Renal and Surgical

Which statement by a 57-year-old postoperative client suggests that he is ready to learn how to care for his new ileostomy? "I think I'll be able to wear one of those pouches my doctor told me about without any problems. What do you think, Nurse?" "I want to know all about my ileostomy, right after you give me my pain medication." "I suppose I have to learn how to take care of this thing eventually, but it sure is disgusting."

"I think I'll be able to wear one of those pouches my doctor told me about without any problems. What do you think, Nurse?"

A client has developed acute renal failure (ARF) as a complication of glomerulonephritis. The nurse assesses the client for which of the following as an expected manifestation of ARF? 1. Hypertension 2. Bradycardia. 3. Decreased cardiac output 4. Decreased central venous pressure

1. ARF caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of ARF is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. ARF from prerenal causes is characterized by decreased blood pressure, or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

A nurse is reviweing the medication record of a client diagnosed with chronic renal failure (CRF). The nurse notes that the client is receiving aluminum hydroxide (Amphojel). The nurse determines that the purpose of this medication is to: 1. Combine with phosphorus and help eliminate phosphates from the body. 2. Prevent ulcers. 3. Promote the elimination of potassium from the body. 4. Prevent constipation

1. Aluminum hydroxide binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose of its use in the client with renal failure.

The client with chronic renal failure has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. The nurse should immediately: 1. Change the dressing. 2. Reinforce the dressing. 3. Flush the peritoneal dialysis catheter. 4. Scrub the catheter with providone-iodine.

1. Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance. Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time of connection or disconnection of peritoneal dialysis.

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which of the following lab tests? 1. Partial thromboplastin time (PTT) 2. Prothrombin time (PT) 3. Thrombin time (TT) 4. Bleeding time

1. Heparin is the anticoagulant used most often during hemodialysis. The hemodialysis nurse monitors the extent of anticoagulation by checking the PTT, which is the appropriate measure of heparin effect. The PT is used to monitor the effect of warfarin (Coumadin) therapy. Thrombin and bleeding times are not used to measure the effect of heparin therapy, although they are useful in the diagnosis of other clotting abnormalities.

Following a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. The nurse interprets this complaint and further assesses the client for: 1. Bleeding. 2. Infection. 3. Renal colic. 4. Bladder perforation.

1. If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding should be suspected. Hypotension, a decreasing hematocrit level, and gross or microscopic hematuria also would indicate bleeding. Signs of infection would not appear immediately following a biopsy. The biopsy site would be the flank area and not the lower abdomen. No data are given to support the presence of renal colic.

The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The priority action for the nurse is to: 1. Discontinue dialysis and notify the physician. 2. Monitor vital signs every 15 minutes for the next hour. 3. Continue dialysis at a slower rate after checking the lines for air. 4. Bolus the client with 500 mL of normal saline to break up the embolus.

1. If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed. Options 2, 3, and 4 are incorrect.

A nursing student is assigned to care for a client with a diagnosis of acute renal failure, diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which of the following statements if made by the nursing student would indicate an adequate understanding of the treatment plan for this client? 1. Prevent loss of electrolytes. 2. Reduce the urine specific gravity. 3. Promote the excretion of wastes. 4. Prevent fluid overload

1. In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 2, 3, and 4 are not the primary concerns in this phase of renal failure.

The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the menu? 1. Cream of wheat, blueberries, coffee 2. Sausage and eggs, banana, orange juice. 3. Bacon, cantaloupe melon, tomato juice. 4. Cured pork, grits, strawberries, orange juice.

1. The diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3, and 4 are high in sodium, phosphorus and potassium.

The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis? 1. Maintain strict aseptic technique. 2. Add heparin to the dialysate solution. 3. Change the catheter site dressing daily. 4. Monitor the client's level of consciousness.

1. The major complication of peritoneal dialysis is peritonitis. Strict aseptic technique is required in caring for the client receiving this treatment. Although option 3 may assist in preventing infection, this option relates to an external site. Options 2 and 4 are unrelated to the major complication of peritoneal dialysis.

A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1. Palpation of a thrill over the fistula. 2. Presence of a radial pulse in the left wrist. 3. Absence of a bruit on auscultation of the fistula. 4. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand.

1. The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the presence of a radial pulse in the left wrist and capillary refill shorter than 3 seconds in the nail beds of the fingers on the left hand are normal findings, they do not assess fistula patency.

The nurse monitoring a client receiving peritoneal dialysis notes that the clietn's outflow is less than the inflow. Select all nursing actions in the situation that apply. 1. Contact the physician. 2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

2, 3, 4, 5. If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing and peritoneal dialysis system are also checked for kinks or twisting and the clamps on the system are checked to ensure that they are open. There is no reason to contact the physician. Increasing the flow rate is an inappropriate action and is not associated with the amount of outflow solution.

A client with chronic renal failure has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse interprets that these assessment data are compatible with: 1. Phosphate overdose 2. Aluminum intoxication 3. Advancing uremia 4. Folic acid deficiency

2. Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of: 1. Infection. 2. Hyperglycemia. 3. Hypophosphatemia. 4. Disequilibrium syndrome.

