Exam 4 NCLEX Style Questions

A. Older than 70 years of age B. Has a BMI of 41 C. Adminsters NPH insulin each morning D. Past history of lymphoma (A client older than 70 years of age is placed at a greater risk from complication of surgery, lifelong immunosuppression, and organ rejection; A client with a BMI of 41 is morbidly obese and is placed at a greater risk for complication of surgery, lifelong immunosuppression, and organ rejection; A client who requires NPH insulin for Type 1 diabetes mellitus is placed at a greater risk from complication of surgery, lifelong immunosuppression, and organ rejection; A client with a past history of cancer such as lymphoma is placed at a greater risk for complication of surgery, lifelong immunosuppression, and organ rejection)

A client who is scheduled for kidney transplantation surgery is assessed by the nurse for risk factors of surgery. Which of the following findings increase the client's risk of surgery? (Select all that apply) A. Older than 70 years of age B. Has a BMI of 41 C. Adminsters NPH insulin each morning D. Past history of lymphoma E. Blood pressure averages 120/70 mm Hg

A. Assess temperature and initiate workup to rule out infection

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

A. The diet is less restricted and dialysis can be performed at home

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. Nonpalpable liver and spleen. C. Tympany on percussion of the abdomen.

A normal physical assessment finding of the GI system is/are (select all that apply) A. Nonpalpable liver and spleen. B. Borborygmi in upper right quadrant. C. Tympany on percussion of the abdomen. D. Liver edge 2 to 4 cm below the costal margin. E. Finding of a firm, nodular edge on the rectal examination.

D. "This is an easy way to rule out having colon cancer" (Fecal occult blood testing is a screening procedure for colon cancer)

A nurse in a clinic is instructing a client about a fecal occult blood test, which requires mailing three specimens. Which of the following statements by the client indicates understanding of the teaching? A. "I will continue taking my Coumadin while I complete these tests" B. "I'm glad I don't have to follow any special diet at this time" C. "This test determines if I have parasites in my bowel" D. "This is an easy way to rule out having colon cancer"

C. Direct billirubin 2.1 mg/dL

A nurse in a clinic is reviewing the lab reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. Serum albumin 4.1 g/dL B. WBC 9,511/uL C. Direct billirubin 2.1 mg/dL D. Serum cholesterol 171 mg/dL

A. "I will plan to limit fiber in my diet"

A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching? A. "I will plan to limit fiber in my diet" B. "I will eat my meals and plan fluid intake between meals" C. "I will switch to black tea instead of drinking coffee" D. "I will try to eat three moderate to large meals per day"

C. Monitor for orthostatic hypotension (The appropriate action by the nurse is to monitor for orthostatic hypotension because the antihypertensive effect of captopril results in a change in blood flow to the kidneys when an initial dose is administered.)

A nurse is administering captopril (Capoten) to a client during renography (kidney scan). Which of the following is an appropriate action by the nurse? A. Assess the client for hypertension B. Limit the client's fluid intake C. Monitor for orthostatic hypotension D. Encourage early ambulation

A. Fever B. Peripheral edema D. Dyspnea E. Proteinuria (A client who has acute glomerulonephritis may have a low-grade fever because of the possible streptococcus infection; Peripheral edema indicates fluid retention cause by fluid and sodium retention with acute glomerulonephritis; A client who has acute glomerulonephritis may display dyspnea because of fluid retention, causing pulmonary edema or congestive heart failure; A client who has acute glomerulonephritis will have protein loss in the urine because of glomeruli involvment)

A nurse is assessing a client who has a diagnosis of acute glomerulonephritis. Which of the following is an expected finding? (Select all that apply) A. Fever B. Peripheral edema C. Polyuria D. Dyspnea E. Proteinuria

C. Client reports having a sore throat

A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease. Which of the following assessment findings is the highest priority? A. Client reports difficulty sleeping B. Blood glucose at 0800 of 140 mg/dL C. Client reports having a sore throat D. Client reports gaining 4 lb in last 6 months

A. Blood pressure C. Urine output D. Serum creatinine E. Serum electrolytes (Assessment of blood pressure for hypotension in a client who has prerenal AKI should assest in determining hypovolemia; Assessment of urine output in a client who has prerenal AKI should assist in determining oliguria; Assessment of serum creatinine should assist in determining the extent of the AKI and the need for intervention; Assessment of serum electrolytes should assist in determining the extent of the AKI and the need for intervention)

A nurse is assessing a client who has prerenal acute kidney injury (AKI). Which of the following should the nurse include in the assessment? (Select all that apply) A. Blood pressure B. Cardiac enzymes C. Urine output D. Serum creatinine E. Serum electrolytes

