Adult Health - Archer Review (3/8) - Urinary/ Renal/ Fluid and Electrolytes

Choice C is correct. When instructing a client on the proper way to perform a 24-hour urinalysis collection, the client should be taught that the specimen collection begins at 0800. At that time, the client should urinate in the toilet. That initial void - officially marking the commencement of the test - is not saved and should be flushed. Following the discarding of this initial first sample, all urine voided by the client during the following 24-hour period must be collected and stored in the designated collection bottles provided by the laboratory (of note, the entire specimen must be refrigerated or kept on ice during the collection period). At 0800 the next morning, the client voids and adds that final specimen to the specimen container, thus marking the end of the 24-hour urinalysis collection.

A client is scheduled to undergo a 24-hour urinalysis, beginning at 0800 on the first day and ending 24 later at 0800 the following day. In preparation for the test, the nurse should instruct the client to do which of the following? A. Discard the specimen taken at 0800 on the second day B. Discard the first and last samples C. Discard the first sample D. Collect all samples

Choices A, B, D, and E are correct. Hypertension is a common complication of CKD. Regular monitoring of blood pressure is essential to detect and manage any fluctuations effectively. CKD can lead to anemia due to decreased erythropoietin production. EPO may be administered to stimulate red blood cell production and manage anemia in clients with CKD. Clients undergoing hemodialysis require an access site, such as an arteriovenous fistula or graft. Regular assessment of the access site is necessary to detect any signs of infection, thrombosis, or compromised blood flow. Impaired kidney function leads to increased serum phosphate levels. Phosphate binders are prescribed to prevent the absorption of dietary phosphate, thus controlling serum phosphate levels.

A client with chronic kidney disease (CKD) is receiving hemodialysis treatment. Which of the following nursing interventions should be implemented for this client? Select all that apply. - Monitor the client's blood pressure before, during, and after hemodialysis. - Administer erythropoietin (EPO) as prescribed to stimulate red blood cell production. - Restrict protein intake to minimize uremic symptoms. - Assess the client's access site for signs of infection or thrombosis. - Administer phosphate binders as prescribed to control serum phosphate levels. - Encourage the client to consume a high-potassium diet to prevent electrolyte imbalances.

Choice B is correct. Sexuality has physical and emotional components, which can be affected by chronic kidney disease. Kidney disease can cause chemical changes in the body, affecting circulation, nerve function, hormones, and energy levels. Chronic kidney disease (CKD) causes decreased testosterone levels (hypogonadism) —low testosterone results in reduced sex drive. Also, any underlying health conditions contributing to CKD (hypertension or diabetes) can affect sexual function. Fatigue is one of the most common symptoms of men with kidney disease. Fatigue can also result from decreased testosterone. Since kidney disease affects the endocrine system, changes in hormone levels may result in reduced sex drive.

A male client with chronic renal failure has questions regarding the effects of his kidney disease on his sexual activity. Which of the following is a sexual complication of chronic renal failure? A. Retrograde ejaculation B. Decreased testosterone C. Hypertrophy of the testicles D. Feelings of euphoria

Choice B is correct. Increased U waves identified on an electrocardiogram (ECG) monitoring are traditionally associated with hypokalemia. Additional ECG manifestations of hypokalemia include ST-segment depression and flat or inverted T waves.

A nurse assesses a client's electrocardiogram (ECG) monitoring and notices U waves. Which laboratory value alteration is known to cause this finding? A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hyponatremia

Choice A is correct. Respiratory acidosis occurs when there is an accumulation of carbon dioxide (CO2) in the body due to inadequate removal of CO2 by the respiratory system. It leads to an increase in the levels of carbon dioxide in the blood, causing a decrease in blood pH and an acidotic state. This condition can disrupt the body's acid-base balance. The pH value is 7.30, which is below the normal range (7.35-7.45), indicating acidemia (acidic blood). The PaCO2 value is 50 mmHg, above the normal range (35-45 mmHg). An elevated PaCO2 indicates respiratory acidosis, which is characterized by excess carbon dioxide (CO2) retention in the blood due to inadequate ventilation. The HCO3- value is 24 mEq/L, within the normal range (22-26 mEq/L). The normal HCO3- level suggests no primary metabolic acid-base imbalance. The PaO2 value is 85 mmHg, within the normal range (>80 mmHg). The PaO2 level is used to assess oxygenation status but does not contribute to determining the acid-base imbalance in this scenario.

A nurse is reviewing arterial blood gas (ABG) results for a client. The ABG report shows the following values: pH 7.30 [7.35-7.45], PaCO2 50 mmHg [35-45 mm Hg], HCO3- 24 mEq/L [22-28 mEq/L], PaO2 85 mmHg [80-100 mm Hg]. A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis

Choice A is correct. Typically, upon completing a Kock pouch procedure, clients will have one or more wound drains, a plastic Medena catheter in the stoma, and a separate (temporary) urinary catheter to drain urine from the client's bladder. Postoperatively, the nurse will monitor the urine output, assess for indications of ostomy pouch leaks, and document the characteristics of the client's stoma. The nurse should closely monitor the client's urine output and inform the health care provider (HCP) if the combined urinary output volume is less than 30 mL/hour (or less than the specified range indicated by the HCP or facility policy). The nurse should regularly check the client's stoma and gauze dressing to ensure the pouch catheter is draining freely while concurrently assessing for indications of ostomy pouch leaks. Noting the characteristics of the stoma provides baseline information regarding the stoma's appearance. A stoma site is usually hyperemic (red or pink) following the procedure. Any changes in the stoma site's color from this initial appearance may indicate an impairment of the arterial blood supply (ischemia). If cyanosis is noted, the nurse must notify the HCP immediately, a

A nurse on a medical-surgical unit cares for a client who has just undergone a procedure for a Kock pouch as a treatment for bladder cancer. The initial nursing interventions for this client would include: A. Monitoring urine output, checking for indications of ostomy pouch leaks, and noting the size, shape, and color of the stoma. B. Speaking to the client's family and updating them regarding the client's status. C. Educating the client about stoma care and skincare. D. Irrigating the catheters as needed.

Choice C is correct. A serum potassium level of 6.1 mEq/L is high. A normal serum potassium level is between 3.5 and 5.0 mEq/L. Hyperkalemia puts the patient at risk for developing cardiac changes and therefore this patient should be on a cardiac monitor.

A patient with a kidney injury has a serum potassium level of 6.1 mEq/L(3.5-5 mEq/L). Which of the following actions is a priority? A. Encourage exercise B. Check the patient's sodium level C. Place the patient on a cardiac monitor D. Encourage increased fluid intake

Choice A is correct. Headache and nausea may be a manifestation associated with dialysis disequilibrium syndrome (DDS). This complication is experienced by clients undergoing their first dialysis and may range from mild to severe.

The nurse cares for a client diagnosed with end-stage renal disease who just returned from initial hemodialysis. Which of the following assessment findings is of the highest concern? A. Headache and nausea B. Scant blood on the AV fistula C. Potassium 3.7 mEq/L [3.5 - 5.0 mEq/L] D. Hemoglobin 8.8 mg/dL [Male: 14-18 g/dL; Female: 12-16 g/dL]

Choices C and E are correct. The client's high potassium level, 5.7 mEq/L is concerning. Salt substitutes contain potassium which makes them more palatable. Excessive intake may lead to hyperkalemia. Adrenal insufficiency causes hyperkalemia because of the insufficient amount of aldosterone, which causes potassium elimination. Less aldosterone, and less potassium elimination, equates to hyperkalemia.

The nurse cares for a client with a potassium of 5.7 mEq/L(3.5-5 mEq/L). The nurse understands that this potassium level may be caused by Select all that apply. Cushing's disease. nasogastric tube suctioning. salt substitutes. hyperinsulinism. adrenal insufficiency.

