Exam 4 adult 1

the nurse completing a physical assessment for a newly admitted pt is unable to feel either kidney on palpation. Which action should the nurse take? a. obtain urine specimen to test for hematuria b. document the information on the assessment form c. ask the patient about any history of sore throat d. ask the HCP about scheduling renal ultrasound

b. document info on assessment form

what should the nurse include in teaching an adult pt to prevent recurrence of kidney stones a. use filter to strain all urine b. drink 3000ml fluid each day c. avoid dietary sources of calcium d. choose diuretic fluids such as coffee

b. drinking 3000ml fluids day

the nurse is examining an adult patient. for what purpose would the nurse use palpation a. determine kidney function b. identify renal bruits c. checking for bladder distention d. assessing for ureteral peristalsis

c. checking for bladder distention

a patient who is taking rifampin for TB calls the clinic and reports having orange discolored urine and tears. Which response by the nurse reflects accurate knowledge about the medication and the patients illness? a. ask the patient about any visual changes in red-green color discrimination b. question the patient about any experiences of SOB, hives, or itching c. explain that orange discolored urine and tears are normal while taking this medication d. advise the patient to stop the drug and report the symptoms to the HCP

c. explain the orange discolored urine and tears are normal while taking this medication

a 72 yr old patient with a history of benign prostatic hyperplasia is admitted with acute urinary retention and elevated BUN and creatinine. Which prescribed therapy will the nurse implement first a. insert catheter b. obtain renal ultrasound c. draw CBC d. infuse NS at 50 ml/hr

a. insert catheter

a 76 yr old with benign prostatic hyperplasia is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider should the nurse implement first. a. insert indwelling catheter b. draw blood for serum creatinine c. schedule IVP d. administer lorazepam

a. insert indwelling catheter.

The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient? a. Supine with the head of the bed elevated 30 degrees b. In a high-Fowler's position with the left arm extended c. On the right side with the left arm extended above the head d. Sitting upright with the arms supported on an over bed table

d. sitting upright with the arms supported on an over bed table

the nurse is caring for a patient who smokes 2 packs a day. Which action by the nurse could help reduce the patients risk of lung cancer? a. teach the patient about the seven warning signs of cancer b. plan to monitor the patients carcinoembryonic antigen level c. teach the patient about annual chest x rays for lung cancer screening d. discuss risks associated with cigarettes during each patient encounter

D. discuss risks associated with cigarettes during each patient encounter

which finding for a patient admitted with glomerulonephritis indicates to the nurse the treatment has been effective a. urine dipstick neg for nitrites b. pt denies pain or burning with voids c. the ASO titer has decreased d. the periorbital and peripheral edema are resolved.

D. periorbital and peripheral edema are resolved

a patient hospitalized with COPD is being discharged home on O2 therapy. Which instruction should the nurse include in the discharge teaching? a. O2 can improve the quality of life b. travel is not possible with the use of O2 devices c. O2 flow should be increased if the patient has more dyspnea d. storage of O2 requires large metal tanks that last 4-6 hours

a. O2 can improve quality of life

the nurse is caring for a patient who just has a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the HCP? a. O2 sat of 88% b. BP of 155/90 c. RR 24 when lying flat d. pain level 5 with deep breathing

a. O2 sat 88%

the nurse is reviewing the medical records of 5 patients who are scheduled for their yearly physical examinations in September. Which patients should receive the inactivated influenza vaccination? a. a 76 yr old nursing home resident b. a 36 yr old female patient who is pregnant c. a 42 yr old patient who has a 15 pack-year smoking history d. a 30 yr old patient who takes corticosteroids for rheumatoid arthritis e. a 24 year old patient who has allergies to penicillin and cephalosporins

a. a 76 year old nursing home resident b. a 36 year old female patient who is pregnant d. a 30 year old patient who take corticosteroids for rheumatoid arthritis

