Module 7 Elimination EAQs

Which condition would the nurse suspect in a client who complains of nocturia, bladder pain, urinary frequency, urgency, and dribbling at the end of urination with a digital rectal examination report indicating smooth, firm, and enlarged prostate tissue surrounding the urethra? A. Prostatitis B. Paraphimosis C. Prostate cancer D. Benign prostatic hyperplasia (BPH)

D. Benign prostatic hyperplasia (BPH) Rationale: BPH is a benign enlargement of the prostate gland caused by excessive accumulation of dihydrotestosterone in the prostate cells, which can stimulate cell growth and overgrowth of prostate tissue surrounding the urethra. The clinical manifestations of BPH include nocturia, bladder pain, urinary frequency, urgency, and dribbling at the end of urination. Presence of fever, chills, back pain, and perineal pain, along with acute urinary symptoms such as dysuria, urinary frequency, urgency, and cloudy urine indicate prostatitis, which involves inflammation of the prostate gland. Paraphimosis is a tightness of the penis foreskin that results in the inability to pull the skin forward from a retracted position and prevents normal return of the skin over the glans. Symptoms of prostate cancer include dysuria, hesitancy, urinary urgency, and leaking or dribbling.

Which action would the nurse take in a client who takes rifampin who tells the nurse, "My urine looks orange."? A. Explain that this is expected B. Check the liver enzymes C. Ask the provider to order a urinalysis D. Ask what foods were eaten

A. Explain that this is expected. Rationale: Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. A urinalysis is not indicated for an anticipated finding. The medication, not food, is responsible for the urine color

Which action is responsible for the therapeutic effect of docusate sodium? A. Lubricates the feces B. Creates an osmotic effect C. Stimulates motor activity D. Softens the feces

D. Softens the feces Rationale: The detergent action of docusate sodium promotes the drawing of fluid into the stool, which softens the feces. Lubricating the feces in the gastrointestinal (GI) tract is the action of lubricant laxatives such as mineral oil. Creating an osmotic effect in the GI tract is the action of saline laxatives, such as magnesium hydroxide, or other osmotics, such as lactulose. Stimulating motor activity of the GI tract is the action of peristaltic stimulants, such as cascara.

A client who had a cesarean birth is unable to void 3 hours after the removal of an indwelling catheter. How would the nurse evaluate the client for bladder distension? A. By catheterizing the client for residual urine B. By palpating the client's suprapubic area gently C. By asking the client whether she still feels the urge to urinate D. By determining whether the client is experiencing suprapubic pain

B. By palpating the client's suprapubic area gently Rationale: Palpation will indicate whether bladder distention is present. The increased intraabdominal space available after birth can result in bladder distention without discomfort. Assessment should be done before interventions. Trauma to the area makes surrounding organs atonic; the client may have a full bladder and not feel the urge to void.

Which lifestyle advice does the nurse give to a client when oral digoxin therapy is initiated? A. Bran can decrease digoxin absorption. B. Digoxin should not be taken with hawthorn supplements. C. Ginseng may cause a dangerous increase in digoxin levels in the blood. D. St. John's Wort can increase digoxin levels in the blood. E. Medications that lower serum potassium or magnesium can worsen digoxin toxicity.

A. Bran can decrease digoxin absorption. B. Digoxin should not be taken with hawthorn supplements. C. Ginseng may cause a dangerous increase in digoxin levels in the blood. E. Medications that lower serum potassium or magnesium can worsen digoxin toxicity. Rationale: Consuming large amounts of bran can decrease the absorption of digoxin. Hawthorn may potentiate the effects of digoxin and should be avoided. Ginseng might increase levels of digoxin. Hypokalemia and hypomagnesemia can worsen digoxin toxicity. St. John's Wort can reduce levels of digoxin in the blood.

Which action would the nurse include in the plan of care for a client admitted with heart failure who has gained 20 pounds in 3 weeks? (SATA) A. Diuretics B. Low-salt diet C. Daily weight checks D. Fluid restriction E. Intake and output F. Oxygen administration

A. Diuretics B. Low-salt diet C. Daily weight checks D. Fluid restriction E. Intake and output F. Oxygen administration Rationale: Interventions for a client with heart failure who has sustained a 20-pound weight gain would be focused on decreasing fluid retention. Interventions could include diuretic administration to increase fluid removal; a low-salt diet with fluid restriction; daily weight checks and measuring intake/output; and oxygen administration, particularly if the client has fluid in the lungs.

