Renal and Urinary NCLEX

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1. It can develop into ventricular fibrillation at any time. 2. It is almost impossible to convert to a normal rhythm. 3. It is uncomfortable for the client, giving a sense of impending doom. 4. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

1. It can develop into ventricular fibrillation at any time

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1. It can develop into ventricular fibrillation at any time. 2. It is almost impossible to convert to a normal rhythm. 3. It is uncomfortable for the client, giving a sense of impending doom. 4. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

1. It can develop into ventricular fibrillation at any time.

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows an irregular wavy line. The nurse interprets that the client is experiencing which rhythm? 1.Sinus tachycardia 2.Ventricular fibrillation 3.Ventricular tachycardia 4.Premature ventricular contractions (PVCs)

3.Ventricular tachycardia

A client in ventricular fibrillation is about to be defibrillated. A nurse knows that to convert this rhythm effectively, the monophasic defibrillator machine should be set at which energy level (in joules, J) for the first delivery? 1. 50 J 2. 120 J 3. 200 J 4. 360 J

4. 360 J

A client in sinus bradycardia, with a heart rate of 45 beats/minute, complains of dizziness and has a blood pressure of 82/60 mm Hg. Which prescription should the nurse anticipate will be prescribed? 1. Defibrillate the client. 2. Administer digoxin (Lanoxin). 3. Continue to monitor the client. 4. Prepare for transcutaneous pacing.

4. Prepare for transcutaneous pacing.

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1.Sensation of palpitations 2.Causative factors, such as caffeine 3.Precipitating factors, such as infection 4.Blood pressure and oxygen saturation

4.Blood pressure and oxygen saturation

The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets that this rhythm is which of the following? A) a. Sinus tachycardia B) b. Atrial fibrillation C) c. Ventricular fibrillation D) d. Ventricular tachycardia

B) b. Atrial fibrillation

A client is admitted to the hospital with a diagnosis of benign prostatic hyperplasia, and a transurethral resection of the prostate is performed. Four hours after surgery, the nurse takes the client's vital signs and empties the urinary drainage bag. Which assessment finding indicates the need to notify the primary health care provider (PHCP)?

Blood pressure, 100/50 mm Hg; pulse, 130 beats per minute

The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? Select all that apply.

Check the level of the drainage bag. 2.Reposition the client to her or his side. 3.Place the client in good body alignment. 4.Check the peritoneal dialysis system for kinks.

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

Decongestants

The nurse is collecting data from a client. Which symptom described by the client is characteristic of an early symptom of benign prostatic hyperplasia?

Decreased force in the stream of urine

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder?

Dysuria and penile discharge

The nurse is reviewing a client's record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the nurse most likely would expect to note which finding?

Elevated creatinine level

The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical examination?

Fever, nausea, vomiting, and painful scrotal edema

The client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse should assess the client during dialysis for which associated manifestations?

Headache, deteriorating level of consciousness, and twitching

The nurse discusses plans for future treatment options with a client with symptomatic polycystic kidney disease. Which treatment should be included in this discussion? Select all that apply.

Hemodialysis 3.Kidney transplant 4.Bilateral nephrectomy

The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the prescribed dwell time for the dialysis because of the risk of which complication?

Hyperglycemia

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

Increased immunosuppression therapy

A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis. The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply.

Insertion of a nephrostomy tube Placement of a ureteral stent with ureteroscopy

A client is admitted to the emergency department following a fall from a horse, and the primary health care provider (PHCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The nurse should take which action?

Notify the PHCP before performing the catheterization.

The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is the priority nursing action?

Notify the primary health care provider (PHCP).

A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, the nurse notes that the client's temperature is 38.5° C (101.2° F). Which nursing action is most appropriate?

Notify the primary health care provider.

A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication?

Pallor, diminished pulse, and pain in the left hand

The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent?

Palpation of a thrill over the fistula.

A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse should plan which actions as a priority? Select all that apply.

Place the client on a cardiac monitor. 2.Notify the primary health care provider (PHCP). 4.Review the client's medications to determine whether any contain or retain potassium.

A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the prostate examination for which characteristic of this disorder?

Tender, indurated prostate gland that is warm to the touch

A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition?