Choices A, B, and E are correct. Sodium plays a vital role in the brain, so imbalances in the serum sodium level can cause significant neurological changes. The client who is hypernatremic, or has a sodium level greater than 145 mEq/L, is at risk for changes in their level of consciousness ranging from restlessness and agitation to lethargy (Choice A), stupor, and coma. A client with a high sodium level often has dry mucous membranes. Hypovolemic hypernatremia is the most common form of hypernatremia. Other causes include renal losses of free water (osmotic diuresis, post obstructive diuresis) or extrarenal losses (diarrhea, sweating, increased insensible losses). Therefore, the client is often dehydrated, and this fluid volume deficit is manifested by dry mucous membranes (Choice B) and excessive thirst (Choice E). Dry mucosa may also be secondary to the relationship sodium has with water. Water follows sodium, so where there is an increased sodium level in the extracellular space, water leaves the cells and follows the sodium into the extracellular space. This causes dry mouth and mucous membranes.

The nurse cares for a client with a serum sodium level of 152 mEq/L (135-145 mEq/L). Which of the following assessment findings would be expected? Select all that apply. Lethargy Dry mucous membranes Tachypnea Cyanosis Excessive thirst

- "This medication may cause me to urinate more often." - "I may notice an increase in my blood pressure." - "My urine will change to an orange or red color."

The nurse educates the client on the prescribed tamsulosin. Which statement, if made by the client, would indicate a need for follow-up? Select all that apply "This medication may cause me to urinate more often." "It will be important for me to change positions slowly." "I may notice an increase in my blood pressure." "My urine will change to an orange or red color." "I should notify my doctor if I have persistent dizziness."

Choice B is correct. The preferred method of urine specimen collection for this client is known as a clean catch midstream urine sample. When clients are ambulatory and competent, this is most often a self-obtained specimen in a private bathroom. If the urine is not collected in a sterile or clean catch manner, the urine sample may be contaminated by bacteria originating from the skin or genital region and not from the urinary tract. This is often described by the clinical laboratory as mixed growth bacteria. A contaminated sample may lead to a false-positive urine culture result. The likelihood of mixed growth bacteria contamination is decreased by instructing the client to collect the specimen from the midstream portion of the client's void.

The nurse has obtained a physician's order to obtain a urine specimen from a client. The nurse should instruct the client to obtain the urine sample A. from the first stream of urine from the bladder. B. midstream from the bladder. C. from the final stream of urine from the bladder. D. by emptying the entire volume of urine in the specimen cup.

Choice B is correct. An IV urography (pyelogram) is a diagnostic test used to gather urinary tract imaging that views the collecting ducts and renal pelvis and outlines the ureters, bladder, and urethra. The client must perform a bowel cleansing the night before to ensure adequate visualization of the urinary tract. During this procedure, the client will empty their bladder, and then an intravenous injection of contrast medium is given, and a series of x-ray films and fluoroscopy is used to observe the passage of urine from the renal pelvis to the bladder. The use of this test has decreased because of computed tomography scans of the urinary tract.

The nurse has taught a client about a scheduled intravenous (IV) urography (pyelogram). Which of the following statements by the client would indicate a correct understanding of the teaching? A. "I should expect a temporary urinary catheter inserted during the procedure." B. "I will take a laxative the night before to clear my bowels." C. "I must fill my bladder with water immediately before the procedure." D. "I may experience blood in my urine for a few days after this procedure."

Choice A is correct. The nurse should assess the client for the presence of orthostatic hypotension. Orthostatic hypotension is often seen in association with hyponatremia secondary to dehydration. Orthostatic or postural hypotension refers to a significant decrease in systolic blood pressure of greater than 20 mmHg or a reduction of at least 10 mmHg in diastolic pressure upon 3 to 5 minutes of standing.

The nurse is assessing a client admitted with hyponatremia secondary to dehydration. Which of the following physical assessment findings would be expected? A. Orthostatic hypotension B. Peaked T-waves on electrocardiogram (ECG) C. Bounding peripheral pulses D. Polyuria

Choice A is correct. Leucocytosis (predominantly neutrophilic) suggests infection in a client on peritoneal dialysis. The most significant complication with peritoneal dialysis is peritonitis. During peritoneal dialysis, the peritoneum is used as the dialyzing membrane, and the dialysate is infused through a catheter tunneled into the peritoneum. Maintaining a sterile technique is essential during peritoneal dialysis. Infection of the peritoneum (peritonitis) may occur due to contamination by touch during exchanges (by pathogenic skin bacteria) or due to an exit-site catheter infection. Peritonitis symptoms include fever, abdominal rigidity, purulent effluent, and nausea/vomiting. Cloudy outflow (into the drainage bag) is one of the earliest signs of peritonitis associated with peritoneal dialysis.

The nurse is assessing a client receiving peritoneal dialysis. Which laboratory result should immediately be reported to the primary healthcare provider (PHCP)? A. WBC 19,000 mm3 [5,000-10,000 mm3] B. Hemoglobin 9 mg/dL [Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L)] C. Calcium 8.6 mg/dL [9.0-10.5 mg/dL] D. Serum pH 7.33 [7.35-7.45]

Choices A, C, and E are correct. Pyelonephritis is an ascending urinary tract infection that involves the kidney. The client exhibits the classic symptoms of cystitis (urinary frequency, dysuria, malaise) along with constitutional symptoms such as fever, chills, and costovertebral tenderness.

The nurse is assessing a client who was just diagnosed with acute pyelonephritis. Which of the following findings should the nurse expect to observe? Select all that apply. Costovertebral angle tenderness Jugular venous distention Fever and chills Urinary retention Dysuria

Choices A, B, D, and E are correct. A diagnosis of renal calculi (kidney stones) describes the presence of uric acid, calcium, cystine, or struvite crystals in the urine that form painful stones within the urinary tract. Typical signs/symptoms of renal calculi include hematuria (blood in urine), renal colic (unilateral pain spasms in flank), and severe radiating pain, which can cause nausea/vomiting, sweating, and elevated blood pressure. Additionally, clients may experience dysuria and increased urinary frequency.

The nurse is assessing a client with urolithiasis. Which of the following would be an expected finding? Select all that apply. Hematuria Renal colic Hypotension Dysuria Increased urinary frequency

Choices A, C, and E are correct. Urinary retention occurs when urine is produced normally but is not entirely emptied from the bladder. Retention can occur because of mechanical obstruction of the bladder outlet (enlarged prostate in a man or vaginal prolapse in a woman). Antihistaminic medications (such as diphenhydramine) tend to have anticholinergic side effects. Urinary retention can occur from the use of drugs with anticholinergic side effects. The bladder muscle's (detrusor smooth muscle) primary function is to "contract" and fully empty the bladder. Detrusor smooth muscle has muscarinic (cholinergic) receptors that facilitate this contraction. Anticholinergic agents impair this function and predispose to urinary retention. Excessive urinary retention eventually results in "overflow" incontinence.

The nurse is assessing assigned clients. Which client has a risk for urinary retention? Select all that apply. A 78-year-old man diagnosed with an enlarged prostate. An 83-year-old woman on bed rest. A 75-year-old woman with vaginal prolapse. An 89-year-old man with dementia. A 73-year-old woman on antihistamines to treat allergies. A 90-year-old man with difficulty walking to the restroom.

Choices A, B, and E are correct. This client's sodium level is critically low. When sodium falls below 125 mEq/L, it is considered severe hyponatremia. Sodium plays a key role in the brain, so low levels of this electrolyte can be devastating and produce symptoms ranging from confusion, lethargy, and stupor as well as seizures and cerebral edema. Abdominal cramps are another symptom of hyponatremia. Since water follows sodium, there are decreased levels of sodium in the blood and decreased fluid. This creates a fluid volume deficit, decreased urine output, muscle spasms, and abdominal cramping. Nausea and vomiting are common signs of hyponatremia.

The nurse is assigned to care for a client with a sodium level of 122 mEq/L(135-145 mEq/L). Which assessment findings does the nurse anticipate based on this lab result? Select all that apply. Confusion Abdominal cramps Tall, peaked t-waves Hypoactive bowel sounds Nausea and vomiting

Choice B is correct. Typically, healthy kidneys excrete 80-90% of the body's potassium. When there is injury or damage to the kidneys, such as with acute renal failure, potassium excretion is impaired. Metabolic acidosis can also occur because of the decreased ability to filter acids and reabsorb bicarbonate. Hence, as hydrogen ions enter the cells, potassium is pushed out of the cells and into the extracellular fluid. If the acute renal failure is related to trauma, the damaged cells release additional potassium into the extracellular fluid. These processes all increase the body's potassium, so the client would be at risk of developing high potassium levels (hyperkalemia).

