Elimination prep u
The nurse is aware that it requires approximately how many half-lives for a client to excrete a medication from the body? A. 4-5 B. 20-25 C. 50-100 D. 10-12
A. 4-5 It takes five to six half-lives to eliminate approximately 98% of a drug from the body.
What represents a pharmacokinetic phase? (Select all that apply.) A. administration B. excretion C. metabolism D. absorption E. distribution
B. excretion C. metabolism D. absorption E. distribution The pharmacokinetic phases are absorption, distribution, metabolism, and excretion. The acronym A.D.M.E. is a helpful way to remember to pharmacokinetic phases.
Which statement best reflects information about the renal system? A. The kidneys consist of two protective layers. B. Most of the fluid filtered by the kidneys is excreted. C. The system includes the kidneys and urinary tract. D. The system is primarily involved with regulating blood pressure.
C. The system includes the kidneys and urinary tract. The renal system consists of the kidneys and structures of the urinary tract: ureters, bladder, and urethra. The kidneys have three protective layers. The system has four major functions: maintaining the volume and composition of body fluids, regulating vitamin D activation, regulating blood pressure, and regulating red blood cell production. Most of the fluid that is filtered by the kidneys is returned to the body.
Which of the following is considered a bulk-forming laxative? A. Mineral oil B. Milk of Magnesia C. Dulcolax D. Metamucil
D. Metamucil Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.
A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? A. Encourage high fluid intake. B. Increase low-fat foods. C. Allow tubes to dangle freely to encourage flow. D. Apply antibiotic ointment to tube site.
A. Encourage high fluid intake. Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.
Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction? A. Failure to void for 8 or more hours B. Severe cramping C. Incontinence D. Distended abdominal area
C. Incontinence A spastic bladder condition causes inability to store urine. Incontinence would be a symptom of inability to store urine.
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? A. "I inherited this disorder from one of my parents." B. "If renal failure develops, I may need to consider dialysis." C. "The cysts can get quite large in size." D. "As long as I have one normal kidney, I should be fine."
D. "As long as I have one normal kidney, I should be fine." Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.
An adult has a serum sample taken to evaluate the BUN-creatinine ratio. Select the result that indicates a normal test. A. BUN 40 mg/dL (14.28 mmol/L) to creatinine 2 mg/dL (176.80 µmol/L) B. BUN 30 mg/dL (10.71 mmol/L) to creatinine 2.5 mg/dL (221.0 µmol/L) C. BUN 25 mg/dL (8.92 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L) D. BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L)
D. BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L) The BUN-creatinine ratio is approximately 10:1. The other results, ratios greater than 15:1, represent prerenal conditions, such as congestive heart failure and upper gastrointestinal bleeding, that produce an elevation in BUN not creatinine.
Which diagnostic study would be effective in determining direct visualization of the bladder and ureters? A. Renal angiography B. MRI C. Ultrasonography D. Cystoscope
D. Cystoscope Cystoscopic examinations can be used for direct visualization of the urethra, bladder, and ureters. Ultrasonography can be used to determine kidney size, and renal radionuclide imaging can be used to evaluate the kidney structures. Radiologic methods, such as excretory urography, provide a means by which kidney structures such as the renal calyces, pelvis, ureters, and bladder can be outlined. Other diagnostic tests include CT scans, MRI, radionuclide imaging, and renal angiography.
The nurse is caring for a client with multiple myeloma with Bence Jones proteins. With this "light chain" form of the disease, it is important for the nurse to include assessment for: A. Fever B. Secondary infection C. Urinary tract infection D. Renal disease
D. Renal disease People with light chain form of multiple myeloma have Bence Jones proteins present that are excreted in the urine and are toxic to the renal tubular structures that can lead to renal failure. Therefore, the nurse should include assessment for signs and symptoms of renal failure.
A patient is scheduled for a test with contrast to determine kidney function. What statement made by the patient should the nurse inform the physician about prior to testing? A. "I am allergic to shrimp." B. "I have had a test similar to this one in the past." C. "I take medication to help me sleep at night." D. "I don't like needles."
A. "I am allergic to shrimp." The nurse should obtain the patient's allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine.
The nurse is caring for a client who is 24 hours after gastric bypass surgery. The client has experienced four episodes of vomiting in the past 12 hours, each producing between 500 and 800 ml of bright yellow-green liquid emesis. What action should the nurse take? A. Contact health are provider for a STAT abdominal x-ray prescription. B. Request additional antiemetic medication be prescribed. C. Increase the client's intravenous fluid rate to replace losses. D. Ask client to only take clear fluids until the health care provider can assess.
