NURS 220 Module 4 Exam

To monitor the progression of decreased urinary stream, the nurse should encourage which type of regular screening? A. Uroflowmetry B. Transrectal ultrasound C. Digital rectal examination (DRE) D. Prostate-specific antigen (PSA) monitoring

C. Digital rectal examination (DRE) Rationale: DRE is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia (BPH) in men older than 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.

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 pressure D. Encourage early ambulation

C. Monitor for orthostatic pressure Rationale: 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 initial dose.

A nurse is reviewing a the result 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 in the morning B. Start a 24-hr urine collection for creatinine clearance C. Obtain a clean-catch urine specimen for culture and sensitivity D. Insert a indwelling catheter urinary catheter to collect urine specimen

C. Obtain a clean-catch urine specimen for culture and sensitivity Ratinonale: This test will identify which antibiotic will be most effective for treating the client's urinary tract infection.

When assessing a patient admitted with nausea and vomiting, which finding best supports the nursing diagnosis of deficient fluid volume? A. Polyuria B. Bradycardia C. Restlessness D. Difficulty breathing

C. Restlessness Rationale: Restlessness is an early cerebral sign that dehydration has progressed to the point where an intracellular fluid shift is occurring. If the dehydration is left untreated, cerebral signs could progress to confusion and later coma.

You receive a physician's order to change a patient's IV from D5½ NS with 40 mEq KCl/L to D5NS with 20 mEq KCl/L. Which serum laboratory values on this same patient best support the rationale for this IV order change? A. Sodium, 136 mEq/L; potassium, 3.6 mEq/L B. Sodium, 145 mEq/L; potassium, 4.8 mEq/L C. Sodium, 135 mEq/L; potassium, 4.5 mEq/L D. Sodium, 144 mEq/L; potassium, 3.7 mEq/L

C. Sodium, 135 mEq/L; potassium, 4.5 mEq/L Rationale: The normal range for serum sodium is 135 to 145 mEq/L, and the normal range for potassium is 3.5 to 5.0 mEq/L. The change in the IV order decreases the amount of potassium and increases the amount of sodium. Therefore, for this order to be appropriate, the potassium level must be near the high end and the sodium level near the low end of their respective ranges.

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. "The procedure determines whether you have a kidney stone" Rationale: The nurse should explain to the client that a KUB can identify renal calculi, strictures, calcium deposits, and obstructions of the urinary system.

When planning the care of a patient with dehydration, what urine output would the nurse instruct the unlicensed assistive personnel to report? A. 60 mL in 90 minutes B. 1200 mL in 24 hours C. 300 mL per 8-hour shift D. 20 mL for 2 consecutive hours

D. 20 mL for 2 consecutive hours Rationale: The minimal urine output necessary to maintain kidney function is 30 mL/hr. If the output is less than this for 2 consecutive hours, the nurse should be notified so that additional fluid volume replacement therapy can be instituted.

The nurse on a medical-surgical unit identifies which patient as having the highest risk for metabolic alkalosis? A. A patient with a traumatic brain injury B. A patient with type 1 diabetes mellitus C. A patient with acute respiratory failure D. A patient with nasogastric tube suction

D. A patient with nasogastric tube suction Rationale: Excessive nasogastric suctioning may cause metabolic alkalosis. Brain injury may cause hyperventilation and respiratory alkalosis. Type 1 diabetes mellitus (diabetic ketoacidosis) is associated with metabolic acidosis. Acute respiratory failure may lead to respiratory acidosis.

A patient in the intensive care unit is receiving gentamicin for treatment of pneumonia from Pseudomonas aeruginosa. What assessment results should the nurse report to the health care provider? A. Decreased weight B. Increased appetite C. Increased urinary output D. Elevated creatinine levels

D. Elevated creatinine levels Rationale: Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the physician because it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia.

While caring for a patient with metastatic bone cancer, which clinical manifestations would alert the nurse to the possibility of hypercalcemia in this patient (select all that apply.)? Select all that apply. A. Weakness B. Paresthesia C. Facial spasms D. Muscle tremors E. Depressed reflexes

A. Weakness E. Depressed reflexes Rationale: Signs of hypercalcemia are lethargy, fatigue, weakness, depressed reflexes, muscle flaccidity, heart block, anorexia, nausea, and vomiting. Paresthesia, facial spasms, and muscle tremors are symptoms of hypocalcemia.

The nurse is teaching resident at the retirement village about prevention of UTIs. One person asks how much fluid she should drink each day. The nurse determines that she weighs 140 lb. Calculate how many ounces of fluid this person should drink each day. How many oz?

56 Divide the weight in pounds by 2; then multiply this number by 80% because 20% of a person's fluid is obtained from food. So 140/2 = 70, 70 × 0.80 = 56 oz to be drunk each day, or seven 8-oz gl

You are caring for a patient receiving D5W at a rate of 125 mL/hr. During the 4:00 PM assessment of the patient, you determine that 500 mL is left in the present IV bag. At what time should the nurse anticipate hanging the next bag of D5W?

8:00 PM Divide the 500 mL left in the IV bag by the hourly rate of 125 mL to calculate that the present solution will remain infusing for another 4 hours. If you made this notation at 4:00 PM, the bag is due to be changed at 8:00 PM.

Which serum potassium result best supports the rationale for administering a stat dose of IV potassium chloride 20 mEq in 200 mL of normal saline over 2 hours? A. 3.1 mEq/L B. 3.9 mEq/L C. 4.6 mEq/L D. 5.3 mEq/L

A. 3.1 mEq/L Rationale: The normal range for serum potassium is 3.5 to 5.0 mEq/L. This IV order provides a substantial amount of potassium. Thus the patient's potassium level must be low. The only low value shown is 3.1 mEq/L.

A 22-yr-old man is admitted to the emergency department with a stab wound to the abdomen. The patient's vital signs are blood pressure 82/56 mm Hg, pulse 132 beats/min, respirations 28 breaths/min, and temperature 97.9° F (36.6° C). Which fluid, if ordered by the health care provider, should the nurse question? A. D5W B. 0.9% saline C. Packed red blood cells D. Lactated Ringer's solution

A. D5W Rationale: IV administration of 0.45% saline is hypotonic and is used for maintenance fluid replacement and dilutes the extracellular fluid. IV solutions used for volume expansion for hypovolemic shock include lactated Ringer's solution and 0.9% saline. If hypovolemia is due to blood loss, blood may be administered.

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenence of homeostasis. Which physiological processes are performed by the kidneys (select all that apply). A. Production of renin B. Activation of Vitamin D C. Carbohydrate metabolism D. Erythropoietin production E. Hemolysis of old red blood cells (RBCs)

A. Production of renin B. Activation of Vitamin D D. Erythropoietin production In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.

A patient is admitted with metabolic acidosis. Which system is not functioning normally? A. Renal system B. Buffer system C. Endocrine system D. Respiratory system

A. Renal system Rationale: When the patient has metabolic acidosis, the kidneys are not combining H+ with ammonia to form ammonium or eliminating acid with secretion of free hydrogen into the renal tubule. The buffer system neutralizes HCl acid by forming a weak acid. The hormone system is not directly related to acid-base balance. The respiratory system releases CO2 that combines with water to form hydrogen ions and bicarbonate. The hydrogen is then buffered by the hemoglobin.

A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention? A. Resumption of normal urinary drainage B. Maintenance of normal sexual functioning C. Prevention of acute or chronic renal failure D. Prevention of fluid and electrolyte imbalances

A. Resumption of normal urinary drainage Rationale: The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, impaired sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

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 and allergy to seafood B. Withhold metformin for 24 hours C. Administer an enema D. Obtain a serum coagulation profile E. Assess for asthma

A. identify and allergy to seafood B. Withhold metformin for 24 hours C. Administer an enema E. Assess for asthma Rationale: Clients who have a seafood allergy are at higher risk for an allergic reaction to the contrast dye they will receive during the procedure. Clients who take metformin are at risk for lactic acidosis from the contrast dye with iodine. Clients should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visual. Clients who have asthma have a higher risk of an exacerbation as an allergic response to the contrast dye.