C. Creatinine clearance of 48 mL/min/m2 (The creatinine clearance 24 hr urine is not within the expected reference range, indicating possible renal failure, and needs to be reported to the provider)

A nurse is assessing laboratory values for a client who may have acute glomerulonephritis. Which of the following findings should the nurse report to the provider? A. Urine specific gravity of 1.022 B. BUN of 16 mg/dL C. Creatinine clearance of 48 mL/min/m2 D. Potassium level of 4.2 mEq/L

D. Temperature elevation (Fever is an indication of bowel perforation during a paracentesis)

A nurse is caring for a client who had a paracentesis. Which of the following findings indicate the bowel was perforated during the procedure? A. Client report of upper chest pain B. Decreased urine output C. Pallor D. Temperature elevation

B. Presence of enzyme immunoassay (EIA)

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following is an expected lab finding? A. Presence of immunoglobin G antibodies (IgG) B. Presence of enzyme immunoassay (EIA) C. Aspartate aminotransferase (AST) 35 units/L D. Alanine aminotransferase (ALT) 15 IU/L

A. Emesis greater than 500mL with a fecal odor B. Report of spasmodic abdominal pain C. Pain relieved with vomiting

A nurse is caring for a client who has a small bowel obstruction from adhesions. Which of the following findings are consistent with this diagnosis? (Select all that apply) A. Emesis greater than 500mL with a fecal odor B. Report of spasmodic abdominal pain C. Pain relieved with vomiting D. Abdomen flat with rebound tenderness to palpation E. Laboratory findings indicating metabolic acidosis

A. Diuretic B. Beta-blocking agent D. Lactulose (Cephulac)

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply) A. Diuretic B. Beta-blocking agent C. Opioid analgesic D. Lactulose (Cephulac) E. Sedative

B. Glomerular filtration rate (GFR) 20 mL/min (The GFR is severely decreased to approximately 20 mL/min, which is indicative of stage 4 chronic kidney disease)

A nurse is caring for a client who has stage 4 chronic kidney disease. Which of the following is an expected laboratory finding? A. Blood urea nitrogen (BUN) 54 mg/dL B. Glomerular filtration rate (GFR) 20 mL/min C. Serum creatinine 1.2 mg/dL D. Serum potassium 5.0 mEq/L

A. Identify client allergy to seafood B. Hold metformin (Glucophage) for 24 hr C. Administer an enema E. Assess client for history of asthma (The client who has an allergy to seafood is at higher risk for an allergic reaction to the contrast dye used in the procedure; The client who takes metformin is at risk for lactic acidosis from the contrast dye with iodine used during the procedure; The client should receive an enema to remove fecal contents, fluid, and gas from the colon for a more clear visualization; A client who has a history of asthma has a higher risk for having an asthma attach as an allergic response to the contrast dye used during the procedure.)

A nurse is caring for a client who has type 2 diabetes mellitus and is to undergo excretory urography. Which of the following are appropriate nursing actions prior to this procedure? (Select all that apply) A. Identify client allergy to seafood B. Hold metformin (Glucophage) for 24 hr C. Administer an enema D. Obtain a client's serum coagulation profile E. Assess client for history of asthma

A. Remove the current bag and hang a new bag (The current bag of TPN should not hang more than 24 hr due to risk of infection)

A nurse is caring for a client who is receiving TPN solution. It has been 24 hours since the current bag of solution was hung, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? A. Remove the current bag and hang a new bag B. Infuse the remaining solution at the current rate and then hang a new bag C. Increase the infusion rate so the remaining solution is administered within the hour and hang a new bag D. Remove the current bag and hang a bag of lactated Ringers solution

C. Assess level of consciousness (The nurse should assess the client's level of consciousness. A change in urea levels can cause increased intracranial pressure, and subsequently, the client's level of consciousness is decreased.)

A nurse is caring for a client who is receiving hemodialysis and develops disequilibrium syndrome. Which of the following is an appropriate action by the nurse? A. Administer an opioid medication B. Monitor for hypertension C. Assess level of consciousness D. Increase the dialysis exchange rate

B. The client is having small, frequent liquid stools

A nurse is caring for an older adult client in an extended care facility. Which of the following indicates the client has a stool impaction causing a large intestine obstruction? A. The client reports he had a bowel movement yesterday B. The client is having small, frequent liquid stools C. The client is flatulent D. The client indicates he vomited once this morning

