MedSurg II Final ?'s

A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek's sign. What deficit does the nurse suspect the patient has? a) Magnesium b) Calcium c) Sodium d) Phosphorus

Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.

the term for a reddened circumscribed lesion that ulcerates and become crusted and is a primary lesion of syphilis is a(n) a. chancre b. actinic cheilitis c. lichen planus d. leukoplakia

a. chancre

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation? a. usual pattern of elimination b. activity levels c. current medications d. alcohol consumption

a. usual pattern of elimination

The most common symptom of esophageal disease is a. vomiting b. dysphagia c. odynophagia d. nausea

b. dysphagia

the nurse is planning care for a client with painful oral lesions. Which food should be included in the clients diet? a. pretzels b. chili c. jello d. hot tea

c. Jello

which is a gerontological consideration associated with the pancreas a. increased rate of pancreatic secretion b. increased bicarbonate output c. increased amount of fibrous material d. increased calcium absorption

c. increased amount of fibrous material

which category of laxatives draws water into the intestine by osmosis a. stimulants b. bulk forming agents c. fecal softeners d. saline agents

d. saline agents

A nurse is completing the admission assessment of a client who has renal calculi. Which of the following findings should the nurse expect? A. Bradycardia B. Diaphoresis C. Nocturia D. Bradypnea

B. CORRECT: Diaphoresis is a manifestation associated with a client who has renal calculi.

The nurse is teaching a client about preventing dysphagia after bariatric surgery. The nurse tells the client to avoid which foods? SATA a. Doughy bread b. cheese c. steak d. peas

a. Doughy bread c. steak

After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching? a) "It is appropriate to warm the dialysate in a microwave." b) "The infusion clamp should be open during infusion." c) "The effluent should be allowed to drain by gravity." d) "It is important to use strict aseptic technique."

"It is appropriate to warm the dialysate in a microwave." The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.

Sevelamer hydrochloride (Renagel) has been prescribed for a client with chronic renal failure. The physician has prescribed Renagel 800 mg orally three times per day with meals to treat the client's hyperphosphatemia. The medication is available in 400 mg tablets. How many tablets per day will the nurse administer to the client?

6 The nurse will administer 2 tablets per dose (800 mg/400 mg per tablet). The client receives a total of 3 doses per day or 6 tablets (2 tablets per dose x 3 doses).

A nurse practitioner is examining a patient who presented at the free clinic with vulvar pruritus. For which assessment finding would the practitioner look that may indicate the patient has an infection caused by Candida albicans? A) Cottage cheese-like discharge B) Yellow-green discharge C) Gray-white discharge D) Watery discharge with a fishy odor

A. The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of T. vaginalis. Gray- white discharge and a fishy odor are signs of G. vaginalis.

A patient with a genital herpes exacerbation has a nursing diagnosis of acute pain related to the genital lesions. What nursing intervention best addresses this diagnosis? A) Cover the lesions with a topical antibiotic. B) Keep the lesions clean and dry. C) Apply a topical NSAID to the lesions. D) Remain on bed rest until the lesions resolve.

B. Feedback: To reduce pain, the lesions should be kept clean and proper hygiene practices maintained. Topical ointments are avoided and antibiotics are irrelevant due to the viral etiology. Activity should be maintained as tolerated.

A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient? A) Bathe daily and keep the perineal region clean. B) Avoid voiding immediately after sexual intercourse. C) Drink liberal amounts of fluids. D) Void at least every 6 to 8 hours.

C

18. A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A) Native Americans B) Caucasian Americans C) African Americans D) Asian Americans

C Feedback: African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

The nurse is educating a patient who is required to restrict potassium intake. What foods would the nurse suggest the patient eliminate that are rich in potassium? a) Salad oils b) Cooked white rice c) Butter d) Citrus fruits

Citrus fruits Foods and fluids containing potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee) are restricted.

An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment? A) Reviewing the patient's 24-hour food recall for changes in diet B) Assessing for recent contact with individuals who have UTIs C) Assessing for changes in the patient's level of psychosocial stress D) Reviewing the patient's medication administration record for recent changes

D

40. What nursing action should the nurse perform when caring for a patient undergoing diagnostic testing of the renal-urologic system? A) Withhold medications until 12 hours post-testing. B) Ensure that the patient knows the importance of temporary fluid restriction after testing. C) Inform the patient of his or her medical diagnosis after reviewing the results. D) Assess the patient's understanding of the test results after their completion.

D Feedback: The nurse should ensure that the patient understands the results that are presented by the physician. Informing the patient of a diagnosis is normally the primary care provider's responsibility. Withholding fluids or medications is not normally required after testing.

28. A patient has experienced excessive losses of bicarbonate and has subsequently developed an acid-base imbalance. How will this lost bicarbonate be replaced? A) The kidneys will excrete increased quantities of acid. B) Bicarbonate will be released from the adrenal medulla. C) Alveoli in the lungs will synthesize new bicarbonate. D) Renal tubular cells will generate new bicarbonate.

D Feedback: To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by the tubules and returned to the body. The lungs and adrenal glands do not synthesize bicarbonate. Excretion of acid compensates for a lack of bicarbonate, but it does not actively replace it.

The nurse is teaching a patient preventative measures regarding vaginal infections. The nurse should include which of the following as an important risk factor? A) High estrogen levels B) Late menarche C) Nonpregnant state D) Frequent douching

D. Feedback: Risk factors associated with vulvovaginal infections include pregnancy, premenarche, low estrogen levels, and frequent douching.

Which of the following nursing actions is most important in caring for the client following lithotripsy? a) Notify the physician of hematuria. b) Administer allopurinol (Zyloprim). c) Strain the urine carefully for stone fragments. d) Monitor the continuous bladder irrigation.

Strain the urine carefully for stone fragments. The nurse should strain all urine following lithotripsy. Stone fragments are sent to the laboratory for chemical anaysis.

Which nursing intervention should the nurse caring for the client with pyelonephritis implement? a) Administer acetaminophen (Tylenol). b) Straight catheterize the client every 4 to 6 hours. c) Restrict fluid intake to 1 liter per day. d) Teach client to increase fluid intake up to 3 liters per day.

Teach client to increase fluid intake up to 3 liters per day. The nurse teaches the client to increase fluid intake to promote renal blood flow and flush bacteria from the urinary tract.

A (Feedback: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.)

The nurse is reviewing the physician's notes from the patient who has just left the clinic. The nurse learns that the physician suspects a malignant breast tumor. On palpation, the mass most likely had what characteristic? A) Nontenderness B) A size of £ 5 mm C) Softness and a regular shape D) Mobility

ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones a. 7 months b. over 1 year c. 4 month d. 1 month

a. 7 months

Which term is used to describe stone formation in a salivary gland, usually the submandibular gland? a. sialolithiasis b. stomatitis c. sialadenitis d. parotitis

a. Sialolithiasis

a client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client (SATA) a. administer plasma b. assist the client to a semi-fowler position c. administer electrolytes d. administer a low-fat diet e. administer pain-relieving medication

a. administer plasma b. assist the client to a semi-fowler position c. administer electrolytes e. administer pain-relieving medication

Which term refers to a protrusion of the intestine through a weakened area in the abd wall a. hernia b. volvulus c. adhesion d. tumor

a. hernia

The nurse eis assisting a client to drain his continent ileostomy (Kock pouch). The nurse shold insert the catheter how far through the nipple/valve a. 3 inches b. 2 inches c. 5 inches d. 4 inches

b. 2 inches

The nurse knows that the serum amylase concentration returns to normal within which time frame a. 24 hours b. 48 hours c. 12 hours d. 36 hours

b. 48 hours

The nurse is conducting an admission assessment and determines that the client's BMI is 37. The nurse documents the BMI as being which class of obesity? a. Class III b. Class II c. Class I d. Overweight

b. Class II

Peptic ulcer disease occurs more frequently in people with which blood type a. A b. O c. AB d. B

b. O

What is the most common cause of esophageal varices a. asterixis b. portal hypertension c. ascites d. jaundice

b. portal hypertension

which term refers to the first portion of the small intestine a. omentum b. pylorus c. duodenum d. peritoneum

c. duodenum

C (Feedback: Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis, although falsenegative and falsepositive findings are possibilities. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early, but is not diagnostic of cancer. Mammography is used to detect tumors that are too small to palpate. Chest x-rays can be used to pinpoint rib metastasis. Neither test is considered diagnostic of breast cancer, however.)

A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what? A) Supervised breast self-examination B) Mammography C) Fine-needle aspiration D) Chest x-ray

D (Feedback: Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with particular risk of recurrence.)

A 35-year-old mother of three young children has been diagnosed with stage II breast cancer. After discussing treatment options with her physician, the woman goes home to talk to her husband, later calling the nurse for clarification of some points. The patient tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The patient's husband has done some online research and is asking why his wife does not have a modified radical mastectomy to be sure all the cancer is gone. What would be the nurse's best response? A) Modified radical mastectomies are very hard on a patient, both physically and emotionally and they really aren't necessary anymore. B) According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial. C) Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence. D) According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.

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

A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patient's lump is cancerous? A) Eversion of the right nipple and mobile mass B) A nonmobile mass with irregular edges C) A mobile mass that is soft and easily delineated D) Nonpalpable right axillary lymph nodes

A nurse is caring for a client who has primary adrenal insufficiency and is preparing to undergo an ACTH stimulation test. Which of the following findings should the nurse expect after an IV injection of cosyntropin? A. No change in plasma cortisol B. Elevated fasting blood glucose C. Decrease in sodium D. Increase in urinary output

A. CORRECT: No change in plasma cortisol indicates primary adrenal insufficiency (Addison's disease or hypocortisolism) after an IV injection of cosyntropin during an ACTH stimulation test due to an inadequate production of cortisol.

9. A patient with renal failure secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of renal failure for which the nurse should monitor the patient? A) Accumulation of wastes B) Retention of potassium C) Depletion of calcium D) Lack of BP control

B Feedback: Retention of potassium is the most life-threatening effect of renal failure. Aldosterone causes the kidney to excrete potassium, in contrast to aldosterone's effects on sodium described previously. Acid-base balance, the amount of dietary potassium intake, and the flow rate of the filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia, the accumulation of wastes, and lack of BP control are complications associated with renal failure, but do not have same level of threat to the patient's well-being as hyperkalemia.

A patient has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed? A) The circumference of the stoma B) The narrowest part of the stoma C) The widest part of the stoma D) Half the width of the stoma

C

36. A patient with a history of incontinence will undergo urodynamic testing in the physician's office. Because voiding in the presence of others can cause situational anxiety, the nurse should perform what action? A) Administer diuretics as ordered. B) Push fluids for several hours prior to the test. C) Discuss possible test results as the patient voids. D) Help the patient to relax before and during the test.

D Feedback: Voiding in the presence of others can frequently cause guarding, a natural reflex that inhibits voiding due to situational anxiety. Because the outcomes of these studies determine the plan of care, the nurse must help the patient relax by providing as much privacy and explanation about the procedure as possible. Diuretics and increased fluid intake would not address the patient's anxiety. It would be inappropriate and anxiety-provoking to discuss test results during the performance of the test.

A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? a) Blood clot formed in the kidneys interfered with the flow b) Obstruction of urine flow from the kidneys c) Decrease in the blood flow through the kidneys d) Structural damage occurred in the nephrons of the kidneys

Decrease in the blood flow through the kidneys Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.

Which of the following causes should the nurse suspect in a client is diagnosed with intrarenal failure? a) Hypovolemia b) Ureteral calculus c) Dysrhythmia d) Glomerulonephritis

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

The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? a) Abdominal distention owing to reflex cessation of intestinal peristalsis b) Pneumonia caused by shallow breathing because of severe incisional pain c) Hypovolemic shock caused by hemorrhage d) Paralytic ileus caused by manipulation of the colon during surgery

Hypovolemic shock caused by hemorrhage If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.

A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? a) Eliminate fat intake and increase protein intake. b) Increase protein, carbohydrates, and fat intake. c) Increase carbohydrates and limit protein intake. d) Increase fat intake and limit carbohydrates.

Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.

Which of the following is a characteristic of the intrarenal category of acute renal failure? a) Decreased creatinine b) Increased BUN c) Decreased urine sodium d) High specific gravity

Increased BUN The intrarenal category of acute renal failure encompasses an increased BUN, increased creatinine, a low specific gravity of urine, and increased urine sodium.

A patient diagnosed AKI has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering which of the following? a) Calcium supplements b) Kayexalate c) IV dextrose 50% d) Sorbitol

Kayexalate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the patient is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.

Which of the following is the hallmark of the diagnosis of nephrotic syndrome? a) Hypokalemia b) Hyponatremia c) Proteinuria d) Hypoalbuminemia

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

which intervention should be included in the plan of care for a client who has undergone a cholecystectomy a. assessing the color of the sclera every shift b. placing the client in the semi-fowler position immediately after surgery c. placing the client on NPO status for 2 days after surgery d. clamping the T-tube immediately after surgery

a. assessing the color of the sclera every shift

Which term most precisely refers to the incision of the common bile duct for removal of stones a. choledocholithotomy b. choledochoduodenostomy c. cholecystostomy d. choledochotomy

a. choledocholithotomy

Which is an age-related change of the hepatobiliary system a. decreased blood flow b. decreased prevalence of gallstones c. increased drug clearance capability d. enlarged liver

a. decreased blood flow

a 70-year old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas a. increases in the rate of pancreatic secretion b. decreases in the physiologic function of major organs c. development of local complications d. increases in the bicarbonate output by the kidneys

b. decreases in the physiologic function of major organs

which dietary modification is used for a client diagnosed with acute pancreatitis a. low carbohydrate diet b. elimination of coffee c. high protein diet d. high fat diet

b. elimination of coffee

The nurse is assessing an 80- year old client for signs and symptoms of gastric cancer. The nurse differentiates which as a s/sx of gastric cancer in the geriatric client, but not in a client under the age of 75 a. abdominal mass b. hepatomegalia c. agitation d. ascites

c. agitation

The nurse is caring for a client with diverticulitis is preparing to administer the clients medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis a. anti-inflammatory b. atnianxiety c. antispasmodic d. antiemetic

c. antispasmodic

the nurse is evaluation a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer a. hemorrhage b. weight loss c. awakening in pain d. vomiting

c. awakening in pain

when caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately a. constipation for more than 2 days b. anorexia for more than 3 days c. change in the clients handwriting and/or cognitive performance d. weight loss of 2 pounds in 3 days

c. change in the clients handwriting and/or cognitive performance

which ulcer is associated with extensive burn injury a. duodenal ulcer b. peptic ulcer c. curling ulcer d. cushing ulcer

c. curling ulcer

Which is one of the primary symptoms of IBS a. pain b. abd distention c. diarrhea d. bloating

c. diarrhea

The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? a) Once on dialysis, the need will be permanent. b) Kidney function will improve with transplant. c) Acute renal failure tends to turn to end-stage failure. d) The kidneys can improve over a period of months.

The kidneys can improve over a period of months. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.

D (Feedback: Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.)

The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work? What would be the nurse's best response? A) Yes, it's known to have a slight protective effect. B) Yes, but studies also show an increased risk of osteoporosis. C) You won't need to worry about getting cancer as long as you take Tamoxifen. D) Tamoxifen is known to be a highly effective protective measure.

C (Feedback: Following an axillary dissection, the patient should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, and undergoing venipuncture on the affected side. Exercises of the hand and arm are encouraged and the use of a sling is not necessary.)

The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When providing patient education regarding rehabilitation, what should the nurse recommend? A) Avoid exercise of the arm for next 2 months. B) Keep cuticles clipped neatly. C) Avoid lifting objects heavier than 10 pounds. D) Use a sling until healing is complete.

The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: a) 2,000 mL of fluid b) 1,000 mL of fluid c) 1,500 mL of fluid d) 500 mL of fluid

1,500 mL of fluid A 1-kg weight gain is equal to 1,000 mL of retained fluid.

At the end of five peritoneal exchanges, a patient's fluid loss was 500 mL. How much is this loss equal to? a) 1.0 lb b) 2 lb c) 0.5 lb d) 1.5 lb

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

The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: a) "Dietary changes can reverse the damage that has occurred in your kidneys." b) "Draining of the cysts and antibiotic therapy will cure your disease." c) "Genetic testing will determine the best treatment for your condition." d) "As the disease progresses, you will most likely require renal replacement therapy."

"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.

The nurse notes that a patient who is retaining fluid had a 1-kg weight gain. The nurse knows that this is equivalent to about how many mL? a) 1,000 mL b) 750 mL c) 250 mL d) 500 mL

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

A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence? A) Stress incontinence B) Reflex incontinence C) Overflow incontinence D) Functional incontinence

A

A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic? A) The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy B) The need to expect a heavy menstrual period following the course of antibiotics C) The risk of developing antibiotic resistance after the course of antibiotics D) The need to undergo a series of three urine cultures after the antibiotics have been completed

A

A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what? A) Hydronephrosis B) Nephritic syndrome C) Pylonephritis D) Nephrotoxicity

A

A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the hourly output is less than what? A) 30 mL B) 50 mL C) 100 mL D) 125 mL

A

A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patient's post-procedure care? A) Strain the patient's urine following the procedure. B) Administer a bolus of 500 mL normal saline following the procedure. C) Monitor the patient for fluid overload following the procedure. D) Insert a urinary catheter for 24 to 48 hours after the procedure.

A

The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patient's bladder? A) Insertion of a suprapubic catheter B) Scheduling the patient immediately for a prostatectomy C) Application of warm compresses to the perineum to assist with relaxation D) Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours

A

The nurse has tested the pH of urine from a patient's newly created ileal conduit and obtained a result of 6.8. What is the nurse's best response to this assessment finding? A) Obtain an order to increase the patient's dose of ascorbic acid. B) Administer IV sodium bicarbonate as ordered. C) Encourage the patient to drink at least 500 mL of water and retest in 3 hours. D) Irrigate the ileal conduit with a dilute citric acid solution as ordered.

A

The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention? A) The patient's suprapubic region is dull on percussion. B) The patient is uncharacteristically drowsy. C) The patient claims to void large amounts of urine 2 to 3 times daily. D) The patient takes a beta adrenergic blocker for the treatment of hypertension.

A

The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's health education, what nutritional guidelines should the nurse provide? A) Restrict protein intake as ordered. B) Increase intake of potassium-rich foods. C) Follow a low-calcium diet. D) Encourage intake of food containing oxalates.

A

The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer? A) Smoking cessation B) Reduction of alcohol intake C) Maintenance of a diet high in vitamins and nutrients D) Vitamin D supplementation

A

3. A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications? A) Do you feel any muscle twitches or spasms? B) Do you feel flushed or sweaty? C) Are you experiencing any dizziness or lightheadedness? D) Are you having any pain that seems to be radiating from your bones?

A Feedback: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.

A (Feedback: Treatment of mastitis consists of antibiotics and local application of cold compresses to relieve discomfort. A broad-spectrum antibiotic agent may be prescribed for 7 to 10 days. The patient should wear a snug bra and perform personal hygiene carefully. Massage is not recommended.)

A new mother who is breastfeeding calls the clinic to speak to a nurse. The patient is complaining of pain in her left breast and describes her breast as feeling doughy. The nurse tells her to come into the clinic and be checked. The patient is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend? A) Apply cold compresses as ordered. B) Avoid wearing a bra until the infection clears. C) Avoid washing the breasts. D) Perform gentle massage to stimulate neutrophil migration.

D (Feedback: Gentle encouragement can help the patient progress toward accepting the change in her appearance. The nurse should not downplay the significance of physical appearance. Explaining that others have had similar experiences may or may not benefit the patient. Asking the patient to describe the appearance of her breast is likely to exacerbate the woman's reluctance to do so.)

A nurse has assessed that a patient is not yet willing to view her mastectomy site. How should the nurse best assist the patient is developing a positive body image? A) Ask the woman to describe the current appearance of her breast. B) Help the patient to understand that many women have gone through the same unpleasant experience. C) Explain to the patient that her body image does not have to depend on her physical appearance. D) Provide the patient with encouragement in an empathic and thoughtful manner.

A (Feedback: Current practice emphasizes the importance of breast self-awareness, which is a woman's attentiveness to the normal appearance and feel of her breasts. BSE does not need to be synchronized with the performance of mammograms. Rapport between the patient and the care provider is beneficial, but does not necessarily determine the effectiveness of BSE. The woman does not need to understand the pathophysiology of breast cancer to perform BSE effectively.)

A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor? A) Women's knowledge of how their breasts normally look and feel B) The rapport that exists between the woman and her primary care provider C) Synchronizing women's routines around BSE with the performance of mammograms D) Women's knowledge of the pathophysiology of breast cancer

A, B, C (Feedback: Patients who have difficulty managing their postoperative care at home may benefit from a home health care referral. The home care nurse assesses the patient's incision and surgical drain(s), adequacy of pain management, adherence to the exercise plan, and overall physical and psychological functioning. It is unnecessary to assess the patient's understanding of cancer at this stage of recovery. Prostheses may be considered later in the recovery process.)

A patient has been discharged home after a total mastectomy without reconstruction. The patient lives alone and has a home health referral. When the home care nurse performs the first scheduled visit this patient, what should the nurse assess? Select all that apply. A) Adherence to the exercise plan B) Overall psychological functioning C) Integrity of surgical drains D) Understanding of cancer E) Use of the breast prosthesis

A (Feedback: Superficial thrombophlebitis of the breast (Mondor disease) is an uncommon condition that is usually associated with pregnancy, trauma, or breast surgery. Pain and redness occur as a result of a superficial thrombophlebitis in the vein that drains the outer part of the breast. The mass is usually linear, tender, and erythematous. Fat necrosis is a condition of the breast that is often associated with a history of trauma. The scenario described does not indicate a recurrent malignancy. DVTs of the breast do not occur.)

A patient who has had a lumpectomy calls the clinic to talk to the nurse. The patient tells the nurse that she has developed a tender area on her breast that is red and warm and looks like someone drew a line with a red marker. What would the nurse suspect is the woman's problem? A) Mondor disease B) Deep vein thrombosis (DVT) of the breast C) Recurrent malignancy D) An area of fat necrosis

C (Feedback: A general guideline is to begin screening 5 to 10 years earlier than the age at which the youngest family member developed breast cancer, but not before age 25 years. In families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Because their mother developed breast cancer at age 48 years, the daughters should begin mammography at age 38 to 43 years.)

A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The woman asks the nurse when her teenage daughters should begin mammography. What is the nurse's best advice? A) Age 28 B) Age 35 C) Age 38 D) Age 48

D (Feedback: Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the patient's unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.)

A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? A) More aggressive chemotherapy B) Left mastectomy C) Radiation therapy D) Bilateral mastectomy

A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply. A) Promotion of HPV immunization B) Encouraging young women to delay first intercourse C) Smoking cessation D) Vitamin D and calcium supplementation E) Using safer sex practices

A, B, C, E. Preventive measures relevant to cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age. Preventive counseling should encourage delaying first intercourse, avoiding HPV infection, participating in safer sex only, smoking cessation, and receiving HPV immunization. Calcium and vitamin D supplementation are not relevant.

16. A patient with ESKD is scheduled to begin hemodialysis. The nurse is working with the patient to adapt the patient's diet to maximize the therapeutic effect and minimize the risks of complications. The patient's diet should include which of the following modifications? Select all that apply. A) Decreased protein intake B) Decreased sodium intake C) Increased potassium intake D) Fluid restriction E) Vitamin D supplementation

A, B, D Feedback: Restricting dietary protein decreases the accumulation of nitrogenous wastes, reduces uremic symptoms, and may even postpone the initiation of dialysis for a few months. Restriction of fluid is also part of the dietary prescription because fluid accumulation may occur. As well, sodium is usually restricted to 2 to 3 g/day. Potassium intake is usually limited, not increased, and there is no particular need for vitamin D supplementation.

Following a recent history of dyspareunia and lower abdominal pain, a patient has received a diagnosis of pelvic inflammatory disease (PID). When providing health education related to self-care, the nurse should address which of the following topics? Select all that apply. A) Use of condoms to prevent infecting others B) Appropriate use of antibiotics C) Taking measures to prevent pregnancy D) The need for a Pap smear every 3 months E) The importance of weight loss in preventing symptoms

A, B. Patients with PID need to take action to avoid infecting others. Antibiotics are frequently required. Pregnancy does not necessarily need to be avoided, but there is a heightened risk of ectopic pregnancy. Weight loss does not directly alleviate symptoms. Regular follow-up is necessary, but Pap smears do not need to be performed every 3 months.

33. A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the patient to improve the patients nutritional intake. What foods should a patient with Cushing syndrome eat to optimize health? Select all that apply. A) Foods high in vitamin D B) Foods high in calories C) Foods high in protein D) Foods high in calcium E) Foods high in sodium

A, C, D Feedback: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the patient in selecting appropriate foods that are also low in sodium and calories.

38. The nurse is leading a workshop on sexual health for men. The nurse should teach participants that organic causes of erectile dysfunction include what? Select all that apply. A) Diabetes B) Testosterone deficiency C) Anxiety D) Depression E) Parkinsonism

A,B,E Feedback: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.

22. A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply. A) Phimosis B) Priapism C) Herpes simplex infection D) Increasing age E) Lack of circumcision

A,D,E Feedback: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of age), lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk factors.

A nurse is caring for a client following a paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? A. Client report of upper chest pain B. Decreased urine output C. Pallor D. Temperature elevation

A. A report of sharp, constant abdominal pain is associated with bowel perforation. B. Decreased urine output is associated with bladder perforation during a paracentesis. C. Pallor may indicate hypovolemia related to fluid removal of ascites fluid during the procedure. D. CORRECT: Fever is an indication of bowel perforation during a paracentesis.

A nurse is assessing a client who has end‐stage kidney disease. Which of the following findings should the nurse expect? (Select all that apply.) A. Anuria B. Marked azotemia C. Crackles in the lungs D. Increased calcium level E. Proteinuria

A. CORRECT: Anuria is a manifestation of end‐stage kidney disease. B. CORRECT: Marked azotemia is elevated BUN and serum creatinine, is a manifestation of end‐stage kidney disease. C. CORRECT: Crackles in the lungs can indicate the client has pulmonary edema, caused from hypervolemia due to end‐stage kidney disease E. CORRECT: Proteinuria is a manifestation of end‐stage kidney disease.

