Med Surg Exam 1 MOCK QUIZ REVIEW

A client has been scheduled to undergo a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). The nurse knows that the client understands preoperative teaching when he makes which statement? "I will have my wife come with me to drive me home after the outpatient procedure." "I understand I may develop urethral strictures as a result of having the TURP." "I'm worried my wife will leave me after the TURP because of the side effect of erectile dysfunction." "I understand there is no danger of retrograde ejaculation following the TURP."

"I understand I may develop urethral strictures as a result of having the TURP." Rationale:Urethral strictures are more frequent for TURP than with nontransurethral procedures. TURP rarely causes erectile dysfunction. It requires an overnight stay. There is chance of retrograde ejaculation.

The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction? "I will not salt my food; instead I'll use salt substitute." "Bananas have a lot of potassium in them; I'll stop buying them." "I need to check to see whether my cola beverage has potassium in it." "I'll drink cranberry juice with my breakfast instead of coffee."

"I will not salt my food; instead I'll use salt substitute. Rationale: The client should avoid salt substitutes. The nurse must caution clients to use salt substitutes sparingly if they are taking other supplementary forms of potassium or potassium-conserving diuretics. Potassium-rich foods to be avoided include many fruits and vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, and cocoa.

Which is considered an isotonic solution? 0.9% normal saline 3% NaCl Dextran in normal saline 0.45% normal saline

0.9% normal saline An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.

Which is considered an isotonic solution? 0.45% normal saline 3% NaCl Dextran in normal saline 0.9% normal saline

0.9% normal saline Rationale:An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.

Which value represents a normal BUN-to-creatinine ratio? 06:01:00 04:01:00 10:01:00 08:01:00

10:01:00 Rationale:A normal BUN-to-creatinine ratio is about 10:1

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 20% 30% 40% 10%

20% Rationale:Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? 20 40 30 50

50 Rationale:Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal.

A nurse is preparing to initiate hemodialysis for a client who has AKI. Which of the following actions should the nurse take? Select all that apply. A. Review the medications the client currently takes B. Assess the AV fistula for a bruit C. Calculate the client's hourly urine output D. Measure the client's weight E. Check blood electrolytes F. Use the access site for venipuncture

A, B, C, D, E (NOT F bc we DO NOT take blood from the arm with the fistula)

A nurse is planning to care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? (Select all that apply) A. Monitor blood glucose levels B. Report cloudy dialysate return C. Warm the dialysate in a microwave oven D. Assess for shortness of breath E. Check the access site dressing for wetness F. Maintain medical asepsis when accessing the catheter insertion site

A,B, D, E, F NOT C (not supposed to be warm and run risk of making temp uneven)

A nurse at a provider's office is caring for an older adult client who is having an annual physical exam. Which of the following findings indicates additional follow-up is needed in regard to the prostate gland? (SATA) A. Prostate-specific antigen (PSA) is 7.1 B. A digital rectal exam (DRE) reveals an enlarged and nodular prostate C. The client reports a weak urine stream D. The client reports urinating once during the night E. Smegma is present below the glans of the penis

A,B,C

The nurse has been assigned to care for various clients. Which client is at the highest risk for a fluid and electrolyte imbalance? A 66-year-old client who had an open cholecystectomy with a T-tube placed that is draining 125 mL of bile per shift. An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide. A 79-year-old client admitted with a diagnosis of pneumonia. A 45-year-old client who had a laparoscopic appendectomy 24 hours ago and is being advanced to a regular diet.

An 82-year-old client who receives all nutrition via tube feedings and whose medications include carvedilol and torsemide. Rationale:The 82-year-old client has three risk factors: advanced age, tube feedings, and diuretic usage (torsemide). This client has the highest risk for fluid and electrolyte imbalances. The 45-year-old client has the risk factor of surgery, the 79-year-old client has the risk factor of advanced age, and the 66-year-old client has the risk factors of age and the bile drain, but none of these are the client at the highest risk.

What is the most common presenting objective symptom of a urinary tract infection in older adults, especially in those with dementia? Change in cognitive functioning Hematuria Back pain Incontinence

Change in cognitive functioning Rationale:The most common objective finding is a change in cognitive functioning, especially in those with dementia; these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.