The nurse provides education related to manifestations of hyperglycemia to a client with type 1 diabetes. Which signs and symptoms, identified by the client, indicate that the teaching was effective? (SATA) A. Thirst B. Headache C. Nervousness D. Fruity breath odor E. Excessive urination

A. Thirst D. Fruity breath odor E. Excessive urination Rationale: Thirst (polydipsia) is associated with hyperglycemia. This is in response to the polyuria associated with hyperglycemia. A fruity odor to the breath is acetone on the breath reflective of the presence of ketones; ketones are a byproduct of fat metabolism in an attempt to meet energy needs because the body is unable to convert glucose to glycogen. Excessive urination occurs when fluid is lost along with glucose as it is excreted in the urine. Headache is associated with hypoglycemia because of central nervous irritation secondary to a low blood glucose level. Nervousness is associated with hypoglycemia because of central nervous system irritation.

Which statement is important for the nurse to teach a client prescribed psyllium 3.5 g twice a day for constipation? A. "Urine may be discolored." B. "Each dose should be taken with a full glass of water." C. "Use only when necessary because it can cause dependence." D. "Daily use may inhibit the absorption of some fat-soluble vitamins."

B. "Each dose should be taken with a full glass of water." Rationale: Because this medication has a strong affinity for fluids, it will swell in the intestine. The large bulk stimulates peristalsis. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna, a stimulant laxative, may discolor urine, not psyllium. Psyllium, a bulk-forming laxative, is among the safest laxatives on the market. It is useful with prolonged therapy because it is not systemically absorbed and is not potent in its action. Prolonged use of lubricant or saline/osmotic laxatives, not bulk-forming laxatives, can inhibit the absorption of some fat-soluble vitamins.

Which order would the nurse identify as a priority nursing action after reviewing the prescriptions for the newly admitted emergency department client with urolithiasis? A. Strain the client's urine. B. Place the client in the high-Fowler position. C. Administer the prescribed morphine. D. Collect a urine specimen for culture and sensitivity

C. Administer the prescribed morphine. Rationale: Pain relief is the priority. Client's report that ureteral colic is excruciatingly painful. Once pain is under control and the client is comfortable, the nurse may implement the other medical and nursing interventions. Although straining all urine is required, pain relief is the priority. Once the client receives the medication for pain control, the nurse will be able to strain the set-aside urine specimen. The high-Fowler position is not necessary. The client can be assisted to assume a position of comfort. The emergency department will have sent the urine to the laboratory for a culture and sensitivity.

A client tells the nurse about recent recurrent episodes of bleeding hemorrhoids. Which instruction would the nurse provide to the client to help prevent future hemorrhoidal episodes? A. Exercise to improve circulation. B. Eat bland foods and avoid spices. C. Consume a high-fiber diet and drink adequate water. D. Use laxatives to avoid constipation and use of the Valsalva maneuver.

C. Consume a high-fiber diet and drink adequate water. Rationale: Consuming a high-fiber diet and drinking adequate water promote regular bowel function, prevent constipation, and prevent straining, which can make hemorrhoids worse; a high-fiber diet provides bulk that stimulates peristalsis, and water promotes a soft stool. Exercise is advisable, but the purpose in this instance is to increase peristalsis, not improve circulation. Bland foods and spices are unrelated to hemorrhoids; bland foods are preferred for clients with gastric or intestinal problems. Laxatives are contraindicated because they are irritating to the bowel, decrease intestinal tone, and promote dependency. The Valsalva maneuver should also be avoided.

Which action will a nurse take when a male client receiving prolonged steroid therapy complains of always being thirsty and urinating frequently? A. Have the client assessed for an enlarged prostate. B. Obtain a urine specimen from the client to test for ketonuria. C. Perform a finger stick to test the client's blood glucose level. D. Assess the client's lower extremities for the presence of pitting edema.

C. Perform a finger stick to test the client's blood glucose level. Rationale: The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention but of hyperglycemia.

Which dietary instruction would be beneficial to a client who has undergone a hypophysectomy and has difficulty passing stools? A. "Drink plenty of water." B. "Eat foods rich in protein." C. "Drink a glass of milk daily." D. "Eat foods rich in carbohydrates.

A. "Drink plenty of water." Rationale: The client should be instructed to drink plenty of water (roughly 8-10 glasses a day) to relieve constipation. Although proteins are required for overall health, proteins will not relieve constipation. Milk may cause constipation in certain individuals. Carbohydrates act as power sources; they do not relieve constipation.

