AH2 Exam #4
A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A. Administer morphine sulfate 4 mg IV. B. Begin an infusion of metoclopramide (Reglan) 10 mg IV. C. Obtain a urine specimen for urinalysis. D. Start an infusion of 0.9% normal saline at 100 mL/hr.
A
A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient? A. "Avoid large crowds and anyone who is sick." B. "Do not take the medication if you are allergic to foods with fatty acids." C. "Expect difficulty with wound healing while you are taking this drug." D. "Monitor your blood pressure and report any significant decrease in it."
A
A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care? A. Ability of the patient and spouse to perform incision care and dressing changes B. Effective coping mechanisms for the patient and spouse after the surgical experience C. Knowledge about the patient's requested pain medications D. Understanding of the importance of keeping scheduled follow-up appointments
A
The nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems? A. Discontinues the IVFE infusion and notifies the health care provider (HCP) B. Documents the findings and continues to monitor C. Slows the rate of flow of the IVFE infusion D. Switches to total parenteral nutrition (TPN)
A
The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? A. "I take my medication only when I have symptoms." B. "I always wipe front to back." C. "I don't use bubble baths and other scented bath products." D. "I try to drink 3 liters of fluid a day."
A
Which condition may predispose a client to chronic pyelonephritis? A. Spinal cord injury B. Cardiomyopathy C. Hepatic failure D. Glomerulonephritis
A
A patient who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime? A. "Avoid all solid foods to allow complete bowel rest." B. "Consume extra fluids to replace fluid losses." C. "Take an over-the-counter antidiarrheal medication." D. "Contact your primary health care provider for an antibiotic medication."
B
An underweight client is receiving nutritional supplements to restore nutritional status. What does the nurse do to assess the effectiveness of the supplements for the client? A. Keeps an accurate and precise food and fluid intake record daily B. Makes certain the client is weighed daily at the same time C. Monitors vital signs every 4 hours and as needed D. Assesses the client's skin for evidence of breakdown weekly
B
The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A. A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4°F (37.4°C) B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C. A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D. A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed
B
When assessing the patient with benign prostatic hyperplasia (BPH), what assessment finding does the nurse anticipate? A. Rectal bleeding B. Distended bladder C. Tenderness over the kidneys D. Enlarged painful prostate gland
B
Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? A. Decreased urine output B. Decreased white blood cells in urine C. Increased red blood cell count D. Increased urine specific gravity
B
The nurse has placed an indwelling urinary catheter via sterile technique. The nurse recognizes that it is how long before bacterial colonization begins? A.12 hours B.24 hours C.48 hours D.72 hours
C
The nurse understands that the patient who has undergone a transurethral resection of the prostate (TURP) is at risk for developing which priority concern? A.Pain B.Infection C.Hemorrhage D.Bladder spasms
C
A client has undergone bariatric surgery. Which nursing intervention is the highest priority in preventing dehydration in this client? A. Ambulating the client as quickly as possible after surgery B. Applying an abdominal binder daily when the client is out of bed C. Observing for tachycardia, nausea, diarrhea, and abdominal cramping D. Providing six small feedings daily and offering fluids frequently
D
An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? A. Draw blood for a complete blood count and serum electrolytes. B. Obtain a stool specimen for culture and sensitivity. C. Administer acetaminophen (Tylenol) 650 mg rectally. D. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.
D
A patient diagnosed with ulcerative colitis (UC) is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? A. "Be aware of the signs/symptoms of toxic megacolon that we discussed." B. "If diarrhea increases, you must let your primary health care provider know." C. "You must avoid pregnancy." D. "You will need to decrease your dose of sulfasalazine (Azulfidine)."
A
The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? A. "I need to be drinking at least 1.5 to 2.5 liters of fluids every day." B. "It is a good idea for me to reduce germs by taking a tub bath daily." C. "Trying to get to the bathroom to urinate every 6 hours is important for me." D. "Urinating 1000 mL on a daily basis is a good amount for me."
A
The nurse is caring for four patients. Which patient does the nurse assess to be at greatest risk of developing a kidney stone? A.Caucasian male who is obese B.African-American female with family history of kidney stones C.Female with history of frequent urinary tract infections D.Hispanic/Latina female who eats animal protein at every meal
A
A client with benign prostatic hyperplasia is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? SELECT ALL THAT APPLY A. Avoid drugs used to treat erection problems. B. Be careful when changing positions. C. Keep all appointments for follow-up laboratory testing. D. Hearing tests will need to be conducted periodically. E. Take the medication in the afternoon.
