Module 2 Test

nitrofurantoin, trimethoprim/sulfamethoxazole

antibiotic therapy for uncomplicated UTI based on empirical evidence and data (3-7 day course)

bladder cancer

cancer with symptoms of hematuria, bladder irritability

Glomerulus

capillary network made up of up to 50 capillaries

Diabetic ketoacidosis (DKA)

caused by a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration

septic shock

complication of pyleonephritis

Impaired glucose tolerance (IGT)

diagnosed if the 2-hour oral glucose tolerance test values are 140-199 mg/dL

sodium and protein restriction (if high BUN)

dietary interventions for glomerulonephritis

Macrovascular complications

disease of the large and medium-size blood vessels that occur with greater frequency an with an earlier onset in people with diabetes

10-16 hours

duration of intermediate insulin

24 hours

duration of long acting insulin

5-7 hours

duration of regular insulin

glomerulonephritis

hematuria, proteinuria, increased BUN, increased creatinine, fluid retention (leads to HTN), chronic disease, periorbital edema, anascara (wide-spread swelling), decreased urine output indicate

heart dysrhythmias

hypokalemia can cause cardiac issues such as

Prediabetes

impaired glucose tolerance, impaired fasting glucose, or both; intermediate stage between normal glucose homeostasis and diabetes in which the blood glucose levels are elevated but not high enough to meet the diagnostic criteria for diabetes

eat regular meals at regular times

individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times b. restrict calories to promote moderate weight loss c. eliminate sucrose and other simple sugars from the diet d. limit saturated fat intake to 30% of dietary calorie intake

pyelonephritis

inflammation of kidney

increased insulin and increased glucose

insulin resistance causes

Regular

insulin that can be given IV

NPH

intermediate insulin

glargine

long acting insulin

Diabetic neuropathy

nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus

4-5.6

normal A1C

23-29

normal CO2

500 (mg/mL)

normal D-Dimer < or =

11-16

normal PT

25-35 sec

normal PTT

4-11

normal WBC

milk, cheese, ice cream, yogurt, all beans (except green beans), lentils, fish with fine bones (sardines, kippers, herring, salmon), dried fruits, nuts, ovaltine, chocolate, cocoa

patients with calcium stones should avoid

sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads

patients with purine stones should avoid

Microvascular complications

result from thickening of the vessel membranes in the capillaries and arterioles in response to conditions of chronic hyperglycemia.

3 Ps, weight loss, fatigue, ketoacidosis

symptoms of T1 diabetes

a,b,c,d,e,f

what characterizes type 2 diabetes? SATA a. B cell exhaustion b. insulin resistance c. genetic predisposition d. altered production of adipokines e. inherited defect in insulin receptors f. inappropriate glucose production by the liver

decreased ability to concentrate urine (decreased renal blood flow and altered hormone levels result in a decreased ability to concentrate urine that results in an increased volume of dilute urine, which does not maintain the usual diurnal elimination pattern.)

A 78 year old man asks the nurse why he has to urinate so much at night. The nurse should explain to the patient that as an older adult, what may contribute to his nocturia? A. decreased renal mass B. decreased detrusor muscle tone C. decreased ability to conserve sodium D. decreased ability to concentrate urine.

Urosepsis

A UTI that has spread systemically and is a life-threatening condition requiring emergency treatment

withdraws the NPH dose into the syringe first

A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. withdraws the NPH dose into the syringe first b. infects air equal to the NPH dose into the NPH vial first c. removes any air bubbles after withdrawing the first insulin d. adds air equal to the insulin dose into the regular vial and withdraws the dose

deposition of immune complexes and complement along the GBM

The immunologic mechanisms involved in glomerulonephritis include: A. tubular blocking by precipitates of bacteria and antibody reactions B. deposition of immune complexes and complement along the GBM C. thickening of the GBM from autoimmune microangiopathic changes D. destruction of glomeruli by proteolytic enzymes contained in the GBM

Chooses a puncture site in the center of the finger pad

The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? A. Chooses a puncture site in the center of the finger pad. B. Washes hands with soap and water to cleanse the site to be used. C. Warms the finger before puncturing the finger to obtain a drop of blood. D. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

I should look at the condition of my feet every day.

The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I am lucky my shoes fit so nice and tight because they give me firm support." D. "When I am allowed up out of bed, I should check the shower water with my toes."

hyperparathyroidism

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes: A. adrenal insufficiency B. serotonin deficiency C. hyperaldosteronism D. hyperparathyroidism

tobacco use

The nurse identifies risks for kidney and bladder cancer in the patient who relates a history of: A. aspirin use B. tobacco use C. chronic alcohol abuse D. use of artificial sweeteners

I may have a hypoglycemic reaction if I drink alcohol on an empty stomach. (The risk for alcohol-induced hypoglycemia is reduced by eating carbohydrates when drinking alcohol. )

The nurse instructs a 22-year-old female patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."

Assess patient's perception of what it means to have diabetes.

The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? A. Assess patient's perception of what it means to have diabetes. B. Ask the patient to write down current knowledge about diabetes. C. Set goals for the patient to actively participate in managing his diabetes. D. Assume responsibility for all of the patient's care to decrease stress level

cheese

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.

The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. B. Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. C. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. D. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes

"Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." (Dry mouth is a common side effect of tolterodine.)

The nurse is caring for a 62-yr-old woman taking tolterodine (Detrol) to treat urinary urgency and incontinence. Which instruction should be included in the discharge plan? a. "Stop smoking for 2 to 3 weeks before starting to take this medication." b. "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." c. "Have your vision checked every 6 months because this drug can cause cataracts." d. "Ask your physician to prescribe an extended-release form if you have loose stools."

Nitrites and leukocyte esterase are present in the urine. (A diagnosis of UTI is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). An elevated WBC count (>11,000 cells/µL) indicates a bacterial infection. An ASO titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.)

The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia and symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis? a. White blood cell count is 7500 cells/µL. b. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. c. Glucose, protein, and ketones are present in the urine. d. Nitrites and leukocyte esterase are present in the urine.

Right lateral side-lying position (After a renal biopsy, a pressure dressing should be applied. The patient should be kept on the affected side for 30 to 60 minutes to apply additional pressure from the patient's own body weight and then on bed rest for 24 hours. )

The nurse is caring for a patient after a right kidney biopsy. Which position would be the most appropriate for this patient immediately after the procedure? a. Right lateral side-lying position b. Reverse Trendelenburg position c. Supine with lower extremities elevated d. High Fowler's position with arms supported

supine (To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.)

The nurse is performing an assessment for a patient and preparing to palpate the kidneys. How should the nurse position the patient for this assessment? a. Prone b. Supine c. Seated at the edge of the bed d. Standing, facing away from the nurse

Administer a cathartic or enema (The nurse will also assess the patient for iodine sensitivity; keep the patient NPO for 8 hours before the procedure; and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.)

The nurse is preparing a patient for an intravenous pyelogram (IVP). What is a priority action by the nurse? a. Administer a cathartic or enema. b. Assess patient for allergies to penicillin. c. Keep the patient NPO for 4 hours preprocedure. d. Advise the patient that a metallic taste may occur during procedure.

Daily weights and measurement of the patient's abdominal girth (Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. )

The nurse is providing care for a patient admitted to the hospital for treatment of nephrotic syndrome. What are the priority nursing assessments? a. Assessment of pain and level of consciousness b. Assessment of serum calcium and phosphorus levels c. Blood pressure and assessment for orthostatic hypotension d. Daily weights and measurement of the patient's abdominal girth

A 48-year-old woman with a hemoglobin A1C of 8.4% (Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C ≥ 6.5%, fasting plasma glucose level =126 mg/dL, 2-hour plasma glucose level =200 mg/dL during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose =200 mg/dL.)

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? A. A 48-year-old woman with a hemoglobin A1C of 8.4% B. A 58-year-old man with a fasting blood glucose of 111 mg/dL C. A 68-year-old woman with a random plasma glucose of 190 mg/dL D. A 78-year-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

I will discard any insulin bottle that is cloudy in appearance. (Intermediate-acting insulin and combination premixed insulin will be cloudy in appearance. )

The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75o F) for up to a month."

urinate before and after sexual intercourse

The nurse teaching the female patient that has frequent UTIs that she should: A. take tub baths with bubble bath B. urinate before and after sexual intercourse C. take prophylactic sulfonamides for the rest of her life D. restrict fluid intake to prevent the need for frequent voiding

extravasation (When infiltrated into the skin, vesicants cause pain, severe local breakdown, and necrosis. Specific measures to ensure adequate dilution, patency, and early detection of extravasation and treatment are important.)

The nurse uses many precautions during IV administration of vesicant chemotherapeutic agents, primarily to prevent a. septicemia. b. extravasation. c. catheter occlusion. d. anaphylactic shock.

Reflex incontinence (Reflex incontinence occurs with no warning, equally during the day and night, and with spinal cord lesions above S2.)

The patient has a thoracic spinal cord lesion and incontinence that occurs equally during the day and night. What type of incontinence is this patient experiencing? a. Reflex incontinence b. Overflow incontinence c. Functional incontinence d. Incontinence after trauma

Avoid extreme temperatures to the area (Avoiding sources of excessive heat and cold will prevent damage to the skin. Only nonmedicated, nonperfumed lotions or creams (e.g., calendula ointment, aloe gel, Aquaphor) are recommended for dry skin. The area should be exposed to air if possible. Gentle cleansing, thorough rinsing, and patting the treatment area dry are recommended.)

