Med Surg
13. A patient states that she rates her pain as a "5" on a 0-to-10 scale post-mastectomy. The provider has ordered morphine 4 mg for moderate pain every 4 hours. The morphine is supplied in a solution of 8 mg/mL. How many mL will the nurse administer? ____ mL
0.5 mL
12. A woman diagnosed with breast cancer had these laboratory tests performed at an office visit: Alkaline phosphatase 125 U/L Total calcium 12 mg/dL Hematocrit 39% Hemoglobin 14 g/dL Which test results indicate to the nurse that some further diagnostics are needed? A. Elevated alkaline phosphatase and calcium suggests bone involvement. B. Only alkaline phosphatase is decreased, suggesting liver metastasis. C. Hematocrit and hemoglobin are decreased, indicating anemia. D. The elevated hematocrit and hemoglobin indicate dehydration.
A
18. A client diagnosed with pyelonephritis asks the nurse "What is the disease?" The nurse's best response "Pyelonephritis is an: A. inflammation of the kidney and renal pelvis." B. inflammation of the prostate gland." C. inflammation of the urethra." D. inflammation of the bladder."
A
8. The nurse is assessing the laboratory findings of a client with a urinary tract infection. The laboratory report notes a "shift to the left" in a client's white blood cell count. Which action by the nurse is most appropriate? a) Request that the laboratory perform a differential analysis on the white blood cells. b) Notify the health care provider and start an IV line for ordered parenteral antibiotics. Correct c) Instruct the client to begin straining all urine for renal calculi. d) Document the finding in the client's chart and continue to monitor.
A Shift to the left means there are young immature leukocytes present. This indicates presence of infection/inflammation. Differential analysis is useful to assess the specific cause of infection
14. A client has been admitted from a nursing home for a workup to determine the cause of several recent falls. What intervention by the nurse takes priority? a) Obtain a clean catch or catheterized urine specimen. b) Document the number of and causative factors for falls. c) Review the results of recent laboratory work for kidney function. d) Facilitate neurologic and social work consultations.
A There is a direct co-relation between UTI and falls in nursing homes. One of the first things to do is rule out UTI and therefore urine specimen
1. A client has a history of renal calculi. Which statement by the client indicates a good understanding of preventive measures? a) "I know I should drink at least 2-3 liters of fluid every day." b) "I can't eat much dairy or other sources of calcium." c) "Aspirin and aspirin-containing products can lead to stones." d) "The doctor will give me antibiotics at the first sign of a stone."
A This question is about preventative measures
17. A woman has been using acupuncture to treat the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which conditions would cause the nurse to recommend against further use of acupuncture? (Select all that apply.) A. Lymphedema B. Bleeding tendencies C. Low white blood cell count D. Elevated serum calcium E. High platelet count
A, B, C
20. The nurse is planning to teach the client about the common signs and symptoms of a urinary tract infection. The nurse should include: (Mark all that apply) A. dysuria. B. foul smelling cloudy urine. C. urgency. D. Chest pain
A, B, C
22. The nurse is developing a teaching plan for the sexually active woman for preventing urinary tract infections. The nurse should instruct the client to: (Mark all that apply) A. wear cotton briefs. B. void before and after intercourse C. take antibiotics before intercourse D. increase fluids to 2.5 quarts per day
A, B, D
14. The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.) A. Age greater than 65 years B. Increased breast density C. Osteoporosis D. Multiparity E. Genetic factors
A, B, E
16. After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the patient's electronic medical record? (Select all that apply.) A. Peau d'orange B. Dense breast tissue C. Nipple retraction D. Mobile mass at two o'clock E. Nontender axillary nodes
A, C, D
15. The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods should be included in the plan? (Select all that apply.) A. Annual mammogram B. Magnetic resonance imaging (MRI) C. Breast ultrasound D. Breast self-awareness E. Clinical breast examination
A, D, E
34. A client asks the nurse, "What are the advantages of peritoneal dialysis over hemodialysis?" Which response by the nurse is accurate? (Select all that apply.) a) "It will give you greater freedom in your scheduling." b) "You have less chance of getting an infection." c) "You need to do it only three times a week." d) "You do not need a machine to do it." e) "You will have fewer dietary restrictions."