The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

a. pap testing c. sunscreen use d. mammography e. colorectal screening

the nurse assesses a patient with chronic obstructive pulmonary disease, who has been admitted after increasing dyspnea over the past 3 days. Which finding is important for the nurse to report to the hcp? a. respirations are 36 breaths/min b. anterior-posterior chest ratio is 1:1 c. lung expansion is decreased bilaterally d. hyperresonance to percussion is present

a. respirations are 36 breaths/min

When a patient is receiving cisplatin (Platinol-AQ) chemotherapy, the nurse will monitor for which adverse effects? (Select all that apply.) a. tinnitus b. heart failure c. hearing loss d. Elevated blood urea nitrogen and creatinine levels e. Numbness or tingling in the extremities f. Elevated glucose and ketone levels

a. tinnitus c. hearing loss d. elevated blood urea nitrogen and creatinine levels e. numbness and tingling in the extremities

an older adult is receiving standard multidrug therapy for TB. Which finding should the nurse report to the HCP? a. yellow-tinged sclera b. orange colored sputum c. thickening of the fingernails d. difficulty hearing high pitched voices

a. yellow tinged sclera

what risks will the nurse plan to teach a 27 year old women who smokes 2 packs a day a. kidney stones b. bladder cancer c. bladder infection d. interstitial cystitis

b. bladder cancer

which information from a patients urinalysis requires the nurse notify the HCP a. pH 6.2 b. trace protein c. WBC 20-26/hpf d. specific gravity 1.021

c. WBC

The nurse will anticipate teaching a patient with nephrotic syndrome who develops flank pain about treatment with a. antibiotics. b. antifungals. c. anticoagulants. d. antihypertensives.

c. anticoagulants

the nurse teaches a patient who has asthma about peak flowmeter use. Which action by the patient indicates the teaching was successful a. the patient inhales rapidly through the mouth piece b. the patient takes montelukast for peak flows in the red zone c. the patient uses albuterol for peak flows in the yellow zone d. the patient calls the HCP when peak flow is in the green zone

c. the patient uses albuterol for peak flows in the yellow zone

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB and has never had a positive test before. Which information should the occupational health nurse plan to teach the staff nurse? a. Standard four-drug therapy for TB b. Need for annual repeat TB skin testing c. Use and side effects of isoniazid (INH) d. Bacille Calmette-Guérin (BCG) vaccine

c. use and side effects of isoniazid

Just before the second course of chemotherapy, the laboratory calls to report that the patient's neutrophil count is 450 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? a. chemotherapy will continue as scheduled b. chemotherapy will resume with a lowered dosage c. hemotherapy will resume after a transfusion of neutrophils. d. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

d. Chemotherapy will be withheld until the neutrophil count returns toward normal levels.

the nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is MOST important to report to the health care provider? a. hematocrit 30% b. platelets 95,000/uL c. hemoglobin 10 d. WBC 2700/ul

d. WBC 2700/ul

which assessment finding for an older patient indicates that the nurse should take immediate action? a. weak cough effort b. barrel shaped chest c. dry mucous membrane d. bilateral basilar crackles

d. bilateral basilar crackles

a young adult employed as a hairstylist who has a 15 pack-yr history arrives for annual examination. Which area of increased risk should the nurse plan to teach the patient? a. renal failure b. kidney stones c. pyelonephritis d. bladder cancer

d. bladder cancer

which assessment data reported by the pt is consistent with lower UTI. a. low urine output b. bilateral flank pain c. nausea and vomiting d. burning on urination

d. burning on urination

a patient with a chronic cough is scheduled to have a bronchoscopy with biopsy. Which intervention will the nurse implement directly after the procedure? a. encourage the patient to drink clear liquids b. place the patient on bedrest for atleast 4 hours c. keep the patient NPO until the gag reflex returns d. maintain the head of bed elevated 90 degrees

c. keep the patient NPO until the gag reflex returns

During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Teach the patient about the need for a colonoscopy at age 50. b. Teach the patient how to do home testing for fecal occult blood. c. Obtain more information from the patient about the family history. d. Schedule a sigmoidoscopy to provide baseline data about the patient.

c. obtain more information from the patient about the family history

a 28 yr old male had just been diagnosed with polycystic kidney disease. Which info should the nurse include in teaching during the first session a. complications of transplant b. methods for treating chronic pain c. options to consider for genetic counseling d. differences between hemodialysis and peritoneal dialysis

c. options to consider for genetic counseling

what should the nurse ask the pt about to determine possible cause of acute glomerulonephritis a. recent bladder infection b. history of kidney stones c. recent sore throat or fever d. history of high BP

c. recent sore throat or fever

the nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? a. nausea b. alopecia c. hematuria d. xerostomia

