PRACTICE URINARY HESI TEST

A client weighed 210 pounds on admission to the hospital. After two days of diuretic therapy, the client weighs 205.5 pounds. How many liters of fluid has the client excreted? Record the answer using a whole number. Record your answer using a whole number. __________ liters

One liter of fluid weighs approximately 2.2 pounds; therefore, a 4.5-pound weight loss equals approximately 2 liters.

A nurse is caring for a client with an indwelling urinary catheter. What is the most important action for the nurse to implement when irrigating the bladder? 1 Use sterile equipment. 2 Instill the fluid under high pressure. 3 Warm the solution to body temperature. 4 Aspirate immediately to ensure return flow

1 The bladder is a sterile body cavity; when introducing a solution/catheter, surgical asepsis is required. Excessive pressure can traumatize the lining of the urinary tract. The solution generally is administered at room temperature. Aspirating immediately to ensure return flow is done if the fluid does not return by gravity; the negative pressure exerted during aspiration may cause trauma.

A client is admitted to the hospital with a ureteral calculus. The nurse expects what urinary clinical findings? 1 Urgency and mild aching pain 2 Foul odor and dark urine 3 Hematuria with sharp pain when voiding 4 Frequency with small amounts of urine

3 Hematuria and pain may result from damage to the ureteral lining as the calculus moves down the urinary tract; the urine may become cloudy or pink tinged. Although severe pain may be present, urgency is not associated with renal calculi; urgency may be associated with an enlarged prostate, cystitis, or other genitourinary problems. The odor of urine is not foul with this condition; the color of urine is not dark with this condition, although it may be cloudy, pink, or red from hematuria. Frequency may occur when the calculus reaches the bladder.

The nurse should ask the client with secondary syphilis about sexual contacts during the past: 1 21 days 2 30 days 3 Three months 4 Six months

4 The client is in the secondary stage, which begins from six weeks to six months after primary contact; therefore, a six-month history is needed to ensure that all possible contacts are located. Any time less than six months may miss contacts that may have become infected.

Before a transurethral resection of the prostate (TURP), a client asks about what to expect postoperatively. The most appropriate response by the nurse is: 1 "You will have an abdominal incision and a dressing." 2 "Your urine will be pink and free of clots." 3 "There will be an incision between your scrotum and rectum." 4 "There will be an indwelling urinary catheter and a continuous bladder irrigation in place."

4 The presence of an indwelling urinary catheter and a continuous bladder irrigation are routine postoperative expectations after a TURP; they provide for hemostasis and urinary excretion. An abdominal incision and dressing are present with a suprapubic, not transurethral, prostatectomy. After a TURP the client initially can expect hematuria and some blood clots; the continuous bladder irrigation keeps the bladder free of clots and the catheter patent. An incision between the scrotum and rectum is associated with a perineal prostatectomy, not a TURP. Test-Taking Tip: A psychological technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, "I know the material, and I'll do well on the test." Try it; many students have found that it works because it reduces "test anxiety."

A nurse instructs a client with a history of frequent urinary tract infections to drink cranberry juice to: 1 Decrease the urinary pH 2 Exert a bactericidal effect 3 Improve glomerular filtration 4 Relieve the symptoms of dysuria

1 Cranberry juice is excreted as hippuric acid, which helps acidify the urine (decrease the pH) and inhibit bacterial growth. Although bacterial growth may be inhibited, bacteria are not destroyed. Glomerular filtration is unaffected by cranberry juice. Cranberry juice acidifies the urine and may increase the burning sensation associated with urination when an infection is present.

A nurse is caring for a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis. What dietary need should the nurse discuss with the client? 1 Low-calorie foods 2 High-quality protein 3 Increased fluid intake 4 Foods rich in potassium

2 Although proteins may be restricted, those eaten should be high-quality proteins that are used to replace proteins lost during dialysis. A high-caloric intake should be encouraged. Increased fluid intake is inappropriate; fluids usually are restricted moderately because of impaired renal function. Foods rich in potassium are inappropriate; high-potassium foods are restricted because of impaired renal function.

A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information? 1 Low purine 2 Low calcium 3 High phosphorus 4 High alkaline ash

2 Calcium and phosphorus are components of these stones; foods high in calcium and phosphorus should be avoided. Low purine and high alkaline ash diets are indicated for clients with gout. Foods high in phosphorus must be avoided. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.

An older adult client is admitted to the hospital with a diagnosis of chronic kidney disease. The nurse reviews the client's medical record. Which clinical finding is a priority to be communicated to the primary health care provider? (SODIUM 135, POTASSIUM 6, HEMOGLOBIN 8.5, CREATININE 20, C/O LETHARGY AND FATIGUE, T 99, P84, R 24, B/P 150/100) 1 Sodium level 2 Potassium level 3 Creatinine results 4 Elevated blood pressure

2 The potassium is increased outside the expected range for an adult, which places the client at risk for a cardiac dysrhythmia; the increased potassium level must be treated immediately because elevated levels can be lethal. A serum sodium of 135 mEq/L is expected because of the electrolyte imbalance and the anemia related to the decreased production of erythropoietin by the kidney in the presence of chronic kidney failure. A creatinine clearance of

1. Which statement regarding treatment with interferon indicates that the client understands the nurse's teaching? 1 "I will drink two to three quarts of fluid a day." 2 "Any reconstituted solution must be discarded in one week." 3 "I can continue driving my car as long as I have the stamina." 4 "While taking this medicine I should be able to continue my usual activity."

1 Adequate fluid intake helps to flush the kidneys and prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution may be stored in the refrigerator for one month. Confusion, dizziness, and hallucinations are side effects of this drug; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flu-like symptoms are common with this drug

A nurse is assessing the urine of a client with a urinary tract infection. For which characteristic should the nurse assess each specimen of urine? 1 Clarity 2 Viscosity 3 Glucose level 4 Specific gravity

1 Cloudy urine usually indicates purulent drainage (pyuria) associated with infection. Viscosity is a characteristic that is not measurable. Urinary glucose levels are not affected by urinary tract infections. Specific gravity yields information related to fluid balance.

A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. The nurse informs the client that one of the substances passing through the membrane is: 1 Blood 2 Sodium 3 Glucose 4 Bacteria

2 Sodium is an electrolyte that passes through the semipermeable membrane during hemodialysis. Red blood cells do not pass through the semipermeable membrane during hemodialysis. Glucose does not pass through the semipermeable membrane during hemodialysis. Bacteria do not pass through the semipermeable membrane during hemodialysis. STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms.

A client is admitted to the hospital with a diagnosis of chronic kidney disease. Which responses should the nurse expect the client to exhibit? (Select all that apply.) 1 Polyuria 2 Paresthesias 3 Hypertension 4 Metabolic alkalosis 5 Widening pulse pressure

2 & 3 Paresthesias occur as a result of excess nitrogenous wastes, altered fluid and electrolyte balance, and altered regulatory functions. Nonfunctioning kidneys cause fluid retention that may result in hypervolemia and hypertension. Polyuria occurs because of extensive nephron damage. Metabolic acidosis, not alkalosis, results from the inability to excrete hydrogen ions and retain bicarbonate. Widening pulse pressure occurs with increased intracranial pressure, not with kidney dysfunction.

Nitrofurantoin (Macrobid) 0.1 gm is prescribed for a client with a urinary tract infection. Each tablet contains 50 mg. How many tablets should the nurse administer? Record your answer using a whole number. __________ tablets

2 tablets First convert 0.1 g to its equivalent in mg by multiplying by 1000 (move the decimal 3 places to the right). Use the "Desire over Have" formula of ratio and proportion to solve the problem.Desire 100 mg x tablets---------------- = ---------Have 50 mg 1 tablet50x = 100x = 100 ÷ 50x = 2 tablets

A client with acute glomerulonephritis reports feeling thirsty. What should the nurse offer the client? 1 Ginger ale 2 Milkshake 3 Hard candy 4 Chicken broth

3 Sucking on hard candy moistens the mouth, but it does not supply extra fluid, which may be restricted due to impaired kidney function. Carbonated beverages are high in sodium and provide additional fluid, which must be restricted. Milk shakes contains both fluid and protein, which must be restricted. Broth contains sodium, which can compound fluid retention problems.

A nurse is caring for a client with complications associated with peritoneal dialysis. For which signs and symptoms should the nurse monitor the client? (Select all that apply.) 1 Pruritus 2 Oliguria 3 Tachycardia 4 Cloudy outflow 5 Abdominal pain

3, 4, & 5 An increase in vital signs, including tachycardia, is associated with peritonitis, a complication of peritoneal dialysis . Cloudy outflow is associated with peritonitis; the presence of purulent material and red blood cells makes the outflow appear cloudy. Abdominal pain is a sign of peritonitis. Pruritus is a result of impaired renal function, not of peritoneal dialysis. Oliguria is a result of end-stage renal disease, not peritoneal dialysis.

A male client has discharge from his penis. Gonorrhea is suspected. To obtain a specimen for a culture, the nurse should: 1 Instruct the client to provide a semen specimen 2 Swab the discharge when it appears on the prepuce 3Teach the client how to obtain a clean catch specimen of urine 4 Swab the drainage directly from the urethra to obtain a specimen

4 Swabbing the drainage directly from the urethra obtains a specimen uncontaminated by environmental organisms. Instructing the client to provide a semen specimen is not as accurate as obtaining the purulent discharge from the site of origin. Swabbing the discharge when it appears on the prepuce will contaminate the specimen with organisms external to the body. Teaching the client how to obtain a clean catch specimen of urine will dilute and possibly contaminate the specimen. STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.

A client with chronic kidney disease is scheduled to begin peritoneal dialysis. When discussing the procedure, the nurse explains that the purpose of the dialysis is to: 1 Help do some of the work usually done by the kidneys 2 Prevent the client from developing complicating heart problems 3 Remove bad chemicals from the body so the disease will not get worse 4 Speed the client's recovery because the kidneys are not responding to other therapy

1 Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a response that may cause increased fear or anxiety. Telling the client that peritoneal dialysis removes bad chemicals from the body so the disease will not get worse may cause an increase in the level of anxiety. Dialysis does not speed recovery; it helps maintain fluid and electrolyte balance. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.

A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. It is most important for the nurse to assess this client for: 1 Blood in the stool 2 Food intolerances 3 Complaints of nausea 4 Hourly urinary output

1 Erosion of blood vessels may lead to hemorrhage, a life-threatening situation further complicated by decreased prothrombin production, which occurs with cirrhosis. Although food intolerances should be identified, there is no immediate threat to life. Although increased intra-abdominal pressure because of ascites may precipitate nausea, there is no immediate threat to life. Hourly urine output measurements are unnecessary.

The nurse is caring for a client four days after the client had a cystectomy and formation of a continent diversion. After observing mucous threads in the client's urine, the nurse should: 1 Recognize that this is an expected response 2 Report this to the health care provider immediately 3 Obtain a specimen for culture and sensitivity 4 Increase the client's fluid intake for the next 12 hours

1 Expecting this response after the diversion response is expected because mucus continually is secreted by the intestinal mucosa. Reporting this to the health care provider immediately is not necessary; mucus is expected with an ileal conduit. Obtaining a specimen for culture and sensitivity is not necessary. At this point postsurgically the mucus is not an indication of infection; mucus in the urine after ureterostomy may indicate infection. Although fluids should be encouraged to maintain urine flow, increasing the client's fluid intake for the next 12 hours will not eliminate mucus, which continually is discharged from the intestinal segment.STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals.

The nurse is providing dietary teaching to a 40-year-old client who is receiving hemodialysis. The nurse should encourage the client to include what in the client's dietary plan? 1 Rice 2 Potatoes 3 Canned salmon 4 Barbecued bee

1 Foods high in carbohydrates and low in protein, sodium, and potassium are encouraged for these clients. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.

A client who is 5 feet, 8 inches tall and weighs 220 pounds is admitted to the hospital with ureteral colic, blood in the urine, and a blood pressure of 150/90. The immediate objective of nursing care for this client is to decrease: 1 Pain 2 Weight 3 Hematuria 4 Hypertension

1 Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is associated with ureteral distention and must be relieved. Weight loss is a long-term goal; reducing pain is the priority. Although the hematuria will be addressed, pain reduction is the priority. Although the client's hypertension will be addressed, pain reduction is the priority.

A nurse is caring for a client who is admitted with ureteral colic and hematuria. The client also has stage 1 hypertension and is overweight. Which assessment finding should the nurse be most concerned about at this time? 1 Pain 2 Weight 3 Hematuria 4 Blood pressure of 120/64

1 Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is caused by ureteral distention. The priority is to relieve the pain. Although the client is overweight and weight loss is desirable, it is a long-term goal. Although hematuria is a concern, blood loss usually is not massive. Hypertension is not specific to urinary calculi.Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question.

