Leadership & Management Quiz 6 LaCharity

19. What intervention is required at this time? 1. Increased doses of immunosuppressive drugs 2. IV antibiotics 3. Conservative management including dialysis 4. Immediate removal of the transplanted kidney

4

17. Based on this information, what nursing action is most important for Ms. C? 1. Teach her about the expected effects of carvedilol. 2. Ask whether she has been taking furosemide daily. 3. Arrange for transport to the ED. 4. Remind her that she should not add salt to food.

1

18. The RN is caring for Ms. J on the first day postoperatively after a kidney transplant. On assessment, her temperature is 100.4°F (38°C), her blood pressure is 168/92 mm Hg, and the patient tells the RN she has pain around the transplant site. What is the best interpretation of these findings? 1. Hyperacute rejection 2. Acute rejection 3. Chronic rejection 4. Transplant site infection

1

2. Based on the client's history and assessment, the nurse will be most concerned about which complication? 1. Pulmonary edema 2. Cor pulmonale 3. Pneumonia 4. Pulmonary embolus

1

23. The nurse is admitting a patient with nephrotic syndrome. Which assessment finding supports this diagnosis? 1. Edema formation 2. Hypotension 3. Increased urine output 4. Flank pain

1

11. The nurse is preparing to leave at the end of the shift. Which oncoming nurse is best to assign to care for Ms. C? 1. Float RN who has worked on the coronary step-down unit for 9 years and has floated to the ICU before 2. RN from a staffing agency who has 5 years of ICU experience and is orienting to the ICU today 3. Experienced ICU RN who is already assigned to care for a newly admitted client with chest trauma 4. Newly graduated RN who needs more experience in caring for clients with left ventricular failure

1

12. The RN is delegating and assigning care for Ms. ] related to her type 2 diabetes. Which action by the RN indicates that the team leader needs to intervene? 1. RN delegates fingerstick glucose check to newly hired UAP. 2. RN assigns administering morning dose of metformin to the LPN/LVN. 3. RN refers the patient to a dietitian for education about a diabetic diet. 4. RN assesses condition of patient's feet daily.

1

15. A patient with incontinence will be taking oxybutynin chloride 5 mg by mouth three times a day after dis-charge. Which information would a nurse be sure to teach this patient before discharge? 1. "Drink fluids or use hard candy when you experience a dry mouth." 2. "Be sure to notify your health care provider (HCP) if you experience a dry mouth." 3. "If necessary, your HICP can increase your dose up to 40 mg/day." 4. "You should take this medication with meals to avoid stomach ulcers."

1

16. Six months later, Ms. J is readmitted to the unit. She has just returned from HD. Which nursing care action should the nurse delegate to the UAP? 1. Measuring vital signs and postdialysis weight 2. Assessing the HD access site for bruit and thrill 3. Checking the access site dressing for bleeding 4. Instructing the patient to request assistance getting out of bed

1

17. A patient has urolithiasis and is passing the stones into the lower urinary tract. What is the priority nursing concern for the patient at this time? 1. Pain 2. Infection 3. Injury 4. Anxiety

1

28. An unlicensed assistive personnel (UAP) reports to the RN that a patient with acute kidney failure had a urine output of 350 mL over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks the nurse how this can happen. What is the nurse's best response? 1. "During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics." 2. "There must be some sort of error. Someone must have failed to record the urine output." 3. "A patient with acute kidney failure retains sodium and water, which counteracts the action of the furosemide." 4. "The gradual accumulation of nitrogenous waste products results in the retention of water and sodium."

1

3. The nurse is caring for a patient with risk for kidney disease for whom a urinalysis has been ordered. What time would the nurse instruct the unlicensed assistive personnel is best to collect this sample? 1. With first morning void 2. Before any meal 3. At bedtime 4. Immediately

1

30. The patient is receiving IV piggyback doses of gentamicin every 12 hours. Which would be the nurse's priority for monitoring during the period that the patient is receiving this drug? 1. Serum creatinine and blood urea nitrogen levels 2. Patient weight every morning 3. Intake and output every shift 4. Temperature

1

32. A patient on the medical-surgical unit with acute kidney failure is to begin continuous arteriovenous hemofiltration (CAVH) as soon as possible. What is the priority collaborative action at this time? 1. Call the charge nurse and arrange to transfer the patient to the intensive care unit. 2. Develop a teaching plan for the patient that focuses on CAVH. 3. Assist the patient with morning bath and mouth care before transfer. 4. Notify the health care provider (HCP) that the patient's mean arterial pressure is 68 mm Hg.

