Genitourinary Disorders Practice Questions

The client asks, "What does an elevated PSA test mean?" On which scientific rationale should the nurse base the response? 1. An elevated PSA can result from several different causes. 2. An elevated PSA can be only from prostate cancer. 3. An elevated PSA can be diagnostic for testicular cancer. 4. An elevated PSA is the only test used to diagnose BPH.

Answer: 1 1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct. 2. An elevated PSA does not indicate only prostate cancer. 3. PSA does not diagnose testicular cancer. 4. An elevated PSA and digital examination are used in combination to diagnose BPH or prostate cancer. TEST-TAKING HINT: Answer options "2" and "4" have the word "only"; an absolute word should cause the test taker to eliminate them as possible answers. Options with words such as "always," "never," and "only" are usually incorrect.

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods containing cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one vitamin a day with extra calcium."

Answer: 1 1. An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate. 2. Cocoa and chocolate are high in calcium and should be avoided or the amount should be decreased to help prevent the formation of calcium phosphate renal stones. 3. Physical activity prevents bone absorption and possible hypercalciuria; therefore, the nurse should instruct the client to walk daily to help retain calcium in bone. 4. The renal calculi are caused by calcium; therefore, the client should not increase calcium intake. TEST-TAKING HINT: This is a urinary problem and fluid is a priority. Therefore, the test taker should select an option addressing fluid, and there is only one option addressing oral intake.

The older client presents to the emergency department reporting burning on urination with an urgency to void, and a temperature of 99.8°F. Which intervention should the nurse implement first? 1. Ask the client to provide a clean voided midstream urine for culture. 2. Insert an 18-gauge peripheral IV catheter and start normal saline fluids. 3. Arrange for the client to be admitted to the medical unit. 4. Initiate the ordered intravenous antibiotic medication.

Answer: 1 1. Before the other options are performed, the nurse should have a urine culture specimen sent to the laboratory for culture. A culture is indicated from the symptoms. 2. The IV catheter will be required before being able to initiate the antibiotic, but getting the urine culture is first. 3. The urine culture is first. 4. The urine culture is first so that treatment can be initiated. TEST-TAKING HINT: Basic nursing principles are applied in test questions, such as the results of cultures will be skewed if the sample is collected after antibiotics have been initiated.

The nurse is caring for a client diagnosed with AKI. Which laboratory values are most significant for diagnosing AKI? 1. BUN and creatinine. 2. WBC and hemoglobin. 3. Potassium and sodium. 4. Bilirubin and ammonia level.

Answer: 1 1. Blood urea nitrogen (BUN) levels reflect the balance between the production and excretion of urea from the kidneys. Creatinine is a by-product of the metabolism of the muscles and is excreted by the kidneys. Creatinine is the ideal substance for determining renal clearance because it is relatively constant in the body and is the laboratory value most significant in diagnosing kidney injury. 2. WBCs (white blood cells) are monitored for infection, and hemoglobin is monitored for blood loss. 3. Potassium (intracellular) and sodium (interstitial) are electrolytes and are monitored for a variety of diseases or conditions not specific to renal function. Potassium levels will increase with renal failure, but the level is not a diagnostic indicator for kidney injury. 4. Bilirubin and ammonia levels are laboratory values determining the function of the liver, not the kidneys. TEST-TAKING HINT: The nurse must know specific laboratory tests for specific organ functioning or conditions. This is memorizing, but it must be done.

The client is reporting chills, fever, and left costovertebral pain. Which diagnostic test should the nurse expect the HCP to prescribe first? 1. A midstream urine for culture. 2. A sonogram of the kidney. 3. An intravenous pyelogram for renal calculi. 4. A CT scan of the kidneys.

Answer: 1 1. Fever, chills, and costovertebral pain are clinical manifestations of a urinary tract infection (acute pyelonephritis), which requires a urine culture first to confirm the diagnosis. 2. A sonogram of the kidney might be ordered if the client has recurrent UTIs to determine if a physical obstruction is causing the recurrent infections but not as the first diagnostic procedure. 3. An intravenous pyelogram is rarely used to determine pyelonephritis because the results are negative 75% of the time in clients diagnosed with acute pyelonephritis. 4. A CT scan might be ordered if other tests have not been conclusive. TEST-TAKING HINT: The question asks which test should be ordered first, and the test taker should determine what the clinical manifestations might be indicating. Fever and chills indicate an infection. The anatomical position of the costovertebral angle (the flank area between a rib and a vertebra) should alert the test taker to the kidney area of the body. A urine culture is most likely to determine if a kidney infection is present.

The client is admitted to the emergency department after a gunshot wound to the abdomen. Which nursing intervention should the nurse implement first to prevent AKI? 1. Administer normal saline IV. 2. Take vital signs. 3. Place the client on telemetry. 4. Assess abdominal dressing.

Answer: 1 1. Preventing and treating shock with blood and fluid replacement will prevent AKI from hypoperfusion of the kidneys. Significant blood loss is expected in the client diagnosed with a gunshot wound. 2. Taking and evaluating the client's vital signs is an appropriate action, but regardless of the results, this will not prevent AKI. 3. Placing the client on telemetry is an appropriate action, but telemetry is an assessment tool for the nurse and will not prevent AKI. 4. Assessment is often the first action, but assessing the abdominal dressing will not help prevent AKI. TEST-TAKING HINT: The test taker must read the stem carefully and understand what the question is asking. Options "2," "3," and "4" are all forms of assessment and do not help prevent AKI because they are not treatments.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical floor. Which nursing task is most appropriate for the registered nurse (RN) to delegate? 1. Collect a clean voided midstream urine specimen. 2. Evaluate the client's 8-hour intake and output. 3. Assist in checking a unit of blood before hanging. 4. Administer a cation-exchange resin enema.

Answer: 1 1. The UAP can collect specimens. Collecting a midstream urine specimen requires the client to clean the perineal area, to urinate a little, and then collect the rest of the urine output in a sterile container. 2. The UAP can obtain the client's intake and output, but the nurse must evaluate the data to determine if interventions are needed or if interventions are effective. 3. Two RNs must check the unit of blood at the bedside before administering it. 4. This is a medication enema, and UAPs cannot administer medications. Also, for this to be ordered, the client must be unstable with an excessively high serum potassium level. TEST-TAKING HINT: Nursing tasks not delegated to a UAP include any task requiring nursing judgment, medication administration, teaching, evaluating, or assessing.

The client receiving dialysis is reporting being dizzy and light-headed. Which action should the nurse implement first? 1. Place the client in the Trendelenburg position. 2. Turn off the dialysis machine immediately. 3. Bolus the client with 500 mL of normal saline. 4. Notify the health-care provider as soon as possible.

Answer: 1 1. The nurse should place the client's chair with the head lower than the body, which will shunt blood to the brain; this is the Trendelenburg position. 2. The blood in the dialysis machine must be infused back into the client before the machine is turned off. 3. Normal saline infusion is the last resort because one of the purposes of dialysis is to remove excess fluid from the body. 4. Hypotension is an expected occurrence in clients receiving dialysis; therefore, the HCP does not need to be notified. TEST-TAKING HINT: The Trendelenburg position is often used as a distracter in questions, and the nurse needs to know it is only used in cases where blood needs to be shunted to the brain.

The female client diagnosed with bladder cancer has a cutaneous urinary diversion and states, "Will I be able to have children now?" Which statement is the nurse's best response? 1. "Cancer does not make you sterile, but sometimes the therapy can." 2. "Are you concerned you can't have children?" 3. "You will be able to have as many children as you want." 4. "Let me have the chaplain come to talk with you about this."

Answer: 1 1. This client is asking for information and should be provided with factual information. The surgery will not make the client sterile, but chemotherapy can induce menopause and radiation therapy to the pelvis can render a client sterile. 2. This is a therapeutic response, but the client asked for information. 3. This is a false statement and lying to the client. 4. This is outside the realm of a chaplain. TEST-TAKING HINT: When the stem has the client asking for specific information, then the nurse should provide the correct information. It is easy to confuse these questions with ones requiring therapeutic responses.

Which statement indicates discharge teaching has been effective for the postoperative TURP client? 1. "I will call the surgeon if I experience any difficulty urinating." 2. "I will take my finasteride daily, the same as before my surgery." 3. "I will continue restricting my oral fluid intake." 4. "I will take my pain medication routinely even if I do not hurt."

Answer: 1 1. This indicates the teaching is effective. 2. Clients do not need to take finasteride (Proscar) postoperatively. 3. There is no reason to restrict the client's fluid intake. 4. Pain medication should be taken as needed. TEST-TAKING HINT: If the test taker is not sure of the correct answer, selecting an option addressing notifying an HCP is usually an appropriate choice.

The client diagnosed with CKD is prescribed a 60-gm protein, 2,000-mg sodium diet. Which food choices indicate the client understands the dietary restrictions? 1. A 4-ounce grilled chicken breast, broccoli, and small glass of unsweet tea. 2. Baked potato with chopped ham and sour cream, 12-ounce steak, and beer. 3. Double patty cheeseburger, french fries, and an artificially sweetened beverage. 4. Roast beef sandwich, potato chips, and soft drink.

Answer: 1 1. This meal has a small portion of protein and does not contain sodium if the client does not add salt. 2. Ham and sour cream are high in sodium content, and 12 ounces of protein is too much for the client. 3. Double burger patties are too much protein, and cheese is high in sodium. 4. Potato chips are high in sodium, and the roast beef could be too much protein. TEST-TAKING HINT: Dietary menus and questions are some of the least favorites of many test takers. Basic rules include, if a choice exists between grilled or fried foods, choose grilled, between chicken or beef, choose chicken. Fresh vegetables are usually better than canned or frozen.

The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care? 1. Provide meticulous skin care and pouching. 2. Apply sterile drainage bags daily. 3. Monitor the pH of the urine weekly. 4. Assess the stoma site every day.

Answer: 1 1. Urine is acidic, and the abdominal wall tissue is not designed to tolerate acidic environments. The stoma is pouched so the urine will not touch the skin. 2. Urinary diversion drainage bags are changed every 4 to 5 days so the skin can remain intact; the bags should be clean but not sterile. 3. The urine will have a normal pH of all urine; it is not necessary to monitor the pH. 4. The stoma should be assessed a minimum of every 2 hours initially, then every 4 hours. TEST-TAKING HINT: The test taker should look at time frames—daily and weekly. If the time frame is not sufficient, then the option can be eliminated as a possible correct answer.

Which information regarding the care of a cutaneous ileal conduit should the nurse discuss with the client? 1. Teach the client to instill a few drops of vinegar into the pouch. 2. Tell the client the stoma should be slightly dusky colored. 3. Inform the client that large clumps of mucus are expected. 4. Tell the client it is normal for the urine to be pink or red in color.

Answer: 1 1. Vinegar will act as a deodorizing agent in the pouch and help prevent a strong urine smell. 2. The stoma should be pink and moist at all times. A dusky color indicates a compromised blood supply to the stoma, and the HCP should be notified immediately. 3. There will be mucus in the urine because of the tissue used to create the diversion, but large clumps of mucus could occlude the stoma or ureters. 4. Urinary drainage should be a pale yellow to amber color. The procedure does not change the color of the urine. TEST-TAKING HINT: A dusky color is never normal when discussing body functioning. There are very few procedures for which bloody urine is a normal expectation.