A. Contact health are provider for a STAT abdominal x-ray prescription. The client is producing bilious emesis (bright yellow-green liquid emesis that resembles bile), which is a warning sign of gastrointestinal obstruction. Obstruction is a rare but serious complication of gastric bypass procedures. The nurse should request the prescription for an x-ray to investigate this possibility. The nurse should also keep the client NPO (not on clear fluids) and may increase fluids, but this is dependent on the client's hydration status and current blood pressure and urine output: information that is not provided. While antiemetic medication may be requested, the diagnosis of the bowel obstruction is most important. If an obstruction is present, the client's vomiting will not be well controlled with medication.
While studying about the process of urination, the nursing student learns that which muscle is known as the "muscle of micturition"? A. Detrusor muscle B. Trigone muscle C. Internal sphincter muscle D. External sphincter muscle
A. Detrusor muscle The detrusor muscle is the muscle of micturition. In the bladder neck is the continuation of the detrusor muscle known as the internal urethral sphincter, which acts as a sphincter when closed. The external sphincter muscle surrounds the urethra distal to the base of the bladder. There is not a trigone muscle; the trigone is the smooth triangular area that is bounded by the openings for the both ureters and the urethra.
Which is one of the primary symptoms of irritable bowel syndrome (IBS)? A. Diarrhea B. Pain C. Bloating D. Abdominal distention
A. Diarrhea The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.
The nurse working in the genitourinary clinic understands that the most common cause for women suffering from urinary incontinence is: A. pelvic organ prolapse (POP). B. obesity. C. urinary tract infection (UTI). D. estrogen replacement therapy (ERT).
A. pelvic organ prolapse (POP). The majority of the more than 13 million people in the United States who experience urinary incontinence are women with POP. Obesity and estrogen deficiency are both factors for developing POP. UTI and ERT do not cause POP.
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching? A. "If renal failure develops, I may need to consider dialysis." B. "As long as I have one normal kidney, I should be fine." C. "I inherited this disorder from one of my parents." D. "The cysts can get quite large in size."
B. "As long as I have one normal kidney, I should be fine." Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.
Nursing assessment findings reveal urinary output < 30 ml/hr, tachycardia, tachypnea, decreased hemoglobin, and acute confusion. The findings are indicative of which nursing diagnosis? A. Acute pain B. Decreased cardiac output C. Urinary retention D. Ineffective airway clearance
B. Decreased cardiac output Clinical manifestations of decreased cardiac output include tachycardia, tachypnea, urinary output < 30 ml/hr, decreased hemoglobin and hematocrit, and acute confusion.
A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client? A. Chest pain B. Nausea C. Hypotension D. Excessive tearing
B. Nausea The most common adverse reactions that are caused due to cephalosporin administration include nausea, vomiting, and diarrhea. Cephalosporin does not cause hypotension, chest pain, or excessive tearing; hypotension and chest pain are some of the adverse reactions of disulfiram.
Which of the following would a nurse classify as a prerenal cause of acute renal failure? A. Prostatic hypertrophy B. Septic shock C. Ureteral stricture D. Polycystic disease
B. Septic shock Prerenal causes of acute renal failure include hypovolemic shock, cardiogenic shock secondary to congestive heart failure, septic shock, anaphylaxis, dehydration, renal artery thrombosis or stenosis, cardiac arrest, and lethal dysrhythmias. Ureteral stricture and prostatic hypertrophy would be classified as postrenal causes. Polycystic disease is classified as an intrarenal cause of acute renal failure
A nurse is assessing a client admitted with deep partial-thickness and full-thickness burns on the face, arms, and chest. Which finding indicates a potential problem? A. Partial pressure of arterial oxygen (PaO2) value of 80 mm Hg B. Urine output of 20 ml/hour C. Rectal temperature of 100.4° F (38° C) D. White pulmonary secretions
B. Urine output of 20 ml/hour A urine output of less than 30 ml/hour in a client with burns indicates a deficient fluid volume. This client's PaO2 value falls within the normal range (80 to 100 mm Hg). White pulmonary secretions are normal. The client's rectal temperature isn't significantly elevated, and the slight increase in temperature probably results from the deficient fluid volume.