B. Change in orientation C. Asterixis E. Fetor hepaticus

A nurse is caring for client who has advanced cirrhosis with worsening hepatic encephalopathy. Which of the following is an expected finding? (Select all that apply) A. Anorexia B. Change in orientation C. Asterixis D. Ascites E. Fetor hepaticus

B. Urine specific gravity 1.040 C. Hematocrit 60% D. Serum potassium 3.0 mEq/L

A nurse is completing an admission assessment of a client who has a small bowel obstruction. Which of the following finding should the nurse report to the provider? (Select all that apply) A. Profuse emesis prior to insertion of the nasogastric tube B. Urine specific gravity 1.040 C. Hematocrit 60% D. Serum potassium 3.0 mEq/L E. WBC 10,000.uL

D. Epigastric pain radiating to left shoulder

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following is an expected finding? A. Pain in the right upper quadrant radiating to right shoulder B. Report of pain being worse when sitting upright C. Pain relieved with defecation D. Epigastric pain radiating to left shoulder

B. Drink canned protein supplements

A nurse is completing discharge teaching to a client who has Crohn's disease. Which of the following should be included in the teaching? A. Decrease intake of calorie-dense foods B. Drink canned protein supplements C. Take calcium supplements daily D. Take a bulk-forming laxative daily

D. Drink at least 2 L of fluids each day

A nurse is completing discharge teaching to a client who has irritable bowel syndrome. Which of the following should be included in the teaching? A. Increase dietary intake of dairy products B. Consume 15 to 20 g of fiber daily C. Plan three moderate to large meals per day D. Drink at least 2 L of fluids each day

C. Stoma should be moist and pink (A pink, moist stoma is an expected finding with a transverse colostomy)

A nurse is completing discharge teaching with a client who is 3 days postoperative for a transverse colostomy. Which of the following should be included in the teaching? A. Mucus will be present in stool for 5 to 7 days after surgery B. Expect 500 to 1000 mL of semi-liquid stoll after 2 weeks C. Stoma should be moist and pink D. Change the ostomy bag when it is 3/4 full

D. "I plan to drink regular cola"

A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client requires further teaching? A. "I plan to eat small, frequent meals" B. "I will eat easy-to-digest foods with limited spice" C. "I will use skim milk when cooking" D. "I plan to drink regular cola"

B. "You may have shoulder pain after surgery"

A nurse is completing preoperative teaching for a client who will undergo a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. "The scope will be passed through your rectum" B. "You may have shoulder pain after surgery" C. "The T-tube will remain in place for 1 to 2 weeks" D. "You should limit how often you walk for 1 to 2 weeks"

A. Increased flatulence can occur following the procedure B. NPO status should be maintained preprocedure (Increased flatulence can occur due to the instillation of air during the procedure; The client is instructed to remain NPO after midnight the night before the procedure)

A nurse is completing preprocedure teaching for a client who will undergo a sigmoidoscopy. Which of the following should be included in the teaching? (Select all that apply) A. Increased flatulence can occur following the procedure B. NPO status should be maintained preprocedure C. Conscious sedation is used D. Repositioning will occur throughout the procedure E. Fluid intake is limited the day after the procedure

D. Hand spasms present when blood pressure is checked

A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to be reported to the provider? A. History of cholelithiasis B. Serum amylase levels three times greater than the expected value C. Client report of severe pain radiating to the back that is rated at an "8" D. Hand spasms present when blood pressure is checked

A. Assess the client's airway (Using the airway, breathing, and circulation (ABC) priorit-setting framework, the priority intervention is airway maintenance)

A nurse is having difficulty arousing a client following an esophagogastroduodenoscopy (EGD). Which of the following is the priority action by the nurse? A. Assess the client's airway B. Allow the client to sleep C. Increase the rate of IV fluid administration D. Evaluate preprocedure laboratory findings

A. Heart rate 140/min B. Vertigo C. Muscle cramps D. Blood pressure 90/56 mm Hg (The client's heart rate of 140/min indicates tachycardia, which is a sign of hypovolemia caused by removal of blood plasma, which decreased fluid volume; Vertigo is a sign of hypovolemia caused by the removal of blood plasma, which decreases fluid volume; Muscle cramping is a sign of tetany caused by the removal of calcium with the blood plasma; The client's blood pressure of 90/56 mm Hg is a sign of hypovolemia caused by the removal of blood plasma, which decreases fluid volume

A nurse is monitoring a client who is receiving plasmapheresis. Which of the following should indicate to the nurse that the client is experiencing side effects from the procedure? (Select all that apply) A. Heart rate 140/min B. Vertigo C. Muscle cramps D. Blood pressure 90/56 mm Hg E. Tinnitus

B. Hemorrhage (Hemorrage is the most immediate client risk following a kidney biopsy if clotting does not occur at the puncture site.)

