UTI Renal Lippincott

48. The client receives heparin while receiv- ing hemodialysis. The nurse explains the rationale supporting anticoagulation by making which of the following statements? I 1. "Regional anticoagulation is achieved by I 2. I 3. I 4. putting heparin in the dialysis machine and protamine sulfate, which reverses the antico- agulation, in the client." "You will receive warfarin sodium (Couma- din) to maintain anticoagulation between treatments." "Heparin does not enter the body, so there is no risk of bleeding." "Clotting time is seriously prolonged for sev- eral hours after each treatment."

1 (48. 1. Regional anticoagulation can be achieved by infusing heparin in the dialyzer and protamine sulfate, its antagonist, in the client. Warfarin sodium (Coumadin) is not used in dialysis treatment. There is some risk of bleeding; however, clotting time is monitored carefully. The client's clotting time will not be seriously affected, although some rebound effect may occur.)

51. The client with acute renal failure is recover- ing and asks the nurse, "Will my kidneys ever func- tion normally again?" The nurse's response is based on knowledge that the client's renal status will most likely: I 1. Continue to improve over a period of weeks. I 2. Result in the need for permanent hemodialysis. I 3. Improve only if the client receives a renal transplant. I 4. Result in end-stage renal failure.

1 (51. 1. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. The client should be taught how to rec- ognize the signs and symptoms of decreasing renal function and to notify the physician if such prob- lems occur. In a client who is recovering from acute renal failure, there is no need for renal transplan- tation or permanent hemodialysis. Chronic renal failure develops before end-stage renal failure.)

1. Encourage the client to increase fluid intake. 2. Withhold the next dose of antihypertensive medication. 3. Restrict the client's sodium intake. 4. Encourage the client to eat at least half of a banana per day.

1 (54. 1. The client's urine specific gravity is ele- vated. Specific gravity is a reflection of the concen- trating ability of the kidneys. This level indicates that the urine is concentrated. By increasing fluid intake, the urine will become more dilute. Antihy- pertensives do not make urine more concentrated unless there is a diuretic component within them. The nurse should not hold a dose of antihyperten- sive medication. Sodium tends to pull water with it; by restricting sodium, less water, not more, will be present. Bananas do not aid in the dilution of urine.)

65. Which of the following statements by the client would indicate that she is at high risk for a recurrence of cystitis? I 1. "I can usually go 8 to 10 hours without need- ing to empty my bladder." I 2. "I take a tub bath every evening." I 3. "I wipe from front to back after voiding." I 4. "I drink a lot of water during the day."

1 (65. 1. Stasis of urine in the bladder is one of the chief causes of bladder infection, and a client who voids infrequently is at greater risk for reinfection. A tub bath does not promote urinary tract infections as long as the client avoids harsh soaps and bubble baths. Scrupulous hygiene and liberal fluid intake (unless contraindicated) are excellent preventive measures, but the client also should be taught to void every 2 to 3 hours during the day.)

68. A client is diagnosed with acute pyelone- phritis. Which of the following instructions should the nurse provide to the client about managing the disease? 1. "Urinate frequently because the bacteria that cause acute pyelonephritis reach the kidneys by means of an infection that progresses upward from lower in the urinary tract." 2. "Taking frequent bubble baths will decrease the likelihood of further episodes of pyelone- phritis." 3. "You should take antibiotics for the rest of your life to prevent urinary tract infections." 4. "By decreasing your fluid intake, you will decrease the need for frequent urination and the irritating effect of urine in your ureter."

1 (68. 1. Pyelonephritis usually begins with colo- nization and infection of the lower urinary tract via the ascending urethral route, and the client should have an adequate intake of fluids to promote the flusing action of urination. Bubble baths and limit- ing fluid intake increase the risk of developing a urinary tract infection. Antibiotics should be used on a short-term basis because the risk of antibiotic resistance may lead to breakthrough infections with increasingly virulent pathogens.)

74. The nurse assesses the client who has chronic renal failure and notes the following: crack- les in the lung bases, elevated blood pressure, and weight gain of 2 lb in 1 day. Based on these data, which of the following nursing diagnoses is appro- priate? I 1. Excess fluid volume related to the kidney's inability to maintain fluid balance. I 2. Ineffective breathing pattern related to fluid in the lungs. I 3. Ineffective tissue perfusion related to inter- rupted arterial blood flow. I 4. Ineffective therapeutic regimen management related to lack of knowledge about therapy.

1 (74. 1. Crackles in the lungs, weight gain, and ele- vated blood pressure are indicators of excess fluid volume, a common complication in chronic renal failure. The client's fluid status should be moni- tored carefully for imbalances on an ongoing basis. Although the client has ineffective breathing, the primary cause is related to the renal failure. There are no data to suggest ineffective tissue perfusion or lack of knowledge.)

77. The dialysis solution is warmed before use in peritoneal dialysis primarily to: I 1. Encourage the removal of serum urea. I 2. Force potassium back into the cells. I 3. Add extra warmth to the body. I 4. Promote abdominal muscle relaxation.