c. hematuria

a patient is scheduled for a computed tomography (CT) scan of the chest with contrast media. Which assessment findings should the nurse report to the HCP before the patient goes for the CT? Select All That Apply. a. allergy to shellfish b. patient reports claustrophobia c. elevated serum creatinine d. recent bronchodilator inhaler use e. inability to remove wedding band

a. allergy to shellfish c. elevated serum creatinine

a patient arrives to the emergency department with a possible nasal fracture after being hit by a baseball. Which finding by the nurse is most important to report to the HCP? a. clear nasal drainage b. report of nasal pain c. bilateral nose swelling and bruising d. inability to breathe through nose

a. clear nasal drainage

a patient develops neutropenia after receiving chemotherapy. which information about ways to prevent infection will the nurse include in the teaching plan. a. cook food thoroughly before eating. b. choose low fiber, low residue foods c. avoid public transportation such as busses d. use rectal suppositories if needed for constipation e. talk to oncologist before having any dental work

a. cook food thoroughly before eating c. avoid public transportation e. talk to oncologist before having any dental work

The nurse is assessing a patient who is receiving chemotherapy with an alkylating drug. Which assessment findings would be considered indications of an oncologic emergency? (Select all that apply.) a. dry, scratchy, or swollen throat b. loss of hair c. decreased red blood cells d. white patches in mouth and throat e. temp of 100.7 f. decreased urine output

a. dry scratchy or swollen throat d. white patches in mouth and throat e. temp of 100.7 f. decreased urine output

which nursing action is of highest priority for a patient with kidney stones who is being admitted to the hospital with gross hematuria and severe colicky left flank pain a. administer prescribed analgesics b. monitor temp every 4 hours c. encourage increased oral fluid intake d. give antiemetics needed for nausea

a. give analgesics

a patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery. Which routine postop orders is most important for the nurse to discuss with the HCP a. give ketorolac PRN for pain b. infuse 5% dextrose in NS at 75mL/hr c. order regular diet after pt is awake and alert d. draw BUN and creatinine for 2 hours

a. give ketorolac for pain

A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action will the nurse use to promote airway clearance? a. help the patient to splint the chest when coughing. b. restrict oral fluids c. Encourage the patient to wear the nasal oxygen cannula. d. encourage pursed lip breathing technique.

a. help the patient to splint the chest when coughing

which nursing action for a pt with COPD could the nurse delegate to experienced UAP. a. measure O2 sat with pulse ox b. monitor for increased O2 need with exercise c. teach the patient about safe use of O2 at home d. adjust O2 to keep saturation in prescribed parameters

a. monitor o2 with pulse ox

the nurse is caring for a hospitalized patient with a decreased GFR who is scheduled for an IVP. which action will be included in the plan of care? a. monitor urine output after procedure b. assist with monitored anesthesia care c. give oral contract solution before the procedure d. insert a large size urinary catheter before IVP

a. monitor the urine output after the procedure

the nurse is caring for a hospitalized older patient who has nasal packing in place after a nose bleed. Which assessment finding will require the most immediate action by the nurse. a. oxygen sat is 89% b. the nose appears red and swollen c. the patient reports level 8 on pain scale d. the patients temperature is 100.1 F

a. oxygen sat is 89%

the nurse supervises a student nurse who is assigned to take care of a patient with active TB. Which action, if performed by the student nurse, would require intervention by the nurse? a. the patient is offered a tissue from the box at the bedside b. a surgical facemask is applied before visiting the patient c. a snack is brought to the patient from the unit refrigerator d. hand washing is performed before entering the patients room

b. a surgical face mask is applied before visiting the patient

which action should the nurse take first when a patient develops epistaxis? a. pack the affected nare tightly with an epistaxis balloon b. apply squeezing pressure to the nostrils for 10 min c. obtain silver nitrate that may be needed for cauterization d. instill a vasoconstrictor medication to the affected nare

b. apply a squeezing pressure to nostrils for 10 min

After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about treatment for drug-resistant TB. b. Ask the patient whether medications have been taken as directed. c. Schedule the patient for directly observed therapy d. Discuss with the health care provider the need for the patient to use an injectable antibiotic.