A, D, E
24. A nurse is caring for a group of clients who each have urinary tract infections. The nurse should know that trimethoprim-sulfamethoxazole is contraindicated in clients who have had a hypersensitivity reaction to which of the following medications? A. Digoxin (Lanoxin) B. Chlorothiazide (Diuril) C. Ranitidine (Zantac) D. Rosiglitazone (Avandia)
B Chlorothiazide contraindicated with sulphonamindes
1. Patients can often prevent the occurrence of chronic urinary tract infections (UTIs) by: a) Drinking a glass of orange juice every day. b) Increasing their daily fluid intake to 3 or 4 L, if it is not contraindicated. c) Remaining on prophylactic antibiotic therapy. d) Using sterile technique when performing perineal care.
B Increasing fluid intake is important as it will help wash our bacteria
16. A middle-aged client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year and asks what can be done to help prevent these infections. Which is the nurse's best response? a. Test your urine daily for the presence of ketone bodies and proteins. b. Use tampons rather than sanitary napkins during your menstrual period. c. Drink more water and empty your bladder every 2 to 3 hours during the day. d. Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled.
C. Increasing fluid intake and regular emptying of the bladder are interventions to prevent urinary tract infection. Keeping the Hemoglobin A1C under 7% is effective at lowering risk for UTI. The expected range is between 4-6%.
23. A client with a history of urinary tract infection should be instructed by the nurse to avoid: A. tea and coffee. B. Cranberry juice C. Apple cider D. Bananas
D higher in natural sugar
17. The client prescribed cephalexin (Keflex) for cystitis that she has had a severe allergic reaction to penicillin in the past. What is the nurse's priority action? a. Reassure the client that Keflex is not penicillin b. Place an allergy alert band on the client's wrist c. Notify the prescriber before administering the first Keflex dose d. Highlight the important information in the client's medical record
D Kelfex is contraindicated with serious hypersensitivity to penicillin
6. The nurse is caring for a patient admitted with severe pain and vomiting related to a renal stone (kidney stone). Management of the pain and nausea are important. Which of the following is also an important intervention for a person with a renal stone? a. Bed Rest b. Daily weights. c. Maintaining bedrest with the head of bed elevated. d. Observing for the presence of stone in the urine.
D Many stones pass spontaneously (without medical intervention) so observing for stones and straining the urine would be an important intervention. It may also be a component of care after interventions such as lithotripsy, stent placement or percutaneous nephrolithotomy.
1. During a hot summer day, an older adult client tells the clinic nurse, "I am not drinking or voiding that much these days." The nurse notes a heart rate of 100 beats/min and a blood pressure of 90/60 mm Hg. Which action does the nurse take first? a) Give the client something to drink. b) Insert an intravenous catheter. c) Teach the client to drink 2 to 3 liters a day. d) Perform a bladder scan to assess urine volume.
a
10. A patient is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and fluorouracil (5-FU) for breast cancer. Which side effect seen in the patient should the nurse report to the provider immediately? A. Shortness of breath B. Nausea and vomiting C. Hair loss D. Mucositis
a
12. When evaluating the effects of a low-protein diet in a client with chronic kidney disease, the nurse is most concerned with which result? a) Albumin level of 2 g/dL b) Calcium level of 8.0 mg/dL c) Potassium level of 5.2 mmol/L d) Magnesium level of 3 mEq/L
a
13. A client with acute kidney injury is placed on a fluid restriction. To determine whether outcomes related to fluid balance are being met, the nurse assesses for which finding? a) Absence of lung crackles b) Decreased serum creatinine level c) Decreased serum potassium level d) Increased muscle strength
a
15. A client who is 2 days post-femoral vein cannulation begins to have difficulty with outflow of blood during dialysis. For which complication does the nurse assess? a) Hematoma at cannula insertion site b) Infection c) Oliguria d) Skin necrosis at cannula insertion site
a
17. Which response by a client indicates an understanding of measures to facilitate the flow of peritoneal dialysate fluid? a) "I will take my stool softeners every day." b) "I will keep the drainage bag at the level of my abdomen." c) "Flushing the catheter is needed with each exchange." d) "Warmed dialysate infusion increases the speed of flow."