1 (77. 1. The main reason for warming the peri- toneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contrib- utes to client comfort by preventing chilly sensa- tions, but this is a secondary reason for warming the solution. The warmed solution does not force potas- sium into the cells or promote abdominal muscle relaxation.)

86. The client with chronic renal failure tells the nurse he takes magnesium hydroxide (milk of magnesia) at home for constipation. The nurse sug- gests that the client switch to psyllium hydrophilic mucilloid (Metamucil) because: I 1. Milk of magnesia can cause magnesium intoxication. I 2. Milk of magnesia is too harsh on the bowel. I 3. Metamucil is more palatable. I 4. Milk of magnesia is high in sodium.

1 (86. 1. Magnesium is normally excreted by the kidneys. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. Milk of magnesia is harsher than Metamucil, but magnesium toxicity is a more serious problem. A client may find both milk of magnesia and Meta- mucil unpalatable. Milk of magnesia is not high in sodium.)

92. A client is receiving continous ambulatory peritoneal dialysis (CAPD). The nurse should assess the client for which of the following signs of perito- neal infection? I 1. Cloudy dialysate fluid. I 2. Swelling in the legs. I 3. Poor drainage of the dialysate fluid. I 4. Redness at the catheter insertion site.

1 (92. 1. Cloudy drainage indicates bacterial activ- ity in the peritoneum. Other signs and symptoms of infection are fever, hyperactive bowel sounds, and abdominal pain. Swollen legs may indicate heart failure. Poor drainage of dialysate fluid is probably the result of a kinked catheter. Redness at the inser- tion site indicates local infection, not peritonitis. However, a local infection that is left untreated can progress to the peritoneum.)

98. Which of the following interventions would be most appropriate for a client who has urge incon- tinence? I 1. Have the client urinate on a timed schedule. I 2. Provide a bedside commode. I 3. Administer prophylactic antibiotics. I 4. Teach the client intermittent self-catheteriza- tion technique.

1 (98. 1. Instructing the client to void at regularly scheduled intervals can help decrease the frequency of incontinence episodes. Providing a bedside com- mode does not decrease the number of incontinence episodes and does not help the client who leads an active lifestyle. Infections are not a common cause of urge incontinence, so antibiotics are not an appro- priate treatment. Intermittent self-catheterization is appropriate for overflow or reflux incontinence, but not urge incontinence, because it does not treat the underlying cause.)

47. During dialysis, the client has disequilibrium syndrome. The nurse should first? I 1. Administer oxygen per nasal cannula. I 2. Slow the rate of dialysis. I 3. Reassure the client that the symptoms are normal. I 4. Place the client in Trendelenburg's position.

2 (47. 2. If disequilibrium syndrome occurs dur- ing dialysis, the most appropriate intervention is to slow the rate of dialysis. The syndrome is believed to result from too-rapid removal of urea and excess electrolytes from the blood; this causes transient cerebral edema, which produces the symptoms. Administration of oxygen and position changes do not affect the symptoms. It would not be appropriate to reassure the client that the symptoms are normal.)

60. The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which of the following responses by the client would indicate that she understands the nurse's instructions? I 1. "I will place ice packs on my perineum." I 2. "I will take hot tub baths." I 3. "I will drink a cup of warm tea every hour." I 4. "I will void every 5 to 6 hours."

2 (60. 2. Hot tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Apply- ing heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffein- ated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encour- aged because it reduces urinary stasis.)

76. A client with chronic renal failure who receives hemodialysis three times a week is experi- encing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply. I 1. Drink fluids before eating solid foods. I 2. Have limited amounts of fluids only when thirsty. I 3. Limit activity. I 4. Keep all dialysis appointments. I 5. Eat smaller, more frequent meals.

2 (76. 2, 4, 5. To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty, eat food before drinking fluids to alleviate dry mouth, encourage strict follow-up for blood work, dialysis, and health care provider visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobiliza- tion because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.)

78. Which of the following assessments would be most appropriate for the nurse to make while the dialysis solution is dwelling within the client's abdomen? I 1. Assess for urticaria. I 2. Observe respiratory status. I 3. Check capillary refill time. I 4. Monitor electrolyte status.

2 (78. 2. During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time ordered by the physician (usually 20 to 45 min- utes). During this time, the nurse should monitor the client's respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client's laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during the treatment, not just during the dwell time.)

79. During the client's dialysis, the nurse observes that the solution draining from the abdo- men is consistently blood-tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct? 1. Bleeding is expected with a permanent peri- tered to prevent infection. 2. Bleeding indicates abdominal blood vessel damage. 3. Bleeding can indicate kidney damage. 4. Bleeding is caused by too-rapid infusion of the dialysate.

2 (79. 2. Because the client has a permanent cathe- ter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the physi- cian should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood- tinged drainage.)

81. Which of the following nursing interventions should be included in the client's plan of care dur- ing dialysis therapy? I 1. Limit the client's visitors. I 2. Monitor the client's blood pressure. I 3. Pad the side rails of the bed. I 4. Keep the client on nothing-by-mouth (NPO) status.

