CHA LP 6 and LP 7
To prevent recurrence of uric acid kidney stones, the nurse teaches the patient to avoid eating: a. milk and cheese. b. sardines and liver. c. spinach and chocolate. d. legumes and dried fruit.
B
What laboratory value should the nurse check before administering captopril to a patient with stage 2 chronic kidney disease? a. Glucose b. Potassium c. Creatinine d. Phosphate
B
What risks will the nurse plan to teach a 27-yr-old woman who smokes two packs of cigarettes daily? a. Kidney stones b. Bladder cancer c. Bladder infection d. Interstitial cystitis
B
What should the nurse assess for when performing a focused examination to determine possible causes of infertility? a. Hydrocele b. Varicocele c. Epididymitis d. Paraphimosis
B
What side effect of leuprolide (Lupron) should the nurse plan to discuss with a patient who has cancer of the prostate? a. Flushing b. Dizziness c. Infection d. Incontinence
A
What will the nurse will ask the patient about to determine the severity of benign prostatic hyperplasia (BPH) symptoms? a. Blood in the urine b. Lower back or hip pain c. Force of urinary stream d. Erectile dysfunction (ED)
C
A 58-yr-old patient is on the medical-surgical unit after undergoing a radical vulvectomy for vulvar carcinoma. What is the greatest risk to the patient at this time? a. Self-care deficit b. Wound infection c. Inadequate nutrition d. Ineffective sexual pattern
B
During routine hemodialysis, a patient reports nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Check the blood pressure (BP). c. Review the hematocrit (Hct) level. d. Give prescribed PRN antiemetic drugs.
B
A 58-yr-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which patient problem is present, based on these findings? a. Poor perfusion b. Inadequate nutrition c. Activity intolerance d. Excess fluid volume
d
Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? a. Blood in urine b. Left flank bruising c. Left flank discomfort d. Decreased urine output
d
A 51-yr-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. What should the nurse explain as an advantage to this procedure? a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. b. Only a small incision is needed, resulting in minimal breast pain and scarring. c. If the biopsy results are negative, no further diagnostic testing will be needed. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
A
A 70-yr-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today. Which patient statement indicates a need for the nurse to provide additional instruction? a. "I should call the doctor if I have incontinence at home." b. "I will avoid driving until I get approval from my doctor." c. "I should schedule yearly appointments for prostate examinations." d. "I will increase fiber and fluids in my diet to prevent constipation."
A
A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first? a. Insert urethral catheter. b. Obtain renal ultrasound. c. Draw a complete blood count. d. Infuse normal saline at 50 mL/hr.
A
A 76-yr-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first? a. Insert an indwelling urinary catheter. b. Draw blood for a serum creatinine level. c. Schedule an intravenous pyelogram (IVP). d. Administer lorazepam (Ativan) 0.5 mg PO.
A
A patient diagnosed with breast cancer asks the nurse what "triple negative" means. What should an accurate response from the nurse about triple-negative breast cancer include? a. The tumor is not likely to be responsive to hormone therapy. b. Treatment with chemotherapy is not likely to be recommended. c. HER-2 receptor testing was repeated for a total of three samples. d. Estrogen receptor testing identified three hormones causing the cancer.
A
A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first? a. Check blood pressure and heart rate. b. Administer morphine sulfate 4 mg IV. c. Transport to radiology for an intravenous pyelogram. d. Insert a urethral catheter and obtain a urine specimen.
A
A patient is unable to void after having an open loop resection and fulguration of the bladder. Which nursing action should be implemented? a. Assist the patient to soak in a 15-minute sitz bath. b. Restrict oral fluids to equal previous urine volume. c. Insert a straight urethral catheter and drain the bladder. d. Teach the patient how to do isometric perineal exercises.
A
A patient who has increased blood urea nitrogen (BUN) and serum creatinine levels is scheduled for a renal arteriogram. Which bowel preparation order would the nurse question for this patient? a. Fleet enema b. Tap-water enema c. Senna/docusate (Senokot-S) d. Bisacodyl (Dulcolax) tablets
A
A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "Tell me what you think is important to know about the surgery." b. "It is essential that you know enough to provide informed consent." c. "Many patients do better after surgery if they have more information." d. "You can wait until after surgery for teaching about pain management."
