Exam 3 Test Bank

The nurse recognizes that the risk for dehydration in the elderly increases significantly due to which age-related change in renal function? 1. decreased ability of the kidney to concentrate urine 2. hypoplasia 3. presence of renal cysts 4. reduced clearance of drugs excreted by the kidney

Correct Answer: 1 Rationale 1: Age-related changes in the kidney include the decreased ability to concentrate urine and compensate for increased or decreased salt intake. When this is combined with diminished effectiveness of antidiuretic hormone (ADH) and a reduced thirst response, both age-related, the elderly patient's risk for dehydration increases. Rationale 2: Hypoplasia is a congenital renal disorder. Rationale 3: Renal cysts are hereditary. Rationale 4: Decreased glomerular filtration rate (GFR), which is an age-related change in renal function, results in reduced clearance of drugs excreted through the kidneys.

A patient is admitted with signs of chronic kidney disease. What finding should the nurse use to determine whether this patient is developing metabolic acidosis? 1. Kussmaul respirations 2. low urine output 3. muscle cramps 4. diarrhea

Correct Answer: 1 Rationale 1: As kidney disease progresses, hydrogen-ion excretion and buffer production are impaired, leading to metabolic acidosis. Respiratory rate and depth increase, as with Kussmaul respirations, to compensate for metabolic acidosis. Rationale 2: Low urine output is often associated with chronic kidney disease and does not indicate metabolic acidosis. Rationale 3: Muscle cramps are often associated with chronic kidney disease and do not indicate metabolic acidosis. Rationale 4: Diarrhea is often associated with chronic kidney disease and does not indicate metabolic acidosis.

The nurse is explaining to a patient the procedure to alleviate pressure on a casted extremity. How should the nurse explain the procedure? 1. "This procedure is called bivalving. The doctor will use a cast saw to split the cast down both sides to relieve pressure on your leg." 2. "This procedure is called an external fixation and will help the bone heal." 3. "This procedure is called an open reduction with internal fixation to help the bone fuse together." 4. "This procedure will help heal your leg faster so that the cast can come off sooner."

Correct Answer: 1 Rationale 1: Bivalving is the process of splitting the cast down both sides to alleviate pressure on or allow visualization of the extremity. Rationale 2: This procedure is not external fixation. Rationale 3: This procedure is not open reduction with internal fixation. Rationale 4: The goal of this procedure is not specifically to promote faster healing.

A patient who received a kidney transplant seven years ago is seen for increasing blood pressure and proteinuria. The nurse realizes that this patient is demonstrating signs of what health problem? 1. chronic rejection 2. acute rejection 3. renal artery stenosis 4. pyelonephritis

Correct Answer: 1 Rationale 1: Chronic rejection may develop months to years following transplant. The manifestations of azotemia, proteinuria, and hypertension are those of progressive kidney disease. Rationale 2: Acute rejection most commonly occurs in the weeks that immediately follow transplant. Rationale 3: Renal artery stenosis manifests with a bruit over the surgical anastomosis site. Rationale 4: Pyelonephritis manifests with abdominal discomfort and low-grade fever.

Following trauma to the musculoskeletal or nervous system, complex regional pain syndrome may develop. The nurse would recognize this complication when what is assessed? 1. The patient complains of persistent pain, swelling, and decreased motion. 2. The patient's bone has not healed within the expected time period. 3. The patient complains of leg swelling, pain, tenderness, and cramping. 4. The patient complains of numbness beyond a cast, and toes are pale, with delayed capillary refill.

Correct Answer: 1 Rationale 1: Complex regional pain syndrome (CRPS) is characterized by intense pain in the affected limb, as well as sensory, autonomic, motor, skin, and bone changes of the extremity. Rationale 2: The failure of a fracture to heal within the usual time period is characteristic of nonunion or delayed union. Rationale 3: Leg swelling, pain, tenderness, and cramping are symptoms of deep vein thrombosis. Rationale 4: Numbness beyond a cast and toes that are pale with delayed capillary refill are symptoms of possible compartment syndrome.

The nurse is caring for a patient receiving peritoneal dialysis. After completing the exchange and draining the dialysate, the nurse notices that the dialysate is cloudy. How should the nurse interpret this finding? 1. a sign of infection 2. a sign of vascular access occlusion 3. the normal appearance of dialysate 4. a sign of possible bowel perforation

Correct Answer: 1 Rationale 1: Dialysate is typically clear; cloudy or malodorous dialysate may indicate infection. Rationale 2: Peritoneal dialysis does not use vascular access. Rationale 3: Dialysate is typically clear. Rationale 4: Blood or feces in the dialysate may indicate organ or bowel perforation.

A patient diagnosed with a fractured left femur complains of chest pain, shortness of breath, and a rash on the chest. What complication should the nurse suspect? 1. fat embolism syndrome 2. deep vein thrombosis 3. compartment syndrome 4. disseminated intravascular coagulation (DIC)

Correct Answer: 1 Rationale 1: Long bone fractures and other major trauma are the primary risk factors for fat embolism syndrome. When the bone is fractured, pressure within the bone marrow rises and exceeds capillary pressure; as a result, fat globules leave the bone marrow and enter the bloodstream. The fat globules lodge in the pulmonary vascular bed or peripheral circulation. Manifestations usually develop within a few hours to a week after injury due to the occlusion of blood supply and the presence of fatty acids. Rationale 2: The symptoms do not indicate deep vein thrombosis. Rationale 3: The symptoms do not indicate compartment syndrome. Rationale 4: The symptoms do not indicate DIC.

The nurse is concerned after performing a neurovascular assessment on an older patient with a lower arm cast. Which finding caused the nurse to become concerned? 1. Pale, cold fingers 2. Slightly edematous fingers 3. Warm, pink skin above the cast 4. Pain rating of 2 on a 0-to-10 scale

Correct Answer: 1 Rationale 1: Pale, cold fingers in a patient with a cast could indicate decreased circulation to the hand. This finding needs to be investigated since the cast could be too tight or compartment syndrome could be developing. Rationale 2: The fingers will be slightly edematous after an arm fracture occurs. Rationale 3: Warm pink skin indicates adequate blood flow to the area. Rationale 4: A pain rating of 2 on a scale from 0 to 10 indicates pain is being adequately controlled.

A patient is prescribed RICE therapy. How should the nurse describe the components of this therapy? 1. rest, ice, compression, and elevation 2. rest, ice, CT scan, and elimination of pain 3. rest, immobilization, CT scan, and elimination of pain 4. rest, immobilization, compression, and elevation

Correct Answer: 1 Rationale 1: RICE is an acronym for rest, ice, compression, and elevation. Rationale 2: CT scan and elimination of pain are not part of the treatment plan. Rationale 3: Immobilization, CT scan, and elimination of pain are not part of the treatment plan. Rationale 4: Immobilization is not part of the treatment plan.

The nurse is changing a patient's stump dressing. The nurse understands that proper technique must be used for the above-the-knee amputation. Which technique should the nurse use for this dressing change? 1. figure-eight bandage 2. compression bandaging technique 3. splinting 4. bivalving

Correct Answer: 1 Rationale 1: The figure-eight bandage is started by bringing the bandage down over the stump and back up around the hips. Stump dressings increase venous return, decrease edema, and help shape the stump for a prosthetic device. Rationale 2: The technique is not compression bandaging. Rationale 3: The technique is not splinting. Rationale 4: Bivalving is used to reduce the risk of compartment syndrome and involves splitting a cast down both sides.

A patient diagnosed with osteomyelitis has a fever of 101.2°F, a white blood cell count of 22,000, and is complaining of severe leg pain. The physician prescribes the following measures. What is the first order the nurse should implement? 1. Start IV D51/2 NS at 125 mL/hr 2. Blood cultures ×2 at different sites 3. Rocephin 1 gram IV twice a day 4. Acetaminophen 650 mg by mouth for temperature above 100°F

Correct Answer: 1 Rationale 1: The nurse should insert the intravenous access line first and draw the blood for the blood cultures through the access line. Rationale 2: Blood cultures should be drawn prior to the initiation of the IV antibiotic. Rationale 3: Once the intravenous line is established, the antibiotic can be started. Rationale 4: Acetaminophen is not a priority at this time and can be provided at any point in the process.

A female patient asks the nurse for ways to prevent recurrent urinary tract infections. How should the nurse respond? 1. "Avoid douching." 2. "Clean the perineal area from back to front." 3. "Use feminine hygiene sprays." 4. "Wear clean nylon underpants."

Correct Answer: 1 Rationale 1: The nurse should suggest measures to maintain the integrity of perineal tissues, including avoiding douching. Rationale 2: Women should be instructed to cleanse the perineal area from front to back after voiding and defecating. Rationale 3: Feminine hygiene sprays should be avoided. Rationale 4: Cotton briefs should be worn.

A patient with facial and chest injuries from a motor vehicle accident has rhonchi in the upper airways. For which problem should the nurse plan care? 1. inability to clear the airway 2. problem with swallowing 3. changes in oral mucous membrane integrity 4. potential for additional injury

Correct Answer: 1 Rationale 1: The patient has facial fractures with subsequent edema that will compromise the airway. The airway must be maintained by helping the patient clear secretions from the oropharynx. Rationale 2: Although problems swallowing may be a possibility, they are not a priority at this time. Rationale 3: There is no evidence that the patient has changes in oral mucous membrane integrity. Rationale 4: There is no evidence that the patient is at risk for additional injuries.

The nurse is caring for a patient with an external fixator device. What care should the nurse provide to this patient? 1. cleansing pin sites per orders to reduce the chance of infection 2. adjusting the tension on the pins whenever the patient experiences pain 3. explaining that bathing in a tub can be resumed after 3 days 4. encouraging the patient to keep the limb with the external fixator very still.