The client is diagnosed with AKI. Which clinical manifestations indicate to the nurse the client is in the recovery period? Select all that apply. 1. Increased alertness and no seizure activity. 2. Increase in hemoglobin and hematocrit. 3. Denial of nausea and vomiting. 4. Decreased urine-specific gravity. 5. Increased serum creatinine level.

Answer: 1, 2, 3 1. AKI affects almost every system in the body. Neurologically, the client may have drowsiness, headache, muscle twitching, and seizures. In the recovery period, the client is alert and has no seizure activity. 2. In renal failure, levels of erythropoietin are decreased, leading to anemia. An increase in hemoglobin and hematocrit indicates the client is in the recovery period. 3. Nausea, vomiting, and diarrhea are common in the client diagnosed with AKI; therefore, an absence of these indicates the client is in the recovery period. 4. The client in the recovery period has an increased urine-specific gravity. 5. The client in the recovery period has a decreased serum creatinine level. TEST-TAKING HINT: This is an alternate-type question in which the test taker may choose as many correct answers as warranted. The test taker should not immediately assume that the option mentioning urine is the correct answer. The nurse must realize kidney injury affects every body system.

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the RN implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting a collection. 3. Collect all urine for 24 hours and place it in the appropriate specimen container. 4. Insert an indwelling catheter in the client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

Answer: 1, 2, 3 1. The HCP may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. 2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. 3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result. 4. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized. 5. The RN can delegate placing the urine output in the proper container to the UAP; therefore, the UAP does not need to notify the nurse when the client urinates. TEST-TAKING HINT: This is an alternate-type question that has more than one correct answer. The test taker must have knowledge of specific laboratory tests.

The nurse is caring for a 1-year-old client diagnosed with chronic pyelonephritis. Which assessment data support the diagnosis of chronic pyelonephritis? Select all that apply. 1. Fever. 2. Flank pain. 3. Failure to thrive. 4. Fifth disease. 5. Hypertension.

Answer: 1, 2, 3, 5 1. Fever can be noted in children diagnosed with chronic pyelonephritis. 2. Flank pain or dysuria are clinical manifestations of chronic pyelonephritis. 3. Failure to thrive may be noted in young children with a diagnosis of chronic pyelonephritis. 4. Fifths disease is not associated with chronic pyelonephritis. 5. Some children with chronic pyelonephritis can be hypertensive. TEST-TAKING HINT: The key to this question is the age of the client. The test taker must be aware of the clinical manifestations of disease processes in all ages of clients. Chronic pyelonephritis occurs more often in infants and children younger than 2 years old than in older children and adults.

The client diagnosed with CKD is prescribed hemodialysis on Monday, Wednesday, and Friday. Which interventions should the dialysis nurse implement? Select all that apply. 1. Weigh the client before and after each treatment. 2. Discuss the recommended fluid restriction. 3. Provide potato chips or pretzels as a snack. 4. Monitor the hemodialysis access site continuously. 5. Keep up a lively conversation during the treatments.

Answer: 1, 2, 4 1. These are called the pre- and post-weights. The pre-weight is used to determine the amount of fluid to be removed during the treatment, and the post-weight is used to determine if the goal was met. 2. Clients experiencing renal failure are not processing the fluids in their bodies. Fluid restrictions are prescribed to allow for some fluid so the client does not become dehydrated but limited so the heart is not overtaxed, causing the client to go into heart failure. 3. Potato chips and pretzels are high in sodium content and could increase a problem with fluid retention. 4. The client's entire blood supply is being removed from the body and then returned after being filtered. The client could bleed to death in a matter of minutes if the access becomes dislodged. 5. Most clients develop a routine of resting during the treatments. The nurse should not keep the client from being able to rest, read, or watch television. TEST-TAKING HINT: This is an alternative format question requiring the test taker to identify each intervention performed by the nurse during hemodialysis. The test taker should be familiar with the basic steps of the dialysis process.

The nurse identifies the concepts of elimination and immunity for a female client diagnosed with a UTI. Which discharge instructions should the nurse provide the client? Select all that apply. 1. Teach the client to wipe from front to back after voiding. 2. Encourage the client to drink cranberry juice each morning. 3. Inform the client that frequent episodes of incontinence are expected. 4. Discuss the clinical manifestations of a recurrent infection. 5. Have the client fill a container of water to sip until at least 2,000 mL are consumed. 6. Request that the client sit in a tub of warm water twice a day for 25 minutes.

Answer: 1, 2, 4, 5 1. A female client should be taught to wipe the meatus and vaginal area from front to back to avoid contaminating the urethra (urinary orifice) with fecal matter. 2. Cranberry juice is acidic and changes the pH of the urine, making the environment less conducive to bacterial growth. 3. Incontinence is not expected for a client diagnosed with a UTI. 4. The client should be taught about the clinical manifestations of a UTI so she can know when to notify the HCP. 5. The client should increase the intake of water to at least 2000 mL/24 hours in order to flush the bacteria from the urinary system. 6. Sitting in a tub of water increases the risk of bacteria entering the urethra. TEST-TAKING HINT: The test taker must remember basic nursing care. Several options are basic nursing interventions.

The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? Select all that apply. 1. Place the solution on an IV pump at the prescribed rate. 2. Monitor blood glucose every 6 hours. 3. Weigh the client weekly, first thing in the morning. 4. Change the IV tubing every 3 days. 5. Monitor intake and output every shift.

Answer: 1, 2, 5 1. TPN is a hypertonic solution with enough calories, proteins, lipids, electrolytes, and trace elements to sustain life. It is administered via a pump to prevent too rapid infusion. 2. TPN contains a 50% dextrose solution; therefore, the client is monitored to ensure the pancreas is adapting to the high glucose levels. 3. The client is weighed daily, not weekly, to monitor for fluid overload. 4. The IV tubing is changed with every bag because the high glucose level can cause bacterial growth. 5. Intake and output are monitored to observe for fluid balance. TEST-TAKING HINT: Options "3" and "5" refer to the same factor—namely, fluid level. The test taker should then determine if the time factors are appropriate. Weekly weighing is not appropriate, so option "3" can be eliminated.

The client diagnosed with cancer of the bladder is undergoing intravesical chemotherapy. Which instructions should the nurse provide the client about the procedure? Select all that apply. 1. Instruct the client to restrict fluids 4 hours before the procedure. 2. Teach not to empty the bladder for 1 to 2 hours after the procedure. 3. Explain that the client will need to administer filgrastim at home. 4. Have the client take acetaminophen before coming to the clinic. 5. Tell the client to sit to avoid urine splashing after the procedure.

Answer: 1, 2, 5 1. The client should restrict fluid intake, caffeinated beverages, and the use of diuretics 4 hours prior to the procedure. 2. The client will need to avoid emptying the bladder for 1 to 2 hours after the procedure. 3. The advantage of administering chemotherapy intravesically is that the systemic side effects of bone marrow suppression are avoided. Filgrastim (Neupogen), a biologic response modifier, is used to stimulate the production of WBCs, so a client is not at risk for developing an infection and is not necessary. 4. The procedure is not painful, so acetaminophen (Tylenol), an analgesic, is not needed. The client may use acetaminophen or ibuprofen for postprocedure body aches or fever. 5. After the procedure, for the first void and the next 6 hours, the client should sit to avoid urine splashing, avoid public toilets or urinating outside, and should be taught the use of bleach to clean the toilet after voiding at home. TEST-TAKING HINT: If the test taker is not aware of the term "intravesical," then dividing the word into its components may be useful. Intra- means "into" and vesical means "bladder." The test taker should choose options that have a direct effect on urine production and elimination.

The nurse is developing a care map for a client diagnosed with chronic kidney disease (CKD) on hemodialysis. Which interrelated concepts should be included in the map? Select all that apply. 1. Fluid and electrolytes. 2. Hematologic regulation. 3. Digestion. 4. Metabolism. 5. Mobility. 6. Nutrition.

Answer: 1, 2, 6 1. The balance of fluids and electrolytes is regulated by the kidneys. 2. Hematologic regulation is an interrelated concept because the client on dialysis does not have a functioning kidney to produce erythropoietin to stimulate the bone marrow to produce red blood cells. In addition, removal of the entire circulating blood three times a week through the dialysis machine places stress on the red blood cells, and they do not last as long as in a nondialyzed body. 3. The CKD client does not have an issue with digestion unless there is a comorbid condition that involves a lack of mobility. 4. The CKD client does not have an issue with metabolism unless there is a comorbid condition that involves a lack of mobility. 5. The CKD client does not have an issue with mobility unless there is a comorbid condition that involves a lack of mobility. 6. Nutrition is an issue because the client must adhere to a restricted diet to decrease the number of toxic metabolites not being eliminated through the kidneys. TEST-TAKING HINT: The test taker must remember the entire client when determining the client's needs and problems, including knowing the pathology of the disease process and how it affects other systems in the body.

The client returned from surgery after having a TURP with cool and clammy skin, and the vitals populated in the flowsheet below. Which interventions should the nurse implement? Select all that apply. - BP: 90/40 - Temp: 98°F - Pulse: 110 - Respirations: 24 1. Assess the urine in the continuous irrigation drainage bag. 2. Decrease the irrigation fluid in the continuous irrigation catheter. 3. Lower the head of the bed while raising the foot of the bed. 4. Contact the surgeon to give an update on the client's condition. 5. Check the client's postoperative creatinine and BUN.

Answer: 1, 3, 4 1. The nurse should assess the drain postoperatively. 2. The client is hemorrhaging, so the nurse should increase the irrigation fluid to clear the red urine, not decrease the rate. 3. The head of the bed should be lowered, and the foot should be elevated to shunt blood to the central circulating system. 4. The surgeon needs to be notified of the change in condition. 5. These laboratory values assess kidney function, not the circulatory system, so this is not an appropriate intervention. TEST-TAKING HINT: When the test taker reads vital signs with the blood pressure decreased and the pulse and respiratory rate elevated, the test taker should recognize the clinical manifestations of shock.

The nurse is inserting an indwelling catheter into a female client. Which interventions should be implemented? Rank in order of performance. 1. Explain the procedure to the client. 2. Set up the sterile field. 3. Insert the catheter. 4. Place absorbent pads under the client. 5. Clean the perineum with povidone-iodine.

Answer: 1, 4, 2, 5, 3 1. The procedure should be explained to the client. 4. Incontinence pads should be placed under the client before beginning the sterile part of the procedure. 2. The sterile field must be set up before cleaning the client's perineum. 5. During the procedure, the perineum is swiped with povidone-iodine (Betadine) or antiseptic swabs from front to back and also down the middle, making only one stroke per swab and discarding after each area (Teas et al., 2018). 3. The catheter should be inserted and the balloon inflated. TEST-TAKING HINT: This is an alternative-type question requiring the test taker to rank the options in the correct order. The test taker must have knowledge of the skills performed by the nurse.

