Med-Surg FINAL

The nurse is reviewing the record of a client with a dx of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? A. Dorsiflex the foot B. Measure abdominal girth C. Ask pt to extend the arms D. Instruct pt to lean forward

C. Ask pt to extend the arms

The nurse assessing the ureterostomy of a postoperative client interprets that the stoma has normal characteristics if which is observed? (only have answer; see other side)

Red and moist

When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation? a. the pt has metastatic lung cancer b. the pt has poorly controlled T1DM c. the pt has a hx of chronic hep C infection d. the pt is infected with HIV

a. the pt has metastatic lung cancer

Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms forward. c. Request that the patient walk with eyes closed. d. Ask the patient to perform the Valsalva maneuver.

b. Ask the patient to extend both arms forward.

Which assessment finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider? a. Foul-smelling urine b. Complaint of flank pain c. Blood pressure 88/45 mm Hg d. Temperature 100.1° F (57.8° C)

c. Blood pressure 88/45 mm Hg

A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to have sexual intercourse. Which action should the nurse take? a. Discuss alternative methods of sexual expression. b. Teach about medication for erectile dysfunction (ED). c. Clarify that TURP does not commonly affect erection. d. Offer reassurance that fertility is not affected by TURP.

c. Clarify that TURP does not commonly affect erection.

What can patients at risk for renal lithiasis do to prevent the stones in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

c. Drink enough fluids to produce dilute urine

A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate? a. Assess the client for iodine or shellfish allergies. b. Educate the client on the side effects of sedation. c. Inform the client a second scan may be needed. d. Teach the client about bowel preparation for the scan.

c. Inform the client a second scan may be needed.

Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider? a. Dysuria b. Hematuria c. Left-sided flank pain d. Temperature 100.1° F

c. Left-sided flank pain

A patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect to find related to this illness? a. Poor skin turgor b. High urine ketones c. Recent weight gain d. Low blood pressure

c. Recent weight gain

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? a. Pink-tinged urine b. Urinary frequency c. Temperature of 100.8° F d. Lethargy

c. Temperature of 100.8° F

20. Which information from a patient's urinalysis requires that the nurse notify the health care provider? a. pH 6.2 b. Trace protein c. WBC 20 to 26/hpf d. Specific gravity 1.021

c. WBC 20 to 26/hpf

The nursing student is explaining principles of hemodialysis to the nursing instructor. Which statement by the student indicates a need for additional study and research on the topic? a. "Dialysis works as molecules from an area of higher concentration move to an area of lower concentration." b. "Blood and dialyzing solution flow in opposite directions across an enclosed semipermeable membrane." c. "Excess water, waste products, and excess electrolytes are removed from the blood." d. "Bacteria and other organisms can also pass through the membrane, so the dialysate must be kept sterile."

d. "Bacteria and other organisms can also pass through the membrane, so the dialysate must be kept sterile."

Which focused data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a . Hemoglobin b. Temperature c. Activity level d. Albumin level

d. Albumin level

What is the most common screening intervention for detecting BPH in men over age 50? a. PSA level b. Urinalysis c. Cystoscopy d. Digital rectal examination

d. Digital rectal examination

A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After assessing the clients behavior, which statement by the nurse would be the most appropriate? a. The urine incontinence should not prevent you from socializing. b. You seem depressed and should seek more pleasant things to do. c. It is common for men at your age to have changes in mood. d. Nocturia could cause interruption of your sleep and cause changes in mood.

d. Nocturia could cause interruption of your sleep and cause changes in mood.

A 51-year-old woman had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to a. choose low-fat foods from the menu. b. perform leg exercises hourly while awake. c. ambulate the evening of the operative day. d. turn, cough, and deep breathe every 2 hours.

d. turn, cough, and deep breathe every 2 hours.

A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. place ice packs around the stoma. B. notify the surgeon about the stoma. C. monitor the stoma every 30 minutes. d.document stoma assessment findings.

d.document stoma assessment findings.

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

Which nursing action will the nurse include in the plan of care for a 35-year-old male patient admitted with an exacerbation of inflammatory bowel disease (IBD)? A. Restrict oral fluid intake. B. Monitor stools for blood. C. Ambulate four times daily. D. Increase dietary fiber intake.

B. Monitor stools for blood.

The home health nurse is teaching a client about the care of a new colostomy. Which client statement demonstrates a correct understanding of the instructions? A. "A dark or purplish-looking stoma is normal and should not concern me." B. "If the skin around the stoma is red or scratched, it will heal soon." C. "I need to check for leakage underneath my colostomy." D. "I should strive for a very tight fit when applying the barrier around the stoma."

C. "I need to check for leakage underneath my colostomy."

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? A. "I must clean with the wipes and then urinate directly into the cup." B. "I will have to drink 2 liters of fluid before providing the sample." C. "I'll start to urinate in the toilet, stop, and then urinate into the cup." D. "It is best to provide the sample while I am bathing."

C. "I'll start to urinate in the toilet, stop, and then urinate into the cup."

Which lab findings are expected in ulcerative colitis as a result of diarrhea and vomiting? A. Increased albumin B. Elevated WBCs C. Decreased Na+, K+, Mg2+, Cl-, and HCO3- D. Decreased Hgb and Hct

C. Decreased Na+, K+, Mg2+, Cl-, and HCO3-

Which problem for a client with cirrhosis takes priority? A. Insufficient knowledge related to the prognosis of the disease process B. Discomfort related to the progression of the disease process C. Potential for injury related to hemorrhage D. Inadequate nutrition related to an inability to tolerate usual dietary intake

C. Potential for injury related to hemorrhage

A client asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting colorectal cancer?" Which dietary selection does the nurse suggest? A. Steak with pasta B. Spaghetti with tomato sauce C. Steamed broccoli with turkey D. Tuna salad with wheat crackers

C. Steamed broccoli with turkey

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome? A. "Have you been passing a lot of gas?" B. "What foods affect your bowel patterns?" C. "Do you have any abdominal distention?" D. "How long have you had abdominal pain?"

D. "How long have you had abdominal pain?"

The nurse is assessing a colostomy in a patient who had a partial colectomy 24 hours ago. Which of these assessment findings is considered normal for a new stoma? A. Pale pink color B. Dusky blue color C. Brown or black color D. Beefy red, darker than oral mucosa

D. Beefy red, darker than oral mucosa

The nurse is assessing a colostomy in a patient who had a colectomy 24 hours ago. Which of these assessment findings is considered normal for a new stoma A. Pale pink color B. Dusky blue color C. Brown or black color D. Dark pink to red color

D. Dark pink to red color

The health care provider orders lactulose for a patient with hepatic encephalopathy. Which finding indicates the medication has been effective? A. Relief of constipation B. Relief of abdominal pain C. Decreased liver enzymes D. Decreased ammonia levels

D. Decreased ammonia levels

The nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine if the client is currently experiencing exacerbation of BPH, the nurse should ask the client about the presence of which early symptom? A. Nocturia B. Urinary retention C. Urge incontinence D. Decreased force in the stream of urine

D. Decreased force in the stream of urine

Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis? A. Absence of jaundice, pain of gradual onset B. Absence of jaundice, pain in right abdominal quadrant C. Presence of jaundice, pain worsening when sitting up D. Presence of jaundice, pain worsening when lying supine

D. Presence of jaundice, pain worsening when lying supine Pain associated with acute pancreatitis usually has an abrupt onset, is located in the mid-epigastric or upper left quadrant, and lessens with sitting up; also, jaundice is present.

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes: a. teaching the patient to use Kegel exercises b.clamping and releasing a catheter to increase bladder tone c.teaching the patient biofeedback mechanisms to suppress the urge to void d.counseling the patient concerning choices of incontinence containment devices

a. teaching the patient to use Kegel exercises

A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea.

b. Monitor the patient for shortness of breath.

A patient passing bloody urine is scheduled for a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate? a. "Your doctor will place a catheter into an artery in your groin and inject a dye that will visualize the blood supply to the kidneys." b. "Your doctor will insert a lighted tube into the bladder, and little catheters will be inserted through the tube into your kidney." c. "Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray." d. "Your doctor will inject a radioactive solution into a vein in your arm and the distribution of the isotope in your kidneys and bladder will be checked."

c. "Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray."

After receiving change-of-shift report on the urology unit, which client does the nurse assess first? a. Client post radical 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 crash and has hematuria d. Client with nephrotic syndrome who has gained 2 kg since yesterday

c. Client who was involved in a motor vehicle crash and has hematuria

A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity b. No treatment with medication unless she develops fever, chills, and flank pain c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests

c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days

The client is six (6) hours postoperative open cholecystectomy and the nurse finds a large amount of red drainage on the dressing. Which intervention should the nurse implement? a. Measure the abdominal girth. b. Palpate the lower abdomen for a mass. c. Turn client onto side to assess for further drainage. d. remove the dressing to determine the source

c. Turn client onto side to assess for further drainage.

