to be drowsy." "I should expect this medication to be effective within 48 hours."

"I should expect that this medication can cause me to be drowsy." (Drowsiness is a known adverse effect of carbidopa-levodopa; therefore, clients are taught to avoid heavy machinery and driving if they experience drowsiness.)

A nurse is caring for a client who has acute kidney injury (AKI). Which of the following serum laboratory findings should the nurse report to the provider? Potassium 5 mEq/L Calcium 9 mg/dL Creatinine 4 mg/dL Amylase 84 units/L

Creatinine 4 mg/dL (A serum creatinine level above the expected reference range of 0.5 to 1.3 mg/dL indicates impaired kidney function. Therefore, the nurse should report this finding to the provider. The nurse should expect the creatinine level to decrease to within the expected reference range with successful treatment of AKI)

A nurse is obtaining a urine specimen for culture and sensitivity from a client who has manifestations of a urinary tract infection. Which of the following actions should the nurse take? Collect the client's urine in a clean specimen container. Instruct the client to start urinating then pass the container into the stream. Obtain the client's first morning urine on the following day. Place the client's urine specimen in a container with a preservative.

Instruct the client to start urinating then pass the container into the stream. (The nurse should instruct the client to start urinating, then pass the container into the stream, and collect 30 to 60 mL of urine in the container.)

A nurse is planning to teach a client who has epilepsy and a new prescription for phenytoin. Which of the following instructions should the nurse plan to include? Rinse with antiseptic mouthwash instead of using dental floss. Use an over-the-counter antihistamine if a rash develops. Slowly taper the medication after 6 consecutive months without seizure activity. Take medications at a consistent time each day to maintain therapeutic blood levels.

Take medications at a consistent time each day to maintain therapeutic blood levels. (The nurse should teach the client to take antiepileptic medications on a regular schedule to maintain therapeutic blood levels and achieve the maximum effect.)

A nurse is monitoring a client following hemodialysis. The nurse should recognize that which of the following factors places the client at risk for seizures? Hypokalemia A rapid increase of catecholamines A rapid decrease in fluid Hypercalcemia

A rapid decrease in fluid (A rapid decrease in fluid and electrolytes during hemodialysis can result in cerebral edema and increased intracranial pressure, placing the client at risk for seizures. This complication is called dialysis disequilibrium syndrome.)

A nurse in an emergency department is caring for a client who suddenly lost consciousness and fell while at home. The provider determines that the client had an embolic stroke. Which of the following medications should the nurse expect to administer? A) Tissue plasminogen activator B) Recombinant factor VIII C) Nitroglycerin D) Lidocaine

A) Tissue plasminogen activator (Tissue plasminogen activator is a thrombolytic agent that should dissolve the blood clot that caused the stroke.)

A nurse is developing a teaching plan for a client who has Ménière's disease. Which of the following instructions should the nurse include? "Move your head slowly to decrease vertigo." "Apply warm packs to the affected ear during acute attacks." "Increase your intake of foods and fluids high in salt." "Take corticosteroids during acute attacks."

"Move your head slowly to decrease vertigo." (The nurse should instruct the client to use slow head movements to keep from worsening the vertigo)

A nurse is teaching a client and her family about the diagnosis and treatment of Alzheimer's disease. Which of the following statements should the nurse identify as an indication that the family understands the teaching? "There is a test for Alzheimer's disease that can establish a reliable diagnosis." "The goal of medication therapy is to reverse the degenerative changes that can occur in brain tissue." "Early manifestations of Alzheimer's disease include mild tremors and muscular rigidity." "The medications that treat Alzheimer's disease can help delay cognitive changes."

"The medications that treat Alzheimer's disease can help delay cognitive changes." (Medications that treat Alzheimer's disease enhance the availability of acetylcholine, which can slow cognitive decline in some clients)

A nurse is teaching a client who has osteoporosis and has a new prescription for alendronate. Which of the following information should the nurse include in the teaching? A) "Take this medication with 8 ounces of milk." B) "Remain upright for 30 minutes after taking this medication." C) "Wait 1 hour after taking other medications to take alendronate." D) "Take vitamin C to promote absorption of this medication."

B) "Remain upright for 30 minutes after taking this medication." (To prevent esophagitis or esophageal ulcers, which can result from alendronate therapy, the client should sit upright for 30 min after taking this medication.)

A nurse is caring for a client who has a spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition? A) Encourage the client to use the Valsalva maneuver. B) Stroke the client's inner thigh. C) Perform the Credé maneuver. D) Administer a diuretic.

