Chronic Final Exam Questions
While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? a.Instruct the client to deep-breathe and cough. b.Document the effluent as output. c.Turn the client to the opposite side. d.Reposition the catheter.
c.Turn the client to the opposite side.
Which factor represents a sign or symptom of digoxin toxicity? a.Serum digoxin level of 1.2 ng/mL (1.5 nmol/L) b.Polyphagia c.Visual changes d.Serum potassium of 5.0 mEq/L (5.0 mmol/L)
c.Visual changes
A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? a.Avoiding venipuncture and blood pressure measurements in the affected arm b.Modifications to allow for complete rest of the affected arm c.How to assess for a bruit in the affected arm d.How to practice proper nutrition
a.Avoiding venipuncture and blood pressure measurements in the affected arm
The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? a.Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. b.Urine output over the past hour was 80 mL. c.Pain is at a level 4 (on a 0-to-10 scale). d.Dressing has a 1-cm area of bleeding.
a.Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min.
A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the client's plan of care? a.Check BUN and creatinine b.Administer medications nurse witheld prior to dialysis c.Observe for signs of hypovolemia d.Assess the access site for bleeding e.Evaluate BP on the arm with AV access
a.Check BUN and creatinine b.Administer medications nurse witheld prior to dialysis c.Observe for signs of hypovolemia d.Assess the access site for bleeding
When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? a.Check vital signs. b.Notify the surgeon. c.Continue to monitor. d.Insert a nasogastric (NG) tube.
a.Check vital signs.
The RN has just received change-of-shift report. Which of the assigned clients would be assessed first? a.Client with chronic kidney failure who was just admitted with shortness of breath b.Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted c.Client with azotemia whose blood urea nitrogen and creatinine are increasing d.Client receiving peritoneal dialysis who needs help changing the dialysate bag
a.Client with chronic kidney failure who was just admitted with shortness of breath
To prevent prerenal acute kidney injury, which person is encouraged to increase fluid consumption? a.Construction worker b.Office secretary c.Schoolteacher d.Taxicab driver
a.Construction worker
An older adult client diagnosed with urge incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? (Select all that apply.) a.Dry mouth b.Increased blood pressure c.Constipation d.Increased intraocular pressure e.Reddish-orange urine color
a.Dry mouth c.Constipation d.Increased intraocular pressure
The 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.Dysuria c.Frequency d.Nocturia e.Urgency
hen assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? a.Eggs b.Ham c.Eggplant d.Macaroni
a.Eggs
Which assessment findings does the nurse expect in a client with kidney cancer? (Select all that apply.) a.Erythrocytosis b.Hypokalemia c.Hypercalcemia d.Hepatic dysfunction e.Increased sedimentation rate
a.Erythrocytosis c.Hypercalcemia d.Hepatic dysfunction e.Increased sedimentation rate
The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? a."Would we filter air circulation?" b."Can we use less radiographic contrast dye?" c."Would we add low-dose dobutamine?" d."Can we decrease IV rates?"
b."Can we use less radiographic contrast dye?"
The 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 need to drink 2½ liters of fluid every day." d."I will not drink fluids after 8 PM each evening."
c."I need to drink 2½ liters of fluid every day."