A client with urinary tract infection is prescribed phenazopyridine (Pyridium). Which of the following instructions would the nurse give the client? A. "This medication will relieve your pain." B. "This medication will prevent re-infection." C. "This medication should be taken at bedtime." D. "This will kill the organism causing the infection."
A. "This medication will relieve your pain." Phenazopyridine (Pyridium) is a urinary analgesic agent used for the treatment of burning and pain associated with UTIs.
Which nursing question is essential when caring for a client prior to a pelvic examination? A. "Would you like to void at this time?" B. "Do you have any sexually transmitted diseases?" C. "Would you like to have assistance to get in position for the exam?" D. "Are you sexually active?"
A. "Would you like to void at this time?" 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 statement accurately describes the etiology of stress incontinence? A. An increase in intra-abdominal pressure that results in involuntary urination B. The involuntary release of urine related to a strong sense of urgency C . Overactivity of the voiding reflexes related to the nervous system damage D. The decrease in smooth muscle of the bladder causing increased urination
A. An increase in intra-abdominal pressure that results in involuntary urination Stress incontinence results in involuntary passage of urine related to increased intra-abdominal pressure with coughing, sneezing, or laughing. The other options refer to the etiology of overactive/urge incontinence.
The nurse is administering a cleansing enema when the client reports cramping. What is the appropriate nursing action? A. Clamp the tube for a brief period and resume at a slower rate. B. Remove the tubing. C. Continue infusing at a faster rate to finish the enema quicker. D. Discontinue the administration of the enema
A. Clamp the tube for a brief period and resume at a slower rate. Cramping can occur with the administration of a cleansing enema. The nurse will clamp the tube for a brief period while the client takes deep breaths, and then resume the infusion, possibly at a slower rate. Other choices are incorrect, as these do not facilitate administration of the enema while providing comfort measures.
A client who is legally blind had orthopedic surgery 3 days ago and wants to urinate. She is using a walker for ambulation. It would be best for the nurse to A. Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. B. Assist the client in using a bedpan. C. Place a bedside commode next to the bed. D. Obtain assistance of another staff member and not have the client use the walker.
A. Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode When the nurse offers seating to a client with low vision or blindness, the nurse should place the client's hand on the arm of the chair. This helps to guide the client in sitting. Though placing the bedside commode next to the bed is a good idea, it is not the best choice. The nurse will encourage the client to use the bedside commode, not the bedpan, for better emptying of the urinary bladder
A patient undergoing a CT scan with contrast has a baseline creatinine level of 3 mg/dL, identifying this patient as at a high risk for developing kidney failure. What is the most effective intervention to reduce the risk of developing radiocontrast-induced nephropathy (CIN)? A. Hydrating with saline intravenously before the test B. Performing the test without contrast C. Administering Garamycin (gentamicin) prophylactically D. Administering sodium bicarbonate after the procedure
A. Hydrating with saline intravenously before the test Radiocontrast-induced nephropathy (CIN) is a major cause of hospital-acquired AKI. This is a potentially preventable condition. Baseline levels of creatinine greater than 2 mg/dL identify patients at high risk. Limiting the patient's exposure to contrast agents and nephrotoxic medications will reduce the risk of CIN (Murphy & Byrne, 2010; Rank, 2013). Administration of N-acetylcysteine and sodium bicarbonate before and during procedures reduces risk, but prehydration with saline is considered the most effective method to prevent CIN (Murphy & Byrne, 2010; Rank, 2013).
A client has a family history of polycystic kidney disease. As the nurse gathers information and completes an assessment related to a polycystic kidney diagnosis, which findings would the nurse expect to find? Select all that apply. A. Hypertension B. No renal stones C. Pain from retroperitoneal bleeding D. Normal urinalysis E. Polyuria
A. Hypertension C. Pain from retroperitoneal bleeding E. Polyuria Hypertension is present in affected clients at the time of diagnosis. Pain from retroperitoneal bleeding is caused by the size and effects of the cysts. Polyuria can occur. Urinalysis shows mild proteinuria, hematuria, and pyuria. Renal stones are common.
A nurse is describing the renal system to a client with a kidney disorder. Which structure would the nurse identify as emptying into the ureters? A. Renal pelvis B. Parenchyma C. Nephron D. Glomerulus
A. Renal pelvis The renal pelvis empties into the ureter which carries urine to the bladder for storage. The nephron consists of the glomerulus, afferent arteriole, efferent arteriole, Bowman's capsule, distal and proximal convoluted tubules, the loop of Henle, and collecting tubule. The nephron is located in the cortex and carries out the functions of the kidney. The parenchyma is made up of the cortex and medulla.