The nurse is caring for a 62-yr-old woman taking tolterodine (Detrol) to treat urinary urgency and incontinence. Which instruction should be included in the discharge plan? A. "Stop smoking for 2 to 3 weeks before starting to take this medication." B. "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." C. "Have your vision checked every 6 months because this drug can cause cataracts." D. "Ask your physician to prescribe an extended-release form if you have loose stools."

B. "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." Rationale: Dry mouth is a common side effect of tolterodine. Patients can suck on hard candy or ice chips or chew gum if dry mouth occurs. Tobacco use does not affect the initiation of this medication. Visual changes (but not cataracts) can occur while taking this medication. Constipation may occur as a side effect of this medication.

After a vasectomy, what instruction should be included in discharge teaching? A. "Some secondary sexual characteristics may be lost after the surgery." B. "Use an alternative form of contraception until your semen is sperm free." C. "Erectile dysfunction may be present for several months after this surgery." D. "You will be uncomfortable, but you may safely have sexual intercourse today."

B. "Use an alternative form of contraception until your semen is sperm free." Rationale: Because vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.

A patient was admitted for a paracentesis to remove ascites fluid. Five liters of fluid was removed. Which IV solution may be used to pull fluid into the intravascular space after the paracentesis? A. 0.9% sodium chloride B. 25% albumin solution C. Lactated Ringer's solution D. 5% dextrose in 0.45% saline

B. 25% albumin solution Rationale: After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be used as a volume expander. Normal saline, lactated Ringer's solution, and 5% dextrose in 0.45% saline will not be effective for this action.

A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? A. E. coli bacteria in his urine B. A very tender prostate gland C. Complaints of chills and rectal pain D. Complaints of urgency and frequency

B. A very tender prostate gland A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatitis.

A 73-yr-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance regarding what condition? A. A tumor of the prostate B. Benign prostatic hyperplasia C. Bladder atony because of age D. Age-related altered innervation of the bladder

B. Benign prostatic hyperplasia Rationale: Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men older than age 50 years and 80% of men older than age 80 years. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.

A patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should that nurse document this abnormal assessment finding? A. Anuria B. Dysuria C. Oliguria D. Enuresis

B. Dysuria Rationale: Painful and difficult urination is characterized as dysuria. Whereas anuria is an absence of urine production, oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.

A 22-yr-old patient's blood pressure during a pre-employment physical examination was 110/68 mm Hg. During a health fair 2 months later, the blood pressure is 154/96 mm Hg. What renal problem could contribute to this rise in blood pressure? A.Renal trauma B. Renal artery stenosis C. Renal vein thrombosis D. Benign nephrosclerosis

B. Renal artery stenosis Rationale: Renal artery stenosis contributes to an abrupt rise in blood pressure, especially in people younger than 30 or older than 50 years of age. Renal trauma usually has hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.

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

When planning care for stable adult patients, the oral intake that is adequate to meet daily fluid needs is A. 500 to 1500 mL. B. 1200 to 2200 mL. C. 2000 to 3000 mL. D. 3000 to 4000 mL.

C. 2000 to 3000 mL. Rationale: Daily fluid intake and output is usually 2000 to 3000 mL. This is sufficient to meet the needs of the body and replace both sensible and insensible fluid losses. These would include urine output and fluids lost through the respiratory system, skin, and GI tract.

A 50-yr-old woman with hypertension has a serum potassium level that has acutely risen to 6.2 mEq/L. Which type of order, if written by the health care provider, should the nurse question? A. Limit foods high in potassium B. Calcium gluconate IV piggyback C. Spironolactone (Aldactone) daily D. Administer intravenous insulin and glucose

C. Spironolactone (Aldactone) daily Rationale: Spironolactone (Aldactone) is a potassium-sparing diuretic that inhibits the exchange of sodium for potassium in the distal renal tubule and helps to prevent potassium loss. Spironolactone is contraindicated in a patient with hyperkalemia (serum potassium >5.0 mEq/L). Management of patients with hyperkalemia may include limiting foods high in potassium, administering IV insulin and glucose, administering IV calcium gluconate, changing to potassium-wasting diuretics (e.g., furosemide [Lasix]), hemodialysis, administering sodium polystyrene sulfonate (Kayexalate), and IV fluid administration.

12. A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. Assess temperature and initiate workup to rule out infection. b. Reassure the patient that this is common after transplantation. c. Provide warm cover for the patient and give 1 g acetaminophen orally. d. Notify the nephrologist that the patient has developed symptoms of acute rejection.

a. Assess temperature and initiate workup to rule out infection. Rationale: The nurse must be astute in the observation and assessment of kidney transplant recipients because prompt diagnosis and treatment of infections can improve patient outcomes. Fever, chills, and dysuria indicate an infection. The temperature should be assessed, and the patient should undergo diagnostic testing to rule out an infection.

It is important for the nurse to assess for which clinical manifestation(s) in a patient who has just undergone a total thyroidectomy (select all that apply)? a. Confusion b. Weight gain c. Depressed reflexes d. Circumoral numbness e. Positive Chvostek's sign

a. Confusion d. Circumoral numbness e. Positive Chvostek's sign Rationale: Inadvertent removal of a portion of or injury to the parathyroid glands during thyroid or neck surgery can result in a lack of parathyroid hormone, leading to hypocalcemia. A positive Chvostek's sign, confusion, and circumoral numbness are manifestations of low serum calcium levels.

8. Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements would be considered true related to nutritional therapy (select all that apply)? a. Fluid is not usually restricted for patients receiving peritoneal dialysis. b. Sodium and potassium may be restricted in someone with advanced CKD. c. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving hemodialysis. d. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving peritoneal dialysis. e. Decreased fluid intake and a diet with phosphate-rich foods are hallmarks of a diet for a patient receiving hemodialysis.

a. Fluid is not usually restricted for patients receiving peritoneal dialysis. b. Sodium and potassium may be restricted in someone with advanced CKD. c. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving hemodialysis. Rationale: Water and any other fluids are not routinely restricted before Stage 5 end-stage renal disease (ESRD). Patients receiving hemodialysis have a more restricted diet than do patients receiving peritoneal dialysis. Patients receiving hemodialysis are frequently educated about the need for a dietary restriction of potassium- and phosphate-rich foods. However, patients receiving peritoneal dialysis may actually require replacement of potassium because of the higher losses of potassium with peritoneal dialysis. Sodium and salt restriction is common for all patients with CKD. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. In general, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains between dialysis sessions (i.e., interdialytic weight gain) are no more than 1 to 2 kg. For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is controversial. Historically, dietary counseling often encouraged restriction of protein for individuals with CKD. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, patients must be taught to avoid high-protein diets and supplements because they may overstress the diseased kidneys.

Which descriptions characterize acute kidney injury (select all that apply)? a. Primary cause of death is infection. b. It almost always affects older people. c. Disease course is potentially reversible. d. Most common cause is diabetic nephropathy. e. Cardiovascular disease is most common cause of death.

a. Primary cause of death is infection. c. Disease course is potentially reversible. Rationale: Acute kidney injury (AKI) is potentially reversible. AKI has a high mortality rate, and the primary cause of death in patients with AKI is infection. The primary cause of death in patients with chronic kidney failure is cardiovascular disease. Most commonly, AKI follows severe, prolonged hypotension or hypovolemia or exposure to a nephrotoxic agent. Older adults are more susceptible to AKI because the number of functioning nephrons decrease with age, but AKI can occur at any age

7. Patients with chronic kidney disease experience an increased incidence of cardiovascular disease related to (select all that apply) a. hypertension. b. vascular calcifications. c. a genetic predisposition. d. hyperinsulinemia causing dyslipidemia. e. increased high-density lipoprotein levels.

a. hypertension. b. vascular calcifications. d. hyperinsulinemia causing dyslipidemia. Rationale: CKD patients have traditional cardiovascular (CV) risk factors, such as hypertension and elevated lipids. Hyperinsulinemia stimulates hepatic production of triglycerides. Most patients with uremia develop dyslipidemia. CV disease may be related to nontraditional CV risk factors, such as vascular calcification and arterial stiffness, which are major contributors to CV disease in CKD. Calcium deposits in the vascular medial layer are associated with stiffening of the blood vessels. The mechanisms involved are multifactorial and incompletely understood, but they include (1) change of vascular smooth muscle cells into chondrocytes or osteoblast-like cells, (2) high total-body amounts of calcium and phosphate as a result of abnormal bone metabolism, (3) impaired renal excretion, and (4) drug therapies to treat the bone disease (e.g., calcium phosphate binders).