The nurse is caring for a client on a medical floor. The nurse would recognize that which diagnosis increases the client's risk of developing hyperkalemia? A. Cushing's syndrome B. Acute renal failure C. Cystic fibrosis D. Bulimia nervosa

Choice B is correct. The average blood urea nitrogen (BUN) for adults (both males and females) ranges from 10 to 20 mg/dL. The client's BUN of 15 mg/dL would fall within this range. This would indicate a therapeutic finding to the prescribed treatment of intravenous fluid.

The nurse is caring for a client who has fluid volume deficit receiving intravenous fluids. Which of the following would indicate the client is achieving the treatment goals? A. Urine output 20 mL/hr B. BUN 15 mg/dL C. Urine specific gravity 1.039 D. Flattened jugular veins

Choice D is correct. The dye used during intravenous urography is sometimes nephrotoxic. Thus clients should be encouraged to increase fluids unless contraindicated.

The nurse is caring for a client who has just returned from an intravenous urography procedure. Which of the following nursing interventions is most important at this time? A. Assess the venipuncture site for redness B. Monitor urinary output C. Instruct the client to remain motionless D. Encourage the client to drink at least 1 L of fluid

Choice A is correct. Treatment goals for a patient with Polycystic Kidney Disease (PKD) include maintaining normotension, the glomerular filtration rate (GFR), and preventing sodium wasting, which is evidence of a decline in renal function. Hypertension is a cardinal finding in PKD, and if a client is achieving the treatment goals, they will maintain regulated blood pressure.

The nurse is caring for a client who has polycystic kidney disease (PKD). Which of the following would indicate the client is achieving treatment goals? A. Blood Pressure 128/63 mmHg B. Creatinine 2.3 mg/dL C. Proteinuria 2+ D. Sodium 132 mEq/L

Choice C is correct. When a client is suffering from severe hypernatremia, monitoring neurological status is the nurse's priority. Neurological complications of hypernatremia range from a restless, agitated client, to a comatose state. Sodium plays a major role in the brain and nervous system, so any imbalances can cause serious neurological symptoms.

The nurse is caring for a client who is severely hypernatremic. Based on the complications from this electrolyte imbalance, the nurse knows that the priority assessment is which of the following? A. Cardiovascular status B. Genitourinary status C. Neurological status D. Gastrointestinal status

Choices A, B, and E are correct. A is correct. The normal serum calcium level is 9-10.5 mg/dL. This client has a high serum calcium level (hypercalcemia). Phosphorus is a medication the nurse would expect to administer to treat hypercalcemia. Phosphorus and calcium have an inverse relationship, so by increasing the serum level of phosphorus the nurse can decrease the serum level of calcium. Oral phosphate is the preferred method of administering phosphorus. If given IV, calcium phosphate forms and precipitates in the tissues. This precipitation phenomenon reduces serum calcium levels very quickly. B is correct. Calcitonin is a medication the nurse would expect to administer to treat hypercalcemia. Calcitonin is a thyroid hormone that decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration. E is correct. Bisphosphonates are intravenous osteoporosis drugs that can quickly lower calcium levels and are often used to treat hypercalcemia due to cancer.

The nurse is caring for a client whose latest lab results show a serum calcium level of 13.2 mg/dL(9-10.5 mg/dL). Which medication does the nurse expect to administer based on this lab result? Select all that apply. Phosphorus Calcitonin Vitamin D IV calcium gluconate IV Bisphosphonates

Choices A, B, and D are correct. A is correct. This client has a phosphorus level of 5.3, which is greater than the normal range of 3.0-4.5 mg/dL (0.97-1.45 mmol/L). Tumor lysis syndrome can cause increased phosphorus levels, because when a tumor lyses the cellular contents (including phosphorus) are spilled out into the blood causing an increase in their serum levels. B is correct. Hypoparathyroidism is a cause of hyperphosphatemia. The client who experiences hypoparathyroidism has too little parathyroid hormone (PTH). PTH regulates the serum calcium concentration through its effects on the bones, kidneys, and intestines. When there is too little PTH, there are decreased calcium levels (hypocalcemia). Since calcium and phosphorus have an inverse relationship, when there are low levels of calcium there are high levels of phosphorus. Thus, hypoparathyroidism causes hyperphosphatemia. D is correct. Renal failure is a cause of hyperphosphatemia. Due to reduced kidney function, phosphorus is not able to be excreted as readily as it normally would, so increased levels of phosphorus build up in the blood causing hyperphosphatemia.

The nurse is caring for a client with a phosphorus level of 5.3 mg/L (1.71 mmol/L) [3.0-4.5 mg/dL (0.97-1.45 mmol/L)]. The nurse identifies which of the following as possible causes of this condition? Select all that apply. tumor lysis syndrome hypoparathyroidism hypercalcemia renal failure anorexia

Choice A is correct. This client has hypernatremia (sodium > 145 mEq/L) and should avoid additional sodium-containing fluids. Dextrose 5% in water replaces water losses due to hypernatremia. It would be an appropriate maintenance fluid for this client because it contains free water with no added sodium or other electrolytes and promotes renal solute excretion.

The nurse is caring for a client with hypernatremia. Which prescribed intravenous fluid (IVF) would be appropriate? A. Dextrose 5% in water (D5W) B. 3% saline C. Lactated ringers D. 0.9% Saline

Choice A is correct. Oliguria is a contraindication to the administration of IV potassium. Parenteral potassium is highly concentrated, and this may cause life-threatening hyperkalemia if the client does not have sufficient urinary output to waste the excess potassium. The nurse must notify the physician of the oliguria so the client does not develop hyperkalemia.

The nurse is caring for a client with hypokalemia scheduled to receive the prescribed 20 mEq of intravenous (IV) potassium. Which client assessment requires notification of the primary healthcare provider (PHCP)? A. Oliguria B. Abdominal distention C. Muscle weakness D. Weak peripheral pulses

Choices A, B, and C are correct. Nephrotic syndrome is a kidney disorder. There is renal glomerular damage, which leads to massive proteinuria. Proteinuria is the increased amount of protein in the urine due to protein loss from the bloodstream. Because protein from the bloodstream is being lost in the urine, there is decreased protein in the bloodstream. This is can be referred to as hypoproteinemia, or hypoalbuminemia, as albumin is the type of protein lost in the bloodstream. This hypoalbuminemia causes decreased oncotic pressure in the vasculature, causing profound edema. Proteinuria is the first classic manifestation of nephrotic syndrome (Choice A). Hypoalbuminemia is the second classic manifestation of nephrotic syndrome (Choice B). Edema is the third classic manifestation of nephrotic syndrome (Choice C).

The nurse is caring for a client with nephrotic syndrome. Which of the following assessment findings would be expected? Select all that apply. Proteinuria Hypoalbuminemia Edema Hyperglycemia Jaundice

Choice B is correct. Outflow failure is suspected when the peritoneal dialysate drainage volume is less than the inflow volume. Constipation often suppresses dialysate outflow. Constipation is a common problem in peritoneal dialysis, and it occurs due to the consumption of prescribed phosphate binders as well as due to decreased intestinal motility from chronic kidney disease itself. For a client with poor outflow, simple repositioning and encouraging the client to have a bowel movement are effective remedies. In as many as 50% of catheter outflow obstructions, correction of constipation resolves the problem. The client having a bowel movement allows decreased intestinal pressure, therefore resolving the outflow failure. Laxatives may be administered. At home, the client can self-administer an enema before the peritoneal dialysis procedure.

The nurse is caring for a client with peritoneal dialysis. The client reports an outflow of only one-half of the dialysate solution that was dwelled. The nurse should instruct the client to do which of the following? A. Apply heat to the abdomen. B. Encourage the client to have a bowel movement. C. Strip the dialysis catheter. D. Instill more dialysate solution.

