Urinary Adaptive Quizzing

Which medical condition is treated by intravenous administration of calcium gluconate? 1 Gigantism 2 Thyroid cancer 3 Diabetes mellitus 4 Hypoparathyroid tetany

4. hypoparathyroid tetany R: Hypoparathyroid tetany is treated by intravenous administration of calcium gluconate. Gigantism is treated by irradiation of the anterior pituitary gland, with subsequent replacement of pituitary hormones. Thyroid cancer is treated by total thyroidectomy with subsequent replacement of thyroid hormones. Diabetes mellitus is treated by administering insulin.

A diet that contains restricted amounts of protein, sodium, and potassium has been prescribed for a client with end-stage renal disease who is receiving dialysis. The nurse is providing dietary instructions. Which statement by the client indicates teaching is effective? 1 "I should avoid using salt substitutes." 2 "I should exclude meat from my diet." 3 "I may not add seasoning to my food." 4 "I may eat low-sodium canned vegetables."

1. "I should avoid using salt substitutes" R: Commercially prepared salt substitutes are high in potassium. Some complete protein foods must be included in the diet. Seasoning that contains neither sodium nor potassium, such as lemon juice, pepper, and herbs, can be used to make food more palatable. Low-sodium canned vegetables contain high potassium concentrations.

A preterm infant is receiving an intravenous electrolyte solution at a rate of 20 mL/hr by way of an umbilical arterial line. At the hourly intake measurement, the nurse observes that 40 mL has infused in the past hour. What is the nurse's first intervention? 1 Taking the vital signs 2 Comparing the intake with the output 3 Checking the primary healthcare provider's prescriptions 4 Slowing the infusion rate to half of the prescribed rate

1. Taking the VS R: The priority is assessing the infant for circulatory overload; changes in the vital signs may indicate a problem that must be addressed quickly. Comparing the intake and output record wastes valuable time that should be spent assessing the infant's response. Checking the primary healthcare provider's prescription wastes valuable time that should be spent assessing the infant's response. After the infant's response is assessed, an adjustment of the infusion rate may be prescribed.

An IV of 800 mL/24 hr is prescribed for a 2-year-old child. At how many milliliters per hour should the nurse set the volume control device? 1. 38 mL 2. 33 mL 3. 28 mL 4. 23 mL

2. 33 mL The volume control device should be set at 33 mL/hr; 800 mL divided by 24 hours equals 33 mL/hr. A rate of 38 mL/hr is too fast; rates of 23 and 28 ml/hr are too slow.

A nurse is caring for a client who is scheduled for cystoscopy. What should the nurse include in the client's postprocedure teaching plan? 1. remain flat in bed for the first 24 hrs 2. increase fluid intake for 3 to 4 days postoperatively 3. notify the nurse if there is any drainage on the dressing 4. bear down when attempting to void during the first 6 hrs

2. increase fluid intake for 3 to 4 days postoperatively R: Increasing fluid intake flushes the bladder internally and helps decrease the risk of infection. Remaining flat in bed for the first 24 hours is unnecessary after a cystoscopy. A cystoscopy is performed through the urethra; a dressing is not necessary. Bearing down increases pressure in the pelvic and perineal area and should be avoided.

A nurse is caring for an infant with hypertrophic pyloric stenosis. A pyloromyotomy is scheduled. Which pathophysiological modification must be addressed before this surgery can be performed safely? 1. Hydration must be restored. 2. The serum chloride level must be restored. 3. Fluid and electrolyte imbalances must be corrected. 4. Malnutrition and respiratory problems must be corrected.

3. Fluid and electrolyte imbalances must be corrected. R: The risks of surgery are greatly increased unless dehydration and metabolic alkalosis from prolonged vomiting are corrected. Although adequate hydration must be achieved, electrolyte balance must be restored as well. Although the chloride level is low, the fluid imbalance must be corrected as well. Malnutrition will be corrected after surgery when the infant retains feedings. Respiratory problems are not associated with pyloric stenosis.

