Urinary/renal 41, Reproductive 16, Antepartum 1

The nurse caring for multiple clients who underwent renal system diagnostic testing should report which post-procedure finding to the health care provider? 1. 150 mL residual urine on bladder scan 2. Burning sensation when voiding after cystoscopy 3. Increased urinary output after arteriogram 4. Less than 10,000 organisms/mL on urine culture

1

The nurse assesses a client who is 2 days postoperative breast reconstruction surgery. The client has 2 closed-suction Jackson Pratt bulb drains in place. There is approximately 10 mL of serosanguineous fluid in each one. One hour later, the nurse notices the bulbs are full of bright red drainage and measures a total output of 200 mL. What is the nurse's priority action? 1. Notify the health care provider (HCP) 2. Open the collection bulb to release excessive negative pressure 3. Record the amount in the output record as wound drainage 4. Reposition the client on the right side

1

The nurse evaluates the results of laboratory tests completed on a client admitted for a non-healing wound. Which of the following values would be a priority for the nurse? 1. Blood urea nitrogen 15 mg/dL (5.4 mmol/L) 2. Serum albumin 3.7 g/dL (37 g/L) 3. Serum potassium 4.5 mEq/L (4.5 mmol/L) 4. Serum sodium 153 mEq/L (153 mmol/L) Incorrect. Correct answer is 4

4

The nurse provides post-procedure teaching for a female client who had a cystoscopy as an outpatient. Which client statement indicates the need for additional instruction? 1. "I can expect pink-tinged urine for at least 24 hours." 2. "I can take a warm bath and acetaminophen if I have discomfort or bladder spasms." 3. "I should expect frequency and burning when I urinate." 4. "I should expect to see blood clots in my urine for up to 24 hours."

4

Which of these instructions is appropriate teaching for a 60-year-old woman? Select all that apply. 1. Consume adequate sources of calcium and vitamin D and take supplements 2. Increase intake of food sources of iron and take supplements 3. Observe for unilateral leg swelling when taking hormone replacement therapy (HRT) 4. Remain upright for 30 minutes when taking a bisphosphonate 5. Vaginal spotting after menopause is a common, insignificant sign of aging

1,3,4

A client underwent extracorporeal shock wave lithotripsy with ureteral stent placement for kidney stones. What information should the nurse give to the client at the time of discharge? Select all that apply. 1. Increase fluid intake to flush out fragments of the stones 2. Report any blood in the urine 3. Report any bruising on the back or abdomen 4. Report any fever or chills 5. Stay in bed for at least 48 hours, getting up only to urinate

1,4

The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What initial actions are appropriate for the nurse to take? Select all that apply. 1. Ask the date of last bowel movement and administer prescribed stool softeners 2. Clamp the catheter and instill an additional 100 mL of dialysate to prime the tubing 3. Contact the client's health care provider 4. Examine the catheter for kinks and obstructions 5. Place the client in the supine position to relieve pressure on the abdomen

1,4

A client suffering from bladder prolapse and subsequent stress urinary incontinence has discussed treatment options with the health care provider (HCP). The nurse evaluates that the client understands support pessary use when the client makes which statement? 1. "After the pessary is surgically placed, I'll experience bladder discomfort for several weeks." 2. "I can remain sexually active while my pessary is in place." 3. "I need to schedule weekly appointments to have the pessary removed and replaced." 4. "I should report any vaginal discharge to my HCP immediately."