The nurse is teaching a group of adults about the signs and symptoms of colorectal cancer. Which common clinical manifestations would the nurse include in the teaching program? (SATA) A. Anemia B. Rectal pain C. Rectal bleeding D. Change in bowel habits E. Severe abdominal distention

A. Anemia C. Rectal bleeding D. Change in bowel habits Rationale: The most common signs are anemia, rectal bleeding, and a change in stool consistency or shape or change in bowel habits. Abdominal, not rectal, pain can occur. Severe abdominal distention does not occur.

Which principle explains how loop diuretics promote diuresis? A. Osmosis B. Filtration C. Diffusion D. Active transport

A. Osmosis Rationale: Loop diuretics inhibit the reabsorption of sodium and water in the ascending loop of Henle. The increased sodium load in the distal tubule causes the passive transfer of water from the glomerular filtrate to urine through the process of osmosis. Filtration refers to solutes; solutes are not being passed into the urine. Diffusion is not specific to fluid; osmosis is. Active transport requires energy; water is passively moved from tubule cells to the urine.

Which treatment strategy would the nurse conclude is the cause of the diarrhea several days after a health care provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery? A. Loperamide B. Esomeprazole C. Bed rest D. Diet alteration

B. Esomeprazole Rationale: Esomeprazole, a proton-pump inhibitor, may cause diarrhea. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, there is no information presented to support this conclusion.

Which type of urinary condition would cholinergic agonists be prescribed for? A. Kidney stones B. Urine retention C. Spastic bladder D. Urinary tract infections

B. Urine retention Rationale: Cholinergics intensify and prolong the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention. Cholinergics will not prevent renal calculi. Anticholinergics, not cholinergic agonists, are prescribed for the frequency and urgency associated with a spastic bladder. Preventing urinary tract infections is a secondary gain because cholinergics help prevent urinary retention that can lead to a urinary tract infection, but this is not the purpose for administering these medications.

The nurse administers vasopressin to a client and recalls that the medication is which type of hormone? A. Growth hormone B. Luteinizing hormone C. Antidiuretic hormone D. Thyroid-stimulating hormone

C. Antidiuretic hormone Rationale: Vasopressin is an antidiuretic hormone. Somatotropin is a growth hormone. Gonadotropin is a luteinizing hormone. Thyrotropin is a thyroid-stimulating hormone.

Which antidiarrheal medication would the nurse anticipate administering to a client with severe diarrhea who is prescribed intravenous fluids, sodium bicarbonate, and an antidiarrheal medication? A. Psyllium B. Bisacodyl C. Loperamide D. Docusate sodium

C. Loperamide Rationale: Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Docusate sodium corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.

An older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. In addition to sodium, which electrolyte would the nurse be most concerned about? A. Calcium B. Chlorides C. Potassium D. Phosphates

C. Potassium Rationale: Potassium, sodium, and bicarbonate are the electrolytes most often lost with diarrhea. With diarrhea, these electrolytes are excreted via the gastrointestinal tract before they can be absorbed. Hypokalemia can cause cardiac dysrhythmias. Serum calcium levels are related to parathyroid function and calcium metabolism. Although the chloride level may be affected by diarrhea, it is not the greatest concern. Phosphate levels are regulated by calcium metabolism and parathormone.

Which preventative would the nurse anticipate will be prescribed daily to avoid straining due to constipation for a client who has had a recent brain attack (cerebrovascular accident/stroke)? A. Stimulant laxatives such as bisacodyl B. Tap-water enemas C. Stool softener D. Saline laxatives such as magnesium citrate

C. Stool softener Rationale: A stool softener can soften stool and promote defecation, thus avoiding the Valsalva maneuver. Stimulant laxatives are not recommended for daily use because laxative dependency has occurred in some clients. Enemas may precipitate a forcible exhalation against a closed glottis (Valsalva maneuver) during evacuation. Elevated intraabdominal and intrathoracic pressures associated with the Valsalva maneuver increase intracranial pressure and should be avoided. Also, daily enemas promote dependence. Saline laxatives can cause hypermagnesemia if given this frequently

Which hormonal deficiency causes diabetes insipidus in a client? A. Prolactin B. Thyrotropin C. Luteinizing hormone D. Antidiuretic hormone (ADH)

D. Antidiuretic hormone (ADH) Rationale: ADH deficiency causes diabetes insipidus. Decreased levels of prolactin may cause decreased amounts of milk secretion after birth. Decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy. Luteinizing hormone deficiency causes menstrual abnormalities, decreased libido, and breast atrophy.