A
A patient will need vascular access for hemodialysis. Which statement by the nurse accurately describes an advantage of a fistula over a graft? a. A fistula is much less likely to clot. b. A fistula increases patient mobility. c. A fistula can be used sooner after surgery. d. A fistula can accommodate larger needles.
A
A patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider? a. Give ketorolac 10 mg PO PRN for pain. b. Infuse 5% dextrose in normal saline at 75 mL/hr. c. Order regular diet after patient is awake and alert. d. Draw blood urea nitrogen (BUN) and creatinine in 2 hours.
A
A patient with endometriosis asks why she is being treated with a contraceptive. What information should the nurse explain about this therapy? a. It suppresses the menstrual cycle by mimicking pregnancy. b. It relieves symptoms such as vaginal atrophy and hot flashes. c. It prevents a pregnancy that could worsen the menstrual bleeding. d. It leads to permanent suppression of abnormal endometrial tissues.
A
A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, "My symptoms are much worse this week." Which response by the nurse is appropriate? a. "Have you taken any over-the-counter (OTC) medications recently?" b. "I will talk to the doctor about a prostate-specific antigen (PSA) test." c. "Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes in size from day to day, and this may be making your symptoms worse."
A
Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum b. A 35-yr-old patient who is concerned that his scrotum "feels like a bag of worms" c. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis d. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy
A
Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. What should the nurse assess before administering the medication? a. Bowel sounds b. Blood glucose c. Blood urea nitrogen (BUN) d. Level of consciousness (LOC)
A
The following male patients recently arrived in the emergency department. Which one should the nurse assess first? a. A 19-yr-old patient who is reporting severe scrotal pain b. A 60-yr-old patient with a nontender ulceration of the glans penis c. A 64-yr-old patient who has dysuria after brachytherapy for prostate cancer d. A 22-yr-old patient who has purulent urethral drainage and severe back pain
A
The nurse is caring for a hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will be included in the plan of care? a. Monitor the urine output after the procedure. b. Assist with monitored anesthesia care (MAC). c. Give oral contrast solution before the procedure. d. Insert a large size urinary catheter before the IVP.
A
What glomerular filtration rate (GFR) would the nurse estimate for a 30-yr-old patient with a creatinine clearance result of 60 mL/min? a. 60 mL/min b. 90 mL/min c. 120 mL/min d. 180 mL/min
A
What information will the nurse plan to teach the patient scheduled for photovaporization of the prostate (PVP)? a. Care of an indwelling urinary catheter. b. Urine will appear bloody for several days. c. Symptom improvement takes 2 to 3 weeks. d. Complications associated with urethral stenting.
A
What should the nurse plan to teach a 67-yr-old patient who has been diagnosed with orchitis? a. Pain management b. Emergency surgery c. Scrotal sac fluid aspiration d. Applying heat to the scrotum
A
What topic should the nurse anticipate teaching a patient who is diagnosed with lobular carcinoma in situ (LCIS)? a. Tamoxifen b. Lumpectomy c. Lymphatic mapping d. Mammaprint testing
A
Which action will the nurse include in the plan of care to maintain the patency of a patient's left arm arteriovenous fistula? a. Auscultate for a bruit at the fistula site. b. Assess the quality of the left radial pulse. c. Compare blood pressures in the left and right arms. d. Irrigate the fistula site with saline every 8 to 12 hours.
A
Which information will the nurse include when teaching a patient who is scheduled for stereotactic core biopsy of the breast? a. A local anesthetic will be given before the biopsy specimen is obtained. b. You will need to lie flat on your back and lie very still during the biopsy. c. A thin needle will be inserted into the lump and aspirated to remove tissue. d. You should not have anything to eat or drink for 6 hours before the procedure.
A
Which medication taken by a patient with decreased renal function will be of most concern to the nurse? a. ibuprofen (Motrin) b. warfarin (Coumadin) c. folic acid (vitamin B9) d. penicillin (Bicillin C-R)
A
What will the nurse plan to teach the patient who is incontinent of urine following a radical retropubic prostatectomy? a. Restrict oral fluid intake. b. Do pelvic muscle exercises. c. Perform intermittent self-catheterization. d. Use belladonna and opium suppositories.
