Chronic Exam 3

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia?

Change in cognitive functioning

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection?

Perform meticulous perineal care daily with soap and water

The nurse is assisting in the transport of a client with an indwelling catheter to the diagnostic studies unit. Which action made by the nursing assistant would require instruction?

The nursing assistant places the drainage bag on the client's abdomen for transport.

A nurse is educating a client who is scheduled for a kidney transplant. Which of the following information about hyper-acute rejection should the nurse include in the teaching?

The organ will need to be removed if hyperacute rejection occurs-- due to the widespread clotting cascade that leads to ischemic necrosis of the transplant kidney

Patients with urolithiasis need to be encouraged to:

Increase their fluid intake so that they can excrete 2.5 to 4 liters every day.

A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer?

Painless, gross hematuria

The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program? Select all that apply.

Perform hand hygiene prior to patient care. Assist the patients with frequent toileting. Provide careful perineal care.

What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss?

The client should consider getting a wig or cap prior to beginning treatment.

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?

Autologous

A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following should the nurse include in the teaching?

Avoid crowds-- methotrexate can cause leukopenia due to bone marrow suppression, increasing the risk of infection

A patient comes to the clinic suspecting a possible UTI. What symptoms of a UTI would the nurse recognize from the assessment data gathered?

Cloudy urine

The nurse is caring for the client following surgery for a urinary diversion. The client refuses to look at the stoma or participate in its care. The nurse formulates a nursing diagnosis of:

Disturbed body image

A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to:

Loss of motor control of the detrusor muscle.

Sympathomimetics have which of the following effects on the body?

Relaxation of bladder wall

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks?

Sun safety and use of sunscreen

Which nursing intervention should the nurse caring for the client with pyelonephritis implement?

Teach client to increase fluid intake up to 3 liters per day.

A nurse is caring for a client who has HIV. Which of the following laboratory findings should suggest to the nurse that medication therapy is effective?

Decreased viral load-- medication therapy should display a decreasing viral protein amount in the blood, indicating positive response to medication therapy

A nurse is caring for a client who has an elevated prostate-specific antigen level. The nurse should anticipate that the client will undergo which of the following diagnostic tests?

Digital rectal examination-- this determines the size and consistency of the prostate

A nurse is providing teaching for a client who is HIV-positive. Which of the following instructions should the nurse include in the teaching?

Discard beverages that have been unrefrigerated for 1 hour-- bacteria can grow in open, unrefrigerated beverages, placing client at risk for infection

Which instruction would be included in a teaching plan for a client diagnosed with a urinary tract infection?

Drink liberal amount of fluids.

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.

Egg white omelet with spinach and mushrooms Steamed broccoli and carrots Turkey breast on whole wheat bread

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

Encourage fluid intake, if possible, to dilute the urine.

A nurse in the emergency department is assessing a newly admitted client. Which of the following findings places the client at increased risk for contracting hepatitis B?

Engaging in unprotected sexual intercourse-- Hep B is transmitted by sexual contact

A nurse is caring for a client who has non-Hodgkin's lymphoma and is receiving chemotherapy. Which of the following is the priority assessment finding?

Erythema at the IV insertion site-- erythema at the IV site can indicate extravasation, which can lead to infection and tissue loss

A nurse is planning an education program about testicular cancer for a group of male adolescents. Which of the following information should the nurse include?

Examine the testicles immediately after showering-- perform self-examination monthly and after showering for easier palpation

Which of the following is a cause of a calcium renal stone?

Excessive intake of vitamin D

Which type of incontinence refers to the involuntary loss of urine due to extrinsic medical factors, particularly medications?

Iatrogenic

A nurse is providing teaching to a group of clients regarding prevention of skin cancer. Which of the following risk factors should the nurse include in the teaching?

Light skin pigmentation-- risk factor for skin cancer

A nurse is caring for a client who has neutropenia. Which of the following findings indicates a need for intervention?

The client's granddaughter is visiting and telling him about her first day of kindergarten-- limit clients to healthy adults, school children can place client at risk for infection

A nurse is reviewing the daily laboratory results for a female client who has acute leukemia. Which of the following values is an expected finding?

WBC count 21,000/mm3-- client will have an elevated WBC count

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?

It targets normal body cells as well as cancer cells.

A nurse is assessing a client who has HIV. Which of the following findings should cause the nurse to suspect that the client's diagnosis has progressed to AIDS?

Small, purple-colored skin lesions-- this is an indication the client has acquired Kaposi's sarcoma, an AIDS-defining illness

Which type of incontinence is the involuntary loss of urine through an intact urethra as a result of coughing?

Stress

A nurse is caring for a client who has a new prescription for clindamycin to treat acute pelvic inflammatory disease. The nurse should monitor for and report which of the following findings to the provider immediately?

Watery diarrhea-- greatest risk to client is pseudomembranous colitis, which manifests as watery diarrhea

The nurse is evaluating the effectiveness of discharge teaching for a client with an oxalate urinary stone. Which statement by the client indicates the need for further teaching by the nurse? Select all that apply.

"I will never have another urinary stone again." "I need to take allopurinol." "Tylenol is best to control my pain." "I'm so glad I don't have to make any changes in my diet."

A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

"Increase your fluid intake to 2 to 3 L per day."

A client presents at the clinic with reports of urinary retention. What question should the nurse ask to obtain additional information about the client's report?

"When did you last urinate?"

A nurse is caring for a client who reports a skin change. Which of the following findings should the nurse report to the provider?

An asymmetrical papule that is pigmented-- this is an indication of malignant melanoma

A nurse is providing care for four clients. Which of the following clients is at the greatest risk for pneumonia?