A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection? Osmolality Blood urea nitrogen Hemoglobin Creatinine

Creatinine Rationale:To calculate creatinine clearance, a 24-hour urine specimen is collected. The serum creatinine concentration is measured midway through the collection.

Which component of client teaching helps the nurse assist a client following treatment for cancer of the prostate gland to manage and minimize the possibility of a recurrence of the primary cancer or metastasis? Avoid strenuous exercises, especially lifting. Have regular prostate-specific antigen (PSA) levels tested and repeat lymph node biopsies. Avoid sexual intercourse for at least 2 years. Undertake pelvic floor retraining exercises.

Have regular prostate-specific antigen (PSA) levels tested and repeat lymph node biopsies. Rationale:Regular monitoring of PSA levels after treatment aids in the early detection of cancer recurrence or metastasis. Repeat lymph node biopsies may be part of the surgical follow-up. Cancer cells are spread via the lymphatic system. Exercise routines and avoiding sexual intercourse are not known to have any role in recurrence of the primary cancer or metastasis.

The nurse is assigned to care for a client with a serum phosphorus concentration of 5.0 mg/dL (1.61 mmol/L). The nurse anticipates that the client will also experience which electrolyte imbalance? Hypermagnesemia Hypocalcemia Hyponatremia Hyperchloremia

Hypocalcemia Rationale:The client is experiencing an elevated serum phosphorus concentration.

The nurse is caring for a client diagnosed with hyperchloremia. Which are signs and symptoms of hyperchloremia? Select all that apply. Lethargy Hypotension Dehydration Tachypnea Weakness

Lethargy Tachypnea Weakness Rationale: The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis: hypervolemia and hypernatremia. Tachypnea; weakness; lethargy; deep, rapid respirations; diminished cognitive ability; and hypertension occur.

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Metabolic acidosis Rationale:The client is at risk for developing metabolic acidosis. Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).

The nurse cares for a client with a right-arm arteriovenous fistula (AVF) for hemodialysis treatments. Which nursing action is contraindicated? Palpating the fistula for a "thrill" Obtaining a blood pressure reading from the right arm Placing the client's watch on the left wrist Obtaining blood samples from the left arm

Obtaining a blood pressure reading from the right arm Rationale:The nurse assesses the vascular access for patency. The bruit, or "thrill," over the venous access site must be evaluated at least every shift. The nurse takes precautions to ensure that the extremity with the vascular access is not used for measuring blood pressure or for obtaining blood specimens; tight dressings, restraints, or jewelry over the vascular access must be avoided as well.

The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI? Initiation Oliguria Recovery Diuresis

Oliguria Rationale:The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.

A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance? Negative Chvostek sign Presence of Trousseau sign Muscle weakness Slurred speech

Presence of Trousseau sign Rationale:After radical neck resection, a client is prone to developing hypocalcemia. Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and metacarpophalangeal joints, and extended interphalangeal joints with fingers together) will occur as ischemia of the ulnar nerve develops.

What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Hypokalemia Hyperalbuminemia Proteinuria

Proteinuria Rationale:Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

A nurse is caring for a client with acute renal failure and hypernatremia. In this case, which action can be delegated to the nursing assistant? Assess the client's weight daily for trends. Monitor for signs and symptoms of dehydration. Provide oral care every 2-3 hours. Teach the client about increased fluid intake.

Provide oral care every 2-3 hours.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? 20 30 10 40

Rationale:Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.

The nurse is caring for a client who had transurethral resection of the prostate (TURP) 1 day ago. Which assessment finding(s) does the nurse expect? Select all that apply. Reports of the urge to void from the client Drainage tube secured to the inner thigh Large amounts of amber-colored urine in the drainage bag Increasing pulse rate and diaphoresis Rounded swelling above the pubis

Reports of the urge to void from the client Drainage tube secured to the inner thigh Large amounts of amber-colored urine in the drainage bag Rationale:Irrigation fluids will increase the amount of fluid in the drainage bag. A change in color from pink to amber indicates reduced bleeding. To prevent traction on the bladder, the drainage tube (not the catheter) is secured to the inner thigh. The nurse explains that the urge to void results from the presence of the catheter and from bladder spasms. Rounded swelling above the pubis is a manifestation of an over distended bladder. Increasing pulse rate and diaphoresis are signs of distress and need to be reported.

