Adv Med Surg Exam 6 (Ch 51-62)

_________________ is commonly referred to as the master gland because of the influence it has on secretion of hormones by other endocrine glands

Pituitary gland

A client is coming to the office to have a growth removed by the doctor. The client asks "What does cryosurgery do to the growth?" What is the correct response? 1 Removes the entire growth 2 Through the application of extreme cold, the tissue is destroyed. 3 Freezes the growth, so the physician can remove it at the next appointment 4 Lasers the growth off

2

A client presents with blistering wounds caused by an unknown chemical agent. How should the nurse intervene? 1 Do nothing until the chemical agent is identified. 2 Irrigate the wounds with water. 3 Wash the wounds with soap and water and apply a barrier cream. 4 Insert a 20-gauge I.V. catheter and infuse normal saline solution at 150 ml/hour.

2

A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? 1 Through the bloodstream (hematogenous spread) 2 By ascending infection (transurethral) 3 Due to a fistula (direct extension) 4 The result of urethra abrasion (sexual intercourse)

2

A nurse is required to monitor the effectiveness of fluid resuscitation in a client who is being treated for burns. Which of the following assessments would indicate the success of the fluid resuscitation? 1 The client's heart rate is rapid. 2 The client's urinary output is 0.5 mL/kg/hour. 3 The client's breathing is unlabored and skin is clammy. 4 The client is conscious.

2

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires: 1 Destruction of the tissue by electrical energy. 2 Removal of the tumor, layer by layer. 3 A process of deep-freezing the tumor, thawing and refreezing. 4 The use of radiation therapy.

2

During a routine checkup, a nurse observes the client's skin to be tight and shiny. Which of the following is the correct indication of this sign? 1 Sebum deficiency 2 Fluid retention 3 Dehydration 4 Protein deficiency

2

The classic lesions of impetigo manifest as 1 comedones in the facial area. 2 honey-yellow crusted lesions on an erythematous base. 3 abscess of skin and subcutaneous tissue. 4 patches of grouped vesicles on red and swollen skin.

2

The nurse is assisting with the collection of a Tzanck smear. What is the suspected diagnosis of the patient? 1 Fungal infection 2 Herpes zoster 3 Psoriasis 4 Seborrheic dermatosis

2

Which factor causes wrinkles among older adults? 1 Decrease in melanin 2 Loss of subcutaneous tissue 3 Decrease in estrogen production 4 Decrease in sebum

2

Which of the following information regarding the transmission of lice would the nurse identify as a myth? 1 Lice can be spread by sharing of hats, caps, and combs. 2 Lice can jump from one individual to another. 3 Lice need to be removed from the hair with a fine comb. 4 Lice can be seen without magnification.

2

Which of the following diagnostic tests would the nurse expect to be ordered to determine the details of the arterial supply to the kidneys? 1 Radiography 2 Angiography 3 Computed tomography (CT scan) 4 Cystoscopy

2 Angiography provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries. Radiography shows the size and position of the kidneys, ureters, and bladder. A CT scan is useful in identifying calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy is used for providing a visual examination of the internal bladder.

The nurse teaches a premenopausal female client to perform breast self-examination (BSE) at which interval? 1 With the onset of menstruation 2 On day 5 to day 7, counting the first day of menses as day 1 3 On day 2 to day 4, counting the first day of menses as day 1 4 Any time during the month

2 BSE is best performed after menses, when less fluid is retained. Because most women notice increased tenderness, lumpiness, and fluid retention before their menstrual period, BSE is not recommended with the onset of menses. Because these symptoms generally continue through menses, BSE is not recommended during that time. BSE is best performed at a time that takes menses into account.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? 1 Pitting edema of the legs 2 An irregular apical pulse 3 Dry mucous membranes 4 Frequent urination

2 Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous? 1 Eversion of the right nipple and mobile mass 2 Nonmobile mass with irregular edges 3 Mobile mass that is soft and easily delineated 4 Nonpalpable right axillary lymph nodes

2 Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction — not eversion — may be a sign of cancer.

A client has a full bladder. Which sound would the nurse expect to hear on percussion? 1 Tympany 2 Dullness 3 Resonance 4 Flatness

2 Dullness on percussion indicates a full bladder; tympany indicates an empty bladder. Resonance is heard over areas that are part air and part solid, such as the lungs. Flatness is heard over very dense tissue, such as the bone or muscle.

Which statement is true regarding endometriosis? 1 It is a malignant lesion similar to those lining the uterus. 2 It affects women of reproductive age. 3 Extensive endometriosis causes many symptoms. 4 Its cause is not linked to infertility.

2 Endometriosis affects women of reproductive age. It is a benign lesion or lesions with cells similar to those lining the uterus. Extensive endometriosis causes few symptoms. Causation has been linked to infertility.

A patient diagnosed with endometriosis asks for an explanation of the disease. What should the nurse explain to the patient? 1 She has developed an infection in the lining of her uterus. 2 Tissue from the lining of the uterus has implanted in areas outside the uterus. 3 The lining of the uterus is thicker than usual, causing heavy bleeding and cramping. 4 The lining of the uterus is too thin because endometrial tissue has implanted outside the uterus.

2 Endometriosis is a chronic disease affecting between 6% and 10% of women of reproductive age (Falcone & Lebovic, 2011) and consisting of a benign lesion or lesions that contain endometrial tissue (similar to that lining the uterus) found in the pelvic cavity outside the uterus.

The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? 1 Palpate both testicles simultaneously for comparison. 2 Palpate each testicle separately, following a warm shower. 3 Palpate the front of the testicle first, where most tumors are found. 4 Palpate for a soft, round shape with normal ridges on the testicles.

2 It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.

Based on the nurse's knowledge of the probable first indicator of prostate cancer, which of the following questions should be included in the history and physical examination? 1 "Are you waking up during the night to urinate?" 2 "Do you have any perineal discomfort?" 3 "Have you noticed a decrease in the volume of your urinary stream?" 4 "Do you have abdominal straining with urination?"

2 Perineal and rectal discomfort may be the first indicators of prostate cancer. The other choices address symptoms of BPH, not cancer metastases.