b. ask the patient whether medications have been taken as directed

a female patient with suspected urinary tract infection is to provide a clean catch urine specimen for culture and sensitivity testing. What should the nurse do to obtain the specimen? a. have the patient empty the bladder completely, then obtain the next urine specimen the patient is able to void b. tell the patient to clean the urethral area, void a small amount into the toilet, then void directly into sterile container c. insert a short sterile mini catheter attached to a collecting container into the urethra and bladder to obtain the specimen d. clean the area around the patients meatus with a povidone iodine swab and then have the patient void into the cup.

b. clean the urethral area, void a small amount into the toilet, then void into the sterile cup

which information will be most important for the nurse to communicate to the HCP about an older patient who has influenza? a. fever of 100.4 b. diffuse crackles in the lungs c. sore throat and frequent cough d. myalgia and persistent headaches

b. diffuse crackles in the lungs

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem? a. Tell the patient to limit social contacts until regrowth of the hair occurs. b. Encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once the chemotherapy is complete.

b. encourage the patient to purchase a wig or hat and wear it once hair loss begins

a patient in the clinic with cystic fibrosis reports increased sweating and muscle weakness during the summer months. Which action by the nurse would be most appropriate? a. teach the patient signs of hypoglycemia b. have the patient add salt to meals c. suggest decreasing intake of fats and calories d. teach the patient about pancreatic enzyme replacement

b. have the patient add salt to meals

a patient with diabetes has ABG results pH 7.28; PaCO2 34 mm Hg; PaO2 85mm Hg; HCO3 18mEq?L. the nurse would expect which finding? a. intercostal retractions b. kussmaul respirations c. low oxygen saturation d. decreased venous O2

b. kussmauls respirations

a 78 yr old patient has been admitted with benign prostatic hyperplasia. What is most appropriate to include in the nursing plan of care. a. limit fluid intake to no more than 1000ml per day b. leave a light on in the bathroom during the night c. ask the patient to use a urinal so that urine can be measured d. pad the patients bed to accommodate overflow incontinence

b. leave a light on in the bathroom at night

a patient has been diagnosed with urinary tract stones that are high in uric acid. Which foods will the nurse teach the pt to avoid a. milk b. liver c. spinach d. chicken e. cabbage f. chocolate

b. liver d. chicken

the nurse is admitting a patient diagnosed with an acute exacerbation of COPD. how should the nurse determine appropriate O2 flowrate? a. minimize O2 use to avoid O2 dependency b. maintain pulse ox at 90% or greater c. administer O2 according to patients level of dyspnea d. avoid O2 administration at a rate of more than 2L

b. maintain a pulse ox of at least 90%

a 46 yr old female pt returns to the clinic with continued dysuria after being treated with trimethoprim and sulfamethoxazole for 3 days. which action will the nurse plan to take a. remind the pt to drink 1000ml of fluids per day b. obtain midstream specimen for culture and sensitivity testing c. suggest us of acetaminophen to relieve symptoms d. tell pt to take meds for 3 more days

b. obtain specimen for culture and sensitivity testing

an adult patient is admitted to the hospital with new onset nephrotic syndrome, which assessment data will the nurse expect to find a. poor skin turgor b. recent weight gain c. elevated urine ketones d. decreased BP

b. recent weight gain

to prevent recurrence of uric acid kidney stones, the nurse teaches the pt to avoid eating a. milk and cheese b. sardines and liver c. spinach and chocolate d. legumes and dried fruit

b. sardines and liver

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

b. stop the infusion if swelling is observed at the site

How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis? a. Palpate along both sides of the lumbar vertebral column. b. Strike a flat hand covering the costovertebral angle (CVA). c. Push fingers upward into the two lowest intercostal spaces. d. Percuss between the iliac crest and ribs along the midaxillary line.

b. strike a flat hand covering the CVA

a patient with COPD has coarse crackles throughout the lung fields and a chronic, nonproductive cough. which nursing intervention will be most effective? a. increase the O2 flow rate to highest prescribed rate b. teach the patient to use a flutter airway clearance device c. reinforce the ongoing use of pursed lip breathing techniques d. teach the patient about consistent use of inhaled corticosteroids

b. teach the patient to use a flutter airway clearance device

a patient gives the admitting nurse health information before a scheduled IVP. which item requires the nurse to intervene before the procedure? a. patient has not had food or drink for 8 hours b. patient lists allergies to shellfish and penicillin c. patient reports costovertebral angle tenderness d. patient used a bisacodyl table the night before

b. the patient lists allergies to shellfish and penicillin

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a. The patient ambulates several times a day in the room. b. The patient's visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

b. the patients visitors bring in some fresh peaches from home

The nurse is teaching a class about the various chemotherapy drugs. Which of these statements explains why alkylating drugs are also called "cell cycle-nonspecific drugs"? a. they are cytotoxic during a specific cell cycle b. they are cytotoxic during any phase of the cell cycle c. they are effective against several types of neoplasms d. They are more highly differentiated than cell cycle-specific drugs.