2. An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis.

The client is admitted to the emergency department following a motor vehicle accident. The client was wearing a lap seat belt when the accident occurred and now the client has hematuria and lower abdominal pain. To assess further whether the pain is caused by bladder trauma, the nurse asks the client if the pain is referred to which of the following area? 1. Hip 2. Shoulder 3. Umbilicus 4. Costovertebral angle

2. Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of the shoulders. Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or hip.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action? 1. Monitor the client. 2. Notify the physician. 3. Elevate the head of the bed. 4. Medicate the client for nausea.

2. Disequilibrium syndrome may be caused by the rapid decreases in the blood urea nitrogen level during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The physician must be notified.

Epoetin alfa (Epogen) is prescribed for a client diagnosed with chronic renal failure. The client asks the nurse about the purpose of the medication. The appropriate response would be which of the following? 1. It is used to lower your blood pressure. 2. It is used to treat anemia. 3. It will help to increase the potassium level in your body. 4. It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity.

2. Epoetin alfa is a medication that is used to treat anemia. Options 1, 3, and 4 are incorrect. Hypertension is a side effect. Hyperkalemia and seizures are adverse effects of the medication.

A client undergoing hemodialysis has an arteriovenous (AV) fistula in the left arm. A related nursing diagnosis for the client is risk for infection. The nurse should formulate which of the following outcome goals as most appropriate for this nursing diagnosis? 1. The client's temperature remains less than 101F 2. The client's WBC count remains within normal limits. 3. The client washes hands at least once per day. 4. The client states to avoid blood pressure measurement in the left arm.

2. General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the nursing diagnosis risk for injury.

A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this disease. The nurse determines that the client needs additional teaching if the client states that the treatment plan includes: 1. Genetic counseling. 2. Sodium restriction. 3. Increased water intake. 4. Antihypertensive medications.

2. Individuals with polycystic kidney disease seem to waste rather than retain sodium. Thus, they need increased sodium and water intake. Aggressive control of hypertension is essential. Genetic counseling is advisable because of the hereditary nature of the disease.

A client is admitted to the hospital with a diagnosis of early-stage chronic renal failure. Which of the following should the nurse expect to note on client assessment? 1. Anuria. 2. Polyuria. 3. Oliguria. 4. Polydypsia.

2. Polyuria occurs early in chronic renal failure and, if untreated, can cause severe dehydration. Polyuria progresses to anuria, and the client loses all normal kidney functions. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic renal failure.

The hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse assesses this client for which of the following manifestations? 1. Warmth, redness, and pain in the left hand. 2. Pallor, diminished pulse, and pain in the left hand. 3. Edema and reddish discoloration of the left arm. 4. Aching pain, pallor, and edema of the left arm.

2. Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth, redness, and pain probably would characterize a problem with infection. The manifestations described in options 3 and 4 are incorrect.

The client with acute renal failure has a serum potassium level of 6.0 mEq/L. The nurse would plan which of the following as a priority action? 1. Check the sodium level. 2. Place the client on a cardiac monitor. 3. Encourage increased vegetables in the diet. 4. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.

2. The client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Vegetables are a natural source of potassium in the diet, and their use would not be increased. The nurse also may assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action of the nurse.

The client who has a history of gout also is diagnosed with urolithiasis and the stones are determined to be of uric acid type. The nurse gives the client instructions in which foods to limit, including: 1. Milk 2. Liver 3. Apples 4. Carrots

2. The client with uric acid stones should avoid foods containing high amounts of purines. This includes limiting or avoiding organ meats such as liver, brain, heart, kidney, and sweetbreads. Other foods to avoid include herring, sardines, anchovies, meat extracts, consommés, and gravies. Foods that are low in purines include all fruits, many vegetables, milk, cheese, eggs, refined cereals, sugars and sweets, coffee, tea, chocolate, and carbonated beverages.

A client has been admitted to the hospital for urinary tract infection an dehydration. The nurse determines that the client has received adequate volume replacement if the BUN drops to: 1. 3 mg/dL 2. 15 mg/dL 3. 29 mg/dL 4. 35 mg/dL

2. The normal blood urea nitrogen level is 8 to 25 mg/dL. Values such as those in options 3 and 4 reflect continued dehydration. Option 1 reflects a lower than normal value, which may occur with fluid volume overload, among other conditions.

The client who has suffered a crush injury to the leg has a highly positive urine myoglobin level. The nurse assesses this particular client carefully for signs of: 1. Brain attack (stroke) 2. Acute tubular necrosis 3. Respiratory failure 4. Myocardial infarction

2. The normal urine myoglobin level is negative. After extensive muscle destruction or damage, myoglobin is released into the bloodstream, where it is cleared from the body by the kidneys. When there is a large amount of myoglobin being cleared from the body, there is a risk of the renal tubules being clogged with myoglobin, causing acute tubular necrosis. This is one form of acute renal failure.