The nurse determines which is a true statement regarding older clients, considering the age-related effects on their GI system? A. They tend usually to have less control of the rectal sphincter. B. They tend to have higher physiologic reserves to compensate for fluid loss. C. They tend to have increased muscle tone and mass. D. They have no awareness of the filling reflex.
A. They tend usually to have less control of the rectal sphincter. Older adults tend to have fewer physiologic reserves to compensate for fluid loss. The older adult usually has less control of the rectal sphincter than a younger adult because of age-related changes in innervations, a diminished awareness of the filling reflex, and decreased muscle tone.
Rotavirus is most severe in children under 24 months of age. What is a typical symptom of rotavirus infection? A. Vomiting that disappears around the second day but diarrhea continues B. Fever that disappears after 7 days following antibiotic treatment C. Projectile vomiting that lasts for the course of the disease D. Mild to moderate fever that gets higher after the second day
A. Vomiting that disappears around the second day but diarrhea continues Rotavirus infection typically begins after an incubation period of less than 24 hours, with mild to moderate fever, and vomiting, followed by onset of frequent watery, stools. The fever and vomiting usually disappear on about the second day, but the diarrhea continues for 5 to 7 days. Dehydration may develop rapidly, particularly in infants.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse? A. "Painless gross hematuria is the first symptom in renal cancer." B. "Very few symptoms are associated with renal cancer." C. "Squamous cell carcinomas do not present with detectable symptoms." D. "You should have sought treatment earlier."
B. "Very few symptoms are associated with renal cancer." Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease. Adenocarcinomas are the most common renal cancer (about 80%),whereas squamous cell renal cancers are rare. It is not therapeutic to place doubt or blame for delayed diagnosis.
A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? A. At 8:00 am, with or without a specimen B. After discarding the 8:00 am specimen C. 6 hours after the urine is discarded D. With the first specimen voided after 8:00 am
B. After discarding the 8:00 am specimen A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.
A client reports having increased incidence of constipation. What can cause constipation? A. inactivity B. All options are correct. C. insufficient fiber D. emotional stress
B. All options are correct. Constipation may result from insufficient dietary fiber and water, ignoring or resisting the urge to defecate, emotional stress, use of drugs that tend to slow intestinal motility, or inactivity. It may stem from several disorders, either in the GI tract or systemically.
Which type of jaundice is the result of increased destruction of red blood cells? A. Hepatocellular B. Hemolytic C. Nonobstructive D. Obstructive
B. Hemolytic Hemolytic jaundice is the result of an increased destruction of red blood cells. Hepatocellular jaundice is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood. Obstructive jaundice resulting from extrahepatic obstruction may be caused by occlusion of the bile duct from a gall stone, inflammatory process, tumor, or pressure from an enlarged organ. Nonobstructive jaundice occurs with hepatitis.
Select the most accurate statement regarding measurements of urinary hormone. A. Drugs will not alter testing results. B. Provide a better measure of hormone levels during a designated period. C. Requires blood and urine sampling. D. Discarded samples will not alter results.
B. Provide a better measure of hormone levels during a designated period. Measurements of urinary hormone or hormone metabolite excretion often are done on a 24-hour urine sample and provide a better measure of hormone levels during that period than hormones measured in an isolated blood sample. The advantages are relative ease of obtaining urine samples and blood sampling is not required. The disadvantages are that timed urine collections often are difficult to obtain and urine samples may be accidentally discarded or inaccurately preserved; drugs or disease states that alter hormone metabolism may interfere with the test results.
The nurse is caring for a client with an indwelling urinary catheter secondary to neurogenic bladder. The nurse completes a prescription to obtain a urine specimen from the catheter. After reviewing the image, what is the most accurate narrative note the nurse would document to demonstrate the steps to obtain the urine specimen were performed appropriately? A. Cleansed access port with warm soap and water, syringe attached and aspirated 10 mL of urine and placed in specimen container. B. Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. C. Obtained urine specimen from urinary drainage bag using a syringe, client expressed no discomfort during or after the procedure, verified prescription and cleansed access port. D. Gathered supplies, checked prescription, collected urine from access port and notified health care provider at the completion of the procedure.