6. Nurses must teach patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply) a. older African Americans. b. patients more than 60 years old. c. those with a history of pancreatitis. d. those with a history of hypertension. e. those with a history of type 2 diabetes.

a. older African Americans. b. patients more than 60 years old. d. those with a history of hypertension. e. those with a history of type 2 diabetes. Rationale: Risk factors for CKD include diabetes mellitus, hypertension, age older than 60 years, cardiovascular disease, family history of CKD, exposure to nephrotoxic drugs, and ethnic minority (e.g., African American, Native American).

5. A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys. b. a rapid decrease in urine output with an elevated BUN. c. an increasing creatinine clearance with a decrease in urine output. d. prostration, somnolence, and confusion with coma and imminent death.

a. progressive irreversible destruction of the kidneys. Rationale: Chronic kidney disease (CKD) involves progressive, irreversible loss of kidney function.

4. One of the nurse's most important roles in relation to acute poststreptococcal glomerulonephritis is to a. promote early diagnosis and treatment of sore throats and skin lesions. b. encourage patients to obtain antibiotic therapy for upper respiratory tract infections. c. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence. d. monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane.

a. promote early diagnosis and treatment of sore throats and skin lesions. Rationale: Acute poststreptococcal glomerulonephritis (APSGN) develops 5 to 21 days after an infection of the tonsils, pharynx, or skin (e.g., streptococcal sore throat, impetigo) by nephrotoxic strains of group A β-hemolytic streptococci. The most important ways to prevent the development of APSGN are early diagnosis and treatment of sore throats and skin lesions.

9. An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that a. successful transplantation usually provides better quality of life than that offered by dialysis. b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. c. hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection. d. the immunosuppressive therapy following transplantation makes the person ineligible to receive other forms of treatment if the kidney fails.

a. successful transplantation usually provides better quality of life than that offered by dialysis. Rationale: Kidney transplantation is extremely successful, with 1-year graft survival rates of about 90% for deceased donor organs and 95% for live donor organs. An advantage of kidney transplantation over dialysis is that it reverses many of the pathophysiologic changes associated with renal failure when normal kidney function is restored. It also eliminates the dependence on dialysis and the need for the accompanying dietary and lifestyle restrictions. Transplantation is less expensive than dialysis after the first year.

11. A major advantage of peritoneal dialysis is a. the diet is less restricted and dialysis can be performed at home. b. the dialysate is biocompatible and causes no long-term consequences. c. high glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss. d. no medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins.

a. the diet is less restricted and dialysis can be performed at home. Rationale: Advantages of peritoneal dialysis include fewer dietary restrictions and the possibility of home dialysis.

During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) a. hypotension. b. ECG changes. c. hypernatremia. d. pulmonary edema. e. urine with high specific gravity.

b. ECG changes d. pulmonary edema Rationale: The nurse monitors the patient in the oliguric phase of acute renal injury for the following: • Hypertension and pulmonary edema: When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (i.e., anuria, oliguria), the neck veins may become distended with a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure (HF), pulmonary edema, and pericardial and pleural effusions. • Hyponatremia: Damaged tubules cannot conserve sodium. Consequently, the urinary excretion of sodium may increase, which results in normal or below-normal serum levels of sodium. • Electrocardiographic changes and hyperkalemia: Initially, clinical signs of hyperkalemia are apparent on electrocardiogram (ECG) demonstrating peaked T waves, widening of the QRS complex, and ST-segment depression. • Urinary specific gravity: Urinary specific gravity is fixed at about 1.010.

The nurse expects the long-term treatment of a patient with hyperphosphatemia secondary to renal failure will include a. fluid restriction. b. calcium supplements. c. magnesium supplements. d. increased intake of dairy products.

b. calcium supplements Rationale: The major conditions that can lead to hyperphosphatemia are acute kidney injury and chronic kidney disease that alter the ability of the kidneys to excrete phosphate. For the patient with renal failure, long-term measures to reduce serum phosphate levels include phosphate-binding agents or gels, such as calcium carbonate, fluid replacement therapy, and dietary phosphate restrictions.

3. The immunologic mechanisms involved in acute poststreptococcal glomerulonephritis include a. tubular blocking by precipitates of bacteria and antibody reactions. b. deposition of immune complexes and complement along the GBM. c. thickening of the GBM from autoimmune microangiopathic changes. d. destruction of glomeruli by proteolytic enzymes contained in the GBM.

b. deposition of immune complexes and complement along the GBM. Rationale: All forms of immune complex disease are characterized by an accumulation of antigen, antibody, and complement in the glomeruli, which can result in tissue injury. The immune complexes activate complement. Complement activation results in the release of chemotactic factors that attract polymorphonuclear leukocytes, histamine, and other inflammatory mediators. The result of these processes is glomerular injury.

10. A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes a. encouraging the patient to drink fruit juices and milk. b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided. c. irrigating the nephrostomy tube with 10 mL of normal saline solution as needed. d. notifying the physician if nephrostomy tube drainage is more than 30 mL/hr.

b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided. Rationale: The nephrostomy tube is inserted directly into the renal pelvis and attached to connecting tubing for closed drainage. The catheter should never be kinked, compressed, or clamped. If the patient complains of excessive pain in the area, or if drainage around the tube is excessive, check the catheter for patency. If irrigation is ordered, strict aseptic technique is required. To prevent overdistention of the renal pelvis and renal damage, no more than 5 mL of sterile saline solution is gently instilled at one time. Infection and secondary stone formation are complications associated with the insertion of a nephrostomy tube. Patients should drink 2 to 3 L of fluid per day to reduce risk of infection and stone formation.

Which patient is at greatest risk for developing hypermagnesemia? a. 83-year-old man with lung cancer and hypertension b. 65-year-old woman with hypertension taking β-adrenergic blockers c. 42-year-old woman with systemic lupus erythematosus and renal failure d. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection

c. 42-year-old woman with systemic lupus erythematosus and renal failure Rationale: Causes of hypermagnesemia include renal failure (especially if the patient is given magnesium products), excessive administration of magnesium for treatment of eclampsia, and adrenal insufficiency.

4. If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. Hyperkalemia and hyponatremia b. Hyperkalemia and hypernatremia c. Hypokalemia and hyponatremia d. Hypokalemia and hypernatremia

c. Hypokalemia and hyponatremia Rationale: In the diuretic phase of AKI, the kidneys have recovered the ability to excrete wastes but not the ability to concentrate urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

The nurse should be alert for which manifestations in a patient receiving a loop diuretic? a. Restlessness and agitation b. Paresthesias and irritability c. Weak, irregular pulse and poor muscle tone d. Increased blood pressure and muscle spasms

c. Weak, irregular pulse and poor muscle tone Rationale: Loop diuretics may result in renal loss of potassium and hypokalemia. Clinical manifestations of hypokalemia include fatigue, muscle weakness, leg cramps, nausea, vomiting, paralytic ileus, paresthesias, decreased reflexes, weak, irregular pulse, polyuria, hyperglycemia, and ECG changes.

Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to a. a decrease in bladder sensory receptors. b. a decrease in the number of functioning nephrons. c. decreased function of the loop of Henle and tubules. d. thickening of the basement membrane of Bowman's capsule.

c. decreased function of the loop of Henle and tubules. Rationale: Older adults have decreased function of the loop of Henle and tubules, which results in the loss of normal diurnal excretory pattern because of a decreased ability to concentrate urine and because of less concentrated urine.

