EAQ TESTING Q & A

A client undergoing tuberculosis therapy reports eye pain that worsens when moving the eyes with decreased color vision. Which medication most likely is responsible for the client's condition? 1 Rifampin 2 Isoniazid 3 Ethambutol 4 Pyrazinamide

Ethambutol Eye pain that is worsened when the eyes are moved with decreased color vision may be indicative of optic neuritis. Ethambutol, especially at high dosages, can cause optic neuritis, a condition that can result in blindness. Rifampin reduces the effectiveness of oral contraceptives, increasing the risk of an unplanned pregnancy, and can change bodily fluid orange. Isoniazid can deplete the body of the B-complex vitamins. Pyrazinamide increases uric acid formation and worsens gout.

The nurse is performing a physical examination of a client by placing the left hand on the back and supporting the client's right side between the rib cage and the iliac crest. Which physical assessment maneuver is the nurse performing on this client? 1 Palpation 2 Percussion 3 Auscultation 4 Inspection

1 The physical assessment involves inspection, palpation, percussion, and auscultation. During palpation of the right kidney, the nurse places the left hand behind and supports the client's right side between the ribcage and the iliac crest. During an inspection, the nurse assesses the client for changes in skin, abdomen, weight, face, and extremities. During percussion, the nurse strikes the fist of one hand against the dorsal surface of the other hand, which is placed flat along the post costovertebral angle (CVA) margin. While performing auscultation, the nurse uses the bell of the stethoscope over both CVAs and in the upper abdominal quadrants.

A nurse is concerned about the public health implications of gonorrhea diagnosed in a 16-year-old adolescent. Which should be of most concern to the nurse? 1 Interviewing the client's parents 2 Finding the client's sexual contacts 3 Instructing the client about birth control measures 4 Determining the reasons for the client's promiscuity

2 Gonorrhea is a highly contagious disease transmitted through sexual intercourse. The incubation period varies, but symptoms usually occur 2 to 10 days after contact. Early effective treatment prevents complications such as sterility. The parents may be unaware that their child has gonorrhea. Most birth control measures do not protect against the transmission of sexually transmitted infections. Contracting venereal infection is not necessarily indicative of promiscuity.

A nurse is notified that the latest potassium level for a client in acute kidney injury is 6.2 mEq (6.2 mmol/L). Which action should the nurse take first? 1 Call the laboratory to repeat the test. 2 Take vital signs and notify the primary healthcare provider. 3 Obtain an electrocardiogram (ECG) strip and obtain an antiarrhythmic medication. 4 Alert the cardiac arrest team.

2 Vital signs monitor the cardiopulmonary status; the primary healthcare provider must treat this hyperkalemia [1] [2] to prevent cardiac dysrhythmias. The cardiac arrest team responds to a cardiac arrest; there is no sign of arrest in this client. A repeat laboratory test will take time and probably reaffirm the original results; the client needs medical attention. Although obtaining an ECG strip is appropriate, obtaining an antiarrhythmic is premature; vital signs and medical attention is needed first.

What are the functions of antidiuretic hormone (ADH)? Select all that apply. 1 Promoting the reabsorption of sodium in the distal convoluted tubule (DCT) 2 Increasing tubular permeability to water 3 Increasing arteriole constriction 4 Controlling calcium balance 5 Stimulating the bone marrow to make red blood cells

2, 3 Antidiuretic hormone (ADH), also known as vasopressin, is a hormone released from the posterior pituitary gland. ADH increases arteriole constriction and tubular permeability to water. Calcium balance is controlled by blood levels of calcitonin and the parathyroid hormone (PTH). Erythropoietin stimulates the bone marrow to make red blood cells. Aldosterone promotes the reabsorption of sodium in the distal convoluted tubule (DCT).

To prevent bleeding after a suprapubic prostatectomy, the client should be instructed to avoid straining on defecation. Which foods should the nurse encourage the client to eat to help prevent constipation during the recovery period? Select all that apply. 1 Scrambled eggs 2 Green peas 3 Milk 4 Apples 5 Oatmeal

2, 4, 5 Apples, oatmeal, and green peas are high in fiber, which helps prevent constipation. Milk and milk products can be constipating; they do not contain bulk. Scrambled eggs contain little dietary fiber and do not prevent constipation.

The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled into the peritoneal cavity. Which information will the nurse share with the client? 1 Because it adds extra warmth to the body because metabolic processes are disturbed 2 Because it helps prevent cardiac dysrhythmias by speeding up removal of excess potassium 3 Because it encourages removal of serum urea by preventing constriction of peritoneal blood vessels 4 Because it forces potassium back into the cells, thereby decreasing serum levels

3 Encouraging the removal of serum urea by preventing constriction of peritoneal blood vessels promotes vasodilation so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution. Heat does not affect the shift of potassium into the cells. The removal of metabolic wastes is affected in kidney failure, not the metabolic processes. Heating dialysis solution does not affect cardiac dysrhythmias.

The nurse is preparing a client who is on metformin therapy and is scheduled to undergo renal computed tomography with contrast dye. What does the nurse anticipate the primary healthcare provider to inform the client regarding the procedure? 1 "Discontinue metformin a half-day prior to procedure." 2 "Discontinue metformin 7 days following the procedure." 3 "Discontinue metformin 1 day prior to procedure." 4 "Discontinue metformin 3 days following the procedure."

3 Metformin can react with the iodinated contrast dye that is given for a renal computed tomography (CT) and cause lactic acidosis. Therefore the nurse anticipates an instruction that the client should discontinue the metformin 1 day before the procedure. Stopping the metformin a half-day before the renal CT may not reduce the risk of lactic acidosis. The client is advised to discontinue the metformin for at least 48 hours after the procedure. It is not necessary to discontinue metformin for 3 to 7 days after a renal CT with contrast media.

Which vascular component of the client's nephron delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta? 1 Afferent arteriole 2 Interlobular artery 3 Efferent arteriole 4 Arcuate artery

3 The efferent arteriole is the vascular component of the nephron that delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta. The arcuate artery is a curved artery of the renal system that surrounds the renal pyramids. The afferent arteriole is the vascular component of the nephron that delivers arterial blood from the branches of the renal artery into the glomerulus. The interlobular artery feeds the lobes of the kidney.

Which retrograde procedure involves the examination of the ureters and the renal pelvises? 1 Urethrogram 2 Cystogram 3 Pyelogram 4 Voiding cystourethrogram

3... A pyelogram is a retrograde examination of the ureters and the pelvis of both kidneys. A cystogram is a retrograde examination of the bladder. An urethrogram is a retrograde examination of the urethra. A voiding cystourethrogram is used to determine whether urine is flowing backward into the urethra.