Which part of the renal system does furosemide exert its effects? A. Distal tubule B. Collecting duct C. Glomerulus of the nephron D. Loop of Henle

D. Loop of Henle Rationale: Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.

The provider has ordered endocrine testing for a client. Arrange the steps to be followed for the urine specimen collection in the correct sequence. 1. Empty bladder and discard the urine 2. The timing for the urine collection begins after this specimen 3. Note the time 4. Empty bladder at the end of the times period and add urine to the collection

Rationale: The procedure to collect urine specimen for endocrine testing involves serial specimens collected over a timed period and begins with emptying the bladder. The initial voiding specimen should be discarded. The client should then note the time at which the specimen is discarded and then begin to collect the urine specimens. At the end of the procedure the client should empty the bladder and add that specimen to the collection.

Which prescribed medication would the nurse anticipate initiating for a client with a Clostridium difficile-associated disease (CDAD)? (SATA) A. Penicillin B. Fidaxomicin C. Ciprofloxacin D. Metronidazole E. Vancomycin

B. Fidaxomicin D. Metronidazole E. Vancomycin Rationale: A new oral antibacterial medication available specifically for managing C. difficile is fidaxomicin. Oral metronidazole and vancomycin have been the medications of choice to treat CDAD. Penicillin is used to treat bacterial infections and not CDAD. Ciprofloxacin has contributed to the development of a new, more virulent strain of this pathogen.

Which statement indicates family understanding of age-related changes and required care after family members received discharge instructions for an older adult male recovering from a urinary tract infection? A. "I place a small glass of water at his side to ensure sipping before bedtime." B. "I respond immediately with the urinal whenever he indicates a need to void." C. "I provide privacy and standby assistance to help him void." D. "I encourage him to use the urinal at least every 2 hours during the day."

C. "I provide privacy and standby assistance to help him void." The family must help the client while he voids and provide privacy to encourage voiding without embarrassment. These measures will promote voiding and prevent urinary retention in the client. Giving the client water to drink just before bed can increase the risk of nocturia. Immediate response to the client when he needs to void reduces the risk of urinary incontinence. Encouraging the client to use the urinal at least every 2 hours helps the client empty the bladder. Voiding at regular intervals reduces the risk of overflow urinary incontinence.

Which prescribed medication will the nurse administer to ensure a bowel movement before discharge for a client who has not had a bowel movement since before surgery, which was 4 days ago? A. Lactulose B. Docusate sodium C. Bisacodyl suppository D. Psyllium

C. Bisacodyl suppository Rationale: A Bisacodyl suppository should produce results before the client leaves the facility; it usually takes effect in 15 to 60 minutes. Lactulose takes about 24 hours to take effect; docusate sodium takes 1 to 3 days; psyllium takes 12 to 24 hours.

A client is admitted with a head injury and has large amounts of clear, colorless urine draining from the urinary catheter. Which physiological response is possibly causing the increased urine output? A. Increased serum glucose B. Deficient renal perfusion C. Inadequate antidiuretic hormone (ADH) secretion D. Excess amounts of intravenous (IV) fluid

C. Inadequate antidiuretic hormone (ADH) secretion Rationale: Deficient ADH from the posterior pituitary results in diabetes insipidus. This can be caused by head trauma; water is not conserved by the body, and excess amounts of urine are produced. Although increased serum glucose may cause polyuria, it is associated with diabetes mellitus, not diabetes insipidus. Ineffective renal perfusion will cause decreased urine production. Although excess amounts of IV fluids may cause dilute urine, it is unlikely that a client with head trauma will be receiving excess fluid because of the danger of increased intracranial pressure.

Which nursing action is a priority before administering prescribed furosemide? A. Weigh the client B. Assess skin turgor C. Review the potassium level results D. Check the 24-hour intake and output.

C. Review the potassium level results Rationale: Although weighing the client, assessing skin turgor, and checking the intake and output are all a part of assessing for hydration, the potassium level should always be checked before administering furosemide. Administering furosemide in the presence of hypokalemia could cause cardiac arrhythmias

Which clinical manifestation would the nurse associate with benign prostatic hyperplasia? A. Perineal edema B. Urethral discharge C. Flank pain radiating to the groin D. Distention of the lower abdomen

D. Distention of the lower abdomen Rationale: Distention of the suprapubic area indicates the bladder is distended with urine and palpable. Perineal edema is not a clinical manifestation of urinary retention and benign prostatic hyperplasia. Urethral discharge typically relates to sexually transmitted infections and may indicate an infection, but not benign prostatic hyperplasia. The discharge would be associated with a urinary infection. Radiating flank pain may indicate renal calculi.