The client diagnosed with CKD has a new arteriovenous fistula in the left forearm. Which intervention should the nurse implement? Select all that apply. 1. Teach the client to carry heavy objects with the right arm. 2. Perform all laboratory blood tests on the left arm. 3. Instruct the client to lie on the left arm during the night. 4. Discuss the importance of not performing any hand exercises. 5. Have the client wash the area with soap and warm water daily.

Answer: 1, 5 1. Carrying heavy objects in the left arm could cause the fistula to clot by putting undue stress on the site, so the client should carry objects with the right arm. 2. The fistula should only be used for dialysis access, not for routine blood draws. 3. The client should not lie on the left arm because this may cause clotting by putting pressure on the site. 4. Hand exercises are recommended for new fistulas to help mature the fistula. 5. The client should wash the area around the access daily with soap and warm water and observe for signs of infection. TEST-TAKING HINT: The test taker must notice the adjectives, such as "left" and "right." Options "2" and "3" have the nurse doing something to the arm with the fistula.

Which interventions should the nurse include when preparing a teaching plan for the client diagnosed with chronic prostatitis? Select all that apply. 1. Sit in a warm sitz bath for 10 to 20 minutes several times daily. 2. Sit in the chair with the feet elevated for 2 hours daily. 3. Drink at least 3,000 mL of oral fluids, especially tea and coffee, daily. 4. Stop broad-spectrum antibiotics as soon as the symptoms subside. 5. Take nonsteroidal anti-inflammatory medications for pain.

Answer: 1, 5 1. The client should sit in a warm sitz bath for 10 to 20 minutes several times each day to provide comfort and assist with healing. 2. Clients should avoid sitting for extended periods because it increases the pressure. 3. Oral fluids should be consumed to satisfy thirst but not to push fluids to dilute the medication levels in the bladder. 4. Broad-spectrum antibiotics are administered for 10 to 14 days and should not be stopped until all medications are taken by the client. 5. Nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen can relieve pain. TEST-TAKING HINT: The test taker must know basic concepts when answering questions; this includes the need for the client to take all prescribed antibiotics. If the test taker is unsure of option "3," drinking plenty of tea and coffee should indicate this is an incorrect answer because these are high in caffeine.

The client has received IV solutions for 3 days through a 20-gauge IV catheter placed in the left cephalic vein. On morning rounds, the nurse notes the IV site is tender to palpation, and a red streak has formed. Which intervention should the nurse implement first? 1. Start a new IV in the right hand. 2. Discontinue the intravenous line. 3. Complete an incident record. 4. Place a warm washrag over the site.

Answer: 2 1. A new IV will be started in the right hand after the IV is discontinued. 2. The client has clinical manifestations of phlebitis, and the IV must be removed to prevent further complications. 3. Depending on the health-care facility, this may or may not be done, but client care comes before documentation. 4. A warm washrag placed on an IV site sometimes provides comfort to the client. If this is done, it should be done for 20 minutes, four times a day. TEST-TAKING HINT: The question is asking for a first action, which means all of the options may be actions the nurse could implement, but only one is the priority. In general, priority actions are to stop the problem, continue treatment, treat the problem, and then document.

The clinic nurse is caring for a client diagnosed with chronic pyelonephritis and prescribed trimethoprim-sulfamethoxazole twice a day for 90 days. Which statement is the scientific rationale for prescribing this medication? 1. The antibiotic will treat the bladder spasms that accompany a UTI. 2. If the urine cannot be made bacteria-free, the medication will suppress bacterial growth. 3. In 3 months, the client should be rid of all bacteria in the urinary tract. 4. The HCP is providing the client with enough medication to treat future infections.

Answer: 2 1. Antibiotics may indirectly treat bladder spasms if the spasms are caused by an infection, but this is not the reason for prescribing trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, in this manner. 2. Some clients develop a chronic infection and must receive antibiotic therapy as a routine daily medication to suppress bacterial growth. The prescription for trimethoprim-sulfamethoxazole (Bactrim), a sulfa antibiotic, will be refilled after the 90 days and continued. 3. Clients with chronic infections may never be free of the bacteria. 4. HCPs do not usually prescribe prn prescriptions for antibiotics. TEST-TAKING HINT: The question is asking why an HCP prescribes long-term use of antibiotics for a client diagnosed with a chronic infection. Antibiotics treat bacterial infections. Based on this, option "1" can be eliminated. Option "3" promises "all," which is false reassurance and can be eliminated. Option "4" describes future infections, but the client currently has an infection, so this option can be eliminated.

The client diagnosed with cancer of the bladder is scheduled to have a cutaneous urinary diversion procedure. Which preoperative teaching intervention specific to the procedure should be included? 1. Demonstrate turn, cough, and deep breathing. 2. Explain a bag will drain the urine from now on. 3. Instruct the client on the use of a PCA pump. 4. Take the client to the ICU to become familiar with it.

Answer: 2 1. Any client undergoing general anesthesia should be taught to turn, cough, and deep breathe to prevent pulmonary complications. This is not specific to a urinary diversion procedure. 2. A urinary diversion procedure involves the removal of the bladder. In a cutaneous procedure, the ureters are implanted in some way to allow for stoma formation on the abdominal wall, and the urine drains into a pouch. There are numerous methods used for creating the stoma. 3. Many clients with multiple types of procedures use PCA pumps to control pain after surgery. 4. This should be done for any client expected to need intensive care postoperatively. TEST-TAKING HINT: The test taker must notice the phrase "specific to the procedure" to be able to answer this question correctly. All of the options are standard interventions for major surgeries, but only one is specific to the procedure.

Which intervention is most important for the nurse to implement for the client diagnosed with possible renal calculi? 1. Assess the client's neurological status every 2 hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.

Answer: 2 1. Assessment is important, but the neurological system is not the priority for a client diagnosed with a urinary problem. 2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone. 3. These are laboratory studies evaluating kidney function, but they are not pertinent when passing a renal stone. These values do not elevate until at least half the kidney function is lost. 4. A dietary recall can be done to determine what types of foods the client is eating that may contribute to the stone formation, but it is not the most important intervention. TEST-TAKING HINT: Remember, if the question asks for "most important," more than one of the options could be appropriate, but only one is most important. Assessment is a priority if the client is not in distress, but the test taker should make sure it is appropriate for the situation.

The nurse is administering morning medications. Which medication should the nurse question administering? Client Record Diagnosis: Acute Renal Failure Allergies: Penicillin MAR: - Furosemide 80 mg PO daily (K+: 4.3) - Erythropoietin Sub Q daily x3 days - Multivitamin with iron PO daily - Levothyroxine 0.75 mcg PO daily 1. Furosemide. 2. Erythropoietin. 3. Multivitamin with iron. 4. Levothyroxine.

Answer: 2 1. Clients diagnosed with renal failure are frequently placed on a diuretic such as furosemide (Lasix). The potassium level is WNL. The nurse would not question administering this medication. 2. Erythropoietin (Epogen) is frequently prescribed for the anemia associated with renal failure; however, this is an incomplete order because no dosage is prescribed. The nurse should contact the HCP to determine the dose to be administered. The dose is determined by units/kilogram/dose. 3. The nurse would not question administering this medication. The client should receive the multivitamin, and iron will assist in the production of red blood cells. 4. The nurse would not question administering levothyroxine (Synthroid). Nothing in the question would lead the nurse to think that the order was incorrect. TEST-TAKING HINT: The test taker and nurse should always remember the five rights of medication administration. An incomplete medication order cannot be implemented until all the requirements of the order are present.

The nurse is caring for a client diagnosed with possible AKI. Which condition predisposes the client to develop prerenal AKI? 1. Diabetes mellitus. 2. Hypotension. 3. Aminoglycosides. 4. Benign prostatic hypertrophy.

Answer: 2 1. Diabetes mellitus is a disease that may lead to CKD. 2. Hypotension, which causes a decreased blood supply to the kidney, is one of the most common causes of prerenal AKI (before the kidney). 3. Nephrotoxic medications are a cause of intrarenal (intrinsic) AKI (directly to the kidney). 4. Benign prostatic hypertrophy (BPH) is a cause of postrenal (obstructive) AKI (after the kidney). TEST-TAKING HINT: The test taker must be cautious of adjectives (words describing something); "prerenal" is the key to selecting the correct answer. The prefix pre- means "before."

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain, and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

Answer: 2 1. Dull flank pain and microscopic hematuria are manifestations of a renal stone in the kidney. 2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and suprapubic pain when voiding are manifestations of a stone in the bladder. 4. Kidney stones and bladder stones may produce no clinical manifestations, but a ureteral stone always causes pain on the affected side because a ureteral spasm occurs when the stone obstructs the ureter. TEST-TAKING HINT: Options "1" and "3" both have assessment data indicating bleeding. The test taker can usually eliminate these as possible answers or eliminate the other two options not addressing blood. Renal stones are painful; therefore, option "4" could be eliminated as a possible answer.

The client diagnosed with AKI is placed on bedrest. The client asks the nurse, "Why do I have to stay in bed? I don't feel bad." Which scientific rationale supports the nurse's response? 1. Bedrest helps increase the blood return to the renal circulation. 2. Bedrest reduces the metabolic rate during the acute stage. 3. Bedrest decreases the workload of the left side of the heart. 4. Bedrest aids in the reduction of peripheral and sacral edema.

Answer: 2 1. Kidney function is improved by about 40% when recumbent, but this is not the scientific rationale for bedrest in AKI. 2. Bedrest reduces exertion and the metabolic rate, thereby reducing catabolism and subsequent release of potassium and accumulation of endogenous waste products (urea and creatinine). 3. This is a scientific rationale for prescribing bedrest in clients diagnosed with heart failure. 4. This is not the scientific rationale for prescribing bedrest. The foot of the bed may be elevated to help decrease peripheral edema, and bedrest causes an increase in sacral edema. TEST-TAKING HINT: The test taker should not jump to conclusions and select the only option with "renal" in the sentence. The nurse must know the normal anatomy and physiology of the body and be aware that keeping someone in bed will not restore kidney function when the kidneys have failed.

The UAP tells the nurse the client diagnosed with CKD has a white crystal-like layer on top of the skin. Which intervention should the RN implement? 1. Have the assistant apply a moisture barrier cream to the skin. 2. Instruct the UAP to bathe the client in cool water. 3. Tell the UAP not to turn the client in this condition. 4. Explain this is normal and do not do anything for the client.

Answer: 2 1. Moisture barrier cream will keep the crystals on the skin. 2. These crystals are uremic frost resulting from irritating toxins deposited in the client's tissues. Bathing in cool water will remove the crystals, promote client comfort, and decrease the itching resulting from uremic frost (Saardi & Schwartz, 2016). 3. The client should be turned every 2 hours or more frequently to prevent skin breakdown. 4. This may occur with CKD, and it does require a nursing intervention. TEST-TAKING HINT: The nurse must know what is normal for specific disease processes, and something coming out of the skin requires some action even if the test taker is not familiar with the disease process. Option "4" could be eliminated based on this test-taking strategy. The test taker should eliminate option "3" because there are very few instances in which the client is not turned or moved; turning and movement are necessary to prevent the development of pressure ulcers.