a
19. A client's temperature after dialysis is 99° F (37.2° C) and was normal before dialysis. Which is the nurse's best action? a) Continue to monitor the temperature. b) Encourage the client to drink fluids. c) Obtain a white blood cell count. d) Prepare to culture the fistula site.
a
23. A client with acute kidney injury had normal assessments 1 hour ago. Now the nurse finds that the client's respiration rate is 44 breaths/min and the client is restless. Which assessment does the nurse perform? a) Obtain an oxygen saturation level. b) Send blood for a creatinine level. c) Assess the client for dehydration. d) Perform a bedside blood glucose.
a
29. A client has end-stage kidney disease (ESKD). The nurse observes tall, peaked T waves on the client's cardiac monitor. Which action by the nurse is best? a) Check the serum potassium level. b) Document the finding in the client's chart. c) Prepare to give sodium bicarbonate. d) Call the health care provider to request an electrocardiogram (ECG).
a
3. A client with a renal calculus has just returned from an extracorporeal shock wave lithotripsy procedure, and the nurse finds an ecchymotic area on the client's right lower back. Which is the nurse's priority intervention? a) Notify the health care provider. b) Apply ice to the site. c) Place the client in the prone position. d) Document the observation in the chart.
a
35. The nurse administering which class of antibiotics would be most concerned about risk of intrarenal damage? a. Aminoglycosides. b. Cephalosporins. c. Fluoroquinolones. d. Penicillins.
a
36. To determine the effectiveness of fluid restriction on a client in acute renal failure, the nurse will assess for which finding? a. Absence of lung crackles. b. Decreased serum creatinine level. c. Decreased serum potassium level. d. Increased muscle strength.
a
4. Which of the following pain regimens may be most helpful in managing the pain of renal colic (urinary stones) as an outpatient? a. Oral opioids and non-steroidal anti-inflammatory drugs (NSAIDS) b. Oral opioids and Beta Blockers c. Oral opioids and Nitrates. d. Oral opioids and Ace Inhibitors
a
40. A client with a decreased glomerular filtration rate (GFR) asks how to prevent further damage to the kidneys. Which is the nurse's best response? a. Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs). b. Kidney damage is inevitable as you age. c. The diuretics you are taking will prevent further damage. d. You will need to follow a high-protein diet
a
41. Which client is most at risk for developing postrenal AKI? a. Client diagnosed with renal calculi b. Client with congestive heart failure c. Client taking NSAIDs for arthritis pain d. Client recovering from glomerulonephritis
a
5. Assessment of the patient with renal calculi (kidney stones) will almost always include: a. Flank pain. b. Hematuria. c. Hypertension. d. Urinary bladder distention.
a
6. A client has been missing some scheduled hemodialysis sessions. Which intervention is most important for the nurse to implement? a) Discussing with the client his or her acceptance of the disease b) Discussing with the client the option of peritoneal dialysis c) Rescheduling the sessions to another day or another time d) Stressing to the client the importance of going to the sessions
a
6. A patient is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the patient would indicate that further teaching is needed? A. "I am glad that these tubes will fall out at home when I finally shower." B. "I should measure the drainage each day to make sure it is less than an ounce." C. "I should be careful how I lie in bed so that I will not kink the tubing." D. "If there is a foul odor from the drainage, I should contact my doctor."
a
6. A young woman is being treated with amoxicillin (Amoxil) for a urinary tract infection. Which is the highest priority instruction for the nurse to give this client? a) "Use a second form of birth control while on the drug." b) "You will experience increased menstrual bleeding while on this drug." c) "You may experience an irregular heartbeat while on the drug d) "Watch for blood in your urine while taking this drug."
a
8. A client is complaining of severe flank and abdominal pain. A flat plate KUB XRAY of the abdomen shows urolithiasis. Which of the following interventions is important? a. Strain all urine b. Limit fluid intake c. Enforce strict bed rest d. Encourage calcium supplements
a
10. A client with chronic hypertension is seen in the clinic. Which assessment indicates that the client's hypertension is not under control? a) Heart rate of 55 beats/min b) Serum creatinine level of 1.9 mg/dL c) Blood glucose level of 128 mg/dL d) Irregular heart sounds
b
10. A postmenopausal female client has had two episodes of bacterial urethritis in the last 6 months. She asks her nurse why this is happening to her now. Which is the nurse's best response? a) "Your immune system becomes less effective as you age." b) "Low estrogen levels can make the tissue more susceptible to infection." c) "You should be more careful with your personal hygiene in this area." d) "It is likely that you have an untreated sexually transmitted infection."
