part 4
The client has returned form a captopril renal scan. Which teaching should the nurse provide when the client returns? A "Arise slowly and call for assistance when ambulating." B "I must measure your intake and output (I&O)." C "We must save your urine because it is radioactive." D "I must attach you to this cardiac monitor."
A
The older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? A "Have you tried using the toilet at least every couple of hours?" B "How does that make you feel?" C "We can fix that." D "That happens when we get older."
A
When assessing the older adult, the nurse teaches the older adult that which age-related change causes nocturia? A Decreased ability to concentrate urine B Decreased production of antidiuretic hormone C Increased production of erythropoietin D Increased secretion of aldosterone
A
Which urinary assessment information indicates the potential need for increased fluids in the client? A Increased blood urea nitrogen B Increased creatinine C Pale-colored urine D Decreased sodium
A
Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist? A Creatinine, 1.9 mg/dL B Fasting glucose, 80 mg/dL C Potassium, 3.9 mEq/L D Sodium, 140 mEq/L
A Creatinine, 1.9 mg/dL Correct: This result is outside the normal range. B Fasting glucose, 80 mg/dL: This result is within normal limits. C Potassium, 3.9 mEq/L: This result is within normal limits. D Sodium, 140 mEq/L: This result is within normal limits.
Who is the most likely person to administer blood products in an operating suite? A. Circulating nurse B. Holding area nurse C. Scrub nurse D. Specialty nurse
A. Circulating nurse Correct: Circulating nurses or "circulators" are registered nurses who coordinate, oversee, and are involved in the client's nursing care in the operating room. Incorrect: B. Holding area nurse: Holding area nurses manage the client's care before surgery. Blood would not yet be needed at this point. C. Scrub nurse: Scrub nurses set up the sterile field, drape the client, and hand sterile supplies, sterile equipment, and instruments to the surgeon and the assistant. D. Specialty nurse: Specialty nurses may be in charge of a particular type of surgical specialty. They are responsible for nursing care specific to clients who need that type of surgery, such as assessing, maintaining, and recommending equipment, instruments, and supplies.
The client is scheduled for intravenous urography. During the assessment, the nurse notes a previous reaction of urticaria, itching, and sneezing to contrast dye. Which precautions does the nurse take? Select all that apply. A Ensures that an antihistamine and a steroid are prescribed B Documents the reaction on the chart C Uses no contrast dye for the procedure D Cancels the procedure E Ensures that the health care provider is aware of the reaction
ABE
The RN is caring for a client who has just had a kidney biopsy. Which of these actions should the nurse perform first? A Obtain BUN and creatinine. B Position the client supine. C Administer pain medications. D Check urine for hematuria.
B
The charge nurse is making client assignments for the day shift. Which client would be best to assign to an LPN/LVN? A A client who has just returned from having a kidney artery angioplasty B A client with polycystic kidney disease who is having a kidney ultrasound C A client who is going for a cystoscopy and cystourethroscopy D A client with glomerulonephritis who is having a kidney biopsy
B
The nurse recognizes that which of these is the best indicator of kidney function? A BUN B Creatinine C AST D Alkaline phosphatase
B
What should the nurse teach the client who is undergoing a study using contrast media? A "You will need to have anesthesia or sedation." B "A feeling of heat or warmth occurs when the contrast is injected." C "Expect your urine to have a pink or red tinge after the procedure." D "You will not be able to eat or drink for 4 to 6 hours after the procedure."
B
Which percussion technique does the nurse use to assess the client with reports of flank pain? A Places fingers outstretched over the flank area and percusses with fingertips B Places one hand with palm down flat over the flank area and uses the other fisted hand to thump the hand on the flank C Places one hand with the palm up over the flank area and cups the other hand to percuss the hand on the flank D Quickly taps the flank area with cupped hands
B
As the nurse obtains the informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response? A. Contacts the anesthesiologist B. Contacts the surgeon C. Explains the procedure D. Has the client sign the form
B. Contacts the surgeon Correct: The nurse is not responsible for providing detailed information about the surgical procedure. Rather, the nurse's role is to clarify facts that have been presented by the physician and to dispel myths that the client or family may have about the surgical experience. Incorrect: A. Contacts the anesthesiologis: The anesthesiologist is responsible for the anesthesia, not the surgical details. C. Explains the procedur: The nurse is not responsible for providing detailed information about the surgical procedure. D. Has the client sign the form: Although the nurse is only witnessing the signature, it is the nurse's role to ensure that the facts are clarified.
What information about the postoperative client does the nurse include in the report to the postanesthesia care unit (PACU) nurse? A. Confirmation of informed consent B. Estimated blood loss C. Type of surgical instruments used D. Type of suture material used
B. Estimated blood loss Correct: Estimated blood loss is important to know, so that the client can be properly monitored. Incorrect: A. Confirmation of informed consent: Informed consent is taken care of before surgery. C. Type of surgical instruments used: It is not necessary for the PACU nurse to know what types of surgical instruments were used, unless they were out of the ordinary. D. Type of suture material used: It is not necessary for the PACU nurse to know what types of suture materials were used.
Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area? A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter. B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. C. Obtain the medical history from a client who is scheduled for a total hip replacement. D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy.
B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. Correct: Insertion of a catheter is within the scope of skills approved for the LPN/LVN. Incorrect: A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter: Preoperative teaching is under the scope of the RN. C. Obtain the medical history from a client who is scheduled for a total hip replacement: History information would be completed by the RN on the unit. D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy: Physical assessment of a preoperative client is within the scope of the RN.
The nurse in the urology clinic is providing teaching for a female client with cystitis. Which of these should be included in the teaching plan? Select all that apply. A Cleanse the perineum from back to front after using the bathroom. B Try to take in 64 ounces of fluid each day. C Be sure to complete the full course of antibiotics. D If your urine remains cloudy, call the clinic. E Expect some flank discomfort until the antibiotic has worked.
BCD
The client is in the emergency department (ED) for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? A Increased oral fluids B IV fluids C Privacy D Health history forms
C
The nurse is teaching the client how to provide a "clean catch" urine specimen. Which statement by the client indicates that teaching was effective? A "I must clean with the wipes and then urinate directly into the cup." B "I will have to drink 2 liters of fluid before providing the sample." C "I'll start to urinate in the toilet, stop, and then urinate into the cup." D "It is best to provide the sample while I am bathing."
C
When a diabetic client returns to the medical unit after IV urography, all of these interventions are prescribed. Which action will the nurse take first? A Give lisper (Humalog) insulin, 12 units subcutaneously. B Request a breakfast tray for the client. C Infuse 0.45% normal saline at 125 mL/hr. D DAdminister captopril (Capote).
C
When caring for the client with uremia, the nurse assesses for which of these symptoms? A Tenderness at the costovertebral angle (CVA) B Cyanosis of the skin C Nausea and vomiting D Insomnia
C
When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which of these? A Abdominal girth B Presence of urinary infection C History of hysterectomy D Hematuria
C
Which instruction does the nurse give the client who needs a clean catch urine specimen? A Save all urine for 24 hours. B I will collect the first specimen of the morning. C Do not touch the inside of the container. D You will receive an isotope injection, then I will collect your urine.
C
Which of the following would alarm the nurse immediately after return of the client from the operating room for cystoscopy performed under conscious sedation? A Pink-tinged urine B Urinary frequency C Temperature of 100.8 D Client lethargic
C
During a preoperative assessment, which statement by the client requires further investigation by the nurse to assess risk? A. "I am taking vitamins." B. "I drink a glass of wine a night." C. "I had a heart attack 4 months ago." D. "I don't like latex balloons."
C. "I had a heart attack 4 months ago." Correct: Cardiac problems increase surgical risks. The risk for a myocardial infarction (MI) during surgery is higher in clients who have heart problems. Incorrect: A. "I am taking vitamins.": The type of vitamins should be assessed, but this is not the highest risk. B. "I drink a glass of wine a night." Incorrect: Moderate alcohol consumption is not considered high-risk behavior. D. "I don't like latex balloons.": A dislike for latex is not the same as a latex allergy. However, it might be a good idea to ask why the client doesn't like latex balloons.
The nurse is instructing the client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching? A. "I will take off my stockings one to three times a day for 30 minutes." B. "My stockings are too loose." C. "These stockings will prevent blood clots." D. "These stockings help promote blood flow."
C. "These stockings will prevent blood clots." Correct: Antiembolism stockings alone will not prevent deep venous thrombosis (DVT). However, along with exercise, they will help promote venous return, which aids in preventing DVT. Incorrect: A. "I will take off my stockings one to three times a day for 30 minutes.": Frequent removal of the stockings is appropriate to allow for hygiene and a break from their wear. B. "My stockings are too loose.": Stockings should be neither too loose (ineffective) nor too tight (inhibit blood flow). D. "These stockings help promote blood flow.": Antiembolism stockings may be used during and after surgery to promote venous return.
The client is having an arthroscopy of the left knee and has just been moved to the surgical holding area. Which statement by the nurse properly identifies the client while the nurse checks the identification label? A. "Are you Mr. Smith?" B. "Good morning, Mr. Smith." C. "What is your name, and where were you born?" D. "What surgery are you having today?"
C. "What is your name, and where were you born?" Correct: The nurse must verify the client's identity with two types of identifiers. This practice prevents errors by drowsy or confused clients. Incorrect: A. "Are you Mr. Smith?": The client may respond inappropriately if he is anxious or sedated. B. "Good morning, Mr. Smith." Incorrect: The client may respond inappropriately if he is anxious or sedated. D. "What surgery are you having today?": Asking the client about his or her surgery does help with identification. However, it is really done to ascertain that the client's perception of the procedure, the operative permit, and the operative schedule are the same.