The client post-thyroidectomy reports numbness and tingling around the mouth and the tips of the fingers. Which intervention should the nurse implement first? 1. Notify the health-care provider immediately. 2. Tap the cheek about 2 cm anterior to the earlobe. 3. Check the serum calcium and magnesium levels. 4. Prepare to administer calcium gluconate IVP.

Answer: 2 1. The HCP may need to be notified, but the nurse should perform an assessment first. 2. These are clinical manifestations of hypocalcemia, and the nurse can confirm this by tapping the cheek to elicit the Chvostek's sign. If the muscles of the cheek begin to twitch, then the HCP should be immediately notified because hypocalcemia is a medical emergency. 3. A positive Chvostek's sign can indicate a low calcium or magnesium level, but serum laboratory levels may have been drawn hours previously or may not be available. 4. If the client does have hypocalcemia, this may be ordered, but it is not implemented before assessment. TEST-TAKING HINT: Assessment is the first step in the nursing process and is an appropriate option to select if the test taker has difficulty when trying to decide between two options.

The male client diagnosed with CKD secondary to diabetes has been receiving dialysis for 12 years. The client is notified he will not be placed on the kidney transplant list. The client tells the nurse he will not be back for any more dialysis treatments. Which response by the nurse is most therapeutic? 1. "You cannot just quit your dialysis. This is not an option." 2. "You're angry at not being on the list, and you want to quit dialysis?" 3. "I will call your nephrologist right now so you can talk to the HCP." 4. "Make your funeral arrangements because you are going to die."

Answer: 2 1. The client does have the right to quit dialysis if desired. 2. Reflecting the client's feelings and restating them are therapeutic responses the nurse should use when addressing the client's issues. 3. This is passing the buck; the nurse should address the client's issues. 4. This may be true, but it is not therapeutic in attempting to get the client to verbalize feelings. TEST-TAKING HINT: When asked to select a therapeutic response, the test taker should select an option with some type of "feeling" in the response, such as "angry" in option "2."

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when ambulating the client.

Answer: 2 1. The client's urinary output should be monitored, but it is not the first nursing intervention. 2. Assessment is the first part of the nursing process and is a priority. The renal colic pain can be so intense it can cause a vasovagal response, with resulting hypotension and syncope. 3. Increased fluid increases urinary output, which will facilitate the movement of the renal stone through the ureter and help decrease pain, but it is not the first intervention. 4. Ambulation will help facilitate the movement of the renal stone through the ureter, and safety is important, but it is not the first intervention. TEST-TAKING HINT: Remember, if the question asks which intervention is first, all four options may be appropriate for the client's diagnosis, but only one has priority. Assessment is the first part of the nursing process and it is the first intervention a nurse should implement if the client is not in distress.

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client 1 day postoperative TURP. Which intervention should the nurse implement? 1. Remove the indwelling catheter. 2. Titrate the NS irrigation to run faster. 3. Administer protamine sulfate IVP. 4. Administer vitamin K slowly.

Answer: 2 1. The indwelling catheter should not be removed because doing so may result in edema, which, in turn, may obstruct the urethra and not allow the client to urinate. 2. Increasing the irrigation fluid will flush out the clots and blood. 3. Protamine is the reversal agent for heparin, an anticoagulant. 4. Vitamin K is the reversal agent for the anticoagulant warfarin (Coumadin). TEST-TAKING HINT: The test taker should eliminate options "3" and "4" because both are medications, and the problem is with continuous irrigation, which does not require medications.

The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first? 1. The client with hemoglobin of 9.8 g/dL and hematocrit of 30%. 2. The client with no palpable thrill or auscultated bruit. 3. The client reporting being exhausted and is sleeping. 4. The client prescribed antihypertensive medication.

Answer: 2 1. These laboratory findings are low but do not require a blood transfusion and often are expected for a client experiencing anemia secondary to ESRD. 2. The client's dialysis access is compromised, so this client should be assessed first. 3. It is not uncommon for a client undergoing dialysis to be exhausted and sleep through the treatment. 4. Clients are instructed not to take their antihypertensive medications before dialysis to help prevent episodes of hypotension. TEST-TAKING HINT: The test taker must determine which client's situation is not normal or expected for the disease process, which in this question is CKD because all clients are in the dialysis unit.

The client is 1 day postoperative TURP. Which task should the RN delegate to the UAP? 1. Increase the irrigation fluid to clear clots from the tubing. 2. Elevate the scrotum on a towel roll for support. 3. Change the dressing on the first postoperative day. 4. Teach the client how to care for the continuous irrigation catheter.

Answer: 2 1. This intervention requires analysis and should not be delegated. 2. Elevating the scrotum on a towel for support is a task that can be delegated to the UAP. 3. The surgeon changes the first dressing; therefore, this cannot be delegated. A TURP does not have a dressing. 4. The RN is responsible for teaching. TEST-TAKING HINT: Teaching, assessing, evaluating, and intervening for unstable clients cannot be delegated to a UAP.

The male client diagnosed with metastatic cancer of the bladder is emaciated and refuses to eat. Which nursing action is an example of the ethical principle of paternalism? 1. The nurse allows the client to talk about not wanting to eat. 2. The nurse tells the client if he does not eat, a feeding tube will be placed. 3. The nurse consults the dietitian about the client's nutritional needs. 4. The nurse asks the family to bring favorite foods for the client to eat.

Answer: 2 1. This is therapeutic communication and is allowing the client autonomy, but it is not an example of paternalism. 2. Paternalism is deciding for the client what is best, similar to a parent making decisions for a child. Feeding a client, as with a feeding tube, without the client wishing to eat is paternalism. 3. Consulting with a dietitian about the nutritional needs of a client is an appropriate nursing intervention, but it does not represent any ethical principle. 4. This is an excellent intervention, but it does not represent any ethical principle. TEST-TAKING HINT: The question asks for an ethical principle, and only two of the options could be considered to represent ethical principles. Option "1" is allowing the client a voice in the situation; the term "paternalism" eliminates this option.

The nurse is caring for a client with a TURP. Which expected outcome indicates the client's condition is improving? 1. The client is using the maximum amount allowed by the PCA pump. 2. The client's bladder spasms are relieved by medication. 3. The client's scrotum is swollen and tender with movement. 4. The client has passed a large, hard, brown stool this morning.

Answer: 2 1. Using the maximum amount of medication does not indicate the client is achieving pain management. 2. Bladder spasms are common, but since the spasms are relieved with medication, this indicates the condition is improving. 3. Scrotal edema and tenderness do not indicate improvement. 4. Clients are administered laxatives or stool softeners to prevent constipation, which could cause increased pressure. TEST-TAKING HINT: The stem asks which option indicates the client is improving. Needing maximum medication (option "1") and scrotal edema (option "3") do not indicate the client is getting better. A bowel movement has nothing to do with the prostate.

The nurse is caring for a client diagnosed with CKD. Which antecedents would the nurse assess? Select all that apply. 1. Current diet. 2. Diabetes. 3. Hypertension. 4. Fluid restriction. 5. Race.

Answer: 2, 3, 5 1. The current diet should be one that limits the complications of CKD; it is current, not an antecedent. 2. Diabetes is a leading cause of CKD caused by the microvascular changes that occur when the blood glucose levels are high. 3. Hypertension is also a leading cause of CKD because hypertension narrows the renal artery and decreases the blood flow to the kidney. 4. Fluid restriction is a recommended treatment for CKD, not an antecedent. 5. Race is an antecedent because genetics are a risk factor for CKD. Non-whites are more at risk for developing CKD, especially when the client has a comorbid condition such as diabetes or hypertension. TEST-TAKING HINT: When answering a "Select all that apply" question, the test taker must look at each option independently of the other options. Each option becomes a true or false question. The NCLEX-RN® can test several diseases or concepts in any multiple-choice question, but this is especially true of "Select all that apply" questions.

Which data support to the nurse the client's diagnosis of acute bacterial prostatitis? Select all that apply. 1. Terminal dribbling. 2. Urinary frequency. 3. Stress incontinence. 4. Sudden fever and chills. 5. Pelvic pain.

Answer: 2, 4, 5 1. Terminal dribbling is a symptom of BPH. 2. Urinary frequency is a sign of an acute or a chronic bacterial prostatitis or a UTI. 3. Stress incontinence occurs in women urinating when coughing, running, or jumping. 4. Clients diagnosed with acute bacterial prostatitis will frequently experience a sudden onset of fever and chills. Clients diagnosed with chronic prostatitis have milder symptoms. 5. Pelvic pain is present in acute bacterial prostatitis. Pelvic pain may be present in chronic prostatitis, but the client will not appear acutely ill. TEST-TAKING HINT: The words "acute" and "bacterial" should cue the test taker into the specific clinical manifestations of infection. Symptoms for any infection are fever and chills. Urinary frequency and pelvic pain are signs of both acute and chronic prostatitis.

The nurse writes the client problem of "fluid volume excess" (FVE). Which intervention should be included in the plan of care? Select all that apply. 1. Change the IV fluid from 0.9% NS to D5W. 2. Restrict the sodium in the client's diet. 3. Monitor blood glucose levels. 4. Prepare the client for hemodialysis. 5. Weigh the client daily.

Answer: 2, 5 1. The nursing plan of care does not include changing the HCP's orders. 2. Fluid volume excess refers to an isotonic expansion of the extracellular fluid by an abnormal expansion of water and sodium. Therefore, sodium is restricted to allow the body to excrete the extra volume. 3. High blood glucose levels result in viscous blood and cause the kidneys to try to fix the problem by excreting the glucose through increasing the urine output, which results in fluid volume deficits. 4. If the FVE is the result of renal failure, then hemodialysis may be ordered, but this information was not provided in the stem of the question. 5. Obtaining a daily weight is essential to provide information about fluid loss or gain. Each kilogram of weight is equivalent to 1 L of fluid. TEST-TAKING HINT: Option "1" is not a nursing prerogative. The test taker should not read into the question.

The client diagnosed with diabetes insipidus weighed 180 pounds when the daily weight was taken yesterday. This morning's weight is 175.6 pounds. One liter of fluid weighs approximately 2.2 pounds. How much fluid, in milliliters, has the client lost?

Answer: 2,000 mL has been lost. First, determine how many pounds the client has lost: 180 - 175.6 = 4.4 pounds lost Then, based on the fact that 1 liter of fluid weighs 2.2 pounds, determine how many liters of fluid have been lost: 4.4 ÷ 2.2 = 2 liters lost Then, because the question asks for the answer in milliliters, convert 2 liters into milliliters: 2 × 1,000 = 2,000 mL TEST-TAKING HINT: The test taker must be able to work basic math problems. This problem has several steps. Sometimes it is helpful to write out what is occurring at each step, such as 4.4 divided by 2.2 kg per pound. This can help the test taker realize if a step has been overlooked. Remember, on the NCLEX-RN®, use the drop-down calculator on the computer.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.

Answer: 3 1. Beer and colas are foods high in oxalate, which can cause calcium oxalate stones. 2. Asparagus and cabbage are foods high in oxalate, which can cause calcium oxalate stones. 3. Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones. 4. Cheese and eggs are foods that help acidify the urine and do not cause the development of uric acid stones. TEST-TAKING HINT: The nurse has to have knowledge of foods included in specific diets. This is memorizing, but the test taker must have this knowledge to answer questions evaluating types of diets for specific diseases and disorders.