B
Which nonhormonal therapies will the nurse suggest for a healthy perimenopausal patient who prefers not to use hormone replacement therapy (HRT)? (Select all that apply.) a. Exercise several times a week. b. Take black cohosh supplements. c. Drink a glass of wine before sleeping. d. Increase intake of dietary soy products. e. Have a daily calcium intake of 1500 mg.
A, B, D, E
Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis? (Select all that apply.) a. Avoid commercial salt substitutes. b. Restrict fluid intake to 1000 mL daily. c. Take phosphate binders with each meal. d. Choose high-protein foods for most meals. e. Have several servings of dairy products daily.
A, C, D
A 25-yr-old patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider? a. Serum creatinine level of 2.1 mg/dL b. Serum potassium level of 6.5 mEq/L c. White blood cell count of 11,500/μL d. Blood urea nitrogen (BUN) of 56 mg/dL
B
A 27-yr-old patient who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is appropriate for the nurse to take? a. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy. b. Ask the patient if he has any questions or concerns about the diagnosis and treatment. c. Inform the patient's wife that concerns about sexual function are common with this diagnosis. d. Document the patient's lack of communication on the health record and continue preoperative care.
B
A 32-yr-old patient has oral contraceptives prescribed for endometriosis. What instruction should the nurse give this patient? a. Expect to experience side effects such as facial hair. b. Take the medication every day for the next 9 months. c. Take calcium supplements to prevent developing osteoporosis during therapy. d. Use a second method of contraception to ensure that she will not become pregnant.
B
A 33-yr-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? a. Take aspirin every 4 hours to reduce inflammation. b. Check wound drains for excessive blood or a foul odor. c. Wear a loose-fitting bra to decrease irritation of the sutures. d. Resume normal activities 2 to 3 days after the mammoplasty.
B
A 36-yr-old patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan? a. There is yellow discharge from the patient's right nipple. b. An area on the breast is hot, pink, and tender to the touch. c. Firm, moveable lumps are in the upper outer breast quadrants. d. The lumps get more painful before the patient's menstrual period.
B
A 62-yr-old female patient has been hospitalized for 4 days with acute kidney injury (AKI) caused by dehydration. Which information will be most important for the nurse to report to the health care provider? a. The creatinine level is 3.0 mg/dL. b. Urine output over an 8-hour period is 2500 mL. c. The blood urea nitrogen (BUN) level is 67 mg/dL. d. The glomerular filtration rate is less than 30 mL/min/1.73 m2
B
A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis?" Which initial response by the nurse is best? a. "It depends on which type of dialysis you are considering." b. "Tell me more about what you are thinking regarding dialysis." c. "You are the only one who can make the decision about dialysis." d. "Many people your age use dialysis and have a good quality of life."
B
A 78-yr-old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care? a. Limit fluid intake to no more than 1000 mL/day. b. Leave a light on in the bathroom during the night. c. Ask the patient to use a urinal so that urine can be measured. d. Pad the patient's bed to accommodate overflow incontinence.
B
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient's abdomen appears bloated after the inflow. d. The patient has abdominal pain during the inflow phase.
B
A healthy 24-yr-old patient who has been vaccinated against human papillomavirus (HPV) has a normal Pap test result. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test? a. You can wait until after age 30 before having another Pap test. b. Pap testing is recommended every 3 years for women your age. c. No further Pap testing is needed until you decide to become pregnant. d. Yearly Pap testing is suggested for women with multiple sexual partners.
B
A patient tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his partner "is losing patience with the situation." Which patient concern should be the focus of the nurse's follow-up questions? a. Low self-esteem b. Role performance c. Increased anxiety. d. Infrequent intercourse.
B
A patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse implement first? a. Infuse normal saline at 50 mL/hr. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Schedule pelvic magnetic resonance imaging
B
A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. More protein is allowed because urea and creatinine are removed by dialysis. c. Dietary potassium is not restricted because the level is normalized by dialysis. d. Unlimited fluids are allowed because retained fluid is removed during dialysis.