b
11. A client is scheduled to have dialysis in 30 minutes and is due for the following medications: vitamin C, B-complex vitamin, and cimetidine (Tagamet). Which action by the nurse is best? a) Give medications with a small sip of water. b) Hold all medications until after dialysis. c) Give the supplements, but hold the Tagamet. d) Give the Tagamet, but hold the supplements.
b
11. A patient is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best? A. "You do not need to worry about lymphedema since you did not have radiation therapy." B. "A risk factor for lymphedema is infection, so wear gloves when gardening outside." C. "Numbness, tingling, and swelling are common sensations after a mastectomy." D. "The risk for lymphedema is a real threat and can be very self-limiting."
b
12. A client with severe bacterial cystitis is prescribed cefadroxil (Duricef) and phenazopyridine (Pyridium). What statement by the client indicates an accurate understanding of these medications? a) "I will not take these drugs with food or milk." b) "I will stop these drugs if I think I am pregnant." c) "An orange color in my urine won't alarm me." d) "I will try to drink a liter of cranberry juice daily."
b
16. A client is admitted with a 3-day history of vomiting and diarrhea. The client's vital signs are blood pressure, 85/60 mm Hg; and heart rate, 105 beats/min. Which intervention by the nurse takes priority? a) Obtain blood and urine cultures. b) Start an IV of normal saline as ordered. c) Administer antiemetic medications. d) Assess the client's recent travel history.
b
18. When providing care for a client receiving peritoneal dialysis, the nurse notices that the effluent is cloudy. Which intervention is most important for the nurse to carry out? a) Irrigate the peritoneal catheter with saline. b) Send a specimen for culture and sensitivity. c) Document the finding in the client's chart. d) Change the dialysate solution and catheter tubing.
b
21. The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD). Which instruction does the nurse provide to this client regarding protein intake? a) "Your protein needs will not change, but you may take more fluids." b) "You will need more protein now because some protein is lost by dialysis." c) "Your protein intake will be adjusted according to your predialysis weight." d) "You no longer need to be on protein restriction."
b
25. A client who is admitted to the hospital with a history of kidney disease begins to have difficulty breathing. Vital signs are as follows: blood pressure, 90/70 mm Hg; heart rate, difficult to feel peripheral pulses. His heart sounds are difficult to hear. Which intervention does the nurse prepare for? a) Administration of digoxin (Lanoxin) b) Draining of pericardial fluid with a needle c) Emergency hemodialysis d) Placement of a pacemaker
b
3. A client with acute kidney failure and on dialysis asks how much fluid will be permitted each day. Which is the nurse's best response? a) "This is based on the amount of damage to your kidneys." b) "You can drink an amount equal to your urine output, plus 700 mL." c) "It is based on your body weight and changes daily." d) "You can drink approximately 2 liters of fluid each day."
b
31. The nurse is caring for a client who is receiving peritoneal dialysis (PD). Which nursing intervention has the greatest priority when a dialysis exchange is performed? a) Adding potassium and antibiotic to the dialysate bags b) Positioning the client on either side c) Using sterile technique when hooking up dialysate bags d) Warming the dialysate fluid in a microwave oven
b
32. The nurse is providing a client with a peritoneal dialysis exchange. The nurse notes the presence of cloudy peritoneal effluent. Which action by the nurse is most appropriate? a) Document the finding in the client's chart. b) Collect a sample to send to the laboratory. c) Reposition the client on the left side. d) Increase the free water content in the next bag.
b
33. A client is 12 hours post-kidney transplantation. The nurse notes that the client has put out 2000 mL of urine in 10 hours. Which assessment does the nurse carry out first? a) Skin turgor b) Blood pressure c) Serum blood urea nitrogen (BUN) level d) Weight of the client
b
44. A client is scheduled to have dialysis in 30 minutes and is due for the following medications: phenobarbital (anticonvulsant), codeine (narcotic), and captopril (ACE-I) Which action by the nurse is best? Accepted any answer as correct a. Give medications with a small sip of water. b. Hold all medications until after dialysis. c. Give the Captopril (ACE-I), but hold phenobarbital (anticonvulsant). d. Give the Codeine, but hold the Captopril (ACE-I).