The patient is learning about skin care related to the external radiation that he is receiving. Which instructions should the nurse include in this teaching? a. Moisturize skin with lotion b. Keep the area covered if it is sore c. Dry the skin thoroughly after cleansing it d. Avoid extreme temperatures to the area

Acetaminophen (Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.)

The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)

b,e,f (Autonomic neuropathy affects most body systems. Manifestations of autonomic neuropathy include erectile dysfunction in men and decreased libido, gastroparesis (N/V, gastroesophageal reflux & feeling full), painless myocardial infaction, postural hypotension, and resting tachycardia. The remaining options would occur with sensory neuropathy)

The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient? Select all that apply: A. Painless foot ulcers B. Erectile dysfunciton C. Burning foot pain at night D. Loss of fine motor control E. Vomiting undigested food F. Painless myocardial infarction

Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced. (no early characteristic symptoms of cancer of the kidney)

Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. Why does this occur? a. The only treatment modalities for the disease are palliative. b. Diagnostic tests are not available to detect tumors before they metastasize. c. Classic symptoms of hematuria and palpable mass do not occur until the disease is advanced. d. Early metastasis to the brain impairs the patient's ability to recognize the seriousness of symptoms

b,d

What disorders and diseases are related to macrovascular complications of diabetes? Select all that apply: A. Chronic kidney disease B. Coronary artery disease C. Microaneurysms and destruction of retinal vessels D. Ulceration & amputation of the lower extremities E. Capillary & arteriole membrane thickening specific to diabetes

interstitial cystitis/painful bladder syndrome (IC/PBS)

What do LUTS symptoms but no bacteria indicate?

Stimulates erythropoiesis (production of RBCs).

What does Epoetin do?

Neutropenia (↓ WBC)

What does Filgrastim treat?

fungal infections

What does Nystatin treat?

It invades and metastasizes.

What factor differentiates a malignant tumor from a benign tumor? a. It causes death. b. It grows at a faster rate. c. It is often encapsulated. d. It invades and metastasizes.

relaxation of pelvic floor and bladder muscles

What is a factor that contributes to an increased incidence of urinary tract infections in aging women? A. length of the urethra B. larger capacity of bladder C. relaxation of pelvic floor and bladder muscles D. tight muscular support at the urinary sphincter

Using strict sterile technique during irrigation and obtaining culture specimens

What is included in nursing care that applies to the management of all urinary catheters in hospitalized patients? a. Measuring urine output every 1 to 2 hours to ensure patency b. Turning the patient frequently from side to side to promote drainage c. Using strict sterile technique during irrigation and obtaining culture specimens d. Daily cleaning of the catheter insertion site with soap and water and application of lotion

smoking

What is the biggest risk factor for Kidney and Bladder cancer?

There is a preexisting abnormality of the urinary tract. (Ascending infections from the bladder to the kidney are prevented by the normal anatomy and physiology of the urinary tract unless a preexisting condition, such as vesicoureteral reflux or lower urinary tract dysfunction (bladder tumors, prostatic hyperplasia, strictures, or stones), is present.)

What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract? a. The kidney is scarred and fibrotic. b. The organism is resistant to antibiotics. c. There is a preexisting abnormality of the urinary tract. d. The patient does not take all of the antibiotics for treatment of a UTI.

has impaired renal function (the BUN is increased in patients with renal problems. It may also be increased when there is rapid or extensive tissue damage from other causes.)

What is the most likely reason that the BUN would be increased in a patient? A. has impaired renal function B. has not eaten enough protein C. has decreased urea in the urine D. may have nonrenal tissue destruction

Check the patient's blood glucose level (Blood glucose testing should be performed whenever hypoglycemia is suspected so that immediate action can be taken if necessary.)

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? A. Call the physician B. Administer insulin as ordered C. Check the patient's blood glucose level D. Assess for other neurologic symptoms

Elevated blood urea nitrogen (BUN) (elevated blood urea nitrogen (BUN) indicates that the kidneys are not clearing nitrogenous wastes from the blood and protein may be restricted until the kidney recovers.)

What manifestation in the patient will indicate the need for restriction of dietary protein in management of acute poststreptococcal glomerulonephritis (APSGN)? a. Hematuria b. Proteinuria c. Hypertension d. Elevated blood urea nitrogen (BUN)

a,d,e

What nursing responsibilities are done to obtain a clean catch urine specimen from a patient (SATA)? A. use sterile container B. must start the test with full bladder C. insert catheter immediately after voiding D. have the patient void, stop and void in container E. have the patient clean the meatus before voiding

Decreased plasma oncotic pressure (The massive proteinuria that results from increased glomerular membrane permeability in nephrotic syndrome leaves the blood without adequate proteins (hypoalbuminemia) to create an oncotic colloidal pressure to hold fluid in the vessels. Without oncotic pressure, fluid moves into the interstitium, causing severe edema.)

What results in the edema associated with nephrotic syndrome? a. Hypercoagulability b. Hyperalbuminemia c. Decreased plasma oncotic pressure d. Decreased glomerular filtration rate

Normal serum glucose & lipid levels

What should the goals of nutrition therapy for the patient with type 2 diabetes include? A. Ideal body weight B. Normal serum glucose & lipid levels C. A special diabetic diet using dietetic foods D. Five small meals per day with a bedtime snack

NO hematuria

What symptom is Nephrotic syndrome missing that is common to other renal issues?

flank pain and fever

What symptoms does pyleonephritis have that is different from cystitis?

c,e

What tissues require insulin to enable movement of glucose into the tissue cells (select all that apply) a. liver b. brain c. adipose d. blood cells e. skeletal muscles

aloe vera

What topical treatment is used for radiation burns?

d,e,f

Which characteristics are associated with urge incontinence (select all that apply)? a. Treated with Kegel exercises b. Found following prostatectomy c. Common in postmenopausal women d. Involuntary urination preceded by urgency e. Caused by overactivity of the detrusor muscle f. Bladder contracts by reflex, overriding central inhibition

biguanide

Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because is reduces hepatic glucose production and enhances tissue uptake of glucose? a. insulin b. biguanide c. meglitinide d. sulfonylurea

Upper UTI (An upper urinary tract infection (UTI) affects the renal parenchyma, renal pelvis, and ureters. A lower UTI is an infection of the bladder and/or urethra. A complicated UTI exists in the presence of obstruction, stones, or preexisting diseases. An uncomplicated UTI occurs in an otherwise normal urinary tract.)

Which classification of urinary tract infection (UTI) is described as infection of the renal parenchyma, renal pelvis, and ureters? a. Upper UTI b. Lower UTI c. Complicated UTI d. Uncomplicated UTI

Intraperitoneal

Which delivery system would be used to deliver regional chemotherapy for metastasis from a primary colorectal cancer? a. Intrathecal b. Intraarterial c. Intravenous d. Intraperitoneal

Systemic lupus erythematosus

Which disease causes connective tissue changes that cause glomerulonephritis? a. Gout b. Amyloidosis c. Diabetes mellitus d. Systemic lupus erythematosus

c,d,e (α-Adrenergic blockers block the stimulation of the smooth muscle of the bladder, 5α-reductase inhibitors decrease outlet resistance, and bethanechol enhances bladder contractions. Baclofen or diazepam is used to relax the external sphincter for reflex incontinence. Anticholinergics are used to relax bladder tone and increase sphincter tone with urge incontinence.)

Which drugs are used to treat overflow incontinence (select all that apply)? a. Baclofen (Lioresal) b. Anticholinergic drugs c. α-Adrenergic blockers d. 5α-reductase inhibitors e. Bethanechol (Urecholine)

a, b, d

Which factors will assist a patient in coping positively with having cancer (select all that apply)? a. Feeling of control b. Strong support system c. Internalization of feelings d. Possibility of cure or control e. A young person will adapt more easily f. Not having had to cope with previous stressful events

Contract muscles around rectum. (To teach pelvic floor exercises (Kegel exercise), the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation.)

Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? a. Tighten both buttocks together. b. Squeeze thighs together tightly. c. Contract muscles around rectum. d. Lie on back and lift the legs together.

Bone marrow and gastrointestinal (GI) mucosa (Tissue that is actively proliferating, such as GI mucosa, esophageal and oropharyngeal mucosa, and bone marrow, exhibits early acute responses to radiation therapy. Radiation ionization breaks chemical bonds in DNA, which renders cells incapable of surviving mitosis. This loss of proliferative capacity yields cellular death at the time of division for both normal cells and cancer cells but cancer cells are more likely to be dividing because of the loss of control of cellular division.)

Which normal tissues manifest early, acute responses to radiation therapy? a. Spleen and liver b. Kidney and nervous tissue c. Bone marrow and gastrointestinal (GI) mucosa d. Hollow organs such as the stomach and bladder

Acute pain

Which nursing diagnosis is priority when caring for a patient with renal calculi? a. Acute pain b. Risk for constipation c. Deficient fluid volume d. Risk for powerlessness

Suggest genetic counseling resources for the children of the patient.

Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? a. Help the patient cope with the rapid progression of the disease. b. Suggest genetic counseling resources for the children of the patient. c. Expect the patient to have polyuria and poor concentration ability of the kidneys. d. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

metformin

Which oral diabetic medication helps with lipids?

a 34 year old woman whose parents both have type 2 diabetes

Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. an obese 50 year old hispanic woman b. a child whose father has type 1 diabetes c. a 34 year old woman whose parents both have type 2 diabetes d. a 12 year old boy whose father has maturity onset diabetes of the young (MODY)

A 73-year-old patient who takes propranolol (Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use â-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.)

Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? A. A 58-year-old patient with diabetic retinopathy B. A 73-year-old patient who takes propranolol C. A 19-year-old patient who is on the school track team D. A 24-year-old patient with a hemoglobin A1C of 8.9%

Nephrotic syndrome

Which renal issue does not cause hematuria?

It occurs with a higher frequency and earlier onset than in the nondiabetic population

Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? A. It can be prevented by tight glucose control B. It occurs with a higher frequency and earlier onset than in the nondiabetic population C. It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes D. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake

I am supposed to have a meal or snack if I drink alcohol

Which statement by the patient with type 2 diabetes is accurate? A. " I am supposed to have a meal or snack if I drink alcohol" B. "I am not allowed to eat any sweets because of my diabetes" C. "I do not need to watch what I eat because my diabetes is not the bad kind". D. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome (Hyperosmolar hyperglycemic syndrome (HHS) is a life-threatening syndrome that can occur in a patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis (DKA) but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. )

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? A. The patient must receive insulin therapy to prevent ketoacidosis B. The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin. C. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections D. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome

creatinine clearance (the rate at which creatinine is cleared from the blood and eliminated in the urine approximates the GFR and is the most specific test of renal function.)

Which test is most specific for renal function? A. renal scan B. serum creatinine C. creatinine clearance D. blood urea nitrogen

Urine for culture and sensitivity (A urine specimen specifically obtained for culture and sensitivity is required to diagnose pyelonephritis because it will show pyuria, the specific bacteriuria, and what drug the bacteria is sensitive to for treatment.)

Which test is required for a diagnosis of pyelonephritis? a. Renal biopsy b. Blood culture c. Intravenous pyelogram (IVP) d. Urine for culture and sensitivity

Calcium oxalate calculi (most common & small enough to get trapped in the ureter.)

Which type of urinary tract calculi are the most common and frequently obstruct the ureter? a. Cystine b. Uric acid c. Calcium oxalate d. Calcium phosphate

cloudy, yellow, RBC 5/hpf, WBC 10/hpf, pH 8.2

Which urinalysis results most likely indicate a urinary tract infection? A. cloudy, yellow, RBC 5/hpf, WBC 10/hpf, pH 8.2 B. yellow, protein 6 mg/dL. pH 6.8, 100 CFU/mL bacteria C. cloudy, brown, ammonia odor, specific gravity 1.030, RBC 3 D. clear, colorless, glucose: trace, ketones: trace, osmolality 500 mOsm/kg

Kock pouch

Which urinary diversion is a continent diversion created by formation of an ileal pouch with a stoma for catheterization? a. Kock pouch b. Ileal conduit c. Orthotopic neobladder d. Cutaneous ureterostomy

1.002 (a urine specific gravity of 1.002 is low, indicating dilute urine and the excretion of excess fluid. )

Which urine specific gravity value would indicate to the nurse that the patient is receiving excessive IV fluid therapy? A. 1.002 B. 1.010 C. 1.025 D. 1.030

1200mL

Which volume of urine in the bladder would cause discomfort and require urinary catheterization? A. 250 mL B. 500 mL C. 1200 mL D. 1500 mL

Glomerulonephritis

____________________ is primarily an immunologic problem (i.e.- diabetes, Lupus, etc.) causing an inflammatory process which damages the glomerulus (parenchyma of kidney!)

Insulin resistance

a condition in which body tissues do not respond to the action of insulin because insulin receptors are unresponsive, are insufficient in number, or both so there is a temporary increase in insulin by the pancreas- causes hyperinsulinemia AND hyperglycemia

Hyperosmolar hyperglycemic syndrome (HHS)

a life-threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

Diabetic nephropathy

a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidneys

Somogyi effect

a rebounding high blood sugar that is a response to low blood sugar.

roll

Remember to _____________ the NPH

A1C

90-day picture of blood glucose control

Midnight before the test (Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level.)

A 51-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? A. 6:00 PM on the evening before the test B. Midnight before the test C. 4:00 AM on the day of the test D. 7:00 AM on the day of the test

Cardiac monitoring to detect potassium changes (This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.)

A 65-year-old patient with type 2 diabetes has a urinary tract infection (UTI). The unlicensed assistive personnel (UAP) reported to the nurse that the patient's blood glucose is 642 mg/dL and the patient is hard to arouse. When the nurse assesses the urine, there are no ketones present. What collaborative care should the nurse expect for this patient? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI. C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration.

Eat 15 g of simple carbohydrates. (When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose.)

A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin.

renal scan

A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is: A. IVP B. VCUG C. renal scan D. loopogram

Maintaining the patient's hope

A patient has been diagnosed with early-stage breast cancer. What is most appropriate for you to focus on? A. Maintaining the patient's hope B. Preparing a will and advance directives C. Discussing replacement child care for the patient's children D. Discussing the patient's past experiences with her grandmother's cancer

chart it as a normal observation

A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucus shreds are seen in the drainage bag. The nurse should: A. notify the physician B. notify the charge nurse C. irrigate the drainage tubes D. chart it as a normal observation

monitor the glucose level at bedtime, between 2 AM and 4 AM, and on arising

A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first? a. increase the evening insulin dose to prevent the dawn phenomenon b. use a single-dose insulin regimen with an intermediate acting insuling c. monitor the glucose level at bedtime, between 2 AM and 4 AM, and on arising d. decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect

Bladder scan

A patient underwent a surgical procedure has a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What is the nurse's first action to assess for urinary retention? a. Bladder scan b. Cystometrogram c. Residual urine test d. Kidneys, ureters, bladder (KUB) x-ray

Tissue biopsy (Although other tests may be used in diagnosing the presence and extent of cancer, biopsy is the only method by which cells can be definitely determined to be malignant.)

A small lesion is discovered in a patient's lung when an x-ray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. Lung scan b. Tissue biopsy c. Oncofetal antigens in the blood d. CT or positron emission tomography (PET) scan

bacteria (bacteria in warm urine specimens multiply rapidly and false or unreliable bacterial counts may occur with urine that has been sitting for periods of time.)

A urinalysis of a urine specimen that is not processed within 1 hour may result in erroneous measurement of A. glucose b. bacteria C. specific gravity D. white blood cells

6.5

A1C for diabetic diagnosis is greater than

Impaired fasting glucose (IFG)

diagnosed when fasting blood glucose levels are 100-125 mg/dL

urinalysis and culture & sensitivity

diagnostics for UTI (cystitis)

UA/C&S, ultrasound, cystoscopy, CT, IVP (not with renal failure), labs, pH or urine (more or less acidici depending on type of stone)

diagnostics for calculi

ultrasound, CBC, UA- NOT contrast imaging

diagnostics for pyleonephritis

low acidity, calcium phosphorus (aka prelief to make urine more alkaline)

dietary changes for interstitial cystitis/painful bladder syndrome (IC/PBS)

3-4 hours

durations of rapid insulins

kidney cancer

hematuria,flank pain, palpable mass, few symptoms until metastatic may indicate

Dawn phenomenon

hyperglycemia that is present on awakening, but no hypoglycemia is present through the night (like with the somogyi effect)

Vesicants

irritants that if inadvertently infiltrated into the skin, may cause severe local tissue breakdown and necrosis.

phenazopyridine

med for pain from UTI

Metoclopramide, Ondansetron, Arepitant

meds to treat N/V from cancer treatments

4.0-11.0

normal WBC

8.5-10.0

normal calcium

96-106

normal chloride

0.6-1.2

normal creatine

70-99

normal fasting plasma glucose

3.8-5.1

normal female RBC

4.3-5.7

normal male RBC

150-400

normal platelets

3.5-5.0

normal potassium

2-4 hours

onset of intermediate insulin

3-4 hours

onset of long acting insulin

15 min

onset of rapid insulins

30-60 min

onset of regular insulin

sulfonylureas

oral diabetic medication most likely to cause hypoglycemia

200

oral glucose tolerance test result for diabetic diagnosis is greater than

Regular then Nph (I want to be an RN)

order to mix insulin

dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans, chocolate, cocoa, instant coffee, ovaltine, tea, worcestershire sauce

patients with oxalate stones should avoid

chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham

patients with purine stones should have in moderation

4-10 hours

peak of intermediate insulin

none

peak of long acting insulin

1-2 hours

peak of rapid insulins

2-4 hours

peak of regular insulin

nephrotic syndrome

peripheral edema (due to changes in oncotic pressure), proteinuria, hyperlipidemia (due to effects on liver), HTN, hypoalbuminemia (low protein in blood) indicates:

orange

phenazopyridine will turn urine

100-125 (and/or impaired glucose tolerance test)

prediabetes- impaired fasting glucose

200

random plasma glucose for diabetic diagnosis is greater than _______ with classic symptoms

Lispro (Humalog) Aspart (Novolog)

rapid insulins

Humulin-R

regular insulin

15g carb snack, check 15 min later, repeat as needed up to 3 times

rule of 15 for treating hypoglycemia

3 Ps, fatigue, infections, prolonged healing, vaginal infections, and visual changes

symptoms of T2 diabetes

Shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor, mental changes (may be sudden)

symptoms of hypoglycemia

oral glucose tolerance test

test of blood glucose in which the patient fasts then drinks a glucose liquid to see how the body uses glucose

Glomerular filtration rate

Amount of blood filtered by the glomeruli each minute (normal range is 125 mL/min)

Benign prostatic hyperplasia (BPH causes urinary stasis, which is a predisposing factor for UTIs.)