B
After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. What topic should the nurse plan to teach the patient? a. Estradiol b. Tamoxifen c. Raloxifene d. Trastuzumab
B
After reviewing the electronic medical record shown in the accompanying figure for a patient who had transurethral resection of the prostate the previous day, which information requires the most rapid action by the nurse? a. Elevated temperature and pulse b. Bladder spasms and urine output c. Respiratory rate and lung crackles d. No prescription for antihypertensive drugs
B
After the insertion of an arteriovenous graft in the right forearm, a patient reports pain and coldness of the right fingers. Which action should the nurse take? a. Remind the patient to take a daily low-dose aspirin tablet. b. Report the patient's symptoms to the health care provider. c. Elevate the patient's arm on pillows above the heart level. d. Teach the patient about normal arteriovenous graft function.
B
An adult patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect? a. Poor skin turgor b. Recent weight gain c. Elevated urine ketones d. Decreased blood pressure
B
The health care provider prescribes finasteride (Proscar) for a patient who has benign prostatic hyperplasia (BPH). What information should the nurse provide when teaching the patient about the drug? a. He should change position from lying to standing slowly to avoid dizziness. b. His interest in sexual activity may decrease while he is taking the medication. c. Improvement in the obstructive symptoms should occur within about 2 weeks. d. He will need to monitor his blood pressure frequently to assess for hypertension.
B
The nurse in a health clinic receives requests for appointments from several patients. Which patient should be seen by the health care provider first? a. A 48-yr-old patient who has perineal pain and a temperature of 100.4° F b. A 58-yr-old patient who has a painful erection that has lasted more than 6 hours c. A 38-yr-old patient who reports that he had difficulty maintaining an erection twice last week d. A 68-yr-old patient who has pink urine after a transurethral resection of the prostate (TURP) 3 days ago
B
The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider? a. The urine output is 900 to 1100 mL/hr. b. The patient's central venous pressure (CVP) is decreased. c. The patient reports level 7 (0- to 10-point scale) incisional pain. d. The blood urea nitrogen (BUN) and creatinine levels are elevated.
B
The nurse is planning care for a patient with severe heart failure who has developed increased blood urea nitrogen (BUN) and creatinine levels. What will be the primary treatment goal in the plan? a. Augmenting fluid volume b. Maintaining cardiac output c. Diluting nephrotoxic substances d. Preventing systemic hypertension
B
The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider? a. Heart rate b. Urine output c. Creatinine clearance d. Blood urea nitrogen (BUN) level
B
The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first? a. Refer the patient for mammography. b. Question the patient about current medications. c. Explain that this is temporary due to hormonal changes. d. Teach the patient how to palpate the breast tissue for lumps.
B
The nurse provides discharge teaching for a 61-yr-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? a. "I will need to use my right arm and to rest the left one." b. "I will avoid reaching over the stove with my left hand." c. "I will keep my left arm in a sling until the incision is healed." d. "I will stop the left arm exercises if moving the arm is painful."
B
The outpatient clinic receives telephone messages from four patients. Which patient should the nurse call back first? a. A 40-yr-old patient who has left side chest and arm pain 2 months after a left modified radical mastectomy b. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue c. A 21-yr-old patient with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene d. A 57-yr-old patient with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching
B
When caring for a patient after cystoscopy, what should the nurse include in the plan of care? a. The patient learns to request narcotics for pain. b. The patient understands to expect blood-tinged urine. c. The patient restricts activity to bed rest for 4 to 6 hours. d. The patient remains NPO for 8 hours to prevent vomiting.
B
Which action will the nurse anticipate taking for an otherwise healthy 50-yr-old who has just been diagnosed with stage 1 renal cell carcinoma? a. Prepare patient for a renal biopsy. b. Provide preoperative teaching about nephrectomy. c. Teach the patient about chemotherapy medications. d. Schedule for a follow-up appointment in 3 months.
B
Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Avoid isometric exercise on the right arm. b. Assist with application of a compression sleeve. c. Keep the right arm at or below the level of the heart. d. Check blood pressure (BP) on both right and left arms.
B
Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation. b. A breast nodule that is 1 cm in size, nontender, and fixed. c. A breast lump that increases in size before the menstrual period. d. A breast lump that is small and mobile, with a rubbery consistency.
B
Which assessment finding should the nurse expect when a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30? a. Persistent skin tenting b. Rapid, deep respirations c. Hot, flushed face and neck d. Bounding peripheral pulses
B
Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation? a. The patient has type 1 diabetes. b. The patient has metastatic lung cancer. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with human immunodeficiency virus.