B. Verified prescription, cleansed access port with antiseptic swab, aspirated urine from access port into sterile specimen container, client tolerated procedure well. The nurse would ensure prescription is obtained, explain procedure to the client, use an antiseptic swab to cleanse the access port, then attach syringe and aspirate urine into the syringe. A specimen from the collecting receptacle (drainage bag) may not be fresh urine and could result in an inaccurate analysis. Always observe sterile technique while collecting a urine specimen from an indwelling catheter. Gather equipment, including a syringe, an antiseptic swab, a sterile specimen container, nonsterile gloves, and only tube tubing if needed; remember to unclamp the catheter after obtaining specimen to avoid reflux of urine into bladder.
The nurse is providing education for a client with frequent constipation about the use of bisacodyl to improve defecation. What statements made by the client indicate that the teaching is effective? Select all that apply. A. "This will help soften the stool but won't stimulate motility." B. "This will help add bulk to my stools to ease defecation." C. "I should increase my fluid intake to help with my bowel movements. D. "It will improve defecation by increasing motility." E. "Bisacodyl will cause irritation of the intestinal mucosa and increase water in the stool."
C. "I should increase my fluid intake to help with my bowel movements. D. "It will improve defecation by increasing motility." E. "Bisacodyl will cause irritation of the intestinal mucosa and increase water in the stool." Stimulant laxatives, such as bisacodyl and senna, improve defecation by increasing motility through irritation of the intestinal mucosa and increased water in the stool. Bulk-forming laxatives such as psyllium hydrophilic mucilloid work by absorbing water into the intestine to soften the stool and increasing stool bulk, but bisacodyl is not considered a bulk forming laxative. Bisacodyl is not a stool softener.
A nurse is conducting a presentation for a local women's group about urinary incontinence. During the presentation, several of the women voice statements about their beliefs related to this condition. Which statements would the nurse identify as misconceptions that need to be corrected? Select all that apply. A. "It can be corrected by surgery and other treatments." B. "It is considered a medical condition." C. "It is an acceptable part of being a woman." D. "It is a condition that cannot be prevented." E. "It is an inevitable part of aging."
C. "It is an acceptable part of being a woman." D. "It is a condition that cannot be prevented." E. "It is an inevitable part of aging." There are many misconceptions about urinary incontinence. Clients may feel that it is: inevitable and not amenable to treatment; a "normal" part of aging; and normal part of being "female"; only treatable by surgery; and a hygiene problem and not a medical condition. Incontinence is preventable, treatable, and often curable.
A nurse is planning care for a client who is taking tolterodine. Which is an appropriate nursing diagnosis that is an indication for using this drug? A. Risk for Deficient Fluid Volume related to the action of the drug B. Risk for Injury related to hyperkalemia secondary to use of the drug C. Altered Urinary Elimination related to overactive bladder D. Risk for Injury related to multiple drug therapies and drug interactions
C. Altered Urinary Elimination related to overactive bladder Altered Urinary Elimination related to overactive bladder is an appropriate nursing diagnosis for a patient taking tolterodine because the drug has a pronounced effect on bladder function. It can cause an increase in residual urine and a decrease in detrusor pressure. Risk for Injury related to multiple drug therapies and drug interactions would be associated with most diuretic drugs. Risk for Injury related to hyperkalemia would be associated with a potassium-sparing diuretic such as triamterene. Risk for Deficient Fluid Volume would be inappropriate because tolterodine interferes with bladder contraction, resulting in a decrease in urine output.
A client could experience increased urination when using which classification of medication? A. Stool softeners B. Central nervous system depressants C. Cholinergic agents D. Analgesic medications
C. Cholinergic agents Cholinergic agents stimulate the detrusor muscle, which causes more frequent urination. Analgesics act to relieve pain. Central nervous system depressants are medicines that include sedatives, tranquilizers, and hypnotics. These drugs can slow brain activity, making them useful for treating anxiety, panic, acute stress reactions, and sleep disorders. Stool softeners makes bowel movements softer and easier to pass.
The nurse is caring for a client who is scheduled for an esophagogastroduodenoscopy (EGD). What action would the nurse take to prepare the client for this procedure? A. Inform client that a chalky-tasting barium contrast mixture will be given to drink before the test. B. Provide a light meal before the test and administer two Fleet enemas. C. Ensure that the client fasts 6 to 12 hours before the test as per policy. D. Ensure that the client ingests a gallon of bowel cleanser, such as polyethylene glycol electrolyte solution, in a short period of time.
C. Ensure that the client fasts 6 to 12 hours before the test as per policy. The nurse would ensure that the client fasted 6 to 12 hours before the test as per policy. The nurse would not provide a light meal before the test, nor administer two Fleet enemas for an EGD. The client would not ingest a gallon of bowel cleanser. The nurse would not give the client a barium contrast mixture to drink.