The client with urolithiasis has a history of chronic urinary tract infections. The nurse plans teaching the client to avoid which of the following? 1. Long-term use of antibiotics. 2. Wearing synthetic underwear and pantyhose. 3. High--phosphate foods, such as dairy products. 4. Foods that make the urine more acidic, such as cranberries.

2. Urolithiasis (struvite stones) can result from chronic infections. They form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Teaching should focus on prevention of infections and ingesting foods to make the urine more acidic. The client should wear cotton (not synthetic) underclothing to prevent the accumulation of moisture and to prevent irritation of the perineal area, which can lead to infection.

To prevent thromboembolism in the post-op client the nurse should include which of the following in the plan of care? Place a pillow under the knees and restrict fluids. Use strict aseptic technique including handwashing and sterile dressing technique Assess bowel sounds in all four quadrants on every shift and avoid early ambulation Assess for Homan's signs on every shift, encourage early ambulation, and maintain adequate hydration.

Assess for Homan's signs on every shift, encourage early ambulation, and maintain adequate hydration.

The client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of: 1. Pyelonephritits 2. Glomerulonephritis 3. Trauma to the bladder or abdomen 4. Renal cancer in the client's family

3. Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather pain would be in the flank area.

A nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which of the following statements if made by the client indicates an accurate understanding of CAPD? 1. A portable hemodialysis machine is used so that I will be able to ambulate during the treatment. 2. A cycling machine is used so the risk for infection is minimized. 3. No machinery is involved, and I can pursue my usual activities. 4. The drainage system can be used once during the day and a cycling machine for 3 cycles at night.

3. CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse bases the response on knowing that the glucose: 1. Decreases the risk of peritonitis. 2. Prevents disequilibrium syndrome. 3. Increases osmotic pressure to produce ultrafiltration. 4. Prevents excess glucose from being removed from the client.

3. Increasing the glucose concentration makes the solution more hypertonic. The more hypertonic the solution, the higher the osmotic pressure for ultrafiltration and thus the greater the amount of fluid removed from the client during an exchange. Options 1, 2, and 4 do not identify the purpose of the glucose.

The nurse is caring for the client who has undergone renal angiography using the left femoral artery for access. The nurse determines that the client is experiencing a complication of the procedure if which of the following is observed? 1. Urine output, 50 mL/hr 2. Blood pressure, 110/74 mm Hg 3. Pallor and coolness of the left leg. 4. Absence of hematoma in the left groin.

3. Potential complications after renal angiography include allergic reaction to the dye, renal damage from the dye, and vascular complications, which include hemorrhage, thrombosis, or embolism. The nurse detects these complications by noting signs and symptoms of allergic reaction, decreased urine output, hematoma or hemorrhage at the insertion site, and/or signs of decreased circulation to the affected leg.

The client with chronic renal failure returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 100.2F. Which of the following is the appropriate nursing action? 1. Encourage fluids. 2. Notify the physician. 3. Continue to monitor vital signs. 4. Monitor the site of the shunt for infection.

3. The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity determinations.

The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information if the client states to record daily the: 1. Amount of activity. 2. Pulse and respiratory rate. 3. Intake and output and weight. 4. Blood urea nitrogen and creatinine levels.

3. The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily. Ideally, the hemodialysis client should not gain more than 0.5 kg of weight/day.

A client diagnosed with chronic renal failure (CRF) is scheduled to begin hemodialysis. The nurse assesses that which of the following neurological and psychosocial manifestations if exhibited by this client would be unrelated to the CRF? 1. Labile emotions. 2. Withdrawal. 3. Euphoria. 4. Depression.

3. The client with CRF often experiences a variety of psychosocial changes. These are related to uremia, as well as the stress associated with living with a chronic disease that is life-threatening. Clients with CRF may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur. Euphoria is not part of the clinical picture for the client in renal failure.

An adult client has had lab work done as part of a routine physical exam. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted? 1. 0.2 mg/dL 2. 0.5 mg/dL 3. 1.9 mg/dL 4. 3.5 mg/dL

3. The normal serum creatinine level for adults is 0.6 to 1.3 mg/dL. The client with a mild degree of renal insufficiency would have a slightly elevated level. A creatinine level of 0.2 mg/dL is low, and a level of 0.5 mg/dL is just below normal. A creatinine level of 3.5 mg/dL may be associated with acute or chronic renal failure.

The client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. The priority nurse action would be to: 1. Check the shunt for the presence of bruit and thrill. 2. Observe the site once as time permits during the shift. 3. Check the results of the prothrombin times as they are determined. 4. Ensure that small clamps are attached to the arteriovenous shunt dressing.

4. An arteriovenous shunt is a less common form of access site but carries a risk for bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site for use if needed. The shunt site also should be assessed at least every 4 hours.

A client is schedule for a excretory urogram. Which of the following would the nurse expect to be prescribed as a component of preparation for this test? 1. NPO status after midnight. 2. Administration of a sedative before the test. 3. Administration of intravenous fluids. 4. Bowel preparation to remove fecal contents.

