GI, Renal, & Urinary

A sexually active young adult client has developed viral hepatitis. Which client statement indicates the need for further teaching?

"I can go back to work right away."

The registered nurse is instructing a new nursing graduate about hemodialysis. Which statement made by the new nursing graduate indicates an understanding of the procedure for hemodialysis? Select all that apply.

-"Heparin sodium is administered during dialysis." -"Dialysis cleanses the blood of accumulated waste products." -"Warming the dialysate increases the efficiency of diffusion."

Which client will the nurse identify as at risk for acute kidney injury? Select all that apply.

-16 y/o male football player in preseason practice -27 y/o female recovering from shock following a car accident. -30 y/o female in ICU receiving multiple IV antibiotics

A client diagnosed with chronic kidney disease (CKD) is scheduled to begin hemodialysis. The nurse determines that which neurological and psychosocial manifestations, if exhibited by this client, are related to the CKD? Select all that apply.

-Agitation -Depression -Withdrawal -Labile emotions

The nurse is preparing to perform a discharge teaching with a client who is started on hemodialysis. Which information should the nurse provide regarding the hemodialysis schedule?

3 to 4 hours of treatment, 3 days per week

A client with chronic pancreatitis needs information on dietary modification to manage the health problem. Which item in the diet should the nurse teach the client to limit?

Fat

A client is admitted to the hospital with acute viral hepatitis. Which sign or symptom should the nurse expect to note based on this diagnosis?

Fatigue

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

Fever, nausea, vomiting, and painful scrotal edema

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective?

"Baked foods such as chicken or fish are all right to eat."

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective?

"Beet greens, parsley, or yogurt will help to control the colostomy odor."

A client with viral hepatitis is having difficulty coping with the disorder. Which question by the nurse is the most appropriate in identifying the client's coping problem?

"Have you enjoyed having visitors?"

When assessing a client with acute glomerulonephritis, which question will the nurse ask to determine if the client is following best practices to slow progression of kidney damage?

"How are you evaluating the amount of daily fluid you drink?"

Which question will the nurse ask the client who has a urinary tract infection to assess the risk for pyelonephritis?

"How long have you had diabetes?"

The nurse has given instructions to a client with hepatitis about postdischarge management during convalescence. The nurse determines that further teaching is needed if the client makes which statement?

"I can resume a full activity level within 1 week."

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching?

"I eat at least 3 large meals each day."

The nurse has provided instructions regarding home care measures for a client with acute pyelonephritis. Which statement by the client indicates a need for further teaching?

"I need to avoid alcohol and highly spiced foods but may continue to drink my coffee every day."

A client with renal cancer is being treated preoperatively with radiation therapy. What statement by the client demonstrates understanding of proper care of the skin over the treatment field?

"I need to avoid skin exposure to direct sunlight and chlorinated water."

The nurse is teaching the postgastrectomy client about measures to prevent dumping syndrome. Which statement by the client indicates a need for further teaching?

"I need to drink liquids with meals."

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching?

"I need to limit my intake of dietary fiber."

Which statement by the client who is prescribed to take pancreatic enzyme replacements indicates a need for further teaching by the nurse?

"I should chew each capsule carefully so that it works in my stomach."

A client with prostatitis following kidney infection has received instructions on management of the condition at home and prevention of recurrence. The nurse determines that education was effective if the client makes which statement?

"I should use warm tub baths and analgesics to increase comfort."

A client has chronic kidney disease (CKD) that does not yet require dialysis. Which client statement indicates the need for further teaching?

"I will reduce the sodium in my diet, and I can use salt substitutes to spice my food."

A home care nurse visits a client who was recently diagnosed with cirrhosis. The nurse provides home care management instructions to the client. Which client statement indicates a need for further instruction?

"I will take acetaminophen if I get a headache."

A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm not sure I can avoid alcohol." What is the most appropriate nursing response?

"I'm not sure that I understand. Would you please explain?"

The nurse is performing an assessment on a client with suspected acute pancreatitis. Which complaint made by the client supports the diagnosis?

"I've been experiencing constant, severe abdominal pain that is unrelieved by vomiting."

The nurse is completing an admission assessment for a client with suspected esophageal cancer. Which statement made by the client indicates the presence of a risk factor for esophageal cancer?

"I've been smoking for 20 years now."

The ambulatory care nurse is providing instructions to a client after a cystoscopy. Which statement by the client indicates a need for further teaching?

"If I notice any pink-tinged urine, I should contact the primary health care provider."

The nurse has given postprocedure instructions to a client who has undergone a colonoscopy. Which statement by the client indicates the need for further teaching?

"It is all right to drive once I've been home for an hour or so."

The graduate nurse is caring for a client with decreased renal perfusion. The registered nurse determines that the graduate nurse demonstrates understanding of why this is occurring if which statement is made?

"It may be a consequence of decreased dopaminergic receptor stimulation."

A client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse should anticipate a prescription from the primary health care provider for which type of diet for this client?

A low-fiber diet

A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment?

A rigid, board-like abdomen

The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs of portal hypertension. Which finding should the nurse interpret as a sign or symptom of portal hypertension?

Abdominal distention

A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse should assess the client for a history of chronic use of which medication?

Acetaminophen

A client with gastritis asks the nurse at a screening clinic about analgesics that will not cause epigastric distress. The nurse should tell the client that which medication is unlikely to cause epigastric distress?

Acetaminophen

The nurse is teaching a client with nephrotic syndrome about managing the disorder. What should the nurse instruct the client to adjust according to the amount of edema present?

Activity level

Which client being managed for dehydration does the nurse consider at greatest risk for possible reduced kidney function?

An 80-year-old man who has benign prostatic hyperplasia

The nurse is working with a client newly diagnosed with chronic kidney disease (CKD) to set up a schedule for hemodialysis. The client states, "This is impossible! How can I even think about leading a normal life again if this is what I'm going to have to do?" The nurse determines that the client is exhibiting which problem?

Anger

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client?

Applesauce and a graham cracker

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain. Appendicitis is suspected, and appropriate laboratory tests are performed. The emergency department nurse reviews the test results and notes that the client's white blood cell (WBC) count is elevated. The nurse also reviews the prescriptions from the primary health care provider (PHCP). The nurse should contact the PHCP to question which prescription if noted in the client's record?