The nurse is preparing a plan of care for the client diagnosed with acute glomerulonephritis. Which statement is an appropriate long-term goal? 1. The client will have a blood pressure within normal limits. 2. The client will show no protein in the urine. 3. The client will maintain normal renal function. 4. The client will have clear lung sounds.

Answer: 3 1. Blood pressure within normal limits is a short-term goal. 2. Lack of protein in the urine is a short-term goal. 3. A long-term complication of glomerulonephritis is that it can become chronic if unresponsive to treatment, and this can lead to end-stage renal disease. Maintaining renal function is an appropriate long-term goal. 4. Clear lung sounds indicate the client has been able to process fluids and excrete them from the body. Preventing pulmonary edema is a short-term goal. TEST-TAKING HINT: Answer options "1," "2," and "4" all refer to body processes controlled or treated immediately after assessment of the problem. The stem is requesting a long-term goal.

The client is admitted to a nursing unit from a long-term care facility with the laboratory results populated in the chart below. Which condition is a cause for these findings? - Hct: 56 - Na+: 152 - K+: 5.5 1. Overhydration. 2. Anemia. 3. Dehydration. 4. Acute kidney injury.

Answer: 3 1. Clients with overhydration or who have FVE experience dilutional values of sodium (135 to 145 mEq/L) and red blood cells (44% to 52%). The levels are lower than normal, not higher. 2. Anemia is a low red blood cell count for a variety of reasons. 3. Dehydration results in concentrated serum, causing laboratory values to increase because the blood has normal constituents but not enough volume to dilute the values to within normal range or possibly lower. 4. In AKI, the kidneys cannot excrete urine, and this results in too much fluid in the body. TEST-TAKING HINT: The test taker must decide first if the values are high or low and then determine what is happening with body fluids in each process. Overhydration and renal failure result in the same fluid shift, so these two options ("1" and "4") could be excluded.

The client diagnosed with AKI is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? 1. Erythropoietin. 2. Calcium gluconate. 3. Regular insulin. 4. Osmotic diuretic.

Answer: 3 1. Erythropoietin is a chemical catalyst produced by the kidneys to stimulate red blood cell production; it does not affect the potassium level. 2. Calcium gluconate helps protect the heart from the effects of high potassium levels. 3. Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily. 4. A loop diuretic, not an osmotic diuretic, may be ordered to help decrease the potassium level. TEST-TAKING HINT: The test taker must be familiar with medical terms such as "hyperkalemia" and know the rationale for administering medications.

The male client diagnosed with CKD received the initial dose of erythropoietin 1 week ago. Which report by the client indicates the need to notify the health-care provider (HCP)? 1. The client reports flu-like symptoms. 2. The client reports being tired all the time. 3. The client reports an elevation in his blood pressure. 4. The client reports discomfort in his legs and back.

Answer: 3 1. Flu-like symptoms are expected and tend to subside with repeated doses; the nurse should suggest acetaminophen (Tylenol) before the injections. 2. Erythropoietin, a biologic response modifier, takes 2 to 6 weeks to become effective in improving anemia and thereby reducing fatigue. 3. After the initial administration of erythropoietin, a client's antihypertensive medications may need to be adjusted. Therefore, this report requires notification of the HCP. Erythropoietin therapy is contraindicated in clients diagnosed with uncontrolled hypertension. 4. Long bone and vertebral pain is an expected occurrence because the bone marrow is being stimulated to increase the production of red blood cells. TEST-TAKING HINT: The test taker should select the potentially life-threatening option or a report requiring the medication to be adjusted or discontinued. The nurse should notify the HCP if the medication is causing an adverse effect, not an expected side effect.

The nurse is caring for a client diagnosed with diabetic ketoacidosis (DKA). Which statement best explains the scientific rationale for the client's Kussmaul's respirations? 1. The kidneys produce excess urine and the lungs try to compensate. 2. The respirations increase the amount of carbon dioxide in the bloodstream. 3. The lungs speed up to release carbon dioxide and increase the pH. 4. The shallow and slow respirations will increase the HCO3 in the serum.

Answer: 3 1. Kussmaul's respirations are the lung's attempt to maintain the narrow range of pH compatible with human life. The respiratory system reacts rapidly to changes in pH. 2. Respiration is the act of moving oxygen and carbon dioxide. Kussmaul's respirations are rapid and deep and allow the client to exhale carbon dioxide. 3. The lungs attempt to increase the blood pH level by blowing off the carbon dioxide (carbonic acid). 4. HCO3 (sodium bicarbonate) is an alkaline (base) substance regulated by the kidneys and is part of the metabolic buffer system, not a respiratory system buffer. The excretion and retention of carbon dioxide (CO2) are regulated by the lungs and therefore a part of the respiratory buffer system. TEST-TAKING HINT: Homeostasis is a delicate balance between acids and bases. The test taker can discard option "1" by realizing the production of urine does not affect the respirations.

The nurse is discussing kidney transplants with clients at a dialysis center. Which type of donation is most common? 1. Living, related donor. 2. Nondirected, altruistic donor. 3. Cadaver donor. 4. Xenotransplantation donor.

Answer: 3 1. Living, related donors occur when a family member or someone close to the recipient donates their kidney to the client. This is not the most common form of kidney donation; however, the kidney is the most commonly given organ by a living donor. 2. Nondirected, altruistic donors are living donors who are strangers to the transplant recipient. This is not the most common form of kidney donation. 3. The most common form of kidney donation is cadaveric or from a deceased donor. 4. Xenotransplantation is the use of healthy animal organs for transplantation into humans. Research is being conducted on transplanting genetically engineered pig kidneys into rhesus monkeys to prove the effectiveness of xenotransplantation for kidney transplants. Xenotransplants of the kidney are not performed in humans at this time. TEST-TAKING HINT: The nurse must be aware of transplantation information and terminology in health care.

The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? - BUN: 15 - Creatinine: 1.2 - GFR: 40 - Creatinine clearance: 100 1. The blood urea nitrogen. 2. The creatinine level. 3. The glomerular filtration rate. 4. The 24-hour creatinine clearance.

Answer: 3 1. Normal BUN levels are 8 to 21 mg/dL or 10 to 31 mg/dL for clients older than age 90 years (Van Leeuwen & Bladh, 2017). 2. Normal creatinine levels are male: 0.61 to 1.2 mg/dL, and Female: 0.51 to 1.11 mg/dL (Van Leeuwen & Bladh, 2017). 3. Glomerular filtration rate (GFR) in a normally functioning kidney is over 60 mL/min/1.73 m^2. If the GFR is decreased below 60 mL/min, it may indicate kidney disease. A GFR of 15 or lower may mean kidney failure. 4. Normal creatinine clearance is 85 to 125 mL/min/1.73 m^2 for males and 75 to 115 mL/min/1.73 m^2 for females. TEST-TAKING HINT: The nurse must memorize common laboratory values. BUN and creatinine levels are common laboratory values used to determine status in a number of diseases.

The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor? 1. Serum calcium. 2. Serum phosphorus. 3. Serum potassium. 4. Serum sodium.

Answer: 3 1. Serum calcium is decreased in conditions such as osteoporosis or post-thyroid surgery but not in vomiting and diarrhea. 2. Serum phosphorus levels are altered in acute and chronic renal failure or diabetic ketoacidosis, among other conditions, but not with acute fluid losses from the gastrointestinal tract. 3. Clients lose potassium from the GI tract or through the use of diuretic medications. Potassium imbalances can lead to cardiac arrhythmias. 4. The body is not at risk of losing sodium from these sources as it is with potassium. TEST-TAKING HINT: The nurse must recognize basic fluids and electrolytes in the body and the implications of excess or loss. The body holds on to sodium and releases potassium.

The nurse and a UAP are caring for a group of clients. Which nursing intervention should the RN perform? 1. Measure the client's output from the indwelling catheter. 2. Record the client's intake and output on the I&O sheet. 3. Instruct the client on appropriate fluid restrictions. 4. Provide water for a client diagnosed with diabetes insipidus.

Answer: 3 1. The UAP can empty the catheter and measure the amount. 2. The UAP can record intake and output on the I&O sheet. 3. The RN cannot delegate teaching. 4. The client has a disease, but all the UAP is being asked to do is take water to the client. TEST-TAKING HINT: This is an example of an "except" question. Frequently, questions ask which tasks can be assigned to the UAP, but this question asks which action the RN should implement. If the test taker does not read carefully, it is easy to jump to the first option for actions the UAP can perform.

The nurse has identified the concept of urinary elimination for a client. Which information is most important for the nurse to provide to the HCP the next day? Intake and Output 0701-1900: Oral (2,200 mL), Intravenous (1,600 mL), Urine (735 mL), Emesis (40 mL) 1901-0700: Oral (1,600 mL), Intravenous (1,400 mL), Urine (575 mL) Total: Oral (3,800 mL), Intravenous (3,000 mL), Urine (1,310 mL), Emesis (40 mL) 1. The client vomited 40 mL on the day shift. 2. The client has adequate oral intake, and IV fluids are not needed. 3. The client has had 6,800 mL intake and 1,350 mL output in the last 24 hours. 4. The client does not like to have to keep the urine for measurement.

Answer: 3 1. The client had a small emesis 24 hours ago, which has not been repeated; this is not pertinent information at this time. 2. Whether or not IV fluids are indicated depends on more than the oral intake. The recommendation to discontinue the IV fluids might be indicated because the client is not able to process all the fluid. 3. The client has a deficit output of almost 5,500 mL. This should be brought to the HCP's attention to determine if renal insufficiency is present. 4. Clients are frequently requested to do things that give the health-care personnel information to assess what is occurring with the client. It is not necessary for the client to "like" saving the urine. TEST-TAKING HINT: The test taker must be able to read and interpret information from graphs to determine important information to report.

Which modifiable risk factor should the nurse identify for the development of cancer of the bladder in a client? 1. Previous exposure to chemicals. 2. Pelvic radiation therapy. 3. Cigarette smoking. 4. Parasitic infections of the bladder.

Answer: 3 1. The client has already been exposed; this cannot be undone. 2. Pelvic radiation is prescribed for cancer in the abdomen. It is a life-saving procedure, but one of the risks of radiation therapy is the development of a secondary cancer. 3. Cigarette smoke contains more than 400 chemicals, 17 of which are known to cause cancer. The risk is directly proportional to the amount of smoking. 4. Clients may be unaware of a parasitic infection of the bladder for some time before diagnosis, but it is not a risk factor for cancer of the bladder. TEST-TAKING HINT: The question asks for a modifiable risk factor. Modifiable factors involve lifestyle changes, weight loss, tobacco use, and eating habits.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two acetaminophen to help decrease the temperature. 3. Come to the clinic and provide a urine specimen for urinalysis. 4. Use a sterile 4 × 4 gauze to strain the client's urine.