A patient undergoes a nephrectomy after having massive trauma to the kidney. Which assessment finding obtained postoperatively is most important to communicate to the surgeon? a. Blood pressure is 102/58. b. Incisional pain level is 8/10. c. Urine output is 20 mL/hr for 2 hours. d. Crackles are heard at both lung bases.

c. Urine output is 20 mL/hr for 2 hours Because the urine output should be at least 0.5 mL/kg/hr, a 40 mL output for 2 hours indicates that the patient may have decreased renal perfusion because of bleeding, inadequate fluid intake, or obstruction at the suture site. The blood pressure requires ongoing monitoring but does not indicate inadequate perfusion at this time. The patient should cough and deep breathe, but the crackles do not indicate a need for an immediate change in therapy. The incisional pain should be addressed, but this is not as potentially life threatening as decreased renal perfusion. In addition, the nurse can medicate the patient for pain.

Glomerulonephritis is characterized by glomerular damage caused by a. growth of microorganisms in the glomeruli. b. release of bacterial substances toxic to the glomeruli. c. accumulation of immune complexes in the glomeruli. d. hemolysis of red blood cells circulating in the glomeruli.

c. accumulation of immune complexes in the glomeruli.

To prepare a 56-year-old male patient with ascites for paracentesis, the nurse a. places the patient on NPO status. b. assists the patient to lie flat in bed. c. asks the patient to empty the bladder. d. positions the patient on the right side.

c. asks the patient to empty the bladder.

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

d. Assess the client for airway patency.

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orientation d. Fewer episodes of bleeding varices

d. Fewer episodes of bleeding varices

The nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Select all that apply. (Saunders: only have answers; see other side)

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

A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, "My symptoms are much worse this week." Which response by the nurse is appropriate? a. "Have you taken any over-the-counter (OTC) medications recently?" b. "I will talk to the doctor about a prostate specific antigen (PSA) test." c. "Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes in size from day to day, and this may be making your symptoms worse."

a. "Have you taken any over-the-counter (OTC) medications recently?"

Q54 ch 65 Which urine characteristic listed on a urinalysis report arouses the nurse's suspicion of a problem in the urinary tract? a. Cloudiness b. Straw color c.Ammonia odor d.One cast per high-powered field

a. Cloudiness

The nurse is conducting a history on a male client to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse? a. Cloudy urine b. Urinary hesitancy c. Post-void dribbling d.Weak urinary stream

a. Cloudy urine

A nurse obtains the health history of a client with a suspected diagnosis of bladder cancer. Which question should the nurse ask when determining this clients risk factors? a. Do you smoke cigarettes? b. Do you use any alcohol? c. Do you use recreational ddrugs? d. Do you take any prescription drugs?

a. Do you smoke cigarettes?

To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating a. milk and cheese. b. sardines and liver. c. legumes and dried fruit. d. spinach, chocolate, and tea.

b. sardines and liver.

The condition of the pt who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the pt has developed liver cancer? a. serum a-fetoprotein level b. ventilation/perfusion scan c. hepatic structure ultrasound d. abdominal girth measurement

c. hepatic structure ultrasound

Which statement by a patient who had a cystoscopy the previous day should be reported immediately to the health care provider? a."My urine looks pink." b. "My IV site is bruised." c. "My sleep was restless." d. "My temperature is 101."

d. "My temperature is 101."

The client is four (4) hours postoperative open cholecystectomy. Which data would warrant immediate intervention by the nurse? a. Absent bowel sounds in all four (4) quadrants. b. The T-tube with 60 mL of green drainage. c. Urine output of 100 mL in the past three (3) hours. d. Refusal to turn, deep breathe, and cough.

d. Refusal to turn, deep breathe, and cough.

A nurse cares for a client who is scheduled for the surgical creation of an ileal conduit. The client states, I am anxious about having an ileal conduit. What is it like to have this drainage tube? How should the nurse respond? a. I will ask the provider to prescribe you an antianxiety medication. b. Would you like to discuss the procedure with your doctor once more? c. I think it would be nice to not have to worry about finding a bathroom. d. Would you like to speak with someone who has an ileal conduit?

d. Would you like to speak with someone who has an ileal conduit?

The nurse will ask a patient being admitted with acute pancreatitis specifically about a history of a. diabetes mellitus. b. high-protein diet. c. cigarette smoking. d. alcohol consumption.

d. alcohol consumption.

A patient with Crohn's disease has megaoblastic anemia. The nurse will anticipate teaching the patient about the ongoing need for a. oral ferrous sulfate tablets. b. regular blood transfusions.ower c. iron dextran (Imferon) infusion. d. cobalamin (B12) nasal spray or injections.

d. cobalamin (B12) nasal spray or injections.

A client with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The client asks the nurse how this is helpful for improving symptoms. How does the nurse reply? A. "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." B. "It provides key nutrients and extra calories to promote healing." C. "It is bland and reduces the secretion of gastric acids." D. "It does not contain caffeine or other GI tract stimulants."

A. "It is absorbed quickly and allows the affected part of the GI tract to rest and heal."

When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? A. A lower-fat diet may be better tolerated for several weeks. B. Do not return to work or normal activities for 3 weeks. C. Bile-colored drainage will probably drain from the incision. D. Keep the bandages on and the puncture site dry until it heals.

A. A lower-fat diet may be better tolerated for several weeks.

When caring for a client with nephrotic syndrome, which intervention should 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

The nurse is teaching a patient about preventing kidney problems. What does the nurse instruct the patient? Select all that apply. A. Consume at least 1 L of fluids daily. B. Reduce the intake of carbonated soft drinks. C. Report any discomfort with the passage of urine. D. Have kidney function checked at least once a year. E. Report any change in frequency or volume of urine

A. Consume at least 1 L of fluids daily. C. Report any discomfort with the passage of urine. D. Have kidney function checked at least once a year. E. Report any change in frequency or volume of urine

Clinical manifestations of cystitis include which of the following? (Select all that apply.) A. Dysuria B. Urinary frequency C. Hematuria D. Cloudy urine E. Pain in the suprapubic area

A. Dysuria B. Urinary frequency D. Cloudy urine E. Pain in the suprapubic area Most patients with cystitis experience dysuria, urinary frequency, cloudy urine, and pain in the suprapubic area or lower back, or both. Hematuria is not generally considered a manifestation of cystitis.

The nurse is teaching a class on diverticulosis. Which interventions should the nurse discuss when teaching ways to prevent an acute exacerbation of diverticulosis? Select all that apply. A. Eat a high fiber diet B. Increase fluid intake C. Elevate the HOB after eating D. Walk 30 minutes a day E. Take an antacid every 2 hours

A. Eat a high fiber diet B. Increase fluid intake D. Walk 30 minutes a day

The client is diagnosed with ARF. Which signs/symptoms indicate to the nurse the client is in the recovery period? Select all that apply. A. Increased alertness and no seizure activity B. Increase in hemoglobin and hematocrit C. Denial of nausea and vomiting D. Decreased urine-specific gravity. E. Increased serum creatinine level

A. Increased alertness and no seizure activity B. Increase in hemoglobin and hematocrit C. Denial of nausea and vomiting

A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." D. "You'll need to drastically modify your alcohol intake."

B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack."

After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? A. Drinking at least 2 liters of water each day is suggested. B. I will decrease the amount of fatty foods in my diet. C. Drinking fluids with my meals will increase bloating. D. I will avoid concentrated sweets and simple carbohydrates.

B. I will decrease the amount of fatty foods in my diet.

Which instruction does the nurse give a client who needs a clean-catch urine specimen? A. "Save all urine for 24 hours." B. "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." C. "Do not touch the inside of the container." D. "You will receive an isotope injection, then I will collect your urine."

C. "Do not touch the inside of the container."

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? A. "I can have a glass of low-fat milk at bedtime." B. "I will have to eliminate all spicy foods from my diet." C. "I will have to use herbal teas instead of caffeinated drinks." D. "I should keep something in my stomach all the time to neutralize the excess acids."

C. "I will have to use herbal teas instead of caffeinated drinks." Patients with GERD should avoid all forms of caffeine. In addition, they should avoid eating before bedtime. Therefore, a patient should not drink a glass of milk before bed or keep something in their stomach at all times. A patient should generally avoid spicy foods, but only ones that cause discomfort.

The healthcare provider is teaching a patient diagnosed with Crohn's disease who is recovering from a bowel resection. Which of the following statements made by the patient indicates the teaching has been effective? A. "Now that the bowel has been removed, the disease is cured." B. "Now I can discontinue taking my multivitamin supplements." C. "The disease might reappear in another part of the bowel." D. "I might develop ulcerative colitis because some of my bowel is missing."

C. "The disease might reappear in another part of the bowel." Crohn's disease is an immune-related disease, which means that removing a highly effect part of the bowel is not curative, because it does not eradicate the source. While it will provide relief of symptoms, lesions may end up affecting another area of the bowel.

