Semester 3, exam 3 notes.

How is sodium polystyrene sulfonate used in CKD?

To bind potassium in the GI tract for expelling. Used to lower potassium levels. If that isn't enough dialyysis may be needed to lowerp otassium to prevent dysrhythmias.

The nurse working on an inpatient hospice unit has received the change-of-shift report. Which client does the nurse assess first? A 62 year old with lung cancer who has cool, clammy, dusky skin, and blood pressure of 64/20 mm Hg. A 26 year old with metastatic breast cancer who is experiencing pain rated at 8 (0-10 scale) and anxiety. A 70 year old with cancer of the colon who has a respiratory rate of 8 with loud, wet-sounding respirations. A 30 year old with AIDS-associated dementia and agitation who is asking for assistance with calling family members.

A 26 year old with metastatic breast cancer who is experiencing pain rated at 8 (0-10 scale) and anxiety. Management of pain is the priority goal for hospice care, so decreasing this client's pain and anxiety should be the first action.The client with AIDS needs rapid assistance, but is the second priority for the nurse in this scenario. The client with lung cancer and the client with colon cancer are exhibiting normal signs and symptoms associated with dying.

A nurse is caring for a child dying from cancer. Which physical sign should the nurse identify that the child is approaching death? A change in the respiratory pattern An increase in the pulse rate A sensation of cold although the body feels hot Loss of hearing followed by loss of other senses

A change in the respiratory pattern In the final hours of life, the respiratory pattern may become labored, with periods of apnea. The pulse becomes weak and slower not faster. The opposite is true; there is a sensation of heat, although the body feels cold. Hearing is the last sense to disappear.

The nurse is caring for client who is receiving erythropoietin. Which assessment finding indicates a positive response to the medication? A decrease in fatigue Potassium within normal range Absence of spontaneous fractures Hematocrit of 26.7%

A decrease in fatigue The assessment finding of less fatigue is considered a positive response to erythropoietin. Treatment of anemia with erythropoietin will result in increased hemoglobin and hematocrit (H&H) and decreased shortness of breath and fatigue.A hematocrit value of 26.7% is low. Erythropoietin would restore the hematocrit to at least 36% to be effective. Erythropoietin stimulates the bone marrow to increase red blood cell production and maturation, increasing H&H, not potassium. Calcium supplements and phosphate binders prevent renal osteodystrophy and do not treat anemia.

What is CKd?

A progresiive irreversible disorder laster longer than 3 months. Kidney function fails and waste eliminatiion decreases.

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which nursing actions are required? (Select all that apply.) Select all that apply. Ensure that no blood pressures are taken in that arm. Teach the client to palpate for a thrill over the site. Elevate the arm above heart level. Auscultate for a bruit every 8 hours. Check brachial pulses daily.

A, B and D. A bruit or swishing sound and a thrill or buzzing sensation upon palpation would be present in this client, indicating patency of the fistula. No blood pressure, venipuncture, or compression, such as lying on the fistula, would occur.Distal pulses and capillary refill would be checked daily. For a forearm fistula, the radial pulse is checked instead of the brachial pulse which is proximal. Elevating the arm increases venous return, possibly collapsing the fistula.

When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? (Select all that apply.) Select all that apply. Encourage the client to participate in changing the ostomy. Encourage the client and family members to express their feelings and concerns. Offer to have a person who is coping with a colostomy visit with the client. Explain to the client that the colostomy is only temporary. Obtain a psychiatric consultation.

A, B, C Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication.Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.

Which common cancers will the nurse inform clients are related to tobacco use? (Select all that apply.) Select all that apply. Lung cancer Cancer of the larynx Bladder cancer Cancer of the tongue Skin cancer Cardiac cancer

A, B, C, D Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with "smokeless" tobacco.The heart does not contain cells that divide; therefore, cardiac cancer is unlikely. Skin cancer generally is related to repeated sun and other ultraviolet exposure, such as that found with tanning beds.

Which warning signs of cancer would the nurse specifically teach in a wellness course directed to a group of older adults? (Select all that apply.) Select all that apply. Persistent hoarseness Severe heartburn Chronic diarrhea Loss of skin turgor Curd-like vaginal discharge Difficulty swallowing with meals

A, B, C, F Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging.

The nurse is caring for a client who is actively dying. What nursing action is appropriate? (Select all that apply.) Select all that apply. Do not encourage the client to stay awake. Offer to insert a Foley catheter for comfort. Place warm blankets on the client to keep them warm. Use moist swabs to keep the mouth and lips moist. Encourage the client to eat ice chips and drink as much as possible. Make sure the room is well-lit.

A, B, D. When caring for a client who is actively dying, the skin may become cold and mottled. Do not apply heating blankets. Using moist swabs will help to keep the client's mouth and lips more comfortable. The room should be dimly lit, with minimal noise and stimulation. The client should be offered ice chips or drink but do not force to drink as much as possible. Allow the clien

The nurse is caring for a client following a kidney transplant. Which assessment data indicate to the nurse possible rejection of the kidney? (Select all that apply.) Select all that apply. Crackles in the lung fields Temperature of 98.8° F (37.1° C) Blood pressure of 164/98 mm Hg Blood urea nitrogen (BUN) 21 mg/dL (7.5 mmol/L), creatinine 0.9 mg/dL (80 mcmol/L) 3+ edema of the lower extremities

A, C and E. Signs and symptoms indicating rejection of a transplanted kidney include: crackles in the lung fields, blood pressure of 164/78 mm Hg, and 3+ edema of lower extremities. These are assessment findings related to fluid retention and transplant rejection.Increasing BUN and creatinine are symptoms of rejection; however, a BUN of 21 mg/dL (7.5 mmol/L) and a creatinine of 0.9 mg/dL (80 mcmol/L) reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.

The nurse is teaching the client about skin protection during radiation therapy. What teaching will the nurse include? (Select all that apply.) Select all that apply. Protect the area by wearing clothing. Avoid all lotions to the area. Avoid exposure to sun and heat. Do not remove the ink markings on your skin. Try to take walks in the early morning or later evening. Do not wash the irradiated area.

A, C, D, E The client can wash the irradiated area daily with either water or a mild soap. Ink or dye used to mark the radiation area should not be removed. The area should be protected by wearing soft clothing over the site, avoiding exposure to the sun and heat. Lotions can be used as long as they are approved by the radiation team. Walking in the early morning or late evening is a good way to avoid more intense sun.

When caring for the client receiving chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? (Select all that apply.) Select all that apply. Bruises Fever Epistaxis Pallor Petechiae

A, C, E Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count (thrombocytopenia).Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which intervention does the nurse plan to implement? (Select all that apply.) Select all that apply. Do not permit fresh flowers or plants in the room. Do not allow the client's 16-year-old son to visit. Observe for bleeding. Teach the client to omit raw fruits and vegetables from the diet. Administer pegfilgrastim. Assess for fever.

A, D, E, F Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim and pegfilgrastim, is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms.Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

Which conditions or factors will the nurse teach at a community seminar as probable transmission routes for HIV? (Select all that apply.) Select all that apply. Using injection drugs Sitting on public toilets Changing a diaper on an HIV positive child Having unprotected intercourse with multiple partners Breast-feeding Being bitten by mosquitos

A, D, E. HIV can be transmitted via breast milk from an infected mother to the child. Unprotected intercourse with an HIV positive adult is a major transmission route. HIV is not spread by mosquito bites or by other insects. It is not transmitted by casual contact. Sharing toilet facilities with an HIV-positive adult does not cause transmission of HIV. Use of injection drugs is a common transmission route. Casual contact such as changing a diaper, even with feces and urine (unless there is significant blood in these excretions), is not a probable transmission route.

Which statements about the transmission of HIV are true? (Select all that apply.) Select all that apply. Clients with HIV-III and no drug therapy are very infectious. Even with appropriate drug therapy, most clients infected with HIV live only about 5 years after diagnosis. HIV may be transmitted only during the end stages of the disease. The most common transmission route is casual contact. Newly infected clients with a high viral load are very infectious. HIV-positive clients who have an undetectable viral load appear to not transmit the disease.

A, E, F. In the first 4 to 6 weeks after infection, the viral numbers in the bloodstream and genital tract are high and sexual transmission is possible. Clients at the end stage of HIV disease (HIV-III [AIDS]) without drug therapy have a high viral load and are particularly infectious. An undetectable viral load now means noninfectious and therefore, not transmittable. Casual contact does not transmit the infection. With appropriate drug therapy, clients with HIV disease live for decades.

Which laboratory results does the nurse expect to decrease in a client who has untreated HIV-III (AIDS)? (Select all that apply.) Select all that apply. Total white blood cell count Viral load CD8+ T-cell HIV antibodies CD4+ T-cell Lymphocytes

A, E, F. The immune target of HIV is the CD4+ T-cell. With infection of this cell, its circulating levels decline and immune function is reduced over time. As a result, total white blood cell counts decrease and circulating lymphocytes decrease. CD8+ T-cell counts are unaffected. HIV antibodies and viral load increase.

Key points concepts of care for people with cancer: safe and effective care

Use aseptic technique during care for open skin areas. During chemo assess venous access device to verify blood return. Use PPE. Inspect oral mucosa for neutropenia patients. Teach about symptoms of infection. Report temp higher than 100.

The client who wants to use Truvada for preexposure prophylaxis (PreP) asks the nurse why testing is needed for HIV status before starting this drug. How does the nurse respond? "Although this drug can help prevent HIV infection, it is not enough by itself to control "the disease if you are HIV positive." "The side effects of this drug are worse if you have a detectable HIV viral load." "If you take this drug and are HIV positive, your risk for co-infection with the hepatitis B virus is increased." Some people have a genetic mutation that increases the risk for life-threatening reactions "while taking this drug if they are also HIV positive."

"Although this drug can help prevent HIV infection, it is not enough by itself to control "the disease if you are HIV positive." The drug can help prevent HIV infection, but alone does not adequately suppress viral replication. In addition, taking it when HIV positive often leads to drug resistance. None of the other statements are true.

An 85-year-old client tells the nurse that she does not perform breast self-exam because there is no history of breast cancer in her family. What is the nurse's best response? "Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased." "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." "You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you." "Examining your breasts once per year when you have your mammogram is sufficient screening for someone with your history."

"Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman.

A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which client statement indicates to the nurse that the client needs further education? "My children have a 50% chance of inheriting the ADPKD gene that causes the disease." "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." "If my children have the ADPKD gene, they will have cysts by the age of 30."

"By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." Further teaching about ADPKD when a mother of two says, "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." There is no way to prevent ADPKD, although early detection and management of hypertension may slow the progression of kidney damage. Limiting salt intake can help control blood pressure.Limiting salt intake can help control blood pressure. Presentation of ADPKD can vary by age of onset, manifestations, and illness severity, even in one family. Almost 100% of those who inherit a polycystic kidney disease (PKD) gene will develop kidney cysts by age 30. Children of parents who have the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease.v

A 3-year-old child is scheduled for surgery to remove a Wilms tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. What would be the most appropriate response from the nurse? "A kidney transplant will be planned." "No additional treatments are usually necessary." "Radiation therapy may be necessary." "Chemotherapy with or without radiation therapy is indicated."

"Chemotherapy with or without radiation therapy is indicated." This determination will be made on the basis of the histologic pattern of the tumor. Chemotherapy with or without radiation therapy is usually indicated. Radiation therapy may be necessary, but chemotherapy is first. Most children with Wilms tumor do not require renal transplants. Additional therapy is indicated after the tumor is removed.

Which statement made by the nurse during an admission assessment for a client who is HIV positive demonstrates a nonjudgmental approach in discussing sexual practices and behaviors? "You must tell me all of your partners' names, so I can let them know about possibly being infected." "I hope you use condoms to protect your partners." "Have you had sex with men or women or both?" "You don't participate in anal intercourse, do you?"

"Have you had sex with men or women or both?" The straightforward approach of asking the client about having sex with men or women is nonjudgmental and most appropriate. "I hope you use..." is a judgmental statement. Naming partners is voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. By stating the question about anal intercourse as a negative is very judgmental.

The school nurse is counseling a teenage student about how to prevent kidney trauma. Which student statement indicates a need for further teaching? "I always wear pads when playing football." "I can't play contact sports since my brother had kidney cancer." "I will avoid riding motorcycles." "I always wear a seat belt in the car."

"I can't play contact sports since my brother had kidney cancer." Further teaching about preventing kidney trauma is needed when the teenage student says, "I can't play any type of contact sports because my brother had kidney cancer." Contact sports and high-risk activities must be avoided if a person has only one kidney. A family history of kidney cancer does not prohibit this type of activity.

Which client statement allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment? "I may lose my hair during this treatment." "I will have a radioactive device in my body for a short time." "I must be positioned in the same way during each treatment." "I will be placed in a semiprivate room for company."

"I will have a radioactive device in my body for a short time." Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific.Because radiation therapy is site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "It is essential for you to wash your hands and avoid people who are ill." "The new kidney will be placed directly below one of your old kidneys." "You will receive dialysis the day before surgery and for about a week after." "Your diseased kidney will be removed when the transplant is performed."

"It is essential for you to wash your hands and avoid people who are ill." Teaching the client to wash hands and stay away from sick people are important points for the nurse to include in teaching for a client scheduled for a kidney transplant. Antirejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential.Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery. After the surgery, the new kidney should begin to make urine.

The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which client statement indicates that teaching has been effective? "Since renal cell carcinoma usually affects both kidneys, I'll need frequent biopsies." "My remaining kidney will provide normal kidney function in a few days or weeks." "I need to decrease my fluid intake to prevent stress to my remaining kidney." "I'll eventually require some type of renal replacement therapy."

"My remaining kidney will provide normal kidney function in a few days or weeks." Effective discharge teaching for a client after a nephrectomy for renal cell carcinoma is indicated when the client says, "my remaining kidney will provide me with normal kidney function in a few days or weeks." After a nephrectomy, the second kidney is expected to provide adequate kidney function, but this may take days or weeks.Renal cell carcinoma typically only affects one kidney. Renal replacement therapy is not the typical treatment for renal cell carcinoma. Fluids would be maintained to flush the remaining kidney.

A nurse is giving a group presentation on cancer prevention and factors that cause cancer. Which statement by a client indicates understanding the education provided? "Nearly 1/3 of cancers in the United States are related to tobacco use." "Red meat helps to prevent cancer development." "If I eat a healthy diet and exercise I will not develop cancer." "Most cancer is hereditary."

"Nearly 1/3 of cancers in the United States are related to tobacco use." Tobacco can be linked directly to the development of about 30% of all cancers in North America.Hereditary cancer occurs in a small percentage of the population. Increased red meat intake appears to increase risk of cancer development. A healthy diet and exercise can be helpful in self-care and overall health, but are not a guarantee that cancer will not develop

A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the best nursing response? "Why are you hesitant?" "You need to tell me so we can determine what is wrong." "Take your time. What is bothering you the most?" "Don't worry, no one else will know."

"Take your time. What is bothering you the most?" The nurse's best response when a client is hesitant to talk about genitourinary dysfunction is "take your time. What is bothering you the most?" Asking the client what is bothering him or her expresses patience and understanding when trying to identify the client's problem. It is important for the nurse to encourage the client to tell his/her own story in familiar, comfortable language.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which client statement indicates understanding of the teaching? "I will drink 8 ounces (236 mL) of water with my medications." "I can stop my medications when my kidney function returns to normal." "If my urine output is decreased, I should increase my fluids." "The antirejection medications will be taken for life."

"The antirejection medications will be taken for life." When the client states that antirejection medications must be taken for life, it indicates that the kidney transplant client understands the discharge teaching. Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys.Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria (decreased urine output) is a symptom of transplant rejection. If this occurs, the transplant team must be contacted immediately. It is not necessary to take antirejection medication with 8 ounces (236 mL) of water.

Which statement made to the nurse by an assistive personnel (AP) assigned to care for an HIV-positive client indicates a breach of confidentiality and requires further education by the nurse? "The client's spouse told me she got HIV from a blood transfusion." "The other assistive personnel and I were out in the hallway discussing our concern about getting HIV from our client." "I told family members they need to wash their hands when they enter and leave the room." "Yes, I understand the reasons why I have don't need to wear gloves when I feed the client."

"The other assistive personnel and I were out in the hallway discussing our concern about getting HIV from our client." Discussing this client's illness outside of the client's room is a breach of confidentiality and requires further education by the nurse. Instruction on handwashing to family members or other visitors is not a breach of confidentiality. Understanding the reasons for when and when not to wear gloves when performing direct client care is not a breach of confidentiality. Relaying a direct conversation to the nurse is not a breach of confidentiality.

The family of a client who is unconscious and dying realizes that their mother will die soon. The client's children are having a difficult time letting go. How will the nurse respond to the needs of this family? "She will soon be in a better place." "She would not want you to cry; she needs you to be strong." "This must be difficult for you." "Things will be ok, just try to enjoy your time together."

"This must be difficult for you." The nurse responds by stating, "This must be difficult for you." This statement tells the family that the nurse is aware of their needs. The nurse knows that she must accept whatever the grieving person says about the situation, must remain present, be ready to listen attentively, and guide gently. In this way, the nurse can help the bereaved prepare for the necessary reminiscence and integration of the loss.The client's or family member's pain of loss should never be minimized. Trite assurances such as saying, "She would not want you to cry" or "Things will be ok," should be avoided. Such comments can actually be barriers to demonstrating care and concern. Never try to explain a client's death or impending death in philosophic or religious terms because such statements are not helpful when the bereaved person has yet to express feelings of anguish or anger.

Which point is most important for the nurse to include when teaching assistive personnel (AP) about protecting themselves from HIV exposure when caring for HIV-positive clients? "Always wear a mask when entering an HIV-positive client's room." "Talk to the employee health nurse about starting preexposure prophylaxis." "Wear gloves when in contact with clients' mucous membranes or nonintact skin." "Wear full protective gear when providing any care to HIV-positive clients."

"Wear gloves when in contact with clients' mucous membranes or nonintact skin." Standard Precautions are all that is needed when caring for any client, including those who have HIV. Masks and full protective gear are not needed. Preexposure prophylaxis is not used for potential occupational exposure.

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? "Eat breakfast and go to bed at the same time every day." "Drink 2 L of fluid and urinate at the same time every day." "Weigh yourself and take your blood pressure." "Check your blood sugar and do a urine dipstick test."

"Weigh yourself and take your blood pressure." When discharging the client with kidney disease, the nurse needs to tell the client to "Weigh yourself and take your blood pressure." Regular weight assessment monitors fluid restriction control while blood pressure control is necessary to reduce cardiovascular complications and slow the progression of kidney dysfunction.

The nurse is performing a spiritual assessment on a dying client. Which question provides the most accurate data on this aspect of the client's life? "Do you believe in God?" "Where have you been attending church?" "Tell me about religion in your life." "What gives you purpose in life?"

"What gives you purpose in life?" The most accurate data about the client's spirituality would come from the question, "What gives you purpose in your life?" Spirituality arises from whatever or whoever provides the client ultimate purpose and meaning. It is not necessarily God, but it could be. It could be the client's definition of a higher power.The client may not believe in God and may find an inquiry about believing in God offensive and judgmental. Religion is considered by many people to be affiliation or membership in a faith community. Members of such a community may be supportive of the client if the client is a member, but this is not the best way to determine what the client's spirituality is. Church attendance is one way that some individuals express their religion, but it does not necessarily define a person's spirituality; asking about church could place the client on the defensive.

The daughter of a client who is dying states, "I don't want my father to be uncomfortable." How will the nurse respond? "Your father will be closely monitored and cared for." "Do you want to talk to the bereavement nurse?" "Your father will be sedated and comfortable." "We will send him to hospice when the time comes."

"Your father will be closely monitored and cared for." The nurse responds by telling the daughter that her father will be closely monitored and cared for. This would reassure the daughter as well as providing support and comfort.The daughter's comment does not require the expertise of a bereavement nurse. Also, asking if the daughter wants to talk to a bereavement nurse is a "yes-or-no" question, it is a nontherapeutic response and may shut off the dialog. The client who is dying is not typically kept sedated; clients are kept comfortable with as little or as much pain medication as needed. A goal is to keep the client alert and able to communicate. Telling the daughter that her father will be sent to hospice when the time comes does not address the daughter's concern about her father's comfort and it closes the dialog.