Apply a heating pad to the lower abdomen for comfort.

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence?

Ask the client to extend the arms.

A client presents to the emergency department with upper gastrointestinal bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client?

Assessment of vital signs

A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing action?

Assist the client in expressing feelings.

The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome. The nurse determines that education was effective if the client states the need to avoid which food?

Corn

A client undergoing hemodialysis begins to experience muscle cramping. What is the best action by the hemodialysis nurse in this situation?

Decrease the ultrafiltration rate.

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

Decreased force in the stream of urine

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis?

Decreased hemoglobin

The nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which should the nurse expect to note in this client?

Decreased serum albumin levels

The nurse checks the gastric residual of an unconscious client receiving nasogastric tube feedings continuously at 50 mL/hr. The nurse notes that the residual is 250 mL at 0800 and 300 mL at 0900. The nurse determines that the client is experiencing which complication?

Delayed gastric emptying

A client has been diagnosed with pyelonephritis. The nurse interprets that which health problem has placed the client at risk for this disorder?

Diabetes mellitus

The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder, if noted on the client's record, should the nurse identify as a risk factor for this disorder?

Diabetes mellitus

A client who has a gastrostomy tube for feeding refuses to participate in the plan of care, will not make eye contact, and does not speak to the family or visitors. The nurse interprets that the client is using which coping mechanism?

Distancing

The nurse is caring for a client postoperatively after creation of a colostomy. What is an appropriate potential client problem?

Disturbed body image

A client with a recently created vascluar access for hemodialysis is being dicharged. Which discharge teaching will the nurse include?

Do not allow BP measurements in the affected arm.

The nurse is caring for a client who has just returned from the operating room after the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is appropriate based on this assessment?

Document the amount and characteristics of the drainage.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate?

Document the findings

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

Dysuria and penile discharge

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

Elevated creatinine level

The nurse is caring for a client with pancreatitis. Which finding should the nurse expect to note when reviewing the client's laboratory results?

Elevated level of amylase

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis, requiring the nurse to contact the primary health care provider?

Elevated serum bilirubin level

A client with an external arteriovenous shunt in place for hemodialysis is at risk for bleeding. Which is the priority nursing intervention?

Ensure that small clamps are attached to the arteriovenous shunt dressing.

The nurse is caring for a client admitted with severe weight loss due to dieting. Based on the data provided, which condition should the nurse suspect is occurring in this client?

Gluconeogenesis

The nursing student is caring for a client with benign prostatic hyperplasia (BPH). The nursing instructor asks the student to identify the clinical manifestations associated with this condition. The student needs further teaching if the student states that which finding is an early symptom of BPH?

Hematuria

The nurse is assigned to care for a client with a Sengstaken-Blakemore tube. Which laboratory result is most focused on evaluating the effectiveness of this tube?

Hemoglobin

The nurse is caring for a client with altered protein metabolism as a result of liver dysfunction. Which finding should the nurse expect to note when reviewing the client's laboratory results?

Increased ammonia level

The nurse is caring for a client with common bile duct obstruction. The nurse should anticipate that the primary health care provider (PHCP) will prescribe which diet for this client?

Low fat

A client is admitted to the hospital with a diagnosis of acute diverticulitis. What should the nurse expect to be prescribed for this client?

NPO status

The nurse caring for a client immediately after transurethral resection of the prostate (TURP) notices that the client has suddenly become confused and disoriented. Which is the priority nursing action for this client?

Notify the primary health care provider (PHCP).

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

Notify the primary health care provider (PHCP).

The nurse is monitoring the urine output of a client with a low serum protein level and urinary output less than 30 mL in the last hour. Based on these data, the nurse understands that low urinary output is caused by which force within the kidneys?

Oncotic pressure

A client with renal cell carcinoma of the left kidney is scheduled for nephrectomy. The right kidney appears normal at this time. The client is anxious about whether dialysis will ultimately be needed. The nurse should plan to use which information in discussions with the client to alleviate anxiety?

One kidney is adequate to meet the needs of the body as long as it has normal function.

A client with a diagnosis of stomach ulcer from gastric hyperacidity asks the nurse why the acid has not caused an ulcer in the small intestine as well. The nurse responds that the pH of intestinal contents is raised by bicarbonate, which is present in which area of the body?

Pancreatic juice

A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment. The nurse assesses for this occurrence by periodically checking the results of which laboratory test?

Partial thromboplastin time (PTT)

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse suggest to the client?

Pasta with sauce

The nurse is planning discharge teaching for a client newly diagnosed with chronic kidney disease (CKD). Which factor will enhance the educational process?

Presence of family

The nurse assessing the ureterostomy of a postoperative client interprets that the stoma has normal characteristics if which is observed?

Red and moist

A client is scheduled for surgical creation of an internal arteriovenous (AV) fistula on the following day. The client says to the nurse, "I'll be so happy when the fistula is made tomorrow. This means I can have that other hemodialysis catheter pulled right out." Which interpretation should the nurse make based on the client's statement?

The client does not understand that the site needs to mature or develop for 1 to 2 weeks before use.

The nurse is evaluating the plan of care for a client with peptic ulcer disease (PUD) who is experiencing acute pain. The nurse determines that the expected outcomes have been met if the nursing assessment reveals which result?

The client has eliminated any irritating foods from the diet.

A client is experiencing the syndrome of inappropriate antidiuretic hormone (ADH) secretion. When explaining this disorder to the client and family, the nurse recalls that ADH works to reabsorb water in which parts of the nephron?

The distal tubule and the collecting duct

The nurse is obtaining a health history for a client with chronic pancreatitis. The health history is most likely to include which as a most common causative factor in this client's disorder?

Use of alcohol

A client with gastric hypersecretion is scheduled for surgery. The nurse teaches the client that the procedure will lessen the stomach's production of acid by altering which structure?

Vagus nerve

A home care nurse is visiting a client with a diagnosis of pernicious anemia that developed as a result of gastric surgery. The nurse instructs the client that in this disorder, because the stomach lining produces a decreased amount of a substance known as the intrinsic factor, the client will need which medication?

Vitamin B12 injections

The nurse should anticipate that the primary health care provider (PHCP) will prescribe which treatment for a client with pernicious anemia?

