nclex questions med surg/patho exam 3

Which client is most at risk for developing a Candida urinary tract infection (UTI)? 1.An obese woman 2.A man with diabetes insipidus 3.A young woman on antibiotic therapy 4.A male paraplegic on intermittent catheterization

3 Rationale:Candida infections, which are fungal infections, develop in persons who are on long-term antibiotic therapy because an alteration of normal flora occurs. These infections also are commonly seen in clients with blood dyscrasias, diabetes mellitus, cancer, or immunosuppression and in those with a drug addiction.

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates an accurate understanding of CAPD? 1."No machinery is involved, and I can pursue my usual activities." 2."A cycling machine is used, so the risk for infection is minimized." 3."The drainage system can be used once during the day and a cycling machine for 3 cycles at night." 4."A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."

1 Rationale:CAPD closely approximates normal renal function, and the client will need to infuse and drain the dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure.

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? 1.This is a normal, expected event. 2.The client is experiencing early signs of ischemic bowel. 3.The client should not have the nasogastric tube removed. 4.This indicates inadequate preoperative bowel preparation.

1 Rationale:As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy. Options 2, 3, and 4 are incorrect interpretations.

The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care? 1.Increase the amount of protein in the diet. 2.Increase the amount of potassium in the daily diet. 3.Maintain a diet high in calories with frequent snacks. 4.Encourage the client to eat a large breakfast and smaller meals later in the day.

3 Rationale:Uremia usually is accompanied by nausea, anorexia, and an unpleasant taste in the mouth. Most clients experience more nausea and vomiting in the morning. Therefore, to maintain optimal nutrition, it is best for these clients to eat a diet that is high in calories with frequent snacks and a light breakfast in the morning and larger meals later in the day. Dietary management usually is aimed at restricting protein, sodium, and potassium.

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply. 1.Diarrhea 2.Black, tarry stools 3.Hyperactive bowel sounds 4.Gray-blue color at the flank 5.Abdominal guarding and tenderness 6.Left upper quadrant pain with radiation to the back

4, 5, 6 Rationale:Grayish-blue discoloration at the flank is known as Grey-Turner's sign and occurs as a result of pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity. The client may demonstrate abdominal guarding and may complain of tenderness with palpation. The pain associated with acute pancreatitis is often sudden in onset and is located in the epigastric region or left upper quadrant with radiation to the back. The other options are incorrect.

A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition? 1.Advancing uremia 2.Phosphate overdose 3.Folic acid deficiency 4.Aluminum intoxication

Rationale:Aluminum hydroxide may be prescribed as a phosphate-binding agent. Aluminum intoxication can occur when there is an accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. It can be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limiting the use of phosphate-binding agents that contain aluminum. The data in the question are not specifically associated with the other conditions noted in the options.

The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine for proteinuria to determine which type of AKI? 1.Prerenal 2.Intrinsic 3.Atypical 4.Postrenal

2 Rationale:In intrinsic failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal failure.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food? 1.Fish 2.Plum juice 3.Fruit juice 4.Cranberries

1 Rationale:Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and meats (especially organ meats) should be restricted. Dietary modifications also may help adjust urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry, plum, or prune juice.

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? 1."I should increase the fiber in my diet." 2."I will need to avoid caffeinated beverages." 3."I'm going to learn some stress reduction techniques." 4."I can have exacerbations and remissions with Crohn's disease."

1 Rationale:Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? 1.Sweating and pallor 2.Bradycardia and indigestion 3.Double vision and chest pain 4.Abdominal cramping and pain

1 Rationale:Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the health care provider (HCP)? 1.Dark red drainage 2.Dark brown drainage 3.Green-tinged drainage 4.Light yellowish-brown drainage

1 Rationale:For the first 12 hours after gastric surgery, the nasogastric tube drainage may be dark brown to dark red. Later, the drainage should change to a light yellowish-brown color. The presence of bile may cause a green tinge. The HCP should be notified if dark red drainage, a sign of hemorrhage, is noted 24 hours postoperatively.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 1.Lying recumbent following meals 2.Consuming small, frequent, bland meals 3.Taking H2-receptor antagonist medication 4.Raising the head of the bed on 6-inch (15 cm) blocks

1 Rationale:Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent, and bland meals; use of H2-receptor antagonists and antacids; and elevation of the thorax following meals and during sleep.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? 1."I need to limit my intake of dietary fiber." 2."I need to drink plenty, at least 8 to 10 cups daily." 3."I need to eat regular meals and chew my food well." 4."I will take the prescribed medications because they will regulate my bowel patterns."

1 Rationale:IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help to produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help to promote normal bowel function. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

The nurse is monitoring a client who has just returned from surgery after a transurethral resection of the prostate (TURP). The client has a 3-way Foley catheter in place for ongoing bladder irrigation. The nurse is observing the color of the client's urine and should expect which urine color during the immediate postoperative period? 1.Pale pink urine 2.Dark pink urine 3.Tea-colored urine 4.Bright red blood with small clots in the urine

1 Rationale:If the bladder irrigation is infusing at a sufficient rate, the urinary drainage through the Foley tubing should be pale pink. Dark pink urine indicates that the rate of the irrigation solution should be increased. Tea-colored urine is not seen after TURP but may be noted in a client with other renal disorders such as renal failure. Bright red bleeding and clots could indicate a complication, and if this is noted, it should be reported to the health care provider.

The nurse is assessing a client who has returned from the postanesthesia care unit after transurethral resection of the prostate (TURP). The nurse should assess for which color in the urinary drainage tubing that indicates proper irrigation and adequate functioning of the device? 1.Pale pink 2.Dark pink 3.Bright red 4.Red with clots

1 Rationale:If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should be increased. Bright red bleeding and red urine with clots should be reported to the surgeon because either finding could indicate complications.

The nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that education was effective if the client chooses which selections from a diet menu? 1.Spinach salad, milk, and a banana 2.Chicken, potatoes, and cranberries 3.Peanut butter sandwich, milk, and prunes 4.Linguini with shrimp, tossed salad, and a plum

1 Rationale:In some client situations, the health care provider may prescribe a diet that consists of foods that yield either an alkaline or an acid residue in the urine. In an alkaline residue diet, all fruits are allowed except cranberries, blueberries, prunes, and plums. Options, 2, 3 and 4 represent an acid residue diet.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1.Notify the health care provider (HCP). 2.Administer the prescribed pain medication. 3.Call and ask the operating room team to perform surgery as soon as possible. 4.Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

1 Rationale:On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time.

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which problem? 1.Anger 2.Projection 3.Depression 4.Withdrawal

1 Rationale:Psychosocial reactions to CKD and hemodialysis are varied and may include anger. Other reactions include personality changes, emotional lability, withdrawal, and depression. The individual client's response may vary depending on the client's personality and support systems. The client in this question is exhibiting anger. The client's behavior is not indicative of projection; in addition, the client's statement does not reflect withdrawal or depression.

The nurse is preparing to teach ostomy care to a client who has just had a urinary diversion; the client expresses concern about body appearance. Which client action indicates that the best initial positive adaptation is being made? 1.Agrees to look at the ostomy 2.Asks to defer ostomy care to the spouse 3.Asks to wait 1 more day before beginning to learn ostomy care 4.States that ostomy care is the nurse's job while the client is in the hospital

1 Rationale:The best initial positive step in learning to care for an ostomy and to accept it as a part of the self is to be able to look at the ostomy. Once the client is able to look at the ostomy and touch it, the client can proceed more successfully to learn about ostomy care. The other options all indicate a deferral or refusal on the part of the client, which makes them less than optimal choices.

A client with chronic kidney disease (CKD) has been taking aluminum hydroxide gel. On the basis of this information, the nurse determines that the client is most at risk for which problem? 1.Constipation 2.Dehydration 3.Inability to tolerate activity 4.Impaired physical mobility

1 Rationale:The client with CKD is almost certain to have a problem with constipation as a result of factors such as fluid restriction, fatigue that limits exercise, and dietary restrictions. In addition, phosphate-binding antacids such as aluminum hydroxide gel cause constipation as a side effect. The other problems listed are unrelated to the information in the question.

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has chronic renal disease. On review of the laboratory results, the nurse most likely would expect to note which finding? 1.Elevated creatinine level 2.Decreased hemoglobin level 3.Decreased red blood cell count 4.Increased number of white blood cells in the urine

1 Rationale:The creatinine level is the most specific laboratory test to determine renal function. The creatinine level increases when at least 50% of renal function is lost. A decreased hemoglobin level and red blood cell count are associated with anemia or blood loss and not specifically with decreased renal function. Increased white blood cells in the urine are noted with urinary tract infection.

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status? 1.Blood pressure 2.Apical heart rate 3.Jugular vein distention 4.Level of consciousness

1 Rationale:The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can best be estimated by the blood pressure, which is an indirect reflection of the adequacy of cardiac output. The heart rate affects the cardiac output but can be altered by factors unrelated to kidney function. Jugular vein distention and level of consciousness are unrelated items.

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? 1.Palpation of a thrill over the fistula 2.Presence of a radial pulse in the left wrist 3.Visualization of enlarged blood vessels at the fistula site 4.Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand

1 Rationale:The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Enlarged visible blood vessels at the fistula site are a normal observation but are not indicative of fistula patency. Although the presence of a radial pulse in the left wrist and capillary refill less than 3 seconds in the nail beds of the fingers on the left hand indicate adequate circulation to the hand, they do not assess fistula patency.

A client is admitted to the emergency department following a fall from a horse and the health care provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action? 1.Notify the HCP before performing the catheterization. 2.Use a small-sized catheter and an anesthetic gel as a lubricant. 3.Administer parenteral pain medication before inserting the catheter. 4.Clean the meatus with soap and water before opening the catheterization kit.

1 Rationale:The presence of blood at the urinary meatus may indicate urethral trauma or disruption. The nurse notifies the HCP, knowing that the client should not be catheterized until the cause of the bleeding is determined by diagnostic testing. The other options include performing the catheterization procedure and therefore are incorrect.

A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client? 1.Assessment of vital signs 2.Completion of abdominal examination 3.Insertion of the prescribed nasogastric tube 4.Thorough investigation of precipitating events

1 Rationale:The priority nursing action is to assess the vital signs. This would provide information about the amount of blood loss that has occurred and provide a baseline by which to monitor the progress of treatment. The client may be unable to provide subjective data until the immediate physical needs are met. Although an abdominal examination and an assessment of the precipitating events may be necessary, these actions are not the priority. Insertion of a nasogastric tube is not the priority and will require a health care provider's prescription; in addition, the vital signs should be checked before performing this procedure.

The nurse is monitoring the urine output of a client with low serum protein level and urinary output less than 30 mL in the last hour. Based on these data, the nurse understands that low urinary output is caused by which force within the kidneys? 1.Oncotic pressure 2.Osmotic pressure 3.Filtration pressure 4.Hydrostatic pressure

1 Rationale:The pulling pressure within the capillaries that is exerted by the plasma proteins is referred to as the oncotic pressure. Osmotic pressure is the movement of water along a pressure gradient. Filtration pressure is the pressure that is exerted with ultrafiltration, in which the pressure within the capillaries is greater than the pressure outside them; this results in fluids being pushed across the membrane into Bowman's capsule. Hydrostatic pressure in the capillaries allows fluid to be filtered out of the blood in the glomerulus.

The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation? 1.Fever 2.Fatigue 3.Clear dialysate output 4.Leaking around the catheter site

1 Rationale:The signs of peritonitis include fever, nausea, malaise, rebound abdominal tenderness, and cloudy dialysate output. Fatigue may be associated with peritonitis, but fever is the most likely sign. Leaking around the catheter site is not an indication of peritonitis.