A 40-year-old man who has a mother who was diagnosed with breast cancer at age 45, a father who was diagnosed with smoking-related lung cancer at age 55, a 33-year-old sister with breast cancer, and a 38-year-old sister with ovarian cancer, asks if he should be concerned for his cancer risk. What is the nurse's best response? "You have two first-degree relatives and two second-degree relatives with cancer, which increases your general risk for cancer." "Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history." "Your risk for cancer is affected by your parents' cancer development; your sisters' cancers have no bearing on your risk." "Your risk is not affected by this family history because most of the cancers arose in female sex-associated tissues."

"Your risk for breast cancer is increased; however, your risk for lung cancer is not affected by this history." This man has four first-degree relatives with cancer, three of whom have cancers that are associated with a genetic risk. The fact that the sisters and mother were diagnosed at relatively young ages increases the likelihood of a genetic predisposition. The genetic association with these cancers also increases the risk for male members of the family. Lung cancer has not been found to have a genetic association.

A client admitted to the hospital states, "Someone asked me to fill out an advance directive when I was admitted, but I was too stressed. What is that for?" How will the nurse respond? "You will need to see a lawyer to complete advance directives." "You need to complete that paperwork before admission." "Advance directives allow a client to convey health care wishes." "Advance directives are for those individuals who are critically ill."

"Advance directives allow a client to convey health care wishes." The nurse responds by stating that advanced directives allow a client to convey his or her wishes about health care. This best addresses the client's comments.Most advance directives are in place before the client becomes severely ill. Many Americans do not have advance directives in place. Legal assistance is not necessary to complete them. Although completing paperwork pertaining to advance directives before admission would be ideal, any time is a good to do this.

A client is being treated for kidney failure. Which nursing statement encourages the client to express his or her feelings? "All of this is new. What can't you do?" "How are you doing this morning?" "Are you afraid of dying?" "What concerns do you have about your kidney disease?"

"What concerns do you have about your kidney disease?" Asking the client about any concerns regarding your disease is an open-ended statement and specific to the client's concerns.Asking the client to explain what he or she can't do implies inadequacy on the client's part. Asking the client if he or she is afraid of dying is too direct and would likely cause the client to be anxious. Asking the client how he or she is doing is too general and does not encourage the client to share thoughts on a specific topic.

Causes of nephrotic syndrome

-Bacterial or viral infections -NSAIDs -heroin -Cancer and genetic predisposition -systemic disease like lupus or diabetes -Strep

Normal protein levels in urine?

0-14 mg/dl.

Normal serum creatinine?

0.7-1.3

What is the appropriate range of urine output for the client who has just undergone a nephrectomy? 30 to 50 mL/hr 50 to 70 mL/hr 23 to 30 mL/hr 41 to 60 mL/hr

30 to 50 mL/hr A urine output of 30 to 50 mL/hr or 0.5 to 1 mL/kg/hr is considered within acceptable range for the client who is post nephrectomy.Output of less than 25 to 30 mL/hr suggests decreased blood flow to the remaining kidney and the onset or worsening of acute kidney injury. A large urine output, followed by hypotension and oliguria, is a sign of adrenal insufficiency.

Normal BUN?

7-20

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is important for the nurse to implement? Adherence to therapy Handwashing Monitoring for low-grade fever Strict clean technique

Handwashing Handwashing is the most important infection control measure for the client receiving immune-suppressive therapy to perform.Adherence to therapy and monitoring for low-grade fever are important but are not infection control measures. The nurse must practice aseptic technique for this client, not simply clean technique.

CKD diet?

Low protein Low sodium Low Potassium Low phosphate

Nephrotic syndrome complications?

Massive proteinuria, prolonged clotting or increased bleeding, reduced kidney function - elevated BUN and creatinine, decreased GFR.

Normal casts?

None or zero to 2 casts.

The nurse is caring for a child with myelosuppression from chemotherapeutic agents. What activities should the nurse include while giving care? Restriction of oral fluids Performing good hand hygiene Instituting strict isolation Giving immunizations appropriate for age

Performing good hand hygiene Good hand hygiene is the most effective means of preventing disease transmission. Strict isolation is not necessary. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine. There is no indication that fluids should be reduced.

Key points for CKD: physiological integrity.

Report conditions that obstruct urine flow. Collaborate with RDN to teach about dietary needs. Teach patients of symptoms of dehydration. Evaluate the patients lab values (creatinine, electrolytes, GFR, albumin) teach signs of fluid overload and hyperkalemia.

The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body? Lung Veins of the legs Abdominal cavity Heart

Abdominal cavity Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.

Why is it important to weiight CKD patients at the same time each day with the same clothing?

Accurate weights are crucial to determine if any potentiial fluid overload might be starting to occur.

Which organs are part of the immune system? (Select all that apply.) Select all that apply. Adenoids Liver Appendix Bone marrow Gallbladder Thyroid gland

Adenoids, appendix, bone marrow.

A client with terminal lung cancer is receiving hospice care at home. Which nursing action will the RN manager ask the LPN/LVN to do? Administer prescribed medications to relieve the client's pain, shortness of breath, and nausea. Teach the family to recognize signs of client discomfort such as restlessness or grimacing. Clarify family members' feelings about the meaning of client behaviors and symptoms. Develop a plan for care after assessing the needs and feelings of both the client and the family.

Administer prescribed medications to relieve the client's pain, shortness of breath, and nausea. LPN/LVNs are educated to administer medications and monitor clients for therapeutic and adverse medication effects; the administration of prescribed medications to the client for pain, shortness of breath, and nausea is appropriate to delegate to the LPN/LVN.Clarifying family members' feelings, developing a plan of care, and teaching the family to recognize signs of discomfort all require broader education and are appropriate for the RN practice level.

A 74-year-old client recovering from lung cancer surgery tells the nurse, "I don't understand why I have lung cancer. I have never even touched a cigarette." Which factor may explain the cause? A history of cardiac disease Advancing age A history of military service A diagnosis of diabetes

Advancing age Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases.Diabetes is not known to cause lung cancer. A history of cardiac disease does not predispose a person to lung cancer, nor does a history of military service.

The nurse manager for home health and hospice is scheduling daily client visits. Which client is appropriate for the assistive personnel to visit? Aggressive brain tumor and needs daily assistance with ambulation and bathing Advanced cirrhosis of the liver and just called the hospice agency reporting nausea Inoperable lung cancer and considering whether to have radiation and chemotherapy Prostate cancer with bone metastases and has new-onset leg weakness and tingling

Aggressive brain tumor and needs daily assistance with ambulation and bathing Assisting clients with activities of daily living such as ambulation and bathing is a common role for assistive personnel working in home health or hospice agencies.Assessing and acting upon a new symptom (nausea), helping clients make decisions, and evaluating a new-onset symptom all require more complex assessment skills and interventions, which are within the RN scope of practice.

What matters can palliative care be used to promote? (Select all that apply.) Select all that apply. Surgical treatment plans versus medical Discussion on advance directives Physical functioning Reduction in disease exacerbations Improved quality of life

All but A. If optimally delivered, palliative care can provide patients with aggressive symptom management while helping to restore and promote physical functioning. Management of symptoms helps to reduce the exacerbations that are common to chronic disease. Palliative care provides an opportunity to engage patients and families with earlier and supportive discussions about advance care planning. Palliative care supports an improved quality of life, whether the treatment plan is through surgical or medical intervention.

In which newly admitted client situations does the nurse initiate a conversation about advance directives? (Select all that apply.) Select all that apply. The laboring mother expecting her first child A client with a non-life-threatening illness A person who currently has advance directives The comatose client who was injured in an automobile crash The client with end-stage kidney disease

All but D. All clients who are hospitalized need to be asked about advance directives by the nurse when they are admitted to a hospital. This is a requirement of the Patient Self-Determination Act. Many nurses feel uncomfortable discussing advance directives with "healthy" clients, but the circumstances of admission do not relieve the nurse of this responsibility. The client with preexisting advance directives still needs to be questioned; it is possible that the client's wishes have changed since the documents were established. Clients who have potentially life-threatening diseases or conditions should establish advance directives while they are able to do so.The comatose client is not considered capable of making decisions about his or her wishes concerning advance directives.

Which assessment findings does the nurse expect in a client with kidney cancer? (Select all that apply.) Select all that apply. Increased sedimentation rate Hepatic dysfunction Erythrocytosis Hypercalcemia Hypokalemia

All but hypokalemia. Assessment findings the nurse expects to assess in a client with kidney cancer include: erythrocytosis, hypercalcemia, hepatic dysfunction, and increased sedimentation rate. Erythrocytosis alternating with anemia and hepatic dysfunction with elevated liver enzymes may occur with kidney cancer. Parathyroid hormone produced by tumor cells can cause hypercalcemia. An elevation in sedimentation rate may occur in paraneoplastic syndromes.Potassium levels (hypokalemia) are not altered in kidney cancer.

Which conditions does the nurse teach a client are some of the seven warning signs of cancer? (Select all that apply.) Select all that apply. Heavy nosebleeds independent of trauma to the nasal mucosa Menstrual bleeding that has decreased Increased pigmentation with deeper coloring in a mole Difficulty starting the stream of urine for the past 6 months Indigestion regardless of food type eaten Thickening of breast tissue in one area

All but menstrual bleeding decreasing. The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Which client assessment findings indicate to the nurse that leukemia may be present? (Select all that apply.) Select all that apply. Multiple bruises Night sweats Severe epistaxis Fever Frequent colds Fatigue

All but severe epistaxis. All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client's platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Which client will the nurse assess as at risk for acute kidney injury (AKI)? (Select all that apply.) Select all that apply. Client in the intensive care unit on high doses of antibiotics Football player in preseason practice Accident victim recovering from a severe hemorrhage Accountant with poorly controlled diabetes mellitus Client who underwent contrast dye radiology Client recovering from gastrointestinal influenza

All but the accountant. To prevent AKI, all people must be urged to avoid dehydration by drinking at least 2 to 3 L of fluids daily, especially during strenuous exercise or work associated with diaphoresis, or when recovering from an illness that reduces kidney blood flow, such as influenza. Contrast media may cause acute renal failure, especially in older clients with reduced kidney function. Recent surgery or trauma, transfusions, or other factors that might lead to reduced kidney blood flow may cause AKI. Certain antibiotics may cause nephrotoxicity.Poorly controlled diabetes mellitus is a risk factor for chronic kidney disease.