Diet Regular diet Medications - Metformin 500 mg PO daily - 3% saline at 75 mL/hr - Naproxen 220 mg PO every 4 hours as needed for fever

The nurse is caring for a client with pneumonia and acute kidney injury Admission Admit to medical-surgical unit Diet Regular diet Activity Out of bed for meals and ambulate as tolerated Weight Daily weights Medications - Metformin 500 mg PO daily - Multivitamin one tab PO daily - Atorvastatin 40 mg PO daily - 3% saline at 75 mL/hr - Azithromycin 500 mg intravenous piggyback once a day - Naproxen 220 mg PO every 4 hours as needed for fever

Choice C is correct. Urge incontinence is also known as overactive bladder (OAB). The essential manifestation of this incontinence is the involuntary loss of urine associated with a strong desire to urinate. Thus, it would be appropriate for a client to void on a timed schedule. Timed voiding enables an individual to gradually increase the amount of urine they may hold without an abrupt urge to go to the bathroom. The goal is also to prolong the time interval between urinating - up to a minimum of three or more hours.

The nurse is caring for a client with urge incontinence. Which of the following actions would be appropriate for the nurse to take? A. Administer prophylactic antibiotics. B. Teach the client intermittent self-catheterization. C. Have the client void on a timed schedule. D. Provide caffeinated beverages with meals.

Choices A, B, C, and E are correct. Furosemide, vancomycin, ibuprofen, and enalapril are all medications that may lead to nephrotoxicity. The concern is that this client's BUN and creatinine are elevated, suggesting an acute kidney injury. If a client has increased creatinine, a thorough review of the medications should be conducted to avoid worsening the acute kidney injury. Furosemide is a loop diuretic and sulfa based. Sulfa is hard on the kidneys and would be avoided in situations like this, where the client's creatinine is elevated. Vancomycin is a glycopeptide and is implicated in causing acute kidney injury. NSAIDs, like ibuprofen, should also be avoided because they decrease renal blood flow. Enalapril is an ACE inhibitor, and while they are nephroprotective, it should not be used if the client has current renal insufficiency.

The nurse is caring for an assigned client. Which prescription requires clarification with the primary healthcare provider (PHCP) based on the laboratory data? See the image below. Select all that apply. furosemide vancomycin ibuprofen citalopram enalapril

Urine analysis Insertion of peripheral vascular access Fall precautions Complete metabolic panel (CMP)

The nurse is collaborating with the physician. Which orders and prescriptions do the nurse anticipate? Select all that apply Urine analysis Insertion of peripheral vascular access Fall precautions Serum ketones Complete metabolic panel (CMP) Lumbar puncture (LP) Intravenous furosemide Electroencephalography (EEG)

Choice D is correct. This client should expect to have an indwelling urinary catheter placed during this procedure. The nurse should discuss this intervention with the client before the procedure and explain that the pressure of the catheter and balloon typically results in a constant urge to void. The urinary catheter left in place is a large lumen, allowing the bladder to be irrigated to prevent the formation of blood clots from the surgery.

The nurse is educating a client about a transurethral resection of the prostate (TURP). Which of the following statements should the nurse make to the client regarding this surgery? A. "This surgery will remove your entire prostate." B. "You will have a nasogastric tube (NGT) left in place following this surgery." C. "You will need to complete a bowel prep the night before this surgery." D. "A urinary catheter will remain in place following this procedure."

Choice D is correct. A client with diabetes insipidus and an NG tube set to low intermittent wall suction is at very high risk for a fluid volume deficit. They have 2 risk factors and are therefore the client at the most risk. In diabetes insipidus, the body puts out huge amounts of dilute urine, depleting the body of fluid. Having an NG tube to suction also removes fluid from the client, by way of their GI secretions, making it another risk factor for fluid volume deficit.

The nurse is going over the list of assigned clients for the shift. The nurse knows which client is most at risk for experiencing a fluid volume deficit? A. A client with cirrhosis B. A client with an ileostomy and normal amount of output C. A client with a BUN of 32 and creatinine of 2.7 D. A client with diabetes insipidus and an NG tube set to low intermittent wall suction

Choice B is correct. Patients with chronic kidney disease (CKD) retain electrolytes such as potassium, which may lead to imbalances. Hyperkalemia, or excess serum potassium levels, often results in cardiac dysrhythmias.

The nurse is placing the patient with chronic kidney disease on a cardiac monitor. This action is primarily performed because: A. Patients with chronic kidney disease are prone to hypertension B. Hyperkalemia may result in dysrhythmias C. Cardiac monitoring is necessary to evaluate the need for hemodialysis D. Patients with chronic kidney disease may experience false episodes of asystole

Choice B is correct. This statement is false and requires follow-up. Bacterial cystitis may be diagnosed based on urine analysis. A simple, clean-catch midstream urine sample is sufficient for diagnosing bacterial cystitis. A 24-hour urine is utilized for diagnosing conditions such as pheochromocytoma and abnormal protein quantification in multiple myeloma - not bacterial cystitis.

The nurse is precepting a new graduate who will be caring for a client with bacterial cystitis. Which of the following statements by the new graduate requires follow-up? A. "The client should be counseled to increase their fluid intake." B. "A 24-hour urine sample will be needed to confirm the diagnosis." C. "Risk factors include frequent intercourse and douching." D. "Cranberry concentrate may be used to prevent future infections."

Choice A is correct. Daily weights are considered the gold standard for monitoring fluid balance. Monitoring for changes in normal pressure is the most direct and useful way to compare changes in fluid status and evaluate needed interventions. Daily weights, if performed correctly, will reveal fluid status as 1 kilogram of weight gain (or loss) = 2.2 pounds = 1 liter (1000 mL) of water.

The nurse is preparing to admit a client with chronic kidney disease and congestive heart failure. Which assessment would most effectively determine the client's fluid balance? A. Daily weight B. Intake and output measurement C. Urine specific gravity D. Serum sodium level

Nephrolithiasis

The nurse is prioritizing the client's care and determines the client is at highest risk for which condition? Nephrolithiasis Urosepsis Cystitis Pyelonephritis

Choice A is correct. A client with renal failure who is receiving hemodialysis must observe dietary modifications that include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids.

The nurse is providing dietary education to a client with renal failure who is receiving hemodialysis. The nurse determines that the teaching has been effective when the client selects which items from the menu? A. Blueberries, cream of wheat, coffee B. Bacon, banana, orange juice C. Sausage, eggs, tomato juice D. Cured pork, grits, kiwi

Choice B is correct. The use of phenazopyridine produces a harmless orange (to red) color in the client's urine.

The nurse is providing discharge instructions to a client prescribed phenazopyridine. Which of the following instructions should the nurse include? A. The amount of urine you void will increase B. Your urine will turn orange in color C. You may notice that your urine is malodorous D. Concentrated urine is an expected finding

Choices B and C are correct. Thiazide diuretics cause calcium retention, making their administration a potential cause of hypercalcemia. Malignancy, especially malignancies with metastasis involving the bones, may induce hypercalcemia from the breakdown of the bone. This causes the calcium to transition into the bloodstream.

The nurse is providing education to a group of nursing students regarding the causes of hypercalcemia. Which of the following information should be included? Select all that apply. hypoparathyroidism. thiazide diuretics. malignancy. end-stage kidney disease. crohn's disease.

Choice A is correct. The client's creatinine is elevated (normal is 0.6-1.2 mg/dL). Elevations in creatinine may be caused by exposure to nephrotoxic substances (toxins, medications, IV contrast). A decrease in renal perfusion may also cause an elevation in creatinine. Most cases of elevated creatinine are caused by exposure to nephrotoxic substances. The nurse should review the client's MAR to determine if the client is taking any nephrotoxic medication.