Answer: 3 1. The client needs to be evaluated for a possible UTI, which may accompany renal calculi. Therefore, the clinic nurse should not give advice without knowing what is wrong with the client. 2. The nurse should not recommend any medication, even acetaminophen (Tylenol), unless the nurse is absolutely sure what is wrong with the client. 3. A urinalysis can assess for hematuria, the presence of WBCs, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying clinical manifestations of UTI. 4. The client needs to strain the urine if there is a possibility of renal calculi, which these clinical manifestations do not support. Further diagnostic testing is needed to determine the presence of renal calculi. TEST-TAKING HINT: Fever, chills, and burning on urination require some type of assessment. Therefore, the test taker should select an option that helps determine what is wrong with the client and "3" is the only such option.

The client receiving hemodialysis is being discharged home from the dialysis center. Which instruction should the nurse teach the client? 1. Notify the HCP if oral temperature is 102°F or greater. 2. Apply ice to the access site if it starts bleeding at home. 3. Maintain fluid and salt restrictions to decrease side effects. 4. Encourage the significant other to make decisions for the client.

Answer: 3 1. The client should not wait until the temperature is 102°F to call the HCP; the client should call when the temperature is 100°F or greater. 2. The client should apply direct pressure and notify the HCP if the access site starts to bleed, not apply ice to the site. 3. The client should maintain fluid and salt restrictions to avoid side effects related to excess salt and fluid accumulation between dialysis treatments. 4. The nurse should encourage the client's independence, not foster dependence by encouraging the significant other to make the client's decision. TEST-TAKING HINT: The test taker must read the question carefully. A temperature of 102°F is usually not acceptable in any client. Fostering dependence in any chronic illness is not encouraged by the nurse, so the test taker could eliminate option "4."

The client, postoperative TURP, asks the nurse, "When will I know if I will be able to have sex after my TURP?" Which response is most appropriate by the nurse? 1. "You seem anxious about your surgery." 2. "Tell me about your fears of impotency." 3. "Potency can return in 6 to 8 weeks." 4. "Did you ask your doctor about your concern?"

Answer: 3 1. The client wants information, and the nurse should provide facts. 2. The client wants information, and the nurse should provide facts. 3. Usually, this is the length of time clients need to wait before having sexual intercourse; this is the information the client wants to know. 4. The client may need to talk with his surgeon, but it should be after the nurse answers the client's question. TEST-TAKING HINT: The client is asking for factual information, and the nurse should provide this information. Options "1" and "2" are therapeutic responses addressing feelings, and option "4" is passing the buck—the nurse can discuss this with the client.

The client diagnosed with AKI is admitted to the intensive care unit and placed on a therapeutic diet. Which diet is most appropriate for the client? 1. A high-potassium and low-calcium diet. 2. A low-fat and low-cholesterol diet. 3. A high-carbohydrate and restricted-protein diet. 4. A regular diet with six small feedings a day.

Answer: 3 1. The diet is low potassium, and calcium is not restricted in AKI. 2. This is a diet recommended for clients diagnosed with cardiac disease and atherosclerosis. 3. Carbohydrates are increased to provide for the client's caloric intake, and protein is restricted to minimize protein breakdown and to prevent the accumulation of toxic waste products. 4. The client must be on a therapeutic diet, and small feedings are not required. TEST-TAKING HINT: The test taker must notice adjectives. A "therapeutic" diet should cause the test taker to eliminate option "4" because it is a regular diet.

The nurse is discharging a client diagnosed with a catheter-associated urinary tract infection (CAUTI). Which information should the nurse include in the discharge teaching? 1. Limit fluid intake so the urinary tract can heal. 2. Collect a routine urine specimen for culture. 3. Take all the antibiotics as prescribed. 4. Tell the client to void every 5 to 6 hours.

Answer: 3 1. The function of the urinary tract is to process fluids and wastes from the body. Limiting its functioning will increase the problem, not help the problem. 2. A routine urine specimen is not a clean voided specimen and cannot be used for culture. 3. The client should be taught to take all the prescribed medication anytime a prescription is written for antibiotics. 4. The client should be taught to void every 2 to 3 hours and to empty the bladder completely. This prevents overdistension of the bladder wall and resulting compromised blood supply, either of which predisposes the client to develop a UTI. TEST-TAKING HINT: Unless contraindicated by a disease process, it is recommended for all clients to drink six to eight glasses of water each day; therefore, option "1" should be eliminated as a possible correct answer. Option "2" has the adjective "routine," which could be eliminated because routine procedures are usually not implemented when the client is ill.

The client, after undergoing an exploratory laparotomy with subsequent removal of a large intestinal tumor, has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the HCP? 1. The pump keeps sounding an alarm indicating the high pressure has been reached. 2. Intake is 1,800 mL, NGT output is 550 mL, and Foley output is 950 mL. 3. On auscultation, crackles and rhonchi in all lung fields are noted. 4. The client has negative pedal edema and an increasing level of consciousness.

Answer: 3 1. The pump is alerting the nurse there is resistance distal to the pump; this does not require notifying the HCP. 2. The client has a 1,800-mL intake and a total output of 1,500 mL. The body has an insensible loss of approximately 400 mL/day through the skin, respiration, and other body functions. This does not warrant notifying the HCP. 3. Crackles and rhonchi in all lung fields indicate the body is not able to process the amount of fluid being infused. This should be brought to the HCP's attention. 4. Negative pedal edema and an increasing level of consciousness indicate the client is not experiencing a problem. TEST-TAKING HINT: The question requires the test taker to distinguish nursing problems from client problems. Option "1" is a nursing problem, and options "2" and "4" are expected results, so the HCP does not need to be notified. Only one option, "3," contains abnormal or life-threatening information.

The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP? 1. Monitor the amount, color, and consistency of urine output. 2. Teach the client about the care of the indwelling Foley catheter. 3. Assist the client to the car when being discharged home. 4. Take the client's postprocedural vital signs.

Answer: 3 1. The urine must be assessed for bleeding and cloudiness. Initially, the urine is bright red, but the color soon diminishes and cloudiness may indicate an infection. This assessment should not be delegated to a UAP. 2. Teaching cannot be delegated to a UAP. The RN should teach and evaluate the effectiveness of the teaching. 3. The UAP could assist the client to the car once the discharge has been completed. 4. The kidney is highly vascular. Hemorrhaging and resulting shock are potential complications of lithotripsy, so the nurse should not delegate vital signs postprocedure. TEST-TAKING HINT: There are some basic rules about delegation: the nurse cannot delegate assessment, teaching, evaluation, or any task requiring judgment.

The telemetry nurse is reviewing the laboratory results for a client. Which further assessment data should the nurse determine before notifying the HCP? - Potassium: 2.3 - Sodium: 139 - Glucose: 143 - Creatinine: 1.5 - BUN: 20 - BNP: 80 1. Obtain the client's 24-hour urine output. 2. Ask the UAP to get a blood glucose reading. 3. Assess the client's telemetry reading. 4. Call the rapid response team (RRT).

Answer: 3 1. The urine output would not be affected by laboratory results. 2. The blood glucose is higher than normal but would not require the RN to notify the HCP. The HCP can note the level during rounds. The UAP does not need to collect a blood glucose reading. 3. The potassium level is at a critical level. Low potassium levels impact the cardiac rhythm by causing a dysrhythmia. The nurse should assess the telemetry reading to determine if this is occurring. 4. At this time, the RRT is not needed. TEST-TAKING HINT: The test taker must be able to read and interpret laboratory results.

The nurse is caring for the client diagnosed with chronic kidney disease (CKD) experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? 1. There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. 2. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. 3. The kidney cannot excrete increased levels of acid because it cannot excrete ammonia or cannot reabsorb sodium bicarbonate. 4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

Answer: 3 1. There is a decrease in the excretion of phosphates and organic acids, not an increase. 2. The red blood cell destruction does not affect the arterial blood pH. 3. This is the correct scientific rationale for metabolic acidosis occurring in the client diagnosed with CKD. 4. This compensatory mechanism occurs to maintain an arterial blood pH between 7.35 and 7.45, but it does not occur as a result of CKD. TEST-TAKING HINT: In option "1," the test taker should note "increased excretion"; CKD does not have any type of increase in excretion, so the test taker could eliminate option "1." Option "4" does not even mention the renal system, and a loss of hydrochloric acid results in metabolic alkalosis, not acidosis, so the test taker can eliminate this option.

The nurse is monitoring the client's laboratory values. Which laboratory report is diagnostic for a UTI? 1. CBC - RBCs: 3.8 - Hgb: 11 - Hct: 33% - Platelet: 250 - WBCs: 12.5 2. Urinalysis - pH: 5.5 - Color: dark amber - Clarity: cloudy - Specific gravity: 1.029 - Osmolality: 450 - WBCs: 4 3. Urine Culture - 48-hour result: Greater than 10^5 E. coli bacteria 4. Metanephrines - Metanephrines, total (24-hour urine: 700

Answer: 3 1. This client has an elevated WBC, but it only informs the nurse that an infection may be present in the body. It is not diagnostic for a UTI. 2. Cloudy urine may indicate a UTI, but the culture is definitive. Cloudy urine may contain protein, WBCs, RBCs, bacteria, or noncellular casts. 3. The urine culture has identified an infectious organism. This is the diagnostic test for a UTI. 4. Twenty-four-hour urine specimens for metanephrines indicate the presence of other diseases but not a UTI. Mild increases in catecholamines in urine can be caused by stress, such as operations, burns, or childbirth. A marked increase in metanephrines indicates a pheochromocytoma (a hereditary tumor on the adrenal medulla or from certain neuroblastomas). TEST-TAKING HINT: The test taker must pay attention to specific words. "Diagnostic" means a test that specifically indicates, without a doubt, the cause of the disease process.

The nurse is examining a 15-year-old female client reporting pain, frequency, and urgency when urinating. After asking the parent to leave the room, which question should the nurse ask the client? 1. "When was your last menstrual cycle?" 2. "Have you noticed any change in the color of the urine?" 3. "Are you sexually active?" 4. "What have you taken for the pain?"

Answer: 3 1. This could be asked with a parent in the room, and the nurse should receive a truthful answer. 2. There is no reason the client should not answer this question in the presence of the parent. 3. These are clinical manifestations of cystitis, a bladder infection, which may be caused by sexual intercourse as a result of the introduction of bacteria into the urethra during the physical act. A teenager may not want to divulge this information in front of the parent. 4. This information could be obtained in front of the parent. TEST-TAKING HINT: The test taker must analyze the client's age, 15, and determine which of the options might not be answered truthfully if the parents are present. In this question, "asking the parent to leave the room" is the key to choosing the correct option.

The nurse is developing a plan of care for a client diagnosed with AKI. Which statement is an appropriate outcome for the client? 1. Monitor intake and output every shift. 2. Decrease of pain by three levels on a 1-to-10 scale. 3. Electrolytes are within normal limits. 4. Administer enemas to decrease hyperkalemia.

Answer: 3 1. This is a nursing intervention, not a client outcome. 2. This is a measurable client outcome, but acute kidney injury does not cause pain. 3. AKI causes an imbalance of electrolytes (potassium, sodium, calcium, phosphorus). Therefore, the desired client outcome is electrolytes within normal limits. 4. A Kayexalate resin enema may be administered to help decrease the potassium level, but this is an intervention, not a client outcome. TEST-TAKING HINT: The nurse must have knowledge of the nursing process. Client outcomes are used to evaluate the planning part of the nursing process. The outcomes must be measurable, client focused, and realistic.

