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Multiple Choice 39. A client has undergone the creation of an Indiana pouch for the treatment of bladder cancer. The nurse identified the nursing diagnosis of "disturbed body image." How can the nurse best address the effects of this urinary diversion on the client's body image? A. Emphasize that the diversion is an integral part of successful cancer treatment. B. Encourage the client to speak openly and frankly about the diversion. C. Allow the client to initiate the process of providing care for the diversion. D. Provide the client with detailed written materials about the diversion at the time of discharge.

B Rationale: Allowing the client to express concerns and anxious feelings can help with body image, especially in adjusting to the changes in toileting habits. The nurse may have to initiate dialogue about the management of the diversion, especially if the client is hesitant. Provision of educational materials is rarely sufficient to address a sudden change and profound change in body image. Emphasizing the role of the diversion in cancer treatment does not directly address the client's body image. PTS: 1 REF: p. 1633 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Select 29. A 76-year-old client with ESKD has been told by the health care provider that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse about feeling unsure about undergoing a kidney transplant. What would be an appropriate response for the nurse to make? A. "The decision is certainly yours to make, but be sure not to make a mistake." B. "Kidney transplants in peoples your age are as successful as they are in younger clients." C. "I understand your hesitancy to commit to a transplant surgery. Success is relatively rare." D. "Have you talked this over with your family?"

B Rationale: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the older adult. However, the success rate of the surgery is comparable to that for younger clients. The other listed options either belittle the client or give the client misinformation. PTS: 1 REF: p. 1570 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Choice 12. A client with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the client's urine output hourly and notifies the health care provider when the hourly output is less than what amount? A. 30 mL B. 50 mL C. 100 mL D. 125 mL

A Rationale: A urine output below 0.5 mL/kg/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis. PTS: 1 REF: p. 1628 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Choice 12. The nurse is caring for a client whose worsening infection places the client at high risk for shock. Which assessment finding would the nurse consider a potential sign of shock? A. Elevated systolic blood pressure B. Elevated mean arterial pressure (MAP) C. Shallow, rapid respirations D. Bradycardia

C Rationale: A symptom of shock is shallow, rapid respirations. Systolic blood pressure drops in shock, and MAP is less than 65 mm Hg. Bradycardia occurs in neurogenic shock; other states of shock have tachycardia as a symptom. Infection can lead to septic shock. PTS: 1 REF: p. 276 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 13. The nurse is performing a focused genitourinary and renal assessment of a client. Where should the nurse assess for pain at the costovertebral angle? A. At the umbilicus and the right lower quadrant of the abdomen B. At the suprapubic region and the umbilicus C. At the lower border of the 12th rib and the spine D. At the 7th rib and the xiphoid process

C Rationale: The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle. PTS: 1 REF: p. 1544 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 6. A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? A. Glucose in the urine B. Albumin in the urine C. Highly dilute urine D. Leukocytes in the urine

C Rationale: Clients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but if present would indicate a urinary tract infection. PTS: 1 REF: p. 1451 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 22. A client is reporting genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform? A. Encourage mobilization. B. Apply topical lidocaine to the client's meatus, as prescribed. C. Apply moist heat to the client's lower abdomen. D. Apply an ice pack to the client's perineum.

C Rationale: Following cystoscopy, moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing the muscles. Ice, lidocaine, and mobilization are not recommended interventions. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 15. A client has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed? A. The circumference of the stoma B. The length, then double it C. The widest part of the stoma D. Half the width of the stoma

C Rationale: The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage. PTS: 1 REF: p. 1630 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 40. A gerontologic nurse is assessing a client who has numerous comorbid health problems. What assessment finding(s) should prompt the nurse to suspect a UTI? Select all that apply. A. Food cravings B. Upper abdominal pain C. Insatiable thirst D. Fever E. New onset of confusion

D, E Rationale: Early symptoms of UTI in older adults include burning, urgency, and fever. Some clients develop incontinence and delirium with the onset of a UTI. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none are directly suggestive of a UTI. PTS: 1 REF: p. 1606 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 39. A client arrives in the emergency department after being burned in a house fire. The client's burns cover the face and the left forearm. What extent of burns does the client most likely have, measured as a percentage?

18, 18% Rationale: When estimating the percentage of body area or burn surface area that has been burned, the Rule of Nines is used: the face is 9% and the forearm is 9%, for a total of 18% in this client. PTS: 1 REF: p. 1868 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 38. Dipstick testing of an older adult client's urine indicates the presence of protein. Which statement is true of this assessment finding? A. This finding needs to be considered in light of other forms of testing. B. This finding is a risk factor for urinary incontinence. C. This finding is likely the result of an age-related physiologic change. D. This result confirms that the client has diabetes.

A Rationale: A dipstick examination should be used as a screening test only, because urine concentration, pH, hematuria, and radiocontrast materials all affect the results. Proteinuria is not diagnostic of diabetes, and it is neither an age-related change nor a risk factor for incontinence. PTS: 1 REF: p. 1548 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 35. The nurse is caring for a client who has just returned to the postsurgical unit following renal surgery. When assessing the client's output from surgical drains, the nurse should physically assess what parameter(s)? Select all that apply. A. Quantity of output B. Color of the output C. Visible characteristics of the output D. Specific gravity of the output E. Potential hydrogen (pH) of the output

A, B, C Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage from the surgical drains are reported and may indicate obstruction. Specific gravity and pH are not normally assessed at the bedside but are sent to the lab if needed. Those two tests are not part of the recommendations. PTS: 1 REF: p. 1594 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 14. The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan? A. A reduced calorie diet, high in nutrients B. Small, frequent meals, high in protein and calories C. Three large, bland meals a day D. A diet high in fiber and plant-sourced fat

B Rationale: A client with hyperthyroidism has an increased appetite. The client should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the client's caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis. PTS: 1 REF: p. 1465 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 13. A triage nurse in the emergency department (ED) receives a phone call from a frantic parent who saw their 4-year-old child tip a pot of boiling water onto themselves. The parent has called an ambulance. What should the nurse in the ED receiving the call instruct the parent to do? A. Cover the burn with ice and secure with a towel. B. Apply butter to the area that is burned. C. Immerse the child in a cool bath. D. Avoid touching the burned area under any circumstances.

C Rationale: After the flames or heat source have been removed or extinguished, the burned area and adherent clothing are soaked with cool water briefly to cool the wound and halt the burning process. Cool water is the best first-aid measure. Ice and butter are contraindicated. Appropriate first aid necessitates touching the burn. PTS: 1 REF: p. 1874 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 20. The nurse is caring for a client who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response? A. Document the presence of a healthy stoma. B. Assess the client for further signs and symptoms of infection. C. Inform the primary care provider that the vascular supply may be compromised. D. Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.

C Rationale: A healthy stoma is pink or red. A change from this color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma. PTS: 1 REF: p. 1629 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 12. The nurse is caring for a client whose acute kidney injury (AKI) resulted from a prerenal cause. Which condition most likely caused this client's health problem? A. Burns B. Glomerulonephritis C. Ureterolithiasis D. Pregnancy

A Rationale: AKI has categories that identify causation. These are prerenal, intrarenal, and postrenal. Prerenal AKI results from hypoperfusion of the kidney caused by volume depletion. Common causes are burns, hemorrhage, gastrointestinal losses, sepsis, and shock. Glomerulonephritis and ureterolithiasis (kidney stones) are associated with intrarenal causes. Pregnancy is linked to postrenal AKI (obstructions distal to the kidney). PTS: 1 REF: p. 1566 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 10. The nurse is caring for a client postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? A. Assessment of the quantity of the client's urine output B. Assessment of the client's incision C. Assessment of the client's abdominal girth D. Assessment for flank or abdominal pain

A Rationale: After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the client's abdomen or incision. PTS: 1 REF: p. 1599 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 33. A nurse is giving discharge instructions to a client following urodynamic testing. What are the priority topics to be addressed by the nurse? A. Beverage limitations, pain control, and urinary expectations B. Antibiotic adherence, carbohydrate restrictions, and urinary expectations C. Protein intake, mobility limitations, and urinary expectations D. Opioid usage, urinary expectations, fat and protein limitations

A Rationale: After the procedure, the client should avoid caffeinated, carbonated, and alcoholic beverages because they can further irritate the bowel and cause pain. The client is encouraged to drink fluids that are not restricted to help clear any hematuria. No other dietary restrictions or limitations are needed. Symptoms of urinary pain and frequency should decrease or subside within a day after the procedure. A further recommendation for pain control is a sitz bath, not opioid use. Clients after this procedure should have instruction about urinary frequency, urgency, dysuria, hematuria, and signs of a urinary tract infection. If an antibiotic was given to the client before the procedure, then the client is encouraged to continue taking the medication. PTS: 1 REF: p. 1546 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 7. A nurse on a burn unit is caring for a client who experienced burn injuries 2 days ago. The client is now showing signs and symptoms of airway obstruction, despite appearing stable since admitted. How should the client's change in status be best understood? A. The client is likely experiencing a delayed onset of respiratory complications B. The client has likely developed a systemic infection C. The client's respiratory complications are likely related to psychosocial stress D. The client is likely experiencing an anaphylactic reaction to a medication

A Rationale: Airway obstruction caused by upper airway edema can take as long as 48 hours to develop. A systemic infection would be less likely to cause respiratory complications. This problem is more likely to be caused by physiologic factors at this phase, not psychological factors. Anaphylaxis must be ruled out, but it is less likely than a response to the initial injury. PTS: 1 REF: p. 1876 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 16. A client with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in the client's cortisol levels. How should the nurse interpret this finding? A. The client's pituitary function is compromised. B. The client's adrenal insufficiency is not treatable. C. The client has insufficient hypothalamic function. D. The client would benefit from surgery.

A Rationale: An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although surgery is not likely indicated. PTS: 1 REF: p. 1449 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 17. A nurse is caring for a 73-year-old client with a urethral obstruction related to prostatic enlargement. When planning this client's care, the nurse should be aware of the risk of what complication? A. Urinary tract infection B. Enuresis C. Polyuria D. Proteinuria

A Rationale: An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male clients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, kidney injury, and urinary tract infections. PTS: 1 REF: p. 1541 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 16. A nurse is caring for a client in the emergent/resuscitative phase of burn injury. During this phase, the nurse should monitor for evidence of what alteration in laboratory values? A. Sodium deficit B. Decreased prothrombin time (PT) C. Potassium deficit D. Decreased hematocrit

A Rationale: Anticipated fluid and electrolyte changes that occur during the emergent/resuscitative phase of burn injury include sodium deficit, potassium excess, and elevated hematocrit. PT does not typically decrease. PTS: 1 REF: p. 1851 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 36. A client is responding poorly to interventions aimed at treating shock and appears to be transitioning to the irreversible stage of shock. What action should the intensive care nurse include during this phase of the client's care? A. Communicate clearly and frequently with the client's family. B. Taper down interventions slowly when the prognosis worsens. C. Transfer the client to a subacute unit when recovery appears unlikely. D. Ask the client's family how they would prefer treatment to proceed.

A Rationale: As it becomes obvious that the client is unlikely to survive, the family must be informed about the prognosis and likely outcome. Opportunities should be provided throughout the client's care for the family to see, touch, and talk to the client. However, the onus should not be placed on the family to guide care. Interventions are not normally reduced gradually when they are deemed ineffective; instead, they are discontinued when they appear futile. The client would not be transferred to a subacute unit. PTS: 1 REF: p. 281 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 2. A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications? A. "Do you feel any muscle twitches or spasms?" B. "Do you feel flushed or sweaty?" C. "Are you experiencing any dizziness or lightheadedness?" D. "Are you having any pain that seems to be radiating from your bones?"

A Rationale: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia. PTS: 1 REF: p. 1470 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 30. The nurse has identified the nursing diagnosis of "Risk for Infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk? A. Maintain aseptic technique when administering dialysate. B. Wash the skin surrounding the catheter site with soap and water prior to each exchange. C. Add antibiotics to the dialysate as prescribed. D. Administer prophylactic antibiotics by mouth or IV as prescribed.

A Rationale: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection. PTS: 1 REF: p. 1585 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 27. A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery? A. Blood glucose B. Assessment of urine for blood C. Weight D. Oral temperature

A Rationale: Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are carried out. The client's blood sugar is more likely to be volatile than body weight or temperature. Hematuria is not a common complication. PTS: 1 REF: p. 1480 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 10. A teenage client is brought to the emergency department with symptoms of hyperglycemia. Based on the fact that the pancreatic beta cells are being destroyed, the client would be diagnosed with what type of diabetes? A. Type 1 diabetes B. Type 2 diabetes C. Non-insulin-dependent diabetes D. Prediabetes

A Rationale: Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy. PTS: 1 REF: p. 1490 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 31. The nurse is caring for a client who has returned to the postsurgical suite after postanesthetic recovery from a nephrectomy. The nurse's most recent assessment reveals increased sedation, shortness of breath, hypotension, and low urine output over the last 2 hours. What is the nurse's best response? A. Assess the client for signs of bleeding and inform the primary provider. B. Perform a full neurological assessment and notify the primary care provider. C. Increase the frequency of taking vital signs, monitor urine output, and notify the provider. D. Palpate the client's torso bilaterally for flank pain and notify the primary care provider.

A Rationale: Bleeding is a major complication of kidney surgery, and if missed can lead to hypovolemic (decreased volume of circulating blood) and hemorrhagic shock. Bleeding can be suspected when the client experiences fatigue, shortness of breath, and urine output of less than 400 mL within 24 hours. The postoperative client is monitored closely and these findings should be reported to the primary care provider. Ruling out the complication of the life-threatening condition of bleeding is the priority decision for this client. Performing a full neurological assessment will be warranted after the priority complications of surgery are ruled out. Increasing the monitoring of vital signs and urine output are just small parts of assessing the client for bleeding. Palpating the client's torso for flank pain may increase the client's pain and does not (in itself) address the most common cause of the client's signs and symptoms. PTS: 1 REF: p. 1595 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 33. A burn client is transitioning from the acute phase of the injury to the rehabilitation phase. The client tells the nurse, "I can't wait to have surgery to reconstruct my face so I look like I used to." What would be the nurse's best response? A. "That's something that you and your doctor will likely talk about after your scars mature." B. "That is something for you to talk to your doctor about because it's not a nursing responsibility." C. "I know this is really important to you, but you have to realize that no one can make you look like you used to." D. "Unfortunately, it's likely that these scars will look like this for the rest of your life."

A Rationale: Burn reconstruction is a treatment option after all scars have matured and is discussed within the first few years after injury. Even though this is not a nursing responsibility, the nurse should still respond appropriately to the client's query. It is true that the client will not realistically look like he or she used to, but this does not instill hope. PTS: 1 REF: p. 1889 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 18. The nurse in the emergency department is caring for a client recently admitted with a likely myocardial infarction (MI). The nurse understands that the client's heart is pumping an inadequate supply of oxygen to the tissues. The nurse knows the client is at an increased risk for MI due to which factor? A. Arrhythmias B. Elevated B-natriuretic peptide (BNP) C. Use of thrombolytics D. Dehydration

A Rationale: Cardiogenic shock occurs when the heart's ability to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues. An elevated BNP is noted after an MI has occurred and does not increase risk. Use of thrombolytics decreases risk of developing blood clots. Dehydration does not lead to MI. PTS: 1 REF: p. 279 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 36. The most recent blood work of a client with a long-standing diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? A. Teach the client about actions to slow the progression of nephropathy. B. Ensure that the client receives a comprehensive assessment of liver function. C. Determine whether the client has been using expired insulin. D. Administer a fluid challenge and have the test repeated.

A Rationale: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the client's liver function is not likely affected. There is no indication for the use of a fluid challenge. PTS: 1 REF: p. 1522 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 2. A client presents to the clinic reporting symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A. Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) B. Random plasma glucose greater than 150 mg/dL (8.3 mmol/L) C. Fasting plasma glucose greater than 116 mg/dL (6.4 mmol/L) on two separate occasions D. Random plasma glucose greater than 126 mg/dL (7.0 mmol/L)

A Rationale: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L), or a fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L). PTS: 1 REF: p. 1492 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 4. The nurse is caring for a client who is exhibiting signs and symptoms of hypovolemic shock following injuries from a motor vehicle accident. In addition to normal saline, which crystalloid fluid should the nurse prepare to administer? A. Lactated Ringer B. Albumin C. Dextran D. 3% NaCl

A Rationale: Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock. Lactated Ringer and 0.9% sodium chloride are isotonic crystalloid fluids commonly used to manage hypovolemic shock. Dextran and albumin are colloids, but Dextran, even as a colloid, is not indicated for the treatment of hypovolemic shock. The 3% NaCl is a hypertonic solution and is not isotonic. PTS: 1 REF: p. 282 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 26. A client with a long-standing diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the client for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A. Infection B. Acute pain C. Acute confusion D. Impaired urinary elimination

A Rationale: Decreased sensations of pain and temperature place clients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function. PTS: 1 REF: p. 1523 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 19. A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care? A. Strain the client's urine following the procedure. B. Administer a bolus of 500 mL normal saline following the procedure. C. Monitor the client for fluid overload following the procedure. D. Insert a urinary catheter for 24 to 48 hours after the procedure.

A Rationale: Following ESWL, the nurse should strain the client's urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL. PTS: 1 REF: p. 1622 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 14. The nurse is caring for a client in intensive care unit whose condition is deteriorating. The nurse receives orders to initiate an infusion of dopamine. Which assessments and interventions should the nurse prioritize? A. Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration B. Reviewing medications, performing a focused cardiovascular assessment, and providing client education C. Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema D. Routine monitoring of vital signs, monitoring the peripheral intravenous site, and providing early discharge instructions

A Rationale: Dopamine is a sympathomimetic agent that has varying vasoactive effects depending on the dosage. When vasoactive medications are given, vital signs must be monitored frequently (at least every 15 minutes until stable, or more often if indicated), not "routinely." Vasoactive medications should be given through a central, not peripheral, venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. High doses can cause vasoconstriction, which increases afterload and thus increases cardiac workload. Because this effect is undesirable in clients with cardiogenic shock, dopamine doses must be carefully titrated. Reviewing medications and laboratory findings, monitoring urine output, assessing for peripheral edema, performing a focused cardiovascular assessment, and providing client education are important nursing tasks, but they are not specific to the administration of IV vasoactive drugs. PTS: 1 REF: p. 289 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 35. A nurse is working with a client who will undergo invasive urologic testing. The nurse has informed the client that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria? A. Increased fluid intake following the test B. Use of an over-the-counter (OTC) diuretic after the test C. Gentle massage of the lower abdomen D. Activity limitation for the first 12 hours after the test

A Rationale: Drinking fluids can help to clear hematuria. Diuretics are not used for this purpose. Activity limitation and massage are unlikely to resolve this expected consequence of testing. PTS: 1 REF: p. 1546 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. The nurse is working with a client whose health history includes occasional episodes of urinary retention. What assessment finding would suggest that the client is currently retaining urine? A. The client's suprapubic region is dull on percussion. B. The client is uncharacteristically drowsy. C. The client claims to void large amounts of urine two to three times daily. D. The client takes a beta adrenergic blocker for the treatment of hypertension.