Which type of hypersensitivity reaction is present in a client with a body temperature of 102 °F, severe joint pain, rashes on the extremities, and enlarged lymph nodes from serum sickness? 1 Delayed reaction 2 Cytotoxic reaction 3 Immediate reaction 4 Immune complex-mediated reaction

4 Serum sickness is a type III immune complex-mediated reaction. A delayed reaction is a type IV hypersensitivity reaction that may include poison ivy skin rashes, graft rejection, and sarcoidosis. A cytotoxic reaction is a type II hypersensitivity reaction that includes autoimmune hemolytic anemia, Goodpasture syndrome, and myasthenia gravis. An immediate reaction is a type I hypersensitive reaction that includes allergic asthma, hay fever, and anaphylaxis. Test-Taking Tip: Serum sickness is manifested by elevated body temperature, severe joint pain, rashes on limbs, and enlarged lymph nodes. Recall the type of hypersensitivity reaction to which serum sickness belongs.

Which statement regarding erythropoietin is true? 1 An erythropoietin deficiency is associated with renal failure. 2 Erythropoietin is released only when there is adequate blood flow. 3 An erythropoietin deficiency causes diabetes. 4 Erythropoietin is released by the pancreas.

...1 correct Erythropoietin is produced by the kidneys; its deficiency occurs in renal failure. Erythropoietin is released by the kidneys, not the pancreas. Erythropoietin deficiency causes anemia. Erythropoietin is secreted in response to hypoxia, which results in decreased oxygenated blood flow to the tissues.

A nurse is caring for a client with a diagnosis of cancer of the prostate. The nurse should teach the client that which serum level will be monitored throughout the course of the disease? 1 Albumin 2 Prostate-specific antigen (PSA) 3 Blood urea nitrogen (BUN) 4 Creatinine

.2..The PSA is an indication of cancer of the prostate; the higher the level, the greater the tumor burden. Albumin is a protein that is an indicator of nutritional and fluid status. Increased creatinine or BUN levels may be caused by impaired renal function as a result of blockage by an enlarged prostate but do not indicate that metastasis has occurred.

Which diagnostic procedure helps in the detection of uropathologic features in a client who has a urinary pouch or ileal conduit? 1 Loopogram 2 Cystogram 3 Computed tomography urogram 4 Urethrogram

1 Loopogram helps in the detection of uropathologic features in a client who has a urinary pouch or ileal conduit. Cystogram helps to visualize the bladder and evaluates vesicoureteral reflux. A computed tomography (CT) urogram provides excellent visualization of kidneys and kidney size can be evaluated. When urethral trauma is suspected, an urethrogram is done before catheterization.

Which is an abnormal finding of the urinary system? 1 Pain in the flank region upon hitting 2 Presence of bowel sounds 3 Nonpalpable urinary bladder 4 Nonpalpable left kidney

1 Normally, a blow in the flank region should not elicit pain. Pain in the flank region upon hitting indicates kidney infection or polycystic kidney disease. But the client experiences pain when his/her flank area is hit; therefore, this is an abnormal finding. The left kidney is covered by the spleen and is not palpable, which is a normal finding. The client has bowel sounds. However, no alteration of bowel sounds is seen. Therefore it is a normal finding. The urinary bladder is not normally palpable, unless it is distended with urine.

A client who has been on hemodialysis for several weeks asks the nurse what substances are being removed by the dialysis. Which substance removal should the nurse share with the client? 1 Sodium 2 Bacteria 3 Glucose 4 Blood

1 Sodium is an electrolyte that passes through the semipermeable membrane during hemodialysis. Red blood cells do not pass through the semipermeable membrane during hemodialysis. Glucose does not pass through the semipermeable membrane during hemodialysis. Bacteria do not pass through the semipermeable membrane during hemodialysis.

A client with a history of chronic kidney disease is hospitalized. Which assessment findings will alert the nurse to kidney insufficiency? 1 Edema and pruritus 2 Facial flushing 3 Diminished force and caliber of stream 4 Dribbling after voiding and dysuria

1 The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production. Pallor, not flushing, occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a urinary pattern that is not caused by chronic kidney disease; this may occur with prostate problems. Diminished force and caliber of stream occur with an enlarged prostate, not kidney disease.

Which part of the kidney produces the hormone bradykinin? 1 Juxtaglomerular cells of the arterioles 2 Kidney tissues 3 Kidney parenchyma 4 Renin-producing granular cells

1 The juxtaglomerular cells of the arterioles produce the hormone bradykinin, which increases blood flow and vascular permeability. The kidney tissues produce prostaglandins that regulate internal blood flow by vasodilation or vasoconstriction. The kidney parenchyma produces erythropoietin that stimulates the bone marrow to make red blood cells. The renin-producing granular cells produce the renin hormone that raises blood pressure as a result of angiotensin and aldosterone secretion.

A nurse is caring for a client who had a nephrectomy because of cancer of the kidney. Which factor will influence the client's ability to deep breathe and cough postoperatively? 1 Pulmonary congestion from preoperative medications 2 Location of the surgical incision 3 Inflammatory process associated with surgery 4 Increased anxiety about the prognosis

2 The location of the surgical site in relation to the diaphragm increases incisional pain when deep breathing or coughing. Anxiety about the prognosis should not interfere with the ability to deep breathe and cough, especially when encouraged by the nurse. Inflammatory changes will cause discomfort in the area of any incision but are not necessarily the prime factor preventing deep breathing after a nephrectomy. The client will need to cough and deep breathe if there is congestion in the lungs.

The nurse is caring for a client on antiretroviral therapy who has Pneumocystis jiroveci pneumonia. Which action is priority? 1 Assisting the client in eating and drinking 2 Maintaining fluid balance in the client 3 Providing adequate oxygenation for the client 4 Encouraging the client to perform breathing exercise

3

A client who has been told she needs a hysterectomy for cervical cancer is upset about being unable to have a third child. Which action should the nurse take next? 1 Emphasize that she does have two children already. 2 Encourage her to focus on her own recovery. 3 Ensure that other treatment options for her will be explored. 4 Evaluate her willingness to pursue adoption.

3 Although a hysterectomy may be performed, conservative management may include cervical conization [1] [2] [3] and laser treatment that do not preclude future pregnancies; clients have a right to be informed by their primary healthcare provider of all treatment options. Willingness to pursue adoption currently is not the issue for this client. Encouraging her to focus on her own recovery and emphasizing that she does have two children already negate the client's feelings.

Which part of the reproductive system secretes androgens in female clients? 1 Ovarian follicle 2 Uterus 3 Ovaries 4 Fallopian tube

3 The ovaries and adrenal glands produce androgens in women. The fetus develops in the uterus during pregnancy. Fallopian tubes facilitate fertilization of oocyte and sperm. Ovarian follicle is a collection of oocytes in the ovary.

A client with acute kidney injury is to receive peritoneal dialysis and asks why the procedure is necessary. Which is the nurse's best response? 1 "It speeds recovery because the kidneys are not responding to regulating hormones." 2 "It removes toxic chemicals from the body so you will not get worse." 3 "It prevents the development of serious heart problems." 4 "It helps perform some of the work usually done by the kidneys."

4 Dialysis removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Stating that peritoneal dialysis "removes toxic chemicals from the body so you will not get worse" is threatening and can cause an increase in anxiety. Dialysis helps maintain fluid and electrolytes; the nephrons are damaged in acute kidney injury, so it may or may not speed recovery.

