Medsurg Final
A 71-year-old client with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make?
"Kidney transplants in clients your age are as successful as they are in younger clients"
The nurse is caring for a client who is admitted to have a low profile gastrostomy device (LPGD) placed. How soon after the original gastrostomy tube is placed can an LPGD be placed?
1 1/2 to 3 months
The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day?
2,000 mL
The nurse caring for a client with suspected renal dysfunction calculates that the clients weight has increased by 5 pounds (2.27kg) in the past 24 hrs. The nurse estimates that the client has retained approximately how much fluid?
2300 mL of loud in 24 hours
A client with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The client weighs 60 kg. The nurse is monitoring the client's urine output hourly and notifies the health care provider when the hourly output is less than what?
30 mL
A nurse is caring for a client who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the client?
Administer an isotonic dextrose solution 1 to 2 hours after discontinuing the PN
The nurse is caring for a client who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the client?
Administer an isotonic solution for 1 to 2 hours after discontinuing the PN
A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in the clients immediate care? Select all that apply.
Administering beta blockers Applying interventions to reduce heart rate
A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's immediate care? Select all that apply.
Administering beta blockers to reduce the heart rate Applying interventions to reduce the clients temperauture
The nurse caring for a client with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?
Administration of dexamethasone orally at 11pm and a plasma cortisol level at 8 am the next morning
An 84 year old woman diagnosed with cancer is admitted to oncology unit for surgical treatment. The client has been in chemotherapeutic agents to decrease tumor size prior to the planned surgery. The nurse caring for the client is aware that what precipitating factors in this client may contribute to AKI? Select all that apply.
Age related physiologic changes Chronic systemic disease
A client requires ongoing treatment and infection-control precautions because of an inherited deficit in immune function. The nurse should recognize that this client most likely has what type of immune disorder?
An autoimmune disorder
An office worker takes a cookie that contains peanut butter. The worker begins wheezing, with an inspiratory stridor and air hunger, and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity?
Anaphylactic (type 1)
A client with chronic kidney disease had been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?
Assess for a thrill or bruit over the vascular access site each shift
A client with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?
Assess for thrill or bruit over the vascular access site each shift
The nurse is reviewing the electronic health record of a client with a history of incontinence. The nurse reads that the health care provider assessed the client's deep tendon reflexes. What condition of the urinary/renal system does this assessment address
Bladder dysfunction
A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery?
Blood glucose
The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurse's assessments most directly addresses a major complication of TPN?
Checking the clients capillary blood glucose levels regularly
A clients health decline necessitates the use of total parenteral nutrition. The client has questioned the need for insertion of a central venous catheter, expressing a preference for a normal IV. the nurse should know that peripheral administration of high concentration PN formulas is contraindicated because of the risk for what complication?
Chemical phlebitis
the nurse is creating a care plan for a patient who is receiving parenteral nutrition. the clients care-plan should include nursing actions relevant to what potential complications? Select all that apply.
Clotted displaced catheter Pneumothorax Hyperglycemia Line sepsis
A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, but the renal replacement therapy is needed to manage the clients hypervolemia and hyperkalemia.. Which of the following therapies will the clients hemodynamic status best tolerate?
Continuous venovenous hemodialysis (CVVHD)
The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all thatapply.
Dietary history Family history of renal stones Medication history
A nurse is caring for a client who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply.
Erythrocyte sedimentation rate C- reactive protein
A nurse has obtained an order to remove a client's NG tube that was placed for feeding. What is the nurse's best initial action?
Explain the process clearly to the client
The nurse is caring for a patient who is postoperative from having a gastrostomy tube placed. What should the nurse do on a daily basis to prevent skin breakdown?
Gently rotate the tube
A 45 year old man with diabetic neuropathy has ESKD and is starting dialysis. What should the nurse teach the client about hemodialysis?
Hemodialysis is a treatment option that is usually required three times a week
A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?
Highly dilute urine
A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what?
Hydronephrosis
The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply
Hypotension Pallor Rapid respiratory rate
A client with a history of dermatitis takes corticosteroids on a regular basis. The nurse should assess the client for which of the following complications of therapy?
Immunosuppression
A gerontologic nurse is caring for an older adult client who has a diagnosis of pneumonia. What age-related change increases older adults' susceptibility to respiratory infections?
Impaired ciliary action
A client who has AIDS has been admitted for the treatment of Kaposi sarcoma. What nursing diagnosis should the nurse by associate with this complication of AIDS?
Impaired skin integrity related to Kaposi sarcoma
A critical care nurse is caring for a client diagnosed with acute pancreatitis. The nurse knows that the indications for starting parenteral nutrition (PN) for this client are what?