Vitamin B12 injections

The nurse has performed a nutritional assessment on a client with cystitis. The nurse should tell the client to consume which beverage to minimize recurrence of cystitis?

Water

After performing an initial abdominal assessment on a client with nausea and vomiting, the nurse should expect to note which finding?

Waves of loud gurgles auscultated in all 4 quadrants

The nurse is caring for four clients who have been recommended to consider bariatric surgery. Which assessment data require immediate nursing intervention?

-BMI of 23 with gastrointestinal reflux

The nurse is working on a medical-surgical nursing unit and is caring for several clients with chronic kidney disease. The nurse interprets that which client is best suited for peritoneal dialysis as a treatment option?

A client with severe heart failure

Which client is most at risk for developing a Candida urinary tract infection (UTI)?

A young woman on antibiotic therapy

The nurse is providing instructions to a client who is scheduled for cystoscopy and possible biopsy under general anesthesia. Which information should the nurse include?

Intravenous fluids may be started on the day of the procedure.

The nurse is caring for a client with acute kidney injury (AKI) experiencing metabolic acidosis. When performing an assessment, the nurse should expect to note which breathing pattern?

Kussmaul respirations

The nurse is providing instructions to a client regarding measures to minimize the risk of dumping syndrome. The nurse should make which suggestion to the client?

Maintain a low-Fowler's position while eating.

The nurse is providing discharge teaching to a client recovering from kidney transplantation. Which client statement indicates understanding?

"The antirejection medication will be taken for life."

The nurse is reviewing the urinalysis results for a client with glomerulonephritis. Which findings should the nurse expect to note? Select all that apply.

-Proteinuria -Hematuria -A dark and smoky appearance of the urine

The nurse is developing a teaching plan for a client with viral hepatitis. The nurse should plan to include which information in the teaching session?

Activity should be limited to prevent fatigue.

A client with uric acid calculi is placed on a low-purine diet. The nurse instructs the client to restrict the intake of which food?

Fish

The nurse is performing an assessment on a client after a cystoscopy. Which assessment finding indicates a need to notify the primary health care provider (PHCP)?

Grossly bloody urine with clots

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching?

"I plan to have a snack 1 hour before going to bed."

The nurse has given instructions about Kegel exercises to a female client with a cystocele. The nurse determines that the client needs further instruction if she makes which statement?

"I should begin voiding and then stop the stream, holding residual urine for an hour."

The nurse provides home care instructions to a client undergoing hemodialysis with regard to care of a newly created arteriovenous (AV) fistula. Which client statement indicates that teaching was effective?

"I should check the fistula every day by feeling it for a vibration."

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching?

"The best position for me is to lie supine with my legs straight."

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply.

-Administer stool softeners as prescribed. -Encourage a high-fiber diet to promote bowel movements without straining. -Apply cold packs to the anal-rectal area over the dressing until the packing is removed.

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply.

-Coffee -Chocolate -Peppermint -Fried chicken

A client had a colectomy with creation of an ileo-anal pouch and temporary ileostomy yesterday morning. The nurse assesses the ostomy and its functioning. Which assessment finding will the nurse report to the primary health care provider?

-No drainage from the ileostomy

When providing care to a client who has undergone a nephrostomy for hydronephrosis, which observation alerts the nurse to a possible complication? Select all that apply.

-Urine output of 15ml for the first hour and then diminishing -A hematocrit value 3% lower than the preoperative value -Sudden onset of abdominal pain that worsens after abdominal palpation. -Blood pressure of 180/90mm Hg that persists despite administration of pain medication.

The ambulatory care nurse is providing instructions to a client who is scheduled for a small bowel biopsy. What should the nurse tell the client?

A signed informed consent form will need to be obtained.

A client with chronic kidney disease (CKD) is prescribed aluminum hydroxide. Which information should the nurse include while instructing the client regarding the action of this medication?

It combines with phosphorus and helps eliminate phosphates from the body.

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse determines that education about positioning to reduce pain was effective if the client avoids which action?

Lying flat

The nurse is preparing to care for a client receiving peritoneal dialysis. Which should be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?

Maintain strict aseptic technique.

Cholestyramine resin is prescribed for a client with an elevated serum cholesterol level. The nurse should instruct the client to take the medication in which way?

Mixed with fruit juice

A client being discharged home after renal transplantation has a risk for infection related to immunosuppressive medication therapy. The nurse determines that the client needs further teaching on measures to prevent and control infection if the client states that it is necessary to take which action?

Monitor urine character and output at least 1 day each week.

The nurse is caring for a client who had a subtotal gastrectomy. The nurse should assess the client for which signs and symptoms of dumping syndrome?

Weakness, diaphoresis, and diarrhea

The nurse has provided home care instructions to a client who had a subtotal gastrectomy. The nurse instructs the client on the signs and symptoms associated with dumping syndrome. Which client statement indicates that teaching was effective?

"It will cause diaphoresis and diarrhea."

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply.

-Nuts -Liver -Lentils

The nurse has inserted a nasogastric (NG) tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts to slowly advance the NG tube with each swallow. The client begins to cough, gag, and choke. Which actions should the nurse take that will result in proper tube insertion and promote client relaxation? Select all that apply.

-Pull the tube back slightly. -Instruct the client to breathe slowly. -Assist the client to take sips of water. -Check the back of the pharynx using a tongue blade and flashlight.

The nurse is performing discharge teaching for a client with chronic pancreatitis. Which information should the nurse include?

Avoid caffeine because it may aggravate symptoms.

The nurse is caring for a client with acute pancreatitis. Which finding should the nurse expect to note when reviewing the laboratory results?

Elevated serum lipase level

A client with a bladder injury has had surgical repair of the injured area with placement of a suprapubic catheter. Which is the most appropriate nursing action to prevent complications of this procedure?

Ensure that the catheter tubing is not kinked.

The nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper fluid balance if which 24-hour intake and output totals are noted?

Intake 1800 mL, output 1750 mL

The nurse is planning teaching for a female client diagnosed with urethritis caused by chlamydial infection. Which information should the nurse plan to include in the teaching session?

Keep follow-up appointments for repeat cultures in 4 to 7 days.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia?

Lying recumbent following meals

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding?