B
Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be needed. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy.
B
Which information will the nurse monitor to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance
B
Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination? a. Testicular self-examination should be done at least weekly. b. Testicular self-examination should be done in a warm room. c. The only structure normally felt in the scrotal sac is the testis. d. Call the health care provider if one testis is larger than the other.
B
Which laboratory result should the nurse check before administering calcium carbonate to a patient with chronic kidney disease? a. Serum potassium b. Serum phosphate c. Serum creatinine d. Serum cholesterol
B
Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been successful? a. Split-pea soup, English muffin, and nonfat milk b. Poached eggs, whole-wheat toast, and apple juice c. Oatmeal with cream, half a banana, and herbal tea d. Cheese sandwich, tomato soup, and cranberry juice
B
Which patient statement indicates that the nurse's teaching about tamoxifen has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will take the medication for 6 to 12 months."
B
What should the nurse ask the patient about to determine possible causes of acute glomerulonephritis? a. Recent bladder infection b. History of kidney stones c. Recent sore throat and fever d. History of high blood pressure
C
Which actions can the nurse working in a women's health clinic delegate to experienced unlicensed assistive personnel (UAP)? (Select all that apply.) a. Call a patient with the results of an endometrial biopsy. b. Assist the health care provider with performing a Pap test. c. Draw blood for CA-125 levels for a patient with ovarian cancer. d. Question a patient about use of medications that may cause amenorrhea. e. Teach the parent of a teenager about human papilloma virus (HPV) vaccine (Gardasil).
B, C
A 28-yr-old male patient has just been diagnosed with polycystic kidney disease. Which information should the nurse include in teaching during the first teaching session? a. Complications of renal transplantation b. Methods for treating severe chronic pain c. Options to consider for genetic counseling d. Differences between hemodialysis and peritoneal dialysis
C
A 53-yr-old patient is scheduled for an annual physical examination. What diagnostic test will the nurse will plan to explain to the patient? a. Urinalysis collection b. Uroflowmetry studies c. Prostate-specific antigen (PSA) d. Transrectal ultrasound scanning (TRUS)
C
A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.
C
A 55-yr-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit). Which information should the nurse report to the health care provider before giving the medication? a. Creatinine 1.6 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg
C
A 58-yr-old woman tells the nurse, "I understand that I have stage 2 breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "It would not be appropriate for me to make a decision about your health." c. "Tell me what you understand about the surgical options that are available." d. "There is no need to make a decision rapidly; you have time to think about this."
C
A 68-yr-old patient admitted to the hospital with dehydration is confused and incontinent of urine. Which nursing action should be included in the plan of care? a. Restrict fluids between meals and after the evening meal. b. Insert an indwelling catheter until the symptoms have resolved. c. Assist the patient to the bathroom every 2 hours during the day. d. Apply absorbent adult incontinence diapers and pads over the bed linens.
C
A patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first? a. Insert a urinary retention catheter. b. Administer epoetin alfa (Epogen). c. Place the patient on a cardiac monitor. d. Give sodium polystyrene sulfonate (Kayexalate).
C
A patient is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides the same benefits as oral HRT. b. Increased risk of colon cancer in women taking HRT requires frequent colonoscopy. c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.
C
A patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function? a. Urine volume b. Creatinine level c. Glomerular filtration rate (GFR) d. Blood urea nitrogen (BUN) level
C
A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? a. "There are several options that I can consider for treating the cancer." b. "I will probably need radiation to the breast after having the surgery." c. "Mastectomy is the best choice to decrease the chance of cancer recurrence." d. "I can probably have reconstructive surgery at the same time as a mastectomy."
C
A patient passing bloody urine has scheduled a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate? a. "Your doctor will place a catheter into an artery in your groin and inject a dye to visualize the blood supply to the kidneys." b. "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidneys." c. "Your doctor will insert a lighted tube in the bladder through your urethra, inspect the bladder, and instill dye to outline your bladder on x-ray." d. "Your doctor will inject a radioactive solution into a vein in your arm, then the isotope in your kidneys and bladder will be visible on a scanner."
C
A patient requests a prescription for birth control pills to control severe abdominal cramping and headaches during her menstrual periods. Which action should the nurse take first? a. Determine whether the patient is sexually active. b. Teach about the side effects of oral contraceptives. c. Take the patient's personal and family health history. d. Suggest nonsteroidal antiinflammatory drugs (NSAIDs).