The nurse is caring for a client who is receiving rituximab for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? Alopecia Fever Allergy Chills

Allergy Allergy is the most common side effect of monoclonal antibody therapy (rituximab), and the nurse must be aware of any allergic reactions the client may exhibit.Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being prescribed? Radioactive iodine-131 Allopurinol Recombinant erythropoietin Potassium chloride

Allopurinol The nurse expects allopurinol to be prescribed, because allopurinol decreases uric acid production and is indicated in TLS. TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances.Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous because the client is already hyperkalemic. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.

Key points for CKD: psychosocial integrity.

Allow patients to express concerns about disruption of lifestyle and considerations for end of life care. Use language and terms that patients can understand. Assess for anxiety, depression and nonacceptance. Refer to community resources and support groups.

A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? Explain that this occurs in some clients and is usually permanent. Inform the client that a small glass of wine may help her relax. Protect the client from infection. Allow the client an opportunity to express her feelings.

Allow the client an opportunity to express her feelings. Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client.Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.

A client has died after a long hospital stay. The family was present at the time of the client's death. Which postmortem nursing action is appropriate? Removing dentures and any prosthetics Raising the head of the bed and opens the client's eyes Asking the family if they wish to help wash the client Asking the family to leave during post-death care

Asking the family if they wish to help wash the client The nurse may ask the family if they wish to be involved in washing the client after the client's death.The family should be allowed to grieve at the bedside of the client. The head of the bed should be flat and the client's eyes closed. The client's dentures and prosthetics should be replaced, not removed.

A client who is dying is having difficulty swallowing oral medications. Which intervention will the nurse implement for this client? Ass the provider if the medications can be discontinued or substituted. Do not administer the medications and document: "Unable to swallow." Ask the pharmacy to substitute intramuscular (IM) equivalents for the medications. Crush the pills, open the sustained-release capsules, and mix them with a spoonful of applesauce.

Ass the provider if the medications can be discontinued or substituted. The nurse will contact the provider to ask if the medications can be discontinued or substituted. Since the client is in the dying process, he or she may no longer require some of the medications prescribed, and other routes may be available for medications that will promote comfort.The IM route is almost never used for clients at the end of life because this method is invasive and painful, and can cause infection. Although some pills may be crushed, sustained-release capsules should not be taken apart and their contents administered directly. The client may still need the medications prescribed for comfort; withholding them could cause discomfort throughout the dying process.

Key points for care of patient with cancer: health promo.

Assist patients and families to find appropriate community resources for support, supplies and care.

The RN is working with assistive personnel (AP) in caring for a group of clients. Which action is best for the RN to delegate to AP? Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria Assisting a client who had a radical nephrectomy 2 days ago to turn in bed Palpating for bladder distention on a client recently admitted with a ureteral stricture Helping the primary health care provider with a kidney biopsy for a client admitted with acute glomerulonephritis

Assisting a client who had a radical nephrectomy 2 days ago to turn in bed The best action for the RN is to have the AP assist a client who had a radical nephrectomy 2 days ago to turn in bed. The AP would be working within legal guidelines when assisting a client to turn in bed.Although assessment of vit

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? Monitor for decreased peripheral pulses. Determine if the client is able to ambulate. Auscultate for pericardial friction rub. Assess for crackles.

Auscultate for pericardial friction rub. The additional assessment needed for the client with uremia is to auscultate the pericardium for friction rub. Clients with CKD are prone to pericarditis. Signs/symptoms of pericarditis include inspiratory chest pain, tachycardia, narrow pulse pressure, low-grade fever, and pericardial friction rub.Crackles and tachycardia are symptomatic of fluid overload. Fever is not present with fluid overload. Although the nurse will monitor pulses, and ambulation is important to prevent weakness and deep vein thrombosis, these are not pertinent to the constellation of signs/symptoms of pericarditis that the client presents with.

The nurse is caring for a child with Wilms tumor. Which preoperative nursing intervention is the most important? Avoid palpating the abdomen. Closely monitor arterial blood gases. Prepare the child and family for renal transplantation. Prepare the child and family for long-term dialysis.

Avoid palpating the abdomen. Wilms tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. Closely monitoring arterial blood gases is not indicated preoperatively for this abdominal surgery. Preparing the child and family for long-term dialysis is not indicated unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative chemotherapy or radiation are used to minimize the size of the tumor. Renal transplantation is planned if both kidneys need to be removed and a compatible living donor exists. Otherwise, dialysis is necessary until a donor organ can be obtained.

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? Increasing dairy products enriched with vitamin D Drinking cola beverages only once daily Consuming a low-calcium diet Avoiding peas, nuts, and legumes

Avoiding peas, nuts, and legumes To prevent renal osteodystrophy in a chronic kidney disease client, the nurse needs to instruct the client to avoid peas, nuts, and legumes. Kidney failure causes hyperphosphatemia, so phosphorus-containing foods such as beans, peas, nuts (peanut butter), and legumes must be restricted.Calcium would not be restricted. Hyperphosphatemia results in a decrease in serum calcium and demineralization of the bone. Cola beverages and dairy products are high in phosphorus, contributing to hypocalcemia and bone breakdown.

A client with a recently created vascular access for hemodialysis is being discharged. Which teaching will the nurse include in the discharge instructions? How to practice proper nutrition? Avoiding venipuncture and blood pressure measurements in the affected arm How to assess for a bruit in the affected arm? Modifications to allow for complete rest of the affected arm

Avoiding venipuncture and blood pressure measurements in the affected arm The nurse must teach the client to avoid venipunctures and blood pressure measures in the arm that contains the newly created vascular access device. Compression of vascular access causes decreased blood flow and may cause occlusion. If this occurs, lifesaving dialysis will not be possible.

While managing care for a client with chronic kidney disease, which action does the registered nurse (RN) plan to delegate to assistive personnel (AP)? (Select all that apply.) Select all that apply. Explain the components of a low-sodium diet. Document the amount the client drinks throughout the shift. Auscultate the client's lung sounds every 4 hours. Check the arteriovenous (AV) fistula for a thrill and bruit. Obtain the client's prehemodialysis weight.

B and E. Actions the RN delegates to the UAP include: obtaining the client's weight and documenting oral fluid intake. These are routine tasks that can be performed by a UAP.Assessment skills (checking the AV fistula and auscultating lung sounds) and client education (explaining special diet) require more education and are in the legal scope of practice of the RN.

The nurse is teaching a class on advance directives. What will the nurse include? (Select all that apply.) Select all that apply. A durable power of attorney for health care is the same as a durable power of attorney for one's health care. A living will identifies health care wishes regarding end of life treatment. A health care proxy can only make decisions once a person no longer has their own ability to make decisions. In order to make a health care decision, a person much be totally oriented. A living will contains funeral directives as well as last wishes for family. Advance directive are the same from state to state.

B, C. Advance directive vary from state to state. While all have similarities, each state is unique. A durable power of attorney for health care is not the same as the durable power of attorney for finances. This can be the same person—but must be defined specifically for both roles. A living will identifies would an individual would (or would not) want when he or she is near death. A living will contains information specific to artificial ventilation, and nutrition or hydration as well as resuscitation directives. It does not contain funeral directives or last wishes for family. In order to make a health care decisions, a person does not need to be totally oriented. However, he or she must be able to receive information and then evaluate, deliberate, and manipulate the information as well as communicate a treatment preference.

What are the most important reasons for considering the use of palliative care in patient care management? (Select all that apply.) Select all that apply. Palliative care is reserved for those patients who are considered terminally ill. Patients live with multiple chronic diseases several years before dying. Palliative care is recommended until cures for illnesses are discovered. Patients live with debilitating symptoms that interfere with the quality of life. Palliative care is used to reduce the symptoms associated with chronic disease.

B, D, E. Because of the aging population in the United States, the older patient often lives with multiple diseases for several years before dying. These diseases produce symptoms that interfere with the activities of daily living and quality of life. Palliative care is symptom management and should be integrated into the management of chronic disease and not reserved only for terminal illness. Palliative care is utilized to help patients live as comfortably as possible (quality of life) for an unspecified amount of time, not just until cures are discovered.

A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the most appropriate nursing response? "The damaged kidneys no longer release a hormone that prevents high blood pressure." "The waste products in the blood interfere with mechanisms that control blood pressure." "There is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products." "Because the kidneys cannot get rid of fluid, blood pressure goes up."

Because the kidneys cannot get rid of fluid, blood pressure goes up." The nurse's best response to a client with chronic kidney disease and high blood pressure is, "Because the kidneys cannot get rid of fluid, blood pressure goes up." In chronic kidney disease, fluid levels increase in the circulatory system.

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? Lipid levels Blood urea nitrogen (BUN) and creatinine White blood cell (WBC) count Hemoglobin and hematocrit (H&H)

Blood urea nitrogen (BUN) and creatinine In the client with hydronephrosis, the nurse monitors the client's BUN and creatinine. BUN and creatinine are kidney function tests. With back-pressure on the kidney, glomerular filtration is reduced or absent, resulting in permanent kidney damage. Hydronephrosis results from the backup of urine secondary to obstruction.

The nurse recognizes that a client's hemangiosarcoma originated in which tissue? Epithelial tissue Blood vessel Skeletal muscle Cartilage

Blood vessel The prefix "hemangio-" is included when cancers of the blood vessel are named.The prefix "rhabdo-" is used when cancers of the skeletal muscle are named.The prefix "chondro-" is included when cancers of cartilage are named. The prefix "adeno-" is included when cancers of epithelial tissues are named.

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment data requires further nursing action? (Select all that apply.) Select all that apply. Blood pressure is 98/56 mm Hg. Urine output over the past hour was 80 mL. Heart rate is 118 beats/min. Dressing has a 1-cm area of bleeding. Abdominal distention. Pain is at a level 4 (on a 0--10 scale).

Bp of 98/56, HR of 118, abdominal distention, pain is at a level 4.

A client is diagnosed with melanoma. Which areas would the nurse anticipate that this client's tumor might metastasize? (Select all that apply.) Select all that apply. Kidneys Liver Gastrointestinal tract Lymph nodes Brain Lungs

C, D, E, F, Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis.