The nurse is reviewing a client's laboratory data. Based on the laboratory result, the nurse should take which action? See the image below. A. Review the medication administration record (MAR) B. Plan to initiate daily fluid restrictions C. Clarify the prescribed chest radiograph (x-ray) D. Insert an indwelling urinary catheter to monitor urinary output

Choice B is correct. Clinical features of acute glomerulonephritis (AGN) include proteinuria, hematuria, periorbital edema, weight gain, high blood pressure, and decreased glomerular filtration rate (GFR).

The nurse is reviewing the assessment data for a client with acute glomerulonephritis (AGN). Which of the following would be an expected finding? A. Ketonuria B. Hematuria C. Polyuria D. Glycosuria

Choice A is correct. Hyperemesis gravidarum is a pregnancy complication characterized by severe nausea, vomiting, weight loss, and possibly dehydration. The intense vomiting is why this condition puts the patient at risk for hypokalemia. The hypokalemia associated with hyperemesis gravidarum is related to the metabolic alkalosis the client experiences due to the vomiting.

The nurse is reviewing the assignment for the shift and will be caring for the following clients. Which client is at risk for hypokalemia? A client with A. hyperemesis gravidarum. B. end-stage renal failure. C. diabetic ketoacidosis. D. third-degree burns.

Choice A is correct. This client has hyponatremia, and infusing more water into the client (D5W) would drive down the sodium further. D5W is a hypotonic solution (although it goes in isotonic, it then becomes hypotonic) and raises blood glucose while restoring intracellular volume. D5W provides an individual with water and some calories. Prolonged use of this fluid may cause hyperglycemia and hyponatremia.

The nurse is reviewing the client's laboratory data. Which current prescription should the nurse clarify with the primary healthcare provider (PHCP)? See the image below. A. Dextrose 5% in water (D5W) B. Dexamethasone C. Digoxin D. Vitamin D

Choice A is correct. This client has hyponatremia, and having the client continue the thiazide diuretic would be detrimental as this would further reduce the sodium. This nurse should question this medication with the PHCP before administration.

The nurse is reviewing the client's laboratory data. Which current prescription should the nurse clarify with the primary healthcare provider (PHCP)? See the image below. A. Hydrochlorothiazide B. Lisinopril C. Naproxen D. Tamsulosin

Choice B is correct. Renal failure can cause a significant imbalance in lab values. Although the lab results listed are abnormal, the elevated potassium level is a life-threatening finding because it may cause lethal cardiac dysrhythmias.

The nurse is reviewing the laboratory results of a client with renal failure. Which laboratory data requires immediate follow-up? A. Blood urea nitrogen 50 mg/dL [10-20 mg/dL] B. Serum potassium 6 mEq/L (6 mmol/L) [3.5-5.0 mEq/L] C. Arterial blood pH 7.30 [7.35-7.45] D. Hemoglobin 10.3 mg/dL (1.03 g/L) [F: 12-16 g/dL (7.4 -9.9 mmol/L) M: 14-18 g/dL (8,7-11.2 mmol/L)]

Choices B and C are correct. Respiratory acidosis is caused by the inability to expel carbon dioxide through airway obstruction or decreased ventilation. A pneumothorax causes shallow breathing, which causes the retention of CO2 (an acid). Opioids are central nervous system depressants. When the client is exposed to toxic levels, the effect causes hypoventilation and the retention of CO2.

The nurse is teaching a class on acid-base imbalances. It would be correct for the nurse to identify which of the following would cause respiratory acidosis? Select all that apply. Aspirin overdose Pneumothorax Opioid overdose Anxiety Renal disease

Choice D is correct. Metabolic alkalosis is a disturbance in the body's acid-base balance characterized by an elevated blood pH and bicarbonate (HCO3-) concentration. Excessive vomiting is a common cause of metabolic alkalosis because it results in the loss of stomach acid (hydrochloric acid, HCl) through repeated vomiting. When stomach acid is lost, the body retains bicarbonate ions, which can lead to an increase in blood pH and the development of metabolic alkalosis.

The nurse is teaching a group of students a potential cause of metabolic alkalosis. It would indicate a correct understanding if a student stated which condition could cause this acid-base imbalance? A. Hyperventilation B. Urinary retention C. Opioid toxicity D. Excessive vomiting

Choices A, B, C, and E are correct. Calcium has multiple roles in ensuring effective blood clotting as it is a pivotal part of the clotting cascade (choice A). Calcium is most recognized for its role in bone and enamel health as it provides density to bones minimizing the fracture risk (choices B and C). Calcium is pivotal in neuromuscular status because of its role in the myelin sheath, which insulates a nerve. Optimal calcium and vitamin D levels maintain appropriate neuromuscular health (choice E).

The nurse is teaching a group of students about fluids and electrolytes. It would be correct for the nurse to state that the role of calcium is to Select all that apply. promote blood clotting. increase bone density. promote healthy dentition. regulate fluid balance. maintain neuromuscular health.

Choices A, C, and E are correct. These statements are not accurate and do require further teaching from the nurse. Acute pyelonephritis is a consequence of untreated cystitis. This produces symptoms similar to cystitis in addition to manifestations of flank pain, fever, and dehydration. Massive amounts of proteinuria are a classic manifestation associated with nephrotic syndrome. A 24-hour urine collection is not necessary to diagnose bacterial cystitis. A simple single specimen, urine analysis (UA), would be evaluated to determine if the client has cystitis. Diabetic nephropathy can be prevented by tight glycemic control reflected in the hemoglobin A1C. The higher the A1C equates to more complications such as diabetic nephropathy.

The nurse is teaching a group of students about renal disorders. Which statement, if made by the student, requires follow-up? Select all that apply. - "Pyelonephritis causes a client to have massive amounts of proteinuria." - "Acute kidney injury may be caused by nephrotoxic medications." - "Bacterial cystitis is diagnosed using a 24-hour urine collection." - "Polycystic kidney disease may cause hematuria after a cyst rupture." - "Diabetic nephropathy is prevented by increasing the hemoglobin A1C."

Choices A, B, and C are correct. 3% saline, D10W (dextrose 10% in water), and D5W0.45% NaCl (5% dextrose with 0.45% sodium chloride combined) are all hypertonic solutions.

The nurse is teaching a group of students on fluid and electrolytes. It would be correct for the student to identify which intravenous (IV) solution as hypertonic? Select all that apply. 3% saline Dextrose 10% in water (D10W) 5% Dextrose with 0.45% Sodium Chloride Lactated Ringers (LR) 0.45% Sodium Chloride (0.45% NaCl)

Choices A, B and E are correct. Heart failure can cause hypervolemia. When the heart is not pumping effectively, there is decreased cardiac output. This means less perfusion to all of the body's organs, including the kidneys. When the kidneys don't get enough blood, the urinary output will decrease; instead of the body getting rid of fluid in the urine, the volume will stay in circulation and cause hypervolemia (Choice A). Renal failure can cause hypervolemia. If the kidneys are failing, they are not effectively making urine. If the body is not excreting fluid in the urine, that fluid is staying in the vascular space and causes hypervolemia (Choice B). Hormonal imbalances, such as those caused by excessive production of cortisol or aldosterone, can lead to an increase in fluid retention and hypervolemia (Choice E).

The nurse is working with a client who has been diagnosed with hypervolemia. Which of the following conditions can cause hypervolemia? Select all that apply. Heart failure Renal failure Type 1 Diabetes Mellitus Third degree burns Hormonal imbalances

Obtain urine specimen via straight (intermittent) urinary catheter Obtain capillary blood glucose (CBG) Record the client's current medications

The nurse obtains orders and prescriptions from the physician. The nurse obtains assistance from a licensed practical/vocational nurse (LPN/VN). Which prescriptions, orders, and nursing actions should the nurse delegate to the LPN? Select all that apply. Obtain urine specimen via straight (intermittent) urinary catheter Insertion of peripheral vascular access Educate the client on the ordered CT scan of the head Obtain capillary blood glucose (CBG) Establish the nursing care plan Record the client's current medications

Choice B is correct. Palmar flexion while obtaining blood pressure demonstrates the trousseau's sign. This sign is associated with severely low levels of magnesium or calcium. It would be appropriate for the nurse to obtain a magnesium level to discern if this level is low, which, if it is, may be replaced as prescribed.