The client is receiving high-flow intravenous (IV) fluid replacement therapy. Which nursing assessment findings are consistent with fluid volume overload? Select all that apply. 1. pulse quality 2. pulse pressure 3. bounding pulse 4. presence of dependent edema 5. neck vein distention in the upright position

3. bounding pulse 4. presence of dependent edema 5. neck vein distention in the upright position R: Bounding pulse, presence of dependent edema, and neck vein distention in the upright position are all indicators of fluid overload, which should be reported by the nurse. Pulse quality and pulse pressure are indicators to monitor the client's response to fluid therapy.

A nurse reviews a medical record of a client with ascites. What does the nurse identify that may be causing the ascites? 1. portal hypotension 2. kidney malfunction 3. decreased liver function 4. decreased production of potassium

3. decreased liver function R: The liver manufactures albumin, the major plasma protein. A deficit of this protein lowers the osmotic (oncotic) pressure in the intravascular space, leading to a fluid shift. An enlarged liver compresses the portal system, causing increased, rather than decreased, pressure. The kidneys are not the primary source of the pathological condition. It is the liver's ability to manufacture albumin that maintains the colloid oncotic pressure. Potassium is not produced by the body, nor is its major function the maintenance of fluid balance.

What is the purpose of administering intravenous (IV) fluids as prescribed while performing detoxification of an alcoholic client? 1. to raise the seizure threshold 2. to encourage better air exchange 3. to correct the client's fluid and electrolyte imbalance 4. to manage the client's tremors, nervousness, and restlessness

3. to correct the client's fluid and electrolyte imbalance While performing detoxification of an alcoholic client, the nurse should administer intravenous (IV) fluids as prescribed to correct the client's fluid and electrolyte imbalances. Magnesium sulfate may be administered as prescribed to raise the seizure threshold in an alcoholic client. While performing detoxification of an alcoholic client with intact swallowing capability, the nurse may elevate the head of the client's bed at least 30 degrees to encourage better air exchange. To manage the client's tremors, nervousness, and restlessness, the nurse may administer chlordiazepoxide or lorazepam as prescribed.

On the first day after a mastectomy, a nurse encourages the client to perform exercises such as flexion and extension of the fingers and pronation and supination of the hand. The client asks why she has to do these exercises. What is the best response by the nurse? 1. "they preserve muscle tone" 2. "they prevent joint contractures" 3. "they help us assess the extent of lymphedema" 4. "they will help stimulate peripheral circulation"

4. "they will help stimulate peripheral circulation" R: These exercises require muscle contractions that put pressure on blood vessels; muscle contraction promotes circulation, increasing tissue oxygen. Muscle atrophy is not a common complication after mastectomy. Contractures are a rare complication after a mastectomy. Lymphedema is assessed by measuring the circumference of the extremity, not by having the client exercise.

A nurse evaluates that a client understands the side effects of hydrochlorothiazide (HCTZ) therapy when the client states that he should call the health care provider if he develops what? 1. insomnia 2. a stuffy nose 3. an increase in thirst 4. genralized weakness

4. Generalized weakness R: Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy. Insomnia is not known to be related to hypokalemia or hydrochlorothiazide therapy. Although a stuffy nose is unrelated to hydrochlorothiazide therapy, it can occur with other antihypertensive drugs. Increased thirst is associated with hypernatremia. Because this drug increases excretion of water and sodium in addition to potassium and chloride, hyponatremia, not hypernatremia, may occur.

A client has 4 ounces of apple juice, 6 ounces of tea, and 240 mL of chicken broth. The nurse calculates that the client ingested how many mL of fluid? Record your answer using a whole number. __________ mL

540 mL 540 mL is a correct calculation. 4 ounces apple juice x 30 mL/ounce = 120 mL, 6 oz tea x 30 mL/ounce = 180 mL, and 240 mL chicken broth provide a total of 540 mL that the client has ingested.

A client is diagnosed with parathyroid dysfunction. Which serum calcium concentration in the client would support the diagnosis? 1. 7.8 mg/dL 2. 8.9 mg/dL 3. 9.7 mg/dL 4. 10.2 mg/d

1. 7.8 mg/dL R: The normal serum calcium concentration ranges from 8.6 to 10.2 mg/dL. A serum calcium concentration below 8.6 mg/dL indicates hypocalcemia and a serum calcium concentration above 10.2 mg/dL indicates hypercalcemia. Parathyroid hormone maintains calcium balance in the body. Hypocalcemia reflects hypoparathyroidism and hypercalcemia suggests hyperparathyroidism. The serum calcium concentration of 7.8 mg/dL is below the normal range and indicates hypocalcemia. Therefore, the client may have hypoparathyroidism, which is a parathyroid dysfunction. Serum calcium concentrations of 8.9 mg/dL, 9.7 mg/dL, and 10.2 mg/dL are all normal findings.