2 (81. 2. Because hypotension is a complica- tion associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client's behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.)

83. After completion of peritoneal dialysis, the nurse should expect the client to exhibit which of the following characteristics? I 1. Hematuria. I 2. Weight loss. I 3. Hypertension. I 4. Increased urine output.

2 (83. 2. Weight loss is expected because of the removal of fluid. The client's weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys' ability to manufacture urine.)

89. The nurse is discussing concerns about sex- ual activity with a client with chronic renal failure. Which one of the following strategies would be most useful? I 1. Help the client to accept that sexual activity will be decreased. I 2. Suggest using alternative forms of sexual expression and intimacy. I 3. Tell the client to plan rest periods after sexual activity. I 4. Suggest that the client avoid sexual activity to prevent embarrassment.

2 (89. 2. Altered sexual functioning commonly occurs in chronic renal failure and can stress mar- riages and relationships. Altered sexual function- ing can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity.)

94. A client has stress incontinence. Which of the following data from the client's history contrib- utes to the client's incontinence? I 1. The client's intake of 2 to 3 L of fluid per day. I 2. The client's history of three full-term preg- nancies. I 3. The client's age of 45 years. I 4. The client's history of competitive swimming.

2 (94. 2. The history of three pregnancies is most likely the cause of the client's current episodes of stress incontinence. The client's fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.)

90. A client with chronic renal failure has asked to be evaluated for a home continuous ambulatory peritoneal dialysis (CAPD) program. The nurse should explain that the major advantage of this approach is that it: I 1. Is relatively low in cost. I 2. Allows the client to be more independent. I 3. Is faster and more efficient than standard peritoneal dialysis. I 4. Has fewer potential complications than stan- dard peritoneal dialysis.

2 (90. 2. The major benefit of CAPD is that it frees the client from daily dependence on dialysis centers, health care personnel, and machines for life-sustaining treatment. This independence is a valuable outcome for some people. CAPD is costly and must be done daily. Adverse effects and com- plications are similar to those of standard peritoneal dialysis. Peritoneal dialysis usually takes less time but cannot be done at home.)

53. A client with a urinary tract infection is to take nitrofurantoin (Macrodantin) four times each day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client? I 1. "You can wait and take the next dose when it is due." I 2. "Double the amount prescribed with your next dose." I 3. "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose." I 4. "Take a lot of water with a double amount of your prescribed dose."

3 (53. 3. Antibiotics have the maximum effect when a blood level of the medication is maintained. How- ever, because nitrofurantoin (Macrodantin) is read- ily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by doubling the dose. The client should not skip a dose if she realizes that she has missed one. Additional fluids, especially water, should be encouraged, but not forced to promote elimination of the antibiotic from the body. Adequate fluid intake aids in the prevention of urinary tract infections, in addition to an acidic urine.)

72. The client with pyelonephritis asks the nurse, "How will I know whether the antibiotics are effectively treating my infection?" The nurse's most appropriate response would be which of the following? 1. "After you take the antibiotics for 2 weeks,you'll not have any infection." 2. "Your health care provider can tell by the color and odor of your urine." 3."Your health care provider will take a urine culture." 4. "When your symptoms disappear, you'll know that your infection is gone."

3 (72. 3. Antibiotics are usually prescribed for a 2- to 4-week period. A urine culture is needed to evaluate the effectiveness of antibiotic therapy. Urine must be examined microscopically to ade- quately determine the presence of bacteria; looking at the color of the urine or checking the odor is not sufficient. Symptoms usually disappear 48 to 72 hours after antibiotic therapy is started, but antibiot- ics may need to continue for up to 4 weeks.)

75. What is the primary disadvantage of using peritoneal dialysis for long-term management of chronic renal failure? I 1. The danger of hemorrhage is high. I 2. It cannot correct severe imbalances. I 3. It is a time-consuming method of treatment. I 4. The risk of contracting hepatitis is high.

3 (75. 3. A disadvantage of peritoneal dialysis in long-term management of chronic renal failure is that it requires large blocks of time. The risk of hemorrhage or hepatitis is not high with peritoneal dialysis. Peritoneal dialysis is effective in maintain- ing a client's fluid and electrolyte balance.)

88. The nurse is instructing the client with chronic renal failure to maintain adequate nutri- tional intake. Which of the following diets would be most appropriate? I 1. High-carbohydrate, high-protein. I 2. High-calcium, high-potassium, high-protein. I 3. Low-protein, low-sodium, low-potassium. I 4. Low-protein, high-potassium.

3 (88. 3. Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the byproducts of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium require- ments remain 1,000 to 2,000 mg/day.)

97. A client has urge incontinence. When obtain- ing the health history, the nurse should ask if the client has: I 1. Inability to empty the bladder. I 2. Loss of urine when coughing. I 3. Involuntary urination with minimal warning. I 4. Frequent dribbling of urine.