Malaise

The nurse should incorporate which in the dietary plan to ensure optimal nutrition for the client during the acute phase of hepatitis? Select all that apply.

-Consume multiple small meals throughout the day. -Allow the client to select foods that are most appealing. -Eliminate fatty foods from the meal trays until nausea subsides.

Which lab finding is indicative of renal function alterations and not dehydration? Select all that apply.

-Creatinine 2.3 mL/dL -Cystatin-c 105 mg/mL -Creatinine clearance 175 mL/min

The nurse is providing discharge instructions for a client following a Roux-en-Y gastric bypass surgery 3 days ago. What will the nurse include in the instructions? Select all that apply.

-Do not drink fluids with meals. -Avoid foods high in carbohydrates. -Eat 6 small meals a day that are high in protein.

The nurse is providing instructions to a client diagnosed with irritable bowel syndrome (IBS) who is experiencing abdominal distention, flatulence, and diarrhea. What interventions should the nurse include in the instructions? Select all that apply.

-Eat yogurt. -Take loperamide to treat diarrhea. -Use stress management techniques. -Avoid foods such as cabbage and broccoli.

The nurse has taught the client with polycystic kidney disease about management of the disorder and prevention and recognition of complications. The nurse should determine that the client understands the instructions if the client states that which should be reported to the primary health care provider (PHCP)? Select all that apply.

-Frequent urination -Burning on urination -A temperature of 100.6º F (38.1º C) -New-onset shortness of breath

A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply.

-Gray-blue color at the flank -Abdominal guarding and tenderness -Left upper quadrant pain with radiation to the back

The nurse is caring for a client with chronic kidney disease. The nurse plans care knowing that besides maintaining urinary elimination, the kidneys also are involved in what body processes? Select all that apply.

-Help regulate blood pressure. -Assist to regulate acid-base balance. -Convert vitamin D to an active form. -Produce erythropoietin for red blood cell synthesis.

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

-Hemodialysis -Kidney transplant -Bilateral nephrectomy

A client recently diagnosed with chronic kidney disease requiring hemodialysis has an arteriovenous fistula for access. The client asks the nurse what complications can occur with the access site. What complications should the nurse inform the client about? Select all that apply.

-Hepatitis -Infection

The nurse is participating in a prostate screening clinic for men. Which complaints by a client are associated with prostatism? Select all that apply.

-Inability to stop urinating -Postvoid dribbling of urine -Increased episodes of nocturia -Hesitancy on initiating the urinary stream

The nurse is performing assessment on a client with acute kidney injury who is in the oliguric phase. Which should the nurse expect to note? Select all that apply.

-Increased serum creatinine level -A low and fixed specific gravity -Increased blood urea nitrogen (BUN) level -Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)

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

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

The nurse is teaching the client with viral hepatitis about the stages of the disease. The nurse should explain to the client that the second stage of this disease is characterized by which specific assessment findings? Select all that apply.

-Jaundice -Clay-colored stools -Elevated bilirubin levels -Dark or tea-colored urine

A nurse is caring for a 34-year-old client newly diagnosed with GERD. Which lifestyle change will the nurse suggest? Select all that apply.

-Lose weight is needed -Do not eat before bed. -Avoid pants with a tight waistband or belt

The nurse is creating a plan of care for a client with cirrhosis and ascites. Which nursing actions should be included in the care plan for this client? Select all that apply.

-Monitor daily weight. -Measure abdominal girth. -Monitor respiratory status. -Assist the client with care as needed.

The nurse has provided instructions to a client with a urinary tract infection regarding foods and fluids to consume that will acidify the urine. Which fluids should the nurse include in the client's teaching plan that will aid in acidifying the urine? Select all that apply.

-Prune juice -Apricot juice -Cranberry juice

A client is diagnosed with epididymitis. The nurse checks the primary health care provider's prescriptions and expects that which measures will be prescribed? Select all that apply.

-Sitz bath -Antibiotics -Scrotal elevation -Bed rest with bathroom privileges

A client who is to have a cystectomy with creation of an ileal conduit asks the nurse why the bowel needs to be cleansed before surgery if the bladder is being removed. Which response by the nurse is the most appropriate?

"A portion of the bowel will be used to create the conduit for urinary diversion."

A client has a new diagnosis of irritable bowel syndrome (IBS) with diarrhea. What health teaching by the nurse is appropriate for this client?

"Avoid dairy products and caffeinated beverages."

The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which assessment question would most specifically elicit information regarding the pain that is associated with acute pancreatitis?

"Does the pain in your stomach radiate to your back?"

The nurse is teaching an older client about measures to prevent constipation. Which statement by the client indicates a need for further teaching?

"I need to decrease fiber in my diet."

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction?

"I should increase the fiber in my diet."

A client is resuming a diet after hemigastrectomy, and the nurse provides dietary instructions. Which statement by the client indicates a need for further teaching?

"I will drink plenty of liquids with meals."

The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement?

"I'm glad I don't have to lie still for this procedure."

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week; however, he is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern that he will not be able to continue the tube feedings at home. Which nursing response is most appropriate at this time?

"Tell me more about your concerns with your diet after going home."

Immediately following a colonoscopy, which client behavior will the nurse report to the health care provider? Select All That Apply.

-Abdominal guarding -Change in mental status

The nurse caring for a client diagnosed with inflammatory bowel disease (IBD) recognizes that which classifications of medications may be prescribed to treat the disease and induce remission? Select all that apply.

-Antimicrobial -Corticosteroid -Aminosalicylate -Biological therapy -Immunosuppressant

A public health nurse is assessing community clients for oral health disorders. Which client is identified at highest risk?

34-year-old with schizophrenia

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome?

Limit fluids taken with meals

The nurse is caring for an older client. The nurse should anticipate that medication dosages will be further adjusted if the client has dysfunction of which organ?

Liver

The nurse is caring for a client who is prescribed a nasogastric (NG) tube for the purpose of stomach decompression. The nurse should anticipate a primary health care provider prescription for which type of suction?

Low and intermittent

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention?

Notify the primary health care provider (PHCP).

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

Notify the primary health care provider.

The nurse is urging a client to cough and deep breathe after nephrectomy. The client tells the nurse, "That's easy for you to say! You don't have to do this." The nurse interprets that the client's statement is most likely to be a result of which factor?