The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs of the common complication of: A. Heart palpitations B. Gastric esophageal reflex C. Kidney Stones D. Bone fractures
C. Kidney Stones The formation of stones in one or both kidneys is caused by the increased urinary excretion of calcium and phosphorus. It occurs in more than 50% of patients with primary hyperparathyroidism. Renal damage causes the kidney stones.
The nurse is caring for a client who has excessive diarrhea. Which acid-base disturbance does the nurse anticipate will result from having excessive diarrhea? A. No change in values from normal B. An increase in bicarbonate C. Metabolic acidosis D. Increased pH value
C. Metabolic acidosis The client who has diarrhea has increased loss of bicarbonate from the intestinal tract, which results in metabolic acidosis. The pH value would be decreased, and the bicarbonate would be decreased.
The clinic nurse assesses a client taking benazepril to control hypertension. What change in the client's health status may require a change in drug therapy? A. The client is diagnosed with depression and begins taking a selective serotonin reuptake inhibitor (SSRI). B. The client is diagnosed with gastroesophageal reflux disease. C. The client's creatinine clearance is steadily declining. D. The client is treated for hepatitis A.
C. The client's creatinine clearance is steadily declining. Benazepril is an angiotensin-converting enzyme inhibitor; drugs in this class are contraindicated in the presence of impaired renal function. Mental illness, hepatic disease, or GERD are not contraindications with this drug.
Which nursing instruction is correct to provide the client following a barium enema? A. Sips of fluid may be increased if tolerated. B. An enema will be used to clear the bowel. C. The stools may be a white or clay colored. D. The client will maintain a low residue diet.
C. The stools may be a white or clay colored. It is important to instruct the client that it is normal to have a white- or clay-colored stool following the barium enema. The client should report the color of the stool to the nurse. A progression of clay colored stools to brown-colored stools should be noted. The client is prescribed a low-residue diet before the procedure. An increased fluid intake is offered to eliminate the barium from the bowel. The client is encouraged to move the bowel independently.
Which condition is an example of physiologic hyperplasia? A. Benign prostatic hyperplasia B. Skin warts C. Uterine enlargement in pregnancy D. Endometrial hyperplasia
C. Uterine enlargement in pregnancy Two common types of physiologic hyperplasia are hormonal and compensatory. Breast and uterine enlargements during pregnancy are examples of a physiologic hyperplasia. The other examples are nonphysiologic hyperplasia.
A hospital client has been scheduled for a barium enema the following morning. The nurse should anticipate what prescription for the client's bowel preparation? A. senna B. magnesium sulfate C. polyethylene glycol-electrolyte solution D. polycarbophil
C. polyethylene glycol-electrolyte solution Polyethylene glycol-electrolyte solution is often prescribed for bowel preparation before diagnostic tests. Magnesium sulfate is more commonly used for emergency situations. Senna and polycarbophil are most often used for short-term relief of constipation.
A client with Crohn's disease is to receive prednisone as part of the treatment plan. Which of the following instructions would be appropriate? A. "Once your symptoms improve, you can stop taking the drug." B. "Take the drug on an empty stomach to avoid upsetting your stomach." C. "Make sure to increase your salt intake to compensate for the loss of fluid." D. "Avoid contact with other people who might have an infection."
D. "Avoid contact with other people who might have an infection." Clients taking corticosteroids may not experience a normal immune response to infection. The client needs to monitor himself or herself for signs and symptoms of infection and to avoid situations where they may be exposed to infection, such as others who might be ill. The drug should be taken with meals to decrease gastrointestinal irritation and should be withdrawn or tapered slowly to prevent Addisonian crisis. Clients also need to limit their sodium intake or follow a low-sodium diet to minimize water retention associated with this drug.
A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs) about prevention. What statement indicates the client understands the teaching? A. "I should take a tub bath at least 3 times per week." B. "I should wipe from back to front." C. "I should empty my bladder after eating a meal." D. "I should take at least 1,000 mg of vitamin C each day."
D. "I should take at least 1,000 mg of vitamin C each day." The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. It is not sufficient to empty the bladder only after eating a meal. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTIs.