2

The charge nurse is making rounds and should immediately intervene when making which observation? 1. A new nurse is using gentle pressure to flush a kidney pelvis catheter with 5 mL of fluid 2. A nursing assistant is hanging a urinary drainage bag on the back of a wheelchair when transporting a client 3. Indwelling urinary catheter is taped to a male client's inner thigh 4. Total oral fluid intake in 24 hours for a client with a urinary diversion device is 2,800 mL

2

The nurse is administering medications to a client experiencing heart palpitations who is scheduled to receive a dose of furosemide. Based on the client's laboratory results, what is the nurse's priority action? Click on the exhibit button for additional information. Exhibit: Laboratory Results Serum electrolytes Result Potassium 2.9 mEq/L (2.9 mmol/L) Magnesium 2.0 mEq/L (1.0 mmol/L) Calcium 8.9 mg/dL (2.23 mmol/L) Sodium 138 mEq/L (138 mmol/L) 1. Calculate total urinary output 2. Hold the furosemide 3. Notify the health care provider (HCP) 4. Obtain a 12-lead electrocardiogram (ECG)

2

The nurse is caring for a 68-year-old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention? 1. Conduct a bladder scan 2. Help the client out of bed 3. Insert an indwelling catheter using sterile technique 4. Obtain a prescription for intermittent catheterization

2

The nurse is reinforcing instructions to a client being discharged from the clinic with a diagnosis of acute prostatitis. Which of the following should be included in the instructions? Select all that apply. 1. Avoid sexual intercourse and masturbation 2. Encourage oral fluid intake 3. Increase consumption of tea or coffee 4. Take sitz baths several times a day 5. Take stool softeners as prescribed

2,4,5

A sexually active female client has had 3 urinary tract infections (UTIs) in 12 months. Which instructions should the nurse include in teaching the client how to prevent UTI recurrence? Select all that apply. 1. Douche with a water and vinegar solution after intercourse 2. Increase daily intake of fluids 3. Use a spermicidal contraceptive jelly 4. Use fragrance-free perineal deodorant products 5. Void immediately after intercourse 6. Wear underwear with a cotton crotch

2,5,6

A client has been given instructions about collecting a urine specimen to test creatinine clearance. The client indicates correct understanding of the specimen collection procedure by making which statement? 1. "A catheter is placed temporarily then removed after I void." 2. "I must provide a midstream sample in a sterile container." 3. "I will need to collect all my urine in a container for 24 hours." 4. "The first AM specimen is best as it is more concentrated."

3

A client underwent a transurethral resection of the prostate (TURP) today and has a 3-way Foley urinary catheter with continuous bladder irrigation (CBI). The client reports lower abdominal pain rated as an 8 on a scale of 0-10. What action should the nurse carry out first? 1. Administer prescribed belladonna-opium suppositories prn 2. Administer prescribed morphine intravenous push prn 3. Check amount and characteristics of urine output 4. Check when the client had the last flatus or bowel movement

3

The nurse employed in a woman's health care clinic would be most concerned about which client statement? 1. "I recently noticed a small, round, painless, mobile lump in my left breast while showering." 2. "Last night while breastfeeding, my nipples were cracked and my breasts were painful." 3. "My right breast is red and warm with little tiny indented areas on the surface of the skin." 4. "Sometimes during my cycle, I notice breast nodules that are movable and feel soft to the touch."

3

A client with chronic kidney disease has a subcutaneous arteriovenous fistula (AVF) placed in the nondominant left wrist for hemodialysis. Which of the following statementsindicate the client understands how to care for the fistula properly? Select all that apply. 1. "I don't need to call my health care provider (HCP) if I have numbness or tingling in my left arm." 2. "I will make sure I always have my blood pressure taken in my nondominant (left) arm." 3. "I will squeeze a small sponge with my left hand several times a day." 4. "I will touch the site and feel for a vibration several times a day." 5. "I will try not to sleep on my left arm."

3,4,5

The nurse prepares a client for discharge following a vasectomy. The client asks, "When can I have sexual intercourse with my wife without using a condom?" What is the bestresponse by the nurse? 1. "Discontinue alternative birth control after at least 5 ejaculations." 2. "There is no need to use alternative birth control following today's procedure." 3. "Use alternative birth control for 6 months following today's procedure." 4. "Use alternative birth control until cleared by the health care provider."