What is a hallmark of the diagnosis of nephrotic syndrome? 1 Hyponatremia 2 Proteinuria 3 Hypoalbuminemia 4 Hypokalemia

2 Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.

The nurse is obtaining the history from a client who is suspected of having pelvic inflammatory disease (PID). Which client statement would help support the suspicion of PID? 1 "My partner and I use condoms during sexual intercourse." 2 "I was 15 years old when I first had sex." 3 "I've never had any sexually transmitted infection." 4 "I haven't had sex with anyone else except my current partner."

2 Risk factors for PID include early age at first intercourse, mutliple sexual partners, frequent intercourse, intercourse without condoms, sex with a partner with a sexually transmitted infection, and a history of sexually transmitted infections or previous pelvic infections. Therefore, the statement about being 15 years old when the client first had sex suggest the presence of a risk factor that would support the suspicion of PID.

A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? 1 A GFR of 90 mL/min/1.73 m2 2 A GFR of 30-59 mL/min/1.73 m2 3 A GFR of 120 mL/min/1.73 m2 4 A GFR of 85 mL/min/1.73 m2

2 Stage 3 of chronic kidney disease is defined as having a GFR of 30-59 mL/min/1.73 m2

A client comes to the emergency department reporting severe testicular pain that started about 1 hour ago. Examination reveals a thickened spermatic cord, an elevated testis, and testicular tenderness. The nurse would interpret these findings to suggest which of the following? 1 Epididymitis 2 Testicular torsion 3 Orchitis 4 Testicular cancer

2 Testicular torsion is manifested by sudent pain in the testicle, usually developing over 1 to 2 hours, accompanied by swelling of the scrotum, testicular tenderness, elevated testis, thickened spermatic cord, and a swollen, painful scrotum. Epididymitis is manifested by low-grade fever, chills, and heaviness in the affected testicle developing over 1 to 2 days. Orchitis is manifested by fever, pain, tenederness in one or both testicles, testicular swelling, penile discharge, blood in the semen, and leukocytosis. It is common after an episode of mumps. Testicular cancer is manifested by a lump or mass on the testicle and usually painless enlargement of the testis that appears gradually.

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? 1- 0.5 lb 2- 1.0 lb 3- 1.5 lb 4- 2 lb

2 The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. A 1-kg (2-lb) weight loss is equal to 1,000 mL.

A 49-year-old woman reports that her last known menstrual cycle occurred over 1 year ago. Her records indicate gravida 0, para 0. Upon further review of the chart, the nurse notes that the client has a positive maternal history of hypertension. Moreover, the client has a positive paternal history of diabetes. With no additional significant history noted, which of the nurse's findings is consistent as a risk factor for breast cancer for this client? 1 Late menopause 2 Nulliparity 3 Family history of hypertension 4 Family history of breast cancer

2 There are a number of risk factors associated with breast cancer. This client's history indicates nulliparity, which is a risk factor for breast cancer. Late menopause (after 55 years of age) is also a risk for breast cancer, but this client experienced her last menstrual period at age 48, so this is not a risk factor for this client. Family history of breast cancer is a risk factor, but this client's history only indicates family histories of hypertension and diabetes. Other risk factors associated with breast cancer include increasing age, personal history of breast cancer, genetic mutations to BRCA1 and BRCA2, early menarche (before 12 years of age), late age at first full-term pregnancy (after 30 years of age), hormone therapy, exposure to ionizing radiation during adolescence or early adulthood, history of benign proliferative breast disease, obesity, and alcohol intake of more than one drink per day.

Which clinical finding should a nurse look for in a client with chronic renal failure? 1 Hypotension 2 Uremia 3 Metabolic alkalosis 4 Polycythemia

2 Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension, metabolic alkalosis, and polycythemia aren't present in renal failure.

A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate, I can't control it and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence? 1 Stress 2 Urge 3 Overflow 4 Functional

2 Urge incontinence occurs when the client experiences the sensation to void but cannot control voiding in time to reach a toilet. Stress incontinence occurs when the client has an involuntary loss of urine that results from a sudden increase in intra-abdominal pressure. Overflow incontinence occurs when the client experiences an involuntary loss of urine related to an over distended bladder; the client voids small amounts frequently and dribbles. Functional incontinence occurs when the client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet.

Which term is used to describe removal of breast tissue and axillary lymph node dissection leaving muscular structure intact as surgical treatment of breast cancer? 1 Segmental mastectomy 2 Modified radical mastectomy 3 Total mastectomy 4 Radical mastectomy

2 A modified radical mastectomy leaves the pectoralis major and minor muscles intact. In a segmental mastectomy, varying amounts of breast tissue are removed, including the malignant tissue and some surrounding tissue to ensure clear margins. In a total mastectomy, breast tissue only is removed. Radical mastectomy includes removal of the pectoralis major and minor muscles in addition to breast tissue and axillary lymph node dissection.

The nurse understands that a client with diabetes mellitus is at greater risk for developing which of the following complications? 1 High blood pressure 2 Urinary tract infections 3 Lifelong obesity 4 Elevated triglycerides

2 Elevated levels of blood glucose and glycosuria supports bacterial growth and places the diabetic at greater risk for urinary tract, skin, and vaginal infections. Obesity, elevated triglycerides, and high blood pressure are considered symptoms of metabolic syndrome, which can result in type 2 diabetes mellitus.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? 1 Cheyne-Stokes respirations 2 Increased urine output 3 Decreased appetite 4 Diaphoresis

2 Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.

Which test is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent? 1 Laparoscopy 2 Hysterosalpingography 3 Hysteroscopy 4 Endometrial ablation

2 Hysterosalpingography is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent. Laparoscopy allows the pelvic structures to be visualized. A hysteroscopy allows direct visualization of all parts of the uterine cavity be means of a lighted optical instrument. Endometrial ablation is the destruction of the uterine lining.

The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following? 1 Headache 2 Hypotension 3 Diaphoresis 4 Palpitations

2 The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comrpises headache, diaphoresis, and palpitations.

A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)? 1 "I've had a fever and noticed I've been running to the bathroom more often." 2 "I'm waking up at night to urinate and I've noticed some burning, too." 3 "I've had trouble getting started when I urinate, often straining to do so." 4 "I've had some pain in my lower abdomen lately and felt a bit sick to my stomach."