C
A patient who had a kidney transplant eight years ago is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone. Which assessment data will be of most concern to the nurse? a. Skin is thin and fragile. b. Blood pressure is 150/92. c. A nontender axillary lump. d. Blood glucose is 144 mg/dL.
C
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine volume b. Calcium level c. Cardiac rhythm d. Neurologic status
C
A patient who was recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to have sexual intercourse. Which action should the nurse take? a. Discuss alternative methods of sexual expression. b. Teach about medication for erectile dysfunction (ED). c. Clarify that TURP does not commonly affect erection. d. Offer reassurance that fertility is not affected by TURP.
C
A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? a. Notify the patient's health care provider. b. Document the QRS interval measurement. c. Check the patient's most recent potassium level. d. Review the chart for the patient's current creatinine level.
C
A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin. What should the nurse monitor for adverse effects of the medication? a. Blood glucose b. Urine osmolality c. Serum creatinine d. Serum potassium
C
Following rectal surgery, a patient voids about 50 mL of urine every 30 to 60 minutes for the first 4 hours. Which nursing action is the priority? a. Encourage the patient to drink more fluids. b. Plan to monitor the patient's intake and output. c. Use an ultrasound scanner to check the postvoiding residual volume. d. Reassure the patient that urinary problems are common after rectal surgery.
C
The nurse in the clinic notes elevated prostate-specific antigen (PSA) levels in the laboratory results of these patients. Which patient's elevated PSA result requires further evaluation? a. A 38-yr-old patient who is being treated for acute prostatitis b. A 52-yr-old patient who goes on long bicycle rides every weekend c. A 48-yr-old patient whose father died of metastatic prostate cancer d. A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia (BPH)
C
The nurse in the dialysis clinic is reviewing the home medications of a patient with chronic kidney disease (CKD). Which medication reported by the patient indicates that patient teaching is required? a. Acetaminophen b. Calcium phosphate c. Magnesium hydroxide d. Multivitamin with iron
C
The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? a. The patient reports fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell count is 5000/μL.
C
The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with: a. antibiotics. b. antifungals. c. anticoagulants. d. antihypertensives.
C
What health history information should the nurse obtain from the patient who has possible testicular cancer? a. Testicular torsion b. Testicular trauma c. Undescended testicles d. Sexually transmitted infection (STI)
C
What potential cause of infection will the nurse consider in the plan of care for a patient immediately after a perineal radical prostatectomy? a. Urinary incontinence b. Prolonged urinary stasis c. Fecal wound contamination d. Suprapubic catheter placement
C
What should the nurse explain to a patient being prepared for colposcopy with a cervical biopsy? a. It involves dilation of the cervix and biopsy of the tissue lining the uterus. b. It will take place in a same-day surgery center so that local anesthesia can be used. c. It is similar to a speculum examination of the cervix and should cause little discomfort. d. It requires that the patient have nothing to eat or drink for 6 hours before the procedure.
C
What should the nurse will teach about when preparing a patient with bladder cancer for intravesical chemotherapy? a. Coping with hair loss b. Premedicating to prevent nausea c. Emptying the bladder before the instillation d. Maintaining oral care during the treatments
C
Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing. b. The patient plans 30 to 60 minutes for a dialysate exchange. c. The patient cleans the catheter while in the bathtub each day. d. The patient slows the inflow rate when experiencing abdominal pain.
C
Which assessment finding may indicate that a patient is experiencing adverse effects to a corticosteroid taken for four years after kidney transplantation? a. Postural hypotension b. Recurrent tachycardia c. Knee and hip joint pain d. Increased serum creatinine
C
Which information about a patient with Goodpasture syndrome requires the most rapid action by the nurse? a. Blood urea nitrogen level is 70 mg/dL. b. Urine output over the last 2 hours is 30 mL. c. Audible crackles bilaterally over the posterior chest to the midscapular level. d. Elevated level of antiglomerular basement membrane (anti-GBM) antibodies.
C
Which information from a patient who had a transurethral resection with fulguration for bladder cancer 3 days ago is most important to report to the health care provider? a. The patient is voiding every 4 hours. b. The patient is using opioids for pain. c. The patient has seen clots in the urine. d. The patient is anxious about the cancer.