A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis? A. Brownie with nuts B. Bowl of mixed fruit C. Grilled turkey D. Baked potato

A. CORRECT: Foods that are high in fat, such as a brownie with nuts, can cause cholecystitis. B. Fruits are low in fat and not associated with cholecystitis. C. Turkey is low in fat and not associated with cholecystitis. D. Baked potatoes are low in fat and not associated with cholecystitis.

At the beginning of a shift, a nurse is assessing a client who has Cushing's disease. Which of the following findings is the priority? A. Weight gain B. Fatigue C. Fragile skin D. Joint pain

A. CORRECT: The greatest risk to a client who has Cushing's disease is fluid retention, which can lead to pulmonary edema, hypertension, and heart failure; therefore, this is the priority finding.

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following laboratory findings should the nurse expect? A. Presence of immunoglobulin G antibodies (IgG) B. Presence of enzyme immunoassay (EIA) C. Aspartate aminotransferase (AST) 35 units/L D. Alanine aminotransferase (ALT) 15 IU/L

A. The presence of IgG is an expected laboratory finding in a client who has hepatitis A infection. B. CORRECT: The presence of EIA is an expected laboratory finding in a client who has a new diagnosis of hepatitis C. C. AST is elevated in clients who have hepatitis C infection; 35 units/L is within the expected reference range. D. ALT is elevated in clients who have hepatitis C infection; 15 units/L is within the expected reference range.

A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign. A. Tap lightly at the costovertebral margin on the client's back. B. Palpate the right lower quadrant. C. Inspect the skin around the umbilicus. D. Auscultate the area below the scapula.

A. This action assesses for pain, which can indicate pyelonephritis. B. This action assesses for the presence of rebound tenderness. C. CORRECT: Cullen's sign is indicated by a bluish‐gray discoloration in the periumbilical area. D. Lung sounds are assessed by auscultating the area below the scapula.

A nurse is caring for a client who is 6 hr postoperative following a transsphenoidal hypophysectomy. The nurse should test the client's nasal drainage for the presence of which of the following? A. RBCs B. Ketones C. Glucose D. Streptococci

C. CORRECT: Cerebral spinal fluid contains glucose. The nurse should test nasal drainage for glucose.

A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the following disorders? a) Acute renal failure b) Chronic renal failure c) Acute glomerulonephritis d) Nephrotic syndrome

Acute glomerulonephritis Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus. Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney. Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications. Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

The nurse is reviewing the potassium level of a patient with kidney disease. The results of the test are 6.5 mEq/L, and the nurse observes peaked T waves on the ECG. What priority intervention does the nurse anticipate the physician will order to reduce the potassium level? a) Administration of a loop diuretic b) Administration of sodium polystyrene sulfonate [Kayexalate]) c) Administration of sodium bicarbonate d) Administration of an insulin drip

Administration of sodium polystyrene sulfonate [Kayexalate]) The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.

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 patient? a) Anemia b) Acidosis c) Pericarditis d) Hyperkalemia

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 patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patient's plan of care? A) Impaired physical mobility related to presence of an indwelling urinary catheter B) Risk for infection related to presence of an indwelling urinary catheter C) Toileting self-care deficit related to urinary catheterization D) Disturbed body image related to urinary catheterization

B

Which of the following is a term used to describe excessive nitrogenous waster in the blood, as seen in acute glomerulonephritis? a) Azotemia b) Proteinuria c) Hematuria d) Bacteremia

Azotemia The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.

A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patient's discharge education, what is the most plausible nursing diagnosis that the nurse should address? A) Impaired mobility related to limitations posed by the ileal conduit B) Deficient knowledge related to care of the ileal conduit C) Risk for deficient fluid volume related to urinary diversion D) Risk for autonomic dysreflexia related to disruption of the sacral plexus

B

A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice? A) Assuming a supine position for self-catheterization B) Using clean technique at home to catheterize C) Inserting the catheter 1 to 2 inches into the urethra D) Self-catheterizing every 2 hours at home

B

What is the term for the concentration of urea and other nitrogenous wastes in the blood? a) Proteinuria b) Azotemia c) Uremia d) Hematuria

Azotemia Azotemia is the concentration of urea and other nitrogenous wastes in the blood. Uremia is an excess of urea and other nitrogenous wastes in the blood. Hematuria is blood in the urine. Proteinuria is protein in the urine.

A nurse on a busy medical unit provides care for many patients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which patient? A) A patient whose diagnosis of chronic kidney disease requires a fluid restriction B) A patient who has Alzheimer's disease and who is acutely agitated C) A patient who is on bed rest following a recent episode of venous thromboembolism D) A patient who has decreased mobility following a transmetatarsal amputation

B

A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? A) Administer prophylactic antibiotics as ordered. B) Limit the use of indwelling urinary catheters. C) Encourage frequent mobility and repositioning. D) Toilet residents who are immobile on a scheduled basis.

B

A patient has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the patient's discharge education accordingly. What preventative measure should the nurse encourage the patient to adopt? A) Increasing intake of protein from plant sources B) Increasing fluid intake C) Adopting a high-calcium diet D) Eating several small meals each day

B

Resection of a patient's bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following? A) Remain NPO for 12 hours prior to the treatment. B) Hold the solution in the bladder for 2 hours before voiding. C) Drink the intravesical solution quickly and on an empty stomach. D) Avoid acidic foods and beverages until the full cycle of treatment is complete.

B

The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach? A) Provide medication teaching related to pseudoephedrine sulfate. B) Teach the patient to perform pelvic floor muscle exercises. C) Prepare the patient for an anterior vaginal repair procedure. D) Provide information on periurethral bulking.

B

The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding? A) Perform a straight catheterization on this patient. B) Avoid further interventions at this time, as this is an acceptable finding. C) Place an indwelling urinary catheter. D) Press on the patient's bladder in an attempt to encourage complete emptying.

B

The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day? A) 1,250 mL B) 2,000 mL C) 2,750 mL D) 3,500 mL

B

The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite? A) Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. C) Men of all ages are less prone to UTIs, but typically experience more severe symptoms. D) The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.

B

17. The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients meal plan? A) A clear liquid diet, high in nutrients B) Small, frequent meals, high in protein and calories C) Three large, bland meals a day D) A diet high in fiber and plant-sourced fat

B Feedback: A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the patients caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.

28. A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

B Feedback: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

5. The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic? A) The possibility of precipitous weight gain B) The need for lifelong steroid replacement C) The need to match the daily steroid dose to immediate symptoms D) The importance of monitoring liver function

B Feedback: Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the patient and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.

40. A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, what is usually indicated? A) Needle aspiration of the corpus cavernosum B) Circumcision C) Abstinence from sexual activity for 6 weeks D) Administration of vardenafil

B Feedback: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is Levitra and would not be used for paraphimosis.

34. The critical care nurse is monitoring the patient's urine output and drains following renal surgery. What should the nurse promptly report to the physician? A) Increased pain on movement B) Absence of drain output C) Increased urine output D) Blood-tinged serosanguineous drain output

B Feedback: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Decreased or absent drainage is promptly reported to the physician because it may indicate obstruction that could cause pain, infection, and disruption of the suture lines. Reporting increased pain on movement has nothing to do with the scenario described. Increased urine output and serosanguineous drainage are expected.

32. A patient is scheduled for diagnostic testing to address prolonged signs and symptoms of genitourinary dysfunction. What signs and symptoms are particularly suggestive of urinary tract disease? Select all that apply. A) Petechiae B) Pain C) Gastrointestinal symptoms D) Changes in voiding E) Jaundice

B, C, D Feedback: Dysfunction of the kidney can produce a complex array of symptoms throughout the body. Pain, changes in voiding, and gastrointestinal symptoms are particularly suggestive of urinary tract disease. Jaundice and petechiae are not associated with genitourinary health problems.

A nurse is reviewing urinalysis results for four clients. Which of the following urinalysis results indicates a urinary tract infection? A. Positive for hyaline casts B. Positive for leukocyte esterase C. Positive for ketones D. Positive for crystals

B. CORRECT: A positive leukocyte esterase indicates a urinary tract infection.

A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the patient's admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply. A) Diarrhea B) High fever C) Hematuria D) Urinary frequency E) Acute pain

C,D,E

The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? a) Uses moisturizing creams b) Pats skin dry after bathing c) Keeps nails trimmed short d) Brief, hot daily showers

Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.

A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment? A) Clearly explain the potential benefits of pelvic floor muscle exercises. B) Ensure the patient knows that surgery will be required if the exercises are unsuccessful. C) Arrange for biofeedback when the patient is learning to perform the exercises. D) Contact the patient weekly to ensure that she is performing the exercises consistently.

C

A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response? A) Inform the patient that urgency and occasional incontinence are expected for the first few weeks post-removal. B) Obtain an order for a loop diuretic in order to enhance urine output and bladder function. C) Inform the patient that this is not unexpected in the short term and scan the patient's bladder following each void. D) Obtain an order to reinsert the patient's urinary catheter and attempt removal in 24 to 48 hours.

C

A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the patient? A) Remind the patient that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. B) Remind the patient that occasional febrile episodes are expected following ESWL. C) Tell the patient to report to the ED for further assessment. D) Tell the patient to monitor his temperature for the next 24 hours and then contact his urologist's office.

C

A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the patient's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? A) IV fluid administration B) Insertion of an indwelling urinary catheter C) Pain management D) Assisting with aspiration of the stone

C

The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response? A) Document the presence of a healthy stoma. B) Assess the patient for further signs and symptoms of infection. C) Inform the primary care provider that the vascular supply may be compromised. D) Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.

C

The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient? A) Limit oral fluid intake for 1 to 2 days. B) Report the presence of fine, sand like particles through the nephrostomy tube. C) Notify the physician about cloudy or foul-smelling urine. D) Report any pink-tinged urine within 24 hours after the procedure.

C

The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling catheter? A) Vigorously clean the meatus area daily. B) Apply powder to the perineal area twice daily. C) Empty the drainage bag at least every 8 hours. D) Irrigate the catheter every 8 hours with normal saline.

C

A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. The nurse should identify which of the following findings as indicative of thyroid crisis? (Select all that apply.) A. Bradycardia B. Hypothermia C. Dyspnea D. Abdominal pain E. Mental confusion

C. CORRECT: Excessive levels of thyroid hormone can cause the client to experience dyspnea. D. CORRECT: When thyroid crisis occurs, the client can experience gastrointestinal conditions, such as vomiting, diarrhea, and abdominal pain. E. CORRECT: Excessive thyroid hormone levels can cause the client to experience mental confusion.

A nurse is planning to teach a client who is being evaluated for Addison's disease about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should base her instructions to the client on which of the following? A. The ACTH stimulation test measures the response by the kidneys to ACTH. B. In the presence of primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTH. C. ACTH is a hormone produced by the pituitary gland. D. The client is instructed to take a dose of ACTH by mouth the evening before the test.

C. CORRECT: Secretion of corticotropin‐releasing hormone from the hypothalamus prompts the pituitary gland to secrete ACTH.

A nurse is teaching a client who is postoperative following a kidney transplant and is taking cyclosporine. Which of the following instructions should the nurse include? A. "Decrease your intake of protein‐rich foods." B. "Take this medication with grapefruit juice." C."Monitor for and report a sore throat to your provider." D."Expect your skin to turn yellow."

C. CORRECT: The client should report any manifestations of an infection because this medication causes immunosuppression.

When preparing a client for hemodialysis, which of the following would be most important for the nurse to do? a) Add the prescribed drug to the dialysate. b) Warm the solution to body temperature. c) Inspect the catheter insertion site for infection. d) Check for thrill or bruit over the access site.

Check for thrill or bruit over the access site. When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.

A female patient's most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurse's data analysis should be informed by what principle? A) Most UTIs in female patients are caused by viruses and do not cause obvious symptoms. B) A diagnosis of bacteriuria requires three consecutive positive results. C) Urine contains varying levels of healthy bacterial flora. D) Urine samples are frequently contaminated by bacteria normally present in the urethral area.

D

A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. A) Food cravings B) Upper abdominal pain C) Insatiable thirst D) Uncharacteristic fatigue E) New onset of confusion

D

A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurse's most appropriate response? A) Report this finding promptly to the primary care provider. B) Obtain a sterile urine sample and send it for culture. C) Obtain a urine sample and check it for pH. D) Reassure the patient that this is an expected phenomenon.

D

An adult patient has been hospitalized with pyelonephritis. The nurse's review of the patient's intake and output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? A) Supplement the patient's fluid intake with a high-calorie diet. B) Emphasize the need to limit intake to 2 L of fluid daily. C) Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. D) Encourage the patient to continue this pattern of fluid intake.

D

36. A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient? A) Apply a cold compress to the pubic area. B) Notify the urologist promptly. C) Irrigate the catheter with 30 to 50 mL of normal saline aS ordered. D) Administer a smooth-muscle relaxant as ordered.

D Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.

A nurse is planning care for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan? A. Maintain the client in a low‐Fowler's position. B. Encourage deep breathing and coughing. C. Encourage the client to brush his teeth when awake and alert. D. Observe dressing drainage for the presence of glucose.

D. CORRECT: The nurse should monitor the drainage to the mustache dressing and observe for the presence of glucose, which would indicate the presence of CSF. Notify the provider if this occurs.

The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? a) Dehydration b) Hyperkalemia c) Hypertension d) Crackles

Dehydration The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.

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

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

C (Feedback: Paget's disease presents with erythema of the nipple and areola. Peau d'orange, which is associated with breast cancer, is caused by interference with lymphatic drainage, but does not cause these specific signs. Nipple inversion is considered normal if long-standing; if it is associated with fibrosis and is a recent development, malignancy is suspected. Acute mastitis is associated with lactation, but it may occur at any age.)

During a recent visit to the clinic a woman presents with erythema of the nipple and areola on the right breast. She states this started several weeks ago and she was fearful of what would be found. The nurse should promptly refer the patient to her primary care provider because the patient's signs and symptoms are suggestive of what health problem? A) Peau d'orange B) Nipple inversion C) Paget's disease D) Acute mastitis

A nurse identifies a nursing diagnosis of Risk for Ineffective Breathing Pattern related to incisional pain and restricted positioning for a client who has had a nephrectomy. Which of the following would be most appropriate for the nurse to include in the client's plan of care? a) Monitor temperature every 4 hours. b) Keep the drainage catheter below the level of insertion. c) Administer isotonic fluid therapy as ordered. d) Encourage use of incentive spirometer every 2 hours.

Encourage use of incentive spirometer every 2 hours. To address the issue of ineffective breathing pattern, encouraging the use of incentive spirometer would be most appropriate to help increase alveolar ventilation. Administering isotonic fluid therapy would be appropriate for issues involving fluid loss such as bleeding or hemorrhage. Keeping the drainage catheter below the level of insertion would be appropriate to reduce the risk of obstruction leading to acute pain. Monitoring the temperature every 4 hours would be appropriate to reduce the client's risk for infection.

Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? a) Absence of pain b) Diuresis c) Fever d) Weight loss

Fever Fever is an indicator of infection or transplant rejection.

The nurse is caring for a patient in the oliguric phase of AKI. What does the nurse know would be the daily urine output? a) 1.5 L b) 1.0 L c) Less than 50 mL d) Less than 400 mL

Less than 400 mL The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The minimum amount of urine needed to rid the body of normal metabolic waste products is 400 mL. In this phase, uremic symptoms first appear and life-threatening conditions such as hyperkalemia develop.

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

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

The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? a) Elevated calcium levels b) Location of discomfort c) Abnormalities in urine d) Structural defects in the kidneys

Location of discomfort The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath. Observing and documenting the characteristics of the client's urine helps the nurse detect abnormalities in the urine. Laboratory blood tests reveal elevated calcium levels, whereas radiography and ultrasonography depict structural defects in the kidneys.

An instructor is preparing a class on renal cancer for a group of students. Which of the following would the instructor include as a possible risk factor? a) Age below 40 years b) Female gender c) Obesity d) Exposure to sunlight

Obesity Risk factors for renal cancer include: age with most renal cancers occurring after age 60, male gender, tobacco use, occupational exposure to industrial chemicals, obesity, unopposed estrogen therapy, polycystic kidney disease, and treatment for renal failure.

Nursing assessment for the patient receiving peritoneal dialysis would include which of the following to detect the most serious complication of this procedure? a) Measure fluid drainage to estimate incomplete recovery of fluid. b) Inspect the catheter site for leakage of dialysate. c) Observe for evidence of bleeding. d) Palpate the abdominal wall for rebound tenderness.

Palpate the abdominal wall for rebound tenderness. Peritonitis is the most serious complication of peritoneal dialysis. To detect rebound tenderness, the nurse presses one hand firmly into the abdominal wall and quickly withdraws the hand. Rebound tenderness exists when pain occurs upon removal; this pain is associated with inflammation of the peritoneal cavity.

When assessing the impact of medications on the etiology of ARF, the nurse recognizes which of the following as the drug that is not nephrotoxic? a) Penicillin b) Gentamicin c) Neomycin d) Tobramycin

Penicillin The three nephrotoxic drugs are aminoglycerides.

The nurse is reviewing the results of a urinalysis on a client with acute pyelonephritis. Which of the following would the nurse most likely expect to find? a) High specific gravity b) Pyuria c) Absent proteinuria d) Slightly acidic pH

Pyuria The chief abnormality noted with the urinalysis is pyuria (combination of bacteria and leukocytes). Specific gravity would be low, pH would be slightly alkaline, and proteinuria would be minimal to mild.

A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? a) Activity intolerance b) Impaired urinary elimination c) Risk for infection d) Toileting self-care deficit

Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.

Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? a) Urine output of 35 to 40 mL/hour b) SpO2 at 90% with fine crackles in the lung bases c) Blood tinged drainage in Jackson-Pratt drainage tube d) Pain of 3 out of 10, 1 hour after analgesic administration

SpO2 at 90% with fine crackles in the lung bases The Risk for Ineffective Breathing Pattern is often a challenge in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.

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

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

Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. a) Shortened QRS complex b) Tall, peaked T waves c) Multiple spiked P waves d) Prolonged ST segment

Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.

which drug is considered a stimulants laxative a. magnesium hydroxide b. psyllium hydrophilic mucilloid c. bisacodyl d. mineral oil

c. bisacodyl

The nurse is performing acute intermittent peritoneal dialysis (PD) on a patient who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. Which of the following is the nurse's best action? a) Lower the head of the bed. b) Turn the patient from side to side. c) Notify the health care provider. d) Push the catheter further into the abdomen.

Turn the patient from side to side. If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.

a nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance? a. ask the client to remain inactive for 5 minutes b. ensure that there are no holes in the pouch c. press the adhesive faceplate from the stomal edge inward d. ensure that no air is trapped in the pouch

a. ask the client to remain inactive for 5 minutes

A client comes to the Emergency Department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect? a) Ureteral stricture b) Urinary calculi c) Renal cell carcinoma d) Acute glomerulonephritis

Urinary calculi Symptoms of a kidney or ureteral stone vary with size, location, and cause. Small stones may pass unnoticed; however, sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia is the classic symptom of urinary calculi. The pain is accompanied by renal or ureteral colic, painful spasms that attempt to move the stone. The pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women. Clients with acute glomerulonephritis may be asymptomatic or may exhibit fever, nausea, malaise, headache, edema (generalized or periorbital), pain, and mild to moderate hypertension. Clients with ureteral stricture may complain of flank pain and tenderness at the costovertebral angle and back or abdominal discomfort. A client with renal cell carcinoma rarely exhibits symptoms early on but may present with painless hematuria and persistent back pain in later stages.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a) Urine output of 20 ml/hour b) Temperature of 99.2° F (37.3° C) c) Serum potassium level of 4.9 mEq/L d) Serum sodium level of 135 mEq/L

Urine output of 20 ml/hour Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

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

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

A nurse is caring for an acutely ill patient. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill patient is which of the following? a) Pulse rate b) Weight c) Edema d) Blood pressure

Weight The most accurate indicator of fluid loss or gain in an acutely ill patient is weight. An accurate daily weight must be obtained and recorded. Blood pressure, pulse rate, and edema are not the most accurate indicator of fluid loss or gain.

the nurse is caring for an older adult who reports xerostomia (dry mouth). The nurse evaluates for the use of which medication a. diuretics b. antiemetics c. antibiotics d. steroids

a. diuretics

C (Feedback: The patient should report sudden cessation of output from the drainage device, which could indicate an occlusion. Gradual decline in output is expected. A temperature of 100.4°F or greater should also be reported to rule out postoperative infection, but a temperature of 98.5°F is not problematic. Fatigue is expected during the recovery period.)

When planning discharge teaching with a patient who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the patient that she should report what sign or symptom to the physician immediately? A) Fatigue B) Temperature greater than 98.5ºF C) Sudden cessation of output from the drainage device D) Gradual decline in output from the drain

The nurse is administering calcium acetate (PhosLo) to a patient with ESKD. When is the best time for the nurse to administer this medication? a) 2 hours before meals b) At bedtime with 8 ounces of fluid c) With food d) 2 hours after meals

With food Hyperphosphatemia and hypocalcemia are treated with medications that bind dietary phosphorus in the GI tract. Binders such as calcium carbonate (Os-Cal) or calcium acetate (PhosLo) are prescribed, but there is a risk of hypercalcemia. The nurse administers phosphate binders with food for them to be effective.

the nurse in the ED admits a client with suspected gastric outlet obstruction. The clients symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? a. NGT insertion b. Stool specimen c. pelvic X-ray d. Oral contrast

a. NGT insertion

The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? SATA a. alterations in mood b. insomnia c. report of headache d. agitation e. decreased deep tendon reflexes

a. alterations in mood b. insomnia d. agitation

The digestion of carbohydrates is aided by a. amylase b. lipase c. secretin d. trypsin

a. amylase

a longitudinal tear or ulceration int he lining of the anal canal is termed a(n) a. hemorrhoid b. anal fissure c. anorectal abscess d. anal fistual

b. anal fissure

which is a true statement regarding gastric cancer a. the prognosis for gastric cancer is good b. women have a higher incidence of gastric cancer c. most cases are discovered before metastasis d. most client are asymptomatic during the early stage of disease

d. most client are asymptomatic during the early stage of disease

celiac sprue is an example of which category of malabsorption a. luminal problems causing malabsorption b. infectious diseases causing generalized malabsorption c. postoperative malabsorption d. mucosal disorders causing generalized malabsorption

d. mucosal disorders causing generalized malabsorption

which medication classification represents a proton pump inhibitor (PPI) a. sucralfate b. metronidazole c. famotidine d. omperazole

d. omeprazole

Clients with IBS are at a significantly increased risk for which condition a. pneumonia b. hypotension c. DVT d. osteoprosis

d. osteoprosis

which condition is the major cause of morbidity and mortality in clients with acute pancreatitis a. shock b. MODS c. Tetany d. pancreatic necrosis

d. pancreatic necrosis

The nurse is caring for a patient with ESKD. Which of the following acid-base imbalances is associated with this disorder? a) pH 7.50, PaCO2 29, HCO3 22- b) pH 7.47, PaCO2 45, HCO3 33- c) pH 7.31, PaCO2 48, HCO3 24- d) pH 7.20, PaCO2 36, HCO3 14-

pH 7.20, PaCO2 36, HCO3 14- Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

postoperatively, a client with a radical neck dissection should be placed in which position? a. fowler b. prone c. supine d. side lying

a. fowler

A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? a) "Let's wait until after the surgery to discuss your treatment plan." b) "Even a perfect match does not guarantee organ rejection." c) "The doctor may decide to delay the use of immunosuppressant drugs." d) "Immunosuppressive drugs guarantee organ success."

"Even a perfect match does not guarantee organ rejection." Even a perfect match does not guarantee that a transplanted organ will not be rejected. Immunosuppressive drugs are used in all organ transplants to decrease incidence of organ rejection. To provide the client with the information needed to provide informed consent, the treatment plan is reviewed and discussed prior to transplant.

A client with chronic renal failure comes to the clinic for a visit. During the visit, he complains of pruritus. Which suggestion by the nurse would be most appropriate? a) "When you shower, use really warm water and an antibacterial soap." b) "Try washing clothes with a strong detergent to ensure that all impurities are gone." c) "Liberally apply alcohol to the areas of your skin where you itch the most." d) "Keep your showers brief, patting your skin dry after showering."

"Keep your showers brief, patting your skin dry after showering." The client with pruritus needs to keep the skin clean and dry. The client should take brief showers with tepid water, pat the skin dry, use moisturizing lotions or creams, and avoid scratching. In addition, the client should use a mild laundry detergent to wash close and an extra rinse cycle to remove all detergent or add 1 tsp vinegar per quart of water to the rinse cycle to remove any detergent residue.

19. A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

A Feedback: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

21. A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How should the nurse interpret this finding? A) The patients pituitary function is compromised. B) The patients adrenal insufficiency is not treatable. C) The patient has insufficient hypothalamic function. D) The patient would benefit from surgery

A Feedback: An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although surgery is not likely indicated.

35. A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery? A) Blood glucose B) Assessment of urine for blood C) Weight D) Oral temperature

A Feedback: Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are carried out. The patients blood sugar is more likely to be volatile than body weight or temperature. Hematuria is not a common complication.

31. A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A) Closely monitoring the input and output of the bladder irrigation system B) Administering parenteral nutrition and fluids as ordered C) Monitoring the patient's level of consciousness and skin turgor D) Scanning the patient's bladder for retention every 2 hours

A Feedback: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

28. Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances? A) Episodes of high psychosocial stress B) Periods of dehydration C) Episodes of physical exertion D) Administration of a vaccine

A Feedback: During stressful procedures or significant illnesses, additional supplementary therapy with glucocorticoids is required to prevent addisonian crisis. Physical activity, dehydration and vaccine administration would not normally be sufficiently demanding such to require glucocorticoids.

23. A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism? A) A 75-year-old female patient with osteoporosis B) A 50-year-old male patient who is obese C) A 45-year-old female patient who used oral contraceptives D) A 25-year-old male patient who uses recreational drugs

A Feedback: Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women.