A 70-year-old client is seeing his primary care provider for an annual examination. Which assessment finding alerts the nurse to an increased risk for bladder cancer? A. A five-pack year history of smoking 45 years ago B. Difficulty starting and stopping the urine stream C. A 30-year occupation as a long-distance truck driver D. A recent colon cancer diagnosis in his 72-year-old brother

C. A 30-year occupation as a long-distance truck driver

What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow

a. A reduction in the size of the prostate gland

After teaching a client with a history of renal calculi, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching? a. I should drink at least 3 liters of fluid every day. b. I will eliminate all dairy or sources of calcium from my diet. c. Aspirin and aspirin-containing products can lead to stones. d. The doctor can give me antibiotics at the first sign of a stone.

a. I should drink at least 3 liters of fluid every day.

After teaching a client who has stress incontinence, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I will limit my total intake of fluids. b. I must avoid drinking alcoholic beverages. c. I must avoid drinking caffeinated beverages. d. I shall try to lose about 10% of my body weight.

a. I will limit my total intake of fluids.

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? a. The patient is alert and oriented. b. The patient denies nausea or anorexia. c. The patient's bilirubin level decreases. d. The patient has at least one stool daily.

a. The patient is alert and oriented.

The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement indicates a lack of understanding by the client? a. There should be no problem with a glass of wine with dinner each night. b. I am so glad that I weaned myself off of coffee about a year ago. c. I need to inform my allergist that I cannot take my normal decongestant. d. My normal routine of drinking a quart of water during exercise needs to change.

a. There should be no problem with a glass of wine with dinner each night.

Q14 CH 66: A patient reports intense urgency, frequency, and bladder pain. Urinalysis results show no white blood cells and no red blood cells and urine culture results are negative for infection. How does the nurse interpret these findings? a. These findings are consistent with a diagnosis of interstitial cystitis. b. Patient could have urethritis due to sexually transmitted disease. c. Signs and symptoms suggest kidney stones; pain is likely to intensify. d. Findings suggest bacterial cystitis that is partially treated by antibiotics.

a. These findings are consistent with a diagnosis of interstitial cystitis.

Sodium polystyrene sulfonate (Kayexalate) is ordered for a patient with hyperkalemia. Before administering the medication, the nurse should assess the a. bowel sounds. b. blood glucose. c. blood urea nitrogen (BUN). d. level of consciousness (LOC).

a. bowel sounds.

When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about a. dietary intake. b. sports involvement. c. environmental exposure to carcinogens. d. long-term use of nonsteroidal antiinflammatory drugs (NSAIDs).

a. dietary intake.

The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse? a. "My sodium level changes by movement from the blood into the dialysate." b. "Dialysis works by movement of wastes from lower to higher concentration." c. "Extra fluid can be pulled from the blood by osmosis." d. "The dialysate is similar to blood but without any toxins."

b. "Dialysis works by movement of wastes from lower to higher concentration." Dialysis works using the passive transfer of toxins by diffusion. Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration. The other statements show a correct understanding about hemodialysis.

A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention? a. A 29-year-old client after a difficult vaginal delivery Habit training b. A 58-year-old postmenopausal client who is not taking estrogen therapy Electrical stimulation c. A 64-year-old female with Alzheimers-type senile dementia Bladder training d. A 77-year-old female who has difficulty ambulating Exercise therapy

b. A 58-year-old postmenopausal client who is not taking estrogen therapy Electrical stimulation

How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected pyelonephritis? a. Palpate along both sides of the lumbar vertebral column. b. Strike a flat hand covering the costovertebral angle (CVA). c. Push fingers upward into the two lowest intercostal spaces. d. Percuss between the iliac crest and ribs along the midaxillary line.

b. Strike a flat hand covering the costovertebral angle (CVA).

Q65 CH 67 The nurse is reviewing the laboratory results for a patient being evaluated for difficulties with passing urine. The urinalysis shows tubular epithelial cells on microscopic examination. How does the nurse interpret this finding? a. Blood chemistries should be evaluated. b. The obstruction is prolonged. c. The patient has a urinary tract infection. d. Glomerular filtration rate is reduced.

b. The obstruction is prolonged.

Which information given by a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago. c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation.

b. The patient used IV drugs about 20 years ago.

When the nurse is caring for a patient who has been admitted with a severe crushing injury after an industrial accident, which laboratory result will be most important to report to the health care provider? a. serum creatinine level 2.1 mg/dL b. serum potassium level 6.5 mEq/L c. WBC 11,500/uL d. BUN 56 mg/dL

b. serum potassium level 6.5 mEq/L

When assessing a client with acute glomerulonephritis, which question about self-management will the nurse ask to determine whether the client is currently following best practices to slow progression of kidney damage? a. "Have you increased your protein intake to promote healing of the damaged nephrons?" b. "Do you avoid contact sports while you are taking cyclosporine?" c. "How are you evaluating the amount of daily fluid you drink?" d. "Have you contacted anyone from our dialysis support services?"

c. "How are you evaluating the amount of daily fluid you drink?"

A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider? a. The ileostomy is draining blood-tinged urine. b. There is serous sanguineous drainage present on the surgical dressing. c. The ileostomy stoma is pale and cyanotic in appearance. d. Oxygen saturations are 92% on room air.

c. The ileostomy stoma is pale and cyanotic in appearance.

A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider? a. The ileostomy is draining blood-tinged urine. b. There is serous sanguineous drainage present on the surgical dressing. c. The ileostomy stoma is pale and cyanotic in appearance. d. Oxygen saturations are 92% on room air.

c. The ileostomy stoma is pale and cyanotic in appearance.

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient admitted with bleeding esophageal varices? a. The medication will reduce the risk for aspiration. b. The medication will inhibit development of gastric ulcers. c. The medication will prevent irritation of the enlarged veins. d. The medication will decrease nausea and improve the appetite.

c. The medication will prevent irritation of the enlarged veins.

A 22-year-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient asks for antidiarrheal medication after each stool. c. The patient uses witch hazel compresses to decrease irritation. d. The patient cleans the perianal area with soap after each stool.

c. The patient uses witch hazel compresses to decrease irritation.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. blood in the urine. b. lower back or hip pain. c. force of urinary stream d. erectile dysfunction (ED).

c. force of urinary stream

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer? a. A 25-year-old female with a history of sexually transmitted diseases b. A 42-year-old male who has worked in a lumber yard for 10 years c. A 55-year-old female who has had numerous episodes of bacterial cystitis d. An 86-year-old male with a 50 pack-year cigarette smoking history

d. An 86-year-old male with a 50 pack-year cigarette smoking history

Which assessment data reported by a 28-year-old male patient is consistent with a lower urinary tract infection (UTI)? a. Poor urine output b. Bilateral flank pain c. Nausea and vomiting d. Burning on urination

d. Burning on urination

A 72-year-old who has benign prostatic hyperplasia is admitted to the hospital with chills, fever, and vomiting. Which finding by the nurse will be most helpful in determining whether the patient has an upper urinary tract infection (UTI)? a. Suprapubic pain b. Bladder distention c. Foul-smelling urine d. Costovertebral tenderness

d. Costovertebral tenderness

The patient comes to the Urgent Care Unit and describes symptoms of diarrhea, abdominal pain, and low-grade fever. She states she has constant abdominal pain in the right lower quadrant and has lost 25 pounds in the past month. What diagnosis does the nurse suspect? a. Ulcerative colitis b. Diverticulitis c. Peritonitis d. Crohn's disease

d. Crohn's disease

Which serum laboratory value indicates to the nurse that the patient's CKD is getting worse? a. Decreased BUN b. Decreased sodium c. Decreased creatinine d. Decreased calculated glomerular filtration rate (GFR)

d. Decreased calculated glomerular filtration rate (GFR)

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? a. Blood in urine b. Left flank bruising c. Left flank discomfort d. Decreased urine output

d. Decreased urine output

A patient comes to the clinic and reports severe flank pain, bladder distention, and nausea and vomiting with increasingly smaller amounts of urine with frank blood. The patient states, "I have kidney stones and I just need a prescription for pain medication." What is the priority concern in the interdisciplinary care of this patient? a. Controlling the patient's pain b. Checking the quantity of blood in the urine c. Flushing the kidneys with oral fluids d. Determining if there is an obstruction

d. Determining if there is an obstruction

A patient rapidly progressing toward end-stage kidney disease asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that what is a contraindication to kidney transplantation? a. Hepatitis C infection b. Coronary artery disease c. Refractory hypertension d. Extensive vascular disease

d. Extensive vascular disease

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)

A male client with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? A. "A change in position may be what is needed for you to have intercourse with your wife." B. "Have you considered going to see a marriage counselor with your wife?" C. "What has your wife said about your pouch system?" D. "You must get clearance from your health care provider before you attempt to have intercourse."

A. "A change in position may be what is needed for you to have intercourse with your wife."

A patient has been diagnosed with mild GERD and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this patient? A. Avoid caffeine-containing foods and beverages. B. Eat 3 meals each day and avoid snacking between meals C. Peppermint lozenges help to reduce stomach upset D. Sleep on your left side with pillow between your legs.