A Rationale: Dullness on percussion of the suprapubic region is suggestive of urinary retention. Clients retaining urine are typically restless, not drowsy. A client experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention. PTS: 1 REF: p. 1627 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 4. The nurse is assessing a client's bladder by percussion. The nurse elicits dullness after the client has voided. How should the nurse interpret this assessment finding? A. The client's bladder is not completely empty. B. The client has kidney enlargement. C. The client has a ureteral obstruction. D. The client has a fluid volume deficit.

A Rationale: Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder. PTS: 1 REF: p. 1545 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 22. Following an addisonian crisis, a client's adrenal function has been gradually regained. The nurse should ensure that the client knows about the need for supplementary corticosteroid therapy in which circumstance? A. A significant illness B. Periods of dehydration C. Episodes of physical exertion D. Administration of a vaccine

A Rationale: During stressful procedures, significant illnesses, or for clients in the third trimester of pregnancy, additional supplementary therapy with corticosteroids is required to prevent addisonian crisis. Physical activity, dehydration, and vaccine administration would not normally add significant stress and would not require supplemental therapy. PTS: 1 REF: p. 1477 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice 8. A client has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. After ensuring cardiopulmonary stability, what would be the nurse's immediate, priority concern when planning this client's care? A. Fluid status B. Risk of infection C. Nutritional status D. Psychosocial coping

A Rationale: During the early phase of burn care, the nurse is most concerned with fluid resuscitation, to correct large-volume fluid loss through the damaged skin. Infection control and early nutritional support are important, but fluid resuscitation is an immediate priority. Coping is a higher priority later in the recovery period. PTS: 1 REF: p. 1873 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. The nurse is assessing a diverse group of clients. What client is at a greater risk for the development of hypothyroidism? A. A 75-year-old female client with osteoporosis B. A 50-year-old male client who is obese C. A 45-year-old female client who uses oral contraceptives D. A 25-year-old male client who uses recreational drugs

A Rationale: Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women. Younger men and women generally face a lower risk. PTS: 1 REF: p. 1456 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 13. A client with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis? A. "Hemodialysis is a treatment option that is usually required three times a week." B. "Hemodialysis is a program that will require you to commit to daily treatment." C. "This will require you to have surgery and a catheter will need to be inserted into your abdomen." D. "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."

A Rationale: Hemodialysis is the most commonly used method of dialysis. Clients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatment usually occurs three times a week for at least 3 to 4 hours per treatment. Peritoneal dialysis, not hemodialysis, requires placement of a catheter inserted into the abdomen. PTS: 1 REF: p. 1577 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 2. In an acute care setting, the nurse is assessing an unstable client. When prioritizing the client's care, the nurse should recognize that the client is at risk for hypovolemic shock in which of the following circumstances? A. Fluid volume circulating in the blood vessels decreases. B. There is an uncontrolled increase in cardiac output. C. Blood pressure regulation becomes irregular. D. The client experiences tachycardia and a bounding pulse.

A Rationale: Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac output is decreased, blood pressure decreases, and pulse is fast, but weak. PTS: 1 REF: p. 285 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 30. A nurse is conducting a class on how to self-manage insulin regimens. A client asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer? A. "If you are going to use up the vial within 1 month, it can be kept at room temperature." B. "If a vial of insulin will be used up within 21 days, it may be kept at room temperature." C. "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." D. "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."

A Rationale: If a vial of insulin will be used up within 1 month, it may be kept at room temperature. PTS: 1 REF: p. 1508 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 21. A client is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what issue? A. Hydronephrosis B. Nephritic syndrome C. Pyelonephritis D. Nephrotoxicity

A Rationale: If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes. PTS: 1 REF: p. 1611 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 27. A client has been brought to the emergency department by paramedics after being found unconscious. The client's MedicAlert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A. IV administration of 50% dextrose in water B. Subcutaneous administration of 10 units of Humalog C. Subcutaneous administration of 12 to 15 units of regular insulin D. IV bolus of 5% dextrose in 0.45% NaCl

A Rationale: In hospitals and emergency departments, for clients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate, and insulin would exacerbate the client's condition. PTS: 1 REF: p. 1513 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 15. The nurse in intensive care unit is admitting a 57-year-old client with a diagnosis of possible septic shock. The nurse's assessment reveals that the client has a normal blood pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurse's analysis of these data should lead to which preliminary conclusion? A. The client is in the compensatory stage of shock. B. The client is in the progressive stage of shock. C. The client will stabilize and be released by tomorrow. D. The client is in the irreversible stage of shock.

A Rationale: In the compensatory stage of shock, the blood pressure remains within normal limits. Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to maintaining adequate cardiac output. Clients display the often-described "fight or flight" response. The body shunts blood from organs such as the skin, kidneys, and gastrointestinal tract to the brain and heart to ensure adequate blood supply to these vital organs. As a result, the skin is cool and clammy, and bowel sounds are hypoactive. In progressive shock, the blood pressure drops. In septic shock, the client's chance of survival is low and he will certainly not be released within 24 hours. If the client were in the irreversible stage of shock, his blood pressure would be very low and his organs would be failing. PTS: 1 REF: p. 276 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 37. A critical care nurse is aware of the high incidence of ventilator-associated pneumonia (VAP) in clients who are being treated for shock. What intervention should be specified in the client's plan of care while the client is ventilated? A. Performing frequent oral care B. Maintaining the client in a supine position C. Suctioning the client every 15 minutes unless contraindicated D. Administering prophylactic antibiotics, as prescribed

A Rationale: Nursing interventions that reduce the incidence of VAP must also be implemented. These include frequent oral care, aseptic suction technique, turning, and elevating the head of the bed at least 30 degrees to prevent aspiration. Suctioning should not be excessively frequent and prophylactic antibiotics are not normally indicated. PTS: 1 REF: p. 280 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 36. While reviewing a client's medical record, the nurse notes that the client has hypothyroidism resulting from dysfunction of the thyroid gland itself. The nurse identifies this as which type of hypothyroidism? A. primary B. central C. secondary D. tertiary

A Rationale: Often clients with hypothyroidism may have primary (thyroidal) hypothyroidism, which refers to dysfunction of the thyroid gland itself. If the cause of the thyroid dysfunction is failure of the pituitary gland, the hypothalamus, or both, then the hypothyroidism is known as central hypothyroidism. If the cause is entirely a pituitary disorder, then it may be referred to as pituitary, or secondary, hypothyroidism. If the cause is a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation by TRH, then it is referred to as hypothalamic, or tertiary, hypothyroidism. PTS: 1 REF: p. 1461 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 34. A client has been living with type 2 diabetes for several years, and the nurse realizes that the client is likely to have minimal contact with the health care system. In order to ensure that the client maintains adequate blood sugar control over the long term, what should the nurse recommend? A. Participation in a support group for persons with diabetes B. Regular consultation of websites that address diabetes management C. Weekly telephone "check-ins" with an endocrinologist D. Participation in clinical trials relating to antihyperglycemics

A Rationale: Participation in support groups is encouraged for clients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on clients' circumstances. PTS: 1 REF: p. 1512 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 23. An emergency department nurse has just received a client with burn injuries brought in by ambulance. The paramedics have started a large-bore IV and covered the burn in cool towels. The burn is estimated as covering 24% of the client's body. How should the nurse best address the pathophysiologic changes resulting from major burns during the initial burn-shock period? A. Administer IV fluids. B. Administer broad-spectrum antibiotics. C. Administer IV potassium chloride. D. Administer packed red blood cells.

A Rationale: Pathophysiologic changes resulting from major burns during the initial burn-shock period include massive fluid losses. Addressing these losses is a major priority in the initial phase of treatment. Antibiotics and PRBCs are not normally given. Potassium chloride would exacerbate the client's hyperkalemia. PTS: 1 REF: p. 1871 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 35. The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer? A. Smoking cessation B. Reduction of alcohol intake C. Maintenance of a diet high in vitamins and nutrients D. Vitamin D supplementation

A Rationale: People who smoke are significantly more likely to develop bladder cancer than those who do not smoke. High alcohol intake and low vitamin intake are not noted to contribute to bladder cancer. PTS: 1 REF: p. 1626 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 18. A client with difficulty voiding and elevated BUN and creatinine values has been referred by the health care provider for further evaluation. The nurse should anticipate the use of what initial diagnostic test? A. Portable bladder ultrasound B. X-ray C. Computed tomography (CT) D. Nuclear scan

A Rationale: Portable bladder ultrasound is a method of detecting urinary retention. These devices provide a three-dimensional image of the bladder and should be used after voiding to detect urine retention. Researchers have reported a decrease in urinary tract infections and a shorter hospital stay when this device is used. A portable bladder ultrasound can be done quickly and frequently at the bedside by the nurse to detect urinary retention. There is no ionizing radiation exposure with a portable ultrasound. X-ray, CT and nuclear scans all use a certain amount of ionizing radiation. PTS: 1 REF: p. 1545 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 21. A client is brought to the emergency department with a burn injury. The nurse knows that the first systemic event after a major burn injury is what event? A. Hemodynamic instability B. Gastrointestinal hypermotility C. Respiratory arrest D. Hypokalemia

A Rationale: The initial systemic event after a major burn injury is hemodynamic instability, which results from loss of capillary integrity and a subsequent shift of fluid, sodium, and protein from the intravascular space into the interstitial spaces. This precedes GI changes. Respiratory arrest may or may not occur, largely depending on the presence or absence of smoke inhalation. Hypokalemia does not take place in the initial phase of recovery. PTS: 1 REF: p. 1871 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 2. A 42-year-old woman comes to the clinic reporting occasional urinary incontinence when sneezing. The clinic nurse should recognize what type of incontinence? A. Stress incontinence B. Reflex incontinence C. Overflow incontinence D. Functional incontinence

A Rationale: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure, such as a result of exertion, sneezing, coughing, or changing positions. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the client to reach the toilet in time for voiding. PTS: 1 REF: p. 1611 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 13. The nurse is caring for a client who is receiving large volumes of crystalloid fluid to treat hypovolemic shock. In light of this intervention, for what sign or symptom should the nurse monitor? A. Hypothermia B. Bradycardia C. Coffee ground emesis D. Pain

A Rationale: Temperature should be monitored closely to ensure that rapid fluid resuscitation does not precipitate hypothermia. IV fluids may need to be warmed during the administration of large volumes. The nurse should monitor the client for cardiovascular overload and pulmonary edema when large volumes of IV solution are given. Coffee ground emesis is an indication of a GI bleed, not shock. Pain is related to cardiogenic shock. PTS: 1 REF: p. 287 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 11. A client presents at the walk-in clinic reporting diarrhea and vomiting. The client has a documented history of adrenal insufficiency. Considering the client's history and current symptoms, the nurse should anticipate that the client will be instructed to increase intake of: A. sodium. B. potassium. C. simple carbohydrates. D. calcium.

A Rationale: The client will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the client may experience the loss of other electrolytes, the major concern is the replacement of lost sodium. PTS: 1 REF: p. 1478 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 15. The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula? A. "A vein and an artery in your arm will be attached surgically." B. "The arm should be immobilized for 4 to 6 days." C. "One needle will be inserted into the fistula for each dialysis treatment." D. "The fistula can be used 5 to 7 days after the surgery for dialysis treatment."

A Rationale: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need several weeks to "mature" before it can be used. The client is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment. PTS: 1 REF: p. 1580 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 11. An emergency department nurse learns from the paramedics that the team is transporting a client who has suffered injury from a scald from a hot kettle. What variables will the nurse consider when determining the depth of burn? A. The causative agent B. The client's pre-injury health status C. The client's prognosis for recovery D. The circumstances of the accident

A Rationale: The following factors are considered in determining the depth of a burn: how the injury occurred, causative agent (such as flame or scalding liquid), temperature of the burning agent, duration of contact with the agent, and thickness of the skin. The client's pre-injury status, circumstances of the accident, and prognosis for recovery are important, but are not considered when determining the depth of the burn. PTS: 1 REF: p. 1868 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 28. A nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A. Always carry a form of fast-acting sugar. B. Perform exercise prior to eating whenever possible. C. Eat a meal or snack every 8 hours. D. Check blood sugar at least every 24 hours.

A Rationale: The following teaching points should be included in information provided to the client on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly. PTS: 1 REF: p. 1513 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 34. A client who is in the acute phase of recovery from a burn injury has yet to experience adequate pain control. What pain management strategy is most likely to meet this client's needs? A. A client-controlled analgesia (PCA) system B. Oral opioids supplemented by NSAIDs C. Distraction and relaxation techniques supplemented by NSAIDs D. A combination of benzodiazepines and topical anesthetics

A Rationale: The goal of treatment is to provide a long-acting analgesic that will provide even coverage for this long-term discomfort. It is helpful to use escalating doses when initiating the medication to reach the level of pain control that is acceptable to the client. The use of client-controlled analgesia (PCA) gives control to the client and achieves this goal. Clients cannot normally achieve adequate pain control without the use of opioids, and parenteral administration is usually required. PTS: 1 REF: p. 1878 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 7. A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client? A. Do not eliminate insulin when nauseated and vomiting. B. Report elevated glucose levels greater than 150 mg/dL (8.3 mmol/L). C. Eat three substantial meals a day, if possible. D. Reduce food intake and insulin doses in times of illness.

A Rationale: The most important issue to teach clients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, and then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL (16.6 mmol/L). PTS: 1 REF: p. 1514 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 4. The nurse is working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to take what action? A. Wash hands carefully and frequently. B. Ensure immediate function of the donated kidney. C. Instruct the client to wear a face mask. D. Bar visitors from the client's room.

A Rationale: The nurse ensures that the client is protected from exposure to infection by hospital staff, visitors, and other clients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the client is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection. PTS: 1 REF: p. 1598 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the client will require further teaching when the client states what? A. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." B. "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." C. "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." D. "I will call the doctor if my blood sugar is over 300 mg/dL (16.6 mmol/L) or if I have ketones in my urine."

A Rationale: The nurse must explain the "sick day rules" again to the client who plans to stop taking insulin when sick. The nurse should emphasize that the client should take insulin agents as usual and test the blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring clients may need supplemental doses of regular insulin every 3 to 4 hours. The client should report elevated glucose levels (greater than 300 mg/dL or 16.6 mmol/L, or as otherwise instructed) or urine ketones to the health care provider. If the client is not able to eat normally, the client should be instructed to substitute with soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the client should have an intake of liquids every 30 to 60 minutes to prevent dehydration. PTS: 1 REF: p. 1514 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice 25. The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk? A. Establish fall-prevention measures. B. Encourage bed rest whenever possible. C. Encourage the use of assistive devices. D. Provide constant supervision.

A Rationale: The nurse should take action to limit the client's risk for falls. However, bed rest has too many harmful effects, and assistive devices may or may not be necessary. Constant supervision is not normally required or practicable. PTS: 1 REF: p. 1481 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 8. The nurse is developing a care plan for a client with Cushing syndrome. What nursing diagnosis should the nurse prioritize? A. Risk for injury related to weakness B. Ineffective breathing pattern related to muscle weakness C. Risk for loneliness related to disturbed body image D. Autonomic dysreflexia related to neurologic changes

A Rationale: The nursing priority is to decrease the risk of injury by establishing a protective environment. The client who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners of furniture. The client's breathing will not be affected, and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an issue for the client, but safety is a priority. PTS: 1 REF: p. 1480 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 27. A public health nurse is educating a group of administrators about decreasing hospitalizations for burns. Which population will the nurse note as the target population for burn injuries? A. Older adults B. Women more than men C. Adults 35-40 years of age D. School-aged teenagers

A Rationale: The population that is most at risk for hospitalization are older adults. Statistically men have a higher incidence of burns over women. Adults from 35 to 40 years of age are not shown to have a high prevalence. School-aged teenagers do not have a higher prevalence of burns with hospitalization than the aging population. PTS: 1 REF: p. 1866 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice Chapter 48: Management of Patients with Kidney Disorders 1. The nurse is assessing a client suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A. Hematuria B. Precipitous decrease in serum creatinine levels C. Hypotension unresolved by fluid administration D. Glucosuria

A Rationale: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Glucosuria does not normally accompany glomerulonephritis, and hypertension is much more likely than hypotension. PTS: 1 REF: p. 1558 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Select 32. A client asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe? A. The right kidney's proximity to the pancreas, liver, and gallbladder B. The indirect impact of digestive enzymes on renal function C. That the peritoneum encapsulates the GI system and the kidneys D. The left kidney's connection to the common bile duct

A Rationale: The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct, liver, and gallbladder may cause GI disturbances. The proximity of the left kidney to the colon (splenic flexure), stomach, pancreas, and spleen may also result in intestinal symptoms. Digestive enzymes do not affect renal function, and the left kidney is not connected to the common bile duct. PTS: 1 REF: p. 1544 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 2. The nurse is caring for a client who has been diagnosed with renal calculi. Prompt management of renal calculi is most important when the stone is located where? A. In the ureteropelvic junction B. In the ureteral segment near the sacroiliac junction C. In the ureterovesical junction D. In the urethra

A Rationale: The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovesical junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter. PTS: 1 REF: p. 1536 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 22. A nurse is caring for a client newly diagnosed with type 1 diabetes. The nurse is educating the client about self-administration of insulin in the home setting. The nurse should teach the client to do what action? A. Avoid using the same injection site more than once in 2 to 3 weeks. B. Avoid mixing more than one type of insulin in a syringe. C. Cleanse the injection site thoroughly with alcohol prior to injecting. D. Inject at a 45-degree angle.