Inability to take in adequate oral food or fluids within 7 days
A client has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the client's discharge education accordingly. What preventative measure should the nurse encourage the client to adopt?
Increasing fluid intake
A nurse is planning the care of a client who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this woman's care needs?
Ineffective role performance related to pain
A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response?
Inform the patient that this is not unexpected in the short term and scan the patient's bladder following each void.
The nurse and urologist have both been unsuccessful in catheterizing a client with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the health care provider to use to drain the client's bladder?
Insertion of a suprapubic catheter
The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan?
Inspection and care of incision
The nurse care plan for a client with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care?
Keep the clients bed linens free of wrinkles
A client is concerned about leakage of gastric contents out of the gastric sump tube the nurse has just inserted. What would the nurse do to prevent reflux gastric contents from coming out of the tube?
Keep the vent lumen above the clients waist
A 76-year-old client with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The client tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make?
Kidney transplants in clients your age are as successful as they are in younger clients
The nurse has identified the nursing diagnosis of "Risk for infection" in a client who undergoes peritoneal dialysis. What nursing action best addresses this risk?
Maintain aseptic technique when administering dialysate
A client has been brought to the emergency department by EMS after being found unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the client's condition. The care team should attempt to assess for what potential causes of anaphylaxis? Select all that apply.
Medications Insect stings Foods
A nurse is caring for a client who has allergic rhinitis. What intervention would be most likely to help the client meet the goal of improved breathing pattern?
Modify the environment to reduce the severity of the allergic sypmtoms
A patient has been brought to the emergency department by EMS after telling a family member that he deliberately took an overdose of NSAIDs a few minutes earlier. If lavage is ordered, the nurse should prepare to assist with the insertion of what type of tube?
Orogastric tube
A client with a recent history of nephrolithiasis has presented to the ED. After determining that the client's cardiopulmonary status is stable, what aspect of care should the nurse prioritize?
Pain management
The nurse is applying standard precautions in the care of a client who has an immunodeficiency. What are key elements of standard precautions? Select all that apply.
Performing hand hygiene Using appropriate personal protective equipment Using safe injection practices
The nurse is caring for a client who has just returned to the post-surgical unit following renal surgery. When assessing the clients output form surgical drains, the nurse should assess what parameters? Select all that apply.
Quantity of output Color of the output Visible characteristics of the output
A client is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The client is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurse's most appropriate response?
Reassure the client that is an expected phenomenom
A patient who suffered a stroke had an NG tube inserted to facilitate feeding shortly after admission. The patient has since become comatose and the patient's family asks the nurse why the physician is recommending the removal of the patient's NG tube and the insertion of a gastrostomy tube. What is the nurse's best response?
Regurgitation and aspiration are less likely.
A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?
Reposition the client to facilitate drainage
The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's health education, what nutritional guidelines should the nurse provide?
Restrict protein intake as ordered.
A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance?
Returning the bicarbonate to the body's circulation
The nurse is planning the care of a client who has a diagnosis of atopic dermatitis, which commonly affects both of her hands and forearms. What risk nursing diagnosis should the nurse include in the client's care plan?
Risk for disturbed body image image related to skin lesions
A client with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the client's plan of care?
Risk for infection related to presence of an indwelling urinary catheter
A nurse is caring for a client with a subclavian central line who is receiving parenteral nutrition (PN). In preparing a care plan for this client, what nursing diagnosis should the nurse prioritize?
Risk for infection related to the presence of a subclavian catheter
A client with rheumatic disease has developed a gastrointestinal bleed. The nurse caring for the client should further assess the client for the adverse effects of what medications?
Salicylate therapy
The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply.
Specific gravity of the clients urine Testing for the presence of glucose in the clients urine Microscopic examination of urine sediment for RBC's Microscopic examination of urine sediment for casts
A client with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the client's postprocedure care?
Strain the clients urine following the procedure
A 15 year old is admitted to the renal unit with a diagnosis of postinfectionous glomerular disease, the nurse should recognize that this is form of kidney disease may have been precipitated by what event?
Streptococcal infection
A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence?
Stress incontinence
A nurse is providing care for a client who has a rheumatic disorder. The nurse's comprehensive assessment includes the client's mood, behavior, LOC, and neurologic status. What is this client's most likely diagnosis?
Systemic lupus erythematosus (SLE)
A nurse is participating in a clients care conference and the team is deciding between parenteral nutrition (PN) and total nutritional admixture (TNA). what advantages are associated with providing TNA rather than PN?
TNA is less costly than PN
The nurse is caring for a client receiving hemodialysis three times weekly. The client has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when proving care for this client?