The nurse has a prescription to obtain a urinalysis specimen from a client with an indwelling urinary catheter. Which actions should the nurse include in performing this procedure? Select all that apply. 1.Explaining the procedure to the client 2.Clamping the tubing of the drainage bag 3.Aspirating a sample from the port on the drainage tubing 4.Obtaining the specimen from the urinary drainage bag 5.Wiping the port with an alcohol swab before inserting the syringe

1, 2, 3, 5 Rationale:A urine specimen is not taken from the urinary drainage bag. Urine undergoes chemical changes while sitting in the bag, so its properties do not necessarily reflect current client status. In addition, it may become contaminated with bacteria from opening the system. The remaining options are correct interventions for obtaining the specimen.

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply. 1.Coffee 2.Chocolate 3.Peppermint 4.Nonfat milk 5.Fried chicken 6.Scrambled eggs

1, 2, 3, 5 Rationale:Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect.

The nurse is caring for a client just after ureterolithotomy and is monitoring the drainage from the ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and determines that which could be the cause of the problem? Select all that apply. 1.Blood clots 2.Mucous shreds 3.Ureteral edema 4.Chemical sediment 5.Catheter displacement

1, 2, 4, 5 Rationale:After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for the first 2 to 3 days. As ureteral edema diminishes, urine leaks around the ureteral catheter and drains directly into the bladder. At this point, drainage through the ureteral catheter diminishes. Immediately after surgery, absence of drainage usually is caused by blockage from blood clots, mucous shreds, chemical sediment, or catheter displacement.

The nurse is creating a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should the nurse include in the plan of care? Select all that apply. 1.Monitor daily weight. 2.Maintain sodium restrictions. 3.Maintain a diet low in protein. 4.Monitor intake and output (I&O). 5.Maintain bed rest when edema is severe.

1, 2, 4, 5 Rationale:Controlling edema is a critical aspect of therapeutic management of nephrotic syndrome. If the GFR is normal, dietary intake of proteins is needed to restore normal plasma oncotic pressure and thereby decrease edema. Daily measurement of weight and abdominal girth, and careful monitoring of I&O will determine whether weight loss is caused by diuresis or protein loss. Dietary modifications may include salt restriction and fluid restriction and are based on the client's symptoms. Bed rest is prescribed to promote diuresis when edema is severe.

A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply. 1.Agitation 2.Euphoria 3.Depression 4.Withdrawal 5.Labile emotions

1, 3, 4, 5 Rationale:The client with CKD often experiences a variety of psychosocial changes. These changes are related to uremia and to the stress associated with living with a chronic disease that is life threatening. Euphoria is not part of the clinical picture for the client in renal failure. Clients with CKD may have labile emotions or personality changes and may exhibit withdrawal, depression, or agitation. Delusions and psychosis also can occur.

A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created for urinary diversion. In creating a discharge teaching plan for the client, the nurse should include which instruction in the plan? 1.Dietary restrictions 2.Technique of catheterization 3.External pouch and application care 4.Proper administration of prophylactic antibiotics

2 Rationale:A Kock pouch is a continent internal ileal reservoir. The nurse instructs the client about the technique of catheterization. Dietary restrictions are not required. There is no external pouch. Antibiotics are not required unless an infection is present; also, antibiotics are prescribed by the health care provider.

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5°C (101.2°F). Which nursing action is most appropriate? 1.Encourage fluid intake. 2.Notify the health care provider. 3.Continue to monitor vital signs. 4.Monitor the site of the shunt for infection.

2 Rationale:A temperature of 101.2°F (38.5°C) is significantly elevated and may indicate infection. The nurse should notify the health care provider (HCP). Dialysis clients cannot have fluid intake encouraged. Vital signs and the shunt site should be monitored, but the HCP should be notified first.

A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should the nurse expect to observe in the client? 1.Bradycardia 2.Hypertension 3.Decreased cardiac output 4.Decreased central venous pressure

2 Rationale:AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for any form of renal failure.

A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? 1.Select foods high in fat. 2.Increase intake of fluids, including juices. 3.Eat a good supper when anorexia is not as severe. 4.Eat less often, preferably only 3 large meals daily.

2 Rationale:Although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat diet, as fat may be tolerated poorly because of decreased bile production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning, so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication? 1.Peritonitis 2.Hyperglycemia 3.Hyperphosphatemia 4.Disequilibrium syndrome

2 Rationale:An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Peritonitis is a risk associated with breaks in aseptic technique. Hyperphosphatemia is an electrolyte imbalance that occurs with renal dysfunction. Disequilibrium syndrome is a complication associated with hemodialysis.

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern? 1.Apnea 2.Kussmaul respirations 3.Decreased respirations 4.Cheyne-Stokes respirations

2 Rationale:Clinical manifestations associated with AKI occur as a result of metabolic acidosis. The nurse would expect to note Kussmaul respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. The breathing patterns noted in options 1, 3, and 4 are not characteristic of AKI.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1."I'm so glad they didn't find any protein in his urine." 2."I noticed his urine was the color of coca-cola lately." 3."His health care provider said his kidneys are working well." 4."The nurse who admitted my child said his blood pressure was low."

2 Rationale:Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly.

The nurse is performing an assessment on a client after a cystoscopy. Which assessment finding indicates a need to notify the health care provider (HCP)? 1.A temperature of 99.4°F (37.4°C) 2.Grossly bloody urine with clots 3.A bluish or green tinge to the urine 4.A blood pressure of 120/82 mm Hg

2 Rationale:Grossly bloody urine with clots following cystoscopy is always an abnormal finding and should be reported to the HCP immediately. The client may have clear or blood-tinged urine after cystoscopy. If a contrast agent such as methylene blue is used, the urine may have an unusual bluish or green tinge. A blood pressure of 120/82 mm Hg and a temperature of 99.4°F (37.4°C) are not abnormal findings at this time.