A Rationale: To prevent lipodystrophy, the client should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90-degree angle. Cleansing the injection site with alcohol is optional. PTS: 1 REF: p. 1509 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 5. The nurse is providing preprocedure teaching about an ultrasound. The nurse informs the client that in preparation for an ultrasound of the lower urinary tract the client will require what action? A. Increased fluid intake to produce a full bladder B. IV administration of radiopaque contrast agent C. Sedation and intubation D. Injection of a radioisotope

A Rationale: Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedure. The administration of a radiopaque contrast agent is required to perform IV urography studies, such as an IV pyelogram. Ultrasonography is a quick and painless diagnostic test and does not require sedation or intubation. The injection of a radioisotope is required for nuclear scan and ultrasonography is not in this category of diagnostic studies. PTS: 1 REF: p. 1549 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 9. The nurse and urologist have both been unsuccessful in catheterizing a client with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the health care provider will use to drain the client's bladder? A. Insertion of a suprapubic catheter B. Scheduling the client immediately for a prostatectomy C. Application of warm compresses to the perineum to assist with relaxation D. Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours

A Rationale: When the client cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm. PTS: 1 REF: p. 1616 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 32. The ICU nurse caring for a client in shock is administering vasoactive medications as per orders. The nurse should administer this medication in what way? A. Through a central venous line B. By a gravity infusion IV set C. By IV push for rapid onset of action D. Mixed with parenteral feedings to balance osmosis

A Rationale: Whenever possible, vasoactive medications should be given through a central venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. An IV pump or controller must be used to ensure that the medications are delivered safely and accurately. They are never mixed with parenteral nutrition. PTS: 1 REF: p. 283 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic? A. The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy B. The need to expect a heavy menstrual period following the course of antibiotics C. The risk of developing antibiotic resistance after the course of antibiotics D. The need to undergo a series of three urine cultures after the antibiotics have been completed

A Rationale: Yeast vaginitis occurs in many clients treated with antimicrobial agents that affect vaginal flora. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics. PTS: 1 REF: p. 1607 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 20. A nurse has reported for a shift at a busy burns and plastics unit in a large university hospital. Which client is most likely to have life-threatening complications? A. A 4-year-old scald victim burned over 24% of the body B. A 27-year-old male burned over 36% of his body in a car accident C. A 39-year-old female client burned over 18% of her body D. A 60-year-old male burned over 16% of his body in a brush fire

A Rationale: Young children and older adults continue to have increased morbidity and mortality when compared to other age groups with similar injuries and present a challenge for burn care. This is an important factor when determining the severity of injury and possible outcome for the client. PTS: 1 REF: p. 1867 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 8. A nurse is preparing a client diagnosed with benign prostatic hyperplasia (BPH) for a lower urinary tract cystoscopic examination. The nurse should caution the client about what common temporary complication of this procedure? A. Urinary retention B. Bladder perforation C. Hemorrhage D. Nausea

A Rationale: After a cystoscopic examination, the client with obstructive pathology may experience urine retention if the instruments used during the examination cause edema. The nurse will carefully monitor the client with prostatic hyperplasia for urine retention. Postprocedure, the client will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 25. A client is admitted to the burn unit after being transported a long distance. The client has burns to the groin area and circumferential burns to both upper thighs. When assessing the client's legs distal to the wound site, the nurse should be cognizant of the risk of what complication? A. Ischemia B. Referred pain C. Cellulitis D. Venous thromboembolism (VTE)

A Rationale: As edema increases, pressure on small blood vessels and nerves in the distal extremities causes an obstruction of blood flow and consequent ischemia. This complication is similar to compartment syndrome. Referred pain, cellulitis, and VTE are not noted complications that occur distal to the injury site. PTS: 1 REF: p. 1871 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 3. A client in the emergent/resuscitative phase of a burn injury has had blood work and arterial blood gases drawn. Upon analysis of the client's laboratory studies, the nurse will expect the results to indicate what findings? A. Hyperkalemia, hyponatremia, elevated hematocrit B. Hypokalemia, hypernatremia, decreased hematocrit C. Hyperkalemia, hypernatremia, decreased hematocrit D. Hypokalemia, hyponatremia, elevated hematocrit

A Rationale: Fluid and electrolyte changes in the emergent/resuscitative phase of a burn injury include hyperkalemia related to the release of potassium into the extracellular fluid, hyponatremia from large amounts of sodium lost in trapped edema fluid, and hemoconcentration that leads to an increased hematocrit. PTS: 1 REF: p. 1871 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 14. A client with end-stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? A. Inform the health care provider and assess the client for signs of infection. B. Flush the peritoneal catheter with normal saline. C. Remove the catheter promptly and have the catheter tip cultured. D. Administer a bolus of IV normal saline as prescribed.

A Rationale: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the health care provider would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection. PTS: 1 REF: p. 1586 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 5. The nurse on a urology unit is working with a client who has been diagnosed with calcium oxalate renal calculi. When planning this client's health education, what nutritional guidelines should the nurse provide? A. Restrict protein intake as prescribed. B. Increase intake of potassium-rich foods. C. Follow a low-calcium diet. D. Encourage intake of food containing oxalates.

A Rationale: Protein is restricted to 60 g/day, while sodium is restricted to 3 to 4 g/day. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The client should avoid intake of oxalate-containing foods and there is no need to increase potassium intake. PTS: 1 REF: p. 1621 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 22. The nurse is assessing a client admitted with renal stones. During the admission assessment, what parameters should the nurse address? Select all that apply. A. Dietary history B. Family history of renal stones C. Medication history D. Surgical history E. Vaccination history

A, B, C Rationale: Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the client to stone formation. When caring for a client with renal stones, it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones. PTS: 1 REF: p. 1622 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 37. A nurse is providing education to the family of a client beginning peritoneal dialysis. The family ask questions concerning catheter placement and stabilization. Which information will the nurse provide about the cuffs? Select all that apply. A. The cuffs are constructed of Dacron polyester material. B. The cuffs will help stabilize the catheter. C. The cuffs prevent the dialysate from leaking. D. The cuffs provide a barrier against microorganisms. E. The cuffs will absorb the dialysate.

A, B, C, D Rationale: Most catheters used for peritoneal dialysis have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate. PTS: 1 REF: p. 1586 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 36. The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply. A. Specific gravity of the client's urine B. Testing for the presence of glucose in the client's urine C. Microscopic examination of urine sediment for RBCs D. Microscopic examination of urine sediment for casts E. Testing for BUN and creatinine in the client's urine

A, B, C, D Rationale: Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are components of serum, not urine. PTS: 1 REF: p. 1548 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 28. The nurse is caring for a client's status after a motor vehicle accident. The client has developed AKI. What are the nurse's roles in caring for this client? Select all that apply. A. Providing emotional support for the family B. Monitoring for complications C. Participating in emergency treatment of fluid and electrolyte imbalances D. Providing nursing care for primary disorder (trauma) E. Directing nutritional interventions

A, B, C, D Rationale: The nurse has an important role in caring for the client with AKI. The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the client's progress and response to treatment, and provides physical and emotional support. Additionally, the nurse keeps family members informed about the client's condition, helps them understand the treatments, and provides psychological support. Although the development of AKI may be the most serious problem, the nurse continues to provide nursing care indicated for the primary disorder (e.g., burns, shock, trauma, obstruction of the urinary tract). The nurse does not direct the client's nutritional status; the dietitian and the health care provider normally collaborate on directing the client's nutritional status. PTS: 1 REF: p. 1569 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 38. A client is being treated in the ICU for neurogenic shock secondary to a spinal cord injury. Despite aggressive interventions, the client's mean arterial pressure (MAP) has fallen to 55 mm Hg. The nurse should assess for the onset of acute kidney injury by referring to what laboratory findings? Select all that apply. A. Blood urea nitrogen (BUN) level B. Urine specific gravity C. Alkaline phosphatase level D. Creatinine level E. Serum albumin level

A, B, D Rationale: Acute kidney injury (AKI) is characterized by an increase in BUN and serum creatinine levels, fluid and electrolyte shifts, acid-base imbalances, and a loss of the renal-hormonal regulation of BP. Urine specific gravity is also affected. Alkaline phosphatase and albumin levels are related to hepatic function. PTS: 1 REF: p. 279 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 16. A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client's diet to maximize the therapeutic effect and minimize the risks of complications. The client's diet should include which of the following modifications? Select all that apply. A. Decreased protein intake B. Decreased sodium intake C. Increased potassium intake D. Fluid restriction E. Vitamin D supplementation

A, B, D Rationale: Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation. PTS: 1 REF: p. 1583 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 26. A client with Cushing syndrome has been hospitalized after a fall. The dietitian works with the client to improve the client's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply. A. Foods high in vitamin D B. Foods high in calories C. Foods high in protein D. Foods high in calcium E. Foods high in sodium

A, C, D Rationale: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories. PTS: 1 REF: p. 1481 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 37. A 45-year-old client has been admitted to the hospital for a hypertensive crisis. The health care provider (HCP) has ruled out a cerebrovascular accident (CVA) but suspects pheochromocytoma. What additional signs and symptoms would further confirm this diagnosis as correct? Select all that apply. A. hypermetabolism B. hyperkalemia C. hyperglycemia D. hyperhidrosis E. hyperpigmentation

A, C, D Rationale: Pheochromocytoma is suspected if the client has hypertension along with signs of nervous system overactivity. The five signs of this condition are: hypertension, headache, hyperhidrosis, hypermetabolism and hyperglycemia. Pheochromocytoma is a rare tumor of the adrenal medulla. The tumor is the cause of hypertension and is usually fatal if undetected and untreated. While this condition can happen at any age, it usually occurs between ages 40 and 50. A client with this condition typically has hypokalemia (low potassium). Hyperpigmentation is associated with Addison disease. PTS: 1 REF: p. 1475 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 34. A nurse is assessing a client with acromegaly. Which finding(s) would the nurse most likely assess? Select all that apply. A. Enlarged feet B. Height greater than 7 feet C. Broad nose D. Enlarged tongue E. Carpal tunnel syndrome

A, C, D, E Rationale: With acromegaly, the excessive skeletal growth occurs only in the feet, the hands, and the superciliary ridge (bony ridge located above the eye sockets). Facial features (nose, lips, ears, and forehead) become broader and larger, the tongue enlarges, the space between the teeth increases, and the lower jaw grows, resulting in an underbite and extended lower jaw. Enlargement also can involve all tissues and organs of the body. As an example, because of soft tissue enlargement, carpal tunnel syndrome can also occur. Height over 7 feet is associated with gigantism, which occurs in children. PTS: 1 REF: p. 1450 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 31. A client is in the acute phase of a burn injury. One of the nursing diagnoses in the plan of care is Ineffective Coping Related to Trauma of Burn Injury. What interventions appropriately address this diagnosis? Select all that apply. A. Promote truthful communication. B. Avoid asking the client to make decisions. C. Teach the client coping strategies. D. Administer benzodiazepines as prescribed. E. Provide positive reinforcement.

A, C, E Rationale: The nurse can assist the client to develop effective coping strategies by setting specific expectations for behavior, promoting truthful communication to build trust, helping the client practice appropriate strategies, and giving positive reinforcement when appropriate. The client may benefit from being able to make decisions regarding his or her care. Benzodiazepines may be needed for short-term management of anxiety, but they are not used to enhance coping. PTS: 1 REF: p. 1886 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Multiple Choice 9. The nurse is performing a shift assessment of a client with aldosteronism. What priority assessment(s) should the nurse include that relate to this condition? Select all that apply. A. Urine output B. Signs or symptoms of venous thromboembolism C. Peripheral pulses D. Blood pressure E. Skin integrity

A, D Rationale: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and blood pressure (BP). Hypertension is the most prominent and almost universal sign of primary aldosteronism. The client's peripheral pulses, risk of venous thromboembolism (VTE), and skin integrity are not typically affected by aldosteronism. PTS: 1 REF: p. 1482 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 21. The intensive care nurse is responsible for the care of a client who is in shock. What cardiac signs or symptoms would suggest to the nurse that the client may be experiencing acute organ dysfunction? Select all that apply. A. Drop in systolic blood pressure of greater than or equal to 40 mm Hg from baselines B. Hypotension that responds to bolus fluid resuscitation C. Exaggerated response to vasoactive medications D. Serum lactate greater than 4 mmol/L E. Mean arterial pressure (MAP) of less than 65 mm Hg

A, D, E Rationale: Signs of acute organ dysfunction in the cardiovascular system include systolic blood pressure <90 mm Hg or MAP <65 mm Hg, drop in systolic blood pressure >40 mm Hg from baselines, or serum lactate >4 mmol/L. An exaggerated response to vasoactive medications and an adequate response to fluid resuscitation would not be noted. PTS: 1 REF: p. 294 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 28. A team of nurses are reviewing the similarities and differences between the different classifications of shock. Which subclassifications of distributive shock should the nurses identify? Select all that apply. A. Anaphylactic B. Hypovolemic C. Cardiogenic D. Septic E. Neurogenic

A, D, E Rationale: The varied mechanisms leading to the initial vasodilation in distributive shock provide the basis for the further subclassification of shock into three types: septic shock, neurogenic shock, and anaphylactic shock. Hypovolemic and cardiogenic shock are not subclassifications of distributive shock. PTS: 1 REF: p. 290 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 12. The nurse caring for a client with suspected renal dysfunction calculates that the client's weight has increased by 5 pounds (2.27 kg) in the past 24 hours. The nurse estimates that the client has retained approximately how much fluid? A. 1,300 mL/ 43.9 fl oz. of fluid in 24 hours B. 2,270 mL/76.7 fl oz. of fluid in 24 hours C. 3,100 mL/104.8 fl oz. of fluid in 24 hours D. 5,000 mL/169.0 fl oz. of fluid in 24 hours

B Rationale: An increase in body weight commonly accompanies edema. To calculate the approximate weight gain from fluid retention, the nurse should remember that 1 kg of weight gain equals approximately 1,000 mL of fluid. Five pounds = 2.27 kg = 2,270 mL. PTS: 1 REF: p. 1546 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. A client's burns have required a homograft. During the nurse's most recent assessment, the nurse observes that the graft is newly covered with purulent exudate. What is the nurse's most appropriate response? A. Perform mechanical débridement to remove the exudate and prevent further infection. B. Inform the primary care provider promptly because the graft may need to be removed. C. Perform range-of-motion exercises to increase perfusion to the graft site and facilitate healing. D. Document this finding as an expected phase of graft healing.

B Rationale: An infected graft may need to be removed, thus the care provider should be promptly informed. ROM exercises will not resolve this problem, and the nurse would not independently perform débridement. PTS: 1 REF: p. 1882 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 4. The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic? A. The possibility of precipitous weight gain B. The need for lifelong steroid replacement C. The need to match the daily steroid dose to immediate symptoms D. The importance of monitoring liver function

B Rationale: Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the client and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects. PTS: 1 REF: p. 1477 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. The nurse is caring for a client scheduled for renal angiography following a motor vehicle accident. What client preparation should the nurse most likely provide before this test? A. Administration of IV potassium chloride B. Administration of a laxative C. Administration of Gastrografin D. Administration of a 24-hour urine test

B Rationale: Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructed x-rays can be obtained. A 24-hour urine test is not necessary prior to the procedure. Gastrografin and potassium chloride are not given prior to renal angiography. PTS: 1 REF: p. 1551 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Response 29. A triage nurse in the emergency department (ED) is on shift when a 4-year-old is carried into the ED by their grandparent. The child is not breathing, and the grandparent states the child was stung by a bee in a nearby park while they were waiting for the child's parent to get off work. Rapid onset of which condition would lead the nurse to suspect that the child is experiencing anaphylactic shock? A. Acute hypertension B. Respiratory distress C. Neurologic compensation D. Cardiac arrest

B Rationale: Characteristics of severe anaphylaxis usually include rapid onset of hypotension, neurologic compromise, and respiratory distress. Cardiac arrest can occur later if prompt treatment is not provided. PTS: 1 REF: p. 296 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 12. An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as being suggestive of diabetes? A. "I've always been a fan of sweet foods, but lately I'm turned off by them." B. "Lately, I drink and drink and can't seem to quench my thirst." C. "No matter how much sleep I get, it seems to take me hours to wake up." D. "When I went to the washroom the last few days, my urine smelled odd."

B Rationale: Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes. PTS: 1 REF: p. 1491 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Select 32. A client who was burned in a workplace accident has completed the acute phase of treatment and the plan of care has been altered to prioritize rehabilitation. What nursing action should be prioritized during this phase of treatment? A. Monitoring fluid and electrolyte imbalances B. Providing education to the client and family C. Treating infection D. Promoting thermoregulation

B Rationale: Client and family education is a priority during rehabilitation. There should be no fluid and electrolyte imbalances in the rehabilitation phase. The presence of impaired thermoregulation or infection would suggest that the client is still in the acute phase of burn recovery. PTS: 1 REF: p. 1886 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 29. A client is scheduled for a diagnostic MRI of the lower urinary system. What preprocedure education should the nurse include? A. The need to be NPO for 12 hours prior to the test B. Relaxation techniques to use during the test C. The need for conscious sedation prior to the test D. The need to limit fluid intake to 1 liter in the 24 hours before the test

B Rationale: Client preparation should include teaching relaxation techniques because the client needs to remain still during an MRI. The client does not normally need to be NPO or fluid-restricted before the test and conscious sedation is not usually implemented. PTS: 1 REF: p. 1549 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 19. A nurse who is taking care of a client with burns is asked by a family member why the client is losing so much weight. The client is currently in the intermediate phase of recovery. What would be the nurse's most appropriate response to the family member? A. "The client is on a calorie-restricted diet in order to divert energy to wound healing." B. "The client's body has consumed fat deposits for fuel because calorie intake is lower than normal." C. "The client actually hasn't lost weight. Instead, there's been a change in the distribution of body fat." D. "The client lost many fluids while being treated in the emergency phase of burn care."