A. Avoid caffeine-containing foods and beverages.

To prevent pre-renal 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

While caring for a patient with an acute kidney injury, the patient complains of severe weakness and palpitations. The electrocardiogram reveals widening of the QRS complex and an elevated T wave. What complication does the nurse suspect in this patient? A. Hyperkalemia B. Hypercalcemia C. Hypernatremia D. Hyperchloremia

A. Hyperkalemia

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)

What is the nurse's priority when changing the appliance for a patient with an ileal conduit? A. Keep the skin free of urine. B. Inspect the peristomal area. C. Cleanse and dry the area gently. D. Affix the appliance to the faceplate.

A. Keep the skin free of urine.

The healthcare provider is assessing a patient diagnosed with ulcerative colitis. The patient has an altered level of consciousness, fever, and lower abdominal distension. Which of these additional findings would confirm a diagnosis of toxic megacolon? A. Leukocytosis B. Bradycardia C. Constipation D. Splenomegaly

A. Leukocytosis

A patient is experiencing bleeding r/t PUD. Which nursing intervention is highest priority? A. Starting a large-bore IV B. Administering IV pain medication C. Preparing equipment for intubation D. Monitoring the patient's anxiety level

A. Starting a large-bore IV Rationale: A large-bore IV is inserted so that blood products can be administered.

Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level

ANS: D The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters should also be monitored, but they are not directly associated with the patient's current symptoms.

A patient in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? A, Teach the patient about antacid effects and side effects. B. Ask the patient about oral intake, current medications and description of episodes C. Suggest that the patient sleep with the head elevated 6 inches (15 cm0 D. Tell the patient to avoid drinking alcohol late in the evening.

B. Ask the patient about oral intake, current medications and description of episodes

What laboratory value is most likely to indicate renal failure? A) Elevated blood urea nitrogen (BUN) B) Low hemoglobin and hematocrit C) Elevated serum creatinine D) Normal urine osmolarity

C) Elevated serum creatinine

The nurse finds a patient vomiting coffee-ground emesis. On assessment, the patient has a blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thread pulse. Which intervention is the nurse's first priority? A. Administering a histamine2 (H2) antagonist B. Initiating enteral nutrition C. Administering IV fluids D. Administering antianxiety medication

C. Administering IV fluids IV fluids is necessary to treat hypovolemia caused by acute GI bleeding.

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a patient who has acute pancreatitis? A. Calcium B. Bilirubin C. Amylase D. Potassium

C. Amylase Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? A. The client must not consume alcohol. B. Avoid sharing the bathroom with the client. C. Members of the household must not share toothbrushes. D. Drink only bottled water and avoid ice.

C. Members of the household must not share toothbrushes.

The nurse is assessing a patient with acute cholecystitis whose abdominal pain is severe. The patient is pale, is diaphoretic, and describes extreme fatigue. Vital signs are: heart rate of 118/minute, BP 95/70, respirations 32/min, temperature 101F. What is the nurse's priority action at this time? A. Instruct the unlicensed assistive personnel (UAP) to reposition the patient for comfort B. Auscultate the patient's abdomen in all four quadrants C. Notify the healthcare provider D. Administer the ordered opioid analgesics

C. Notify the healthcare provider

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? A. Obtain the charts from the previous admission. B. Listen for bowel sounds in all quadrants. C. Obtain pulse and blood pressure. D. Ask about abdominal pain.

C. Obtain pulse and blood pressure.

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? A. give an IV H2 antagonist B. Call the blood bank C. Insert a nasogastric (NG) tube and connect to suction D. Administer 1 L of Lactated Ringer's solution

D. Administer 1L of Lactated Ringer's solution

Which problem is highest priority for the nurse to identify in the client who had an open cholecystectomy surgery? A. Alteration in nutrition B. Alteration in skin integrity C. Alteration in urinary pattern D. Alteration in comfort

D. Alteration in comfort

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? A. Antibiotic(s) and nonsteroidal anti-inflammatory drugs (NSAIDS) B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), antacid, and corticosteroids D. Antibiotic(s) and proton pump inhibitors

D. Antibiotic(s) and proton pump inhibitors

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a patient's GERD. Which change does the nurse recommend to this patient? A. Eat only two or three meals daily. B. Sleep flat in a left side-lying position. C. Drink tea instead of coffee. D. Avoid working while bent over the computer

D. Avoid working while bent over the computer

The nurse closely monitors the client with acute pancreatitis for which life-threatening complication? A. Jaundice B. Type I diabetes C. Abdominal pain D. Disseminated intravascular coagulation (DIC)

D. Disseminated intravascular coagulation (DIC)

The patient was diagnosed with prerenal AKI. The nurse should know that what is most likely the cause of the patient's diagnosis? A.IV tobramycin (Nebcin) B.Incompatible blood transfusion C.Poststreptococcal glomerulonephritis D.Dissecting abdominal aortic aneurysm

D.Dissecting abdominal aortic aneurysm

A client is admitted to the emergency department following a fall from a horse. The health care provider (HCP) prescribes the insertion of an indwelling urinary catheter. The nurse notes blood at the urinary meatus while preparing for the procedure. Which action should the nurse take? (Saunders: only have answer; see other side)

Notify the HCP

Which nursing action is of highest priority for a 68-year-old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? a. Administer prescribed analgesics. b. Monitor temperature every 4 hours. c. Encourage increased oral fluid intake. d. Give antiemetics as needed for nausea.

a. Administer prescribed analgesics.

A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first? a. Check blood pressure and heart rate. b. Administer morphine sulfate 4 mg IV. c. Transport to radiology for an intravenous pyelogram. d. Insert a urethral catheter and obtain a urine specimen.

a. Check blood pressure and heart rate.

A 51-year-old woman with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? a. Fever b. Nausea c. Joint pain d. Headache

a. Fever

During an acute exacerbation of inflammatory bowel disease, a patient is to receive total parenteral nutrition (TPN) and lipids. Which of these interventions is the priority when caring for this patient? a. Monitor the patient's blood glucose per protocol b. Infuse the solution in a large peripheral vein c. Change the administration set every 72 hours d. Monitor urine specific gravity every shift

a. Monitor the patient's blood glucose per protocol

The nurse is caring for a patient who has hypovolemic shock secondary to trauma. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour? a. Urinary output b. Presence of edema c. Urine color d. Presence of pain

a. Urinary output

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about a. medication use. b. fluid restriction. c. enteral nutrition. d. activity restrictions.

a. medication use.

The nurse cares for a patient complaining of sudden onset of severe right flank pain. The patient is diagnosed with urinary calculi. Which of the following nursing actions has the HIGHEST priority? a) Ensure that the patient remain NPO b) Strain all urine through several layers of gauze c) Assess the patient's grip strength and pupil reactivity d) Obtain a clean-catch urine specimen

b) Strain all urine through several layers of gauze

A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the clients right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

b. Apply an ice pack to the site.

Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance

b. Phosphate level

In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on what? a. Total daily urine output b. Glomerular filtration rate c. Degree of altered mental status d. Serum creatinine and urea levels

b. Glomerular filtration rate

What is the most serious electrolyte disorder associated with kidney disease? a. Hypocalcemia b. Hyperkalemia c. Hyponatremia d. Hypermagnesemia

b. Hyperkalemia

22-year-old female patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider? a. Urinary urgency b. Left-sided flank pain c. Intermittent hematuria d. Burning with urination

b. Left-sided flank pain

A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and the following arterial blood gas results: pH 7.28, PaCO2 30 mm Hg, PaO2 86 mm Hg, HCO3− 18 mEq/L (18 mmol/L). The nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in which value? a. pH b. Potassium level c. Bicarbonate level d. Carbon dioxide level

b. Potassium level

A patient diagnosed with ulcerative colitis is admitted to the medical unit. When assessing the patient, which of these findings would be of the most concern? a. Oral temperature of 99.0 F (37.2 C) b. Rebound tenderness c. Bloody diarrhea d. Borborygmi

b. Rebound tenderness

To detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices, it is most important for the nurse to monitor a. bilirubin levels. b. ammonia levels. c. potassium levels. d. prothrombin time.

b. ammonia levels.

When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

c. Check the calcium level in the chart.

A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. Unlimited fluids are allowed because retained fluid is removed during dialysis. c. More protein is allowed because urea and creatinine are removed by dialysis. d. Dietary potassium is not restricted because the level is normalized by dialysis.

c. More protein is allowed because urea and creatinine are removed by dialysis.

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective? a. The patient reports no chest pain. b. Blood pressure is 140/90 mm Hg. c. Stools test negative for occult blood. d. The apical pulse rate is 68 beats/minute.

c. Stools test negative for occult blood.

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check laboratory results for a. potassium level. b. total cholesterol. c. serum phosphate. d. serum creatinine.

c. serum phosphate.

Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? a. Bladder distention b. Foul-smelling urine c. Suprapubic discomfort d. Costovertebral tenderness

d. Costovertebral tenderness

The client is a 62-year-old admitted 2 days ago with traumatic injuries and hypovolemic shock from a car crash. The nurse reviewing the client's daily laboratory test results notices the following values. Which result is most important to primary heath care providers immediately? A. Serum sodium 132 mEq/L B. Serum potassium 6.9 mEq/L C. BUN 24 mg/dL D. Hematocrit 32% ; hemoglobin 9.2g/dL

B. Serum potassium 6.9 mEq/L

Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis? A. The patient s urine is bright yellow. B. The patient s stools are tan colored. C. The patient has increased pain after eating. D. The patient complains of chronic heartburn.

B. The patients stools are tan colored.

A patient is newly admitted with nephrotic syndrome and has proteinuria, edema, hyperlipidemia, and hypertension. What is the priority for nursing care? a. Consult the dietitian to provide adequate nutritional intake. b. Prevent kidney and urinary tract infection. c. Monitor fluid volume and the patient's hydration status. d. Prepare the patient for a renal biopsy.

c. Monitor fluid volume and the patient's hydration status.

A nurse is teaching a client with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client? A. "Avoid large crowds and anyone who is sick." B. "Do not take the medication if you are allergic to foods with fatty acids." C. "Expect difficulty with wound healing while you are taking this drug." D. "Monitor your blood pressure and report any significant decrease in it."

A. "Avoid large crowds and anyone who is sick." The client should avoid being around large crowds to prevent developing an infection. The client should not take the medication if he or she is allergic to certain proteins. Although immune suppression may occur to some degree, the client should not experience difficulty with wound healing while taking adalimumab. The client should not experience a decrease in blood pressure from taking this drug.

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first? A. A midstream urine for culture. B. A sonogram of the kidney. C. An intravenous pyelogram for renal calculi. D. A CT scan of the kidneys.

A. A midstream urine for culture.

Which urinalysis findings indicate that the patient has a urinary tract infection? Select all that apply. A. Bacteria B. Cloudy urine C. Increased pH D. Presence of red blood cells E. Decreased specific gravity

A. Bacteria B. Cloudy urine D. Presence of red blood cells

To assist the patient with stress incontinence, what is the best thing the nurse should teach the patient to do? a. Void every 2 hours to prevent leakage. b. Use absorptive perineal pads to contain urine. c. Perform pelvic floor muscle exercises 40 to 50 times per day. d. Increase intraabdominal pressure during voiding to empty the bladder completely.

c. Perform pelvic floor muscle exercises 40 to 50 times per day.

Which information will the nurse include when teaching a patient how to avoid chronic constipation (select all that apply)? A. Many over-the-counter (OTC) medications can cause constipation. B. Stimulant and saline laxatives can be used regularly. C. Bulk-forming laxatives are an excellent source of fiber. D. Walking or cycling frequently will help bowel motility. E. A good time for a bowel movement may be after breakfast.

A. Many over-the-counter (OTC) medications can cause constipation. C. Bulk-forming laxatives are an excellent source of fiber. D. Walking or cycling frequently will help bowel motility. E. A good time for a bowel movement may be after breakfast. Stimulant and saline laxatives should be used infrequently. Use of bulk-forming laxatives, regular early morning timing of defecation, regular exercise, and avoiding many OTC medications will help the patient avoid constipation.

A client with diverticulitis has developed peritonitis following diverticular rupture. The nurse should assess the client to determine which of the following? Select all that apply. A. Percuss the abdomen to note resonance and tympany. B. Percuss the liver to note lack of dullness. C. Monitor the vital signs for fever, tachypnea, and bradycardia. D. Assess presence of polyphagia and polydipsia. E. Auscultate bowel sounds to note frequency.

A. Percuss the abdomen to note resonance and tympany. B. Percuss the liver to note lack of dullness. E. Auscultate bowel sounds to note frequency. Assessment during peritonitis will reveal fever, tachypnea, and tachycardia. The abdomen becomes rigid with rebound tenderness and there will be absent bowel sounds. Percussion will show resonance and tympany indicating paralytic ileus; loss of liver dullness may indicate free air in the abdomen. There is anorexia, nausea, and vomiting as peristalsis decreases.

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix). due. Which action should the nurse take? a. Administer both drugs. b. Administer the spironolactone. c. Withhold the spironolactone and administer the furosemide. d. Withhold both drugs until discussed with the health care provider.

ANS: B Spironolactone is a potassium-sparing diuretic and will help increase the patient's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider.

The nurse is caring for a client with a bleeding duodenal ulcer who was admitted to the hospital after vomiting bright, red blood. Which condition does the nurse anticipate when the client develops a sudden, sharp pain in the midepigastric region and a rigid, board-like abdomen? A. Pancreatitis B. Ulcer perforation C. Small bowel obstruction D. Development of additional ulcers

B. Ulcer perforation The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in board-like abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation.

When taking a nursing history from a pt with BPH, the nurse would expect the pt to report: a. nocturia, dysuria, and bladder spasms b. urinary frequency, hematuria, and perineal pain c. urinary hesitancy, postvoid dribbling, and weak urinary stream d. urinary urgency with a forceful urinary stream and cloudy urine

c. urinary hesitancy, postvoid dribbling, and weak urinary stream

A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about A. substitution of acetaminophen (Tylenol) for the NSAID B. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa C. reasons for using corticosteroids to treat the rheumatoid arthritis D. use of enteric-coated NSAIDs to reduce gastric irritation

B. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa

The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 beaths/min. Which admission request does the nurse implement first? A. Type and crossmatch for 4 units of packed RBCs B. Infuse 0.9% normal saline solution at 200 mL/hr C. Give pantoprazole (Protonix) 49 mg IV now and then daily D. Insert a NG tube and connect to low intermittent suction

B. Infuse 0.9% normal saline solution at 200 mL/hr Rationale: The nurse must first infuse 0.9% normal saline solution at 200 mL/hr for the patient with acute gastric bleeding and hypotension associated with volume loss. The nurse's immediate concern is correcting the hypovolemia. A type of crossmatch, administration of pantoprazole, and insertion of NG tube must all be done eventually.

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness

d. Muscle twitching and finger numbness (hypocalcemia)

A patient in the emergency department has just been diagnosed with peritonitis caused by a ruptured diverticulum. Which prescribed intervention will the nurse implement first? A. Insert a urinary catheter to drainage. B. Infuse metronidazole (Flagyl) 500 mg IV. C. Send the patient for a computerized tomography scan. D. Place a nasogastric (NG) tube to intermittent low suction.

B. Infuse metronidazole (Flagyl) 500 mg IV. Because peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated.

The nurse is caring for a patient with second- and third-degree burns to 50% of the body. The nurse prepares fluid resuscitation based on knowledge of the Parkland (Baxter) formula that includes which of the following recommendations? A. The total 24-hour fluid requirement should be administered in the first 8 hours. B. One half of the total 24-hour fluid requirement should be administered in the first 8 hours. C. One third of the total 24-hour fluid requirement should be administered in the first 4 hours. D. One half of the total 24-hour fluid requirement should be administered in the first 4 hours.

B. One half of the total 24-hour fluid requirement should be administered in the first 8 hours. Fluid resuscitation with the Parkland (Baxter) formula recommends that one half of the total fluid requirement should be administered in the first 8 hours, one quarter of total fluid requirement should be administered in the second 8 hours, and one quarter of total fluid requirement should be administered in the third 8 hours.

A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. Which diagnosis does the nurse expect? A.Starvation B. Pancreatitis C. Systemic sepsis D. Diabetic ketoacidosis

B. Pancreatitis

Which information will the nurse monitor in order to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? A. Blood pressure B. Phosphate level C. Neurologic status D. Creatinine clearance

B. Phosphate level

A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patient's discharge education, what is the most plausible nursing diagnosis that the nurse should address? A) Impaired mobility related to limitations posed by the ileal conduit B) Deficient knowledge related to care of the ileal conduit C) Risk for deficient fluid volume related to urinary diversion D) Risk for autonomic dysreflexia related to disruption of the sacral plexus

B) Deficient knowledge related to care of the ileal conduit

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. "Should we filter air circulation?" B. "Can we use less radiographic contrast dye?" C. "Should we add low-dose dobutamine?" D. "Should we decrease IV rates?"

B. "Can we use less radiographic contrast dye?"

The nurse identifies that which patient is at highest risk for developing colon cancer? A. A 28-year-old male who has a body mass index of 27 kg/m2 B. A 32-year-old female with a 12-year history of ulcerative colitis C. A 52-year-old male who has followed a vegetarian diet for 24 years D. A 58-year-old female taking prescribed estrogen replacement therapy

B. A 32-year-old female with a 12-year history of ulcerative colitis Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity (body mass index ≥ 30 kg/m2); family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, hereditary nonpolyposis colorectal cancer syndrome; red meat (=7 servings/week); cigarette use; and alcohol (=4 drinks/week).