A nurse is monitoring for post operative complications in a client who had a kidney biopsy. Which of the following complications causes the most immediate risk to the client? A. Infection B. Hemorrhage C. Hematuria D. Kidney failure

A. Obtain a capillary blood glucose four times daily C. Monitor vital signs three times during the 12 hr shift D. Change the TPN tubing every 24 hours (The client is at risk for hyperglycemia during the administration of TPN and may require supplemental insulin; Vital signs are recommended every 4-8 hours to assess for fluid volume excess and infection; It is recommended to change the IV tubing that is used to administer TPN every 24 hours)

A nurse is planning care for a client who has a new prescription for total parental nutrition (TPN). Which of the following interventions should in included in the plan of care? (Select all that apply) A. Obtain a capillary blood glucose four times daily B. Administer prescribed medications through a secondary port on the TPN IV tubing C. Monitor vital signs three times during the 12 hr shift D. Change the TPN tubing every 24 hours E. Ensure a daily aPTT is obtained

C. Assess bowel sounds D. Provide oral hygiene every 2 hr E. Clamp the NG tube during ambulation

A nurse is planning care for a client who has a small bowel instruction and an NG tube in place. Which of the following nursing interventions should be included in the plan of care? (Select all that apply) A. Subtract the NG drainage from the client's output B. Irrigate the NG tube every 8 hr C. Assess bowel sounds D. Provide oral hygiene every 2 hr E. Clamp the NG tube during ambulation

A. Provide a high-protein diet B. Assess the urine for blood C. Monitor for intermittent anuria (The nurse should provide the client with a high-protein diet because of the right rate of protein breakdown that occurs with acute kidney injury; The nurse should assess the client's urine for blood, stones, and particles indicating an obstruction of the urinary structures that leave the kidney; The nurse should assess the client for intermittent anuria because of possible bilateral obstruction of the urinary structures that leave the kidney)

A nurse is planning care for a client who has postrenal acute kidney injury due to metastatic cancer. The client has a serum creatinine of 5 mg/dL. Which of the following are appropriate actions by the nurse? (Select all that apply) A. Provide a high-protein diet B. Assess the urine for blood C. Monitor for intermittent anuria D. Administer diuretic medication E. Provide NSAIDs for pain

C. Plan to administer a fluid challenge (The nurse should plan to administer a fluid challenge for hypovolemia, which is indicated by the client's low urinary output and blood pressure.)

A nurse is planning care for a client who has prerenal acute kidney injury following abdominal aortic aneurysm repair. The client's urinary output is 80 mL in the past 4 hr, and blood pressure is 92/58 mm Hg. Which of the following should be included in the plan of care? A. Prepare the client for a CAT scan with contrast dye B. Anticipate urine specific gravity to be 1.010 C. Plan to administer a fluid challenge D. Place client in Trendelenberg position

A. Assess for jugular vein distention B. Provide frequent mouth rinses C. Auscultate for a pleural friction rub E. Monitor for dysrhythmias (The nurse should assess for jugular vein distention, which may indicate fluid overload and congestive heart failure; The nurse should provide frequent mouth rinses due to uremic halitosis caused by urea waste in the blood; The nurse should auscultate for a pleural friction rub related to respiratory failure and pulmonary edema caused by acid base imbalances and fluid retention; The nurse should monitor for dysrhythmias related to increased serum potassium, which is not being excreted by the kidneys)

A nurse is planning care for a client who has stage 4 chronic kidney disease. Which of the following should the nurse include in the plan of care? (Select all that apply) A. Assess for jugular vein distention B. Provide frequent mouth rinses C. Auscultate for a pleural friction rub D. Assess using the Glasgow Coma scale E. Monitor for dysrhythmias

A. Monitor serum glucose levels B. Report cloudy dialysate return D. Assess for shortness of breath E. Check the access site dressing for wetness (The nurse should monitor serum glucose levels because the dialysate solution contains glucose; The nurse should monitor for cloudy dialysate return, which indicates an infection. Clean, light yellow solution is expected during the outflow process; The nurse should assess for shortness of breath, which may indicate the client's inability to tolerate a large volume of dialysate; The nurse should check the access site dressing for wetness and determine whether the tubing is kinked, pulled, clamped, or twisted, which can increase the risk for exit site infections)

A nurse is planning care for a client who is having peritoneal dialysis. Which of the following are appropriate nursing actions? (Select all that apply) A. Monitor serum glucose levels B. Report cloudy dialysate return C. Warm the dialysate in a microwave D. Assess for shortness of breath E. Check the access site dressing for wetness F. Maintain medical asepsis when accessing the catheter insertion site