3 (97. 3. A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urine retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is com- mon in male clients after some types of prostate sur- gery or may occur in women after the development of a vesicovaginal or urethrovaginal fistula.)

67. The nurse explains to the client the impor- tance of drinking large quantities of fluid to prevent cystitis. The nurse should tell the client to drink: I 1. Twice as much fluid as usual. I 2. At least 1 quart more than usual. I 3. A lot of water, juice, and other fluids through- out the day. I 4. At least 3,000 mL of fluids daily.

4 (67. 4. Instructions should be as specific as pos- sible, and the nurse should avoid general statements such as "a lot." A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 quart more than she usually drinks if her intake was inadequate to begin with.)

70. Which of the following factors would put the client at increased risk for pyelonephritis? I 1. History of hypertension. I 2. Intake of large quantities of cranberry juice. I 3. Fluid intake of 2,000 mL/day. I 4. History of diabetes mellitus.

4 (70. 4. A client with a history of diabetes mel- litus, urinary tract infections, or renal calculi is at increased risk for pyelonephritis. Others at high risk include pregnant women and people with structural alterations of the urinary tract. A history of hyper- tension may put the client at risk for kidney damage, but not kidney infection. Intake of large quantities of cranberry juice and a fluid intake of 2,000 mL/day are not risk factors for pyelonephritis.)

85. The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel (Amphojel). Which of the following statements would indicate that the client understands the teaching? I 1. "I'll take it every 4 hours around the clock." I 2. "I'll take it between meals and at bedtime." I 3. "I'll take it when I have a sour stomach." I 4. "I'll take it with meals and bedtime snacks."

4 (85. 4. Aluminum hydroxide gel (Amphojel) is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not adminis- tered to treat hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.)

93. A client with a fracture develops compart- ment syndrome. Which of the following signs should alert the nurse to impending organ failure? I 1. Crackles. I 2. Jaundice. I 3. Generalized edema. I 4. Dark, scanty urine.

4 (93. 4. The client with compartment syndrome may release myoglobin from damaged muscle cells into the circulation. This becomes trapped in the renal tubules, resulting in dark, scanty urine, pos- sibly leading to acute renal failure. Crackles may suggest respiratory complications; jaundice suggests liver failure; and generalized edema may suggest heart failure. However, these are not associated with compartment syndrome.)

95. The primary goal of nursing care for a client with stress incontinence is to: I 1. Help the client adjust to the frequent episodes of incontinence. I 2. Eliminate all episodes of incontinence. I 3. Prevent the development of urinary tract infections. I 4. Decrease the number of incontinence episodes.

4 (95. 4. The primary goal of nursing care is to decrease the number of incontinence episodes and the amount of urine expressed in an episode. Behavioral interventions (e.g., diet and exercise) and medications are the nonsurgical management methods used to treat stress incontinence. With- out surgical intervention, it may not be possible to eliminate all episodes of incontinence. Helping the client adjust to the incontinence is not treating the)

99. A client is scheduled for an intravenous pyelogram (IVP). The evening before the procedure, the nurse learns that the client has a sensitivity to shellfish. The nurse should: I 1. Administer a cathartic to the client to empty the colon. I 2. Administer an antiflatulent to the client to relieve gas. I 3. Keep the client on nothing-by-mouth (NPO) status. I 4. Cancel the IVP and notify the physician.

4 (99. 4. Sensitivity to shellfish or iodine may cause an anaphylactic reaction to the contrast material, which contains iodine. Administering a cathartic or antiflatulent will not prevent an anaphylactic reaction to the contrast material. Keeping a client on NPO status for 8 hours before the procedure is part of the usual preparation for such a procedure to pre- vent aspiration of food or fluids if the client vomits when lying on the X-ray table.)

166. A client with chronic renal failure is expe- riencing central nervous system changes caused by uremic toxins. Which nursing intervention would be most appropriate for addressing the changes? I 1. Allow the client to grieve for body image changes. I 2. Restrict foods that are high in potassium. 3. Restrict fluid intake to 1,000 mL/day. I 4. Assess the client's mental status regularly.

4 (166. 4. Central nervous system changes include such symptoms as apathy, lethargy, and decreased concentration. Seizures and coma can also occur. The nurse should assess the client's level of con- sciousness at regular intervals and maintain client safety. Allowing the client to express feelings related to body image changes and restricting foods high in potassium and fluid intake are all appropriate activi- ties, but they are not related to the central nervous system changes.)

52. The nurse is teaching an 80-year-old client with a urinary tract infection about the importance of increasing fluids in the diet. Which of the follow- ing puts this client at a risk for not obtaining suffi- cient fluids? I 1. Diminished liver function. I 2. Increased production of antidiuretic hor- mone. I 3. Decreased production of aldosterone. I 4. Decreased ability to detect thirst.

4 (52. 4. The sensation of thirst diminishes in those greater than 60 years of age; hence, fluid intake is decreased and dissolved particles in the extracel- lular fluid compartment become more concentrated. There is no change in liver function in older adults, nor is there a reduction of ADH and aldosterone as a normal part of aging.)