4. An excretory urogram is an invasive test that uses contrast radiopaque dye to assess the ability of the kidneys to excrete dye in the urine. Bowel preparation is necessary to permit adequate visualization of the kidneys, ureters, and bladder. Options 1, 2, and 3 usually are not components of preparation for this test.

The client with chronic renal failure is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication: 1. During dialysis. 2. Just before dialysis. 3. The day after dialysis. 4. On return from dialysis.

4. Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire day to resume the medication. This would lead to ineffective control of the blood pressure.

A nurse is caring for a client with acute renal failure (ARF). When performing an assessment, the nurse would expect to note which of the following breathing patterns? 1. Decreased respirations. 2. Apneic 3. Cheyne-Stokes 4. Kussmaul's

4. Clinical manifestations associated with ARF occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul's respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. Options 1, 2, and 3 are not characteristic of ARF.

The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for: 1. Hypertension, tachycardia, and fever. 2. Hypotension, bradycardia, and hypothermia. 3. Restlessness, irritability, and generalized weakness. 4. Headache, deteriorating level of consciousness, and twitching.

4. Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

A nurse is analyzing the posthemodialysis lab test results for a client with chronic renal failure (CRF). The nurse interprets that the dialysis is having an expected but nontherapeutic effect if the results indicate a decreased: 1. Phosphorus. 2. Creatinine. 3. Potassium. 4. Red blood cell count

4. Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia, because RBCs are lost in dialysis from blood sampling and anticoagulation during the procedure, and from residual blood that is left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process.

A client newly diagnosed with renal failure has just been started on peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate? 1. Stop the dialysis. 2. Slow the infusion. 3. Decrease the amount to be infused. 4. Explain that the pain will subside after the first few exchanges.

4. Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment. The infusion amount should not be decreased, and the infusion should not be slowed or stopped.

On the second post-op day following an inguinal herniorrhaphy, the nurse assessing a client's wound would expect to find A small amount of serous drainage, edges approximated, and a pink color. A large amount of sanguineous drainage and edges pink in color. No drainage, the edges brown and coming apart. A Penrose drain putting out large amounts of serosanguineous drainage.

A small amount of serous drainage, edges approximated, and a pink color.

The physician progress note indicated a plan to let a client's wound heal by tertiary intention. The nurse determines that healing has occurred when which of the following is observed? Wound is smaller but irregular Very little scarring has occurred Tissue loss prevents edges from approximating A wide scar is present over the area of wound closure.

A wide scar is present over the area of wound closure.

The nurse is caring for a client who underwent a total hip replacement yesterday. Which of the following assessments is not indicated for this client at this time? Presence of Homan's sign Ability to flex and adduct affected hip Temperature Complaints of pain

Ability to flex and adduct affected hip

An adult underwent a below-the-knee amputation 4 days ago. He is complaining of burning crushing pain in his amputated foot. What is the best action for the nurse to take in relation to administering his ordered pain medication? Explain to the client that he really is not having pain and encourage him to wait until later for his pain medication. Acknowledge the client's pain and administer the pain medication. Acknowledge the client's pain, but tell him he really shouldn't use pain medication for his pain. Explain to the client that he really is not having pain and administer his pain medication.

Acknowledge the client's pain and administer the pain medication.

A client who is scheduled for an outpati9ent surgical procedure arrives at the hospital. During the preoperative assessment, the nurse smells alcohol on the client's breath. The nurse reports this finding to the surgeon, prior to completing the preoperative assessment, after drawing which conclusion about the significance of this finding? Alcohol can affect the client's response to anesthesia and surgery. Alcohol can increase the risk for respiratory complications. Use of sedatives and hypnotics prior to surgery can decrease the alcohol effects. Physiological and psychological responses are slowed down by recent alcohol intake.

Alcohol can affect the client's response to anesthesia and surgery.

A woman underwent a D & C under general anesthesia. She was placed in lithotomy position during surgery. Because she was placed in lithotomy position, what assessment is essential in the immediate postoperative period? Check pulses. Check presence of sensation in lower extremities. Check for foot drop. Check blood pressure.

Check blood pressure.

A 68-year-old client is undergoing an endoscopy, which will require conscious sedation. Which of the following findings in her history indicates the need for further assessment? Allergic to bee stings Hypertension Gastrointestinal bleed Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease

A client experiences would dehiscence when coughing. After assisting the client to a low Fowler's position with legs slightly elevated, what is the next best action? Push the internal organs back into the abdominal opening. Cover the wound with a moist hydrocolloid dressing. Cover the wound with a sterile, saline-moistened dressing. Use Steri-Strips to hold the wound together.

Cover the wound with a sterile, saline-moistened dressing.