4

A client with advanced kidney disease has serum potassium of 7.1 mEq/L (7.1 mmol/L) and creatinine of 4.5 mg/dL (398 µmol/L). What is the priority prescribed intervention? 1. Administer IV 50% dextrose and regular insulin 2. Administer IV furosemide 3. Administer oral sodium polystyrene sulfonate 4. Prepare the client for hemodialysis catheter placement

1

The nurse is caring for a 78-year-old client with a urinary tract infection (UTI). Which assessment finding would be most concerning and require immediate follow-up by the nurse? 1. Confusion 2. Presbyopia 3. Temperature 100.2 F (37.8 C) 4. White blood cell (WBC) count 12,000/mm3

1

The nurse working in the ambulatory clinic is teaching a client measures to prevent chlamydia transmission and recurrence. Which statement by the client indicates a need forfurther teaching? 1. "I can resume sexual intercourse a few days after starting treatment." 2. "I may still transmit the infection even if I do not have symptoms." 3. "I will make sure my partner gets treated as well." 4. "I will use a condom during all future sexual encounters."

1

A client at 32 weeks gestation goes into cardiac arrest. What is the nurse's best action while performing cardiopulmonary resuscitation (CPR) for this client? 1. Compress chest at second intercostal space, right sternal border 2. Perform chest compressions slightly higher on the sternum 3. Place hands just below the diaphragm to perform chest compressions 4. Position client in the supine position for optimal compressions

2

Which nursing instruction is the highest priority when teaching a 38-year-old female client newly diagnosed with stress incontinence? 1. Coaching related to Kegel exercises 2. Importance of voiding every 2 hours 3. Minimizing caffeine and alcohol 4. Use of incontinence pads and pessary

2

A client is being discharged home after an open radical prostatectomy. Which statement indicates a need for further teaching? 1. "I will try to drink lots of water." 2. "I will try to walk in my driveway twice a day." 3. "I will wash around my catheter twice a day." 4. "If I get constipated, I will use a suppository."

4

After reviewing the urinalysis report data on a client, which question is most appropriate for the nurse to ask? Click on the exhibit button for additional information. Exhibit: Urinalysis Specimen type: Midstream Color Amber Specific gravity 1.031 Red blood cells None White blood cells Rare Protein None Glucose Absent 1. "Do you have a family history of diabetes?" 2. "Do you have any burning or difficulty urinating?" 3. "Have you suffered any recent kidney trauma?" 4. "What has your fluid intake been for the last 24 hours?"

4

The nurse is caring for a 72-year-old client with a history of renal calculi and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2 F (38.4 C), and flank pain. Which of the following is the priority nursing intervention? 1. Administer intravenous antibiotics 2. Check baseline serum creatinine level 3. Have the client strain all urine 4. Obtain blood and urine cultures

4

The nurse prepares to instill dialysate for a client receiving peritoneal dialysis. Which nursing action is priority? 1. Ensuring that the drainage collection bag is below the level of the abdomen 2. Placing the client in semi-Fowler's position 3. Recording the characteristics (eg, color) of output dialysate 4. Using sterile technique when spiking and attaching the bag of dialysate

4

What intervention is essential prior to starting a client on atorvastatin therapy? 1. Assessing for muscle strength 2. Assessing the client's dietary intake 3. Determining if the client is on digoxin therapy 4. Monitoring liver function tests

4

A nurse is teaching a client with a surgically repaired undescended testis about testicular self-examination (TSE). Which instructions should be included in the teaching? Select all that apply. 1. Perform the examination during a warm bath or shower 2. Perform the examination monthly on the same day 3. Report if one testis is slightly larger than the other 4. Report if there is a hard mass over the testis 5. Use both hands to feel each testis separately