The typical fluid replacement for the patient with a fluid volume deficit is a. dextran. b. 0.45% saline. c. lactated Ringer's. d. 5% dextrose in 0.45% saline.

c. lactated Ringer's Rationale: Administration of an isotonic solution expands only the extracellular fluid (ECF). There is no net loss or gain from the intracellular fluid (ICF). An isotonic solution is the ideal fluid replacement for a patient with an ECF volume deficit. Examples of isotonic solutions include lactated Ringer's solution and 0.9% NaCl.

10. To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should (select all that apply) a. monitor the BP in the affected arm. b. irrigate the graft daily with low-dose heparin. c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. frequently monitor the pulses and neurovascular status distal to the graft.

c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. frequently monitor the pulses and neurovascular status distal to the graft. Rationale: A thrill can be felt on palpation of the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein. The BP should not be taken in the arm with the AV graft.

A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is a(n) a. IVP. b. VCUG. c. renal scan. d. loopogram.

c. renal scan Rationale: A renal scan is used to evaluate the anatomic structures, perfusion, and function of kidneys. The scan shows the location, size, and shape of the kidneys and helps assess blood flow, glomerular filtration, tubular function, and urinary excretion. In some facilities, a numerical value ("split" renal function) may be assigned (i.e., percent contributed by each kidney).

7. The nurse recommends genetic counseling for the children of a patient with a. nephrotic syndrome. b. chronic pyelonephritis. c. malignant nephrosclerosis. d. adult-onset polycystic kidney disease.

d. adult-onset polycystic kidney disease. Rationale: The adult form of polycystic kidney disease (PKD) is an autosomal dominant disorder. If one parent has the disease, the child has a 50% chance of developing PKD. Many patients who have adult PKD have had children by the time the disease is diagnosed. Patients need appropriate counseling regarding plans for having more children, and genetic counseling resources should be provided for the children.

1. In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through a. the bloodstream. b. the lymphatic system. c. a descending infection. d. an ascending infection.

d. an ascending infection. Rationale: The organisms that usually cause urinary tract infections (UTIs) are introduced via the ascending route from the urethra, and the infections originate in the perineum.

A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with the a. structural support of the kidney. b. regulation of the concentration of urine. c. entry and exit of blood vessels at the kidney. d. collection and drainage of urine from the kidney.

d. collection and drainage of urine from the kidney. Rationale: The outer layer of the kidney is the cortex, and the inner layer is the medulla. The medulla consists of a number of pyramids. The apices (tops) of these pyramids are called papillae, through which urine passes to enter the calyces. The minor calyces widen and merge to form major calyces, which form a funnel-shaped sac called the renal pelvis. The minor and major calyces transport urine to the renal pelvis, from which it drains through the ureter to the bladder.

RIFLE defines three stages of AKI based on changes in a. blood pressure and urine osmolality. b. fractional excretion of urinary sodium. c. estimation of GFR with the MDRD equation. d. serum creatinine or urine output from baseline.

d. serum creatinine or urine output from baseline. Rationale: The RIFLE classification is used to describe the stages of AKI. RIFLE standardizes the diagnosis of AKI. Risk (R) is the first stage of AKI, followed by injury (I), which is the second stage, and then increasing in severity to the final or third stage of failure (F). The two outcome variables are loss (L) and end-stage renal disease (E). The first three stages are characterized by the serum creatinine level and urine output.

A patient with suspected renal insufficiency is scheduled for a creatinine clearence dianostic test. Which instructions would be appropriate for the nurse to provide to the patient? A. "Empty your bladder and discard the urine; then save all urine for 24 hours." B. "Your blood creatinine level will be tested after you eat a high protein meal." C. "This test should not be preformed if you have allergies to iodine or shellfish." D. "A sterile container must be used to store the urine during the collection period."

A. "Empty your bladder and discard the urine; then save all urine for 24 hours." Rationale: The patient should discard the first urination when this test is started. Urine should be saved from all subsequent urinations for 24 hours. Creatinine clearance testing does not involve the injection of contrast dye. A serum creatinine is determined during the 24-hour period and used in the calculation to determine creatinine clearance. Consumption of a high-protein meal is not indicated. Sterile containers would be indicated if cultures are performed to determine the presence of microorganisms.

A 21-yr-old female patient came to the clinic for instruction to prevent recurrence of urinary tract infections. Which patient statement indicates that teaching was effective? A. "I will urinate before and after having intercourse." B. "I will use vinegar as a vaginal douche every week." C. "I should drink three 8-oz glasses of water daily." D. "I can stop the antibiotics when symptoms disappear."

A. "I will urinate before and after having intercourse." Rationale: The woman should empty her bladder before and after sexual intercourse. She should avoid vaginal douches and maintain adequate oral fluid intake (15 mL per pound of body weight). All of the antibiotics should be taken as prescribed even if symptoms are no longer present.

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure? A. "You might have pink-tinged urine and burning after your cystoscopy." B. "You'll need to refrain from eating or drinking after midnight the day before the test." C. "The morning of the test, you will drink some water that contains a contrast solution." D. "You'll require a urinary catheter inserted before the cystoscopy, and it will be in place for a few days."

A. "You might have pink-tinged urine and burning after your cystoscopy." Rationale: Pink-tinged urine, burning, and frequency are common after a cystoscopy. The patient does not need to be NPO before the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? A. A 30-yr-old white man with a history of cryptorchidism B. A 48-yr-old African American man with erectile dysfunction C. A 19-yr-old Asian man who had surgery for testicular torsion D. A 28-yr-old Hispanic man with infertility caused by a varicocele

A. A 30-yr-old white man with a history of cryptorchidism Rationale: The incidence of testicular cancer is four times higher in white men than in African American men. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to exogenous estrogen, and testicular cancer in the contralateral testis.

Which nursing diagnosis is priority when caring for a patient with renal calculi? A. Acute pain B. Risk for constipation C. Deficient fluid volume D. Risk for powerlessness

A. Acute pain Rationale: Urinary stones are associated with severe abdominal or flank pain. Whereas deficient fluid volume is unlikely to result from urinary stones, constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.

The nurse is preparing a patient for an intravenous pyelogram (IVP). What is the priority nursing action by the nurse? A. Administer a cathartic or enema B. Assess patient for allergies to penicillin C. Keep the patient NPO for 4 hours preprocedure D. Advise the patient that a metallic taste may occur during procedure

A. Administer a cathartic or enema Rationale: Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity; keep the patient NPO for 8 hours before the procedure; and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.

When assessing the patient with a multi-lumen central line, the nurse notices that the cap is off one of the lines. On assessment, the patient is in respiratory distress and the vital signs show hypotension and tachycardia. What is the nurse's priority action? A. Administer oxygen B. Notify the health care provider C. Rapidly administer more IV fluid D. Reposition the patient on the right side

A. Administer oxygen Rationale: The cap off the central line could allow entry of air into the circulation, causing an air embolus. To manage an air embolus, oxygen is administered; the catheter is clamped, and the patient is positioned on the left side with the head down. Then the health care provider is notified.

The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? A. Avoid straining during defecation. B. Restrict fluids to prevent incontinence. C. Sexual functioning will not be affected. D. Prostate examinations are not needed after surgery.

A. Avoid straining during defecation. Rationale: Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.

A patient underwent a surgical procedure has a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What is the nurse's first action to assess for urinary retention? A. Bladder scan B. Cystometrogram C. Residual urine test D. Kidneys, ureaters, Bladder (KUB) x-ray

A. Bladder scan Rationale: If the patient is unable to void, the bladder may be palpated for distention or percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicoureteral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder, so this assessment would not be helpful for this patient.

A patient with type 2 diabetes is reporting a second urinary tract infections(UTI)within the past month. Which medication should the nurse expect to be ordered for the recurrent infection? A. Ciprofloxacin B. Fosfomycin C. Nitrofurantoin D. Trimethoprim-sulfamethoxazole

A. Ciprofloxacin Rationale: This UTI is a complicated UTI because the patient has type 2 diabetes, and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin , and trimethoprim-sulfamethoxazole should be used for uncomplicated UTIs.