The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist teaches a client who has had a cystectomy about which care principles for the client's postdischarge 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
Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? a.Functional b.Overflow c.Stress d.Urge
c.Stress
A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100°F (37.8°C). Which drug does the primary health care provider prescribe? a.Nitrofurantoin (Macrodantin) after intercourse b.Estrogen (Premarin) c.Trimethoprim/sulfamethoxazole (Bactrim) d.Phenazopyridine (Pyridium) with intercourse
c.Trimethoprim/sulfamethoxazole (Bactrim)
When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the primary health care provider? a.Dark pink-colored urine b.Small amount of urine leaking around the catheter c.Tube that has stopped draining d.Creatinine of 1.8 mg/dL (160 mcmol/L)
c.Tube that has stopped draining
Which factor is an indicator for a diagnosis of hydronephrosis? a.History of nocturia b.History of urinary stones c.Recent weight loss d.Urinary incontinence
b.History of urinary stones
A client with acute kidney injury is receiving a fluid challenge of 500 mL of normal saline over 1 hour. With a drop factor of 20 drops/mL, how many drops per minute does the nurse infuse? Formula gtts = (Amt. to be infused × drop factor) divide by 60
167 drops/min
Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? a.Diltiazem (Cardizem) b.Lisinopril (Zestril) c.Clonidine (Catapres) d.Doxazosin (Cardura)
b.Lisinopril (Zestril)
A nurse is reviewing manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? Select all that apply. a.Anorexia b.Heat intolerance c.Constipation d.Palpitations e.Weight loss
b.Heat intolerance d.Palpitations e.Weight loss
A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a serum creatinine of 5 mg/dL. Which of the following interventions should the nurse include in the plan? Select all that apply. a. Provide a high-protein diet b. Assess the urine for blood c.Monitor for intermittent anuria d.Weight the client once per week e.Provide NSAIDs for pain
a. Provide a high-protein diet b. Assess the urine for blood c.Monitor for intermittent anuria
A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (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 (236 ml) 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 (236 ml) of water." e."You will need to take all of this drug to get the benefits."
A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? a."Because the kidneys cannot get rid of fluid, blood pressure goes up." b."The damaged kidneys no longer release a hormone that prevents high blood pressure." c."The waste products in the blood interfere with other mechanisms that control blood pressure." d."This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."
a."Because the kidneys cannot get rid of fluid, blood pressure goes up."
A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? a."By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." b."Even though my children don't have symptoms at the same age I did, they can still have ADPKD." c."If my children have the ADPKD gene, they will have cysts by the age of 30." d."My children have a 50% chance of inheriting the ADPKD gene that causes the disease."
a."By maintaining a low-salt diet in our house, I can prevent ADPKD in my children."
A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? a.Adherence to therapy b.Handwashing c.Monitoring for low-grade fever d.Strict clean technique
b.Handwashing
A nurse is preoperative teaching with a client who is scheduled for a kidney transplant about a rejection of a transplanted kidney. Which of the following statements should the nurse include in the teaching? Select all that apply. a."Expect an immediate removal of the donor kidney for a hyperacute reaction" b."You may need to begin dialysis to monitor your kidney function for a hyperacute rejection" c."A fever is a manifestation of an acute reaction" d."Fluid retention is a manifestation of an acute rejection" e."Your provider will increase your immunosuppressive medications for a chronic rejection"
a."Expect an immediate removal of the donor kidney for a hyperacute reaction" b."You may need to begin dialysis to monitor your kidney function for a hyperacute rejection" c."A fever is a manifestation of an acute reaction" e."Your provider will increase your immunosuppressive medications for a chronic rejection"
he school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching? a."I can't play any type of contact sports because my brother had kidney cancer." b."I avoid riding motorcycles." c."I always wear pads when playing football." d."I always wear a seat belt in the car.
a."I can't play any type of contact sports because my brother had kidney cancer."
The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? a."I need to 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 need to be drinking at least 1.5 to 2.5 liters of fluids every day."
The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? a."I take my medication only when I have symptoms." b."I always wipe front to back." c."I don't use bubble baths and other scented bath products." d."I try to drink 3 liters of fluid a day."
a."I take my medication only when I have symptoms."
A client who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the client 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."
What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? (Select all that apply.) a."Your urine will be strained after the procedure." b."Be sure to finish all of your antibiotics." c."Immediately call the primary health care provider if you notice bruising." d."Remember to drink at least 3 liters of fluid a day to promote urine flow." e."You will need to change the incisional dressing once a day."
a."Your urine will be strained after the procedure." b."Be sure to finish all of your antibiotics." d."Remember to drink at least 3 liters of fluid a day to promote urine flow."