A client presents with a localized bacterial infection of mucous membranes. Which organism is most likely responsible for this condition in the client? 1 Giardia 2 Aspergillus fumigatus 3 Corynebacterium diphtheria 4 Mycobacterium tuberculosis

Corynebacterium diphtheria Diphtheria is a re-emerging infection that can be characterized by localized infection of mucous membranes or skin. It is caused by Corynebacterium diphtheria. Giardia, a parasite, causes giardiasis, a diarrheal illness known as traveler's diarrhea. Aspergillosis is a lung disease caused by Aspergillus fumigatus, a fungus. Mycobacterium tuberculosis causes tuberculosis.

A client is transferred to the postanesthesia care unit after undergoing a pyelolithotomy. The client's urinary output is 50 mL/hr. What should the nurse do? 1 Record the output as an expected finding. 2 Milk the client's nephrostomy tube. 3 Encourage the client to drink oral fluids. 4 Notify the primary healthcare provider.

1 An output of 50 mL/hr is adequate; when urine output drops below 20 to 30 mL/hr, it may indicate renal failure, and the primary healthcare provider should be notified. Encouraging the client to drink oral fluids is contraindicated; the client probably still will be under the influence of anesthesia, and the gag reflex may be depressed. Milking the client's nephrostomy tube is unnecessary because the output is adequate.

After reviewing the urinalysis reports of a client with kidney dysfunction, the nurse suspects the presence of myoglobin. Which finding in the test reports supports the nurse's suspicion? 1 Very pale yellow colored urine 2 Dark amber colored urine 3 Red-colored urine 4 Brown-colored urine

3 Red-colored urine in clients with kidney dysfunction indicates the presence of myoglobin. Brown-colored urine indicates increased bilirubin levels. Dark amber urine indicates concentrated urine. Very pale yellow urine indicates dilute urine.

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

1 Brachytherapy, in which isotope seeds are implanted in the tumor, interferes with cell multiplication, which should control the growth and metastasis of cancerous tumors. Radiation affects healthy as well as abnormal cells; urinary output will increase with successful therapy. With brachytherapy of the bladder, increase in pulse strength is not a sign of success. Bone marrow sites may be affected by radiation, resulting in a reduction of WBCs.

A nurse is caring for a client who is experiencing urinary incontinence. The client has an involuntary loss of small amounts (25 to 35 mL) of urine from an overdistended bladder. How should this be documented in the client's medical record? 1 Overflow incontinence 2 Stress incontinence 3 Functional incontinence 4 Urge incontinence

1 Overflow incontinence [1] [2] [3] describes what is happening with this client; overflow incontinence occurs when the pressure in the bladder overcomes sphincter control. Urge incontinence describes a strong need to void that leads to involuntary urination regardless of the amount in the bladder. Stress incontinence occurs when a small amount of urine is expelled because of an increase in intraabdominal pressure that occurs with coughing, lifting, or sneezing. Functional incontinence occurs from other issues rather than the bladder, such as cognitive (dementia) or environmental (no toileting facilities). Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.

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

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

A nurse is assessing the urine of a client with a urinary tract infection. For which characteristic should the nurse assess each specimen of urine? 1 Viscosity 2 Clarity 3 Specific gravity 4 Glucose level Cloudy urine usually indicates drainage associated with infection. Viscosity is a characteristic that is not measurable in urine. Urinary glucose levels are not affected by urinary tract infections. Specific gravity yields information related to fluid balance.

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

The registered nurse is preparing to assess a client's renal system. Which statement by the nurse indicates effective technique? 1 "I must first palpate the client if a tumor is suspected." 2 "I must first auscultate the client and then proceed to percussion and palpation." 3 "I must first listen for normal pulse at the client's wrist region." 4 "I must first examine tender abdominal areas and then proceed to nontender areas."

2 Palpation and percussion can cause an increase in normal bowel sounds and hide abdominal vascular sounds. Therefore it is wise to perform auscultation prior to percussion and palpation during clinical assessment of the renal system. Palpation should be avoided if a client is suspected of having a tumor because it could harm the client. It is more important as part of clinical assessment of the renal system to listen for bruit by auscultating over the renal artery. Bruit indicates renal artery stenosis. The nontender areas should be examined prior to tender areas to avoid confusion regarding radiating pain from the tender area being percussed.

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

2, 3, 5 A urinary calculus may obstruct urine flow, which will be reflected in a decreased output; obstruction may result in hydronephrosis [1] [2]. Urine is strained to determine whether any calculi or calcium gravel is passed. Reduction of pain is a priority. A calculus obstructing a ureter causes flank pain that extends toward the abdomen, scrotum and testes, or vulva; the pain begins suddenly and is severe (renal colic). Fluids should be encouraged to promote dilute urine and facilitate passage of the calculi. Recording the blood pressure is not critical.

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

2, 3, 5 Tea, rhubarb, and spinach are high in calcium oxalate. Limiting oxalate-rich foods limits oxalate absorption and the formation of calcium oxalate calculi. Milk is an acceptable calcium-rich protein and is avoided in calcium stones but not with oxalate stones. Liver is a purine-rich food that may be eaten. Test-Taking Tip: When using this program, be sure to note if you guess at an answer. This will permit you to identify areas that need further review. Also it will help you to see how correct your guessing can be.

A nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? 1 Progesterone 2 Prolactin 3 Inhibin 4 Estrogen

2...Prolactin is the hormone that initiates and produces milk during lactation. Inhibin prevents the secretions of follicle stimulating hormone and gonadotropin releasing hormone. Estrogen and progesterone are the sex hormones produced by the ovaries.

A client has glomerulonephritis. To prevent future attacks of glomerulonephritis, the nurse planning discharge teaching includes which instruction? 1 "Avoid situations that involve physical activity." 2 "Restrict fluid intake." 3 "Seek early treatment for respiratory infections." 4 "Take showers instead of bubble baths."

3 A common cause of glomerulonephritis is a streptococcal infection. This infection initiates an antibody formation that damages the glomeruli. Any fluid restriction is moderated as the client improves; fluid is allowed to prevent urinary stasis. The alkalinity of bubble baths is linked to urinary tract infections, not glomerulonephritis. Moderate activity is helpful in preventing urinary stasis, which can precipitate urinary infection.

The nurse prepares a client for a Papanicolaou test (Pap test). What should the nurse instruct the client before conducting the test? 1 Douche the vagina with soap 2 Empty the bladder 3 Avoid sexual intercourse for at least 24 hours before the test 4 Avoid scheduling a Pap test to be performed during menses

3 The Papanicolaou test is a cytological study used to detect precancerous and cancerous cells within the cervix. The nurse should advise the client to avoid sexual intercourse at least 24 hours before the test to prevent test misinterpretations. A client undergoing a pelvic examination should empty her bladder immediately before the test. Douching the vagina with soap or applying deodorants may lead to false test results. The Papanicolaou test should be scheduled between the client's menstrual periods so that the menstrual flow does not interfere with laboratory analysis.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. Which urinary finding should the nurse conclude needs to be reported to the primary healthcare provider? 1 Acidic pH 2 Glucose negative 3 Presence of large proteins 4 Bacteria negative

3 The glomeruli are not permeable to large proteins such as albumin or red blood cells (RBCs), and it is abnormal if albumin or RBCs are identified in the urine; their presence should be reported. The urine can be acidic; normal pH is 4.0 to 8.0. Glucose and bacteria should be negative; these are normal findings.