A patient was admitted 2 weeks ago after multiple traumatic injuries in a motor vehicle collision. The patient now has a serum creatinine at 3.9 mg/dL and a blood urea nitrogen (BUN) of 100 mg/dL. Which medication, if ordered by the health care provider, should the nurse question? A. Gentamicin B. Nitrofurantoin C. Acetaminophen D. Morphine sulfate

A. Gentamicin Rationale: Elevated serum creatinine and BUN indicate renal insufficiency or acute kidney injury. Medications (e.g., prescribed, over-the-counter, and herbs) should be evaluated for nephrotoxic potential. Many drugs are known to be nephrotoxic (see Table 44-3); gentamicin is a potential nephrotoxic agent.

What is the nurse's priority when changing the appliance for a patient with an ileal conduit? A. Keep the skin free of urine. B. Inspect the peristomal area. C. Cleanse and dry the area gently. D. Affix the appliance to the faceplate.

A. Keep the skin free of urine. Rationale: The nurse's priority is to keep the skin free of urine because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed; the area will be gently cleaned and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.

Eight months after the delivery of her first child, a 31-yr-old woman sought care for occasional incontinence when sneezing or laughing. Which measure should the nurse recommend first? A. Kegel exercises B. Use of adult incontinence pads' C. Intermittent self-catheterization D. Dietary changes including fluid restriction

A. Kegel exercises Rationale: Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem, and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.

A dehydrated patient is receiving a hypertonic solution. Which assessments must be done to avoid adverse risks associated with these solutions (select all that apply.)? Select all that apply. A. Lung sounds B. Bowel sounds C. Blood pressure D. Serum sodium level E. Serum potassium level

A. Lung sounds C. Blood pressure D. Serum sodium level Rationale: Blood pressure, lung sounds, and serum sodium levels must be monitored frequently because of the risk for excess intravascular volume with hypertonic solutions.

The urinalysis of a patient reveals a high microorganism count. What data should the nurse use to determine which part of the urinary tract is infected (select all that apply.)? A. Pain location B. Fever and chills C. Mental confusion D. Urinary hesitancy E. Urethral discharge F. Postvoid dribbling

A. Pain location E. Urethral discharge Rationale: Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.

You are caring for a patient admitted with diabetes mellitus, malnutrition, and a massive GI bleed. In analyzing the morning lab results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which factors in this patient (select all that apply.)? Select all that apply. A. The potassium level may be increased if the patient has nephropathy. B. The patient has been eating excessive amounts of foods that increase potassium levels. C. The patient may be excreting extra sodium and retaining potassium secondary to malnutrition. D. There may be excess potassium being released into the blood as a result of massive blood transfusion. E. The potassium level may be increased because of dehydration that accompanies high blood glucose levels.

A. The potassium level may be increased if the patient has nephropathy. D. There may be excess potassium being released into the blood as a result of massive blood transfusion. E. The potassium level may be increased because of dehydration that accompanies high blood glucose levels. Rationale: Hyperkalemia may result from hyperglycemia, renal insufficiency, or cell death. Diabetes mellitus, along with the stress of hospitalization and illness, can lead to hyperglycemia. Renal insufficiency is a complication of diabetes. Because malnutrition does not cause sodium excretion accompanied by potassium retention, it is not a contributing factor to this patient's potassium level. Stored hemolyzed blood can cause hyperkalemia when large amounts are transfused rapidly. The patient with a massive GI bleed would have an nasogastric tube and not be eating.

A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? A. Ultrasound B. Cremasteric reflex C. Doppler ultrasound D. Transillumination with a flashlight

A. Ultrasound Rationale: When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

The nurse counsels a 64-yr-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? A. Venison, crab, and liver B. Spinach, cabbage, and tea C. Milk, yogurt, and dried fruit D. Asparagus, lentils, and chocolate

A. Venison, crab, and liver Rationale: Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation (see Table 45-12).

You are admitting a patient with complaints of abdominal pain, nausea, and vomiting. A proximal bowel obstruction is suspected. Which acid-base imbalance do you anticipate in this patient? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

B. Metabolic alkalosis Rationale: Because gastric secretions are rich in HCl acid, the patient who is vomiting will lose a significant amount of gastric acid and be at an increased risk for metabolic alkalosis.

A nurse is admitting a patient with advanced renal carcinoma. Which clinical manifestations represent the "classic triad" observed in patients with renal cancer? A. Fever, chills, and flank pain B. Hematuria, flank pain, and palpable mass C. Hematuria, proteinuria, and palpable mass D. Flank pain, palpable abdominal mass, and proteinuria

B. Hematuria, flank pain, and palpable mass Rationale: There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.

The nurse coordinates postoperative care for a 70-yr-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply.)? A. Clean around the catheter daily. B. Increase flow of irrigation solution. C. Teach the patient how to perform Kegel exercises. D. Provide instructions to the patient on catheter care. E. Administer oxybutynin (Ditropan) for bladder spasms. F. Manually irrigate the urinary catheter to restore catheter flow.

B. Increase flow of irrigation solution. E. Administer oxybutynin (Ditropan) for bladder spasms. Rationale: The nurse may delegate the following to an LPN/LVN: monitor catheter drainage for increased blood or clots, increase flow of irrigating solution to maintain light pink color in outflow, and administer antispasmodics and analgesics as needed. The UAP will clean around the catheter daily. A registered nurse may not delegate teaching, assessments, or clinical judgments to a LPN/LVN.

You are caring for a patient admitted with heart failure. The morning laboratory results reveal a serum potassium level of 2.9 mEq/L. Which classification of medications should you withhold until consulting with the health care provider? A. Antibiotics B. Loop diuretics C. Bronchodilators D. Antihypertensives

B. Loop diuretics Rationale: Loop diuretics are contraindicated during episodes of hypokalemia because these medications cause the kidneys to excrete sodium and potassium. Thus administration of this type of medication at this time would worsen the hypokalemia, putting the patient at risk for dysrhythmias. The prescribing physician should be consulted for potassium replacement therapy, and the drug should be withheld until the potassium has returned to normal range.

The nurse provides nutritional counseling for a 45-yr-old man with nephrotic syndrome. The nurse determines teaching has been successful if the patient selects which breakfast menu? A. Scrambled eggs, milk, yogurt, and sliced ham B. Oatmeal, nondairy creamer, banana, and orange juice C. Cottage cheese, peanut butter, white bread, and coffee D. Waffle, bacon strips, tomato juice, and canned peaches

B. Oatmeal, nondairy creamer, banana, and orange juice Rationale: Patients with nephrotic syndrome should follow a low-sodium (2-3 g/day), low- to moderate-protein (0.5-0.6 g/kg/day) diet. Ham, milk products, peanut butter, and bacon are high in sodium. Eggs, milk products, and peanut butter are high in protein.

You are caring for a patient admitted with a diagnosis of chronic obstructive pulmonary disease (COPD) who has the following arterial blood gas results: pH 7.33, PaO2 47 mm Hg, PaCO2 60 mm Hg, HCO3 32 mEq/L, and O2 saturation of 92%. What is the correct interpretation of these results? A. Fully compensated respiratory alkalosis B. Partially compensated respiratory acidosis C. Normal acid-base balance with hypoxemia D. Normal acid-base balance with hypercapn

B. Partially compensated respiratory acidosis Rationale: A low pH (normal, 7.35-7.45) indicates acidosis. In a patient with respiratory disease such as COPD, the patient retains carbon dioxide (normal, 35-45 mm Hg), which acts as an acid in the body. For this reason, the patient has respiratory acidosis. The elevated HCO3 indicates a partial compensation for the elevated CO2.

While performing patient teaching regarding hypercalcemia, which statements are appropriate (select all that apply.)? A. Have patient restrict fluid intake to less than 2000 mL/day. B. Renal calculi may occur as a complication of hypercalcemia. C. Weight-bearing exercises can help keep calcium in the bones. D. The patient should increase daily fluid intake to 3000 to 4000 mL. E. Any heartburn can be managed with an as needed calcium-containing antacid.