b. they are cytotoxic during any phase of the cell cycle

a young female patient with cystic fibrosis tells the nurse that she is considering trying to become pregnant. Which initial response by the nurse is best? a. are you aware of the normal lifespan for patients with CF b. would you like more information to help you with that decision c. you should have genetic counseling before making that decision d. many women with CF do not have difficulty bearing children

b. would you like more information to help you with that decision

the nurse teaches a patient about the transmission of TB. Which statement, if made by the patient, indicates the teaching was effective? a. I will take the bus instead of driving b. I will stay indoors whenever possible c. My spouse will sleep in another room d. I will keep my windows closed at home

c. My spouse will sleep in another room

a patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate? a. have the patient eat large meals when nausea is not present b. offer dry crackers and carbonated fluids during chemotherapy c. administer prescribed antiemetics 1 hour before the treatments d. give the patient a glass of citrus fruit beverage during treatments

c. administer prescribed antiemetics 1 hour before the treatments

which nursing action is essential for a patient immediately after renal biopsy. a. insert a urinary catheter and test urine for microscopic hematuria b. check blood glucose to assess for hyperglycemia or hypoglycemia c. apply pressure dressing and position patient on the affected side d. monitor BUN and creatinine to assess renal function

c. apply pressure dressing, position patient on affected side

A patient diagnosed with active TB is homeless and has a history of chronic alcohol use. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. repeat warnings about the high risk for infecting others several times b. give the patient written instructions about how to take the medications c. arrange for a daily meal and drug administration at a community center d. arrange for the patients friend to administer the medication on schedule

c. arrange for a daily meal and drug administration at a community center

a male patient in the clinic provides a urine sample that is red-orange in color. Which action should the nurse take? a. notify the HCP b. teach correct midstream collection c. ask about current med use d. question about UTI risk factors

c. ask about current med use

a patient who has acute glomerulonephritis is hospitalized with hyperkalemia. which information will the nurse monitor to evaluate the effectiveness of prescribed calcium gluconate IV a. urine volume b. calcium level c. cardiac rhythm d. neurologic status

c. cardiac rhythm

what action should the nurse take first when a patients urine dipstick test indicates a small amount of protein a. send urine specimen to lab to test for ketones b. obtain a clean catch urine for culture and sensitivity testing c. inquire about which medications the patient is currently taking d. ask the patient about any family history of chronic renal failure

c. inquire about which meds the pt is taking

which information will the nurse include when teaching the patient with a UTI about the use of phenazopyridine a. take for atleast 7 days b. it may cause photosensitivity c. it may change urine color d. take before sex

c. it may change urine color

which action should the nurse take to prepare a patient with pleural effusion for a thoracentesis? a. remind the patient not to eat or drink for 6 hours b. start a peripheral IV line to administer sedative c. position the patient sitting up on the side of the bed d. obtain a collection device to hold 3 L of pleural fluid

c. position the patient sitting up on the side of the bed

Using the illustrated technique, the nurse is assessing for which finding in a patient with chronic obstructive pulmonary disease (COPD)? (hands on lower back during expansion) a. Hyperresonance b. Tripod positioning c. Accessory muscle use d. Reduced chest expansion

c. reduced excursion

the nurse is caring for a patient with left sided lung cancer. Which finding would be most important for the nurse to report to the hcp? a. hematocrit 32% b. pain with deep inspiration c. serum sodium of 126 meq/l d. Decreased breath sounds on left side

c. serum sodium 126meq/l

What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration? a. Reduce the infusion rate. b. Discontinue the IV, and apply warm compresses. c. Stop the infusion immediately, but leave the IV catheter in place. d. Change the infusion to normal saline, and inject the area with hydrocortisone.