The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure? 1 Increase in blood pressure 2 Decrease in serum sodium concentration 3 Decrease in erythropoietin 4 Increase in serum phosphate levels

3 The hormone erythropoietin, produced by the kidneys, stimulates the bone marrow to produce red blood cells. In renal failure there is a deficiency of erythropoietin that often results in the client developing anemia. Therefore the nurse is instructed to administer blood. In renal failure, increased blood pressure is due to impairment of renal vasodilator factors and is not treated by administration of blood. Phosphate is retained in the body during renal failure, causing binding of calcium leading to done demineralization, not anemia. Increase in urinary sodium concentration and decrease in serum sodium concentration trigger the release of renin from the juxtaglomerular cells.

A nurse is performing peritoneal dialysis for a client. Which action should the nurse take? 1 Withhold the routine medications until after the procedure. 2 Infuse the dialysate solution slowly over several hours. 3 Warm the dialysate solution slightly before instillation. 4 Place the client in a side-lying position.

3 The infusion should be warmed to body temperature to decrease abdominal discomfort and promote dilation of peritoneal vessels. The side-lying position may restrict fluid inflow and prevent maximum urea clearance; the client should be placed in the semi-Fowler position. The infusion of dialysate solution should take approximately 10 to 20 minutes. Routine medications should not interfere with the infusion of dialysate solution.

A client with a renal disorder is scheduled for an intravenous pyelogram (IVP). Which interventions should the nurse undertake prior to the procedure? Select all that apply. 1 Instruct the client to lie still during the procedure 2 Have the client remove all metal objects 3 Ensure that the consent form is signed 4 Administer an enema or cathartic to the client 5 Assess the client for iodine sensitivity

3,4,5 The presence, position, shape, and size of kidneys, ureters, and bladder can be evaluated using an intravenous pyelogram (IVP). The contrast medium used in the procedure may cause hypersensitivity reactions. Therefore, the nurse should assess the client for sensitivity to iodine prior to the procedure. The nurse should use a cathartic or enema to empty the colon of feces and gas. An IVP does need a consent form since the procedure is invasive. The nurse has the client remove all metal objects before performing a magnetic resonance imaging (MRI) procedure. The nurse instructs the client to lie still during a computed tomographic (CT) scan procedure; during an IVP the client may be asked to turn certain ways.

A nurse evaluates that a client with chronic kidney disease understands an adequate source of high biologic-value (HBV) protein when the client selects which food from the menu? 1 Apple juice 2 Raw carrots 3 Cottage cheese 4 whole wheat bread

3... Cottage cheese contains more protein than the other choices. Apple juice is a source of vitamins A and C, not protein. Raw carrots are a carbohydrate source and contain beta-carotene. Whole wheat bread is a source of carbohydrates and fiber. Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation).

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

4 4 The response "You seem to be nervous about going home" is the best reply. Reflection conveys acceptance and encourages further communication. The response "I'm sure you can do it" is false reassurance that does not help to reduce anxiety. The response "Oh, a family member can do it for you" provides false reassurance and removes the focus from the client's needs. The response "Perhaps you can stay in the hospital another day" is unrealistic, and it is too late to suggest this

Which instruction would be most beneficial for an aging African-American client with hypertension? 1 "Record blood pressure weekly." 2 "Check the pulse daily." 3 "Visit an ophthalmologist monthly." 4 "Have an annual urinalysis."

4 African-American clients have 20% less blood flow to the kidneys because of high sodium consumption. This causes anatomical changes in the blood vessels, thereby increasing the risk of kidney failure. Therefore instructing the client with hypertension to have an annual urine examination would be beneficial. If the client has protein in the urine, this is a sign of high blood pressure and can signify kidney damage. Checking the pulse daily poses no harm to the individual, but does not determine if the client has hypertension. Recording the blood pressure weekly is not a good indicator of an aging African-American client with hypertension. The client's blood pressure should be taken at least daily to determine if the client has problems. If the client has an eye-related problem, visiting an ophthalmologist should be suggested.

A client is admitted to the hospital with a diagnosis of cancer of the liver with ascites and is scheduled for a paracentesis. Which nursing intervention is appropriate to include in the client's plan of care? 1 Marking the anesthetic insertion site 2 Cleansing the intestinal tract 3 Discussing the operating room set-up 4 Having the client void before the procedure

4 Because the trocar is inserted below the umbilicus, having the client void decreases the danger of puncturing the bladder. Cleansing the intestinal tract is not necessary because the gastrointestinal tract is not involved in a paracentesis. The primary healthcare provider, not the nurse, uses a local anesthetic to block pain during the insertion of the aspirating needle; marking the site usually is not done. A paracentesis usually is performed in a treatment room or at the client's bedside, not in the operating room.

The nurse is performing bedside sonography for a female client who underwent a hysterectomy. Which nursing intervention needs correction? 1 Pointing the scan head so the ultrasound is projected towards the client's coccyx 2 Placing the midline of the probe over the abdomen about 1.5 inches (3.8 cm) above the pubic bone 3 Placing an ultrasound gel pad right above the pubic bone 4 Using the female icon on the bladder scanner

4 Before performing a bedside sonography, the male or female icon on the scanner should be selected. The male icon should be selected for men and for women who have undergone a hysterectomy. An ultrasound gel pad should be placed right above the pubic bone. The scan head should be pointed in such a way that the ultrasound is projected towards the client's coccyx. The midline of the probe should be placed over the abdomen about 1.5 inches (3.8 cm) above the pubic bone.

A nurse is assessing a client with a diagnosis of kidney failure for clinical indicators of metabolic acidosis. What should the nurse conclude is the reason metabolic acidosis develops with kidney failure? 1 Inability of the renal tubules to reabsorb water to dilute the acid contents of blood 2 Impaired glomerular filtration, causing retention of sodium and metabolic waste products 3 Depressed respiratory rate due to metabolic wastes, causing carbon dioxide retention 4 Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate

4 Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The rate of respirations increases in metabolic acidosis to compensate for a low pH. The fluid balance does not significantly alter the pH. The retention of sodium ions is related to fluid retention and edema rather than to acidosis.

A client scheduled for a transurethral prostatectomy expresses concern about the effect the surgery will have on sexual ability. Which information should the nurse share with the client? 1 Will have prolonged erections 2 Will be impotent 3 May have a diminished sex drive 4 May experience retrograde ejaculations

4 Ejection of semen into the bladder instead of the urethra is common after a transurethral prostatectomy. The surgery should not interfere with the libido and will not cause prolonged erections. Impotence is not typical with this approach; it may occur with the retroperitoneal approach.