The nurse performs a physical assessment on a client and observes the client demonstrate palmar flexion while obtaining the blood pressure. The nurse should take which action? A. Obtain the blood pressure on the client's calf B. Request an order for a magnesium level C. Assess the client's orthostatic blood pressure D. Obtain capillary blood glucose (CBG)

Choice A is correct. For a client with advanced PKD, NSAIDs should be avoided. NSAIDs cause decreased renal blood flow and would be unhelpful (if not detrimental) in PKD management. If the newly hired nurse requests a prescription of ketorolac, an NSAID, this would require follow-up because it would be inappropriate.

The nurse preceptor is orienting a newly hired nurse caring for a client with advanced polycystic kidney disease (PKD). Which of the following actions by the newly hired nurse would require follow-up by the nurse preceptor? A. Requesting a prescription for ketorolac to help relieve the client's pain. B. Instructing the client on how to use guided imagery as a comfort strategy. C. Applying dry heat to the client's abdomen or flank for pain relief. D. Provides the client with foods high in fiber and low in salt.

Choices A and C are correct. These laboratory values require follow-up because they are not within normal limits. The labs depict hyponatremia (any sodium less than 135 mEq/L) and hypocalcemia (any calcium less than 9 mg/dL). Causes of hyponatremia include dehydration, diuretics (especially thiazides), and SIADH. Causes of hypocalcemia include hypoparathyroidism, chronic renal failure, and vitamin D deficiency.

The nurse reviews a client's laboratory data. Which laboratory data requires follow-up? See the image below. Select all that apply. Sodium Potassium Calcium BUN Creatinine

Choice A is correct. A potassium level over 5.0 mEq/L indicates hyperkalemia and is known for causing alterations to the cardiac rhythm. Tall peaked T waves with a shortened QT interval are usually the first findings. ECG changes do not always correlate with the severity of the potassium alterations.

The nurse reviews a client's laboratory results and notes that their potassium level is 5.6 mEq/L (3.5-5 mEq/L). Which change to the cardiac rhythm would be expected? A. Narrow and peaked T-waves B. ST-segment elevation C. Peaked P-waves D. Noticeable U-waves

Choices A, C, and D are correct. The normal sodium level is 135-145 mEq/L. This client's sodium level is hyponatremic and lower than the normal range. SIADH is a condition that can lead to hyponatremia. In SIADH, there is too much ADH. ADH causes water retention, and therefore too much water is retained. Due to the volume, so much water is retained in the vascular space that the amount of sodium present is relatively less than before. This is relative hyponatremia. Addison's disease can lead to hyponatremia. In Addison's disease, there is decreased aldosterone secretion. Aldosterone functions to facilitate sodium reabsorption in the collecting ducts of the kidney. So, with less aldosterone, there is less sodium reabsorption, leading to less sodium (hyponatremia) Psychogenic polydipsia is a condition that can lead to hyponatremia. In this condition, the client cannot stop drinking water. They drink so much water that they dilute their blood volume with free water. This large increase in free water causes relative hyponatremia.

The nurse reviews lab values for a client and notes a serum sodium level of 125 mEq/L(135-145 mEq/L). The nurse knows that this sodium level could be attributed to which conditions? Select all that apply. Syndrome of inappropriate antidiuretic hormone (SIADH) Diabetes Insipidus Addison's disease Psychogenic polydipsia Salt water drowning

Choice B is correct. A bronchodilator would benefit this client as the arterial blood gas demonstrates respiratory acidosis. The accumulation of CO2 causes respiratory acidosis, and a bronchodilator such as formoterol or albuterol would help exhale the excessive CO2.

The nurse reviews the client's arterial blood gas (ABG). Based on the results, which prescription should the nurse request from the primary healthcare provider (PHCP)? See the image below. A. Supplemental oxygen B. Bronchodilator C. Regular insulin D. Sodium polystyrene

Pain level Dysuria

The nurse reviews the client's triage information. Which two (2) client findings require immediate follow-up? Oral temperature Ran out of his prescriptions Pain level Dysuria Blood pressure Recent job loss Medical history

Correct Responses D and E. The client's blood pressure demonstrates hypotension and is concerning because he is symptomatic based on the neurological assessment and the reports of dizziness. Hypotension is a common complication following hemodialysis because of many factors, such as too much fluid being removed, leading to a reduction in blood volume, and the temperature of dialysate being warm, leading to vasodilation. The client's neurological status (dizziness) requires follow-up because this is an unexpected finding after dialysis. The dizziness is likely related to the hypotension.

The nurse reviews the nursing note, vital signs, assessment, and medical history Which clinical data is most concerning to the nurse? Select all that apply A/V fistula assessment Oxygen saturation Pulse Blood pressure Neurological assessment Temperature Anuria

Choice D is correct. Urine specific gravity measures the concentration of urine. The nurse notes that this urine is very dark and therefore very concentrated. The nurse suspects that the client is dehydrated based on this assessment of the client's urine color. In dehydrated clients, there are more particles in the urine, creating a higher urine specific gravity. The normal range for urine specific gravity is 1.005 to 1.030, so the nurse expects the client's urine specific gravity lab value to be higher than 1.030. This is the only lab value showing an increased urine specific gravity.

The nurse sees the following (shown in the exhibit), while emptying the urinary indwelling catheter. Which urine specific gravity level does the nurse expect to see, based on this assessment of the client's urine? See the exhibit. View Exhibit A. 0.990 B. 1.000 C. 1.020 D. 1.060

Choice A is correct. This patient is experiencing hypokalemia, also known as a deficiency in potassium or a blood serum potassium level of less than 3.5 mmol/L. Low potassium affects the heart's ability to repolarize, which is reflected in an EKG with a flat T wave and, occasionally, the presence of a U wave.

The nurse taking care of a malnourished patient reviews their lab results and notes that the patient is currently hypokalemic. The nurse knows that given this condition, the patient should be monitored for which changes in their EKG? A. U wave and a flat T wave B. An inverted QRS complex C. Absence of a U wave D. Exaggerated QRS complex

Choice A is correct. The kidneys cannot excrete excess hydrogen ions or reabsorb bicarbonate with ATN. Due to the inability to excrete the excess acid (hydrogen ions) paired with the inability to hang on to the needed base (bicarbonate), acidosis ensues. This is due to the malfunction of the kidneys, not the lungs, so it is classified as metabolic acidosis. Choice C is correct. ATN can cause hyponatremia. Due to lower urinary output, there is hypervolemia. With fluid retention and high volume remaining in the blood vessels, the amount of sodium in the body is diluted. This is called relative dilutional hyponatremia. Choice E is correct. The kidneys play a crucial role in regulating the levels of electrolytes such as sodium, potassium, and calcium in the body. ATN can disrupt this process, leading to imbalances that can cause a range of symptoms, including muscle weakness, confusion, and heart rhythm abnormalities.

The nurse understands that which of the following are complications of acute tubular necrosis (ATN)? Select all that apply. Metabolic acidosis High thyroxine levels Hyponatremia Decreased parathyroid levels Electrolyte imbalances

Choice A is correct. When caring for a patient with SIADH, the nurse should carefully monitor for changes in mental status and level of consciousness. SIADH causes excess free water retention and hyponatremia, which may lead to confusion and behavioral changes. These alterations in the mental state may also lead to seizures. Patients with SIADH may also experience cardiac dysrhythmias.

The oncoming nurse learns that her new patient is suffering from Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion. Which of the following nursing actions is the most important? A. Assess the patient's mental status B. Provide oral hygiene C. Keep accurate intake and output measurements D. Reduce stress and discomfort

Nortriptyline is a tricyclic antidepressant used for depression and obsessive-compulsive disorders. This medication is significantly anticholinergic and would further irritate the client's BPH symptoms. The other medications are not purported to aggravate this condition.