B. Renal calculi may occur as a complication of hypercalcemia. C. Weight-bearing exercises can help keep calcium in the bones. D. The patient should increase daily fluid intake to 3000 to 4000 mL. Rationale: A daily fluid intake of 3000 to 4000 mL is necessary to enhance calcium excretion and prevent the formation of renal calculi, a potential complication of hypercalcemia. Tums are a calcium-based antacid that should not be used in patients with hypercalcemia. Weight-bearing exercise does enhance bone mineralization.

Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? A. Help the patient cope with the rapid progression of the disease. B. Suggest genetic counseling resources for the children of the patient. C. Expect the patient to have polyuria and poor concentration ability of the kidneys. D. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

B. Suggest genetic counseling resources for the children of the patient. Rationale: PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.

The nurse is performing an assessment for a patient and preparing to palpate the kidneys. How should the nurse position the patient for this assessment? A. Prone B. Supine C. Seated at the edge of the bed D. Standing, facing away from the nurse

B. Supine To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.

The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving orders, what should the nurse do? A. Keep the patient on bed rest. B. Use 5 mL of sterile saline to irrigate. C. Use 30 mL of water to gently irrigate. D. Have the patient turn from side to side.

B. Use 5 mL of sterile saline to irrigate. Rationale: With a nephrostomy tube, if the tube is occluded and irrigation is ordered, the nurse should use 5 mL or less of sterile saline to gently irrigate it. The patient with a ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.

The nurse is caring for a 76-yr-old woman admitted to the medical unit with hypernatremia and dehydration after prolonged fever. The best beverage to offer the patient is A. malted milk. B. orange juice. C. tomato juice. D. hot chocolate.

B. orange juice. Rationale: Orange juice would be the safest option because it has the least amount of sodium (~2 mg in 8 oz). Hot chocolate has approximately 75 mg sodium in 8 ounces. Tomato juice has approximately 650 mg sodium in 8 oz. Malted milk has approximately 625 mg sodium in 8 oz.

The nurse is caring for a patient after right kidney biopsy. Which position would be most appropriate for this patient immediately after the procedure? A. Right lateral side-lying position B. reverse Trendelenburg position C. Supine with lower extremities elevated D. High fowler's position with arms supported

B. reverse Trendelenburg position Rationale: After a renal biopsy, a pressure dressing should be applied. The patient should be kept on the affected side for 30 to 60 minutes to apply additional pressure from the patient's own body weight and then on bed rest for 24 hours. High Fowler's position with arms supported is a position for a patient in respiratory distress. Reverse Trendelenburg position is used to maintain circulation to the legs in peripheral artery insufficiency. Supine with legs elevated puts excessive pressure on the diaphragm and should generally be avoided.

The nurse prepares a patient for discharge after a cystoscopy. It is most important for the nurse to provide additional information in response to which patient statement? A. "I should drink plenty fluids to prevent complications." B. "If my urine is cloudy, I should contact my health care provider." C. "Bright red bleeding is normal for a few days after the procedure." D. "Sitz baths and acetaminophen will help to reduce my discomfort."

C. "Bright red bleeding is normal for a few days after the procedure." Rationale: Bright red bleeding after a cystoscopy is not normal and should be reported immediately. Other complications include urinary retention, bladder infection, and perforation of the bladder. Patients should drink plenty of fluids and expect burning on urination, pink-tinged urine, and urinary frequency. Warm sitz baths, heat, and mild analgesics may be used to relieve discomfort.

A hospitalized older patient reports his foreskin is retracted and will not return to normal. Which action is the priority? A. Start antibiotics. B. Apply ice to reduce swelling. C. Attempt to move the foreskin over the glans. D. Call the physician to prepare for circumcision.

C. Attempt to move the foreskin over the glans Rationale: Paraphimosis can occur when the foreskin is pulled back during bathing, during catheter insertion, or after intercourse and not returned to the normal position. Attempting to return the foreskin over glans is the priority action. If the nurse is unsuccessful, then ice would be applied to decrease swelling. If the foreskin is not returned to the normal position manually by the health care provider, then circumcision would be indicated. Paraphimosis is considered a urologic emergency because arterial blood flow to the glans penis is impaired.

The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? A. Grilled steak, French fries, and vanilla shake B. Hamburger with cheese, pudding, and coffee C. Baked chicken, peas, apple slices, and skim milk D. Grilled cheese sandwich, onion rings, and hot tea

C. Baked chicken, peas, apple slices, and skim milk A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

An older male patient visits his primary care provider because of burning on urination and production of foul-smelling urine. What contributing factor should the health care provider consider? A. High-purine diet B. Sedentary lifestyle C. Benign prostatic hyperplasia (BPH) D. Recent use of broad-spectrum antibiotics

C. Benign prostatic hyperplasia (BPH) Rationale: BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, but a diet high in purines is associated with renal calculi.

A patient has scleroderma and hypertension. The nurse knows this could be related to which renal diagnoses? A. Obstructive uropathy B. Goodpasture syndrome C. Chronic glomerulonephritis D. Calcium oxalate urinary calculi

C. Chronic glomerulonephritis Rationale: Hypertension occurs with chronic glomerulonephritis, which may be found in patients with scleroderma. Obstructive uropathy, Goodpasture syndrome, and calcium oxalate urinary calculi are not related to scleroderma and do not cause hypertension.

A patient informs the nurse that they are having burning on urination, dysuria, and frequency. What is the best response by the nurse? A. "Drink less fluid so you don't have to void so often." B. "Take some acetaminophen to decrease discomfort." C. Come in so we can check a clean-catch urine specimen." D. "Avoid caffeine and spicy food to decrease inflammation."

C. Come in so we can check a clean-catch urine specimen." Rationale: The patient's symptoms are typical of a urinary tract infection. To verify this, a clean-catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.

A patient is one day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? A. Requires two tablets of Tylenol #3 during the night B. Complains of fatigue and claims to have minimal appetite C. Continuous bladder irrigation (CBI) infusing, but output has decreased D. Expressed anxiety about his planned discharge home the following day

C. Continuous bladder irrigation (CBI) infusing, but output has decreased Rationale: A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.

Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? A. Tighten both buttocks together. B. Squeeze thighs together tightly. C. Contract muscles around rectum. D. Lie on back and lift the legs together.

C. Contract muscles around rectum. Rationale: To teach pelvic floor exercises (Kegel exercise), the nurse should instruct the patient (without contracting the legs, buttocks, or abdomen) to contract the muscles around the rectum (pelvic floor muscles) as if stopping a stool, which should result in a pelvic lifting sensation.

The nurse is caring for an older adult patient taking bumetanide. What age-related changes does the nurse inform the patient that may be experienced? A. Benign enlargement of prostatic tissues B. Decrease sensation of bladder capacity C. Decreased function of the loop of Henle D. Less absorption in the Bowman's capsule

C. Decreased function of the loop of Henle Rationale: Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus, the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.

Which action is most important for the nurse to take when caring for a patient with a subclavian triple-lumen catheter? A. Change the injection cap after the administration of IV medications. B. Use a 5-mL syringe to flush the catheter between medications and after use. C. During removal of the catheter, have the patient perform the Valsalva maneuver. D. If resistance is met when flushing, use the push-pause technique to dislodge the clot.

C. During removal of the catheter, have the patient perform the Valsalva maneuver. Rationale: The nurse should withdraw the catheter while the patient performs the Valsalva maneuver to prevent an air embolism. Injection caps should be changed at regular intervals but not routinely after medications. Flushing should be performed with at least a 10-mL syringe to avoid excess pressure on the catheter. If resistance is encountered during flushing, force should not be applied. The push-pause method is preferred for flushing catheters but not used if resistance is encountered during flushing.

You are caring for an older patient who is receiving IV fluids postoperatively. During the 8:00 AM assessment of this patient, you note that the IV solution, which was ordered to infuse at 125 mL/hr, has infused 950 mL since it was hung at 4:00 AM. What is the priority nursing intervention? A. Slow the rate to keep vein open until next bag is due at noon. B. Notify the health care provider and complete an incident report. C. Listen to the patient's lung sounds and assess respiratory status. D. Asses the patient's cardiovascular status by checking pulse and blood pressure.