59. The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which would be the nurse's best approach? I 1. Arrange a meeting with the client, her hus- band, the physician, and the nurse. I 2. Insist that the client talk with her husband because good communication is necessary for a successful marriage. I 3. Talk first with the husband alone and then with both of them together to share the hus- band's reactions. I 4. Spend time with the client addressing her concerns and then stay with her while she talks with her husband.

4 (59. 4. As newlyweds, the client and her husband need to develop a strong communication base. The nurse can facilitate communication by preparing and supporting the client. Given the situation, an inter- disciplinary conference is inappropriate and would not promote intimacy for the client and her husband. Insisting that the client talk with her husband is not addressing her fears. Being present allows the nurse to facilitate the discussion of a difficult topic. Having the nurse speak first with the husband alone shifts responsibility away from the couple.)

55. A client has nephropathy. The physician orders that a 24-hour urine collection be done for creatinine clearance. Which of the following actions is necessary to ensure proper collection of the specimen? I 1. Collect the urine in a preservative-free con- tainer and keep it on ice. I 2. Inform the client to discard the last voided specimen at the conclusion of urine collec- tion. I 3. Ask the client what his weight is before beginning the collection of urine. I 4. Request an order for insertion of an indwell- ing urinary catheter.

1 (55. 1. All urine for creatinine clearance deter- mination must be saved in a container with no preservatives and refrigerated or kept on ice. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate. It is not necessary to have an indwelling urinary catheter inserted for urine col- lection.)

62. When teaching the client with a urinary tract infection about taking phenazopyridine hydrochlo- ride (Pyridium), the nurse should tell the client to expect: I 1. Bright orange-red urine. I 2. Incontinence. I 3. Constipation. I 4. Slight drowsiness.

1 (62. 1. The client should be told that phenazopyridine hydrochloride (Pyridium) turns the urine a bright orange-red, which may stain underwear. It can be frightening for a client to see orange-red urine without having been forewarned. Other common adverse effects associated with phenazopyridine include headaches, gastrointesti- nal disturbances, and rash. Phenazopyridine does not cause incontinence, constipation, or drowsiness.)

16. A client is prescribed atropine 0.4 mg intramus- cularly. The atropine vial is labeled 0.5 mg/mL. How many milliliters should the nurse plan to administer? ____________________________ mL.

0.8

100. The nurse finds a container with the client's urine specimen sitting on a counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least 2 hours. The nurse should: I 1. Discard the urine and obtain a new specimen. I 2. Send the urine to the laboratory as quickly as possible. I 3. Add fresh urine to the collected specimen and send the specimen to the laboratory. I 4. Refrigerate the specimen until it can be trans- ported to the laboratory.

1 (100. 1. The appropriate action would be to discard the specimen and obtain a new one. Urine that is allowed to stand at room temperature will become alkaline, with multiplying bacteria. The specimen should be examined within 1 hour after urination.)

93. What should the nurse teach the client to do to prevent stress incontinence? Select all that apply. I 1. Use techniques that strengthen the sphincter and structural supports of the bladder, such as Kegel exercises. 2. Avoid dietary irritants (e.g., caffeine, alco- holic beverages). 3. Not to laugh when in social gatherings. 4. Carry an extra incontinence pad when away from home. 5. Obtain a fluid intake of 500 mL/day.

1, 2 (93. 1, 2. Laughing may be a part of one's social- ization, so it should not be discouraged. In non-re- stricted clients, a fluid intake of at least 2 to 3 L/day is encouraged; clients with stress incontinence may reduce their fluid intake to avoid incontinence at the risk of developing dehydration and urinary tract infections. Establishing a voiding schedule would be more effective in the prevention of stress incon- tinence rather than carrying incontinence pads. Dietary irritants and natural diuretics, such as caf- feine and alcoholic beverages, may increase stress incontinence. Kegel exercises strengthen the sphinc- ter and structural supports of the bladder.)

82. The client performs his own peritoneal dialy- sis. What should the nurse teach the client about preventing peritonitis? Select all that apply. I 1. Broad-spectrum antibiotics may be administered to prevent infection. 2. Antibiotics may be added to the dialysate to treat peritonitis. 3. Clean technique is permissible for prevention of peritonitis. 4. Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort. 5. Peritonitis is the most common and serious complication of peritoneal dialysis.

1, 2, 4, 5 (82. 1, 2, 4, 5. Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peri- tonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Perito- nitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.)

71. To assess the client's mental stauts, the nurse should monitor which of the following laboratory tests? Select all that apply. I 1. Serum sodium I 2. Potassium levels. I 3. Arterial blood gases I 4. Hemoglobin. I 5. Serum blood urea nitrogen I 6. Creatinine levels. I 7. Urinalysis.

5, 6 (71. 5, 6. Serum BUN and creatinine are the tests most commonly used to assess renal function, with creatinine being the most reliable indicator. Nonrenal factors may affect BUN levels as well as serum sodium and potassium levels. Arterial blood gases and hemoglobin are not used to assess renal status. Urinalysis is a general screening test.)