b
5. A client is receiving treatment with levofloxacin (Levaquin). Which teaching topics does the nurse include in this client's care plan? a) How to assess blood pressure b) How to assess a radial pulse c) How to assess a carotid pulse d) How to assess respirations
b
7. A client has a serum creatinine level of 2 mg/dL and a urine output of 1000 mL/day. How does the nurse categorize the client's kidney injury? a) Intrarenal b) Nonoliguric c) Prerenal d) Postrenal
b
9. A client has kidney stones from secondary Hyperuricemia or high uric acid. Which diet restrictions does the nurse anticipate teaching? a) Avoid foods high in saturated fat (fried foods) b) Avoid foods high in purine (red wine, sardines) c) Avoid foods high in fiber (plums, apricots) d) Avoid foods high in whole wheat (oatmeal, rice)
b
9. Which client statement indicates a good understanding regarding antibiotic therapy for recurrent urinary tract infections? a) "If my urine becomes lighter and clearer, I can stop taking my medicine." b) "Even if I feel completely well, I should take the medication until it is gone." c) "When my urine no longer burns, I will no longer need to take the antibiotics." d) "If I have a fever higher than 100° F (37.8° C), I should take twice as much medicine."
b
1. Which finding in a female patient by the nurse would receive the highest priority of further diagnostics? A. Tender moveable masses throughout the breast tissue B. A 3-cm firm, defined mobile mass in the lower quadrant of the breast C. Nontender immobile mass in the upper outer quadrant of the breast D. Small, painful mass under warm reddened skin
c
13. A confused client is hospitalized for possible pneumonia and is admitted from the emergency department with an indwelling catheter in place. During interdisciplinary rounds the following day, what question by the nurse takes priority? a) "Do you want daily weights on this client?" b) "Will the client be able to return home?" c) "Can we discontinue the in-dwelling catheter?" d) "Should we get another chest x-ray today?"
c
14. A client with chronic kidney disease is scheduled to be given the following medications: digoxin (Lanoxin) and epoetinalfa (Epogen). The client reports nausea and vomiting and wishes to wait to take the medications. Which action by the nurse is most appropriate? a) Administer both medications with soda crackers. b) Allow the client to wait an hour before taking the medications. c) Review today's potassium level and notify the health care provider. d) Call the health care provider to get an order for anti-nausea medication.
c
2. A client is taking furosemide (Lasix). To detect a common adverse effect, the nurse obtains which assessment as a priority? a) Breath sounds b) Heart sounds c) Intake and output d) Nutritional patterns
c
2. Which client is at greatest risk for development of a urinary tract infection? a) Middle-aged female client who has never been pregnant. b) Middle-aged male client who is taking cyclophosphamide for cancer therapy. c) Older female client not taking estrogen replacement. d) Older male client with mild congestive heart failure.
c
2. With a history of breast cancer in the family, a 48-year-old female patient is interested in learning about the modifiable risk factors for breast cancer. After the nurse explains this information, which statement made by the patient indicates that more teaching is needed? A. "I am fortunate that I breast-fed each of my three children for 12 months." B. "It looks as though I need to start working out at the gym more often." C. "I am glad that we can still have wine with every evening meal." D. "When I have menopausal symptoms, I must avoid hormone replacement therapy."
c
22. A client was just admitted to the emergency department for new-onset confusion. As the nurse starts the IV line, the client says he just finished a hemodialysis session. The IV site is bleeding briskly. What action by the nurse takes priority? a) Assess for a bruit and thrill over the vascular access site. b) Draw blood for coagulation studies and white blood cell count. c) Prepare to administer protamine sulfate. d) Hold constant firm pressure with a gauze pad for 5 minutes.