C. Listen to the patient's lung sounds and assess respiratory status. Rationale: After 4 hours of infusion time, 500 mL of IV solution should have infused, not 950 mL. This patient is at risk for fluid volume excess, and you should assess the patient's respiratory status and lung sounds as the priority action and then notify the health care provider for further orders.

Which nursing intervention is most appropriate when caring for a patient with dehydration? A. Monitor skin turgor every shift. B. Auscultate lung sounds every 2 hours. C. Monitor daily weight and intake and output. D. Encourage the patient to reduce sodium intake.

C. Monitor daily weight and intake and output. Measuring weight is the most reliable means of detecting changes in fluid balance. Weight loss would indicate the dehydration is worsening, whereas weight gain would indicate restoration of fluid volume.

The patient has a history of cardiovascular disease and has developed erectile dysfunction. He is frustrated because he is taking nitrates and cannot take erectogenic medications. What should the nurse do first? A. Give the patient choices for penile implant surgery. B. Recommend counseling for the patient and his partner. C. Obtain a thorough sexual, health, and psychosocial history. D. Assess levels of testosterone, prolactin, luteinizing hormone, and thyroid hormones.

C. Obtain a thorough sexual, health, and psychosocial history. Rationale: The nurse's first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.

Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? A. Assessing the patient's incision B. Irrigating the patient's urinary catheter C. Reporting complaints of pain or bladder spasms D. Evaluating the patient's pain and selecting analgesia

C. Reporting complaints of pain or bladder spasms Rationale: Cleaning around the catheter, recording intake and output, and reporting complaint of pain or bladder spasms to the registered nurse are appropriate tasks for delegation to the UAP. Selecting analgesia, irrigating the patient's catheter, and assessing the incision are not appropriate skills or tasks for unlicensed personnel.

When caring for a patient with nephrotic syndrome, which food selection indicates the patient understands dietary teaching? A. Peanut butter and crackers B. One small grilled pork chop C. Salad made of fresh vegetables D. Spaghetti with canned spaghetti sauce

C. Salad made of fresh vegetables Rationale: Of the options listed, only salad made with fresh vegetables would be acceptable for the diet that limits sodium and protein as well as saturated fat if hyperlipidemia is present. Peanut butter and crackers are processed, so they contain significant sodium, and peanut butter contains some protein. A pork chop is a high-protein food with saturated fat. Canned spaghetti sauce is also high in sodium.

A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD) admitted for pneumonia. What laboratory finding would be consistent with decreased kidney function in this patient? A. Serum uric acid 5.2 mg/dL B. Uric specific gravity of 1.040 C. Serum Creatinine of 2.3 mg/dL D. Blood urea nitrogen (BUN) of 10 mg/dL

C. Serum Creatinine of 2.3 mg/dL Rationale: An expected assessment finding related to decreased kidney function in the aging process is an increased serum creatinine. Other expected assessments include an elevated BUN and inability to concentrate urine (with urine specific gravity fixed at 1.010). Uric acid is used as a screening test for disorders of purine metabolism or kidney disease; values depend on renal function, rate of purine metabolism, and dietary intake of food rich in purines. Normal reference intervals: serum creatinine, 0.6 to 1.3 mg/dL; BUN, 6 to 20 mg/dL; urine specific gravity, 1.003 to 1.030; and serum uric acid, 2.3 to 6.6 mg/dL (female) or 4.4 to 7.6 mg/dL (male).

The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care (select all that apply.)? Select all that apply. A. Casts in his urine B. Presence of α-fetoprotein C. Serum PSA level 10 ng/mL D. Onset of erectile dysfunction E. Nodularity of the prostate gland F. Development of a urinary tract infection

C. Serum PSA level 10 ng/mL The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues. E. Nodularity of the prostate gland The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues.

The nurse is providing care for a patient admitted to the hospital for treatment of nephrotic syndrome. What are the priority nursing assessments? A. Assessment of pain and level of consciousness B. Assessment of serum calcium and phosphorus levels C. Blood pressure and assessment for orthostatic hypotension D. Daily weights and measurement of the patient's abdominal girth

D. Daily weights and measurement of the patient's abdominal girth Rationale: Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome.

When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which fluid shift to occur because of the fluid volume deficit? A. Fluid movement from the blood vessels into the cells B. Fluid movement from the interstitial spaces into the cells C. Fluid movement from the blood vessels into interstitial spaces D. Fluid movement from the interstitial space into the blood vessels

D. Fluid movement from the interstitial space into the blood vessels Rationale: In dehydration, fluid is lost first from the blood vessels. To compensate, fluid moves out of the interstitial spaces into the blood vessels to restore circulating volume in that compartment. As the interstitial spaces then become volume depleted, fluid moves out of the cells into the interstitial spaces.

A patient admitted to the emergency department after a motor vehicle accident. Which urinalysis findings would the nurse expect if kidney trauma occurred (select all that apply.)? A. Casts B. Glucose C. Bilirubin D. Myoglobinuria E. Red blood cells F. White blood cells

D. Myoglobinuria E. Red blood cells Rationale: After kidney trauma, the nurse will expect urinalysis results to be positive for myoglobin and red blood cells. Casts in urine indicate blood destruction intravascularly. Glucose in urine could indicate diabetes. Bilirubin in urine is suggestive liver dysfunction. White blood cells in urine indicate infection.

The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia and symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis? A. White blood cell count is 7500 cells/μL. B. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. C. Glucose, protein, and ketones are present in the urine. D. Nitrites and leukocyte esterase are present in the urine.

D. Nitrites and leukocyte esterase are present in the urine. Rationale: A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). The presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/μL) indicates a bacterial infection. AASO titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.

You are caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which serum laboratory result would you identify as an adverse effect related to this therapy? A. Sodium falling to 138 mEq/L B. Potassium rising to 4.1 mEq/L C. Magnesium rising to 2.9 mg/dL D. Phosphorus falling to 2.1 mg/dL

D. Phosphorus falling to 2.1 mg/dL Calcium has an inverse relationship with phosphorus in the body. When phosphorus levels fall, calcium rises, and vice versa. Because hypercalcemia rarely occurs as a result of calcium intake, the patient's phosphorus falling to 2.1 mg/dL (normal, 2.4-4.4 mg/dL) may be a result of the phosphate-binding effect of calcium carbonate.

When a patient reports acute, severe, renal colic pain in the lower abdomen, the nurse suspects that the patient is most likely to have an obstruction at which area? A. Kidney B. Urethra C. Bladder D. Ureterovesical junction

D. Ureterovesical junction Rationale: The ureterovesical junction is the narrowest part of the urethra and easily obstructed by urinary calculi. With a stone in the kidney or at the ureteropelvic junction, the pain may be dull costovertebral flank pain. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urethra seldom has obstruction related to stones.

The nurse obtained a urine specimen from a patient. What results should the nurse recognize as an abnormal finding? A. pH of 6.0 B. amber yellow color C. Specific gravity of 1.025 D. White blood cells (WBCs) 9/hpf

D. White blood cells (WBCs) 9/hpf Rationale: Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference range for specific gravity is 1.003 to 1.030.

You are caring for a patient admitted with an exacerbation of asthma. After several treatments, the ABG results are pH 7.40, PaCO2 40 mm Hg, HCO3 24 mEq/L, PaO2 92 mm Hg, and O2 saturation of 99%. You interpret these results as A. metabolic acidosis. B. respiratory acidosis. C. respiratory alkalosis. D. within normal limits.

D. within normal limits. Rationale: The normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mm Hg, and HCO3 is 22 to 26 mEq/L. Normal PaO2 is >80 mm Hg. Normal oxygen saturation is >95%. Because the patient's results all fall within these normal ranges, the nurse can conclude that the patient's blood gas results are within normal limits.

During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is a. osmosis. b. diffusion. c. active transport. d. facilitated diffusion.

a. osmosis Rationale: Osmosis is the movement of water between two compartments separated by a semipermeable membrane. Water moves through the membrane from an area of low solute concentration to an area of high solute concentration.