A client is diagnosed as having kidney failure. During the oliguric phase the nurse should assess the client for: 1 Hyperkalemia 2 Hypocalcemia 3 Hypernatremia 4 Hypoproteinemia

1 The kidneys retain potassium during the oliguric phase of kidney failure; an elevated potassium level is one of the main indicators of the need for dialysis. Hypercalcemia occurs, not hypocalcemia. Hyponatremia occurs, not hypernatremia. Hyperproteinemia occurs, not hypoproteinemia. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process

Which clinical manifestations does a nurse expect that a client with renal calculi might report? (Select all that apply.) 1 Blood in the urine 2 Irritability and twitching 3 Dry, itchy skin and pyuria 4 Frequency and urgency of urination 5 Pain radiating from the kidney to a shoulder

1 & 4 Hematuria is a common clinical manifestation of renal calculi. Frequency and a sense of urgency may occur because of irritation caused by the calculi; the most common expectation is sharp, severe pain. Irritability may occur because of discomfort; twitching does not occur. Pyuria may occur when infection is present; skin problems do not occur. Pain radiates from the flank to the groin area.

A client has a kidney transplant. The nurse should monitor for which signs associated with rejection of the transplant? (Select all that apply.) 1 Fever 2 Oliguria 3 Jaundice 4 Moon face 5 Weight gain

1, 2 & 5 Fever is a characteristic of the systemic inflammatory response to the antigen (transplanted kidney). Oliguria (100 to 400 mL daily) or anuria (less than 100 mL daily) occurs when the transplanted kidney is rejected and fails to function. Weight gain can occur from fluid retention when the transplanted kidney fails to function or as a result of steroid therapy. This response must be assessed further. Jaundice is unrelated to rejection. Moon face is a side effect of steroid therapy; it is not a sign of rejection.

A nurse is caring for a client with end-stage renal disease who has a mature arteriovenous (AV) fistula. What nursing care should be included in the client's plan of care? (Select all that apply.) 1 Auscultate for a bruit. 2 Palpate the site to identify a thrill. 3 Irrigate with saline to maintain patency. 4 Avoid drawing blood from the affected extremity. 5 Keep the fistula clamped until ready to perform dialysis

1,2, &4 The presence of a bruit indicates patency of the AV fistula. The presence of a vibration or thrill indicates patency of the AV fistula. Drawing blood is avoided to prevent damage to the AV fistula. An AV fistula is internal and is not irrigated. The AV fistula is under the skin and is not clamped.Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude.

When a client returns from the postanesthesia care unit after a kidney transplant, the nurse should plan to measure the client's urinary output every: 1 15 minutes 2 One hour 3 Two hours 4 Three hours

2 Output is critical when assessing kidney function. The urinary output should be monitored every 30 to 60 minutes; decreasing urinary output is a sign of rejection. It is not necessary to monitor urinary output every 15 minutes. Two or three hours are too infrequent to monitor output immediately after a transplant. It is essential to monitor output more frequently to evaluate whether the new kidney is working or whether it is being rejected.

A client is admitted to the hospital with urinary retention, and an indwelling urinary catheter is prescribed by the health care provider. What should the nurse do to help prevent the client from developing a urinary tract infection? 1 Assess urine specific gravity 2 Maintain the prescribed hydration 3 Collect a weekly urine specimen 4 Empty the drainage bag frequently

2 Promoting hydration maintains urine production that flushes the bladder, thereby preventing urinary stasis and possible infection. Although assessing urine specific gravity may help identify a urinary tract infection, it will not prevent it. Although collecting a weekly urine specimen for culture and sensitivity may help identify a urinary tract infection, it will not prevent it. The collection bag is emptied once every shift unless the bag is full and needs to be emptied sooner; changing the bag periodically, not emptying it, may help prevent infection.

A client with tuberculosis is started on a chemotherapy protocol that includes rifampin (RIF). The nurse evaluates that the teaching about rifampin is effective when the client states: 1 "I need to drink a lot of fluid while I take this medication." 2 "I can expect my urine to turn orange from this medication." 3 "I should have my hearing tested while I take this medication." 4 "I might get a skin rash because it is an expected side effect of this medication."

2 RIF causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this drug; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin

A nurse is caring for a client who has a radium implant for cancer of the cervix. What is the priority nursing intervention? 1 Store urine in lead-lined containers. 2 Restrict visitors to a 10-minute stay. 3 Wear a lead-lined apron when giving care. 4 Avoid giving injections in the gluteal muscle.

2 Restriction of each visitor to a 10-minute stay minimizes the risk for exposure. Some institutions will not allow visitors while an implant is in place. The urine is not radioactive. Lead-lined aprons are not effective shields against rays emitted by internal sources of radiation. Radium implants will not affect the location of intramuscular injections.

An acute, life-threatening complication for which a nurse should assess a client in the early postoperative period after a radical nephrectomy is: 1 Sepsis 2 Hemorrhage 3 Renal failure 4 Paralytic ileus

2 The kidney, an extremely vascular organ, receives a large percentage of the blood flow, and hemorrhage from the operative site can occur. Sepsis and renal failure may occur later in the postoperative period. Paralytic ileus can occur, but it is not life threatening. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, "I will study for the exam." Specify how many hours, what day and time, and what material you will cover.

When assessing a client during peritoneal dialysis, a nurse observes that drainage of the dialysate from the peritoneal cavity has ceased before the required volume has returned. What should the nurse instruct the client to do? 1 Drink a glass of water 2 Turn from side to side 3 Deep breathe and cough 4 Rotate the catheter periodically

2 Turning from side to side will change the position of the catheter, thereby freeing the drainage holes of the tubing, which may be obstructed. Drinking a glass of water and deep breathing and coughing do not influence drainage of dialysate from the peritoneal cavity. The position of the catheter should be changed only by the health care provider.

A client's urine specific gravity is being measured. For what condition should the nurse conduct a focused assessment when a client's specific gravity is increased? 1 Fluid overload 2 Low-grade fever 3 Diabetes insipidus 4 Chronic kidney disease

2 An elevated temperature can lead to dehydration and an increased urine specific gravity (more than 102.5). When there is edema or fluid overload, the accumulating body fluid will cause a decrease in the specific gravity of the urine. A client with diabetes insipidus excretes a large amount of dilute urine; dilute urine will have a decreased specific gravity. In chronic kidney disease there is an inability to concentrate urine and urine will be dilute. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

A client has undergone surgery with general anesthesia. Within how many hours after surgery should the nurse notify the health care provider if the client does not void? 1 4 hours 2 8 hours 3 12 hours 4 16 hours

2 Decreased bladder muscle tone results from the depressant effects of anesthesia and the handling of tissues and adjacent organs during surgery. Catheterization may be necessary to prevent overdistention of the bladder. Four hours may be too early to expect recovery from the depressant effects of anesthesia. Twelve and 16 hours are too long to wait to call the health care provider. This length of time without voiding may result in overdistention of the bladder.

A client with acute kidney failure is to receive peritoneal dialysis and asks why the procedure is necessary. The nurse's best response is, "It: 1 Prevents the development of serious heart problems." 2 Helps perform some of the work usually done by the kidneys." 3 Removes toxic chemicals from the body so you will not get worse." 4 Speeds recovery because the kidneys are not responding to other therapy."

2 Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Stating that peritoneal dialysis "removes toxic chemicals from the body so you will not get worse" is threatening and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolyte balance; there are no data to indicate the cause of the acute kidney failure or previous therapy.

A nurse concludes that the anemia that accompanies chronic kidney disease should be treated because it contributes to: 1 Uremic frost 2 Chronic fatigue 3 Tubular necrosis 4 Dependent edema

2 Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathological condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.

A nurse is caring for a client who had a kidney transplant. Which test is most important for determining whether a client's newly transplanted kidney is working effectively? 1 Renal scan 2 Serum creatinine 3 24-hour urine output 4 White blood cell (WBC) count

2 Serum creatinine, a test of renal function, measures the kidneys' ability to excrete metabolic wastes; creatinine, a nitrogenous product of protein breakdown, is elevated in renal insufficiency. Renal scan will not provide information about the filtering ability of the transplanted kidney. Although intake and output will be monitored, this will not provide information about the ability of kidney to excrete metabolic wastes. The WBC count will not reflect functioning of a transplanted kidney.

A nurse is providing preoperative teaching for a client who is scheduled for a transurethral resection of the prostate. What should the nurse include in the client's postoperative teaching plan? 1 The urine will be bright red for 24 to 48 hours 2 Spasms of the bladder occur during the first 24 to 48 hours 3 To decrease bladder contractions, the Valsalva maneuver and Kegel exercises will be encouraged 4 To maintain proper fluid balance, oral fluids are restricted during continuous urinary bladder irrigations

2 Spasms result from irritation of the bladder during surgery; they decrease in intensity and frequency as healing occurs. Urine that is bright red for 24 to 48 hours is too long; this indicates hemorrhage. Drainage should be dark red and after the first few hours gradually turn pink. The Valsalva maneuver should be avoided because it may initiate prostatic bleeding, not bladder contractions. The presence of continuous bladder irrigation (CBI) is unrelated to the amount of oral fluids that should be consumed; once the continuous bladder irrigation is discontinued, oral fluids should be encouraged.

When receiving hemodialysis, the complication of the removal of too much sodium may occur. For which clinical findings associated with hyponatremia should the nurse assess the client? (Select all that apply.) 1 Chvostek sign 2 Muscle cramps 3 Extreme fatigue 4 Cardiac dysrhythmias

2 & 3 Sodium is the most abundant cation in the extracellular fluid and functions as part of the sodium/potassium pump. In the presence of a deficit, the client will exhibit confusion, lethargy, headache, and muscle cramps. Lethargy results in the presence of a deficit. Spasm of the facial muscles following a tap over the facial nerve (Chvostek sign) indicates hypocalcemia. Cardiac dysrhythmias are associated with increases or decreases in potassium and calcium. An increase in body temperature reflects a possible infection, not an electrolyte imbalance.

A nurse is caring for a client with a ureteral calculus. Which are the most important nursing actions? (Select all that apply.) 1 Limiting fluid intake at night 2 Monitoring intake and output 3 Straining the urine at each voiding 4 Recording the client's blood pressure 5 Administering the prescribed analgesic

2, 3, & 5 A urinary calculus may obstruct urine flow, which will be reflected in a decreased output; obstruction may result in hydronephrosis. Urine is strained to determine whether any calculi or calcium gravel is passed. Reduction of pain is a priority. A calculus obstructing a ureter causes flank pain that extends toward the abdomen, scrotum and testes, or vulva; the pain begins suddenly and is severe (renal colic). Fluids should be encouraged to promote dilute urine and facilitate passage of the calculi. Blood pressure assessment is of no particular importance to the client with kidney stones (calculi).

A nurse obtains a health history from a client with the diagnosis of renal calculi. The nurse concludes that the factor that most likely contributed to the calculi development is the client's: 1 High cholesterol diet 2 Excessive exercise program 3 Excess ingestion of antacids 4 Frequent consumption of alcohol

3 An excessive use of antacids may result in hypercalciuria; most calculi contain calcium combined with phosphate or other substances. Cholesterol is unrelated to the formation of renal calculi; cholesterol stones in the gallbladder are the result of increased cholesterol synthesis in the liver. Immobility with the associated demineralization of bone, not exercise, contributes to the formation of renal calculi. Alcohol intake is unrelated to renal calculi formation.

A client who is to begin continuous ambulatory peritoneal dialysis (CAPD) asks the nurse what this treatment entails. What information should the nurse include in the explanation? 1 Peritoneal dialysis is done in an ambulatory care clinic. 2 Hemodialysis and peritoneal dialysis are provided continuously. 3 The peritoneal membrane allows passage of toxins into the dialysate. 4 A quarter of a liter of dialysate is maintained inter- and intraperitoneally

3 Dialysate is introduced into the peritoneal cavity, where fluids, electrolytes, and wastes are exchanged through the peritoneal membrane. The client can dialyze alone in any location without the need for machinery and continuous technical supervision. Hemodialysis is not necessary with this procedure. Each exchange involves 2 to 3 L of dialysate intraperitoneally, not interperitoneally, for a specified time (dwell time) before being drained. STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.

