TERM 3 HESI REVIEW

The nurse is caring for a client who had a renal biopsy. Which interventions would the nurse include in the plan of care for the client after this procedure? Select all that apply. Restricting fluids during the first 24 hours Administering pain medication as prescribed Monitoring vital signs and the puncture site frequently Testing serial urine samples with dipsticks for occult blood Ambulating the client in the room and hall for short distances

Administering pain medication as prescribed Monitoring vital signs and the puncture site frequently Testing serial urine samples with dipsticks for occult blood After renal biopsy, the nurse ensures that the client remains in bed for at least 24 hours. Vital signs and puncture site assessments are done frequently during this time. Encouraging fluids is done to reduce possible clot formation in the kidney and urinary tract. Testing is done on serial urine samples with urine dipsticks to evaluate bleeding. Analgesics are often needed to manage the renal colic pain that some clients feel after this procedure.

A client with a burn injury is scheduled for an autograft. The nurse is planning care for the client for immediately after the graft procedure. Which would the nurse include in the plan of care? Select all that apply.

Administering pain medications as prescribed Monitoring the donor site and the graft site for signs of infection Donor sites may be covered by a film dressing to hasten healing and decrease pain; they are not left open to air. The donor site is often more painful than the graft site, and pain medications are prescribed. The sites are monitored for infection. The graft area is immobilized for 3 to 7 days, not just 24 hours, to permit attachment of the graft to the wound base. Pressure dressings are worn as soon as grafts heal but not right after the procedure.

After a renal biopsy, the client complains of pain at the biopsy site that radiates to the front of the abdomen. Which would this indicate?

Bleeding

A client with chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril. When would the nurse plan to administer this medication? During dialysis Just before dialysis The day after dialysis On return from dialysis

On return from dialysis Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and from having the medication removed from the bloodstream by dialysis. There is no rationale for waiting a full day to resume the medication. This would lead to ineffective control of the blood pressure.

The nurse prepares to administer sodium polystyrene sulfonate to a client with chronic kidney disease for which laboratory abnormality?

Potassium level of 7.2 mEq/L

The nurse is reinforcing instructions to a client about the types of fluids that assist in prevention and treatment of urinary tract infections (UTIs). The nurse instructs the client to consume which fluids? Select all that apply. Milk Soda Prune juice Apple juice Cranberry juice

Prune juice Apple juice Cranberry juice

The nurse is assigned to assist in caring for a client with frostbite of the toes. Which would the nurse anticipate to be prescribed for this condition? Rapid and continual rewarming of the toes when flushing occurs Rapid and continual rewarming of the toes in cold water for 45 minutes Rapid and continual rewarming of the toes in hot water for 15 to 20 minutes Rapid and continual rewarming of the toes in a warm-water bath until flushing of the skin occurs

Rapid and continual rewarming of the toes in a warm-water bath until flushing of the skin occurs

The nurse is caring for a hospitalized client following cystoscopy. Which discharge instructions are given to the client? Select all that apply. Use antispasmodics for pain. Restrict oral fluids for 1 to 2 days. Expect pink-tinged urine for 1 week. Take sitz baths for voiding discomfort. Report severe pain to health care provider.

Use antispasmodics for pain. Take sitz baths for voiding discomfort. Report severe pain to health care provider. Discharge instructions following cystoscopy include: (1) taking prescribed analgesics or antispasmodics for pain, (2) taking sitz baths to help relieve pain and urinary frequency, (3) drinking 2 to 3 liters of fluids daily unless contraindicated, and (4) expecting urine to be pink tinged for 1 to 2 days. Severe pain needs to be reported.

A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. Which statement indicates that the client understood the instructions? Stop antibiotic therapy when pain subsides. Exercise as much as possible to stimulate circulation. Use warm sitz baths and analgesics to increase comfort. Keep fluid intake to a minimum to decrease the need to void.

Use warm sitz baths and analgesics to increase comfort. Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The client is also taught to rest, increase fluid intake, and use sitz baths for comfort. Antimicrobial therapy is always continued until the prescription is completely finished.

Epoetin Alfa

Used to treat anemia

A client had a radical neck dissection with a musculocutaneous flap. Twenty-four hours following the procedure, the nurse observes that the flap has a slightly blue hue. The nurse draws which conclusion?

Venous circulation is being impaired. The blue color is a sign of venous engorgement resulting from venous stasis, which increases local tissue hypoxia and can lead to necrosis of the area affected. This is not a normal expectation. Heat application would cause more damage to the tissue. There is no evidence to support option 4.

pyelonephritis

a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney. Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems.

what is sutilains treatments used for

a biochemical debridement of second and third-degree burns, incisional traumatic and pyrogenic wounds and ulcers occurring due to peripheral vascular diseases.

The nurse is assigned to care for a client with a leg ulcer. Sutilains treatments are prescribed. The nurse would avoid which action when performing the treatment?