Correct Answer: 1 Rationale 1: The pins require care to reduce the risk of infection. Rationale 2: Adjusting the device is outside the scope of nursing; this is a physician's responsibility. Rationale 3: Bathing (soaking in water) in a tub is not permitted due to the chance of infection through pin sites. Rationale 4: An external fixator is meant to increase the patient's independence while maintaining immobilization.

The nurse is preparing to assess an older patient with age-related renal dysfunction. What should the nurse include in this assessment? 1. evidence of medication or drug toxicity 2. recreational activities 3. activity status 4. daily meal pattern

Correct Answer: 1 Rationale 1: With age-related changes in kidney function, there is a decrease in glomerular filtration rate (GFR). This can lead to a decrease in the clearance of drugs, primarily through the kidneys. The nurse should assess this patient for drug toxicity. Rationale 2: Recreational activities may or may not be affected. Rationale 3: Activity status may or may not be affected. Rationale 4: Meal patterns may or may not be affected.

A patient is scheduled to have an arteriovenous (AV) fistula created for hemodialysis. What should the nurse include when teaching the patient about this fistula? Select all that apply. 1. Avoid using the arm with the fistula for blood pressure readings. 2. A functioning fistula has a palpable pulse and bruit. 3. Ensure the use of the dominant hand and arm for placement. 4. The fistula can be used immediately after its creation. 5. Venipunctures should be performed on the arm with the fistula.

Correct Answer: 1, 2 Rationale 1: The arm in which is fistula is placed should not be used for blood pressure, and that arm should be marked as not available for these purposes. Rationale 2: A functional arteriovenous (AV) fistula has a palpable pulse and a bruit on auscultation. Rationale 3: The nondominant arm is preferred for fistula placement. Rationale 4: It takes about a month for the fistula to mature. Rationale 5: The arm in which is fistula is placed should not be used for venipuncture and that arm should be marked as not available for these purposes.

An older patient lives at home alone. Which assessment data would indicate modifiable risk factors for a hip fracture? Select all that apply. 1. complaints of lower extremity weakness 2. problems with balance 3. medications: atenolol 50 mg daily, lisinopril 10 mg daily, Xanax 0.25 mg daily, Seroquel 50 mg daily 4. report of sleeping with two pillows 5. complaints of nonproductive dry cough

Correct Answer: 1, 2, 3 Rationale 1: Modifiable risk factors for hip fracture include lower body weakness. Rationale 2: Modifiable risk factors for hip fracture include problems with walking and balance. Rationale 3: Modifiable risk factors for hip fracture include taking four or more medications or any psychoactive medications. Rationale 4: Sleeping with two pillows is not considered a modifiable risk factor. Rationale 5: A nonproductive cough is not considered a modifiable risk factor.

After sustaining a fracture, a patient was treated by applying ice and a cast. After several weeks, the cast is removed and the patient is able to ambulate without difficulty. Which positive local factors influenced this patient's bone healing? Select all that apply. 1. immobilization 2. timely correction of displacement 3. application of ice 4. delay in correction of displacement 5. malnutrition

Correct Answer: 1, 2, 3 Rationale 1: The limb was immobilized. This is a positive local factor that influenced bone healing. Rationale 2: The limb was casted. This is a positive local factor that influenced bone healing. Rationale 3: The patient was immediately treated with ice. This is a positive local factor that influenced bone healing. Rationale 4: There was no delay in treatment and bone healing occurred within the expected time frame. Rationale 5: There is no indication the patient was malnourished.

The healthcare provider suggests that a 65-year-old female patient take 1200 mg of calcium supplements every day. Before the patient leaves the clinic, what suggestions should the nurse make when instructing the patient about this supplement? Select all that apply. 1. Take 600 mg of calcium with lunch. 2. Take 600 mg of calcium with breakfast. 3. Take 400 mg of calcium with breakfast, lunch, and dinner. 4. Take 600 mg of calcium with breakfast and 600 mg at bedtime. 5. Take the full dose of 1200 mg of calcium in the morning on an empty stomach.

Correct Answer: 1, 2, 3 Rationale 1: The nurse should recommend that the prescribed dose of calcium be limited to no more than 600 mg at a time because the amount absorbed declines at higher doses. This means that the maximum dose for any meal should be 600 mg of calcium. This would be appropriate for lunch. Rationale 2: The nurse should recommend that the prescribed dose of calcium be limited to no more than 600 mg at a time because the amount absorbed declines at higher doses. This means that the maximum dose for any meal should be 600 mg of calcium. This would be appropriate for breakfast. Rationale 3: The nurse should recommend that the prescribed dose of calcium be limited to no more than 600 mg at a time because the amount absorbed declines at higher doses. Recommending 400 mg of calcium with breakfast, lunch, and dinner would be appropriate. Rationale 4: Calcium should be taken with food, so recommending a dose at bedtime is not appropriate. Rationale 5: Calcium should be taken with food, so recommending the complete dose on an empty stomach is not appropriate.

A patient with a history of osteoarthritis reports discomfort unrelieved by the prescribed medications. Which nonpharmacological interventions might assist the patient in managing the discomfort? Select all that apply. 1. Suggest the use of ice to the painful joints. 2. Encourage rest of the painful joints. 3. Discuss the use of relaxation techniques. 4. Encourage distraction techniques. 5. Advise the patient to avoid water-based exercises.

Correct Answer: 1, 2, 3, 4 Rationale 1: Ice may decrease the patient's discomfort. Rationale 2: Rest is a nonpharmacological method to reduce pain associated with osteoarthritis. Rationale 3: Relaxation techniques are nonpharmacological methods to reduce pain associated with osteoarthritis. Rationale 4: Distraction is a nonpharmacological method to reduce pain associated with osteoarthritis. Rationale 5: Water-based exercises are recommended for the patient with osteoarthritis.

The nurse suspects that a patient is experiencing fat embolism syndrome (FES). Which assessment data support the nurse's clinical decision? Select all that apply. 1. pulse oximetry 88% 2. petechiae observed on the chest and upper arms 3. complaints of shortness of breath 4. respiratory rate 32 5. skin warm and dry

Correct Answer: 1, 2, 3, 4 Rationale 1: Pulmonary circulation may be disrupted, and free fatty acids damage the alveolar-capillary membrane. Pulmonary edema, impaired surfactant production, and atelectasis can result in significant respiratory distress syndrome. Rationale 2: Petechiae may result from microvascular clotting or the accompanying thrombocytopenia. Rationale 3: Respiratory manifestations of dyspnea are often the first indicator of FES. Rationale 4: Respiratory manifestations of tachypnea are often the first indicators of FES. Rationale 5: This is a normal finding.

A patient with osteoporosis is prescribed the bisphosphanate alendronate (Fosamax). What should the nurse include when teaching the patient about this medication? Select all that apply. 1. Take the medication as directed with clear water only. 2. Avoid lying down for 30-60 minutes after taking the drug. 3. Consume no food or fluids for 30 minutes after taking the drug. 4. Take calcium and vitamin D supplements as instructed by your healthcare provider. 5. For ease in swallowing, you may chew the tablet thoroughly.

Correct Answer: 1, 2, 3, 4 Rationale 1: The nurse should teach the patient taking alendronate (Fosamax) to take the medication with clear water only. Rationale 2: The patient should avoid lying down for 30-60 minutes after taking the drug to prevent esophageal irritation. Rationale 3: No food or fluids should be consumed for 30 minutes after taking the drug so as to not interfere with the drug's absorption. Rationale 4: Calcium and vitamin D supplements are to be taken as prescribed. Rationals 5: The tablet should not be crushed, broken, or chewed.

The nurse is concerned that a patient with a below-the-knee amputation is at risk for delayed healing. What information from the patient's medical history led the nurse to make this clinical decision? Select all that apply. 1. body mass index 15 2. history of hypokalemia 3. smokes 2 ppd of cigarettes 4. takes vitamin supplements 5. treated for right heart failure

Correct Answer: 1, 2, 3, 5 Rationale 1: Healing after an amputation is delayed if the patient's diet lacks the proper nutrients to meet the body's increased metabolic demands during healing. Rationale 2: Electrolyte imbalances can contribute to delayed healing processes. Rationale 3: Smoking compromises healing by causing vasoconstriction and reduced blood flow to the stump. Rationale 4: Vitamin supplements would help with wound healing. Rationale 5: Decreased cardiac output reduces blood flow and delays healing.

The nurse is providing discharge instructions to a patient recovering from an above-the-knee amputation. What should the nurse include in this teaching? Select all that apply. 1. techniques for wrapping the stump 2. installation of grab bars in the bathroom 3. type and frequency of stump exercises 4. the importance of resting with the stump elevated on pillows 5. resuming activities of daily living as soon as possible

Correct Answer: 1, 2, 3, 5 Rationale 1: The nurse should teach the patient to wrap the stump appropriately in preparation for fitting the prosthesis. Rationale 2: The nurse should discuss household modifications to promote independence, such as grab bars in the bathroom. Rationale 3: The nurse should teach the patient how to perform stump exercises to maintain joint mobility and muscle tone in the affected limb. Rationale 4: Elevating the stump on pillows can cause contractures, which will interfere with the ability to effectively use a prosthesis. Rationale 5: The patient should be encouraged to resume physical activities as soon as possible. This improves the patient's health, well being, and self-esteem.