B) Stroke the client's inner thigh. (The nurse should stimulate micturition by stroking the client's inner thigh. Other techniques include pinching the skin above the groin and providing digital anal stimulation)

A nurse is reviewing the laboratory report of a client who has acute kidney injury (AKI). Which of the following findings should the nurse expect? (Select all that apply.) BUN 30 mg/dL Urine output 40 mL in the past 3 hr Potassium 3.6 mEq/L Calcium 9.8 mg/dL Hematocrit 30%

BUN 30 mg/dL Urine output 40 mL in the past 3 hr Hematocrit 30% (BUN 30 mg/dL is correct. A BUN level above the expected reference range of 10 to 20 mg/dL is an expected finding of AKI. Urine output 40 mL in the past 3 hr is correct. The client's urine output indicates oliguria. The degree of oliguria varies with the stage of AKI. For the injury stage, the criterion is less than 0.5 mL/kg for 12 or more hr. Potassium 3.6 mEq/L is incorrect. The client's potassium level is within the expected reference range of 3.5 to 5 mEq/L. An elevated potassium level is an expected finding of AKI. Calcium 9.8 mg/dL is incorrect. The client's calcium level is within the expected reference range of 9 to 10.5 mg/dL. The nurse should expect a client who has AKI to have an abnormal calcium level. Hematocrit 30% is correct. A hematocrit level below the expected reference range of 42 to 52% for males and 37 to 47% for females is an expected finding of AKI)

A nurse is providing teaching to a male client who has a continent internal ileal reservoir following surgery to treat bladder cancer. Which of the following client statements indicates an understanding of the teaching? "This should not affect my ability to function sexually." "I should expect to gain some weight during the next few weeks." "I will need to avoid foods that produce intestinal gas." "I must insert a catheter through my stoma to drain the urine."

"I must insert a catheter through my stoma to drain the urine." (The client should perform self-catheterization to drain the urine from the continent internal ileal reservoir. The nurse should encourage the client to perform self-catheterization before traveling or attending social events to promote confidence in social situations.)

A nurse is reviewing postoperative instructions with a client following cataract surgery. Which of the following client statements indicates an understanding of the instructions? "I should call my doctor if my vision gets worse." "I will take aspirin for eye discomfort." "I can blow my nose to clear out any drainage." "I can lift objects up to 20 pounds."

"I should call my doctor if my vision gets worse." (The client should expect an improvement in vision after the surgery, so the nurse should instruct the client to report negative changes in vision immediately.)

A nurse is planning care for a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL) to treat urolithiasis. Which of the following actions should the nurse plan to take? Place the client in semi-Fowler's position. Prepare to intubate the client. Monitor urine flow through a nephrostomy tube. Apply electrodes for cardiac monitoring.

Apply electrodes for cardiac monitoring. (The nurse should apply electrodes for continuous monitoring of the client's cardiac rhythm during ESWL. This monitoring allows the provider to synchronize shock waves with the R wave.)

A nurse is caring for a postoperative client following arteriovenous (AV) fistula creation in the left arm. Which of the following actions should the nurse take? Measure blood pressure in the client's left arm every 4 hr. Keep the client's left arm in a dependent position. Auscultate for bruits in the client's fistula every 4 hr. Instruct the client to sleep on the affected side.

Auscultate for bruits in the client's fistula every 4 hr. (The nurse should auscultate for a bruit and palpate for a thrill every 4 hr to verify that the AV fistula is patent)

A nurse is teaching a client who has a new diagnosis of acute pyelonephritis. Which of the following instructions should the nurse include in the teaching? Drink up to 1,500 mL of fluid per day. Avoid the use of NSAIDs for pain. Check peripheral blood glucose levels twice per day. Increase dietary protein intake.

Avoid the use of NSAIDs for pain. (The nurse should instruct the client to avoid the use of NSAIDs for pain because they can further damage the kidney, causing papillary necrosis and reflux)

*A nurse is planning care for a client who is postoperative following a nephrectomy. Which of the following assessments is the nurse's priority? Bowel sounds WBC count Pain level Blood pressure

Blood pressure (The greatest risk to the client is injury from acute adrenal insufficiency caused by accidental removal or damage to the adrenal gland intraoperatively. The nurse should evaluate the client for hypotension and for a decrease in urine output)

*A nurse is caring for a client who has viral meningitis. Which of the following actions should the nurse take? Assess the client's neurologic status every 8 hr. Initiate droplet precautions. Check capillary refill at least every 4 hr. Place the client in a well-lit environment.

Check capillary refill at least every 4 hr (The nurse should perform a complete vascular assessment at least every 4 hr to monitor for vascular compromise)

A nurse is caring for a client who has a basilar skull fracture following a fall from a ladder. Which of the following assessment findings should the nurse report to the provider? Glasgow Coma Scale score of 15 Intracranial pressure reading of 15 mm Hg Ecchymosis at base of skull Clear drainage from nose

Clear drainage from nose (Clear drainage from the nose indicates that cerebrospinal fluid is leaking from the skull fracture. This places the client at risk for meningeal infection because micro-organisms have access to the cranium through the nose and the tear in the dura. The nurse should report this finding to the provider.)