The physician has diagnosed the client with benign prostatic hyperplasia (BPH) The nurse reviews the client's current medications and plans to question which prescription? Lisinopril Nortriptyline Clonidine Aspirin

Choice B is correct. To monitor for signs of nephrotoxicity; the nurse should monitor the results of kidney function tests closely while the patient is taking gentamicin. Gentamicin is an aminoglycoside drug, that is capable of causing severe adverse effects in some patients. The most significant concerns are their effects on the inner ear and the kidneys. Damage to the inner ear, or ototoxicity, may cause hearing impairment, dizziness, persistent headache, or ringing in the ears. Nephrotoxicity is recognized by abnormal kidney function tests, such as elevated serum creatinine or blood urea nitrogen.

There is a new patient in your clinic. Six months ago, he had a kidney transplant and is taking immunosuppressive drugs. Recently, he has been experiencing repeated bacterial infections and was switched to different antibiotics throughout the past six months. The physician suspected kidney infection. He is admitted to the hospital and administered gentamicin 300 mg daily by IV infusion. Which of the following tests should the nurse monitor? A. Input and output ratio B. Kidney function tests C. Visual acuity tests D. Fasting blood glucose levels

Choices A, D and E are correct. Chvostek's sign is an indication of hypocalcemia. This sign is positive if the patient's upper lip twitches upon tapping over a branch of the facial nerve on the same side (Choice A). Trousseau's sign is also an indication of hypocalcemia. Trousseau's is positive if a carpopedal spasm is observed upon inflating a blood pressure cuff past the systolic blood pressure ( Choice D). Other signs and symptoms of hypocalcemia may include muscle cramps, numbness and tingling in the fingers and toes, tetany, seizures, and cardiac arrhythmias (Choice E).

Which nursing assessment finding are consistent with hypocalcemia? Select all that apply. Chvostek's sign Grey-Turner's sign Homan's sign Trousseau's sign Numbness and tingling of the fingers and toes

Choice A is correct. "Impaired urinary elimination related to an alkaline urinary pH" is the most appropriate nursing diagnosis for an immobilized client on complete bed rest. A urinary pH of 9.9 is abnormal, as this is outside the normal urinary pH value range of 4.5 to 8.0. A urinary pH of less than 4.5 is considered acidic, while urinary pH values greater than 8.0 are considered alkaline. Abnormal alkalinity, a known complication of immobility, places the client at risk for the formation of renal calculi and urinary impairments.

Which of the following nursing diagnoses is the most appropriate for an immobilized client on complete bed rest who has a blood calcium level of 9.9 mg/dL and a urinary pH of 9.9? A. Impaired urinary elimination related to an alkaline urinary pH B. Demineralization related to immobilization and complete bed rest C. At risk for impaired urinary elimination related to immobilization D. At risk for hypocalcemia related to bone demineralization

Choice A is correct. This patient is experiencing respiratory acidosis. His pH is low, pCO2 is elevated, and bicarbonate is within normal limits. This is most likely due to chronic carbon dioxide retention because of COPD. Since this patient is experiencing a COPD exacerbation, acute CO2 retention on top of chronic hypercapnia occurs, and respiratory acidosis will be worsened.

A 90-year-old male with COPD, CHF, and hypertension is brought to the emergency department by ambulance. A nebulizer is in place upon arrival. After blood tests are drawn, the patient's arterial blood gas shows the values below. What is this patient exhibiting? pH: 7.18, CO2: 67, bicarbonate: 23 A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis

Choice D is correct. Hypovolemia is a common prerenal cause of acute kidney injury (AKI). Prerenal reasons are those factors that are external to the kidney. Hypovolemia causes a decrease in blood flow to the organs. Hypovolemia can lead to intrarenal kidney disease.

A common prerenal cause of acute kidney injury is: A. Nephrotoxicity B. Bladder cancer C. Contrast media D. Hypovolemia

Choice C is correct. This patient is at risk of developing bladder spasms if the bladder is completely drained. Anything over 800 mL that is drained out at one time puts the patient at risk for developing bladder spasms since there is not enough time to adjust from being abundant to shrinking.

An emergency department nurse is taking care of a 68-year-old female after she fell. The paramedics said that she was on the bathroom floor for approximately 10 hours. The nurse is straight catheterizing the patient for a urine sample when she notices the amount of urine reaches 800 mL. The urine is still flowing heavily. What action should the nurse take and why? A. Drain the patient's bladder entirely and place a small amount in a urine specimen cup. This patient needs a urine sample to check for rhabdomyolysis. B. Continue draining the bladder fully, then place a Foley catheter to monitor for sufficient urine output. C. Stop draining the patient's bladder because the patient is at risk for developing bladder spasms. D. Stop draining the patient's bladder and consult the physician for further instructions.

Choices A and C are correct. Normal saline (0.9% NS) is an isotonic solution (Choice A). Lactated ringers (LR) is an isotonic solution (Choice C).

As a nurse, you are administering intravenous fluids to a client. Which of the following types of IV fluids would be classified as isotonic? Select all that apply. Normal saline ½ Normal saline Lactated ringers D10W 3% NaCl

vital signs; dosage increase of diuretic; fluid volume deficit

Based on the client's ___ and ____ this client is at highest risk for ____

Choice C is correct. Here, the client is being instructed to consume cranberry juice to alter the pH of the urine as part of the acid-ash diet. The acid-ash diet is based on the concept that by altering the composition of one's diet, one can change the pH of their urine. Here, the goal is to make the client's urine more acidic, which may help reduce some symptoms of cystitis that the client is experiencing. Therefore, the nurse would utilize the client's urine pH as an assessment parameter to indicate whether this recommendation has been effective.

Following a diagnosis of cystitis, a client was instructed to drink cranberry juice. Changes in which of the following assessment parameters would indicate to the nurse that this recommendation has been effective? A. Urine specific gravity B. Leukocyte count C. Urine pH D. Protein level

Choice B is correct. Following the client's complaint, the most appropriate response by the nurse would be to check the patency of the urinary catheter, as the most frequent reason for an urge to void while an indwelling catheter is in place is blocked tubing. The nurse would appropriately verbalize this action to the client with Choice B.

Following surgery for a prolapsed bladder, a 74-year-old female client is two days postoperative with an indwelling urinary catheter. While the nurse is making morning rounds, the client states, "I feel like peeing again!" The most appropriate response for the nurse is: A. "It's just bladder spasms. Nothing to worry about." B. "Let me look at your urine bag to ensure it's draining properly." C. "You should do Kegel exercises regularly to stop this urge to void." D. "Is this the first time this has happened?"

Choice A is correct. In addition to other functions, sodium controls and manages circulating blood volume, it maintains circulating blood volume, and it also is necessary for the transmission of nerve impulses.

Intravenous therapies often consist of electrolyte replacement therapies. Select the electrolyte that is accurately paired with one of its functions. A. Sodium: The control and management of circulating blood volume. B. Bicarbonate: The regulation of extracellular fluid. C. Chloride: The regulation of plasma protein. D. Calcium: The metabolism of fats, carbohydrates, and proteins.

Choice A is correct. This client is likely affected by an alteration of the renal system. The image depicts a client undergoing peritoneal dialysis, probably due to chronic kidney disease (CKD). Specifically, the client's decreased kidney function affects urinary elimination, including the excretion of waste, fluid and electrolyte balance, regulation of acid-base balance, anemia, and hormone secretion. Impaired kidney function ultimately affects every organ system unless diligently managed. Renal replacement therapy (RRT) refers to life-supporting treatments provided to clients with renal failure. RRT replaces the non-hormonal renal function in clients with renal failure. Renal replacement therapy options include intermittent hemodialysis, continuous hemodialysis, and peritoneal dialysis. Peritoneal dialysis allows clients more autonomy, as the procedure may often be performed from the comfort of the client's home following the appropriate client training.

The client depicted in the image below is most likely affected by an alteration of which body system? A. The renal system B. The gastrointestinal system C. The endocrine system D. The reproductive system

prostate hyperplasia

The client is at highest risk of developing ____

shock

The client is demonstrating signs and symptoms of _____

Choice B is correct. The focus of the question is the psychosocial problem. Of the options listed, anxiety is the only choice for an appropriate psychosocial issue.