3

A patient will be receiving biologic dressings. The nurse understands that biologic dressings, which use skin from living or recently deceased humans, are known by what name? 1 Autografts 2 Heterografts 3 Homografts 4 Xenografts

3

The nurse examines a patient and notices a herpes simplex/zoster skin lesion. How does the nurse document this lesion? 1 Macule 2 Papule 3 Vesicle 4 Wheal

3

The nurse is caring for a client who is brought to the emergency department after being found unconscious outside in hot weather. Dehydration is suspected. Baseline lab work including a urine specific gravity is ordered. Which relation between the client's symptoms and urine specific gravity is anticipated? 1 The specific gravity will be inversely proportional 2 The specific gravity will equal to one 3 The specific gravity will be high. 4 The specific gravity will be low

3

The nurse is caring for a patient who has sustained severe burns to 50% of the body. The nurse is aware that fluid shifts during the first week of the acute phase of a burn injury cause massive cell destruction. What should the nurse report immediately when reviewing laboratory studies? 1 Hypernatremia 2 Hypokalemia 3 Hyperkalemia 4 Hypercalcemia

3

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make? 1 It is more invasive than squamous cell carcinoma (SCC). 2 It metastasizes through blood or the lymphatic system. 3 It begins as a small, waxy nodule with rolled translucent, pearly borders. 4 It is a malignant proliferation arising from the epidermis.

3

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? 1 Shopping mall 2 Swimming pool 3 College dormitory 4 Gymnasium

3

To meet early nutritional demands for protein, a 198-lb (90-kg) burned patient will need to ingest a minimum of how much protein every 24 hours? 1 90 g/day 2 110 g/day 3 180 g/day 4 270 g/day

3 2 grams per kg

A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? 1 Decreased blood urea nitrogen (BUN) 2 Increased serum albumin 3 Increased serum creatinine 4 Decreased potassium

3 In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.

The nurse is assessing a patient with a primary skin lesion called a macule. What does the nurse understand is a clinical example of this lesion? 1 Hives 2 Impetigo 3 Port-wine stains 4 Psoriasis

3 A macule is a flat, nonpalpable skin color change (color may be brown, white, tan, purple, red) less than 1 cm with a circumscribed border. Examples include freckles, flat moles, petechia, rubella, vitiligo, port wine stains, and ecchymosis.

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oopherectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following? 1 Leukopenia 2 Neurotoxicity 3 Bladder dysfunction 4 Clotting deficiencies

3 After a total abdominal hysterectomy and bilateral salpingo-oopherectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.

A client who had intracavity radiation treatment for cervical cancer 1 month earlier reports small amounts of vaginal bleeding. This finding most likely represents: 1 recurrence of the carcinoma. 2 development of a rectovaginal fistula. 3 an expected effect of the radiation therapy. 4 infection secondary to a change in vaginal flora.

3 After intracavity radiation, some vaginal bleeding occurs for 1 to 3 months. Intermittent, painless vaginal bleeding is a classic symptom of cervical cancer, but given the client's history, bleeding in more likely a result of the radiation. The passage of feces through the vagina, not vaginal bleeding, is a sign of rectovaginal fistula. Vaginal infections are indicated by various types of vaginal discharge, not vaginal bleeding.

Which assessment finding is most important in determining which client has a higher risk for developing testicular cancer? 1 Previous sexually transmitted infection (STI) 2 Low sperm count 3 Cryptorchidism as an infant 4 Family history of cancer

3 Caucasian men who have had cryptorchidism as an infant, regardless of whether an orchiopexywas performed, are at higher risk for incidence of testicular cancer. STIs, low sperm count, and family history of general cancers are not indicative of testicular cancer risk.

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? 1 Encouraging coughing and deep breathing 2 Promoting carbohydrate intake 3 Limiting fluid intake 4 Providing pain-relief measures

3 During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and IV fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? 1 Arterial pH 7.25 2 Plasma bicarbonate 12 mEq/L 3 Blood glucose level 1,100 mg/dl 4 Blood urea nitrogen (BUN) 15 mg/dl

3 HHNS occurs most frequently in older clients. It can occur in clients with either type 1 or type 2 diabetes mellitus but occurs most commonly in those with type 2. The blood glucose level rises to above 600 mg/dl in response to illness or infection. As the blood glucose level rises, the body attempts to rid itself of the excess glucose by producing urine. Initially, the client produces large quantities of urine. If fluid intake isn't increased at this time, the client becomes dehydrated, causing BUN levels to rise. Arterial pH and plasma bicarbonate levels typically remain within normal limits.

Following morning hygiene of an elderly client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome? 1 Erection of the penis 2 Unclean glans 3 Painful swelling 4 Nausea and vomiting

3 Paraphimosis results in strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans. Erection of the penis in the presence of phimosis can cause pain but is not a result of retracted foreskin. Nausea and vomiting are not indicated with retraction of foreskin.

A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms? 1 Use a pure vinegar douche daily. 2 Use skin protectants containing zinc oxide. 3 Take sitz baths frequently. 4 Avoid yogurt with active lactobacilli cultures.

3 Sitz baths are recommended to relieve the client's itching and burning as well as relieve swelling of the vulva and perineum. Skin protectants containing zinc oxide promote healing. A vinegar (1 to 2 tablespoons) and water (1 pint) douche daily may be used to combat the vaginitis when the client is symptomatic. Taking Lactobacillus acidophilus in capsule form or eating yogurt containing active cultures of lactobacilli can help restore normal vaginal microorganisms.

A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to: 1 Compromised ligament and pelvic floor support of the urethra. 2 Uninhibited detrusor contractions. 3 Loss of motor control of the detrusor muscle. 4 A stricture or tumor in the bladder.

3 Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void. These patients also experience hyperreflexia in the absence of normal sensations associated with voiding.

Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"? 1 "Don't take your insulin or oral antidiabetic agent if you don't eat." 2 "It's okay for your blood glucose to go above 300 mg/dl while you're sick." 3 "Test your blood glucose every 4 hours." 4 "Follow your regular meal plan, even if you're nauseous."