A nurse is preparing to discharge a client who had a transurethral prostatectomy for benign prostatic hyperplasia. The nurse evaluates that the client understands the discharge teaching when the client states: 1 "I will drink 6-8 cups of fluid daily and no fluids near bedtime." 2 "Now I don't have to go back to my health care provider's office." 3 "I will use stool softeners regularly for the next one to two months." 4 "I plan to go home and have sexual intercourse with my spouse."

3 Straining at stool should be avoided for four to six weeks after surgery, or until permitted by the health care provider; avoiding straining supports healing and limits precipitation of bleeding. Eight glasses of fluid a day is insufficient fluid; between 2500 and 3000 mL/day should be consumed to ensure adequate flushing of the bladder and urethra. The client should have continued medical supervision. Sexual intercourse should be avoided until permitted by the health care provider.

A client with acute glomerulonephritis complains of thirst. The most appropriate item that the nurse can offer to relieve the client's thirst is: 1 Ginger ale 2 Milkshake 3 Hard candy 4 Cup of broth

3 Sucking on a hard candy will relieve thirst and increase carbohydrates, but does not supply extra fluid. The goal is to minimize unnecessary fluid intake. Carbonated beverages contain sodium and provide additional fluid, which must be restricted. A milkshake contains both fluid and protein, which must be restricted. Broth contains sodium, which increases fluid retention. STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.

The nurse is providing care to a client who is being treated for bacterial cystitis. Before discharge, it is most important for the client to: 1 Understand the need to drink 4 L of water per day, an essential measure to prevent dehydration 2 Be able to identify dietary restrictions and plan menus 3 Achieve relief of symptoms and to maintain kidney function 4 Recognize signs of bleeding, a complication associated with this type of procedure

3 To have relief of symptoms and continued urine output are measurable responses to therapy and are the desired outcomes. Four liters of water per day is too much fluid; 2 to 3 L a day is recommended to flush the bladder and urethra. Dietary restrictions are not necessary with cystitis. Bleeding is not a complication associated with this procedure.

Which is the most serious complication for which the nurse must monitor a client with kidney failure? 1 Anemia 2 Weight loss 3 Hyperkalemia 4 Platelet dysfunction

3 Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as cardiac arrest. Anemia may occur, but is not the most serious complication and should be treated in relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used. Weight loss alone is not life threatening. Platelet dysfunction may occur because of decreased cell surface adhesiveness, but it is not as life threatening as hyperkalemia.

A nurse reviews the history of a client who is hospitalized with a diagnosis of urinary calculi and identifies which factor may have contributed to the development of the calculi? 1 Increased fluid intake 2 Urine specific gravity of 1.017 3 History of hyperparathyroidism 4 Jogging 3 miles a day

3 Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.

A nurse teaches the signs of organ rejection to a client who had a kidney transplant. What should be included in the education? 1 Weight loss 2 Subnormal temperature 3 Elevated blood pressure 4 Increased urinary outpu

3 Hypertension is caused by hypervolemia because of the failure of the new kidney. Weight gain, not loss, occurs with a rejection of the kidney because of fluid retention. The client will have an elevated temperature exceeding 100° F with kidney rejection. Urine output will be decreased or absent, depending on the degree of kidney rejection. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

A client admitted to the hospital in the oliguric phase of acute renal failure estimates that the urine output for the last 12 hours was less than 240 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. The nurse concludes that this amount of fluid was prescribed to: 1 Equal the expected urinary output for the next 24 hours 2 Prevent the development of hypostatic pneumonia and fever 3 Compensate for both insensible and expected output over the next 24 hours 4 Prevent hyperkalemia, which can lead to life-threatening cardiac dysrhythmias

3 Insensible losses are 400 to 500 mL in 24 hours; the measured output is about 400 mL in 24 hours based on the available history. Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. At least 2500 mL daily is necessary to help prevent hypostatic pneumonia and its associated fever. Hyperkalemia in acute renal failure is caused by inadequate glomerular filtration and is not related to fluid intake.

A client is diagnosed as having invasive cancer of the bladder, and radiation therapy is scheduled. What should the nurse expect the client to demonstrate that indicates success of radiation therapy? 1 Decrease in urine output 2 Increase in physical strength 3 Shrinkage of the tumor on scanning 4 Increase in the quantity of white blood cells (WBCs)

3 Radiation interferes with cell multiplication, which should control the growth and metastasis of cancerous tumors. Radiation affects healthy as well as abnormal cells; urinary frequency and diarrhea can result. Malaise, not an increase in physical strength, is an effect of radiation therapy. Bone marrow sites may be affected by radiation, resulting in a reduction of WBCs.

A nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet because: 1 A person's body tends to retain fluid when a salt substitute is included in the diet. 2 Limiting salt substitutes in the diet prevents a buildup of waste products in the blood. 3 Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats. 4 A substance in the salt substitute interferes with the transfer of fluid across capillary membranes, resulting in anasarca.

3 Salt substitutes usually contain potassium, which can lead to hyperkalemia; dysrhythmias are associated with hyperkalemia. Sodium , not salt substitutes, in the diet causes retention of fluid. Salt substitutes do not contain substances that influence blood urea nitrogen (BUN) and creatinine levels; these are the result of protein metabolism. There is no such substance in salt substitutes that interferes with the transfer of fluid across capillary membranes.

A nurse is caring for a client after surgical creation of a conduit diversion. What is the major disadvantage of a conduit diversion that the nurse should consider when caring for this client? 1 Peristalsis is greatly decreased. 2 Stool continuously oozes from it. 3 Urine continuously drains from it. 4 Absorption of nutrients is diminished.

3 The ureters are implanted in a segment of the ileum, and urine drains continually because there is no sphincter; continent catheterizable stomal reservoirs do not continually drain but are accessed with a catheter approximately every four hours. Ileal conduits are not neurologically innervated; therefore, no peristalsis exists. No feces are present in an ileal conduit. Absorption of nutrients is not affected by an ileal conduit.

A client is injured in a motor vehicle accident and admitted for observation. Damage to the bladder is evident. The nurse takes the client's history and concludes that the client is at increased risk of bladder rupture based on the history of: 1 Multiple bouts of cystitis 2 Familial history of bladder cancer 3 Not having voided for six hours 4 Drinking two 8-oz. cups of coffee during the six-hour trip

3 The walls of a full bladder are stretched thinner and are more susceptible to rupture when traumatized. A history of cystitis predisposes the client to developing future bladder infections, not to rupturing the bladder. A family member with bladder cancer might increase the risk of cancer; however, it will not predispose the client to bladder rupture. Drinking two cups of coffee will not result in a significant amount of urine production. .STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) Amount of time needed; (2) Amount of time available; (3) "Best" time to study; (4) Time for emergencies and relaxation.

A nurse is reviewing the laboratory reports of a client with a diagnosis of end-stage renal disease. What test result should the nurse anticipate? 1 Arterial pH 7.5 2 Hematocrit of 54% 3 Creatinine of 1.2 mg/dL 4 Potassium of 6.3 mEq/L

4 Clients with end-stage renal disease have impaired potassium excretion so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L. Clients with end-stage renal disease usually have a serum pH that is less than 7.35 due to metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated. Clients with end-stage renal disease have decreased erythropoietin which leads to decreased red blood cell production and hematocrit (HCT); a hematocrit of 54% exceeds the expected range for HCT, which is 42% to 52% for males and 35% to 47% for females; therefore, it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL is within the expected range of 0.7-1.4 mg/dL and therefore is not anticipated.

When admitting a client with benign prostatic hyperplasia, the most relevant assessment made by the nurse is: 1 Perineal edema 2 Urethral discharge 3 Flank pain radiating to the groin 4 Distention of the suprapubic area

4 Distention of the suprapubic area indicates that the bladder is distended with urine and therefore palpable. Perineal edema is not related to urinary retention and benign prostatic hyperplasia. Urethral discharge may be related to sexually transmitted infections. Radiating flank pain may indicate renal calculi.STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.

Which clinical manifestation should a nurse expect a client with diabetes insipidus to exhibit? 1 Increased blood glucose 2 Decreased serum sodium 3 Increased specific gravity 4 Decreased urine osmolarity

4 Insufficient antidiuretic hormone (ADH) decreases water uptake by the kidney tubules, resulting in very dilute urine with low osmolarity. Diabetes insipidus does not affect glucose levels. Serum sodium levels increase because of hemoconcentration. Specific gravity decreases with dilute urine.Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings.

A client is scheduled for an intravenous pyelogram (IVP). The nurse explains that on the day before the IVP the client must: 1 Avoid fats and proteins 2 Drink a large amount of fluids 3 Omit dinner and limit beverages 4 Take a laxative before going to bed

4 Laxatives remove feces and flatus, providing better visualization. An IVP does not require restrictions of fat and proteins. Large amounts of fluids may dilute the dye, impairing visualization. A light dinner and beverage are permitted.STUDY TIP: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment.

During the postoperative period after surgery for a kidney transplant, the client's creatinine level is 3.1 mg/dL. What should the nurse do first in response to this laboratory result? 1 Notify the health care provider. 2 Check the intravenous (IV) infusion. 3 Obtain current blood test results. 4 Assess for decreased urine output.

4 The expected serum creatinine range is 0.5 to 1.2 mg/dL. The nurse should obtain additional information that may indicate acute rejection; therefore, the nurse must first assess for decreased urine output and changes in vital signs. Once additional data are collected (e.g., urine output, current blood work reports) and the IV infusions are checked, the nurse should contact the health care provider, explain the situation, and implement further prescriptions. Eventually the nurse should ensure that proper infusion rates, along with IV medications, are being maintained after the client is first assessed for decreased urine output and for changes in vital signs. Current blood work reports should be obtained after the client is assessed for decreased urine output and changes in vital signs.

A nurse administers sodium polystyrene sulfonate (Kayexalate) to a client with chronic renal failure. Which finding provides evidence that the intervention is effective? 1 Frequent, loose stools 2 Improved mental status 3 Sodium increases to 137 mEq/L 4 Potassium decreases to 4.2 mEq/

4 This resin exchanges sodium ions for potassium in the large intestine to lower the serum potassium level; 4.2 mEq/L is in the expected range for potassium. Constipation is a more common side effect. Mental status improvement is not a therapeutic effect of the drug. Sodium retention is an adverse effect; 137 mEq/L is in the expected range for sodium.STUDY TIP: In the first pass through the exam, answer what you know and skip what you do not know. Answering the questions you are sure of increases your confidence and saves time. This is buying you time to devote to the questions with which you have more difficulty.

A nurse administers trimethoprim-sulfamethoxazole (Bactrim) to a client diagnosed with a urinary tract infection. What should the nurse monitor to determine the therapeutic effectiveness of the drug? 1 Breath sounds 2 Hemoglobin level 3 Consistency of stool 4 White blood cell (WBC) count

4 Trimethoprim-sulfamethoxazole blocks two consecutive steps in the bacterial synthesis of essential nucleic acids and protein; resolution of infection is reflected by a WBC in the expected range. This drug may be used to treat various types of infections; therapeutic responses will depend on the location of the infection, which is not specified. This drug may cause hemolytic anemia, which alters the hemoglobin level, but this is a side effect. This drug may be used to treat various types of infections; therapeutic responses will depend on the location of the infection, which is not specified.

The nurse provides education to a client about the side effects of furosemide (Lasix). Which client statements indicate that the teaching is understood? (Select all that apply.) 1 "I must not eat citrus fruits." 2 "I should wear dark glasses." 3 "I should avoid lying flat in bed." 4 "I should change my position slowly." 5 "I must eat a food that contains potassium every day."

4 & 5 Furosemide may cause hypovolemia, which can result in orthostatic hypotension with sudden changes in position. With loop diuretics, such as furosemide, an increased sodium load is presented to the distal tubule; this prompts an increase in sodium secretion as well as a corresponding increase in potassium secretion. Citrus fruits, particularly oranges, are high in potassium and should be encouraged when the client is taking furosemide because this medication can cause hypokalemia. Furosemide does not cause photophobia. Lying horizontally has no relationship to furosemide.

A client with urge incontinence is receiving oxybutynin (Ditropan XL) 30 mg orally. Each tablet contains 5 mg. How many tablets should the nurse administer? Record your answer using a whole number. _____ tablets

6 Use the "Desire over Have" formula of ratio and proportion to solve the problem.Desire 30 mg x tablets--------------- = ---------Have 5 mg 1 tablet5x = 30x = 30 ÷ 5x = 6 tablets

A nurse is caring for a client with glomerulonephritis. What should the nurse instruct the client to do to prevent recurrent attacks? 1 Take showers instead of tub baths. 2 Continue the same restrictions on fluid intake. 3 Avoid situations that involve physical activity. 4 Seek early treatment for respiratory tract infections

4 Hemolytic streptococci, common in throat infections, can initiate an immune reaction that damages the glomeruli. Baths may be linked to urethritis, not glomerulonephritis. Fluid restriction is moderated as the client improves; fluid helps prevent urinary stasis. Activity helps prevent urinary stasis.