Which medication is the first-line medication used to treat a client with mild diarrhea who is diagnosed with a Clostridium difficile infection? A. Rifaximin B. Fidaxomicin C. Vancomycin D. Metronidazole

D. Metronidazole Rationale: Metronidazole is the first-line treatment prescribed to clients with a Clostridium difficile infection. Rifaximin is used to treat traveler's diarrhea caused by Escherichia coli. Fidaxomicin is reserved for clients who are at risk for the relapse of or have recurrent Clostridium difficile infections. Vancomycin is preferred for serious Clostridium difficile infections.

Which rationale will the nurse provide to a client with Crohn ' s disease who asks why the prescribed vitamins have to be given intravenously (IV) rather than by mouth? A. "They provide more rapid action results." B. "They decrease colon irritability." C. "Oral vitamins are less effective." D. "Intestinal absorption may be inadequate." E. "Allergic responses are less likely to occur."

A. "They provide more rapid action results." C. "Oral vitamins are less effective." D. "Intestinal absorption may be inadequate." Rationale: Absorption through the gastrointestinal (GI) tract is impaired, and parenteral administration goes directly into the intravascular compartment. Disease of the GI tract hampers absorption. Because the mucosa of the intestinal tract is damaged, its ability to absorb vitamins taken orally is greatly impaired. IV vitamins do not decrease colonic irritability. Route of administration does not affect allergic response.

Why is blood glucose self-monitoring preferred over urine glucose testing? A. Blood glucose monitoring is more accurate. B. Blood glucose monitoring is easier to perform. C. Blood glucose monitoring is done by the client. D. Blood glucose monitoring is not influenced by medications.

A. Blood glucose monitoring is more accurate. Rationale: Blood glucose testing is a more direct and accurate measure; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder. Whereas blood and urine testing is relatively simple, testing the blood involves additional knowledge. Both procedures can be done by the client. Whether or not it is influenced by medications is not a factor. Although some urine tests are influenced by medications, there are methods to test urine to bypass this effect.

Which factor would the nurse assess for a client reporting constipation? A. Diet B. Fluid intake C. Use of laxatives D. Date of last bowel movement E. Use of opioid pain medications

A. Diet B. Fluid intake C. Use of laxatives D. Date of last bowel movement E. Use of opioid pain medications Rationale: If a client complains of constipation, the nurse would inquire about factors related to constipation including diet, fluid intake, laxative use, date of last bowel movement, and whether or not the client is taking opioid pain medications.

Which electrolyte deficiency triggers the secretion of renin? A. Sodium B. Calcium C. Chloride D. Potassium

A. Sodium Rationale: Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells. Deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin.

Which medication would the nurse identify as a risk factor for straining due to constipation in a client with a myocardial infarction receiving digoxin, fluoxetine, morphine, and docusate sodium? A. Digoxin B. Morphine C. Docusate D. Fluoxetine

B. Morphine Rationale: Morphine is an opioid. Opioids decrease peristalsis, which may precipitate constipation; straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart. Digoxin is unrelated to intestinal peristalsis and the potential for constipation. Docusate sodium is a stool softener, which would relieve, not cause, constipation. A side effect of fluoxetine is diarrhea, not constipation.

Which structure surrounding the male urethra would the nurse describe to a client scheduled for dilation of the urethra? A. Epididymis B. Prostate gland C. Seminal vesicle D. Bulbourethral gland

B. Prostate gland Rationale: The prostate gland is shaped like a ring, with the urethra passing through its center. The epididymis lies along the top and sides of the testes. The seminal vesicles are on the posterior surface of the bladder. The bulbourethral gland lies below the prostate.

For which condition is an adult client with a weakened urinary sphincter at risk? A. Bladder distention B. Skin irritation C. Tendency to fall D. Urinary retention

B. Skin irritation Rationale: The weakening of the urinary sphincter results in involuntary dribbling of urine, which increases the risk of skin irritation and infections. Maintaining thorough hygiene in the perineum area reduces the chance of occurrence of infection or skin rash. The nurse should observe for signs of bladder distention in clients who have a tendency to retain urine. Keeping a bedside light at night is an intervention to prevent night falls in clients who have nocturia. A weakened urinary sphincter will cause loss of urine.

Which genitourinary factor contributes to urinary incontinence in older adult clients and needs to be considered by the nurse when planning the care for these clients? A. Sensory deprivation B. Urinary tract infection C. Frequent use of diuretics D. Inaccessibility of a bathroom

B. Urinary tract infection Rationale: Urinary incontinence in older adults can be a sign of urinary tract infection. Urinary tract infections affect the genitourinary tract and interfere with voluntary control of micturition. Sensory deprivation is a neurological, not a genitourinary, factor. Frequent use of diuretics is an iatrogenic, not genitourinary, factor. Inaccessibility of a bathroom is an environmental, not genitourinary, factor.