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client? 1.Prevent fluid overload. 2.Prevent loss of electrolytes. 3.Promote the excretion of wastes. 4.Reduce the urine specific gravity.

2 Rationale:In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in this phase of AKI.

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the health care provider? 1.Stoma is beefy red and shiny 2.Purple discoloration of the stoma 3.Skin excoriation around the stoma 4.Semi-formed stool noted in the ostomy pouch

2 Rationale:Ischemia of the stoma would be associated with a dusky or bluish or purple color. A beefy red and shiny stoma is normal and expected. Skin excoriation needs to be addressed and treated but does not require as immediate attention as purple discoloration of the stoma. Semi-formed stool is a normal finding.

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? 1.Hypertension 2.Generalized edema 3.Increased urinary output 4.Frank, bright red blood in the urine

2 Rationale:Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain; periorbital and facial edema that is most prominent in the morning; leg, ankle, labial, or scrotal edema; decreased urine output and urine that is dark and frothy; abdominal swelling; and blood pressure that is normal or slightly decreased.

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? 1.Urine is clear amber. 2.Urination is not painful. 3.Urge incontinence is not present. 4.A reddish-orange discoloration of the urine is present.

2 Rationale:Phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of urine but this is a side effect of the medication, not the desired effect.

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first? 1."Have you had any diarrhea?" 2."Have you been constipated recently?" 3."Have you had any abdominal discomfort?" 4."Have you had an increased amount of flatulence?"

2 Rationale:Reduced outflow from the dialysis catheter may be caused by the catheter position, infection, or constipation. Constipation may contribute to a reduced outflow because peristalsis seems to aid in drainage. Options 1, 3, and 4 are unrelated to the causes of reduced outflow from the dialysis catheter.

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder? 1.Hypoglycemia 2.Diabetes mellitus 3.Coronary artery disease 4.Orthostatic hypotension

2 Rationale:Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and presence of an indwelling urinary catheter or frequent catheterization. The conditions noted in the remaining options are not associated risk factors.

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury? 1.Prerenal 2.Intrarenal 3.Postrenal 4.Extrarenal

2 Rationale:Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the kidney. The cause and the type of renal failure may determine the interventions used in treatment.

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? 1.Leg exercises 2.Early ambulation 3.Irrigating the nasogastric tube 4.Coughing and deep-breathing exercises

3 Rationale:In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which sign(s)/symptom(s) of duodenal ulcer? 1.Weight loss 2.Nausea and vomiting 3.Pain relieved by food intake 4.Pain radiating down the right arm

3 Rationale:A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the mid-epigastric area. The client with duodenal ulcer usually does not experience weight loss or nausea and vomiting. These symptoms are more typical in the client with a gastric ulcer.

The nurse is admitting a client from the postanesthesia care unit who has had percutaneous nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely involve monitoring which device? 1.Ureteral stent 2. Suprapubic tube 3. Nephrostomy tube 4.Jackson-Pratt drain

3 Rationale:A nephrostomy tube is put in place after percutaneous nephrolithotomy for calculi in the renal pelvis. The client also may have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect elimination of the calculous fragments. Options 1, 2, and 4 are incorrect.

The nurse is urging a client to cough and deep breathe after nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is most likely to be a result of which factor? 1.A stress response to the ordeal of surgery 2.A latent fear of needing dialysis if the surgery is unsuccessful 3.Pain that is intensified because of the location of the incision near the diaphragm 4.Effects of circulating metabolites that have not been excreted by the remaining kidney

3 Rationale:After nephrectomy, the client may be in considerable pain. This is because of the size of the incision and its location near the diaphragm, which make coughing and deep breathing very uncomfortable. For this reason, opioids are used liberally and may be most effective when provided as patient-controlled analgesia or through epidural analgesia. The items in the other options are not likely factors for the client's statement.

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement? 1.The client has an accurate understanding of the procedure and aftercare. 2.The client does not realize how painful removal of the dialysis catheter will be. 3.The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use. 4.The client is not aware that the alternative access site is left in place prophylactically for 2 months.

3 Rationale:An AV fistula is the internal creation of an arterial-to-venous anastomosis. This causes engorgement of the vein, allowing both the artery and the vein to be easily cannulated for hemodialysis. Fistulas take 1 to 2 weeks to mature (engorgement) or develop before they can be used for dialysis, so the current method of access must remain in place to be used during that period. Options 1, 2, and 4 are incorrect interpretations of the client's statement.

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition? 1.Pyelonephritis 2.Glomerulonephritis 3.Trauma to the bladder or abdomen 4.Renal cancer in the client's family

3 Rationale:Bladder trauma or injury should be considered or suspected in the client with low abdominal pain and hematuria. Glomerulonephritis and pyelonephritis would be accompanied by fever and are thus not applicable to the client described in this question. Renal cancer would not cause pain that is felt in the low abdomen; rather, the pain would be in the flank area.

A client is being evaluated as a potential kidney donor for a family member. The client asks the nurse why separate teams are evaluating donor and recipient. What is the most appropriate response by the nurse? 1.Helps reduce the cost of the preoperative workup 2.Saves the client and the recipient valuable preoperative time 3.Avoids a conflict of interest between the team evaluating the recipient and the team evaluating the donor 4.Provides for a sufficient number of persons reviewing the case so that no information is overlooked

3 Rationale:Both the kidney donor and the kidney recipient need thorough medical and psychological evaluation before transplant surgery. Separate teams evaluate the donor and the recipient to avoid a conflict of interest in providing care for the 2 clients. Options 1, 2, and 4 are not related to the purpose of this approach.

The nurse, who is administering bethanechol chloride, is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose? 1.Dry skin 2.Dry mouth 3.Bradycardia 4.Signs of dehydration

3 Rationale:Cholinergic overdose of bethanechol chloride produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Remember that the sympathetic nervous system speeds the heart rate and the cholinergic (parasympathetic) nervous system slows the heart rate. Treatment includes supportive measures and the administration of atropine sulfate (anticholinergic) subcutaneously or intravenously.

