renal/urinary
A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? a. Diaphoresis b. Increased urine output c. Decreased appetite d. Cheyne-Stokes respirations
b
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? a. Appendicitis b. Pancreatitis c. Gastric ulcer d. Cholecystitis
b
A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? a. Developing no acute complications from the pancreatitis b. Achieving adequate fluid and electrolyte balance c. Maintaining normal respiratory function d. Maintaining satisfactory pain control
c
A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: a. 25 g of carbohydrates. b. 10 g of carbohydrates. c. 20 g of carbohydrates. d. 15 g of carbohydrates.
d
What is the duration of regular insulin? a. 24 hours b. 3 to 5 hours c. 12 to 16 hours d. 4 to 6 hours
d
A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. a. venous pressure b. blood coagulation c. fluid output d. fluid accumulation
a, d
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values? a. Elevated urea levels b. Hypocalcemia c. Hyperkalemia d. Elevated white blood cells
c
A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? a. Limiting I.V. fluid intake according to the physician's order b. Providing the client with plenty of P.O. fluids c. Reserving a site for a peripherally inserted central catheter (PICC) d. Providing generous servings at mealtime
c
When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? a. Hyponatremia b. Polyphagia c. Hypoglycemia d. Ketonuria
c
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? a. MODS b. shock c. tetany d. pancreatic necrosis
d
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse? a. Turn the client from side to side. b. Notify the health care provider. c. Push the catheter further into the abdomen. d. Lower the head of the bed.
a
A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply. a. Younger than 30 years of age b. Ketosis-prone c. Little or no endogenous insulin d. Older than 65 years of age e. Obesity at diagnoses
a, b, c
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a. weight loss. b. hematuria. c. increased urine output. d. increased blood pressure.
a
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: a. weight loss. b. increased blood pressure. c. hematuria d. increased urine output.
a
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is: a. acute cholecystitis b. hepatitis A c. hepatitis B d. pancreatitis
a
The assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority? a. Ineffective breathing pattern b. Fatigue c. Excess fluid volume d. Imbalanced nutrition: less than body requirements
a
The nurse advises the patient with chronic pyelonephritis that he should: a. Increase fluids to 3 to 4 L/24 hours to dilute the urine. b. Decrease his sodium intake to prevent fluid retention. c. Decrease his intake of calcium rich foods to prevent kidney stones. d. Limit his fluid intake to 1.5 L/day to minimize bladder fullness, which could cause backward pressure on the kidneys.
a
A client is in end-stage chronic renal failure and is being added to the transplant list. The nurse explains to the client how donors are found for clients needing kidneys. Which statement is accurate? a. The client is placed on a transplant list at the local hospital. b. Donors are selected from compatible living or deceased donors. c. Donors with hypertension may qualify. d. Donors must be relatives.
b
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a. Reduced hematocrit b. Elevated urobilinogen in the urine c. Clay-colored stools d. Straw-colored urine
c
Lispro (Humalog) is an example of which type of insulin? a. Intermediate-acting b. long acting c. rapid d. short
c
Which of the following insulins are used for basal dosage? a. Aspart (Novolog) b. NPH (Humulin N) c. Glargine (Lantus) d. Lispro (Humalog)
c
A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds: a. 120 mg/dL b. 160 mg/dL c. 140 mg/dL d. 180 mg/dL
d
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. b. Heart rate is 126 beats/minute. c. Blood pressure is 90/50 mm Hg. d. Urine output measures more than 200 ml/hour.
a
Which condition or laboratory result supports a diagnosis of pyelonephritis? a. Low white blood cell (WBC) count b. Myoglobinuria c. Ketonuria d. Pyuria
d
Trousseau sign is elicited a. by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. b. after making a clenched fist and opening the hand; the palm remains blanched when pressure is placed over the radial artery. c.when the foot is dorsiflexed and there is pain in the calf. d. by tapping sharply over the facial nerve just in front of the parotid gland and anterior to the ear, causing spasm or twitching of the mouth, nose, and eye.