B Rationale: Clients lose a great deal of weight during recovery from severe burns. Reserve fat deposits are catabolized as a result of hypermetabolism. Clients are not placed on a calorie restriction during recovery, and fluid losses would not account for weight loss later in the recovery period. Changes in the overall distribution of body fat do not occur. PTS: 1 REF: p. 1884 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 31. A nurse on a busy medical unit provides care for many clients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which client? A. A client whose diagnosis of chronic kidney disease requires a fluid restriction B. A client who has Alzheimer disease and who is acutely agitated C. A client who is on bed rest following a recent episode of venous thromboembolism D. A client who has decreased mobility following a transmetatarsal amputation

B Rationale: Clients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk for injury or trauma associated with indwelling catheter use. PTS: 1 REF: p. 1619 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 11. A client newly diagnosed with type 2 diabetes has been told by their family that they can no longer consume alcohol. The client asks the nurse if abstaining from all alcohol is necessary. What is the nurse's best response? A. "You should stop all alcohol intake. Alcohol is absorbed by your body before other important nutrients and may lead to very high blood glucose levels." B. "You do not need to give up alcohol entirely but there are potential side effects specific to clients with diabetes that you should consider." C. "You should no longer consume alcohol since it causes immediate low blood glucose levels in diabetic clients." D. "You can still consume alcohol, but limit your consumption to no more than 3 glasses of wine or beer daily because of the high sugar content of alcohol."

B Rationale: Clients with diabetes do not need to give up alcoholic beverages entirely. Moderation is the key. Moderate intake is no more than 1 alcoholic beverage (light beer, wine) for women and 2 drinks for men daily. Recommendations include avoiding mixed drinks and liqueurs because of the possibility of excessive weight gain, elevated glucose levels, and hyperlipidemia. Clients should be aware of potential side effects of alcohol consumption. These include diabetic ketoacidosis and hypoglycemia To combat possible hypoglycemia, clients with diabetes should not consume alcohol on an empty stomach. PTS: 1 REF: p. 1496 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 16. A client being treated in the hospital has been experiencing occasional urinary retention. What voiding trigger technique would help this client? A. Using a bedpan instead of a commode B. Dipping the client's hands in warm water C. Performing a bladder scan after voiding D. Encouraging male clients to use a urinal in bed

B Rationale: Dipping the client's hands in warm water is a urinary trigger technique that helps encourage clients to start voiding. Other trigger techniques include turning on the faucet while the client is attempting to void and stroking the abdomen or inner thighs. Using a commode instead of a bedpan is a nursing measure to encourage normal voiding patterns. Encouraging a male client to use a urinal while standing is more natural and comfortable and is also linked to voiding patterns. Bladder scanning after voiding will assess whether the client is retaining urine but is not a trigger technique. PTS: 1 REF: p. 1616 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 23. A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what factor most likely caused this short-term change in treatment? A. Alterations in bile metabolism and release have likely caused hyperglycemia. B. Stress has likely caused an increase in the client's blood sugar levels. C. The client's efforts did not control the diabetes using nonpharmacologic measures. D. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

B Rationale: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The client's need for insulin is unrelated to the action of bile. The client's normal routine of nonpharmacological strategies of diet and exercise have been changed due to the client's admission to the hospital. Therefore, the client cannot overestimate what they cannot control. Electrolyte/ fluid balances may have some bearing on glucose levels, but stress is the most impactful cause of the change happening to this client.- PTS: 1 REF: p. 1526 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Select 38. A client with hyperthyroidism is being treated with radioactive iodine therapy. After receiving the dose of radioiodine, the nurse would assess the client for: A. hypothyroidism. B. thyroid storm. C. hypothermia. D. agranulocytosis.

B Rationale: Radioactive iodine ablation initially causes an acute release of thyroid hormone from the thyroid gland and may cause an increase of symptoms. The client is observed for signs of thyroid storm, not hypothyroidism. Hyperpyrexia, not hypothermia, is associated with thyroid storm. Agranulocytosis is a complication associated with antithyroid drug therapy. PTS: 1 REF: p. 1462 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 29. A client with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the client's plan of care? A. Impaired physical mobility related to presence of an indwelling urinary catheter B. Risk for infection related to presence of an indwelling urinary catheter C. Deficient knowledge regarding indwelling urinary catheter care D. Disturbed body image related to urinary catheterization

B Rationale: Fifty percent of all hospital-acquired infections are urinary tract infections (UTI), with a large number being associated with indwelling urinary catheters. This adverse infection is frequently referred to as a CAUTI (catheter associated urinary tract infection) and considered in the United States as a "never event". According to the National Quality Forum (NQF), never events are errors in health care that are identifiable, preventable, and serious for clients. Since the risk of infection is substantial; it is prioritized over functional and psychosocial diagnosis of mobility, knowledge deficits, and disturbed body image for this client. PTS: 1 REF: p. 1617 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 35. An 11-year-old client has been brought to the emergency department by their parent, who reports that the client may be having a "really bad allergic reaction to peanuts" after trading lunches with a peer. The triage nurse's rapid assessment reveals the presence of respiratory and cardiac arrest. Which interventions should the nurse prioritize? A. Establishing central venous access and beginning fluid resuscitation B. Establishing a patent airway and beginning cardiopulmonary resuscitation (CPR) C. Establishing peripheral intravenous (IV) access and administering IV epinephrine D. Performing a comprehensive assessment and initiating rapid fluid replacement

B Rationale: If cardiac arrest and respiratory arrest are imminent or have occurred, CPR is performed. A patent airway is also an immediate priority. Epinephrine is not withheld pending IV access, and fluid resuscitation is not a priority. PTS: 1 REF: p. 297 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 21. A client is being treated for AKI and the client daily weights have been ordered. The nurse notes a weight gain of 3 pounds (1.4 kg) over the past 48 hours. What nursing diagnosis is suggested by this assessment finding? A. Imbalanced nutrition: More than body requirements B. Excess fluid volume C. Sedentary lifestyle D. Adult failure to thrive

B Rationale: If the client with AKI gains or does not lose weight, fluid retention should be suspected. Short-term weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain. PTS: 1 REF: p. 1568 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Select 38. A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action? A. Advance the catheter 2 to 4 cm further into the peritoneal cavity. B. Reposition the client to facilitate drainage. C. Aspirate from the catheter using a 60-mL syringe. D. Infuse 50 mL of additional dialysate.

B Rationale: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate. PTS: 1 REF: p. 1588 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 33. A client with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the client's initial phase of treatment? A. Monitoring the client for dysrhythmias B. Maintaining and monitoring the client's fluid balance C. Assessing the client's level of consciousness D. Assessing the client for signs and symptoms of venous thromboembolism

B Rationale: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the client for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority. PTS: 1 REF: p. 1515 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 10. The nurse has implemented a bladder retraining program for an older adult client. The nurse places the client on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the client typically has approximately 50 mL of urine remaining in the bladder after voiding. What would be the nurse's best response to this finding? A. Perform a straight catheterization on this client. B. Avoid further interventions at this time, as this is an acceptable finding. C. Place an indwelling urinary catheter. D. Press on the client's bladder in an attempt to encourage complete emptying.

B Rationale: In adults older than 60 years of age, 50 to 100 mL of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted. PTS: 1 REF: p. 1616 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 20. The nurse's assessment of a client with thyroidectomy suggests tetany, and a review of the most recent blood work corroborates this finding. The nurse should prepare to administer what intervention? A. Oral calcium chloride and vitamin D B. IV calcium gluconate C. STAT levothyroxine D. Administration of parathyroid hormone (PTH)

B Rationale: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication. PTS: 1 REF: p. 1473 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 34. A client has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the client's discharge education accordingly. What preventive measure should the nurse encourage the client to adopt? A. Increasing intake of protein from plant sources B. Increasing fluid intake C. Adopting a high-calcium diet D. Eating several small meals each day

B Rationale: Increased fluid intake is encouraged to prevent the recurrence of kidney stones. Protein intake from all sources should be limited. Most clients do not require a low-calcium diet, but increased calcium intake would be contraindicated for all clients. Eating small, frequent meals does not influence the risk for recurrence. PTS: 1 REF: p. 1622 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 15. The nurse is caring for a client who describes changes in voiding patterns. The client states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be much urine flow." What would the nurse expect this client's physical assessment to reveal? A. Hematuria B. Urine retention C. Dehydration D. Kidney injury

B Rationale: Increased urinary urgency and frequency coupled with decreasing urine volume strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and kidney injury both result in a decrease in urine output, but the client with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany kidney injury and dehydration due to decreased urine production. PTS: 1 REF: p. 1542 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 4. A client has experienced an electrical burn and has developed thick eschar over the burn site. Which of the following topical antibacterial agents will the nurse expect the health care provider to order for the wound? A. Silver sulfadiazine 1% (Silvadene) water-soluble cream B. Mafenide acetate 10% (Sulfamylon) hydrophilic-based cream C. Silver nitrate 0.5% aqueous solution D. Acticoat

B Rationale: Mafenide acetate 10% hydrophilic-based cream is the agent of choice when there is a need to penetrate thick eschar. Silver products do not penetrate eschar; Acticoat is a type of silver dressing. PTS: 1 REF: p. 1881 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 9. The nurse is providing education to a client that is scheduled for mechanical débridement of a wound. The nurse knows that mechanical débridement involves which element? A. A spontaneous separation of dead tissue from the viable tissue B. Removal of eschar until the point of pain and bleeding occurs C. Shaving of burned skin layers until bleeding, viable tissue is revealed D. Early closure of the wound

B Rationale: Mechanical débridement can be achieved through the use of surgical scissors, scalpels, or forceps to remove the eschar until the point of pain and bleeding occurs. Mechanical débridement can also be accomplished through the use of topical enzymatic débridement agents. The spontaneous separation of dead tissue from the viable tissue is an example of natural débridement. Shaving the burned skin layers and early wound closure are examples of surgical débridement. PTS: 1 REF: p. 1881 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Select 31. A client who has been taking corticosteroids for several months is experiencing muscle wasting. The client has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend? A. Activity limitation to conserve energy B. Consumption of a high-protein diet C. Use of over-the-counter (OTC) vitamin D and calcium supplements D. Passive range-of-motion exercises

B Rationale: Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises maintain flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease muscle wasting. Activity limitation would exacerbate the problem. PTS: 1 REF: p. 1485 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 8. The nurse is discussing macrovascular complications of diabetes with a client. The nurse would address what topic during this dialogue? A. The need for frequent eye examinations for clients with diabetes B. The fact that clients with diabetes have an elevated risk of myocardial infarction C. The relationship between kidney function and blood glucose levels D. The need to monitor urine for the presence of albumin

B Rationale: Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and kidney function are considered to be microvascular. PTS: 1 REF: p. 1519 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 6. A nurse in the intensive care unit (ICU) receives a report from the nurse in the emergency department (ED) about a new client being admitted with a neck injury received while diving into a lake. The ED nurse reports that the client's blood pressure is 85/54, heart rate is 53 beats per minute, and skin is warm and dry. What does the ICU nurse recognize that the client is probably experiencing? A. Anaphylactic shock B. Neurogenic shock C. Septic shock D. Hypovolemic shock

B Rationale: Neurogenic shock can be caused by spinal cord injury. The client will present with a low blood pressure; bradycardia; and warm, dry skin due to the loss of sympathetic muscle tone and increased parasympathetic stimulation. Anaphylactic shock is caused by an identifiable offending agent, such as a bee sting. Septic shock is caused by bacteremia in the blood and presents with a tachycardia. Hypovolemic shock presents with tachycardia and a probable source of blood loss. PTS: 1 REF: p. 296 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 16. A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? A. Ask the client to describe the process in detail. B. Observe the client drawing up and administering the insulin. C. Provide a health education session reviewing the main points of insulin delivery. D. Review the client's first hemoglobin A1C result after discharge.

B Rationale: Nurses should assess the client's ability to perform diabetes-related self-care as soon as possible during the hospitalization or office visit to determine whether the client requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the client performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the client about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning. PTS: 1 REF: p. 1509 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 8. The nurse is transferring a client who is in the progressive stage of shock into the intensive care unit from the medical unit. Nursing management of the client should focus on which intervention? A. Reviewing the cause of shock and prioritizing the client's psychosocial needs B. Assessing and understanding shock and the significant changes in assessment data to guide the plan of care C. Giving the prescribed treatment, but shifting focus to providing family time as the client is unlikely to survive D. Promoting the client's coping skills in an effort to better deal with the physiologic changes accompanying shock

B Rationale: Nursing care of clients in the progressive stage of shock requires expertise in assessing and understanding shock and the significance of changes in assessment data. Early interventions are essential to the survival of clients in shock; thus, suspecting that a client may be in shock and reporting subtle changes in assessment are imperative. Psychosocial needs, such as coping, are important considerations, but they are not prioritized over physiologic health. PTS: 1 REF: p. 279 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 17. The nurse in the intensive care unit is caring for a 47-year-old, obese client who is in shock following a motor vehicle accident. What would be the main challenge in meeting this client's elevated energy requirements during prolonged rehabilitation? A. Loss of adipose tissue B. Loss of skeletal muscle C. Inability to convert adipose tissue to energy D. Inability to maintain normal body mass

B Rationale: Nutritional energy requirements are met by breaking down lean body mass. In this catabolic process, skeletal muscle mass is broken down even when the client has large stores of fat or adipose tissue. Loss of skeletal muscle greatly prolongs the client's recovery time. Loss of adipose tissue, the inability to convert adipose tissue to energy, and the inability to maintain normal body mass are not main concerns in meeting nutritional energy requirements for this client. PTS: 1 REF: p. 298 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 39. A client is receiving pharmacologic therapy for treatment of hyperthyroidism and is prescribed propylthiouracil (PTU). When developing this client's plan of care, the nurse integrates understanding that this drug: A. suppresses release of thyroid hormone. B. blocks synthesis of T3 to T4. C. reduces the amount of thyroid tissue. D. destroys overactive thyroid cells.

B Rationale: PTU blocks the synthesis of hormones, the conversion of T3 to T4. Sodium or potassium iodide (SSKI) and dexamethasone suppress the release of thyroid hormones. Thyroid hormones aid in reducing the amount of thyroid tissue and may be given with antithyroid medications to put the thyroid gland at rest. Radioactive iodine is used to destroy overactive thyroid cells. PTS: 1 REF: p. 1453 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 8. The clinic nurse is preparing a plan of care for a client with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach? A. Provide medication teaching related to pseudoephedrine sulfate. B. Teach the client to perform pelvic floor muscle exercises. C. Prepare the client for an anterior vaginal repair procedure. D. Provide information on periurethral bulking.

B Rationale: Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions have a behavioral approach. PTS: 1 REF: p. 1613 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 37. A home care nurse is performing a visit to a client's home to perform wound care following the client's hospital treatment for severe burns. While interacting with the client, the nurse should assess for evidence of what complication? A. Psychosis B. Posttraumatic stress disorder C. Delirium D. Vascular dementia

B Rationale: Posttraumatic stress disorder (PTSD) is the most common psychiatric disorder in burn survivors, with a prevalence that may be as high as 45%. As a result, it is important for the nurse to assess for this complication of burn injuries. Psychosis, delirium, and dementia are not among the noted psychiatric and psychosocial complications of burns. PTS: 1 REF: p. 1868 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 17. A client is scheduled for a CT scan of the abdomen with contrast. The client has a baseline creatinine level of 2.3 mg/dL (203 mol/L). In preparing this client for the procedure, the nurse anticipates what orders? A. Monitor the client's electrolyte values every hour before the procedure. B. Provide adequate hydration before the procedure C. Start hemodialysis immediately prior to the CT scan D. Obtain a creatinine clearance by collecting a 24-hour urine specimen.

B Rationale: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL (177 mol/L) identify the client as being at high risk. Preprocedure hydration the day prior to the test is effective in prevention. The nurse would not monitor the client's electrolytes every hour pre-procedure because this would not change the client's risk factors. To decrease this risk factor, an intervention is needed. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast. PTS: 1 REF: p. 1567 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

1. A nurse in the ICU is planning the care of a client who is being treated for shock. What statement best describes the pathophysiology of this client's health problem? A. Blood is shunted from vital organs to peripheral areas of the body. B. Cells lack an adequate blood supply and are deprived of oxygen and nutrients. C. Circulating blood volume is decreased with a resulting change in the osmotic pressure gradient. D. Hemorrhage occurs as a result of trauma, depriving vital organs of adequate perfusion.

B Rationale: Shock is a life-threatening condition with a variety of underlying causes. Shock is caused when the cells do not have an adequate blood supply and are deprived of oxygen and nutrients. In cases of shock, blood is shunted from peripheral areas of the body to the vital organs. Hemorrhage and decreased blood volume are associated with some, but not all, types of shock. PTS: 1 REF: p. 274 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 5. A nurse is caring for a client with type 1 diabetes. The client's medication administration record includes the administration of regular insulin three times daily. Knowing that the client's lunch tray will arrive at 11:45 AM, when should the nurse administer the client's insulin? A. 10:45 AM B. 11:30 AM C. 11:45 AM D. 11:50 AM

B Rationale: Short-acting insulin is called regular insulin. It is in a clear solution and is usually given 15 minutes before a meal or in combination with a longer-acting insulin. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia. PTS: 1 REF: p. 1500 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 21. A client with recurrent urinary tract infections has just undergone a cystoscopy and reports slight hematuria during the first void after the procedure. What is the nurse's most appropriate action? A. Administer a STAT dose of vitamin K, as prescribed. B. Reassure the client that this is not unexpected and then monitor the client for further bleeding. C. Promptly inform the health care provider of this assessment finding. D. Position the client supine and insert a Foley catheter, as prescribed.

B Rationale: Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected after cystoscopy. The nurse should explain this to the client and ensure that the bleeding resolves. No clear need exists to report this finding and it does not warrant insertion of a Foley catheter or vitamin K administration. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 6. A client has just been diagnosed with type 2 diabetes. The health care provider has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the health care provider prescribe for this client? A. A sulfonylurea B. A biguanide C. A thiazolidinedione D. An alpha-glucosidase inhibitor

B Rationale: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin, and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha-glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level. PTS: 1 REF: p. 1505 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 9. The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD? A. A client with a history of polycystic kidney disease B. A client with diabetes mellitus and poorly controlled hypertension C. A client who is morbidly obese with a history of vascular disorders D. A client with severe chronic obstructive pulmonary disease

B Rationale: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A client with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the client with diabetes and hypertension is likely at highest risk for ESKD. PTS: 1 REF: p. 1570 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 14. The nurse is teaching a health class of older adults about urinary tract infections (UTI)s. What characteristic of UTIs should the nurse cite? A. Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. B. The prevalence of UTIs in older men approaches that of women in the same age group. C. Men of all ages are less prone to UTIs, but typically experience more severe symptoms. D. The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.