3 The nurse should instruct a client with diabetes mellitus to check his blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when he's sick. If the client's blood glucose level rises above 300 mg/dl, he should call his physician immediately. If the client is unable to follow the regular meal plan because of nausea, he should substitute soft foods, such as gelatin, soup, and custard.

The nurse is outlining the female internal reproductive structures on a diagram. Where on the diagram would the nurse highlight the typical site of ovum fertilization? 1 The nurse would highlight the uterus. 2 The nurse would highlight the cervix. 3 The nurse would highlight the fallopian tube. 4 The nurse would highlight the ovaries.

3 The nurse would highlight the fallopian tubes as the site of ovum fertilization. Once fertilized, the fertilized egg moves to the uterus for implantation. The cervix is the lower, narrowed neck portion leading to the center of the uterus. The ovaries release the ovum, which is swept into the fallopian tubes.

The nurse is providing preoperative instruction for a patient who will be having an excisional breast biopsy. The patient asks the nurse what type of bra should be used after the procedure. What should the nurse inform the patient? 1 The patient should avoid the use of a bra for 24 hours after the procedure. 2 The patient may wear a bra as long as it is an underwire bra. 3 The patient should wear a supportive bra after the procedure. 4 The patient will not be able to wear a bra until the sutures are removed.

3 The use of a supportive bra following surgery is encouraged to limit movement of the breast and reduce discomfort.

A female client presents to the health clinic for a routine physical examination. The nurse observes that the client's urine is bright yellow. Which question is most appropriate for the nurse to ask the client? 1 "Have you noticed any vaginal bleeding?" 2 "Do you take phenytoin daily?" 3 "Do you take multiple vitamin preparations?" 4 "Have you had a recent urinary tract infection?"

3 Urine that is bright yellow is an anticipated abnormal finding in the client taking a multivitamin preparation. Urine that is orange may be caused by intake of phenytoin or other medications. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female client, the use of vaginal creams.

Which is the main cause of anemia in a client with active uterine leiomyoma? 1 Poor intake of foods containing iron 2 Hemolysis 3 Menorrhagia 4 Pressure of the fibroid on the pelvic veins

3 Uterine leiomyomas or fibroids cause menorrhagia, which in turn can cause anemia. Poor dietary intake of iron does not cause anemia but aggravates the problem. Though there can be a feeling of pressure in the pelvic region, this does not cause anemia.

Laboratory studies indicate a client's blood glucose level is 185 mg/dl. Two hours have passed since the client ate breakfast. Which test would yield the most conclusive diagnostic information about the client's glucose use? 1 Fasting blood glucose test 2 6-hour glucose tolerance test 3 Serum glycosylated hemoglobin (Hb A1c) 4 Urine ketones

3 Hb A1c is the most reliable indicator of glucose use because it reflects blood glucose levels for the prior 3 months. Although a fasting blood glucose test and a 6-hour glucose tolerance test yield information about a client's use of glucose, the results are influenced by such factors as whether the client recently ate breakfast. Presence of ketones in the urine also provides information about glucose use but is limited in its diagnostic significance.

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? 1 Cool, clammy skin 2 Jugular vein distention 3 Increased urine osmolarity 4 Decreased serum sodium level

3 In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: 1 iodine and thyroid-stimulating hormone (TSH). 2 thyrotropin-releasing hormone (TRH) and TSH. 3 TSH, triiodothyronine (T3), and calcitonin. 4 T3, thyroxine (T4), and calcitonin.

4

The nurse is conducting a health history when a middle-aged client states that her last menstrual period was 6 months ago. Upon further questioning, the client also states that symptoms of hot flashes and mood fluctuations. Which question should the nurse ask next? 1 "Do you feel like hurting yourself?" 2 "Are you finished having children?" 3 "When was your first menstrual period?" 4 "Are you taking any hormone replacement therapy?"

4

The nurse is differentiating between a macule and a papule when evaluating a client's skin lesion. The nurse determines that the lesion is a papule when which characteristic is noted? 1 Flat with skin color change 2 Circumscribed border 3 Greater than 1 cm in diameter 4 Elevated and palpable

4

The nurse is reviewing the results of a client's renal function study. The nurse understands that which value represent a normal BUN-to-creatinine ratio? 1- 4:1 2- 6:1 3- 8:1 4- 10:1

4

When assessing a client with partial-thickness burns over 60% of the body, which finding should the nurse report immediately? 1 Complaints of intense thirst 2 Moderate to severe pain 3 Urine output of 70 ml the first hour 4 Hoarseness of the voice

4

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: 1 sodium. 2 potassium. 3 magnesium. 4 phosphorus.

4 PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? 1 Renal angiography 2 Intravenous pyelography 3 Excretory urogram 4 Cystoscopy

4 Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.

The nurse in the gynecology clinic is interviewing a patient who informs the nurse that her mother and aunt had carcinoma of the cervix. What does the nurse recognize are two chief symptoms of early carcinoma that the patient should be questioned about? 1 Leukoplakia and metrorrhagia 2 Dyspareunia and foul-smelling vaginal discharge 3 "Strawberry" spots and menorrhagia 4 Leukorrhea and irregular vaginal bleeding or spotting

4 Early cervical cancer rarely produces symptoms. If symptoms are present, they may go unnoticed as a thin, watery vaginal discharge often noticed after intercourse or douching. When symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse occur, the disease may be advanced.

A patient who has been treated for uric acid stones is being discharged from the hospital. What type of diet does the nurse discuss with the patient? 1 Low-calcium diet 2 High-protein diet 3 Low-phosphorus diet 4 Low-purine diet

4 For uric acid stones, the patient is placed on a low-purine diet to reduce the excretion of uric acid in the urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided, and other proteins may be limited.

Which nursing question is essential when caring for a client prior to a pelvic examination? 1 "Are you sexually active?" 2 "Do you have any sexually transmitted diseases?" 3 "Would you like to have assistance to get in position for the exam?" 4 "Would you like to void at this time?"

4 Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client. Asking client history questions is completed at the beginning of the appointment. It is important to offer assistance to those who may need help in assuming the lithotomy position.