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food? 1.Breads 2.Poultry 3.Chocolate 4.Prune juice

3 Rationale:Clients with oxalate stones should avoid foods high in oxalate, such as tea, instant coffee, cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits, apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may help increase oxalate excretion in the urine.

A client who is undergoing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect? 1.Infection 2.An intact catheter 3.Bowel perforation 4.Bladder perforation

3 Rationale:Complications of a peritoneal catheter include infection, perforation of the bowel or bladder, and bleeding. Brown-tinged returns suggest bowel perforation, which usually is accompanied by severe abdominal pain and diarrhea. Cloudy or opaque returns suggest possible infection. Urine-colored returns suggest possible bladder perforation. An intact catheter is unrelated to the information provided in the question.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? 1.Ambulate following a meal. 2.Eat high-carbohydrate foods. 3.Limit the fluids taken with meals. 4.Sit in a high Fowler's position during meals.

3 Rationale:Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

A home care nurse is making home visits to an older client with urinary incontinence who is very concerned about the incontinent episodes. Which finding by the nurse indicates that the client has an environmental barrier to normal voiding? 1.Presence of hand railings in the bathroom 2.Having 1 bathroom on each floor of the home 3.Bathroom located on the second floor, bedroom on the first floor 4.Night light present in the hall between the bedroom and bathroom

3 Rationale:Having the bathroom on the second floor and the bedroom on the first floor may pose a problem for the older client with incontinence. The need to negotiate the stairs and the distance both may interfere with reaching the bathroom in a timely fashion. It is more helpful to the incontinent client to have a bathroom on the same floor as the bedroom or to have a commode rented for use. Hand railings and night lights are helpful to the client in reaching the bathroom quickly and safely.

The nurse is caring for a client who was prescribed furosemide. The nurse should monitor the client for damage of which kidney structure? 1.Pelvis 2.Calyx 3.Nephron 4.Renal artery

3 Rationale:The nephron is the functional unit of the kidney that is responsible for clearance of excess fluid and waste products of metabolism. The renal pelvis and calices collect urine to send to the ureter. The renal artery brings blood to the kidney for filtering by the nephron.

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about managing the condition between dialysis treatments. The nurse should plan to include the instruction that weight gain between dialysis treatments should be ideally what value? 1. 11 to 13 lbs (5 to 6 kg) 2. 4.5 to 9 lbs (2 to 4 kg) 3. 2 to 3 lbs (1 to 1.5 kg) 4. 1 to 2 lbs (0.5 to 1.0 kg)

3 Rationale:Limiting weight gain to 2 to 3 lbs (1 to 1.5 kg) between dialysis treatments helps prevent the hypotension that occurs with the removal of large volumes of fluid during dialysis. The nurse instructs the client in how to manage daily fluid allotment to assist the client in staying within a low fluid intake range to prevent excess weight gain. Options 1, 2, and 4 are incorrect.

The nurse has administered a dose of meperidine hydrochloride to a client with renal colic as treatment for pain. The nurse carefully monitors this client for which side and adverse effect of this medication? 1.Bradycardia 2.Hypertension 3.Urinary retention 4.Increased respirations

3 Rationale:Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

A client undergoing hemodialysis begins to experience muscle cramping. What is the best action by the hemodialysis nurse in this situation? 1.Administer hypotonic saline. 2.Increase the ultrafiltration rate. 3.Decrease the ultrafiltration rate. 4.Administer magnesium sulfate.

3 Rationale:Muscle cramps during hemodialysis result from either too rapid removal of water and sodium or neuromuscular hypersensitivity. The nurse corrects this situation by either slowing down the ultrafiltration rate on the hemodialyzer or administering hypertonic or isotonic normal saline. Magnesium sulfate is not prescribed to correct this occurrence.

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions? 1.Increase intake of dairy products. 2.Avoid citrus fruits and citrus juices. 3.Avoid green, leafy vegetables such as spinach. 4.Increase intake of meat, fish, plums, and cranberries.

3 Rationale:Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The food items in options 1, 2, and 4 are acceptable to consume.

The nurse is teaching a client with nephrotic syndrome about managing the disorder. What should the nurse instruct the client to adjust according to the amount of edema present? 1.Salt intake 2.Water intake 3.Activity level 4.Use of diuretics

3 Rationale:The client is taught to adjust the activity level according to the amount of edema. As edema decreases, activity can increase. Correspondingly, as edema increases, the client should increase rest periods and limit activity. Bed rest is recommended during periods of severe edema. The client with nephrotic syndrome usually has a standard limit set on sodium intake. Fluids are not restricted unless the client also is hyponatremic. Diuretics are prescribed on a specific schedule, and doses are not titrated according to the level of edema.

The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process? 1.Anxiety 2.Memory deficits 3.Presence of family 4.Short attention span

3 Rationale:The client with CKD may have several barriers to learning. The presence of family members is helpful because they need to understand the disease and treatment and may help reinforce information with the client after the formal teaching session is over. Anxiety about the disease and its ramifications frequently interferes with learning. Physiological effects of the disease process also impair the client's mental functioning. Specifically, the client may exhibit a short attention span and have memory deficits. Mental functioning usually improves once hemodialysis has begun.

A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in which parts of the nephron? 1.The glomerulus and the calices 2.The loop of Henle and the distal tubule 3.The distal tubule and the collecting duct 4.The proximal tubule and the loop of Henle

3 Rationale:The distal tubule and the collecting duct of the nephron require the presence of ADH for water reabsorption. The hormone increases the permeability of the membranes to allow water to flow more easily along the concentration gradient. The glomerulus filters but does not reabsorb. The calices are responsible for collecting the urine. The proximal tubule and the loop of Henle reabsorb water without the assistance of ADH.