The nurse is caring for a patient recovering from a below-the-knee amputation. What should be included in this patient's plan of care for the first 48 hours? Select all that apply. 1. Elevate the stump. 2. Keep the knee extended. 3. Apply a knee immobilizer. 4. Out of bed in bedside chair as much as possible. 5. Provide passive ROM exercises every 4 hours.

Correct Answer: 1, 2, 3, 5 Rationale 1: The patient with a below-the-knee amputation should elevate the stump. Rationale 2: The patient with a below-the-knee amputation should keep the knee extended. Rationale 3: A knee immobilizer may be used to help maintain joint extension. Rationale 4: The patient with an above-the-knee amputation should not sit for prolonged periods of time because this can lead to hip contractures. Rationale 5: All joints should receive either active or passive ROM exercises every 2 to 4 hours.

The nurse has identified that a patient recovering from an above-the-knee amputation has a problem with pain control. Which nursing interventions would be beneficial for this patient? Select all that apply. 1. administering analgesics before pain reaches a higher level 2. splinting and supporting the injured area 3. elevating the stump on three pillows 4. encouraging deep breathing and relaxation exercises 5. repositioning the patient every 8 hours

Correct Answer: 1, 2, 4 Rationale 1: Analgesics alleviate pain by stimulating opiate receptor sites. Giving pain medication when the pain is rated at a lower level allows for more effective pain management. Rationale 2: Splinting prevents additional injury by immobilizing the stump and reducing edema while molding the stump for a good prosthetic fit. Rationale 3: Elevating the stump can increase the risk for hip contractures. Rationale 4: Deep breathing and relaxation will increase the effectiveness of analgesics and modify the pain experience. Rationale 5: The patient should be repositioned every 2 hours to prevent muscle cramping and prolonged pressure on any area.

The nurse is reviewing modifiable and nonmodifiable risk factors of osteoporosis with a patient. What should the nurse include as modifiable risk factors? Select all that apply. 1. calcium deficiency 2. high-protein diet 3. female 4. decrease in estrogen levels 5. diabetes mellitus

Correct Answer: 1, 2, 4 Rationale 1: Calcium deficiency is an important modifiable risk factor that contributes to osteoporosis. Calcium and vitamin D supplements and a diet including foods high in calcium and vitamin D will help correct the deficiency. Rationale 2: A high-protein diet can cause acidosis, which can contribute to osteoporosis since calcium is withdrawn from the kidney as the kidneys attempt to buffer the excess acid. Rationale 3: Being female is an unmodifiable risk factor. Rationale 4: Decreasing levels of the hormone estrogen are a modifiable risk factor for osteoporosis. Rationale 5: Diabetes mellitus is not a modifiable risk factor, although it may be controlled.

The nurse is reviewing the health histories for a group of assigned patients. Which patients should the nurse identify as being at the greatest risk for the development of osteoporosis? Select all that apply. 1. a Caucasian female 2. a postmenopausal female 3. a large-boned African American female 4. a patient taking corticosteroid therapy 5. a 32-year-old male

Correct Answer: 1, 2, 4 Rationale 1: European Americans are at a higher risk for osteoporosis. Rationale 2: Low estrogen levels associated with being postmenopause is a modifiable risk factor for the development of osteoporosis. Rationale 3: African Americans have a lower risk for osteoporosis because of denser bone mass. Rationale 4: Anyone who takes a glucocorticoid medication for more than 3 months is at risk for glucocorticoid-induced osteoporosis. Rationale 5: A 32-year-old male has a low risk of developing osteoporosis.

The healthcare provider is pleased that an adolescent's broken arm has healed within 4 weeks. What factors in the patient's health history facilitated the healing of this fracture? Select all that apply. 1. The patient is 17 years old. 2. There are no active disease processes in the health history. 3. The patient waited 4 hours to get the fracture treated. 4. The patient bicycles and plays tennis nearly every day. 5. The patient drinks four 8-ounce glasses of milk a day.

Correct Answer: 1, 2, 4, 5 Rationale 1: Positive systemic factors that affect wound healing include younger age. Rationale 2: Positive systemic factors that affect wound healing include the absence of infection or diseases. Rationale 3: A delay in the correction of the displacement is a local factor that would negatively impact the healing of the fracture. Rationale 4: Positive systemic factors that affect wound healing include a moderate activity level prior to injury. Rationale 5: Positive systemic factors that affect wound healing include adequate amounts of calcium.

A patient has been diagnosed with complex regional pain syndrome (CRPS). The nurse reviews the medical record for which factors that increase the risk for this syndrome? Select all that apply. 1. Female gender 2. History of cardiac disease 3. Older age 4. Injury to upper rather than lower extremity 5. Fair skin and auburn hair

Correct Answer: 1, 3 Rationale 1: Female gender is a risk factor for CRPS. Rationale 2: CRPS is not more frequent if the patient has a history of cardiac disease. Rationale 3: Old age is a risk factor for CRPS. Rationale 4: CRPS is not more frequent if the patient has an injury to the upper rather than lower extremity. Rationale 5: CRPS is not more frequent if the patient has fair skin and auburn hair.

The week following a below-the-knee amputation, the patient complains of toes cramping in the amputated food. What strategies can the nurse use to help alleviate this discomfort? Select all that apply. 1. TENS unit therapy 2. Increased vitamin D in the diet 3. Mirror therapy 4. Fluid restriction 5. Tightening the stump dressing

Correct Answer: 1, 3 Rationale 1: Phantom limb pain is distressing and difficult to manage. Some relief may be obtained with TENS therapy. Rationale 2: There is no evidence that increased vitamin D in the diet is effective. Rationale 3: Relief from phantom limb pain may be obtained with mirror therapy. Rationale 4: There is no evidence that fluid restriction is effective. Rationale 5: There is no evidence that tightening the stump dressing is effective.

A patient is scheduled to have skeletal traction. What should the nurse recognize about this type of traction? 1. Weighted skin traction will be applied. 2. A surgical pin will be inserted into a bone and the traction will be applied to the pin. 3. A cast will be applied to the area and a traction device will be connected to the cast. 4. Manual traction will be applied.

Correct Answer: 2 Rationale 1: Skin traction is used in short-term therapies and does not require the insertion of mechanical hardware. Rationale 2: Skeletal traction requires the insertion of a pin directly into the bone. This insertion is performed under sterile conditions in the surgical environment. Skeletal traction is used when more weight or longer-term immobilization is desired to maintain proper alignment. Rationale 3: A cast is not applied in skeletal traction. Rationale 4: Manual traction is not part of skeletal traction.

A patient with chronic kidney disease is trying to decide between hemodialysis and peritoneal dialysis. What should the nurse encourage the patient to consider as advantages of peritoneal dialysis? Select all that apply. 1. liberal intake of fluids 2. better metabolite elimination 3. better self-management 4. minimal vascular complications 5. lower risk of infection

Correct Answer: 1, 3, 4 Rationale 1: More liberal intake of fluid and nutrients is often allowed for the patient on continuous ambulatory peritoneal dialysis (CAPD). Rationale 2: The major disadvantages of peritoneal dialysis include less effective metabolite elimination. Rationale 3: The patient on peritoneal dialysis is better able to self-manage the treatment regimen, which reduces feelings of helplessness. Rationale 4: Peritoneal dialysis has several advantages over hemodialysis. Heparinization and vascular complications associated with an arteriovenous (AV) fistula are avoided. Rationale 5: The major disadvantages of peritoneal dialysis include risk for infection (peritonitis).

During the assessment the nurse suspects a patient with injuries from a motor vehicle crash sustained kidney trauma. What did the nurse assess to make this clinical decision? Select all that apply. 1. Turner sign 2. nausea and vomiting 3. microscopic hematuria 4. blood pressure 88/58 mm Hg 5. heart rate 118 beats per minute

Correct Answer: 1, 3, 4, 5 Rationale 1: In kidney trauma, retroperitoneal bleeding from the kidney may cause Turner sign, a bluish discoloration of the flank. Rationale 2: Nausea and vomiting are not manifestations of kidney trauma. Rationale 3: The primary manifestation of kidney trauma includes microscopic hematuria. Rationale 4: In kidney trauma, signs of shock such as hypotension can occur. Rationale 5: In kidney trauma, signs of shock such as tachycardia can occur.

A patient with osteoporosis is prescribed alendronate (Fosamax). What should the nurse include when instructing the patient about this medication? Select all that apply. 1. Report new or worsening heartburn, and difficult or painful swallowing. 2. Take the medication with orange juice one hour after food. 3. Do not lie down for 30 minutes after taking medication. 4. Take vitamin C supplements as instructed for bone mineralization. 5. This medication has a gradual response and continues for months after the drug is stopped.

Correct Answer: 1, 3, 5 Rationale 1: New or worsening heartburn, and difficult or painful swallowing are adverse reactions to the medication. Rationale 2: Alendronate should be administered with water 30 minutes before food or other medications. Rationale 3: Lying down within thirty minutes of ingestion of the medication may precipitate adverse gastrointestinal reactions. Rationale 4: Vitamin D supplements should be used as well as calcium and not vitamin C. Rationale 5: This medication has a gradual response and continues for months after the drug is stopped.

The nurse is providing discharge instructions to a patient recovering from a total hip replacement. What should the nurse include in these instructions? Select all that apply. 1. use and weight bearing of affected limb 2. not to do exercises if experiencing discomfort 3. possible complications such as infection or dislocation 4. continuing pain medications for only two days after discharge 5. full recovery in up to six months

Correct Answer: 1, 3, 5 Rationale 1: Patient education should focus on the continued progression of exercise and ambulation. Rationale 2: There will be some degree of discomfort when exercising the affected limb, but this can be controlled with mild analgesics. Rationale 3: Patient should be instructed to report increasing pain, redness, swelling, fever or deformity of hip. Rationale 4: Postoperative pain medication will be necessary for longer than two days. Without proper pain control, the patient may not progress with exercise and ambulation. Rationale 5: Recovery from total hip replacement is 80% complete in four weeks and 100% complete in six months.