13. A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens? A) Continuous inflow and outflow of irrigation solution B) Intermittent inflow and continuous outflow of irrigation solution C) Continuous inflow and intermittent outflow of irrigation solution D) Intermittent flow of irrigation solution and prevention of hemorrhage

A Feedback: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

37. A nurse is working with a patient who will undergo invasive urologic testing. The nurse has informed the patient that slight hematuria may occur after the testing is complete. The nurse should recommend what action to help resolve hematuria? A) Increased fluid intake following the test B) Use of an OTC diuretic after the test C) Gentle massage of the lower abdomen D) Activity limitation for the first 12 hours after the test

A Feedback: Drinking fluids can help to clear hematuria. Diuretics are not used for this purpose. Activity limitation and massage are unlikely to resolve this expected consequence of testing.

24. A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this patient's concern? A) Inform the patient that urinary control is likely to return gradually. B) Arrange for the patient to be assessed by his urologist. C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D) Teach the patient to perform intermittent self-catheterization.

A Feedback: It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

32. A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A) Provide empathy and encouragement in an effort to foster a positive outlook. B) Tell the patient it is his decision whether to accept or reject chemotherapy. C) Report the patient's statement to members of his support system. D) Refer the patient to social work.

A Feedback: Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.

34. A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A) Pelvic floor exercises B) Intermittent urinary catheterization C) Reduced physical activity D) Active range of motion exercises

A Feedback: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

16. A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A) Chronic bacterial prostatitis B) Orchitis C) Benign prostatic hyperplasia D) Urolithiasis

A Feedback: Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.

17. To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what? A) Report the planned use of dietary supplements to the physician. B) Decrease the intake of fluids to prevent urinary retention. C) Abstain from sexual activity for 2 weeks following the initiation of treatment. D) Anticipate a temporary worsening of urinary retention before symptoms subside.

A Feedback: Some herbal supplements are contraindicated with Proscar, thus their planned use should be discussed with the physician or pharmacist. The patient should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.

1. The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When assessing this patient, what sign or symptom would the nurse expect? A)Fatigue B) Bulging eyes C) Palpitations D) Flushed skin

A Feedback: Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.

12. A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A) Testicular cancer is a highly curable type of cancer. B) Testicular cancer is very difficult to diagnose. C) Testicular cancer is the number one cause of cancer deaths in males. D) Testicular cancer is more common in older men.

A Feedback: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

11. A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

A Feedback: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

32. The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk? A) Establish falls prevention measures. B) Encourage bed rest whenever possible. C) Encourage the use of assistive devices. D) Provide constant supervision.

A Feedback: The nurse should take action to prevent the patients risk for falls. Bed rest carries too many harmful effects, however, and assistive devices may or may not be necessary. Constant supervision is not normally required or practicable.

10. You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan? A) Risk for injury related to weakness B) Ineffective breathing pattern related to muscle weakness C) Risk for loneliness related to disturbed body image D) Autonomic dysreflexia related to neurologic changes

A Feedback: The nursing priority is to decrease the risk of injury by establishing a protective environment. The patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners or furniture. The patients breathing will not be affected and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an issue for the patient, but safety is a priority.

13. A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following? A) Increase his intake of sodium until the GI symptoms improve. B) Increase his intake of potassium until the GI symptoms improve. C) Increase his intake of glucose until the GI symptoms improve. D) Increase his intake of calcium until the GI symptoms improve.

A Feedback: The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.

30. A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A) Disturbed Body Image Related to Effects of Surgery B) Spiritual Distress Related to Effects of Cancer Surgery C) Social Isolation Related to Effects of Surgery D) Risk for Loneliness Related to Change in Self-Concept

A Feedback: The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.

31. A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is the most common cause of this health problem? A) Therapeutic use of corticosteroids B) Pheochromocytoma C) Inadequate secretion of ACTH D) Adrenal tumor

A Feedback: Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other options also cause adrenocortical insufficiency, but they are not the most common causes.

C (Feedback: The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding.)

A woman scheduled for a simple mastectomy in one week is having her preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period? A) Limit her intake of green leafy vegetables. B) Increase her water intake to 8 glasses per day. C) Stop taking aspirin. D) Have nothing by mouth for 6 hours before surgery.

33. The nurse is caring for a patient who has returned to the postsurgical suite after post-anesthetic recovery from a nephrectomy. The nurse's most recent hourly assessment reveals a significant drop in level of consciousness and BP as well as scant urine output over the past hour. What is the nurse's best response? A) Assess the patient for signs of bleeding and inform the physician. B) Monitor the patient's vital signs every 15 minutes for the next hour. C) Reposition the patient and reassess vital signs. D) Palpate the patient's flanks for pain and inform the physician.

A Feedback: Bleeding may be suspected when the patient experiences fatigue and when urine output is less than 30 mL/h. The physician must be made aware of this finding promptly. Palpating the patient's flanks would cause intense pain that is of no benefit to assessment.

8. A nurse is preparing a patient diagnosed with benign prostatic hypertrophy (BPH) for a lower urinary tract cystoscopic examination. The nurse informs the patient that the most common temporary complication experienced after this procedure is what? A) Urinary retention B) Bladder perforation C) Hemorrhage D) Nausea

A Feedback: After a cystoscopic examination, the patient with obstructive pathology may experience urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the patient with prostatic hyperplasia for urine retention. Post-procedure, the patient will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.

10. The nurse is caring for a patient postoperative day 4 following a kidney transplant. When assessing for potential signs and symptoms of rejection, what assessment should the nurse prioritize? A) Assessment of the quantity of the patient's urine output B) Assessment of the patient's incision C) Assessment of the patient's abdominal girth D) Assessment for flank or abdominal pain

A Feedback: After kidney transplantation, the nurse should perform all of the listed assessments. However, oliguria is considered to be more suggestive of rejection than changes to the patient's abdomen or incision.

17. A nurse is caring for a 73-year-old patient with a urethral obstruction related to prostatic enlargement. When planning this patient's care, the nurse should be aware of the consequent risk of what complication? A) Urinary tract infection B) Enuresis C) Polyuria D) Proteinuria

A Feedback: An obstruction of the bladder outlet, such as in advanced benign prostatic hyperplasia, results in abnormally high voiding pressure with a slow, prolonged flow of urine. The urine may remain in the bladder, which increases the potential of a urinary tract infection. Older male patients are at risk for prostatic enlargement, which causes urethral obstruction and can result in hydronephrosis, renal failure, and urinary tract infections.

32. The nurse has identified the nursing diagnosis of "risk for infection" in a patient who undergoes peritoneal dialysis. What nursing action best addresses this risk? A) Maintain aseptic technique when administering dialysate. B) Wash the skin surrounding the catheter site with soap and water prior to each exchange. C) Add antibiotics to the dialysate as ordered. D) Administer prophylactic antibiotics by mouth or IV as ordered.

A Feedback: Aseptic technique is used to prevent peritonitis and other infectious complications of peritoneal dialysis. It is not necessary to cleanse the skin with soap and water prior to each exchange. Antibiotics may be added to dialysate to treat infection, but they are not used to prevent infection.

12. Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it? A) Heart failure B) Glomerulonephritis C) Ureterolithiasis D) Aminoglycoside toxicity

A Feedback: By causing inadequate renal perfusion, heart failure can lead to prerenal failure. Glomerulonephritis and aminoglycoside toxicity are renal causes, and ureterolithiasis is a postrenal cause.

4. The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after the patient has voided. How should the nurse interpret this assessment finding? A) The patient's bladder is not completely empty. B) The patient has kidney enlargement. C) The patient has a ureteral obstruction. D) The patient has a fluid volume deficit.

A Feedback: Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying. Enlargement of the kidneys can be attributed to numerous conditions such as polycystic kidney disease or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.

7. A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the patient reviews the initial orders written by the physician and notes that an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? A) Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. B) Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this patient. C) A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. D) There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.

A Feedback: Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding. Measuring intake and output is not a function of the laboratory. The laboratory does not save urine to test creatinine clearance at a later time. The laboratory does not monitor the urine for sodium or potassium concentrations.

13. A 45-year-old man with diabetic nephropathy has ESKD and is starting dialysis. "What should the nurse teach the patient about hemodialysis? A) "Hemodialysis is a treatment option that is usually required three times a week." B) "Hemodialysis is a program that will require you to commit to daily treatment." C) "This will require you to have surgery and a catheter will need to be inserted into your abdomen." D) "Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again."

A Feedback: Hemodialysis is the most commonly used method of dialysis. Patients receiving hemodialysis must undergo treatment for the rest of their lives or until they undergo successful kidney transplantation. Treatments usually occur three times a week for at least 3 to 4 hours per treatment.

14. A patient with ESKD receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurse's most appropriate action? A) Inform the physician and assess the patient for signs of infection. B) Flush the peritoneal catheter with normal saline. C) Remove the catheter promptly and have the catheter tip cultured. D) Administer a bolus of IV normal saline as ordered.

A Feedback: Peritonitis is the most common and serious complication of peritoneal dialysis. The first sign of peritonitis is cloudy dialysate drainage fluid, so prompt reporting to the primary care provider and rapid assessment for other signs of infection are warranted. Administration of an IV bolus is not necessary or appropriate and the physician would determine whether removal of the catheter is required. Flushing the catheter does not address the risk for infection.

15. The nurse is planning patient teaching for a patient with ESKD who is scheduled for the creation of a fistula. The nurse would include which of the following in teaching the patient about the fistula? A) A vein and an artery in your arm will be attached surgically. B) The arm should be immobilized for 4 to 6 days. C) One needle will be inserted into the fistula for each dialysis treatment. D) The fistula can be used 2 days after the surgery for dialysis treatment.

A Feedback: The fistula joins an artery and a vein, either side-to-side or end-to-end. This access will need time, usually 2 to 3 months, to "mature" before it can be used. The patient is encouraged to perform exercises to increase the size of the affected vessels (e.g., squeezing a rubber ball for forearm fistulas). Two needles will be inserted into the fistula for each dialysis treatment.

4. The nurse is working on the renal transplant unit. To reduce the risk of infection in a patient with a transplanted kidney, it is imperative for the nurse to do what? A) Wash hands carefully and frequently. B) Ensure immediate function of the donated kidney. C) Instruct the patient to wear a face mask. D) Bar visitors from the patient's room.

A Feedback: The nurse ensures that the patient is protected from exposure to infection by hospital staff, visitors, and other patients with active infections. Careful handwashing is imperative; face masks may be worn by hospital staff and visitors to reduce the risk for transmitting infectious agents while the patient is receiving high doses of immunosuppressants. Visitors may be limited, but are not normally barred outright. Ensuring kidney function is vital, but does not prevent infection.

1. The nurse is assessing a patient suspected of having developed acute glomerulonephritis. The nurse should expect to address what clinical manifestation that is characteristic of this health problem? A) Hematuria B) Precipitous decrease in serum creatinine levels C) Hypotension unresolved by fluid administration D) Glucosuria

A Feedback: The primary presenting feature of acute glomerulonephritis is hematuria (blood in the urine), which may be microscopic (identifiable through microscopic examination) or macroscopic or gross (visible to the eye). Proteinuria, primarily albumin, which is present, is due to increased permeability of the glomerular membrane. Blood urea nitrogen (BUN) and serum creatinine levels may rise as urine output drops. Some degree of edema and hypertension is noted in most patients.

33. A patient asks the nurse why kidney problems can cause gastrointestinal disturbances. What relationship should the nurse describe? A) The right kidney's proximity to the pancreas, liver, and gallbladder B) The indirect impact of digestive enzymes on renal function C) That the peritoneum encapsulates the GI system and the kidneys D) The left kidney's connection to the common bile duct

A Feedback: The proximity of the right kidney to the colon, duodenum, head of the pancreas, common bile duct, liver, and gallbladder may cause GI disturbances. The proximity of the left kidney to the colon (splenic flexure), stomach, pancreas, and spleen may also result in intestinal symptoms. Digestive enzymes do not affect renal function and the left kidney is not connected to the common bile duct.

2. A nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? A) In the ureteropelvic junction B) In the ureteral segment near the sacroiliac junction C) In the ureterovesical junction D) In the urethra

A Feedback: The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter.

18. A patient with elevated BUN and creatinine values has been referred by her primary physician for further evaluation. The nurse should anticipate the use of what initial diagnostic test? A) Ultrasound B) X-ray C) Computed tomography (CT) D) Nuclear scan

A Feedback: Ultrasonography is a noninvasive procedure that passes sound waves into the body through a transducer to detect abnormalities of internal tissues and organs. Structures of the urinary system create characteristic ultrasonographic images. Because of its sensitivity, ultrasonography has replaced many other diagnostic tests as the initial diagnostic procedure.

5. The nurse is providing pre-procedure teaching about an ultrasound. The nurse informs the patient that in preparation for an ultrasound of the lower urinary tract the patient will require what? A) Increased fluid intake to produce a full bladder B) IV administration of radiopaque contrast agent C) Sedation and intubation D) Injection of a radioisotope

A Feedback: Ultrasonography requires a full bladder; therefore, fluid intake should be encouraged before the procedures. The administration of a radiopaque contrast agent is required to perform IV urography studies, such as an IV pyelogram. Ultrasonography is a quick and painless diagnostic test and does not require sedation or intubation. The injection of a radioisotope is required for nuclear scan and ultrasonography is not in this category of diagnostic studies.

B (Feedback: Instructions about BSE should be provided to men if they have a family history of breast cancer, because they may have an increased risk of male breast cancer. It is not within the scope of the practice of a nurse to refer a patient for a mammogram or to a surgeon; these actions are not necessary or recommended. In the absence of symptoms or a diagnosis, referral to a support group is unnecessary.)

A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the patient's history that his father was treated for breast cancer. What should the nurse provide to the patient before he leaves the clinic? A) A referral for a mammogram B) Instructions about breast self-examination (BSE) C) A referral to a surgeon D) A referral to a support group

B (Feedback: It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the patient to her primary care provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau d'orange), a classic sign of advanced breast cancer. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. The patient's knowledge of breast cancer is relevant, but is not a time-dependent priority. This finding is not an age-related change.)

A 45-year-old woman comes into the health clinic for her annual check-up. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred in a few months. What assessment would be most appropriate for the nurse to make? A) Evaluate the patient's milk production. B) Palpate the area for a breast mass. C) Assess the patient's knowledge of breast cancer. D) Assure the patient that this likely an age-related change.

B (Feedback: Providing the patient with realistic expectations about the healing process and expected recovery can help alleviate fears. Offering the patient alternative treatment options is not within the nurse's normal scope of practice. Addressing survival rates may or may not be beneficial for the patient. Written material is rarely sufficient to meet patients' needs.)

A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this patient knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this patient's fears? A) Provide written material on the procedure that has been scheduled for the patient. B) Provide the patient with relevant information about expected recovery. C) Give the patient current information on breast cancer survival rates. D) Offer the patient alternative treatment options.

B (Feedback: Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.)

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor? A) Age-related physiologic changes B) Medication adverse effects C) Poor nutrition D) Fluid overload

A. CORRECT: A decrease in serum sodium is caused by an increase in the secretion of ADH. C. CORRECT: A decrease in serum osmolarity is caused by an increase in the secretion of ADH.

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse expect? (Select all that apply.) A. Decreased serum sodium B. Urine specific gravity 1.001 C. Serum osmolarity 230 mOsm/L D. Polyuria E. Increased thirst

B (Feedback: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.)

A nurse is examining a patient who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this patient's diagnosis? A) The patient will be scheduled for radiation therapy. B) The patient might be referred for a biopsy. C) The patient's breast mass is considered an age-related change. D) The patient's diagnosis is likely related to her use of oral contraceptives.

C (Feedback: Each breast contains 12 to 20 cone-shaped lobes, which are made up of glandular elements (lobules and ducts) and separated by fat and fibrous tissue that binds the lobes together. These breast lobes do not consist of tendons, ligaments, endocrine glands, or smooth muscle.)

A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements? A) Modified tendons and ligaments B) Connective tissue and smooth muscle C) Lobules and ducts D) Endocrine glands and sebaceous glands

B (Feedback: Incisional biopsy surgically removes a portion of a mass. This is performed to confirm a diagnosis and to conduct special studies that will aid in determining treatment. Incisional biopsies cannot always remove the whole mass, nor is it always beneficial to the patient to do so. The procedure is not chosen because of the potential for pain, the possibility of recovery from mastectomy, or the patient's age.)

A patient at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the patient asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurse's best response? A) An incisional biopsy is performed because it's known to be less painful and more accurate than other forms of testing. B) An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment. C) An incisional biopsy is performed to assess the potential for recovery from a mastectomy. D) An incisional biopsy is performed on patients who are younger than the age of 40 and who are otherwise healthy.

A (Feedback: Treatment for breast cancer depends on the disease stage and type, the patient's age and menopausal status, and the disfiguring effects of the surgery. For this patient, lumpectomy is the most likely option because the nodule is well-defined. The patient usually undergoes radiation therapy afterward. Because a lumpectomy is possible, mastectomy would not be the treatment of choice.)

A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment? A) Lumpectomy and radiation B) Partial mastectomy and radiation C) Partial mastectomy and chemotherapy D) Total mastectomy and chemotherapy

A (Feedback: If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.)

A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond? A) Not until the drain is removed B) On the second postoperative day C) Now, if you wash gently with soap and water D) Seven days after your surgery

C (Feedback: A trusted ally to assist in making treatment choices is beneficial to the patient's coping ability. It is condescending and inappropriate to ask if the patient is feeling alright these days or is concerned about the diagnosis. The patient's education level is irrelevant.)

A patient has just been diagnosed with breast cancer and the nurse is performing a patient interview. In assessing this patient's ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask this patient? A) What is your level of education? B) Are you feeling alright these days? C) Is there someone you trust to help you make treatment choices? D) Are you concerned about receiving this diagnosis?

A (Feedback: During the preoperative visit, the nurse assesses the patient for any specific educational, physical, or psychosocial needs that she may have. This can be accomplished by encouraging her to verbalize her fears, concerns, and questions. Reviewing her medical history may be beneficial, but it is not the best way to ascertain her needs. Discussing possible findings of the biopsy and possible treatment options is the responsibility of the treating physician.)

A patient has just been told she needs to have an incisional biopsy of a right breast mass. During preoperative teaching, how could the nurse best assess this patient for specific educational, physical, or psychosocial needs she might have? A) By encouraging her to verbalize her questions and concerns B) By discussing the possible findings of the biopsy C) By discussing possible treatment options if the diagnosis is cancer D) By reviewing her medical history

A (Feedback: Although many patients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma.)

A patient has just returned to the postsurgical unit from post-anesthetic recovery after breast surgery for removal of a malignancy. What is the most likely major nursing diagnosis to include in this patient's immediate plan of care? A) Acute pain related to tissue manipulation and incision B) Ineffective coping related to surgery C) Risk for trauma related to post-surgical injury D) Chronic sorrow related to change in body image

D (Feedback: The radiation exposure of mammogram is equivalent to about 1 hour of exposure to sunlight. Consequently, the benefits of mammography far outweigh any risks associated with the procedure. Negative consequences are insignificant, and do not accumulate later in life.)

A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram? A) It does not use radiation. B) Radiation levels are safe as long as mammograms are performed only once per year. C) The negative effects of radiation do not accumulate until late in life. D) Radiation from a mammogram is equivalent to an hour of sunlight.

The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply. A) Dietary history B) Family history of renal stones C) Medication history D) Surgical history E) Vaccination history

A,B,C

D (Feedback: The patient is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences. The nurse may educate the patient's spouse or partner to listen for concerns, but the nurse should not tell the patient's spouse what to do. The patient must consult with her physician and make her own decisions about further treatment. The patient needs to express her sadness, frustration, and fear. She cannot be expected to be optimistic at all times.)

A patient in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The patient shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well to her diagnosis and surgery. What nursing intervention is most appropriate to support this patient's coping? A) Encourage the patient's spouse or partner to be supportive while she recovers. B) Encourage the patient to proceed with the next phase of treatment. C) Recommend that the patient remain optimistic for the sake of her children. D) Arrange a referral to a community-based support program.

B, C, D (Feedback: Prior to discharge from the ambulatory surgical center or the office, the patient must be able to tolerate fluids, ambulate, and void. The patient must have somebody to accompany her home and would not be discharged with urinary catheter in place.)

A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply. A) Patient must understand when she can begin ambulating B) Patient must have someone to accompany her home C) Patient must understand activity restrictions D) Patient must understand care of the biopsy site E) Patient must understand when she can safely remove her urinary catheter

A (Feedback: Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy.)

A patient is to undergo an ultrasound-guided core biopsy. The patient tells the nurse that a friend of hers had a stereotactic core biopsy. She wants to understand the differences between the two procedures. What would be the nurse's best response? A) An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation. B) An ultrasound-guided core biopsy is a little more expensive, but it doesn't use radiation and it is faster. C) An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster. D) An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less expensive.

D (Feedback: The 5-year survival rate is approximately 15% for stage IV breast cancer. Surgery is still a likely treatment, but the disease would not be considered to be highly treatable. Self-resolution of the disease is not a possibility.)

A patient newly diagnosed with breast cancer states that her physician suspects regional lymph node involvement and told her that there are signs of metastatic disease. The nurse learns that the patient has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis? A) The patient is not a surgical candidate. B) The patient's breast cancer is considered highly treatable. C) There is a 10% chance that the patient's cancer will self-resolve. D) The patient has a 15% chance of 5-year survival

A (Feedback: In the breast cancer diagnostic phase it is appropriate to acknowledge the patient's feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills made be necessary, but the nurse should begin by acknowledging the patient's feelings. Fear is not necessarily indicative of ineffective coping.)

A patient who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. During the nurse's admission assessment, the nurse observes that the patient is distracted and tense. What is it important for the nurse to do? A) Acknowledge the fear the patient is likely experiencing. B) Describe the support groups that exist in the community. C) Assess the patient's stress management skills. D) Document a nursing diagnosis of ineffective coping.

D (Feedback: Galactography is a diagnostic procedure that involves injection of less than 1 mL of radiopaque material through a cannula inserted into the ductal opening on the areola, which is followed by mammography. It is performed to evaluate an abnormality within the duct when the patient has bloody nipple discharge on expression, spontaneous nipple discharge, or a solitary dilated duct noted on mammography. X-ray, PET, and ultrasound are not typically used for this purpose.)

A woman calls the clinic and tells the nurse she has had bloody drainage from her right nipple. The nurse makes an appointment for this patient, expecting the physician or practitioner to order what diagnostic test on this patient? A) Breast ultrasound B) Radiography C) Positron emission testing (PET) D) Galactography

D (Feedback: During the preoperative consultation, the patient should be informed of a possibility that sensory changes of the nipple (e.g., numbness) may occur. There is no consequent increase in breast cancer risk and it does not affect future mammography results. Chronic pain is not an expected complication.)

A woman is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the patient is aware of what potential consequence? A) Chronic breast pain B) Unclear mammography results C) Increased risk of breast cancer D) Decreased nipple sensation

37. The nurse is caring for a patient who has just returned to the post-surgical unit following renal surgery. When assessing the patient's output from surgical drains, the nurse should assess what parameters? Select all that apply. A) Quantity of output B) Color of the output C) Visible characteristics of the output D) Odor of the output E) pH of the output

A, B, C Feedback: Urine output and drainage from tubes inserted during surgery are monitored for amount, color, and type or characteristics. Odor and pH are not normally assessed.

39. A nurse on the renal unit is caring for a patient who will soon begin peritoneal dialysis. The family of the patient asks for education about the peritoneal dialysis catheter that has been placed in the patient's peritoneum. The nurse explains the three sections of the catheter and talks about the two cuffs on the dialysis catheter. What would the nurse explain about the cuffs? Select all that apply. A) The cuffs are made of Dacron polyester. B) The cuffs stabilize the catheter. C) The cuffs prevent the dialysate from leaking. D) The cuffs provide a barrier against microorganisms. E) The cuffs absorb dialysate

A, B, C, D Feedback: Most of these catheters have two cuffs, which are made of Dacron polyester. The cuffs stabilize the catheter, limit movement, prevent leaks, and provide a barrier against microorganisms. They do not absorb dialysate.

30. The nurse is caring for a patient status after a motor vehicle accident. The patient has developed AKI. What is the nurse's role in caring for this patient? Select all that apply. A) Providing emotional support for the family B) Monitoring for complications C) Participating in emergency treatment of fluid and electrolyte imbalances D) Providing nursing care for primary disorder (trauma) E) Directing nutritional interventions

A, B, C, D Feedback: The nurse has an important role in caring for the patient with AKI. The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances, assesses the patient's progress and response to treatment, and provides physical and emotional support. Additionally, the nurse keeps family members informed about the patient's condition, helps them understand the treatments, and provides psychological support. Although the development of AKI may be the most serious problem, the nurse continues to provide nursing care indicated for the primary disorder (e.g., burns, shock, trauma, obstruction of the urinary tract). The nurse does not direct the patient's nutritional status; the dietician and the physician normally collaborate on directing the patient's nutritional status.

38. The nurse is preparing to collect an ordered urine sample for urinalysis. The nurse should be aware that this test will include what assessment parameters? Select all that apply. A) Specific gravity of the patient's urine B) Testing for the presence of glucose in the patient's urine C) Microscopic examination of urine sediment for RBCs D) Microscopic examination of urine sediment for casts E) Testing for BUN and creatinine in the patient's urine

A, B, C, D Feedback: Urine testing includes testing for specific gravity, glucose, RBCs, and casts. BUN and creatinine are components of serum, not urine.

11. The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the nurse include? Select all that apply. A) Urine output B) Signs or symptoms of venous thromboembolism C) Peripheral pulses D) Blood pressure E) Skin integrity

A, D Feedback: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP. The patients peripheral pulses, risk of VTE, and skin integrity are not typically affected by aldosteronism.

The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this patient at this time? A) Provide emotional support to the patient and her family. B) Implement distraction and relaxation techniques. C) Offer to inform the patients family of this diagnosis. D) Teach the patient about the importance of maintaining a positive attitude.

A. Emotional support is an integral part of nursing care at this point in the disease progression. It is not normally appropriate for the nurse to inform the family of the patient's diagnosis. It may be inappropriate and simplistic to focus on distraction, relaxation, and positive thinking.

The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor the patient? A) Leukopenia B) Metabolic acidosis C) Hyperphosphatemia D) Respiratory alkalosis

A. Feedback: Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur. Acidñbase imbalances and elevated phosphate levels are not anticipated.

A female patient with HIV has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this patient? A) This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually. B) The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. C) The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. D) The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.