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury? 1."The increase in urine output indicates the return of some renal function." 2."The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." 3."The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." 4."The blood urea nitrogen and creatinine levels will continue to rise during the first few days of diuresis."

3 Rationale:The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000 mL in a 24-hour period. This increase in urine output indicates the return of some renal function; however, blood urea nitrogen and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.

The nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount of kidney perfusion should the nurse anticipate? 1.100 to 300 mL/min 2.500 to 1000 mL/min 3.1200 to 1500 mL/min 4.2000 to 2500 mL/min

3 Rationale:The kidneys normally receive about 20% to 25% of the cardiac output when the client is at rest. If the cardiac output is 6 L/min, the kidneys receive 1.2 to 1.5 L/min, which is equal to 1200 to 1500 mL/min.

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder? 1.Headache 2.Hypotension 3.Flank pain and hematuria 4.Complaints of low pelvic pain

3 Rationale:The most common findings with polycystic kidney disease are hematuria and flank or lumbar pain that is either colicky in nature or dull and aching. Other common findings include proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common finding and may be associated with cardiomegaly and heart failure. The client may complain of a headache, but this is not a specific assessment finding in polycystic kidney disease.

The nurse is preparing to perform a discharge teaching with a client who is started on hemodialysis. Which information should the nurse provide regarding the hemodialysis schedule? 1. 5 hours of treatment 2 days per week 2. 2 hours of treatment 6 days per week 3. 3 to 4 hours of treatment 3 days per week 4. 2 to 3 hours of treatment 5 days per week

3 Rationale:The typical schedule for hemodialysis is 3 to 4 hours of treatment 3 days per week. Individual adjustments are made according to variables such as the size of the client, type of dialyzer, rate of blood flow, personal client preferences, and other factors.

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia? 1.Nocturia 2.Scrotal edema 3.Occasional constipation 4.Decreased force in the stream of urine

4 Rationale:Decreased force in the stream of urine is an early symptom of benign prostatic hyperplasia. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur. Constipation or scrotal edema is not associated with benign prostatic hyperplasia.

A client with a bladder injury has had surgical repair of the injured area with placement of a suprapubic catheter. Which is the most appropriate nursing action to prevent complications of this procedure? 1.Monitor urine output once per shift. 2.Measure specific gravity once per shift. 3.Encourage an excessive intake of oral fluids. 4.Ensure that the catheter tubing is not kinked.

4 Rationale:A complication after surgical repair of the bladder is disruption of sutures, caused by tension on them from urine buildup. The nurse prevents this from happening by ensuring that the catheter is able to drain freely. This involves basic catheter care, including keeping the tubing free from kinks, maintaining the tubing at a level below the bladder, and monitoring the flow of urine frequently. Monitoring of urine output every shift is insufficient to detect decreased flow from catheter kinking. Measurement of urine specific gravity and an excessive intake of oral fluids do not prevent complications of bladder surgery.

A week after kidney transplantation, a client develops a temperature of 101°F (38.3°C), the blood pressure is elevated, and there is tenderness over the transplanted kidney. The serum creatinine is rising and urine output is decreased. The x-ray indicates that the transplanted kidney is enlarged. Based on these assessment findings, the nurse anticipates which treatment? 1.Antibiotic therapy 2.Peritoneal dialysis 3.Removal of the transplanted kidney 4.Increased immunosuppression therapy

4 Rationale:Acute rejection most often occurs within 1 week after transplantation but can occur any time posttransplantation. Clinical manifestations include fever, malaise, elevated white blood cell count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. Treatment consists of increasing immunosuppressive therapy. Antibiotics are used to treat infection. Peritoneal dialysis cannot be used with a newly transplanted kidney due to the recent surgery. Removal of the transplanted kidney is indicated with hyperacute rejection, which occurs within 48 hours of the transplant surgery.

A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication? 1.It prevents ulcers. 2.It prevents constipation. 3.It promotes the elimination of potassium from the body. 4.It combines with phosphorus and helps eliminate phosphates from the body.

4 Rationale:Aluminum hydroxide may be prescribed for a client with CKD. It binds with phosphate in the intestines for excretion in the feces, thus lowering phosphorus levels. It can cause constipation, and it does not promote the elimination of potassium. It may be used in the treatment of hyperacidity associated with gastric ulcers, but this is not the purpose of its use in the client with renal failure.

The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching? 1."I should try to maintain an acid ash diet." 2."I should increase my fluid intake to 3 L per day." 3."I should take my daily dose of vitamin C to acidify the urine." 4."I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

4 Rationale:Clients with acute pyelonephritis should be instructed to try to maintain an acid ash diet, which may be of some benefit. Also, they should increase fluid intake to 3 L per day; this helps relieve dysuria and flushes bacteria out of the bladder. However, for clients with chronic pyelonephritis and renal dysfunction, an increase in fluid intake may be contraindicated. Medications such as vitamin C help acidify the urine. Juices such as cranberry, plum, and prune juice will leave an acid ash in the urine. Caffeine, alcohol, chocolate, and highly spiced foods are avoided to prevent potential bladder irritation.

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations? 1.Hypertension, tachycardia, and fever 2.Hypotension, bradycardia, and hypothermia 3.Restlessness, irritability, and generalized weakness 4.Headache, deteriorating level of consciousness, and twitching

4 Rationale:Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing increased intracranial pressure and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates. Tachycardia and fever are associated with infection. Generalized weakness is associated with low blood pressure and anemia. Restlessness and irritability are not associated with disequilibrium syndrome.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action? 1.Monitor the client. 2.Elevate the head of the bed. 3.Assess the fistula site and dressing. 4.Notify the health care provider (HCP).

4 Rationale:Disequilibrium syndrome may be caused by rapid removal of solutes from the body during hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP.

The graduate nurse is caring for a client with decreased renal perfusion. The registered nurse determines that the graduate nurse demonstrates understanding of why this is occurring if which statement is made? 1."It can be due to an increase in serotonin levels." 2."It may be due to overhydration with intravenous fluids." 3."It may be due to the client's hemoglobin of 13.2 g/dL (132 mmol/L)." 4."It may be a consequence of decreased dopaminergic receptor stimulation."