The nurse is caring for a client with a diagnosis of acute kidney failure associated with drug toxicity. When the client complains of thirst, the nurse should offer: Ice chips Warm milk Hard candy Carbonated soda

Hard candy Sucking on candy will relieve thirst and provide calories without supplying extra fluid. Ice chips add to the restricted fluid intake. Milk contains both fluids and proteins, which should be restricted with acute kidney failure. Carbonated beverages may be high in sodium and provide additional fluid; both should be restricted. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low fat, high protein, low-calorie diet ).

A nurse is evaluating a client's response to fluid replacement therapy. Which clinical finding indicates adequate tissue perfusion to vital organs? 1 Urinary output of 30 mL in an hour 2 Central venous pressure reading of 2 mm Hg 3 Baseline pulse rate of 120 that decreases to 110 beats/min within a 15-minute period 4 Baseline blood pressure of 50/30 that increases to 70/40 mm Hg within a 30-minute period

1 A urinary output rate of 30 mL/hour is considered adequate for perfusion of the kidneys, heart, and brain. A central venous pressure reading of 2 mm Hg indicates hypovolemia. A baseline pulse rate of 120 that decreases to 110 beats/min within a 15-minute period and a baseline blood pressure of 50/30 that increases to 70/40 mm Hg within a 30-minute period indicate improvement but not necessarily adequate tissue perfusion.

The most essential nursing intervention for a client with a nephrostomy tube is to: 1 Ensure free drainage of urine 2 Milk the tube every two hours 3 Instill 2 mL of normal saline every eight hours 4 Keep an accurate record of intake and output

1 The tube must be kept patent to prevent urine backup, hydronephrosis, and kidney damage. Milking the tube every two hours is unnecessary unless the tube is not functioning. Instilling 2 mL of normal saline every eight hours is a dependent function and requires a health care provider's prescription. Although keeping an accurate record of intake and output is important, it will not ensure free drainage of urine, which is the priority.

The nurse provides discharge instructions to a male client that had a ureterolithotomy. The client has a history of recurrent urinary tract infections (UTIs). The teaching should include that indicators of a UTI are: 1 Urgency or frequency of urination 2 The inability to maintain an erection 3 Pain radiating to the external genitalia 4 An increase in the alkalinity of the urine

1 Urgency or frequency of urination occur with a urinary tract infection because of bladder irritability; burning on urination and fever are additional signs of a UTI. The inability to maintain an erection is not related to a UTI. Pain radiating to the external genitalia is a symptom of a urinary calculus, not infection. An increase in alkalinity or acidity of urine is not a sign of a UTI; this may be caused by altering the diet to include foods that form acid ash or alkaline ash.

A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which responses? (Select all that apply.) 1 Weight loss 2 Negative nitrogen balance 3 Increased urine specific gravity 4 Excessive loss of potassium ions 5 Pronounced retention of sodium ions

1 & 4 Each liter of fluid weighs 2.2 pounds. Assessing weight loss is an objective measure of the effectiveness of the drug. Furosemide is a diuretic that causes rapid diuresis. Furosemide is a potent diuretic that is used to provide rapid diuresis in clients with pulmonary edema; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. A negative nitrogen balance drug does not affect protein metabolism. With increased fluid loss, the specific gravity is likely to be lowered. Furosemide inhibits the reabsorption of sodium.

A client is to have hemodialysis. What must the nurse do before this treatment? 1 Obtain a urine specimen to evaluate kidney function. 2 Weigh the client to establish a baseline for later comparison. 3 Administer medications that are scheduled to be given within the next hour. 4 Explain that the peritoneum serves as a semipermeable membrane to remove wastes.

2 A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.

The nurse recalls that what scientific principle is basic to caring for a client with an indwelling urinary catheter? 1 Inertia 2 Gravity 3 Osmosis 4Diffusion

2 An indwelling urinary catheter always is positioned so that the level of the bladder is higher than the level of the drainage container; gravity promotes urine flow. Inertia refers to a property of matter. Osmosis refers to the movement of water across a semipermeable membrane; it is not responsible for the flow of urine through a catheter. Diffusion refers to the passage of molecules from an area of higher concentration to one of lower concentration.

A client with an ileal conduit is being prepared for discharge. As part of the discharge teaching, the nurse instructs the client to: 1 Abstain from beer and alcohol consumption 2 Maintain fluid intake of at least 2 L daily 3 Notify the health care provider if the stoma size decreases 4 Avoid getting soap and water on the peristomal skin

2 High-fluid intake flushes the ileal conduit and prevents infection and obstruction caused by mucus or uric acid crystals. Alcohol is not contraindicated with an ileal conduit. Notifying the health care provider if the stoma size decreases is expected; as edema decreases, the stoma will become smaller. Soap and water on the peristomal area help prevent irritation from waste products.

A nurse is assessing the urine of a client with a urinary tract infection. What appearance should the nurse expect this client's urine to have? 1 Smoky 2 Cloudy 3 Orange-amber 4 Yellow-brown

2 Cellular debris, white blood cells, bacteria, and pus can cause the urine to become cloudy. Dark, smoky urine usually suggests hematuria. Orange-amber color of urine may indicate concentrated urine; also, it can be caused by phenazopyridine (Pyridium) or foods such as beets. Yellow-brown to olive green color of urine indicates excessive bilirubin.

A client is diagnosed with calcium oxalate renal calculi. Which nutrients should the nurse teach the client to avoid? (Select all that apply.) 1 Milk 2 Nuts 3 Liver 4 Spinach 5 Rhubarb

2, 4, & 5 Nuts, especially peanuts, almonds, and pecans, should be avoided. Clients with struvite stones (staghorn stones) also should avoid nuts. Rhubarb and spinach are high in calcium oxalate. Other examples include beets, wheat bran, tea, chocolate, and coffee. Limiting oxalate-rich foods limits oxalate absorption and the formation of calcium oxalate calculi. Milk is an acceptable calcium-rich protein. Research indicates that it reduces oxalate absorption. Liver is a purine-rich food that may be eaten. All meats, especially organ meats, anchovies, sardines, fish roes, herring, meat extracts, and broths, are purine-rich foods. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.

Twenty-four hours after a penile implant the client's scrotum is edematous and painful. The nurse should: 1 Assist the client with a sitz bath 2 Apply warm soaks to the scrotum 3 Elevate the scrotum using a soft support 4 Prepare for an incision and drainage procedure

3 Elevating the scrotum using a soft support increases lymphatic drainage, reducing edema and pain. Assisting the client with a sitz bath and applying warm soaks to the scrotum increase circulation to the area, intensifying edema and pain in this client. Preparing for an incision and drainage procedure is not indicated; scrotal swelling is caused by the trauma of surgery, not infection.

A client is taught how to change the dressing and how to care for a recently inserted nephrostomy tube. On the day of discharge the client states, "I hope I can handle all this at home; it's a lot to remember." The best response by the nurse is: 1 "I'm sure you can do it." 2 "Oh, a family member can do it for you." 3 "You seem to be nervous about going home." 4 "Perhaps you can stay in the hospital another day."

3 Reflection conveys acceptance and encourages further communication. The response "I'm sure you can do it" is false reassurance that does not help to reduce anxiety. The response "Oh, a family member can do it for you" provides false reassurance and removes the focus from the client's needs. The response "Perhaps you can stay in the hospital another day" is unrealistic, and it is too late to suggest this.

A nurse is caring for a client with an undescended testicle. The nurse teaches the client that the main reason why the testicles are suspended in the scrotum is to: 1 Protect the sperm from the acidity of urine. 2 Facilitate the passage of sperm through the urethra. 3 Protect the sperm from high abdominal temperatures. 4 Facilitate their maturation during embryonic development

3 Sperm cells are fragile and can be destroyed by heat, causing sterility. Sperm do not move through the urine; they are found in semen. Sperm achieve motion from their flagella; they move from the epididymis to the vas deferens to the ejaculatory ducts to the urethra. During embryonic development the testes are not suspended.

A client who is diagnosed with sexual dysfunction makes a comment to the nurse, "Well, I guess my sex life is over." What is the most appropriate response by the nurse? 1 "I'm sorry to hear that." 2 "Oh, you have a lot of good years left." 3 "You are concerned about your sex life?" 4 "Have you asked your health care provider about that?"

3 The response "You are concerned about your sex life?" explores the meaning of the statement and allows further expression of concern. The response "I'm sorry to hear that" does not allow an explanation of feelings and cuts off communication. The response "Oh, you have a lot of good years left" lacks both empathy and understanding; it also cuts off communication. The response "Have you asked your health care provider about that?" shirks responsibility; the client may be embarrassed to ask the health care provider and needs the nurse to act as facilitator.

A male client reports dysuria, nocturia, and difficulty starting the urinary stream. A cystoscopy and biopsy of the prostate gland have been scheduled. After the procedure the client reports an inability to void. The nurse should: 1 Limit oral fluids until the client voids 2 Assure the client that this is expected 3 Insert a urinary retention catheter 4 Palpate above the pubic symphysis

4 A full bladder is palpable with urinary retention and distention, which are common problems after a cystoscopy because of urethral edema. Fluids dilute the urine and reduce the chance of infection after cystoscopy and should not be limited. Although urinary retention can occur, it is not expected; the nurse must assess the extent of bladder distention and discomfort. More conservative nursing methods, such as running water or placing a warm cloth over the perineum, should be attempted to precipitate voiding; catheterization carries a risk of infection.

1. A nurse assesses a newly admitted client with renal colic to determine the signs and symptoms that are present. The nurse assesses the client for which primary subjective symptom? 1 Uremia 2 Nausea 3 Voiding at night 4 Flank discomfort

4 A subjective symptom must be experienced and described by the client; flank pain, pain on the side of the body between the ribs and the ileum, accompanies renal colic. Uremia and voiding at night are objective signs that can be verified by observation or measurement. Although nausea is a subjective symptom and can occur with the severe pain associated with renal colic, it is not as significant as flank pain

A health care provider prescribes furosemide (Lasix) for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in what part of the renal system? 1 Distal tubule 2 Collecting duct 3 Glomerulus of the nephron 4 Loop of Henle

4 Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders and xanthines act in the glomerulus of the nephron in the kidney.

A client with the diagnosis of chronic kidney disease develops hypocalcemia. Which clinical manifestations should the nurse expect the client with hypocalcemia to exhibit? (Select all that apply.) 1 Acidosis 2 Lethargy 3 Bone pain 4 Chvostek sign 5 Muscle cramps

4 & 5 Chvostek sign is elicited by tapping the face in front of the ear over the facial nerve; a positive sign is evidence of tetany and is caused by decreased serum calcium. Muscle cramps result from decreased serum calcium; functions of calcium include muscle contraction and transmission of nerve impulses. Acidosis decreases calcium that binds to albumin, resulting in more ionized calcium (free calcium) in the blood. Lethargy and weakness are associated with hypercalcemia. Hypercalcemia greater than 11 mg/dL causes bone pain and fractures; it is related to demineralization of bone.

A client is scheduled to have an indwelling urinary catheter inserted before abdominal surgery. The nurse should insert the catheter in what location in the illustration? 1 a 2 b 3 c 4 d

B B is the urethral orifice, which anatomically is between the clitoris and the vagina; it is the opening into the urethra, the tubular structure that drains urine from the bladder. A is the clitoris, which is situated beneath the anterior commissure, partially hidden between the anterior extremities of the labia minora. C is the opening of the vagina; it is the part of the female genitalia that forms a canal from the vaginal orifice through the vestibule to the uterine cervix. D is the anus; it is the terminal end of the anal canal that is connected to the rectum; the rectum is a portion of the large intestine that is between the anal canal and the descending sigmoid colon. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

The nurse reviews the medical records of four male clients and concludes that the client that is at highest risk of developing prostate cancer is the: 1.Black 55-year-old 2 White 45-year-old 3 Asian 55-year-old 4Hispanic 45-year-old

1 Cancer of the prostate is rare before age 50 but increases with each decade; black men develop cancer of the prostate twice as often and at an earlier age than white men. White men develop prostatic cancer half as often as black men, but more commonly than Asian or Hispanic men. Asian and Hispanic men have a lower incidence of prostatic cancer and a lower mortality rate than white and black men.