Which is a characteristic of a breast cancer mass? 1 Occurs as disseminated masses 2 Symmetrical mass 3 Tender upon palpation 4 Firm, hard, embedded in surrounding tissue

4 A characteristic of a breast cancer mass is a firm, hard, embedded lesion in surrounding tissue. It has an irregular shape, usually is not tender, and occurs as a single mass in one breast.

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following? 1 Herniation of the rectum into the vagina 2 Protrusion of intestinal wall into the vagina 3 Downward displacement of the cervix 4 Bulging of the bladder into the vagina

4 A cystocele is the bulging of the bladder into the vagina. A rectocele is a herniation of the rectum into the vagina. An enterocele is a protrusion of the intestinal wall into the vagina. An uterovaginal prolapse is the downward displacement of the cervix anywhere from low in the vagina to outside the vagina.

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? 1 Blood urea nitrogen (BUN) level of 22 mg/dl 2 Serum creatinine level of 1.2 mg/dl 3 Temperature of 100.2° F (37.8° C) 4 Urine output of 250 ml/24 hours

4 ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin? 1 Administer the total daily dosage in two doses. 2 Draw up the drug first, then add regular insulin. 3 It is rapidly absorbed and has a fast onset of action. 4 Do not mix with other insulins.

4 Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would cause precipitation. When administering glargine insulin, it is very important to read the label carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.

A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is? 1 Retinal detachment 2 Periorbital swelling 3 Bulging eyes 4 Exophthalmos

4 Exophthalmos is an abnormal bulging or protrusion of the eyes and periorbital swelling. These findings are not consistent with retinal detachment

An older adult female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse should suspect which disorder? 1 Diabetes mellitus 2 Diabetes insipidus 3 Hypoparathyroidism 4 Hyperparathyroidism

4 Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone. Clients also exhibit hypercalciuria-causing polyuria. Although clients with diabetes mellitus and diabetes insipidus have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than by polyuria.

A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? 1 Above-normal urine and serum osmolality levels 2 Below-normal urine and serum osmolality levels 3 Above-normal urine osmolality level, below-normal serum osmolality level 4 Below-normal urine osmolality level, above-normal serum osmolality level

4 In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: 1 a blood pressure of 130/70 mm Hg. 2 a blood glucose level of 130 mg/dl. 3 bradycardia. 4 a blood pressure of 176/88 mm Hg.

4 Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide. Which laboratory test is the most important for confirming this disorder? 1 Serum potassium level 2 Serum sodium level 3 Arterial blood gas (ABG) values 4 Serum osmolarity

4 Serum osmolarity is the most important test for confirming HHNS; it's also used to guide treatment strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren't as important as serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? 1 Encourage oral fluids. 2 Administer furosemide (Lasix) 20 mg IV 3 Start hemodialysis after a temporary access is obtained. 4 Start IV fluids with a normal saline solution bolus followed by a maintenance dose.

4 The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? 1 Shows damage to the kidneys 2 If risk for chronic pyelonephritis is likely 3 Reveals causative microorganisms 4 Detects calculi, cysts, or tumors

4 Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

Normal RBC count

4-6 million

An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care? 1 Application of an ostomy pouch 2 Intermittent catheterizations 3 Exercises to promote sphincter control 4 Irrigating the urinary diversion

A An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care. Intermittent catheterizations and irrigations are appropriate for a continent urinary diverse such as a Kock or Indiana pouch. Exercises to promote sphincter control are appropriate for an ureterosigmoidoscopy.

What is the outer region of the adrenal gland that is vital to life has cortisol and aldosterone?

Adrenal Cortex

what is responsible for flight or fight response and includes epinephrine and norepinephrine?

Adrenal medulla

protein in blood; maintains the proper amount of water in the blood

Albumin

The fight-or-flight response ________ your pupils, which allows more light to enter your eyes so that you can see your surroundings better _____________ your heart rate. ___________your bronchi

Dilates Increases HR Dilates bronchioles

urinary diversion in which the ureters are connected to the ileum with a stoma created on the abdominal wall

Ileal conduit

_________________ is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate.

Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate.

state in which a person experiences involuntary passage of urine that occurs soon after a strong sense of urgency to void (overactive bladder)

Urge incontinence

nosocomial infection

a disease acquired in a hospital or clinical setting UTI

neurogenic bladder

a urinary problem caused by interference with the normal nerve pathways associated with urination

Pruritus is the presence of:

an itching or burning sensation

Cystoscopy means

bladder examination

Varicella Zoster Virus

chicken pox

removal of the bladder

cystectomy

protrusion of the bladder

cystocele

Decrease in albumin can be associated with?

edema

______________ is a highly convoluted duct behind the testis, along which sperm passes to the vas deferens.

epidiymitis

Pyleonephritis

inflammation of the kidneys

Pyleonephritis means?

inflammation of the kidneys

pyelonephritis

inflammation of the renal pelvis

orchitis means?

inflammation of the testes

nephrotic syndrome

loss of large amounts of plasma protein, usually albumin, through urine due to an increased permeability of the glomerular membrane

herpes zoster

shingles

testicular torsion is what?

twisting of the spermatic cord

cryptorchidism means?

undescended testicles

A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? 1 Kidney 2 Ureter 3 Bladder 4 Urethra

1

A client is very concerned about possibly having breast cancer, especially after caring for a close family member who recently died from the disease. The nurse informs the client that the primary and most common sign of breast cancer is a: 1 painless mass in the breast, most often in the upper outer quadrant. 2 painful mass in the breast, most often in the upper outer quadrant. 3 painless mass in the breast, most often in the lower quadrant near the nipple. 4 painful mass in the breast, most often in the lower quadrant near the nipple.

1

A client who has been burned significantly is taken by air ambulance to the burn unit. What physiologic process furthers a burn injury? 1 inflammatory 2 neuroendocrine 3 intravascular fluid excess 4 hypertension

1

A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact? 1 The left kidney usually is slightly higher than the right one. 2 The kidneys are situated just above the adrenal glands. 3 The average kidney is approximately 5 cm (2 in.) long and 2 to 3 cm (0.8 to 1.2 in.) wide. 4 The kidneys lie between the 10th and 12th thoracic vertebrae.