Pain that is intensified because of the location of the incision near the diaphragm

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

Pallor, diminished pulse, and pain in the left hand

The nurse is reviewing laboratory test results for the client with liver disease and notes that the client's albumin level is low. Which nursing action is focused on the consequence of low albumin levels?

Palpating for peripheral edema

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

Palpation of a thrill over the fistula.

The nurse is assessing a client with liver disease for signs and symptoms of low albumin. Which sign or symptom should the nurse expect to note?

Peripheral edema

The nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the material if the client states to increase intake of which food?

Pork

The primary health care provider writes prescriptions for a client with chronic kidney disease (CKD). Which prescription should the nurse question?

Provide a high-protein diet.

A client with an arteriovenous fistula in the left arm who is undergoing hemodialysis is at risk for infection. Which should the nurse formulate as the best outcome goal for this client problem?

The client's white blood cell (WBC) count remains within normal limits.

The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse should formulate a response using what fact about the kidneys?

The kidneys generally require and receive about 20% to 25% of the resting cardiac output.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. Which would the nurse expect the client to report about the pain?

The pain usually increases after vomiting.

Pancreatin is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication?

The stool is less fatty and decreases in frequency.

A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse?

This is a normal, expected event.

A client with chronic kidney disease has completed a hemodialysis treatment. The nurse should use which standard indicators to evaluate the client's status after dialysis?

Vital signs and weight

The nurse is caring for a client with pernicious anemia. Which prescription by the primary health care provider (PHCP) should the nurse anticipate?

Vitamin B12

A client is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching?

Whole milk

A client with a new colostomy is concerned about the odor from stool in the ostomy drainage bag. The nurse should teach the client to include which food in the diet to reduce odor?

Yogurt

A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan?

Assessing for the return of the gag reflex

The nurse is caring for a client whose urine output was 25 mL per hour for 2 consecutive hours. The nurse reviews the primary health care provider's prescriptions and plans care, knowing that which client-related factor would increase the amount of blood flow to the kidneys?

Release of low levels of dopamine

A client has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome?

Remove fluids from the meal tray.

Which client assessment data is essential for the nurse to report to the health care provider before a renal scan is performed?

Reports pregnancy

The clinic nurse is performing an abdominal assessment on a client and preparing to auscultate bowel sounds. The nurse should place the stethoscope in which quadrant first? Click on the image to indicate your answer.

Right lower quadrant

The nurse assists a primary health care provider in performing a liver biopsy. After the procedure, the nurse should place the client in which position?

Right side

The nurse is caring for a patient with cirrhosis who has hepatic encephalopathy. Which assessment finding should the nurse report to the primary health care provider?

Seizure

Before providing care for a client in the late stages of chronic kidney disease (CKD), the nurse should review the results of which most relevant laboratory studies?

Serum potassium, serum calcium

The nurse is caring for a group of clients on the surgical nursing unit. The nurse anticipates that the client who underwent which procedure is most likely to have some long-term residual difficulty with absorption of nutrients?

Small bowel resection

A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this disease. The nurse should determine that the client needs further teaching if the client states that which is included in the treatment plan?

Sodium restriction

A client with nephrolithiasis arrives at the clinic for a follow-up visit. Laboratory analysis of the stone that the client passed 1 week earlier indicates that the stone is composed of calcium oxalate. Based on these data, what food item does the nurse instruct the client to avoid?

Spinach

The nurse has provided dietary instructions to a client with renal calculi who must learn about the foods that yield an alkaline residue in the urine. The nurse determines that education was effective if the client chooses which selections from a diet menu?

Spinach salad, milk, and a banana

The nurse is caring for a client with spinal cord injury (SCI) who is participating in a bowel retraining program. What should the nurse anticipate to promote during the bowel retraining program?

Stimulation of the parasympathetic reflex center at the S1 to S4 level in the spinal cord

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

Sweating and pallor

A client with chlamydial infection has received instructions on self-care and prevention of further infection. The nurse determines that the client needs further teaching if the client states that he or she will take which action?

Take an antibiotic so as to prophylactically prevent symptoms of Chlamydia.

The nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which client factor documented by the nurse would increase the risk for PUD?

Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis

A cystectomy is performed for a client with a diagnosis of bladder cancer, and a Kock pouch is created for urinary diversion. In creating a discharge teaching plan for the client, the nurse should include which instruction in the plan?

Technique of catheterization

The nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) are primary characteristics of the preicteric phase?

Fatigue, anorexia, and nausea

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

Hyperglycemia

A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse should expect to note which abnormal finding documented on the client's medical record?

Hypertension

During a home care visit, an adult client complains of chronic constipation. What should the nurse tell the client to do?

Increase fluid and dietary fiber intake.

The primary health care provider has determined that a client has contracted hepatitis A based on flu-like symptoms and jaundice. Which statement made by the client supports this medical diagnosis?

"I ate shellfish about 2 weeks ago at a local restaurant."

The nurse is caring for a client just after ureterolithotomy and is monitoring the drainage from the ureteral catheter hourly. Suddenly, the catheter stops draining. The nurse assesses the client and determines that which could be the cause of the problem? Select all that apply.

-Blood clots -Mucous shreds -Chemical sediment -Catheter displacement

Which adverse drug effects will the nurse assess for in a hospitalized client who is prescribed an anticholinergic drug to manage incontinence? (Select all that apply.) A. Insomnia B. Blurred vision C. Constipation D. Dry mouth E. Loss of sphincter control F. Increased sweating G. Worsening mental function

-Blurred vision -Constipation -Dry mouth -Worsening mental function

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

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

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply.

-Maintain NPO (nothing by mouth) status. -Encourage coughing and deep breathing. -Give hydromorphone intravenously as prescribed for pain.

The nurse is creating a plan of care for a client with a diagnosis of nephrotic syndrome whose glomerular filtration rate (GFR) is normal. Which interventions should the nurse include in the plan of care? Select all that apply.

-Monitor daily weight. -Maintain sodium restrictions.-Monitor intake and output (I&O). -Maintain bed rest when edema is severe.

The nurse is caring for a client with acute pancreatitis. Which medications should the nurse expect to be prescribed for treatment of this problem? Select all that apply.