A female client has a history of recurrent urinary tract infections. What should the nurse include in the teaching plan when teaching the client about health practices that may help decrease future urinary tract infections? 1 Wear cotton underpants. 2 Void at least every 6 hours. 3 Increase alkaline ash foods in the diet. 4 Wipe from back to front after toileting

1 Cotton allows air to circulate and does not retain moisture the way synthetic fabrics do; microorganisms multiply in warm, moist environments. Drinking 3 L of fluids a day and voiding every 2 hours help to flush ascending microorganisms from the bladder, thereby reducing the risk for urinary tract infections. Foods high in acid, not alkaline, ash help to acidify urine; this urine is less likely to support bacterial growth. Wiping from back to front after toileting may transfer bacteria from the perianal area toward the urinary meatus, which will increase the risk for urinary tract infection.

A nurse is providing postoperative care to a client who had a kidney transplant. What assessment is the best indicator of the functioning of the newly transplanted kidney? 1 Renal scan 2 Serum creatinine 3 White blood cell (WBC) count 4 Intake and output balance daily

2 Serum creatinine, a test of renal function, measures the kidneys' ability to excrete metabolic wastes; creatinine, a nitrogenous product of protein breakdown, is increased with kidney insufficiency. A renal scan does not provide information about the filtering ability of the new kidney. A WBC count does not reflect functioning of the new kidney. Although intake and output should be monitored, this does not provide information about the kidneys' ability to excrete metabolic wastes.

A nurse is caring for a client who just had surgery to repair an inguinal hernia. To limit a common complication associated with this surgery, the nurse should: 1 Apply an abdominal binder 2 Place a support under the scrotum 3 Teach the client to cough several times an hour 4 Encourage the client to eat a high carbohydrate diet

2 After inguinal hernia repair, the scrotum commonly becomes edematous and painful; drainage is facilitated by elevating the scrotum on rolled linen or using a scrotal support. An abdominal binder will not support the operative site; the incision is too low. Coughing increases intraabdominal pressure and should be avoided because it strains the operative site. Obesity is a factor in the development of hernias; high carbohydrate diets should be discouraged.

A nurse is planning to administer a prescribed intravenous solution that contains potassium chloride. What assessment should be brought to the health care provider's attention before administration of the intravenous (IV) line? 1 Uncharacteristic irritability 2 Poor tissue turgor with tenting 3 Urinary output of 200 mL during the previous 8 hours 4 Oral fluid intake of 300 mL during the previous 12 hours

3 Decreased urinary output will result in the retention of potassium, causing hyperkalemia. Reporting uncharacteristic irritability is unnecessary; this is a sign of dehydration, which can be corrected with appropriate hydration. Reporting poor tissue turgor with tenting is unnecessary; this may indicate dehydration, which is probably the rationale for the fluid prescribed. Reporting an oral fluid intake of 300 mL during the previous 12 hours is unnecessary; this can precipitate dehydration or can compound an existing dehydration, which can be treated with appropriate hydration.

After a successful kidney transplant for a client with end-stage kidney disease, the nurse anticipates that laboratory studies will demonstrate: 1 Increased specific gravity 2 Correction of hypotension 3 Elevated serum potassium 4 Decreasing serum creatinine

4 As the transplanted organ functions, nitrogenous wastes are eliminated, lowering the serum creatinine. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. With end-stage kidney disease, fluid retention causes hypertension. There should be a correction of hypertension, not hypotension. After the transplant, the serum potassium should correct to within expected limits for an adult.

A nurse is caring for a client who had a kidney transplant. What sign indicates that the client may be rejecting the transplanted kidney? 1 Fever 2 Hematuria 3 Moon face 4 Yellow sclera

1 Fever is a characteristic of the systemic inflammatory response to the antigen (transplanted kidney). Hematuria is not indicative of rejection; however, its occurrence necessitates further investigation. A moon face (moon facies) is an effect of steroid therapy and does not indicate rejection. Jaundice is unrelated to rejection of a transplanted kidney.

An older client who is living in a nursing home is admitted to the hospital to be treated with intravenous antibiotics for sepsis resulting from a urinary tract infection. The client becomes agitated and attempts to pull out the IV. The health care provider prescribes a stat dose of haloperidol (Haldol) 0.5 mg IM. The haloperidol is available in a vial that states there are 2 mg/mL. How much solution should the nurse administer? Include a leading zero if applicable. Record your answer using two decimal places. __________ mL

0.25 mL Solve the problem by using ratio and proportion. Desire 0.5 mg x mL------------- = ----Have 2 mg 1 mL2x = 0.5x = 0.5 ÷ 2x = 0.25 mL Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be available for you to determine your response, which you will then type in the provided space.

A client with a history of benign prostatic hypertrophy asks whether cranberry juice prevents bladder infections. The nurse replies that cranberry juice may be helpful because it: 1 Increases acidity of the urine 2 Soothes irritated bladder walls 3 Improves glomerular filtration rate 4 Destroys microorganisms in the bladder

1 An acid-ash diet, including cranberries, lowers the pH of the urine and discourages pathogenic growth. Acid urine does not soothe bladder walls. The glomerular filtration rate is not affected. An acid medium will discourage further growth but will not kill existing organisms. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

A client has surgery to repair a bladder laceration. The nursing intervention that takes priority in the postoperative care of this client is: 1 Repositioning frequently 2 Giving lower back care 3 Implementing range-of-motion (ROM) exercises 4 Providing teaching related to incision care

1 Frequent position changes are important to ensure efficient urinary drainage; gravity promotes flow, which prevents obstruction. Back care is necessary but is not a priority. ROM is of minimal importance because the client will be able to move without limitation. Teaching information related to discharge care is not a priority at this time.

Trimethoprim-sulfamethoxazole (Septra) is prescribed for a client with cystitis. When teaching about the medication, the nurse instructs the client to: 1 Drink 8 to 10 glasses of water daily 2 Drink two glasses of orange juice daily 3 Take the medication with meals 4 Take the medication until symptoms subside

1 A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken one hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

A female client has a history of frequent urinary tract infections (UTIs). To decrease the incidence of the infections, the nurse instructs the client to increase fluid intake and: 1 Empty the bladder every three hours 2 Take warm bubble baths 3 Wipe from back to front 4 Take a prophylactic antibiotic after sexual intercourse

1 Emptying the bladder every three hours helps prevent stasis of urine; urinary stasis supports bacterial growth. Tub baths with soapy bubbles are thought to increase, not decrease, the risk of UTIs because soap is irritating to mucous membranes. It is not necessary to wash the perineal area from the urethra toward the rectum. The concern about wiping from back to front is allowing fecal material to enter the perineal area and potentially cause irritation. The nurse should, however, take into consideration the different schools of thought about wiping from the urethral area to the rectal area. Taking a prophylactic antibiotic after sexual intercourse is an inappropriate use of antibiotics that may support the development of resistant strains of bacteria; antibiotics should be used judiciously and be prescribed by a licensed health care provider.

A client with chronic renal failure has been on hemodialysis for two years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely: 1 An attempt to punish the nursing staff 2 A constructive method of accepting reality 3 A defense against underlying depression and fear 4 An effort to maintain life and to live it as fully as possible

3 Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.

A nurse is counseling a woman who had recurrent urinary tract infections. What factor should the nurse explain is the reason why women are at a greater risk than men for contracting a urinary tract infection? 1 Altered urinary pH 2 Hormonal secretions 3 Juxtaposition of the bladder 4 Proximity of the urethra to the anus

4 Because the female's urethra is closer to the anus than the male's, it is at greater risk for becoming contaminated. Urinary pH is within the same range in both males and females. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in males and females.

A client who is dehydrated is to receive an intravenous (IV) solution of normal saline to be infused at 175 mL/hr. The drop factor of the IV set is 15 gtts/mL. At what drop rate should the nurse adjust the flow to provide the prescribed solution? Record your answer using a whole number. __________ gtts/min

44 44 gtts/min is a correct calculation. Multiply the amount of fluid to be infused (175 mL) by the drop factor (15) and divide this result by the amount of time in minutes (1 hr x 60 min).

After a nephrectomy a client arrives in the post-anesthesia care unit in the supine position. Which action should be employed by the nurse to assess the client for signs of hemorrhage? 1 Turn the client to observe the dressings. 2 Press the client's nail beds to assess capillary refill. 3 Observe the client for hemoptysis when suctioning. 4 Monitor the client's blood pressure for a rapid increase

1 Because of the anatomic position of the incision, drainage will flow by gravity and accumulate under the client lying in the supine position. Nail beds indicate peripheral perfusion, not early hemorrhage. Respiratory hemorrhage is not common after kidney surgery. The blood pressure decreases and the pulse rate increases with hemorrhage.Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.

A client who had a lithotripsy for a renal calculus is to be discharged from the hospital. What should the nurse include in the home care instructions? 1 Drink at least 3 L of fluid daily for four weeks 2 Eliminate organ meats from the diet for six weeks 3 Increase the intake of dairy products for five days 4 Restrict movement for three days before resuming usual activities

1 Increasing fluid intake aids in the passage of fragments of the calculus that remain after the lithotripsy. Organ meats are high in purine, an amino acid, which is a causative factor in the formation of uric acid crystals; they should be avoided by people with gout. Calcium is the major component of the most common type of calculus; the intake of dairy products, which are high in calcium, should be limited. Early ambulation is encouraged to aid in the passage of fragments of the calculus that remain after a lithotripsy.STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it.

Which action should be included in the plan of care for a client who has had pelvic surgery 1 Encouraging the client to ambulate in the hallway. 2 Elevating the client's legs by raising the bed's knee support. 3 Assisting the client to dangle the legs over the side of the bed. 4 Maintaining the client on bed rest until the bandages are removed.

1 Muscle contractions during ambulation improves venous return, preventing venous stasis and thrombus formation. Elevating the client's legs by raising the bed's knee support places pressure on popliteal spaces, limiting venous return and increasing the risk for thrombus formation. Assisting the client to dangle the legs over the side of the bed places pressure on popliteal spaces, limiting venous return and increasing the risk for thrombus formation. Bed rest is associated with venous stasis, which increases the risk for thrombus formation.

After a transurethral vaporization of the prostate, the client returns to the unit with an indwelling urinary catheter and a continuous bladder irrigation. The client puts the call light on to report the need to urinate. What should the nurse do first? 1 Assess that the tubing attached to the collection bag is patent 2 Obtain the client's vital signs 3 Explain that the balloon inflated in the bladder causes this feeling 4 Review the client's intake and output

1 The drainage tubing may be obstructed. Retained fluid raises intravesicular pressure, causing discomfort similar to the urge to void. The client's vital signs are not related to the complaint. Although it is true that the balloon inflated in the bladder causes this feeling, the patency of the gravity system should be ascertained before determining the cause of the complaint. Although the nurse may review the client's intake and output, it is not the priority. Whether urine is draining from the tubing at this point in time is significant.

Despite receiving 2900 mL intake for two days, the client's urine output has progressively diminished. The nurse identifies that the urinary output is less than 40 mL/hr over the past three hours. What action should the nurse take? 1 Assess breath sounds and obtain vital signs 2 Decrease the intravenous (IV) flow rate and increase oral fluids 3 Insert an indwelling catheter to facilitate emptying of the bladder 4 Check for dependent edema by assessing the lower extremities

1 The imbalance in intake and output, with a decreasing urinary output, may indicate kidney failure. The retention of excess body fluid can precipitate the development of heart failure. Assessing breath sounds and obtaining the vital signs are necessary when monitoring for these complications. In the presence of hypervolemia, oral and intravenous fluid intake should be decreased. There are no data to support a problem with excretion of urine; the problem is with insufficient production. The insertion of a urinary retention catheter requires a health care provider's prescription. Checking for dependent edema by assessing the lower extremities is an appropriate assessment after respirations and vital signs are assessed.

During discharge teaching, a client with an ileal conduit asks how frequently the urine pouch should be emptied. The best reply by the nurse is: 1 "To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours." 2 "To prevent skin irritation, it should be emptied every hour if any urine has collected in the bag." 3 "To reduce the risk of infection, the system should be opened as little as possible; two times a day is adequate." 4 "To reduce the cost of drainage pouches, it should be emptied once the system is switched to a bedside collection bag."

1 The weight of a full bag can pull the appliance from the skin and cause leakage; it should be emptied approximately every two to three hours or when half full. Emptying the collection bag every hour is too often; it should be emptied when it is half full. With proper technique, draining the pouch should not put the individual at risk for infection. The collection bag would be too full if emptied only twice a day. Drainage pouches need not be thrown away when emptied; permanent appliances can be washed and reused.