B Rationale: The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging, resulting in increased incidence. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs. PTS: 1 REF: p. 1605 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 28. What should the nurse teach a client on corticosteroid therapy in order to reduce the client's risk of adrenal insufficiency? A. Take the medication late in the day to mimic the body's natural rhythms. B. Always have enough medication on hand to avoid running out. C. Skip up to 2 doses in cases of illness involving nausea. D. Take up to 1 extra dose per day during times of stress.

B Rationale: The client and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The client should be instructed to have an adequate supply of the corticosteroid medication always available to avoid running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids should normally be taken in the morning to mimic natural rhythms. PTS: 1 REF: p. 1484 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 36. Resection of a client's bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following? A. Remain NPO for 12 hours prior to the treatment. B. Hold the solution in the bladder for 2 hours before voiding. C. Drink the intravesical solution quickly and on an empty stomach. D. Avoid acidic foods and beverages until the full cycle of treatment is complete.

B Rationale: The client is allowed to eat and drink before the instillation procedure. Once the bladder is full, the client must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment. PTS: 1 REF: p. 1627 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 3. A nurse is caring for a female client whose urinary retention has not responded to conservative treatment. When educating this client about self-catheterization, the nurse should encourage what practice? A. Assuming a supine position for self-catheterization B. Using clean technique at home to catheterize C. Inserting the catheter 1 to 2 inches (2.5 to 5 cm) into the urethra D. Self-catheterizing every 2 hours at home

B Rationale: The client may use a "clean" (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female client assumes a Fowler position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction. PTS: 1 REF: p. 1620 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 26. A client is brought to the renal unit from the PACU status postresection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this client? A. Increasing oral intake B. Managing postoperative pain C. Managing dialysis D. Increasing mobility

B Rationale: The client requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this client. Dialysis is not necessary following kidney surgery. PTS: 1 REF: p. 1564 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 4. A 52-year-old client is scheduled to undergo ileal conduit surgery. When planning this client's discharge education, what is the most plausible nursing diagnosis that the nurse should address? A. Impaired mobility related to limitations posed by the ileal conduit B. Deficient knowledge related to care of the ileal conduit C. Risk for deficient fluid volume related to urinary diversion D. Risk for autonomic dysreflexia related to disruption of the sacral plexus

B Rationale: The client will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion. PTS: 1 REF: p. 1629 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 34. The nurse is reviewing the electronic health record of a client with a history of incontinence. The nurse reads that the health care provider assessed the client's deep tendon reflexes. What condition of the urinary/renal system does this assessment address? A. Renal calculi B. Bladder dysfunction C. Benign prostatic hyperplasia (BPH) D. Recurrent urinary tract infections (UTIs)

B Rationale: The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of testing for neurologic causes of bladder dysfunction because the sacral area, which innervates the lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic function does not directly influence the course of renal calculi, BPH or UTIs. PTS: 1 REF: p. 1546 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 17. The health care provider has ordered a fluid deprivation test for a client suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments? A. Temperature and oxygen saturation B. Heart rate and blood pressure C. Breath sounds and bowel sounds D. Color, warmth, movement, and sensation of extremities

B Rationale: The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The client's condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, blood pressure and heart rate monitoring are priorities over the other listed assessments. PTS: 1 REF: p. 1451 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 25. A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? A. Sequestering free hydrogen ions in the nephrons B. Returning bicarbonate to the body's circulation C. Retaining ammonium chloride D. Excreting bicarbonate in the urine

B Rationale: The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions. Other functions include synthesizing ammonia and excreting ammonium chloride PTS: 1 REF: p. 1539 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 17. The nurse reviews foot care with an older adult client. Why would the nurse feel that foot care is so important to this client? A. An older adult client with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

B Rationale: The nurse recognizes that providing information on the long-term complications—especially foot and eye problems—associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the older adult with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs given for diabetes. PTS: 1 REF: p. 1525 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 33. A nurse is providing care to a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse understands that the primary problem involves the: A. anterior pituitary gland. B. posterior pituitary gland. C. thyroid gland. D. adrenal gland.

B Rationale: The posterior lobe of the pituitary gland secretes antidiuretic hormone (ADH), also known as vasopressin; too little ADH results in diabetes insipidus (DI), while too much ADH leads to syndrome of inappropriate antidiuretic hormone (SIADH). SIADH is not associated with a problem involving the anterior pituitary, thyroid, or adrenal glands. PTS: 1 REF: p. 1450 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 15. A client with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. What is the priority nursing diagnosis for a client with this condition? A. Risk for peripheral neurovascular dysfunction B. Excess fluid volume C. Hypothermia D. Ineffective airway clearance

B Rationale: The priority nursing diagnosis for a client with SIADH is excess fluid volume, as the client retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH. The client is not at risk for neurovascular dysfunction or a compromised airway. PTS: 1 REF: p. 1452 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 3. A nurse is caring for a client with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples? A. A fasting serum potassium level and a random urine sample B. A 24-hour urine specimen and a serum creatinine level midway through the urine collection process C. A BUN and serum creatinine level on three consecutive mornings D. A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

B Rationale: To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured. PTS: 1 REF: p. 1539 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 11. The nurse is caring for a client recently diagnosed with renal calculi. The nurse should instruct the client to increase fluid intake to a level where the client produces at least how much urine each day? A. 1,250 mL B. 2,000 mL C. 2,750 mL D. 3,500 mL

B Rationale: Unless contraindicated by kidney injury or hydronephrosis, clients with renal stones should drink at least eight 8-oz (250 mL) glasses of water daily or have IV fluids prescribed to keep the urine dilute. Urine output exceeding 2 L a day is advisable. PTS: 1 REF: p. 1625 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Select 23. A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? A. Administer prophylactic antibiotics as prescribed. B. Limit the use of indwelling urinary catheters. C. Encourage frequent mobility and repositioning. D. Toilet residents who are immobile on a scheduled basis.

B Rationale: When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally given. Mobility does not have a direct effect on UTI risk. PTS: 1 REF: p. 1607 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 5. A client who is in shock is receiving dopamine in addition to IV fluids. What principle should inform the nurse's care planning during the administration of a vasoactive drug? A. The drug should be discontinued immediately after blood pressure increases. B. The drug dose should be tapered down once vital signs improve. C. The client should have arterial blood gases drawn every 10 minutes during treatment. D. The infusion rate should be titrated according the client's subjective sensation of adequate perfusion.

B Rationale: When vasoactive medications are discontinued, they should never be stopped abruptly because this could cause severe hemodynamic instability, perpetuating the shock state. Subjective assessment data are secondary to objective data. Arterial blood gases should be carefully monitored, but draws every 10 minutes are not the norm. PTS: 1 REF: p. 283 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 23. A client on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this client? A. The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. B. The client's disease is incurable and the nurse's interventions will be supportive. C. The client will eventually require surgical removal of his or her renal cysts. D. The client is likely to respond favorably to lithotripsy treatment of the cysts.

B Rationale: Nursing actions focus on support and symptom control. It is not self-limiting and is not treated surgically or with lithotripsy. PTS: 1 REF: p. 1562 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Response 22. An adult client has survived an episode of shock and will be discharged home to finish the recovery phase of his disease process. The home health nurse plays an integral part in monitoring this client. What aspect of this care should be prioritized by the home health nurse? A. Providing supervision to home health aides in providing necessary client care B. Assisting the client and family to identify and mobilize community resources C. Providing ongoing medical care during the family's rehabilitation phase D. Reinforcing the importance of continuous assessment with the family

B Rationale: The home care nurse reinforces the importance of continuing medical care and helps the client and family identify and mobilize community resources. The home health nurse is part of a team that provides client care in the home. The nurse does not directly supervise home health aides. The nurse provides nursing care to both the client and family, not just the family. The nurse performs continuous and ongoing assessment of the client; he or she does not just reinforce the importance of that assessment. PTS: 1 REF: p. 298 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 38. A client with diabetes is asking the nurse what causes diabetic ketoacidosis (DKA). Which of the following is a correct statement by the nurse? A. "DKA can be caused by taking too much insulin." B. "DKA can be caused by taking too little insulin." C. "DKA can happen without a cause." D. "DKA will not happen with type 1 diabetes."

B Rationale: Three main causes of DKA are decreased or missed dose of insulin, illness or infection, and undiagnosed and untreated diabetes. DKA may be the initial manifestation of type 1 diabetes. For prevention of DKA related to illness, the client should attempt to consume frequent small portions of carbohydrates. Drinking fluid every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours, and the client should take the usual dose of insulin. PTS: 1 REF: p. 1514 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 32. The critical care nurse is monitoring the client's urine output and drains following renal surgery. What should the nurse promptly report to the primary care provider? A. Increased pain on movement B. Absence of drain output C. Increased urine output D. Blood-tinged serosanguineous drain output

B Rationale: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected. PTS: 1 REF: p. 1594 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 31. A 52-year-old client is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply. A. Petechiae B. Pain C. Gastrointestinal symptoms D. Changes in voiding E. Jaundice

B, C, D Rationale: Dysfunction of the kidney can produce a complex array of symptoms throughout the body. Pain, changes in voiding, and gastrointestinal symptoms are particularly suggestive of urinary tract disease. Petechiae is not associated with genitourinary health problems. Jaundice is not a sign of urinary tract infection in an adult; it is seen typically in newborns. PTS: 1 REF: p. 1542 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 26. A critical care nurse is planning assessments in the knowledge that clients in shock are vulnerable to developing fluid replacement complications. For what signs and symptoms should the nurse monitor the client? Select all that apply. A. Hypovolemia B. Difficulty breathing C. Cardiovascular overload D. Pulmonary edema E. Hypoglycemia

B, C, D Rationale: Fluid replacement complications can occur, often when large volumes are given rapidly. Therefore, the nurse monitors the client closely for cardiovascular overload, signs of difficulty breathing, and pulmonary edema. Hypovolemia is what necessitates fluid replacement, and hypoglycemia is not a central concern with fluid replacement. PTS: 1 REF: p. 287 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 39. A client is brought to the emergency department. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply. A. Leukocytosis B. Glycosuria C. Dehydration D. Hypernatremia E. Hyperglycemia

B, C, E Rationale: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hyponatremia and increased osmolarity occur. Leukocytosis does not take place. PTS: 1 REF: p. 1516 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 29. The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply. A. Epistaxis B. Pallor C. Rapid respiratory rate D. Bounding pulse E. Hypotension

B, C, E Rationale: The client at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis. PTS: 1 REF: p. 1478 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 9. A client with gross hematuria has been admitted to a surgical floor in preparation for an upper cystoscopy in the morning. What post-procedure interventions would the nurse anticipate for this client? Select all that apply. A. Nothing by mouth (NPO) B. Intermittent straight catheterization C. Sedative agent administration D. Moist heat to abdomen E. Monitor for urinary retention

B, D, E Rationale: Post-procedural management is directed at relieving any discomfort from the procedure. Moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing muscles. The client may experience urinary retention, so intermittent straight catheterization may be necessary for a few hours after the procedure. The nurse would also monitor the client for signs of urinary tract infection and obstruction. NPO and sedative agent administration is accomplished before the procedure. A cystoscope examination/procedure is used to directly visualize the urethra and bladder. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 7. An inpatient client with acute kidney injury (AKI) has moderate edema to both legs. What resulting skin conditions would increase the client's likelihood of skin breakdown? Select all that apply. A. Atopic dermatitis B. Pruritus C. Psoriasis D. Urticaria E. Excoriation

B, E Rationale: The skin may be dry or susceptible to breakdown as a result of edema. Excoriation and itching (pruritus) may result from the deposits of irritating toxins in the client's tissue due to AKI. Prevention recommendations include bathing in cool water, assisting or encouraging frequent turning and repositioning as well as keeping the skin clean and moisturized. Clients should be instructed to keep nails trimmed to help prevent scratches. Atopic dermatitis or eczema has strong genetic links and is commonly associated with asthma and hay fever. Eczema results in red, dry, and itchy patches of skin. Urticaria or hives are raised, red welts that suddenly appear on the skin and are usually caused by an allergic reaction. Psoriasis is a chronic skin condition characterized by thick red patches or plaques of skin covered with white or silvery scales. Psoriasis is usually linked to an autoimmune response. PTS: 1 REF: p. 1567 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 33. The ICU nurse is caring for a client in hypovolemic shock following a postpartum hemorrhage. For what serious complication of treatment should the nurse monitor the client? A. Anaphylaxis B. Decreased oxygen consumption C. Abdominal compartment syndrome D. Decreased serum osmolality

C Rationale: Abdominal compartment syndrome (ACS) is a serious complication that may occur when large volumes of fluid are given. The scenario does not describe an antigen-antibody reaction of any type. Decreased oxygen consumption by the body is not a concern in hypovolemic shock. With a decrease in fluids in the intravascular space, increased serum osmolality would occur. PTS: 1 REF: p. 282 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 38. A nurse who provides care on a burn unit is preparing to apply a client's ordered topical antibiotic ointment. What action should the nurse perform when administering this medication? A. Apply the new ointment without disturbing the existing layer of ointment. B. Apply the ointment using a sterile tongue depressor. C. Apply a layer of ointment approximately 1/16 inch thick. D. Gently irrigate the wound bed after applying the antibiotic ointment.

C Rationale: After removing the old ointment from the wound bed, the nurse should apply a layer of ointment 1/16-inch thick using clean gloves. The wound would not be irrigated after application of new ointment. PTS: 1 REF: p. 1888 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 26. A client experienced a 33% TBSA burn 72 hours ago. The nurse observes that the client's hourly urine output has been steadily increasing over the past 24 hours. How should the nurse best respond to this finding? A. Obtain an order to reduce the rate of the client's IV fluid infusion. B. Report the client's early signs of acute kidney injury (AKI). C. Recognize that the client is experiencing an expected onset of diuresis. D. Administer sodium chloride as prescribed to compensate for this fluid loss.

C Rationale: As capillaries regain integrity, 48 or more hours after the burn, fluid moves from the interstitial to the intravascular compartment and diuresis begins. This is an expected development and does not require a reduction in the IV infusion rate or the administration of NaCl. Diuresis is not suggestive of AKI. PTS: 1 REF: p. 1876 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 22. A client with severe burns is admitted to the intensive care unit to stabilize and begin fluid resuscitation before transport to the burn center. The nurse should monitor the client closely for what signs of the onset of burn shock? A. Confusion B. High fever C. Decreased blood pressure D. Sudden agitation

C Rationale: As fluid loss continues and vascular volume decreases, cardiac output continues to decrease and the blood pressure drops, marking the onset of burn shock. Shock and the accompanying hemodynamic changes are not normally accompanied by confusion, fever, or agitation. PTS: 1 REF: p. 1872 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 18. A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? A. Hemodialysis B. Peritoneal dialysis C. Continuous venovenous hemodialysis (CVVHD) D. Plasmapheresis

C Rationale: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable client. Peritoneal dialysis is not the best choice, as the client may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance. PTS: 1 REF: p. 1584 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Select 35. A 40-year-old male client with a history of childhood non-Hodgkin lymphoma and radiation treatment is being admitted for thyroid cancer. The client is a commercial airline pilot, does not smoke, exercises regularly, and eats mostly take-out food. What risk factors are primarily associated with his diagnosis? A. Childhood cancer and physical activity B. Employment and smoking history C. Age and radiation history D. Dietary choices and gender

C Rationale: Cancer of the thyroid is less prevalent than other forms of cancer, but the incidence of the condition is increasing. Thyroid cancer is more likely to develop in clients younger than 50 years old. Exposure to radiation or external radiation of the head, neck or chest in infancy and childhood increases the risk of this condition. Women, not men, are at a greater risk for this condition. Additional risk factors include smoking, low physical activity, unhealthy eating habits, and high stress levels. PTS: 1 REF: p. 1450 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 3. The nurse is caring for a client with a diagnosis of Addison disease. What sign or symptom is most closely associated with this health problem? A. Truncal obesity B. Hypertension C. Muscle weakness D. Moon face

C Rationale: Clients with Addison disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Clients with Cushing syndrome demonstrate truncal obesity, "moon" face, acne, abdominal striae, and hypertension. PTS: 1 REF: p. 1477 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 23. A 30-year-old female client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse prioritize when planning the client's care? A. Decisional conflict related to treatment options B. Spiritual distress related to changes in cognitive function C. Disturbed body image related to changes in physical appearance D. Powerlessness related to disease progression

C Rationale: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerlessness may exist, but disturbed body image is more likely to be present. Cognitive changes take place in clients with Cushing syndrome, but these may or may not cause spiritual distress. PTS: 1 REF: p. 1479 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 7. The nurse caring for a client with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? A. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours B. Administration of dexamethasone IV, followed by an x-ray of the adrenal glands C. Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning D. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is given

C Rationale: Dexamethasone (1 mg) is given orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome. PTS: 1 REF: p. 1480 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 29. A client has experienced burns to the upper thighs and knees. Following the application of new wound dressings, the nurse should perform what nursing action? A. Instruct the client to keep the wound site in a dependent position. B. Administer PRN analgesia as prescribed. C. Assess the client's peripheral pulses distal to the dressing. D. Assist with passive range-of-motion exercises to "set" the new dressing.

C Rationale: Dressings can impede circulation if they are wrapped too tightly. The peripheral pulses must be checked frequently and burned extremities elevated. Dependent positioning does not need to be maintained. PRN analgesics should be given prior to the dressing change. ROM exercises do not normally follow a dressing change. PTS: 1 REF: p. 1861 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 40. The nurse is providing education to a client that is to undergo a thyroidectomy. When planning care for this client, the nurse should include which example in their education? A. Pharmacological therapy is not necessary prior to the surgery. B. Symptoms of the disease will disappear immediately after surgery. C. Balance periods of activity and exercise with rest. D. There is no risk for hypothyroidism after the surgery.