The client diagnosed with cancer of the bladder states, "I have young children. I am too young to die." Which statement is the nurse's best response? 1. "This cancer is treatable, and you should not give up." 2. "Cancer occurs at any age. It is just one of those things." 3. "You are afraid of dying and what will happen to your children." 4. "Have you talked to your children about your death?"

Answer: 3 1. This is advising the client, a nontherapeutic technique. 2. This statement does not address the client's feelings. 3. This is an example of restating, a therapeutic technique used to clarify the client's feelings and encourage a discussion of those feelings. 4. The stem did not say the client was dying. The stem said the client feels too young to die. A conversation to discuss the client's death with the children may be premature. TEST-TAKING HINT: When the question requires a therapeutic response, the test taker should select an option addressing the client's feelings.

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water 2 hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

Answer: 3 1. This is appropriate for the client with uric acid stones. 2. The nurse should recommend drinking one to two glasses of water at night to prevent the concentration of urine during sleep. 3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract. 4. This is a treatment for an existing renal stone, not a discharge teaching intervention after successfully passing a renal calculus. TEST-TAKING HINT: The test taker should remember to read the question carefully. The question asks for a "discharge teaching" intervention. This rules out option "4," which is a treatment, as a potential answer.

The client is 2 days post-ureterosigmoidostomy for cancer of the bladder. Which assessment data warrants notification of the HCP by the nurse? 1. The client reports pain at a "3," 30 minutes after being medicated. 2. The client reports it hurts to cough and deep breathe. 3. The client ambulates to the end of the hall and back before lunch. 4. The client is lying in a fetal position and has a rigid abdomen.

Answer: 4 1. A report of a "3" on a 1-to-10 pain scale is expected after medication and does not warrant notifying the HCP. 2. Pain on coughing and deep breathing after surgery is expected. 3. This indicates the client is able to ambulate and is doing activities needed to recover. 4. The client is drawn up in a position that relieves pressure off the abdomen; a rigid abdomen is an indicator of peritonitis, a medical emergency. TEST-TAKING HINT: When the test taker is deciding on a priority question, the test taker should decide if the situation is expected or if it is life-threatening.

The client diagnosed with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shellfish or iodine. 2. Keep the client NPO 8 hours before the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive, and there is no discomfort.

Answer: 4 1. An ultrasound does not require the administration of contrast dye. 2. Food, fluids, and ordered medication are not restricted before this test. 3. This is not an invasive procedure, so a signed consent is not required. 4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied, which produces sound waves, resulting in a picture. TEST-TAKING HINT: The nurse must be aware of preprocedure and postprocedure teaching and care. The test taker must know the invasive and noninvasive diagnostic tests in general. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are a few of the noninvasive diagnostic tests.

The RN and a licensed practical nurse (LPN) are caring for a group of clients. Which intervention should be assigned to the LPN? 1. Assessment of the client after a Kock pouch procedure. 2. Monitoring of the postoperative client with a WBC of 22 × 10^3/microL. 3. Administration of the prescribed antineoplastic medications. 4. Care for the client going for an MRI of the kidneys.

Answer: 4 1. Assessment cannot be assigned to an LPN, no matter how knowledgeable the LPN. 2. This client has the laboratory clinical manifestations of infection; therefore, the nurse should assess and care for this client. 3. Antineoplastic medication is administered only by a qualified RN. 4. It is in the scope of practice for the LPN to care for this client. TEST-TAKING HINT: The client least ill or having the least invasive procedure should be the client assigned to the LPN.

The nurse is developing a nursing care plan for the client diagnosed with CKD. Which nursing problem is a priority for the client? 1. Low self-esteem. 2. Knowledge deficit. 3. Activity intolerance. 4. Excess fluid volume.

Answer: 4 1. Low self-esteem, related to dependency, role changes, and changes in body image, is a pertinent client problem, but psychosocial problems are not a priority over physiological problems. 2. Teaching is always an important part of the care plan, but it is not a priority over a physiological problem. 3. Activity intolerance related to fatigue, anemia, and retention of waste products is a physiological problem, but it is not a life-threatening problem. 4. Excess fluid volume is the priority because of the stress placed on the heart and vessels, which could lead to heart failure, pulmonary edema, and death. TEST-TAKING HINT: The test taker must read the stem of the question and understand what the question is asking. This is a priority question. This means all the options are pertinent problems for CKD, but only one is the priority. Applying Maslow's hierarchy of needs is one way to determine priorities: physiological problems are priority over psychosocial problems, and life-threatening conditions take first priority.

The client diagnosed with CKD is receiving peritoneal dialysis. Which assessment data warrant immediate intervention by the nurse? 1. Inability to auscultate a bruit over the fistula. 2. The client's abdomen is soft, is nontender, and has bowel sounds. 3. The dialysate being removed from the client's abdomen is clear. 4. The dialysate instilled was 1,500 mL and removed was 1,500 mL.

Answer: 4 1. Peritoneal dialysis is administered through a catheter inserted into the peritoneal cavity; a fistula is used for hemodialysis. 2. Peritonitis, inflammation of the peritoneum, is a serious complication resulting in a hard, rigid abdomen. Therefore, a soft abdomen does not warrant immediate intervention. 3. The dialysate return is normally colorless or straw-colored, but it should never be cloudy, which indicates an infection. 4. Because the client is in ESRD, fluid must be removed from the body, so the output should be more than the amount instilled. These assessment data require intervention by the nurse. TEST-TAKING HINT: The words "warrant immediate intervention" should clue the test taker into selecting an option with abnormal or unexpected data for the client.

The client diagnosed with AKI has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? 1. Administer a phosphate binder. 2. Type and crossmatch for whole blood. 3. Assess the client for leg cramps. 4. Prepare the client for dialysis.

Answer: 4 1. Phosphate binders are used to treat elevated phosphorus levels, not elevated potassium levels. 2. Anemia is not the result of an elevated potassium level. 3. Assessment is an independent nursing action, which is appropriate for the elevated potassium level, but the question asks for a collaborative treatment. 4. Normal potassium level is 3.5 to 5.3 mEq/L. A level of 6.8 mEq/L is life-threatening and could lead to cardiac dysrhythmias. Therefore, the client may be dialyzed to decrease the potassium level quickly. This requires an HCP order, so it is a collaborative intervention. TEST-TAKING HINT: Adjectives must be noted when reading the stem of the question and the answer options.

Which nursing diagnosis is a priority for the client after a TURP? 1. Potential for sexual dysfunction. 2. Potential for an altered body image. 3. Potential for chronic infection. 4. Potential for hemorrhage.

Answer: 4 1. TURPs can cause sexual dysfunction, but if there were a sexual dysfunction, it is not a priority over a physiological problem such as hemorrhaging. 2. This is not a life-threatening problem. 3. This client has had this problem preoperatively. 4. This is a potentially life-threatening problem. TEST-TAKING HINT: A basic concept the test taker must know is, for most surgeries, the highest priority problem is hemorrhaging. Hemorrhaging is life-threatening.

The nurse caring for a client diagnosed with CKD writes a client problem of "noncompliance with dietary restrictions." Which intervention should be included in the plan of care? 1. Teach the client the proper diet to eat while undergoing dialysis. 2. Refer the client and significant other to the dietitian. 3. Explain the importance of eating the proper foods. 4. Determine the reason for the client not adhering to the diet.

Answer: 4 1. Teaching is an intervention for a knowledge deficit, not noncompliance. 2. Referring the client does not address the issue of noncompliance. 3. Noncompliance is a client's choice, and explaining interventions will not necessarily make the client choose differently. 4. Noncompliance is a choice the client has a right to make, but the nurse should determine the reason for the noncompliance and then take appropriate actions based on the client's rationale. For example, if the client has financial difficulties, the nurse may suggest how the client can afford the proper foods along with medications, or the nurse may be able to refer the client to a social worker. TEST-TAKING HINT: The test taker must always clarify and understand exactly what the question is asking the nurse to do. Answer options "1," "2," and "3" have the nurse doing the talking; only option "4" is allowing the client to explain the lack of compliance.

The client diagnosed with a UTI has a blood pressure of 83/56 mm Hg and a pulse of 122 bpm. Which should the nurse implement first? 1. Notify the health-care provider (HCP). 2. Hang the IVPB antibiotic at the prescribed rate. 3. Check the laboratory work to determine if the urine culture has been completed. 4. Increase the normal saline IV fluids from keep open to 150 mL/hour on the IV pump.

Answer: 4 1. The HCP should be notified, but this delay could cost the client's life; this client is in septic shock. 2. The IVPB will not treat the client as quickly as increasing the IV fluids. This would be the second action to be performed by the nurse. 3. This is not the time to check the EHR for information; it is the time for action. 4. This is septic shock and not fluid volume shock, but the circulatory system is still compromised. Increasing the fluid volume will support the client's BP until the IVPB is infused. TEST-TAKING HINT: The test taker must remember: "If in stress, do not assess; do something that will treat the client."

The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented? 1. Encourage fluids orally. 2. Administer 10% saline solution IVPB. 3. Administer antidiuretic hormone intranasally. 4. Place on seizure precautions.

Answer: 4 1. The client probably will be placed on fluid restriction. Fluids should not be encouraged for a client with a low sodium level (normal: 135 to 145 mEq/L). 2. Hypertonic solutions of saline are 3% to 5%, not 10%, because of the extreme nature of hypertonic solutions. Hypertonic solutions of saline may be used, but very cautiously; if the sodium levels are increased too rapidly, a massive fluid shift can occur in the body, resulting in neurological damage and heart failure. 3. The antidiuretic hormone (vasopressin) causes water retention in the body and increases the problem. 4. Clients with sodium levels less than 120 mEq/L are at risk for seizures as a complication. The lower the sodium level, the greater the risk of a seizure. TEST-TAKING HINT: The test taker must memorize certain common laboratory values and understand how deviations in the electrolytes affect the body.

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is the priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Alteration in comfort.

Answer: 4 1. The client's fluid volume is increased, and there is usually not a fluid volume loss. 2. Knowledge deficit is important to help prevent future renal calculi, but this is not a priority when the client is in pain, which will occur with an acute episode. 3. Impaired urinary elimination may occur, but it is not a priority for the client diagnosed with an acute episode of calculi. 4. Pain is the priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin. TEST-TAKING HINT: Remember Maslow's hierarchy of needs: airway and pain are a priority. No option mentions possible airway problems, so pain is the priority.

The client from a long-term care facility is admitted to the medical unit with a fever, hot flushed skin, and clumps of white sediment in the indwelling catheter. Which intervention should the nurse implement first? 1. Start an IV with a 20-gauge catheter. 2. Initiate antibiotic therapy IVPB. 3. Collect a urine specimen for culture. 4. Change the indwelling catheter.