An older male patient visits his primary care provider because of burning on urination and production of foul-smelling urine. What contributing factor should the health care provider consider? a. High-purine diet b. Sedentary lifestyle c. Benign prostatic hyperplasia (BPH) d. Recent use of broad-spectrum antibiotics

A1C 9% (Lowering hemoglobin A1C (to less than 7%) reduces microvascular and neuropathic complications. Tighter glycemic control (normal hemoglobin A1C level, less than 6%) may further reduce complications but increases hypoglycemia risk. )

Analyze the following diagnostic finding for your patient with type 2 diabetes. Which result will need further assessment? A. A1C 9% B. BP 126/80 mmHg C. FBG 130mg/dL (7.2 mmol/L) D. LDL cholesterol 100 mg/dL (2.6mmol/dL)

Associated with alkaline urine

Besides being mixed with struvite or oxalate stones, what characteristic is associated with calcium phosphate calculi? a. Associated with alkaline urine b. Genetic autosomal recessive defect c. Three times as common in women as in men d. Defective gastrointestinal (GI) and kidney absorptiona.

Carcinogens

Cancer-causing agents capable or producing cell alterations. Detoxified by protective enzymes and are harmlessly excreted.

Interstitial cystitis

Chronic painful inflammatory disease of the bladder characterized by symptoms of urgency, frequency, and pain in the ladder and/or pelvis

Staging

Classifying the extent and spread of disease is termed ____________: This classification system is based on the anatomic extent of disease rather than on cell appearance.

e,f

Delegation Decision: Which nursing interventions could be delegated to unlicensed assistive personnel (UAP) (select all that apply)? a. Assess the need for catheterization. b. Use bladder scanner to estimate residual urine. c. Teach patient pelvic floor muscle (Kegel) exercises. d. Insert indwelling catheter for uncomplicated patient. e. Assist incontinent patient to commode at regular intervals. f. Provide perineal care with soap and water around a urinary catheter.

Hydronephrosis

Dilation or enlargement of the renal pelvises and calyces

decreased function of the loop of Henle and tubules

Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to: A. a decrease in bladder sensory receptors B. a decrease in the number of functioning nephrons C. decreased function of the loop of Henle and tubules D. thickening of the basement membrane of Bowman's capsule

Clear breath sounds in all lung fields (A nephrectomy incision is usually in the flank, just below the diaphragm or in the abdominal area. Although the patient is reluctant to breathe deeply because of incisional pain, the lungs should be clear. Decreased sounds and shallow respirations are abnormal and would require intervention.)

During assessment of the patient who has a nephrectomy, what should the nurse expect to find? a. Shallow, slow respirations b. Clear breath sounds in all lung fields c. Decreased breath sounds in the lower left lobe d. Decreased breath sounds in the right and left lower lobes

Radiation

Energy that is emitted from a source and travels through space or some material.

Cystometrogram

Evaluates bladder's capacity to contract and expel urine

Teletherapy

External beam radiation--most common form of radiation treatment delivery. The patient is exposed to radiation from a megavoltage treatment machine.

150

FSBS should be less than

126

Fasting plasma glucose for diabetic diagnosis is greater than

test urine for microscopic bleeding with a dipstick (bleeding from the kidney following a biopsy is the most serious complication of the procedure and urine must be examined for both gross and microscopic blood, in addition to vital signs and hematocrit levels being monitored.)

Following a renal biopsy, what is the nurse's priority? A. offer warm sitz baths to relieve discomfort B. test urine for microscopic bleeding with a dipstick C. expect the patient to experience burning on urination D. monitor the patient for symptoms of a urinary infection.

I'll know if I have sores or lesions on my feet because they will be painful

Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? A. "I should wash my feet daily with soap & warm water" B. "I should always wear shoes to protect my feet from injury" C. "If my feet are cold, I should wear socks instead of a heating pad" D. "I'll know if I have sores or lesions on my feet because they will be painful"

Nephron

Functional unit of the kidney

Glomerulonephritis

Immune related inflammation of the glomeruli characterized by proteinuria, hematuria, decreased urine production, and edema

Histologic Grading

In ________ of tumors, the appearance of cells and degree of differentiation are evaluated pathologically. For many tumor types, four grades are used to evaluate abnormal cells based on the degree to which the cells resemble the tissue of origin.

Urinary retention

Inability to empty the bladder when a person voids (micturition)

Pyelonephritis

Inflammation (usually caused by infection) of the renal parenchyma and collecting system (AKA tubules and collecting ducts)

Cystitis

Inflammation of the bladder

Cystoscopy

Inspects the interior of the bladder with a tubular lighted scope

Urinary incontinence

Involuntary leakage of urine

Nephrolithiasis

Kidney stone disease

Frequency Urgency Nocturia Dysuria Stream changes Hesitancy Incomplete Emptying Dribbling (Storage (FUND) and Voiding (SHED))

LUTS symptoms

cystitis (lower UTI)

LUTS symptoms indicate: (Frequency Urgency Nocturia Dysuria Stream changes Hesitancy Incomplete Emptying Dribbling)

Costovertebral angle

Landmark to locate kidneys formed by the rib cage and the vertebral column

Creatinine

More reliable than BUN as a determinant of renal function. End product of muscle and protein metabolism and is released at a constant rate. (normal range 0.5-1.2)

Polycystic kidney disease

Most common life-threatening genetic disease in the world. The cortex and medulla are filled with large, thin-walled cysts that are several millimeters to several centimeters in diameter

Ileal conduit

Most commonly performed incontinent urinary diversion procedure. Ileum is converted into a conduit for urinary drainage

Stricture

Narrowing of the lumen of the ureter or urethra

a,d

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply): A. nonpalpable left kidney B. auscultation of renal artery bruit C. CVA tenderness elicited by a kidney punch D. no CVA tenderness elicited by a kidney punch E. palpable bladder to the level of the pubic symphysis

Renal biopsy

Obtains renal tissue for examination to determine type of kidney disease or to follow progress of kidney disease.

Severe, colicky back pain radiating to the groin

On assessment of the patient with a renal calculus passing down the ureter, what should the nurse expect the patient to report? a. A history of chronic UTIs b. Dull, costovertebral flank pain c. Severe, colicky back pain radiating to the groin d. A feeling of bladder fullness with urgency and frequency

specific gravity of 1.035

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find: A. a pH of 8.4 B. RBCs of 4/hpf C. color: yellow, cloudy D. specific gravity of 1.035

promote early diagnosis and treatment of sore throats and skin lesions

One of the most important roles of the nurse in relation to acute poststreptococcal glomerulonephritis is to: A. promote early diagnosis and treatment of sore throats and skin lesions B. encourage patient to request antibiotic therapy for all upper respiratory infections C teach patient with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence D. monitor patient for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane

fluid shifts resulting from the osmotic effect of hyperglycemia

Polydipsia and Polyuria related to diabetes mellitus are primarily due to: A. the release of ketones from cells during fat metabolism B. fluid shifts resulting from the osmotic effect of hyperglycemia C. damage to the kidneys from exposure to high levels of glucose D. changes in RBCs resulting from attachment of excessive glucose to hemoglobin

5.7-6.4

Prediabetes A1C

Lithotripsy

Procedure used to eliminate calculi from the urinary tract. Techniques include: 1. laser 2. Extracorporeal shock-wave 3. Percutaneous ultrasonic 4. electrohydraulic lithotripsy

Nephrotic Syndrome

Results when glomerulus is excessively permeable to plasma protein, causing proteinuria that leads to low plasma albumin and tissue edema

Metastasis

Spread of cancer to a distant site. Certain cancers seem to have an affinity for a particular tissue or organ as a site of metastasis.

invade and metastasize

The ability of malignant tumor cells to _____________ and _______________is the major difference between benign and malignant neoplasms.

decreased colloidal osmotic pressure caused by loss of serum albumin

The edema that occurs in nephrotic syndrome is due to: A. increased hydrostatic pressure caused by sodium retention B. decreased aldosterone secretion from adrenal insufficiency C. increased fluid retention caused by decreased glomerular filtration D. decreased colloidal osmotic pressure caused by loss of serum albumin

"You can get a wig now to match your hair so you will not look different." (Hair loss with radiation is usually permanent.)

The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A. "When your hair grows back it will be patchy." B. "Don't use your curling iron and that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact "Look Good, Feel Better" to figure out what to do about this."