A nurse is performing a pain assessment for a client who is postoperative. Which of the following findings should the nurse use to determine the severity of the client's pain? Client's vital sign changes Client's report of the type of pain Client's nonverbal communication Client's report of pain on a pain scale

Client's report of pain on a pain scale (The nurse should use a client's report of pain on a standardized pain scale to determine the severity of the client's pain.)

*A nurse is assessing a client who has chronic kidney disease and has completed the third peritoneal dialysis (PD) treatment. Which of the following findings should the nurse report to the provider? Greater outflow of dialysate than inflow Weight loss Cloudy dialysate effluent Report of pain during inflow

Cloudy dialysate effluent (Cloudy or opaque drainage is an early manifestation of peritonitis. The nurse should notify the provider immediately because infection can be a life-threatening complication)

A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply.) Crepitus with joint movement Decreased range of motion of the affected joint Low-grade fever Spongy tissue over the joints Joint pain that resolves with rest

Crepitus with joint movement Decreased range of motion of the affected joint Joint pain that resolves with rest (Crepitus with joint movement is correct. Osteoarthritis is a degenerative joint disease. Crepitus, a grating sound, is an expected finding with clients who have osteoarthritis as loosened bone and cartilage move around in the fluid inside the joint. Decreased range of motion of the affected joint is correct. Decreased range of motion is an expected finding with clients who have osteoarthritis because the client's pain limits movement. Low-grade fever is incorrect. Osteoarthritis does not cause systemic manifestations. Rheumatoid arthritis causes many systemic manifestations, including low-grade fever, weakness, anorexia, and paresthesias. Spongy tissue over the joints is incorrect. Spongy joint tissue is an expected finding with rheumatoid arthritis, which is an inflammatory disease, not a degenerative disease. Joint pain that resolves with rest is correct. Joint pain that resolves with rest is an expected finding with clients who have osteoarthritis. A client who has osteoarthritis experiences increased pain with activity and decreased pain with rest.)

A nurse is caring for a client who is recovering from a stroke and has right-sided homonymous hemianopsia. To help the client adapt to the hemianopsia, the nurse should take which of the following actions? A) Check the client's cheek on the affected side after meals to be sure no food remains there. B) Encourage the client to sit upright with their head tilted slightly forward during meals. C) Provide the client with eating utensils that have large handles. D) Remind the client to look consciously at both sides of their meal tray.

D) Remind the client to look consciously at both sides of their meal tray. (Clients who have right-sided homonymous hemianopsia have lost the right visual field of both eyes and might only eat the food they are able to see on the left half of the meal tray. Therefore, the nurse should remind the client to look at both sides of his meal tray to help compensate for the visual loss.)

A nurse is performing an admission assessment of a client who has acute glomerulonephritis. The nurse should expect which of the following findings? Low blood pressure Polyuria Dark-colored urine Weight loss

Dark-colored urine (Clients who have acute glomerulonephritis usually excrete urine that is a dark, reddish-brown color)

A nurse is reviewing the medical records of four clients. The nurse should identify which of the following disorders as a risk factor for chronic pyelonephritis? Parkinson's disease Diabetes mellitus Peptic ulcer disease Gallbladder disease

Diabetes mellitus (A client who has diabetes mellitus is at risk for the development of chronic pyelonephritis because of the reduced bladder tone that results from diabetic neuropathy.)

*A nurse is assessing a client who is quadriplegic following a cervical fracture at vertebral level C5. The client reports a throbbing headache and nausea. The nurse notes facial flushing and a blood pressure of 220/110 mm Hg. Which of the following actions should the nurse take first? Administer hydralazine via IV bolus. Loosen the client's clothing. Empty the client's bladder. Elevate the head of the client's bed.

Elevate the head of the client's bed. (These assessment findings indicate that the client is experiencing autonomic dysreflexia and is at greatest risk for possible rupture of a cerebral vessel or increased intracranial pressure. The first action the nurse should take is to move the client from a supine to an upright position, which will result in rapid postural hypotension.)

A nurse is reviewing the medical history of a client who has end-stage kidney disease. The nurse should identify that which of the following factors in the client's history is a contraindication for receiving hemodialysis? History of hemophilia Difficulty with ambulation Decreased WBC count Iodine allergy

History of hemophilia (The nurse should identify that a history of a major bleeding disorder is a contraindication for hemodialysis. A client who has hemophilia bleeds excessively following minor breaks in the skin and is at high risk for extreme blood loss during hemodialysis treatment)

*A nurse is assessing a client who had a right hemispheric stroke. Which of the following neurologic deficits should the nurse expect? Aphasia Right-sided neglect Impulsive behavior Inability to read

Impulsive behavior (The nurse should expect clients who had a right hemispheric stroke to demonstrate impulsive behavior, poor judgment, and lack of awareness of neurologic deficits.)