9. In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes a. teaching the patient to use Kegel exercises. b. clamping and releasing a catheter to increase bladder tone. c. teaching the patient biofeedback mechanisms to suppress the urge to void. d. counseling the patient concerning choice of incontinence containment device.

a. teaching the patient to use Kegel exercises. Rationale: Pelvic floor muscle training (i.e., Kegel exercises) is used to manage stress, urge, or mixed urinary incontinence.

6. A patient is admitted to the hospital with severe renal colic. The nurse's first priority in management of the patient is to a. administer opioids as prescribed. b. obtain supplies for straining all urine. c. encourage fluid intake of 3 to 4 L/day. d. keep the patient NPO in preparation for surgery.

a. administer opioids as prescribed. Rationale: Pain management and patient comfort are primary nursing responsibilities in managing an obstructing stone and renal colic.

During physical assessment of the urinary system, the nurse a. cannot palpate the left kidney b. palpates an empty bladder as a small nodule. c. finds a dull percussion sound when 100 mL of urine is present in the bladder. d. palpates above the symphysis pubis to determine the level of urine in the bladder.

a. cannot palpate the left kidney Rationale: The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it. Occasionally the lower pole of the right kidney is palpable. The urinary bladder is normally not palpable unless it is distended with urine. If the bladder is full, it may be felt as a smooth, round, firm organ and is sensitive to palpation.

The nursing care for a patient with hyponatremia and fluid volume excess includes a. fluid restriction. b. administration of hypotonic IV fluids. c. administration of a cation-exchange resin. d. placement of an indwelling urinary catheter.

a. fluid restriction Rationale: In hyponatremia that is caused by water excess, fluid restriction often is all that is needed to treat the problem. The patient would only require an indwelling urinary catheter if the patient is unable to assist with maintaining an accurate output record.

The lungs act as an acid-base buffer by a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load. c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. d. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.

a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. Rationale: As a compensatory mechanism, the respiratory system acts on the CO2 + H2O side of the reaction by altering the rate and depth of breathing to "blow off" (through hyperventilation) or "retain" (through hypoventilation) CO2.

Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply) a. nonpalpable left kidney. b. auscultation of renal artery bruit. c. CVA tenderness elicited by a kidney punch. d. no CVA tenderness elicited by a kidney punch. e. palpable bladder to the level of the pubic symphysis.

a. nonpalpable left kidney d. no CVA tenderness elicited by a kidney punch Rationale: In the physical assessment of the urinary system, normal findings include no CVA tenderness, nonpalpable kidneys and bladder, and no palpable masses.

An older woman was admitted to the medical unit with GI bleeding and fluid volume deficit. Clinical manifestations of this problem are (select all that apply) a. weight loss. b. dry oral mucosa. c. full bounding pulse. d. engorged neck veins. e. decreased central venous pressure.

a. weight loss. b. dry oral mucosa. e. decreased central venous pressure. Rationale: Body weight loss, especially sudden change, is an excellent indicator of overall fluid volume loss. Other clinical manifestations of fluid volume deficit include dry mucous membranes and a decreased central venous pressure, which reflect fluid volume loss.

A patient with kidney disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of a. tubular secretion. b. glomerular filtration. c. capillary permeability. d. concentration of filtrate.

b. glomerular filtration Rationale: The amount of blood filtered each minute by the glomeruli is expressed as the glomerular filtration rate (GFR). The normal GFR is about 125 mL/min.

8. The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of a. aspirin use. b. tobacco use. c. chronic alcohol abuse. d. use of artificial sweeteners.

b. tobacco use. Rationale: Cigarette smoking is the most significant risk factor for renal cell carcinoma. An increased incidence has also been identified in first-degree relatives of patients with this condition. Other risk factors include obesity, hypertension, and exposure to asbestos, cadmium, and gasoline. Risk for renal cancer is also increased in individuals who have acquired cystic disease of the kidney in association with end-stage renal disease. Risk factors for bladder cancer include smoking, exposure to dyes used in the rubber and cable industries, and chronic abuse of phenacetin-containing analgesics.

2. The nurse teaches the female patient who has frequent UTIs that she should a. take tub baths with bubble bath. b. urinate before and after sexual intercourse. c. take prophylactic sulfonamides for the rest of her life. d. restrict fluid intake to prevent the need for frequent voiding.

b. urinate before and after sexual intercourse. Rationale: When teaching a patient to prevent a recurrence of a urinary tract infection, the nurse should explain the importance of emptying the bladder before and after sexual intercourse.

5. The edema that occurs in nephrotic syndrome is due to a. increased hydrostatic pressure caused by sodium retention. b. decreased aldosterone secretion from adrenal insufficiency. c. increased fluid retention caused by decreased glomerular filtration. d. decreased colloidal osmotic pressure caused by loss of serum albumin.

d. decreased colloidal osmotic pressure caused by loss of serum albumin. Rationale: The increased permeability of the glomerular membrane found in nephrotic syndrome is responsible for the massive excretion of protein in the urine. This results in decreased serum protein levels and subsequent edema formation. Ascites and anasarca (i.e., massive generalized edema) develop if hypoalbuminemia is severe.

11. A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should a. notify the physician. b. notify the charge nurse. c. irrigate the drainage tube. d. document it as a normal observation.

d. document it as a normal observation. Rationale: Patients with an ileal conduit have mucus in the urine. The mucus is secreted by intestinal mucosa, which is used to create the ileal conduit, in response to the irritating effect of urine.

The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes a. hyperaldosteronism. b. serotonin deficiency. c. adrenal insufficiency. d. hyperparathyroidism.

d. hyperparathyroidism Rationale: Excessive levels of circulating parathyroid hormone (PTH) usually lead to hypercalcemia and hypophosphatemia. In the kidneys, the excess calcium cannot be reabsorbed, so the calcium levels in the urine increase (i.e., hypercalciuria). This excess urinary calcium, along with a large amount of urinary phosphate, can lead to calculi formation.

The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to a. apply warm moist compresses to the insertion site. b. attempt to force 10 mL of normal saline into the device. c. place the patient on the left side with head-down position. d. instruct the patient to change positions, raise arm, and cough.

d. instruct the patient to change positions, raise arm, and cough. Rationale: Interventions for catheter occlusion include instructing the patient to change position, raise an arm, and cough; assessing for and alleviating clamping or kinking of the tube; flushing the catheter with normal saline through a 10-mL syringe (do not force flush); using fluoroscopy to determine cause and site of occlusion; and instilling anticoagulant or thrombolytic agents.

A patient has the following arterial blood gas results: pH 7.52, PaCO2 30 mm Hg, HCO3− 24 mEq/L. The nurse determines that these results indicate a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

d. respiratory alkalosis Rationale: Respiratory alkalosis (carbonic acid deficit) occurs with hyperventilation. The primary cause of respiratory alkalosis is hypoxemia from acute pulmonary disorders. Anxiety, central nervous system (CNS) disorders, and mechanical overventilation also increase ventilation rate and decrease the partial pressure of arterial carbon dioxide (PaCO2). This leads to a decrease in carbonic acid level and to alkalosis.

During the postoperative care of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because a. older adults have an impaired thirst mechanism and need reminding to drink fluids. b. water accounts for a greater percentage of body weight in the older adult than in younger adults. c. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures. d. small losses of fluid are significant because body fluids account for 45% to 50% of body weight in older adults.

d. small losses of fluid are significant because body fluids account for 45% to 50% of body weight in older adults. Rationale: In the older adult, body water content averages 45% to 50% of body weight; therefore small losses can lead to a greater risk of fluid-related problems.

On reading the urinalysis results of a dehydrated patient, the nurse would expect to find a. a pH of 8.4. b. RBCs of 4/hpf. c. color: yellow, cloudy. d. specific gravity of 1.035.

d. specific gravity of 1.035 Rationale: Normal specific gravity of urine is 1.003 to 1.030; the concentrating ability of the kidneys is maximal in producing morning urine (1.025 to 1.030). A high urinary specific gravity value indicates dehydration.