A. Feedback: HIV-positive women have a higher rate of HPV. Infections with HPV and HIV together increase the risk of malignant transformation and cervical cancer. Thus, women with HIV infection should have frequent Pap smears. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

You are caring for a patient who has been diagnosed with genital herpes. When preparing a teaching plan for this patient, what general guidelines should be taught? A) Thorough handwashing is essential. B) Sun bathing assists in eradicating the virus. C) Lesions should be massaged with ointment. D) Self-infection cannot occur from touching lesions during a breakout.

A. Feedback: The risk of reinfection and spread of infection to others or to other structures of the body can be reduced by handwashing, use of barrier methods with sexual contact, and adherence to prescribed medication regimens. The lesions should be allowed to dry. Touching of lesions during an outbreak should be avoided; if touched, appropriate hygiene practices must be followed.

A patient comes to the free clinic complaining of a gray-white discharge that clings to her external vulva and vaginal walls. A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time? A) Advise the patient that this is an overgrowth of normal vaginal flora. B) Discuss the effect of this diagnosis on the patients fertility. C) Document the vaginal discharge as normal. D) Administer acyclovir as ordered.

A. Gray-white discharge that clings to the external vulva and vaginal walls is indicative of an overgrowth of Gardnerella vaginalis. The patient's discharge is not a normal assessment finding. Antiviral medications are ineffective because of the bacterial etiology. This diagnosis is unlikely to have a long-term bearing on the patient's fertility.

A nurse in a provider's office is assessing a client who has hypothyroidism and recently began treatment with thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse that the client might need a decrease in the dosage of the medication? A. Hand tremors B. Bradycardia C. Pallor D. Slow speech

A. CORRECT: The nurse should identify hand tremors as a manifestation of hyperthyroidism that can result from thyroid hormone replacement therapy. The nurse should report this finding to the provider due to the possible need for a decrease in the dosage of medication.

A nurse is caring for a pregnant patient with active herpes. The teaching plan for this patient should include which of the following? A) Babies delivered vaginally may become infected with the virus. B) Recommended treatment is excision of the herpes lesions. C) Pain generally does not occur with a herpes outbreak during pregnancy. D) Pregnancy may exacerbate the mothers symptoms, but poses no risk to the infant.

A. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk for fetal morbidity and mortality if this occurs. Lesions are not controlled with excision. Itching and pain accompany the process as the infected area becomes red and swollen. Aspirin and other analgesics are usually effective in controlling the pain.

A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection? A) Trichomonas vaginalis B) Candidiasis C) Gardnerella D) Gonorrhea

A. The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white to yellow-white discharge clinging to external vulva and vaginal walls. Gonorrhea often produces no symptoms.

A patient with trichomoniasis comes to the walk-in clinic. In developing a care plan for this patient the nurse would know to include what as an important aspect of treating this patient? A) Both partners will be treated with metronidazole (Flagyl). B) Constipation and menstrual difficulties may occur. C) The patient should perform Kegel exercises 30 to 80 times daily. D) Care will involve hormone therapy to control the pain.

A. The most effective treatment for trichomoniasis is metronidazole (Flagyl). Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week. In pelvic inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises are prescribed to help strengthen weakened muscles associated with cystocele and other structural deficits. Hormone therapy does not address the etiology of trichomoniasis.

A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Client reports pain relieved by eating. B. Client states that pain often occurs at night. C. Client reports a sensation of bloating. D. Client states that pain occurs 30 min to 1 hr after a meal. E. Client experiences pain upon palpation of the epigastric region.

A. A client who has a duodenal ulcer will report that pain is relieved by eating. B. Pain that rarely occurs at night is an expected finding. C. CORRECT: A client report of a bloating sensation is an expected finding. D. CORRECT: A client who has a gastric ulcer will often report pain 30 to 60 min after a meal. E. CORRECT: Pain in the epigastric region upon palpation is an expected finding.

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? A. Pain in right upper quadrant radiating to right shoulder B. Report of pain being worse when sitting upright C. Pain relieved with defecation D. Epigastric pain radiating to the left shoulder

A. A client who has cholecystitis will report pain in the right upper quadrant radiating to the right shoulder. B. A client who has pancreatitis will report pain being worse when lying down. C. A client who has pancreatitis will report that pain is relieved by assuming the fetal position. D. CORRECT: A client who has pancreatitis will report severe, boring epigastric pain that radiates to the back, left flank, or left shoulder.

A nurse is completing discharge teaching with a client who has Crohn's disease. Which of the following instructions should the nurse include in the teaching? A. Decrease intake of calorie‐dense foods. B. Drink canned protein supplements. C. Increase intake of high fiber foods. D. Take a bulk‐forming laxative daily.

A. A high‐protein diet is recommended for the client who has Crohn's disease. B. CORRECT: A high‐protein diet is recommended for the client who has Crohn's disease. Canned protein supplements are encouraged. C. A low‐fiber diet is recommended for the client who has Crohn's disease to reduce inflammation. D. Bulk‐forming laxatives are recommended for the client who has diverticulitis.

A nurse is assessing an older adult client in an extended care facility. The nurse should recognize which of the following findings is a manifestation of an obstruction of the large intestine due to a fecal impaction? A. The client reports he had a bowel movement yesterday. B. The client is having small, frequent liquid stools. C. The client is flatulent. D. The client indicates he vomited once this morning.

A. A report of a bowel movement yesterday does not indicate a mechanical obstruction of the large intestine due to a fecal impaction. B. CORRECT: Small, frequent liquid stools can be passed around a fecal impaction. Other manifestations include constipation and rectal pain. C. The presence of flatus does not indicate a mechanical obstruction of the large intestine due to a fecal impaction. D. A report of a single episode of vomiting does not indicate a mechanical obstruction of the large intestine due to a fecal impaction. Frequent vomiting is a manifestation of a small‐bowel obstruction.

A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? (Select all that apply.) A. Anorexia B. Change in orientation C. Asterixis D. Ascites E. Fetor hepaticus

A. Anorexia is present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. B. CORRECT: A change in orientation indicates hepatic encephalopathy in a client who has advanced cirrhosis. C. CORRECT: Asterixis, a coarse tremor of the wrists and fingers, is observed as a late complication in a client who has cirrhosis and hepatic encephalopathy. D. Ascites can be present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. E. CORRECT: Fetor hepaticus, a fruity breath odor, is a finding of hepatic encephalopathy in the client who has advanced cirrhosis.

A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the client's risk of surgery? (Select all that apply.) A. Age older than 70 years B. BMI of 41 C. Administering NPH insulin each morning D. Past history of lymphoma E. Blood pressure averaging 120/70 mm Hg

A. CORRECT: A client older than 70 years has an increased risk for complications from surgery, lifelong immunosuppression, and organ rejection. B. CORRECT: A client who has a BMI of 41 is morbidly obese and is at an increased risk for complications of surgery, lifelong immunosuppression, and organ rejection. C. CORRECT: A client who requires NPH insulin for type 1 diabetes mellitus is at an increased risk from complication of surgery, lifelong immunosuppression, and organ rejection. D. CORRECT: A client who has a history of cancer, such as lymphoma, is at an increased risk for complications of surgery, lifelong immunosuppression, and organ rejection.

A nurse in an intensive care unit is planning care for a client who has myxedema coma. Which of the following actions should the nurse include? (Select all that apply.) A. Observe cardiac monitor for dysrhythmias. B. Observe for evidence of urinary tract infection. C. Initiate IV fluids using 0.9% sodium chloride. D. Administer a levothyroxine IV bolus. E. Provide warmth using a heating pad.

A. CORRECT: A client who has myxedema can have a flat or inverted T wave as well as ST deviations. B. CORRECT: An infection, such as in the urinary tract, can precipitate myxedema coma. The nurse should observe the client for manifestations of infection so that the underlying illness can be treated. C. CORRECT: Hyponatremia is an expected finding in the presence of myxedema coma. IV therapy is administered using 0.9% sodium chloride. D. CORRECT: Myxedema coma is a severe complication of hypothyroidism that if left untreated can lead to coma or death. Levothyroxine is administered IV bolus to treat the condition.

A nurse is caring for several clients. Which of the following clients are at risk for developing pyelonephritis? (Select all that apply.) A. A client who is at 32 weeks of gestation B. A client who has kidney calculi C. A client who has a urine pH of 4.2 D. A client who has a neurogenic bladder E. A client who has diabetes mellitus

A. CORRECT: A client who is at 32 weeks of gestation is at risk for developing pyelonephritis because of increased pressure on the urinary system during pregnancy causing reflux or retention of urine. B. CORRECT: A client who has kidney calculi is at risk for pyelonephritis because stones harbor bacteria. D. CORRECT: The client who has a neurogenic bladder can retain urine, promoting bacterial growth and causing pyelonephritis. E. CORRECT: The client who has diabetes mellitus is at risk of pyelonephritis because glucose that can be in the urine promotes bacterial growth.

A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching? A. "I will plan to limit fiber in my diet." B. "I will restrict fluid intake during meals." C."I will switch to black tea instead of drinking coffee." D."I will try to eat three moderate to large meals a day."

A. CORRECT: A low‐fiber diet is recommended for the client who has ulcerative colitis to reduce inflammation. B. A client who has dumping syndrome should avoid fluids with meals. C. Caffeine can increase diarrhea and cramping. The client should avoid caffeinated beverages, such as black tea. D. Small, frequent meals are recommended for the client who has ulcerative colitis.

A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The nurse should anticipate prescriptions for which of the following medications? (Select all that apply.) A. Antacids B. Histamine2 receptor antagonists C. Opioid analgesics D. Fiber laxatives E. Proton pump inhibitors

A. CORRECT: Antacids neutralize gastric acid which irritates the esophagus during reflux. B. CORRECT: Histamine2 receptor antagonists decrease acid secretion, which contributes to reflux. C. Opioid analgesics are not effective in treating GERD. D. Fiber laxatives are not effective in treating GERD. E. CORRECT: Proton pump inhibitors decrease gastric acid production, which contributes to reflex

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury. Which of the following actions should the nurse take? (Select all that apply.) A. Review the medications the client currently takes. B. Assess the AV fistula for a bruit. C. Calculate the client's hourly urine output. D. Measure the client's weight. E. Check serum electrolytes. F. Use the access site area for venipuncture.

A. CORRECT: By reviewing the medications the client currently takes, the nurse can determine which medications to withhold until after dialysis. B. CORRECT: Assessing the AV fistula for a bruit determines the patency of the fistula for dialysis. D. CORRECT: Measuring the client's weight before dialysis is essential for comparing it with the client's weight after dialysis. E. CORRECT: Checking the serum electrolytes determines the need for dialysis.

A nurse is caring for a client who has type 2 diabetes mellitus and will have excretory urography. Prior to the procedure, which of the following actions should the nurse take? (Select all that apply.) A. Identify an allergy to seafood. B. Withhold metformin for 24 hr. C. Administer an enema. D. Obtain a serum coagulation profile. E. Assess for asthma.

A. CORRECT: Clients who have an allergy to seafood are at higher risk for an allergic reaction to the contrast dye they will receive during the procedure. B. CORRECT: Clients who take metformin are at risk for lactic acidosis from the contrast dye with iodine they will receive during the procedure. C. CORRECT: Clients should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization. E. CORRECT: Clients who have asthma have a higher risk of an exacerbation as an allergic response to the contrast dye they will receive during the procedure.

A nurse is planning postoperative care for a client following a kidney transplant surgery. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Obtain daily weights. B. Assess dressings for bloody drainage. C. Replace hourly urine output with IV fluids. D. Expect oliguria in the first 4 hr. E. Monitor serum electrolytes.

A. CORRECT: Daily weights are obtained to assess fluid status. B. CORRECT: Drainage on the dressing is assessed to monitor for hemorrhage or hematoma. C. CORRECT: Hourly urine output with IV fluid replacement is monitored to detect abrupt decrease in urine output, which can indicate rejection or other serious conditions of the transplant kidney. E. CORRECT: Serum electrolytes is monitored because electrolytes loss can occur with postoperative diuresis.

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply.) A. Diuretic B. Beta‐blocking agent C. Opioid analgesic D. Lactulose E. Sedative

A. CORRECT: Diuretics facilitate excretion of excess fluid from the body in a client who has cirrhosis. B. CORRECT: Beta‐blocking agents are prescribed for a client who has cirrhosis to prevent bleeding from varices. C. Opioid analgesics are metabolized in the liver. They should not be administered to a client who has cirrhosis. D. CORRECT: Lactulose is prescribed for a client who has cirrhosis to aid in the elimination of ammonia in the stool. E. Sedatives are metabolized in the liver. They should not be administered to a client who has cirrhosis.

A nurse is preoperative teaching with a client who is scheduled for a kidney transplant about rejection of a transplanted kidney. Which of the following statements should the nurse include in the teaching? (Select all that apply.) A. "Expect an immediate removal of the donor kidney for a hyperacute rejection." B. "you may need to begin dialysis to monitor your kidney function for a hyperacute rejection." C."A fever is a manifestation of an acute rejection." D."Fluid retention is a manifestation of an acute rejection." E. "your provider will increase your immunosuppressive medications for a chronic rejection."

A. CORRECT: Immediate removal of the donor kidney is treatment for hyperacute rejection. C. CORRECT: Fever is a manifestation of an acute rejection. D. CORRECT: Fluid retention is a manifestation of an acute rejection.

A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation which of the following substances as an indication that the client has this disorder A. Triiodothyronine B. Plasma‐free metanephrine C. Urine cortisol D. Urine osmolality

A. CORRECT: Increased triiodothyronine (T3) indicates hyperthyroidism.

A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with this diagnosis? (Select all that apply.) A. Emesis greater than 500 mL with a fecal odor B. Report of spasmodic abdominal pain C. High‐pitched bowel sounds D. Abdomen flat with rebound tenderness to palpation E. Laboratory findings indicating metabolic acidosis

A. CORRECT: Large emesis with a fecal odor is a finding in a client who has a small bowel obstruction. B. CORRECT: Report of abdominal pain is a finding in a client who has a small bowel obstruction. C. CORRECT: High‐pitched bowel sounds are a manifestation of a small‐ or large‐bowel obstruction. D. Abdominal distention is a finding in a client who has a small bowel obstruction. E. Metabolic alkalosis due to the loss of gastric acid is a finding in a client who has a small bowel obstruction.

A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Limit physical activity. B. Avoid alcohol. C. Take acetaminophen for comfort. D. Wear a mask when in public places. E. Eat small frequent meals.

A. CORRECT: Limiting physical activity and taking frequent rest breaks conserves energy and assists in the recovery process for a client who has hepatitis B. B. CORRECT: Alcohol is metabolized in the liver and should be avoided by the client who has hepatitis B. C. Acetaminophen is metabolized in the liver and should be avoided by the client who has hepatitis B. D. Hepatitis B is a blood‐borne disease. Wearing a mask is not necessary to prevent transmission to others. E. CORRECT: The client who has hepatitis B should eat small frequent meals to promote improved nutrition due to the presence of anorexia.

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Rigid abdomen B. Tachycardia C. Elevated blood pressure D. Circumoral cyanosis E. Rebound tenderness

A. CORRECT: Manifestations of perforation include a rigid, board‐like abdomen. B. CORRECT: Tachycardia occurs due to gastrointestinal bleeding that accompanies a perforation. C. Hypotension is an expected finding in a client who has a perforation and bleeding. D. Circumoral cyanosis is not a manifestation of perforation. E. CORRECT: Rebound tenderness is an expected finding in a client who has a perforation.

A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Monitor CBC. B. Monitor triiodothyronine (T3). C. Instruct the client to increase consumption of shellfish. D. Advise the client to take the medication at the same time every day. E. Inform the client that an adverse effect of this medication is iodine toxicity.

A. CORRECT: Methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia. The nurse should monitor CBC. B. CORRECT: Methimazole reduces thyroid hormone production. The nurse should monitor T3. D. CORRECT: Methimazole should be taken at the same time every day to maintain blood levels.

A nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse expect? (Select all that apply.) A. Low sodium B. High potassium C. Increased urine osmolality D. High urine sodium E. Increased urine specific gravity

A. CORRECT: SIADH results in water retention, causing a low sodium level. C. CORRECT: SIADH results in an increase in urine osmolality due to the decreased urine volume. D. CORRECT: SIADH results in water retention, causing a high urine sodium level. E. CORRECT: SIADH results in water retention, causing an increase in urine specific gravity.

A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.) A. "I plan to eat small, frequent meals." B. "I will eat easy‐to‐digest foods with limited spice." C."I will use skim milk when cooking." D."I plan to drink regular cola." E. "I will limit alcohol intake to two drinks per day."

A. CORRECT: Small, frequent meals are recommended for the client who has pancreatitis. B. CORRECT: Bland, easy‐to‐digest foods are recommended for the client who has pancreatitis. C. CORRECT: Low‐fat foods are recommended for the client who has pancreatitis. D. Caffeine‐free beverages are recommended for the client who has pancreatitis. Regular cola contains caffeine. E. The client who has pancreatitis should avoid any alcohol intake.

A nurse is planning care for a client who has Cushing's disease. The nurse should recognize that clients who have Cushing's disease are at increased risk for which of the following? (Select all that apply.) A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures E. Dysphagia

A. CORRECT: Suppression of the immune system places the client at risk for infection. B. CORRECT: The overproduction of cortisol inhibits the production of a protective mucus lining in the stomach and causes an increase in the amount of gastric acid. These factors place clients who have Cushing's disease at increased risk for gastric ulcers D. CORRECT: Clients who have Cushing's disease are at risk for bone fractures because decreased calcium absorption leads to osteoporosis.

A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? (Select all that apply.) A. Suction equipment B. Humidified oxygen C. Flashlight D. Tracheostomy tray E. Chest tube tray

A. CORRECT: The client can require oral or tracheal suctioning. The nurse should ensure that suctioning equipment is available. B. CORRECT: The client can require supplemental oxygen due to respiratory complications. Humidified oxygen thins secretions and promotes respiratory exchange. This equipment should be available. D. CORRECT: The client can experience respiratory obstruction. A tracheostomy tray should be available at the bedside.

A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Obtain a capillary blood glucose four times daily. B. Administer prescribed medications through a secondary port on the TPN IV tubing. C. Monitor vital signs three times during the 12‐hr shift. D. Change the TPN IV tubing every 24 hr. E. Ensure a daily aPTT is obtained.

A. CORRECT: The client is at risk for hyperglycemia during the administration of TPN and can require supplemental insulin. B. No other medications or fluids should be administered through the IV tubing being used to administer TPN due to the increased risk of infection and disruption of the rate of TPN infusion. C. CORRECT: Vital signs are recommended every 4 to 8 hr to assess for fluid volume excess and infection. D. CORRECT: It is recommended to change the IV tubing that is used to administer TPN every 24 hr. E. aPTT measures the coagulability of the blood, which is unnecessary during the administration of TPN.

A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Take the medication 1 hr before a meal. B. Limit NSAIDs when taking this medication. C. Expect skin flushing when taking this medication. D. Increase fiber intake when taking this medication. E. Chew the medication thoroughly before swallowing.

A. CORRECT: The client is instructed to take the medication 1 hr before meals. B. CORRECT: The client is instructed to limit taking NSAIDs when on this medication. C. Skin flushing is not an adverse effect of this medication. D. Fiber intake does not need to be increased when taking this medication. E. The client is instructed to swallow the capsule whole. It should not be crushed or chewed.

A nurse is planning care for a client who has chronic pyelonephritis. Which of the following actions should the nurse plan to take? (Select all that apply.) A. Provide a referral for nutrition counseling. B. Encourage daily fluid intake of 1 L. C. Palpate the costovertebral angle. D. Monitor urinary output. E. Administer antibiotics.

A. CORRECT: The client requires adequate nutrition to promote healing. C. CORRECT: The nurse should gently palpate the costovertebral angle for flank tenderness, which can indicate inflammation and infection. D. CORRECT: The nurse should monitor urinary output to determine that 1 to 3 L of urine is excreted daily. E. CORRECT: The nurse should administer antibiotics to treat the bacteriuria and decrease progressive damage to the kidney.

A nurse is completing discharge teaching with a client who is 3 days postoperative following a transverse colostomy. Which of the following should the nurse include in the teaching? A. Mucus will be present in stool for 5 to 7 days after surgery. B. Expect 500 to 1,000 mL of semi liquid stool after 2 weeks. C. Stoma should be moist and pink. D. Change the ostomy bag when it is 3⁄4 full

A. Mucus and blood can be present for 2 to 3 days after surgery. B. Output should become stool‐like, semi‐formed, or formed within days to weeks. C. CORRECT: A pink, moist stoma is an expected finding with a transverse colostomy. D. The ostomy bag should be changed when it is 1⁄4 to 1⁄2 full.

A nurse is preparing educational material to present to a female client who has frequent urinary tract infections. Which of the following information should the nurse include? (Select all that apply.) A. Avoid sitting in a wet bathing suit. B. Wipe the perineal area back to front following elimination. C. Empty the bladder when there is an urge to void. D. Wear synthetic fabric underwear. E. Take a shower daily.

A. CORRECT: The client should avoid sitting in a wet bathing suit, which can increase the risk for a UTI by colonization of bacteria in a moist, warm environment. C. CORRECT: The client should empty the bladder when there is an urge to void rather than retain urine for an extended period of time, which increases the risk for a UTI. E. CORRECT: The client should take a shower daily to promote good body hygiene and decrease colonization of bacteria in the perineal area that can cause a UTI.

A nurse is completing discharge teaching with a client who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Avoid foods that trigger exacerbation. B. Consume 15 to 20 g of fiber daily. C. Plan three moderate to large meals per day. D. Drink at least 2 L fluids each day.

A. CORRECT: The client should eliminate foods that trigger exacerbation. B. A client who has IBS should increase daily fiber intake to 30 to 40 g. C. A client who has IBS should eat small frequent meals. D. CORRECT: A client who has IBS should drink 2 to 3 L fluids per day to promote a consistent bowel pattern.

A nurse is reviewing discharge instructions with a client who had spontaneous passage of a calcium phosphate renal calculus. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Limit intake of food high in animal protein. B. Reduce sodium intake. C. Strain urine for 48 hr. D. Report burning with urination to the provider. E. Increase fluid intake to 3 L/day.

A. CORRECT: The client should limit the intake of food high in animal protein, which contains calcium phosphate. B. CORRECT: The client should limit intake of sodium, which affects the precipitation of calcium phosphate in the urine. D. CORRECT: The client should report burning with urination to the provider because this can indicate a urinary tract infection. E. CORRECT: The client should increase fluid intake to 2 to 3 L/day. A decrease in fluid intake can cause dehydration, which increases the risk of calculi formation.

A nurse is caring for a client who is receiving TPN solution. The current bag of solution was hung 24 hr ago, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? A. Remove the current bag and hang a new bag. B. Infuse the remaining solution at the current rate and then hang a new bag. C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag. D. Remove the current bag and hang a bag of lactated Ringer's.

A. CORRECT: The current bag of TPN should not hang more than 24 hr due to the risk of infection. B. The current bag of TPN should not hang more than 24 hr due to the risk of infection. C. The rate of TPN infusion should never be increased abruptly due to the risk of hyperglycemia. D. Administration of TPN should never be discontinued abruptly due to the sudden change in blood glucose that can occur.

A nurse is planning care for a client who has Stage 4 chronic kidney disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Assess for jugular vein distention. B. Provide frequent mouth rinses. C. Auscultate for a pleural friction rub. D. Provide a high‐sodium diet. E. Monitor for dysrhythmias.

A. CORRECT: The nurse should assess for jugular vein distention, which can indicate fluid overload and heart failure. B. CORRECT: The nurse should provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood. C. CORRECT: The nurse should auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention. E. CORRECT: The nurse should monitor for dysrhythmias related to increased serum potassium caused by Stage 4 chronic kidney disease

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Check BUN and serum creatinine. B. Administer medications the nurse withheld prior to dialysis. C. Observe for signs of hypovolemia. D. Assess the access site for bleeding. E. Evaluate blood pressure on the arm with AV access.

A. CORRECT: The nurse should check the BUN and serum creatinine to determine the presence and degree of uremia or waste products that remain following dialysis. B. CORRECT: The nurse should withhold medications the treatment can partially dialyze. After the treatment, the nurse should administer the medications. C. CORRECT: A client who is post‐dialysis is at risk for hypovolemia due to a rapid decease in fluid volume. D. CORRECT: The nurse should assess the access site for bleeding because the client receives heparin during the procedure to prevent clotting of blood.

A nurse is planning care for a client who has a small bowel instruction and a nasogastric (NG) tube in place. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Document the NG drainage with the client's output. B. Irrigate the NG tube every 8 hr. C. Assess bowel sounds. D. Provide oral hygiene every 2 hr. E. Monitor NG tube for placement.

A. CORRECT: The nurse should document the NG drainage as output. This helps determine the amount of fluid replacement needed. B. The NG tube is irrigated every 4 hr to maintain patency. C. CORRECT: Bowel sounds should be assessed to evaluate treatment and resolution of the obstruction. D. CORRECT: An NG tube promotes mouth breathing. The nurse should provide frequent oral hygiene to provide comfort. E. CORRECT: The nurse should check the placement of the NG tube prior to irrigation to prevent aspiration and periodically to prevent an increase in abdominal distention.

A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? (Select all that apply.) A. Evaluate intake and output. B. Monitor laboratory reports of electrolytes. C. Provide three large meals a day. D. Administer ibuprofen for pain. E. Observe stool characteristics.

A. CORRECT: The nurse should evaluate the client's intake and output to prevent electrolyte loss and dehydration. B. CORRECT: The nurse should monitor the client's electrolyte laboratory values to prevent fluid loss and dehydration. C. The nurse should instruct the client to eat small, frequent meals. D. The nurse should instruct the client to avoid taking ibuprofen, an NSAID, because of its erosive capabilities. E. CORRECT: The nurse should instruct the client to report to the provider any indication of the presence of blood in the stools, which can indicate gastrointestinal bleeding.

A nurse is reviewing bowel prep using polyethylene glycol with a client scheduled for a colonoscopy. Which of the following instructions should the nurse include in the teaching? A. Check with the provider about taking current medications when consuming bowel prep. B. Consume a normal diet until starting the bowel prep. C. Expect the bowel prep to not begin acting until the day after all the prep is consumed. D. Discontinue the bowel prep once feces start to be expelled.