A. Obtain daily weights B. Assess dressings for bloody drainage C. Replace hourly urine output with IV fluids E. Monitor serum electrolytes (Daily weights should be obtained by the nurse to assess the client's fluid status; Bloody drainage should be assessed by the nurse, which can indicate hemorrhage or hematoma; Hourly urine output with IV fluid replacement should be monitored by the nurse to detect abrupt decrease in urine output, which may indicate rejection or other serious conditions of the transplant kidney; Serum electrolytes should be monitored by the nurse, because electrolytes loss may occur with postoperative diuresis)

A nurse is planning postoperative care for a client who had kidney transplant surgery. Which of the following should the nurse include in the plan of care? (Select all that apply) A. Obtain daily weights B. Assess dressings for bloody drainage C. Replace hourly urine output with IV fluids D. Position in semi-Fowler's E. Monitor serum electrolytes

A. Check BUN and serum creatinine B. Administer medications held prior to dialysis C. Observe for signs of hypovolemia D. Assess the access site for bleeding (The nurse should check the BUN and serum creatinine to determine the presence and degree of uremia or waste products that remain following dialysis; Medications that can be partially dialysed during the treatment should be withheld. After the treatment, the nurse should administer the medications; A client who is post-dialysis is at risk for hypovolemia due to a rapid decrease in fluid volume; The nurse should assess site for bleeding because heparin is administered during the procedure to prevent clotting of blood with the dialyzing surfaces)

A nurse is planning postprocedure care for a client who received hemodialysis. Which of the following should the nurse include in the plan of care? (Select all that apply) A. Check BUN and serum creatinine B. Administer medications held prior to dialysis C. Observe for signs of hypovolemia D. Assess the access site for bleeding E. Evaluate blood pressure on side of AV access

B. Offer a glass of water following medication administration

A nurse is preparing to administer pancrelipase (Vlokase) to a client who has pancreatitis. Which of the following is an appropriate nursing action? A. Administer medication 30 min after a snack B. Offer a glass of water following medication administration C. Administer the medication 30 min before bed D. Sprinkle the contents on peanut butter

A. Review the client's current medication history B. Assess the client's arteriovenous fistula for a bruit D. Obtain the client's weight E. Check the client's serum electrolytes (Reviewing the client's current medication history will determine what medications to hold until after dialysis; Assessing the client's AV fistula for a bruit determines the patency of the fistula for dialysis; Obtaining the client's weight before dialysis is needed to compare with the client's weight after dialysis; Checking the client's serum electrolytes determines the need for dialysis)

A nurse is preparing to initiate hemodialysis for a client who has acute kidney injury and has been hospitalized. Which of the following are appropriate nursing actions? (Select all that apply) A. Review the client's current medication history B. Assess the client's arteriovenous fistula for a bruit C. Calculate the client's total urine output during the shift D. Obtain the client's weight E. Check the client's serum electrolytes F. Use the client's access site area for venipuncture

C. "The cause of the disease is not known." (With chronic glomerulonephritis, the kidney atrophies, and tissue is not available for biopsy and diagnosis, making it difficult to determine the cause.)

A nurse is presenting information to a client who has a new diagnosis of chronic glomerulonephritis. Which of the following nursing statements is appropriate? A. "A high-sodium diet is recommended." B. "The destruction of the glomeruli occurs rapidly." C. "The cause of the disease is not known." D. "To compensate, the number of functioning nephrons is increased."

B. Apply a dry, sterile dressing (Application of a sterile dressing will contain the drainage and allow continuous assessment of color and quantity)

A nurse is providing care to a client who is 1 day postoperative paracentesis. The nurse observes clear, pale-yellow fluid leaking from the operative site. Which of the following is an appropriate nursing intervention? A. Place a clean towel near the drainage site B. Apply a dry, sterile dressing C. Attach an ostomy bag D. Place the client in a supine position

B. Clamp T-tube for 1 to 2 hr before and after meals E. Empty drainage bag every 8 hr

A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? (Select all that apply) A. Take baths rather than showers B. Clamp T-tube for 1 to 2 hr before and after meals C. Keep the drainage system above the level of the gallbladder D. Expect to have constipation E. Empty drainage bag every 8 hr

B. "Monitoring electrolytes frequently determines kidney status." C. "Scheduled kidney biopsies determine kidney status." D. "Restarting dialysis depends on marked azotemia" E. "Plan to have the immunosuppressive medication increased" (Frequent monitoring of electrolyte studies determines the progression of kidney failure and the need for dialysis; Kidney biopsies do determine the progression of kidney failure and the need for dialysis; Marked azotemia does determine the progression of kidney failure and the need to restart this treatment; Increasing immunosuppressive medication may suppress the progression of kidney failure and the need to restart this dialysis)