The nurse completes the preoperative checklist on the client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure? A. Age of 59 years B. General anesthesia complications experienced by the client's brother C. Diet-controlled diabetes mellitus D. Ten pounds over the client's ideal body weight
C. Diet-controlled diabetes mellitus Correct: Diabetes contributes an increased risk for surgery. Incorrect: A. Age of 59 years: Older adults are at greater risk for surgical procedures. This client is not classified as an older adult. B. General anesthesia complications experienced by the client's brother: Family medical history and problems with anesthetics may indicate possible reactions to anesthesia, but this is not the best answer. D. Ten pounds over the client's ideal body weight: Obesity increases the risk for poor wound healing, but being 10 pounds overweight does not categorize this client as obese.
The preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? A. Instructs the client to quit smoking B. Teaches about the dangers of tobacco C. Teaches the importance of incentive spirometry D. Tells the client where the smoking lounge
C. Teaches the importance of incentive spirometry Correct: Incentive spirometry is good for lung hygiene. It encourages deep breathing. Incorrect: A. Instructs the client to quit smoking: The nurse can suggest quitting, but it is not therapeutic to instruct it at this time. B. Teaches about the dangers of tobacco: The nurse can educate the client about the dangers of tobacco, but teaching on this topic would not be therapeutic at this time. D. Tells the client where the smoking lounge is: Directing the client to the smoking lounge is not helpful.
At 8 AM, the registered nurse is admitting to the outpatient surgery department a client who is scheduled for sinus surgery. Which information given by the client would be of most immediate concern to the nurse? A. The client has an allergy to iodine and shellfish. B. The client was nauseated after a previous surgery. C. The client had a small glass of juice at 7 AM. D. The client expresses anxiety about the surgery.
C. The client had a small glass of juice at 7 AM. Correct: Clients need to be NPO for a sufficient length of time before surgery. Intake of food or fluids may delay the start time of the surgery; the nurse needs to notify the surgeon and anesthesia for possible rescheduling. Incorrect: A. The client has an allergy to iodine and shellfish: The nurse should confirm that the information is charted, and that the client has the correct allergy band identification. B. The client was nauseated after a previous surgery: Many clients experience nausea after surgery. The nurse should document this in the client's information. D. The client expresses anxiety about the surgery: The nurse should talk with the client and explore the anxiety; this is a normal feeling before surgery.
The client had IV urography 8 hours ago. Which nursing intervention is the priority for this client? A Maintaining bedrest B Medicating for pain C Monitoring for hematuria D Promoting fluid intake
D
The client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take? A Asks the client to sign the informed consent B Cancels the procedure C Asks the client's spouse to sign the form D Notifies the department and the provider
D
The nurse has the following assignment. Which client should be encouraged to consume 2 to 3 liters of fluid each day? A Client with chronic kidney disease B Client with heart failure C Client with complete bowel obstruction D Client with hyperparathyroidism
D
When planning an assessment of the urethra, what does the nurse do first? A. Examines the meatus B. Notes any unusual discharge C. Records the presence of abnormalities D. Dons gloves
D
Which technique does the nurse use to obtain a sterile urine specimen from the client with a Foley catheter? A Disconnects the Foley catheter from the drainage tube and collects urine directly from the Foley B Removes the existing catheter and obtains a sample during the process of inserting a new Foley C Uses a sterile syringe to withdraw urine from the urine collection bag D Clamps the tubing, attaches a syringe to the specimen, and withdraws at least 5 mL of urine
D
The nurse is educating a preoperative client about colostomy surgery. The colostomy surgery is categorized as what type of surgery? A Cosmetic B Curative C Diagnostic D Palliative
D Palliative Palliative surgery is performed to relieve symptoms of a disease process but does not cure the disease. Incorrect: A Cosmetic: Cosmetic surgery is performed primarily to alter or enhance personal appearance. B Curative: Curative surgery is performed to resolve a health problem by repairing or removing the cause. C Diagnostic: Diagnostic surgery is performed to determine the origin and cause of a disorder or the cell type for cancer.
The nurse is educating the client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction? A. "I will wake up with a tube in my throat." B. "I will have a bandage on my chest." C. "My family will not be able to see me right away." D. "Pain medication will take away my pain."
D. "Pain medication will take away my pain." Correct: Pain medication will minimize pain but will not take it away completely. Incorrect: A. "I will wake up with a tube in my throat.": This is an accurate statement. B. "I will have a bandage on my chest.": This is an accurate statement. C. "My family will not be able to see me right away.": This is an accurate statement.
A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which orders should the registered nurse accomplish first? A. Use electrical clippers to cut hair at the surgical site. B. Start an infusion of lactated Ringer's solution at 75 mL/hr. C. Administer one half of the client's usual lispro insulin dose. D. Draw blood for glucose, electrolyte, and complete blood count values.