96. The nurse is developing a teaching plan for a client with stress incontinence. Which of the follow- ing instructions should be included? I 1. Avoid activities that are stressful and upsetting. I 2. Avoid caffeine and alcohol. I 3. Do not wear a girdle. I 4. Limit physical exertion.

2

57. A 24-year-old female client comes to an ambulatory care clinic in moderate distress with a probable diagnosis of acute cystitis. When obtaining the client's history, the nurse should ask the client if she has had: I 1. Fever and chills. I 2. Frequency and burning on urination. I 3. Flank pain and nausea. I 4. Hematuria.

2 ( 57. 2. The classic symptoms of cystitis are severe burning on urination, urgency, and frequent urina- tion. Systemic symptoms, such as fever and nausea and vomiting, are more likely to accompany pyelo- nephritis than cystitis. Hematuria may occur, but it is not as common as frequency and burning.)

69. Which of the following symptoms would most likely indicate that the client has pyelonephri- tis? I 1. Ascites. I 2. Costovertebral angle (CVA) tenderness. I 3. Polyuria. I 4. Nausea and vomiting.

2 (69. 2. Common symptoms of pyelonephritis include CVA tenderness, burning on urination, uri- nary urgency or frequency, chills, fever, and fatigue. Ascites, polyuria, and nausea and vomiting are not indicative of pyelonephritis.)

80. During dialysis, the nurse observes that the flow of dialysate stops before all the solution has drained out. The nurse should: I 1. Have the client sit in a chair. I 2. Turn the client from side to side. I 3. Reposition the peritoneal catheter. I 4. Have the client walk.

2 (80. 2. Fluid return with peritoneal dialysis is accomplished by gravity flow. Actions that enhance gravity flow include turning the client from side to side, raising the head of the bed, and gently massag- ing the abdomen. The client is usually confined to a recumbent position during the dialysis. The nurse should not attempt to reposition the catheter.)

63. A client has been prescribed nitrofurantoin (Macrodantin) for treatment of a lower urinary tract infection. Which of the following instructions should the nurse include when teaching the client how to take this medication? Select all that apply. 1. "Take the medication on an empty stomach." 2. Your urine may become brown in color." "Increase your fluid intake." 3. "Take the medication until your symptoms subside." 4. "Take the medication with an antacid to decrease gastrointestinal distress."

2, 3 (63. 2, 3. Clients who are taking nitrofurantoin (Macrodantin) should be instructed to take the medication with meals and to increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need to be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medica- tion should not be taken with antacids as this may interfere with the drug's absorption.)

20. A client takes hydrochlorothiazide (HCTZ) for treatment of essential hypertension. The nurse should instruct the client to report which of the following? Select all that apply. I 1. Muscle twitching. I 2. Abdominal cramping. I 3. Diarrhea. I 4. Confusion. I 5. Lethargy. I 6. Muscle weakness.

2, 5, 6 (20. 2, 5, 6. Hydrochlorothiazide is a thiazide diuretic used in the management of mild to moder- ate hypertension, and in the treatment of edema associated with: heart failure, renal dysfunction, cir- rhosis, corticosteroid therapy, and estrogen therapy. It increases the excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule of the kidneys. It promotes the excretion of chlo- ride, potassium, magnesium, and bicarbonate. Side effects include: drowsiness, lethargy, and muscle weakness, but not muscle twitching. Although there may be abdominal cramping, there is not diarrhea. The client does not become confused as a result of taking this drug.)

61. The client with cystitis is given a prescrip- tion for phenazopyridine hydrochloride (Pyridium). The nurse should teach the client that this drug is used to treat urinary tract infections by: I 1. Releasing formaldehyde and providing bacte- riostatic action. I 2. Potentiating the action of the antibiotic. I 3. Providing an analgesic effect on the bladder mucosa. I 4. Preventing the crystallization that can occur with sulfa drugs.

3 ( 61. 3. Phenazopyridine hydrochloride (Pyrid- ium) is a urinary analgesic that works directly on the bladder mucosa to relieve the distressing symp- toms of dysuria. Phenazopyridine does not have a bacteriostatic effect. It does not potentiate antibiot- ics or prevent crystallization.)

The nurse should assess the client with blad- der cancer for which of the following? I 1. Suprapubic pain. I 2. Dysuria. I 3. Painless hematuria. I 4. Urine retention.

3 (3. 3. Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include urinary frequency, dysuria, and urinary urgency, but these are not as common as hematuria. Suprapubic pain and urine retention do not occur in bladder cancer.)

113. A client with chronic renal failure tells the nurse that her skin feels dry and is constantly itch- ing. Based on these data, which of the following is an appropriate nursing diagnosis? I 1. Ineffective health maintenance related to poor hygiene. I 2. Chronic pain related to skin irritation. I 3. Risk for impaired skin integrity related to severe pruritus. I 4. Ineffective coping related to manifestations of chronic illness.