Answer: 4 1. The first action is to get a viable urine culture, so the causative pathogen can be identified. An IV should be started, but this is not the first action. 2. Initiating an IV antibiotic is a priority, but obtaining a culture is done first to make sure the HCP can treat the causative organism. 3. This is not the first intervention because the culture will be obtained when the new catheter has been inserted. 4. Unless the nurse can determine the catheter has been inserted within a few days, the nurse should replace the catheter and then get a specimen. This will provide the most accurate specimen for analysis. TEST-TAKING HINT: In a question requiring the test taker to choose a "first" action, the test taker usually can order the choices 1, 2, 3, 4. In this question, options "4," "3," "1," and "2" should be the order of interventions.

The client with a TURP and continuous irrigation catheter reports the need to urinate. Which intervention should the nurse implement first? 1. Call the surgeon to inform the HCP of the client's report. 2. Administer the client a narcotic medication for pain. 3. Explain to the client this sensation happens frequently. 4. Assess the continuous irrigation catheter for patency.

Answer: 4 1. The nurse should not call a surgeon until all assessment is completed. 2. Pain medication should not be administered until the cause of the problem is determined and all complications are ruled out. 3. Telling a client that what he is experiencing is expected without assessing the situation is dangerous. 4. The nurse should always assess any report before dismissing it as a commonly occurring problem. TEST-TAKING HINT: When the question requires the test taker to decide which intervention should be first, assessment is usually first. If the test taker has no idea which intervention is correct, the test taker should choose assessment.

The client is in the intensive care unit (ICU) after a motor vehicle accident in which the client lost an estimated 3 units of blood. Which action by the nurse could prevent the client from developing AKI? 1. Take and document the client's vital signs every hour. 2. Assess the client's dressings every 2 hours. 3. Check the client's urinary output every shift. 4. Maintain the client's blood pressure greater than 100/60.

Answer: 4 1. The nurse taking vital signs and documenting them will not prevent AKI because an action is not initiated that will directly affect the client's health status because of the results of the data. The nurse must always initiate an intervention based on abnormal data assessed. 2. Assessing the client's dressing will allow the nurse to be aware of bleeding but does not prevent AKI. 3. The urinary output is checked to ensure the kidneys are being perfused, but there is no action that will maintain the perfusion in this option. 4. Maintaining the client's blood pressure to greater than 100/60 ensures perfusion of the kidneys. AKI occurs when the kidneys have not been adequately perfused. Vasopressor drips are used to maintain BP. TEST-TAKING HINT: The test taker must be aware of the purpose behind medications and the results of inadequate administration of certain critical medications.

The female client in an outpatient clinic is being sent home with a diagnosis of UTI. Which instruction should the nurse teach to prevent a recurrence of a UTI? 1. Clean the perineum from back to front after a bowel movement. 2. Take warm tub baths instead of hot showers daily. 3. Void immediately preceding sexual intercourse. 4. Avoid coffee, tea, colas, and alcoholic beverages.

Answer: 4 1. The perineum should be cleaned from front to back after a bowel movement to prevent fecal contamination of the urethral meatus. 2. The temperature of the water does not matter, but the client should take showers instead of baths to prevent bacteria in the bath water from entering the urethra. 3. Voiding immediately after, not before, sexual intercourse uses the action of the urine passing through the urethra to the outside of the body to flush bacteria from the urethra that might have been introduced during intercourse. 4. Coffee, tea, cola, and alcoholic beverages are urinary tract irritants. TEST-TAKING HINT: The test taker might jump to option "3" as the correct answer if the test taker did not read the word "preceding."

The nurse is caring for clients in a renal surgery unit. After the afternoon report, which client should the nurse assess first? 1. The male client just returned from a CT scan stating he left his glasses in the x-ray department. 2. The client 1 day postoperative with a moderate amount of serous drainage on the dressing. 3. The client scheduled for surgery in the morning and wants an explanation of the operative procedure before signing the permit. 4. The client, after ileal conduit surgery this morning, has not had any drainage in the drainage bag.

Answer: 4 1. This client does not need to be assessed first. A unit secretary can call the department and check on the glasses. 2. A moderate amount of serous drainage is expected after surgery. Serous drainage is a pale yellow body fluid. Sanguineous is the term used to describe bloody drainage. 3. The nurse is not responsible for informing the client about operative procedures. The surgeon should be notified to see this client and provide the explanation. 4. An ileal conduit is a procedure diverting urine from the bladder and provides an alternate cutaneous pathway for urine to exit the body. Urinary output should always be at least 30 mL/hr. This client should be assessed to make sure the stents placed in the ureters have not become dislodged or blocked. TEST-TAKING HINT: Basic care of any postoperative client is to ensure urinary output. Two of the options involve tasks that can be delegated or are not in the realm of the nurse.

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/dL. 4. A white blood cell count of 14 × 10^3/microL.

Answer: 4 1. This potassium level is within normal limits, 3.5 to 5.3 mEq/L. 2. Hematuria is not uncommon after the removal of a kidney stone. 3. A normal creatinine level is a male: 0.61 to 1.21 mg/dL, female: 0.51 to 1.11 mg/dL. 4. The white blood cell count is elevated; normal is 4.5 to 11.1 × 10^3/microL. TEST-TAKING HINT: The nurse must know normal laboratory data and be able to apply the normal and abnormal results to specific diseases and disorders.

The nurse is admitting a client diagnosed with acute kidney injury (AKI). Which question is most important for the nurse to ask during the admission interview? 1. "Have you recently traveled outside the United States?" 2. "Did you recently begin a vigorous exercise program?" 3. "Is there a chance you have been exposed to a virus?" 4. "What over-the-counter medications do you take regularly?"

Answer: 4 1. Usually, there are no diseases or conditions warranting this question when discussing AKI. 2. Vigorous exercise will not impede blood flow to the kidneys, leading to AKI. 3. Usually, viruses do not cause AKI. 4. Medications such as NSAIDs and some herbal remedies are nephrotoxic; therefore, asking about medications is appropriate. TEST-TAKING HINT: Asking about medications, especially over-the-counter and herbal remedies, during the admission interview is an important intervention because many medications are nephrotoxic and hepatotoxic.

The nurse performs bladder irrigation through an indwelling catheter. The nurse instilled 90 mL of sterile normal saline. The catheter drained 710 mL. What is the client's output?

Answer: 620 mL of urine. The amount of sterile normal saline is subtracted from the total volume removed from the catheter. 710 - 90 = 620. TEST-TAKING HINT: This is a simple subtraction problem, but the test taker must understand any fluid used to irrigate a body system must be subtracted from the total volume in the suction device or catheter bag to get accurate information of the client's fluid-balance status.

The client diagnosed with CKD is placed on a fluid restriction of 1,500 mL/day. On the 7 a.m. to 7 p.m. shift, the client drank an 8-ounce cup of coffee, 4 ounces of juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid can the 7 p.m. to 7 a.m. nurse give to the client?

Answer: 720 mL The nurse must add up how many milliliters of fluid the client drank during the 7 a.m. to 7 p.m. shift and then subtract that number from 1,500 mL to determine how much fluid the client can receive on the 7 p.m. to 7 a.m. shift. One ounce is equal to 30 mL. The client drank 26 ounces (8 + 4 + 12 + 2) of fluid, or 780 mL (26 × 30) of fluid. Therefore, the client can have 720 mL (1,500 - 780) of fluid during the 7 p.m. to 7 a.m. shift. TEST-TAKING HINT: The test taker must have knowledge of basic conversion factors. Use the drop-down calculator on the computer examination to ensure accuracy in computations.

The nurse emptied 2,000 mL from the drainage bag of a client's continuous irrigation after transurethral resection of the prostate (TURP). The amount of irrigation in the bag hanging was 3,000 mL at the beginning of the shift. There were 1,800 mL left in the bag 8 hours later. What is the correct urine output at the end of the 8 hours?

Answer: 800 mL First, determine the amount of irrigation fluid: 3,000 - 1,800 = 1,200 mL of irrigation fluid Then, subtract 1,200 mL of irrigation fluid from the drainage of 2,000 mL to determine the urine output: 2,000 - 1,200 = 800 mL of urine output TEST-TAKING HINT: The test taker should use the drop-down calculator for the NCLEX-RN® examination.

The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first? 1. The client in normal sinus rhythm with a peaked T wave. 2. The client diagnosed with atrial fibrillation with a rate of 100. 3. The client diagnosed with a myocardial infarction and occasional PVCs. 4. The client diagnosed with a first-degree atrioventricular block and a rate of 92.

Answer: 1 1. A client diagnosed with a peaked T wave could be experiencing hyperkalemia. Changes in potassium levels can initiate cardiac dysrhythmias and instability. 2. Fluctuations in rate are expected in clients diagnosed with atrial fibrillation, and a heart rate of 100 is at the edge of a normal rate. 3. Most people experience an occasional premature ventricular contraction (PVC); this does not warrant the nurse assessing this client first. 4. A first-degree block is not an immediate problem. TEST-TAKING HINT: The test taker must know the normal data so the abnormal will be apparent. The normal heart rate is 60 to 100 bpm. The nurse should assess the client with an abnormal or life-threatening condition first.

The client with a continent urinary diversion is being discharged. Which discharge instructions should the nurse include in the teaching? 1. Have the client demonstrate catheterizing the stoma. 2. Instruct the client on how to pouch the stoma. 3. Explain the use of a bedside drainage bag at night. 4. Tell the client to call the HCP if the temperature is 99°F or less.

Answer: 1 1. A continent urinary diversion is a surgical procedure in which a reservoir is created to hold urine until the client can self-catheterize the stoma. The nurse should observe the client's technique before discharge. 2. The purpose of creating a continent diversion is so the client will not need a pouch. 3. Clients with cutaneous diversions that drain constantly use a bedside drainage bag at night, not those with continent diversions. 4. The client should be taught to notify the HCP if the temperature is 100°F or greater. TEST-TAKING HINT: Options "2" and "3" are related to continuous drainage and could be eliminated on this basis. The word "continent" in the stem should key the test taker to the fact this diversion is a procedure in which there is no continuous drainage of urine.

The nurse is caring for a pregnant client diagnosed with acute pyelonephritis. Which scientific rationale supports the client being hospitalized for this condition? 1. The client must be treated aggressively to prevent maternal and fetal complications. 2. The nurse can force the client to drink fluids and avoid nausea and vomiting. 3. The client will be dehydrated, and there won't be sufficient blood flow to the baby. 4. Pregnant clients historically are afraid to take the antibiotics as ordered.

Answer: 1 1. A pregnant client diagnosed with a UTI will be admitted for aggressive IV antibiotic therapy to decrease the risk of preterm labor and delivery, septic shock, and other complications. After symptoms subside, the client will be sent home to complete the course of treatment with oral medications. 2. The nurse cannot "force" a client to drink, and forcing fluids could result in nausea and vomiting, not prevent it. 3. The client may or may not be dehydrated. 4. Pregnant clients have a right to be concerned about taking medications, but most are comfortable taking medications prescribed by the obstetrician. TEST-TAKING HINT: In option "2" the nurse is "forcing" a client to do something, which should be eliminated as a possible correct answer. Option "4" is a broad generalization about "all" pregnant clients and should be discarded as a possible correct answer.