Struvite calculi (most common in women and always occur with UTIs. They are also usually large staghorn type.)

The female patient with a UTI also has renal calculi. The nurse knows that these are most likely which type of stone? a. Cystine b. Struvite c. Uric acid d. Calcium phosphate

check the bath water is not too hot

The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP) a. discuss complications of diabetes b. check the bath water is not too hot c. check the patients technique for drawing up insulin d. teach the patient to use a meter for self-monitoring of blood glucgose

A combination of treatment modalities is effective for controlling many cancers.

The goals of cancer treatment are based on what principle? A. Surgery is the single most effective treatment for cancer. B. Initial treatment is always directed toward cure of the cancer. C. A combination of treatment modalities is effective for controlling many cancers. D. Although cancer cure is rare, quality of life can be increased with treatment modalities.

mixing an evening dose of regular insulin with insulin glargine in one syringe for administration

The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator c. placing the insulin bottle currently in use in a small container on the bathroom countertop d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration

rapid respiration with deep inspirations

The nurse is assessing a newly admitted diabetic patient. Which observation should be addressed as the priority by the nurse? a. bilateral numbness of both hands b. stage II pressure ulcer on the right heel c. rapid respiration with deep inspirations d. areas of lumps and dents on the abdomen

Use 5 mL of sterile saline to irrigate. (With a nephrostomy tube, if the tube is occluded and irrigation is ordered, the nurse should use 5 mL or less of sterile saline to gently irrigate it. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.)

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving orders, what should the nurse do? a. Keep the patient on bed rest. b. Use 5 mL of sterile saline to irrigate. c. Use 30 mL of water to gently irrigate. d. Have the patient turn from side to side.

Decreased function of the loop of Henle (Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus, the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.)

The nurse is caring for an older adult patient taking bumetanide. What age-related changes does the nurse inform the patient that may be experienced? a. Benign enlargement of prostatic tissues b. Decreased sensation of bladder capacity c. Decreased function of the loop of Henle d. Less absorption in the Bowman's capsule

Excessive thirst

The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

Smoking cessation (Lung cancer is the leading cause of cancer deaths in the United States for both women and men and smoking cessation is one of the most important cancer prevention behaviors.)

The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the most important preventive action for both women and men? a. Smoking cessation b. Routine colonoscopies c. Protection from ultraviolet light d. Regular examination of reproductive organs

"Bright red bleeding is normal for a few days after the procedure."

The nurse prepares a patient for discharge after a cystoscopy. It is most important for the nurse to provide additional information in response to which patient statement? a. "I should drink plenty of fluids to prevent complications." b. "If my urine is cloudy, I should contact my health care provider." c. "Bright red bleeding is normal for a few days after the procedure." d. "Sitz baths and acetaminophen will help to reduce my discomfort."

stress incontinence

The patient complains of "wetting when she sneezes." How should the nurse document this information? A. nocturia B. Mictruition C. urge incontinence D. stress incontinence

10:30 PM to 1:30 AM (Regular insulin exerts peak action in 2 to 5 hours)

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM

a,c,e,f

The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level? Select all that apply: A. HA B. Unsteady gait C. Abdominal cramps D. Emotional changes E. Increase in uringation F. Weakness & fatigue

inability to void

The physician documented that the patient has urinary retention. How should the nurse explain this when the nursing student asks what it is? A. inability to void B. no urine formation C. large amount of urine output D. increased incidence of urination

a,e

The urinalysis of a patient reveals a high microorganism count. What data should the nurse use to determine which part of the urinary tract is infected (select all that apply.)? a. Pain location b. Fever and chills c. Mental confusion d. Urinary hesitancy e. Urethral discharge f. Postvoid dribbling

Perform pelvic floor muscle exercises 40 to 50 times per day. (kegels)

To assist the patient with stress incontinence, what is the best thing the nurse should teach the patient to do? a. Void every 2 hours to prevent leakage. b. Use absorptive perineal pads to contain urine. c. Perform pelvic floor muscle exercises 40 to 50 times per day. d. Increase intraabdominal pressure during voiding to empty the bladder completely.

acetaminophen

To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with a. aspirin b. acetaminophen c. sodium bicarbonate d. meperidine (demerol)

Plan activity & food intake related to blood glucose levels

To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? A. Plan activity & food intake related to blood glucose levels B. When blood glucose is greater than 250 mg/dL and ketones are present C. When glucose monitoring reveals that blood glucose is in the normal range D. When blood glucose levels are high, because exercise always has a hypoglycemic effect

African Americans have a higher death rate from cancer than whites.

Trends in the incidence and death rates of cancer include which of the following facts? A. Lung cancer is the most common type of cancer in men. B. A higher percentage of women than men have lung cancer. C. Breast cancer is the leading cause of cancer death in women. D. African Americans have a higher death rate from cancer than whites.

That is a good range for your glucose levels

Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 & 90 mg/dL. What is the best response by the nurse? A. "That is a good range for your glucose levels" B. "You should call your HCP because you need to have your insulin increased" C. "That level is too low in view of your recent hypoglycemia and you should increase your food intake" D. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal"

Hydroureter

Ureter dilation and distention

Immunotherapy

Uses the immune system, the body's main defense against infection and disease, to fight cancer. 1. Can boost or manipulate the immune system and create an environment that is not conductive for cancer cells to grow. 2. Attack cancer cells directly.

renal failure

When is IVP contraindicated?

Vague abdominal discomfort and disorientation

While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. What clinical manifestations is the patient most likely to experience? a. Cloudy urine and fever b. Urethral burning and bloody urine c. Vague abdominal discomfort and disorientation d. Suprapubic pain and slight decline in body temperature

INsulin takes K IN

Why does insulin cause hypokalemia?

Urethral stricture (patient with urethral stricture will benefit from being taught to dilate the urethra by self-catheterization every few days)

With which diagnosis will the patient benefit from being taught to do self-catheterization? a. Renal trauma b. Urethral stricture c. Renal artery stenosis d. Accelerated nephrosclerosis

allow her to communicate about the meaning of this experience.

You are caring for a 59-year-old woman who had surgery 1 day earlier for removal of a suspected malignant abdominal mass and who is awaiting the pathology report. The patient is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to A. motivate change in unhealthy lifestyles. B. educate her about the seven warning signs of cancer. C. instruct her about healthy stress relief and coping practices. D. allow her to communicate about the meaning of this experience.

a,d,e

You are caring for a patient with newly diagnosed type I diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (Select all that apply) A. Insulin administration B. Elimination of sugar from diet C. Need to reduce physical activity D. Use of portable blood glucose monitor E. Hyperglycemia prevention, symptoms, and treatment

Diabetes Mellitus (DM)

a chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both

metabolic syndrome

a collection of symptoms including insulin resistance, high triglycerides, decreased HDLs, increased LDLs, and HTN

indicator of inflammation

C-peptide is an

reduces glucose production by the liver and enhances glucose transport into the cell

How do Biguanides work?

increases production from the pancreas

How do sulfonylureas work?

decreases insulin need

How does weight loss help with blood glucose?

no organisms (bacteria) in urine

How is interstitial cystitis/painful bladder syndrome different from UTI?

Brachytherapy

Radiation can also be delivered as _______________, which means "close" or internal radiation treatment. It consists of the implantation or insertion of radioactive materials directly into the tumor (interstitial) or in close proximity to the tumor (intracavitary or intraluminal).

Calculus

Refers to the stone (lithiasis refers to the formation of the stone)

pyleonephritis (upper UTI)

back/flank pain, fever, chills, malaise, N/V, anorexia indicate:

It is more difficult to achieve strict glucose control than in younger patients

A 72-yr-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? A. It is more difficult to achieve strict glucose control than in younger patients B. Treatment is not warranted unless the patient develops severe hyperglycemia C. It does not include treatment with insulin because of limited dexterity and vision D. It usually requires that a younger family member be responsible for care of the patient

Rapid, deep respirations (Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the urine or blood.)

A diabetic patient has a serum glucose level of 824mg/dL (45.7 mol/dL) and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of A. polyuria B. Severe hydration C. Rapid, deep respirations D. Decreased serum potassium

Drink at least 2 quarts of water every day.

A female patient with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding prevention of recurrence. What should the nurse include in the teaching plan instructions for this patient? a. Empty the bladder at least 4 times a day. b. Drink at least 2 quarts of water every day. c. Wait to urinate until the urge is very intense. d. Clean the urinary meatus with an antiinfective agent after voiding.

Cancer

A group of diseases characterized by uncontrolled and unregulated growth of cells.

Hematuria, flank pain, and palpable mass

A nurse is admitting a patient with advanced renal carcinoma. Which clinical manifestations represent the "classic triad" observed in patients with renal cancer? a. Fever, chills, and flank pain b. Hematuria, flank pain, and palpable mass c. Hematuria, proteinuria, and palpable mass d. Flank pain, palpable abdominal mass, and proteinuria

Serum creatinine 2.3 of mg/dL (normal is 0.5-1.2)

A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD) admitted for pneumonia. What laboratory finding would be consistent with decreased kidney function in this patient? a.Serum uric acid of 5.2 mg/dL b. Urine specific gravity of 1.040 c. Serum creatinine 2.3 of mg/dL d. Blood urea nitrogen (BUN) of 10 mg/dL

FPG for all individuals at age 45 and then every 3 years

A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? A. OGTT for all minority populations every year B. FPG for all individuals at age 45 and then every 3 years C. Testing people under the age of 21 for islet cell antibodies D. Testing for type 2 diabetes in all overweight or obese individuals

With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." C."With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

Measure ureteral urinary drainage every 1 to 2 hours.