C
Which information from a patient's urinalysis requires that the nurse notify the health care provider? a. pH 6.2 b. Trace protein c. WBC 20 to 26/hpf d. Specific gravity 1.021
C
Which information will the nurse teach a patient who has chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Intercourse or masturbation will help relieve symptoms. d. Cold packs used every 4 hours will decrease inflammation.
C
Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein? a. Start continuous pulse oximetry. b. Restrict the patient's protein intake. c. Restrict physical activity to bed rest. d. Discontinue the urethral retention catheter.
C
Which nursing action is essential for a patient immediately after a renal biopsy? a. Insert a urinary catheter and test urine for microscopic hematuria. b. Check blood glucose to assess for hyperglycemia or hypoglycemia. c. Apply a pressure dressing and position the patient on the affected side. d. Monitor blood urea nitrogen (BUN) and creatinine to assess renal function.
C
Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes? a. Teach the patient to use the ordered patient-controlled analgesia every 10 minutes. b. Obtain a permanent breast prosthesis before the patient is discharged from the hospital. c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. d. Insist that the patient examine the surgical incision when the initial dressings are removed.
C
Which question is most pertinent for the nurse to ask a 43-yr-old patient about her risk for breast cancer? a. "Do you currently smoke tobacco?" b. "Have you ever had a breast injury?" c. "At what age did you start having menstrual periods?" d. "Is there a family history of fibrocystic breast changes?"
C
Which question should the nurse ask when assessing a 60-year-old patient who has a history of benign prostatic hyperplasia (BPH)? a. "Have you noticed any unusual discharge from your penis?" b. "Has there been any change in your sex life in the past year?" c. "Has there been a decrease in the force of your urinary stream?" d. "Have you been experiencing any difficulty in achieving an erection?"
C
Which statement by a patient with interstitial cystitis indicates to the nurse that further instruction is needed? a. "I should stop having coffee and orange juice for breakfast." b. "I will buy calcium glycerophosphate (Prelief) at the pharmacy." c. "I will start taking high potency multiple vitamins every morning." d. "I should call the doctor about increased bladder pain or foul urine."
C
Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. "I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my output each day to help calculate the amount I can drink." d. "I need erythropoietin injections to boost my immunity and prevent infection."
C
Which topic should the nurse include when planning a teaching session for a patient with benign nephrosclerosis? a. Preventing bleeding with anticoagulants b. Obtaining and documenting daily weight c. Monitoring and recording blood pressure d. Measuring daily intake and output volumes
C
Which statement by a patient who had a cystoscopy the previous day should the nurse report immediately to the health care provider? a. "My urine looks pink." b. "My IV site is bruised." c. "My sleep was restless." d. "My temperature is 101."
D
A patient has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient manage discomfort? a. Avoid aerobic exercise during her menstrual period. b. Use cold packs on the abdomen and back for pain relief. c. Talk with her health care provider about beginning antidepressant therapy. d. Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts.
D
A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/VN)? a. Teaching the patient how to avoid injury to the left arm b. Assessing the patient's range of motion for the left arm c. Evaluating the patient's understanding about drain care d. Giving an analgesic 30 minutes before scheduled arm exercises
D
A patient reports leg cramps during hemodialysis. What action should the nurse take? a. Massage the patient's legs. b. Reposition the patient supine. c. Give acetaminophen (Tylenol). d. Infuse a bolus of normal saline.
D
A patient who has a large cystocele was admitted 10 hours ago but has not yet voided. If the patient reports no urge to void, which action should the nurse take first? a. Insert a straight catheter per the PRN order. b. Encourage the patient to increase oral fluids. c. Notify the health care provider of the inability to void. d. Use an ultrasound scanner to check for urinary retention.
D
A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. What should the nurse plan to do? a. Vaccinate the patient with sipuleucel-T (Provenge). b. Provide the patient with information about cryotherapy. c. Teach the patient about placement of intraurethral stents. d. Schedule the patient for annual prostate-specific antigen testing.