ABC
A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? SELECT ALL THAT APPLY A. Be certain to wear sunscreen and protective clothing." B. Drink at least 3 liters of fluids every day." C. Take this drug with 8 ounces (236 ml) of water." D. Try to urinate frequently to keep your bladder empty." E. You will need to take all of this drug to get the benefits."
ABCE
What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? SELECT ALL THAT APPLY A. "Your urine will be strained after the procedure." B. "Be sure to finish all of your antibiotics." C. "Immediately call the primary health care provider if you notice bruising." D. "Remember to drink at least 3 liters of fluid a day to promote urine flow." E. "You will need to change the incisional dressing once a day."
ABD
Six months later, the patient's symptoms have not significantly improved, and he is referred to a surgeon for a transurethral resection of the prostate (TURP). Postoperatively, what are the priority nursing interventions for this patient? (Select all that apply.) ● A. Assess for signs of infection. B. Check urine output every 2 hours. C. Keep the patient on bed rest for at least 2 days. D. Remind the patient that urine will be blood-tinged. E. Administer pain and antispasmodic drugs as needed.
ABDE
The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? SELECT ALL THAT APPLY A. Dysuria B. Enuresis C. Frequency D. Nocturia E. Urgency F. Polyuria
ACDE
A client has undergone transurethral resection of the prostate (TURP). Which interventions does the nurse incorporate in this client's postoperative care? SELECT ALL THAT APPLY A. Administer antispasmodic medications. B. Encourage the client to urinate around the catheter if pressure is felt. C. Perform intermittent urinary catheterization every 4 to 6 hours. D. Place the client in a supine position with his knees flexed. E. Assist the client to mobilize as soon as permitted.
AE
After returning from transurethral resection of the prostate, the client's urine in the continuous bladder irrigation system is a burgundy color. Which client needs does the nurse anticipate after the surgeon sees the client? SELECT ALL THAT APPLY A. Antispasmodic drugs B. Emergency surgery C. Forced fluids D. Increased intermittent irrigation E. Monitoring for anemia
AE
A Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient about caring for a new ileostomy. What information is most important to include? A. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." B. "Call your primary health care provider if your stoma has a bluish or pale look." C. "Notify the primary health care provider if output from your stoma has a sweetish odor." D. "Remember that you must wear a pouch system at all times."
B
A client has a primary problem of inadequate nutrition caused by the effects of chemotherapy. The client is receiving continuous enteral feedings through a nasogastric (NG) tube. What does the RN ask the LPN/LVN to do for this client? A. Assess nutritional parameters on the client every 3 days. B. Check the residual volume of the NG tube every 4 hours. C. Monitor the client for signs and symptoms of pneumonia. D. Teach the client about the purpose of enteral feedings.
B
A nurse is teaching a patient about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advice the patient? A. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." B. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." C. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." D. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."
B
A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse expect the primary health care provider to prescribe? A. Balsalazide (Colazal) B. Loperamide (Imodium) C. Mesalamine (Asacol) D. Milk of Magnesia (MOM)
B
A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? A. Bacteria on the patient's hands B. Ingestion of parasites in the water C. Insufficient vaccinations D. Overcooked food
B
A patient has vague symptoms that indicate an acute inflammatory bowel disorder. Which signs/symptoms are most indicative of Crohn's disease (CD)? A. Abdominal pain relieved by bending the knees, constipation B. Chronic diarrhea, abdominal colicky pain, and fever C. Epigastric cramping & persistent rectal bleeding D. Hypotension with vomiting and headache
B
A patient is admitted with severe viral gastroenteritis caused by norovirus. The patient asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? A. "You may have contracted it from an infected infant." B. "You may have consumed contaminated food or water." C. "You may have come into contact with an infected animal." D. "You may have had contact with the blood of an infected person."