A nurse is providing information to a client who has chronic rejection of a transplanted kidney. Which of the following statements should the nurse include? (Select all that apply) A. "Immediate removal of the donor kidney is planned." B. "Monitoring electrolytes frequently determines kidney status." C. "Scheduled kidney biopsies determine kidney status." D. "Restarting dialysis depends on marked azotemia" E. "Plan to have the immunosuppressive medication increased"

B. Pitting edema (Pitting edema is an indication of fluid overload, a manifestation of a complication of acute glomerulonephritis)

A nurse is providing teaching on the manifestation of complications to a client who has acute glomerulonephritis. Which of the following complications should the client report to the provider? A. Dry cough B. Pitting edema C. Weight gain of 2 lb in 1 week D. Temperature of 98.4F

D. Hemodialysis returns a balance to serum electrolytes (Hemodialysis returns a balance to serum electrolytes by removing excess sodium, potassium, fluids, and waste products; and restores acid-base balance)

A nurse is providing teaching to a client who has chronic kidney disease and is to start hemodialysis. Which of the following information should the nurse include in the teaching? A. Hemodialysis restores renal function B. Hemodialysis replaces hormonal function of the renal system C. Hemodialysis allows an unrestricted diet D. Hemodialysis returns a balance to serum electrolytes

D. "The procedure determines whether a kidney stone is present." (A KUB can identify renal calculi, strictures, calcium deposits, or obstructions.)

A nurse is providing teaching to a client who is to have an x-ray of the kidneys, ureters, and bladders (KUB). Which of the following statements should the nurse include in the teaching? A. "Contrast dye is given 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 a kidney stone is present."

C. "Notify the provider if you experience a sore throat"

A nurse is reinforcing teaching for a client who has a prescription for sulfsalazine (Azulfidine). Which of the following should the nurse include in the teaching? A. "Take the medication 1 or 2 hr after eating" B. "This medication may cause yellowing of the sclera" C. "Notify the provider if you experience a sore throat" D. "This medication may cause your stools to turn black"

C. Obtain a clean-catch urine specimen for culture and sensitivity. (Obtaining a clean-catch urine specimen for culture and sensitivity is an appropriate nursing action because this determines the antibiotic that will be most effective for treatment of the urinary tract infection.)

A nurse is reviewing a client's laboratory findings for urinalysis. The findings indicate the urine is positive for leukoesterase and nitrites. Which of the following is an appropriate nursing action? A. Repeat the test early the next 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 urinary catheter to collect a urine sample.

D. This medication dissolves gall stones

A nurse is reviewing a new prescription for ursodiol (Ursodeoxycholic Acid) with a client who has cholelithiasis. Which of the following should be included in the teaching A. This medication reduces biliary spasms B. This medication reduces inflammation in the biliary tract C. This medication dilates the bile duct to promote passage of bile D. This medication dissolves gall stones

A. Brownie with nuts

A nurse is reviewing nutrition teaching for a client who has cholecystitis. Which of the following food choices can trigger cholecystitis? A. Brownie with nuts B. Bowl of mixed fruit C. Grilled turkey D. Baked potato

A. Check with the provider about taking current medications when consuming bowel prep (Some medications may be withheld when taking Golytely due to their risk of absorption. This should be discussed with the provider)

A nurse is reviewing the bowel prep using polyethylene glycol (Golytely) with a client scheduled for a colonoscopy. Which of the following should be included in the teaching? A. Check with the provider about taking current medications when consuming bowel prep B. Consume a normal diet until starting the bowel prep C. The bowel prep will not begin acting until the day after it is consumed D. The bowel prep may be discontinued once feces start to be expelled

C. Inspect the skin around the umbilicus

A nurse is reviewing the health record of a client who has pancreatitis. The physical exam report by the provider indicates the presence of Cullen's sign. Which of the following is an appropriate action by the nurse to identify this finding? A. Tap lightly at the costovertebral margin on the client's back B. Palpate the client's right lower quadrant C. Inspect the skin around the umbilicus D. Auscultate the area below the client's scapula

C. Gastrointestinal x-ray with contrast (A gastrointestinal x-ray with contrast involves the client drinking barium, which is then traced through the small intestine to the junction with the colon. This would identify a tumor in the jejunum)