Which individual is at the highest risk of developing a urinary tract infection (UTI)? A. A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension B. A 60-year-old man with a history of cardiovascular disease who is recovering in hospital from a coronary artery bypass graft C. A 38-year-old man with high urine output due to antidiuretic hormone insufficiency D. A 30-year-old woman with poorly controlled diabetes mellitus
D. A 30-year-old woman with poorly controlled diabetes mellitus Young women as well as persons with diabetes are at high risk of UTIs. Neither postsurgical recovery nor renal failure are necessarily direct risks for UTI development, and high urine output would decrease rather than increase UTI risk.
A patient with chronic kidney failure experiences decreased levels of erythropoietin. What serious complication related to those levels should the nurse assess for when caring for this client? A. Acidosis B. Hyperkalemia C. Pericarditis D. Anemia
D. Anemia Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of RBCs, nutritional deficiencies, and the patient's tendency to bleed, particularly from the GI tract. Erythropoietin, a substance normally produced by the kidneys, stimulates bone marrow to produce RBCs (Murphy, Bennett, & Jenkins, 2010). In ESKD, erythropoietin production decreases and profound anemia results, producing fatigue, angina, and shortness of breath.
A client who underwent an anterior colporrhaphy 6 hours ago has not voided. She reports some discomfort in her suprapubic area. Which of the following would the nurse expect to do? A. Obtain an order for an analgesic. B. Apply ice to the area. C. Administer a stool softener. D. Catheterize the client.
D. Catheterize the client. After repair of a cystocele (anterior colporrhaphy), the client is encouraged to void within a few hours. If the client does not void within this period and reports discomfort or pain in the bladder region after 6 hours, the client should be catheterized to prevent pressure on the suture line. Stool softeners may be appropriate after a posterior colporrhaphy (repair of a rectocele) or repair of a complete perineal laceration. Ice can be applied locally after an external perineal repair. Because the client is post surgery, analgesics most likely would have been ordered already. In this situation, the pain is from bladder distention; relief of this distention through catheterization would subsequently relieve the client's pain.
What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? A. Come to the clinic for IV fluid therapy daily. B. Limit the fluid intake at night. C. Weigh daily. D. Consume adequate amounts of fluid.
D. Consume adequate amounts of fluid. The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.
The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug? A. Superinfections and phlebitis B. Headache and dizziness C. Lethargy and paresthesias D. Diarrhea and nausea
D. Diarrhea and nausea The most common adverse effects associated with ceftriaxone, a cephalosporin, include those affecting the GI tract, such as nausea, vomiting, diarrhea, abdominal pain, and flatulence. Headache, dizziness, lethargy, and paresthesias can occur as well as superinfections and phlebitis (with IV administration), but these are not the most common.
The nurse is teaching a client with multiple sclerosis about prevention of urinary tract infection (UTI) and renal calculi. Which nutrition recommendations by the nurse would be the most likely to reduce the risk of these conditions? A. Drink a large amount of fluids, especially milk products, and eat a diet that includes multiple sources of vitamin D. B. Eat foods and ingest fluids that will cause the urine to be less acidic. C. Eat foods containing vitamins C, D, and E, and drink at least 2 L of fluid a day. D. Increase fluids (2500 mL/day) and maintain urine acidity by drinking cranberry juice.
D. Increase fluids (2500 mL/day) and maintain urine acidity by drinking cranberry juice. Increasing fluid intake will provide an internal irrigation and dilute the urine. This will lessen the probability of renal calculi forming. Cranberry juice is helpful in acidifying the urine and lessening the incidence of cystitis. Ingesting large amounts of milk and vitamin D will not decrease incidence of a UTI or renal calculi. Foods containing vitamins will not necessarily prevent these problems, nor will less acidic urine.
A client is receiving an IV infusion of mannitol (Osmitrol) after undergoing intracranial surgery to remove a brain tumor. To confirm that this drug is producing its therapeutic effect, the nurse should consider which finding most significant? A. Decreased heart rate B. Decreased level of consciousness (LOC) C. Elevated blood pressure D. Increased urine output
D. Increased urine output The therapeutic effect of mannitol is diuresis, which is confirmed by an increased urine output. A decreased LOC and elevated blood pressure may indicate lack of therapeutic effectiveness. A decreased heart rate doesn't indicate that mannitol is effective.
A client has been diagnosed with an intestinal obstruction and has a nasogastric tube set to low continuous suction. Which acid-base disturbance is this client at risk for developing? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
D. Metabolic alkalosis Metabolic alkalosis is a clinical disturbance characterized by a high pH and a high plasma bicarbonate concentration. The most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. Gastric fluid has an acid pH, and loss of this acidic fluid increases the alkalinity of body fluids.