1

34. The RN is supervising a senior nursing student who is caring for a 78-year-old patient scheduled for an intravenous pyelography test. What information would the RN be sure to stress about this procedure to the nursing student? 1. "After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults." 2. "The purpose of this procedure is to measure kidney size. 3. "Because this procedure assesses kidney function, there is no need for a bowel prep." 4. "Keep the patient NPO after the procedure because during the procedure the patient will receive drugs that affect the gag reflex.

1

4. The results of Ms. J's 24-hour urine collection reveals a creatinine clearance of 65 mL/min (1.09 mL/sec). How does the nurse best interpret this finding? 1. Creatinine clearance is lower than normal. 2. Creatinine clearance is higher than normal. 3. Creatinine clearance is within normal range. 4. Creatinine clearance indicates adequate kidney function

1

6. The RN reviews Ms. J's laboratory results. Which laboratory finding is of most concern? 1. Serum potassium level of 7.1 mEq/L (7.1 mmol/L) 2. Serum creatinine level of 7.3 mg/dL (645 mol/L) 3. Blood urea nitrogen level of 180 mg/dL (64.3 mmol/L) 4. Serum calcium level of 7.8 mg/dL (1.95 mmol/L)

1

8. Ms. J states that she feels increasingly short of breath. The nurse team leader is supervising an LPN/LVN and a UAP. Which nursing care action for Ms. J should be most appropriately assigned to the LPN/ LVN? 1. Checking for residual urine with the bedside bladder scanner 2. Planning restricted fluid amounts to be given with meals 3. Assessing breath sounds for increased bilateral crackles 4. Discussing renal replacement therapies with the patient

1

9. The charge nurse would assign the nursing care of which patient to an LPN/LVN, working under the supervision of an RN? 1. A 48-year-old patient with cystitis who is taking oral antibiotics 2. A 64-year-old patient with kidney stones who has a new order for lithotripsy 3. A 72-year-old patient with urinary incontinence who needs bladder training 4. A 52-year-old patient with pyelonephritis who has severe acute flank pain

1

6. The nurse is providing care for a patient after a kids biopsy. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP) Select all that apply. 1. Check vital signs every 4 hours for 24 hours. 2. Remind the patient about strict bed rest for 2 to 6 hours. 3. Reposition the patient by log-rolling with supporting backroll. 4. Measure and record urine output. 5. Assess the dressing site for bleeding and check complete blood count results. 6. Teach the patient to resume normal activities after 24 hours if there is no bleeding.

1, 2, 3, 4

26. The nurse is teaching a patient how best to prevent renal trauma after an injury that required a left nephrectomy. Which points would the nurse include in the teaching plan? Select all that apply. 1. Always wear a seat belt. 2. Avoid contact sports. 3. Practice safe walking habits. 4. Wear protective clothing if you participate in contact sports. 5. Use caution when riding a bicycle. 6. Always avoid use of drugs that may damage the kidney.

1, 2, 3, 5

11. Ms. Is care plan includes the nursing concern, excess fluid volume. What interventions are appropriate for this nursing concern? Select all that apply. 1. Measure weight daily. 2. Monitor daily intake and output. 3. Restrict sodium intake with meals. 4. Restrict fluid to 1500 mL plus urine output. 5. Assess for crackles in the lungs every shift. 6. Check for peripheral edema and note any increase.

1, 2, 3, 5, 6

1. Which patient admission tasks should the nurse delegate to the experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Check vital signs every 4 hours. 2. Record accurate intake and output. 3. Place a saline lock in left forearm. 4. Check oxygen saturation by pulse oximetry. 5. Teach the patient the importance of keeping oxygen in place. 6. Check and record the fingerstick blood glucose before lunch

1, 2, 4, 6

27. The nurse is providing nursing care for a patient with acute kidney failure for whom volume overload has been identified. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Measuring and recording vital sign values every 4 hours 2. Weighing the patient every morning using a standing scale 3. Administering furosemide 40 mg orally twice a day 4. Reminding the patient to save all urine for intake and output measurement 5. Assessing breath sounds every 4 hours 6. Ensuring that the patient's urinal is within reach

1, 2, 4, 6

35. The RN supervising a senior nursing student is discussing methods for preventing acute kidney injury (AkI. Which points would the RN be sure to include in this discussion? Select all that apply. 1. Encourage patients to avoid dehydration by drinking adequate fluids. 2. Instruct patients to drink extra fluids during periods of strenuous exercise. 3. Immediately report a urine output of less than 2 mL/kg/hr. 4. Record intake and output and weigh patients daily. 5. Question any prescriptions for potentially nephrotoxic drugs. 6. Monitor laboratory values that reflect kidney function.

1, 2, 4, 6

16. Which information will the nurse include when developing the discharge teaching plan? Select all that apply. 1. Plan to weigh yourself every day at the same time. 2. Call if you feel more short of breath or have weight gain. 3. Take the furosemide every evening at bedtime. 4. Drink at least 2500 mL of fluids daily. 5. Move slowly when changing from a lying to a standing position. 6. You will need a follow-up appointment soon after being discharged. 7. Avoid cooking with salt or adding salt to foods.

1, 2, 5, 6, 7

13. Which current laboratory values for this client will be most important for the nurse to review? Select all that apply. 1. Potassium 2. Glucose 3. Magnesium 4. B-type natriuretic peptide (BNP) 5. Calcium 6. Albumin 7. Creatinine

1, 3, 4, 7

14. All of Ms. C's medications are scheduled to be given at 9:00 AM. Based on the client's assessment data and laboratory results, which medications will the nurse hold until after consulting with the HCP? Select all that apply. 1. Furosemide 2. Aspirin 3. KCI 4. Enalapril 5. Digoxin

1, 5

22. A male patient must undergo intermittent catheterization. The nurse is preparing to insert a catheter to assess the patient for postvoid residual. Place the steps for intermittent catheterization in the correct order. 1. Assist the patient to the bathroom and ask the patient to attempt to void. 2. Retract the foreskin and hold the penis at a 60-to 90-degree angle. 3. Open the catheterization kit and put on sterile gloves. 4. Lubricate the catheter and insert it through the meatus of the penis. 5. Position the patient supine in bed or with the head slightly elevated. 6. Drain all the urine present in the bladder into 3 container. 7. Cleanse the plans penis starting at the meatus ad working outward. 8. Remove the catheter, clean the penis, and measure the amount of urine returned.

1, 5, 3, 2, 7, 4, 6, 8

25. The nurse is caring for a patient with renal cell carcinoma (adenocarcinoma of the kidney). While serving as preceptor for a new nurse orienting to the unit, the nurse is asked why this patient is not receiving chemotherapy. What is the best response? 1. "The prognosis for this form of cancer is very poor, and we will be providing only comfort measures." 2. "Nephrectomy is the preferred treatment because chemotherapy has been shown to have only limited effectiveness against this type of cancer." 3. "Research has shown that the most effective means of treating this form of cancer is with radiation therapy." 4. "Radiofrequency ablation is a minimally invasive procedure that is the best way to treat renal cell carcinoma."

2

1. The nurse is reviewing the lab values for a patient with risk for urinary problems. Which finding is of most concern to the nurse? 1. Blood urea nitrogen (BUN) of 10 mg/mL (3.6 mmol/L) 2. Presence of glucose and protein in urine 3. Serum creatinine of 0.6 mg/mL (53 mcmol/L) 4. Urinary pH of 8

2

10. Ms. C's HCP arrives and, after assessing her status, prescribes nesiritide 100 mcg (2 mcg/kg) IV bolus followed by a continuous IV infusion of 0.5 mcg/min (0.01 mcg/kg/min). Which parameter is most important to monitor during the nesiritide infusion? 1. Heart rate 2. Blood pressure 3. Peripheral edema 4. Neurologic status

2

10. The nurse is admitting a 66-year-old male patient suspected of having a urinary tract infection (UTI). Which part of the patient's medical history supports this diagnosis? 1. Patient's wife had a UTI 1 month ago 2. Followed for prostate disease for 2 years 3. Intermittent catheterization 6 months ago 4. Kidney stone removal 1 year ago

2

12. Which of the assessment findings described earlier are most important to report to the HCP? 1. Crackles and oxygen saturation 2. Frequent PVCs and fuzzy vision 3. Apical murmur and pulse rate 4. Ankle edema and current weight

2

13. After discussing renal replacement therapies with the HCP and nurse, Ms. J is considering hemodialysis (HID). Which statement indicates that Ms. J needs additional teaching about HID? 1. "I will need surgery to create an access route for HID." 2. "I will be able to eat and drink what I want after I start dialysis." 3. "I will have a temporary dialysis catheter for a few months." 4. "I will be having dialysis three times every week."

2

2. During admission assessment, Ms. J has all of these findings. For which finding should the nurse notify the HCP immediately? 1. Bilateral pitting ankle and calf edema rated +2 2. Crackles in both lower and middle lobes 3. Dry and peeling skin on both feet 4. Faint but palpable pedal and post-tibial pulses

2

24. When the nurse must apply containment strategies for a patient with incontinence, what is the major risk? 1. Incontinence-associated dermatitis 2. Skin breakdown 3. Infection 4. Fluid imbalance

2

29. Which patient will the charge nurse assign to an RN floated to the acute care unit from the surgical intensive care unit (SICU)? 1. A patient with kidney stones scheduled for lithotripsy this morning 2. A patient who has just undergone surgery for renal stent placement 3. A newly admitted patient with an acute urinary tract infection (UTI) 4. A patient with chronic kidney failure who needs teaching on peritoneal dialysis

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3. Which action will the nurse take next? 1. Activate the hospital's Rapid Response Team (RRT). 2. Switch to a nonrebreather mask at a 02 flow rate of 15 L/min. 3. Assist the client to cough and deep breathe. 4. Administer the prescribed morphine sulfate 2 mg IV to the client.

2

31. A patient diagnosed with acute kidney failure had a urine output of 1560 mL for the past 8 hours. The LPN/LVN who is caring for this patient under the RN's supervision asks how a patient with kidney failure can have such a large urine output. What is the RN's best response? 1. "The patient's kidney failure was caused by hypovolemia, and we have given him IV fluids to correct the problem." 2. "Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day. 3. "With that much urine output, there must have been a mistake in the patient's diagnosis. 4. "An increase in urine output like this is an indicator that the patient is entering the recovery phase of acute kidney failure."

2

8. Ms. C's potassium level is 3.3 mEg/L (3.3 mmol/L). The HCP prescribes potassium chloride (KCI) 10 mEg IV. How should the nurse administer the KCI? 1. Use an infusion pump to give the KCI over 10 minutes. 2. Dilute the KCI in 100 mL of 5% dextrose in water (DsW) and infuse over 1 hour. 3. Administer the KCI by IV push over at least 1 minute using a 10-mL syringe. 4. Add the KCI to 1 L of D;W and administer over 8 hours.

2

19. The RN is teaching a patient how to perform intermittent self-catheterization for a long-term problem with incomplete bladder emptying. Which are important points for teaching this technique? Select all that apply. 1. Always use sterile techniques. 2. Proper hand washing and cleaning of the catheter reduce the risk for infection. 3. A small lumen and good lubrication of the catheter prevent urethral trauma. 4. A regular schedule for bladder emptying prevents distention and mucosal trauma. 5. The social work department can help you with the purchase of sterile supplies. 6. if you are uncomfortable with this procedure, a home health nurse can do it.

2, 3, 4

9. The team leader RN observes the UP perform all of these actions for Ms. J. For which actions must the RN intervene? Select all that apply. 1. Assisting the patient to replace her oxygen nasal cannula 2. Checking vital signs after the patient has had something cold to drink 3. Ambulating with the patient to the bathroom and back 4. Increasing the patient's oxygen flow rate by nasal cannula from 2 to 4 L/min 5. Washing the patient's back, legs, and feet with warm water 6. Reminding Ms. J to perform prescribed incentive spirometry every hour while awake

2, 4

5. Which risk factors in Ms. J's history indicate increased risk for chronic kidney disease (CKD)? Select all that apply. 1. GERD 2. Hypertension 3. Four pregnancies 4. Type 2 diabetes 5. Coronary artery disease (CAD) 6. Cataracts

2, 4, 5

20. The charge nurse must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roommates? 1. A 58-year-old patient with urothelial cancer receiving multiagent chemotherapy 2. A 63-year-old patient with kidney stones who has just undergone open ureterolithotomy 3. A 24-year-old patient with acute pyelonephritis and severe flank pain 4. A 76-year-old patient with urge incontinence and a urinary tract infection (UTI)

3, 4

1. What action should the nurse take first? 1. Listen to the breath sounds. 2. Ask when the dyspnea started. 3. Check the oxygen saturation. 4. Raise the head of the bed to 75 degrees.

3

12. The RN is supervising a new graduate nurse who is orientating to the unit. The new nurse asks why the patient with uncomplicated cystitis is being discharged with a prescription for ciprofloxacin 250 mg twice a day for only 3 days. What is the RN's best response? 1. "We should check with the health care provider because the patient should take this drug for 10 to 14 days." 2. "A 3-day course of ciprofloxacin is not the appropriate treatment for a patient with uncomplicated cystitis." 3. "Research has shown that a 3-day course of ciprofloxacin is effective for uncomplicated cystitis and there is increased patient adherence to the plan of care." 4. "Longer courses of antibiotic therapy are required for hospitalized patients to prevent nosocomial infections.

3

14. The RN is precepting a new nurse orientating to the unit, who is providing care for Ms. J after her return from surgery to create a left forearm access for dialysis. Which action by the orienting nurse requires that the preceptor intervene? 1. Monitoring the patient's operative site dressing for evidence of bleeding 2. Obtaining a blood pressure reading by placing the cuff on the right arm 3. Drawing blood for laboratory studies from the temporary dialysis line 4. Administering acetaminophen with codeine PO for moderate postoperative pain

3

14. The nurse is creating a care plan for older adult patients with incontinence. For which patient will a bladder-training program be an appropriate intervention? 1. Patient with functional incontinence caused by mental status changes 2. Patient with stress incontinence due to weakened bladder neck support 3. Patient with urge incontinence and abnormal detrusor muscle contractions 4. Patient with transient incontinence related to loss of cognitive function

3

15. Assessment of Ms. J after dialysis reveals all of these findings. Which assessment finding necessitates immediate notification of the HCP? 1. Weight decrease of 4.5 lb (2 kg) 2. Systolic blood pressure decrease of 14 mm Hg 3. Decreased level of consciousness 4. Small blood spot near the center of the dressing

3

18. The RN is supervising a nurse orientating to the acute care unit who is discharging a patient admitted with kidney stones and who underwent lithotripsy. Which statement by the orienting nurse to the patient requires that the supervising RN intervene? 1. "You should finish all of your antibiotics to make sure that you don't get a urinary tract infection (UTI)." 2. "Remember to drink at least 3 L of fluids every day to prevent another stone from forming." 3. "Report any signs of bruising to your health care provider (HCP) immediately because this indicates bleeding." 4. "You can return to work in 2 days to 6 weeks, depending on what your HCP prescribes."

3

2. For which patient is the nurse most concerned about the risk for developing kidney disease? 1. A 25-year-old patient who developed a urinary tract infection (UTI) during pregnancy 2. A 55-year-old patient with a history of kidney stones 3. A 63-year-old patient with type 2 diabetes 4. A 79-year-old patient with stress urinary incontinence

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20. While making rounds, the RN finds Ms. J in tears and sobbing. She states, "I just don't want to have to go back to dialysis 3 days a week!" What is the nurse's best response? 1. "Would you like me to call someone to come in and sit with you?" 2. "You can always get on the list for another kidney transplant." 3. "Tell me some more about how you are feeling." 4. "Let me call your health care provider to come in and speak with you."

3

3. Which task associated with the patient's 24-hour urine collection is appropriate for the nurse to delegate to the UAP? 1. Instructing Ms. J to collect all urine with each voiding 2. Teaching Ms. J the purpose of collecting urine for 24 hours 3. Ensuring that all of Ms. J's urine collected for the test is kept on ice 4. Assessing Ms. J's urine for color, odor, and sediment

3

36. The nurse is caring for a patient with chronic kidney disease after hemodialysis. Which patient care action should the nurse delegate to the experienced unlicensed assistive personnel (UAP)? 1. Assess the patient's access site for a thrill and bruit. 2. Monitor for signs and symptoms of postdialysis bleeding. 3. Check the patient's postdialysis blood pressure and weight. 4. Instruct the patient to report signs of dialysis disequilibrium syndrome immediately.

3

5. Ms. C's blood pressure is 98/52 mm Hg, and her apical pulse is 116 beats/min. The cardiac monitor shows sinus tachycardia at a rate of 110 to 120 beats/min. Which action prescribed by the health care provider (HCP) will the nurse implement first? 1. Give enalapril 2.5 mg PO. 2. Administer furosemide 100 mg IV. 3. Obtain a blood potassium level. 4. Insert a no. 16 French Foley catheter.

3

5. The nurse is caring for a patient with risk for incomplete bladder emptying. Which noninvasive finding best supports this problem? 1. Patient is able to void additional 100 mL after nurse massages over the bladder. 2. Patient voids additional 350 mL with insertion of an intermittent catheter. 3. Patient has post void residual of 275 mL documented by bedside bladder scanner. 4. Patient has constant dribbling between voidings.

3

8. Which laboratory result is of most concern to the nurse for an adult patient with cystitis? 1. Serum white blood cell (WBC) count of 9000/mm (9 × 109/L) 2. Urinalysis results showing 1 or 2 WBCs present 3. Urine bacteria count of 100,000 colonies per milliliter 4. Serum hematocrit of 36%

3

15. Using the SBAR (situation, background, assessment, recommendation) format, indicate the order in which the nurse will communicate concerns to the HCP. 1. "Today her lungs are clear to auscultation, but her potassium level is 3.4 mEg/L (3.4 mmol/L). I am concerned that she may have digoxin toxicity." 2. 'T'd like to obtain a digoxin level and administer additional potassium supplements before giving the prescribed digoxin and furosemide." 3. "This is the nurse caring for Ms. C; I am calling because she has some PVCs and reports fuzzy vision. 4. "Ms. C was admitted several days ago with pulmonary edema and dyspnea. She has been receiving digoxin and furosemide daily since admission."

3, 4, 1, 2

18. Which additional finding by the home health nurse will be most important to communicate to the HCP? 1. Blood pressure is 108/54 mm Hg. 2. Apical pulse is 56 beats/min. 3. Client states that she takes her daily medications after eating. 4. Client reports that she snores when asleep and always feels sleepy.

4

10. The RN team leader assigns the LPN/LVN to give Ms. J's 9:00 AM oral medications. Which key instruction or action will be most important that the RN give the LPN/LVN regarding administering Ms. J's atenolol 50-mg tablet? 1. Give this drug with just a few swallows of water. 2. Ask the patient if she has been taking a diuretic at home. 3. Instruct the patient to use the bedside commode. 4. Check the patient's heart rate and blood pressure.

4

11. A patient is being admitted to rule out interstitial cystitis. What should the nurse's plan of care for this patient include specific to this diagnosis? 1. Take daily urine samples for urinalysis. 2. Maintain accurate intake and output records. 3. Obtain an admission urine sample to determine electrolyte levels. 4. Teach the patient about the cystoscopy procedure.