A nurse teaches a client who is scheduled for a kidney transplant about the need for immunosuppressive medications. The nurse determines that the client understands the teaching when the client states, "I must take these medications: 1 For the rest of my life." 2 Until the surgery is over." 3 Until the anastomosis heals." 4 During the intraoperative period."

1 These drugs must be taken continuously to prevent rejection of the transplanted organ. The danger of rejection always exists. The client must take the medications longer than after the surgery or until the anastomosis heals or during the intraoperative period. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

A client who is suspected of having Cushing syndrome is admitted to the hospital. The nurse plans to monitor this client for: 1 Hypokalemia 2 Hypovolemia 3 Hypocalcemia 4 Hyponatremia

1 With glucocorticoid excess, aldosterone hypersecretion occurs and sodium is retained; therefore, potassium is excreted, leading to hypokalemia. Hypervolemia occurs because of sodium and water retention precipitated by aldosterone. Hypocalcemia is not associated with aldosteronism. Aldosterone hypersecretion causes sodium retention and hypernatremia, not hyponatremia.

The nurse reviews the medical records of four male clients and concludes that the client that is at highest risk of developing prostate cancer is the: 1 Black 55-year-old 2 White 45-year-old 3 Asian 55-year-old 4 Hispanic 45-year-old

1 Cancer of the prostate is rare before age 50 but increases with each decade; black men develop cancer of the prostate twice as often and at an earlier age than white men. White men develop prostatic cancer half as often as black men, but more commonly than Asian or Hispanic men. Asian and Hispanic men have a lower incidence of prostatic cancer and a lower mortality rate than white and black men.

A client is admitted to a medical unit with the diagnosis of acute kidney failure. The nurse reviews the client's laboratory data, performs a physical assessment, and obtains the client's vital signs. What should the nurse conclude the client is most likely experiencing? (T 98.9, P 78, R 20, BP 180/100, C/0 NAUSEA, DIARRHEA, ABDOMAINAL PAIN, MUSCLE WEAKENESS. POTASSIUM 5,8 mEq/L, SODIUM 140 mEq/L, CALCIUM 9.0) 1 Hyperkalemia 2 Hyponatremia 3 Hypouricemia 4 Hypercalcemia

1 Damaged kidneys are unable to excrete potassium, resulting in hyperkalemia. Potassium, part of the sodium-potassium pump, is involved with muscle contraction. The clinical manifestations indicate hyperkalemia. The expected serum level of potassium is 3.5 to 5.5 mEq/L. Hyponatremia generally is not associated with acute renal failure; hyponatremia is associated with headache, muscle weakness, apathy, and abdominal cramps, not with an irregular pulse or diarrhea. The expected serum level of sodium is 136 to 145 mEq/L. With acute kidney failure the serum sodium may be normal, increased, or decreased. Hypouricemia will not occur, because serum uric acid is increased in clients with kidney failure. Hypercalcemia is not associated with the assessment data listed in the scenario. The expected serum calcium level is 9.0 to 10.5 mg/dL. The serum calcium level with acute kidney failure may be slightly decreased.

A nurse is caring for a client who had a kidney transplant. What sign indicates that the client may be rejecting the transplanted kidney? 1 Fever 2 Hematuria 3 Moon face 4Yellow sclera

1 Fever is a characteristic of the systemic inflammatory response to the antigen (transplanted kidney). Hematuria is not indicative of rejection; however, its occurrence necessitates further investigation. A moon face (moon facies) is an effect of steroid therapy and does not indicate rejection. Jaundice is unrelated to rejection of a transplanted kidney.

A client will be taking nitrofurantoin (Macrobid) 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? 1 Increase the intake of fluids. 2 Strain the urine for crystals and stones. 3 Stop the drug if urinary output increases. 4 Maintain the exact time schedule for taking the drug

1 To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.

A client who is recovering from deep partial-thickness burns develops chills, fever, flank pain, and malaise. The health care provider makes a tentative diagnosis of urinary tract infection. Which diagnostic tests should the nurse expect the health care provider to prescribe to confirm this diagnosis? 1 Urinalysis and urine culture and sensitivity 2 Cystoscopy and bilirubin level 3 Creatinine clearance and albumin/globulin (A/G) ratio 4 Specific gravity and pH of the urine

1. The client's adaptations may indicate a urinary tract infection; a culture of the urine will identify the microorganism. A cystoscopy is too invasive as a screening procedure; altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms. Creatinine clearance reflects renal function; A/G ratio reflects liver function. Although an increased urine specific gravity may indicate red blood cells (RBCs), white blood cells (WBCs), or casts in the urine, which are associated with urinary tract infection, it will not identify the causative organism.

The nurse reviews a client's medication history, which includes a cholinergic medication. The client states, "I take that for some kind of urinary problem." The nurse recalls that cholinergic medications are prescribed primarily for what type of urinary condition? 1 Kidney stones 2 Flaccid bladder 3 Spastic bladder 4 Urinary tract infections

2 Cholinergics intensify and prolong the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention. Cholinergics will not prevent renal calculi. Anticholinergics are prescribed for the frequency and urgency associated with a spastic bladder. Preventing urinary tract infections is a secondary gain because cholinergics help prevent urinary retention that can lead to a urinary tract infection, but this is not the primary purpose for administering these drugs.

The nurse is providing postoperative care eight hours after a client had a total cystectomy and the formation of an ileal conduit. What assessment finding should be reported immediately? 1 Edematous stoma 2 Dusky-colored stoma 3 Absence of bowel sounds 4 Pink-tinged urinary drainage

2 Dusky-colored stoma may denote a compromised blood supply to the stoma and impending necrosis. Edematous stoma and absence of bowel sounds are expected in the early postoperative period after this surgery. Pink-tinged urine may be present in the immediate postoperative period.

A client is admitted to the hospital from the emergency department with a diagnosis of urolithiasis. The nurse reviews the client's clinical record and performs an admission assessment. What is the priority nursing action? 1 Strain the client's urine. 2 Administer the prescribed morphine. 3 Place in the high-Fowler position. 4 Collect a urine specimen for culture and sensitivity. 00:00:26

2 Pain relief is the priority. Clients report that ureteral colic is excruciatingly painful. Once pain is under control and the client is comfortable, other medical and nursing interventions can be implemented. Although straining all urine is required, pain relief is the priority. Once the client is medicated for pain, the urine that was set aside can be strained. The high-Fowler position is not necessary. The client can be assisted to assume a position of comfort. The urine was sent for a culture and sensitivity in the emergency department.

A nurse is assessing a client who is scheduled for a liver biopsy. What assessment finding needs to be reported immediately because it warrants a postponement of the liver biopsy? 1 Mental confusion 2 International normalized ratio (INR) of 4.0 3 Presence of an infectious disease 4 Foods high in vitamin K eaten before the biopsy

2 Prolonged INR time indicates that the client has a deficiency in clotting; this should be corrected before the biopsy is performed to prevent hemorrhage. The client with mental confusion will need support and the health care provider may need assistance, but the test can be done. A biopsy is not contraindicated in the presence of an infectious disease. Vitamin K is needed for the production of prothrombin; however, ingestion does not guarantee clotting activity.

A nurse is caring for an older bedridden male client who is incontinent of urine. What nursing intervention is the most satisfactory initial approach to managing urinary incontinence? 1 Restricting fluid intake 2 Offering the urinal regularly 3 Applying incontinence pants 4 Inserting an indwelling urinary catheter

2 Retraining the bladder includes a routine pattern of attempts to void, which may increase bladder muscle tone and produce a conditioned response. Restricting fluid intake can result in dehydration and a urinary tract infection in an older client. Applying incontinence pants does not address the cause of the incontinence; also it promotes skin breakdown and can lower self-esteem. Inserting an indwelling urinary catheter increases the risk of a urinary tract infection, promotes an atonic bladder, and prolongs incontinence. Also, it requires a health care provider's prescription.

A sexually active client presents with a sore throat and a generalized rash. The client states that a chancre that had been present healed approximately three months ago. The physical assessment and the serologic test findings indicate a diagnosis of syphilis. The nurse recognizes that the client is experiencing what stage of syphilis? 1 Primary 2 Secondary 3 Latent 4 Tertiary

2 The client has secondary syphilis, which occurs one to three months after healing of the primary lesion and lasts for several weeks to as long as a year; it is the stage at which the individual is most infectious. Primary syphilis is the stage of initial infection and is characterized by the presence of a chancre, a painless lesion at the site of infection. Latent syphilis occurs after the secondary stage and before the late stage of syphilis; in latent syphilis the immune system is able to suppress the infection and there are no clinical signs and symptoms. Tertiary syphilis, also known as late syphilis, is the final stage of syphilis; 20% to 40% do not demonstrate signs and symptoms during this stage. At this stage it is a slowly progressive inflammatory disease that can involve many organs; common complications include paresis, brain attack, dementia, psychosis, aortitis, and meningitis.

A postmenopausal woman who has cancer of the breast decides to have a lumpectomy followed by chemotherapy. After receiving chemotherapy for several weeks, she says to a nurse at the clinic, "I don't feel well." The nurse reviews the medical record. Based on this information, what does the nurse conclude is the client's priority need? 1 Promoting rest 2 Preventing infection 3 Avoiding bodily harm 4 Maintaining fluid balance

2 The prevention of infection is the priority because an infection can be life-threatening for a client who is immunocompromised. Chemotherapeutic medications depress the bone marrow, causing leukopenia. This client's white blood cell count is below the expected range of 4500 to 11,000/mm3 for an older female adult. Although the elevation in the client's temperature, pulse, and respirations may be related to the direct effects of the chemotherapeutic agents, they also may reflect that the client is resisting a microbiological stress. Although a balance between rest and activity is important, it is not the priority . While chemotherapeutic medications depress the bone marrow and cause anemia, this client's red blood cell count is within the expected range of 4.0 to 5.0 million/mm 3 for an older female adult. The client's hemoglobin level is within the expected range of 11.5 to 16.0 g/dL. Even though preventing injury is important, it is not the priority . Although chemotherapeutic medications depress the bone marrow, causing thrombocytopenia, this client's platelet count is within the expected range of 150,000 to 400,000/mm 3 for an adult. While maintaining fluid balance is important, it is not the priority . The client's hematocrit is within the expected range of 38% to 41% for an older female adult, indicating that the client is not dehydrated. The client's blood pressure is not decreased, which occurs with dehydration. Although chemotherapeutic medications may cause nausea, vomiting, and diarrhea, the client did not indicate that these occurred.

A client has a permanent colostomy. During the first 24 hours, there is no drainage from the colostomy. The nurse concludes that this is a result of the: 1 Edema after the surgery 2 Absence of intestinal peristalsis 3 Decrease in fluid intake before surgery 4 Effective functioning of the nasogastric tube

2 Absence of peristalsis is caused by manipulation of abdominal contents and the depressant effects of anesthetics and analgesics. Edema will not interfere with peristalsis; edema may cause peristalsis to be less effective, but some output will result. An absence of fiber has a greater effect on decreasing peristalsis than does decreasing fluids. A nasogastric tube decompresses the stomach; it does not cause cessation of peristalsis. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

A routine urinalysis is prescribed for a client. What should the nurse do if the specimen cannot be sent immediately to the laboratory? 1 Take no special action. 2 Refrigerate the specimen. 3 Store it in the dirty utility room and send it later. 4 Discard the specimen and collect another specimen later.

2 Refrigeration retards the growth of bacteria and may preserve the specimen for several hours. Growth of bacteria will alter the pH and the glucose and protein levels in the urine; it must be refrigerated to retard growth. Discarding the specimen and collecting another specimen later represents an unnecessary waste of time, effort, and money. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of this text over an extended period of time ensures your understanding of the mechanics of the examination and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.

When performing a peritoneal dialysis procedure, the nurse should: 1 Place the client in a side-lying position 2 Warm dialysate solution slightly before instillation 3 Infuse the dialysate solution slowly over several hours 4 Withhold the routine medications until after the procedure

2 The infusion should be warmed to body temperature to lessen abdominal discomfort and promote dilation of peritoneal vessels. The side-lying position may restrict fluid inflow and prevent maximum urea clearance; the client should be placed in the semi-Fowler position. The infusion of dialysate solution should take approximately 5 to 10 minutes. Routine medications should not interfere with the infusion of dialysate solution

A pathology report states that a client's urinary calculus is composed of uric acid. Which should the nurse instruct the client to avoid? 1 Milk 2Liver 3Cheese 4 Vegetables

2 Uric acid stones are controlled by a low-purine diet. Foods high in purine, such as organ meats and extracts, should be avoided. Milk should be avoided with calcium, not uric acid, stones. Cheese should be avoided with cystine, not uric acid, stones. Vegetables do not have to be avoided; however, legumes should be kept to a minimum.