-Morphine -Dicyclomine -Pantoprazole -Acetazolamide

The nurse is conducting an interview of an older client and is concerned about the possibility of benign prostatic hyperplasia (BPH). Which are characteristics of this disorder? Select all that apply.

-Nocturia -Incontinence -Enlarged prostate

The nurse is caring for a client with a complete large bowel obstruction. What assessment findings would the nurse expect? select all that apply

-Obstipation -Abdominal distension -Abdominal pain

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply.

-Orthopnea and dyspnea -Petechiae and ecchymosis -Poor body posture and balance -Abdominal distention and tenderness

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

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

A client with liver dysfunction has low serum levels of fibrinogen and a prolonged prothrombin time (PT). Based on these findings, which actions should the nurse plan to promote client safety? Select all that apply.

-Provide the client with a soft toothbrush. -Instruct the client to use an electric razor. -Monitor all secretions for frank or occult blood

A client with chronic kidney disease (CKD) is being managed by continuous ambulatory peritoneal dialysis (CAPD). During outflow, the nurse notes that only half of the 2-L dialysate has returned, and the flow has stopped. Which interventions should the nurse take to enhance the outflow? Select all that apply.

-Reposition the client. -Make sure the peritoneal catheter is not kinked. -Check that the drainage bag is lower than the client's abdomen. -Assess the stool history, and institute elimination measures if the client is constipated.

A 28-year-old female client states, "I don't know why I get cystitis every year. I don't drink much at work so that I can avoid using the public toilet." Which teaching by the nurse is most likely to reduce her risk for cystitis? Select all that apply.

-Suggest that she drink at least 2 to 3ml of fluid throughout the day. -Instruct her to always wipe her perineum from front to back after each toilet use. -Reinforce that she should complete the entire course of antibiotics as prescribed. -Instruct her to empty her bladder immediately before intercourse.

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply.

-Fever -Complaints of indigestion -Pain in the upper right quadrant after a fatty meal

A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which assessment is essential to include in the plan of care following the procedure?

Assessing for the presence of the gag reflex

A client who has undergone gastric surgery has a nasogastric (NG) tube connected to low intermittent suction that is not draining properly. Which action should the nurse take initially?

Check the suction device to make sure it is working.

The nurse is caring for a client with a resolved intestinal obstruction who has a nasogastric tube in place. The primary health care provider has now prescribed that the nasogastric tube be removed. What is the priority nursing assessment prior to removing the tube?

Checking for the presence of bowel sounds in all 4 quadrants

Which finding noted in the client on continuous ambulatory peritoneal dialysis (CAPD) should be reported to the primary health care provider (PHCP)?

Cloudy yellow dialysate output

A client has been diagnosed with polycystic kidney disease. On assessment of the client, the nurse should observe for which most common manifestation of this disorder?

Flank pain and hematuria

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the primary health care provider prescribing?

Oral corticosteroids

Lactulose is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated?

The fecal pH is acidic.

The nurse is caring for a client immediately after nephrectomy and renal transplantation. What is the most appropriate datum to use in planning administration of intravenous fluids to this client?

The number of milliliters in the previous hour's urine output

The nurse is caring for a client with peritonitis from a perforated appendix. Which abdominal assessment finding will the nurse most likely expect?

-Board-like abdomen

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

Acute kidney injury

The home health nurse is planning to make a home visit to a client who has undergone surgical creation of an ileal conduit. The nurse should include which information on ostomy care in discussion with the client?

Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery?

Fluid and electrolyte imbalance

The nurse is creating a plan of care for a client with chronic kidney disease and uremia. The nurse is developing interventions to assist in promoting an increased dietary intake while at the same time maintaining necessary dietary restrictions. Which action should the nurse include in the plan of care?

Maintain a diet high in calories with frequent snacks.

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication?

Pernicious anemia

The nurse is admitting a client who has an arteriovenous (AV) fistula in the right arm for hemodialysis. Which nursing intervention is the best way to prevent injury to the AV site?

Placing a sign at the bedside that reads "No blood pressure measurements or venipunctures in the right arm"

The nurse is caring for a client with a bladder infection. The nurse plans care understanding that the primary risk factor for spread of infection in this client is dysfunction of which structure?

Ureterovesical junction

The nurse is performing an admission assessment on a client who has been admitted to the hospital with a diagnosis of suspected gastric ulcer. The nurse is asking the client questions about pain. Which client statement supports the diagnosis of gastric ulcer?

"My pain comes shortly after I eat, maybe a half hour or so later."

A patient who had the Stretta procedure to treat severe GERD is being discharged. Which patient statement requires further nursing teaching? Select all that apply

-"Dysphagia after this procedure is normal" -"It's important to stop my proton pump inhibitor" -"I might cough up some blood following this procedure"

A client with end-stage renal disease (ESRD) has the problem of ineffective coping. Which nursing interventions are appropriate in working with this client? Select all that apply.

-Acknowledge the client's feelings. -Assess the client and family's coping patterns. -Explore the meaning of the illness with the client. -Give the client information when the client is ready to listen.

Which teaching will the nurse include when educating a client who is scheduled to have an esophagogastroduodenoscopy (EDG)? Select All That Apply.

-Anesthesia will be used for sedation -The procedure takes about 20-30 mins to complete -A separate test will be required to obtain any needed biopsies -You will need to refrain from eating for at least 6-8 hours before the EGD

The nurse is caring for a hospitalized client with pancreatitis. Which findings should the nurse look for and expect to note when reviewing the laboratory results? Select all that apply.

-Elevated lipase level -Elevated trypsin level -Elevated amylase level

A client is being evaluated as a potential kidney donor for a family member. The client asks the nurse why separate teams are evaluating the donor and recipient. What is the most appropriate response by the nurse?

Avoids a conflict of interest between the team evaluating the recipient and the team evaluating the donor

The nurse is providing dietary instructions to a client hospitalized for pancreatitis. Which food should the nurse instruct the client to avoid?

Chili

Which symptom(s) in a client during the first 12 hours after a kidney biopsy indicates to the nurse a possible complication from the procedure?

The heart rate is 118, blood pressure is 108/50, and peripheral pulses are thready.

The nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury?

"The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period."

The nurse measures the cardiac output of a client and finds it to be 6 L/min. Which amount of kidney perfusion should the nurse anticipate?