3 (113. 3. Clients with chronic renal failure are sus- ceptible to uremia, an accumulation of nitrogenous waste products in the blood. Clinical manifestations include dry, itchy skin that can be severe in nature. Because of the irritation of the skin and the inclina- tion to scratch, clients are prone to impaired skin integrity. The pruritus is not a result of poor hygiene. Chronic pain is not a likely result of the pruritus and is not a priority nursing diagnosis. The data do not support the nursing diagnosis of Ineffective coping.)

84. Aluminum hydroxide gel (Amphojel) is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of giving this drug? I 1. Relieving the pain of gastric hyperacidity. I 2. Preventimg Curling's stress ulcers. I 3. Binding phosphate in the intestine. I 4. Reversing metabolic acidosis.

3 (84. 3. A client in renal failure develops hyper- phosphatemia that causes a corresponding excre- tion of the body's calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling's stress ulcers and do not affect metabolic acidosis.)

91. The client asks about diet changes when using continuous ambulatory peritoneal dialy- sis (CAPD). Which of the following would be the nurse's best response? I 1. "Diet restrictions are more rigid with CAPD because standard peritoneal dialysis is a more effective technique." I 2. "Diet restrictions are the same for both CAPD and standard peritoneal dialysis." I 3. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because dialysis is constant." I 4. "Diet restrictions with CAPD are fewer than with standard peritoneal dialysis because CAPD works more quickly."

3 (91. 3. Dietary restrictions with CAPD are fewer than those with standard peritoneal dialysis because dialysis is constant, not intermittent. The constant slow diffusion of CAPD helps prevent accumulation of toxins and allows for a more liberal diet. CAPD does not work more quickly, but more consistently. Both types of peritoneal dialysis are effective.)

19. The nurse is teaching a client about using topical gentamicin sulfate (Garamycin). Which of the following comments by the client indicates the need for additional teaching? 1. "I will avoid being out in the sun for long periods." 2. "I should stop applying it once the infected area heals." 3. "I'll call the physician if the condition worsens." 4. "I should apply it to large open areas."

4 (19. 4. The aminoglycoside antibiotic gentamicin sulfate should not be applied to large denuded areas because toxicity and systemic absorption are pos- sible. The nurse should instruct the client to avoid excessive sun exposure because gentamicin sulfate can cause photosensitivity. The client should be instructed to apply the cream or ointment for only the length of time prescribed because a superin- fection can occur from overuse. The client should contact the physician if the condition worsens after use.)

50. The nurse teaches the client how to recog- nize signs and symptoms of infection in the shunt by telling the client to assess the shunt each day for: I 1. Absence of a bruit. I 2. Sluggish capillary refill time. I 3. Coolness of the involved extremity. I 4. Swelling at the shunt site.

4 (50. 4. Signs and symptoms of an external access shunt infection include redness, tenderness, swell- ing, and drainage from around the shunt site. The absence of a bruit indicates closing of the shunt. Sluggish capillary refill time and coolness of the extremity indicate decreased blood flow to the extremity.)

45. The client in acute renal failure has an external cannula inserted in the forearm for hemo- dialysis. Which of the following nursing measures is appropriate for the care of this client? I 1. Use the unaffected arm for blood pressure measurements. I 2. Draw blood from the cannula for routine labo- ratory work. I 3. Percuss the cannula for bruits each shift. I 4. Inject heparin into the cannula each shift.

1 (45. 1. The unaffected arm should be used for blood pressure measurement. The external can- nula must be handled carefully and protected from damage and disruption. In addition, a tourniquet or clamps should be kept at the bedside because dislodgment of the cannula would cause arterial hemorrhage. The arm with the cannula is not used for blood pressure measurement, I.V. therapy, or venipuncture. Patency is assessed by auscultating for bruits every shift. Heparin is not injected into the cannula to maintain patency. Because it is part of the general circulation, the cannula cannot be heparinized.)

46. The nurse initiates the client's first hemodi- alysis treatment. The client develops a headache, confusion, and nausea. The nurse should assess the client further for: I 1. Disequilibrium syndrome. I 2. Myocardial infarction. I 3. Air embolism. I 4. Peritonitis.

1 (46. 1. Common symptoms of disequilibrium syn- drome include headache, nausea and vomiting, con- fusion, and even seizures. Disequilibrium syndrome typically occurs near the end or after the completion of hemodialysis treatment. It is the result of rapid changes in solute composition and osmolality of the extracellular fluid. These symptoms are not related to cardiac function, air embolism, or peritonitis.)

66. To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which of the following measures in her daily routine? I 1. Wearing cotton underpants. I 2. Increasing citrus juice intake. I 3. Douching regularly with 0.25% acetic acid. I 4. Using vaginal sprays.

1 (66. 1. A woman can adopt several health- promotion measures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncot- ton underpants, and irritating substances, such as bubble baths and vaginal soaps and sprays. Increas- ing citrus juice intake can be a bladder irritant. Regular douching is not recommended; it can alter the pH of the vagina, increasing the risk of infection.)