The nurse is caring for a patient with a long leg cast. What should the nurse include when assessing this patient for indications of compromised circulation? Select all that apply. 1. swelling of the toes 2. drainage on the cast 3. increased temperature 4. foul odor 5. a tight cast

Correct Answer: 1, 5 Rationale 1: Constriction of circulation reduces venous return and increases pressure within the vessels. Fluid then shifts into the interstitial space, causing edema. Rationale 2: Drainage would indicate potential infection. Rationale 3: Increased temperature would indicate potential infection. Rationale 4: Foul odor would indicate potential infection. Rationale 5: Edema can cause the cast to become tight. A tight-fitting cast can lead to compartment syndrome.

A patient is prescribed etidronate (Didronel). Which interventions would be appropriate when administering the medication to the patient? Select all that apply. 1. Administer the medication in the morning with water. 2. Administer the medication with milk. 3. Administer the medication after meals. 4. Assessment of fluoride levels annually. 5. Avoid intake for 30 minutes after use.

Correct Answer: 1, 5 Rationale 1: The medication is best administered with water 30 minutes before a meal. Rationale 2: Milk products should be avoided. Rationale 3: The medication should be taken on an empty stomach. Rationale 4: There is no reason to evaluate fluoride levels with this medication. Rationale 5: Intake must be avoided for 30 minutes after administration.

A patient who was in a fight sustained several direct blows to the face. The nurse assesses an elevated pulse (P 108), elevated respiratory rate (RR 24), and obvious deformity to the right side of the face. What should the nurse identify as the priority of care for this patient? 1. frequently assessing the blood pressure for signs of shock and initiating IV fluids 2. monitoring the elevated respiratory rate and maintaining the airway 3. monitoring the elevated pulse rate and looking for signs of pallor 4. frequently assessing for facial pain and administering pain medication p.r.n.

Correct Answer: 2 Rationale 1: Although IV fluids may be initiated, the patient's assessment does not reflect a significant risk for shock. Rationale 2: With facial fractures, the potential risk for airway compromise must be considered. The nurse helps the patient clear secretions from the oropharynx and reports elevated respiratory rate (tachypnea) to the physician. Rationale 3: The injuries will cause bruising and discoloration, not pallor. Rationale 4: While the patient will require ongoing pain assessment and management, this is not the most important nursing action.

The nurse is preparing instructional materials for a patient recovering from a fractured leg. The nurse should teach the patient to take in adequate amounts of which mineral essential to bone healing? 1. Sodium 2. Calcium 3. Potassium 4. Magnesium

Correct Answer: 2 Rationale 1: Sodium is not a mineral needed for bone healing. Rationale 2: After a fracture and during bone healing, osteoblasts continue to form collagen fibers and bone matrix, which are gradually mineralized with calcium and mineral salts. Rationale 3: Potassium is not a mineral needed for bone healing. Rationale 4: Magnesium is not a mineral needed for bone healing.

During a home visit, the nurse evaluates discharge teaching provided to a patient recovering from an acute kidney injury (AKI). Which patient statement indicates that teaching has been effective? 1. "I can drink up to 6 beers a day." 2. "I will avoid taking drugs that may harm my kidneys." 3. "I will limit my fluid intake to 1500 mL or less per day." 4. "I will catheterize myself for residual urine at least once a week."

Correct Answer: 2 Rationale 1: Because alcohol can increase the nephrotoxicity of some material, alcohol ingestion should be discouraged. Rationale 2: Prior to discharge, the patient should have been instructed to avoid nephrotoxic drugs and chemicals for up to 1 year following an episode of AKI. During recovery, nephrons are vulnerable to damage by nephrotoxins such as NSAIDs, some antibiotics, radiologic contrast media, and heavy metals. Rationale 3: Fluid restriction may or may not be applicable for this patient. Rationale 4: The patient recovering from acute kidney injury is not retaining urine and will not need to self-catheterize for residual urine.

A patient recovering from a fractured hip is at risk for developing deep vein thrombosis (DVT). The nurse anticipates that which treatment would be indicated for the patient at this time? 1. heparin 2. prevention 3. vena cava filter 4. massaging the affected extremity

Correct Answer: 2 Rationale 1: Heparin may be used to treat DVT but not to prevent it. Rationale 2: The best treatment for DVT is prevention. Early mobilization of the fracture and early ambulation of the patient are imperative. Frequent assessment of the injured extremity may lead to early recognition of DVT and prevent the formation of pulmonary embolus. Antiembolism stockings and sequential compression devices will increase venous return and prevent stasis of blood. Rationale 3: This is not indicated. Rationale 4: Massaging may increase the risk for DVT.

A patient with chronic kidney disease is diagnosed with hypertension. The nurse realizes that this patient's blood pressure needs to be controlled because 1. it is the easiest diagnosis to treat. 2. not doing so increases the risk of adverse effects on the kidneys. 3. medications are available to treat this disorder. 4. everyone should have low-normal blood pressure.

Correct Answer: 2 Rationale 1: Hypertension is not always easily diagnosed. Rationale 2: Management of hypertension to maintain blood pressure within normal limits the risk of adverse effects on the kidneys. Rationale 3: Just because medications are available to treat the disorder is not a rationale for why blood pressure should be controlled. Rationale 4: The idea of everyone having low-normal blood pressure does not apply to this patient because of the new diagnosis and history of chronic kidney disease.

A patient is diagnosed with a humeral fracture. What should the nurse identify as a priority treatment goal for the patient? 1. immediate surgical correction 2. immobilizing the fractured bone in normal anatomic position 3. applying ice and compression to the injured arm 4. applying elastic bandage wrap and elevating the arm

Correct Answer: 2 Rationale 1: Immediate surgical correction is not the correct intervention for this diagnosis. Rationale 2: The priority is to immobilize the bone so that the fracture will heal in its correct anatomic position. This will allow unimpaired range of motion and prevent deformities or misalignment of the arm. Rationale 3: Applying ice and compression to the injured arm is not the top priority intervention. Rationale 4: Applying an ace wrap and elevating the injured arm is not the top priority intervention.

The nurse is preparing a teaching session for community members on osteoporosis. What should the nurse include as a potential complication for this health problem? 1. Infection 2. Fractures 3. Blood clots 4. Contractures

Correct Answer: 2 Rationale 1: Infection is not a potential complication of osteoporosis. Rationale 2: Fractures are a potential complication due to loss of bone mass. Rationale 3: Blood clots are not a potential complication of osteoporosis. Rationale 4: Contractures are not a potential complication of osteoporosis.

A patient with a compound, open fracture of the femur is scheduled for immediate surgery. Which patient problem does the nurse prioritize when planning care for the immediate postoperative period? 1. The patient is unstable and may fall. 2. There is a high risk of infection. 3. It will require more than one nurse to help the patient transfer. 4. The patient may be fearful of another injury.

Correct Answer: 2 Rationale 1: Instability and falling is the second highest priority. Rationale 2: Since this is a compound fracture, the skin is broken and tissue is damaged. There is a high risk of infection occurring in the bone, which is very difficult to treat. Rationale 3: Transfers may require the assistance of more than one person, but this is not the highest priority. Rationale 4: Depending on the cause of the fracture, the patient may be fearful, but the risk of infection is a higher priority.

The nurse is evaluating the effectiveness of dietary teaching provided to a patient with chronic kidney disease. Which menu choices indicate that the patient understands the dietary regimen? 1. bacon and eggs for breakfast; hot dog with sauerkraut for lunch; baked canned ham with green peas for dinner 2. apple and oatmeal for breakfast; peanut butter sandwich for lunch; pasta with fish for dinner 3. two bananas for breakfast; rice and beans for lunch; fruit salad, green beans, and an 8-ounce steak for dinner 4. half a cantaloupe and three eggs for breakfast; a baked potato with processed cheese spread and broccoli for lunch; chicken, pinto beans, squash, and pecan pie for dinner

Correct Answer: 2 Rationale 1: Processed foods (canned ham, sauerkraut, cheese spread) contain high levels of sodium, which is restricted. Rationale 2: The patient with chronic kidney disease needs to adhere to a low-protein, sodium- and potassium-restricted diet. These menu choices adhere to the dietary regimen. Rationale 3: These menu choices include excessive amounts of potassium (bananas) and protein, which are restricted. Rationale 4: These menu choices include processed foods (canned ham, sauerkraut, cheese spread) that contain high levels of sodium, which is restricted.

The nurse is planning care for a patient recovering from an above-the-knee amputation. Which position should the nurse include in this patient's plan of care? 1. Sims' position as tolerated 2. prone for 1 hour, several times a day 3. high Fowler's position 4. sitting in a chair while awake

Correct Answer: 2 Rationale 1: Sims' position would likely be uncomfortable for the patient. Rationale 2: A complication following above-the-knee amputation is developing a contracture of the joint above the amputation. Lying prone prevents abnormal flexion and fixation of the extremity. Rationale 3: High Fowler's position can lead to hip contracture. Rationale 4: Prolonged sitting can lead to hip contracture.