The nurse is providing education to a client with calculi in the calyces of the right kidney. The client is scheduled to have the calculi removed. Which information should the nurse include in the teaching? 1 The surgery will be performed transurethrally. 2 After surgery, a suprapubic catheter will be in place. 3 During the surgery, the right ureter will be removed. 4 After surgery, there will be a small incision in the right flank area.

4 If the calculi are in the renal pelvis, a percutaneous pyelolithotomy is performed; the calculi are removed via a small flank incision. Removal of the right ureter is not necessary. Performing surgery transurethrally is used for calculi in the ureters and renal pelvis. Placement of a suprapubic catheter usually is unnecessary.

The nurse is performing an assessment of a client's reproductive system. Which action should the nurse take? 1 Maintain friendly demeanor with the client during assessment 2 Ask about sexual practices at the beginning of assessment 3 Ask about menstrual history at the beginning of assessment 4 Maintain gender-specific terms while questioning during assessment

...3 It is necessary to gather health information as part of an assessment of the reproductive system. The nurse should always start the questioning with minimally sensitive information such as menstrual history. This will help the client adjust gradually. The nurse should maintain a professional demeanor while assessing or taking a reproductive health history. Sensitive information, such as client's sexual practices, should be asked after basic and less-sensitive topics. The nurse should make use of gender-neutral terms while questioning the client regarding their sexual partners.

What is the function of the structure labeled in the given figure? 3204932528 1 Holds the fetus 2 Secretes ovum 3 Serves as entry to the sperm 4 Massages the ovaries

...4...The structure labeled in the figure represents the fallopian tubes, fingerlike projections that massage the ovaries to facilitate ovum extraction. The ovaries produce ovum. The uterus accommodates the fetus. The cervix serves as an entry to the sperm and is also involved in expulsion of menses.

Which urinalysis finding indicates a urinary tract infection? 1 Presence of leukoesterase 2 Presence of crystals 3 Presence of ketones 4 Presence of bilirubin

1 Leukoesterases are released by white blood cells as a response to an infection or inflammation. Therefore, the presence of this chemical in urine indicates a urinary tract infection. The presence of crystals in the urine indicates that the specimen had been allowed to stand. Presence of bilirubin in the urine indicates anorexia nervosa, diabetic ketoacidosis, and prolonged fasting. The presence of ketones indicates diabetic ketoacidosis.

A client is diagnosed with condyloma acuminatum. Which finding in the client supports the diagnosis? 1 Moist, fleshy projections on the penis 2 Pus-filled ulcers on the penis 3 Swollen penis with tight foreskin 4 Macules on the penis

1 Moist, fleshy projections on the penis with single or multiple projections is a clinical manifestation of condyloma acuminatum. Macules on the penis or scrotum are clinical manifestations of penile erythema. Chancroid is manifested by pus-filled ulcers on the penis. A swollen penis with tight foreskin is a clinical manifestation of paraphimosis

A client is diagnosed with condyloma acuminatum. Which finding in the client supports the diagnosis? 1 Moist, fleshy projections on the penis 2 Pus-filled ulcers on the penis 3 Swollen penis with tight foreskin 4 Macules on the penis

1...Moist, fleshy projections on the penis with single or multiple projections is a clinical manifestation of condyloma acuminatum. Macules on the penis or scrotum are clinical manifestations of penile erythema. Chancroid is manifested by pus-filled ulcers on the penis. A swollen penis with tight foreskin is a clinical manifestation of paraphimosis.

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

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

A client has a permanent colostomy. During the first 24 hours there is no drainage from the colostomy. How should the nurse interpret this finding? 1 Effective functioning of the nasogastric tube is causing this. 2 Absence of intestinal peristalsis is causing this. 3 Edema after the surgery is causing this. 4 Decrease in fluid intake before surgery is causing this.

2 Absence of peristalsis is caused by manipulation of abdominal contents and the depressant effects of anesthetics and analgesics. Edema will not interfere with peristalsis; edema may cause peristalsis to be less effective, but some output will result. An absence of fiber has a greater effect on decreasing peristalsis than does decreasing fluids. A nasogastric tube decompresses the stomach; it does not cause cessation of peristalsis.

A client is admitted to the hospital with severe flank pain, nausea, and hematuria caused by a ureteral calculus. What should be the nurse's initial intervention? 1 Obtain a urine specimen for culture. 2 Administer the prescribed analgesic. 3 increase oral fluid intake. 4 Strain all urine output.

2...Pain of renal colic may be excruciating; unless relief is obtained, the client will be unable to cooperate with other therapy. Urine can be saved and strained after the client's priority needs are met. Increasing fluid intake may or may not be helpful. If the stone is large the fluid can build up, leading to hydronephrosis; however, if the stone is small, fluids may help flush the stone. Although a culture generally is prescribed, this is not the priority when a client has severe pain.

What age-related changes are associated with the female genitalia? Select all that apply. 1 Firm breasts 2 Erected nipples 3 Graying of pubic hair 4 Dry vagina 5 Decreased size of the labia majora

3,4,5 An elderly female client may have dry, smooth, and thin vaginal walls due to atrophy of the vaginal tissue and secretory glands on the vaginal walls. Graying and thinning pubic hair and decreased size of the labia majora and clitoris are also normal signs of aging. The client may have increased flabbiness and fibrosis of the breasts, which hang lower on the chest wall, along with decreased erection of the nipples.

The nurse is caring for a client in the postanesthesia care unit. The client had a suprapubic prostatectomy for cancer of the prostate and has a continuous bladder irrigation (CBI) in place. Which primary goal is the nurse trying to achieve with the CBI? 1 Provide continuous pressure on the prostatic fossa. 2 Stimulate continuous formation of urine. 3 Facilitate the measurement of urinary output. 4 Prevent the development of clots in the bladder.

4 A continuous flushing of the bladder dilutes the bloody urine and empties the bladder, preventing clots. Fluid instilled into the bladder does not affect kidney function. Urinary output can be measured regardless of the amount of fluid instilled. The urinary retention catheter is not designed to exert pressure on the prostatic fossa.

What is the concentration of estradiol in the blood during the follicular phase of the menstrual cycle? 1 159 pg/mL 2 165 pg/mL 3 171 pg/mL 4 130 pg/mL

4 In the follicular phase of the menstrual cycle, 20-150 pg/mL of estradiol is released. Therefore 130 pg/mL of estradiol would be its concentration during the follicular phase of the menstrual cycle. Concentrations of 159, 165, and 171 pg/mL are greater than the reference range.

Which condition should be reported immediately to the primary healthcare provider? 1 Rectal bleeding for 2 days after prostate biopsy 2 Pelvic pain immediately after colposcopy 3 Light vaginal bleeding for 1 to 2 days following a hysterosalpingogram 4 Body temperature of 102° F with vaginal discharge 48 hours after cervical biopsy

4 The client with cervical biopsy should immediately report to the primary healthcare provider if experiencing a body temperature of 102° F with vaginal discharge. This is because fever and vaginal discharge that develops 48 hours after cervical biopsy may be the signs of infection related to the procedure. The client should take pain relievers for pelvic pain after colposcopy. Light vaginal bleeding for 1 to 2 days following hysterosalpingogram is common. If the amount of bleeding increases or extends beyond 2 days, the healthcare provider should be notified. Light rectal bleeding for a few days is common after prostate biopsy.

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

CORRECT 1 Turning from side to side will change the position of the catheter, thereby freeing the drainage holes of the tubing, which may be obstructed. Drinking a glass of water and deep breathing and coughing do not influence drainage of dialysate from the peritoneal cavity. The position of the catheter should be changed only by the primary healthcare provider

A client with an indwelling catheter is prescribed a urinalysis test. Arrange the steps involved in the collection of the urine sample in correct order. 1.Clamp drainage tubing 2.Attach a sterile syringe 3.Aspirate the urine 4. Remove the clamp

In a client with an indwelling catheter, urine sample is collected by first applying a clamp, distal to the injection port, on to the drainage tubing. Then the injection port cap of the catheter drainage tubing is cleaned with alcohol. The next step is to attach a 5-mL sterile syringe into the port and aspirate the urine sample required. Finally the clamp is removed so that the drainage is resumed.

Which medication class helps to prevent human immunodeficiency virus (HIV) incorporating its genetic material into the client's cell? 1 Entry inhibitors 2 Protease inhibitors 3 Integrase inhibitors 4 Reverse transcriptase inhibitors

Integrase inhibitors such as raltegravir and dolutegravir bind with integrase enzymes and prevent HIV from incorporating its genetic material into the host (client's) cell. Entry inhibitors prevent the binding of HIV. Protease inhibitors prevent the protease enzyme from cutting HIV proteins into the proper lengths needed to allow viable virions to assemble. Reverse transcriptase inhibitors inhibit the action of reverse transcriptase

The nurse is assisting the primary healthcare provider during a renal ultrasonography. Arrange the steps involved in the procedure in correct sequence. Incorrect 2 Apply gel over skin Incorrect 4 Wipe cotton pad over gel Correct 3. Move transducer across skin Incorrect 1 Place client in prone position

The client undergoing renal ultrasonography should first be placed in the prone position. Then the sonographic gel should be applied on the client's skin over the back and flank regions. Then the transducer is moved across the client's skin to measure the echoes. The images are visualized on the display screen. At the end of the procedure the gel is removed from the client's skin by using a piece of wet cotton or cloth over the gel.

A tuberculin skin test with purified protein derivative (PPD) tuberculin is performed as part of a routine physical examination. When does the nurse instruct the client to make an appointment so the test can be read? 1 1 week 2 12 hours 3 24 to 48 hours 4 48 to 72 hours

It takes 48 to 72 hours for antibodies to respond to the antigen and form an indurated area. The results of tuberculosis skin tests that are not read within this timeframe will not be accurate.

Tests reveal that a client has phosphatic renal calculi. The nurse teaches the client that the diet may include which food item? 1 Chocolate 2 Apples 3 Cheddar cheese 4 Rye bread

answer: 2 Apples are low in phosphate; fresh fruit is low in phosphorus. Chocolate contains more phosphate than apples. Rye bread contains more phosphate than apples. Cheese is made with milk, which contains phosphate and should be avoided. Dairy products are high in phosphorus. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

What is the function of the structure labeled in the given figure? picture wont copy onto here.... 1 Holds the fetus 2 Secretes ovum 3 Serves as entry to the sperm 4 Massages the ovaries

correct 4 The structure labeled in the figure represents the fallopian tubes, fingerlike projections that massage the ovaries to facilitate ovum extraction. The ovaries produce ovum. The uterus accommodates the fetus. The cervix serves as an entry to the sperm and is also involved in expulsion of menses.

The nurse is reviewing the urinalysis reports of four clients with renal disorders. Which client's finding signifies the presence of excessive bilirubin? 1 Client 1 2 Client 2 3 Client 3 4 Client 4

yellow brown to olive green Client 3's urinalysis reports findings of the presence of yellow-brown to olive-green-colored urine which signifies excessive bilirubin. Client 1's urinalysis report findings of the presence of amber-yellow-colored urine signifies a normal finding. Client 2's urinalysis report findings of the presence of dark, smoky-colored urine signifies hematuria. Client 4's urinalysis report findings of orange-red or orange-brown-colored urine indicates the presence of phenazopyridine in the urine.

After a transurethral prostatectomy, a client returns to the postanesthesia care unit with a three-way indwelling catheter with continuous bladder irrigation. Which nursing action is the priority? 1 Observing the suprapubic dressing for drainage 2 Maintaining the client in the semi-Fowler position 3 Monitoring for bright red blood in the drainage bag 4 Encouraging fluids by mouth as soon as the gag reflex returns

3 Blood clots are normal 24 to 36 hours after surgery, but bright red blood can indicate hemorrhage. The surgery is performed through the urinary meatus and urethra; there is no suprapubic incision. It is unnecessary to keep the client in the semi-Fowler position. The client is initially allowed nothing by mouth and then advanced to a regular diet as tolerated. Continuous irrigation supplies enough fluid to flush the bladder.

The nurse finds that a client with a urinary disorder has very pale-yellow-colored urine. What is the significance of this abnormal finding? 1 It indicates dilute urine. 2 It indicates concentrated urine. 3 It indicates the presence of myoglobin. 4 It indicates blood in the urine.

Dilute urine tends to appear very pale-yellow in color. Dark-red or brown color urine indicates the presence of blood in the urine. Dark-amber color urine indicates concentrated urine. Red color urine may indicate the presence of myoglobin.

How long will a client's ovum stay viable after its release to get fertilized? 1 72 hours 2 78 hours 3 76 hours 4 74 hours

Ovum can be fertilized up to 72 hours after its release. The ovum disintegrates after 72 hours, and menstruation begins soon after. Therefore the ovum cannot be viable for 74, 76, or 78 hours, and fertilization will not occur.

The nurse is aware that the Cowper gland is also often referred to by which other term? 1 Skene gland 2 Prostate gland 3 Bartholin gland 4 Bulbourethral gland

4 Cowper glands are accessory glands of the male reproductive system; they are also referred to as the bulbourethral glands. Skene glands are a part of the female reproductive system. The prostate gland is also a gland of the male reproductive system. Bartholin glands are part of the female reproductive system.

Which hormone is released in response to low serum levels of calcium? 1 Atrial natriuretic peptide 2 Renin 3 Parathyroid hormone 4 Erythropoietin

3 If serum calcium levels decline, the parathyroid gland releases parathyroid hormone to maintain calcium homeostasis. Renin is a hormone released in response to decreased renal perfusion; this hormone is responsible for regulating blood pressure. Erythropoietin is released by the kidneys in response to poor blood flow to the kidneys; it stimulates the production of red blood cells. Atrial natriuretic peptide is produced by the right atrium of the heart in response to increased blood volume. This hormone then acts on the kidneys to promote sodium excretion, which decreases the blood volume.

A nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? 1 Progesterone 2 Prolactin 3 Inhibin 4 Estrogen

answer 2 Prolactin is the hormone that initiates and produces milk during lactation. Inhibin prevents the secretions of follicle stimulating hormone and gonadotropin releasing hormone. Estrogen and progesterone are the sex hormones produced by the ovaries.

Which component of the client's nephron acts as a receptor site for the antidiuretic hormone and regulates water balance? 1 Proximal convoluted tubule 2 Distal convoluted tubule 3 Bowman's capsule 4 Collecting ducts

4 The collecting ducts regulate water balance and act as a receptor site for antidiuretic hormone. The Bowman's capsule collects glomerular filtrate and funnels it into the tubule. The distal convoluted tubule acts as a site for additional water and electrolyte reabsorption. The proximal convoluted tubule is the site for reabsorption of sodium, chloride, water, and urea.

A nurse educates the client about the relationship between the kidneys and blood pressure. Which term should the nurse use to describe the part of the kidney that senses changes in blood pressure? 1 Macula densa 2 Calices 3 Glomerulus 4 Juxtaglomerular cells

...1..The macula densa, a part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood. Calices are cup-like structures, present at the end of each papilla that collect urine. The glomerulus is the initial part of the nephron, which filters blood to make urine. Juxtaglomerular cells secrete renin. Renin is produced when sensing cells in the macula densa sense changes in blood volume and pressure.

A client with ascites has a paracentesis, and 1500 mL of fluid is removed. For which immediate response is it most important for the nurse to monitor? 1 Respiratory congestion 2 Increase in temperature 3 Rapid, thready pulse 4 Decreased peristalsis

...3 Fluid shifts from the intravascular compartment into the abdominal cavity, causing hypovolemia. A rapid, thready pulse [1] [2], which is indicative of shock, is a compensatory response to this shift. Decreased peristalsis is not likely to occur in the immediate period. After a paracentesis, intravascular fluid shifts into the abdominal cavity, not into the lungs. Increase in temperature is not the priority; body temperature usually is not affected immediately; an infection will take several days

A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse most likely observe written in the client's medical record? 1 Pyelonephritis 2 Nephrotic syndrome 3 Cystitis 4 Chronic glomerulonephritis

...3...Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria. Chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload. Nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria. Pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness.

Which drug prescribed to a client with a urinary tract infection (UTI) turns urine reddish-orange in color? 1 Nitrofurantoin 2 Ciprofloxacin 3 Phenazopyridine 4 Amoxicillin

...3...Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts a characteristic orange or red color to urine. Amoxicillin is a penicillin form that could cause pseudomembranous colitis as a complication; it is not associated with reddish-orange colored urine. Ciprofloxacin is a quinolone antibiotic used for treating UTIs and can cause serious cardiac dysrhythmias and sunburns. It is not, however, responsible for reddish-orange colored urine. Nitrofurantoin is an antimicrobial medication prescribed for UTIs. This drug may affect the kidneys but is not associated with reddish-orange colored urine.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis results. Which urinary finding should the nurse conclude needs to be reported to the primary healthcare provider? 1 Acidic pH 2 Glucose negative 3 Presence of large proteins 4 Bacteria negative

...3..The glomeruli are not permeable to large proteins such as albumin or red blood cells (RBCs), and it is abnormal if albumin or RBCs are identified in the urine; their presence should be reported. The urine can be acidic; normal pH is 4.0 to 8.0. Glucose and bacteria should be negative; these are normal findings.

Tests reveal that a client has phosphatic renal calculi. The nurse teaches the client that the diet may include which food item? 1 Chocolate 2 Apples 3 Cheddar cheese 4 Rye bread Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

...Apples are low in phosphate; fresh fruit is low in phosphorus. Chocolate contains more phosphate than apples. Rye bread contains more phosphate than apples. Cheese is made with milk, which contains phosphate and should be avoided. Dairy products are high in phosphorus.

The nurse is caring for a client with ureteral colic. To prevent the development of renal calculi in the future, which strategy should be included in the client's plan of care? 1 Excluding milk products from the diet 2 Interventions to decrease the serum creatinine level 3 Instructing the client to drink 8 to 10 glasses of water daily 4 A urinary output goal of 2000 mL per 24 hours

.3..Increasing fluid intake [1] [2] dilutes the urine, and crystals are less likely to coalesce and form calculi. An elevated serum creatinine has no relationship to the formation of renal calculi. Calcium restriction is necessary only if calculi have a calcium phosphate basis. Producing only 2000 mL of urine per 24 hours is inadequate. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.

Which urinary diagnostic test does not require any dietary or activity restrictions for the client before or after the test? 1 Renal scan 2 Concentration test 3 Renal arteriogram 4 Renal biopsy

1 A renal scan does not require any dietary or activity restrictions. A renal biopsy requires bed rest for 24 hours after the procedure. A renal arteriogram requires the client to maintain bed rest with affected leg straight. A concentration test requires the client to fast after a given time in the evening.

A client reports to a health clinic because a sexual partner recently was diagnosed as having gonorrhea. The health history reveals that the client has engaged in receptive anal intercourse. What should the nurse assess for in this client? 1 Anal itching 2 Ribbon-shaped stools 3 Melena 4 Constipation

1 Anal itching and irritation can occur from having anal intercourse with a person infected with gonorrhea. Frank rectal bleeding, not upper gastrointestinal bleeding (melena), occurs. Painful defecation, not constipation, occurs. The shape of formed stool does not change; however, defection can be painful.

A nurse is caring for an older bedridden male client who is incontinent of urine. Which action should the nurse take first? 1 Offer the urinal regularly. 2 Insert an indwelling urinary catheter. 3 Apply incontinence pants. 4 Restrict fluid intake.

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

Which parts of the nephron are the sites for the regulation of water balance? Select all that apply. 1 Loop of Henle 2 Descending limb (DL) 3 Proximal convoluted tubule (PCT) 4 Bowman capsule (BC) 5 Glomerulus

1, 2 A loop of Henle is a part of a nephron that continues from the proximal convoluted tubule (PCT). It is permeable to water, sodium chloride, and urea and is a site for the regulation of water balance. The descending limb (DL) continues from the loop of Henle. It is permeable to water, sodium chloride, and urea and is a site for the regulation of water balance. The glomerulus is a site of glomerular filtration. The Bowman capsule (BC) is a site of the collection of glomerular filtrate. The proximal convoluted tubule (PCT) is a site for the reabsorption of sodium, chloride, glucose, water, amino acids, potassium, and calcium.

What are the general manifestations associated with clients who have urinary system disorders? Select all that apply. 1 Nausea and vomiting 2 Facial edema 3 Excessive thirst 4 Elevated blood pressure 5 Stress incontinence

1,3,4 The general manifestations associated with urinary system disorders include excessive thirst, nausea and vomiting, and elevated blood pressure. The specific manifestations associated with urinary system disorders include facial edema and stress incontinence.