Applying the sutilains immediately followed by a dry sterile dressing The wound should be cleansed with a sterile solution before treatment. The nurse then should thoroughly moisten the wound with sterile normal saline or sterile water and apply a loose thin dressing after applying a thin film of sutilains extending ¼ to ½ inch beyond the area to be debrided. The ointment should be refrigerated.

A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. Which are the signs/symptoms of transurethral resection (TUR) syndrome? Tachycardia and diarrhea Bradycardia and confusion Increased urinary output and anemia Decreased urinary output and bladder spasms

Bradycardia and confusion TUR syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

The nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of infection. Which sign/symptom is likely to present first? Fever Urgency Confusion Frequency

Confusion In an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls. Frequency and urgency may commonly occur in an older client, and fever can be associated with a variety of conditions.

A client with chronic kidney disease is receiving ferrous sulfate. The nurse would monitor the client for which common side effect associated with this medication? Diarrhea Weakness Headache Constipation

Constipation Ferrous sulfate is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipation. Options 1, 2, and 3 are not associated with this medication.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? Hematocrit of 33% (0.33) Platelet count of 400,000 mm3 (400 × 109/L) White blood cell count of 6000 mm3 (6.0 × 109/L) Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

Hematocrit of 33% (0.33) Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% (0.42 to 0.52); Female: 37% to 47% (0.37 to 0.47). Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

The nurse is providing instructions to a client with a diagnosis of scabies regarding the administration of crotamiton. Which statement by the client indicates an understanding regarding the application of this medication?

"I will massage the medication into the skin from my chin downward and apply a second application in 24 hours, followed by a cleansing bath 48 hours after the second application." The client is instructed to massage the medication into the skin of the entire body, starting with the chin and working downward. The head and face are treated only if needed. Special attention should be given to skin folds and creases. Contact with eyes, mucous membranes, and any region of inflammation should be avoided. A second application is made 24 hours after the first. A cleansing bath should be taken 48 hours after the second application, and, if needed, treatment can be repeated in 7 days.

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse would take which actions? Contact the nephrologist. Check the level of the drainage bag. Reposition the client to his or her side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks. Increase the flow rate of the peritoneal dialysis solution.

Check the level of the drainage bag. Reposition the client to his or her side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks. Rationale:If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing on the peritoneal dialysis system is also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open. There is no reason to contact the nephrologist. Increasing the flow rate is an inappropriate action and is unassociated with the amount of outflow solution.

A client is receiving topical corticosteroid therapy in the treatment of psoriasis. The nurse expects the primary health care provider to prescribe which measure to maximize the effectiveness of this therapy? Rubbing the application into the skin 2Placing the area under a heat lamp for 20 minutes 3Applying a dry sterile dressing over the affected area 4Covering the application with a warm, moist dressing and an occlusive outer wrap

Covering the application with a warm, moist dressing and an occlusive outer wrap The nurse can enhance penetration of topical corticosteroid therapy to the client with psoriasis by applying warm moist heat and an occlusive outer wrap. The wrap may consist of a plastic film, glove, bootie, or a similar item. If large surface areas of skin are involved, the occlusive therapy may be limited to 12 hours per day to minimize local and systemic side effects. The remaining options are not measures that will enhance the effectiveness of therapy.

The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client would be questioned about the use of which class of medications? Diuretics Antibiotics Antitussives Decongestants

Decongestants Episodes of urinary retention can be triggered by certain medications such as decongestants, anticholinergics, and antidepressants. Diuretics, antibiotics, and antitussives generally do not trigger urinary retention. Retention also can be precipitated by other factors such as alcoholic beverages, infection, bed rest, and becoming chilled.

A client is scheduled for intravenous pyelography (IVP). Which priority nursing action would the nurse take? Restrict fluids. Administer a sedative. Determine if there is a history of allergies.

Determine if there is a history of allergies.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder noted on the client's record would the nurse identify as a risk factor for this diagnosis? Hypoglycemia Diabetes mellitus Coronary artery disease Orthostatic hypotension

Diabetes mellitus Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

A male client has a tentative diagnosis of urethritis. The nurse would assess the client for which manifestation of the disorder? Hematuria and pyuria Dysuria and proteinuria Hematuria and urgency Dysuria and penile discharge

Dysuria and penile discharge Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not associated with urethritis. Proteinuria is associated with kidney dysfunction.

The nurse is reviewing the client's record and notes that the primary health care provider (PHCP) has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Elevated serum creatinine level Elevated thrombocyte cell count Decreased red blood cell (RBC) count Decreased white blood cell (WBC) count Elevated blood urea nitrogen (BUN) level

Elevated serum creatinine level Decreased red blood cell (RBC) count Elevated blood urea nitrogen (BUN) level

The nurse is caring for a client with epididymitis. The nurse anticipates noting which group of findings on data collection? Diarrhea, groin pain, and scrotal edema Fever, diarrhea, groin pain, and ecchymosis Fever, nausea and vomiting, and painful scrotal edema Nausea, vomiting, and scrotal edema with widespread ecchymosis

Fever, nausea and vomiting, and painful scrotal edema