1,2,4,5

The nurse caring for a group of clients on the gynecology unit recognizes that which are at increased risk for developing breast cancer? Select all that apply. 1. 24-year-old whose sister had breast cancer at age 38 2. 32-year-old with genetic mutations in the BRCA1 and BRCA2 genes 3. 45-year-old whose menstrual period began at age 17 4. 56-year-old who is postmenopausal and has gained 50 lb (22.6 kg) in the last 5 years 5. 65-year-old who took combined oral contraceptives for 15 years

1,2,4,5

The nurse is performing discharge teaching on nutritional therapy for a client with chronic kidney disease. Which statement indicates that further teaching is needed? 1. "Because I have chronic kidney disease, I should avoid canned soups and cold cut sandwiches." 2. "I can use a salt substitute because I am required to restrict both sodium and potassium in my daily diet." 3. "I must avoid eating raw carrots and tomatoes on my salads because I take hemodialysis treatments." 4. "The ice cream I eat should be counted in my daily fluid intake because it becomes liquid at room temperature."

2

The nurse is reviewing the history of several female clients. The nurse will recommend Papanicolaou (Pap) cervical cancer screening for which individual? 1. 18-year-old who reports being sexually active for the last 3 years 2. 32-year-old whose last Pap screening at age 29 was negative 3. 51-year-old who had a total hysterectomy with cervical removal 4. 67-year-old whose Pap tests were negative at age 61 and 64

2

The nurse preparing an educational seminar on sexually transmitted infections for female college students should advise that which 2 infections are leading causes of pelvic inflammatory disease and infertility? 1. Genital herpes and HIV 2. Gonorrhea and chlamydia 3. Human papillomavirus and syphilis 4. Yeast and trichomoniasis

2

When a client diagnosed with acute urinary retention is emergently catheterized, the nurse should initially assess for which priority manifestation that may occur as a result of the catheterization? 1. Dysuria 2. Hypotension 3. Infection 4. Tachycardia

2

The emergency department nurse cares for 5 clients. Which of the clients below are at risk for developing metabolic acidosis? Select all that apply. 1. 25-year-old client with claustrophobia who was stuck in an elevator for 2 hours 2. 36-year-old client with food poisoning and severe diarrhea for the past 3 days 3. 40-year-old client with 3-day history of chemotherapy-induced vomiting 4. 75-year-old client with pyelonephritis and hypotension 5. 82-year-old client due for hemodialysis with clotted arteriovenous shunt

2,4,5

A client diagnosed with end-stage renal disease comes to the dialysis clinic for treatment. Which actions should the nurse take to prepare the client for hemodialysis? Select all that apply. 1. Administer subcutaneous heparin to decrease clotting during dialysis 2. Administer the client's morning doses of carvedilol and lisinopril 3. Check the client's medical records to determine the last post-dialysis weight 4. Obtain a set of client vital signs and the client's current weight 5. Palpate the fistula in the client's arm for a thrill and auscultate for a bruit

3,4,5

A client undergoes transurethral resection of the prostate for benign prostatic hyperplasia. The client has a 28 Fr, 30-mL balloon, 3-way Foley catheter with continuous bladder irrigation. Which assessment by the nurse is the best indication that the bladder irrigation is running at an adequate rate? 1. Blood pressure 120/80 mm Hg, pulse 80/min 2. Client has no bladder spasms 3. Intake 3200 mL, output 3000 mL 4. Output urine is light pink in color

4

A client's arterial blood gases (ABGs) are shown in the exhibit. The nurse would expect which finding to demonstrate that the client is compensating for the ABGs? Click on the exhibit button for additional information. Exhibit: Laboratory results PH 7.25 PO2 79 mm Hg (10.5 kPa) PaCO2 35 mm Hg (4.66 kPa) HCO3- 12 mEq/L (12 mmol/L) 1. Decrease in bicarbonate reabsorption 2. Decrease in respiratory rate 3. Increase in bicarbonate reabsorption 4. Increase in respiratory rate