The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition? A. Ecchymoti peripheral IV site B. Heart rate 110. respiratory rate 26, BP 90/55 C. Guaiac-positive diarrhea stools D. Nausea

B. Heart rate 110, respiratory rate 26, BP 90/55 (hypovolemic shock)

Which assessment finding is a consequence of the oliguric phase of AKI? A. Hypovolemia B. Hyperkalemia C. Hypernatremia D.Thrombocytopenia

B. Hyperkalemia

Which findings from a urinalysis indicate the presence of a urinary tract infection (UTI)? Select all that apply. A. Casts B. Red blood cells C. White blood cells D. Combination of a positive leukocyte esterase and nitrate F. Presence of more than 20 epithelial cells/high-power field

B. Red blood cells C. White blood cells D. Combination of a positive leukocyte esterase and nitrate

The nurse is assessing a client's alcohol intake to determine whether it is the underlying cause of the client's attacks of pancreatitis. Which question does the nurse ask to elicit this information? A. "Do you usually binge drink?" B. "Do you tend to drink more on holidays or weekends?" C. "Tell me more about your alcohol intake." D. "Estimate how many episodes of binge drinking you do in a week."

C. "Tell me more about your alcohol intake."

The nurse is reviewing the medication history for a patient diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole (Nexium) once daily. The patient reports that this proton pump inhibitor medication doesn t completely control the symptoms. The nurse contacts the primary health care provider to discuss which intervention? A. Adding a second proton pump inhibitor medication B. Increasing the dose of esomeprazole C. Changing to a twice-daily dosing regimen D. Switching to omeprazole (Prilosec)

C. Changing to a twice-daily dosing regimen

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell (WBC) count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

C. Elevated lipase, elevated white blood cell (WBC) count, elevated glucose

A client's ulcerative colitis signs and symptoms have been present for longer than 1 week. The nurse should assess the client for signs and symptoms of which of the following complications? A. Heart failure. B. Deep vein thrombosis. C. Hypokalemia. D. Hypocalcemia

C. Hypokalemia.

The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? A. Administer heparin intravenously. B. Remove the urinary catheter. C. Notify the health care provider. D. Irrigate the catheter with sterile saline.

C. Notify the health care provider. Bleeding and/or blood clots are potential complications of cystoscopy and may obstruct the catheter and decrease urine output. The nurse should monitor urine output and notify the health care provider of obvious blood clots or a decreased or absent urine output. Heparin will not be administered due to bleeding. The urinary catheter is allowing close monitoring of the urinary system and should not be removed at this time. The Foley catheter may be irrigated with sterile saline, as ordered.

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalance? A. hyperkalemia and hyponatremia B. hyperkalemia and hypernatremia C. hypokalemia and hyponatremia D. hypokalemia and hypernatremia

C. hypokalemia and hyponatremia

When the nurse caring for a client with severe chronic kidney disease asks what dietary modifications he has made for the disease, he reports the following actions. Which action indicates to the nurse that additional client education is needed? A. Using a scale to measure protein weight B. Taking calcium and vitamin D supplements daily C. Eliminating bananas, citrus fruits, and avocados D. Using a salt-substitute instead of ordinary table salt

D. Using a salt-substitute instead of ordinary table salt

Which interventions does the nurse expect to implement when caring for a patient with diverticulitis? (Select all that apply.) a. Laxative and enemas as ordered b. IV fluids to prevent dehydration c. Broad-spectrum antibiotics d. Teach the patient to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe

b. IV fluids to prevent dehydration c. Broad-spectrum antibiotics d. Teach the patient to refrain from lifting or straining e. Keep the patient NPO if symptoms are severe

32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for a. renal failure. B. kidney stones. C. pyelonephritis. D. bladder cancer.

D. bladder cancer. Exposure to the chemicals involved with working as a hairdresser and in smoking both increase the risk of bladder cancer, and the nurse should assess whether the patient understands this risk. The patient is not at increased risk for renal failure, pyelonephritis, or kidney stones.

All of the following are causes of chronic pancreatitis except for: A.Alcoholism B.Immunoglobulin destruction C.Gallstones D.Drug use

D.Drug use

A patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse implement first? a. Infuse normal saline at 50 mL/hr. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Schedule pelvic magnetic resonance imaging

b. Insert a urinary retention catheter.

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take first? A. Notify the patient's health care provider. B. Document the QRS interval measurement. C. Review the chart for the patient's current creatinine level. D. Check the medical record for the most recent potassium level.

D. Check the medical record for the most recent potassium level.

Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. Patient with diabetes mellitus b. Patient with hypertensive crisis c. Patient who tried to overdose on acetaminophen d. Patient with major surgery who required a blood transfusion

d. Patient with major surgery who required a blood transfusion

The nurse is providing care for a patient admitted to the hospital for treatment of nephrotic syndrome. What are the priority nursing assessments? A. Assessment of pain and level of consciousness B. Assessment of serum calcium and phosphorus levels C. Blood pressure and assessment for orthostatic hypotension D. Daily weights and measurement of the patient's abdominal girth

D. Daily weights and measurement of the patient's abdominal girth

The nurse reviews a medication history for a patient newly diagnosed with PUD who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary HCP will request which medication for this patient? A. Bismuth subsalicylate (Pepto-Bismol) B. Magnesium hydroxide (Maalox) C. Metronidazole (Flagyl) D. Misoprostol (Cytotec)

D. Misoprostol (Cytotec)

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

Which of the following assessment findings would lead the nurse to suspect the client has nephrotic syndrome? A. Renal colic and increased serum sodium B. Proteinuria and generalized edema C. Hematuria and anemia D. Proteinuria and generalized edema

D. Proteinuria and generalized edema

Why are adenomatous polyps removed during a colonoscopy? A. They eventually cause intestinal obstruction. B. They are prone to bleeding and lead to anemia. C. They lead to familial adenomatous polyposis (FAP). D. They are closely linked to colorectal cancer.

D. They are closely linked to colorectal cancer.

Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? A. "Peppermint tea may reduce your symptoms." B. "You should avoid eating between meals to reduce acid secretion." C. "Vigorous physical activities may increase the incidence of reflux." D. "Keep the head of your bed elevated on blocks."

D. "Keep the head of your bed elevated on blocks."

Glomerulonephritis DEFINITION:

Glomerulonephritis is not an infection but rather an antibody-induced injury to the glomerulus, where either autoantibodies against the glomerular basement membrane (GBM) directly damage the tissue or antibodies reacting with nonglomerular antigens are randomly deposited as immune complexes along the GBM. Prior infection by bacteria or viruses may stimulate the antibody production but is not present or active at the time of glomerular damage.

Notecard: Lab values for renal failure

Highlights: -Creatinine: increased -Potassium: increased -Magnesium: Increased -Overall osmolarity: Increased -Calcium: Decreased -pH: Decreased or normal -serum and paCO2: decreased (bc metabolic acidosis) -HCO3-: decreased (bc metabolic acidosis) -Hbg & hct: decreased (kidneys can't make EPO)

What findings on urinalysis are indicative of cystitis? (don't have all the options; see other side for answers)

Pyuria (neutrophils in the urine) Bacteriuria Hematuria Positive leukocyte esterase and/or nitrite dipstick NO casts (only seen with actual kidney issues)

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which of the following factors in the patient's history increases the patient's risk for colorectal cancer? a. Osteoarthritis b. History of rectal polyps c. History of lactose intolerance d. Use of herbs as dietary supplements

b. History of rectal polyps

An older male comes to the emergency room with a history of urinary frequency, urgency, and low back pain. The nurse recognizes that these are symptoms of which of the following? a) Benign prostatic hypertrophy b) Herniated intervertebral disk c) Kidney stones d) Renal failure

a) Benign prostatic hypertrophy

A young woman tells the nurse that she gets frequent urinary tract infections that seem to follow sexual intercourse. Which questions would the nurse ask? Select all that apply. a. "Do you use a diaphragm or spermicides for contraception?" b. "Do you feel guilty or embarrassed about your sexual activities?" c. "Have you considered abstaining from intercourse?" d. "Do you and your partner(s) wash the perineal area before intercourse?" e. "Some positions cause more irritation during sex. Have you noticed this?" f. "Do you and your partner(s) ever engage in anal intercourse?"

a. "Do you use a diaphragm or spermicides for contraception?" d. "Do you and your partner(s) wash the perineal area before intercourse?" e. "Some positions cause more irritation during sex. Have you noticed this?"

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? a. "Have you tried using the toilet at least every couple of hours?" b. "How does that make you feel?" c. "We can fix that." d. "That happens when we get older."

a. "Have you tried using the toilet at least every couple of hours?"

After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)? a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about α-interferon therapy. d. Give hepatitis B immune globulin. e. Teach about choices for oral antiviral therapy.

a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. d. Give hepatitis B immune globulin. The recommendations for hepatitis B exposure include both vaccination and immune globulin administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis.