1

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? 1 100 units of regular insulin in normal saline solution 2 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution 3 100 units of regular insulin in dextrose 5% in water 4 100 units of NPH insulin in dextrose 5% in water

1

A patient diagnosed with Addison's disease would be expected to have which of the following skin pigmentations? 1 Bronze 2 Yellow 3 Gray 4 Orange-green

1

A patient has a burn injury that has destroyed all of the dermis and extends into the subcutaneous tissue, involving the muscle. This type of burn injury would be documented as which of the following? 1 Full-thickness 2 Superficial 3 Superficial partial-thickness 4 Deep partial-thickness

1

A positive chandelier sign is indicative of which of the following? 1 Pelvic infection 2 Endometriosis 3 Uterine prolapse 4 Rectocele

1

After completing a skin assessment of an older adult patient, the nurse documents evidence of lentigines, which indicate which of the following? 1 Freckles 2 Dryness 3 Itchy spots 4 Yellowish waxy deposits

1

Development of malignant melanoma is associated with which risk factor? 1 History of severe sunburn 2 African American heritage 3 Skin that tans easily 4 Residence in the Northeast

1

Immediately after a burn injury, electrolytes need to be evaluated for a major indicator of massive cell destruction, which is: 1 Hyperkalemia. 2 Hypernatremia. 3 Hypocalcemia. 4 Hypoglycemia.

1

In a client with burns on the legs, which nursing intervention helps prevent contractures? 1 Applying knee splints 2 Elevating the foot of the bed 3 Hyperextending the client's palms 4 Performing shoulder range-of-motion exercises

1

Petechiae are associated with which of the following disorders? 1 Thrombocytopenia 2 Deep vein thrombosis 3 Pulmonary emboli 4 Acute respiratory distress syndrome (ARDS)

1

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? 1 Increases ability for glucose to get into the cell and lowers blood sugar 2 Creates an overall feeling of well-being and lowers risk of depression 3 Decreases need for pancreas to produce more cells 4 Decreases risk of developing insulin resistance and hyperglycemia

1

The nurse documents the skin color change of a dark-skinned African American patient in cardiogenic shock as: 1 Ashen gray and dull. 2 Dusky blue. 3 Reddish pink. 4 Whitish pink.

1

The nurse is caring for a client who has a type of urinary diversion that requires an external ostomy bag to collect the urine. This client has: 1 an incontinent urinary diversion. 2 a continent urinary diversion. 3 a urethroplasty. 4 a cystectomy.

1

The nurse is completing a routine urinalysis using a dipstick. The test reveals an increased specific gravity. The nurse should suspect which condition? 1 Decreased fluid intake 2 Increased fluid intake 3 Glomerulonephritis 4 Diabetes insipidus

1

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include? 1 Use shampoo with piperonyl butoxide. 2 Use shampoo with Kwell. 3 Wash clothes in cold water. 4 Disinfect brushes and combs with bleach.

1

What is the duration of regular insulin? 1 4 to 6 hours 2 3 to 5 hours 3 12 to 16 hours 4 24 hours

1

Which is the correct term for the ability of the kidneys to clear solutes from the plasma? 1 Renal clearance 2 Glomerular filtration rate 3 Specific gravity 4 Tubular secretion

1

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? 1 Azotemia 2 Proteinuria 3 Hematuria 4 Bacteremia

1

Which of the following is an age-related change associated with the renal system? 1 Renal arteries thicken 2 Kidney weight increases 3 Blood flow increase 4 Increased bladder capacity

1

Which of the following is the most common site of a nosocomial infection? 1 Urinary tract 2 Respiratory tract 3 Gastrointestinal tract 4 Skin

1

Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? 1 Ensure immunizations against infectious diseases such as mumps. 2 Engage in activities and exercises that minimize heavy lifting. 3 Encourage the consumption of foods that are rich in fat and starch. 4 Urge the limited intake of foods and fluids containing caffeine.

1

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure? 1 Increased serum creatinine level 2 Decreased serum potassium level 3 Increased red blood cell count 4 Increased serum calcium level

1 In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.

The term used to describe total urine output less than 0.5 mL/kg/hr is 1 oliguria. 2 anuria. 3 nocturia. 4 dysuria.

1 Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. The specific gravity measures urine concentration by measuring the density of urine and comparing it with the density of distilled water. Which is an example of how urine concentration is affected? 1 On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. 2 On a hot day, a person who is perspiring profusely and taking little fluid has high urine output with a low specific gravity. 3 A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has scant urine output with a high specific gravity. 4 When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity may vary widely.

1 On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity. A person who has a high fluid intake and who is not losing excessive water from perspiration, diarrhea, or vomiting has copious urine output with a low specific gravity. When the kidneys are diseased, the ability to concentrate urine may be impaired and the specific gravity remains relatively constant.

The client is admitted to the hospital with a diagnosis of acute pyelonephritis. Which clinical manifestations would the nurse expect to find? 1 Costovertebal angle tenderness 2 Suprapubic pain 3 Pain after voiding 4 Perineal pain

1 Acute pyelonephritiis is characterized by costovertebal angle tenderness. Suprapubic pain is suggestive of bladder distention or infection. Urethral trauma and irritation of the bladder neck can cause pain after voiding. Perineal pain is experienced by male clients with prostate cancer or prostatitis.

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate? 1 Albumin 2 Bacteria 3 Red blood cells 4 White blood cells

1 Albumin is one of the most important blood proteins that leak into the urine. Although small amounts may leak undetected for years, its leakage into the urine is among the earliest signs that can be detected. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria but in fewer than 5% of people without microalbuminuria. The urine should be checked annually for the presence of microalbumin.

A client is experiencing some secretion abnormalities, for which diagnostics are being performed. Which substance is typically reabsorbed and not secreted in urine? 1 glucose 2 potassium 3 creatinine 4 chloride

1 Amino acids and glucose typically are reabsorbed and not excreted in the urine. The filtrate that is secreted as urine usually contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.