C Rationale: Due to the fatigue of the disease process itself and the stress of surgery, there needs to be an even balance of activity and rest for the client. Pharmacological therapy is needed prior to surgery. Symptoms of the disease will gradually taper off after surgery. There is a risk for hypothyroidism after surgery due to the partial or complete removal of thyroid gland. PTS: 1 REF: p. 1465 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 11. The acute care nurse is providing care for an adult client who is in hypovolemic shock. The nurse recognizes that antidiuretic hormone (ADH) plays a significant role in this health problem. What assessment finding will the nurse likely observe related to the role of antidiuretic hormone during hypovolemic shock? A. Increased hunger B. Decreased thirst C. Decreased urinary output D. Increased capillary perfusion

C Rationale: During hypovolemic shock, a state of hypernatremia occurs. Hypernatremia stimulates the release of ADH by the pituitary gland. ADH causes the kidneys to further retain water in an effort to raise blood volume and blood pressure. In a hypovolemic state the body shifts blood away from anything that is not a vital organ, so hunger is not an issue; thirst is increased as the body tries to increase fluid volume; and capillary profusion decreases as the body shunts blood away from the periphery and to the vital organs. PTS: 1 REF: p. 282 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 14. A nurse is teaching a client with a partial-thickness wound how to wear the elastic pressure garment. How often should the nurse instruct the client to wear this garment? A. 4 to 6 hours a day for 6 months B. During waking hours for 2 to 3 months after the injury C. Continuously D. At night while sleeping for a year after the injury

C Rationale: Elastic pressure garments are worn continuously (i.e., 24 hours a day). PTS: 1 REF: p. 1889 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 4. A nurse is providing health education to a teenage client newly diagnosed with type 1 diabetes mellitus, as well as the client's family. The nurse teaches the client and family nonpharmacologic measures that will decrease the body's need for insulin. What measure provides the greatest impact on glucose reduction? A. Adequate sleep B. Low stimulation C. Exercise D. Low-fat diet

C Rationale: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low-fat intake and low levels of stimulation do not reduce a client's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is as pronounced as that of exercise. PTS: 1 REF: p. 1496 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 3. A client newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline should the nurse teach the clients at this class? A. Low fat generally indicates low sugar. B. Protein should constitute 30% to 40% of caloric intake. C. Most calories should be derived from carbohydrates. D. Animal fats should be eliminated from the diet.

C Rationale: For all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet. PTS: 1 REF: p. 1494 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 20. The nurse is caring for a client who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the health care provider? A. Scant hematuria B. Renal colic C. Temperature 37.9°C (100.2°F) orally D. Infiltration of the client's intravenous catheter

C Rationale: Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The health care provider should be notified of the client's body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary care provider. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 35. A client with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client? A. Examine feet weekly for redness, blisters, and abrasions. B. Avoid the use of moisturizing lotions. C. Avoid hot-water bottles and heating pads. D. Dry feet vigorously after each bath.

C Rationale: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the client should gently, not vigorously, pat feet dry to avoid injury. PTS: 1 REF: p. 1525 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 20. A pregnant client has been diagnosed with gestational diabetes. The client is shocked by the diagnosis, stating that they are conscientious about their health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A. Increased caloric intake during the first trimester B. Changes in osmolality and fluid balance C. The effects of hormonal changes during pregnancy D. Overconsumption of carbohydrates during the first two trimesters

C Rationale: Hyperglycemia and eventual gestational diabetes develop during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality. PTS: 1 REF: p. 1491 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Choice 11. The nurse is caring for a client in acute kidney injury (AKI). Which complication would most clearly warrant the administration of polystyrene sulfonate? A. Hypernatremia B. Hypomagnesemia C. Hyperkalemia D. Hypercalcemia

C Rationale: Hyperkalemia (high potassium) is a common complication of AKI. If the client's potassium is elevated but does not cause ECG (electrocardiography) changes, then polystyrene sulfonate may be administered since it reduces serum potassium levels. It is not recommended for emergency treatment since it takes more than 6 hours to work. Polystyrene sulfonate does not treat low (hypo) magnesium, high sodium (hypernatremia), or high calcium (hypercalcemia). PTS: 1 REF: p. 1568 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 30. A client has had a indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the client informs the nurse that the client is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response? A. Inform the client that urgency and occasional incontinence are expected for the first few weeks post-removal. B. Obtain an order for a loop diuretic in order to enhance urine output and bladder function. C. Inform the client that this is not unexpected in the short term and scan the client's bladder following each void. D. Obtain an order to reinsert the client's urinary catheter and attempt removal in 24 to 48 hours.

C Rationale: Immediately after the indwelling catheter is removed, the client is placed on a timed voiding schedule, usually every 2 to 3 hours. At the given time interval, the client is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely, straight catheterization may be performed. An indwelling catheter would not be reinserted to resolve the problem, and diuretics would not be beneficial. Ongoing incontinence is not an expected finding after catheter removal. PTS: 1 REF: p. 1619 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 30. The ICU nurse is caring for a client in neurogenic shock following an overdose of antianxiety medication. When assessing this client, the nurse should recognize what characteristic of neurogenic shock? A. Hypertension B. Cool, moist skin C. Bradycardia D. Signs of sympathetic stimulation

C Rationale: In neurogenic shock, the sympathetic system is not able to respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock. PTS: 1 REF: p. 296 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 32. A student with diabetes reports feeling nervous and hungry. The school nurse assesses the student and finds the child has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A. A combination of protein and carbohydrates, such as a small cup of yogurt B. Two teaspoons of sugar dissolved in a cup of apple juice C. Half of a cup of juice, followed by cheese and crackers D. Half a sandwich with a protein-based filling

C Rationale: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. Initial treatment should be followed with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and the additional sugar may result in a sharp rise in blood sugar that will last for several hours. PTS: 1 REF: p. 1511 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 13. A client has returned to the floor after having a thyroidectomy for thyroid cancer. What laboratory finding may be an early indication of parathyroid gland injury or removal? A. Hyponatremia B. Hypophosphatemia C. Hypocalcemia D. Hypokalemia

C Rationale: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the health care provider immediately because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia. PTS: 1 REF: p. 1471 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 13. A diabetes educator is teaching a client about type 2 diabetes. The educator recognizes that the client understands the primary treatment for type 2 diabetes when the client states: A. "I read that a pancreas transplant will provide a cure for my diabetes." B. "I will take my oral antidiabetic agents when my morning blood sugar is high." C. "I will make sure to follow the weight loss plan designed by the dietitian." D. "I will make sure I call the diabetes educator when I have questions about my insulin."

C Rationale: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some clients may require insulin on an ongoing basis, or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes. PTS: 1 REF: p. 1493 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze

Multiple Choice Chapter 46: Management of Patients with Diabetes 1. A client with type 1 diabetes has told the nurse that the client's most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? A. The client should withhold the next scheduled dose of insulin. B. The client should promptly eat some protein and carbohydrates. C. The client's insulin levels are inadequate. D. The client would benefit from a dose of metformin.

C Rationale: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the client's ketonuria. Metformin will not cause short-term resolution of hyperglycemia. PTS: 1 REF: p. 1499 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 7. The intensive care nurse caring for a client in shock is planning assessments and interventions related to the client's nutritional needs. Which physiologic process contributes to these increased nutritional needs? A. The use of albumin as an energy source by the body because of the need for increased adenosine triphosphate B. The loss of fluids due to decreased skin integrity and decreased stomach acids due to increased parasympathetic activity C. The release of catecholamines that creates an increase in metabolic rate and caloric requirements D. The increase in gastrointestinal (GI) peristalsis during shock, and the resulting diarrhea

C Rationale: Nutritional support is an important aspect of care for clients in shock. Clients in shock may require 3,000 calories daily. This caloric need is directly related to the release of catecholamines and the resulting increase in metabolic rate and caloric requirements. Albumin is not primarily metabolized as an energy source. The special nutritional needs of shock are not related to increased parasympathetic activity, but are instead related to increased sympathetic activity. GI function does not increase during shock. PTS: 1 REF: p. 283 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 23. A critical care nurse is aware of similarities and differences between the treatments for different types of shock. What intervention is used in all types of shock? A. Aggressive hypoglycemic control B. Administration of hypertonic IV fluids C. Early provision of nutritional support D. Aggressive antibiotic therapy

C Rationale: Nutritional support is necessary for all clients who are experiencing shock. Hyperglycemic (not hypoglycemic) control is needed for many clients. Hypertonic IV fluids are not normally utilized and antibiotics are necessary only in clients with septic shock. PTS: 1 REF: p. 280 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 2. The nurse is caring for an acutely ill client. What assessment finding should prompt the nurse to inform the health care provider that the client may be exhibiting signs of acute kidney injury (AKI)? A. An inability to initiate voiding for 2 days. B. The urine is cloudy and has visible sediment with a foul odor. C. Average urine output has been 10 mL/hr for several hours. D. Client reports left-sided flank pain.

C Rationale: Oliguria (<400 mL/day of urine or 0.5 mL/kg an hour over 6 hours) is the most common clinical situation seen in AKI. The client's inability to void and/or urine hesitancy is typically seen with kidney stones, prostate problems, and/or a urinary tract infection (UTI). Urine that has visible sediment and is cloudy and foul smelling is more suggestive of a UTI. Acute flank pain is sometimes seen in AKI. Generally, flank pain has some connection to a variety of kidney diseases like acute glomerular inflammation and polycystic kidney disease. PTS: 1 REF: p. 1564 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 30. Results of a client's 24-hour urine sample indicate osmolality of 510 mOsm/kg (510 mmol/kg), which is within reference range. What conclusion can the nurse draw from this assessment finding? A. The client's kidneys are capable of maintaining acid-base balance. B. The client's kidneys reabsorb most of the potassium that the client ingests. C. The client's kidneys can produce sufficiently concentrated urine. D. The client's kidneys are producing sufficient erythropoietin.

C Rationale: Osmolality is the most accurate measurement of the kidney's ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acid-base balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted. PTS: 1 REF: p. 1548 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 10. The nurse is caring for a client in the ICU who has been diagnosed with multiple organ dysfunction syndrome (MODS). The nurse's plan of care should include what intervention? A. Encouraging the family to stay hopeful and educating them to the fact that, in nearly all cases, the prognosis is good B. Encouraging the family to leave the hospital and to take time for themselves as acute care of MODS clients may last for several months C. Promoting communication with the client and family along with addressing end-of-life issues D. Discussing organ donation on a number of different occasions to allow the family time to adjust to the idea

C Rationale: Promoting communication with the client and family is a critical role of the nurse with a client in progressive shock. It is also important that the health care team address end-of-life decisions to ensure that supportive therapies are congruent with the client's wishes. Many cases of MODS result in death, and the life expectancy of clients with MODS is usually measured in hours and possibly days, but not in months. Organ donation should be offered as an option on one occasion, and then allow the family time to discuss and return to the health care providers with an answer following the death of the client. PTS: 1 REF: p. 297 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply

Multiple Choice 27. A nurse is working with a female client who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment? A. Clearly explain the potential benefits of pelvic floor muscle exercises. B. Ensure the client knows that surgery will be required if the exercises are unsuccessful. C. Arrange for biofeedback when the client is learning to perform the exercises. D. Contact the client weekly to ensure that they are performing the exercises consistently.

C Rationale: Research shows that written or verbal instruction alone is usually inadequate to teach an individual how to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted pelvic muscle exercise (PME) uses either electromyography or manometry to help the individual identify the pelvic muscles involved when performing PME. This objective assessment is likely superior to weekly contact with the client. Surgery is not necessarily indicated if behavioral techniques are unsuccessful. PTS: 1 REF: p. 1614 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 6. A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

C Rationale: Stages of chronic kidney disease are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR. PTS: 1 REF: p. 1557 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 20. The nurse is providing care for a client who is in shock after massive blood loss from a workplace injury. The nurse recognizes that many of the findings from the most recent assessment are due to compensatory mechanisms. What compensatory mechanism will increase the client's cardiac output during the hypovolemic state? A. Third spacing of fluid B. Dysrhythmias C. Tachycardia D. Gastric hypermotility

C Rationale: Tachycardia is a primary compensatory mechanism to increase cardiac output during hypovolemic states. The third spacing of fluid takes fluid out of the vascular space. Gastric hypermotility and dysrhythmias would not increase cardiac output and are not considered to be compensatory mechanisms. PTS: 1 REF: p. 277 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 2. The current phase of a client's treatment for a burn injury prioritizes wound care, nutritional support, and prevention of complications such as infection. Based on these care priorities, the client is in what phase of burn care? A. Emergent B. Immediate resuscitative C. Acute D. Rehabilitation

C Rationale: The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to 72 hours after the burn injury. During this phase, attention is directed toward continued assessment and maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal function. Infection prevention, burn wound care (i.e., wound cleaning, topical antibacterial therapy, wound dressing, dressing changes, wound débridement, and wound grafting), pain management, and nutritional support are priorities at this stage. Priorities during the emergent or immediate resuscitative phase include first aid, prevention of shock and respiratory distress, detection and treatment of concomitant injuries, and initial wound assessment and care. The priorities during the rehabilitation phase include prevention of scars and contractures, rehabilitation, functional and cosmetic reconstruction, and psychosocial counseling. PTS: 1 REF: p. 1873 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 16. The nurse in a rural nursing facility will be receiving a client in hypovolemic shock due to a massive postpartum hemorrhage after giving birth at home. Which principle should guide the nurse's administration of intravenous fluid? A. 5% albumin is preferred because it is inexpensive and is always readily available. B. Dextran should be given because it increases intravascular volume and counteracts coagulopathy. C. Whatever fluid is most readily available in the clinic should be given, due to the nature of the emergency. D. Lactated Ringer solution is ideal because it increases volume, buffers acidosis, and is the best choice for clients with liver failure.

C Rationale: The best fluid to treat shock remains controversial. In emergencies, the "best" fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids, such as dextran and albumin, should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Albumin is very expensive and is a blood product so it is not always readily available for use. Dextran does increase intravascular volume, but it increases the risk for coagulopathy. Lactated Ringer is a good solution choice because it increases volume and buffers acidosis, but it should not be used in clients with liver failure because the liver is unable to convert lactate to bicarbonate. This client does not have liver disease. PTS: 1 REF: p. 287 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 5. A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy? A. The client's diet should be low protein with ample fat. B. The client may experience short-term changes in cognition. C. The client is at an increased risk for developing infection. D. The client is at a decreased risk for development of thrombophlebitis and thromboembolism.

C Rationale: The client is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. The diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects. PTS: 1 REF: p. 1487 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice Chapter 49: Management of Patients with Urinary Disorders 1. A female client has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this client? A. Bathe daily and keep the perineal region clean. B. Avoid voiding immediately after sexual intercourse. C. Drink liberal amounts of fluids. D. Void at least every 6 to 8 hours.

C Rationale: The client is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The client should be encouraged to shower rather than bathe. PTS: 1 REF: p. 1609 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 6. The nurse is caring for a client who underwent percutaneous (endourologic) lithotripsy earlier in the day. What instruction should the nurse give the client? A. Limit oral fluid intake for 1 to 2 days. B. Report the presence of fine, sand-like particles through the nephrostomy tube. C. Notify the health care provider about cloudy or foul-smelling urine. D. Report any pink-tinged urine within 24 hours after the procedure.

C Rationale: The client should report the presence of foul-smelling or cloudy urine since this is suggestive of a urinary tract infection (UTI). Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand-like debris is normal due to residual stone products. Hematuria is common after lithotripsy. PTS: 1 REF: p. 1621 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Select 33. A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? A. IV fluid administration B. Insertion of an indwelling urinary catheter C. Pain management D. Assisting with aspiration of the stone

C Rationale: The client with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the client's need for IV fluids or for catheterization. Kidney stones cannot be aspirated. PTS: 1 REF: p. 1621 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 27. A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase? A. Hypokalemia B. Hypocalcemia C. Dehydration D. Acute flank pain

C Rationale: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The client must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase. Excessive losses of potassium and calcium are not typical during this phase, and diuresis does not normally result in pain. PTS: 1 REF: p. 1565 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. The health care provider has explained to a client that the client has developed diabetic neuropathy in the right foot. Later that day, the client asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? A. "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years." B. "The cause is not known for sure but it is thought to have something to do with ketoacidosis." C. "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." D. "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose and ketone levels."

C Rationale: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugar (rather than fluctuations or variations in blood sugars) is thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies. PTS: 1 REF: p. 1523 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 16. The nurse is caring for a client with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a blood pressure (BP) of 98/52 mm Hg. The nurse should recognize that the client's kidneys will compensate by secreting what substance? A. Antidiuretic hormone (ADH) B. Aldosterone C. Renin D. Angiotensin

C Rationale: The kidneys have an important function in the autoregulation of BP. When the vasa recta detects a decrease in BP, specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the BP to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in BP. Aldosterone and angiotensin are part of this complex process but renin is required to start this process. ADH is a hormone and vasopressin can increase the BP but is secreted by the pituitary gland, not the kidneys. PTS: 1 REF: p. 1539 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 28. A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult? A. "If possible, try to drink at least 4 liters of fluid daily." B. "Ensure that you avoid replacing water with other beverages." C. "Remember to drink frequently, even if you don't feel thirsty." D. "Make sure you eat plenty of salt in order to stimulate thirst."