The nurse recalls that what scientific principle is basic to caring for a client with an indwelling urinary catheter? 1 Inertia 2 Gravity 3 Osmosis 4 Diffusion

2 An indwelling urinary catheter always is positioned so that the level of the bladder is higher than the level of the drainage container; gravity promotes urine flow. Inertia refers to a property of matter. Osmosis refers to the movement of water across a semipermeable membrane; it is not responsible for the flow of urine through a catheter. Diffusion refers to the passage of molecules from an area of higher concentration to one of lower concentration. Content Area - Medic

The laboratory values of a client with renal calculi reveal a serum calcium within expected limits and an elevated serum purine. The nurse concludes that the stone probably is composed of: 1 Cystine 2 Uric acid 3 Calcium oxalate 4 Magnesium ammonium phosphate

2 Purines are precursors of uric acid, which crystallizes. Cystine stones are caused by a rare hereditary defect resulting in inadequate renal tubular reabsorption of cystine (inborn error of cystine metabolism). Serum purine will not be elevated if the stone is composed of calcium oxalate. A struvite stone sometimes is called a magnesium ammonium phosphate stone and is precipitated by recurrent urinary tract infections with coliform bacteria

A female client who has recurrent urinary tract infections (UTIs) is inquiring about the prevention of future UTIs. What information should the nurse include when teaching the client? (Select all that apply.) 1 Avoid fluid intake after 6 pm 2 Drink 8 to 10 glasses of water each day 3 Urinate immediately after sexual intercourse 4 Increase the daily intake of carbonated beverages 5 Clean the perineal area with an astringent soap twice a day

2 & 3 Drinking 8 to 10 glasses of water spaced throughout the day flushes the urinary tract and minimizes urinary stasis. Urination flushes the urethra and urinary meatus, limiting the presence of microorganisms. Limiting fluid intake contributes to stasis of urine. Carbonated and caffeinated beverages irritate the bladder and should be avoided. Cleaning the perineum with harsh soaps is irritating to the skin and mucous membranes, and can contribute to the development of UTIs in susceptible women.

A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result confirmed the diagnosis? 1 Rectal examination 2 Serum phosphatase level 3 Biopsy of prostatic tissue 4 Pap smear of prostatic fluid

3 A definitive diagnosis of the cellular changes associated with benign prostatic hyperplasia is made by biopsy, with subsequent microscopic evaluation. Palpation of the prostate gland through rectal examination is not a definitive diagnosis; this only reveals size and configuration of the prostate. The serum phosphatase level will provide information as to the activity of phosphorus in the body; a definitive diagnosis cannot be made with this test. The Pap smear of prostatic fluid test will not yield a definitive diagnosis because malignant cells might not be present in the fluid. STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently.

An older adult client is demonstrating mild confusion after surgical repair of a hernia. What should the nurse do to provide for this client's safety? 1 Use a nightlight in the client's room. 2 Secure a prescription for a soft vest restraint. 3 Activate the position-sensitive bed alarm. 4 Raise the four side rails on the client's bed

3 A positional bed alarm is a noninvasive devise to protect a client who attempts to get out of bed unassisted. Staff members must immediately respond to the alarm to ensure that clients are protected from potential injury. Although a nightlight may help orient a client at night, it does not help during the daylight hours. A vest restraint is a measure of last resort when all other less restrictive measures have proven to be ineffective. Confused clients often become more agitated when all the side rails are raised, posing an increased, not a decreased, risk of injury. Confused clients may try to climb over the side rails or try to exit from the end of the bed, placing them at risk for entrapment or a fall. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or responses that appear to be degrading

Before a client with syphilis can be treated, what should be determined? 1 Portal of entry 2 Size of chancre 3 Existence of allergies 4 Names of sexual contacts

3 Although the treatment of choice is penicillin, clients who are allergic must be given other antimicrobial agents to avoid an anaphylactic reaction. The portal of entry does not influence treatment. The chancre is present only in the primary stage; it does not alter treatment. Although contacts should be identified and notified, treatment should not be delayed.

A client with uremic syndrome has the potential to develop many complications. Which complication should the nurse anticipate? 1 Hypotension 2 Hypokalemia 3 Flapping hand tremors 4 Elevated hematocrit values

3 An elevation in uremic waste products causes irritation of the nerves, resulting in flapping hand tremors (asterixis, "liver flap"). Hypertension results from kidney failure because of sodium and water retention. The diseased kidney is unable to excrete potassium ions, resulting in hyperkalemia, not hypokalemia. The hematocrit value will be low because of a decreased production of erythropoietin, a hormone synthesized in the kidney; erythropoietin regulates the production of erythrocytes. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience.

A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which response to the medication? 1 Retention of sodium ions 2 Negative nitrogen balance 3 Excessive loss of potassium ions 4 Increase in the urine specific gravity

3 Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism. With edema, the specific gravity of the fluid more likely will be low. Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams have specified time limits, you should pace yourself during the practice testing period accordingly. It is helpful to estimate the time that can be spent on each item and still complete the examination in the allotted time. You can obtain this figure by dividing the testing time by the number of items on the test. For example, a 1-hour (60-minute) testing period with 50 items averages 1.2 minutes per question. The NCLEX exam is not a timed test. Both the number of questions and the time to complete the test varies according to each candidate's performance. However, if the test taker uses the maximum of 5 hours to answer the maximum of 265 questions, each question equals 1.3 minutes.

A nurse is caring for a client receiving hemodialysis for chronic kidney disease. The nurse should monitor the client for what complication? 1 Peritonitis 2 Renal calculi 3 Hepatitis B 4 Bladder infection

3 Hepatitis type B is transmitted by blood or blood products. The hemodialysis and routine transfusions needed for a client in end-stage renal failure constitute a high risk for exposure. Peritonitis is a danger for individuals receiving peritoneal dialysis. Renal calculi are not a complication of hemodialysis; they often occur in clients who are confined to prolonged bed rest. Dialysis does not involve the bladder and will not contribute to the development of a bladder infection.

An older adult client states, "I walk 2 miles a day for exercise, but now that the weather is hot, I am worried about becoming dehydrated." What should the nurse teach the client? 1 Drink fruit juices if you start to feel dehydrated. 2 Thirst is a good guide to use to determine fluid intake. 3 Fluids should be increased if the urine is getting darker. 4 Water should be consumed when the skin becomes dry

3 In hot weather, dark-colored urine indicates dehydration. The amount of fluid to be excreted is less, and the body is attempting to conserve fluid. Fruit juices should be avoided during rehydration because of their high sugar content. By the time people become thirsty, they already are dehydrated, especially older adults. Dry skin in older adults may be related to aging rather than to dehydration. Water intake should be adequate (in hot weather, dark-colored urine indicates dehydration. The amount of fluid to be excreted is less, and the body is attempting to conserve fluid. Approximately 2000 mL daily is needed) and spaced throughout the day.

To help prevent a cycle of recurring urinary tract infections, the nurse should plan to instruct a female client to 1 Increase the daily intake of citrus juice 2 Douche regularly with alkaline agents 3 Urinate as soon as possible after intercourse 4 Wipe carefully from back to front

3 Intercourse may cause urethral inflammation, increasing the risk of infection; voiding clears the urinary meatus and urethra of microorganisms. Most fruit juices, with the exception of cranberry juice, cause alkaline urine, which promotes bacterial growth. Douching is no longer recommended because it alters the vaginal flora. Perineal care should be accomplished with wipes from the urinary meatus toward the rectum to help prevent microorganisms from the vaginal or rectal areas from reaching the urinary meatus.

A client comes to the emergency department because of minimal urinary output despite drinking adequate fluid. The client's blood pressure is 190/94. For what additional clinical manifestation associated with this data, should the nurse assess the client? 1 Thirst 2 Urinary retention 3 Weight gain 4 Urinary hesitancy

3 Oliguria is the inability to produce more than 400 to 500 mL of urine daily. Expected daily urinary output is 1000 to 3000 mL daily, depending on the volume of fluid intake. If urine is not being produced in the presence of an average daily intake, fluid will be retained and reflected in weight gain. One liter of fluid weighs 2.2 pounds. Excess fluid contributes to an increase in circulating blood volume, causing hypertension. Thirst is associated with dehydration, not hypertension and oliguria. Urinary retention is unrelated to hypertension and oliguria. Urinary retention is the inability to empty the bladder caused by urethral obstruction, lesions involving the nerve pathways to and from the bladder or involving reflex centers in the brain or spinal cord, and medications. Urine is retained in the bladder until increased abdominal pressure causes urine to be lost involuntarily. Urinary hesitancy is an involuntary delay in initiating urination and is unrelated to hypertension and oliguria.

A nurse is caring for a client with acute kidney failure who is receiving a protein-restricted diet. The client asks why this diet is necessary. What information should the nurse include in a response to the client's questions? 1 A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses. 2 Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein synthesis. 3 This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys. 4 Urea nitrogen cannot be used to synthesize amino acids in the body, so the nitrogen for amino acid synthesis must come from the dietary protein.

3 The amount of protein permitted in the diet (usually less than 50 g) depends on the extent of kidney function; excess protein causes an increase in urea concentration, which should be avoided Adequate calories are provided to prevent tissue catabolism, which also results in an increase in metabolic waste products. In kidney failure the kidneys are unable to eliminate the waste products of a high protein diet. The body is able to synthesize the nonessential amino acids. Urea is a waste product of protein metabolism; the body is able to synthesize the nonessential amino acids.

A client who has repeated episodes of cystitis is scheduled for a cystoscopy to determine the possibility of urinary tract abnormalities. The client asks the nurse to describe the procedure. The nurse's most appropriate response is, "This procedure is: 1 A computerized scan that outlines the bladder and surrounding tissue." 2 An x-ray film of the abdomen, kidneys, ureters, and bladder after administration of dye." 3 The visualization of the inside of the bladder with an instrument connected to a source of light." 4 The visualization of the urinary tract through ureteral catheterization and the use of radiopaque material."

3 The response that the procedure is "the visualization of the inside of the bladder with an instrument connected to a source of light" answers the client's question and provides an accurate description of a cystoscopy. A cystoscopy is not a computerized examination. A cystoscopy does not involve x-ray films or dye. Radiopaque material is not used in a cystoscopy and the catheter is inserted into the bladder via the urethra, not the ureters

The nurse determines that which genitourinary factor contributes to urinary incontinence in older adults? 1 Sensory deprivation 2 Urinary tract infection 3 Frequent use of diuretics 4 Inaccessibility of a bathroom

3 Urinary tract infections affect the genitourinary tract and interfere with voluntary control of micturition. Sensory deprivation is a neurological, not a genitourinary, factor. Frequent use of diuretics is an iatrogenic, not genitourinary, factor. Inaccessibility of a bathroom is an environmental, not genitourinary, factor. Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer.

A nurse is notified that the latest potassium level for a client in acute renal failure is 6.2 mEq. What action should the nurse take? 1 Alert the cardiac arrest team 2 Call the laboratory to repeat the test 3 Take vital signs and notify the primary health care provider 4 Obtain an ECG strip and obtain an antiarrhythmic medication

3 Vital signs monitor the cardiopulmonary status; the health care provider must treat this hyperkalemia to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Obtaining an ECG strip and having an antiarrhythmic available are correct interventions if available, but the priority is medical attention and the health care provider should be notified immediately.

A client experiences difficulty in voiding after an indwelling urinary catheter is removed. The nurse determines that this difficulty most likely is related to: 1 Fluid imbalance 2 Sedentary lifestyle 3 Interruption in previous voiding habits 4 Nervous tension following the procedure

3 An indwelling catheter dilates the urinary sphincters, keeps the bladder empty, and short-circuits the reflex mechanism based on bladder distention. When the catheter is removed, the body must adapt to functioning once again. Although fluid imbalance may cause difficulty in voiding, there are no data presented to draw this conclusion. A sedentary lifestyle and nervous tension will not cause this problem. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.

A client with a urinary retention catheter reports discomfort in the bladder and urethra. What should the nurse do first? 1 Milk the tubing gently. 2 Notify the health care provider. 3 Check the patency of the catheter. 4 Irrigate the catheter with prescribed solutions.