When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which should the nurse expect the health care provider to prescribe? 1. calcium 2. magnesium 3. bicarbonate 4. potassium chloride

1. calcium R: These signs may indicate calcium depletion as a result of accidental removal of parathyroid glands during thyroidectomy. Symptoms associated with hypomagnesemia include tremor, neuromuscular irritability, and confusion. Symptoms associated with metabolic acidosis include deep, rapid breathing, weakness, and disorientation. Symptoms associated with hypokalemia include muscle weakness and dysrhythmias.

The occurrence of which condition would warrant the nurse calling the primary health care provider to discontinue the intravenous (IV) fluids? 1. crackles in lungs 2. poor skin turgor 3. urine output of 240 mL over right hours 4. increased in b/p from 110/76 to 130/68

1. crackles in lungs R: Crackles in the lungs indicate the client is overloaded with fluids. The nurse should notify the primary health care provider to discontinue the IV fluid. Poor skin turgor is a sign that the client needs fluids. A urine output of 240 mL in eight hours is adequate per the textbooks, but may not be adequate for certain clients. Therefore, simply having a urine output of 30 mL/hr is not an indication that the IV fluid should be decreased or discontinued. An increase in blood pressure is to be expected with administration of fluid.

The primary health care provider prescribed carbamazepine to a client with central diabetes insipidus. The serum osmolarity is 600 mOsm (mmol)/kg. Which will be an effective outcome of the drug? 1. decreased thirst 2. decreased seizures 3. decreased urine output 4. increased serum calcium lvls

1. decreased thirst R: Carbamazepine helps to decrease thirst associated with central diabetes insipidus (DI). While carbamazepine is an antiseizure medication, when given to clients with central DI, it decreases thirst. Urine output is decreased by hormone replacement therapy. Carbamazepine does not affect serum calcium levels.

A client reports vomiting and diarrhea for 3 days. What clinical finding will most accurately indicate that the client has a fluid deficit? 1. presence of dry skin 2. loss of body weight 3. decrease in blood pressure 4. altered general appearance

2. loss of body weight R: Dehydration is measured most readily and accurately by serial assessments of body weight; 1 L of fluid weighs 2.2 lb. Although dry skin may be associated with dehydration, it also is associated with aging and some disorders (e.g., hypothyroidism). Although hypovolemia eventually will result in a decrease in blood pressure, it is not an accurate, reliable measure because there are many other causes of hypotension. Altered appearance is too general and not an objective determination of fluid volume deficit.

A client develops heart failure. Which response should the nurse expect when assessing the client? 1. weight loss 2. peripheral edema 3. decreased heart rate 4. increased urinary output

2. peripheral edema R: Peripheral edema occurs secondary to sodium and fluid retention, which results from a decreased cardiac output associated with heart failure. There is progressive weight gain, not loss, because of fluid retention. Because of the decreased cardiac output, the sympathetic nervous stimulation is increased, increasing the heart rate (tachycardia). A decreased urinary output occurs as a result of a decreased volume of blood passing through the kidneys, secondary to the decreased cardiac output.

A nurse who is assigned to care for a 6-month-old infant with diarrhea is reviewing the infant's medical history, assessment findings, laboratory reports, and practitioner prescriptions. The infant weighs 15lb (7 kg). The healthcare provider has written a prescription for potassium chloride to be added to the IV fluids. What assessment finding signals the nurse to question this prescription? 1 Incessant crying 2 Inadequate tissue turgor 3 Urinary output of 4 mL for the last 8 hours 4 Oral fluid intake of 12 mL over 8 hours

3 An infant weighing 15½ lb (7 kg) should have a minimum urine output of 1 mL/kg/hr, or 7 mL/hr. This infant's output is only 2 mL/hr over 8 hours or 0.25 ml/kg/hr. Decreased urine output will result in retention of potassium, causing hyperkalemia. Intractable crying is the expected response of an ill 6-month-old infant. Inadequate tissue turgor is an indication of dehydration, which is the reason for the IV infusion. There is no reason to question the prescription for the oral fluid intake amount because the IV infusion is supplementing the oral rehydration therapy.