Which clients with long-term urinary problems does the nurse refer to community resources and support groups? (Select all that apply.) a.A 32-year-old with a cystectomy b.A 44-year-old with a Kock pouch c.A 48-year-old with urinary calculi e.A 78-year-old with urinary incontinence f.An 80-year-old with dementia
a.A 32-year-old with a cystectomy b.A 44-year-old with a Kock pouch e.A 78-year-old with urinary incontinence
Which finding in the first 24 hours after kidney transplantation requires immediate intervention? a.Abrupt decrease in urine output b.Blood-tinged urine c.Incisional pain d.Increase in urine output
a.Abrupt decrease in urine output
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.Administer morphine sulfate 4 mg IV. b.Begin an infusion of metoclopramide (Reglan) 10 mg IV. c.Obtain a urine specimen for urinalysis. d.Start an infusion of 0.9% normal saline at 100 mL/hr.
a.Administer morphine sulfate 4 mg IV.
When caring for a client with nephrotic syndrome, which intervention would be included in the plan of care? a.Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss b.Administering heparin to prevent deep vein thrombosis (DVT) c.Providing antibiotics to decrease infection d.Providing transfusion of clotting factors
a.Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss
A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the client's risk of surgery? Select all that apply a.Age >72 years b.BMI of 41 c.Administering NPH insulin each morning d.past history of lymphoma e.blood pressure averaging 120/70 mm HG
a.Age >72 years b.BMI of 41 c.Administering NPH insulin each morning e.blood pressure averaging 120/70 mm HG
A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? Select all that apply. a.Anuria b.Marked azotemia c.Crackles in the lungs d.Increased Calcium levels e.Proteinuria
a.Anuria c.Crackles in the lungs d.Increased Calcium levels
A nurse is planning care for client who has stage four CKD. Which of the following actions should the nurse include in the plan of care? Select all that apply. a.Assess for JVD b.Provide frequent mouth rinses c. Auscultate for a pleural friction rub d.Provide high-sodium diet e.Monitor for dysrhythmias
a.Assess for JVD b.Provide frequent mouth rinses c. Auscultate for a pleural friction rub e.Monitor for dysrhythmias
A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? a.Auscultate for pericardial friction rub. b.Assess for crackles. c.Monitor for decreased peripheral pulses. d.Determine if the client is able to ambulate.
a.Auscultate for pericardial friction rub.
Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) a.Football player in preseason practice b.Client who underwent contrast dye radiology c.Accident victim recovering from a severe hemorrhage d.Accountant with diabetes e.Client in the intensive care unit on high doses of antibiotics f.Client recovering from gastrointestinal influenza
a.Football player in preseason practice b.Client who underwent contrast dye radiology c.Accident victim recovering from a severe hemorrhage e.Client in the intensive care unit on high doses of antibiotics f.Client recovering from gastrointestinal influenza
A nurse in a provider's office is assessing a client who has hypothyroidism and recently began treatment with thyroid hormone replacement therapy. Which of the following findings should indicate the nurse that the client might need a decrease in the dosage of the medication? a.Hand tremors b.Bradycardia c.Pallor d.Slow speech
a.Hand tremors
Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? a.Increased blood urea nitrogen (BUN) b.Increased creatinine level c.Pale-colored urine d.Decreased sodium level
a.Increased blood urea nitrogen (BUN)
A nurse in a provider's office is planning care for client who has a new diagnosis of Graves' disease and new prescription of methimazole. Which of the following interventions should the nurse include in the plan of care? Select all that apply. a.Monitor CBC b.Monitor triiodothyronine (T3) c.Instruct client to increase consumption of shellfish d.Advise the client to take the medication at the same time every day e.Inform the client that an adverse effect of this medication is iodine toxicity
a.Monitor CBC b.Monitor triiodothyronine (T3) d.Advise the client to take the medication at the same time every day
A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? Select all that apply. a.Monitor serum glucose levels b.Report cloudy dialysate return c.Warm the dialysate in the microwave d.Assess for SOB e.Check access site for wetness
a.Monitor serum glucose levels b.Report cloudy dialysate return d.Assess for SOB e.Check access site for wetness
The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? a.Nonsteroidal anti-inflammatory drugs (NSAIDs) b.Angiotensin-converting enzyme (ACE) inhibitors c.Opiates d.Calcium channel blockers
a.Nonsteroidal anti-inflammatory drugs (NSAIDs)
A nurse in an intensive care unit is planning care for a client who has myxedema coma. Which of the following actions should the nurse include? Select all that apply. a.Observe cardiac monitor for dysrythmias b.Observe for evidence of a UTI c.Initiate IV fluids using 0.9% sodium chloride d.Administer a levothyroxine IV bolus e.Provide warmth using a heating pad
a.Observe cardiac monitor for dysrythmias b.Observe for evidence of a UTI c.Initiate IV fluids using 0.9% sodium chloride d.Administer a levothyroxine IV bolus
While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) a.Obtain the client's prehemodialysis weight. b.Check the arteriovenous (AV) fistula for a thrill and bruit. c.Document the amount the client drinks throughout the shift. d.Auscultate the client's lung sounds every 4 hours. e.Explain the components of a low-sodium diet.