3 Checking the patency of the catheter ensures drainage and prevents bladder distention and other complications. Patency of the catheter should be established before any other intervention. Milking the tubing gently is premature; this may be necessary if the catheter is clogged and usually is required when the drainage is viscous rather than liquid. Assessment is necessary before consultation with the health care provider. Irrigation is avoided if possible because of the associated risk for infection.

A nurse is planning to administer a prescribed intravenous solution that contains potassium chloride. What assessment should be brought to the health care provider's attention before administration of the intravenous (IV) line? 1 Uncharacteristic irritability 2 Poor tissue turgor with tenting 3 Urinary output of 200 mL during the previous 8 hours 4 Oral fluid intake of 300 mL during the previous 12 hours

3 Decreased urinary output will result in the retention of potassium, causing hyperkalemia. Reporting uncharacteristic irritability is unnecessary; this is a sign of dehydration, which can be corrected with appropriate hydration. Reporting poor tissue turgor with tenting is unnecessary; this may indicate dehydration, which is probably the rationale for the fluid prescribed. Reporting an oral fluid intake of 300 mL during the previous 12 hours is unnecessary; this can precipitate dehydration or can compound an existing dehydration, which can be treated with appropriate hydration.

A client who is diagnosed with sexual dysfunction makes a comment to the nurse, "Well, I guess my sex life is over." What is the most appropriate response by the nurse? 1 "I'm sorry to hear that." 2 "Oh, you have a lot of good years left." 3 "You are concerned about your sex life?" 4 "Have you asked your health care provider about that?"

3 The response "You are concerned about your sex life?" explores the meaning of the statement and allows further expression of concern. The response "I'm sorry to hear that" does not allow an explanation of feelings and cuts off communication. The response "Oh, you have a lot of good years left" lacks both empathy and understanding; it also cuts off communication. The response "Have you asked your health care provider about that?" shirks responsibility; the client may be embarrassed to ask the health care provider and needs the nurse to act as facilitator.

A client just had a suprapubic prostatectomy. Which action should the nurse implement to prevent a secondary bladder infection? 1 Observe for signs of uremia 2 Attach the catheter to suction 3 Clamp off the connecting tube 4 Change the dressings frequently

4 After a suprapubic prostatectomy, leakage of urine generally is identified around the suprapubic tube; this creates an environment in which bacteria can flourish if the dressing is not changed frequently. Uremia is caused by inadequate kidney function; it is not directly related to bladder infection. Negative pressure on the bladder may traumatize the delicate tissue; urine should flow because of gravity. Clamping off the tube causes urinary stasis, which increases the risk for infection.Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it.

To facilitate micturition in a male client, the nurse should instruct him to: 1 Use a urinal for voiding 2 Drink cranberry juice daily 3 Wash the hands after voiding 4 Assume the standing position for voiding

4 Assuming the standing position for voiding uses gravity to allow urine to exert pressure on the area of the trigone, initiating relaxation of the urinary sphincter and facilitating micturition. Although using a urinal for voiding may be important when urine is collected to be strained, analyzed, or measured, it will not facilitate micturition. An acid-ash diet may be used to prevent urinary infection and the formation of calcium stones; it will not facilitate micturition. Washing the hands after voiding is important after urination but will not help facilitate micturition.

After prostate surgery a client's indwelling catheter and continuous bladder irrigation (CBI) are to be removed. The nurse discusses the procedure with the client. The nurse evaluates that the teaching is understood when the client states, "After the catheter is removed I probably will: 1 Have dilute urine." 2 Be unable to urinate." 3 Produce dark red urine." 4 Experience some burning on urination.

4 Because of the trauma to the mucous membranes of the urinary tract, burning on urination is an expected response that should subside gradually. The urine should no longer be dilute after the continuous bladder irrigation is discontinued and removed. However, the urine may have a slight pink tinge because of the trauma from the surgery and the presence of the catheter. An inability to urinate should not occur unless the indwelling catheter is removed too soon and there is still edema of the urethra. Production of dark red urine is a sign of hemorrhage, which should not occur.

The nurse is caring for a client who has been diagnosed with glomerulonephritis. What initial urinary finding supports this diagnosis? 1 Anuria 2 Dysuria 3 Polyuria 4 Hematuria

4 Blood in the urine (hematuria) and red blood cell casts are classic manifestations of the onset of glomerulonephritis because of the increased permeability of the vascular bed in the kidneys. Suppression of urine formation (anuria) is not an initial manifestation of glomerulonephritis; oliguria may be present. Pain or burning on urination (dysuria) is indicative of cystitis, not glomerulonephritis. Excessive urination (polyuria) does not occur as an initial change with glomerulonephritis; polyuria and nocturia may occur later with chronic glomerulonephritis when the renal structures are destroyed. Test-Taking Tip: Make educated guesses when necessary.

What does the nurse determine is the most likely cause of renal calculi in clients with paraplegia? 1 High fluid intake 2 Increased intake of calcium 3 Inadequate kidney function 4 Accelerated bone demineralization

4 Calcium that has left the bones as a response to prolonged inactivity enters the blood and may precipitate in the kidneys, forming calculi. Increased fluid intake is helpful in avoiding this condition by preventing urinary stasis. Calcium intake usually is limited to prevent the increased risk for calculi. Calculi may develop despite adequate kidney function; kidney function may be impaired by the presence of calculi and urinary tract infections associated with urinary stasis or repeated catheterizations.

A nurse evaluates that a client understands the side effects of hydrochlorothiazide (HCTZ) therapy when the client states, "I should call my health care provider if I develop: 1 Insomnia." 2 A stuffy nose." 3 An increase in thirst." 4 Generalized weakness."

4 Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy. Insomnia is not known to be related to hypokalemia or hydrochlorothiazide therapy. Although a stuffy nose is unrelated to hydrochlorothiazide therapy, it can occur with other antihypertensive drugs. Increased thirst is associated with hypernatremia. Because this drug increases excretion of water and sodium in addition to potassium and chloride, hyponatremia, not hypernatremia, may occur.

A client is suspected of having late-stage (tertiary) syphilis. When obtaining a health history, the nurse determines that the client statement that most supports this diagnosis is: 1 "I noticed a wart on my penis." 2 "I have sores all over my mouth." 3 "I've been losing a lot of hair lately." 4 "I'm having trouble keeping my balance."

4 Neurotoxicity, as manifested by ataxia, is evidence of tertiary syphilis, which may involve the central nervous system (CNS); other CNS signs include confusion, paralysis, delusions, impaired judgment, and slurred speech. A sore on the penis occurs in the secondary stage. Sores in the mouth occur in the secondary stage. Alopecia is not a sign of late-stage syphilis.

A client with chronic kidney disease is admitted to the hospital with severe infection and anemia. The client is depressed and irritable. The client's spouse asks the nurse about the anticipated plan of care. What is an appropriate nursing response? 1 "The staff will provide total care because the infection causes severe fatigue." 2 "Mood elevators will be prescribed to improve depression and irritability." 3 "Iron will be prescribed for the anemia and the stools will be dark." 4 "The intake of meat, eggs, and cheese will be restricted so the kidneys can clear the body of waste products."

4 One of the kidney's functions is to excrete nitrogenous waste from protein metabolism; restriction of protein intake decreases the workload of the damaged kidneys. The client is encouraged to be as active and independent as possible. Medications are avoided because they may mask symptoms. Iron supplements are not tolerated well by clients in kidney failure and reduce the client's own stimulus to produce red blood cells; folate usually is prescribed.

A lithotripsy to break up renal calculi is unsuccessful, and a nephrolithotomy is performed. Which postoperative clinical indicator should the nurse report to the health care provider? 1 Passage of pink-tinged urine 2 Pink drainage on the dressing 3 Intake of 1750 mL in 24 hours 4 Urine output of 20 to 30 mL/hr

4 Output should be at least 30 mL/hr or more; a decreased output may indicate obstruction or impaired kidney function. Blood, tinting the urine pink, is expected. Drainage may be pink; bright red drainage should be reported. The intake of 1750 mL in 24 hours is adequate; however, a higher intake usually is preferred (e.g., 2000 to 3000 mL).

A nurse is caring for a client with a diagnosis of chronic kidney failure who has just been told by the health care provider that hemodialysis is necessary. Which clinical manifestation indicates the need for hemodialysis? 1 Ascites 2 Acidosis 3 Hypertension 4 Hyperkalemia

4 Protein breakdown liberates cellular potassium ions, leading to hyperkalemia, which can cause a cardiac dysrhythmia and standstill. The failure of the kidneys to maintain a balance of potassium is one of the main indications for dialysis. Ascites occurs in liver disease and is not an indication for dialysis. Dialysis is not the usual treatment for acidosis; usually this responds to administration of alkaline drugs. Dialysis is not a treatment for hypertension; this is usually controlled by antihypertensive medication and diet.

The nurse assesses a male client with a preliminary diagnosis of cancer of the urinary bladder. The nurse recalls that which sign or symptom is a common early sign of cancer of the urinary system: 1 Dysuria 2 Retention 3 Hesitancy 4 Hematuria

4 Research statistics indicate that hematuria is the most common early sign of cancer of the urinary system, probably because of the urinary system's rich vascular network. Dysuria is not specific for bladder cancer; usually it is associated with an enlarged prostate in the male. Retention is not specific for bladder cancer; usually it is associated with an enlarged prostate in the male. Hesitancy is not specific for bladder cancer; usually it is associated with an enlarged prostate in the male.

What should a nurse do when caring for a client with continuous bladder irrigation? 1 Measure the output hourly. 2 Monitor the specific gravity of the urine. 3 Irrigate the catheter with saline three times daily. 4 Subtract the amount of irrigant instilled from the output

4 The amount of irrigant instilled must be deducted from the total output to determine the amount of urine voided. Measuring the output hourly is unnecessary. Specific gravity measures the concentration of urine; this measurement will be inaccurate because the urine is diluted with irrigant. Irrigating the catheter with saline three times daily is unnecessary; the bladder is being irrigated constantly.

A client in a nursing home is diagnosed with urethritis. What should the nurse plan to do before initiating antibiotic therapy prescribed by the health care provider? 1 Prepare for urinary catheterization. 2 Teach the client how to perform perineal care. 3 Start a 24-hour urine collection. 4 Obtain a urine specimen for culture and sensitivity

4 The causative organism should be isolated before starting antibiotic therapy. Catheterization is not a routine intervention for urethritis. Although client teaching is important, it is not the priority at this time. A 24-hour urine test will not determine the infective organism causing the problem. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. The nurse concludes that the presence of what substance in the urine needs to be reported to the health care provider? 1 Sodium 2 Potassium 3 Urea nitrogen 4 Large proteins

4 The glomeruli are not permeable to large proteins such as albumin or red blood cells (RBCs), and it is abnormal if albumin or RBCs are identified in the urine; their presence should be reported. The proximal tubules are responsible for regulating water, electrolytes (including sodium and potassium), urea nitrogen, and pH; the byproducts of this regulation appear in normal urine.

Which nursing action can best prevent infection from a urinary retention catheter? 1 Cleansing the perineum 2 Encouraging adequate fluids 3 Irrigating the catheter once daily 4 Cleansing around the meatus routinely

4 Cleansing the urinary meatus and adjacent skin removes accumulated bacteria, limiting the possible introduction of microbes into the urinary tract. The catheter should be stabilized so that bathing does not advance the catheter further into the meatus. Although cleansing the perineal area is helpful, it is actually the organisms closest to the meatus that gain entry to the urinary tract first. Although encouraging fluids helps prevent urinary stasis and subsequent infection, the most common source of infection is microorganisms from around the meatus. Irrigations require opening the closed drainage system, allowing the entry of microorganisms; this increases the risk for infection.

A 40-year-old client scheduled for a hemi-colectomy because of ulcerative colitis asks if having a hemi-colectomy means wearing a pouch and having bowel movements in an abnormal way. Which is the best response by the nurse? 1 "Yes, hemi-colectomy is the same as a colostomy." 2 "Yes, but it will be temporary until the colitis is cured." 3 "No, that is necessary when a tumor is blocking the rectum." 4 "No, only part of the colon is removed and the rest reattached."

4 Hemi-colectomy is removal of part of the colon with an anastomosis between the ileum and transverse colon; a colostomy is not necessary. With a colostomy the intestine opens on the abdomen, whereas in a hemi-colectomy a portion of the intestine is resected and the ends reconnected. "Yes, but it will be temporary until the colitis is cured" is the description of a temporary colostomy; a cure occurs only when the entire colon is removed. A colostomy is done for a variety of reasons other than a tumor; a colectomy with a colostomy is only one intervention that may be used to treat a tumor.