Trauma to the bladder or abdomen

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmomary edema. The nurse immediately asks another nurse to contact the health care provider and prepares to implement which priority interventions (SATA). a. Administering oxygen b. Inserting a Foley catheter c. Administering furosemide d. Administering morphine sulfate intravenously e. Transporting the client to the coronary care unit f. Placing the client in a low Fowler's side-lying position

a. Administering oxygen b. Inserting a Foley catheter c. Administering furosemide d. Administering morphine sulfate intravenously

The nurse should evaluate that defibrillation of a client was most successful if which observation was made? a. Arousable, sinus rhythm, blood pressure (BP) 116/72 mmHg b. Nonarousable, sinus rhythm, BP 88/60 mmHg c. Arousable, marked bradycardia, BP 86/54 mmHg d. Nonarousable, supraventricular tachycardia, BP 122/60 mmHg

a. Arousable, sinus rhythm, blood pressure (BP) 116/72 mmHg

A client is admitted to the emergency department with chest pain that is consistent with myocardial infarction based on elevated troponin levels. Heart sounds are normal and vital signs are noted on the client's chart. The nurse should alert the health care provider because these changes are most consistent with which complication? Refer to chart a. Cardiogenic shock b. Cardiac tamponade c. Pulmonary embolism d. Dissecting thoracic aortic aneurysm

a. Cardiogenic shock

A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute. A nurse assesses the client for: a. Hypotension and dizziness b. Nausea and vomiting c. Hypertension and headache d. Flat neck veins

a. Hypotension and dizziness

A client's electrocardiogram strip shows atrial and ventricular rates of 110 bpm. the PR intercal is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? a. Sinus tachycardia b. Sinus bradycardia c. SInus dysrhythmia d. Normal sinus rhythm

a. Sinus tachycardia

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? a. The neurovascular status is normal because of increased blood flow through the leg. b. The neurovascular status is moderately impaired, and the surgeon should be called. c. The neurovascular status is slightly deteriorating and should be monitored for another hour. d. The neurovascular statis is adequate from an arterial approach, but venous complications are arising

a. The neurovascular status is normal because of increased blood flow through the leg.

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective? a. Muffled heart sounds b. A rise in blood pressure c. jugular venous distention d. Client expressions of dyspnea

b. A rise in blood pressure

A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 ml/hr for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L) on the basis of these findings the nurse would anticipate that the client is at risk for which problem? a. hypovolemia b. Acute kidney injury c. Glomerulonephritis d. Urinary tract infection

b. Acute kidney injury

A client who had cardiac surgery 24 hours ago has had a urine output averaging 20mL/hour for 2 hours. THe client received a single bolus of 500 mL if intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? a. Hypovolemia b. Acute kidney injury c. Glomerulonephritis d. Urinary tract infectioN

b. Acute kidney injury

The nurse is caring for a client who had a restriction of an abdominal aortic aneurysm yesterday. The client has an intravenous (IV) infusion at a rate of 150ml/hr, unchanged for the last 10 hours. The client's urine output for the last 3 hours has been 90, 50, and 28mL (28mL is most recent). The client's blood urea nitrogen level is 35 mg/dL (12.6 mmol/L) and the serum creatinine level is 1.8 mg/dL (159 mcmol/L), measured this morning. WHich nursing action is the priority? a. Check the urine specific gravity. b. Call the healthcare provider (HCP). c. Put the IV line on a pump so that the infusion rate is sure to stay stable. d. Check to see if the client had a blood sample for a serum albumin level drawn.

b. Call the healthcare provider (HCP).

A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds? a. Stridor b. Crackles c. Scattered rhonci d. Diminished breath sounds

b. Crackles

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would beed to be withheld for 24 hours before the procedure and for 48 hours after the procedure? a. Glipizide b. Metformin c. Repaglinide d. Regular insulin

b. Metformin

The nurse is evaluating a client response to cardioversion. WHich assessment would be the priority? a. Blood pressure b. Status of airway c. Oxygen flow rates d. Level of consiousness

b. Status of airway

A client with myocardial infarction is deveoping cardiogenic shock. Because of the risk of myocardial ischemia, what condition should the nurse carefully assess the client for? a. bradycardia b. ventricular dysrhythmias c. Rising diastolic blood pressure d. Falling central venous pressure

b. ventricular dysrhythmias

The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse correctly interpret this rhythm? a. Asystole b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia

c. Ventricular fibrillation

The client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. WHich statement by the client indicates the need for further teaching? a. "I should notify my doctor if my feet or legs start to swell." b. "My doctor told me to call his office if my pulse rate decreases below 60." c. "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." d. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

d. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should asses which item based on priority? a. Anxiety level of the client and family b. Presence of a MedicAlert card for the client to carry c. Knowledge of restrictions on post discharge physical activity d. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver

d. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver

The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the pad on the client's chest and before discharge, which intervention is a priority? a. Ensure that the client has been intubated. b. Set the defilbrillator to the "synchronize" mode. c. Administer and amiodarone bolus intravenously. d. Confirm that the rhythm is actually ventricular fibrillation.

d. Confirm that the rhythm is actually ventricular fibrillation.

The nurse is reviewing and electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds and QRS complexes measure 0.06 seconds. The overall heart rate is 64 bpm. Which action should the nurse take? a. Check vital signs b. Check laboratory test results. c. Notify the health care provider d. Continue to monitor for any rhythm change.

d. Continue to monitor for any rhythm change.