A nurse is reviewing the health record of a client who is being admitted with a suspected tumor of the jejunum. The nurse should anticipate a prescription for which of the following tests? A. Serum alpha-fetoprotein B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Gastrointestinal x-ray with contrast D. Urine bilirubin

B. Increased erythrocyte sedimentation rate (ESR) C. Increased WBC

A nurse is reviewing the lab findings of a client who has an acute exacerbation of Crohn's disease. Which of the following lab findings is indicative of Crohn's disease? (Select all that apply) A. Increased hematocrit B. Increased erythrocyte sedimentation rate (ESR) C. Increased WBC D. Increased folic acid E. Increased serum albumin

A. Limit physical activity B. Avoid alcohol E. Eat small frequent meals

A nurse is teaching a client who has hepatitis A about home care. Which of the following should the nurse include in the teaching? (Select all that apply) A. Limit physical activity B. Avoid alcohol C. Take acetaminophen for comfort D. Wear a mask when in public places E. Eat small frequent meals

C. Take a magnesium supplement (The client should take a magnesium supplement, because magnesium is lost when taking cyclosporine)

A nurse is teaching diet recommendations to a client who had a kidney transplant and is taking cyclosporine (Neoral). Which of the following recommendations should the nurse include in the teaching? A. Decrease protein rich foods B. Drink grapefruit juice C. Take a magnesium supplement D. Restrict intake of bananas and raisins

D. Provide a high-calorie, high-carbohydrate diet

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A. Initiate contact precautions B. Weight client weekly C. Measure abdominal girth 3 in above the umbilicus D. Provide a high-calorie, high-carbohydrate diet

A. Anuria B. Marked azotemia C. Crackles in the lungs E. Proteinuria (Anuria indicates the client has end-stage kidney disease, necessitating kidney transplantation as a treatment; Marked azotemia is elevated BUN and serum creatinine, indicates the client has end-stage kidney disease, necessitating kidney transplantation as a treatment; Crackles in the lungs can indicate the client has pulmonary edema, caused from end-stage kidney disease necessitating kidney transplantation as a treatment; Proteinuria indicates the client has end-stage kidney disease, necessitating kidney transplantation as a treatment)

A nurse who is a member of the transplant team is assessing information on a client who has end-stage kidney disease. Which of the following client indications should the nurse expect to find? (Select all that apply) A. Anuria B. Marked azotemia C. Crackles in the lungs D. Increased calcium levels E. Proteinuria

B. Bilirubin is not being conjugated and excreted into the bile by the liver.

A patient has an elevated blood level of indirect (unconjugated) bilirubin. One cause of this finding is that A. The gallbladder is unable to contract to release stored bile. B. Bilirubin is not being conjugated and excreted into the bile by the liver. C. The Kupffer cells in the liver are unable to remove bilirubin from the blood. D. There is an obstruction in the biliary tract preventing flow of bile into the small intestine.

D. Chart is an a normal observation

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. Chart is an a normal observation

D. Parasympathetic stimulation

A patient is admitted to the hospital with a diagnosis of diarrhea with dehydration. The nurse recognizes that increased peristalsis resulting in diarrhea can be related to A. Sympathetic inhibition B. Mixing and propulsion C. Sympathetic stimulation D. Parasympathetic stimulation

A. Progressive irreversible destruction of the kidneys

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. Administer opioids as prescribed

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 3-4 L/day D. Keep the patient NPO in preparation for surgery

A. Decreased bile flow into the intestine.

A patient is jaundiced and her stools are clay colored (gray). This is most likely related to A. Decreased bile flow into the intestine. B. Increased production of urobilinogen. C. Increased production of cholecystokinin. D. Increased bile and bilirubin in the blood.

B. Encouraging fluids of at least 2-3 L/day after nausea has subsided

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 2-3 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

C. Follow-up colonoscopies will be needed to ensure that the cancer does not recur.

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that A. Chemotherapy will begin after the patient recovers from the surgery. B. Both chemotherapy and radiation can be used as palliative treatments. C. Follow-up colonoscopies will be needed to ensure that the cancer does not recur. D. A wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

B. Release of bicarbonate by the pancreas.

As gastric contents move into the small intestine, the bowel is normally protected from the acidity of gastric contents by the A. Inhibition of secretin release. B. Release of bicarbonate by the pancreas. C. Release of pancreatic digestive enzymes. D. Release of gastrin by the duodenal mucosa.