A. CORRECT: The nurse should instruct the client to check with the provider about taking current medication, because some medications can be withheld when taking polyethylene glycol due to their lack of absorption. B. The nurse should instruct the client to consume a clear liquid diet prior to starting the bowel prep. C. The nurse should instruct the client that the actions of polyethylene glycol begin within 2 to 3 hr after consumption. D. The nurse should instruct the client to consume the full amount prescribed.

A nurse is planning care for a client who will undergo peritoneal dialysis. Which of the following actions should the nurse take? (Select all that apply.) A. Monitor serum glucose levels. B. Report cloudy dialysate return. C. Warm the dialysate in a microwave oven. D. Assess for shortness of breath. E. Check the access site dressing for wetness. F. Maintain medical asepsis when accessing the catheter insertion site.

A. CORRECT: The nurse should monitor serum glucose levels because the dialysate solution contains glucose. B. CORRECT: The nurse should monitor for cloudy dialysate return, which indicates an infection. Clear, light‐yellow solution is typical during the outflow process. D. CORRECT: The nurse should assess for shortness of breath, which can indicate inability to tolerate a large volume of dialysate. E. CORRECT: The nurse should check the access site dressing for wetness and look for kinking, pulling, clamping, or twisting of the tubing, which can increase the risk for exit‐site infections.

A nurse is planning care for a client who has postrenal AKI due to metastatic cancer. The client has a serum creatinine of 5 mg/dL. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Provide a high‐protein diet. B. Assess the urine for blood. C. Monitor for intermittent anuria. D. Weight the client once per week. E. Provide NSAIDs for pain.

A. CORRECT: The nurse should provide a high‐protein diet due to the high rate of protein breakdown that occurs with acute kidney injury. B. CORRECT: The nurse should assess urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney. C. CORRECT: The nurse should assess for intermittent anuria due to obstruction or damage to kidneys or urinary structures.

A nurse is completing preprocedure teaching for a client who will undergo a sigmoidoscopy. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Increased flatulence can occur following the procedure. B. NPO status should be maintained preprocedure. C. Conscious sedation is used. D. Repositioning will occur throughout the procedure. E. Fluid intake is limited the day after the procedure.

A. CORRECT: The nurse should teach the client that increased flatulence can occur due to the instillation of air during the procedure. B. CORRECT: The nurse should instruct the client to remain NPO after midnight the night before the procedure. C. The nurse should inform the client that sedation is not indicated for a sigmoidoscopy. D. The nurse should inform the client that the position to lie for the procedure is on the left side. E. The nurse should instruct the client to increase, not limit fluid intake following the procedure.

A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings should the nurse expect for this client? (Select all that apply.) A. Sodium 150 mEq/L B. Potassium 3.3 mEq/L C. Calcium 8.0 mg/dL D. Lymphocyte count 35% E. Fasting glucose 145 mg/dL

A. CORRECT: This finding is above the expected reference range. Hypernatremia is an expected finding for clients who have Cushing's disease. B. CORRECT: This finding is below the expected reference range. Hypokalemia is an expected finding for clients who have Cushing's disease. C. CORRECT: This finding is below the expected reference range. Hypocalcemia is an expected finding for clients who have Cushing's disease. E. CORRECT: This finding is above the expected reference range. Clients who have Cushing's disease have an elevated fasting blood glucose because the disorder affects glucose metabolism.

A nurse is reviewing laboratory results for a client who has Addison's disease. Which of the following laboratory results should the nurse expect for this client? (Select all that apply.) A. Sodium 130 mEq/L B. Potassium 6.1 mEq/L C. Calcium 11.6 mg/dL D. Blood urea nitrogen (BUN) 28 mg/dL E. Fasting blood glucose 148 mg/dL

A. CORRECT: This finding is below the expected reference range. In the presence of Addison's disease, insufficient glucose can cause sodium and water excretion. Hyponatremia is an expected finding. B. CORRECT: This finding is above the expected reference range. Hyperkalemia is an expected finding for a client who has Addison's disease. C. CORRECT: This finding is above the expected reference range. Hypercalcemia is an expected finding for a client who has Addison's disease. D. CORRECT: This BUN level is above the expected reference range, which is an expected finding for a client who has Addison's disease due to dehydration.

A nurse is having difficulty arousing a client following an esophagogastroduodenoscopy (EGD). Which of the following is the priority action by the nurse? A. Assess the client's airway. B. Allow the client to sleep. C. Prepare to administer an antidote to the sedative. D. Evaluate preprocedure laboratory findings.

A. CORRECT: When using the airway, breathing, and circulation priority‐setting framework, assessing and maintaining an open airway is the priority action the nurse should take. B. The nurse should continue to allow the client to rest. However, another action is the priority. C. The nurse should prepare to administer an antidote to the sedative used during the procedure. However, another action is the priority. D. The nurse should evaluate the preprocedure laboratory findings. However, another action is the priority.

A nurse is reviewing a new prescription for ursodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? A. This medication is used to decrease acute biliary pain. B. This medication requires thyroid function monitoring every 6 months. C. This medication is not recommended for clients who have diabetes mellitus. D. This medication dissolves gallstones gradually over a period of up to 2 years.

A. Opioid analgesics are preferred for the treatment of acute biliary pain. B. The client should have an ultrasound of the gallbladder every 6 months during the first year of treatment to determine effectiveness of the medication. C. Ursodiol is used cautiously in clients who have liver conditions or disorders with varices. D. CORRECT: Ursodiol is a bile acid that gradually dissolves cholesterol‐based gall stones. The medication can be taken for up to 2 years.

A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? A."I can take my medications with soda." B. "Peppermint tea will increase my indigestion." C."Wearing an abdominal binder will limit my symptoms." D."I will drink hot chocolate at bedtime to help me sleep." E. "I can lift weights as a way to exercise."

A. Carbonated beverages decrease LES pressure and should be avoided by the client who has a hiatal hernia. B. CORRECT: Peppermint decreases LES pressure and should be avoided by the client who has a hiatal hernia C. Tight restrictive clothing or abdominal binders should be avoided by the client who has a hiatal hernia, as this increases intra‐abdominal pressure and causes the protrusion of the stomach into the thoracic cavity. D. The client should avoid consuming anything immediately prior to bedtime. Additionally, chocolate relaxes the lower esophageal sphincter and should be avoided by a client who has a hiatal hernia E. Heavy lifting and vigorous activities are to be avoided in the client who has a hiatal hernia.

A nurse in a clinic is instructing a client about a fecal occult blood test, which requires mailing three specimens. Which of the following statements by the client indicates understanding of the teaching? A. "I will continue taking my warfarin while I complete these tests." B. "I'm glad I don't have to follow any special diet at this time." C."This test determines if I have parasites in my bowel." D."This is an easy way to screen for colon cancer."

A. Clients are instructed to stop taking anticoagulants prior to obtaining stool specimens for fecal occult blood testing because they can interfere with the results. B. Clients are instructed to avoid consuming red meat, chicken, and fish prior to obtaining stool specimens for fecal occult blood testing because this can interfere with the results. C. Fecal occult blood testing does not identify parasites present in stool. D. CORRECT: Fecal occult blood testing is a screening procedure for colon cancer.

A nurse is completing discharge teaching for a client who has an infection due to Helicobacter pylori (H. pylori). Which of the following statements by the client indicates understanding of the teaching? A. "I will continue my prescription for corticosteroids." B. "I will schedule a CT scan to monitor improvement." C."I will take a combination of medications for treatment." D."I will have my throat swabbed to recheck for this bacteria."

A. Corticosteroid use is a contributing factor to an infection caused by H. pylori. B. An esophagogastroduodenoscopy is done to evaluate for the presence of H. pylori and to evaluate effectiveness of treatment. C. CORRECT: A combination of antibiotics and a histamine2 receptor antagonist is used to treat an infection caused by H. pylori. D. H. pylori is evaluated by obtaining gastric samples, not a throat swab.

A nurse is teaching about pernicious anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching? A. Pernicious anemia is caused when the cells producing gastric acid are damaged. B. Expect a monthly injection of vitamin B12. C. Plan to take vitamin K supplements. D. Pernicious anemia is caused by an increased production of intrinsic factor.

A. Damage to parietal cells has occurred, which leads to pernicious anemia and causes a decrease of the intrinsic factor by the stomach parietal cells. B. CORRECT: The nurse should include in the information that the client will receive a monthly injection of vitamin B12 to treat pernicious anemia due to a decrease of the intrinsic factor by the stomach parietal cells. C. Vitamin K supplements are given to clients who have a bleeding disorder. D. Parietal cell damage results in insufficient production of intrinsic factor by the stomach parietal cells.

A nurse is teaching a client who has a new prescription for famotidine. Which of the following statements by the client indicates understanding of the teaching? A. "The medicine coats the lining of my stomach." B. "The medication should stop the pain right away." C."I will take my pill 1 hr before meals." D."I will monitor for bleeding from my nose."

A. Famotidine decreases gastric acid output. It does not have a protective coating action. B. The client might need to take famotidine for several days before pain relief occurs when starting this therapy. C. CORRECT: The client should take famotidine 1 hr before meals to decrease heartburn, acid indigestion, and sour stomach. D. The nurse should instruct the client to monitor for GI bleeding when taking famotidine.

A nurse is reviewing the serum laboratory data of a client who has an acute exacerbation of Crohn's disease. Which of the following laboratory tests should the nurse expect to be elevated? (Select all that apply.) A. Hematocrit B. Erythrocyte sedimentation rate C. WBC D. Folic acid E. Albumin

A. Hematocrit is decreased as a result of chronic blood loss. B. CORRECT: Increased erythrocyte sedimentation rate is a finding in a client who has Crohn's disease as a result of inflammation. C. CORRECT: Increased WBC is a finding in a client who has Crohn's disease. D. A decrease in folic acid level is indicative of malabsorption due to Crohn's disease. E. A decrease in serum albumin is indicative of malabsorption due to Crohn's disease.

A nurse on a medical‐surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A. Initiate contact precautions. B. Weigh the client weekly. C. Measure abdominal girth 7.5 cm (3 in) above the umbilicus. D. Provide a high‐calorie, high‐carbohydrate diet.

A. Hepatitis B is transmitted via blood. Standard precautions are adequate. B. Daily weights are obtained to monitor fluid status. C. The client's abdominal girth is measured over the largest part of the abdomen, which will vary by client. D. CORRECT: The client who has hepatitis B should have a diet high in calories and carbohydrates

A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Loss of tooth enamel C. Sweet taste in mouth D. Absence of eructation

A. Hypersalivation is an expected finding in a client who has GERD. B. CORRECT: Tooth erosion is an expected finding in a client who has GERD. C. A client who has GERD would report a bitter taste in the mouth. D. Increased burping is an expected finding in a client who has GERD.

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? A. Instruct the client to chew the medication before swallowing. B. Offer a glass of water following medication administration. C. Administer the medication 30 min before meals. D. Sprinkle the contents on peanut butter.

A. Pancrelipase should be swallowed without chewing to reduce irritation and slow the release of the medication. B. CORRECT: The client should drink a full glass of water following administration of pancrelipase. C. Pancrelipase should be administered with every meal and snack. D. The contents of the pancrelipase capsule may be sprinkled on nonprotein foods, and peanut butter is a protein food.

A nurse is completing an admission assessment for a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Emesis prior to insertion of the nasogastric tube B. Urine specific gravity 1.040 C. Hematocrit 60% D. Serum potassium 3.0 mEq/L E. WBC 10,000/uL

A. Profuse emesis is an expected finding for a client who has a small bowel obstruction. The nurse does not need to report this finding to the provider. B. CORRECT: This urine specific gravity is greater than the expected reference range of 1.005 to 1.030. An increased urine specific gravity is an indication of dehydration. The nurse should report this finding to the provider. C. CORRECT: The Hct is greater than the expected reference range of 42% to 52% for men and 37% to 47% for women. An elevated HCT indicates hemoconcentration, which is due to dehydration. D. CORRECT: This serum potassium is below the expected reference range of 3.5 to 5.0 mEq/L caused by potassium loss from vomiting. Hypokalemia can cause dysrhythmias, muscle weakness, and lethargy, and requires potassium replacement. The nurse should report this finding to the provider E. This WBC is within the expected reference range of 5,000 to 10,000/mm3. The nurse does not need to report this finding to the provider.

A nurse is admitting a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? A. Propranolol B. Metoclopramide C. Ranitidine D. Vasopressin

A. Propranolol is not used for clients who are actively bleeding. It can be given prophylactically to decrease portal hypertension. B. Metoclopramide decreases motility of the esophagus and stomach. C. Histamine2‐receptor antagonists are administered following surgical procedures for bleeding esophageal varices. D. CORRECT: Vasopressin constricts blood vessels and is used to treat bleeding esophageal varices.

A charge nurse is teaching a group of unit nurses about a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statements by a unit nurse indicates understanding of the purpose of the procedure? A. "The client will have increased duodenal gastric emptying." B. "The client will have a reduction of gastric acid secretions." C."The client will have an increase of gastric mucus secretion." D."The client will have an increased secretion of hydrogen/potassium ATPase enzymes."

A. Pyloroplasty will increase gastric emptying, which is performed to widen the opening from the stomach to the duodenum. B. CORRECT: Selective vagotomy will reduce gastric acid secretions. C. Prostaglandin analog medication will stimulate mucosal protection and decrease gastric acid secretions. D. A histamine2 antagonist medication will inhibit gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in the gastric parietal cells.

A nurse is reviewing the health record of a client who has a suspected tumor of the jejunum. The nurse should anticipate a prescription for which of the following tests? (Select all that apply.) A. Serum alpha‐fetoprotein B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Gastrointestinal x‐ray with contrast D. Small bowel capsule endoscopy (M2A) E. Colonoscopy

A. Serum alpha‐fetoprotein is a laboratory test used in cases of suspected liver cancer. B. An ERCP is used to visualize the duodenum, biliary ducts, gall bladder, liver, and pancreas. C. CORRECT: A gastrointestinal x‐ray with contrast involves the client drinking barium, which is then traced through the small intestine to the junction with the colon. This would identify a tumor in the jejunum. D. CORRECT: M2A is a procedure in which the client swallows a capsule with a glass of water for a video enteroscopy to visualize the entire small bowel over an 8‐hr period. E. A colonoscopy is the use of a flexible fiberoptic colonoscope, which enters through the anus, to visualize the rectum and the sigmoid, descending, transverse, and ascending colon.

A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy with T‐tube placement. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Take baths rather than showers. B. Clamp T‐tube for 1 hr before and after meals. C. Keep the drainage system above the level of the abdomen. D. Expect to have the T‐tube removed 3 days postoperatively. E. Report brown‐green drainage to the provider.

A. Soaking in bath water is not recommended while the T‐tube is in place due to the increased risk for introduction of organisms and infection. B. CORRECT: The T‐tube is clamped 1 hr before and after meals to provide the bile needed for digestion of food. C. CORRECT: The provider may prescribe elevation of the T‐ above the level of the abdomen to prevent the total loss of bile. D. The T‐tube usually remains in place for 1 to 3 weeks postoperatively. E. The purpose of the T‐tube is to drain bile from the common bile duct. Bile is brown‐green, so this is an expected finding.

A nurse is providing care to a client who is 1 day postoperative following a paracentesis. The nurse observes clear, pale‐yellow fluid leaking from the operative site. Which of the following is an appropriate nursing intervention? A. Place a clean towel near the drainage site. B. Apply a dry, sterile dressing. C. Apply direct pressure to the site. D. Place the client in a supine position.

A. Sterile dressings should be applied to the operative site to prevent infection and allow for assessment of drainage. B. CORRECT: Application of a sterile dressing will contain the drainage and allow continuous assessment of color and quantity. C. Application of direct pressure can cause discomfort and potential harm to the client. The nurse should apply a sterile dressing to the site and monitor the quantity and characteristic of the drainage. D. The client should be placed with the head of the bed elevated to promote lung expansion.

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching? A. "Take the medication 2 hr after eating." B. "Discontinue this medication if your skin turns yellow‐orange." C."Notify the provider if you experience a sore throat." D."Expect your stools to turn black."

A. Sulfasalazine should be taken right after meals and with a full glass of water to reduce gastric upset and prevent crystalluria. B. yellow‐orange coloring of the skin and urine is a harmless effect of sulfasalazine. C. CORRECT: Sulfasalazine can cause blood dyscrasias. The client should monitor and report any manifestations of infection, such as a sore throat. D. Sulfasalazine can cause thrombocytopenia and bleeding. Black stools are a manifestation of gastrointestinal bleeding, and the client should report this to the provider.

A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. "The scope will be passed through your rectum." B. "you might have shoulder pain after surgery." C."you will have a Jackson‐Pratt drain in place after surgery." D."you should limit how often you walk for 1 to 2 weeks."

A. Surgery is possibly performed through the rectum during the natural orifice transluminal endoscopic surgery (NOTES) approach. B. CORRECT: Shoulder pain is expected postoperatively due to free air that is introduced into the abdomen during laparoscopic surgery. C. A Jackson‐Pratt may be placed during the open surgery approach. D. The client is instructed to ambulate frequently following a laparoscopic surgical approach to minimize the free air that has been introduced.

A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to report? A. History of cholelithiasis B. Elevated serum amylase level C. Decrease in bowel sounds upon auscultation D. Hand spasms present when blood pressure is checked

A. The client is at risk for chronic obstructive pancreatitis from cholelithiasis. However, another finding is the priority to report. B. The client is at risk for pancreatic abscess or pseudocyst, which a continuous elevation of amylase can indicate. Increased serum amylase is expected for 2 to 3 days with acute pancreatitis. However, another finding is the priority to report. C. The client is at risk for paralytic ileus from acute pancreatitis. However, another finding is the priority to report. D. CORRECT: The greatest risk to the client is ECG changes and hypotension from hypocalcemia. Hand spasms when taking blood pressure is a manifestation of hypocalcemia.

A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. The nurse should recognize which of the following findings as the priority? A. Client reports difficulty sleeping. B. The client's urine is positive for glucose. C. Client reports having an elevated body temperature. D. Client reports gaining 4 lb in the last 6 months.

A. The client is at risk for sleep deprivation because prednisone can cause anxiety and insomnia. However, another finding is the priority. B. The client is at risk for hyperglycemia because prednisone can cause glucose intolerance. However, another finding is the priority. C. CORRECT: The greatest risk to the client is infection because prednisone can cause immunosuppression. Therefore, the nurse should identify indications of an infection, such as an elevated body temperature, as the priority finding. D. The client is at risk for weight gain because prednisone can cause fluid retention. However, another finding is the priority.

A nurse is completing discharge teaching to a client who is postoperative following fundoplication. Which of the following statements by the client indicates understanding of the teaching? A. "When sitting in my lounge chair after a meal, I will lower the back of it." B. "I will try to eat three large meals a day." C."I will elevate the head of my bed on blocks." D."When sleeping, I will lay on my left side."

A. The client is instructed to remain upright after eating following a fundoplication. B. The client is instructed to avoid large meals after a fundoplication. C. CORRECT: After a fundoplication, the client is instructed to elevate the head of the bed to limit reflux. D After a fundoplication, the client is instructed to sleep on the right side.

A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? A. Eat three moderate‐sized meals a day. B. Drink at least one glass of water with each meal. C. Eat a bedtime snack that contains a milk product. D. Increase protein in the diet.

A. The client should consume small, frequent meals rather than moderate‐sized meals. B. The client should eliminate liquids with meals and for 1 hr prior to and following meals. C. The client should avoid milk products. D. CORRECT: The client should eat a high‐protein, high‐fat, low‐fiber, and moderate‐ to low‐carbohydrate diet.

A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching? A. Take the medication with food. B. Monitor for diarrhea. C. Wait 1 hr before taking other oral medications. D. Maintain a low‐fiber diet.

A. The nurse should advise the client to take aluminum hydroxide on an empty stomach. B. The nurse should include in the teaching that aluminum hydroxide can cause constipation. C. CORRECT: The nurse should advise the client not to take oral medications within 1 hr of an antacid. D. The nurse should include in the teaching for the client to increase dietary fiber due to the constipating effect of the medication.

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. Serum amylase 80 units/L B. WBC 9,000/mm3 C. Direct bilirubin 2.1 mg/dL D. Alkaline phosphatase 25 units/L

A. The nurse should expect the client who has cholelithiasis to have an elevated serum amylase level if pancreatic involvement is present. A serum amylase of 80 units/L is within the expected reference range. B. The nurse should expect the client who has cholelithiasis to have an elevated WBC level due to inflammation. A WBC of 9,000/mm3 is within the expected reference range. C. CORRECT: The nurse should expect the client who has cholelithiasis to have an elevated direct bilirubin level if the bile duct is obstructed. A direct bilirubin level of 2.1 mg/dL is greater than the expected reference range. D. The nurse should expect the client who has cholelithiasis to have an elevated alkaline phosphatase (ALP) level if the common bile duct is obstructed. An ALP of 25 units/L is less than the expected reference range.

25. A physician explains to the patient that he has an inflammation of the Cowper glands. Where are the Cowper glands located? A) Within the epididymis B) Below the prostate, within the posterior aspect of the urethra C) On the inner epithelium lining the scrotum, lateral to the testes D) Medial to the vas deferens

B Feedback: Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

15. While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see? A) Hyperthermia and tachypnea B) Hypertension and heart rate changes C) Hypotension and hypothermia D) Hyperthermia and bradycardia

B Feedback: Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with marked increases in BP and changes in heart rate. The use of sodium nitroprusside and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign changes may occur related to surgical complications, the most common changes are related to hypertension and changes in the heart rate.

39. A patient who has been taking corticosteroids for several months has been experiencing muscle wasting. The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend? A) Activity limitation to conserve energy B) Consumption of a high-protein diet C) Use of OTC vitamin D and calcium supplements D) Passive range-of-motion exercises

B Feedback: Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises maintain flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease muscle wasting. Activity limitation would exacerbate the problem.

15. A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patient's history, what might the nurse note that contributes to erectile dysfunction? A) The patient has been treated for a UTI twice in the past year. B) The patient has a history of hypertension. C) The patient is 66 years old. D) The patient leads a sedentary lifestyle.

B Feedback: Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems.

10. A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Retinopathy C) Hypotension D) Diabetic nephropathy

B Feedback: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually contraindicated with diabetic retinopathy.

23. A 75-year-old male patient is being treated for phimosis. When planning this patient's care, what health promotion activity is most directly related to the etiology of the patient's health problem? A) Teaching the patient about safer sexual practices B) Teaching the patient about the importance of hygiene C) Teaching the patient about the safe use of PDE-5 inhibitors D) Teaching the patient to perform testicular self-examination

B Feedback: Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.

21. A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy? A) There will be no ejaculate after a vasectomy, though the patient's potential for orgasm is unaffected. B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C) There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D) There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.

B Feedback: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.

22. The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments? A) Temperature and oxygen saturation B) Heart rate and BP C) Breath sounds and bowel sounds D) Color, warmth, movement, and sensation of extremities

B Feedback: The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patients condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, BP and heart rate monitoring are priorities over the other listed assessments.

23. A patient is being treated for AKI and the patient daily weights have been ordered. The nurse notes a weight gain of 3 pounds over the past 48 hours. What nursing diagnosis is suggested by this assessment finding? A) Imbalanced nutrition: More than body requirements B) Excess fluid volume C) Sedentary lifestyle D) Adult failure to thrive

B Feedback: If the patient with AKI gains or does not lose weight, fluid retention should be suspected. Short-term weight gain is not associated with excessive caloric intake or a sedentary lifestyle. Failure to thrive is not associated with weight gain.

36. What should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of adrenal insufficiency? A) Take the medication late in the day to mimic the bodys natural rhythms. B) Always have enough medication on hand to avoid running out. C) Skip up to 2 doses in cases of illness involving nausea. D) Take up to 1 extra dose per day during times of stress.

B Feedback: The patient and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The patient should be instructed to have an adequate supply of the corticosteroid medication always available to avoid running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids should normally be taken in the morning to mimic natural rhythms.

4. A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication? A) Sexual stimulation is not needed to obtain an erection. B) The drug should be taken 1 hour prior to intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) The drug has the potential to cause permanent visual changes.

B Feedback: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may occur, but these are transient.

29. A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action? A) Cleanse the skin surrounding the suprapubic tube. B) Inform the urologist of this finding. C) Remove the suprapubic tube and apply a wet-to-dry dressing. D) Administer antispasmodic drugs as ordered.

B Feedback: The physician should be informed if there is significant leakage around a suprapubic catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

18. A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is what? A) Risk for peripheral neurovascular dysfunction B) Excess fluid volume C) Hypothermia D) Ineffective airway clearance

B Feedback: The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH. The patient is not at risk for neurovascular dysfunction or a compromised airway.

26. The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent blood work corroborate this finding. The nurse should prepare to administer what intervention? A) Oral calcium chloride and vitamin D B) IV calcium gluconate C) STAT levothyroxine D) Administration of parathyroid hormone (PTH)

B Feedback: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication.

17. A patient on the critical care unit is postoperative day 1 following kidney transplantation from a living donor. The nurse's most recent assessments indicate that the patient is producing copious quantities of dilute urine. What is the nurse's most appropriate response? A) Assess the patient for further signs or symptoms of rejection. B) Recognize this as an expected finding. C) Inform the primary care provider of this finding. D) Administer exogenous antidiuretic hormone as ordered.

B Feedback: A kidney from a living donor related to the patient usually begins to function immediately after surgery and may produce large quantities of dilute urine. This is not suggestive of rejection and treatment is not warranted. There is no obvious need to report this finding.

34. A patient with a history of progressively worsening fatigue is undergoing a comprehensive assessment which includes test of renal function relating to erythropoiesis. When assessing the oxygen transport ability of the blood, the nurse should prioritize the review of what blood value? A) Hematocrit B) Hemoglobin C) Erythrocyte sedimentation rate (ESR) D) Serum creatinine

B Feedback: Although historically hematocrit has been the blood test of choice when assessing a patient for anemia, use of the hemoglobin level rather than hematocrit is currently recommended, because that measurement is a better assessment of the oxygen transport ability of the blood. ESR and creatinine levels are not indicative of oxygen transport ability.

31. A 71-year-old patient with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make? A) "The decision is certainly yours to make, but be sure not to make a mistake." B) "Kidney transplants in patients your age are as successful as they are in younger patients." C) "I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare." D) "Have you talked this over with your family?"

B Feedback: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the elderly. However, the outcome is comparable to that of younger patients. The other listed options either belittle the patient or give the patient misinformation.