A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, what is an appropriate nursing action? a. Milk or strip the catheter every 2 hours. b. Measure ureteral urinary drainage every 1 to 2 hours. c. Irrigate the catheter with 30-mL sterile saline every 4 hours. d. Encourage ambulation to promote urinary peristaltic action..

dysuria

A patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding? a. Anuria b. Dysuria c. Oliguria d. Enuresis

Come in so we can check a clean-catch urine specimen.

A patient informs the nurse that they are having burning on urination, dysuria, and frequency. What is the best response by the nurse? a. "Drink less fluid so you don't have to void so often." b. "Take some acetaminophen to decrease the discomfort." c. "Come in so we can check a clean-catch urine specimen." d. "Avoid caffeine and spicy food to decrease inflammation."

administer opioids as prescribed

A patient is admitted to the hospital with severe renal colic caused by renal lithiasis. The nurse's first priority in management of the patient is to: A. administer opioids as prescribed B. obtain supplies for straining all urine C. encourage fluid intake of 3-4L/day D keep the patient NPO in preparation for surgery

A,C,D (The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis since potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH.)

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. E. This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

a,c,d (Malnutrition does not cause sodium excretion accompanied by potassium retention; it is not a contributing factor to this patient's potassium level. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. Kidneys may have difficulty excreting potassium if renal insufficiency exists. You must consider the potential for metabolic ketoacidosis because potassium leaves the cell when hydrogen enters in an attempt to compensate for a low pH.)

A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. Which factors could contribute to this laboratory result (select all that apply)? A. The level may be increased as a result of dehydration that accompanies hyperglycemia. B. The patient may be excreting extra sodium and retaining potassium because of malnutrition. C. The level is consistent with renal insufficiency that can develop with renal nephropathy. D. The level may be raised because of metabolic ketoacidosis caused by hyperglycemia. E. The level may be raised because excess insulin is being given and causing potassium shifts.

Advise patient to experiment with spices and seasonings to enhance the flavor of food.

A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention is a priority? A. Advise the patient to eat foods that are fatty, fried, or high in calories. B. Discuss the need for parenteral or enteral feedings with the physician. C. Advise the patient to drink nutritional supplement beverage at least three times per day. D. Advise patient to experiment with spices and seasonings to enhance the flavor of food.

Temperature of 101.9° F, fatigue, and shortness of breath (Neutropenia is most common in patients receiving chemotherapy, and it can place them at serious risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.)

A patient receiving chemotherapy and irradiation for head and neck cancer has a white blood cell (WBC) count of 1.9 × 103/μL, hemoglobin level of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the complete blood cell (CBC) results, what is the most serious clinical finding? A. Cough, rhinitis, and sore throat B. Fatigue, nausea, and skin redness at site of irradiation C. Temperature of 101.9° F, fatigue, and shortness of breath D. Skin redness at site of irradiation, headache, and constipation

a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia

A patient with Type 1 diabetes uses 20 Units of Novolin 70/30 in the morning and at 6 pm. When teaching the patient about this regimen, what should the nurse emphasize? a. hypoglycemia is most likely to occur before the noon meal b. flexibility in food intake is possible because insulin is available 24 hours a day c. a set meal pattern with a bedtime snack is necessary to prevent hypoglycemia d. premeal glucose checks are required to determine needed changes in daily dosing

Prevent breast cancer

A patient with a genetic mutation of BRCA1 and a family history of breast cancer is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. What is the reason for this procedure? a. Prevent breast cancer b. Diagnose breast cancer c. Cure or control breast cancer d. Provide palliative care for untreated breast cancer

You might have pink-tinged urine and burning after your cystoscopy.

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure? a. "You might have pink-tinged urine and burning after your cystoscopy." b. "You'll need to refrain from eating or drinking after midnight the day before the test." c. "The morning of the test, you will drink some water that contains a contrast solution." d. "You'll require a urinary catheter inserted before the cystoscopy, and it will be in place for a few days."

Empty the drainage bag every 2 to 3 hours and measure the urinary output. (Urine drains continuously from an ileal conduit and the drainage bag must be emptied every 2 to 3 hours and measured to ensure adequate urinary output. Fitting for a permanent appliance is not done until the stoma shrinks to its normal size in a few weeks. With an ileal conduit, mucus is present in the urine because it is secreted by the ileal segment as a result of the irritating effect of the urine but the surgery causes paralytic ileus and the patient will be NPO for several days postoperatively. Self-catheterization is performed when patients have formation of a continent Kock pouch.)

A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, what should the nurse plan to do? a. Measure and fit the stoma for a permanent appliance. b. Encourage high oral intake to flush mucus from the conduit. c. Teach the patient to self-catheterize the stoma every 4 to 6 hours. d. Empty the drainage bag every 2 to 3 hours and measure the urinary output.

Administer the usual insulin dosage

A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms, Which advice from the nurse with be the best for this patient? A. Administer the usual insulin dosage B. Hold fluid intake until the nausea subsides C. Come to the clinic immediately for evaluation & treatment D. Monitor the blood glucose every 1-2 ours and call if it rises over 150 mg/dL

Administer glucagon 1 mg IM or SQ (If a patient with diabetes is unconscious, immediate treatment for hypoglycemia must be given to prevent brain damage, and IM or SQ adminstration of 1 mg of glucagon should be done. If the unconsciousness has another cause, such as ketosis, the rise in glucose caused by the glucagon is not as dangerous as the low glucose level. Following administration of the glucagon, the patient should be transported to a medical facility for further treatment and evaluation. Oral carbohydrates cannot be given when patients are unconscious, and insulin is contraindicated without knowledge of the patient's glucose level.)

A patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? A. Have the patient drink some orange juice B. Administer 10 U of regular insulin SQ C. Call for an ambulance to transport the patient to a medical facility D. Administer glucagon 1 mg IM or SQ

Obtain comprehensive dental care. (A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1c below 7%, and coughing and deep breathing with splinting would be important for any type of surgery, but not the priority with mitral valve replacement for this patient. )

A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? A. Avoid sick people and wash hands. B. Obtain comprehensive dental care. C. Maintain hemoglobin A1 c below 7%. D. Coughing and deep breathing with splinting

Advise the patient to discuss using herbal therapy with her HCP before using it

A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication. The patient tells the nurse she would rather control her blood sugar with herbal therapy. Which action should the nurse take? A. Teach the patient that herbal therapy is not safe and should not be used B. Advise the patient to discuss using herbal therapy with her HCP before using it C. Encourage the patient to give the prescriptive medication time to work before using herbal therapy D. Teach the patient that if she takes herbal therapy, she will have to monitor her blood sugar more often

glomerular filtration

A patient with renal disease has oliguria and a creatinine clearance of 40mL/min. These finding most directly reflect abnormal functions of: A. tubular secretion B. glomerular filtration C. capillary permeability D. concentration of filtrate

Pain with bladder filling that is transiently relieved by urination

A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis? a. Residual urine greater than 200 mL b. A large, atonic bladder on urodynamic testing c. A voiding pattern that indicates psychogenic urinary retention d. Pain with bladder filling that is transiently relieved by urination

Ciprofloxacin (This UTI is a complicated UTI because the patient has type 2 diabetes, and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin , and trimethoprim-sulfamethoxazole should be used for uncomplicated UTIs.)

A patient with type 2 diabetes is reporting a second urinary tract infections(UTI)within the past month. Which medication should the nurse expect to be ordered for the recurrent infection? a. Ciprofloxacin b. Fosfomycin c. Nitrofurantoin d. Trimethoprim-sulfamethoxazole

encouraging fluids of at least 2 to 3 L per day after nausea has subsided

A patient with ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes: A. encouraging the patient to drink fruit juices and milk B. encouraging fluids of at least 2 to 3 L per day after nausea has subsided C. irrigating the nephrostomy tube with 10mL of normal saline as needed D. notifying the physician if tube drainage is more than 30mL/hr

Kussmaul respirations (In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. )

A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations

collection and drainage of urine from the kidney

A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with: A. the structural support of the kidney B. regulation of the concentration of urine C. the entry and exit of blood vessels at the kidney D. collection and drainage of urine from the kidney

Use a wick to keep the skin dry during appliance changes. (Because the stoma continuously drains urine, a wick formed of a rolled-up 4 × 4 gauze or a tampon is held against the stoma to absorb the urine while the skin is cleaned and a new appliance is attached. The skin is cleaned with warm water only because soap and other agents cause drying and irritation and clean, not sterile, technique is used. The appliance should be left in place for as long as possible before it loosens and allows leakage onto the skin, perhaps up to 14 days.)

A teaching plan developed by the nurse for the patient with a new ileal conduit includes instructions to do what? a. Clean the skin around the stoma with alcohol every day. b. Use a wick to keep the skin dry during appliance changes. c. Use sterile supplies and technique during care of the stoma. d. Change the appliance every day and wash it with soap and warm water.

Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days (Unless a patient has a history of recurrent UTIs or a complicated UTI, trimethoprim-sulfamethoxazole (TMP- SMX) or nitrofurantoin (Macrodantin) is usually used to empirically treat an initial UTI without a culture and sensitivity or other testing. Asymptomatic bacteriuria does not justify treatment but symptomatic UTIs should always be treated.)

A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate bacteriuria. What should the nurse anticipate for this patient? a. Obtaining a clean-catch midstream urine specimen for culture and sensitivity b. No treatment with medication unless she develops fever, chills, and flank pain c. Empirical treatment with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days d. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests

Kegel exercises

Eight months after the delivery of her first child, a 31-yr-old woman sought care for occasional incontinence when sneezing or laughing. Which measure should the nurse recommend first? a. Kegel exercises b. Use of adult incontinence pads c. Intermittent self-catheterization d. Dietary changes including fluid restriction

increase urine output with hydration therapy (Hyperkalemia and hyperuricemia are characteristic of tumor lysis syndrome, which is the result of rapid destruction of large numbers of tumor cells. Signs include hyperuricemia that causes acute kidney injury, hyperkalemia, hyperphosphatemia, and hypocalcemia. To prevent renal failure and other problems, the primary treatment includes increasing urine production using hydration therapy and decreasing uric acid concentrations using allopurinol (Zyloprim).)

During initial chemotherapy a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be to a. increase urine output with hydration therapy. b. establish electrocardiographic (ECG) monitoring. c. administer a bisphosphonate such as pamidronate (Aredia). d. restrict fluids and administer hypertonic sodium chloride solution.

cannot palpate the left kidney

During physical assessment of the urinary system, the nurse: A. cannot palpate the left kidney B. palpates an empty bladder as a small nodule C. finds a dull percussion sound when 100mL of urine is present in the bladder D. palpates above the symphysis pubis to determine the levels of urine in the bladder

a,c

During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132 mg/dL (7.33 mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which lab results (select all that apply) a. A1C of 7.5% b. glycosuria for 3+ c. FPG greater than or equal to 126 mg/dL (7.0 mmol/L) d. random blood glucose of 126 mg/dL (7.0 mmol/L) e. a 2 hour oral glucose tolerance test (OGTT) of 190 mg/dL (10.5 mmol/L)

teaching the patient to use Kegel exercises

In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes: A. teaching the patient to use Kegel exercises B. clamping and releasing a catheter to increase bladder tone C. teaching the patient biofeedback mechanisms to suppress the urge to void D. counseling the patient concerning choice of incontinence containment devices

Bladder (Intravesical regional chemotherapy is administered into the bladder via a urinary catheter)

For which type of malignancy should the nurse expect the use of the intravesical route of regional chemotherapy delivery? a. Bladder b. Leukemia c. Osteogenic sarcoma d. Metastasis to the brain

accumulation of immune complexes in the glomeruli. (Glomerulonephritis is not an infection but rather an antibody-induced injury to the glomerulus, where either autoantibodies against the glomerular basement membrane (GBM) directly damage the tissue or antibodies reacting with nonglomerular antigens are randomly deposited as immune complexes along the GBM. )

Glomerulonephritis is characterized by glomerular damage caused by a. growth of microorganisms in the glomeruli. b. release of bacterial substances toxic to the glomeruli. c. accumulation of immune complexes in the glomeruli. d. hemolysis of red blood cells circulating in the glomeruli.

an ascending infection

In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organism that causes pyelonephritis usually reached the kidneys through: A. the bloodstream B. the lymphatic system C. a descending infection D. an ascending infection

polydipsia

In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. fatigue b. polydipsia c. polyphagia d. recurrent infections

hypoxemia (erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow.)

In which clinical situation would the increased release of erythropoietin be expected? A. hypoxemia B. hypotension C. hyperkalemia D. fluid overload

accelerates the transport of amino acids into cells and their synthesis into protein

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. enhances the breakdown of adipose tissue for energy b. stimulates hepatic glycogenolysis and gluconeogenesis c. prevents the transport of triglycerides into adipose tissue d. accelerates the transport of amino acids into cells and their synthesis into protein

a,b,d

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which physiologic processes are performed by the kidneys (select all that apply.)? a. Production of renin b. Activation of vitamin D c. Carbohydrate metabolism d. Erythropoietin production e. Hemolysis of old red blood cells (RBCs)

Increased triglyceride levels (Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes.)

Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

at mealtime or within 15 minutes of meals

Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. once a day b. one hour before meals c. 30 to 45 minutes before meals d. at mealtime or within 15 minutes of meals

secondary malignancies

One possible long-term effect of radiation therapy is

Spinach, cabbage, and tomatoes (Oxalate-rich foods should be limited to reduce oxalate excretion. Foods high in oxalate include spinach, rhubarb, asparagus, cabbage, and tomatoes, in addition to chocolate, coffee, and cocoa. )

Prevention of calcium oxalate stones would include dietary restriction of which foods or drinks? a. Milk and milk products b. Dried beans and dried fruits c. Liver, kidney, and sweetbreads d. Spinach, cabbage, and tomatoes

Encourage fluid intake of 3 L/day. (A high fluid intake maintains dilute urine, which decreases bacterial concentration in addition to washing stone fragments and expected blood through the urinary system following lithotripsy. High urine output also prevents supersaturation of minerals.)

Priority Decision: Following electrohydraulic lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. What is the most appropriate nursing intervention for this patient? a. Monitor for hematuria. b. Encourage fluid intake of 3 L/day. c. Apply moist heat to the flank area. d. Strain all urine through gauze or a special strainer.

Obtain a detailed pain history including quality, location, intensity, duration, and type of pain. (The priority in pain management is to obtain a comprehensive history of the patient's pain. This will determine the medications most useful for this patient's pain to enable giving the dose that relieves the pain with the fewest side effects. Teaching the patient about the lack of tolerance and addiction associated with effective cancer pain management will also be important for this patient's pain management.)

Priority Decision: The patient with advanced cancer is having difficulty controlling her pain. She says she is afraid she will become addicted to the opioids. What is the first thing the nurse should do for this patient? a. Administer a nonsteroidal antiinflammatory drug. b. Assess the patient's vital signs and behavior to determine the medication to use. c. Have the patient keep a pain diary to better assess the patient's potential addiction. d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain.

hesitancy

The male patient is admitted with a diagnosis of benign prostatic hyperplasia. What urination characteristics should the nurse expect to assess in this patient? A. oliguria B. hesistancy c. hematuria D. pneumatiruia

use a central venous access device

The most effective method of administering a chemotherapeutic agent that is a vesicant is to a. give it orally b. give it intraarterially c. use an Ommaya reservoir d. use a central venous access device

Reduces glucose production by the liver and enhances insulin sensitivity. (Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.)

The newly diagnosed patient with type 2 diabetes has been prescribed metformin (Glucophage). What should the nurse tell the patient to best explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying.

Cleaning the puncture site with alcohol before the puncture

The nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? A. Doing the SMBG before and after exercising B. Puncturing the finger on the side of the finger pad C. Cleaning the puncture site with alcohol before the puncture D. Holding the hand down for a few minutes before the puncture

Glycosylated hemoglobin level

The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level

Venison, crab, and liver (Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation)

The nurse counsels a 64-yr-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? a. Venison, crab, and liver b. Spinach, cabbage, and tea c. Milk, yogurt, and dried fruit d. Asparagus, lentils, and chocolate

impaired glucose tolerance

The nurse determines that a patient with a 2 hour OGTT of 152 mg/dL has a. diabetes b. elevated A1C c. impaired fasting glucose d. impaired glucose tolerance

requires that use of radioactive precautions during nursing care

The nurse explains to a patient undergoing brachytherapy of the cervix that she a. must undergo simulation to locate the treatment area b. requires that use of radioactive precautions during nursing care c. may experience desquamation of the skin on the abdomen and upper legs d. requires shielding of the ovaries during treatment to prevent ovarian damage

I can help control my blood pressure by avoiding foods high in salt. (Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.)

The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "Smokeless tobacco products decrease the risk of kidney damage." B. "I can help control my blood pressure by avoiding foods high in salt." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week. (The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days per week and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.)

The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control his blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen." B. "I will go running each day when my blood sugar is too high to bring it back to normal." C. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." D. "I will take a brisk 30-minute walk 5 days per week and do resistance training 3 times a week."

a,e

The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type two diabetes. What information should be included? (select all that apply). a. maintain a healthy weight b. exercise for 60 minutes each day c. have BP checked regularly d. assess for visual changes on monthly basis e. monitor for polyuria, polyphagia, and polydipsia

White blood cells (WBCs) 9/hpf (Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference range for specific gravity is 1.003 to 1.030.)

The nurse obtained a urine specimen from a patient. What result should the nurse recognize as an abnormal finding? a. pH of 6.0 b. Amber yellow color c. Specific gravity of 1.025 d. White blood cells (WBCs) 9/hpf

Most patients with APSGN recover completely or rapidly improve with conservative management.

The nurse plans care for the patient with APSGN based on what knowledge? a. Most patients with APSGN recover completely or rapidly improve with conservative management. b. Chronic glomerulonephritis leading to renal failure is a common sequela to acute glomerulonephritis. c. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane. d. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis, resulting in kidney failure.