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

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

Which statement indicates the nurse has a correct understanding about kidney ultrasonography? 1 Kidney ultrasonography primarily makes use of iodinated contrast dye. 2 Kidney ultrasonography gives three-dimensional information regarding kidneys. 3 Kidney ultrasonography makes use of sound waves and has minimal risk. 4 Kidney ultrasonography is performed on the client with an empty bladder.

3 Kidney ultrasonography is a minimal risk diagnostic procedure. Ultrasonography makes use of sound waves which, when reflected from internal organs of varying density, will produce the images of the kidneys, bladder, and associated structures on the display screen. While a dye can be used in computed tomography (CT), it is not the primary method. Generally kidney ultrasonography is performed on the client with full bladder. A CT gives three-dimensional information about the kidney and associated structures.

A client arrives at a health clinic reporting hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse most likely observe written in the client's medical record? 1 Pyelonephritis 2 Nephrotic syndrome 3 Cystitis 4 Chronic glomerulonephritis

3 CORRECT Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria. Chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload. Nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria. Pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness

Which test helps to identify fibroids, tumors, and fistulas while performing a reproductive tract examination? 1 Mammography 2 Computed tomography 3 Ultrasonography 4 Hysterosalpingography

4 A hysterosalpingogram is an X-ray used to evaluate tubal anatomy and patency and used to identify uterine problems such as fibroids, tumors, and fistulas. A mammography is an X-ray of the soft tissue of the breast. An ultrasonography (US) is a technique used to assess fibroids, cysts, and masses. Computer tomography is used to detect and evaluate masses and identify lymphatic enlargement from metastasis. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

The nurse observes a client with kidney failure has increased rate and depth of breathing. Which laboratory parameter does the nurse suspect is associated with this client's condition? 1 Potassium 8 mEq/L 2 Phosphorous 7 mg/dL 3 Hemoglobin 10 g/dL 4 Bicarbonate 15 mEq/L

4 An increased rate and depth of breathing is called Kussmaul respiration and occurs due to metabolic acidosis in clients with kidney disease. Serum bicarbonate level decreases in metabolic acidosis. The normal range of serum bicarbonate is 23-30 mEq/L. Therefore the bicarbonate value of 15 mEq/L is associated with Kussmaul respirations in the client. The normal serum potassium is 3.5-5 mEq/L. Therefore a potassium level of 8 mEq/L indicates hyperkalemia and is associated with changes in cardiac rate and rhythm. The normal range of hemoglobin is 12-16 g/dL in females and 14-18 g/dL in males. Therefore a Hgb of 10 g/dL indicates anemia; this is associated with fatigue, pallor, and shortness of breath. The normal range of serum phosphorous is 3-4.5 mg/dL. Therefore a phosphorous value of 7 mg/dL indicates hyperphosphatemia, which is associated with hypocalcemia and demineralization of bone.

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

4 Hemicolectomy [1] [2] is removal of part of the colon with an anastomosis between the ileum and transverse colon; a colostomy is not necessary. With a colostomy the intestine opens on the abdomen, whereas in a hemicolectomy a portion of the intestine is resected and the ends reconnected. "Yes, but it will be temporary until the colitis is cured" is the description of a temporary colostomy; a cure occurs only when the entire colon is removed. A colostomy is done for a variety of reasons other than a tumor; a colectomy with a colostomy is only one intervention that may be used to treat a tumor.

A nurse is evaluating a client's understanding of peritoneal dialysis. Which information in the client's response indicates an understanding of the purpose of the procedure? 1 Providing fluid for intracellular spaces 2 Cleaning the peritoneal membrane 3 Reestablishing kidney function 4 Removing toxins in addition to other metabolic wastes

4 Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution. Peritoneal dialysis acts as a substitute for kidney function; it does not reestablish kidney function. The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in the abdominal cavity does not enter the intracellular compartment

The urinalysis report of a client reveals cloudy urine. What does a nurse infer from the client's report? 1 The client has a biliary obstruction. 2 The client has diabetic ketoacidosis. 3 The client has been on a starvation diet. 4 The client has a urinary infection.

4 The urine becomes cloudy when an infection is present due to the presence of leukocytes. Therefore the nurse concludes that the client has a urinary infection. In cases of biliary obstruction, the urine contains bilirubin. The presence of ketones in the urine indicates diabetic ketoacidosis or prolonged starvation

The nurse is caring for a client with ureteral colic. To prevent the development of renal calculi in the future, which strategy should be included in the client's plan of care? 1 Excluding milk products from the diet 2 Interventions to decrease the serum creatinine level Correct 3 Instructing the client to drink 8 to 10 glasses of water daily 4 A urinary output goal of 2000 mL per 24 hours

Correct 3 Increasing fluid intake [1] [2] dilutes the urine, and crystals are less likely to coalesce and form calculi. An elevated serum creatinine has no relationship to the formation of renal calculi. Calcium restriction is necessary only if calculi have a calcium phosphate basis. Producing only 2000 mL of urine per 24 hours is inadequate. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question

A client is scheduled to have an indwelling urinary catheter inserted before abdominal surgery. The nurse should insert the catheter in what location in the illustration? 3142352560 1 d 2 c 3 a 4 b

Correct 4 b Option B is the urethral orifice, which anatomically is between the clitoris and the vagina; it is the opening into the urethra, the tubular structure that drains urine from the bladder. Option A is the clitoris, which is situated beneath the anterior commissure, partially hidden between the anterior extremities of the labia minora. Option C is the opening of the vagina; it is the part of the female genitalia that forms a canal from the vaginal orifice through the vestibule to the uterine cervix. Option D is the anus; it is the terminal end of the anal canal that is connected to the rectum; the rectum is a portion of the large intestine that is between the anal canal and the descending sigmoid colon. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.

A nurse educates the client about the relationship between the kidneys and blood pressure. Which term should the nurse use to describe the part of the kidney that senses changes in blood pressure? 1 Macula densa 2 Calices 3 Glomerulus 4 Juxtaglomerular cells

correct 1 The macula densa, a part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood. Calices are cup-like structures, present at the end of each papilla that collect urine. The glomerulus is the initial part of the nephron, which filters blood to make urine. Juxtaglomerular cells secrete renin. Renin is produced when sensing cells in the macula densa sense changes in blood volume and pressure.

Which drug prescribed to a client with a urinary tract infection (UTI) turns urine reddish-orange in color? 1 Nitrofurantoin 2 Ciprofloxacin 3 Phenazopyridine 4 Amoxicillin

correct:3 Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts a characteristic orange or red color to urine. Amoxicillin is a penicillin form that could cause pseudomembranous colitis as a complication; it is not associated with reddish-orange colored urine. Ciprofloxacin is a quinolone antibiotic used for treating UTIs and can cause serious cardiac dysrhythmias and sunburns. It is not, however, responsible for reddish-orange colored urine. Nitrofurantoin is an antimicrobial medication prescribed for UTIs. This drug may affect the kidneys but is not associated with reddish-orange colored urine.