12. The nurse caring for a patient with suspected renal dysfunction calculates that the patient's weight has increased by 5 pounds in the past 24 hours. The nurse estimates that the patient has retained approximately how much fluid? A) 1,300 mL of fluid in 24 hours B) 2,300 mL of fluid in 24 hours C) 3,100 mL of fluid in 24 hours D) 5,000 mL of fluid in 24 hours

B Feedback: An increase in body weight commonly accompanies edema. To calculate the approximate weight gain from fluid retention, remember that 1 kg of weight gain equals approximately 1,000 mL of fluid. Five lbs = 2.27 kg = 2,270 mL.

24. The nurse is caring for a patient scheduled for renal angiography following a motor vehicle accident. What patient preparation should the nurse most likely provide before this test? A) Administration of IV potassium chloride B) Administration of a laxative C) Administration of Gastrografin D) Administration of a 24-hour urine test

B Feedback: Before the procedure, a laxative may be prescribed to evacuate the colon so that unobstructed x-rays can be obtained. A 24-hour urine test is not necessary prior to the procedure. Gastrografin and potassium chloride are not administered prior to renal angiography.

40. A patient with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the patient's abdomen is increasing in girth. What is the nurse's most appropriate action? A) Advance the catheter 2 to 4 cm further into the peritoneal cavity. B) Reposition the patient to facilitate drainage. C) Aspirate from the catheter using a 60-mL syringe. D) Infuse 50 mL of additional dialysate.

B Feedback: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the patient from side to side or raising the head of the bed. The catheter should never be pushed further into the peritoneal cavity. It would be unsafe to aspirate or to infuse more dialysate.

15. The nurse is caring for a patient who describes changes in his voiding patterns. The patient states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there doesn't seem to be a great deal of urine flow." What would the nurse expect this patient's physical assessment to reveal? A) Hematuria B) Urine retention C) Dehydration D) Renal failure

B Feedback: Increased urinary urgency and frequency coupled with decreasing urine volumes strongly suggest urine retention. Hematuria may be an accompanying symptom, but is likely related to a urinary tract infection secondary to the retention of urine. Dehydration and renal failure both result in a decrease in urine output, but the patient with these conditions does not have normal urine production and decreased or minimal flow of urine to the bladder. The symptoms of urgency and frequency do not accompany renal failure and dehydration due to decreased urine production.

25. A patient on the medical unit has a documented history of polycystic kidney disease (PKD). What principle should guide the nurse's care of this patient? A) The disease is self-limiting and cysts usually resolve spontaneously in the fifth or sixth decade of life. B) The patient's disease is incurable and the nurse's interventions will be supportive. C) The patient will eventually require surgical removal of his or her renal cysts. D) The patient is likely to respond favorably to lithotripsy treatment of the cysts.

B Feedback: PKD is incurable and care focuses on support and symptom control. It is not self-limiting and is not treated surgically or with lithotripsy.

30. A patient is scheduled for a diagnostic MRI of the lower urinary system. What pre-procedure education should the nurse include? A) The need to be NPO for 12 hours prior to the test B) Relaxation techniques to apply during the test C) The need for conscious sedation prior to the test D) The need to limit fluid intake to 1 liter in the 24 hours before the test

B Feedback: Patient preparation should include teaching relaxation techniques because the patient needs to remain still during an MRI. The patient does not normally need to be NPO or fluid-restricted before the test and conscious sedation is not usually implemented.

18. A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders? A) Monitor the patient's electrolyte values every hour before the procedure. B) Preprocedure hydration and administration of acetylcysteine C) Hemodialysis immediately prior to the CT scan D) Obtain a creatinine clearance by collecting a 24-hour urine specimen.

B Feedback: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patient's electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.

21. A patient with recurrent urinary tract infections has just undergone a cystoscopy and complains of slight hematuria during the first void after the procedure. What is the nurse's most appropriate action? A) Administer a STAT dose of vitamin K, as ordered. B) Reassure the patient that this is not unexpected and then monitor the patient for further bleeding. C) Promptly inform the physician of this assessment finding. D) Position the patient supine and insert a Foley catheter, as ordered.

B Feedback: Some burning on voiding, blood-tinged urine, and urinary frequency from trauma to the mucous membranes can be expected after cystoscopy. The nurse should explain this to the patient and ensure that the bleeding resolves. No clear need exists to report this finding and it does not warrant insertion of a Foley catheter or vitamin K administration.

9. The nurse coming on shift on the medical unit is taking a report on four patients. What patient does the nurse know is at the greatest risk of developing ESKD? A) A patient with a history of polycystic kidney disease B) A patient with diabetes mellitus and poorly controlled hypertension C) A patient who is morbidly obese with a history of vascular disorders D) A patient with severe chronic obstructive pulmonary disease

B Feedback: Systemic diseases, such as diabetes mellitus (leading cause); hypertension; chronic glomerulonephritis; pyelonephritis; obstruction of the urinary tract; hereditary lesions, such as in polycystic kidney disease; vascular disorders; infections; medications; or toxic agents may cause ESKD. A patient with more than one of these risk factors is at the greatest risk for developing ESKD. Therefore, the patient with diabetes and hypertension is likely at highest risk for ESKD.

35. The nurse is reviewing the electronic health record of a patient with a history of incontinence. The nurse reads that the physician assessed the patient's deep tendon reflexes. What condition of the urinary/renal system does this assessment address? A) Renal calculi B) Bladder dysfunction C) Benign prostatic hyperplasia (BPH) D) Recurrent urinary tract infections (UTIs)

B Feedback: The deep tendon reflexes of the knee are examined for quality and symmetry. This is an important part of testing for neurologic causes of bladder dysfunction, because the sacral area, which innervates the lower extremities, is in the same peripheral nerve area responsible for urinary continence. Neurologic function does not directly influence the course of renal calculi, BPH or UTIs.

26. A patient with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? A) Sequestering free hydrogen ions in the nephrons B) Returning bicarbonate to the body's circulation C) Returning acid to the body's circulation D) Excreting bicarbonate in the urine

B Feedback: The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.

28. A patient is brought to the renal unit from the PACU status post resection of a renal tumor. Which of the following nursing actions should the nurse prioritize in the care of this patient? A) Increasing oral intake B) Managing postoperative pain C) Managing dialysis D) Increasing mobility

B Feedback: The patient requires frequent analgesia during the postoperative period and assistance with turning, coughing, use of incentive spirometry, and deep breathing to prevent atelectasis and other pulmonary complications. Increasing oral intake and mobility are not priority nursing actions in the immediate postoperative care of this patient. Dialysis is not necessary following kidney surgery.

3. A nurse is caring for a patient with impaired renal function. A creatinine clearance measurement has been ordered. The nurse should facilitate collection of what samples? A) A fasting serum potassium level and a random urine sample B) A 24-hour urine specimen and a serum creatinine level midway through the urine collection process C) A BUN and serum creatinine level on three consecutive mornings D) A sterile urine specimen and an electrolyte panel, including sodium, potassium, calcium, and phosphorus values

B Feedback: To calculate creatinine clearance, a 24-hour urine specimen is collected. Midway through the collection, the serum creatinine level is measured.

39. Dipstick testing of an older adult patient's urine indicates the presence of protein. Which of the following statements is true of this assessment finding? A) This finding needs to be considered in light of other forms of testing. B) This finding is a risk factor for urinary incontinence. C) This finding is likely the result of an age-related physiologic change. D) This result confirms that the patient has diabetes. Select all that apply.

B, C, D Feedback: A dipstick examination, which can detect from 30 to 1000 mg/dL of protein, should be used as a screening test only, because urine concentration, pH, hematuria, and radiocontrast materials all affect the results. Proteinuria is not diagnostic of diabetes and it is neither an age-related change nor a risk factor for incontinence.

37. The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply. A) Epistaxis B) Pallor C) Rapid respiratory rate D) Bounding pulse E) Hypotension

B, C, E Feedback: The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.

25. A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patients immediate care? Select all that apply. A) Administering diuretics to prevent fluid overload B) Administering beta blockers to reduce heart rate C) Administering insulin to reduce blood glucose levels D) Applying interventions to reduce the patients temperature E) Administering corticosteroids

B, D Feedback: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.

19. The nurse is caring for a patient with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply. A) Percuss for pain in the right lower abdominal quadrant. B) Assess for the presence of peripheral edema. C) Auscultate the patient's apical heart rate for dysrhythmias. D) Assess the patient's BP. E) Assess the patient's orientation and judgment.

B, D Feedback: Most patients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.

35. A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A) Abstaining from sexual intercourse for at least 14 days postprocedure B) Wearing a scrotal support garment C) Using sitz baths D) Applying a heating pad intermittently E) Staying on bed rest for 48 to 72 hours postprocedure

B,C Feedback: Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the patient to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

The nurse is caring for a patient with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this patients analgesic regimen be best managed? A) Analgesia should be withheld unless the patients pain becomes unbearable. B) Scheduled analgesia should be administered around-the-clock to prevent pain. C) All analgesics should be given on a PRN, rather than scheduled, basis. D) Opioid analgesics should be avoided and NSAIDs exclusively provided.

B. Because of the wide excision, the patient may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to relieve pain, increase the patient's comfort level, and allow mobility. Opioids are usually required.

A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the patients health history. What clinical manifestation would the nurse expect to assess? A) Fish-like vaginal odor B) Increased abdominal girth C) Fever and chills D) Lower abdominal pelvic pain

B. Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever, chills, and abdominal pelvic pain are atypical.

A middle-aged female patient has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the patient is visibly surprised and embarrassed by this offer. How should the nurse best respond? A) Most women with HIV dont know they have the disease. If you have it, its important we catch it early. B) This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history. C) The rationale for this testing is so that you can begin treatment as soon as testing comes back, if its positive. D) Youre being offered this testing because you are actually in the prime demographic for HIV infection.

B. Feedback: Because patients may be reluctant to discuss risk-taking behavior, routine screening should be offered to all women between the ages of 13 to 64 years in all health care settings. Assuring a woman that the offer of testing is not related to a heightened risk may alleviate her anxiety. Middle-aged women are not the prime demographic for HIV infection. The nurse should avoid causing fear by immediately discussing treatment or the fact that many patients are unaware of their diagnosis.

When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A) Late childbearing B) Human papillomavirus (HPV) C) Postmenopausal bleeding D) Tobacco use

B. Feedback: HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.

A 31-year-old patient has returned to the post-surgical unit following a hysterectomy. The patients care plan addresses the risk of hemorrhage. How should the nurse best monitor the patients postoperative blood loss? A) Have the patient void and have bowel movements using a commode rather than toilet. B) Count and inspect each perineal pad that the patient uses. C) Swab the patients perineum for the presence of blood at least once per shift. D) Leave the patients perineum open to air to facilitate inspection.

B. Feedback: To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, and monitors vital signs. The perineum is not swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are applied to the perineum; it is not open to air.

A patient is post-operative day 1 following a vaginal hysterectomy. The nurse notes an increase in the patients abdominal girth and the patient complains of bloating. What is the nurses most appropriate action? A) Provide the patient with an unsweetened, carbonated beverage. B) Apply warm compresses to the patients lower abdomen. C) Provide an ice pack to apply to the perineum and suprapubic region. D) Assist the patient into a prone position.

B. If the patient has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended and prone positioning would be uncomfortable.

A patient has been diagnosed with endometriosis. When planning this patients care, the nurse should prioritize what nursing diagnosis? A) Anxiety related to risk of transmission B) Acute pain related to misplaced endometrial tissue C) Ineffective tissue perfusion related to hemorrhage D) Excess fluid volume related to abdominal distention

B. Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable.

A patient comes to the clinic complaining of a tender, inflamed vulva. Testing does not reveal the presence of any known causative microorganism. What aspect of this patients current health status may account for the patients symptoms of vulvitis? A) The patient is morbidly obese. B) The patient has type 1 diabetes. C) The patient has chronic kidney disease. D) The patient has numerous allergies.

B. Vulvitis, an inflammation of the vulva, may occur as a result of other disorders, such as diabetes, dermatologic problems, or poor hygiene. Obesity, kidney disease, and allergies are less likely causes than diabetes.

A 14-year-old is brought to the clinic by her mother. The mother explains to the nurse that her daughter has just started using tampons, but is not yet sexually active. The mother states I am very concerned because my daughter is having a lot of stabbing pain and burning. What might the nurse suspect is the problem with the 14-year-old? A) Vulvitis B) Vulvodynia C) V aginitis D) Bartholins cyst

B. Vulvodynia is a chronic vulvar pain syndrome. Symptoms may include burning, stinging, irritation, or stabbing pain and may follow the initial use of tampons or first sexual experience. Vulvitis is an inflammation of the vulva that is normally infectious. Bartholin's cyst results from the obstruction of a duct in one of the paired vestibular glands located in the posterior third of the vulva, near the vestibule.

A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate calculus. To decrease the chance of recurrence, the nurse should instruct the client to avoid which of the following foods? (Select all that apply.) A. Red meat B. Black tea C. Cheese D. Whole grains E. Spinach

B. CORRECT: A client who has renal calculi composed of calcium oxalate should avoid intake of black tea because it is a source of oxalate. E. CORRECT: A client who has renal calculi composed of calcium oxalate should avoid intake of spinach because it is a source of oxalate.

A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings should the nurse expect? (Select all that apply.) A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness

B. CORRECT: Abnormal menstrual periods, including menorrhagia and amenorrhea, are manifestations of hypothyroidism. C. CORRECT: Dry skin is a manifestation of hypothyroidism. E. CORRECT: Hoarseness is a manifestation of hypothyroidism.

A nurse in an acute care facility is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse anticipate? (Select all that apply.) A. IV therapy with 0.45% sodium chloride B. Regular insulin C. Hydrocortisone sodium succinate D. Sodium polystyrene sulfonate E. Furosemide

B. CORRECT: Clients who have acute adrenal insufficiency are hyperkalemic. Insulin is administered to shift potassium into the cells. C. CORRECT: Hydrocortisone sodium succinate is administered as replacement therapy of both glucocorticoid and mineralocorticoid. D. CORRECT: Clients who have acute adrenal insufficiency are hyperkalemic. Sodium polystyrene sulfonate is administered because it absorbs potassium. E. CORRECT: Loop and thiazide diuretics promote potassium excretion and are administer to treat hyperkalemia.

A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following laboratory findings is expected for a client who has this condition? A. Elevated serum T4 B. Decreased serum T3 C. Elevated serum thyroid stimulating hormone D. Decreased serum cholesterol

B. CORRECT: Decreased serum T3 is an expected finding for a client who has hypothyroidism.

A nurse is caring for a client who asks why the provider bases his medication regimen on his HbA1c instead of his log of morning fasting blood glucose results. Which of the following responses should the nurse make? A. "HbA1c measures how well insulin is regulating your blood glucose between meals." B. "HbA1c indicates how well your have regulated your blood glucose over the past 120 days." C."HbA1c is the first test your doctor prescribed to determine that you have diabetes." D."HbA1c determines if the your doctor should adjust your insulin dosage."

B. CORRECT: HbA1c measures blood glucose control over the past 120 days

A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (Select all that apply.) A. Anorexia B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia

B. CORRECT: Hyperthyroidism increases the client's metabolism, causing heat intolerance. D. CORRECT: Hyperthyroidism increases the client's metabolism, causing palpitations. E. CORRECT: Hyperthyroidism increases the client's metabolism, causing weight loss.

A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify that which of the following laboratory results is an expected finding? A. Decreased thyrotropin receptor antibodies B. Decreased thyroid‐stimulating hormone (TSH) C. Decreased free thyroxine index D. Decreased triiodothyronine

B. CORRECT: In the presence of Graves' disease, low TSH is an expected finding. The pituitary gland decreases the production of TSH when thyroid hormone levels are elevated.

A nurse is providing medication teaching for a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? (Select all that apply.) A. Take the medication on an empty stomach. B. Notify the provider of any illness or stress. C. Report any manifestations of weakness or dizziness. D. Do not discontinue the medication suddenly. E. Eat a low‐sodium diet

B. CORRECT: Physical and emotional stress increase the need for hydrocortisone. The provider may increase the dosage when stress occurs. C. CORRECT: Weakness and dizziness are indications of adrenal insufficiency. The client should report these indications to the provider. D. CORRECT: Rapid discontinuation can result in adverse effects, including acute adrenal insufficiency. If hydrocortisone is to be discontinued, the dose should be tapered.

A nurse is providing instructions to a client who has Graves' disease and has a new prescription for propranolol. Which of the following information should the nurse include? A. "An adverse effect of this medication is jaundice." B. "Take your pulse before each dose." C."The purpose of this medication is to decrease production of thyroid hormone." D."you should stop taking this medication if you have a sore throat."

B. CORRECT: Propranolol can cause bradycardia. The client should take his pulse before each dose. If there is a significant change, he should withhold the dose and consult the provider.

A nurse is reviewing client laboratory data. The nurse should recognize that which of the following findings is expected for a client who has Stage 4 chronic kidney disease? A. Blood urea nitrogen (BUN) 15 mg/dL B. Glomerular filtration rate (GFR) 20 mL/min C. Serum creatinine 1.1 mg/dL D. Serum potassium 5.0 mEq/L

B. CORRECT: The GFR is severely decreased to approximately 20 mL/min, which is indicative of stage 4 chronic kidney disease.

A nurse is monitoring a client who had a kidney biopsy for postoperative complications. Which of the following complications should the nurse identify as causing the greatest risk to the client? A. Infection B. Hemorrhage C. Hematuria D. Pain

B. CORRECT: The greatest risk to the client following a kidney biopsy is hemorrhage due to a lack of clotting at the puncture site. The nurse should report this finding to the provider immediately.

A nurse is assessing a client during a water deprivation test. For which of the following complications should the nurse monitor the client? A. Bradycardia B. Orthostatic hypotension C. Neck vein distention D. Crackles in lungs

B. CORRECT: The nurse should monitor for orthostatic hypotension resulting from dehydration during a water deprivation test.

A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Weight gain is expected while taking this medication. B. Medication should not be discontinued without the advice of the provider. C. Follow‐up serum TSH levels should be obtained. D. Take the medication on an empty stomach. E. Use fiber laxatives for constipation.

B. CORRECT: The provider carefully titrates the dosage of this medication. It should be increased slowly until the client reaches a euthyroid state. The client should not discontinue the medication unless directed to do so by the provider. C. CORRECT: Serum TSH levels are used to monitor the effectiveness of the medication. D. CORRECT: The medication should be taken on an empty stomach to promote absorption.

A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse anticipate? A. Absence of glucose B. Decreased specific gravity C. Presence of ketones D. Presence of red blood cells

B. CORRECT: The urine of a client who has diabetes insipidus will be dilute with a urine specific gravity of less than 1.005.

1. An adolescent is identified as having a collection of fluid in the tunica vaginalis of his testes. The nurse knows that this adolescent will receive what medical diagnosis? A) Cryptorchidism B) Orchitis C) Hydrocele D) Prostatism

C Feedback: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes. Cryptorchidism is the most common congenital defect in males, characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.

20. The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find? A) Hair loss B) Moon face C) Bulging eyes D) Fatigue

C Feedback: Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes) and fine tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.

29. A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the patients care? A) Decisional conflict related to treatment options B) Spiritual distress related to changes in cognitive function C) Disturbed body image related to changes in physical appearance D) Powerlessness related to disease progression

C Feedback: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerless may exist, but disturbed body image is more likely to be present. Cognitive changes take place in patients with Cushing syndrome, but these may or may not cause spiritual distress.

9. The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered

C Feedback: Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.

16. A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A) Hyponatremia B) Hypophosphatemia C) Hypocalcemia D) Hypokalemia

C Feedback: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

20. A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, "My father died of prostate cancer at age 48." The nurse should instruct him on which of the following health promotion activities? A) The patient will need PSA levels drawn starting at age 55. B) The patient should have testing for presence of the CDH1 and STK11 genes. C) The patient should have PSA levels drawn regularly. D) The patient should limit alcohol use due to the risk of malignancy.

C Feedback: PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.

4. The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most closely associated with this health problem? A) Truncal obesity B) Hypertension C) Muscle weakness D) Moon face

C Feedback: Patients with Addisons disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Patients with Cushing syndrome demonstrate truncal obesity, moon face, acne, abdominal striae, and hypertension.

8. A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? A) Glucose in the urine B) Albumin in the urine C) Highly dilute urine D) Leukocytes in the urine

C Feedback: Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.

3. A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what? A) Varicocele B) Epididymitis C) Prostatitis D) Hydrocele

C Feedback: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord.

2. An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem? A) Bowen's disease B) Peyronie's disease C) Phimosis D) Priapism

C Feedback: Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowen's disease is an in situ carcinoma of the penis. Peyronie's disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.

27. A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals "stoney" hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A) A normal finding B) A sign of early prostate cancer C) Evidence of a more advanced lesion D) Metastatic disease

C Feedback: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not suggestive of metastatic disease.

26. A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin an assessment by doing which of the following? A)Briefly teaching the patient about normal sexual physiology B)Assuring the patient that what he says will be confidential C)Asking the patient if he is willing to discuss sexual functioning D)Ensuring patient privacy

C Feedback: The PLISSIT (permission, limited information, specific suggestions, intensive therapy) model of sexual assessment and intervention may be used to provide a framework for nursing interventions. By beginning with the patient's permission, the nurse establishes a patient-centered focus.

14. A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction

C Feedback: The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.

6. The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body? A) Eggs B) Shellfish C) Table salt D) Red meat

C Feedback: The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.

7. A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy? A) The patients diet should be low protein with ample fat. B) The patient may experience short-term changes in cognition. C) The patient is at an increased risk for developing infection. D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.

C Feedback: The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.

2. A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient? A) Side-lying (lateral) with one pillow under the head B) Head of the bed elevated 30 degrees and no pillows placed under the head C) Semi-Fowlers with the head supported on two pillows D) Supine, with a small roll supporting the neck

C Feedback: When moving and turning the patient, the nurse carefully supports the patients head and avoids tension on the sutures. The most comfortable position is the semi-Fowlers position, with the head elevated and supported by pillows.

29. A nurse is caring for a patient who is in the diuresis phase of AKI. The nurse should closely monitor the patient for what complication during this phase? A) Hypokalemia B) Hypocalcemia C) Dehydration D) Acute flank pain

C Feedback: The diuresis period is marked by a gradual increase in urine output, which signals that glomerular filtration has started to recover. The patient must be observed closely for dehydration during this phase; if dehydration occurs, the uremic symptoms are likely to increase. Excessive losses of potassium and calcium are not typical during this phase, and diuresis does not normally result in pain.

38. The nurse is caring for a patient after kidney surgery. The nurse is aware that bleeding is a major complication of kidney surgery and that if it goes undetected and untreated can result in hypovolemia and hemorrhagic shock in the patient. When assessing for bleeding, what assessment parameter should the nurse evaluate? A) Oral intake B) Pain intensity C) Level of consciousness D) Radiation of pain

C Feedback: Bleeding is a major complication of kidney surgery. If undetected and untreated, this can result in hypovolemia and hemorrhagic shock. The nurse's role is to observe for these complications, to report their signs and symptoms, and to administer prescribed parenteral fluids and blood and blood components. Monitoring of vital signs, skin condition, the urinary drainage system, the surgical incision, and the level of consciousness is necessary to detect evidence of bleeding, decreased circulating blood, and fluid volume and cardiac output. Bleeding is not normally evidenced by changes in pain or oral intake.

20. A patient is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the patient develops acute kidney injury. The patient is hemodynamically unstable, but renal replacement therapy is needed to manage the patient's hypervolemia and hyperkalemia. Which of the following therapies will the patient's hemodynamic status best tolerate? A) Hemodialysis B) Peritoneal dialysis C) Continuous venovenous hemodialysis (CVVHD) D) Plasmapheresis

C Feedback: CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable patient. Peritoneal dialysis is not the best choice, as the patient may have sustained abdominal injuries during the accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and electrolyte balance.

22. A patient is complaining of genitourinary pain shortly after returning to the unit from a scheduled cystoscopy. What intervention should the nurse perform? A) Encourage mobilization. B) Apply topical lidocaine to the patient's meatus, as ordered. C) Apply moist heat to the patient's lower abdomen. D) Apply an ice pack to the patient's perineum.

C Feedback: Following cystoscopy, moist heat to the lower abdomen and warm sitz baths are helpful in relieving pain and relaxing the muscles. Ice, lidocaine, and mobilization are not recommended interventions.

20. The nurse is caring for a patient who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician? A) Scant hematuria B) Renal colic C) Temperature 100.2°F orally D) Infiltration of the patient's intravenous catheter

C Feedback: Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the patient's body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary care physician.

11. The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)? A) Hypernatremia B) Hypomagnesemia C) Hyperkalemia D) Hypercalcemia

C Feedback: Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.

2. The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform the physician that the patient may be exhibiting signs of acute kidney injury (AKI)? A) The patient is complains of an inability to initiate voiding. B) The patient's urine is cloudy with a foul odor. C) The patient's average urine output has been 10 mL/hr for several hours. D) The patient complains of acute flank pain.

C Feedback: Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI. Flank pain and inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a urinary tract infection.

31. Results of a patient's 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within reference range. What conclusion can the nurse draw from this assessment finding? A) The patient's kidneys are capable of maintaining acid-base balance. B) The patient's kidneys reabsorb most of the potassium that the patient ingests. C) The patient's kidneys can produce sufficiently concentrated urine. D) The patient's kidneys are producing sufficient erythropoietin.

C Feedback: Osmolality is the most accurate measurement of the kidney's ability to dilute and concentrate urine. Osmolality is not a direct indicator of renal function as it relates to erythropoietin synthesis or maintenance of acid-base balance. It does not indicate the maintenance of healthy levels of potassium, the vast majority of which is excreted.

25. Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for the patient to be assessed for what health problem? A) Diabetes insipidus B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C) Diabetes mellitus D) Renal carcinoma

C Feedback: Renal glycosuria can occur on its own as a benign condition. It also occurs in poorly controlled diabetes, the most common condition that causes the blood glucose level to exceed the kidney's reabsorption capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.

6. A patient has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m2. Based on this GFR, the nurse interprets that the patient's chronic kidney disease is at what stage? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

C Feedback: Stages of chronic renal failure are based on the GFR. Stage 3 is defined by a GFR in the range of 30 to 59 mL/min/1.73 m2. This is considered a moderate decrease in GFR.