A. Rebound abdominal pain.

Assessment findings suggestive of peritonitis include A. Rebound abdominal pain. B. A soft, distended abdomen. C. Dull, continuous abdominal pain. D. Observing that the patient is restless

D. Serum creatinine or urine output from baseline

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

B. Listen in the epigastrium and all four quadrants for 2 minutes for bowel sounds.

During an examination of the abdomen the nurse should A. Position the patient in the supine position with the bed flat and knees straight. B. Listen in the epigastrium and all four quadrants for 2 minutes for bowel sounds. C. Use the following order of techniques: inspection, palpation, percussion, auscultation. D. Describe bowel sounds as absent if no sound is heard in the lower right quadrant after 2 minutes.

B. ECG changes D. Pulmonary Edema

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

A. Increase fluid intake.

The appropriate collaborative therapy for the patient with acute diarrhea caused by a viral infection is to A. Increase fluid intake. B. Administer an antibiotic. C. Administer antimotility drugs. D. Quarantine the patient to prevent spread of the virus.

D. Decreased colloidal osmotic pressure caused by loss of serum albumin

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

B. Deposition of immune complexes and complement along the GBM

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 contained in the GBM

A. A sigmoid colostomy.

The nurse explains to the patient undergoing ostomy surgery that the procedure that maintains the most normal functioning of the bowel is A. A sigmoid colostomy. B. A transverse colostomy. C. A descending colostomy. D. An ascending colostomy.

B. Tobacco use

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

A. Persistent abdominal pain. B. Marked abdominal distention.

The nurse performs a detailed assessment of the abdomen of a patient with a possible bowel obstruction, knowing that manifestations of an obstruction in the large intestine are (select all that apply) A. Persistent abdominal pain. B. Marked abdominal distention. C. Diarrhea that is loose or liquid. D. Colicky, severe, intermittent pain. E. Profuse vomiting that relieves abdominal pain.

D. Adult-onset polycystic kidney disease

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

B. Urinate before and after sexual intercourse

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

C. Hypokalemia and hyponatremia

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

B. Often has no symptoms.

In contrast to diverticulitis, the patient with diverticulosis A. Has rectal bleeding. B. Often has no symptoms. C. Has localized cramping pain. D. Frequently develops peritonitis.

C. Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy.

In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between ulcerative colitis and Crohn's disease is that Crohn's disease A. Frequently results in toxic megacolon. B. Causes fewer nutritional deficiencies than ulcerative colitis. C. Often recurs after surgery, whereas ulcerative colitis is curable with a colectomy. D. Is manifested by rectal bleeding and anemia more frequently than is ulcerative colitis.

A. Teaching the patient to use Kegel exercises.

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.

B. Sedation may be used during the procedure.

In preparing a patient for a colonoscopy, the nurse explains that A. A signed permit is not necessary. B. Sedation may be used during the procedure. C. Only one cleansing enema is necessary for preparation. D. A light meal should be eaten the day before the procedure.

D. An ascending infection

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 infections D. An ascending infection

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

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

A. Gastroenteritis B. Ectopic pregnancy C. Gastrointestinal bleeding D. Irritable bowel syndrome E. Inflammatory bowel disease

When a 35-year-old female patient is admitted to the emergency department with acute abdominal pain, which possible diagnosis should you consider that may be the cause of her pain (select all that apply)? A. Gastroenteritis B. Ectopic pregnancy C. Gastrointestinal bleeding D. Irritable bowel syndrome E. Inflammatory bowel disease

C. "Have you traveled to a foreign country in the last year?"

When the nurse is assessing the health perception-health maintenance pattern as related to GI function, an appropriate question to ask is A. "What is your usual bowel elimination pattern?" B. "What percentage of your income is spent on food?" C. "Have you traveled to a foreign country in the last year?" D. "Do you have diarrhea when you are under a lot of stress?"

A. Primary cause of death is infection C. Disease course is potentially reversible

Which descriptions characterized 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 neuropathy E. Cardiovascular disease is most common cause of death

B. Has a loss of taste buds, especially for sweet and salt.

An 80-year-old man states that, although he adds a lot of salt to his food, it still does not have much taste. The nurse's response is based on the knowledge that the older adult A. Should not experience changes in taste. B. Has a loss of taste buds, especially for sweet and salt. C. Has some loss of taste but no difficulty chewing food. D. Loses the sense of taste because the ability to smell is decreased.

A. Successful transplantation usually provides better quality of life than that offered by dialysis

An ESKD 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. 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

Nurses need to teach patients at risk for developing chronic kidnye 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. 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

Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements would be considered true related to nutritional therapy? 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. Increased fluid intake and a diet with potassium-rich foods are hallmarks of a diet for a patient receiving hemodialysis

A. Promote early diagnosis and treatment of sore throats and skin lesions

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 patiens 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. Hypertension B. Vascular calcifications D. Hyperinsulinemia causing dyslipidemia

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