The nurse is caring for a client who was admitted with fluid volume excess (FVE). Which nursing assessments should the nurse include in the ongoing monitoring of the client? Select all that apply. Skin assessment for edema and turgor Blood pressure, heart rate, and rhythm Intake and output, urine volume, and color Strength testing for muscle wasting Nutritional status and diet

Skin assessment for edema and turgor Blood pressure, heart rate, and rhythm Intake and output, urine volume, and color Nutritional status and diet Rationale:To assess for FVE the nurse measures blood pressure, heart rate and rhythm, and breath sounds; inspects the skin to look for edema and turgor; and inspects neck veins. Intake and output, daily weight, urine volume and color, dyspnea, and thirst are assessments that will assist the nurse in identifying improvement or worsening of the fluid volume excess.

Which is an effect of aging on upper and lower urinary tract function? Susceptibility to develop hypernatremia Increased blood flow to the kidney Acid-base balance Increased glomerular filtration rate

Susceptibility to develop hypernatremia Rationale:The elderly are more susceptible to developing hypernatremia.

Is the following statement true or false? A 24-hour urine collection is the primary test of renal clearance.

TRUE

Is the following statement true or false? Transurethral resection of the prostate is the most common surgical procedure used to remove the hypertrophied portion of the prostate gland.

True

True or False S/S of hypernatremia are thirst elevated body temperature swollen and dry tongue sticky mucous membranes hallucinations lethargy restlessness irritability simple partial or tonic-clonic seizures pulmonary edema hyperreflexia twitching nausea, vomiting anorexia elevated pulse elevated blood pressure.

True

A client is to undergo a TURP for BPH. Which statement is accurate with regard to a TURP? A TURP causes erectile dysfunction. Urethral strictures are more frequent for TURP than for nontransurethral procedures. It is done on an outpatient basis. There is no danger of retrograde ejaculation.

Urethral strictures are more frequent for TURP than for nontransurethral procedures. Rationale:Urethral strictures are more frequent for TURP than with nontransurethral procedures. TURP rarely causes erectile dysfunction. It requires an overnight stay. There is danger of retrograde ejaculation.

A client is to undergo a TURP for BPH. Which statement is accurate with regard to a TURP? Urethral strictures are more frequent for TURP than for nontransurethral procedures. It is done on an outpatient basis. A TURP causes erectile dysfunction. There is no danger of retrograde ejaculation.

Urethral strictures are more frequent for TURP than for nontransurethral procedures. Rationale:Urethral strictures are more frequent for TURP than with nontransurethral procedures. TURP rarely causes erectile dysfunction. It requires an overnight stay. There is danger of retrograde ejaculation.

The nurse instructs a client to perform continuous ambulatory peritoneal dialysis correctly at home. Which educational information should the nurse provide to the client? Clean the catheter insertion site daily with soap. Wear a mask while handling any dialysate solutions. Keep the catheter stabilized to the abdomen, below the belt line. Use an aseptic technique during the procedure.

Use an aseptic technique during the procedure. Rationale:The client should be instructed to use an aseptic technique during the procedure. The client should also demonstrate the continuous ambulatory peritoneal dialysis (CAPD) exchange procedure for the nurse using an aseptic technique (clients on continuous cycling peritoneal dialysis [CCPD] should also demonstrate an exchange procedure in case of failure or unavailability of a cycling machine).

When the bladder contains 400 to 500 mL of urine, this is referred to as specific gravity. renal clearance. functional capacity. anuria.

functional capacity. Rationale:A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 400 to 500 mL of urine, referred to as the "functional capacity." Anuria is a total urine output less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine.

A clinical manifestation related to metastasis from prostate cancer is weight gain. hip pain. thrombocytopenia. polyuria

hip pain. Rationale:Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urine output), and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.

The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.47, PaCO2 45, HCO3 33- pH 7.31, PaCO2 48, HCO3 24- pH 7.50, PaCO2 29, HCO3 22- pH 7.20, PaCO2 36, HCO3 14-

pH 7.20, PaCO2 36, HCO3 14- Rationale:Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3 -) and to reabsorb sodium bicarbonate (HCO3 -). There is also decreased excretion of phosphates and other organic acids.