The nurse is caring for clients in the preanesthesia room. the nurse notes one client, who is an older adult, has an increased surgical risk based on which of the following factors? Decreased kidney function leading to potential fluid and electrolyte imbalances Increased hunger sensation leading to postoperative complications from hyperacidity Inability to comprehend the seriousness of surgical interventions leading to noncompliance Poor cardiovascular status leading to decreased pain sensation

Decreased kidney function leading to potential fluid and electrolyte imbalances

The nurse enters a woman's room to administer 10 mg Valium PO, the ordered pre-op medication for her hysterectomy. During the conversation, the client tells the nurse that she and her husband are planning to have another child in the coming year. The best action for the nurse to take is which of the following? Do not administer the pre-op medication, notify the nursing supervisor and the physician. Go ahead and administer the medication as ordered. Check to see if the client has signed a surgical consent. Send the client to the operating room (OR) without the medication.

Do not administer the pre-op medication, notify the nursing supervisor and the physician.

The nurse is caring for a 7-year-old child scheduled for surgery in the morning. While conducting preoperative teaching, the nurse would choose which of the following visual aids to enhance the child's learning about the perioperative experience? Videotapes Colorful brochures Dolls and puppets A visit from the surgeon

Dolls and puppets

The nurse is caring for a client who has just had a craniotomy. The client has an intracranial pressure monitor in place and is becoming more lethargic. The intracranial pressure is high. How should the nurse position the client? Elevate the head of the 90˚. Position the client upright with pillow support under the head. Place the client flat in bed with the legs elevated 15˚ on pillows. Position the client on the left side with pillow support to the back. Elevate the head of the bed 30˚ with a pillow under the head.

Elevate the head of the bed 30˚ with a pillow under the head.

The nurse is caring for a woman who is on hemodialysis. She has an arteriovenous fistula. Which finding is expected when assessing the fistula? Ecchymotic area Enlarged veins Pulselessness Redness

Enlarged veins

The morning before a scheduled hysterectomy related to uterine cancer, the client informs the nurse that she does not want to go through with the procedure. Which of the following steps should the nurse take next? Inform the client that the surgery is necessary and that there is nothing to worry about. Notify the surgeon that the client is refusing surgery and needs to be sedated. Inform the surgeon of the client's statement so that the surgeon can talk with the client. Note the client's statement on the chart and reassess the client.

Inform the surgeon of the client's statement so that the surgeon can talk with the client.

Which of the following is the most dangerous possible adverse effect of inhalation anesthetics? Hypertension Increased intracranial pressure Malignant hyperthermia Atrial tachycardia

Malignant hyperthermia

A client with a perforated gastric ulcer is scheduled for emergency surgery. The client cannot sign the operative consent form because of sedation from narcotic analgesics that have been administered. The nurse should take which of the following most appropriate actions in the care of this client? Obtain a telephone consent from a family member and have the consent witnessed by two persons. Obtain a court order for the surgery Send the client to surgery without the consent form being signed. Have the hospital chaplain sign the informed consent immediately.

Obtain a telephone consent from a family member and have the consent witnessed by two persons.

A client in renal failure is to have a serum blood urea nitrogen level determined. What will this diagnostic test measure? Fractional urine of ½%. Return of fecal material in the outflow. An increase in sodium transfer to serum. Outflow of less than 100 ml of inflow.

Outflow of less than 100 ml of inflow.

After an anesthesiologist delivers nitrous oxide with a face mask, which of the following is the priority assessment? Oxygen saturation Blood pressure Heart rate Temperature

Oxygen saturation

The hemodialysis client with a left arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following manifestations? Warmth, redness, and pain in the left hand Pallor, diminished pulse, and pain in the left hand Edema and reddish discoloration of the left arm Aching pain, pallor, and edema of the left arm

Pallor, diminished pulse, and pain in the left hand

A female client is being prepared for surgery. When the nurse asks the client to remove her wedding ring, the client refuses. Which of the following would be the most appropriate response by the nurse? Encourage the client to use soapy water to remove the ring if it is tight. Explain that the hospital cannot be responsible for jewelry worn during surgery. Notify the surgeon's office that the surgeon must see the client in the preoperative holding area. Tape the ring in place before the client is transported to the preoperative holding area.

Tape the ring in place before the client is transported to the preoperative holding area.

A nurse is conducting preoperative teaching with a client about the use of an incentive spirometer in the postoperative period. The nurse would include which piece of information in discussions with the client? Keep a loose seal between the lips and the mouthpiece Inhale as rapidly as possible After maximum inspiration, hold the breath for 15 seconds and exhale The best results are achieved when the head of the bed is elevated 45 to 90 degrees.

The best results are achieved when the head of the bed is elevated 45 to 90 degrees.

A client has been admitted for surgery for resection of nerve roots. The client, observing the written comment that the surgery is palliative, asks what this means. The nurse would offer which of the following explanations? The surgery schedule is overbooked, so the client's surgery may be delayed. The surgeon is against performing the surgery. The exact surgical procedure has not been decided. The procedure will be done to relieve pain but will not cure the problem.

The procedure will be done to relieve pain but will not cure the problem.

An adult who has chronic obstructive pulmonary disease (COPD) is scheduled for surgery and the physician has recommended an epidural anesthetic. The nurse should know that general anesthesia was not recommended for this client because There is too high a risk for pressures sores developing There is less effect on the respiratory system with epidural anesthesia Central nervous system control of vascular constriction would be affected with general anesthesia There is too high a risk of lacerations to the mouth, bruising of lips, and damage to teeth.