D. Draw blood for glucose, electrolyte, and complete blood count values. Correct: If blood work is abnormal, the surgery may be rescheduled. The blood work needs to be drawn and sent to the laboratory first to confirm that results are within normal limits. This is not of immediate concern. Incorrect: A. Use electrical clippers to cut hair at the surgical site: Removal of hair can be accomplished in the operating room directly before the start of surgery. While important, it is not of immediate concern. B. Start an infusion of lactated Ringer's solution at 75 mL/hr: The IV infusion is not the first task to accomplish for preoperative clients. This can be accomplished after the laboratory orders have been completed. This is not of immediate concern. C. Administer one half of the client's usual lispro insulin dose: The nurse should check blood glucose with the laboratory orders before administration of lispro.
As the nurse is about to give the preoperative medication to the client going into surgery, it is discovered that the preoperative permit is not signed. What does the nurse do? A. Calls the surgeon B. Calls the anesthesiologist C. Gives the medication as ordered D. Has the client sign the permit
D. Has the client sign the permit Correct: The nurse may ask the client to sign the permit, after which the medication can be administered. Incorrect: A. Calls the surgeon Incorrect: Calling the surgeon is not necessary. B. Calls the anesthesiologist: Calling the anesthesiologist is not necessary. C. Gives the medication as ordered: It is illegal for the client to sign the permit after being sedated.
The client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. Why is this preoperative procedure done? A. Decreases expected blood loss during surgery B. Eliminates any risk of infection C. Ensures that the bowel is sterile D. Reduces the number of intestinal bacteria
D. Reduces the number of intestinal bacteria Correct: Bowel or intestinal preparations are performed to empty the bowel to minimize the leaking of bowel contents, prevent injury to the colon, and reduce the number of intestinal bacteria. Incorrect A. Decreases expected blood loss during surgery: Decreasing expected blood loss is not the goal of a bowel preparation. B. Eliminates any risk of infection: Eliminating infection risk is not the goal of a bowel preparation. While the bowel prep may reduce the number of intestinal bacteria, it will not completely eliminate the risk of infection. C. Ensures that the bowel is sterile: Sterilizing the bowel is not the goal of a bowel preparation.
In going through the preoperative checklist, the nurse notices that the client's armband does not match the handwritten name on the informed consent, but it matches the stamped name. What does the nurse do first? A. Calls admissions B. Cancels the surgery C. Contacts the surgeon D. Talks to the operating team
D. T alks to the operating team Correct: The operating team should be called to see if any clients with similar names are having surgery done. The client should confirm the spelling of his or her last name. Also, confirm the procedure that is expected to be done and compare it with the informed consent form. Incorrect: A. Calls admissions: Calling admissions is not the first step. The stamp is correct. B. Cancels the surgery: Canceling surgery is not done by the floor nurse. C. Contacts the surgeon: This is an administrative issue, not one for the surgeon.
The older client's adult child tells the nurse that the client does not want life support. What does the nurse do first? A. Calls the legal department to draft the paperwork B. Documents this in the chart C. Thanks the person and does nothing D. Talks to the client
D. Talks to the client Correct: The nurse should determine the client's wishes and state of mind. Incorrect: A. Calls the legal department to draft the paperwork: Calling the legal department is not what the nurse should do first. B. Documents this in the chart: Documenting this in the chart is not what the nurse should do first. C. Thanks the person and does nothing: Doing nothing is not appropriate.
For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider (HCP)? Select all that apply. a. Client with an allergy to shrimp b. Client with a history of asthma c. Client who requests morphine sulfate every 3 hours d. Client with a blood urea nitrogen of 62 mg/dL (22.1 mmol/L) and a creatinine of 2.0 mg/dL (177 umol/L) e. Client who took metformin (Glucophage) 4 hours ago
a, b, d, and e
A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns to the unit? a. "Arise slowly and call for assistance when ambulating." b. "I must measure your intake and output." c. "We must save your urine because it is radioactive." d. "I must attach you to this cardiac monitor."
a. "Arise slowly and call for assistance when ambulating."
Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. What information does a nurse provide to this client about taking her prescribed trimethoprim/sulfamethoxazole (Bactrim)? Select all that apply. a. "Be certain to wear sunscreen and protective clothing." b. "Drink at least 3 liters of fluids every day." c. "Take this drug with 8 ounces of water." d. "Try to urinate frequently to keep your bladder empty." e. "You will need to take all of this drug to get the benefits."
a. "Be certain to wear sunscreen and protective clothing." b. "Drink at least 3 liters of fluids every day." c. "Take this drug with 8 ounces of water." e. "You will need to take all of this drug to get the benefits." (a) Wearing sunscreen and protective clothing is important to do while on this drug. Increased sensitivity to the sun can lead to severe sunburn. (b, c) Sulfamethoxazole can form crystals that precipitate in the kidney tubules. Fluid intake prevents this complication. (e) Clients should be cautioned to take all of the drug that is prescribed for them, even if their symptoms improve or disappear soon. INCORRECT: (d)Emptying the bladder is important-but not keeping it empty-as is stated here. The client should be advised to urinate every 3 to 4 hours or more often if he or she feels the urge.
An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? a. "Have you tried using the toilet at least every couple of hours?" b. "How does that make you feel?" c. "We can fix that." d. "That happens when we get older."
a. "Have you tried using the toilet at least every couple of hours?"
A nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences of them. Which client statement shows correct understanding of what the nurse has taught? a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." b. "It is a good idea for me to reduce germs by taking a tub bath daily." c. "Trying to get to the bathroom to urinate every 6 hours is important for me." d. "Urinating 1000 mL on a daily basis is a good amount for me."
a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." To reduce the number of UTIs, clients should be drinking a minimum of 1.5 to 2.5 liters of fluid (mostly water) each day.
A nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. a. Dysuria b. Enuresis c. Frequency d. Nocturia e. Urgency f. Polyuria
a. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." c. Frequency d. Nocturia e. Urgency (a) Dysuria-painful urination-is a symptom of a UTI. (c) Frequency-frequent urinating and in small amounts-is a sign of a UTI. (d) Nocturia-urinating at night-is (or can be) a symptom of a UTI. (e) Urgency-having the urge to urinate quickly-is a symptom of a UTI. INCORRECT: (b) Enuresis-bed-wetting-is not a sign of a UTI. (f) Polyuria-increased amounts of urine production-is not a sign of a UTI.
Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. She is started on antibiotics and sent home. She returns to the clinic 3 days later-with the same symptoms. When asked about the previous UTI and medication regimen, she states, "I only took the first dose because after that, I felt better." How does the nurse respond? a. "Not completing your medication can lead to return of your infection." b. "That means your treatment will be prolonged with this new infection." c. "This means you will now have to take two drugs instead of one." d. "What you did was okay; however, let's get you started on something else."
a. "Not completing your medication can lead to return of your infection." Not completing the drug regimen can lead to recurrence of an infection and to bacterial drug resistance.
Which client with a long-term urinary problem does the nurse refer to community resources and support groups? Select all that apply. a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch c. 48-year-old with urinary calculi d. 78-year-old with urinary incontinence e. 80-year-old with dementia
a. 32-year-old with a cystectomy b. 44-year-old with a Kock pouch d. 78-year-old with urinary incontinence (a) The client with a cystectomy would benefit from community resources and support groups. Others who have had their bladders removed are good sources for information and for help in establishing coping mechanisms. (b) The client with a Kock pouch would benefit from community resources and support groups. Others who have had their bladders removed and are using an alternate method for urinating are good sources for information and for help in establishing coping mechanisms. (d) The older adult client with urinary incontinence would benefit from community resources and support groups. Others who have had this problem can provide methods of living with the problem or methods of curing (or minimizing) it.
A client with these assessment data is preparing to undergo a computed tomography (CT) scan with contrast Assessment Data: BUN 54 mg/dL Creatinine 2.4 mg/dL Ca 8.5 mg/dL Which medication does the nurse plan to administer before the procedure? a. Acetylcysteine (Mucomyst) b. Metformin (Glucophage) c. Captopril (Capoten) d. Acetaminophen (Tylenol)
a. Acetylcysteine (Mucomyst)
A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? a. Administers morphine sulfate 4 mg IV b. Begins an infusion of metoclopramide (Reglan) 10 mg IV c. Obtains a urine specimen for urinalysis d. Starts an infusion of 0.9% normal saline at 100 mL/hr
a. Administers morphine sulfate 4 mg IV Morphine administered IV will decrease the pain and the associated sympathetic nervous system reactions of nausea and hypotension.
Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function? a. An 80-year-old man who has benign prostatic hyperplasia b. A 62-year-old woman with a known allergy to contrast media c. A 48-year-old woman with established urinary incontinence d. A 45-year-old man receiving oral and intravenous fluid therapy
a. An 80-year-old man who has benign prostatic hyperplasia
Which age-related change can cause nocturia? a. Decreased ability to concentrate urine b. Decreased production of antidiuretic hormone c. Increased production of erythropoietin d. Increased secretion of aldosterone
a. Decreased ability to concentrate urine
Which urinary assessment information for a client indicates the potential need for increased fluids? a. Increased blood urea nitrogen b. Increased creatinine c. Pale-colored urine d. Decreased sodium
a. Increased blood urea nitrogen
When obtaining a health history from a 22-year-old female client who has new onset urinary incontinence, which findings or factors does the nurse consider significant? (Select all that apply.) a. Chemical exposure in the workplace b. A burning sensation occurring on urination c. Urinating 10 times daily although fluid intake remains unchanged d. A recent change in the client's oral contraceptive prescription e. A new inability to hold urine (urgency) f. A "stinky" odor from the urine
b, c, e, and f
The nurse is admitting a client who has type 2 diabetes (T2D) and is scheduled for surgery. Which laboratory findings from this client's admission panel does the nurse report as indicating possible abnormal kidney function? (Select all that apply.) a. Presence of ammonia in the urine b. Urine microalbumin 240 mcg/24 hour (0.240 g/24 hour) c. Urine specific gravity of 1.028 d. Blood urea nitrogen of 38 mg/dL (13.5 mmol/L) f. Serum creatinine 2.2 mg/dL (294.3 mcmol/L) g. Blood osmolarity 290 mOsm/kg (290 mmol/kg)
b, d, and f
A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instructions does the nurse provide for postprocedure home care? a. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." b. "Do not share your toilet with family members for the next 24 hours." c. "Please be sure to stand when you are urinating." d. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."
b. "Do not share your toilet with family members for the next 24 hours." The toilet should not be shared for 24 hours following the procedure because others using the toilet could be infected with the live virus that was instilled into the client. If the toilet must be shared, then specific cleaning precautions need to be taken each time the client uses the toilet. The best scenario is for the client not to share the toilet.
A nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? a. "A small-lumen catheter will help prevent injury to my urethra." b. "I will use a new, sterile catheter each time I do the procedure." c. "My family members can be taught to help me if I need it." d. "Proper handwashing before I start the procedure is very important."
b. "I will use a new, sterile catheter each time I do the procedure." Catheters are cleaned and re-used. Proper handwashing and cleaning of the catheter have shown no increase in bacterial complications. Catheters are replaced when they show signs of deteriorating.
A nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? a. 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours c. 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy d. 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed
b. 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours Anuria may indicate urinary obstruction at the bladder neck or urethra and is an emergency because obstruction can cause acute kidney failure. The client may be oversedated and may not be aware of any discomfort caused by bladder distention.
The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? a. Client who has just returned from having a kidney artery angioplasty b. Client with polycystic kidney disease who is having a kidney ultrasound c. Client who is going for a cystoscopy and cystourethroscopy d. Client with glomerulonephritis who is having a kidney biopsy
b. Client with polycystic kidney disease who is having a kidney ultrasound
Which laboratory test is the best indicator of kidney function? a. Blood urea nitrogen (BUN) b. Creatinine c. Aspartate aminotransferase (AST) d. Alkaline phosphatase
b. Creatinine
Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence and is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. a. Administer the drug at bedtime. b. Encourage increased fluids. c. Increase fiber. d. Limit the intake of dairy products. e. Offer hard candy for "dry" mouth.
b. Encourage increased fluids. c. Increase fiber. e. Offer hard candy for "dry" mouth. (b) Anticholinergics cause constipation. Increasing fluids will help with this problem. (c) Anticholinergics cause constipation. An increase in daily fiber in the client's diet will help. (e) Anticholinergics cause extreme dry mouth. INCORRECT: (a) Taking the drug at night will not have an effect on the complications encountered-dry mouth and constipation. The drug is usually taken three to four times a day. (d) Limiting dairy products does not have an effect on the complications encountered-dry mouth and constipation.
Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. The health care provider prescribes the drug, estrogen (Premarin). Which risks does the nurse tell the client to expect? Select all that apply. a. Dry mouth b. Endometrial cancer c. Increased intraocular pressure d. Thrombophlebitis e. Vaginitis
b. Endometrial cancer d. Thrombophlebitis (b) Estrogen use can increase the risk for endometrial cancer. (d) Estrogen use can increase the risk for thrombophlebitis. Women who smoke-especially-should not use this drug. INCORRECT: (a) Dry mouth is not a side effect of estrogen use. (c) Increased intraocular pressure is not a side effect of estrogen use. It is a problem with anticholinergic use. (e) Vaginitis is not a side effect of estrogen use. However, clients should report any unusual vaginal bleeding.
Which percussion technique does the nurse use to assess a client who reports flank pain? a. Place outstretched fingers over the flank area and percuss with the fingertips. b. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. c. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. d. Quickly tap the flank area with cupped hands.
b. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank.
The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? a. Obtain blood urea nitrogen (BUN) and creatinine. b. Position the client supine. c. Administer pain medications. d. Check urine for hematuria.
b. Position the client supine.
Which interventions are helpful in preventing bladder cancer? Select all that apply. a. Drinking 2½ liters of fluid a day b. Showering after working with or around chemicals c. Stopping the use of tobacco d. Using pelvic floor muscle exercises e. Wearing a lead apron when working with chemicals f. Wearing gloves and a mask when working around chemicals and fumes
b. Showering after working with or around chemicals c. Stopping the use of tobacco f. Wearing gloves and a mask when working around chemicals and fumes (b)Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Bathing after exposure to them is advisable. (c) Tobacco use is one of the highest if not the highest risk factor in the development of bladder cancer. (f) Certain chemicals (e.g., those used by professional hairdressers) are known to be carcinogenic in evaluating the risk for bladder cancer. Protective gear is advised. INCORRECT: (a) Increasing fluid intake is helpful for some urinary problems such as urinary tract infection (UTI), but no correlation has been noted between fluid intake and bladder cancer risk. (d) Using pelvic floor muscle strengthening exercises (Kegel) is helpful with certain types of incontinence; but no data show that these exercises prevent bladder cancer. (e) Precautions should be taken when working with chemicals; however, lead aprons are used to protect from radiation.
Which instruction does the nurse give a client who needs a clean-catch urine specimen? a. "Save all urine for 24 hours." b. "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." c. "Do not touch the inside of the container." d. "You will receive an isotope injection, then I will collect your urine."
c. "Do not touch the inside of the container."
A nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? a. "I must avoid drinking carbonated beverages." b. "I need to douche vaginally once a week." c. "I should drink 2½ liters of fluid every day." d. "I will not drink fluids after 8 PM each evening."
c. "I should drink 2½ liters of fluid every day." Drinking 2½ liters of fluid a day flushes out the urinary system and helps reduce the risk for cystitis.
The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? a. "I must clean with the wipes and then urinate directly into the cup." b. "I will have to drink 2 liters of fluid before providing the sample." c. "I'll start to urinate in the toilet, stop, and then urinate into the cup." d. "It is best to provide the sample while I am bathing."
c. "I'll start to urinate in the toilet, stop, and then urinate into the cup."
Situation: A 53-year-old postmenopausal woman reports "leaking urine" when she laughs. She has five children, all delivered vaginally. She is in good health and has tried pelvic floor (Kegel) exercises, which have not helped. She is not taking any medications and has no allergies to medication. She is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? a. "They can relieve your anxiety associated with incontinence." b. "They help your bladder to empty." c. "They may be used to improve urethral resistance." d. "They decrease your bladder's tone."
c. "They may be used to improve urethral resistance." Bladder pressure is greater than urethral resistance; drugs may be used to improve urethral resistance.
A nurse is educating a female about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? a. "Douche-but only once a month." b. "Use only white toilet paper." c. "Wipe from your front to your back." d. "Wipe with the softest toilet paper available."
c. "Wipe from your front to your back." Wiping front to back keeps organisms in the stool from coming close to the urethra, which increases the risk for infection.
A cognitively impaired client has urge incontinence. Which method for achieving continence does a nurse include in the client's care plan? a. Bladder training b. Credé method c. Habit training d. Kegel exercises
c. Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.
When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? a. Abdominal girth b. Presence of urinary infection c. History of hysterectomy d. Hematuria
c. History of hysterectomy
The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: Assessment Data: BUN 26 mg/dL Creatinine 1.0 mg/dL) HbA1c 6.9% Glucose 132 mg/dL Which intervention is essential for the nurse to perform? a. Obtain a thyroid-stimulating hormone (TSH) level. b. Report the blood urea nitrogen (BUN) and creatinine. c. Hold the metformin 24 hours before and on the day of the procedure. d. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.
c. Hold the metformin 24 hours before and on the day of the procedure.
When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? a. Give lispro (Humalog) insulin, 12 units subcutaneously. b. Request a breakfast tray for the client. c. Infuse 0.45% normal saline at 125 mL/hr. d. Administer captopril (Capoten).
c. Infuse 0.45% normal saline at 125 mL/hr.
When caring for a client with uremia, the nurse assesses for which symptom? a. Tenderness at the costovertebral angle (CVA) b. Cyanosis of the skin c. Nausea and vomiting d. Insomnia
c. Nausea and vomiting
The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? a. Administer heparin intravenously. b. Remove the urinary catheter. c. Notify the health care provider (HCP). d. Irrigate the catheter with sterile saline.
c. Notify the health care provider (HCP).
A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? a. Increased oral fluids b. IV fluids c. Privacy d. Health history forms
c. Privacy
The certified wound, ostomy, continence nurse (CWOCN) or enterostomal therapist (ET) teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? a. Nutritional and dietary care b. Respiratory care c. Stoma and pouch care d. Wiping from front to back (asepsis)
c. Stoma and pouch care The enterostomal therapist demonstrates external pouch application, local skin care, pouch care, methods of adhesion, and drainage mechanisms.
Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? a. Functional b. Overflow c. Stress d. Urge
c. Stress Pelvic floor (Kegel) exercise therapy for women with stress incontinence strengthens the muscles of the pelvic floor, thereby helping decrease the occurrence of incontinence.
Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? a. Pink-tinged urine b. Urinary frequency c. Temperature of 100.8°F (38.2°C) d. Lethargy
c. Temperature of 100.8°F (38.2°C)
Situation: A 32-year-old female with a urinary tract infection reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the nurse expect the health care provider to prescribe? a. Nitrofurantoin after intercourse b. Premarin c. Trimethoprim/sulfamethoxazole d. Trimethoprim with intercourse
c. Trimethoprim/sulfamethoxazole Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole or fosfomycin is effective in treating uncomplicated, community-acquired UTI in women.
A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? a. "Blood in my urine has become less noticeable; maybe I don't need this procedure." b. "I have been taking cephalexin (Keflex) for an infection." c. "I previously had several ESWL procedures performed." d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."
d. "I take over-the-counter naproxen (Aleve) twice a day for joint pain." Because a high risk for bleeding during ESWL has been noted, clients should not take NSAIDs before this procedure. The ESWL will have to be rescheduled for this client.
An older adult woman confides to a nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? a. "Don't worry about it. You need them." b. "Shop at night-when stores are less crowded." c. "Tell everyone that they are for your husband." d. "That is tough. What do you think might help?"
d. "That is tough. What do you think might help?" This response acknowledges the client's concerns and attempts to help the client think of methods to solve her problem.
A nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? a. "For the best effect, perform all your exercises while you are seated on the toilet." b. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." c. "Results should be visible to you within 72 hours." d. "You know that you are exercising correct muscles if you can stop urine flow in midstream."
d. "You know that you are exercising correct muscles if you can stop urine flow in midstream." When the client can start and stop the urine stream, the pelvic muscles are being used.
A health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? a. "It will act as an antibacterial drug." b. "This drug will treat your infection, not the symptoms of it." c. "You need to take the drug on an empty stomach." d. "Your urine will turn red or orange while on the drug."
d. "Your urine will turn red or orange while on the drug." Phenazopyridine (Pyridium) will turn the client's urine red or orange. Care should be taken because it will stain undergarments. Clients should be warned about this effect of the drug because it will be alarming to them if they are not informed.
Which client does the nurse manager on a medical unit assign to an experienced LPN/LVN? a. 42-year-old with painless hematuria who needs an admission assessment b. 46-year-old scheduled for cystectomy who needs help in selecting a stoma site c. 48-year-old receiving intravesical chemotherapy for bladder cancer d. 55-year-old with incontinence who has intermittent catheterization prescribed
d. 55-year-old with incontinence who has intermittent catheterization prescribed Insertion of catheters is within the education and legal scope of practice for LPNs/LVNs.
Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? a. Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. b. Remove the existing catheter and obtain a sample during the process of inserting a new Foley. c. Use a sterile syringe to withdraw urine from the urine collection bag. d. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.
d. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.
The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? a. Client with chronic kidney disease b. Client with heart failure c. Client with complete bowel obstruction d. Client with hyperparathyroidism
d. Client with hyperparathyroidism
When planning an assessment of the urethra, what does the nurse do first? a. Examine the meatus. b. Note any unusual discharge. c. Record the presence of abnormalities. d. Don gloves.
d. Don gloves.
A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the health care provider (HCP) visited the client the day before. What action does the nurse take? a. Asks the client to sign the informed consent b. Cancels the procedure c. Asks the client's spouse to sign the form d. Notifies the department and the HCP
d. Notifies the department and the HCP
A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? a. Maintaining bedrest b. Medicating for pain c. Monitoring for hematuria d. Promoting fluid intake
d. Promoting fluid intake
Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? a. Encouraging them to drink fluids b. Irrigating all catheters daily with sterile saline c. Recommending catheters should be placed in all clients d. Re-evaluating periodically the need for indwelling catheters
d. Re-evaluating periodically the need for indwelling catheters Studies have shown that re-evaluating the need for indwelling catheters in clients is the most effective way to prevent UTI in the hospital setting.
A client who is 6 months pregnant comes to the Prenatal Clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? a. Discharges the client to her home for strict bedrest for the duration of the pregnancy b. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria c. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up
d. Refers the client to the Clinic Nurse Practitioner (CNP) for immediate follow-up Pregnant women with UTI require prompt and aggressive treatment because simple cystitis can lead to acute pyelonephritis. This in turn can cause preterm labor-with adverse effects for the fetus.
A nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by a health care provider, for a client with a urinary tract infection (UTI) does the nurse question? a. Bactrim b. Cipro c. Noroxin d. Tegretol
d. Tegretol Drug alerts state that confusion is frequent (sound alike and look alike) between the drugs Tequin and Tegretol. The former is used for UTI, and the latter is prescribed as an oral anticonvulsant.
Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure? a. The client experiences nausea and vomiting after drinking juice. b. The biopsy site is tender to light palpation. c. The abdomen is distended and the client reports abdominal discomfort. d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.
d. The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.
A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection (UTI). Which nursing action can the home health RN delegate to a home health aide (unlicensed assistive personnel [UAP])? a. Assisting the client in developing a schedule for when to take prescribed antibiotics b. Inserting a straight catheter as necessary if the client is unable to empty the bladder c. Teaching the client how to use the Credé maneuver to empty the bladder more fully d. Using a bladder scanner (with training) to check residual bladder volume after the client voids
d. Using a bladder scanner (with training) to check residual bladder volume after the client voids Use of a bladder scanner is noninvasive and can be accomplished by a home health aide (UAP) who has been trained and evaluated in this skill.
One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body areas? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses
d. Words that the client uses
A nurse is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? a. Children's terms that are easily understood b. Slang words and terms that are heard "socially" c. Technical and medical terminology d. Words that the client uses
d. Words that the client uses The nurse should use the terms with which the client is most familiar, so there is no chance for the client to misunderstand information. Using the client's language ensures the comfort level for the client.
A nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates correct understanding of these procedures? a. "If I restrict my oral intake of fluids, the adjustment will be easier." b. "I must go to the restroom more often because my urine will be excreted through my anus." c. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." d."I will have to drain my pouch with a catheter."
d."I will have to drain my pouch with a catheter." For the client with a neobladder and a Kock pouch, urine is collected in a pouch and is drained with the use of a catheter.