A client has an edematous glans penis, pain, and an extremely constricted foreskin. What treatment would the physician likely prescribe? 1 circumcision 2 narcotic analgesics 3 increased hygienic measures 4 scrotal support

1 Circumcision is recommended to relieve phimosis and paraphimosis permanently.

Which value does the nurse recognize as the best clinical measure of renal function? 1 Creatinine clearance 2 Circulating ADH concentration 3 Volume of urine output 4 Urine-specific gravity

1 Creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

Which outcome indicates that treatment of a client with diabetes insipidus has been effective? 1 Fluid intake is less than 2,500 ml/day. 2 Urine output measures more than 200 ml/hour. 3 Blood pressure is 90/50 mm Hg. 4 Heart rate is 126 beats/minute.

1 Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

Which of the following may result if prostate cancer invades the urethra or bladder? 1 Hematuria 2 Backache 3 Hip pain 4 Rectal discomfort

1 Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.

A nurse is teaching a client about a circumision. Which external reproductive structure is removed by circumcision? 1 Prepuce 2 Glans 3 Corpora cavernosa 4 Mons pubis

1 In an uncircumcised male, the prepuce, sometimes referred to as the foreskin, that covers the glans is removed by cicumcision. The glans is the rounded head of the penis. The corpora cavernosa is erectile tissue. The mons pubis is fatty tissue near the pubic bones.

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)? 1 Presence of islet cell antibodies 2 Obesity 3 Rare ketosis 4 Requirement for oral hypoglycemic agents

1 Individuals with type 1 diabetes often have islet cell antibodies and are usually thin or demonstrate recent weight loss at the time of diagnosis. These individuals are prone to experiencing ketosis when insulin is absent and require exogenous insulin to preserve life.

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer? 1 NPH 2 Iletin II 3 Lispro (Humalog) 4 Glargine (Lantus)

1 Intermediate-acting insulins are called NPH insulin (neutral protamine Hagedorn) or Lente insulin. Lispro (Humalog) is rapid acting, Iletin II is short acting, and glargine (Lantus) is very long acting.

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? 1 Glomerulonephritis 2 Hypovolemia 3 Ureteral calculus 4 Dysrhythmia

1 Intrarenal causes of renal failure include prolonged renal ischemia, nephrotoxic agents, and infectious processes such as acute glomerulonephritis.

Which of the following is a term used to describe excessive menstrual bleeding? 1 Menorrhagia 2 Amenorrhea 3 Dysmenorrhea 4 Metrorrhagia

1 Menorrhagia is excessive menstrual bleeding. Amenorrhea is the absence of menses. Dysmenorrhea is painful menses. Metrorrhagia is excessive and prolonged menstrual bleeding.

Which of the following occurs late in chronic glomerulonephritis? 1 Peripheral neuropathy 2 Nosebleed 3 Stroke 4 Seizure

1 Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.

Which of the following is considered first-line treatment for prostate cancer? 1 Radical prostatectomy 2 Radiation 3 Hormonal therapy 4 Cryosurgery

1 Radical prostatectomy is the complete surgical removal of the prostate, seminal vesicles, and often the surrounding fat, nerves, lymph nodes and blood vessels. It is considered the standard first-line treatment for prostate cancer. If prostate cancer is detected in its early stage, the treatment may be curative radiation therapy. Hormonal therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of dihydrotestosterone.

Which of the following hormones is secreted by the juxtaglomerular apparatus? 1 Renin 2 Aldosterone 3 Antidiuretic hormone (ADH) 4 Calcitonin

1 Renin is a hormone directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus. ADH, also known as vasopressin, plays a key role in the regulation of extracellular fluid by excreting or retaining water. Calcitonin regulates calcium and phosphorous metabolism.

The nurse is reviewing the client's urinalysis results. The finding that is most suggestive of dehydration of the client is: 1 Specific gravity 1.035 2 Creatinine 0.7 mg/dL 3 Protein 15 mg/dL 4 Bright yellow urine

1 Specific gravity is reflective of hydration status. A concentrated specific gravity, such as 1.035, is suggestive of dehydration. Bright yellow urine suggests ingestion of mulitiple vitamins. Proteinuria can be benign or be caused by conditions which alter kidney function. Creatinine measures the ability of the kidney to filter the blood. A level of 0.7 is within normal limits.

Which type of biopsy is used for nonpalpable lesions found on mammography? 1 Stereotactic 2 Excisional 3 Incisional 4 Tru-Cut core

1 Stereotactic biopsy uses computer location of the suspicious area found on biopsy, followed by core needle insertion and sampling of tissue, for pathologic examination. An excisional biopsy is the usual procedure for any palpable breast mass. Incisional biopsy is performed on a palpable mass when tissue sampling alone is required. Tru-Cut core biopsy is used when a tumor is relatively large and close to the skin surface.

Sympathomimetics have which of the following effects on the body? 1 Relaxation of bladder wall 2 Decrease of heart rate 3 Constriction of bronchioles 4 Constriction of pupils

1 Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.

A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response? 1 adrenal medulla 2 thyroid gland 3 adrenal cortex 4 pineal gland

1 The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.

The opening into the vagina on the perineum is called the 1 introitus. 2 adnexa. 3 cervix. 4 hymen.

1 The introitus is the vaginal orifice. Adnexa is used to describe the fallopian tubes and ovaries together. The cervix is the bottom (interior) part of the uterus that is located in the vagina. The hymen is a tissue that may cover the vaginal opening partially or completely before vaginal penetration.

The examiner is preparing to perform a pelvic examination. Which of the following would be done first? 1 Inspection of the external genitalia 2 Inspection of the cervix 3 Specimen collection for a Pap smear 4 Bimanual palpation

1 The pelvic examination begins with inspection of the external genitalia. This is followed by a speculum examination in which the cervix is inspected and then specimens for Pap smear and other testing are obtained. As the speculum is removed, the vagina is inspected. A bimanual examination follows.

Which structure collects the spermatocytes and nourishes them until they are able to move about spontaneously? 1 epididymis 2 seminiferous tubules 3 vas deferens 4 spermatic cord

1 The spermatocytes form within the seminiferous tubules. The epididymis collects the spermatocytes from the seminiferous tubules. The spermatocytes are nourished in the epididymis until they become motile and move into the vas deferens. The vas deferens is connected to the epididymis and moves sperm along the ductal pathway. The vas deferens is joined with a network of blood vessels and nerves collectively referred to as the spermatic cord.