There is less effect on the respiratory system with epidural anesthesia

An adult is receiving morphine via a PCA pump after her surgery. The best method for the nurse to use to evaluate her level of pain is to ask the client To rate her pain on a scale of 1-10 If the morphine is working for her If she is feeling any pain If she needs her morphine level increased

To rate her pain on a scale of 1-10

The nurse is caring for a client who has had a total gastrectomy. The client complains of weakness, palpitations, cramping pains, and diarrhea. He is also experiencing reactive hypoglycemia. What is the best explanation for these signs and symptoms? Rapid distention of the jejuna loop anastomosed to the stomach. Lack of fluid intake at mealtime. There is only a small opening from the gastric remnant to the jejunum. The hypotonic intestinal contents draw extracellular fluid from the circulating blood volume into the jejunum to dilute the high concentration of electrolytes and sugars.

Rapid distention of the jejuna loop anastomosed to the stomach.

A registered nurse is instructing a new nursing graduate about hemodialysis. Which statement if made by the new nursing graduate would indicate an inaccurate understanding of the procedure for hemodialysis? 1. Sterile dialysate must be used. 2. Warming the dialysate increases the efficiency of diffusion. 3. Heparin sodium is administered during dialysis. 4. Dialysis cleanses the blood from accumulated waste products.

1. Dialysate is made from clear water and chemicals and is free from any metabolic waste products or medications. Bacteria and other microorganisms are too large to pass through the membrane; therefore, the dialysate does not need to be sterile. The dialysate is warmed to approximately 100° F to increase the efficiency of diffusion and to prevent a decrease in the client's blood temperature. Heparin sodium inhibits the tendency of blood to clot when it comes in contact with foreign substances. Option 4 is the purpose of dialysis.

A client with chronic renal failure has completed a hemodialysis treatment. The nurse would use which of the following standard indicators to evaluate the client's status after dialysis? 1. Vital signs and weight. 2. Potassium level and weight. 3. Vital signs and BUN. 4. BUN and creatinine levels.

1. Following dialysis, the client's vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client's predialysis weight to determine effectiveness of fluid extraction. Laboratory studies are done as per protocol but are not necessarily done after the hemodialysis treatment has ended.

A nurse is giving general instructions to a client receiving hemodialysis. Which of the following statements would be appropriate for the nurse to include? 1. Several types of medications should be withheld on the day of dialysis until after the procedure. 2. Medications should be double-dosed on the morning of hemodialysis to prevent loss. 3. It's acceptable to exceed the fluid restriction on the day before hemodialysis. 4. It's acceptable to eat whatever you want on the day before hemodialysis.

1. Many medications are dialyzable, which means they are extracted from the bloodstream during dialysis. Therefore, many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be "double-dosed," because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.

The nurse is reviewing the client's record and notes that the physician has documented that the client has a renal disorder. On review of the lab results, the nurse most likely would expect to note which of the following? 1. Decreased hemoglobin level. 2. Elevated BUN 3. Decreased red blood cell count. 4. Decreased white blood cell count.

2. Measuring the blood urea nitrogen level is a frequently used laboratory test to determine renal function. The blood urea nitrogen level starts to rise when the glomerular filtration rate falls below 40% to 60%. A decreased hemoglobin level and red blood cell count may be noted if bleeding from the urinary tract occurs or if erythropoietic function by the kidney is impaired. An increased white blood cell count is most likely to be noted in renal disease.

A nurse is working with the client newly diagnosed with chronic renal failure (CRF) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse assesses that the client is exhibiting: 1. Withdrawal 2. Depression 3. Anger 4. Projection

3. Psychosocial reactions to CRF and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client has not projected blame on the nurse, nor does the client statement reflect withdrawal or depression.

The nurse develops a postprocedure plan of care for a client who had a renal biopsy. The nurse avoids documenting which intervention in the plan? 1. Administering analgesics as needed. 2. Encouraging fluids to at least 3 L in the first 24 hours. 3. Testing serial urine samples with dipsticks for occult blood. 4. Ambulating the client in the room and hall for short distances.

4. Following renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation at the biopsy site. Serial urine samples are assayed by Hematest with urine dipsticks to evaluate bleeding. Analgesics often are needed to manage the renal colic pain that some clients feel after this procedure.

A client newly diagnosed with chronic renal failure (CRF) has many learning needs regarding the disease. The nurse prepares a teaching plan to help the client adapt to the disease. The nurse recognizes that which of the following client characteristics or factors is least likely to interfere with the client's ability to learn? 1. Anxiety. 2. Memory deficits. 3. Short attention span. 4. Presence of family.

4. The client with CRF may have several barriers to learning. Anxiety about the disease and its ramifications frequently may interfere with learning. Physiological effects of the disease process also impair the client's mental functioning. Specifically, the client may exhibit a short attention span and have memory deficits. Mental functioning usually improves once hemodialysis has begun. The presence of family members is helpful because they need to understand the disease and treatment and may help reinforce information with the client after the formal teaching session is over.