a.Obtain the client's prehemodialysis weight. c.Document the amount the client drinks throughout the shift.
When caring for a client with polycystic kidney disease, which goal is most important? a.Preventing progression of the disease b.Performing genetic testing c.Assessing for related causes d.Consulting with the dialysis unit
a.Preventing progression of the disease
When taking the health history of a client with acute glomerulonephritis (GN), the nurse questions the client about which related cause of the problem? a.Recent respiratory infection b.Hypertension c.Unexplained weight loss dNeoplastic disease
a.Recent respiratory infection
The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) a.Restricted protein b.Liberal sodium c.Restricted fluids d.Low potassium e.Low fat
a.Restricted protein c.Restricted fluids d.Low potassium
A nurse is preparing to initiate hemodialysis for a client who has an acute kidney injury. Which of the following actions should the nurse take? Select all that apply. a.Review the medications the client currently takes b.Assess the AV fistula for a bruit c.Calcuate the client's hourly urine output d.Measure the client's weight e.Check serum electrolytes
a.Review the medications the client currently takes b.Assess the AV fistula for a bruit d.Measure the client's weight e.Check serum electrolytes
Which condition may predispose a client to chronic pyelonephritis? a.Spinal cord injury b.Cardiomyopathy c.Hepatic failure d.Glomerulonephritis
a.Spinal cord injury
A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? Select all that apply. a.Suction equipment b.Humidified oxygen c.Flashlight d. Tracheostomy tray e.Chest tube tray
a.Suction equipment b.Humidified oxygen d. Tracheostomy tray
Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued? (Select all that apply.) a.Three-day postoperative client b.client in the step-down unit c.Comatose client with careful monitoring of intake and output (I&O) d.Incontinent client with perineal skin breakdown e.Incontinent older adult in long-term care
a.Three-day postoperative client b.client in the step-down unit e.Incontinent older adult in long-term care
A nurse is planning postoperative care for a client following a kidney transplant surgery. Which of the following actions should the nurse include in the plan of care? Select all that apply. a.obtain daily weights b.assess dressings for bloody drainage c.replace hourly urine output with IV fluids d.expect oliguria within the first 4 hours e.monitor serum electrolytes
a.obtain daily weights b.assess dressings for bloody drainage c.replace hourly urine output with IV fluids d.expect oliguria within the first 4 hours
A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for post procedure 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 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."
A nurse is providing instructions to a client who has Graves' disease and has a new prescription for propranolol. Which of the following information should the nurse include? a."An adverse effect of this medication is jaundice" b."Take your pulse before each dose." c."The purpose of this medication is to decrease the production of thyroid hormone." d."You should stop taking this medication if you have a sore throat."
b."Take your pulse before each dose."
A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? a."Don't worry, no one else will know." b."Take your time. What is bothering you most?" c."Why are you hesitant?" d."You need to tell me so we can determine what is wrong."
b."Take your time. What is bothering you most?"
A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? a."I'll talk to the health care provider and have your name removed from the waiting list." b."You sound frustrated with the situation." c."You're right, the wait is endless for some people." d."I'm sure you'll get a phone call soon that a kidney is available."
b."You sound frustrated with the situation."