What is the normal adult bladder capacity? A. 50 to 100 mL B. 100 to 200 mL C. 400 to 500 mL D. 600 to 800 mL

C

The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit? Select all that apply. Calcium 7.5 mg/dL; hypotension and irritability Phosphate 5.0 mg/dL; tachycardia and nausea and emesis Magnesium 1.5 mg/dL; mood changes and insomnia Potassium 6.4 mEq/L; dysrhythmias and abdominal distention Chloride 90 mEq/L; irritability and seizures

Calcium 7.5 mg/dL; hypotension and irritability Phosphate 5.0 mg/dL; tachycardia and nausea and emesis Potassium 6.4 mEq/L; dysrhythmias and abdominal distention Rationale:Decreased calcium, increased potassium, and increased phosphate levels are associated with ESKD, along with the signs and symptoms associated with these serum values. Decreased magnesium and chloride levels are not associated with ESKD.

The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? Normal serum concentration ranges from 135 to 145 mEq/L (135-145 mmol/L). Hallucinations Confusion Headache Nausea

Confusion Rationale: Hyponatremia exists when the serum concentration decreases below 135 mEq/L (135 mmol/L). When the serum sodium concentration decreases to <115 mEq/L (<115 mmol/L), signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur. General manifestations of hyponatremia include poor skin turgor, dry mucosa, headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes, including altered mental status, status epilepticus, and coma, are probably related to cellular swelling and cerebral edema associated with hyponatremia. Hallucinations are associated with increased serum sodium concentrations.

A nurse is working in an oncology treatment center. Which clinical manifestation when reported by a client would the nurse know may be related to metastasis from prostate cancer? Weight gain of 3 pounds in 1 month Large amounts of dilute urine when voiding Constant hip aching and discomfort Frequent nighttime urination

Constant hip aching and discomfort Rationale:Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, oliguria, weight loss, weakness, nausea, and spontaneous pathologic fractures. These symptoms may be the first indications of prostate cancer.

Which value does the nurse recognize as the best clinical measure of renal function? Urine-specific gravity Creatinine clearance Volume of urine output Circulating ADH concentration

Creatinine clearance Rationale:Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching? A. Hemodialysis restores kidney function B. Hemodialysis replaces hormonal function of the renal system C. Hemodialysis allows an unrestricted diet D. Hemodialysis returns a balance to blood electrolytes

D

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? Glomerulonephritis Increased fluid intake Diabetes insipidus Decreased fluid intake

Decreased fluid intake Rationale:When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases. Disorders or conditions that cause decreased urine-specific gravity include diabetes insipidus, glomerulonephritis, and severe renal damage. Disorders that can cause increased specific gravity include diabetes, nephritis, and fluid deficit.

Is the following statement true or false? The incidence of BPH among men older than 50 years of age is 65%.

False it is 50%

A 55-year-old Asian man has a PSA level of 4.8 ng/mL. Based on the client's PSA level, which assessment question does the nurse need to ask? "Do you wear boxers or briefs?" "When was the last time you experienced ejaculation?" "Will you remember to schedule your next PSA test in 1 year?" "How often do you include foods high in purines in your diet?"

"When was the last time you experienced ejaculation?" Rationale:Values of PSA may increase after ejaculation. PSA levels are measured in nanograms per milliliter. In most laboratories, values less than 4.0 ng/mL are generally considered normal, and values greater than 4.0 ng/mL are considered elevated. Foods high in purines place individuals at risk for gout, but purines do not increase PSA levels. Because the client's PSA level is elevated, further assessment is indicated. Type of underwear affects how close the testes are held to the body and may affect male fertility; type of underwear does not affect PSA levels.

The nurse is caring for a client in the intensive care unit (ICU) following a near-drowning event in saltwater. The client is restless, lethargic, and demonstrating tremors. Additional assessment findings include swollen and dry tongue, flushed skin, and peripheral edema. The nurse anticipates that the client's serum sodium value would be 155 mEq/L (155 mmol/L) 145 mEq/L (145 mmol/L) 125 mEq/L (125 mmol/L) 135 mEq/L (135 mmol/L)

155 mEq/L (155 mmol/L) Rationale: The client is experiencing signs and symptoms (S/S) of hypernatremia. Hypernatremia is a serum sodium concentration >145 mEq/L (>145 mmol/L). A cause of hypernatremia is near drowning in seawater (which contains a sodium concentration of approximately 500 mEq/L).