Which practices are generally recommended to prevent sexual transmission of HIV? (Select all that apply.) Select all that apply. Oral contraceptives taken consistently Natural-membrane condoms for genital and anal intercourse Latex gloves for finger or hand contact with the vagina or rectum Latex dental dam genital and anal intercourse Water-based lubricant with a latex condom Latex or polyurethane condoms for genital and anal intercourse

C, D, E, F. Latex or polyurethane condoms, dental dams, and gloves for genital and anal intercourse can prevent HIV from contacting susceptible tissues. Water-based lubricants must be used instead of oil-based or greasy lubricants because these can easily rub holes in the condoms. Oral contraceptives provide no protection against transmission of HIV or any other sexually transmitted infection.

Key points of cancer development: physiological integrity.

Cancer cells originate from normal body cells. Transformation involves a mutation of the genes and loss of cellular regulation. Oncogenes that are overexpressed can cause a cell to develop to a tumor. Tumors mostly arrive from cells capable of cell division. Tobacco use causes 30% of all cancer. Adults with reduced immunity have higher risk of cancer development. Cancer cells that are less differentiated and have a higher mitotic index are "more malignant" and harder to cure.

When caring for a client 24 hours after a nephrectomy, the nurse assesses abdominal distention. Which action will the nurse perform next? Insert a nasogastric (NG) tube. Notify the surgeon. Check vital signs. Continue to monitor.

Check vital signs. After noting a distended abdomen in a client who had a nephrectomy 24 hours ago, the nurse next needs to check the client's vital signs. The client's abdomen may be distended from bleeding. Hemorrhage or adrenal insufficiency causes hypotension, so vital signs must be taken to see if a change in blood pressure has occurred.The surgeon would be notified after vital signs are assessed. Just continuing to monitor is not appropriate. An NG tube is not indicated for this client.

After receiving change-of-shift report on the urology unit, which client will the nurse assess first? Client who was involved in a motor vehicle collision and has hematuria. Client with nephrotic syndrome who has gained 2 kg since yesterday. Client with glomerulonephritis who has cola-colored urine. Client postradical nephrectomy whose temperature is 99.8° F (37.6° C).

Client who was involved in a motor vehicle collision and has hematuria. After the change-of-shift report, the nurse first needs to assess the client who was involved in a motor vehicle collision. The nurse would be aware of the risk for kidney trauma after a motor vehicle crash. This client needs further assessment and evaluation to determine the extent of blood loss and the reason for the hematuria because hemorrhage can be life threatening.

The RN working on an oncology unit has just received report on these clients. Which client will the nurse assess first? Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy. Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour. Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature.

Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature. The nurse should see the client with chemotherapy-induced neutropenia first. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people.The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.

The RN has just received change-of-shift report. Which client will the nurse assess first? Client with azotemia whose blood urea nitrogen and creatinine are increasing. Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted. Client receiving peritoneal dialysis who needs help changing the dialysate bag. Client with chronic kidney failure who was just admitted with shortness of breath.

Client with chronic kidney failure who was just admitted with shortness of breath. After the change-of-shift report, the nurse must first assess the newly admitted client with chronic kidney failure and shortness of breath, the dyspnea of the client with chronic kidney failure may indicate pulmonary edema and must be assessed immediately.The client with kidney insufficiency is stable and assessment can be performed later. The client with azotemia requires assessment and possible interventions but is not at immediate risk for life-threatening problems. The client receiving peritoneal dialysis can be seen last because it is a slow process and the client has no urgent needs.

Which concept is the highest priority for the nurse to consider in planning care for the client with HIV-III who has candidial stomatitis? Cellular regulation Gas exchange Comfort Nutrition

Comfort Candidial stomatitis causes considerable oral discomfort and difficulty eating and swallowing. Ice chips and cool liquids can help reduce the discomfort until prescribed antifungal agents have reduced the infection symptoms. Some clients may have pain to the point that opioid analgesics are needed. Gas exchange and cellular regulation are not directly affected by the problem. Although nutrition is negatively affected, it is the pain that interferes most with nutrition.

To prevent prerenal acute kidney injury, which person will the nurse encourage to increase fluid consumption? Office secretary Construction worker School teacher Taxicab driver

Construction worker Construction workers perform physical labor and work outdoors, especially in warm weather. Working in this type of atmosphere causes diaphoresis and places this worker at risk for dehydration and prerenal azotemia.The office secretary and schoolteacher work indoors and, even without air conditioning, will not lose as much fluid to diaphoresis as someone performing physical labor. The taxicab driver, even without air conditioning, will not experience diaphoresis and fluid loss like the construction worker.

Which instruction is appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy? Consume a diet high in fiber. Bathe in cold water. Wear cotton gloves when cooking. Make sure shoes are snug.

Consume a diet high in fiber. A high-fiber diet will assist with constipation related to neuropathy.The client should bathe in warm not cold water, not hotter than 96° F. Cotton gloves may prevent harm from scratching, but protective gloves should be worn for cooking, washing dishes, and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

When assessing a client with acute glomerulonephritis, which assessment finding causes the nurse to notify the primary health care provider? Purulent wound on the leg Crackles throughout the lung fields Cola-colored urine History of diabetes

Crackles throughout the lung fields The nurse notifies the primary health care provider if crackles throughout the lung fields are heard in a client with acute glomerulonephritis. Crackles indicate fluid overload resulting from kidney damage. Shortness of breath and dyspnea are typically associated. The primary health care provider must be notified of this finding.Glomerulonephritis may result from infection (e.g., purulent wound); it is not an emergency about which to notify the primary health care provider. The history of diabetes would have been obtained on admission. Dark urine is expected in glomerulonephritis.

What symptoms of fluid overload should CKD patients wattch for?

Decreased uriine output, rapid bounding pulse, rapid sshallow respirs, dependent edema, crackles or wheezing, distended neck veins, decreased o2, hypertension, narrowed pulses pressure. It's also important to monitor LOC and ask about headaches or blurred vision.

The nurse is explaining the stages of grief in the order they occur. Explanation by the nurse is correct if which sequence is followed? acceptance, anger, bargaining, denial, sadness Bargaining, anger, acceptance, sadness, denial Denial, anger, bargaining, sadness, acceptance Sadness, anger, denial, bargaining, acceptance

Denial, anger, bargaining, sadness, acceptance Anger is the second stage. Denial is the first stage. Bargaining is the third stage. Sadness or depression is the fourth stage. Acceptance is the fifth and final stage.

End stage kidney disease treatments?

Diialysis, kidney transplant. eryhtropoieten for anemia. Phosphrous binders.

A client with end-stage kidney disease has been placed on fluid restrictions. Which assessment data indicates to the nurse that the fluid restriction has not been followed? Dyspnea and anxiety at rest Blood pressure of 118/78 mm Hg Central venous pressure (CVP) of 6 mm Hg Weight loss of 3 lb (1.4 kg) during hospitalization

Dyspnea and anxiety at rest The assessment finding that shows that the client has not adhered to fluid restriction is dyspnea and anxiety at rest. Dyspnea is a sign of fluid overload and possible pulmonary edema. The nurse needs to assist the client in correlating symptoms of fluid overload with nonadherence to fluid restriction.Nonadherence to fluid restriction results in fluid volume excess and higher blood pressures. 118/78 mm Hg is a normal blood pressure. Excess fluid intake and fluid retention are manifested by an elevated CVP (>8 mm Hg) and weight gain, not weight loss.

Which signs and symptoms does the nurse expect to find in a client diagnosed with Pneumocystis jiroveci infection? Dyspnea, tachypnea, persistent dry cough, and fever Substernal chest pain and difficulty swallowing Fever, persistent cough, and vomiting blood Cough with copious thick sputum, fever, and dyspnea

Dyspnea, tachypnea, persistent dry cough, and fever P. jiroveci causes pneumonia with dry cough, shortness of breath, breathlessness, and fever. Thick sputum and vomiting blood are not present. Substernal chest pain and difficulty swallowing are associated with an oral and esophageal candida infection. Vomiting blood is not associated with any type of pneumonia.

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends which food selection? Eggs Ham Eggplant Macaroni

Eggs The nurse recommends eggs as a dietary protein need for a client on peritoneal dialysis. Other suggested protein-containing foods for this client are milk and meat.Although a protein, ham is high in sodium and needs to be avoided. Vegetables and pasta contain mostly carbohydrates. Peritoneal dialysis clients are allowed 1.2 to 1.5 g of protein/kg/day because protein is lost with each exchange.

Key points for CKD: health promo and maintenance.

Encourage to follow fluid and dietary restrictions. Teach patients expected side effects to prescribed drugs. Teach signs of peritonitis (pain, tenderness, swelling, fever)

When educating a client with B-cell lymphoma, a nurse tells the client that a virus can contribute to the development of their cancer. Which virus is linked with B-cell lymphoma? Human lymphotrophic virus type II Human papilloma virus Epstein-Barr virus Hepatitis B virus

Epstein-Barr virus The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma.Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma

A 10-year-old girl requires daily medications for a chronic illness. The girl's mother tells the nurse that she has to nag her child to take her medicine before school. What is the most appropriate nursing intervention to promote the child's compliance? Ask the child to bring her medicine containers to each medical appointment so that the pills can be counted. Discuss with her mother the damaging effects of nagging. Establish a contract with the child that includes rewards for taking her medicine. Suggest "time-outs" when the child forgets to take her medicine.

Establish a contract with the child that includes rewards for taking her medicine. For school-age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance. Monitoring the medicine supply may be tried if the contracting is not successful. However, a school-age child will quickly figure out what you are doing. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem solving rather than criticize her actions. Time-outs should be used only if the behavior contracting is not successful.

Optimal symptom management is primarily based upon which type of care? Nurse-directed care Evidence-based practice Hospice-directed care Physician-directed care

Evidence-based practice The use of the best evidence can support high-quality interventions that are used in optimal symptom management and improved quality of life. Physician-directed care and Nurse-directed care are incorrect since palliative care is an interdisciplinary team approach to care. Hospice-directed care is incorrect as it is for the terminally ill and dying patient.