The nurse has taught the client with polycistic kidney disease about management of the disorder and prevention and recognition of complications. The nurse determines that the client understands the instructions if the client states that there is no reason to be concerned about: 1. Burning on urination. 2. A temperature of 100.6F 3. New-onset shortness of breath. 4. A blood pressure of 105/68 mmHg

4. The client with polycystic kidney disease should report any signs and symptoms of urinary tract infection so that treatment may begin promptly. Lowered blood pressure is not a complication of polycystic kidney disease, and it is an expected effect of antihypertensive therapy. The client would be concerned about increases in blood pressure because control of hypertension is essential. The client may experience heart failure as a result of hypertension, and thus any symptoms of heart failure, such as shortness of breath, are also a concern.

A client with chronic renal failure (CRF) is on fluid restriction. The client is fatigued and therefore has a limited tolerance for activity. The client takes aluminum hydroxide gel (Alternagel) as a phosphate binder. On the basis of this information, the nurse determines that the client is most at risk for which of the following nursing diagnoses? 1. Impaired physical mobility. 2. activity intolerance. 3. Deficient fluid volume. 4. Constipation.

4. The client with renal failure is almost certain to have a problem with constipation as a result of factors such as fluid restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding antacids such as aluminum hydroxide gel cause constipation as a side effect.

A client is undergoing diagnostic tests to rule out a diagnosis of renal disease. The lab results indicate a ratio of BUN to creatinine of 15:1. The nurse determines that this result indicates: 1. A fluid volume deficit 2. Liver failure 3. A fluid volume excess 4. A normal ratio

4. The normal ratio of BUN to creatinine is approximately 10:1 to 15:1. A value lower than 10:1 would indicate diminished urea concentration. A value greater than 15:1 would indicate inadequate renal function.

While planning postoperative care for an obese client prior to surgery, the nurse would develop which nursing diagnosis specific to the effect obesity has on postsurgical recovery? Risk for ineffective tissue perfusion (cardiopulmonary) Excess fluid volume Risk for impaired skin integrity (pressure ulcers) Ineffective thermoregulation

Risk for ineffective tissue perfusion (cardiopulmonary)

The nurse asks the client about previous surgeries. The client asks the nurse why this information is important. The nurse would explain that previous surgeries can do which of the following? Interfere with the absorption of anesthetic agents Affect the ability of the client to comprehend the instructions prior to surgery Affect the central nervous system Alter the client's responses to surgery

Alter the client's responses to surgery

When performing a surgical dressing change of a client's abdominal dressing, a nurse notes an increase in the amount of drainage and separation of the incision line. The underlying tissue is visible to the nurse. The nurse would do which of the following in the initial care of this would? Leave the incision open to the air to dry the area Apply a sterile dressing soaked in povidone-iodine (Betadine). Irrigate the wound and apply a sterile dry dressing. Apply a sterile dressing soaked with normal saline.

Apply a sterile dressing soaked with normal saline.

An adult client is one day post subtotal thyroidectomy. The nurse planning care for the day knows that it is most important to Carry out range of motion exercises to the neck and shoulders every shift. Maintain bed rest with client in supine position at all times. Ask client questions every hour or two to assess for hoarseness. Provide tracheostomy care every shift and suction prn to maintain a patent airway.

Ask client questions every hour or two to assess for hoarseness.

An adult who is one-day post abdominal cholecystectomy complains to the nurse that she is having abdominal pain. The nurse goes in to assess her pain utilizing a visual analog scale. Which action by the nurse would be initially most important? Have the client describe the type and location of pain. Check the chart for the pain medication order. Assess the client's abdomen. Ask the client to locate the pain on a linear scale.

Ask the client to locate the pain on a linear scale.

A nurse receives a telephone call from the postanesthesia care unit stating that a client is being transferred to the surgical unit. The nurse plans to do which of the following first on arrival of the client? Assess the patency of the airway. Assess the vital signs to compare with preoperative measurements. Check the dressing to assess for bleeding. Check tubes or drains for patency.

Assess the patency of the airway.

An adult has undergone surgery for a detached retina. What is essential to include in the postoperative care plan? Up ad lib with assistance. Notify physician of severe pain that does not respond to pain medication, and/or severe nausea and vomiting. Bedrest with bed flat. Notify physician of any mucoid discharge.

Notify physician of severe pain that does not respond to pain medication, and/or severe nausea and vomiting.