Taking a BP reading on the affected arm can damage the fistula
A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client?
Tell the client to report to the ED for further assessment
A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the patient?
Tell the patient to report to the ED for further assessment.
A client is in the primary infection stage of HIV. What is true of this client's current health status
The client is infected with HIV but lacks HIV specific antibodies
A client's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding?
The client is likely to have increased serum creatinine levels
The nurse is assessing a client's risk for impaired immune function. What assessment finding should the nurse identify as a risk factor for decreased immunity?
The client is under significant psychosocial stress
A client is vigilant in her efforts to "take good care of herself" but is frustrated by her recent history of upper respiratory infections and influenza. What aspect of the client's lifestyle may have a negative effect on immune response?
The client works out at the gym twice daily
Results if a clients 24 hour urine sample indicate osmolality of 510 mOsm/ kg, which is within reference range. What conclusion can the nurse draw form this assessment finding?
The clients kidney can produce sufficiently concentrated urine
A nurse on the renal unit is caring for a client who will soon begin peritoneal dialysis. The family of the client asks for education about the peritoneal dialysis catheter that has been placed in the client's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply
The cuffs are made of Dacron polyester The cuffs stabilize the catheter The cuffs prevent the dialysate from leaking The cuffs provide a barrier against microorganism
A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic reaction. What is the nurse's priority for health education?
The need for the parents to carry an epinephrine pen
A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic?
The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy
A client has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed?
The widest part of the stoma
A client has been admitted to the medical unit with a diagnosis of ureteral colic, secondary to urolithiasis. When performing the client's admission assessment, the nurse may assess what signs and symptoms that are characteristic of this diagnosis? Select all that apply.
Urinary frequency Hematuria Acute pain
The nurse is caring for a 73 year old client with a urethras obstruction related to prostatic enlargement. When planning this client care, the nurse should be aware of the risk of what complication?
Urinary tract infection
The nurse is caring for a client who describes changes in his voiding patterns. The client states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be much urine flow." What would the nurse expect this client's physical assessment to reveal?
Urine retention
A client's primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the client's immune response. This physiologic state is known as what?
Viral set point
The nurse is working on the renal transplant unit. Tp reduce the risk of infection in a client with a transplanted kidney, it is imperative for the nurse to do what?
Wash hands carefully and frequently
What should the nurse teach a client on corticoidsteriod therapy in order to reduce the clients risk of adrenal insufficiency?
always have enough medication on hand to avoid running out
A client is reporting genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform?
apply moist heat to the clients lower abdomen
A client who has been taking corticoid steroids for several months has been experiencing muscle wasting. The client has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend?
consumption of high protein diet
A client with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for in the critical care unit. The priority nursing diagnosis for a client with this condition is what?
excess fluid volume
The nurse is caring for a client diagnosed with hypothyroidism secondary to Hashimoto Thyroiditis. When assessing this client, what sign or symptom would the nurse expect?
fatigue
A client with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value?
hemoglobin
The nurse is caring for a client who has been diagnosed with renal calculi. prompt management of renal calculi is most important when the stone is located where?
in the ureteropelvic junction
The nurse is providing preprocedure teaching about an ultrasound. the nurse informs the client that in preparation for an ultrasound of the lower urinary tract the client will require what?
increased fluid intake to produce full bladder
The nurse is caring for a client who has a nasogastric tube that has been in place for 2 days. Before administering a scheduled feeding the nurse should
position the client upright
A client had experienced excessive losses of bicarbonate and has subsequently developed an acid base imbalance. How will this lost of bicarbonate be replaced?
renal tubular cells will generate new bicarbonate
The nurse is caring for a client with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the client's kidneys will compensate by secreting what substance?
renin
The nurse on a urology unit is working with a client who has been diagnosed with oxalate renal calculi. When planning this client's health education, what nutritional guidelines should the nurse provide?
restrict protein intake as prescribed
A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid base balance?
returning bicarbonate to the body's circulation
The nurse is developing a care plan for a client with Cushing syndrome. what nursing diagnosis should the nurse prioritize?
risk for injury related to weakness
A client has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client?
semi fowlers with the head supported on two pillows
A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client know to do what action?
slowly taper down the dose of prednisone, as prescribed
A 21-year-old male has just been diagnosed with a spondyloarthropathy. What nursing intervention should the nurse prioritize?
teaching about symptom management
A client is prescribed corticoidsteriod therapy. What would be priority information for the nurse to give the client who is prescribed longterm corticoidsteriod therapy?
the client is at an increased risk for developing infection
The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic?
the need for lifelong steroid replacement
The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite?
the prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group