The nurse is coordinating interprofessional palliative care interventions for the client who is dying. Which goal is the nurse seeking to meet? Facilitating a peaceful death for the client Ensuring an expedited death Meeting all of the client's needs Avoiding symptoms of client distress

Facilitating a peaceful death for the client Facilitating a peaceful death for the client is one of the goals of palliative care.Symptoms of distress cannot be avoided but can be controlled. Expedited death is not a goal of palliative care. Identifying client needs is a goal of palliative care, but it is not always possible to meet all of the client's needs (e.g., to prevent death or lengthen life).

A child with lymphoma is receiving extensive radiation therapy. The nurse should be familiar about the most common side effect of this treatment? Lymphadenopathy Neuropathy Seizures Fatigue

Fatigue Fatigue is the most common side effect of radiation therapy. For children, the fatigue may be especially distressing, because it means they cannot keep up with their peers. Seizures are unlikely, because cranial irradiation is not usually involved in the treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

The nurse is teaching a client undergoing radiation therapy for laryngeal cancer. Which potential side effects will the nurse include? (Select all that apply.) Select all that apply. Fatigue Difficulty urinating Change in taste Difficulty swallowing Changes in hair color Changes in skin of the neck

Fatigue, change in taste, difficulty swallowing, changes in skin on the neck.

Which part of the HIV infection process is disrupted by the antiretroviral drug class of nucleoside reverse transcriptase inhibitors (NRTIs)? Clipping the newly generated viral proteins into smaller functional pieces Activating the viral enzyme "integrase" within the infected host's cells Binding of the virus's gp120 protein to one of the CD4+ coreceptors Forming counterfeit bases that prevent DNA synthesis and viral replication

Forming counterfeit bases that prevent DNA synthesis and viral replication The NRTIs have a similar structure to the four bases of DNA, making them "counterfeit" bases. They fool the HIV enzyme reverse transcriptase into using these counterfeit bases so that viral DNA synthesis and replication are suppressed.

Which actions or behaviors represent to the nurse that a client is engaging in secondary cancer prevention practices? (Select all that apply.) Select all that apply. Eating a diet high in fiber and low in animal fat Having a health checkup, including chest x-ray, annually Obtaining a colonoscopy every 5 years Electing to have both ovaries removed a person who has a BRCA2 mutation Getting a mammogram or breast MRI annually Having a mole removed from the neck

Getting a mammogram or breast mri annually and having a health checkup, including chest x-ray annually.

The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression? Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% 5000 white blood cells/mm3 (5 × 109/L) 250,000 platelets/mm3 (250 × 109/L) Potassium level of 2.9 mEq/L (2.9 mmol/L) and diarrhea

Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% has anemia demonstrated by low hemoglobin and hematocrit levels.The client with diarrhea and a potassium level of 2.9 mEq/L (2.9 mmol/L) has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 (250 × 109/L), and the client with 5000 white blood cells/mm3 (5 × 109/L) demonstrate normal values.

The potential effects of chronic illness or disability on a child's development vary at different ages. Which is a threat to a toddler's normal development? Hindered mobility Poorly defined body image Sense of guilt that the child caused the illness or disability Limited opportunities for socialization

Hindered mobility The inability to move about and master the environment will inhibit the toddler's developing autonomy. Poorly defined body image, limited opportunities for socialization, and sense of guilt that the child caused the illness or disability are characteristic of effects on a preschooler's development, not at the toddler stage. Poorly defined body image, limited opportunities for socialization, and sense of guilt that the child caused the illness or disability are characteristic of effects on a preschooler's development. Poorly defined body image, limited opportunities for socialization, and sense of guilt that the child caused the illness or disability are characteristic of effects on a preschooler's development.

End-of-life care is most synonymous with which type of care? Palliative care Quality of life Supportive care Hospice care

Hospice care End-of-life care is most synonymous with hospice care. Hospice care uses palliative care for the imminently dying by introducing a team of interdisciplinary healthcare professionals at the end of a patient's life. The Medicare Hospice Benefit requires that a patient have a prognosis of 6 months or less to be enrolled in this type of care. Palliative care is incorrect since it can be used to manage symptoms in patients who are living with symptomatic chronic disease several years before death. Supportive care is the type of care predominately used for patients with cancer and undergoing active cancer therapies. Quality of life can be enhanced through the implementation of all of these deliveries of care.

What complications can occur with CKD?

Hypertension, hyperparathyroiidism, anemiia, hyperglycemiia and dyslipiidemia.

The nurse is caring for a client with kidney failure. Which assessment data indicates the need for increased fluids? Decreased sodium level Pale-colored urine Increased blood urea nitrogen (BUN) Increased creatinine level

Increased blood urea nitrogen (BUN) An increase in BUN can be an indication of dehydration, and a needed increase in fluids.Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted and does not indicate that an increase in fluids is necessary. Sodium is increased, not decreased, with dehydration.

When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? Infection Drug toxicity Polycythemia Dose-limiting side effects

Infection The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase.Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction.

With which antiretroviral drug class will the nurse teach clients to prevent harm by reporting any new onset muscle weakness and muscle pain to the immunity health care provider? Fusion inhibitors Integrase inhibitors Nucleoside reverse transcriptase inhibitors Protease inhibitors

Integrase inhibitors The integrase inhibitor class of drugs can cause muscle breakdown (rhabdomyolysis) especially in adults taking a "statin" (type of lipid-lowering drug). The first symptoms of rhabdomyolysis are muscle pain and weakness. None of the other classes of antiretroviral drugs have this side effect.

Denial is a common reaction to the diagnosis of a disability or chronic illness. What should the nurse understand about denial as a defense mechanism? It prevents the mobilization of energies toward goal-directed, problem-solving behavior. It is a necessary cushion to prevent disintegration. It prevents a sense of hope. It is maladaptive.

It is a necessary cushion to prevent disintegration. Adaptive denial is effective as the family begins to learn the effect that the diagnosis will have on the family. Denial is not maladaptive until it interferes with treatment goals. Denial may allow a sense of hope at a time when the family is feeling overwhelmed by the diagnosis. Initially using denial to cope with the diagnosis enables families to mobilize energies toward goal-directed problem solving.

What is used to treat hyperkalemia in CKD?

Iv glucose (dex 50) and regular insulin to move potassium iinto the cells.

What ace iinhibitors are given for CKD? ARB'S? Calcium channel blockers?

Lisinopril is the primary. Then benazepril, quinapril, rapipril. Irbesartan, losartan, olmesartan, valsartan. Amlodiipine and nifedipine.

Which condition, when assessed in a client who is dying requires the nurse to take action? Alternating apnea and rapid breathing Cool extremities Moaning Anorexia

Moaning Moaning indicates pain and requires pain medication.Alternating apnea and rapid breathing, anorexia, and cool extremities are normal assessment findings in the client who is dying.

The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? Observe for motor deficits. Monitor weight. Monitor platelets. Trend red blood cells and hemoglobin and hematocrit.

Monitor weight. Cachexia results in extreme body wasting, malnutrition, and severe weight loss.Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.

A client with terminal pancreatic cancer is near death and reports increasing shortness of breath with associated anxiety. Which hospice protocol order will the nurse implement first? Morphine sulfate sublingually as needed Albuterol solution per nebulizer Prednisone elixir 10 mg orally Oxygen 2 to 6 L/min per nasal cannula

Morphine sulfate sublingually as needed Morphine sulfate is the standard treatment for the dyspneic client who is near death.Albuterol, oxygen, and steroids may be useful, but should be used as adjuncts to therapy with morphine.

A toddler with mucosal ulceration related to chemotherapy is not eating because of pain. The nurse would expect to administer which solution to ease the child's discomfort? Lemon glycerin swabs for cleansing Local anesthetic such as viscous lidocaine before meals Mouthwashes with hydrogen peroxide Mouthwashes with normal saline solution

Mouthwashes with normal saline solution Normal saline solution mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without risking adverse effects on the mucosa or adverse effects caused by the child swallowing the rinse. Viscous lidocaine is not recommended for toddlers because it depresses the gag reflex. Lemon glycerin swabs can irritate eroded tissue and cause tooth decay. Hydrogen peroxide delays healing by breaking down protein.

Which cancer type does the nurse interpret from a client's pathology report that indicates "stage 2 rhabdomyosarcoma"? Muscle Brain Bone Breast

Muscle The term "rhabdomyo" refers to bone and "sarcoma" refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma.

End stage kindey diseases symptoms?

Nausea, vomitiing, loss of appetiite, fatigue, muscle twiitch / cramps, swelling feet and ankles, chest pain / pressure, SOB, hypertension, weight loss, anorexia, GI bleeding.

The nurse teaches a client who is recovering from acute kidney injury to avoid which type of medication? Opioids Nonsteroidal anti-inflammatory drugs (NSAIDs) Calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors

Nonsteroidal anti-inflammatory drugs (NSAIDs) Clients recovering from acute kidney disease need to be taught to avoid NSAIDs. NSAIDs may be nephrotoxic to a client with acute kidney disease and must be avoided.ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially in the diabetic client, from progression of kidney disease. Opioids may be used by clients with kidney disease if severe pain is present. Excretion, however, may be delayed. Calcium channel blockers can improve the glomerular filtration rate and blood flow within the kidney.

The nurse is caring for a client with hemorrhage secondary to kidney trauma. Which element does the nurse anticipate will be used for volume expansion? Platelet infusions 5% dextrose in water Normal saline solution Fresh-frozen plasma

Normal saline solution To provide volume expansion to a client with hemorrhage secondary to kidney trauma, the nurse expects that normal saline solution will be used. Isotonic solutions and crystalloid solutions are administered for volume expansion. 0.9% sodium chloride (NS) and 5% dextrose in 0.45% sodium chloride may also be given. Lactated Ringer's solution may be used if the client has no liver damage.

Comfort care is an intervention carried out by which professional discipline? Clergy Medicine Nursing Volunteers

Nursing Comfort care is a term that is often used by physicians and nurses in the context of dying, terminally ill, or seriously ill patients. Yet, comfort care is predominantly used by nurses, who attend to the dying patient and family by providing physical comfort measures, such as repositioning, mouth care, and skin care, while valuing the ongoing medical management of the patient's symptoms. Therefore, the other answers are incorrect—it is primarily the nurse who provides comfort care.