4

A nurse is providing teaching about contraception. Which of the following is appropriate contraceptive teaching? Select all that apply. 1. An intrauterine device is a preferred contraceptive method for women with multiple sexual partners 2. Back-up contraception is required for the first 3 months after initiating oral contraceptive pills 3. Diaphragm contraceptive devices also provide protection from HIV infection 4. Emergency contraception can reduce the risk of pregnancy for up to 5 days after intercourse 5. Women who smoke and take oral contraceptives are at risk for blood clots and heart attacks

4,5

A 14-year-old is seen in the sexually transmitted disease (STD) outpatient department and diagnosed with gonorrhea. The client tells the nurse of having sexual relations with only a 19-year-old partner. What is the best response by the nurse? 1. "Has your partner been evaluated and treated by a health care provider?" 2. "I have to report your situation to local law enforcement." 3. "One of your parents will need to consent to your treatment." 4. "You should use a condom when you have sex."

1

A client with chronic kidney disease has blood laboratory results as shown in the exhibit. What is the best afternoon snack to provide to this client? Click on the exhibitbutton for additional information. Exhibit: Laboratory results Sodium 150 mEq/L (150 mmol/L) Potassium 6.0 mEq/L (6.0 mmol/L) Chloride 100 mEq/L (100 mmol/L) Calcium 9.0 mg/dL (2.25 mmol/L) Magnesium 2.0 mg/dL (1.0 mmol/L) Phosphorus 5.8 mg/dL (1.87 mmol/L) 1. Apple slices with caramel dip 2. Chips and avocado dip 3. Nonfat yogurt with orange slices 4. Vanilla pudding with strawberries

1

A client with diabetes mellitus is admitted to the surgical unit after a vaginal hysterectomy. The client received 6 units of regular insulin subcutaneously and metoprolol 50 mg by mouth in the post-anesthesia care unit. Which statement by the unlicensed assistive personnel would require immediate action by the nurse? 1. "I changed the client's perineal pad 3 times in the last 2 hours." 2. "I have been encouraging the client to exercise the legs while in bed." 3. "I thought you should know the client voided 500 mL of straw-colored urine." 4. "I just took the client's vital signs, which are blood pressure 108/60 mm Hg, pulse 58, and respirations 12."

1

The emergency department nurse performs an admission assessment for a client with priapism of about 3 hours duration who also has sickle cell anemia. What assessment finding is of most concern and warrants immediate notification of the health care provider? 1. Bluish discoloration of the erect penis 2. Drank a 6-pack of beer 8 hours ago 3. Extreme penile pain rated as 9 on 0-10 scale 4. Has not voided for at least 6 hours

1

The evening shift nurse reviews the preoperative checklist and latest serum laboratory values for an elderly client with a ruptured diverticulum who is scheduled for surgery in the early morning. Which laboratory value is most important for the nurse to report to the health care provider? 1. Creatinine level 2.5 mg/dL (221 µmol/L) 2. Potassium level 3.5 mEq/L (3.5 mmol/L) 3. Sodium level 134 mEq/L (134 mmol/L) 4. White blood cell count 16,000/mm3 (16.0 × 109/L)

1

The nurse reviews a prescription to insert an indwelling urinary catheter in a hospitalized client. Which rationale for indwelling urinary catheter insertion is most appropriate? 1. The client has acute urinary retention 2. The client is confused and incontinent 3. The client is elderly and at risk for falls 4. The client is receiving intravenous diuretics

1

The nurse assesses a client receiving peritoneal dialysis. Which assessment findings are most important for the nurse to report to the health care provider? Select all that apply. 1. Cloudy outflow 2. Low-grade fever 3. Oliguria 4. Pruritus 5. Tachycardia

1,2,5

A client had a percutaneous nephrolithotripsy to remove left kidney stones 3 hours ago. Since then, the indwelling urethral catheter has drained 125 mL of urine, and the nephrostomy tube has drained 0 mL. The client now reports left flank pain radiating to the left groin and severe nausea. What is the appropriate nursing intervention? 1. Assess the urethral catheter for kinks and obstruction 2. Irrigate the nephrostomy tube with 5 mL of sterile normal saline as prescribed 3. Irrigate the urethral catheter with 50 mL of sterile normal saline as prescribed 4. Place the client in the prone position to facilitate urine drainage