4 Rationale:Dopaminergic receptors are found in the renal blood vessels and in the nerves. When stimulated, they dilate renal arteries and help modulate release of the neurotransmitter dopamine. Renal artery dilation helps improve urine output by increasing blood flow through the kidneys. Serotonin is a local hormone that is released from platelets after an injury; it constricts arterioles but dilates capillaries. Dehydration, not overhydration, would decrease renal perfusion. A hemoglobin of 13.2 g/dL (132 mmol/L) is a normal value.

The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted? 1.Intake 1500 mL, output 800 mL 2.Intake 3000 mL, output 2000 mL 3.Intake 2400 mL, output 2900 mL 4.Intake 1800 mL, output 1750 mL

4 Rationale:For the client on a normal diet, the normal fluid intake is approximately 1200 to 1800 mL of measurable fluids per day. The client's output in the same period should be about the same and does not include insensible losses, which are extra. Insensible losses are offset by the fluid in solid foods, which also is not measured.

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the health care provider (HCP)? 1.Red, bloody urine 2.Pain rated as 2 on a 0-10 pain scale 3.Urinary output of 200 mL higher than intake 4.Blood pressure, 100/50 mm Hg; pulse, 130 beats/minute

4 Rationale:Frank bleeding (arterial or venous) may occur during the first day after surgery. Some hematuria is usual for several days after surgery. A urinary output of 200 mL more than intake is adequate. A client pain rating of 2 on a 0-10 scale indicates adequate pain control. A rapid pulse with a low blood pressure is a potential sign of excessive blood loss. The HCP should be notified.

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem? 1.The client washes hands at least once per day. 2.The client's temperature remains lower than 101°F (38.3°C). 3.The client avoids blood pressure (BP) measurement in the left arm. 4.The client's white blood cell (WBC) count remains within normal limits.

4 Rationale:General indicators that the client is not experiencing infection include a temperature and WBC count within normal limits. The client also should use proper hand-washing technique as a general preventive measure. Hand washing once per day is insufficient. It is true that the client should avoid BP measurement in the affected arm; however, this would relate more closely to the problem of risk for injury.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should formulate a response using what fact about the kidneys? 1.The kidneys get fatigued from having to filter too much fluid. 2.The kidneys can react adversely to moderate doses of furosemide. 3.The kidneys will shut down easily if serum levels of digoxin are high. 4.The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

4 Rationale:Heart failure is referred to as a prerenal cause of acute kidney injury because heart failure results in decreased blood flow to the kidneys. The kidneys normally receive about 20% to 25% of the cardiac output and require adequate perfusion to function properly. With a significant or prolonged decrease in blood supply, the kidneys can fail. Options 1 and 3 are incorrect. As for option 2, large doses of furosemide resulting in severe dehydration may lead to decreased kidney perfusion, but moderate doses of furosemide do not cause prerenal acute kidney injury, and furosemide may be used to treat acute kidney injury.

The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased? 1.Potassium 2.Creatinine 3.Phosphorus 4.Red blood cell (RBC) count

4 Rationale:Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen, creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also worsens anemia because RBCs are lost during dialysis from blood sampling and anticoagulation and from residual blood left in the dialyzer. Although all of these results are expected, only the lowered RBC count is nontherapeutic and worsens the anemia already caused by the disease process.

A client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1.Diuretics 2.Antibiotics 3.Antilipemics 4.Decongestants

4 Rationale:In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antlipemics do not affect ability to urinate.

The nurse is caring for a client immediately after nephrectomy and renal transplantation. What is the most appropriate datum to use in planning administration of intravenous fluids to this client? 1.A strict hourly rate of 100 mL 2.A strict hourly rate of 150 mL 3.One half of the previous hour's urine output 4.The number of milliliters in the previous hour's urine output

4 Rationale:Intravenous fluids are managed very carefully after nephrectomy and renal transplantation. Fluids are usually given according to a formula that takes into account the previous hour's urine output. The desired urine output is generally high; therefore, options 1, 2, and 3 are incorrect.

The nurse has given instructions about Kegel exercises to a female client with a cystocele. The nurse determines that the client needs further instruction if she makes which statement? 1."I should stop and start my stream of urine during a voiding." 2."I should tighten my perineal muscles for up to 10 seconds several times a day." 3."I should tighten my perineal muscles for up to 5 minutes 3 or 4 times a day." 4."I should begin voiding and then stop the stream, holding residual urine for an hour."

4 Rationale:Kegel muscles strengthen the perineal floor and are useful in the prevention and management of cystocele, rectocele, and enterocele. Several ways to perform Kegel exercises are acceptable. One method entails starting and stopping the flow of urine during a single voiding for about 5 seconds. Also, these exercises may be done by holding perineal muscles taut for up to 10 seconds several times a day or for 5 minutes 3 or 4 times a day. Residual urine should not be held in the bladder for long periods because this could promote urinary tract infection.

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include? 1."It is acceptable to eat whatever you want on the day before hemodialysis." 2."It is acceptable to exceed the fluid restriction on the day before hemodialysis." 3."Medications should be double-dosed on the morning of hemodialysis because of potential loss." 4."Several types of medications should be withheld on the day of dialysis until after the procedure."

4 Rationale:Many medications are dialyzable, which means that they are extracted from the bloodstream during dialysis. Therefore, many medications may be withheld on the day of dialysis until after the procedure. It is not typical for medications to be double-dosed because there is no way to be certain how much of each medication is cleared by dialysis. Clients receiving hemodialysis are not routinely taught that it is acceptable to disregard dietary and fluid restrictions.