An older adult client who has dysphagia-- increased risk for aspiration when eating

The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?

Anticholinergic

A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?

Acute pain

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:

chemotherapy exposure and risk factors.

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply.

dietary substances environmental factors viruses

A decrease in circulating white blood cells is

leukopenia

A client is being treated for a malignant bladder tumor. What would be included in treatment of a small tumor? Select all that apply.

resection and fulguration, topical application of an antineoplastic drug

A client with urinary retention needs to undergo a procedure to insert an indwelling catheter. What should the nurse discuss with the health care provider before catheterization?

type and size of the catheter to be used

A client who has a history of neurogenic bladder presents with fever, burning, and suprapubic pain. What would the nurse suspect is the problem?

urinary tract infection

A nurse is providing teaching to a client who is scheduled for a pap test. The nurse should inform the client that she is being tested for which of the following?

Cervical cancer

A nurse is assessing a client who has systemic lupus erythematous (SLE). Which of the following findings should the nurse expect? (select all that apply)

Decreased urine output-- due to kidney damage Butterfly rash-- scaly rash on the face Joint inflammation

Which of the following is a term used to describe the process of programmed cell death?

Apoptosis

A nurse caring for a patient with a neurogenic bladder knows to assess for the major complication of:

Infection

Which type of medication may be used to inhibit bladder contraction in a client with incontinence?

Anticholinergic agent

A nurse is providing teaching to a client who has rheumatoid arthritis and reports persistent pain. Which of the following responses should the nurse make?

Ask a friend of family member to help with household chores-- this helps reduce the risk for joint injury and give the client opportunity to rest

A nurse is providing teaching to a client who has Hodgkin's lymphoma and is undergoing external radiation treatment. Which of the following instructions should the nurse include?

Avoid direct sun exposure to the skin-- skin is more sensitive to sunburn due to the external radiation

A nurse is teaching a client who is receiving chemotherapy. The client's laboratory results indicate bone marrow suppression. Which of the following instructions should the nurse include in the teaching?

Bathe with antimicrobial soap twice per day-- this decreases exposure to micro-organisms

The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder?

Hematuria

A nurse is providing teaching to a client who has systemic lupus erythematosus (SLE). Which of the following statements by the client indicates an understanding of the teaching?

I should wear gloves when it is cold outside-- Raynaud's commonly accompanies SLE

A nurse is providing teaching to a client who has a new prescription for amoxicillin to treat a respiratory infection. Which of the following statements by the client indicates an understanding of the teaching?

I will use a backup method of birth control while I am taking this medication-- antibiotics accelerate the elimination of oral contraception, making them less effective

A nurse is planning an education program for a group of high school teachers who will be taking students on a hike. Which of the following information should the nurse include regarding Lyme disease?

If you develop pain and stiffness in your joints, you should see your doctor-- manifestations of stage 1 include flu-like symptoms, bulls eye rash and joint pain/ stiffness

The nurse is caring for a client with recurrent urinary tract infections. Which of the following body structures would the nurse instruct as the most frequent cause of women's urinary tract infections?

The urethra

A nurse is performing a breast examination of a female client who is pregnant. Which of the following findings should the nurse report to the provider?

Breast tissue with an orange-peel appearance-- can indicate a blockage of lymph channels, which is a manifestation of advanced breast cancer

A nurse is providing teaching to a client who has an allergy to peanuts. Which of the following instructions is the priority to include in the teaching?

Carry an emergency anaphylaxis kit

After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an IV infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?

It's an abnormal finding that requires further assessment.

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?

Kidney

A nurse is caring for a client who has viral pneumonia. Which of the following findings should the nurse report to the provider immediately?

Left shift in WBC differential-- this indicates that the pneumonia if of bacterial origin, left shift can be a manifestation of sepsis

Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?

Low purine

A patient who has been treated for uric acid stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient?

Low-purine diet

A client undergoes surgery to remove a malignant tumor, followed by a urinary diversion procedure. The nurse's postoperative plan of care should include which action?

Maintain skin and stomal integrity.

A patient has had surgery to create an ileal conduit for urinary diversion. What is a priority intervention by the nurse in the postoperative phase of care?

Monitor urine output hourly and report output less than 30 mL/hr.

A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?

Painless hematuria

A nurse is reviewing the laboratory report for a client who has Hodgkin's lymphoma. Which of the following findings should the nurse expect?

Reed-Sternberg cells-- cancer cells specific to Hodgkin's lymphoma in the lymph nodes

Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis?

Risk for infection

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?

Stomatitis

A nurse is caring for a client who has leukemia and a platelet count of 48,000/mm3. Which of the following actions should the nurse take?

Test the client's urine and stool for occult blood-- a client who is thrombocytopenic is at risk for occult bleeding

A nurse is teaching the parent of a child about administration guidelines for the human papilloma virus (HPV) vaccine. Which of the following information should the nurse include?

Three doses are administered to adolescents who start the series after age 15-- males should receive as well, since they could be carriers

A nurse is caring for a client who is admitted with enlarged lymph nodes and a fever. To confirm a diagnosis of bacterial pharyngitis, the nurse should anticipate which of the following diagnostic tests?

Throat culture-- this identifies specific micro-organisms present in the pharynx

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate I can't control it, and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence?

Urge

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence?

Urge

A group of students are reviewing information about disorders of the bladder and urethra. The students demonstrate understanding of the material when they identify which of the following as a voiding dysfunction?

Urinary retention

Which of the following is the most common site of a nosocomial infection?

Urinary tract

The nurse recognizes that urinalysis results that most likely indicate a urinary tract infection include:

WBC 50