A 23-year-old has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? a. Asterixis and lethargy b. Jaundiced sclera and skin c. Elevated total bilirubin level d. Liver 3 cm below costal margin

a. Asterixis and lethargy

ch 66 q 67 The urine output of a patient with a kidney stone has decreased from 40 mL/hr to 5 mL/hr. What is the nurse's priority action? a. Check patency of IV access and notify the health care provider. b. Perform the Credé maneuver on the patient's bladder. c. Test the urine for ketone bodies. d. Document the finding and continue monitoring.

a. Check patency of IV access and notify the health care provider.

A patient who is diagnosed with nephrotic syndrome has 3+ ankle and leg edema and ascites. Which nursing diagnosis is a priority for the patient? a. Excess fluid volume related to low serum protein levels b. Activity intolerance related to increased weight and fatigue c. Disturbed body image related to peripheral edema and ascites d. Altered nutrition: less than required related to protein restriction

a. Excess fluid volume related to low serum protein levels

A nurse assesses a client who has had two episodes of bacterial cystitis in the last 6 months. Which questions should the nurse ask? (Select all that apply.) a. How much water do you drink every day? b. Do you take estrogen replacement therapy? c. Does anyone in your family have a history of cystitis? d. Are you on steroids or other immune-suppressing drugs? e. Do you drink grapefruit juice or orange juice daily?

a. How much water do you drink every day? b. Do you take estrogen replacement therapy? d. Are you on steroids or other immune-suppressing drugs Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis.

A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's blood pressure (BP). c. Instruct the patient to avoid high-potassium foods. d. Call the lab and request a redraw of the lab to verify results.

a. Place the patient on a cardiac monitor.

A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.) a. I can continue to take antacids to relieve heartburn. b. I need to ask for an antibiotic when scheduling a dental appointment. c. Ill need to check my blood sugar often to prevent hypoglycemia. d. The dose of my pain medication may have to be adjusted. e. I should watch for bleeding when taking my anticoagulants.

b. I need to ask for an antibiotic when scheduling a dental appointment. c. Ill need to check my blood sugar often to prevent hypoglycemia. d. The dose of my pain medication may have to be adjusted. e. I should watch for bleeding when taking my anticoagulants.

The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement? a. "I can expect yellow-green drainage from the incision for a few days." b. "I can remove the bandages on my incisions tomorrow and take a shower." c. "I should plan to limit my activities and not return to work for 4 to 6 weeks." d. "I will need to maintain a low-fat diet for life because I no longer have a gallbladder."

b. "I can remove the bandages on my incisions tomorrow and take a shower."

The community nurse is talking with a group of individuals about colorectal cancer (CRC) risk factors. Which community participant is at the highest risk for development of CRC? a. 23-year-old vegetarian b. 30-year old with Crohn's disease c. 39-year old with no family history of cancer d. 46-year old with genetic predisposition to cancer

b. 30-year old with Crohn's disease

A nurse receives new prescriptions for a client with severe burn injuries who is receiving fluid resuscitation per the Parkland formula. The clients urine output continues to range from 0.2 to 0.25 mL/kg/hr. Which prescription should the nurse question? a. Increase intravenous fluids by 100 mL/hr. b. Administer furosemide (Lasix) 40 mg IV push. c. Continue to monitor urine output hourly. d. Draw blood for serum electrolytes STAT.

b. Administer furosemide (Lasix) 40 mg IV push. The plan of care for a client with a burn includes fluid and electrolyte resuscitation. Furosemide would be inappropriate to administer. Postburn fluid needs are calculated initially by using a standardized formula such as the Parkland formula. However, needs vary among clients, and the final fluid volume needed is adjusted to maintain hourly urine output at 0.5 mL/kg/hr. Based on this clients inadequate urine output, fluids need to be increased, urine output needs to be monitored hourly, and electrolytes should be evaluated to ensure appropriate fluids are being infused.

Which characteristics pertain to Crohn's disease (CD)? Select all that apply. a. It begins in the rectum and proceeds in a continuous manner toward the cecum. b. Fistulas commonly develop. c. There are five to six soft, loose, nonbloody stools per day. d. There is an increased risk of colon cancer. e. Some patients experience extraintestinal manifestations such as migratory polyarthritis, ankylosing spondylitis, and erythema nodosum. f. There is a cobblestone appearance of the internal intestine.

b. Fistulas commonly develop. c. There are five to six soft, loose, nonbloody stools per day. f. There is a cobblestone appearance of the internal intestine.

The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.) a. I need to decrease sodium, cholesterol, and protein in my diet. b. My weight should be maintained at a body mass index of 30. c. Smoking should be stopped as soon as I possibly can. d. I can continue to take an aspirin every 4 to 8 hours for my pain. e. I really only need to drink a couple of glasses of water each day.

b. My weight should be maintained at a body mass index of 30. d. I can continue to take an aspirin every 4 to 8 hours for my pain. e. I really only need to drink a couple of glasses of water each day.

The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the clients abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs.

b. Notify the health care provider immediately.

A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a shift to the left in a clients white blood cell count. Which action should the nurse take? a. Request that the laboratory perform a differential analysis on the white blood cells. b. Notify the provider and start an intravenous line for parenteral antibiotics. c. Collaborate with the unlicensed assistive personnel (UAP) to strain the clients urine for renal calculi. d. Assess the client for a potential allergic reaction and anaphylactic shock.

b. Notify the provider and start an intravenous line for parenteral antibiotics.

nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a shift to the left in a clients white blood cell count. Which action should the nurse take? a. Request that the laboratory perform a differential analysis on the white blood cells. b. Notify the provider and start an intravenous line for parenteral antibiotics. c. Collaborate with the unlicensed assistive personnel (UAP) to strain the clients urine for renal calculi. d. Assess the client for a potential allergic reaction and anaphylactic shock.

b. Notify the provider and start an intravenous line for parenteral antibiotics.

A patient returns to the clinic with recurrent dysuria after being treated with trimethoprim and sulfamethoxazole (Bactrim) for 3 days. Which action will the nurse plan to take? a. Remind the patient about the need to drink 1000 mL of fluids daily. b. Obtain a midstream urine specimen for culture and sensitivity testing. c. Teach the patient to take the prescribed Bactrim for at least 3 more days. d. Suggest that the patient use acetaminophen (Tylenol) to treat the symptoms.

b. Obtain a midstream urine specimen for culture and sensitivity testing.

The nurse is reviewing the patient's history, assessment findings, and laboratory results for a patient with suspected kidney problems. Which manifestation is the main feature of nephrotic syndrome? a. Abrupt onset flank asymmetry b. Proteinuria greater than 3.5 g in 24 hours c. Serum sodium greater than 148 mmol/L d. Serum cholesterol (total) 190 mg/dL

b. Proteinuria greater than 3.5 g in 24 hours

A 68-year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2 mEq/L (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum HCO3- is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. Loop diuretics b. Renal replacement therapy c. Insulin and sodium bicarbonate d. Sodium polystyrene sulfonate (Kayexalate)

b. Renal replacement therapy

The nurse is caring for a client who has just been prescribed a glucocorticoid to treat an exacerbation of ulcerative colitis. What teaching will the nurse provide? a. Decrease the drug dose during the next exacerbation. b. Report fever to healthcare provider immediately. c. Determine if the client's insurance covers payment for this medication. d. This drug will act as an antidiarrheal.

b. Report fever to healthcare provider immediately.

The client is a 62-year-old admitted 2 days ago with traumatic injuries and hypovolemic shock from a car crash. The nurse reviewing the client's daily laboratory test results notices the following values. Which result is most important to report to the health care provider immediately? a. Serum sodium 132 mEq/L (mmol/L) b. Serum potassium 6.9 mEq/L (mmol/L) c. Blood urea nitrogen 24 mg/dL (mmol/L) d. Hematocrit 32% (0.32 volume fraction); hemoglobin 9.2 g/dL (92 g/L)

b. Serum potassium 6.9 mEq/L (mmol/L)

A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider? a. Serum creatinine level 2.1 mg/dL b. Serum potassium level 6.5 mEq/L c. White blood cell count 11,500/µL d. Blood urea nitrogen (BUN) 56 mg/dL

b. Serum potassium level 6.5 mEq/L

In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. Hematuria b. Specific gravity fixed at 1.010 c. Urine sodium of 12 mEq/L (12 mmol/L) d. Osmolality of 1000 mOsm/kg (1000 mmol/kg)

b. Specific gravity fixed at 1.010

The nurse is caring for a 73-year-old man who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? a. The patient complains of right upper-quadrant pain with palpation. b. The patient's hands flap back and forth when the arms are extended. c. The patient has ascites and a 2-kg weight gain from the previous day. d. The patient's skin has multiple spider-shaped blood vessels on the abdomen.

b. The patient's hands flap back and forth when the arms are extended.

Q21 Ch 66 The nurse is reviewing the laboratory results for an older adult patient with an indwelling catheter. The urine culture is pending, but the urinalysis shows greater than 105 colony- forming units, and the differential white blood cell count shows a "left shift." The nurse will monitor for additional signs/symptoms associated with which condition? a. Interstitial cystitis b. Urosepsis c. Complicated cystitis d. Bladder cancer

b. Urosepsis

To detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices, it is most important for the nurse to monitor a. bilirubin levels. b. ammonia levels. c. potassium levels. d. prothrombin time.

b. ammonia levels.