C Rationale: The nurse emphasizes the need to drink throughout the day even if the client does not feel thirsty because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive, and fluids other than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for increased fluid intake. PTS: 1 REF: p. 1541 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 33. The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? A. The importance of increased fluid intake B. Signs and symptoms of rejection C. Inspection and care of the incision D. Techniques for preventing metastasis

C Rationale: The nurse teaches the client to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving a vehicle, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the client has minimal control on the future risk for metastasis. PTS: 1 REF: p. 1565 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 19. Which of the following clients with type 1 diabetes is most likely to experience adequate glucose control? A. A client who skips breakfast when the glucose reading is greater than 220 mg/dL (12.3 mmol/L) B. A client who never deviates from the prescribed dose of insulin C. A client who adheres closely to a meal plan and meal schedule D. A client who eliminates carbohydrates from the daily intake

C Rationale: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by clients. For clients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, helps maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes. PTS: 1 REF: p. 1494 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 11. The nurse is caring for a client suspected of having renal dysfunction. When reviewing laboratory results for this client, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? A. Potassium and sodium B. Bicarbonate and urea C. Glucose and protein D. Creatinine and chloride

C Rationale: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that they are not excreted in the urine. PTS: 1 REF: p. 1537 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 14. The nurse on a nephrology unit is caring for a diverse group of clients. For which client would a kidney biopsy most likely be contraindicated? A. A 64-year-old client with chronic glomerulonephritis B. A 57-year-old client with proteinuria C. A 42-year-old client with morbid obesity D. A 16-year-old client with signs of kidney transplant rejection

C Rationale: There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a kidney biopsy include unexplained acute kidney injury, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 17. A nurse is developing a care plan for a client with a partial-thickness burn, and determines that an appropriate goal is to maintain position of joints in alignment. What is the best rationale for this intervention? A. To prevent neuropathies B. To prevent wound breakdown C. To prevent contractures D. To prevent heterotopic ossification

C Rationale: To prevent the complication of contractures, the nurse will establish a goal to maintain position of joints in alignment. Gentle range-of-motion exercises and a consult to PT and OT for exercises and positioning recommendations are also appropriate interventions for the prevention of contractures. Joint alignment is not maintained specifically for preventing neuropathy, wound breakdown, or heterotopic ossification. PTS: 1 REF: p. 1888 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 13. The nurse is caring for a client with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a client with an indwelling catheter? A. Vigorously clean the meatus area daily. B. Apply powder to the perineal area twice daily. C. Empty the drainage bag at least every 8 hours. D. Irrigate the catheter every 8 hours with normal saline.

C Rationale: To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection. PTS: 1 REF: p. 1619 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? A. Avoiding heavy alcohol use B. Control of sodium intake C. Smoking cessation D. Adherence to recommended immunization schedules

C Rationale: Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and sodium intake. Immunizations do not address an individual's risk of renal cancer. PTS: 1 REF: p. 1563 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 19. A client admitted to the medical unit with impaired renal function reports severe, stabbing pain in the flank and lower abdomen. The client is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location? A. Meatus B. Bladder C. Ureter D. Urethra

C Rationale: Ureteral pain is characterized as a dull, continuous pain that may be intense with voiding. The pain may be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone being present in the bladder. Stones are not normally situated in the urethra or meatus. PTS: 1 REF: p. 1541 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 5. The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this client? A. Using a stethoscope for auscultating the fistula is contraindicated B. The client feels best immediately after the dialysis treatment C. Taking a BP reading on the affected arm can damage the fistula D. The client should not feel pain during initiation of dialysis

C Rationale: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, clients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful. PTS: 1 REF: p. 1588 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Fill in the Blank Chapter 45: Assessment and Management of Patients with Endocrine Disorders 1. A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client? A. Side-lying with one pillow under the head B. Head of the bed elevated 30 degrees and no pillows placed under the head C. Semi-Fowler with the head supported on two pillows D. Supine, with a small roll supporting the neck

C Rationale: When moving and turning the client, the nurse carefully supports the client's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler position, with the head elevated and supported by pillows. PTS: 1 REF: p. 1469 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 10. A client with a partial-thickness burn injury had a xenograft applied 2 weeks ago. The nurse notices that the xenograft is separating from the burn wound. What is the nurse's most appropriate intervention? A. Reinforce the xenograft dressing with another piece of Biobrane. B. Remove the xenograft dressing and apply a new dressing. C. Trim away the separated xenograft. D. Notify the health care provider for further emergency-related orders.

C Rationale: Xenografts adhere to granulation tissue. As the tissue heals the xenograft will become removed from the scar tissue. Applying more of the xenograft will not continue to heal the wound (as it is already healed). It is not an emergency and reinforcement is not necessary. PTS: 1 REF: p. 1883 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 36. The nurse is caring for a client after kidney surgery. When assessing for bleeding, what assessment parameter should the nurse evaluate? A. Oral intake B. Pain intensity C. Level of consciousness D. Radiation of pain

C Rationale: Bleeding is a major complication of kidney surgery. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake. PTS: 1 REF: p. 1594 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 20. An older adult client diagnosed with cancer is admitted to the oncology unit for surgical treatment. The client has been on chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to acute kidney injury (AKI)? Select all that apply. A. Anxiety and agitation B. Low body mass index (BMI) C. Age-related physiologic changes D. Chronic systemic disease E. Nothing by mouth (NPO) status

C, D, E Rationale: Changes in kidney function with normal aging increase the susceptibility of older clients to kidney dysfunction and kidney injury. In addition, the presence of chronic, systemic diseases increases the risk of AKI. This client was on chemotherapeutic agents that frequently cause nausea and vomiting, which contribute to dehydration. Older adult clients taking medications may cause alterations in renal flow and clearance. The client was made NPO prior to surgery, making them more susceptible to AKI even with parenteral fluids. A low BMI and anxiety are not risk factors for acute renal disease. PTS: 1 REF: p. 1567 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 32. A client has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the client's admission assessment, the nurse should be aware that what signs and symptoms are characteristic of this diagnosis? Select all that apply. A. Diarrhea B. High fever C. Hematuria D. Urinary frequency E. Acute pain

C, D, E Rationale: Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia. Often, the client has a desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteral colic. Diarrhea is not associated with this presentation, and a fever is usually absent due to the noninfectious nature of the health problem. PTS: 1 REF: p. 1621 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Select 30. A client has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply. A. Pupillary response B. Creatinine and BUN levels C. Potassium level D. Peripheral pulses E. Blood pressure

C, E Rationale: Clients with primary aldosteronism (Conn syndrome) exhibit a profound decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response, peripheral pulses, and renal function are not directly affected. PTS: 1 REF: p. 1483 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice Chapter 57: Management of Patients with Burn Injury 1. A client is brought to the emergency department from the site of a chemical fire, where the client suffered a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. On inspection, the skin appears charred. Based on these assessment findings, what is the depth of the burn on the client's arm? A. Superficial partial thickness B. Deep partial thickness C. Full partial thickness D. Full thickness

D Rationale: A full-thickness burn involves total destruction of the epidermis and dermis and, in some cases, underlying tissue as well. Wound color ranges widely from white to red, brown, or black. The burned area is painless because the nerve fibers are destroyed. The wound can appear leathery; hair follicles and sweat glands are destroyed. Edema may also be present. Superficial partial-thickness burns involve the epidermis and possibly a portion of the dermis; the client will experience pain that is soothed by cooling. Deep partial-thickness burns involve the epidermis, upper dermis, and portion of the deeper dermis; the client will report pain and sensitivity to cold air. Full partial thickness is not a depth of burn. PTS: 1 REF: p. 1867 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 37. A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy? A. Persistently cold feet B. Pain that does not respond to analgesia C. Acute pain, unrelieved by rest D. The presence of a tingling sensation

D Rationale: Although approximately half of clients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication. PTS: 1 REF: p. 1522 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 34. A client with end stage renal disease (ESKD) is being treated for a right ankle fracture unrelated to a fall. The client's lab values show high phosphate levels, low calcium levels, and low vitamin D levels. What is the most likely reason for this client's fracture? A. Osteoporosis B. Codman triangle C. Hypertrophic osteoarthropathy D. Renal osteodystrophy

D Rationale: An abnormality seen in ESKD is called renal osteodystrophy or uremic bone disease. It is a disease that involves complex changes in calcium, phosphate, and parathormone balances. Damage seen in ESKD results in an increase in phosphate and a decrease in calcium (reciprocal relationship), which causes increased production from the parathyroid. Clients with ESKD cannot handle these increases, effectively resulting in bone changes and bone disease. All of the other choices can cause fractures but are not typically suspected in a client with ESRD with the presented lab values. Osteoporosis, where bone becomes brittle and fragile, is usually diagnosed with a bone density scan. Codman triangle is a radiologic sign seen commonly on x-rays. It is usually an indication of bone tumors. Hypertrophic osteoarthropathy (HOA) is characterized by abnormal proliferation (growth) of skin and periosteal tissue involving the extremities. Diagnosis is typically from x-rays and physical findings. PTS: 1 REF: p. 1571 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 34. The intensive care unit nurse is caring for a client with sepsis whose tissue perfusion is declining. What sign would indicate to the nurse that end-organ damage may be occurring? A. Urinary output increases B. Skin becomes warm and dry C. Adventitious lung sounds occur in the upper airway D. Heart and respiratory rates are elevated

D Rationale: As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the client begins to show signs of organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (e.g., acute kidney injury, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Adventitious lung sounds occur throughout the lung fields, not just in the upper fields of the lungs. PTS: 1 REF: p. 293 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 37. A client is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The client is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurse's most appropriate response? A. Report this finding promptly to the primary care provider. B. Obtain a sterile urine sample and send it for culture. C. Obtain a urine sample and check it for pH. D. Reassure the client that this is an expected phenomenon.

D Rationale: Because mucous membrane is used in forming the conduit, the client may excrete a large amount of mucus mixed with urine. This causes anxiety in many clients. To help relieve this anxiety, the nurse reassures the client that this is a normal occurrence after an ileal conduit procedure. Urine testing for culture or pH is not required. PTS: 1 REF: p. 1629 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 35. The nurse caring for a client who is recovering from full-thickness burns is aware of the client's risk for contracture and hypertrophic scarring. How can the nurse best reduce this risk? A. Apply skin emollients as prescribed after granulation has occurred. B. Keep injured areas immobilized whenever possible to promote healing. C. Administer oral or IV corticosteroids as prescribed. D. Encourage physical activity and range-of-motion exercises.

D Rationale: Exercise and the promotion of mobility can reduce the risk of contracture and hypertrophic scarring. Skin emollients are not normally used in the treatment of burns, and these do not prevent scarring. Steroids are not used to reduce scarring, as they also slow the healing process. PTS: 1 REF: p. 1888 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 7. A female client's most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse's data analysis should be informed by what principle? A. Most UTIs in female clients are caused by viruses and do not cause obvious symptoms. B. A diagnosis of bacteriuria requires three consecutive positive results. C. Urine contains varying levels of healthy bacterial flora. D. Urine samples are frequently contaminated by bacteria normally present in the urethral area.

D Rationale: Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology. PTS: 1 REF: p. 1606 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 31. A client has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the client and will implement a program of health education. What is the nurse's priority action? A. Ensure that the client understands the basic pathophysiology of diabetes. B. Identify the client's body mass index. C. Teach the client "survival skills" for diabetes. D. Assess the client's readiness to learn.

D Rationale: Before initiating diabetes education, the nurse assesses the client's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education. PTS: 1 REF: p. 1508 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Select 10. A kidney biopsy has been scheduled for a client with a history of acute kidney injury. The client asks the nurse why this test has been scheduled. What is the nurse's best response? A. "A biopsy is routinely ordered for all clients with renal disorders." B. "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." C. "A biopsy is often ordered for clients before they have a kidney transplant." D. "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

D Rationale: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute kidney injury, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 3. The nurse is caring for a client with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The client has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the client to take the prescribed medication at what time? A. Only when needed B. Daily at bedtime C. First thing in the morning D. With each meal

D Rationale: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be given with food to be effective. PTS: 1 REF: p. 1570 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 21. A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to take what action? A. Take the drug concurrent with levothyroxine. B. Take each dose of prednisone with a dose of calcium chloride. C. Gradually replace the prednisone with an over-the-counter (OTC) alternative. D. Slowly taper down the dose of prednisone, as prescribed.

D Rationale: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no over-the-counter (OTC) substitutes for prednisone, and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency. PTS: 1 REF: p. 1484 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 14. A diabetes nurse educator is presenting current recommendations for levels of caloric intake. What are the current recommendations that the nurse would describe? A. 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B. 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C. 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D. 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

D Rationale: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet. PTS: 1 REF: p. 1494 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand

Multiple Response 39. An immunocompromised 65-year-old client has developed a urinary tract infection, and the care team recognizes the need to prevent an exacerbation of the client's infection that could result in urosepsis and septic shock. Which action should the nurse perform to reduce the client's risk of septic shock? A. Apply an antibiotic ointment to the client's mucous membranes, as prescribed. B. Perform passive range-of-motion exercises unless contraindicated. C. Initiate total parenteral nutrition (TPN). D. Remove invasive devices as soon as they are no longer needed.

D Rationale: Early removal of invasive devices can reduce the incidence of infections. Broad application of antibiotic ointments is not performed. TPN may be needed, but this does not directly reduce the risk of further infection. Range-of-motion exercises are not a relevant intervention. PTS: 1 REF: p. 292 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. A client's burns are estimated at 36% of total body surface area; fluid resuscitation has been ordered in the emergency department. After establishing intravenous access, the nurse should anticipate the administration of what fluid? A. 0.45% NaCl with 20 mEq/L KCl B. 0.45% NaCl with 40 mEq/L KCl C. Normal saline D. Lactated Ringer

D Rationale: Fluid resuscitation with lactated Ringer (LR) should be initiated using the American Burn Association's (ABA) fluid resuscitation formulas. LR is the crystalloid of choice because its composition and osmolality most closely resemble plasma and because use of normal saline is associated with hyperchloremic acidosis. Potassium chloride solutions would exacerbate the hyperkalemia that occurs following burn injuries. PTS: 1 REF: p. 1874 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 19. The nurse is caring for a client admitted with cardiogenic shock. The client is experiencing chest pain and there is an order for the administration of morphine. In addition to pain control, what is the main rationale for administering morphine to this client? A. It promotes coping and slows catecholamine release. B. It stimulates the client so he or she is more alert. C. It decreases gastric secretions. D. It dilates the blood vessels.

D Rationale: For clients experiencing chest pain, morphine is the drug of choice because it dilates the blood vessels and controls the client's anxiety. Morphine would not be prescribed to promote coping or to stimulate the client. The rationale behind using morphine would not be to decrease gastric secretions. PTS: 1 REF: p. 288 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 21. A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does this syndrome most often occur? A. Clients who are obese and who have no known history of diabetes B. Clients with type 1 diabetes and poor dietary control C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D. Middle-aged or older people with either type 2 diabetes or no known history of diabetes

D Rationale: HHS occurs most often in older clients (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. HHS is a serious metabolic disorder resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin. Obesity does play a role in HHS but clients usually have a history of type 2 diabetes. Clients with type 1 diabetes usually present with DKA (diabetic ketoacidosis). Adolescents with type 2 have a low incidence of this condition. PTS: 1 REF: p. 1516 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 24. A client with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following? A. IV antibiotics B. Oral antihypertensives C. Parenteral nutrition D. IV corticosteroids

D Rationale: IV administration of corticosteroids (methylprednisolone sodium succinate may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency or other common complications of adrenalectomy. PTS: 1 REF: p. 1476 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 10. The home care nurse is conducting client teaching with a client on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when should the home care nurse instruct the client to take the corticosteroids? A. In the evening between 4 PM and 6 PM B. Prior to going to sleep at night C. At noon every day D. In the morning between 7 AM and 8 AM

D Rationale: In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects. PTS: 1 REF: p. 1484 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 3. The emergency nurse is admitting a client experiencing a GI bleed who is believed to be in the compensatory stage of shock. What assessment finding would be most consistent with the early stage of compensation? A. Increased urine output B. Decreased heart rate C. Hyperactive bowel sounds D. Cool, clammy skin

D Rationale: In the compensatory stage of shock, the body shunts blood from the organs, such as the skin and kidneys, to the brain and heart to ensure adequate blood supply. As a result, the client's skin is cool and clammy. Also in this compensatory stage, blood vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the urine output decreases. PTS: 1 REF: p. 276 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 29. A nurse is teaching basic "survival skills" to a client newly diagnosed with type 1 diabetes. What topic should the nurse address? A. Signs and symptoms of diabetic nephropathy B. Management of diabetic ketoacidosis C. Effects of surgery and pregnancy on blood sugar levels D. Recognition of hypoglycemia and hyperglycemia

D Rationale: It is imperative that newly diagnosed clients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the client's immediate "survival skills" following a new diagnosis. PTS: 1 REF: p. 1506 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 7. A geriatric nurse is performing an assessment of body systems on an older adult client. The nurse should be aware of what age-related change affecting the renal and urinary systems? A. Increased ability to concentrate urine B. Increased bladder capacity C. Urinary incontinence D. Decreased glomerular filtration rate

D Rationale: Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of an older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone. PTS: 1 REF: p. 1539 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 26. An older adult has experienced a new onset of urinary incontinence, and family members identify this problem as being unprecedented. When assessing the client for factors that may have contributed to incontinence, the nurse should prioritize what assessment? A. Reviewing the client's 24-hour food recall for changes in diet B. Assessing for recent contact with individuals who have UTIs C. Assessing for changes in the client's level of psychosocial stress D. Reviewing the client's medication administration record for recent changes

D Rationale: Many medications affect urinary continence in addition to causing other unwanted or unexpected effects. Stress and dietary changes could potentially affect the client's continence, but medications are more frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result from contact with infected individuals. PTS: 1 REF: p. 1612 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 25. A client with type 2 diabetes has been managing his blood glucose levels using diet and metformin. Following an ordered increase in the client's daily dose of metformin, the nurse should prioritize which of the following assessments? A. Monitoring the client's neutrophil levels B. Assessing the client for signs of impaired liver function C. Monitoring the client's level of consciousness and behavior D. Reviewing the client's creatinine and BUN levels

D Rationale: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the client's kidney function. This drug does not typically affect clients' neutrophils, liver function, or cognition. PTS: 1 REF: p. 1505 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 12. The nurse is caring for a client with hyperparathyroidism. What level of activity would the nurse expect to promote? A. Complete bed rest B. Bed rest with bathroom privileges C. Out of bed (OOB) to the chair twice a day D. Ambulation and activity as tolerated

D Rationale: Mobility, through walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Bed rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the client to getting out of bed only a few times a day also increases calcium excretion and the associated risks. PTS: 1 REF: p. 1471 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 17. A nurse's colleague has applied an incontinence pad to an older adult client who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? A. Diuretics should be promptly discontinued when an older adult experiences incontinence. B. Restricting fluid intake is recommended for older adults experiencing incontinence. C. Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. D. Urinary incontinence is not considered a normal consequence of aging.