1200 to 1500 mL/min

The nurse is planning a teaching session with a client who has chronic kidney disease (CKD) about managing the condition between dialysis treatments. The nurse should plan to include the instruction that weight gain between dialysis treatments should be ideally what value?

2 to 3 lb (1 to 1.5 kg)

A client is diagnosed with renal colic. What would the nurse do first?

Administer opioids as prescribed.

A home care nurse is making home visits to an older client with urinary incontinence who is very concerned about the incontinent episodes. Which finding by the nurse indicates that the client has an environmental barrier to normal voiding?

Bathroom located on the second floor, bedroom on the first floor

A client is readmitted to the hospital with dehydration after surgery for creation of an ileostomy. The nurse assesses that the client has lost 3 lb of weight, has poor skin turgor, and has concentrated urine. The nurse interprets the client's clinical picture as correlating most closely with recent intake of which medication, which is contraindicated for the ileostomy client?

Biscodyl

The nurse is caring for a client with a low thrombin level as a result of liver dysfunction. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication?

Bleeding

The nurse is assessing the renal function of a client at risk for acute kidney injury. After noting the amount of urine output and urine characteristics, the nurse proceeds to assess which as the best indirect indicator of renal status?

Blood pressure

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

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

A client has urinary calculi composed of uric acid. The nurse is teaching the client dietary measures to prevent further development of uric acid calculi. The nurse should inform the client that it is acceptable to consume which item?

Cottage cheese

In performing a physical assessment of a client with chronic kidney disease (CKD), which finding should the nurse anticipate?

Crackles auscultated in the lungs

The nurse is caring for a client with biliary obstruction. The nurse interprets that obstruction of which passage is related to the client's condition?

Cystic duct

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the primary health care provider (PHCP)?

Dark red drainage

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

Decongestants

The nurse is reviewing the primary health care provider's prescriptions written for a client admitted to the hospital with acute pancreatitis. Which prescription requires follow-up by the nurse?

Full liquid diet

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively?

low fiber

The registered nurse is precepting a new nurse who is caring for a client with pernicious anemia as a result of a gastrectomy. Which statement made by the new nurse indicates understanding of this diagnosis?

"Decreased production of intrinsic factor by the stomach affects absorption of vitamin B12 in the small intestine."

The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laënnec's cirrhosis. Which question related to the client's history would be most important to ask?

"Do you abuse alcohol?"

A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first?

"Have you been constipated recently?"

The client with a small bowel obstruction asks the nurse to explain the purpose of the nasogastric tube attached to continuous gastric suction. The nurse determines that teaching has been effective if the client makes which statement?

"It will help to remove gas and fluids from my stomach and intestine."

The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates an accurate understanding of CAPD?

"No machinery is involved, and I can pursue my usual activities."

The nurse is giving general instructions to a client receiving hemodialysis. Which statement would be most appropriate for the nurse to include?

"Several types of medications should be withheld on the day of dialysis until after the procedure."

What discharge teaching will the nurse provide to a client who had gastric bypass surgery? Select all that apply.

-Be certain to stay hydrated by drinking water. -Report any back, shoulder, or abdominal pain to the surgeon. -Each of your meals should initially contain about 5 tablespoons of food.

The nurse is planning care for a client who had a laparoscopic Whipple surgery. For which complication will the nurse assess? Select all that apply.

-Bleeding -Wound infection -Intestinal obstruction -Diabetes mellitus -Abdominal abscess

The primary health care provider prescribes bismuth subsalicylate for a client as part of treating H.pylori infection. What health teaching will the nurse include for the client about this drug?

"The drug may cause your tongue and stool to turn black."

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching?

"The medication will cause constipation."

The nurse is teaching a client with renal cancer who is scheduled for a renal artery embolization about the procedure. Which statement by the client indicates that the educational session was effective?

"This will decrease the size of the tumor because its blood supply will be removed after placement of an absorbable gelatin sponge."

The nurse teaches a preoperative client about the use of a nasogastric (NG) tube for the planned surgery. Which statement indicates to the nurse that the client understands when the tube can be removed in the postoperative period?

"When my bowels begin to function again, and I begin to pass gas."

A client is receiving adefovir for management of hepatitis B. What health teaching will the nurse provide for the client about this drug? Select all that apply.

-"Avoid places with crowds and individuals who have an infection." -"Get your lab work done regularly because the drug can affect your kidneys."

What health teaching will the nurse include to promote gastric health for an adult client? Select all that apply.

-"Stop smoking or using tobacco of any form." -"Do not drink excessive amounts of alcohol." -"Avoid excessive amounts of pickled or smoked food." -"Avoid taking large amounts of NSAIDs."

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer?

A rigid, board-like abdomen

For which hospitalized client does the nurse recommend the ongoing use of a urinary catheter?

A 74-year-old man who has lung cancer with brain metastasis and is being transitioned to hospice.

The nurse is caring for a postoperative client who has just returned from surgery for creation of a colostomy. The nurse inspects the colostomy stoma and recognizes that which is a normal assessment finding for this client?

A brick-red color

The nurse is caring for a client after abdominal surgery and creation of a colostomy. The nurse is assessing the client for a prolapsed stoma and should expect to note which observation if this is present?

A stoma that is elongated with a swollen appearance

A primary health care provider (PHCP) prescribes a Salem sump tube for gastrointestinal intubation. Which item should the nurse obtain from the supply room?

A tube with a large lumen and an air vent

The client with a crush injury to the leg has a highly positive urine myoglobin level. The nurse should assess this client carefully for signs and symptoms of which problem?

Acute tubular necrosis

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which primary health care provider (PHCP) prescription documented in the client's medical record?

Administer 30 mL of milk of magnesia (MOM).

The nurse is caring for a client on a mechanical ventilator who has a nasogastric tube in place. The nurse is assessing the pH of the gastric aspirate and notes that the pH is 4.5. Based on this finding, the nurse should take which action?

Administer a dose of a prescribed antacid.

A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How should the nurse schedule the medications for administration?

Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide.

A client with ulcerative colitis has a prescription to begin a salicylate compound medication to reduce inflammation. What instruction should the nurse give the client regarding when to take this medication?

After meals

The nurse is preparing to teach ostomy care to a client who has just had a urinary diversion; the client expresses concern about body appearance. Which client action indicates that the best initial positive adaptation is being made?