The client is diagnosed with acute kidney failure. Which of the following is an appropriate psychosocial problem for the nurse to include in the care plan? A. Imbalanced nutrition: less than body requirements related to altered metabolic state and dietary restrictions. B. Anxiety related to the disease process and uncertainty of prognosis. C. Excess fluid volume related to compromised regulatory mechanisms secondary to acute renal failure. D. Risk for infection related to invasive procedures and an altered immune response secondary to renal failure.

Choice A is correct. The most significant risk factor for a urinary tract infection is the presence of an indwelling urinary catheter. Bacteria may colonize the tip of the catheter within 48 hours of its placement. Thus, the nurse recognizes that having this invasive device is a key risk factor for UTI.

The infection control nurse assesses clients at risk for a urinary tract infection (UTI). Which client is at the greatest risk of developing a UTI? A client with A. a chronic indwelling urinary catheter receiving intravenous diuretics. B. diabetes mellitus who is receiving intravenous antibiotics for a wound infection. C. obesity being treated for urge incontinence. D. a history of frequent bladder infections.

Choice B is correct. The normal range for serum potassium is between 3.5-5 mEq/L, so this client's level is low. Hypokalemia can lead to life-threatening cardiac arrhythmias. Of the options provided, initiating telemetry monitoring would be the highest priority to assess the client's heart function and monitor for any changes.

The nurse is reviewing labs for a client with a serum potassium level of 3.3 mEq/L(3.5-5 mEq/L). The nurse should take which essential action? A. Educate the client on potassium-rich foods B. Implement continuous telemetry monitoring C. Obtain an order for calcium gluconate D. Assess the client's neurological status

administering prescribed pain control

The priority nursing for this client is ____

Choice D is correct. When there is an excessive loss of fluid within the body, dehydration can occur. Dehydration may be caused by acute illness or a chronic disease process. Common symptoms include dry mucous membranes, dark urine, decreased urinary output, confusion, low blood pressure, muscle cramps, and constipation.

When assessing for dehydration, the nurse should observe for which of the following? A. Headache and increased urinary output B. Weight gain and edema C. Hypertension and decreased urinary output D. Hypotension, headache, and dry mucous membranes

Choice C is correct. Oliguria (urine output less than 400 mL/24 hours) is the most common initial sign of an AKI. It is usually seen within the first week of the injury.

Which assessment data should the nurse recognize as a sign of acute kidney injury (AKI)? A. Hypernatremia B. Metabolic alkalosis C. Oliguria D. Hypokalemia

Urinary hesitancy Urination at night Weak urinary stream

Which assessment findings are most significant? Select all that apply. Vital signs Urinary hesitancy Aspirin prescription Urine color Urination at night Weak urinary stream

Dehydration

Which factor best explains the client's findings? Dehydration Blood glucose Irregular pulse Limited mobility

Obstructed urinary tract

Which factor best explains the client's symptoms? Alterations in antidiuretic hormone Obstructed urinary tract Urinary stone formation Increased bladder control

Choice C is correct. 3% saline is a hypertonic solution, so the nurse should monitor for signs/symptoms of fluid volume overload and pulmonary edema (increased blood pressure, crackles in lungs, shortness of breath). This type of fluid increases extracellular osmolality and volume. High osmotic pressure causes water to shift from inside cells into the extracellular fluid. Hypertonic solutions are used to treat hypovolemia and hyponatremia.

Which nursing intervention would be a priority for a patient receiving 3% saline maintenance fluids? A. Monitor serum HCO3- B. Monitor urine sodium C. Assess blood pressure D. Collect 24-hour urine output

Choices A, C, and E are correct. A decrease in skin turgor may indicate hypovolemia or a fluid volume deficit. Healthy skin turgor is a rapid recoil; it is most commonly checked on the back of the hand. When the skin is pinched up, it recoils to its normal position very quickly. If it recoils slowly, then it is a sign that the surface is dehydrated and is a good indicator of a fluid volume deficit (Choice A). Dry mucous membranes are an indication of hypovolemia. When the body has a fluid volume deficit or is dehydrated, the mucous membranes are one of the first places to dry out. This is an excellent assessment to monitor for fluid status; if the mucous membranes appear well hydrated, the patient is probably not dehydrated (Choice C). Low blood pressure is an initial symptom of hypovolemia because hypovolemia leads to a decrease in the volume of blood plasma in the body. (Choice E)

Which of the following signs and symptoms may lead the nurse to suspect hypovolemia? Select all that apply. Decreased skin turgor Increased urine output Dry mucous membranes Weight gain Low blood pressure

Urine analysis Post-void bladder scan Digital rectal exam

Which orders does the nurse anticipate from the primary healthcare provider (PHCP)? Select all that apply Urine analysis Post-void bladder scan Insertion of indwelling urinary catheter Testicular ultrasound Digital rectal exam

Dehydration Cystitis Delirium

Which three (3) problems is the client most likely experiencing? Select all that apply Dehydration Dementia Cystitis Delirium Diabetic ketoacidosis Atrial fibrillation with rapid ventricular response

Which two (2) findings in the nursing assessment require follow-up? Disorientation No range of motion on left side Blood glucose Atrial fibrillation Urinary incontinence Hyperlipidemia Irregular pulse

Which two (2) findings in the nursing assessment require follow-up? Disorientation No range of motion on left side Blood glucose Atrial fibrillation Urinary incontinence Hyperlipidemia Irregular pulse

Choice D is correct. Although hypoparathyroidism symptoms often mirror hypocalcemia, the nurse should suspect hypoparathyroidism in this client based on the client's complaints and presentation. Hypoparathyroidism symptoms often manifest as numbness and tingling of the lips and hands, tetany, carpopedal spasms (Trousseau's sign), Chvostek's sign, and/or muscle/abdominal cramps. ECG analysis often reveals changes in the T waves and prolonged QT intervals. Due to low serum calcium levels, serum phosphorus levels are usually increased, as phosphorus and calcium have an inverse relationship in this situation.

A client was admitted to the emergency department due to low serum calcium levels. Upon further examination, the client demonstrates carpopedal spasms and reports numbness in their lips and hands. An ECG revealed a prolonged QT interval. Based on this information, the nurse should suspect which condition? A. Hyperthyroidism B. Hypothyroidism C. Hyperparathyroidism D. Hypoparathyroidism

Choice C is correct. Following a transurethral resection of the prostate (TURP), clients often receive continuous bladder irrigation (CBI) to prevent clot retention, bladder spasms, and post-operative hemorrhage. If the continuous infusion or drainage of the sterile fluid ceases, the nurse should inspect the CBI set for the presence of a clot. If a clot is present, the most appropriate intervention would be for the nurse to attempt to dislodge any existing clot by gently aspiration the lump or irrigation through the out-port with the goal of allowing the continuous bladder irrigation to resume. Following this intervention, the nurse should document all relevant details of the intervention, including, but not limited to, a description of the clot removed.

A client with benign prostatic hyperplasia (BPH) is post-operative following transurethral resection of the prostate and is now on continuous bladder irrigation. Upon assessment, the nurse notes that the drainage from the urinary catheter has stopped. Which nursing intervention is most appropriate? A. Reinsert a new catheter B. Increase the infusion rate of the irrigation C. Attempt to dislodge a clot D. Contact the health care provider (HCP)

Choice D is correct. Ulcerative colitis is a chronic inflammatory bowel disease in which the large intestine becomes inflamed and ulcerated, leading to flare-ups of water or bloody diarrhea, abdominal cramping, and fever. During severe ulcerative colitis flare-ups, clients may experience ten or more episodes of diarrhea per day. During these events, the client loses a large volume of fluid, resulting in a deficient fluid volume. When assessing this client, one would anticipate a finding of an elevated serum osmolality and elevated urine specific gravity due to the client's deficient fluid volume status.

A client experiencing an acute exacerbation of ulcerative colitis underwent diagnostic testing and was found to have elevated serum osmolality and urine specific gravity. Which of the following is related to these findings? A. Renal insufficiency B. Diabetes insipidus C. Hypoaldosteronism D. Deficient fluid volume