Which test would the nurse check to determine whether a transplanted kidney is functioning? A. White blood cell (WBC) cell count B. Renal ultrasound C. Serum creatinine level D. 24-hour urinary output

C. Serum creatinine level Rationale Serum creatinine concentration measures the kidney's ability to excrete metabolic wastes. Creatinine, a nitrogenous product of protein breakdown, is increased with renal insufficiency. WBC count does not measure kidney function; white blood cells usually are depressed because of immunosuppressive therapy to prevent rejection. Renal ultrasound is more valuable for assessing structure than function. Although 24- hour urinary output should be considered, it is not as definitive as the serum creatinine level.

Which mechanism of action explains how diuretics reduce blood pressure? A. They facilitate vasodilation. B. They promotes smooth muscle relaxation. C. They reduce the circulating blood volume. D. They block the sympathetic nervous system

C. They reduce the circulating blood volume. Rationale: Diuretics decrease blood volume by blocking sodium reabsorption in the renal tubules, thus promoting fluid loss and reducing arterial pressure. Direct relaxation of arteriolar smooth muscle is accomplished by vasodilators, not diuretics. Vasodilators, not diuretics, act on vascular smooth muscle. Medications that act on the nervous system, not diuretics, inhibit sympathetic vasoconstriction.

Which factor may contribute to a client developing urinary calculi? A. Increased fluid intake B. Urine specific gravity of 1.017 C. Jogging 3 miles (4.8 km) a day D. History of hyperparathyroidism

D. History of hyperparathyroidism Rationale: Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles (4.8 km) daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.

Which new prescription will the nurse question when reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea? A. Oral psyllium B. Oral potassium supplement C. Intravenous normal saline D. Magnesium citrate

D. Magnesium citrate Rationale: Oral psyllium will absorb the watery diarrhea, giving more bulk to the stool. An oral potassium supplement is appropriate because diarrhea causes potassium loss. Intravenous normal saline is the intervention of choice to manage dehydration due to diarrhea. Magnesium citrate has a laxative effect and would worsen the client's dehydration.

The nurse is caring for a client with type 2 diabetes mellitus and renal insufficiency. The client is scheduled for a computerized tomography (CT) scan with contrast. Which medication would the nurse withhold to prevent lactic acidosis? A. Pioglitazone B. Insulin C. Glyburide D. Metformin

D. Metformin Rationale: The metformin would be held in clients with renal impairment, as this medication along with contrast dye can cause lactic acidosis. Pioglitazone, insulin, and glyburide do not cause lactic acidosis.

Which prescription by the health care provider would the nurse question when caring for a client who is hospitalized for an acute myocardial infarction? A. Long-acting beta blocker B. Daily low-dose aspirin tablet C. H 1 blocker to reduce gastric acid secretions D. Rectal suppository as needed for constipation

D. Rectal suppository as needed for constipation Rationale: Rectal stimulation can stimulate the vagus nerve and cause bradycardia and is avoided in clients who have had myocardial infarction. Long-acting beta blockers are commonly prescribed after myocardial infarction to prevent cardiac remodeling and heart failure. Low-dose aspirin is typically prescribed to clients with coronary artery disease or myocardial infarction to prevent new coronary artery thrombus from forming. H 1 blockers are frequently prescribed to hospitalized clients to prevent formation of stress-related gastric ulcers

Which mechanism would a nurse recall when caring for a client prescribed bisacodyl for constipation? A. Producing bulk B. Softening feces C. Lubricating feces D. Stimulating peristalsis

D. Stimulating peristalsis Rationale: Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. Bisacodyl is not a bulk cathartic. Bulk-forming laxatives, such as psyllium hydrophilic mucilloid, form soft, pliant bulk that promotes physiological peristalsis. Bisacodyl is not a stool softener. Stool softeners, such as docusate sodium, permit fat and water to penetrate feces, which softens and delays the drying of the feces. Bisacodyl is not an emollient. Emollient laxatives, such as mineral oil, lubricate the feces and decrease absorption of water from the intestinal tract.

Which suggestion would the nurse provide to the parent whose child has been constipated for 3 days? (SATA) A. Give laxatives to the child. B. Reduce the child's fluid intake. C. Include dairy products in the child's diet daily. D. Increase the child's physical activity. E. Include food with a high fiber content in the child's diet.

A. Give laxatives to the child. D. Increase the child's physical activity. E. Include food with a high fiber content in the child's diet. Rationale: Constipation is the infrequent and difficult passage of stools, but it can be managed by following certain measures. Laxatives may help ease the passage of stools to relieve constipation. Bowel movements can also be promoted by increasing physical activity and adding fiber to the diet to add bulk to the stool to relieve constipation. Low fluid intake and consumption of dairy products can increase the risk for constipation.