In conducting client teaching with a client who will undergo peritoneal dialysis at home, the nurse includes discussion on what common and significant complication of peritoneal dialysis? Pulmonary embolism Hypotension Dyspnea Peritonitis

Peritonitis

The nurse has taught the client to perform deep breathing and coughing exercises. The nurse determines that the client needs more teaching when the client is observed doing which of the following? Sitting upright before performing deep breathing and coughing exercise Taking deep breaths before attempting to cough Placing both hands vertically and lightly on either side of the incision Using a pillow for splinting during coughing

Placing both hands vertically and lightly on either side of the incision

A postoperative client asks a nurse why it is so important to deep breathe and cough after surgery. In formulating a response the nurse incorporates the understanding that retained pulmonary secretions in a postoperative client can lead to Fluid imbalance. Carbon dioxide retention Pulmonary edema Pneumonia

Pneumonia

In a child with acute renal failure, the nurse would help to prevent hyperkalemia by limiting which of the following foods in the child's diet? Grains, cheese, and citrus fruits Potatoes, tomatoes, and oranges Cereals, processed sugars, and wheat Rice, leafy green vegetables, and carbonated beverages

Potatoes, tomatoes, and oranges

A client is scheduled for surgery in the morning. Preoperative orders have been written. What is most important to do before surgery? Verify that all laboratory work is complete. Inform family or next of kin. Have all consent forms signed.

Have all consent forms signed.

The nurse is evaluating a client's response to hemodialysis. The laboratory values reflect that dialysis is achieving positive results. Which lab values would not reflect changes resulting from the hemodialysis? Serum creatinine levels Dissolved pressure of carbon dioxide Serum potassium levels Hemoglobin levels

Hemoglobin levels

A client who underwent preadmission testing had blood drawn for serum laboratory studies, including a complete blood count, electrolytes, coagulation studies, and a creatinine level. Which of the following laboratory results would be reported to the surgeon's office by the nurse, knowing that it could cause surgery to be postponed? Platelets, 210,000 cells/μL Serum creatinine, 0.8 mg/dL Sodium, 141 mEq/L Hemoglobin, 8.9 mg/dL

Hemoglobin, 8.9 mg/dL

The nurse is caring for a person who is admitted in acute renal failure. The appearance of a U wave on the ECG should alert the nurse to check laboratory values for Hyperkalemia Hypokalemia Hypernatremia Hyponatremia

Hypokalemia

The nurse is caring for a client undergoing a hemodialysis procedure places high priority on evaluating the client frequently for what common complication during the treatment? Hyperglycemia Infection and fever Dialysis dementia Hypotension

Hypotension

An adult had a thyroidectomy this morning. The client begins to complain of circumoral tingling. The nurse assesses a positive Chovstek's sign and a positive Trousseau's sign. The nurse understands that the most common cause of these symptoms is which of the following? Inadvertent removal of the parathyroid glands during the thyroidectomy surgery. Overuse of radioactive iodine given preoperatively to clients undergoing thyroidectomy. A history of insufficient intake of iodine. Overstimulation of parathormone during the thyroid surgery.

Inadvertent removal of the parathyroid glands during the thyroidectomy surgery

When assessing a post-op client, the nurse notes a nasogastric tube to low constant suction, the absence of a bowel movement since surgery, and no bowel sounds. The most appropriate plan of care based on these findings is to Increase the client's mobility and ensure he is receiving adequate pain relief. Increase coughing, turning, and deep breathing exercises. Discontinue the nasogastric tube as the client does not need it any more. Assess for bladder pain and distention.

Increase the client's mobility and ensure he is receiving adequate pain relief.

A nurse is monitoring the status of a postoperative client. The nurse would become most concerned with which of the following signs that could indicate an evolving complication? Blood pressure of 110/70 mm Hg and a pulse of 86 beats per min Increasing restlessness Hypoactive bowel sounds in all four quadrants A negative Homan's sign

Increasing restlessness

A toddler is being prepared for a surgical procedure. This is the child's first experience with surgery. The child's mother expresses concern about the child's psychological adaptation to the surgery. While planning for postoperative care, the nurse recognizes that which of the following is likely to be the child's greatest concern? Anticipated pain Body image changes Communication difficulties Separation from parents

Separation from parents

The nurse is admitting a woman who is scheduled for a total hip replacement. What is the most effective way to initiate the interview? Sit quietly until the client initiates the conversation. Start the interview with easy questions to build a rapport. Try not to seem too friendly too soon. Do not dwell on the diagnosis and its effect on the client.

Start the interview with easy questions to build a rapport.

The nurse is infusing dialysate during peritoneal dialysis. What is a nursing action to make the client more comfortable at this time? Increase the rate of flow. Raise the head of the bed. Turn the client from side to side. Refrigerate the fluid before infusion.

Turn the client from side to side.

The nurse is teaching a client about the concept of dialysis and how it works for the body. It is the nurse's understanding that dialysis is a technique that Will move blood through a semipermeable membrane into a dialysate that is used to remove waste products as well as correct fluid and electrolyte imbalances. Will add electrolytes and water to the blood when passing through a semipermeable membrane to correct electrolyte imbalances. Will increase potassium to the blood when passing through a semipermeable membrane to correct electrolyte imbalances. Allow the nurse to choose to use either diffusion osmosis or ultrafiltration to correct the client's fluid and electrolyte imbalance.

Will move blood through a semipermeable membrane into a dialysate that is used to remove waste products as well as correct fluid and electrolyte imbalances.