A client is scheduled for a renal angiography. Which of the following would be appropriate before the test? A. Monitor the client for signs of electrolyte and water imbalance. B. Assess the client's mental changes. C. Evaluate the client for periorbital edema. D. Monitor the client for an allergy to iodine contrast material.
D. Monitor the client for an allergy to iodine contrast material. A renal angiography procedure will be contraindicated if the client is allergic to iodine contrast material. Therefore, it is important for the nurse to monitor the client for an allergy to iodine contrast material. The nurse monitors the client for the signs of electrolyte and water imbalance, mental changes, and periorbital edema at any time regardless of the test being done.
A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is: A. Bisacodyl (Dulcolax) B. Psyllium (Metamucil) C. Polyethylene glycol solution (MiraLAX) D. Polyethylene glycol-electrolyte solution (NuLYTELY)
D. Polyethylene glycol-electrolyte solution (NuLYTELY) Polyethylene glycol-electrolyte solution taken orally will rapidly provoke extensive diarrhea with complete emptying of the lower intestine. Polyethylene glycol solution, bisacodyl, and psyllium work much more slowly and are useful in managing constipation.
The nurse teaches a client with renal insufficiency to limit protein intake. What is an appropriate explanation for this restriction? A. Proteins contain high amounts of sodium to excrete. B. Protein catabolism stimulates aldosterone production. C. Proteins overwork the kidneys because they cause fluid retention. D. Protein metabolism increases the need for renal excretion of acids.
D. Protein metabolism increases the need for renal excretion of acids. Fixed, or nonvolatile acids, such as sulfuric, hydrochloric, and phosphoric acid are the products of protein metabolism and are eliminated by the kidneys. In renal insufficiency and failure, the kidneys are less able to eliminate the higher amount of acid. The volatile acids such as carbon dioxide leave the body through the lungs. Proteins contain high amounts of potassium.
During a visit to the pediatrician's office, a parent inquires about toilet training the 2-year-old child. Which toilet training readiness factor should the nurse include in teaching the parent about toilet training? A. When your child can hold the urine for 4 to 5 hours. B. When you child continues playing when diapers are wet. C. When your child expresses interest in the toilet. D. When your child can recognize bladder fullness.
D. When your child can recognize bladder fullness. Toilet training usually begins around ages 2 or 3 years. Toilet training should not begin until the child is able to hold urine for 2 hours, recognizes the feeling of bladder fullness, communicates the need to void, and controls urination until seated on the toilet.
The nurse is caring for a client who has dark amber, strongly aromatic urine with nausea and vomiting. Which condition does the nurse anticipate? A. hypovolemia B. renal failure C. balanced fluids D. dehydration
D. dehydration The nurse anticipates that the client may be dehydrated, which is characterized by strongly aromatic, dark amber urine. The symptoms are not associated with hypovolemia, balanced fluids, nor renal failure.
Which clinical finding should a nurse look for in a client with chronic renal failure? A. hypotension B. polycythemia C. metabolic alkalosis D. uremia
D. uremia 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 was in labor for more than 36 hours and now reports urine leaking from her vagina. On examination the nurse would be inspecting for: A. urge incontinence fistula. B. vesicovaginal fistula. C. rectovaginal fistula. D. urethrovaginal fistula.
D. urethrovaginal fistula. The majority of genital fistulas are the result of obstetric trauma. When labor is obstructed or prolonged, this unrelieved compression causes ischemia, which causes pressure necrosis and subsequent fistula formation. A urethrovaginal fistula is formed between the urethra and vagina. Vesicovaginal fistulas occur between the bladder and genital tract. A rectovaginal fistula would occur between the rectum or sigmoid colon and vagina. Urge incontinence would result with the urine leaking from the urethra, not vagina.
A 17-year-old male has developed phimosis to the point that he is having difficulty voiding. The nurse should prepare this teenager for: A. Radiation therapy to loosen the foreskin B. Traumatic retraction of the foreskin C. Injection of lidocaine into the head of the penis D.Circumcision
D.Circumcision Phimosis refers to a tightening of the prepuce or penile foreskin that prevents its retraction over the glans. If symptomatic phimosis occurs after childhood, it can cause difficulty with voiding or sexual activity. Circumcision is then the treatment of choice. Radiation therapy is utilized for cancer treatment. Lidocaine and forceful retraction of the foreskin is not a standard treatment for phimosis