A client admitted to the hospital in the oliguric phase of acute renal failure estimates that the urine output for the last 12 hours was less than 240 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. The nurse concludes that this amount of fluid was prescribed to do what? 1. equal the expected urinary output for the next 24 hours 2. prevent the development of hypostatic pneumonia and fever 3. compensate for both insensible and expected output over the next 24 hours 4. prevent hyperkalemia, which can lead to life-threatening cardiac dysrhythmias

3. compensate for both insensible and expected output over the next 24 hours R: Insensible losses are 400 to 500 mL in 24 hours; the measured output is about 400 mL in 24 hours based on the available history. Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. At least 2500 mL daily is necessary to help prevent hypostatic pneumonia and its associated fever. Hyperkalemia in acute renal failure is caused by inadequate glomerular filtration and is not related to fluid intake.

An older adult client states, "I walk 2 miles a day for exercise, but now that the weather is hot, I am worried about becoming dehydrated." What should the nurse teach the client? 1. drink fruit juices if you start to feel dehydrated. 2. thirst is a good guide to use to determine fluid intake. 3. fluids should be increased if the urine is getting darker. 4. water should be consumed when the skin becomes dry.

3. fluids should be increased if the urine is getting darker. In hot weather, dark-colored urine indicates dehydration. The amount of fluid to be excreted is less, and the body is attempting to conserve fluid. Fruit juices should be avoided during rehydration because of their high sugar content. By the time people become thirsty, they already are dehydrated, especially older adults. Dry skin in older adults may be related to aging rather than to dehydration. Water intake should be adequate (in hot weather, dark-colored urine indicates dehydration. The amount of fluid to be excreted is less, and the body is attempting to conserve fluid. Approximately 2000 mL daily is needed) and spaced throughout the day.

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical manifestations will the nurse expect to find? 1 Increased blood urea nitrogen (BUN) and hypotension 2 Hyperkalemia and poor skin turgor 3 Hyponatremia and decreased urine output 4 Polyuria and increased specific gravity of urine

3. hyponatremia and decreased urine output Antidiuretic hormone (ADH) causes water retention, resulting in a decreased urine output and dilution of serum electrolytes. Blood volume may increase, causing hypertension. Diluting the nitrogenous wastes in the blood decreases rather than increases the BUN. Water retention dilutes electrolytes. The client is overhydrated rather than underhydrated, so turgor is not poor. ADH acts on the nephron to cause water to be reabsorbed from the glomerular filtrate, leading to reduced urine volume. The specific gravity of urine is elevated as a result of increased concentration.

A nurse anticipates that dialysis will be necessary for a 12-year-old child with chronic kidney disease when the child begins to exhibit what? 1. hypotension 2. hypokalemia 3. hypervolemia 4. hypercalcemia

3. hypovolemia R: Hypervolemia results when the kidneys have failed and are no longer able to maintain homeostasis, the blood pressure is high, and cardiac overload is imminent. Hypertension, not hypotension, is present when kidney failure occurs. Hyperkalemia, not hypokalemia, occurs with kidney failure. Hypocalcemia, not hypercalcemia, is present when kidney failure occurs.

The nurse manager of the infection control service is teaching a class for nurses on the care of young children with viral infection-related diarrhea. What therapy should the nurse manager recommend? 1. BRAT diet until after the diarrhea has stopped 2. antiviral agent until the prescription is finished 3. oral rehydration therapy until fluid balance is restored 4. antidiarrheal agent after each stool until stools become formed

3. oral rehydration therapy until fluid balance is restored R: Oral rehydration therapy (ORT) is important because the percentage of fluid to body mass is higher in young children than adults, and fluid and electrolyte imbalance with shock can occur quickly. The BRAT diet (bananas, rice, applesauce, and tea/toast) is no longer recommended. ORT and a regular diet should be encouraged. There are no antiviral agents for the treatment of viral infection-related diarrhea. Antidiarrheal agents, such as Kaopectate or Imodium, may be harmful because they slow the course of the disease by retaining the virus-containing stool in the intestine.