D Rationale: Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence. PTS: 1 REF: p. 1612 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 9. A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes? A. Have blood glucose levels checked annually. B. Stop using tobacco in any form. C. Undergo eye examinations regularly. D. Lose weight, if obese.

D Rationale: Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent diabetes. PTS: 1 REF: p. 1493 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 5. An occupational health nurse is called to the floor of a factory where a worker has sustained a flash burn to the right arm. The nurse arrives and the flames have been extinguished. The next step is to "cool the burn." How should the nurse cool the burn? A. Apply ice to the site of the burn for 5 to 10 minutes. B. Wrap the client's affected extremity in ice until help arrives. C. Apply an oil-based substance to the burned area until help arrives. D. Wrap cool towels around the affected extremity intermittently.

D Rationale: Once the burn has been sustained, the application of cool water is the best first-aid measure. Soaking the burn area intermittently in cool water or applying cool towels gives immediate and striking relief from pain, and limits local tissue edema and damage. However, never apply ice directly to the burn, never wrap the person in ice, and never use cold soaks or dressings for longer than several minutes; such procedures may worsen the tissue damage and lead to hypothermia in people with large burns. Oils are contraindicated. PTS: 1 REF: p. 1874 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 32. The nurse is providing care for an older adult client whose current medication regimen includes levothyroxine. As a result, the nurse should be aware of the heightened risk of adverse sedation effects when administering an intravenous (IV) dose of what medication? A. A fluoroquinolone antibiotic B. A loop diuretic C. A proton pump inhibitor (PPI) D. A benzodiazepine

D Rationale: Oral thyroid hormones interact with many other medications. Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor-like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Benzodiazepine is a sedative and may be used to treat seizures and alcohol withdrawal. Concurrent usage with levothyroxine can increase benzodiazepine's sedation effects. Concurrent use of fluoroquinolone antibiotics can decrease absorption of the antibiotic. A loop diuretic and proton pump inhibitor IV have no adverse sedation effects. A PPI taken in pill form can inhibit levothyroxine absorption if taken together. PTS: 1 REF: p. 1457 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 25. The nurse performing the health interview of a client with a new onset of periorbital edema has completed a genogram, noting the health history of the client's siblings, parents, and grandparents. This assessment addresses the client's risk of what kidney disorder? A. Nephritic syndrome B. Acute glomerulonephritis C. Nephrotic syndrome D. Polycystic kidney disease (PKD)

D Rationale: PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders. PTS: 1 REF: p. 1562 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 12. A nurse is caring for a client who has sustained a deep partial-thickness burn injury. In prioritizing the nursing diagnoses for the plan of care, the nurse will give the highest priority to what nursing diagnosis? A. Activity intolerance B. Anxiety C. Ineffective coping D. Acute pain

D Rationale: Pain is inevitable during recovery from any burn injury. Pain in the burn client has been described as one of the most severe types of acute pain. Management of the often-severe pain is one of the most difficult challenges facing the burn team. While the other nursing diagnoses listed are valid, the presence of pain may contribute to these diagnoses. Management of the client's pain is the priority, as it may have a direct correlation to the other listed nursing diagnoses. PTS: 1 REF: p. 1884 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 24. The nurse is caring for a client in shock who is receiving enteral nutrition. What is the basis for enteral nutrition being the preferred method of meeting the body's needs? A. It slows the proliferation of bacteria and viruses during shock. B. It decreases the energy expended through the functioning of the GI system. C. It assists in expanding the intravascular volume of the body. D. It promotes GI function through direct exposure to nutrients.

D Rationale: Parenteral or enteral nutritional support should be initiated as soon as possible. Enteral nutrition is preferred, promoting GI function through direct exposure to nutrients and limiting infectious complications associated with parenteral feeding. Enteral feeding does not decrease the proliferation of microorganisms or the amount of energy expended through the functioning of the GI system and it does not assist in expanding the intravascular volume of the body. PTS: 1 REF: p. 283 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Response 27. The intensive care unit nurse is caring for a client in distributive shock who is experiencing pooling of blood in the periphery. The nurse should assess for signs and symptoms of: A. increased stroke volume. B. increased cardiac output. C. decreased heart rate. D. decreased venous return.

D Rationale: Pooling of blood in the periphery results in decreased venous return. Decreased venous return results in decreased stroke volume and decreased cardiac output. Decreased cardiac output, in turn, causes decreased blood pressure and, ultimately, decreased tissue perfusion. Heart rate increases in an attempt to meet the demands of the body. PTS: 1 REF: p. 290 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 22. A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? A. Psychosocial stress B. Hypersensitivity to an immunization C. Menarche D. Streptococcal infection

D Rationale: Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes. PTS: 1 REF: p. 1558 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 23. The nurse is caring for a client who is going to have an open renal biopsy. What nursing action should the nurse prioritize when preparing this client for the procedure? A. Discuss the client's diagnosis with the family. B. Bathe the client before the procedure with antiseptic skin wash. C. Administer antivirals before sending the client for the procedure. D. Keep the client NPO prior to the procedure.

D Rationale: Preparation for an open biopsy is similar to that for any major abdominal surgery. When preparing the client for an open biopsy, the nurse would keep the client NPO. The nurse may discuss the diagnosis with the family, but that is not a preparation for the procedure. A preprocedure wash is not normally ordered and antivirals are not given in anticipation of a biopsy. PTS: 1 REF: p. 1552 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 30. A nurse is caring for a client with burns who is in the later stages of the acute phase of recovery. The plan of nursing care should include which of the following nursing actions? A. Maintenance of bed rest to aid healing B. Choosing appropriate splints and functional devices C. Administration of beta adrenergic blockers D. Prevention of venous thromboembolism

D Rationale: Prevention of deep vein thrombosis (DVT) is an important factor in care. Early mobilization of the client is important. The nurse monitors the splints and functional devices, but these are selected by occupational and physical therapists. The hemodynamic changes accompanying burns do not normally require the use of beta blockers. PTS: 1 REF: p. 1880 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 28. A nurse is performing a home visit to a client who is recovering following a long course of inpatient treatment for burn injuries. When performing this home visit, the nurse should do which of the following? A. Assess the client for signs of electrolyte imbalances. B. Administer fluids as prescribed. C. Assess the risk for injury recurrence. D. Assess the client's psychosocial state.

D Rationale: Recovery from burns can be psychologically challenging; the nurse's assessments must address this reality. Fluid and electrolyte imbalances are infrequent during the rehabilitation phase of recovery. Burns are not typically a health problem that tends to recur; the experience of being burned tends to foster vigilance. PTS: 1 REF: p. 1887 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 9. When caring for a client in shock, one of the major nursing goals is to reduce the risk that the client will develop complications of shock. How can the nurse best achieve this goal? A. Provide a detailed diagnosis and plan of care in order to promote the client's and family's coping. B. Keep the health care provider updated with the most accurate information because in cases of shock the nurse often cannot provide relevant interventions. C. Monitor for significant changes and evaluate client outcomes on a scheduled basis focusing on blood pressure and skin temperature. D. Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment.

D Rationale: Shock is a life-threatening condition with a variety of underlying causes. It is critical that the nurse apply the nursing process as the guide for care. Shock is unpredictable and rapidly changing so the nurse must understand the underlying mechanisms of shock. The nurse must also be able to recognize the subtle as well as more obvious signs and then provide rapid assessment and response to provide the client with the best chance for recovery. Coping skills are important, but not the ultimate priority. Keeping the health care provider updated with the most accurate information is important, but the nurse is in the best position to provide rapid assessment and response, which gives the client the best chance for survival. Monitoring for significant changes is critical, and evaluating client outcomes is always a part of the nursing process, but the subtle signs and symptoms of shock are as important as the more obvious signs, such as blood pressure and skin temperature. Assessment must lead to diagnosis and interventions. PTS: 1 REF: p. 274 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 6. An emergency department nurse has just admitted a client with a burn. What characteristic of the burn will primarily determine whether the client experiences a systemic response to this injury? A. The length of time since the burn B. The location of burned skin surfaces C. The source of the burn D. The total body surface area (TBSA) affected by the burn

D Rationale: Systemic effects are a result of several variables. However, TBSA and wound severity are considered the major factors that affect the presence or absence of systemic effects. PTS: 1 REF: p. 1868 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 15. A client is brought to the ED by paramedics, who report that the client has partial-thickness burns on the chest and legs. The client has also suffered smoke inhalation. What is the priority in the care of a client who has been burned and suffered smoke inhalation? A. Pain B. Fluid balance C. Anxiety and fear D. Airway management

D Rationale: Systemic threats from a burn are the greatest threat to life. The ABCs of all trauma care apply during the early post-burn period. While all options should be addressed, pain, fluid balance, and anxiety and fear do not take precedence over airway management. PTS: 1 REF: p. 1872 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 19. A client is admitted to a surgical unit after a thyroidectomy. The nurse takes and maintains the inflated blood pressure cuff on the client and observes a carpopedal spasm. What does this result indicate? A. Chvostek sign and hypocalcemia B. Thyroid storm and elevated triiodothyronine C. Homans sign and deep vein thrombosis D. Trousseau sign and overt tetany

D Rationale: The Trousseau sign is positive when carpopedal spasm (spasms of the hand or, less commonly, the feet) is induced by occluding the blood flow to the arm for 3 minutes and indicates tetany. Chvostek sign is positive when a sharp tapping over the facial nerve causes spasm, or twitching of the mouth, nose and eye. Chvostek sign also indicates tetany (neuronal excitability), which is usually associated with hypocalcemia. This result is not the product of a thyroid storm, which involves the excessive release of thyroid hormones given the client's surgery. Although blood pressure can be acquired on the leg; this is not the test for the Homans sign. A positive Homans sign is pain in the calf of the leg upon dorsiflexion of the foot and would suggest a deep vein thrombosis (DVT). PTS: 1 REF: p. 1473 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 45: Assessment and Management of Clients With Endocrine Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 26. A client's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding? A. The client is likely to have a decreased level of blood urea nitrogen (BUN). B. The client is at risk for hypokalemia. C. The client is likely to have irregular voiding patterns. D. The client is likely to have increased serum creatinine levels.

D Rationale: The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to 2.0 mL/sec) to a high of 200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium. PTS: 1 REF: p. 1540 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Multiple Choice 38. The nurse is collaborating with the wound-ostomy-continence (WOC) nurse to teach a client how to manage a new ileal conduit in the home setting. To prevent leakage or skin breakdown, the nurse should encourage which of the following practices? A. Empty the collection bag when it is between one-half and two-thirds full. B. Limit fluid intake to prevent production of large volumes of dilute urine. C. Reinforce the appliance with tape if small leaks are detected. D. Avoid using moisturizing soaps and body washes when cleaning the peristomal area.

D Rationale: The client is instructed to avoid moisturizing soaps and body washes when cleaning the area because they interfere with the adhesion of the pouch. To maintain skin integrity, a skin barrier or leaking pouch is never patched with tape to prevent accumulation of urine under the skin barrier or faceplate. Fluids should be encouraged, not limited, and the collection bag should not be allowed to become more than one-third full. PTS: 1 REF: p. 1629 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply

Multiple Choice 36. While performing a client's ordered wound care for the treatment of a burn, the client has made a series of sarcastic remarks to the nurse and criticized the nurse's technique. How should the nurse best interpret this client's behavior? A. The client may be experiencing an adverse drug reaction that is affecting cognition and behavior. B. The client may be experiencing neurologic or psychiatric complications of the client's injuries. C. The client may be experiencing inconsistencies in the care being provided. D. The client may be experiencing anger about current circumstances that the client is deflecting toward the nurse.

D Rationale: The client may experience feelings of anger. The anger may be directed outward toward those who escaped unharmed or toward those who are now providing care. While drug reactions, complications, and frustrating inconsistencies in care cannot be automatically ruled out, it is not uncommon for anger to be directed at caregivers. PTS: 1 REF: p. 1885 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 57: Management of Clients with Burn Injury KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze

Multiple Choice 25. The intensive care unit nurse is caring for an acutely ill client with signs of multiple organ dysfunction syndrome (MODS). The nurse knows the client is at risk for developing MODS due to all of the following EXCEPT: A. Malnutrition B. Advanced age C. Multiple comorbidities D. Progressive dyspnea

D Rationale: The client with advanced age is at risk for developing MODS due to the lack of physiological reserve. The client with malnutrition metabolic compromise and the client with multiple comorbidities is at risk for developing MODS due to decreased organ function. Progressive dyspnea is the first sign of MODS. PTS: 1 REF: p. 297 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 19. A client has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the client about what priority topic? A. Typical diet B. Allergy status C. Psychosocial stressors D. Current medication use

D Rationale: The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress. PTS: 1 REF: p. 1567 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 8. A client admitted with nephrotic syndrome is being cared for on the medical unit. When writing this client's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? A. Constipation related to immobility B. Risk for injury related to altered thought processes C. Hyperthermia related to the inflammatory process D. Excess fluid volume related to generalized edema

D Rationale: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is "Excess fluid volume related to generalized edema." Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen. PTS: 1 REF: p. 1561 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 48: Management of Clients With Kidney Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select 37. What nursing action should the nurse perform when caring for a client undergoing diagnostic testing of the renal-urologic system? A. Withhold medications until 12 hours post-testing. B. Ensure that the client knows the importance of temporary fluid restriction after testing. C. Inform the client of the medical diagnosis after reviewing the results. D. Assess the client's understanding of the test results after their completion.

D Rationale: The nurse should ensure that the client understands the results that are presented by the health care provider. Informing the client of a diagnosis is normally the primary provider's responsibility. Withholding fluids or medications is not normally required after testing. PTS: 1 REF: p. 1547 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 15. An older adult client with type 2 diabetes is brought to the emergency department by the client's daughter. The client is found to have a blood glucose level of 600 mg/dL (33.3 mmol/L). The client's daughter reports that the client recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A. Administration of antihypertensive medications B. Administering sodium bicarbonate intravenously C. Reversing acidosis by administering insulin D. Fluid and electrolyte replacement

D Rationale: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not given to clients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA). PTS: 1 REF: p. 1517 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 46: Assessment and Management of Clients With Diabetes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 28. A client has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this client's high risk for urinary retention and should implement what intervention in the client's plan of care? A. Relaxation techniques B. Sodium restriction C. Lower abdominal massage D. Double voiding

D Rationale: To enhance emptying of a flaccid bladder, the client may be taught to "double void." After each voiding, the client is instructed to remain on the toilet, relax for 1 to 2 minutes, and then attempt to void again in an effort to further empty the bladder. Relaxation does not affect the neurologic etiology of a flaccid bladder. Sodium restriction and massage are similarly ineffective. PTS: 1 REF: p. 1617 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 27. A client has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? A. The kidneys will excrete increased quantities of acid. B. Bicarbonate will be released from the adrenal medulla. C. Alveoli in the lungs will synthesize new bicarbonate. D. Renal tubular cells will generate new bicarbonate.

D Rationale: To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. The lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid compensates for a lack of bicarbonate, but it does not actively replace it. PTS: 1 REF: p. 1539 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 25. An adult client has been hospitalized with pyelonephritis. The nurse's review of the client's intake and output records reveals that the client has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? A. Supplement the client's fluid intake with a high-calorie diet. B. Emphasize the need to limit intake to 2 L of fluid daily. C. Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. D. Encourage the client to continue this pattern of fluid intake.

D Rationale: Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. Consequently, there is no need to supplement this fluid intake with additional calories or sodium. PTS: 1 REF: p. 1611 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 49: Management of Clients With Urinary Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Choice 6. The nurse is caring for a client who has a fluid volume deficit. When evaluating this client's urinalysis results, what should the nurse normally anticipate? A. Decrease in blood urea nitrogen (BUN) B. Less antidiuretic hormone (ADH) released C. Decreased urine osmolality D. Increased urine specific gravity

D Rationale: Urine specific gravity depends largely on hydration status. A decrease in fluid intake will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. Blood urea nitrogen (BUN) levels are usually elevated with volume deficits related to dehydration. With decreased water intake as seen in a client with fluid volume deficit, blood osmolality increases, which stimulates antidiuretic hormone (ADH) release. ADH acts on the kidney, increasing water reabsorption and returning the blood osmolality to a normal level. Normally, urine osmolality increases (urine is concentrated) with fluid volume deficits. PTS: 1 REF: p. 1548 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Multiple Choice 31. The critical care nurse is preparing to initiate an infusion of a vasoactive medication to a client in shock. What goal of this treatment should the nurse identify? A. Absence of infarcts or emboli B. Reduced stroke volume and cardiac output C. Absence of pulmonary and peripheral edema D. Maintenance of adequate mean arterial pressure

D Rationale: Vasoactive medications can be given in all forms of shock to improve the client's hemodynamic stability when fluid therapy alone cannot maintain adequate MAP. Specific medications are selected to correct the particular hemodynamic alteration that is impeding cardiac output. These medications help increase the strength of myocardial contractility, regulate the heart rate, reduce myocardial resistance, and initiate vasoconstriction. They are not specifically used to prevent emboli, edema, or infarcts. PTS: 1 REF: p. 283 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Multiple Select Chapter 47: Assessment of Kidney and Urinary Function 1. The care team is considering the use of dialysis in a client whose renal function is progressively declining. Renal replacement therapy is indicated in which situation? A. creatinine level drops below 1.2 mg/dl (110mmol/L) B. blood urea nitrogen (BUN) is above 15 mg/dl C. urinalysis (dipstick test) reveals 140 mg/dl of protein D. functioning nephrons are less than 20%

D Rationale: When the total number of functioning nephrons is less than 20%, renal replacement therapy needs to be considered. Dialysis is an example of renal replacement therapy. Prior to the loss of greater than 80% of the nephron's functioning ability, the client may have mild symptoms of compromised renal function, but symptom management is often obtained through dietary modifications and drug therapy. The listed creatinine level is within normal range for men and slightly elevated for women. The BUN levels are within normal ranges. Proteinuria up to 150 mg/dl, as an occasional finding, is considered normal. Persistent proteinuria can indicate several medical problems including glomerular disease. PTS: 1 REF: p. 1536 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 47: Assessment of Kidney and Urinary Function KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand