MED SURG EXAM 1

A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? a. Renal calculi b. Dysrhythmias c. Osmotic dierresis d. Acute pyelonephritis

Renal Calculi

Identify ABG pH: 7.30 PaCo2: 82 mm/Hg HCO3: 21 mEq/L

Respiratory Acidosis

A client on the medical unit has a documented history of polycystic kidney disease. What principle should guide the nurse's care of this client? a. the client disease is incurable and the nurse's interventions will be supportive b. the disease is self limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life c. the client will eventually require surgical removal of his or her renal cysts d. the client is likely to respond favorably to lithotripsy treatment of the cysts.

The client's disease is incurable and the nurse's interventions will be supportive.

The nurse is assessing the client's ileal conduit stoma in the clinic. Which assessment finding would be of greatest concern to the nurse? a. the stoma is dusky red b. the skin surrounding the stoma is red c. Yellow urine is draining from the stoma d. The urine has an ammonia odor

The stoma is dusky red

A client admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The Client is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location? a. ureter b. meatus c. bladderr d. urethera

Ureter

To obtain information about the chief report and medical history of an older client, the nurse asks the client about any medication history. Why is obtaining a medication history important? a. It may indicate multiple medications taken by the client b. it may reflect the client's childhood and family illnesses. c. It may indicate the client's general health. d. It may indicate drugs that should not be prescribed to the client

it may indicate multiple medications taken by the client

A client asks the nurse why a creatinine clearance test is accurate. The nurse would reply which of the following? a. "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney" b. "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate" c. Creatinine is a stress related response that is excreted by the kidney" d. "Creatinine is found in the urine to make the urine acidic and can be measured"

"Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney"

A client diagnosed with hypernatremia needs fluid volume replacement. What intravenous solution would be the safest for the nurse to administer?

0.45% sodium chloride

The nurse coming on shift ont he medical unit is taking a report on the four clients. What does the nurse know is at the greatest risk for developing ESKD? a. a client with diabetes mellitus and poorly controlled hypertension b. A client with a history of polycystic kidney disease c. A client who is morbidly obese with a history of vascular disorders d. A client with severe chronic obstructive pulmonary disease

A client with diabetes mellitus and poorly controlled hypertension

The nurse has implemented a bladder retraining program for an older adult client. The nurse places the client on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the client typically has approximately 40 mL of urine remaining in the bladder after voiding. What would be the nurse's best response to this finding? a. Avoid further interventions at this time, as this is an acceptable finding b. Place an indwelling urinary catheter c. Press on the client's bladder in an attempt to encourage complete emptying d. Perform a straight catheterization on this client

Avoid further interventions at this time, as this is an acceptable finding

The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important? a. Catheterize the client immediately after the client voids b. Set up a routine schedule of every 4 hours to check for residual urine c. Check for residual after the client reports the urge to void. d. Record the volume of urine obtained

Catheterize the client immediately after the client voids

The nurse is educating a patient who will be performing self catheterization at home. What information provided by the nurse will help reduce the incidence of infection? a. Clean the catheter with antibacterial soap, thoroughly rinse and dry b. Sterilize the catheter by boiling it in water for 20 minutes c. Insert the catheter for urine drainage three times per day d. A new catheter must be used each time catheterization is required.

Clean the catheter with antibacterial soap, thoroughly rinse and dry

The nurse knows that a client diagnosed with pyelonephritis will show what signs and symptoms? Select all that apply? a. Cloudy or amber colored urine b. Low back pain c. Clear yellow urine d. Fever e. Nausea and vomiting

Cloudy or amber colored urine. Low back pain. Fever. Nausea and Vomiting

A creatinine clearance test has been ordered. The nurse prepares to a. collect the client's urine for 24 hours b. obtain a clean catch urine c. Obtain a blood specimen d. Insert a straight catheter for a specimen

Collect the client's urine for 24 hours

A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the patient about what topic? a. Current medication use b. Typical died c. Allergy status d. Psychosocial stressors

Current medication use

A geriatric nurse is performing as assessment of body systems on and 85 year old client. The nurse realizes what particular change is an age related change affecting the renal or urinary system? a. Decreased glomerular filtration rate b. Increased ability to concentrate urine c. Urinary incontinence d. Increased bladder capacity

Decreased glomerular filtration rate.

A nurse reviews the results of an electrocardiogram for a patient who is being assessed for hypokalemia. Which of the following would the nurse notice as the most significant diagnostic indicator? a. Elevated U wave b. Widened QRS wave c. Flat P wave d. Peaked T wave

Elevated U wave

A client is experiencing edema in the tissue. What type of intravenous fluid would the nurse expect to be prescribed? a. hypertonic solution b. hypotonic fluid c. no intravenous solution d. isotonic fluid

Hypertonic solution

You are the nurse caring for a 65 year old client who is in renal failure. During your assessment, the client complains of tingling in her lips and fingers whenever someone touches or apply pressure. She tells you that she gets a spasm in her wrist and hand and that is very painful. Which electrolyte imbalance would you suspect? a. Hypocalcemia b. Hyperphosphatemia c. Hypokalemia d. Hypermagnesemia

Hypocalcemia

The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? Select all that apply. a. Any voiding disorders b. The patient's occupation. c. The presence of hypertension or diabetes. d. the patient's financial status e. The ability of the patient to manage activities of daily living

Any voiding disorders. The patient's occupation. The presence of hypertension or diabetes.

A client presents with muscle weakness, tremors, slow muscle movements and vertigo. What fluid and electrolyte imbalance would the nurse relate to the client's findings? a. hypomagnesemia b. hyponatremia c. hypokalemia d,. hypocalcemia

Hypomagnesemia

Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to prerenal, which condition most likely caused it? a. Heart failure b. Aminoglycoside toxicity c. Glomerulonephritis d. Ureterolithiasis

Heart Failure

The nurse is caring for a client whose acute kidney injury has prerrenal cause. What is most likely caused this client's health problem? a. Heart failure b. Glomerulonephritis c. Ureterolithiasis d. Aminoglycoside toxicity

Heart Failure

The nurse is caring for a client being treated with isotonic IV fluid for hypernatremia. What complication of hypernatremia should the nurse continuously monitor for? a. Cerebral edema b. Renal failure c. Red blood cell hydrrolysis d. Red blood cell crenation

Cerebral edema

An 83 year old female client with heart failure develops hypokalemia as a result of her therapy. you suggest that she increase her dietary intake of potassium. The nurse knows the client has an understand of dietary items with potassium if she states she will incorporate which of the following into her diet? a. Chocolate, orange juice, bananas b. Canned soup, peas, milk c. Apples, whole wheat bread, and oatmeal d. Dairy products and whole grians

Chocolate, orange juice, bananas

A client is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what? a. Hydronephrosis b. Nephritic Syndrome c. Polycystic Kidney Disease d. Nephrotoxicity

Hydronephrosis

The nurse is assessing a patient with renal stones. During the administration what parameters would be priorities for the nurse to address? Select all that apply a. Dietary history b. Family history of renal stones c. Medication history d. Past exposure to cadmium, lead, phosphates e. Vaccination history

Dietary history. Family history of renal stones. Medication history.

Your client with Crohn's disease develops tremors while receiving TPN. Suspected hypomagnesemia, you asses her neuromuscular system. You should expect to see what symptom? a. Difficulty swallowing b. Slowed heart rate c. Hypoactive DTRs d. Elevated serum potassium

Difficulty swallowing

The nurse is caring for a client with an indwelling urinary catheter. The nurse is aware that what nursing action helps to prevent infection in clients with an indwelling catheter? a.Empty the drainage bag at least every 8 hours b. Vigorously clean the meatus area daily c. Apply powder to the perineal area twice daily d. Irrigate the catheter every 8 hours with normal saline

Empty the drainage bag at least every 8 hours

You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance? a. Hypovolemia b. Hypercalcemia

Hypovolemia

An older client is experiencing an increasingly troublesome need to urinate several times through the night. The client's prostate is within normal limits, and the physician prescribes limiting fluid intake after the evening meal. What is another important intervention to keep the client safe? a. Increase fluid intake throughout the day b. Decrease overall fluid intake c. Decrease salt intake d. Increase protein intake.

Increase fluid intake throughout the day

You are making initial shift assessments on your patient's. While assessing one patient's peripheral IV site, you note edema around the insertion site. How should you document his complication related to IV therapy? a. infiltration b. air emboli c. peripheral edema d. fluid volume deficit

Infiltration

The nurse is creating an education plan for a client who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? a. Inspection and care of the incision b. The importance of increased fluid intake c. Signs and symptoms of rejection d. Techniques for preventing metastasis

Inspection and care of the incision

A patient who complains of a dull, continusou pain in the suprrapubic arrrea that occurs and at the end of, voiding would most likely be diagnosed with which of the following? a. Interstitial cystitis b. A kidney stone c. Acute pyelonephritis d. Prrostatic Cancer

Interstitial cystitis

The nurse is giving morning medications and has an order to give 0.45% sodium chloride. The nurse understand that giving a hypertonic IV solution to a client may cause too much fluid to be? a. Pulled from the cells into the bloodstream, which may cause the cells to shrink b. Pulled out of the bloodstream into the cells c. Pushed out of the bloodstream into the extravascular spaces d. Pulled from the cells into the bloodstream, which may cause the cells to increase in size

Pulled from the cells into the bloodstream, which may cause the cells to shrink

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find? a. pyuria b. absent proteinuria c. Slightly acidic pH d. High specific gravity

Pyuria

A client has been experiencing severe pain and hematuria and is hardly able to ambulate into the physician's office. The physician suspects kidney stones and orders diagnostic test to confirm. What test would the physician order? a. KUB b. Ultrasound c. CT d. MRI

KUB

A client reports having to get up frequently to void in the night, or nocturia. What is the probable cause of his problem? a. neurogenic bladder b. decreased renal concentrating ability c. heart failure d. diabetes mellitus

Neurogenic bladder

A client is admitted to the acute care unit. Initial laboratory values reveal serum sodium of 1 mEq/L. The nurse completes a physical assessment on the patient. What clinical manifestation would be most common for this patient? a. Neurological Changes b. Hyperactive deep tendon reflexes c. Depression d. ECG changes

Neurological Changes

The nurse is caring for a female patient who is seen often for recurrent lower UTI. The nurse is educating the patient on risk factors for developing a lower UTI. The nurse determines that instruction regarding prevention of future UTI's has been effective when the patient states? a. Not voiding after sexual intercourse can cause a lower UTI b. I should ingest large amounts of water c. I should wear loose fitting clothing d. frequent urination can cause UTI's

Not voiding after sexual intercourse can cause a lower UTI

The nurse is adding the intake and output results for a client diagnosed with dehydration. The nurse notes a 24 hour intake of 1500 mL/day between oral fluids and intravenous solutions. The output is calculated as 2800 mL/day from urine output, emesis, and HEmovac drainage. Which nursing action is best to maintain an acceptable fluid balance? a. Offer a prescribed antiemetic medication b. Suggest a fluid restriction c. Encourage oral fluids d. Remove the Hemovac

Offer a prescribed antiemetic medication

A patient is admitted to a hospital with a diagnosis of spastic, neurogenic bladder. The nurse is aware that the pathophysiology of this condition is primarily due to which of the following occurrences? a. Patient's inability to exert motor control b. Bladder distended until overflow incontinence occurs c. Presence of a lower motor neuron lesion

Patient's inability to exert motor control

The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameter? Select all that apply a. Specific gravity of the client's urine b. Testing for the presence of glucose in the client's urine c. Microscopic examination of urine sediment for RBC's d. Microscopic examination of urine sediment for casts e. Testing for BUN and creatinine in the client's urine

Specific gravity of the client's urine. Testing for the presence of glucose in the client's urine. Microscopic examination of urine sediment for RBC's. Microscopic examination of urine sediment for casts

A client has a glomerular filtration rate of 43 mL/min/1.73 m2. Based on this the nurse interprets that the client's chronic kidney disease is at what stage? a. stage 1 b. stage 2 c. stage 3 d. stage 4

Stage 3

Nursing continues to recognize and participate in collaboration with other health care disciplinary teams to meet the complex needs of the client. Which of the following is the best example of collaborative practice model? a. The nurse and physician jointly making clinical decisions b. The nurse accompanying the physician on rounds c. The nurse making a referral on behalf of the client d. The nurse attending an appointment with the client

The nurse and physician jointly making clinical decisions