c
24. A client has end-stage kidney disease (ESKD). Which food selection by the client demonstrates understanding of a low-sodium, low-potassium diet? a) Bananas b) Ham c) Herbs and spices d) Salt substitutes
c
26. A client with chronic kidney disease states that he will be going to the dentist for a planned tooth extraction. Which is the nurse's best response? a) "Rinse your mouth with an antiseptic solution after the procedure." b) "Kidney disease is probably what caused your dental decay." c) "You should receive prophylactic antibiotics before any dental procedure." d) "You may take any medication for pain that the dentist prescribes."
c
3. In which of the following situations would the nurse most likely question the order for an indwelling urinary catheter? a) A 26-year-old patient with pathologic fractures and AIDs who is receiving Hospice care. b) A critically ill patient confined to bed who is on strict I&O's. c) A 73-year old ambulatory heart failure patient receiving twice a day diuretics. d) The incontinent acute care patient with a sacral full thickness pressure ulcer
c
37. The nurse is caring for a newly admitted patient with acute kidney injury (AKI). Urine output is less than 400 ml/day and dilute. What nursing interventions would be appropriate at this stage of AKI? a. Discontinue cardiac monitoring to facilitate ambulation. b. Eliminating all protein in the patient's diet. c. Monitoring and likely restricting potassium intake in the diet. d. Pushing oral fluids to support the blood pressure.
c
38. In acute kidney injury (AKI), which of the following is a priority nursing intervention? a. Ambulating the patient to prevent osteoporotic changes. b. Monitoring electrolytes and replacing losses. c. Teaching the patient about protein and potassium dietary restrictions. d. Teaching the patient to perform in and out urinary catheterization.
c
39. The nurse develops a plan of care for the patient with Acute Kidney Injury (AKI). Which of the following nursing diagnoses addresses a major cause mortality in patients with AKI? a. Altered nutrition: more than body requirements. b. Ineffective thermoregulation. c. Risk for infection. d. Risk for injury.
c
4. A 35-year-old woman is diagnosed with stage III breast cancer. She seems to be extremely anxious. What action by the nurse is best? A. Encourage the patient to search the Internet for information tonight. B. Ask the patient if sexuality has been a problem with her partner. C. Explore the idea of a referral to a breast cancer support group. D. Assess whether there has been any mental illness in her past.
c
4. What teaching will the nurse provide for the patient taking a sulfonamide for uncomplicated cystitis? a) Do not be alarmed if the urine appears orange. b) Do not take antacids when using this medication. c) Increase fluids and wear sunscreen, long sleeves, and hats in the sunlight. d) Take an extra dose at bedtime if dysuria continues for more than 24 hours.
c
42. The patient is an 87-year-old African-American woman who has type 2 diabetes and hypertension. She has just finished a course of IV Vancomycin 3 days ago to treat an infection that developed at her long term care facility. Today she is sent to the emergency department by the medical director of the long term care facility because she has gained 8 pounds in three days and has symptoms of heart failure. She is unable to remember the last time she urinated. The notes from the long term care facility document 60 ml urine output in the last 24 hours. Her admitting diagnosis is possible acute kidney injury. Her vital signs are as follows: temperature 99.5° F; pulse 110 and irregular; respirations 32; blood pressure 176/110. What additional assessment data should the nurse collect? a. Hematocrit (HCT), Hemoglobin (Hgb), and Iron levels b. Ankle-brachial index, BP with a Doppler, and Ultrasound of the bladder c. Listen to the lungs, check for peripheral edema, and palpate abdomen d. Assess skin integrity, test urine Ph, and draw a serum cortisol level.