4

13. A 28-year-old married female patient with cystitis requires instruction about how to prevent future urinary tract infections (UTIs). The supervising RN has assigned this teaching to a newly graduated nurse. Which statement by the new graduate requires that the supervising RN intervene? 1. "You should always drink 2 to 3 L of fluid every day." 2. "Empty your bladder regularly even if you do not feel the urge to urinate. 3. "Drinking cranberry juice daily will decrease the number of bacteria in your bladder." 4. "It's okay to soak in the tub with bubble bath because it will keep you clean."

4

16. The nurse is providing care for a patient with reflex urinary incontinence. Which action could be appropriately assigned to a new LPN/LVN? 1. Teaching the patient bladder emptying by the Credé method 2. Demonstrating how to perform intermittent self-catheterization 3. Discussing when to report the side effects of betha-nechol chloride to the health care provider (HCP) 4. Reinforcing the importance of proper hand washing to prevent infection

4

17. Ms. J is preparing for discharge. The RN is supervising a student nurse, who is teaching the patient about her discharge medications. For which statement by the student nurse will the RN intervene? "Sevelamer prevents your body from absorbing phosphorus. 2. "Take your folic acid after dialysis on dialysis days. 3. "The docusate is to prevent constipation that may be caused by ferrous sulfate.' 4. "You must take the epoetin alfa three times a week by mouth to treat anemia."

4

21. The patient problem of constipation related to compression of the intestinal tract has been identified in a patient with polycystic kidney disease. Which eat action should the nurse assign to a newly-trained LPN/LVN? 1. Instructing the patient about foods that are high in fiber 2. Teaching the patient about foods that assist in promoting bowel regularity 3. Assessing the patient for previous bowel problems and bowel routine 4. Administering docusate sodium 100 mg by mouth twice a day

4

33. The nurse is caring for a patient admitted with dehydration secondary to deficient antidiuretic hormone (ADH). Which specific gravity value supports this diagnosis? 1. 1.010 2. 1.035 3. 1.020 4. 1.002

4

4. The nurse has delegated collection of a urinalysis specimen to an experienced unlicensed assistive personnel (UAP). For which action must the nurse intervene? 1. The UAP provides the patient with a specimen cup. 2. The UAP reminds the patient of the need for the specimen. 3. The UAP assists the patient to the bathroom. 4. The UAP allows the specimen to sit for more than 1 hour.

4

4. What additional assessment data are most important to obtain at this time? 1. Skin color and capillary refill 2. Orientation and pupil reaction to light 3. Heart sounds and point of maximum impulse 4. Blood pressure and apical pulse

4

6. Which prescribed action is best to assign to the experienced LPN/LVN who is assisting with the client's care? 1. Give enalapril 2.5 mg PO. 2. Administer furosemide 100 mg IV. 3. Obtain a blood potassium level. 4. Insert a no. 16 French Foley catheter.

4

7. The nurse administers morphine sulfate 2 mg IV to Ms. C. A new RN graduate who has just started in the ICU asks why morphine is prescribed for this cli-ent. What is the best response? 1. "To help prevent chest discomfort." 2. "To slow Ms. C's respiratory rate." 3. "To lower Ms. C's anxiety level." 4. "To decrease venous return to the heart."

4

7. The nurse is providing nursing care for a 24 year old female patient admitted to the acute care unit with diagnosis of cystitis. Which intervention should the nurse delegate to the unlicensed assistive persons (UAP)? 1. Teaching the patient how to secure a clean-and urine sample 2. Assessing the patients urine for color, odor, ad sediment 3. Reviewing the nursing care plan and add nursing interventions 4. Providing the patient with a clean-catch urine sample container

4

7. Which medication should the nurse be prepared to administer to lower the patient's potassium level? 1. Furosemide 40 mg IV push 2. Epoetin alfa 300 units/kg subcutaneously 3. Calcium 1 tablet PO 4. Sodium polystyrene sulfonate 15 g PO

4

9. After infusing the KCI, the nurse administers the furosemide to Ms. C. Which nursing action will be most useful in evaluating whether the furosemide is having the desired effect? 1. Weighing the client daily 2. Measuring hourly urine output 3. Monitoring blood pressure 4. Assessing lung sounds

4