A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of: 1 Vulvar pruritus. 2 Dysuria. 3 Vaginal pain. 4 Dyspareunia.

1 Vulvar pruritus is the chief complaint of those diagnosed with candidiasis

The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? 1 Gigantism 2 Dwarfism 3 Acromegaly 4 Simmonds' disease

1 When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.

A client reports having to get up frequently to void in the night, or nocturia. What is not a probable cause of his problem? 1 neurogenic bladder 2 decreased renal concentrating ability 3 heart failure 4 diabetes mellitus

1 Neurogenic bladder will cause a delay, or difficulty in initiating voiding, called hesitancy. Nocturia may be caused by decreased renal concentrating ability, heart failure, diabetes mellitus, incomplete bladder emptying, excessive fluid intake at bedtime, nephrotic syndrome, or cirrhosis with ascites.

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled? 1 6.5% 2 7.5% 3 8.0% 4 8.5%

1 Normally, the level of glycosylated hemoglobin is less than 7%. Thus, a level of 6.5% would indicate that the client's blood glucose level is well controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dl. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.

Which of the following is classified as a upper urinary tract infection (UTI)? Select all that apply. 1 Acute pyelonephritis 2 Renal abscess 3 Cystitis 4 Urethritis 5 Prostatatis

1, 2 Upper UTIs include acute pyelonephritis, renal abscess, perineal abscess, chronic pyelonephritis, and interstitial nephritis. Lower UTIs include cystitis, urethritis, and prostatitis.

In which of the following renal disorders would one suspect a decreased urine specific gravity? Select all that apply 1 Diabetes insipidus 2 Glomerulonephritis 3 Severe renal damage 4 Diabetes 5 Fluid deficits

1, 2, 3 Disorders or conditions that cause decreased urine specific gravity (ie, dilute urine) include diabetes insipidus, glomerulonephritis, and severe renal damage that may cause a fixed specific gravity of 1.010. Etiologies associated with increased urine specific gravity include diabetes mellitus, patients who have recently received high density radiopaque dyes, and fluid deficit.

While assessing a patient at the clinic the nurse notes patchy, milky white spots. The nurse knows that this finding is a symptom of what? 1 Jaundice 2 Sjorgen's syndrome 3 Addison's disease 4 Vitiligo

4

Urine-specific gravity depends largely on hydration status. When fluid intake decreases, specific gravity normally _____________. With high fluid intake, specific gravity_______________.

. When fluid intake decreases, specific gravity normally increases. With high fluid intake, specific gravity decreases.

partial pressure of oxygen range

160 mmHg

When fluid intake is normal, the specific gravity of urine should be: 1 1.000 2 Less than 1.010 3 Greater than 1.025 4 1.010 to 1.025

4

Normal urine output per hour

30 mL/hr or 1-2 ml/kg/hr

energy releasing process that breaks down large molecules.

Catobolism

the person has bladder control but cannot use the toilet in time

Functional incontinence

enuresis

bed wetting

increase albumin can indicate?

dehydration

The "true skin" or second layer of skin is called the

dermis

Photochemotherapy has been used as a treatment for which of the following skin disorders? 1 Shingles 2 Psoriasis 3 Allergic dermatitis 4 Rosacea

2

Production of melanin is controlled by a hormone secreted by which gland? 1 Thyroid 2 Hypothalamus 3 Adrenal 4 Parathyroid

2

The expert nurse is assisting a novice nurse insert a Foley catheter. The novice nurse has tried unsuccessfully to insert the catheter, and the expert nurse is providing verbal guidance while spreading which area to reveal the urethral opening? 1 Labia majora and minora 2 Meatus 3 Clitoris 4 Fourchette

1 The labia majora and minora are a portion of the external genitalia and when parted reveals the urethral opening. The meatus refers to an opening or passage. The clitoris is sensitive erectile tissue considered the site of sexual pleasure. The fourchette is the area beneath the vaginal opening at the base of the labia majora.

Which hormone is secreted by the posterior pituitary? 1 Vasopressin 2 Calcitonin 2 Corticosteroids 3 Somatostatin

1 Vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication? 1 The short-acting insulin is withdrawn before the intermediate-acting insulin. 2 The intermediate-acting insulin is withdrawn before the short-acting insulin. 3 Different types of insulin are not to be mixed in the same syringe. 4 If administered immediately, there is no requirement for withdrawing one type of insulin before another.

1 When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."

A nurse is aware that after a burn injury and respiratory difficulties have been managed, the next most urgent need is to: 1 Measure hourly urinary output. 2 Replace lost fluids and electrolytes. 3 Prevent renal shutdown. 4 Monitor cardiac status.

2

A group of students are reviewing the female reproductive system in preparation for a test. Which of the following if identified by the students as an internal structure indicates successful learning? 1 Vulva 2 Labia majora 3 Mon pubis 4 Vagina

4

The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure? 1 Cortisol 2 Vasopressin 3 Albumin 4 Renin

4

The nurse is caring for a client with chronic kidney disease. The patient has gained 4 kg in the past 3 days. In milliliters, how much fluid retention does this equal? __________________

4000 1 kg= 2 lbs.= 1000 ml

partial pressure of arterial oxygen range

80-100 mm Hg

Normal GFR Range

90-120 mL/min

what is specific gravity? The higher the number the more____________?

Measures how your kidneys are functioning and concentration urine

emptying of the bladder without the sensation of the need to void (such as in spinal cord injury patients)

Reflex incontinence

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine

Expothalmos (Proptosis)

abnormal protrusion of the eyeball caused by hyperthyroidism

Aldosterone

adrenal cortex- Aldosterone

Graves disease is caused by?

an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos

A client who has undergone a surgical biopsy of a suspected breast lesion is being prepared for discharge from the ambulatory surgical center. The client is alert and oriented. Which criterion would be of least importance in determining her readiness for discharge? 1 Having a bowel movement 2 Being able to ambulate 3 Voiding an adequate amount of urine 4 Tolerating fluids by mouth

1

pruritus means?

itching