D
A young adult employed as a hair stylist who has a 15 pack-year history of cigarette smoking arrives for an annual physical examination. Which area of increased risk should the nurse plan to teach the patient? a. Renal failure b. Kidney stones c. Pyelonephritis d. Bladder cancer
D
After a transurethral resection of the prostate (TURP), a 64-yr-old patient with continuous bladder irrigation reports painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first? a. Increase the flowrate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.
D
After receiving change-of-shift report, which patient should the nurse assess first? a. Patient who is scheduled for the drain phase of a peritoneal dialysis exchange. b. Patient with stage 4 chronic kidney disease who has an elevated phosphate level. c. Patient with stage 5 chronic kidney disease who has a potassium level of 3.4 mEq/L. d. Patient who has just returned from having hemodialysis with a heart rate of 110/min.
D
The health care provider prescribes the following interventions for a patient with acute prostatitis caused by Escherichia coli. Which intervention should the nurse question? a. Give trimethoprim/sulfamethoxazole 1 tablet daily for 28 days. b. Administer ibuprofen 400 mg every 8 hours as needed for pain. c. Instruct patient to avoid sexual intercourse until treatment is complete. d. Catheterize the patient as needed if symptoms of urinary retention develop.
D
The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? a. Explain the discharge care of the axillary drains. b. Teach the patient how to deep breathe and cough. c. Discuss options for postoperative pain management. d. Ask the patient to describe what she knows about the surgery.
D
What should the nurse plan to teach a 57-year-old man who is scheduled for an annual physical examination? a. Increased risk for testicular cancer b. Possible changes in erectile function c. Normal decreases in testosterone level d. Prostate-specific antigen (PSA) testing
D
What test will the nurse plan to explain to a 61-yr-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate-specific antigen (PSA) level? a. Cystourethroscopy b. Uroflowmetry studies c. Magnetic resonance imaging (MRI) d. Transrectal ultrasonography (TRUS)
D
What will the nurse teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin)? a. Hot flashes may occur with the medication. b. Serum electrolyte levels will be drawn monthly. c. The patient will need frequent eye examinations. d. The patient should call if she notices ankle swelling.
D
When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Teach the patient how to perform Kegel exercises. b. Monitor for increases in bleeding or presence of clots. c. Increase the flowrate of the irrigation if clots are noted. d. Report any patient reports of pain or spasms to the nurse.
D
When the nurse is working in the women's health care clinic, which action is appropriate to take? a. Teach a healthy 30-yr-old patient about the need for an annual mammogram. b. Discuss scheduling an annual clinical breast examination with a 22-year-old patient. c. Explain to a 60-yr-old patient that mammography frequency can be reduced to every 3 years. d. Teach a 34-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI).
D
Which assessment information collected by the nurse may present a contraindication to a testosterone replacement therapy (TRT)? a. The patient has noticed a decrease in energy level for a few years. b. The patient's symptoms have increased steadily over the past few years. c. The patient has been using sildenafil (Viagra) several times every week. d. The patient has had a gradual decrease in the force of his urinary stream.
D
Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? a. Bladder distention b. Foul-smelling urine c. Suprapubic discomfort d. Costovertebral tenderness
D
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective? a. The urine dipstick is negative for nitrites. b. The patient denies pain or burning with voiding. c. The antistreptolysin-O (ASO) titer has decreased. d. The periorbital and peripheral edema are resolved.
D
Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Antibiotics are infused continuously through the bladder irrigation. d. Bladder irrigation prevents obstruction of the catheter after surgery.
D
After change-of-shift report, which patient should the nurse assess first? a. Patient who has cloudy urine after bladder reconstruction. b. Patient with a urethral stricture who has not voided for 12 hours. c. Patient who voided bright red urine after returning from lithotripsy. d. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg.
b
A 68-yr-old male patient who has bladder cancer had a cystectomy with creation of an Indiana pouch. Which topic will be included in patient teaching? a. Application of ostomy appliances b. Barrier products for skin protection c. Catheterization technique and schedule d. Analgesic use before emptying the pouch
c
After ureterolithotomy, a patient has a left ureteral catheter and a urethral catheter in place. Which action will the nurse include in the plan of care? a. Provide teaching about home care for both catheters. b. Apply continuous steady tension to the ureteral catheter. c. Call the health care provider if the ureteral catheter output drops suddenly. d. Clamp the ureteral catheter off when output from the urethral catheter stops.
c