The nurse instructs a patient with acute kidney injury that the expected result of taking sodium polystyrene sulfonate (Kayexalate) is to do what? 1. replace sodium 2. remove potassium 3. replace magnesium 4. exchange calcium for sodium

Correct Answer: 2 Rationale 1: Sodium polystyrene sulfonate (Kayexalate) is not used to replace sodium. Rationale 2: Sodium polystyrene sulfonate (Kayexalate) is given to remove potassium in the patient with acute kidney injury by exchanging sodium for potassium, primarily in the large intestine. Rationale 3: Sodium polystyrene sulfonate (Kayexalate) is not used to replace magnesium. Rationale 4: Sodium polystyrene sulfonate (Kayexalate) does not exchange calcium for sodium.

A female patient who was treated 3 months ago for a UTI is experiencing the same symptoms now. What should the nurse ask the patient during the health assessment? 1. "How much milk do you drink each day?" 2. "What form of birth control are you using?" 3. "Does your partner have similar symptoms?" 4. "Did you complete the antibiotic prescribed for the first infection?"

Correct Answer: 2 Rationale 1: The amount of milk consumed each day is not a factor in causing a UTI. Rationale 2: The use of a diaphragm and spermicidal compounds for birth control are risk factors for the development of UTIs. Rationale 3: Asking about a partner having similar symptoms is not the most pertinent question. Rationale 4: Symptoms of a UTI are largely relieved within 24 to 48 hours of starting antibiotic therapy. The recurrence time factor of the UTI is too long to be a failure to complete antibiotic treatment the first time.

A patient with an indwelling urinary catheter is exhibiting signs of asymptomatic bacteriuria. What would be the best course of action for this patient? 1. beginning intravenous antibiotic therapy 2. removing the catheter and beginning antibiotic therapy 3. beginning 3-day course of oral antibiotic therapy 4. removing the catheter and monitoring for continued signs of bacteriuria

Correct Answer: 2 Rationale 1: The catheter needs to be removed before antibiotic therapy is begun. Rationale 2: The preferred treatment for catheter-associated urinary tract infections (UTIs) is to remove the indwelling catheter, then administer a 10- to 14-day course of oral antibiotic therapy to eliminate the infection. Rationale 3: Antibiotics for this health problem should be prescribed for 10 to 14 days. Rationale 4: Removing the catheter without initiating antibiotic therapy would not solve the problem. The infection could worsen.

Following the application of a cast to a patient's right lower leg, the nurse is monitoring for complications. Which assessment data leads the nurse to be concerned about a serious complication? 1. The toes on the right foot are pink and warm, and sensation is intact. 2. The patient complains of numbness in the right foot and toes. 3. The patient reports itching under the cast. 4. The patient complains of general discomfort in the lower-right leg.

Correct Answer: 2 Rationale 1: The exposed extremities should be pink and warm, with sensation. Rationale 2: Numbness should be reported right away. It may indicate pressure on nerves or blood vessels related to a tight cast, which can lead to compartment syndrome. Rationale 3: Itching is anticipated for the patient who recently had a cast applied. Rationale 4: Generalized discomfort is anticipated for the patient who recently had a cast applied.

Following a kidney transplant, the nurse notes that a patient's urine is cloudy. What should the nurse do about this finding? 1. Record the finding. 2. Notify the physician. 3. Irrigate the urinary catheter. 4. Increase the intravenous flow rate.

Correct Answer: 2 Rationale 1: The nurse needs to do more than just record the finding. Rationale 2: Cloudy urine could be a manifestation of infection. Prompt treatment is vital to preserve integrity of the transplanted organ in an immunocompromised patient. Rationale 3: There is no evidence to support that the urinary catheter needs to be irrigated. Rationale 4: Increasing the intravenous fluid rate would necessitate an order from the healthcare provider.

A patient with an open fracture of the left femur that punctured the skin waited 2 hours before getting to the hospital. What would be the priority problem to address when caring for this patient? 1. insufficient nutrition 2. high potential for infection 3. low body temperature 4. fear and anxiety

Correct Answer: 2 Rationale 1: There is no indication of malnutrition. Rationale 2: The open bone fracture has been exposed to contaminants. The delay in treatment prolongs the patient's exposure to bacteria. This patient is at risk for infection that can delay healing and possibly result in osteomyelitis and ultimately a loss of the limb. Rationale 3: There is no indication the patient is hypothermic. Rationale 4: The patient might be fearful and anxious, but this is not a priority at this time.

A patient diagnosed with a symptomatic urinary tract infection (UTI) is prescribed phenazopyridine (Pyridium). What should the nurse instruct the patient about the color of the urine? 1. It will have a green tint. 2. It will become orange or red. 3. It will turn brown. 4. It will become clearer and pale yellow.

Correct Answer: 2 Rationale 1: This medication does not turn the color of urine to green. Rationale 2: Phenazopyridine (Pyridium) turns urine orange or red. Rationale 3: This medication does not turn the color of urine to brown. Rationale 4: This medication does not turn the color of urine to a clear pale yellow.

The nurse is concerned that patients on an orthopedic care area are at risk for compartment syndrome. In which circumstances should the nurse assess for manifestations of compartment syndrome? Select all that apply. 1. fasciotomy 2. cast applied to a limb 3. crush injury to a limb 4. fat embolism 5. total hip replacement surgery

Correct Answer: 2, 3 Rationale 1: Fasciotomy is a treatment that can be used in the management of compartment syndrome. Rationale 2: External compression of a limb by a cast that constricts the limb can lead to compartment syndrome. Rationale 3: Acute compartment syndrome may result from hemorrhage and edema within the compartment after a fracture, crush injury, or surgery. Rationale 4: Fat embolism is a complication associated with long bone fractures or crushing injuries. Rationale 5: Compartment syndrome does not typically occur after hip replacement surgery.

A patient with osteoporosis taking calcitonin is experiencing nausea and vomiting. What should the nurse do about the patient's complaint? 1. Alternate nares when administering the medication. 2. Hold the next dose of calcitonin and notify the physician. 3. Monitor and record the frequency and amount of emesis. 4. Increase the amount of vitamin D in the diet.

Correct Answer: 3 Rationale 1: Changing the route will not affect the adverse effects of this medication. Rationale 2: Holding the dose is not indicated, and the physician does not require immediate notification. Rationale 3: Calcitonin is associated with nausea and vomiting. These manifestations will subside. The nurse will need to record the event. Rationale 4: Although vitamin D intake should be increased in the diet when calcitonin is prescribed, it does not address the question.

The nurse is preparing to administer an osmotic diuretic to a patient. What should the nurse do when providing this medication? Select all that apply. 1. Check solution for crystallization prior to IV administration. 2. Evaluate urine output after test dose is given. 3. Assess for signs of worsening heart failure. 4. Assess for orthostatic hypotension. 5. Monitor patient for signs of ototoxicity.

Correct Answer: 2, 3 Rationale 1: There is no documentation that these solutions crystallize. Rationale 2: A test dose may be given, and urine output is evaluated for an adequate response. Rationale 3: The patient should be assessed for signs of worsening heart failure because of the increased vascular volume that occurs with these medications. Rationale 4: Orthostatic hypotension is not an issue due to the increase in intravascular volume but should be assessed when giving loop diuretics. Rationale 5: Ototoxicity is a concern with high doses of loop diuretics.

A patient is recovering from a below-the-knee amputation. For which complications should the nurse assess this patient? Select all that apply. 1. diabetes mellitus 2. phantom pain 3. infection 4. chronic stump pain 5. contractures

Correct Answer: 2, 3, 4, 5 Rationale 1: Diabetes mellitus is not a complication of a below-the-knee amputation. Rationale 2: Phantom limb pain more frequently affects people who had pain in the amputated limb prior to its removal than those who did not. Rationale 3: A patient who experiences a traumatic amputation has a greater risk of infection than the person who has a planned amputation. However, even planned amputations carry a risk of infection. Rationale 4: Chronic stump pain is the result of neuroma formation. Rationale 5: A contracture is an abnormal flexion and fixation of a joint caused by muscle atrophy and shortening. Contracture of the joint above the amputation is a common complication.

Documentation from the previous shift reveals that a patient in a long leg cast had a decreased pedal pulse. The patient was medicated for a reported pain rated an 8 on the scale of 1 to 10. Which additional findings, occurring on this shift, should the nurse immediately report to the healthcare provider? Select all that apply. 1. Fever 2. Weakness 3. Cyanotic foot 4. Tingling in the foot 5. Severe pain with passive flexion

Correct Answer: 2, 3, 4, 5 Rationale 1: Fever is not a manifestation of compartment syndrome. Rationale 2: Pain and normal or decreased pulses are early signs of compartment syndrome. Now the patient is experiencing later manifestations of compartment syndrome, including weakness. Rationale 3: Cyanosis is a later manifestation of compartment syndrome. Rationale 4: Tingling ins a later manifestation of compartment syndrome. Rationale 5: Severe pain with passive flexion is a later manifestation of compartment syndrome.

An older patient with a history of diabetes is experiencing poor healing of a fractured ankle. The nurse recognizes that which factors contribute to the delay in bone healing? Select all that apply. 1. immobilization 2. advanced age 3. diabetes 4. moderate activity level prior to injury 5. presence of foreign body at the fracture site

Correct Answer: 2, 3, 5 Rationale 1: Immobilization would be a positive factor. Rationale 2: Advanced age would have a negative effect on bone healing. Rationale 3: A systemic disease such as diabetes would have a negative effect on bone healing. Rationale 4: A moderate activity level before the fracture would be a positive factor. Rationale 5: The presence of a foreign body such as glass or dirt would be a negative factor in bone healing.

The nurse is planning care for a patient beginning hemodialysis. What should be included in this patient's plan of care? Select all that apply. 1. Restrict fluid and protein intake. 2. Obtain weight and orthostatic vital signs. 3. Determine urine specific gravity and pH. 4. Monitor serum creatinine, BUN, and hematocrit levels. 5. Assess blood pressure of the extremity where fistula has been created.