A dying client becomes increasingly withdrawn and begins to refuse to eat and drink. What intervention will the nurse implement? Administer intravenous hydration. Call the family to come in right away. Offer ice chips. Bring in the client's favorite food.

Offer ice chips. The client who is dying should not be forced to eat or drink, but small sips of liquids or ice chips at frequent intervals can be offered if the client is alert and able to swallow. This helps the client with problems of dehydration and "dry mouth."The client's metabolic needs have decreased, so the client will not want any food or drink. Calling the family is not yet necessary in this client's case. Because the dying client's metabolic needs have decreased, invasive procedures are not currently necessary.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting? Naloxone Ondansetron Diazepam Morphine

Ondansetron Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Lorazepam, a benzodiazepine, may also be given for nausea.Morphine is a narcotic analgesic or opiate and may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only.

What effect does a "passenger" mutation in a gene have on cancer development? Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies. These mutations enhance the effectiveness of carcinogens causing direct DNA damage of a normal cell, increasing the likelihood of cancer development. These mutations protect against cancer development by reversing the effects of initiation. Passenger mutations are another term for proto-oncogene gene mutations.

Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies. Although passenger mutations are often found along with driver mutations in later cancer stages, they appear to have no effect on initial cancer development or cancer cell survival. Their presence can be used to identify advanced cancer types and may also be used as "targets" for newer cancer therapies.

Key points for care of patient with cancer: physiological integrity

Perform total assessment. Assess pain level regularly. Instruct patients to use prescribed antiemtic drugs. Closely monitor patients receiving any type of target therapy. Stress importance of adhering to prescribed med schedule.

A child with newly diagnosed leukemia has been admitted for the initial round of chemotherapy. What common signs and symptoms of leukemia related to bone marrow involvement would the nurse expect to find either in the child's history or during the assessment? Muscle wasting, weight loss, and fatigue Headache, papilledema, and irritability Petechiae, infection, and fatigue Decreased intracranial pressure, psychosis, and confusion

Petechiae, infection, and fatigue These are signs of infiltration of the bone marrow: petechiae from lowered platelet count, infection from the decreased number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

A client who is dying cannot swallow and is accumulating audible mucus in the upper airway (death rattles). These noises are upsetting to family members. What nursing action is appropriate? Place the client in a side-lying position so secretions can drain. Use a Yankauer suction tip to remove secretions from the client's upper airway. Position the client in a high-Fowler position to minimize secretions. Assist the family in leaving the room so that they can compose themselves.

Place the client in a side-lying position so secretions can drain. Placing the client in a side-lying position to facilitate draining of secretions (by gravity) is the appropriate nursing care intervention. As secretions diminish, noisy respirations will decrease.Asking the family to leave at this important time is not appropriate. Placing the client in a high-Fowler position is ineffective in helping the client who has lost the ability to swallow and increases the danger of choking and aspiration. Oropharyngeal suctioning is not recommended for removal of secretions, because it is not effective and may even agitate the client.

Which client problem does the nurse determine as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? Potential for injury related to sensory and motor deficits Altered sexual function related to erectile dysfunction Potential for lack of understanding related to side effects of chemotherapy Potential for ineffective coping strategies related to loss of motor control

Potential for injury related to sensory and motor deficits The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities.Every chemotherapy client needs to be taught related side effects of chemotherapy. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.

A pediatric nurse is counseling parents regarding the home care of a child with a cardiac defect before corrective surgery. What information should the nurse stress? The need to be extremely concerned about cyanotic spells Promoting normalcy within the limits of the child's condition Reducing caloric intake to decrease cardiac demands Relaxing discipline and limit setting to prevent crying

Promoting normalcy within the limits of the child's condition The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake. The child needs discipline and appropriate limits. Because cyanotic spells will occur in some children with some defects, the parents need to be taught how to manage these.

The nurse is preparing a client for nephrostomy tube insertion. Which factor must be assessed by the nurse before the procedure? Blood urea nitrogen (BUN) and creatinine Prothrombin time (PT) and international normalized ratio (INR) Intake and output (I&O) Hemoglobin and hematocrit (H&H)

Prothrombin time (PT) and international normalized ratio (INR) Before insertion of a nephrostomy tube into a client, it is essential for the nurse to monitor the client's PT and INR. The procedure will be cancelled or delayed if coagulopathy in the form of prolonged PT/INR exists because dangerous bleeding may result. Nephrostomy tubes are placed to prevent and treat kidney damage.

The nurse is caring for a preschool child after the removal of a brain tumor. What should the nurse include in the child's care? (Select all that apply.) Select all that apply. Allow unlimited visitors so that the child does not get lonely. Position the child side-lying in the Trendelenburg position. Provide close supervision while the child is regaining consciousness. Observe for colorless drainage at the operative site. Avoid giving analgesics because of altered consciousness.

Provide close supervision and observe for colorless drainage. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. The child needs to be observed closely. Careful assessment of the vital signs and monitoring for signs of increasing intracranial pressure need to be done. The child should not be positioned in the Trendelenburg position postoperatively. Analgesics can be used for postoperative pain but generally not opioids. Only parents of the child should visit at designated times to prevent overstimulation and potential for increased intracranial pressure.

When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? Providing oral care with a disposable mouth swab Maintaining NPO until the lesions have resolved Encouraging oral care with commercial mouthwash Administering a biological response modifier

Providing oral care with a disposable mouth swab The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care.Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition and hydration are important during cancer treatment; a local anesthetic may be prescribed.

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 L of normal saline infused over 2 hours. Which staff member would be assigned to care for the client? LPN/LVN with experience working on the medical unit. New graduate RN who just finished a 6-week orientation. RN who has floated from pediatrics for this shift. RN who usually works on the general surgical unit.

RN who usually works on the general surgical unit. The RN who usually works on the general surgical unit would have the most experience in taking care of surgical clients and would be most capable of monitoring the client receiving rapid fluid infusions. This client is at risk for complications such as pulmonary edema and acute kidney failure.

Imagiing tests for CKD?

Radiography for bone abnormalitiies and disease progressoin. KUB or CT scans without contrast to rule out obstruction.

A child is receiving chemotherapy through a newly implanted Port-a-Cath. What information should the nurse share with the parents about the implanted access device? The skin does not need to be pierced for access. It is easy to use for self-administered infusions. Regular physical activity, including swimming, does not need to be limited. It cannot be dislodged from the port, even if child "plays" with the port site.

Regular physical activity, including swimming, does not need to be limited. Because this device is totally under the skin, there are no activity limitations for the child, except when the port is in use. The port site is under the skin, but a special needle is used to access it. There is a potential for dislodging the access needle, but not the port itself. Because the port is totally under the skin, a needle must be used to access the port. The port has to be accessed with a special needle.

The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome will the nurse teach the client is the goal of palliative surgery? Prolonging the client's survival time Relief of symptoms or improved quality of life Allowing other therapies to be more effective Cure of the cancer

Relief of symptoms or improved quality of life The focus and goal of palliative surgery is to help relieve symptoms of end-stage cancer and improve quality of life during the survival time.

What are the five stage of kindey CKD?

Stage 1: eGFR 90 or greater. Stage 2: 60-89. Stage 3: 30-59. Stage 4: 15-29. Stage 5: less than 15.

Which client circumstance would prompt the nurse to create a three-generation pedigree to more fully explore the possibility of increased genetic risk for cancer? Smoked for 20 years but quit 5 years ago Personal history of excessive sun exposure Most family adult members are overweight Strong family history of breast cancer

Strong family history of breast cancer Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk.

Key points for cancer development: Health promotion / maintenance.

Teach adults to avoid tanning beds. Use sunscreen or protective clothing during sun exposure. Encourage patients to participate in cancer screening. Assist in smoking cessation. Assess patients knowledge of cancer. Ask about exposure to environmental agents. Obtain family history.

A hospice client becomes too weak to swallow. What does the nurse do initially to increase the client's comfort? Explains to the family that aspiration may be a concern. Administers nutrition and fluids through a nasogastric tube. Teaches the family how to provide oral care. Obtains a physician order to initiate an IV line.

Teaches the family how to provide oral care. Because the oral mucosa will become dry, the initial action taken by the nurse would be to teach the family members how to moisten the lips and mouth.Although fluids can be given through a nasogastric tube and through an IV line, these are generally considered to increase discomfort by prolonging the client's suffering. Aspiration is not a concern in terminally ill clients, because fluids are not given orally to clients with decreased swallowing.

The nurse is caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter. Which assessment finding requires nursing action? Mild discomfort at the insertion site Temperature 100.8° F (38.2° °C) Anorexia 1+ ankle edema

Temperature 100.8° F (38.2° °C) In this client situation, the nurse reports an assessment finding of a temperature of 100.8° F (38.2° C) to the HCP. Infection is a major complication of temporary catheters. All symptoms of infection, including fever, must be reported to the provider because the catheter may have to be removed.Mild discomfort at the insertion site is expected with a subclavian hemodialysis catheter. During acute injury, oliguria with resulting fluid retention and 1+ ankle edema is expected. Rising blood urea nitrogen may result in anorexia, nausea, and vomiting.

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider (HCP) immediately? Temperature of 101.2° F (38.4° C) Sinus bradycardia, rate of 58 beats/min Pulse oximetry reading of 95% Blood pressure of 148/90 mm Hg

Temperature of 101.2° F (38.4° C) The nurse needs to immediately report a peritoneal dialysis client's temperature of 101.2° F (38.4° C) to the HCP. Peritonitis is the major complication of PD, caused by intra-abdominal catheter site contamination. Meticulous aseptic technique must be used when caring for PD equipment.A pulse oximetry reading of 95% is a normal saturation. Although a heart rate of 58 beats/min is slightly bradycardic, the HCP can be informed upon visiting the client. Clients with kidney failure tend to have slightly higher blood pressures due to fluid retention. This is not as serious as a fever.

Home care is being considered for a child with a serious chronic illness. In preparing the family for discharge, the case manager has the family provide total care for the child while the child is still hospitalized. What is the most important expectation as a result of this strategy? The family becomes excited about becoming involved in the care. The family learns the essential elements of providing care before going home. There could be legal issues related to the family caring for the child. The child will learn which family member can best meet the physical needs at home.