c. stop the infusion immediately, but leave the iv in place

the health care provider writes an order for a patient who has a positive TB skin test. Which action should the nurse take. a. teach about the reason for blood tests b. schedule an appointment for a chest x ray c. teach the patient about providing specimens for 3 consecutive days d. instruct the patient to collect several separate sputum specimens today

c. teach the patient about providing specimens for 3 consecutive days

a patient with CF has blood glucose levels that are consistently between 180-250. Which action will the nurse expect to implement? a. discuss the role of diet in blood glucose control b. evaluate the patients use of pancreatic enzymes c. teach the patient about administration of insulin d. give oral hypoglycemic meds before meals

c. teach the pt about administration of insulin

which assessment finding is most important to report to the HCP regarding a pt who has had left sided extracorporeal shock wave lithotripsy a. blood in urine b. left flank bruising c. left flank discomfort d. decreased urine output

d. decreased UO

the nurse is performing TB skin tests in a clinic that has many patients who have immigrated to the US. Which question is important for the nurse to ask before the skin test? a. do you take OTC medications b. do you have any family members with a history of TB c. how long has it been since you moved to the US d. did you receive the bacille calmette-guerin vaccine for TB

d. did you receive the vaccine

a 58 yr old male who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. which pt problem is present based on these findings a. poor perfusion b. inadequate nutrition c. activity intolerance d. excess fluid volume

d. excess fluid volume

which statement by a 22 yr old female with cystitis indicates to the nurse that instruction regarding prevention of future UTIs has been effective a. i can use vaginal antiseptic sprays to reduce bacteria b. i will drink a quart of water or other fluids every day c. i will wash with soap and water before sex d. i will empty my bladder every 3-4 hours during the day

d. i will empty my bladder every 3-4 hours during the day

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider? a. elevated WBC b. Frequent loose stools c. Complaints of nausea and vomiting d. Increase in carcinoembryonic antigen (CEA)

d. increase in carcinoembryonic antigen CEA

a hospitalized patient who has possible renal insufficiency after coronary artery bypass surgery will have a creatinine clearance test. which item will the nurse need to obtain a. urinary catheter b. sterile specimen cup c. cleansing towelettes d. large urine container

d. large urine container

a young adult patient with cystic fibrosis is admitted to the hospital with increased dyspnea. which intervention should the nurse include in the plan of care? a. schedule a sweat chloride test b. arrange for a hospice nurse visit c. place the patient on a low sodium diet d. perform chest physiotherapy every 4 hours

d. perform chest physiotherapy every 4 hours

a patient newly diagnosed with asthma is being discharged. the nurse anticipates including which topic in the discharge teaching a. complications associated with O2 therapy b. use of long acting b-adrenergic meds c. side effects of sustained release theophylline d. self administration of inhaled corticosteroids

d. self administration of inhaled corticosteroids

a patient is hospitalized with active TB. Which assessment finding would indicate to the nurse that prescribed airborne precautions are likely to be discontinued? a. chest x ray shows no upper lobe infiltrates b. TB medications have been taken for 6 months c. mantoux testing shows an induration of 10mm d. sputum smears for acid fast bacilli are negative

d. sputum smears for acid fast bacilli are negative

a 55 yr old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. which intervention is appropriate to include in the plan of care a. assist to the bathroom Q3hr b. place a commode at pt bedside c. demonstrate how to perform crede maneuver d. teach kegel exercises

d. teach kegel exercises

which finding will be most helpful in determining whether a 67 yr old pt with benign prostatic hyperplasia has an upper UTI a. bladder distention b. foul smelling urine c. suprapubic discomfort d. costovertebral tendernes

d. tenderness

The nurse analyzes the results of a patient's arterial blood gases (ABGs). Which finding would require immediate action? a. The bicarbonate level (HCO3-) is 31 mEq/L. b. The arterial oxygen saturation (SaO2) is 92%. c. The partial pressure of CO2 in arterial blood (PaCO2) is 31 mm Hg. d. The partial pressure of oxygen in arterial blood (PaO2) is 62 mm Hg.

d. the partial pressure of oxygen in arterial blood PaO2 is 62 mm Hg

which information will the nurse include in the teaching plan for a patient newly diagnosed with asthma a. use the inhaled corticosteroid when SOB occurs b. inhale slowly and deeply when using dry powder inhaler c. hold your breath for 5 seconds after using bronchodilator inhaler d. tremors are an expected side effect of rapidly acting bronchodilators

d. tremors are an expected side effect of rapidly acting bronchodilators