Correct Answer: 2, 4 Rationale 1: Restricting fluid and protein intake would affect renal function but not necessarily the hemodialysis treatments. Rationale 2: Nursing care for the patient undergoing hemodialysis includes measuring weight and orthostatic blood pressure changes. These data provide baseline information to help evaluate the effects of hemodialysis. The patient who is hypertensive may not tolerate rapid fluid volume changes during dialysis. Rationale 3: The patient may not have a urine output to assess specific gravity and pH. Rationale 4: Monitoring laboratory values helps determine the effectiveness of the treatment and the timing of future dialysis sessions. Rationale 5: The extremity with the fistula should not be used for blood pressure assessment.

The nurse is instructing a patient about foods high in calcium. The nurse knows the teaching was effective when the patient chooses which foods for a meal? Select all that apply. 1. chicken 2. collard greens 3. bananas 4. sardines 5. whole milk

Correct Answer: 2, 4, 5 Rationale 1: Chicken is not high in calcium. Rationale 2: Other food sources of calcium include dark green, leafy vegetables such as collard greens. Rationale 3: Bananas are not a source of calcium. Rationale 4: Other food sources of calcium include sardines. Rationale 5: Milk and milk products are the best sources of calcium.

A perimenopausal patient is experiencing frequency, urgency, nocturia, dysuria, and cloudy, rust-colored urine for the third time in the past 2 years. What should the nurse include when teaching this patient? Select all that apply. 1. Preprocedure instructions for an IVP. 2. Recommendations for perineal cleansing. 3. Recommendations for screening cystoscopy. 4. Potential benefits of estrogen vaginal cream. 5. Return to the office in 10 days for follow-up culture.

Correct Answer: 2, 4, 5 Rationale 1: Imaging studies such as intravenous pyelography are used to evaluate for structural or functional abnormalities of the kidneys, ureters, and bladder. Rationale 2: Instructions on cleansing may prevent further infections. Rationale 3: In general, further diagnostic testing is not indicated for women experiencing three or fewer UTIs per year. Instrumentation of the urinary tract such as with a cystoscopy is a major risk factor for a UTI. Rationale 4: In perimenopausal women, vaginal cream may maintain tissue integrity to prevent bacterial colonization of perineal tissues. Rationale 5: The nurse needs to inform the patient that a urine culture in 10 days is done to ensure antibiotic therapy was effective.

The nurse is caring for a patient with a deep venous thrombosis (DVT) of the left lower extremity. What additional body system should the nurse carefully monitor in this patient? 1. Renal 2. Digestive 3. Respiratory 4. Hematologic

Correct Answer: 3 Rationale 1: DVT does not typically affect the renal system. Rationale 2: DVT does not typically affect the digestive system. Rationale 3: The tail of the clot or the entire thrombus may dislodge and become an embolus, ultimately lodging in the pulmonary circulation (pulmonary embolism). Patients with DVT of the lower extremity require careful monitoring of the respiratory system for manifestations of emboli. Rationale 4: DVT does not typically affect the hematologic system.

A patient with a history of recurrent urinary tract infections (UTIs) asks if there are any complementary approaches to reducing the risk of developing future infections. What should the nurse instruct this patient? Select all that apply. 1. Limit the intake of vitamin C. 2. Drink blueberry juice. 3. Apply lavender over the abdomen. 4. Take saw palmetto. 5. Drink cranberry juice.

Correct Answer: 2, 4, 5 Rationale 1: Limiting vitamin C will not reduce the risk of developing UTIs. Rationale 2: Blueberry juice is commonly used to prevent and treat UTIs. Rationale 3: Adding lavender to bathwater, not applying it to the abdomen, may relieve the discomfort of a UTI. Rationale 4: Herbal supplements, such as saw palmetto, have a urinary antiseptic effect and may be beneficial in treating or preventing UTIs. Rationale 5: Research supports the use of cranberry products to prevent UTIs in women with recurrent symptomatic infections.

The nurse is preparing teaching for a patient with mild osteoarthritis of the knees. Which medication treatments should the nurse include in these instructions? Select all that apply. 1. Opioids 2. NSAIDs 3. Hormones 4. Antibiotics 5. Hyaluronic acid

Correct Answer: 2, 5 Rationale 1: An opioid analgesic may be necessary for patients with advanced OA whose pain is severe, but not for mild pain. Rationale 2: The pain of OA can often be managed through the use of mild analgesics such as acetaminophen or over-the-counter NSAIDs such as ibuprofen. Rationale 3: Hormones are not used to treat OA. Rationale 4: Antibiotics are not used to treat OA. Rationale 5: Intra-articular hyaluronic acid (HA) is an option for patients with OA of the knee joint.

The nurse is evaluating the effectiveness of instruction provided to a patient with a newly applied arm cast. Which statements indicate that additional teaching is required? Select all that apply. 1. "I can wrap the cast in plastic wrap to protect it." 2. "I can use a blow dryer to make the cast dry faster." 3. "I will call the doctor if the arm starts to hurt more." 4. "I can use a sling to distribute the weight of the cast." 5. "I can use a coat hanger to scratch itchy skin under the cast."

Correct Answer: 2, 5 Rationale 1: The cast can be wrapped in plastic wrap to protect it. Rationale 2: The cast dries from the inside out; a blow dryer should not be used to speed drying. Rationale 3: The healthcare provider should be notified if pain increases. Rationale 4: A sling can be used to distribute the weight of an arm cast evenly around the neck. Rationale 5: Nothing should be inserted under the cast. A blow dryer on the cool setting can be used to relieve itching.

The nurse is planning care to reduce the risk of a patient in the ICU from developing acute kidney injury (AKI). Which intervention should the nurse implement for this patient? 1. Administer antihypertensive drugs. 2. Avoid all potential nephrotoxic drugs. 3. Maintain fluid volume and cardiac output. 4. Assess for a history of diabetes or hypertension.

Correct Answer: 3 Rationale 1: Administering antihypertensive medications will not prevent the developer of AKI. Rationale 2: It is impossible to avoid all potentially nephrotoxic medications. When a nephrotoxic drug or substance must be used, the risk of AKI can be reduced by using the minimum effective dose, maintaining hydration, and eliminating other known nephrotoxins from the medication regimen. Rationale 3: The most common causes of AKI are ischemia, sepsis, and exposure to nephrotoxins. The kidney is particularly vulnerable because of the amount of blood that passes through it. A fall in blood pressure or volume can cause ischemia of kidney tissues. Sepsis also produce hemodynamic effects with generalized vasodilation and a fall in GFR. Rationale 4: Although a history of diabetes or HTN can increase a patient's risk for developing kidney disease, these health problems are not the most common cause of AKI in the intensive care unit.

An older female patient asks why she is having more urinary tract infections (UTIs) now that she is older. What should the nurse explain is a contributing factor to the incidence of UTIs among older adult females? 1. reduced risk of urinary stasis 2. enhanced immune response 3. loss of tissue elasticity 4. reduced and less protective prostatic secretions

Correct Answer: 3 Rationale 1: An increased risk of urinary stasis contributes to the higher incidence of UTIs in older females. Rationale 2: An impaired immune response contributes to the increased incidence of UTIs in older females. Rationale 3: The loss of tissue elasticity results in changes in bladder position, which contributes to the development of UTIs. Rationale 4: Prostatic secretions are found in males.

The nurse is planning care for a patient with kidney disease who is having difficulty maintaining adequate nutrition. Which intervention should the nurse include in this patient's plan of care? 1. Provide antiemetics after meals. 2. Schedule meals for three times each day. 3. Provide mouth care before meals. 4. Weigh once per week.

Correct Answer: 3 Rationale 1: Antiemetics should be administered 30 to 60 minutes before meals. Rationale 2: The patient would benefit from small meals and between-meal snacks. Rationale 3: Mouth care improves taste, stimulates the appetite, and maintains the integrity of oral mucous membranes. Rationale 4: The patient should be weighed daily before breakfast.

A patient is placed in Buck's traction after a hip fracture. What should be included in this patient's plan of care? 1. providing pin site care every shift as prescribed 2. placing an abduction pillow between the legs for alignment 3. having another person hold the weights when pulling the patient up in bed 4. turning the patient to the unaffected side every 2 hours

Correct Answer: 3 Rationale 1: Buck's traction is skin traction; no skeletal pins are used. Rationale 2: An abduction pillow is used postoperatively. Rationale 3: Buck's traction is used preoperatively to control muscle spasms, immobilize a fractured hip, and maintain alignment of an extremity. Often, patients will "scoot" down toward the end of the bed, and the weights are resting on the floor. To avoid injury and added pain, one person holds the weights while the others use a lift sheet to reposition the patient. Rationale 4: A patient cannot be turned with this type of therapy.

A patient with diabetes and heart disease is diagnosed with chronic kidney disease. Which medication order should the nurse question for this patient? 1. calcium channel blocker 2. beta-blocker 3. oral antihyperglycemic agent 4. analgesic

Correct Answer: 3 Rationale 1: Calcium channel blockers may be used with dosage adjustment. Rationale 2: Beta-blockers may be used with dosage adjustment. Rationale 3: Drugs such as metformin (Glucophage) and other oral antihyperglycemic agents eliminated by the kidney are to be avoided. Rationale 4: Analgesics may be used with dosage adjustment.