A patient with peptic ulcer disease associated with the presence of Helicobacter pylori is treated with triple drug therapy. The nurse will plan to teach the patient about a. sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol). b. amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec). c. famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix). d. metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan).

b. amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec). The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.

A patient with nephrotic syndrome develops flank pain. The nurse will anticipate teaching the patient about treatment with a. antibiotics. b. anticoagulants. c. corticosteroids. d. antihypertensives.

b. anticoagulants. Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery.

b. discontinue the patient's oral food intake.

A patient who had surgery for creation of an ileal conduit 3 days ago will not look at the stoma and requests that only the ostomy nurse specialist does the stoma care. The nurse identifies a nursing diagnosis of a. anxiety related to effects of procedure on lifestyle. b. disturbed body image related to change in function. c. readiness for enhanced coping related to need for information. d. self-care deficit (toileting) related to denial of altered body function.

b. disturbed body image related to change in function.

The health care provider prescribes finasteride (Proscar) for a patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

b. his interest in sexual activity may decrease while he is taking the medication.

When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first? a. insert a urinary retention catheter b. place the pt on a cardiac monitor c. administer epoetin alfa (epogen, procrit) d. give sodium polystyrene sulfonate (Kayexalate)

b. place the pt on a cardiac monitor

Teaching in relation to home management after a laparoscopic cholecystectomy should include a. keeping the bandages on the puncture sites for 48 hours. b. reporting any bile-colored drainage or pus from any incision. c. using over-the-counter antiemetics if nausea and vomiting occur. d. emptying and measuring the contents of the bile bag from the T tube every day.

b. reporting any bile-colored drainage or pus from any incision. Rationale: The following discharge instructions are taught to the patient and caregiver after a laparoscopic cholecystectomy: First, remove the bandages on the puncture site the day after surgery and shower. Second, notify the surgeon if any of the following signs and symptoms occur: redness, swelling, bile-colored drainage or pus from any incision; and severe abdominal pain, nausea, vomiting, fever, or chills. Third, gradually resume normal activities. Fourth, return to work within 1 week of surgery. Fifth, resume a usual diet, but a low-fat diet is usually better tolerated for several weeks after surgery.

When the nurse is caring for a patient who has been admitted with a severe crushing injury after an industrial accident, which laboratory result will be most important to report to the health care provider? a. serum creatinine level 2.1 mg/dL b. serum potassium level 6.5 mEq/L c. WBC 11,500/uL d. BUN 56 mg/dL

b. serum potassium level 6.5 mEq/L

A female patient with a suspected urinary tract infection (UTI) is to provide a clean-catch urine specimen for culture and sensitivity testing. To obtain the specimen, the nurse will a. have the patient empty the bladder completely, then obtain the next urine specimen that the patient is able to void. b. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup. c. insert a short sterile "mini" catheter attached to a collecting container into the urethra and bladder to obtain the specimen. d. clean the area around the meatus with a povidone-iodine (Betadine) swab, and then have the patient void into a sterile container.

b. teach the patient to clean the urethral area, void a small amount into the toilet, and then void into a sterile specimen cup.

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? a. Antibiotic(s), antacid, and corticosteroid b. Antibiotic(s), aspirin, and antiulcer/protectant c. Antibiotic(s), proton pump inhibitor, and bismuth d. Antibiotic(s) and nonsteroidal anti-inflammatory drugs (NSAIDs)

c. Antibiotic(s), proton pump inhibitor, and bismuth To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

A client reports ongoing episodes of heartburn. The nurse educates the client on prevention and control of reflux by recommending dietary elimination of which food item? a. Lean steak b. Carrot sticks c. Chocolate candy d. Air-popped popcorn

c. Chocolate candy Foods that decrease esophageal sphincter pressure, such as fatty food, caffeine, and chocolate, should be avoided.

A 72-year-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? a. Patient has not voided for the last 4 hours. b. Skin is dry with poor turgor on all extremities. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the last 6 hours.

c. Crackles are heard halfway up the posterior chest.

During a routine screening colonoscopy on a 56-year-old patient, a rectosigmoidal polyp was identified and removed. The patient asks the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse? a. "It is very rare for polyps to become malignant but you should continue to have routine colonoscopies." b. "Individuals with polyps have a 100% lifetime risk of developing colorectal cancer and at an earlier age than those without polyps." c. "All polyps are abnormal and should be removed but the risk for cancer depends on the type and if malignant changes are present." d. "All polyps are premalignant and a source of most colon cancer. You will need to have a colonoscopy every 6 months to check for new polyps."

c. "All polyps are abnormal and should be removed but the risk for cancer depends on the type and if malignant changes are present."

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first? a. 40-year-old with chronic pancreatitis who has gnawing abdominal pain b. 58-year-old who has compensated cirrhosis and is complaining of anorexia c. 55-year-old with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) d. 36-year-old recovering from a laparoscopic cholecystectomy who has severe shoulder pain

c. 55-year-old with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)

A patient with severe burns has crystalloid fluid replacement ordered using the Parkland formula. The initial volume of fluid to be administered in the first 24 hours is 30,000 mL. The initial rate of administration is 1875 mL/hr. After the first 8 hours, what rate should the nurse infuse the IV fluids? a. 350 mL/hour b. 523 mL/hour c. 938 mL/hour d. 1250 mL/hour

c. 938 mL/hour Half of the fluid replacement using the Parkland formula is administered in the first 8 hours and the other half over the next 16 hours. In this case, the patient should receive half of the initial rate, or 938 mL/hr.

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care? a. Restrict daily dietary protein intake. b. Reposition the patient every 4 hours. c. Perform passive range of motion twice daily. d. Place the patient on a pressure-relief mattress.

d. Place the patient on a pressure-relief mattress. The pressure-relieving mattress will decrease the risk for skin breakdown for this patient. Adequate dietary protein intake is necessary in patients with ascites to improve oncotic pressure. Repositioning the patient every 4 hours will not be adequate to maintain skin integrity. Passive range of motion will not take the pressure off areas such as the sacrum that are vulnerable to breakdown.

What indicates to the nurse that a patient with oliguria has prerenal oliguria? a. Urine testing reveals a low specific gravity. b. Causative factor is malignant hypertension. c. Urine testing reveals a high sodium concentration. d. Reversal of oliguria occurs with fluid replacement.

d. Reversal of oliguria occurs with fluid replacement.

After teaching a client who has a history of cholelithiasis, the nurse assesses the clients understanding. Which menu selection made by the client indicates the client clearly understands the dietary teaching? a. Lasagna, tossed salad with Italian dressing, and low-fat milk b. Grilled cheese sandwich, tomato soup, and coffee with cream c. Cream of potato soup, Caesar salad with chicken, and a diet cola d. Roasted chicken breast, baked potato with chives, and orange juice

d. Roasted chicken breast, baked potato with chives, and orange juice

A patient with a history of kidney stones presents with severe flank pain, nausea, vomiting, pallor, and diaphoresis. He reports freely passing urine, but it is bloody. What is the priority concern? a. Possible hemorrhage b. Impaired tissue perfusion c. Impaired urinary elimination d. Severe pain

d. Severe pain

What accurately describes the care of the patient with CKD? a. A nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable is iron. b. The syndrome that includes all of the signs and symptoms seen in the various body systems in CKD is azotemia. c. The use of morphine is contraindicated in the patient with CKD because accumulation of its metabolites may cause seizures. d. The use of calcium-based phosphate binders in the patient with CKD is contraindicated when serum calcium levels are increased.

d. The use of calcium-based phosphate binders in the patient with CKD is contraindicated when serum calcium levels are increased.

Which test is required for a diagnosis of pyelonephritis? a. Renal biopsy b. Blood culture c. Intravenous pyelogram (IVP) d. Urine for culture and sensitivity

d. Urine for culture and sensitivity

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy

d. Willingness to adhere to drug therapy

After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first? a. document the QRS interval b. notify the pts HCP c. look at the pts current BUN and creatinine levels d. check the chart for the most recent blood potassium level

d. check the chart for the most recent blood potassium level The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.

A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should a. notify the physician. b. notify the charge nurse. c. irrigate the drainage tube. d. document it as a normal observation

d. document it as a normal observation

When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about a. nausea. b. flank pain. c. poor urine output. d. pain with urination.

d. pain with urination.

When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about a. nausea. b. flank pain. c. poor urine output. d. pain with urination.

d. pain with urination. Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI.

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for: a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations.

d. rapid respirations.

When assessing a patient with acute pancreatitis, the nurse would expect to find a. hyperactive bowel sounds. b. hypertension and tachycardia. c. a temperature greater than 102°F (38.9°C). d. severe midepigastric or left upper quadrant (LUQ) pain

d. severe midepigastric or left upper quadrant (LUQ) pain