101. A client with early acute renal failure has anemia, tachycardia, hypotension, and shortness of breath. The physician has ordered 2 units of packed red blood cells (RBCs). Prior to initiating the blood transfusion the nurse should determine if? Select all that apply. I 1. there is an I.V. access with the appropriate tub ing and normal saline as the priming solution 2. there is a signed informed consent for transfu- sion therapy 3. blood typing and cross-matching is docu- mented in the medical record? 4. the vital signs have been taken and docu- mented in accordance with facility policy and procedure? 5. there is the second unit of blood in the medi- cation room? 6. the client has an identification bracelet and red blood band?

1, 2, 3, 4, 6. (101. 1, 2, 3, 4, 6. Before ordering and administer- ing packed RBCs, the nurse should assess the I.V. site to make sure it has an 18G to 20G Angiocath. The nurse should also ensure that normal saline solution is used to prime the tubing to prevent RBCs from adhering to the tubing. The client must indicate informed consent for the procedure by signing the consent form. The client's blood must be typed to determine ABO blood typing and Rh factor and ensure that the client receives compatible blood. Cross-matching is done to detect the pres- ence of recipient antibodies to the donor's minor antigens. Vital signs provide a baseline reference for continuous monitoring throughout the transfusion. An identification bracelet and red blood band are essential for client identification per facility policy. Two nurses must double check the client's identi- fication with the client listed on the unit of RBCs. The transfusion should be started within 30 minutes of the time that the RBC unit is checked out of the blood bank. Thus, no blood should be kept in the medication room before transfusion.)

73. The client with acute pyelonephritis wants to know the possibility of developing chronic pyelone- phritis. The nurse's response is based on knowledge that which of the following disorders most com- monly leads to chronic pyelonephritis? I 1. Acute pyelonephritis. I 2. Recurrent urinary tract infections. I 3. Acute renal failure. I 4. Glomerulonephritis.

2 (73. 2. Chronic pyelonephritis is most commonly the result of recurrent urinary tract infections. Chronic pyelonephritis can lead to chronic renal failure. Single cases of acute pyelonephritis rarely cause chronic pyelonephritis. Acute renal failure is not a cause of chronic pyelonephritis. Glomerulone- phritis is an immunologic disorder, not an infectious disorder.)

87. The nurse is determining which teaching approaches for the client with chronic renal failure and uremia would be most appropriate. The nurse should: I 1. Provide all needed teaching in one extended session. I 2. Validate the client's understanding of the material frequently. I 3. Conduct a one-on-one session with the client. I 4. Use videotapes to reinforce the material as needed.

2 (87. 2. Uremia can cause decreased alertness, so the nurse needs to validate the client's comprehen- sion frequently. Because the client's ability to con- centrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videotapes because clients may not be able to maintain alertness during the viewing of the videotape.)

102. The nurse is instructing the unlicensed nurs- ing personnel (UAP) about the correct technique for obtaining a clean-catch urine culture from a female client. Which of the following statements indicates that the assistant has understood the instructions? I 1. "I will have the client completely empty her bladder into the specimen cup." 2. "I will need to catheterize the client to get the urine specimen." 3. "I will ask the client to clean her labia, void into the toilet, and then into the specimen cup." 4. "I will obtain the specimen in the afternoon after the client has had plenty of fluids."

3 (102. 3. The correct technique for a clean-catch urine culture specimen is to have the female client clean the labia from front to back, void into the toi- let, and then void into the cup. The client does not need to fully empty her bladder into the cup. It is not necessary to catheterize the client to obtain the specimen. The first voided specimen of the day has the highest bacterial counts.)

166. Which of the following has the highest priority in the care of a client with chronic renal failure? 1. itching. 2. Achieve pain control with analgesics. 3. Maintain a low-sodium diet. 4. Measure abdominal girth daily.

3 (166. 3. It is appropriate for the client to be on a low-sodium diet to help decrease fluid retention. Dry skin and pruritus are common in renal failure. Lotions are used to relieve the dry skin, and anti- histamines may be used to control itching; corticos- teroids are not used. Pain is not a major problem in chronic renal failure, but analgesics that are excreted by the kidneys must be avoided. It is not necessary to measure abdominal girth daily because ascites is not a clinical problem in renal failure.)

49. Which of the following abnormal blood val- ues would not be improved by dialysis treatment? I 1. Elevated serum creatinine level. I 2. Hyperkalemia. I 3. Decreased hemoglobin concentration. I 4. Hypernatremia.

3 (49. 3. Dialysis has no effect on anemia. Because some red blood cells are injured during the proce- dure, dialysis aggravates a low hemoglobin concen- tration. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances.)

58. The client asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that in most instances, cystitis is caused by: I 1. Congenital strictures in the urethra. I 2. An infection elsewhere in the body. I 3. Urinary stasis in the urinary bladder. I 4. An ascending infection from the urethra.

4 ( 58. 4. Although various conditions may result in cystitis, the most common cause is an ascend- ing infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.)