a
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Potassium b. Vitamin K c. Vitamin B d. Oral bile acids
b
Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator? a. pH and HCO3 b. Blood pressure c. Urine protein d. Serum glucose
d
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? a. Structural defects in the kidneys b. Abnormalities in urine c. Location of discomfort d. Elevated calcium levels
c
A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? a. Tell the client that she looks fine and offer to help her with makeup. b. Tell the client she needs to learn to accept herself as she is and be compliant during treatment. c. Tell the client she'll feel better if she consistently takes the thyroid replacement medication. d. Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency.
d
When caring for a client with cirrhosis, which symptoms should a nurse report immediately? Select all that apply. a. diarrhea or constipation b. signs of GI bleeding c. change in mental status d. anorexia and dyspepsia
c, b
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is: a. acute cholecystitis b. hepatitis B c. pancreatitis d. hepatitis A
a
A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? a. Pancreatitis b. Hyperparathyroidism c. Diabetes mellitus d. Hyperuricemia
c
The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? a. Lifelong obesity b. Elevated triglycerides c. Urinary tract infections d. Low blood pressure
c
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus? a. Blood sugar 170 mg/dL b. Respirations of 12 breaths/minute c. Fruity breath d. Cloudy urine
c
Which is a gerontological consideration associated with the pancreas? a. Increased calcium absorption b. Increased bicarbonate output c. Increased rate of pancreatic secretion d. Increased amount of fibrous material
d
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis? a. Perform deep-breathing exercises vigorously. b. Wear a mask when performing exchanges. c. Avoid carrying heavy items. d. Auscultate the lungs frequently.
b
A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? a. Riboflavin deficiency b. Vitamin K deficiency c. Vitamin A deficiency d. Folic acid deficiency
b
The nurse passes out medications while a client prepares for hemodialysis. The client is ordered to receive numerous medications including antihypertensives. What is the best action for the nurse to take? a. Check with the dialysis nurse about the medications. b. Administer the medications as ordered. c. Ask if the client wants to take the medications. d. Hold the medications until after dialysis.
d
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? a. "Have you had a recent head injury?" b. "Do you experience skin breakouts?" c. "Has your shoe size increased recently?" d. "Is there any family history of acromegaly?"
c
The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? a. Kanamycin b. Lactulose c. Cholestyramine d. Spironolactone
b
Which is the best nursing explanation for the symptom of polyuria in a client with diabetes mellitus? a. With diabetes, drinking more results in more urine production. b. High sugar pulls fluid into the bloodstream, which results in more urine production. c. The body's requirement for fuel drives the production of urine. d. Increased ketones in the urine promote the manufacturing of more urine.
b
A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? a. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." b. "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." c. "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." d. "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."
c
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? a. 100 units of regular insulin in dextrose 5% in water b. 100 units of NPH insulin in dextrose 5% in water c. 100 units of regular insulin in normal saline solution d. 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution
c
A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? a. "You must have the second one in 1 year and the third the following year." b. "You must have the second one in 2 weeks and the third in 1 month." c. "You must have the second one in 1 month and the third in 6 months." d. "You must have the second one in 6 months and the third in 1 year."
c
The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? a. It aids in the process of gluconeogenesis. b. It decreases the intestinal absorption of glucose. c. It stimulates the pancreatic beta cells. d. It carries glucose into body cells.
d
Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? a. Administering oral analgesics around the clock b. Maintaining a high-Fowler's position c. Allowing a clear liquid diet during the acute phase d. Providing intensive insulin therapy
d
The nurse is preparing a presentation for a group of adults at a local community center about diabetes. Which of the following would the nurse include as associated with type 2 diabetes? a. Little to no relation to pre-diabetes b. Onset most common during adolescence c. Less common than type 1 diabetes d. Insulin production insufficient
d
Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? a. Fasting blood glucose test b. Serum glycosylated hemoglobin (Hb A1c) c. 6-hour glucose tolerance test d. Urine ketones
b
Which type of incontinence refers to involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure? a. overflow b. reflex c. urge d. stress
d
Which hormones are secreted by the posterior lobe of the pituitary gland? Select all that apply. a. Follicle-stimulating hormone (FSH) b. Thyroid-stimulating hormone (TSH) c. Luteinizing hormone (LH) d. Oxytocin e.Vasopressin
d, e
A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time? a. 745 b.800 c. 815 d. 830
a
Which medication may be ordered to relieve discomfort associated with a UTI? a. Nitrofurantoin b. Levofloxacin c.Ciprofloxacin d. Phenazopyridine
d
A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? a. High-dose corticosteroids b. Paracentesis c. Azathioprine d. Liver transplantation
a
A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? a. Tetany related to hypocalcemia b. Muscle pain related to referred pain manifestations c. Muscle spasm related to hypokalemia d. Tetany related to hypercalcemia
a
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a. Creatinine b. Chloride c. Albumin d. Urobilinogen
c
A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? a. Cool, moist skin b. Arm and leg trembling c. Slow, shallow respirations d. Rapid, thready pulse
d
A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? a. temp b. albumin c. hemoglobin d. bilirubin
b
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply. a. Ecchymoses b. Cyanosis of the lips c. Jaundice d. Petechiae e. Aphthous stomatitis
a, c, d
A client has just been diagnosed with type 1 diabetes. When teaching the client and family how diet and exercise affect insulin requirements, the nurse should include which guideline? a. "You'll need less insulin when you exercise or reduce your food intake." b. "You'll need less insulin when you increase your food intake." c. "You'll need more insulin when you exercise or increase your food intake." d. "You'll need more insulin when you exercise or decrease your food intake."