c
45. A patient with Chronic Kidney Disease is on the following medications: Ferrous Sulfate Epogen (Epoetinalfa) and a multivitamin daily. Which labs values should the nurse expect to monitor? a. Dilantin and tegretol levels b. Uric acid and platelet count. c. Hemoglobin and hematocrit. d. Intercranial pressure and volume
c
5. A patient has just returned from a right radical mastectomy. Which action by the unlicensed assistive personnel (UAP) would the nurse consider unsafe? A. Checking the amount of urine in the urine catheter collection bag B. Elevating the right arm on a pillow C. Taking the blood pressure on the right arm D. Encouraging the patient to squeeze a rolled washcloth
c
5. Which staff member does the charge nurse assign to care for a client newly diagnosed with chronic kidney disease? a) Licensed practical nurse who usually works on the unit b) Registered nurse floated from the hemodialysis unit c) Registered nurse who has taken care of this client before d) Registered nurse with the most years of experience
c
50. A patient has been diagnosed with end-stage renal disease. In addition to patient's complaints of fatigue, anorexia, dyspnea, and nocturia, the nurse's assessment findings include: +1 pedal edema, basilar crackles in both lungs, and clear, pale urine. VS are: T 98.8° F, P 86, R 28, and BP 178/92. Lab values: Hct (hematocrit) 30%; Hgb 9.5 g/dL K+ (Potassium) 6.0 meq/L, Phosphorus 7.0 mg/dL. Which of the lab values are outside of normal range for adults? a. Potassium only b. Hct/Hgb and Phosphorous c. Hct/Hgb, K, and Phosphorus d. All are in the normal range.
c
7. A client is receiving treatment with liquid nitrofurantoin (Furadantin). Which is the highest priority instruction that the nurse can provide to this client regarding accurate administration of the medication? a) "The medication should be mixed with cold water before drinking it b) "Urine will turn orange immediately after you swallow the drug." c) "You should ask the pharmacist for a syringe to measure the dose." d) "The drug is available in granules that must be dissolved."
c
7. The patient with a renal calculus (kidney stone) had an extracorporeal shock wave lithotripsy (ESWL) procedure 24 hours ago for urinary stones now has a fever of 101° F (38.3° C). Which is the nurse's priority intervention Which is the most appropriate nursing intervention at this time? a. Applying an ice pack to the right flank. b. Documenting the observation as the only action. c. Notifying the physician. d. Placing the patient in the prone position.
c
7. What comfort measure can only be performed by a nurse, as opposed to an unlicensed assistive personnel (UAP), for a patient who returned from a left modified radical mastectomy 4 hours ago? A. Placing the head of bed at 30 degrees B. Elevating the left arm on a pillow C. Administering morphine for pain at a "4" on a 0-to-10 scale D. Supporting the left arm while initially ambulating the patient
c
8. A client has a serum creatinine level of 2.5 mg/dL, a serum potassium level of 6 mmol/L, an arterial pH of 7.32, and a urine output of 250 mL/day. Which phase of acute kidney failure is the client experiencing? a) Intrarenal b) Nonoliguric c) Oliguric d) Postrenal
c
9. A client has been diagnosed with acute postrenal kidney injury. Which assessment finding does the nurse assess most carefully for? a) Blood urea nitrogen (BUN), 35 mg/dL b) Creatinine, 2.5 mg/dL c) Feeling of urgency d) Weight gain and edema
c
9. A patient is starting hormonal therapy with tamoxifen (Nolvadex) to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug? A. It blocks the release of luteinizing hormone. B. It interferes with cancer cell division. C. It selectively blocks estrogen in the breast. D. It inhibits DNA synthesis in rapidly dividing cells.
c
11. A client is hospitalized with urinary retention, has an indwelling catheter, and is getting IV fluids. Which intervention does the nurse add to the care plan to address the priority problem for this client? a) Perform catheter care per policy every shift. b) Encourage fluid intake to 1 liter/day. c) Apply a moisture barrier cream daily. d) Document accurate intake and output (I&O) each shift.
d
15. The nurse is working with a 32-year-old woman who returns for recurrent urinary tract infections (UTIs). Which of the following statements should be included in the teaching plan? a. Avoid urinating directly after intercourse to minimize introduction of bacteria. b. Use a vaginal douche (rinse) after intercourse until the infection is gone. c. Use spermicidal agents as a contraceptive agent to further protect against UTIs. d. Urinating directly after intercourse to minimize introduction of bacteria
d
2. A client has kidney stones from secondary hyperoxaluria. Which medication does the nurse anticipate administering? a) Phenazopyridine (Pyridium) b) Propantheline (Pro-Banthine) c) Tolterodine (Detrol-LA) d) Allopurinol (Zyloprim)
d
20. The RN has assigned a client with a newly placed arteriovenous (AV) fistula in the right arm to an LPN. Which information about the care of this client is most important for the RN to provide to the LPN? a) "Avoid movement of the right extremity." b) "Place gentle pressure over the fistula site after blood draws." c) "Start any IV lines below the site of the fistula." d) "Take blood pressure in the left arm."