13. The nurse is performing a focused genitourinary and renal assessment of a patient. Where should the nurse assess for pain at the costovertebral angle? A) At the umbilicus and the right lower quadrant of the abdomen B) At the suprapubic region and the umbilicus C) At the lower border of the 12th rib and the spine D) At the 7th rib and the xyphoid process

C Feedback: The costovertebral angle is the angle formed by the lower border of the 12th rib and the spine. Renal dysfunction may produce tenderness over the costovertebral angle.

29. A nurse is aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should the nurse provide to an older adult? A) "If possible, try to drink at least 4 liters of fluid daily." B) "Ensure that you avoid replacing water with other beverages." C) "Remember to drink frequently, even if you don't feel thirsty." D) "Make sure you eat plenty of salt in order to stimulate thirst."

C Feedback: The nurse emphasizes the need to drink throughout the day even if the patient does not feel thirsty, because the thirst stimulation is decreased. Four liters of daily fluid intake is excessive and fluids other than water are acceptable in most cases. Additional salt intake is not recommended as a prompt for increased fluid intake.

35. The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan? A) The importance of increased fluid intake B) Signs and symptoms of rejection C) Inspection and care of the incision D) Techniques for preventing metastasis

C Feedback: The nurse teaches the patient to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the patient has minimal control on the future risk for metastasis.

11. The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results for this patient, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? A) Potassium and sodium B) Bicarbonate and urea C) Glucose and protein D) Creatinine and chloride

C Feedback: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose is completely reabsorbed in the tubule and normally does not appear in the urine. However, glucose is found in the urine if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb. Protein molecules are also generally not found in the urine because amino acids are also filtered at the level of the glomerulus and reabsorbed so that it is not excreted in the urine.

14. The staff educator is giving a class for a group of nurses new to the renal unit. The educator is discussing renal biopsies. In what patient would the educator tell the new nurses that renal biopsies are contraindicated? A) A 64-year-old patient with chronic glomerulonephritis B) A 57-year-old patient with proteinuria C) A 42-year-old patient with morbid obesity D) A 16-year-old patient with signs of kidney transplant rejection

C Feedback: There are several contraindications to a kidney biopsy, including bleeding tendencies, uncontrolled hypertension, a solitary kidney, and morbid obesity. Indications for a renal biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.

26. The nurse is providing a health education workshop to a group of adults focusing on cancer prevention. The nurse should emphasize what action in order to reduce participants' risks of renal carcinoma? A) Avoiding heavy alcohol use B) Control of sodium intake C) Smoking cessation D) Adherence to recommended immunization schedules

C Feedback: Tobacco use is a significant risk factor for renal cancer, surpassing the significance of high alcohol and sodium intake. Immunizations do not address an individual's risk of renal cancer.

19. A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location? A) Meatus B) Bladder C) Ureter D) Urethra

C Feedback: Ureteral pain is characterized as a dull continuous pain that may be intense with voiding. The pain may be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone being present in the bladder. Stones are not normally situated in the urethra or meatus.

5. The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? A) Using a stethoscope for auscultating the fistula is contraindicated. B) The patient feels best immediately after the dialysis treatment. C) Taking a BP reading on the affected arm can damage the fistula. D) The patient should not feel pain during initiation of dialysis.

C Feedback: When blood flow is reduced through the access for any reason (hypotension, application of BP cuff/tourniquet), the access site can clot. Auscultation of a bruit in the fistula is one way to determine patency. Typically, patients feel fatigued immediately after hemodialysis because of the rapid change in fluid and electrolyte status. Although the area over the fistula may have some decreased sensation, a needle stick is still painful.

16. The nurse is caring for a patient with a nursing diagnosis of deficient fluid volume. The nurse's assessment reveals a BP of 98/52 mm Hg. The nurse should recognize that the patient's kidneys will compensate by secreting what substance? A) Antidiuretic hormone (ADH) B) Aldosterone C) Renin D) Angiotensin

C Feedback: When the vasa recta detect a decrease in BP, specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the BP to increase. The adrenal cortex secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in response to poor perfusion or increasing serum osmolality. The result is an increase in BP.

22. An 84-year-old woman diagnosed with cancer is admitted to the oncology unit for surgical treatment. The patient has been on chemotherapeutic agents to decrease the tumor size prior to the planned surgery. The nurse caring for the patient is aware that what precipitating factors in this patient may contribute to AKI? Select all that apply. A) Anxiety B) Low BMI C) Age-related physiologic changes D) Chronic systemic disease E) NPO status

C, D Feedback: Changes in kidney function with normal aging increase the susceptibility of elderly patients to kidney dysfunction and renal failure. In addition, the presence of chronic, systemic diseases increases the risk of AKI. Low BMI and anxiety are not risk factors for acute renal disease. NPO status is not a risk, provided adequate parenteral hydration is administered.

38. A patient has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply. A) Pupillary response B) Creatinine and BUN levels C) Potassium level D) Peripheral pulses E) BP

C, E Feedback: Patients with aldosteronism exhibit a profound decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response, peripheral pulses, and renal function are not directly affected.

While taking a health history on a 20-year-old female patient, the nurse ascertains that this patient is taking miconazole (Monistat). The nurse is justified in presuming that this patient has what medical condition? A) Bacterial vaginosis B) Human papillomavirus (HPV) C) Candidiasis D) Toxic shock syndrome (TSS)

C. Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat.

A patient has returned to the post-surgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period? A) Placing the patient in high Fowlers position B) Administering sitz baths every 4 hours C) Monitoring the integrity of the surgical site D) Avoiding analgesics unless the patients pain is unbearable

C. Feedback: An important intervention for the patient who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The patient should be placed in low Fowler's position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after of wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the patient's comfort level.

A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the patients subsequent care, the nurse should prioritize actions with what goal? A) Preventing hemorrhage B) Ensuring the patient knows the treatment is palliative, not curative C) Protecting the safety of the patient, family, and staff D) Ensuring that the patient adheres to dietary restrictions during treatment

C. Feedback: Care must be taken to protect the safety of patients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment.

When reviewing the electronic health record of a female patient, the nurse reads that the patient has a history of adenomyosis. The nurse should be aware that this patient experiences symptoms resulting from what pathophysiologic process? A) Loss of muscle tone in the vaginal wall B) Excessive synthesis and release of unopposed estrogen C) Invasion of the uterine wall by endometrial tissue D) Proliferation of tumors in the uterine wall

C. Feedback: In adenomyosis, the tissue that lines the endometrium invades the uterine wall. This disease is not characterized by loss of muscle tone, the presence of tumors, or excessive estrogen.

A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A) Internal beam radiation B) Trachelectomy C) Brachytherapy D) External radiation

C. Feedback: Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or both.

A patient is being discharged home after a hysterectomy. When providing discharge education for this patient, the nurse has cautioned the patient against sitting for long periods. This advice addresses the patients risk of what surgical complication? A) Pudendal nerve damage B) Fatigue C) Venous thromboembolism D) Hemorrhage

C. Feedback: The patient should resume activities gradually. This does not mean sitting for long periods, because doing so may cause blood to pool in the pelvis, increasing the risk of thromboembolism. Sitting for long periods after a hysterectomy does not cause postoperative nerve damage; it does not increase the fatigue factor after surgery or the risk of hemorrhage.

The nurse is planning health education for a patient who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention? A) Wear tight-fitting synthetic underwear. B) Use bubble bath to eradicate perineal bacteria. C) Avoid feminine hygiene products, such as sprays. D) Restrict daily bathing.

C. Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Douching is generally discouraged, as is the use of feminine hygiene products. Daily bathing is not restricted.

A patient has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage what health promotion activity to address the patients hormone imbalance and infertility? A) Kegel exercises B) Increased fluid intake C) Weight loss D) Topical antibiotics as ordered

C. Lifestyle modification is critical in the treatment of PCOS, and weight management is part of the treatment plan. As little as a weight loss of 5% of total body weight can help with hormone imbalance and infertility. Antibiotics are irrelevant, as PCOS does not have an infectious etiology. Fluid intake and Kegel exercises do not influence the course of the disease.

A 30-year-old patient has come to the clinic for her yearly examination. The patient asks the nurse about ovarian cancer. What should the nurse state when describing risk factors for ovarian cancer? A) Use of oral contraceptives increases the risk of ovarian cancer. B) Most cases of ovarian cancer are attributed to tobacco use. C) Most cases of ovarian cancer are considered to be random, with no obvious causation. D) The majority of women who get ovarian cancer have a family history of the disease.

C. Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having a familial connection. Contraceptives and tobacco have not been identified as major risk factors.

A student nurse is caring for a patient who has undergone a wide excision of the vulva. The student should know that what action is contraindicated in the immediate postoperative period? A) Placing patient in low Fowlers position B) Application of compression stockings C) Ambulation to a chair D) Provision of a low-residue diet

C. Sitting in a chair would not be recommended immediately in the postoperative period. This would place too much tension on the incision site. A low Fowler's position or, occasionally, a pillow placed under the knees, will reduce pain by relieving tension on the incision. Application of compression stocking would prevent a deep vein thrombosis from occurring. A low-residue diet would be ordered to prevent straining on defecation and wound contamination.

A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? (Select all that apply.) A. Reduced BUN B. Elevated cardiac enzymes C. Reduced urine output D. Elevated serum creatinine E. Elevated serum calcium

C. CORRECT: A manifestation of prerenal AKI is reduced urine output. D. CORRECT: A manifestation of prerenal AKI is elevated serum creatinine. E. CORRECT: A manifestation of prerenal AKI is reduced calcium level.

A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings is the priority for the nurse to report to the provider? A. Flank pain that radiates to the lower abdomen B. Client report of nausea C. Absent urine output for 1 hr D. Serum WBC count 15,000/mm3

C. CORRECT: The greatest risk to this client is damage to the kidney resulting from obstruction of urine flow by the renal calculus. Therefore, the priority finding for the nurse to report to the provider is anuria.

A nurse is caring for a client who develops disequilibrium syndrome after receiving hemodialysis. Which of the following actions should the nurse take? A. Administer an opioid medication. B. Monitor for hypertension. C. Assess level of consciousness. D. Increase the dialysis exchange rate.

C. CORRECT: The nurse should assess the client's level of consciousness. A change in urea levels can cause increased intracranial pressure. Subsequently, the client's level of consciousness decreases.

A nurse administered captopril to a client during a renal scan. Which of the following actions should the nurse take? A. Assess for hypertension. B. Limit the client's fluid intake. C. Monitor for orthostatic hypotension. D. Encourage early ambulation.

C. CORRECT: The nurse should monitor for orthostatic hypotension because this is an adverse effect of captopril. This results in a change in blood flow to the kidneys after the initial dose.

A nurse is reviewing the results of a client's urinalysis. The findings indicate the urine is positive for leukocyte esterase and nitrites. Which of the following actions should the nurse take? A. Repeat the test early the next morning. B. Start a 24‐hr urine collection for creatinine clearance. C. Obtain a clean‐catch urine specimen for culture and sensitivity. D. Insert an indwelling catheter urinary catheter to collect a urine specimen.

C. CORRECT: The nurse should obtain a clean‐catch urine specimen for culture and sensitivity. This test will identify which antibiotic will be most effective for treating the client's urinary tract infection.

A nurse is planning care for a client who has prerenal acute kidney injury (AKI) following abdominal aortic aneurysm repair. Urinary output is 60 mL in the past 2 hr, and blood pressure is 92/58 mm Hg. The nurse should anticipate which of the following interventions? A. Prepare the client for a CT scan with contrast dye. B. Plan to administer nitroprusside. C. Prepare to administer a fluid challenge. D. Plan to position the client in Trendelenburg.

C. CORRECT: The nurse should plan to administer a fluid challenge for hypovolemia, which is indicated by the client's low urinary output and blood pressure.

A nurse is providing discharge reaching for a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse include? (Select all that apply.) A. Brush your teeth after every meal or snack. B. Avoid bending at the knees. C. Eat a high‐fiber diet. D. Notify the provider of any sweet‐tasting drainage. E. Notify the provider of a diminished sense of smell.

C. CORRECT: To avoid constipation, which contributes to increased intracranial pressure, the client should eat a high‐fiber diet and take docusate. D. CORRECT: Sweet‐tasting fluid is an indication of a cerebrospinal fluid leak. The client should notify the provider.

A nurse's colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? A) Diuretics should be promptly discontinued when an older adult experiences incontinence. B) Restricting fluid intake is recommended for older adults experiencing incontinence. C) Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. D) Urinary incontinence is not considered a normal consequence of aging.

D

A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding? A) Use a slipper bedpan. B) Apply a cold compress to the perineum. C) Have the patient lie in a supine position. D) Provide privacy for the patient.

D

A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patient's high risk for urinary retention and should implement what intervention in the patient's plan of care? A) Relaxation techniques B) Sodium restriction C) Lower abdominal massage D) Double voiding

D

8. A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A) The patient should not be in contact with the baby after delivery. B) The patient's treatment poses no risk to his daughter or her infant. C) The patient's brachytherapy may be contraindicated for safety reasons. D) The patient should avoid close contact with his daughter for 2 months.

D Feedback: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.

27. A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following? A) Take the drug concurrent with levothyroxine (Synthroid). B) Take each dose of prednisone with a dose of calcium chloride. C) Gradually replace the prednisone with an OTC alternative. D) Slowly taper down the dose of prednisone, as ordered.

D Feedback: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no OTC substitutes for prednisone and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.

19. A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this patient? A) Increased body temperature B) Jaundice C) Copious urine output D) Decreased BP

D Feedback: Decreased BP may occur with hypofunction of the adrenal cortex. Decreased function of the adrenal cortex does not affect the patients body temperature, urine output, or skin tone.

7. A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowler's position B) Prone position C) Supine position D) Lithotomy position

D Feedback: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowler's position.

9. A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)

D Feedback: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.

30. A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following? A) IV antibiotics B) Oral antihypertensives C) Parenteral nutrition D) IV corticosteroids

D Feedback: IV administration of corticosteroids (methylprednisolone sodium succinate [Solu-Medrol]) may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency or other common complications of adrenalectomy.

24. A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect? A) Anaphylaxis B) Nausea and vomiting C) Increased risk of drug interactions D) Prolonged duration of effect

D Feedback: In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although these may potentially result from the prolonged half-life of drugs.

12. The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids? A) In the evening between 4 PM and 6 PM B) Prior to going to sleep at night C) At noon every day D) In the morning between 7 AM and 8 AM

D Feedback: In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.

14. The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote? A) Complete bed rest B) Bed rest with bathroom privileges C) Out of bed (OOB) to the chair twice a day D) Ambulation and activity as tolerated

D Feedback: Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Best rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to getting out of bed only a few times a day also increases calcium excretion and the associated risks.

37. A patient confides to the nurse that he cannot engage in sexual activity. The patient is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this patient to assess his sexual functioning? A) Sperm count B) Ejaculation capacity tests C) Engorgement tests D) Nocturnal penile tumescence tests

D Feedback: Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep using various methods to determine number, duration, rigidity, and circumference of penile erections; the results help identify whether the erectile dysfunction is caused by physiologic and/or psychological factors. A sperm count would be done if the patient was complaining of infertility. Ejaculation capacity tests and engorgement tests are not applicable for assessment in this circumstance.

40. The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication? A) A fluoroquinalone antibiotic B) A loop diuretic C) A proton pump inhibitor (PPI) D) A benzodiazepine

D Feedback: Oral thyroid hormones interact with many other medications.Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Antibiotics, PPIs and diuretics do not cause the same risk.

39. A patient has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The patient's interdisciplinary plan of care should prioritize which of the following interventions? A) Penile implant B) PDE-5 inhibitors C) Physical therapy D) Psychotherapy

D Feedback: Patients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.

34. A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks duration can suppress the adrenal cortex for how long? A) Up to 4 weeks B) Up to 3 months C) Up to 9 months D) Up to 1 year

D Feedback: Suppression of the adrenal cortex may persist up to 1 year after a course of corticosteroids of only 2 weeks duration.

33. A 57-year-old male comes to the clinic complaining that when he has an erection his penis curves and becomes painful. The patient's diagnosis is identified as severe Peyronie's disease. The nurse should be aware of what likely treatment modality? A) Physical therapy B) Treatment with PDE-5 inhibitors C) Intracapsular hydrocortisone injections D) Surgery

D Feedback: Surgical removal of mature plaques is used to treat severe Peyronie's disease. There is no potential benefit to physical therapy and hydrocortisone injections are not normally used. PDE-5 inhibitors would exacerbate the problem.

6. A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A) It is most common among men over 55. B) It is one of the least curable solid tumors. C) It typically does not metastasize. D) It is highly responsive to treatment.

D Feedback: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

5. A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink

D Feedback: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.

10. A kidney biopsy has been scheduled for a patient with a history of acute renal failure. The patient asks the nurse why this test has been scheduled. What is the nurse's best response? A) "A biopsy is routinely ordered for all patients with renal disorders." B) "A biopsy is generally ordered following abnormal x-ray findings of the renal pelvis." C) "A biopsy is often ordered for patients before they have a kidney transplant." D) "A biopsy is sometimes necessary for diagnosing and evaluating the extent of kidney disease."

D Feedback: Biopsy of the kidney is used in diagnosing and evaluating the extent of kidney disease. Indications for biopsy include unexplained acute renal failure, persistent proteinuria or hematuria, transplant rejection, and glomerulopathies.

3. The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus-binding medication at what time? A) Only when needed B) Daily at bedtime C) First thing in the morning D) With each meal

D Feedback: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective.

7. A geriatric nurse is performing an assessment of body systems on an 85-year-old patient. The nurse should be aware of what age-related change affecting the renal or urinary system? A) Increased ability to concentrate urine B) Increased bladder capacity C) Urinary incontinence D) Decreased glomerular filtration rate

D Feedback: Many age-related changes in the renal and urinary systems should be taken into consideration when taking a health history of the older adult. One change includes a decreased glomerular surface area resulting in a decreased glomerular filtration rate. Other changes include the decreased ability to concentrate urine and a decreased bladder capacity. It also should be understood that urinary incontinence is not a normal age-related change, but is common in older adults, especially in women because of the loss of pelvic muscle tone.

27. The nurse performing the health interview of a patient with a new onset of periorbital edema has completed a genogram, noting the health history of the patient's siblings, parents, and grandparents. This assessment addresses the patient's risk of what kidney disorder? A) Nephritic syndrome B) Acute glomerulonephritis C) Nephrotic syndrome D) Polycystic kidney disease (PKD)

D Feedback: PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Nephritic syndrome, acute glomerulonephritis, and nephrotic syndrome are not genetic disorders.

24. A 15-year-old is admitted to the renal unit with a diagnosis of postinfectious glomerular disease. The nurse should recognize that this form of kidney disease may have been precipitated by what event? A) Psychosocial stress B) Hypersensitivity to an immunization C) Menarche D) Streptococcal infection

D Feedback: Postinfectious causes of postinfectious glomerular disease are group A beta-hemolytic streptococcal infection of the throat that precedes the onset of glomerulonephritis by 2 to 3 weeks. Menarche, stress, and hypersensitivity are not typical causes.

23. The nurse is caring for a patient who is going to have an open renal biopsy. What would be an important nursing action in preparing this patient for the procedure? A) Discuss the patient's diagnosis with the family. B) Bathe the patient before the procedure with antiseptic skin wash. C) Administer antivirals before sending the patient for the procedure. D) Keep the patient NPO prior to the procedure.

D Feedback: Preparation for an open biopsy is similar to that for any major abdominal surgery. When preparing the patient for an open biopsy you would keep the patient NPO. You may discuss the diagnosis with the family, but that is not a preparation for the procedure. A pre-procedure wash is not normally ordered and antivirals are not administered in anticipation of a biopsy.

27. A patient's most recent laboratory findings indicate a glomerular filtration rate (GFR) of 58 mL/min. The nurse should recognize what implication of this diagnostic finding? A) The patient is likely to have a decreased level of blood urea nitrogen (BUN). B) The patient is at risk for hypokalemia. C) The patient is likely to have irregular voiding patterns. D) The patient is likely to have increased serum creatinine levels.

D Feedback: The adult GFR can vary from a normal of approximately 125 mL/min (1.67 to 2.0 mL/sec) to a high of 200 mL/min. A low GFR is associated with increased levels of BUN, creatinine, and potassium.

36. A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care? A) Ensure that the patient moves the extremity with the vascular access site as little as possible. B) Change the dressing over the vascular access site at least every 12 hours. C) Utilize the vascular access site for infusion of IV fluids. D) Assess for a thrill or bruit over the vascular access site each shift.

D Feedback: The bruit, or "thrill," over the venous access site must be evaluated at least every shift. Frequent dressing changes are unnecessary and the patient does not normally need to immobilize the site. The site must not be used for purposes other than dialysis.

21. A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but preliminary assessment reveals no obvious risk factors for this health problem. The nurse should recognize the need to interview the patient about what topic? A) Typical diet B) Allergy status C) Psychosocial stressors D) Current medication use

D Feedback: The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or stress.

8. A patient admitted with nephrotic syndrome is being cared for on the medical unit. When writing this patient's care plan, based on the major clinical manifestation of nephrotic syndrome, what nursing diagnosis should the nurse include? A) Constipation related to immobility B) Risk for injury related to altered thought processes C) Hyperthermia related to the inflammatory process D) Excess fluid volume related to generalized edema

D Feedback: The major clinical manifestation of nephrotic syndrome is edema, so the appropriate nursing diagnosis is "Excess fluid volume related to generalized edema." Edema is usually soft, pitting, and commonly occurs around the eyes, in dependent areas, and in the abdomen.

6. The nurse is caring for a patient who has a fluid volume deficit. When evaluating this patient's urinalysis results, what should the nurse anticipate? A) A fluctuating urine specific gravity B) A fixed urine specific gravity C) A decreased urine specific gravity D) An increased urine specific gravity

D Feedback: Urine specific gravity depends largely on hydration status. A decrease in fluid intake will lead to an increase in the urine specific gravity. With high fluid intake, specific gravity decreases. In patients with kidney disease, urine specific gravity does not vary with fluid intake, and the patient's urine is said to have a fixed specific gravity.

1. The care team is considering the use of dialysis in a patient whose renal function is progressively declining. Renal replacement therapy is indicated in which of the following situations? A) When the patient's creatinine level drops below 1.2 mg/dL (110 mmol/L) B) When the patient's blood urea nitrogen (BUN) is above 15 mg/dL C) When approximately 40% of nephrons are not functioning D) When about 80% of the nephrons are no longer functioning

D Feedback: When the total number of functioning nephrons is less than 20%, renal replacement therapy needs to be considered. Dialysis is an example of a renal replacement therapy. Prior to the loss of about 80% of the nephron functioning ability, the patient may have mild symptoms of compromised renal function, but symptom management is often obtained through dietary modifications and drug therapy. The listed creatinine and BUN levels are within reference ranges.

The nurse is providing preoperative education for a patient diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this patient? A) Menstrual periods will continue to occur for several months, some of them heavy. B) Normal activity will be permitted within 48 hours following surgery. C) After a hysterectomy, hormone levels remain largely unaffected. D) The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

D. The intestinal tract and the bladder need to be empty before the patient is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The patient is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The patient is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The patient's hormonal balance is upset, which usually occurs in reproductive system disturbances. The patient may experience depression and heightened emotional sensitivity to people and situations.

The nurse notes that a patient has a history of fibroids and is aware that this term refers to a benign tumor of the uterus. What is a more appropriate term for a fibroid? A) Bartholins cyst B) Dermoid cyst C) Hydatidiform mole D) Leiomyoma

D. A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a ìfibroid.î A Bartholin's cyst is a cyst in a paired vestibular band in the vulva, whereas a dermoid cyst is a benign tumor that is thought to arise from parts of the ovum and normally disappears with maturation. A hydatidiform mole is a type of gestational neoplasm.

A 25-year-old patient diagnosed with invasive cervical cancer expresses a desire to have children. What procedure might the physician offer as treatment? A) Radical hysterectomy B) Radical culposcopy C) Radical trabeculectomy D) Radical trachelectomy

D. A procedure called a radical trachelectomy is an alternative to hysterectomy in women with invasive cervical cancer who are young and want to have children. In this procedure, the cervix is gripped with retractors and pulled down into the vagina until it is visible. The affected tissue is excised while the rest of the cervix and uterus remain intact. A drawstring suture is used to close the cervix. For a woman who wants to have children, a radical hysterectomy would not provide the option of children. A radical culposcopy and a radical trabeculectomy are simple distracters for this question.

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea who has presented at the clinic. The student should include which of the following in the care plan for this patient? A) The patient may benefit from oral contraceptives. B) The patient must avoid use of tampons. C) The patient is susceptible to urinary incontinence. D) The patient should also be treated for chlamydia.

D. Because of the high incidence of coinfection with chlamydia and gonorrhea, the patient should also be treated for chlamydia. Avoiding the use of tampons is part of the self- care management of a patient with possible toxic shock syndrome (TSS). The patient is not susceptible to incontinence and there is no indication for the use of oral contraceptives.

A patient with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? A) Clotrimazole (Gyne-Lotrimin) B) Metronidazole (Flagyl) C) Podophyllin (Podofin) D) Acyclovir (Zovirax)

D. Feedback: Acyclovir (Zovirax) is an antiviral agent that can suppress the symptoms of genital herpes and shorten the course of the infection. It is effective at reducing the duration of lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast infections. Metronidazole is the most effective treatment for trichomoniasis. Posophyllin is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes.

A patient has herpes simplex 2 viral infection (HSV2). The nurse recognizes that which of the following should be included in teaching the patient? A) The virus causes cold sores of the lips. B) The virus may be cured with antibiotics. C) The virus, when active, may not be contracted during intercourse. D) Treatment is aimed at relieving symptoms.

D. HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSVñ1 causes ìcold sores,î and varicella zoster causes shingles.

A nurse providing prenatal care to a pregnant woman is addressing measures to reduce her postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend? A) Maintenance of good perineal hygiene B) Prevention of constipation C) Increased fluid intake for 2 weeks postpartum D) Performance of pelvic muscle exercises

D. Some disorders related to ìrelaxedî pelvic muscles (cystocele, rectocele, and uterine prolapse) may be prevented. During pregnancy, early visits to the primary provider permit early detection of problems. During the postpartum period, the woman can be taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to increase muscle mass and strengthen the muscles that support the uterus and then to continue them as a preventive action. Fluid intake, prevention of constipation, and hygiene do not reduce this risk.