a
A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following? a. diabetes mellitus b. hyperparathyroidism c hypothyroidism d. hyperthyroidisms
a
Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding during this procedure signals a significant problem? a. White blood cell (WBC) count of 20,000/mm3 b. Hematocrit (HCT) of 35% c. Potassium level of 3.5 mEq/L d. Blood glucose level of 200 mg/dl
a
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? a. Perform meticulous perineal care daily with soap and water b. Use clean technique during insertion c. Place the catheter bag on the client's abdomen when moving the client d. Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens
a
The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? a. Pancreatitis can elevate the diaphragm and alter the breathing pattern. b. Pancreatitis causes alterations to hemoglobin, impairing oxygenation. c. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation.
a
What is the recommended dietary treatment for a client with chronic cholecystitis? a. low-fat diet b. low-protein diet c. high-fiber diet d. low-residue diet
a
A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: a. Impaired adjustment. b. Deficient knowledge (treatment regimen). c. Health-seeking behaviors (diabetes control). d. Defensive coping.
b
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? a. Different types of insulin are not to be mixed in the same syringe. b. The short-acting insulin is withdrawn before the intermediate-acting insulin. c. If administered immediately, there is no requirement for withdrawing one type of insulin before another. d. The intermediate-acting insulin is withdrawn before the short-acting insulin.
b
A major goal when caring for a catheterized patient is to prevent infection. Select all the nursing actions that apply. a. Disconnect the tubing to collect urine samples. b. Wash the perineal area with soap and water at least twice daily. c. Irrigate the catheter every 24 hours. d. Empty the collection bag at least every 8 hours to reduce bacterial growth. e. Suspend the drainage bag off the floor.
b, d, e
A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? a. Adventitious breath sounds and hypertension b. Presence of easy bruising and bradycardia c. Pain with abdominal distention and hypotension d. Presence of blood in the client's stool and recent hypertension
c
A client who has worked for a company that produces paint and varnishing compounds for 24 years is visiting the clinic reporting chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of the skin and sclera. The client reports clay-colored stools and frequent nosebleeds. Which type of cirrhosis is the likely cause of the client's symptoms? a. billary b. alcoholic c. postnecrotic d. respiratory
c
Which clinical characteristic is associated with type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)? a. Client is usually thin at diagnosis b. Clients demonstrate islet cell antibodies c. Blood glucose can be controlled through diet and exercise d. Client is prone to ketosis
c
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? a. "Don't take your insulin or oral antidiabetic agent if you don't eat." b. "It's okay for your blood glucose to go above 300 mg/dl while you're sick." c. "Test your blood glucose every 4 hours." d. "Follow your regular meal plan, even if you're nauseous."
c
Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a. Nonobstructive b. Obstructive c.Hemolytic d. Hepatocellular
c
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin? a. They have no effect. b. They decrease the need for insulin. c. They cause wide fluctuations in the need for insulin. d. They increase the need for insulin.
d
A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? a. The result of urethra abrasion (sexual intercourse) b. Through the bloodstream (hematogenous spread) c. Due to a fistula (direct extension) d. By ascending infection (transurethral)
d