A patient with a long leg cast is exhibiting signs of compartment syndrome. What should the nurse prepare to aid in the treatment of the patient? 1. extra pillows to elevate the casted extremity above the heart 2. Doppler to assess the strength of peripheral pulses 3. straps to wrap around the bivalved cast 4. percussion hammer to assess reflexes for damage

Correct Answer: 3 Rationale 1: Elevating the leg above the heart would compromise circulation. Rationale 2: A Doppler could be used to assess pulses but this is not a therapeutic treatment for compartment syndrome. Rationale 3: Compartment syndrome occurs when excess pressure in a limited space constricts the structures within a compartment, reducing circulation to muscles and nerves. Treatment can include removing the cast entirely or bivalving it (splitting it apart with a cast cutter) and securing the two sides with straps. Rationale 4: A percussion hammer is used to check reflexes, but this is not a therapeutic treatment for compartment syndrome.

A patient with acute kidney injury (AKI) is prescribed furosemide (Lasix). The nurse realizes that this medication will be helpful to the patient because it will 1. preserve protein. 2. keep sodium in the body. 3. reduce edema. 4. be the gentlest diuretic to use.

Correct Answer: 3 Rationale 1: Furosemide does not preserve protein. Rationale 2: Furosemide may also be used to manage salt and water retention associated with ARF as it helps to eliminate sodium. Rationale 3: If restoration of renal blood flow does not improve urinary output, a potent loop diuretic such as furosemide may be given with intravenous fluids to help manage fluid overload. Rationale 4: Medications are not typically prescribed by their "gentleness." Each patient's response to a medication can be unique.

The patient diagnosed with osteoarthritis reports achieving pain relief when using an over-the-counter ointment on the affected areas. When reviewing safe administration practices, which principle should the nurse include in the teaching? 1. Apply heat to the affected area after applying ointment. 2. Alternate heat and cold after ointment application. 3. Limit the use of ointment to 3‒4 times per day. 4. Initial skin irritation is common and will subside within a few weeks of initiating treatment.

Correct Answer: 3 Rationale 1: Heat use and these preparations should not be combined. Rationale 2: Heat use and these preparations should not be combined; cold applications do not promote pain relief. Rationale 3: Over-the-counter preparations should be used only 3‒4 times per day. Rationale 4: If skin irritation is noted, the medication should be discontinued.

The nurse is teaching a patient about hemodialysis. How should the nurse explain this process? 1. It adds potassium to the blood when passing through the dialyzer and works on the principle of diffusion. 2. It allows a choice of either diffusion osmosis or ultrafiltration to remove excess water from the body. 3. It moves blood through a semipermeable membrane into a dialyzer that is used to remove waste products as well as correct fluid and electrolyte imbalances. 4. It will add electrolytes and water to the blood when passing through a semipermeable membrane to correct electrolyte imbalances.

Correct Answer: 3 Rationale 1: Hemodialysis removes electrolytes from the body and works on the principles of diffusion and ultrafiltration. Rationale 2: Hemodialysis uses both principles of diffusion and ultrafiltration to remove electrolytes. Rationale 3: Hemodialysis uses the principles of diffusion and ultrafiltration to remove electrolytes, waste products, and excess water from the body. Blood is taken from the patient and pumped into the dialyzer, where a semipermeable membrane allows small molecules to pass through. Rationale 4: Hemodialysis removes electrolytes and excess water from the body.

The nurse is providing teaching about topical medications for a group of patients who have been diagnosed with osteoarthritis. Which medication should the nurse review as being a topical preparation? 1. ketoprofen 2. naproxen 3. capsaicin 4. celecoxib

Correct Answer: 3 Rationale 1: Ketoprofen is an oral medication. Rationale 2: Naproxen is an oral medication. Rationale 3: Capsaicin is a topical preparation proven to relieve pain in patients with osteoarthritis without the adverse systemic effects of oral medications. Rationale 4: Celecoxib is an oral medication.

The nurse is discussing the goals of treatment with a patient experiencing end-stage renal disease. Which goal should the nurse identify as being appropriate for this patient? 1. Identify a live-in caregiver. 2. Demonstrate the ability to independently perform hemodialysis in the home. 3. State the advantages and disadvantages of type of renal replacement therapies. 4. Relate the hospice philosophy and identify indicators of the need for hospice care.

Correct Answer: 3 Rationale 1: Patients may be able to live independently or with the assistance of a part time caregiver. Rationale 2: Few patients perform hemodialysis in the home. Rationale 3: The patient's ability to state advantages and disadvantages of renal replacement therapies indicate understanding of treatment options and the ability to make informed decisions on treatment. Rationale 4: Many people live for a number of years on dialysis, so hospice is not an immediate concern.

A patient with pyelonephritis asks the nurse to explain the condition. How should the nurse respond? 1. "It is an infection of the lower urinary tract." 2. "It is an inflammation of the bladder." 3. "It is an infection of the kidney." 4. "It is a blockage in the tube from your kidney to your bladder."

Correct Answer: 3 Rationale 1: Pyelonephritis does not occur in the lower urinary tract. Rationale 2: Pyelonephritis is not an inflammation of the bladder. Rationale 3: Pyelonephritis is an infection of the renal pelvis and parenchyma, the functional unit of the kidney. Rationale 4: Pyelonephritis does not occur in the ureter.

Nonunion of a fractured tibia is seen in a patient after 8 weeks in a long leg cast. Which intervention may be necessary to encourage bone healing? 1. removing the old cast and reapplying another 2. placing the patient in Buck's traction 3. surgical intervention with open reduction and internal fixation 4. bone debridement

Correct Answer: 3 Rationale 1: Removing the cast and applying a new one would not help a patient with a nonunion fracture. Rationale 2: Buck's traction is not indicated. Rationale 3: With nonunion, the patient will have persistent pain and movement at the fracture site. The site will need to be realigned and held in place with plates and screws to maintain the alignment. Rationale 4: There is no evidence that the bone needs to be debrided.

The nurse needs to reposition a patient with a fractured leg. Which action should the nurse take when moving this patient? 1. making sure the extremity is supported distal to the fracture 2. disconnecting the weights from the balanced traction setup 3. supporting the extremity above and below the fracture 4. supporting the leg directly under the fracture

Correct Answer: 3 Rationale 1: Supporting the limb distally may cause pain or spasms. Rationale 2: If traction were in use, weights would not be removed. Rationale 3: Support above and below the fracture site helps prevent displacement of bony fragments and reduces the risk of further nerve damage. Rationale 4: Supporting the leg directly under the fraction can cause pain and spasms.

A patient whose recovery from a fracture has been very slow is prescribed a treatment that will increase the migration of osteoblasts and osteoclasts to the fracture site. For which treatment should the nurse instruct this patient? 1. open reduction and manipulation 2. open visualization and debridement 3. electrical bone stimulation 4. fracture assimilation

Correct Answer: 3 Rationale 1: Surgical intervention will not increase the migration of osteoblasts and osteoclasts. Rationale 2: Surgical intervention will not increase the migration of osteoblasts and osteoclasts. Rationale 3: Electrical bone stimulation, in which an electrical current is applied at the fracture site, increases the migration of osteoblasts and osteoclasts to the site. Rationale 4: Surgical intervention will not increase the migration of osteoblasts and osteoclasts.

The nurse is caring for an older patient who is prone to developing urinary tract infections (UTIs). Which method of bladder emptying should the nurse recommend for this patient? 1. Credé method 2. indwelling urinary catheterizations 3. intermittent catheterization 4. timed intervals for taking patient to bathroom to void

Correct Answer: 3 Rationale 1: The Credé method is a technique used to assist patients with spinal cord injury to empty the bladder. Rationale 2: An indwelling urinary catheter has a higher risk of infection. Rationale 3: Intermittent catheterization carries a lower risk of infection and is preferred for patients who are unable to empty the bladder by voiding. Rationale 4: Timed intervals for voiding would not be effective if the patient is unable to empty the bladder by voluntary voiding. The urine would remain in the bladder and be a site for infection to develop.

The nurse is completing the instructions to a patient who underwent a cadaver kidney transplant and is ready for discharge from the hospital. What patient statement indicates that further teaching is needed? 1. "I'll call my doctor if I notice any decrease in my urine output." 2. "I know to check my weight on a regular basis." 3. "I'm glad I won't have to take immunosuppressants any longer." 4. "I'll tell my friends to stay away from me if they have colds or the flu."

Correct Answer: 3 Rationale 1: The patient should contact the physician with any decreases in urine output. Rationale 2: The patient will need to check weight on a regular basis. Rationale 3: Unless the donor and recipient are identical twins, immunosuppressants are taken to minimize the immune response to reject the transplanted organ. Rationale 4: The patient should also avoid individuals who have colds or the flu.

A patient is diagnosed with an open compound fracture and is scheduled for immediate surgery. On which problems should the nurse focus during the patient's immediate postoperative period? 1. difficulty with mobility 2. anxiety related to the surgical procedure 3. potential for infection 4. possibility of falling

Correct Answer: 3 Rationale 1: The patient will have difficulty with mobility; however, this is not the priority during the immediate postoperative period. Rationale 2: The surgery has been completed. The risk of anxiety about the surgery should be resolved. Rationale 3: The patient with an open, compound fracture has multiple bone breaks penetrating through the skin, and must be assessed and cared for vigilantly for signs of infection. Rationale 4: The patient may have problems ambulating and be at risk for falling; however, this is not the priority during the immediate postoperative period.

A patient recovering from an amputation refuses to look at the stump or participate in care. For what problem should the nurse plan interventions to help this patient? 1. infection 2. insufficient nutrition 3. problems with body image 4. risk for chronic pain

Correct Answer: 3 Rationale 1: The patient's reluctance to look at the wound does not indicate a risk for infection. Rationale 2: There is no indication that the patient has insufficient nutrition. Rationale 3: Although amputation is a reconstructive surgery, the patient's body image will be disturbed. The patient's reluctance to look at the stump or participate in care supports this problem identification. Rationale 4: There is no evidence that the patient will experience chronic pain.