The family learns the essential elements of providing care before going home. Having the family provide total care for the child while the child is still hospitalized is very appropriate, but the eagerness depends on the specific family. At least two family members should be comfortable with caring for the child before discharge. As long as the family members are taught the care and can provide return demonstrations of what has been learned and have their questions answered, there is little legal liability. There needs to be enough time for the family to learn as well. The family needs to learn the skills necessary to care for the child at home. This supervised period of care is essential for properly preparing the family to assume the care of the child.

The nurse educator is describing a rhabdomyosarcoma to a group of new nurses. Teaching by the nurse is correct if which explanation is provided? It is a common hereditary neoplasm of childhood. It is the most common bone tumor of childhood. The most common sites are the head and neck. It is a benign tumor that is not commonly found in children.

The most common sites are the head and neck. Although striated muscle fibers from which this tumor arises can be found anywhere in the body, the most common sites are the head and neck. Rhabdomyosarcoma arises from skeletal muscle tissue, not bone. Rhabdomyosarcoma is not known to be hereditary. Rhabdomyosarcoma is highly malignant.

The parents of a child with a newly diagnosed chronic illness ask how much to tell the child's siblings. Which information should be explained by the nurse? Siblings rarely have negative feelings about their sibling's illness. The siblings need to understand that they will be expected to help with the therapies whenever the parents are unavailable. Siblings react in a predictable manner in relationship to the illness of a family member. The siblings should receive education regarding the ill child's condition, treatment, physical changes, disabilities, and expected disease progression.

The siblings should receive education regarding the ill child's condition, treatment, physical changes, disabilities, and expected disease progression. Nursing care of siblings involves education regarding the ill child's condition, treatment, physical changes, disabilities, and expected disease progression. The siblings should ideally be kept up to date regarding changes in the ill child's condition, both positive and negative. The same principles of honest communication apply both to siblings and to the child with the illness. However, what information is ultimately shared with siblings is at the parents' discretion. They may resent being left in the care of other family members as the parents are consumed with the care of the ill child. Siblings may experience guilt and shame about such feelings. They should not be responsible for the care of their ill sibling. Siblings often have feelings of guilt regarding their perceived role in the ill child's condition. Many children have had thoughts of what life would be like without having to share material possessions and parental love with their sibling(s). When a sibling then becomes ill, the guilt and associated emotions may be overwhelming. Siblings do not react in a predictable manner to the illness of a family member. They can also go through the stages of grief as a result of the illness. Grades and health status can be affected by the sibling's illness.

How will the nurse interpret the finding on a client's pathology report that indicates a cancerous tumor is aneuploid? The tumor is completely undifferentiated. The tumor is fast growing. Metastasis has already occurred. The tumor has an abnormal number of chromosomes.

The tumor has an abnormal number of chromosomes. A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition.

How will the nurse interpret the finding on a client's pathology report that a cancerous tumor has a mitotic index of 8%? The tumor has not yet undergone carcinogenesis. The tumor is slow-growing. Metastasis has already occurred. The tumor has an abnormal number of chromosomes.

The tumor is slow-growing. A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index.

Which assessment data in a client with chronic glomerulonephritis (GN) warrants the nurse to contact the primary health care provider? Itchy skin Serum potassium of 5.0 mEq/L (5.0 mmol/L) Mild proteinuria Third heart sound (S3)

Third heart sound (S3) When a third heart sound (S3) is heard in a client with chronic glomerulonephritis, the nurse needs to contact the primary health care provider. S3 indicates fluid overload secondary to failing kidneys. The primary health care provider would be notified and instructions obtained.

What is the first action a nurse should take after sustaining a needlestick injury after injecting a client who is known to be HIV positive? Send the syringe and needle to the laboratory for analysis of viral load. Inform the charge nurse. Thoroughly scrub and flush the puncture site. Go to the employee clinic for postexposure prophylaxis.

Thoroughly scrub and flush the puncture site. Although the nurse would also inform the charge nurse and go to the employee clinic to initiate postexposure prophylaxis, the first action is to clean the puncture site by washing it thoroughly with soap and water for at least 1 minute as recommended by the CDC. Viral load cannot be determined by analyzing the syringe and needle.

A nurse is caring for an 8-year-old child who has a chronic illness. The child has a tracheostomy, and a parent is rooming-in during this hospitalization. The parent insists on providing almost all the child's care and tells the nurses how to care for the child. Based on the nurse's knowledge of family-centered care, the nurse recognizes that the parent has what need at this time based on concepts of family-centered care? To be able to assume the nurse's role during the hospitalization To minimize interactions between the nurse and the family To know how to provide all aspects of the child's care perfectly To have total control of the family situation even in the hospital

To know how to provide all aspects of the child's care perfectly The nurse recognizes that the philosophy of family-centered care states that the parents are the experts in the care of their child. The nurse functions collaboratively with the family. Because these parents care for this child with complex health needs at home, they are most familiar with the care requirements and routine. These parents advocate for their child. The nurse's role includes assessment and evaluation, not just the implementation phase.

The nurse is caring a client who had a nephrostomy tube inserted 4 hours ago. Which assessment requires nursing action? Small amount of urine leaking around the catheter Creatinine of 1.8 mg/dL (160 mcmol/L) Dark pink-colored urine Tube that has stopped draining

Tube that has stopped draining The nurse will need to inform the primary health care provider when a nephrostomy tube that was inserted 4 hours ago does not drain. It could be obstructed or dislodged.Pink or red drainage is expected for 12 to 24 hours after insertion and would gradually clear. The nurse may reinforce the dressing around the catheter to address leaking urine. However, the primary health care provider must be notified if there is a large quantity of leaking drainage, which may indicate tube obstruction. A creatinine level of 1.8 mg/dL (160 mcmol/L) is expected in a client early after nephrostomy tube placement (due to the minor kidney damage that required the nephrostomy tube).

A client who is dying is having difficulty swallowing oral medications. Which intervention will the nurse implement for this client? Ass the provider if the medications can be discontinued or substituted. Do not administer the medications and document: "Unable to swallow." Ask the pharmacy to substitute intramuscular (IM) equivalents for the medications. Crush the pills, open the sustained-release capsules, and mix them with a spoonful of applesauce.While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action will the nurse implement? Document the effluent as output. Instruct the client to cough. Reposition the catheter. Turn the client to the opposite side.

Turn the client to the opposite side. The nurse's first action in this situation is to turn the client to the opposite side. With peritoneal dialysis, usually 1 to 2 L of dialysate is infused by gravity into the peritoneal space. The fluid dwells in the peritoneal cavity for a specified time, then drains by gravity into a drainage bag. The peritoneal effluent or outflow generally is a continuous stream after the clamp is completely open. Potential causes of flow difficulty include constipation, kinked or clamped connection tubing, the client's position, fibrin clot formation, and catheter displacement. If inflow or outflow drainage is inadequate, reposition the client to stimulate inflow or outflow. Turning the client to the other side or ensuring that he or she is in good body alignment may help.

What labs are important to CKD?

Urinalysis to detect RBC (4.3-5.65 mil), WBC (4-11k), casts, protein and glucose. BUN (7-20) and serum creatinine (0.7-1.3) Hct (12.1-17.2) and Hgb (36.1-50.3%). Ultrasound to detect obstructions and kiidney size. Biopsy.

Labs of concern with nephrotic syndrome?

Urine protein (high) low serum albumins less than 3g/dl. Increased serum lipid levels, fat in urine.

Key points for CKD: safe and effective care enviroment.

Use sterile technique at all times. Implement fall precautions and consider phsyical therapy for CKD patients.Use skin protection measures to reduce inury and pressure sores. Alert HCP of assessments indicating hypotension, dehydration, or hypovolemia. Avoid BP readings in arm with vascular accesss. Do not use kidney replacement vascular access device to give IV fluids.

Which intervention will the oncology nurse use to prevent disseminated intravascular coagulation (DIC)? Monitoring platelets Using strict aseptic technique to prevent infection Administering packed red blood cells Administering low-dose heparin therapy for clients on bedrest

Using strict aseptic technique to prevent infection Sepsis is a major cause of DIC, especially in the oncology client. The oncology nurse must use strict asepsis to prevent any infection.Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

Which laboratory test does the nurse analyze to determine the effectiveness of combination antiretroviral drug therapy in an HIV-positive client? Viral load testing Enzyme-linked immunosorbent assay Fourth generation testing Western blot analysis

Viral load testing Only viral load testing directly measures the actual amount of HIV viral RNA particles present in 1 mL of blood. Changes in the number indicate therapy effectiveness. Higher numbers indicate lack of effectiveness and lower numbers indicate the drugs are working. The other tests are used to determine whether the client is infected with HIV and do not change with therapy.

When assessing a client with acute pyelonephritis, which finding does the nurse anticipate? (Select all that apply.) Select all that apply. Oliguria Vomiting Dysuria Chills Suprapubic pain

Vomiting, dysuria, chills. The findings the nurse expects to find in a client with acute pyelonephritis include: vomiting, chills, and dysuria. Nausea and vomiting and chills along with fever may occur. Dysuria (burning), urgency, and frequency can also occur.Suprapubic pain is indicative of cystitis, not kidney infection (pyelonephritis). Flank, back, or loin pain are symptoms of acute pyelonephritis. Oliguria is related to kidney impairment from severe or long-standing pyelonephritis.

Nursing interventions for end stage kidney disease?

Weight at the same time each day. Monitor strict I/o. Teach signs of fluid overload such as rapid bounding pulse, rapid shallow respirs, edema, crackles / wheezing, decreased o2, elevated bp, distended veins.

Nephrotic syndrom symptoms?

Weight gain, fattigue, foamy urine, loss of appetite. For children - edema, anorexia, fatigue, abdominal pain, respiratory infection and weight gain.

How iis hypertension controlled in CKD? What about anemiia?

With antihypertensives liike diuretics, b-adrenergic blocks, CCB's ace inhibs and angiotensin blockers. Anemia is treated with exogenous erythropoietiin.

Lifestyle changes to improve CKD?

exerciise, avoiid alchy, stop smokin, follow diet.

How does drug buildup occur with CKD?

the kidneys are weaker and can't fully excrete drugs as quickly. Drugs like digoxin, diabetic agents, antiibiotiics and opiods become more concerning.