What is the appropriate range of urine output for the client who has just undergone a nephrectomy? a.23 to 30 mL/hr b.30 to 50 mL/hr c.41 to 60 mL/hr d.50 to 70 mL/hr
b.30 to 50 mL/hr
The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? a.A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4°F (37.4°C) b.A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours c.A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy d.A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed
b.A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours
The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen? a.Increase in analgesics b.Addition of a corticosteroid c.Administration of a diuretic d.Course of antibiotic therapy
b.Addition of a corticosteroid
The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP? a.Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria b.Assisting a client who had a radical nephrectomy 2 days ago to turn in bed c.Helping the primary health care provider with a kidney biopsy for a client admitted with acute glomerulonephritis d.Palpating for bladder distention on a client recently admitted with a ureteral stricture
b.Assisting a client who had a radical nephrectomy 2 days ago to turn in bed
When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) a.Check brachial pulses daily. b.Auscultate for a bruit every 8 hours. c.Teach the client to palpate for a thrill over the site. d.Elevate the arm above heart level. e.Ensure that no blood pressures are taken in that arm.
b.Auscultate for a bruit every 8 hours. c.Teach the client to palpate for a thrill over the site. e.Ensure that no blood pressures are taken in that arm.
hich instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? a.Consuming a low-calcium diet b.Avoiding peas, nuts, and legumes c.Drinking cola beverages only once daily d.Increasing dairy products enriched with vitamin D
b.Avoiding peas, nuts, and legumes
Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) a.Blood urea nitrogen (BUN) 21 mg/dL (7.5 mmol/L), creatinine 0.9 mg/dL (80 mcmol/L) b.Crackles in the lung fields c.Temperature of 98.8°F (37.1°C) d.Blood pressure of 164/98 mm Hg e.3+ edema of the lower extremities
b.Crackles in the lung fields d.Blood pressure of 164/98 mm Hg e.3+ edema of the lower extremities
When assessing a client with acute glomerulonephritis, which finding causes the nurse to notify the primary health care provider? a.Purulent wound on the leg b.Crackles throughout the lung fields c.History of diabetes d.Cola-colored urine
b.Crackles throughout the lung fields
Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? a.Decreased urine output b.Decreased white blood cells in urine c.Increased red blood cell count d.Increased urine specific gravity
b.Decreased white blood cells in urine
A client diagnosed with urge incontinence is started on tolterodine (Detrol). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? (Select all that apply.) a.Take the drug at bedtime. b.Encourage increased fluids. c.Increase fiber intake. d.Limit the intake of dairy products. e.Use hard candy for dry mouth.
b.Encourage increased fluids. c.Increase fiber intake e.Use hard candy for dry mouth.
A nurse is reveiweing client labratory data. The nurse should recognize which of the following findings is expected for a client who has stage 4 CKD? a.BUN 15 mg/dL b.GFR 20ml/min c.Serum creatinine 1.1 mg/dL d.Serum potassium 5.0 mEq/L
b.GFR 20ml/min
A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? Select all that apply. a.Weight gain is expected while taking this medication b.Medication should not be discontinued without the advice of the provider c.Follow up TSH levels should be obtained d.Take the medication on an empty stomach e.Use fiber laxatives for constipation
b.Medication should not be discontinued without the advice of the provider c.Follow up TSH levels should be obtained d.Take the medication on an empty stomach
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
When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider (HCP)? a.Mild discomfort at the insertion site b.Temperature 100.8°F (38.2°C) c.1+ ankle edema d.Anorexia
b.Temperature 100.8°F (38.2°C)
Which sign or symptom, when assessed in a client with chronic glomerulonephritis (GN), warrants a call to the primary health care provider? a.Mild proteinuria b.Third heart sound (S3) c.Serum potassium of 5.0 mEq/L (5.0 mmol/L) d.Itchy skin
b.Third heart sound (S3)
The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include 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 (2 liters) of fluid each day. c.Be sure to complete the full course of antibiotics. d.If urine remains cloudy, call the clinic. e.Expect some flank discomfort until the antibiotic has worked.
b.Try to take in 64 ounces (2 liters) of fluid each day. c.Be sure to complete the full course of antibiotics. d.If urine remains cloudy, call the clinic.