Which finding indicates that a client is at an increased risk for colorectal cancer (CRC)? (SATA) A. Presence of dark, tarry stools B. Family history of polyposis C. 20-year history of ulcerative colitis D. Unintentional 20-pound weight loss E. Change in bowel pattern for 3 months

A. Presence of dark, tarry stools B. Family history of polyposis C. 20-year history of ulcerative colitis D. Unintentional 20-pound weight loss E. Change in bowel pattern for 3 months Rationale: Dark, tarry stools; a family history of polyposis; a 20-year history of ulcerative colitis; unintentional weight loss of 20 pounds; and a change in bowel patterns lasting 3 months are all findings that would warrant further evaluation for CRC. All of these clients are at higher risk for CRC. Dark, tarry stools occur from occult blood loss. A client who reports a longstanding change in bowel pattern should be tested for CRC. Familial polyposis is a precursor to CRC. Ulcerative colitis is an inflammatory bowel disease that increases the client's risk for CRC. Any client who experiences an unexplained and unintentional weight loss should be evaluated for cancer.

Which intervention is indicted as initial treatment for a client who had a hemorrhoidectomy? A. Giving an enema B. Applying moist heat C. Administering stool softeners D. Encouraging sitz baths E. Providing occlusive dressings to the area

B. Applying moist heat C. Administering stool softeners D. Encouraging sitz baths Rationale Moist heat dilates the blood vessels, thereby increasing circulation to the area; this is soothing and promotes healing. Stool softeners are prescribed to avoid straining on defecation and constipation. Baths, especially sitz baths, are advised to promote healing and cleaning of the area. Enemas and occlusive dressings are not used.

Which information would the nurse include when teaching about why women are more susceptible to urinary tract infections than men? A. Inadequate fluid intake B. Poor hygienic practices C. The length of the urethra D. The disruption of mucous membranes

C. The length of the urethra Rationale: The length of the urethra is shorter in women than in men; therefore microorganisms have a shorter distance to travel to reach the bladder. The proximity of the meatus to the anus in women also increases the incidence of urinary tract infections. Fluid intake may or may not be adequate in both men and women and does not account for the difference. Hygienic practices can be inadequate in men or women. Mucous membranes are continuous in both men and women.

Which condition is it most important for the nurse to assess for in a client admitted to the hospital for acute gastritis and ascites secondary to alcohol use and cirrhosis? A. Nausea B. Blood in the stool C. Food intolerances D. Hourly urinary output

B. Blood in the stool Rationale: Erosion of blood vessels may lead to hemorrhage, a life-threatening situation further complicated by decreased prothrombin production, which occurs with cirrhosis. Although increased intra-abdominal pressure because of ascites may precipitate nausea, there is no immediate threat to life. Although food intolerances should be identified, there is no immediate threat to life. Hourly urine output measurements are unnecessary.

Which finding for a client with pulmonary edema who received furosemide is the best indicator that the treatment has been effective? A. Urine output over 1 hour is 200 mL. B. Oxygen saturation per pulse oximetry is 99%. C. Cardiac monitor shows sinus rhythm, rate 98 beats/minute. D. No jugular vein distention is seen with head elevated to 90 degrees

B. Oxygen saturation per pulse oximetry is 99%. Rationale: Because pulmonary congestion associated with pulmonary edema causes severe hypoxemia, the client's oxygen saturation is the best indicator of effective treatment. A good urine output also shows that furosemide is effective, but is not as clear an indicator of improvement in pulmonary edema as the high oxygen saturation. Tachycardia is a common finding with pulmonary edema and having a heart rate in the high normal range may indicate improvement in the client's condition, but improvement in pulmonary parameters is a better indicator for this client. Jugular vein distension is an indicator of right heart failure, whereas pulmonary edema is caused by left ventricular failure.

Which intervention would the nurse implement when providing care for an older adult male client who is immobile and incontinent of urine? A. Restrict the client's fluid intake. B. Regularly offer the client a urinal. C. Apply incontinence pants. D. Insert an indwelling urinary catheter.

B. Regularly offer the client a urinal. Rationale: Regularly offering the urinal is the first step. Retraining the bladder includes a routine pattern of attempts to void, which may increase bladder muscle tone and produce a conditioned response. Restricting fluid intake can result in dehydration and a urinary tract infection in an older client. Applying incontinence pants does not address the cause of the incontinence, promotes skin breakdown, and may lower the client's selfesteem. Inserting an indwelling urinary catheter increases the risk of a urinary tract infection. Insertion of an indwelling urinary catheter requires a primary health care provider's prescription.