2

A 25-year-old marathon runner is admitted for suspected rhabdomyolysis. The client has oliguria, dark amber urine, and muscle pain. The nurse should implement which prescription first? 1. ECG 2. IV morphine 2 mg 3. Normal saline bolus 4. Urine sample

3

The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis? 1. Constant; increased by pressure over the suprapubic area 2. Dull and continuous; occasional spasms over the suprapubic area 3. Dull flank pain; extending toward the umbilicus 4. Excruciating; sharp flank pain radiating to the groin

3

The nurse obtains the breast self-examination (BSE) history of a group of female clients. Which client needs further teaching on the best timing of monthly BSEs? 1. A 28-year-old taking oral contraceptives who performs BSE when beginning a new set of pills 2. A 35-year-old with regular periods who performs BSE 5 days after menstruation 3. A 42-year-old with irregular periods who performs BSE when menstruation ends 4. A 56-year-old postmenopausal woman who performs BSE on the first day of the month

3

Which health history information would be most important for the nurse to obtain when assessing a client with suspected bladder cancer who reports painless hematuria? 1. Family risk factors 2. Industrial chemical exposure 3. Tobacco use 4. Usual diet

3

A nurse in the gynecology clinic is reviewing client histories. Which report would be most concerning to the nurse? 1. 25-year-old client who reports a fish-like vaginal odor for the past month 2. 30-year-old client with an intrauterine device who reports heavy bleeding with menses 3. 40-year-old client with endometriosis who reports persistent pain during intercourse 4. 60-year-old client who reports bloating and pelvic pressure for the past 2 months

4

The nurse cares for a client scheduled for a percutaneous left kidney biopsy as an outpatient. Which intervention should the nurse include in the client's post-procedure care plan? 1. Compare pre- and post-procedure BUN and creatinine levels 2. Insert and maintain the patency of an indwelling urinary catheter 3. Maintain prone position for at least 30 minutes 4. Monitor vital signs every 15 minutes for the first hour

4

A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia? 1. Intravenous calcium gluconate 2. Intravenous regular insulin with dextrose 3. Oral sodium polystyrene sulfonate 4. Transport to hemodialysis unit

1

A client who was discharged 3 days ago following prostatectomy calls the clinic and tells the nurse of passing some small blood clots and experiencing a decreased urinary stream. What is the nurse's best response? 1. "I'll consult the health care provider (HCP) and then give you further instructions." 2. "Those symptoms are normal the first week following surgery." 3. "Try to bear down as if having a bowel movement." 4. "You should increase your daily fluid intake."

1

The nurse assesses a client diagnosed with chronic kidney disease who had an internal arteriovenous fistula performed on the left arm yesterday. Which assessment finding would require immediate follow-up? 1. A bruit cannot be auscultated over the fistula site 2. Capillary refill of 2 seconds is assessed on the left hand 3. Client reports squeezing a rubber ball with the left hand several times daily 4. Incision is dry with no redness and has sterile skin closures in place

1

A client requires immediate dialysis after suffering sudden kidney failure. What is the most appropriate procedure for which the nurse should prepare the client? 1. Arteriovenous fistula (AVF) placement in the arm 2. Arteriovenous graft (AVG) placement in the arm 3. Central line placement in the groin area 4. Peritoneal dialysis catheter placement in the abdomen

3

A client returns to the unit after receiving hemodialysis for the first time. The client appears restless and reports headache and nausea. What is the priority intervention? 1. Administer antihypertensives that were held prior to dialysis 2. Administer PRN ondansetron to relieve nausea 3. Contact the health care provider 4. Place client in Trendelenburg position

3