A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception of femininity. What intervention would be most appropriate for this patient? A) Reassure the patient that she will still be able to have children. B) Reassure the patient that she does not have to have sex to be feminine. C) Reassure the patient that you know how she is feeling and that you feel her anxiety and pain. D) Reassure the patient that she will still be able to have intercourse with sexual satisfaction and orgasm.

D. The patient needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate to reassure the patient that she will still be able to have children; there is no reason to reassure the patient about not being able to have sex. There is no way you can know how the patient is feeling and it would be inappropriate to say so.

A nurse is teaching a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements by the client indicates understanding of the teaching? A. "I will be fully awake during the procedure." B. "Lithotripsy will reduce my chances of having stones in the future." C."I will report any bruising that occurs to my doctor." D."Straining my urine following the procedure is important."

D. CORRECT: A client is instructed to strain urine following lithotripsy to verify that the calculi have passed.

A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching? A. "I can drink up to 2 quarts of fluid a day." B. "I will need to use insulin to control my blood glucose levels." C."I should expect to gain weight during this illness." D."Muscle weakness is a symptom of diabetes insipidus."

D. CORRECT: Muscle weakness, weight loss, extreme thirst, headache, constipation, and dizziness are manifestations of dehydration that occurs with diabetes insipidus.

A nurse is caring for a client who has a urinary tract infection (UTI). Which of the following is the priority intervention by the nurse? A. Offer a warm sitz bath. B. Recommend drinking cranberry juice. C. Encourage increased fluids. D. Administer an antibiotic.

D. CORRECT: The greatest risk to the client is injury to the renal system and sepsis from the UTI. The priority intervention is to administer antibiotics.

A nurse is teaching a client who will have an x‐ray of the kidneys, ureters, and bladder. Which of the following statements should the nurse include in the teaching? A. "you will receive contrast dye during the procedure." B. "An enema is necessary before the procedure." C."you will need to lie in a prone position during the procedure." D."The procedure determines whether you have a kidney stone."

D. CORRECT: The nurse should explain to the client that a KUB can identify renal calculi, strictures, calcium deposits, and obstructions of the urinary system.

A nurse is teaching a client who has chronic kidney disease and is to begin hemodialysis. Which of the following information should the nurse include in the teaching? A. Hemodialysis restores kidney function. B. Hemodialysis replaces hormonal function of the renal system. C. Hemodialysis allows an unrestricted diet. D. Hemodialysis returns a balance to serum electrolytes.

D. CORRECT: The nurse should explain to the client that hemodialysis restores electrolyte balance by removing excess sodium, potassium, fluids, and waste products, and also restores acid‐base balance.

The client with chronic renal failure is exhibiting signs of anemia. Which is the best nursing rationale for this symptom? a) Azotemia b) Diminished erythropoietin production c) Electrolyte imbalances d) Impaired immunologic response

Diminished erythropoietin production Erythropoietin is a hormone produced in the kidneys, and this production is inadequate in chronic renal failure, which results in anemia. Azotemia, impaired immune response, and electrolyte imbalance are associated with chronic renal failure but not indicated with anemia.

C (Feedback: Annual clinical breast examination is recommended for women aged 40 years and older. Younger women may have examinations less frequently.)

For which of the following population groups would an annual clinical breast examination be recommended? A) Women over age 21 B) Women over age 25 C) Women over age 40 D) All post-pubescent females with a family history of breast cancer

Which of the following is as integumentary manifestation of chronic renal failure? a) Tremors b) Seizures c) Gray-brown skin color d) Asterixis

Gray-brown skin color Integumentary manifestations of chronic renal failure include a gray-bronze skin color and ecchymosis. Asterixis, tremors, and seizures are neurological manifestations of chronic renal failure.

The laboratory results for a patient with renal failure, accompanied by decreased glomerular filtration, would be evaluated frequently. Which of the following is the most sensitive indicator of renal function? a) Creatinine clearance of 90 mL/min b) Serum creatinine of 1.5 mg/dL c) Urinary protein level of 150 mg/24h. d) BUN of 20 mg/dLb

Serum creatinine of 1.5 mg/dL As glomerular filtration decreases, the serum creatinine and BUN levels increase and the creatinine clearance decreases. Serum creatinine is the more sensitive indicator of renal function because of its constant production in the body. The BUN is affected not only by renal disease but also by protein intake in the diet, tissue catabolism, fluid intake, parenteral nutrition, and medications such as corticosteroids.

B (Feedback: Late age at first pregnancy is a risk factor for breast cancer. None of the other listed aspects of the patient's health history is considered to be a risk factor for breast cancer.)

The nurse is performing a comprehensive health history of a patient who is in her 50s. The nurse should identify what risk factor that may increase this patient's risk for breast cancer? A) The patient breastfed each of her children. B) The patient gave birth to her first child at age 38. C) The patient experienced perimenopausal symptoms starting at age 46. D) The patient experienced menarche at age 13.

D (Feedback: BSE is best performed after menses, on day 5 to day 7, counting the first day of menses as day 1. Monthly performance is recommended.)

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time? A) At the time of menses B) At any convenient time, regardless of cycles C) Weekly D) Between days 5 and 7 after menses

C (Feedback: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the patient to raise both arms overhead. Citing American Cancer Society recommendations does not address the woman's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.(

The nurse leading an educational session is describing self-examination of the breast. The nurse tells the women's group to raise their arms and inspect their breasts in a mirror. A member of the women's group asks the nurse why raising her arms is necessary. What is the nurse's best response? A) It helps to spread out the fat that makes up your breast. B) It allows you to simultaneously assess for pain. C) It will help to observe for dimpling more closely. D) This is what the American Cancer Society recommends.

a client with an esophageal disorder comes to the hospital with symptoms that include halitosis and sour taste in the mouth. These symptoms are associated most directly with which condition a. esophageal diverticula b. GERD c. hiatal hernia d. achalasia

a. esophageal diverticula

which characteristics is a risk factor for colorectal cancer a. familial polyposis b. low fat, low protein, high fiber diet c. history of skin cancer d. age younger than 40 years

a. familial polyposis

the nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be a. fecal incontinence b. heorrhoids c. diarrhea d. dark, tarry stools

a. fecal incontinence

the nurse is creating a discharge teaching plan for a client after surgery for oral cancer. Which should be included in the teaching plan? SATA a. follow-up medical app b. follow-up dental app c. oral hygiene d. use of humidification

a. follow-up medical app b. follow-up dental app c. oral hygiene d. use of humidification

which type of jaundice seen in adults is the result of increased destruction of red blood cells a. hemolytic b. hepatocellular c. nonbstructive d. obstructive

a. hemolytic

the nurse is caring for a client during the postoperative period following radical neck dissection. Which finding should be reported to the physician? a. high epigastric pain and/or discomfort b. crackles that clear after coughing c. temperature of 99 degrees F d. serous . drainage on the dressing

a. high epigastric pain and/or discomfort

an elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to a. hypokalemia b. hyponatremia c. hyperkalemia d. hypernatremia

a. hypokalemia

Which is the most prominent sign of IBD a. intermittent pain b. abdominal distention c. increased peristalsis d. hyperactive bowel sounds

a. intermittent pain

a nurse is preparing a client for ERCP the client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? SATA a. it can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts b. it can assess for ecchymosis in the body c. it can evaluate the presence and location of ductal stones and aid in stone removal d. it is used in the diagnostic evaluation of acute pancreatitis e. it can assess the anatomy of the pancreas and the pancreatic and biliary duct

a. it can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts c. it can evaluate the presence and location of ductal stones and aid in stone removal e. it can assess the anatomy of the pancreas and the pancreatic and biliary duct

which enzyme aids int he digestion of fats a. lipase b. amylase c. secretin d. trypsin

a. lipase

a client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal a. maintaining airway b. maintaining fluid volume c. relieving the clients anxiety d. controlling bleeding

a. maintaining airway

Which assessments are important in a client diagnosed with ascites a. measurement of abdominal girth b. weight c. foul-smelling breath d. palpation of abdomen for a fluid shift

a. measurement of abdominal girth

a typical sign/symptom of appendicitis is a. nausea b. pain when pressure is applied to the right lower quadrant c. high fever d. left lower quadrant pain

a. nausea

the nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience a. pain 2 to 3 hours after a meal b. weight loss c. vomiting d. hemorrhage

a. pain 2 to 3 hours after a meal

a client is admitted to the health care center with hyperglycemia, a 15-pound weight loss, and reports of vague upper and mid abdominal pain that increases in intensity at night. The client's health history indicates alcoholism, smoking of a pack of cigarettes daily, and diabetes for the past 20 years. Upon examination the nurse finds swelling in the feet and abdominal ascites. Based on the clinical manifestations, which condition is the most likely diagnosis a. pancreatic carcinoma b. cholecystitis c. pancreatic pseudocysts d. acute pancreatitis with edema

a. pancreatic carcinoma

The nurse is monitoring a client's post operative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports tot he physician that the client has signs/symptoms of which complication a. peritonitis b. ileus c. pelvic abscess d. hemorrhage

a. peritonitis

a client with GERD comes to the physicians office reporting a burning sensation in the esophagus. The nurse documents that the client is experiencing a. pyrosis b. dysphagia c. odynophagia d. dyspepsia

a. pyrosis

which liver function study is used to show the size of the liver and hepatic blood flow and obstruction a. radioisotope liver scan b. electroencephalography c. magnetic resonance imaging d. angiography

a. radioisotope liver scan

a client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test a. serum amylase b. serum potassium c. serum bilirubin d. serum calcium

a. serum amylase

which is the most common report by clients with pancreatitis a. severe, radiating abdominal pain b. increased appetite and weight gain c. increased and painful urination d. tarry, black stools and urine

a. severe, radiating abdominal pain

Which term describes an inflammation of the salivary glands a. sialadenitis b. pyosis c. stomatitis d. parotitis

a. sialadenitis

a client who has been having recurrent attacks of severe abdominal pain over the past few months informs the physician about a 25 pound weight loss in the past year. The nurse attributes which factor as the most likely cause of this weight loss a. skipping meals out of fear of painful attacks b. ingesting a low-fat diet to prevent abdominal pain c. malabsorption d. vomiting after heavy meals

a. skipping meals out of fear of painful attacks

which medication is used to decrease portal pressure, halting bleeding of esophageal varices a. vasopressin b. spironolactone c. nitroglycerin d. cimetidine

a. vasopressin

which term is used to describe a chronic liver disease in which scar tissue surrounds the portal areas a. compensated cirrhosis b. biliary cirrhosis c. post necrotic cirrhosis d. alcoholic cirrhosis

d. alcoholic cirrhosis

the nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? SATA a. urinary incontinence related to general debility and muscle wasting b. activity intolerance related to fatigue, general debility, muscle wasting, and discomfort c. risk for injury related to altered clotting mechanisms d. disturbed body image related to changes in appearance, sexual dysfunction, and role function e. altered nutrition, more than body requirements, related to decreased activity and bed rest

b. activity intolerance related to fatigue, general debility, muscle wasting, and discomfort c. risk for injury related to altered clotting mechanisms d. disturbed body image related to changes in appearance, sexual dysfunction, and role function

a client has undergone a radial neck dissection. His skin graft site is pale. This indicates which condition? a. infection b. arterial thrombosis c. possible necrosis d. venous congestion

b. arterial thrombosis

the nurse is creating a plan of care for a client who is not able to tolerate brushing his teeth. The nurse includes which mouth irrigation in the plan of care a. mouthwash and water b. baking soda and water c. dextrose and water d. full-strength peroxide

b. baking soda and water

Which term refers to intestinal rumbling a. tenesmus b. borborgymus c. aztorrhea d. diverticulitis

b. borborgymus

Which is the most common presenting symptom of colon cancer a. weight loss b. change in bowel c. fatigue d. anorexia

b. change in bowel

Which is an accurate statement regarding cancer of the esophagus a. it is 3x more common in women than men in the US b. chronic irritation of the esophagus is a known risk factor c. it is seen more frequently in caucasian americans than in african americans d. it usually occur in the fourth decade of life

b. chronic irritation of the esophagus is a known risk factor

The nurse is irrigating a clients colostomy when the client begins to report cramping. What is the appropriate action by the nurse? a. discontinue the irrigation immediately b. clamp the tubing and allow client to rest c. change irrigation fluid to normal saline d. increase the rate of administration

b. clamp the tubing and allow client to rest

the nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid a. skim milk b. decaffeinated coffee c. octreotide d. acetaminophen

b. decaffeinated coffee

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation a. dust with nystatin powder b. dry skin thoroughly after washing c. apply barrier powder d. apply triamcinolone acetonide spray

b. dry skin thoroughly after washing

a client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir a. at least once every 2 days b. every 4-6 hour c. at least once a day d. three or four times daily

b. every 4-6 hour

which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels a. dry mouth, which makes the client thirsty b. frequent vomiting, leading to loss of fluid volume c. acetone in the urine d. high glucose concentration in the blood

b. frequent vomiting, leading to loss of fluid volume

the nurse is assessing the skin graft site of a client who has undergone a radical neck dissection. The skin graft site is pink. The nurse documents which result a. venous congestion of graft b. healthy graft c. infection of graft d. possible necrosis of graft

b. healthy graft

the nurse identifies which type of jaundice in an adult experiencing a transfusion reaction a. obstructive b. hemolytic c. hepatocellular d. nonobstructive

b. hemolytic

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition a. asterixis b. hepatic encephalopathy c. cirrhosis d. portal hypertension

b. hepatic encephalopathy

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone a. biopsy b. lithotripsy c. chemotherapy d. radiation

b. lithotripsy

a young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issue and assigns the high priority to which client outcome a. establishing a stable home environment b. minimizing social isolation c. reducing the spread of the disease d. identifying the source of exposure to hepatitis

b. minimizing social isolation

The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? a. paralytic ileus and abdominal distention b. muscle twitching and finger numbness c. elevated blood glucose concentration d. hypotension

b. muscle twitching and finger numbness

a client has undergone a liver biopsy. Which post procedure position is appropriate a. trendelenburg b. on the right side c. high fowler d. on the left side

b. on the right side

a nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a client's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The client is placed in high fowler position and a blood pressure cuff is secured around the arm in preparation for which procedure a. abdominal ultrasound b. paracentesis c. liver biopsy d. dialysis

b. paracentesis

The nurse is preparing to assess the donor site of a client who underwent a myocutaneous flap after radical neck dissection. The nurse prepares to assess the most commonly used muscle for this surgery. Which muscle should the nurse assess? a. sternomastoid b. pectoralis major c. biceps d. trapezius

b. pectoralis major

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis a. use of loop diuretics to increase the incidence of pancreatitis b. self-digestion of the pancreas by its own proteolytic enzyme c. calcification of the pancreatic duct, leading to its blockage d. fibrosis and atrophy of the pancreatic gland

b. self-digestion of the pancreas by its own proteolytic enzyme

a client with hepatic cirrhosis question the nurse about the possible use of an herbal supplement- milk thistle- to help heal the liver. which is the most appropriate response by the nurse a.you should not use herbal supplements in conjunction with medical treatment b. silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated. c. you can use milk thistle instead of the medications you have been prescribed d. herbal supplements are approved by the FDA, so there should be no problem with their usage fi you check with your primary care provider

b. silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated.

which is an accurate statement regarding gastric cancer a. a diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer b. the incidence of stomach cancer continues to decrease in the united states c. most gastric cancer-related deaths occur in people younger than 40 years d. females have a higher incidence of gastric cancers than males

b. the incidence of stomach cancer continues to decrease in the united states

a client discharged after a laparoscopic cholecystectomy calls the surgeons office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client a. this pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use b. this pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort c. this may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation d. this pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated

b. this pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort

The presence of mucus and pus in the stools suggests which condition? a. intestinal malabsorption b. ulcerative colitis c. small bowel disease d. disorders of the colon

b. ulcerative colitis

which statement correctly identifies a difference between duodenal and gastric ulcers a. malignancy is associated with duodenal ulcers b. vomiting is uncommon in clients with duodenal ulcers c. a gastric ulcer is caused by hyper-secretion of stomach acid d. weight gain may occur with a gastric ulcer

b. vomiting is uncommon in clients with duodenal ulcers

a client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client a. you would not be scheduled for a transplant if there was a concern about rejection b. you will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs. c. the problem of rejection is not as common in liver transplants as in other organ transplants d. it is easier to get a good tissue match with liver transplants than with other types of transplants.

b. you will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs.

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? a. infectious disease b. gastric resection c. inflammation of all layers of intestinal mucosa d. disaccharidase deficiency

c. inflammation of all layers of intestinal mucosa

THe nurse is planning for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client a. performing range of motion (ROM) leg exercises hourly while the client is awake b. teaching the client to choose low-fat foods from the menu c. assisting the client to turn, cough, and deep breathe every 2 hours d. assisting the client to ambulate the evening of the operative day

c. assisting the client to turn, cough, and deep breathe every 2 hours

The nurse teaches the client with GERD which measure to manage the disease a. minimize intake of caffeine, beer, milk, and foods containing peppermint or spearmint b. eat a low-carb diet c. avoid eating or drinking 2 hours before bedtime d. elevate the foot of the bed on a 6-8 inch blocks

c. avoid eating or drinking 2 hours before bedtime

a client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have a. hypertension b. warm, dry skin c. bile stained vomiting d. weight loss

c. bile stained vomiting

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because they a. can digest high-fat food b. are at risk for hepatic encephalopathy c. cannot tolerate a high glucose concentration d. are at risk for gallbladder contraction

c. cannot tolerate a high glucose concentration

Diet therapy for clients diagnosed with IBS includes a. fluids with meals b. caffeinated products c. high fiber diet d. spicy foods

c. high fiber diet

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia a. warm moist skin b. polyuria c. hypotension d. bradycardia

c. hypotension

a nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority a. developing no acute complications form the pancreatitis b. maintaining satisfactory pain control c. maintaining normal respiratory function d. achieving adequate fluid and electrolyte balance

c. maintaining normal respiratory function

the nurse working in the recovery room is caring for a client who had a radical neck dissection. The nurse notices that the client makes a coarse, high-pitched sound upon inspiration. Which intervention by the nurse is appropriate? a. document the presence of stridor b. lower the head of the bed c. notify the physician d. administer a breathing treatment

c. notify the physician

what initial measure can the nurse implement to reduce risk of injury for a client with liver disease a. apply soft wrist restraints b. prevent visitors, so as not to agitate the client c. pad the side rials on the bed d. raise all four side rials on the bed

c. pad the side rials on the bed

The nurse is teaching the client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriated diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu a. baked chicken with sweet potato french fries, corn bread, and tea b. ham and cheese sandwich, baked beans, potatoes, and coffee c. pancakes with butter and honey, orange juice d. omelet with green peppers, onions, mushrooms, and cheese with milk

c. pancakes with butter and honey, orange juice

which term describes the passage of a hollow instrument into a cavity to withdraw fluid a. dialysis b. asterixis c. paracentesis d. ascites

c. paracentesis

Which term refers to the symptom of gastroesophageal reflux disease (GERD) which is characterized by a burning sensation in the esophagus? a. odynophagia b. dyspepsia c. pyrosis d. dysphagia

c. pyrosis

clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency a. hypoprothrombinemia b. beriberi c. scurvy d. night blindness

c. scurvy

Which type of diarrhea is caused by increased production of water and electrolytes by the intestinal mucosa and their secretion into the intestinal lumen a. mixed diarrhea b. osmotic diarrhea c. secretory diarrhea d. diarrheal disease

c. secretory diarrhea

the nurse is caring for a client scheduled to undergo radical neck dissection. During preoperative teaching, the nurse states that an associated complication is a. neck distention b. venous engorgement c. shoulder drop d. clavicle fracture

c. shoulder drop

a client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for a such a client? a. instruct the client to avoid prune or apple juice b. instruct the client to keep a record of food intake c. suggest fluid intake of at least 2 L/day d. assist the client regarding the correct diet or to minimize food intake

c. suggest fluid intake of at least 2 L/day

Which is a true statement regarding regional enteritis (Crohn's disease) a. it has a progressive disease pattern b. it is characterized by pain in the lower left abd. quadrant c. the clusters of ulcers take on a cobblestone appearance d. the lesions are in the continuous contact with one another

c. the clusters of ulcers take on a cobblestone appearance

a client has a NG tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment a. the tube provides relief from nausea and vomiting b. the tube helps control fluid and electrolyte imbalance c. the tube allow the gastrointestinal tract to rest d. the tube allows toxins to be removed

c. the tube allow the gastrointestinal tract to rest

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, NPO, and administration of TPN. Which does the nurse attribute as the reason for NPO status a. to drain the pancreatic bed b. to prevent the occurrence of fibrosis c. to avoid inflammation of the pancreas d. to aid opening up of pancreatic duct

c. to avoid inflammation of the pancreas

a client is admitted to the health care center with severe abdominal pain rated 10 on a 1-10 scale, tachycardia hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4mg slow intravenous pyelogram (IVP), as ordered. The nurse plans for which foal after administration of this mediation a. to control blood pressure b. to diagnose the cause of abdominal pain c. to increase the client's pain threshold d. to control muscle spasms

c. to increase the client's pain threshold

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor a. temperature b. bilirubin c. hemoglobin d. albumin

d. albumin

what is the most common cause of small bowel obstruction a. hernia b. volvus c. neoplasms d. adhesions

d. adhesions

the nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem a. restrict dietary protein intake b. perform passive range-of-motion exercises four times a day c. reposition the client every 4 hours d. arrange for a low air loss bed

d. arrange for a low air loss bed

the nurse is assessing a client with gastric cancer. The nurse anticipates that the assessment will reveal which finding a. abdominal pain below the umbilicus b. weight gain c. increased appetite d. bloating after meals

d. bloating after meals

the nurse is caring for a client with history of bulimia. The client complains of retrosternal pain and dysphagia after forcibly causing herself to vomit after a large meal. The nurse suspects which condition a. zenker diverticulum b. periapical abscess c. halitosis d. boerhaave syndrome

d. boerhaave syndrome

when caring for a client with cirrhosis, which symptoms should the nurse report immediately? a. fatigue and weight loss b. diarrhea or constipation c. anorexia and dyspepsia d. change in mental status

d. change in mental status

which foods should be avoided following acute gallbladder inflammation a. coffee b. cooked fruits c. mashed potatoes d. cheese

d. cheese

which is a clinical manifestation of cholelithiasis a. epigastric distress before a meal b. abdominal pain in the upper left quadrant c. nonpalpable abdominal mass d. clay-colored stools

d. clay-colored stools

Which statement provides accurate information regarding cancer of the colon and rectum a. colon cancer has no hereditary component b. rectal cancer affects more than twice as many people as colon cancer c. the incidence of colon and rectal cancer decreases with age d. colorectal cancer is the third most common site of cancer in the US

d. colorectal cancer is the third most common site of cancer in the US

Which is the primary symptom of achalasia a. pulmonary symptoms b. chest pain c. heartburn d. difficulty swallowing

d. difficulty swallowing

a client is being treated for diverticulosis. Which information should the nurse include in this clients teaching plan? a. use laxatives or enemas at least once a week b. avoid daily exercise; indulge only in mild activity c. avoid unprocessed bran in the diet d. drink at least 8 to 10 large glasses of fluid every day

d. drink at least 8 to 10 large glasses of fluid every day

The most common symptom of esophageal disease is a. nausea b. vomiting c. odynophagia d. dysphagia

d. dysphagia

Halitosis and a sour taste in the mouth are clinical manifestations associated most directly with a. achalasia b. hiatal hernia c. gastroesophageal reflux d. esophageal diverticula

d. esophageal diverticula

which medication is classified as a histamine-2 receptor antagonist a. metronidazole d. lansoprazole c. esmoeprazole d. famotidine

d. famotidine

The nurse is conducing a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcer is a. alcohol and tobacco b. stress and anxiety c. ibuprofen and aspirin d. gram-negative bacteria

d. gram-negative bacteria

the nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a s/sx of possible hemorrhage a. bradycardia b. hypertension c. polyuria d. hematemesis

d. hematemesis

the nurse in the ED is admitting a client with bloody stools. The nurse documents this finding as a. melena b. tarry stools c. steatorrhea d. hematochezia

d. hematochezia

which is a true statement regarding the nursing considerations in administration of metronidazole a. the drug should be given before meals b. it may cause weight gain c. metronidazole decreases the effect of warfarin d. it leaves a metallic taste in the mouth

d. it leaves a metallic taste in the mouth

which mouth condition is associated with HIV infection a. candidiasis b. krythoplakia c. stomatitis d. kaposi sarcoma

d. kaposi sarcoma

the nurse provides health teaching to inform the client with oral cancer that a. most oral cancers are painful at the outset b. blood testing is used to diagnose oral cancer c. a typical lesion is soft and crater like d. many oral cancers produce no symptoms in the early stages

d. many oral cancers produce no symptoms in the early stages

a client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN a. monitor for reports of nausea and vomiting b. measure abdominal girth every shift c. auscultate the abdomen for bowel sounds every 4 horus d. measure blood glucose concentration every 4-6 hours

d. measure blood glucose concentration every 4-6 hours

the nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis cause by H.Pylori is implicated in which disease/condition a. pernicious anemia b. colostomy c. systemic infection d. peptic ulcers

d. peptic ulcers

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be a. semi mushy b. fluid c. mushy d. solid

d. solid

which is an accurate clinical manifestations associated with hemorrhage? a. bradycardia b. tachypnea c. hypotension d. tachycardia

d. tachycardia

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern a. the client reports nausea and anorexia b. the client has gained 2kg from the previous day c. the skin on the client's abdomen has multiple spider-shaped blood vessels d. the client's hands flap back and forth when the arms are extended

d. the client's hands flap back and forth when the arms are extended

Which symptoms characterizes regional enteritis a. severe diarrhea b. rectal bleeding c. diffuse involvement d. transmural thickening

d. transmural thickening

which position should be used for a client undergoing a paracentesis a. supine b. prone c. trendelenburg d. upright at the edge of the bed

d. upright at the edge of the bed

which condition indicates an overdose of lactulose a. fecal impaction b. constipation c. hypoactive bowel sounds d. watery diarrhea

d. watery diarrhea