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? 40% 30% 50% 20%

50% Rationale:Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) concentrations.

If they have ESRD they WILL have a fistula for dialysis so what should you do? A.) Just take the blood pressure on either arm? B.) Ask the patient which arm or side it is on/located?

B.) you want to ask the pt which arm it is in and draw the blood and take the BP from the OPPOSITE arm that it is in.

A nurse is teaching a client who will have an x-ray of the KUB (kidneys ureter bladder). Which of the following statements should the nurse include in teaching? A. You will receive contrast dye during the procedure. B. An enema is necessary before the procedure. C. You will need to lie in a prone position during the procedure. D. The procedure will determine whether you have a kidney stone.

D

During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication? Dehydration Renal calculi Hypokalemia Oliguria

Dehydration Rationale:Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with acute kidney injury (AKI) is hyperkalemia.

The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L) and a fluid volume excess. The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving? Change the lactated Ringer solution to 2.5% dextrose. Increase the rate of the intravenous lactated Ringer solution. Change the lactated Ringer solution to 3% saline. Discontinue the intravenous lactated Ringer solution.

Discontinue the intravenous lactated Ringer solution Rationale:The lactated Ringer intravenous (IV) fluid is contributing to both the fluid volume excess and the hyperkalemia.

If you have an AV fistula it is ok to take the BP on the same arm as the AV fistula? True or False

False-• very important to know if you pt has an AV fistula you do not take BP in that arm and you do not draw blood out of that arm bc this contributes to clotting and infection

The nurse cares for a client after extensive abdominal surgery. The client develops an infection that is treated with IV gentamicin. After 4 days of treatment, the client develops oliguria, and laboratory results indicate azotemia. The client is diagnosed with acute tubular necrosis and transferred to the ICU. The client is hemodynamically stable. Which dialysis method would be most appropriate for the client? Hemodialysis Continuous venovenous hemofiltration (CVVH) Continuous arteriovenous hemofiltration (CAVH) Peritoneal dialysis

Hemodialysis Rationale:The client is hemodynamically stable and hemodialysis would be most appropriate. Hemodialysis is used for clients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for clients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) who require long-term or permanent renal replacement therapy. Peritoneal dialysis (PD) may be the treatment of choice for clients with renal failure who are unable or unwilling to undergo hemodialysis or kidney transplantation. CAVH and CVVH are used for client who are hemodynamically unstable.

Which could be a potential cause of respiratory acidosis? Hyperventilation Diarrhea Hypoventilation Vomiting

Hypoventilation Rationale:Respiratory acidosis is always due to inadequate excretion of CO2, with inadequate ventilation, resulting in elevated plasma CO concentration, which causes increased levels of carbonic acid.

Which factor contributes to UTI in older adults? Immunocompromise Sporadic use of antimicrobial agents Low incidence of chronic illness Active lifestyle

Immunocompromise Rationale:Factors that contribute to urinary tract infection in older adults include immunocompromise, high incidence of chronic illness, immobility, frequent use of antimicrobial agents, incomplete emptying of the bladder, and obstructed urine flow.

What is a characteristic of the intrarenal category of acute kidney injury (AKI)? Increased BUN Decreased urine sodium Decreased creatinine High specific gravity

Increased BUN Rationale:The intrarenal category of acute kidney injury (AKI) encompasses an increased BUN, increased creatinine, a low-normal specific gravity of urine, and increased urine sodium. Intrarenal AKI is the result of actual parenchymal damage to the glomeruli or kidney tubules. Acute tubular necrosis (ATN), AKI in which there is damage to the kidney tubules, is the most common type of intrinsic AKI. Characteristics of ATN are intratubular obstruction, tubular back leak (abnormal reabsorption of filtrate and decreased urine flow through the tubule), vasoconstriction, and changes in glomerular permeability. These processes result in a decrease of GFR, progressive azotemia, and fluid and electrolyte imbalances.