When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? (Select all that apply.) a.Suprapubic pain b.Vomiting c.Chills d.Dysuria e.Oliguria
b.Vomiting c.Chills d.Dysuria
A nurse in a provider's office is reviewing the health record of a client who is being evaluated for for Graves' disease. The nurse should identify which of the following lab results is an expected finding? a.decreased thyrotropin receptor antibodies b.decreased TSH c.decreased free thyroxine index d.decreased triiodothyronine
b.decreased TSH
A nurse is in a provider's office is reviewing labratory results of a client who is being evaluated for hypothyroidism. Which of the following lab results is expected in a client who has this condition? a.elevated serum t4 b.decreased serum t3 c.elevated serum thyroid stimulating hormone d.decreased serum cholesterol
b.decreased serum t3
A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings should the nurse expect? Select all that apply. a.diarrhea b.menorrhagia c.dry skin d.increased libido e.hoarseness
b.menorrhagia c.dry skin e.hoarseness
A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? a."Your diseased kidneys will be removed at the same time the transplant is performed." b."The new kidney will be placed directly below one of your old kidneys." c."It is essential for you to wash your hands and avoid people who are ill." d."You will receive dialysis the day before surgery and for about a week after."
c."It is essential for you to wash your hands and avoid people who are ill."
A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include? a."Decrease your intake of protein-rich foods." b."Take this medication with grapefruit juice" c."Monitor for and report a sore throat to your provider" d."Expect your skin to turn yellow"
c."Monitor for and report a sore throat to your provider"
Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? a."I can stop my medications when my kidney function returns to normal." b."If my urine output is decreased, I should increase my fluids." c."The antirejection medications will be taken for life." d."I will drink 8 ounces (236 ml) of water with my medications."
c."The antirejection medications will be taken for life."
A 53-year-old postmenopausal woman reports "leaking urine" when she laughs and 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."
The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection (UTI). 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 front to back." d."Wipe with the softest toilet paper available."
c."Wipe from front to back."
A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? a.Administer an opioid medication b.Monitor for HTN c.Assess LOC d.Increase dialysis exchange rate
c.Assess LOC
The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? a.Hemoglobin and hematocrit (H&H) b.White blood cell (WBC) count c.Blood urea nitrogen (BUN) and creatinine d.Lipid levels
c.Blood urea nitrogen (BUN) and creatinine
After receiving change-of-shift report on the urology unit, which client does the nurse assess first? a.Client postradical nephrectomy whose temperature is 99.8°F (37.6°C) b.Client with glomerulonephritis who has cola-colored urine c.Client who was involved in a motor vehicle collision and has hematuria d.Client with nephrotic syndrome who has gained 2 kg since yesterday
c.Client who was involved in a motor vehicle collision and has hematuria
A nurse is assessing a client who is 12 hour postoperative following a thyroidectomy. The nurse should identify which of the following finding as indicative of thyroid crisis? Select all that apply. a.Bradycardia b.Hypothermia c.Dyspnea d.Abdominal pain e.Mental confusion
c.Dyspnea d.Abdominal pain e.Mental confusion
A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? a.Blood pressure of 118/78 mm Hg b.Weight loss of 3 pounds (1.4 kg) during hospitalization c.Dyspnea and anxiety at rest d.Central venous pressure (CVP) of 6 mm Hg
c.Dyspnea and anxiety at rest
A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? a.Bladder training b.Credé method c.Habit training d.Kegel exercises
c.Habit training
Which nursing activity illustrates proper aseptic technique during catheter care? a.Applying Betadine ointment to the perineal area after catheterization b.Irrigating the catheter daily c.Positioning the collection bag below the height of the bladder d.Sending a urine specimen to the laboratory for testing
c.Positioning the collection bag below the height of the bladder
A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hours and BP is 92/58 mm Hg. The nurse should anticipate which of the following interventions? a.Prepare the client for a CT scan with contrast dye b.Plan to administer nitroprusside c.Prepare to administer a fluid challenge d.Plan to position the client in Trendelenburg
c.Prepare to administer a fluid challenge
A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration would be cared for by which staff member? a.RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma b.RN who is caring for a client who just returned after having renal artery balloon angioplasty c.RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy d.RN who is currently admitting a client with acute hypertension and possible renal artery stenosis
c.RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy
A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member would be assigned to care for the client? a.RN who has floated from pediatrics for this shift b.LPN/LVN with experience working on the medical unit c.RN who usually works on the general surgical unit d.New graduate RN who just finished a 6-week orientation
c.RN who usually works on the general surgical unit
A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? Select all that apply. a.Reduced BUN b.Elevated cardiac enzymes c.Reduced urine output d.Elevated serum creatinine e.Elevated serum calcium
c.Reduced urine output d.Elevated serum creatinine
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 primary health care provider before the ESWL procedure begins? a."Blood in my urine has become less noticeable, so 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."