A nurse is monitoring a client with renal failure for signs of fluid excess. Which finding does the nurse identify as inconsistent with fluid excess? 1. increased weight 2. distended neck vein 3. orthostatic hypotension 4. abnormal breath sounds

3. orthostatic hypotension R: Hypertension, not hypotension, is an indicator of fluid volume excess. Fluid excess causes weight gain; one liter weighs 2.2 lb. Fluid excess increases the intravascular volume, leading to jugular vein distention. Fluid excess causes fluid in the alveoli that leads to crackles, a sign of pulmonary edema.

A client admitted for uncontrolled hypertension and chest pain was prescribed a low-sodium diet and started on furosemide. The nurse should instruct the client to include which foods in the diet? 1. liver 2. apples 3. cabbage 4. bananas

4. bananas R: Furosemide is a loop diuretic that eliminates potassium by preventing renal absorption. Bananas have a significant amount of potassium. Bananas: 450 mg; cabbage: 243 mg; liver: 73.6 mg; apples: 100-120 mg.

A dehydrated 15-month-old toddler is admitted to the pediatric unit with a diagnosis of intractable diarrhea. After several days of treatment the child is reevaluated. Which finding indicates to the nurse that the child's hydration status has improved? 1. increased heart rate 2. decreased blood pressure 3. increased capillary refill time 4. decreased urine specific gravity

4. decreased urine specific gravity R: Signs of rehydration include increased urine output and a dilution of the urine, which results in a decrease in specific gravity. A classic sign of dehydration is oliguria and a concomitant increase in the urine specific gravity as the body attempts to compensate for the fluid loss by releasing antidiuretic hormone. With rehydration the heart rate and capillary refill time should decrease and return to their expected ranges, and blood pressure should increase to the normal range.

A nurse is caring for a client who is receiving serum albumin. What indicates that the albumin is effective? 1. improved clotting of blood 2. formation of red blood cells 3. activation of white blood cells (WBCs) 4. effective cardiac output

4. effective cardiac output R: Serum albumin, a protein, establishes the plasma colloid osmotic (oncotic) pressure because of its high molecular weight and size. Indicators of adequate osmotic pressure include an effective cardiac output. Blood clotting involves blood protein fractions other than albumin; for example, prothrombin and fibrinogen are within the alpha- and beta-globulin fractions. Red blood cell formation (erythropoiesis) occurs in red marrow and can be related to albumin only indirectly; albumin is the blood transport protein for thyroxine, which stimulates metabolism in all cells, including those in red bone marrow. Albumin does not activate WBCs; WBCs are activated by antigens and substances released from damaged or diseased cells.

A client who has been taking diuretics is admitted to the hospital with hypokalemia. For which clinical findings should the nurse assess the client? 1. hyperactive reflexes 2. bounding, irregular pulse 3. nausea, vomiting, and diarrhea 4. leg weakness and muscle cramps

4. leg weakness and muscle cramps Rationale: Muscular weakness and cramps may occur with hypokalemia because impulse conduction of skeletal muscles is impaired. An adequate level of potassium is necessary for effective functioning of the sodium-potassium pump. Hyperactive reflexes indicate hyperkalemia, not hypokalemia. The pulse is weak and irregular with hypokalemia because of an impaired conduction system in cardiac muscle. Diarrhea is caused by hyperkalemia, not hypokalemia.

Which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client? 1. serum sodium of 139 mEq/L (139 mmol/L) 2. serum chloride of 100 mEq/L (100 mmol/L) 3. serum calcium of 10.2 mg/dL (2.55 mmol/L) 4. serum potassium of 7.2 mEq/L (7.2 mmol/L)

4. serum potassium of 7.2 mEq/L (7.2 mmol/L) R: Hyperkalemia causes dysrhythmias and cardiac arrest. The normal serum potassium concentration ranges between 3.5 and 5.0 mEq/L (3.5-5.0 mmol/L). A concentration of 7.2 mEq/L (7.2 mmol/L) indicates hyperkalemia. The normal concentration of sodium in the serum ranges between 135 and 145 mEq/L (135-145 mmol/L). The normal chloride concentration ranges between 96 and 106 mEq/L (96-106 mmol/L). The normal serum calcium level ranges be