d
27. A client hospitalized for worsening kidney injury suddenly becomes restless and agitated. Assessment reveals tachycardia and crackles bilaterally at the bases of the lungs. Which is the nurse's first intervention? a) Begin ultrafiltration. b) Administer an antianxiety agent. c) Place the client on mechanical ventilation. d) Place the client in high Fowler's position.
d
28. The nurse is caring for a client with chronic kidney disease who has developed uremia. Which assessment finding does the nurse correlate with this problem? a) Decreased breath sounds b) Foul-smelling urine c) Heart rate of 50 beats/min d) Respiratory rate of 40 breaths/min
d
3. A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate? A. Discourage this surgery since the woman is still of childbearing age. B. Reassure the patient that reconstructive surgery is as easy as breast augmentation. C. Inform the patient that this surgery removes all mammary tissue and cancer risk. D. Include support people, such as the male partner, in the decision making.
d
30. Which assessment parameter does the nurse monitor in a client with chronic kidney disease to determine fluid and sodium retention status? a) Capillary refill b) Intake and output c) Muscle strength d) Weight and blood pressure
d
4. Which statement by a client who has undergone kidney transplantation indicates a need for more teaching? a) "I will need to continue to take insulin for my diabetes." b) "I will have to take my cyclosporine for the rest of my life." c) "I will take the antibiotics three times daily until the medication is finished." d) "My new kidney is working fine. I do not need to take medications any longer."
d
43. Chronic kidney disease is described as being at Stage 2 when: a. Blood urea nitrogen and serum creatinine levels are extremely high. b. Urine specific gravity reaches 1.025 c. The patient no longer excretes urine d. Glomerular filtration rate is less than 90 mL/min
d
46. A patient with newly diagnosed Stage 5 Chronic Kidney Disease asks how much fluid he can drink each day. Which is the nurse's best response? a. There are no guidelines; you should drink when you are thirsty. b. You can drink all you want during the day, but do not drink fluids 4 hours before you go to bed. c. You should drink at least 2L of fluid each day to prevent further damage. d. As a general guide, your fluid restriction could be up to 1.5 L per day.
d
47. A client who has chronic kidney disease is being discharged from the hospital after being treated for anemia. Which information is most important for the nurse to provide the client specific to this discharge? a. Increase your intake of foods with protein. b. Do not monitor your daily intake and output. c. Maintain bedrest until you feel stronger. d. Take your erythropoietin (Epogen) as ordered.
d
48. The many changes in laboratory values in the patient with AKI are usually similar to those occurring in Chronic Kidney disease expect for: a. rising BUN b. elevated creatinine levels c. abnormal electrolyte values. d. increased phosphate levels
d
49. The RN has assigned a client with a newly placed arteriovenous (AV) fistula in the right arm to an LPN. Which information about the care of this client is most important for the RN to provide to the LPN? a. "Avoid movement of the right extremity." b. "Place gentle pressure over the fistula site after blood draws." c. "Start any IV lines below the site of the fistula." d. "Take blood pressure in the left arm."
d
51. The patient has just returned to the nursing unit after a routine, uncomplicated hemodialysis treatment. Which of the following is an appropriate nursing intervention? a. Begin discharge teaching. b. Encourage the patient to ambulate. c. Keep the patient NPO until the patient is able to void. d. Assess for signs and symptoms of bleeding.
d
52. A nurse noted that a patient with chronic kidney disease (CKD) had a glomerular filtration rate (GFR) of 25 ml/min (stage 4 CKD). Given the lab result, how might the plan of care be changed for this patient? a. Increased drug dosages or a shorter interval between doses of some medications. b. No change in drug dosages or frequency of medications. c. No interpretation can be made from this data. d. Reduced drug dosages or a longer interval between doses of some medications.
d
8. During dressing changes, the nurse assesses a patient who has had breast reconstruction. Which finding would cause the nurse to take immediate action? A. Slightly reddened incisional area B. Blood pressure of 128/75 mm Hg C. Temperature of 99° F (37.2° C) D. Dusky color of the flap
d