B
The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first? A. A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift B. A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C) C. A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it D. A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea
B
The nurse is caring for four patients. Which patient does the nurse identify as at highest risk for acute pyelonephritis? A.19-year-old male with spinal cord injury B.27-year-old female with urinary reflux C.37-year-old male with HIV infection D.44-year-old female with urinary tract stones
B
The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? SELECT ALL THAT APPLY A. Cleanse the perineum from back to front after using the bathroom. B. Try to take in 64 ounces (2 liters) of fluid each day. C. Be sure to complete the full course of antibiotics. D. If urine remains cloudy, call the clinic.
BCD
When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? SELECT ALL THAT APPLY A. Suprapubic pain B. Vomiting C. Chills D. Dysuria E. Oliguria
BCD
A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely experiencing? A. Calcium imbalance B. Fluid volume deficit C. Fluid volume overload D. Potassium imbalance
C
A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the patient with self-care? A. Instructing the patient about the use of electrolyte-containing oral rehydration products B. Administering loperamide (Imodium) 4 mg from the patient's medicine cabinet C. Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions D. Teaching the patient how to clean the perineal area after each loose stool
C
A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices? A. "Drinking carbonated beverages will help with your abdominal distress." B. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." C. "Lactose-containing foods should be reduced or eliminated from your diet." D. "Raw vegetables and high-fiber foods may help to diminish your symptoms."
C
An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action? A. Pain when coughing B. States, "I am too tired to walk very much" C. States, "I feel like the incision is splitting open" D. Temperature of 100.8°F (38.2°C).
C
The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection (UTI). What does the nurse instruct the client to do? A. "Douche—but only once a month." B. "Use only white toilet paper." C. "Wipe from front to back." D. "Wipe with the softest toilet paper available."
C
The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A. "I must avoid drinking carbonated beverages." B. "I need to douche vaginally once a week." C. "I need to drink 2½ liters of fluid every day." D. "I will not drink fluids after 8 PM each evening."
C
The patient has a prostate ultrasound and is diagnosed with BPH. The health care provider prescribes drug therapy with finasteride (Proscar). What will the nurse teach the patient about this drug? A. It will constrict the prostate gland and improve urine flow. B. This drug will interact with Viagra and increase side effects. C. It will decrease the level of dihydrotesterone (DHT) and shrink the prostate. D. It may cause postural hypotension; care should be taken when changing positions.
C
Which nursing activity illustrates proper aseptic technique during catheter care? A. Applying Betadine ointment to the perineal area after catheterization B. Irrigating the catheter daily C. Positioning the collection bag below the height of the bladder D. Sending a urine specimen to the laboratory for testing
C
An RN receives the change-of-shift report about these four clients. Which client does the nurse assess first? A. A 30-year-old admitted 2 hours ago with malnutrition associated with malabsorption syndrome B. A 45-year-old who had gastric bypass surgery and is reporting severe incisional pain C. A 50-year-old receiving total parenteral nutrition (TPN) with a blood glucose (BG) level of 300 mg/dL (16.7 mmol/L) D. A 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min
D
An older male is being evaluated for hydronephrosis. What priority health history question will the nurse ask? A."Do you have high blood pressure?" B."Have you had a recent urinary tract infection?" C."Do you have a family history of kidney disease?" D."Do you have difficulty starting and continuing urination?"
D
Hormone treatment for prostate cancer works by which action? A. Decreased blood flow to the tumor B. Destruction of the tumor C. Shrinkage of the tumor D. Suppression of the growth of the tumor
D
The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A. "I am so relieved that I can continue eating my fried fish meals every week." B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D. "I will no longer be able to have red wine with my dinner."
D
The nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately? A. Bowel sounds are not audible in all quadrants. B. Client's skin under the panniculus is excoriated. C. The client reports pain when being repositioned. D. Urine output total is 15 mL for the past 2 hours.
D
What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? A. Limit fluid intake. B. Increase caffeine consumption. C. Limit sugar intake. D. Drink about 3 liters of fluid daily.
D
When discussing care and treatment of prostate cancer with clients, it is important for the nurse to remember that the most common issue among men who have been diagnosed with prostate cancer is the alteration of which factor? A. Comfort because of surgical pain B. Mobility after treatment C. Nutrition because of radiation side effects D. Sexual function after treatment
D
Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A. Encouraging them to drink fluids B. Irrigating all catheters daily with sterile saline C. Recommending that catheters be placed in all clients D. Periodically reevaluating the need for indwelling catheters
D
Urolithiasis
stones in the urinary tract