A client has just had a Foley catheter removed and is to be started on a bladder retraining program. Which intervention will provide the most useful information about the client's ability to empty the bladder? 1.Calculating total fluid intake for the shift 2.Recording the amount of the client's voidings 3.Assisting the client to the bathroom every 2 hours 4.Measuring postvoid residual using a bladder scan

4 Rationale:Measuring postvoid residual gives specific information about the ability of the bladder to empty completely. Recording intake and output and assisting the client to the bathroom are general interventions but do not provide information about the client's ability to empty the bladder.

The nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which should the nurse expect to note in this client? 1.Decreased serum lipids 2.Signs of fluid volume deficit 3.Decreased protein in the urine 4.Decreased serum albumin levels

4 Rationale:Nephrotic syndrome describes a variety of signs and symptoms that accompany any condition that markedly impairs filtration by glomerular capillary membranes and results in increased permeability to protein. Hallmark signs and symptoms of this syndrome include increased serum lipids, edema, increased excretion of protein in the urine, and decreased serum albumin levels.

The nurse is preparing to care for a client after a renal scan. Which intervention should the nurse include in the postprocedure plan of care? 1.Limit contact with the client to 20 minutes per hour. 2.Place the client on radiation precautions for 18 hours. 3.Save all urine in a radiation-safe container for 18 hours. 4.Wear gloves if contact with the client's urine will occur.

4 Rationale:No specific precautions are necessary after a renal scan. Urination into a commode is acceptable without risk from the small amount of radioactive material to be excreted. The nurse wears gloves to maintain body secretion precautions. Options 1, 2, and 3 are unnecessary.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1.Bradycardia 2.Numbness in the legs 3.Nausea and vomiting 4.A rigid, boardlike abdomen

4 Rationale:Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid-epigastric area and spreading over the abdomen, which becomes rigid and boardlike. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? 1.Warmth, redness, and pain in the left hand 2.Ecchymosis and audible bruit over the fistula 3.Edema and reddish discoloration of the left arm 4.Pallor, diminished pulse, and pain in the left hand

4 Rationale:Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal findings for a fistula.

The ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by the client indicates a need for further teaching? 1."I should increase my fluid intake." 2."I can apply heat to my lower abdomen." 3."I may have some burning on urination for the next few days." 4."If I notice any pink-tinged urine, I should contact the health care provider."

4 Rationale:The client is instructed that pink-tinged urine and burning on urination are expected for 1 to 2 days after the procedure. Increased fluid intake is encouraged. Application of heat to the lower abdomen, administration of mild analgesics, and the use of sitz baths may relieve discomfort. The client also is advised to avoid alcoholic beverages for 2 days after the test.

A client being discharged home after renal transplantation has a risk for infection related to immunosuppressive medication therapy. The nurse determines that the client needs further teaching on measures to prevent and control infection if the client states that it is necessary to take which action? 1.Take an oral temperature daily. 2.Use good hand-washing technique. 3.Take all scheduled medications exactly as prescribed. 4.Monitor urine character and output at least 1 day each week.

4 Rationale:The client receiving immunosuppressive medication therapy must learn and use infection control methods for use at home. The client self-monitors urine output and its characteristics on a daily basis. The client must learn proper hand-washing technique and should take the temperature daily to detect early infection. This is especially important because the client also takes corticosteroids, which mask signs and symptoms of infection. All medications should be taken exactly as prescribed.

A client is having difficulty coughing and deep-breathing because of pain after a nephrectomy. Which action by the nurse is helpful in promoting optimal respiratory function? 1.Administering pain medication just before ambulation 2.Administering pain medication when the client asks for it 3.Encouraging the use of the incentive spirometer every 8 hours 4.Assisting the client to splint the incision during respiratory exercise

4 Rationale:The client who has had a nephrectomy may have pain with coughing and deep breathing and other respiratory exercises because the location of the incision is so close to the diaphragm. The nurse assists the client by offering opioid analgesics when due, encouraging incentive spirometer use hourly, and assisting the client to splint the incision during coughing. If the client takes pain medication only before ambulation, control of pain may be insufficient, which will not promote optimal respiratory function (pain medication should be offered 30 to 45 minutes before the client ambulates). Laparoscopic nephrectomy can also be performed. Compared to conventional nephrectomy, the laparoscopic approach is less painful and requires no sutures or staples, involves a shorter hospital stay, and has a much faster recovery.

A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan? 1.Monitoring the temperature 2.Monitoring complaints of heartburn 3.Giving warm gargles for a sore throat 4.Assessing for the return of the gag reflex

4 Rationale:The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also important; however, the client's airway is the priority.

The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure? 1.Urethra 2.Nephron 3.Glomerulus 4.Ureterovesical junction

4 Rationale:The ureterovesical junction is the point at which the ureters enter the bladder. At this juncture, the ureter runs obliquely for 1.5 to 2 cm through the bladder wall before opening into the bladder. This anatomical pathway prevents reflux of urine back into the ureter and, in essence, acts as a valve to prevent urine from traveling back into the ureter and up to the kidney.

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1.Hematuria and pyuria 2.Dysuria and proteinuria 3.Hematuria and urgency 4.Dysuria and penile discharge

4 Rationale:Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not associated with urethritis. Proteinuria is associated with kidney dysfunction.

A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply. 1.Peritoneal dialysis 2.Analysis of the urinary stone 3.Intravenous opioid analgesics 4.Insertion of a nephrostomy tube 5.Placement of a ureteral stent with ureteroscopy

4, 5 Rationale:Urolithiasis is the condition that occurs when a stone forms in the urinary system. Hydronephrosis develops when the stone has blocked the ureter and urine backs up and dilates and damages the kidney. Priority treatment is to allow the urine to drain and relieve the obstruction in the ureter. This is accomplished by placement of a percutaneous nephrostomy tube to drain urine from the kidney and placement of a ureteral stent to keep the ureter open. Peritoneal dialysis is not needed since the kidney is functioning. Stone analysis will be done later when the stone has been retrieved and analyzed. Opioid analgesics are necessary for pain relief but do not treat the obstruction.