The nurse is preparing an educational session for employees of a manufacturing plant regarding emergency care of amputated digits. What should the nurse include when teaching about this type of injury? 1. Immediately transport the person to the hospital. 2. Place the amputated digit in a storage bag filled with warm water. 3. Wrap the amputated digit in a towel, place it in a plastic bag, and lay it on ice. 4. Place the digit in a plastic bag and tape the bag to the patient's extremity.

Correct Answer: 3 Rationale 1: The person does need to be transported to the hospital but the amputated digit needs to be addressed first. Rationale 2: Warm water should not be used to preserve an amputated digit. Rationale 3: After a traumatic amputation of a digit, the nurse should instruct those present to wrap the amputated part in a clean cloth, place in a plastic bag, and put the bag on ice. Do not let the amputated part come into direct contact with the ice or water. This will preserve the amputated finger so that it can be surgically reattached. Rationale 4: The digit should not be taped on the patient.

An older patient with osteoporosis has a history of falls and dementia. What intervention will best aid in the prevention of injuries? 1. using of wrist restraints 2. using furniture as obstacles to keep the patient in the bed 3. keeping the bed in a low position 4. keeping a nightlight on in the room

Correct Answer: 3 Rationale 1: The use of restraints could increase the incidence of injury. Rationale 2: Using the furniture as an obstacle could cause injury if the patient is able to get up. Rationale 3: Keeping the bed in a low position will reduce the incidence of injury should the patient attempt to get up. Rationale 4: A nightlight is useful but is not the best means to prevent injury.

A patient is diagnosed with an oblique fracture of the left femur. In which order should the nurse explain the steps of healing? Choice 1. bony callus formation Choice 2. fibrocartilaginous callus formation Choice 3. hematoma formation Choice 4. remodeling

Correct Answer: 3, 2, 1, 4 Rationale 1: The third stage of fracture healing, bony callus formation, begins 3 to 4 weeks after the injury and continues for 2 to 3 months. Osteoblasts continue to form collagen fibers and bone matrix, which are gradually mineralized with calcium and mineral salts. Rationale 2: Within 48 hours, fibroblasts and new capillaries growing into the fracture form granulation tissue that gradually replaces the hematoma. Phagocytes remove cell debris. Osteoblasts migrate to the fracture site, where they build a web of collagen fibers from both sides of the fractured bone. Chondroblasts lay down patches of cartilage as a base for bone growth. This fibrocartilaginous callus connects bone fragments, splinting the fracture and maintaining bone alignment. Rationale 3: When a bone fractures, bleeding and tissue damage at the site of the fracture initiate an inflammatory response. A hematoma forms between the fractured bone ends and around the bone surfaces. Rationale 4: During the remodeling phase, excess callus is removed and new bone is laid down along the fracture line. The fracture site calcifies and the bone reunites.

A married female patient has a history of repeated urinary tract infections (UTIs). What should the nurse include in the assessment of this patient? 1. activity status 2. employment status 3. height and weight 4. preferred method of birth control

Correct Answer: 4 Rationale 1: Activity status does not have a direct relationship to repeat UTIs. Rationale 2: Employment status does not have a direct relationship to repeat UTIs. Rationale 3: Height and weight do not have a direct relationship to repeat UTIs. Rationale 4: Risk factors for UTIs include sexual intercourse and the use of diaphragm and spermicidal compounds for birth control.

A patient who is recovering from acute kidney injury (AKI) is being discharged. What should the nurse include in this patient's instructions? 1. Resume a normal diet. 2. Use over-the-counter medications as needed. 3. Instruct to weigh self at least once a month. 4. Avoid alcohol consumption.

Correct Answer: 4 Rationale 1: Additional teaching includes dietary restrictions. Rationale 2: Additional teaching includes avoiding exposure to nephrotoxins, particularly those found in over-the-counter products. Rationale 3: Additional teaching includes monitoring weight closely as a way to assess fluid status. Once a month is not enough. Rationale 4: Because alcohol can increase the nephrotoxicity of some drugs, discourage alcohol ingestion.

A patient recovering from a total hip replacement has vital signs assessed by unlicensed assistive personnel. Which vital sign value should cause the most concern for the nurse? 1. blood pressure 110/76 2. heart rate 82 3. respiratory rate 18 4. temperature 102° F

Correct Answer: 4 Rationale 1: Blood pressure of 110/76 is within normal limits. Rationale 2: Heart rate of 82 is within normal limits. Rationale 3: Respiratory rate of 18 is within normal limits. Rationale 4: The elevated temperature may indicate an infectious process, such as a surgical site infection, and would need rapid intervention.

Prior to signing informed consent for a total hip replacement, the patient asks the nurse if she should be concerned about complications. How should the nurse respond? 1. "Complications are rare with this type of surgery." 2. "Do you know someone who had complications after this type of surgery?" 3. "Your surgeon has a low complication rate." 4. "What complications did your surgeon mention in the explanation of your surgery?"

Correct Answer: 4 Rationale 1: Complications can result from any surgery. Rationale 2: One person may not have the same postoperative course as someone else. Rationale 3: Many variables in addition to the surgeon complication rate influence the occurrence of complications. Rationale 4: The surgeon should include risks and benefits when the surgery is discussed with the patient. After assessing the patient's understanding of the procedure, the nurse should provide further explanations and clarification as needed.

A patient is diagnosed with postrenal acute kidney injury (AKI). The nurse realizes that this type of kidney injury can be caused by what health problem? 1. drug toxicity 2. hypovolemia 3. sepsis 4. benign prostatic hypertrophy

Correct Answer: 4 Rationale 1: Drug toxicity would be considered a prerenal cause of AKI. Rationale 2: Hypovolemia would be considered a prerenal cause of AKI. Rationale 3: Sepsis would be considered a prerenal cause of AKI. Rationale 4: Causes for postrenal AKI include benign prostatic hypertrophy.

The nurse administers epoetin alfa (Epogen) to a patient on dialysis. What should the nurse expect the therapeutic effect of this medication to be? 1. It enhances absorption of iron and folate in the intestinal tract. 2. It combats the effects of dialysis on bone marrow. 3. It promotes elimination of nephrotoxic drugs from the body. 4. It treats the anemia seen in chronic kidney disease patients on dialysis.

Correct Answer: 4 Rationale 1: Epoetin alfa does not affect absorption of iron or folate. Rationale 2: Epoetin alfa has no action on bone marrow. Rationale 3: Epoetin alfa does not promote elimination of nephrotoxic drugs from the body. Rationale 4: In chronic kidney disease, erythropoietin production in the kidney declines, which suppresses RBC production leading to anemia. Erythropoeisis-stimulating agents such as epoetin alfa increase RBC production.

A 30-year-old female patient diagnosed with early onset of osteoporosis asks the nurse how she could be at risk for this disease, since she is so active. Which response by the nurse is most correct? 1. "You might have placed underlying stress on your skeleton from your frequent exercise." 2. "You are at an age when your estrogen levels have begun to decline drastically, thus increasing your risk for the development of osteoporosis." 3. "Do your bones feel weak or painful?" 4. "Your dietary practices might be partially responsible."

Correct Answer: 4 Rationale 1: Exercise is beneficial in the prevention of osteoporosis. It does not increase the likelihood of osteoporosis. Rationale 2: At 30 years of age, this is unlikely. Rationale 3: The patient is seeking information. She is not requiring an assessment at this time. Rationale 4: There is an increasing incidence of osteoporosis in female athletes as a result of intense dieting.

During an assessment the nurse determines that a patient with knee pain is at risk for osteoarthritis. What did the nurse assess in this patient? 1. Having a history of falls 2. Eating a diet high in calcium 3. Walking 30 minutes each day 4. Being overweight by 30 pounds

Correct Answer: 4 Rationale 1: Falls do not predispose an individual to develop OA. Rationale 2: A diet high in calcium has no effect on the development of OA. Rationale 3: Walking 30 minutes every day could help prevent the development of OA. Rationale 4: Excessive weight contributes to the development of OA, especially in the hip and knee. Increasing body weight significantly increases the load placed on the knees during walking.

A patient is diagnosed with chronic pyelonephritis. The nurse recognizes that this patient is prone to developing which health problem? 1. renal calculi 2. cystitis 3. acute renal failure 4. chronic kidney disease

Correct Answer: 4 Rationale 1: Renal calculi are generally caused by dietary intake, not by chronic pyelonephritis. Rationale 2: Cystitis may cause acute pyelonephritis. Rationale 3: Cystitis may cause acute renal failure. Rationale 4: Chronic pyelonephritis involves chronic inflammation and scarring of the tubules and interstitial tissues of the kidney. It is a common cause of chronic kidney disease.

The nurse instructs a female patient on ways to prevent urinary tract infections (UTIs). Which patient statement indicates that teaching has been effective? 1. "I should void every 6 hours while I am awake." 2. "I should limit my intake of water so I won't need to urinate so often." 3. "I should wear only nylon underpants." 4. "I should drink 2 to 2-1/2 quarts of fluid per day."

Correct Answer: 4 Rationale 1: The patient should not delay emptying the bladder when the urge is felt. Emptying the bladder every 2-4 hours is recommended to prevent urinary stasis. Rationale 2: Fluid intake should be increased. Rationale 3: Cotton underpants are best, and nylon should be avoided because synthetic fibers dry and irritate the perineal area and promote bacteria growth. Rationale 4: An intake of 2 to 2-1/2 quarts of fluid per day will help to prevent UTIs.