The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a 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."
The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? a."I am so relieved that I can continue eating my fried fish meals every week." b."I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." c."My wife will be happy to know that I can keep enjoying her liver and onions recipe." d."I will no longer be able to have red wine with my dinner."
d."I will no longer be able to have red wine with my dinner."
The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? a."Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." b."I'll eventually require some type of renal replacement therapy." c."I'll need to decrease my fluid intake to prevent stress to my remaining kidney." d."My remaining kidney will provide me with normal kidney function now."
d."My remaining kidney will provide me with normal kidney function now."
An older adult woman confides to the 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?"
During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? a."Drink 2 liters of fluid and urinate at the same time every day." b."Eat breakfast and go to bed at the same time every day." c."Check your blood sugar and do a urine dipstick test." d."Weigh yourself and take your blood pressure."
d."Weigh yourself and take your blood pressure."
A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? a."All of this is new. What can't you do?" b."Are you afraid of dying?" c."How are you doing this morning?" d."What concerns do you have about your kidney disease?"
d."What concerns do you have about your kidney disease?"
The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? a."For the best effect, perform all of 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."
Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? a.A 42-year-old with painless hematuria who needs an admission assessment b.A 46-year-old scheduled for cystectomy who needs help in selecting a stoma site c.A 48-year-old receiving intravesical chemotherapy for bladder cancer d.A 55-year-old with incontinence who has intermittent catheterization prescribed
d.A 55-year-old with incontinence who has intermittent catheterization prescribed
What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? a.Limit fluid intake. b.Increase caffeine consumption. c.Limit sugar intake. d.Drink about 3 liters of fluid daily.
d.Drink about 3 liters of fluid daily.
A nurse is teaching a client who has CKD and is to begin hemodialysis. Which of the following infomration should the nurse include in the teaching? a.Hemodialysis restores kidney function b.Hemodialysis replaces hormonal function of the renal system c.Hemodialysis allows an unrestricted diet d.Hemodialysis returns a balance to serum electrolytes
d.Hemodialysis returns a balance to serum electrolytes
Which staff member does the charge nurse assign to a client who has benign prostatic hyperplasia (BPH) and hydronephrosis and needs an indwelling catheter inserted? a.RN float nurse who has 10 years of experience with pediatric clients b.LPN/LVN who has worked in the hospital's kidney dialysis unit until recently c.RN without recent experience who has just completed an RN refresher course d.LPN/LVN with 5 years of experience in an outclient urology surgery center
d.LPN/LVN with 5 years of experience in an outclient urology surgery center
Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? a.Hematocrit of 26.7% b.Potassium within normal range c.Absence of spontaneous fractures d.Less fatigue
d.Less fatigue
When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used? a.Fresh-frozen plasma b.Platelet infusions c.5% dextrose in water d.Normal saline solution (NSS)
d.Normal saline solution (NSS)
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 that catheters be placed in all clients d.Periodically reevaluating the need for indwelling catheters
d.Periodically reevaluating the need for indwelling catheters
Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? a.History of hiatal hernia b.Presence of diabetes and glycosylated hemoglobin of 6.8% c.History of basal cell carcinoma on the nose 5 years ago d.Presence of tuberculosis
d.Presence of tuberculosis
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 for immediate follow-up
d.Refers the client to the clinic nurse practitioner for immediate follow-up
When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider (HCP) immediately? a.Pulse oximetry reading of 95% b.Sinus bradycardia, rate of 58 beats/min c.Blood pressure of 148/90 mm Hg d.Temperature of 101.2°F (38.4°C)
d.Temperature of 101.2°F (38.4°C)
3A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the 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