Oatmeal, nondairy creamer, banana, and orange juice (Patients with nephrotic syndrome should follow a low-sodium (2-3 g/day), low- to moderate-protein (0.5-0.6 g/kg/day) diet. Ham, milk products, peanut butter, and bacon are high in sodium. Eggs, milk products, and peanut butter are high in protein.)

The nurse provides nutritional counseling for a 45-yr-old man with nephrotic syndrome. The nurse determines teaching has been successful if the patient selects which breakfast menu? a. Scrambled eggs, milk, yogurt, and sliced ham b. Oatmeal, nondairy creamer, banana, and orange juice c. Cottage cheese, peanut butter, white bread, and coffee d. Waffle, bacon strips, tomato juice, and canned peaches

adult-onset polycystic renal disease

The nurse recommends genetic counseling for the children of a patient with: A. nephrotic syndrome B. chronic pyelonephritis C. malignant nephrosclerosis D. adult-onset polycystic renal disease

An insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy (When insulin is insufficient and glucose cannot be used for cellular energy, the body uses stored fats to meet energy needs. Free fatty acids from stored triglycerides are metabolized in the liver in such large quantities that ketones are formed. Ketones are acidic and alter the pH of the blood, causing acidosis. Osmotic diuresis from the elimination of both glucose and ketones in the urine causes dehydration, not ketosis. The loss of bicarbonate and skipping a meal after insulin administration do not cause ketosis.)

The nurse should observe the patient for symptoms of ketoacidosis when: A. Illnesses causing N/V lead to bicarbonate loss with body fluids. B. Glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss C. An insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy D. The patient skips meals after taking insulin, leading to rapid metabolism of glucose & breakdown of fats for energy

Implement a walking program (Walking programs scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves and help to combat the depression caused by inactivity. Ignoring the fatigue or overstressing the body can make symptoms worse and the patient should rest before activity and as necessary.)

To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program b. Ignore the fatigue as much as possible c. Do the most stressful activities when fatigue is tolerable d. Schedule rest periods throughout the day whether fatigue is present or not

Malignant Neoplasms

Tumors that have undifferentiated borders

Enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms (Biologic therapies are normal components of the immune system and are used therapeutically to restore, augment, or modulate host immune system mechanisms. They have direct antitumor effects or other biologic effects to assist in immune activity against cancer cells. Virtually all biologic therapies may cause a flu-like syndrome.)

What describes a primary use of biologic therapy in cancer treatment? a. Protect normal, rapidly reproducing cells of the gastrointestinal system from damage during chemotherapy b. Prevent the fatigue associated with chemotherapy and high-dose radiation as seen with bone marrow depression c. Enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms d. Depress the immune system and circulating lymphocytes as well as increase a sense of well-being by replacing central nervous system deficits

percusses the kidney with a firm blow at the posterior costovertebral angle (to assess for kidney tenderness, the nurse strikes the fist of one hand over the dorsum of the other hand at the posterior costovertebral angle. The upper abdominal quadrants and costovertebral angles are auscultated for vascular bruits in the renal vessesls and aorta and an empty bladder is not palpable)

What accurately describes a normal physical assessment of the urinary system by the nurse? A. auscultates the lower abdominal quadrants for fluid sounds B. palpates an empty bladder at the level of the syphysis pubis C. percusses the kidney with a firm blow at the posterior costovertebral angle D. positions the patient prone to palpate the kidneys with a posterior approach

a,b,e

What are common diagnostic studies done for a patient with severe renal colic (SATA)? A. CT scan B. urinalysis C. cytoscopy D. ureteroscopy E. abdominal ultrasound

Drink enough fluids to produce dilute urine (Because crystallization of stone constituents can precipitate and unite to form a stone when in supersaturated concentrations, one of the best ways to prevent stones of any type is by drinking adequate fluids to keep the urine dilute and flowing (e.g., an output of about 2 L of urinea day). )

What can patients at risk for renal lithiasis do to prevent the stones in many cases? a. Lead an active lifestyle b. Limit protein and acidic foods in the diet c. Drink enough fluids to produce dilute urine d. Take prophylactic antibiotics to control UTIs

The patient is a source of radiation and personnel must wear film badges during care. (Brachytherapy is the implantation or insertion of radioactive materials directly into the tumor or in proximity to the tumor and may be curative. The patient is a source of radiation and in addition to implementing the principles of time, distance, and shielding, film badges should be worn by caregivers to monitor the amount of radiation exposure.)

When a patient is undergoing brachytherapy, what is it important for the nurse to be aware of when caring for this patient? a. The patient will undergo simulation to identify and mark the field of treatment. b. The patient is a source of radiation and personnel must wear film badges during care. c. The goal of this treatment is only palliative and the patient should be aware of the expected outcome. d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue.

ureterovesical junction (ureterovesical junction is the narrowest part of the urethra and easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction, the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones.)

When a patient reports acute, severe, renal colic pain in the lower abdomen, the nurse suspects that the patient is most likely to have an obstruction at which area? a. Kidney b. Urethra c. Bladder d. Ureterovesical junction

achieving a normal weight

When caring for a patient with metabolic syndrome, what should the nurse give the highest priority to teach the patient about? a. achieving a normal weight b. performing daily aerobic exercise c. eliminating red meat from the diet d. monitoring blood glucose periodically

Salad made of fresh vegetables (Of the options listed, only salad made with fresh vegetables would be acceptable for the diet that limits sodium and protein as well as saturated fat if hyperlipidemia is present. )

When caring for a patient with nephrotic syndrome, which food selection indicates the patient understands dietary teaching? a. Peanut butter and crackers b. One small grilled pork chop c. Salad made of fresh vegetables d. Spaghetti with canned spaghetti sauce

Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation. (Calcium glycerophosphate (Prelief) alkalinizes the urine and can help to relieve the irritation from acidic foods.)

When caring for the patient with interstitial cystitis, what can the nurse teach the patient to do? a. Avoid foods that make the urine more alkaline. b. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder. c. Always keep a voiding diary to document pain, voiding frequency, and patterns of nocturia. d. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.

Smoking

When obtaining a nursing history from a patient with cancer of the urinary system, what does the nurse recognize as a risk factor associated with both kidney cancer and bladder cancer? a. Smoking b. Family history of cancer c. Chronic use of phenacetin d. Chronic, recurrent nephrolithiasis

Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects.

When teaching the patient with cancer about chemotherapy, which approach should the nurse take? a. Avoid telling the patient about possible side effects of the drugs to prevent anticipatory anxiety. b. Assure the patient that the side effects from chemotherapy are uncomfortable but never life threatening. c.Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects. d. Inform the patient that chemotherapy-related alopecia is usually permanent but can be managed with lifelong use of wigs.

consistently use the same size of insulin syringe to avoid dosing errors

When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. pull back on the plunger after inserting the needle to check for blood b. consistently use the same size of insulin syringe to avoid dosing errors c. clean the skin at the injection site with an alcohol swab before each injection d. rotate the infection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies

Secondary malignancies

When the patient asks about the late effects of chemotherapy and high-dose radiation, what areas of teaching should the nurse plan to include when describing these effects? a. Third space syndrome b. Secondary malignancies c. Chronic nausea and vomiting d. Persistent myelosuppression

a,c,e

Which are appropriate therapies for patients with diabetes mellitus? (select all that apply) A. Use of statins to treat dyslipidemia B. Use of diuretics to treat nephropathy C. Use of ACE inhibitors to treat nephropathy D. Use of serotonin agonists to decrease appetite E. Use of laser photocoagulation to treat retinopathy

fever

Which characteristic is more likely with acute pyelonephritis than with a lower UTI? a. Fever b. Dysuria c. Urgency d. Frequency

fluoroquinolones

antibiotics for complicated (not resolved) UTIs

Diabetic retinopathy

the process of microvascular damage to the retina as a result of chronic hyperglycemia, nephropathy, and hypertension in patients with diabetes.

Chemotherapy (Anti-neoplastic therapy)

the use of chemicals as a systemic therapy for cancer.

Hematopoietic Stem Cell Transplantation (HSCT)

therapeutic approach involving of stem cells collected from the peripheral blood (previously referred to as bone marrow transplant because bone marrow was the original source of stem cells when the procedure was first developed)

daily weight, Na restriction, diuretics, moderate protein diet, infection control

treatments for nephrotic syndrome

tight glycemic control can be maintained

when teaching the patient with Type 1 diabetes, what should the nurse emphasize as the major disadvantage of using an insulin pump? a. tight glycemic control can be maintained b. errors in insulin dosing are less likely to occur c. complications of insulin therapy are prevented d. frequent blood glucose monitoring is unnecessary

fasting blood glucose result of 120 mg/dL

which lab results would indicate the patient has prediabetes? a. glucose tolerance result of 132mg/dL b. glucose tolerance result of 240 mg/dL c. fasting blood glucose result of 80 mg/dL d. fasting blood glucose result of 120 mg/dL

stimulate glucose output by the liver

why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. decrease glucose production b. stimulate glucose output by the liver c. increase glucose transport into the cells d. independently regulate glucose level in the blood