A nurse is teaching a client who has urge urinary incontinence about bladder retraining. Which of the following instructions should the nurse include? "If you are unable to urinate, sit on the toilet every 4 hours with water running in the sink." "Increase the intervals between urination by 15 minutes per day when able to remain continent." "Immediately empty your bladder when you have the urge to urinate." "If you are unable to urinate, plan to self-catheterize every 3 to 4 hours."

Increase the intervals between urination by 15 minutes per day when able to remain continent." (The nurse should instruct the client to increase the length of time between urination by 15 min per day when able to remain continent. The goal is to have 3- to 4-hr intervals between urination.)

*A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? Hypoactive deep-tendon reflexes Ascending paralysis Intention tremors Increased lacrimation

Intention tremors (Clients who have multiple sclerosis are at risk for motor dysfunction, with intention tremors, poor coordination, and loss of balance)

A nurse is planning care for a client who has a closed traumatic brain injury from a fall and is receiving mechanical ventilation. Which of the following interventions is the nurse's priority? Maintain a PaCO2 of approximately 35 mm Hg. Provide small doses of fentanyl via IV bolus for pain management. Measure body temperature every 1 to 2 hr. Reposition the client every 2 hr.

Maintain a PaCO2 of approximately 35 mm Hg. (The greatest risk to this client is injury from increased intracranial pressure. Therefore, the nurse's priority intervention is to maintain the PaCO2 at 35 to 38 mm Hg to prevent hypercarbia and subsequent vasodilation that can lead to an increase in intracranial pressure.)

*A nurse in an emergency department is assessing a client who reports sudden, severe eye pain with blurry vision. The provider determines that the client has primary angle-closure glaucoma. Which of the following medications should the nurse expect to administer? Osmotic diuretics via IV bolus Mydriatic ophthalmic drops Corticosteroid ophthalmic drops Epinephrine via IV bolus

Osmotic diuretics via IV bolus (The nurse should expect to administer prescribed osmotic diuretics, such as mannitol, to reduce intraocular pressure and prevent damage to the eye.)

A nurse is caring for a client who is 72 hr postoperative following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? Remind the client that the surgery removed the limb. Change the dressing on the client's residual limb. Request a prescription for gabapentin for the client. Elevate the client's residual limb above heart level.

Request a prescription for gabapentin for the client. (The nurse should request a prescription for a nonopioid medication to help minimize phantom limb pain. Gabapentin is an oral antiepileptic medication that is effective for treating sharp, burning, phantom limb pain.)

A nurse is caring for a client following extracorporeal shock wave lithotripsy (ESWL) for the treatment of calcium phosphate kidney stones. Which of the following actions should the nurse take? Monitor the client's urine for ketones. Provide the client with an increased animal protein diet. Limit the client's fluid intake to 1.5 L per day. Strain all of the client's urine.

Strain all of the client's urine.

A nurse is performing an admission assessment for a client who has severe chronic kidney disease (CKD). Which of the following findings should the nurse expect? Tachypnea Hypotension Exophthalmos Insomnia

Tachypnea (The nurse should expect a client who has severe CKD to have tachypnea because of metabolic acidosis. Will have HTN due to fluid retention)

A nurse in an emergency department is caring for a client who reports costovertebral angle tenderness, nausea, and vomiting. Which of the following laboratory values should the nurse report to the provider? WBC count 15,000/mm3 BUN 15 mg/dL Urine specific gravity 1.020 Urine pH 5.5

WBC count 15,000/mm3

*A nurse is planning care for a client who has acute glomerulonephritis. The nurse should plan to provide which of the following interventions? Weigh the client daily. Encourage the client to drink 2 to 3 L of fluid per day. Instruct the client to ambulate every 2 hr. Check the client's blood glucose level.

Weigh the client daily. (The nurse should monitor fluid retention by weighing the client daily. A decrease in weight indicates the effectiveness of the therapy.)

A nurse is planning education about cyclosporine for a client who had a kidney transplant 2 days ago. Which of the following statements should the nurse plan to include? "You might have hair loss due to the medication therapy you'll be taking." "You will need to continue taking this medication to protect your new kidneys." "Use an over-the-counter anti-inflammatory medication for aches and pains." "Your risk for infection will increase if you stop taking this medication."

You will need to continue taking this medication to protect your new kidneys." (The client must take cyclosporine daily for the life of the transplanted organ)