Which condition might occur with respiratory acidosis? Decreased blood pressure Increased intracranial pressure Decreased pulse Mental alertness

Increased intracranial pressure Rationale:If respiratory acidosis is severe, intracranial pressure may increase, resulting in papilledema and dilated conjunctival blood vessels. Increased blood pressure, increased pulse, and decreased mental alertness occur with respiratory acidosis.

Which condition might occur with respiratory acidosis? Mental alertness Increased intracranial pressure Decreased blood pressure Decreased pulse

Increased intracranial pressure Rationale:If respiratory acidosis is severe, intracranial pressure may increase, resulting in papilledema and dilated conjunctival blood vessels. Increased blood pressure, increased pulse, and decreased mental alertness occur with respiratory acidosis.

When caring for a client who has risk factors for fluid and electrolyte imbalances, which assessment finding is the highest priority for the nurse to follow up? Blood pressure 96/53 mm Hg Mild confusion Weight loss of 4 lb Irregular heart rate

Irregular heart rate Rationale:Irregular heart rate may indicate a potentially life-threatening cardiac dysrhythmia. Potassium, magnesium, and calcium imbalances may cause dysrhythmias.

Which is an effect of aging on upper and lower urinary tract function? More prone to develop hypernatremia Acid-base balance Increased glomerular filtration rate Increased blood flow to the kidneys

More prone to develop hypernatremia Rationale:The elderly are more prone to develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.

The nurse recognizes what conditions cause elevated prostate-specific antigen (PSA) levels in the absence of prostate cancer. Select all that apply. erectile dysfunction acute prostatitis transurethral resection of the prostate (TURP) benign prostatic hyperplasia (BPH) acute urinary retention

acute prostatitis transurethral resection of the prostate (TURP) benign prostatic hyperplasia (BPH) acute urinary retention

The nurse is analyzing the arterial blood gas (ABG) results of a client diagnosed with severe pneumonia. Which of the following ABG results indicates respiratory acidosis? pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L pH: 7.40, PaCO2: 40 mm Hg, HCO3-: 24 mEq /L pH: 7.50, PaCO2: 30 mm Hg, HCO3-: 24 mEq/L pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L

pH: 7.20, PaCO2: 65 mm Hg, HCO3-: 26 mEq/L Rationale: Respiratory acidosis is a clinical disorder in which the pH is less than 7.35-7.40 and the PaCO2 is greater than 40-45 mm Hg and a compensatory increase in the plasma HCO3- occurs. Respiratory acidosis may be either acute or chronic.The ABG of pH: 7.32, PaCO2: 40 mm Hg, HCO3-: 18 mEq/L indicates metabolic acidosis.The ABGs of pH: 7.50, PaCO2: 30 mm Hg, and HCO3-: 24 mEq/L indicate respiratory alkalosis.The ABGs of pH 7.40, PaCO2: 40 mm Hg, and HCO3-: 24 mEq/L indicate a normal result/no imbalance.

Which arterial blood gas (ABG) result would the nurse anticipate for a client with a 3-day history of vomiting? pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 pH: 7.45, PaCO2: 32 mm Hg, HCO3-: 21 pH: 7.34, PaCO2: 60 mm Hg, HCO3: 34 pH: 7.28, PaCO2: 25 mm Hg, HCO3: 15

pH: 7.55, PaCO2: 60 mm Hg, HCO3-: 28 Rationale:The client's ABG would likely demonstrate metabolic alkalosis. Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+. A common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis, where only gastric fluid is lost

The nurse recognizes what conditions cause elevated prostate-specific antigen (PSA) levels in the absence of prostate cancer. Select all that apply. transurethral resection of the prostate (TURP) acute urinary retention acute prostatitis erectile dysfunction benign prostatic hyperplasia (BPH)

transurethral resection of the prostate (TURP) acute urinary retention acute prostatitis benign prostatic hyperplasia (BPH) Rationale:Acute urinary retention, acute prostatitis, BPH, and recent TURP can cause elevated PSA levels in the absence of prostate cancer.

A client presents to the ED reporting left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing: cystitis. pyelonephritis. Urethral infection. ureteral stones.

ureteral stones. Rationale:The findings are constant with ureteral stones, edema or stricture, or a blood clot