Which rationale explains the purpose of administering diphenoxylate hydrochloride to clients with acquired immunodeficiency syndrome (AIDS)? A. To manage pain B. To manage diarrhea C. To manage candidal esophagitis D. To manage behavioral problems

B. To manage diarrhea Rationale: Diphenoxylate hydrochloride is an antidiarrheal medication prescribed to clients with AIDS to manage frequent diarrhea experienced by a client with AIDS. Opioid analgesics such as tramadol are used to manage pain. Ketoconazole can be used to treat candidal esophagitis associated with AIDS. Behavioral problems are managed with psychotropic medications.

The nurse observes that a client' s urine has a sweet fruity odor. Which information is important to evaluate when performing a further client assessment? A. Vital signs B. Fluid balance C. Serum glucose level D. Dietary calorie count

C. Serum glucose level Rationale: Sweet fruity-smelling urine is an indicator of ketoacidosis, which can result from uncontrolled diabetes. Hyperglycemia and hypoglycemia are assessed by serum glucose monitoring. Vital signs, fluid imbalance, and dietary counts have no relation to sweet fruity-smelling urine.

Which action by the nurse would be best when a client who has been admitted with pulmonary edema and received furosemide intravenously needs to void? A. Place the client on a bedpan. B. Use adult diapers for the client. C. Help the client walk to the bathroom. D. Assist the client to a bedside commode.

D. Assist the client to a bedside commode. Rationale: Assisting the client to a bedside commode allows the client to keep the head elevated, which is needed in clients with pulmonary edema to improve oxygenation. Placing a bedpan will require that the head of the bed be lowered so that the bedpan can be placed and will increase the client's work of breathing. Using adult diapers on client who is not incontinent is disrespectful and demeaning to the client. Having the client walk to the bathroom will increase cardiac workload, which should be avoided in clients with pulmonary edema.

How does sodium biphosphate, prescribed for a client before a colonoscopy, accomplish its therapeutic effect? A. Irritates the intestinal mucosa B. Provides water-absorbing bulk C. Softens stool by exerting a detergent effect D. Increases osmotic pressure in the intestines

D. Increases osmotic pressure in the intestines Rationale: Sodium biphosphate is a saline (hypertonic) cathartic that increases osmotic pressure within the intestine so that body fluids are drawn into the bowel, stimulating bowel stretching, peristalsis, and defecation. Intestinal stimulants increase peristalsis by irritating the mucosa. Bulk-forming laxatives are cellulose derivatives that remain in the intestinal tract and absorb water; they stimulate peristalsis by increasing bulk. Emollients have a detergent action, softening stool by facilitating its absorption of water.

Which nursing intervention would help an older adult experiencing urinary incontinence? (SATA) A. Provide nutritional support. B. Provide voiding opportunities. C. Avoid indwelling catheterization. D. Provide beverages and snacks frequently. E. Promote measures to prevent skin breakdown

B. Provide voiding opportunities. C. Avoid indwelling catheterization. E. Promote measures to prevent skin breakdown Rationale: An older adult should be provided voiding opportunities to minimize urinary incontinence. Indwelling catheterization should be avoided because this action increases the risk of infection, weakens bladder tone, and may cause discomfort. Measures to prevent skin breakdown should be taken because the client may develop skin problems due to incontinence. Nutritional support and frequent beverages and snacks should be provided to a client with malnutrition.

Which statement is important for the nurse to include in the teaching plan of a client with irritable bowel syndrome who has instructions to take psyllium for constipation? A. "Urine may be discolored." B. "Stop taking the laxative once a bowel movement occurs." C. "Each dose should be taken with a full glass of water or juice." D. "Daily use may inhibit the absorption of some fat-soluble vitamins."

C. "Each dose should be taken with a full glass of water or juice." Rationale: This bulk-forming laxative works by absorbing water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna, a stimulant laxative, may cause urine discoloration. Bulk-forming laxatives, such as psyllium, are the only laxatives that are recommended for long-term use and in cases of irritable bowel syndrome; they are used to prevent constipation and should not be stopped once a bowel movement occurs. Prolonged use of lubricant laxatives, such as mineral oil, can inhibit the absorption of some fat-soluble vitamins.

Which manifestations are exhibited with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? A. Increased blood urea nitrogen (BUN) and hypotension B. Hyperkalemia and poor skin turgor C. Hyponatremia and decreased urine output D. Polyuria and increased specific gravity of urine

C. Hyponatremia and decreased urine output Rationale: Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.