Agrees to look at the ostomy

The nurse has taught the client with chronic pancreatitis about risk factor modification to reduce the incidence of recurrences. The nurse determines that teaching was effective if the client states that it will be necessary to control which factor?

Alcohol intake

A client with epididymitis is upset about the extent of scrotal edema. Attempts to reassure the client that this condition is temporary have not been effective. The nurse should plan to address which client problem?

Altered body appearance related to change in the appearance of the scrotum

A client with chronic kidney disease (CKD) has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these assessment data are compatible with which condition?

Aluminum intoxication

A client is having difficulty coughing and deep breathing because of pain after a nephrectomy. Which action by the nurse is helpful in promoting optimal respiratory function?

Assisting the client to splint the incision during respiratory exercise

A client passes a urinary stone, and laboratory analysis of the stone indicates that it is composed of calcium oxalate. On the basis of these data, which should the nurse specifically include in the dietary instructions?

Avoid green, leafy vegetables such as spinach.

A client who is undergoing peritoneal dialysis calls the nurse at the renal unit and reports the presence of severe abdominal pain and diarrhea. The client also informs the nurse that the peritoneal dialysis returns are brown-tinged in color. Which would the nurse suspect?

Bowel perforation

A client with benign prostatic hyperplasia undergoes a transurethral resection of the prostate. Postoperatively the client is receiving continuous bladder irrigations. The nurse assesses the client for manifestations of transurethral resection syndrome. Which assessment data would indicate the onset of this syndrome?

Bradycardia and confusion

The nurse is giving instructions to a client with cholecystitis about food to exclude from the diet. Which food item identified by the client indicates that the educational session was successful?

Brown gravy

The nurse should instruct a client with an ileostomy to include which action as part of essential care of the stoma?

Cleanse the peristomal skin meticulously.

A client with appendicitis is scheduled for an appendectomy. The nurse providing preoperative teaching for the client describes the location of the appendix by stating that it is attached to which part of the gastrointestinal (GI) system?

Cecum

A Penrose drain is in place on the first postoperative day in a client who has undergone a cholecystectomy procedure. Serosanguineous drainage is noted on the dressing covering the drain. Which nursing intervention is most appropriate?

Change the dressing.

The client with chronic kidney disease has an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter dressing while bathing. Which action should the nurse immediately take?

Change the dressing.

The nurse is providing dietary instructions to a client with an oxalate kidney stone. The nurse should instruct the client to avoid which food?

Chocolate

A client receiving a cleansing enema complains of pain and cramping. The nurse should take which corrective action?

Clamp the tubing for 30 seconds, and restart the flow at a slower rate.

The nurse is caring for a client prescribed enteral feeding via a newly inserted nasogastric (NG) tube. Before initiating the enteral feeding, the nurse should perform which action first?

Confirm NG placement by x-ray study.

A client with chronic kidney disease (CKD) has been taking aluminum hydroxide gel. On the basis of this information, the nurse determines that the client is most at risk for which problem?

Constipation

The client diagnosed with benign prostatic hyperplasia (BPH) is scheduled for a transrectal ultrasound examination and a test to measure the level of prostate-specific antigen (PSA). The client says to the nurse, "I can't remember . . . can you tell me again why I need these tests to be done?" The nurse responds, knowing that these tests are done for which purpose?

Help to rule out the possibility of cancer

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The primary health care provider (PHCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and should be reported to the PHCP immediately?

Hematemesis

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication?

Decreased diarrhea

The nurse cares for a client following a Roux-en-Y gastric bypass surgery. Which nursing intervention is appropriate?

Encourage the client to ambulate.

The nurse is preparing to administer an intermittent enteral feeding through a nasogastric (NG) tube. Which priority assessment should the nurse perform?

Evaluate absorption of the last feeding.

A client with cirrhosis complicated by ascites is admitted to the hospital. The client reports a 10-lb weight gain over the past 1½ weeks. The client has edema of the feet and ankles, and his abdomen is distended, taut, and shiny with striae. Which client problem is most appropriate at this time?

Excessive body fluid volume

The nurse is providing instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of peritonitis, a serious complication, is most likely to be associated with which clinical manifestation?

Fever

A client with peptic ulcer disease states that stress frequently causes exacerbation of the disease. The nurse determines that which item mentioned by the client is most likely to be responsible for the exacerbation?

Frequent need to work overtime on short notice

The nurse has implemented a bowel maintenance program for an unconscious client. The nurse would evaluate the plan as best meeting the needs of the client if which method was successful in stimulating a bowel movement?

Glycerin suppository

The nurse is caring for a client who is receiving bolus feedings via a nasogastric tube. As the nurse is finishing the feeding, the client asks for the bed to be positioned flat for sleep. The nurse understands that which is the appropriate position for this client at this time?

Head of bed elevated 30 to 45 degrees, with the client in the right lateral position for 60 minutes

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

Headache, deteriorating level of consciousness, and twitching

The medication history of a client with peptic ulcer disease reveals intermittent use of several medications. The nurse would teach the client that which of these medications are not a part of the treatment plan because of its irritating effects on the lining of the gastrointestinal tract?

Ibuprofen

The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which piece of assessment data should alert the nurse to this occurrence?

Inability to pass flatus

The nurse provides discharge instructions to a client after prostatectomy. What is the priority discharge instruction for this client?

Increase fluid intake to at least 2.5 L/day.

A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition?

Increase intake of fluids, including juices.

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

Increased immunosuppression therapy

The nurse is reviewing the list of components contained in the peritoneal dialysis solution with the client. The client asks the nurse about the purpose of the glucose contained in the solution. The nurse should base the response on knowing that which is the action of the glucose in the solution?

Increases osmotic pressure to produce ultrafiltration

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, should the nurse question?

Indomethacin

The nurse has completed teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse should determine that education was effective if the client states to record which parameters daily?

Intake and output (I&O) and weight

The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg because the client is at risk for developing which type of acute kidney injury?

Intrarenal

The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine for proteinuria to determine which type of AKI?

Intrinsic

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify?

Irrigating the NG tube

The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis?

Leukocytosis with a shift to the left

The nurse is assisting a client with Crohn's disease to ambulate to the bathroom. After the client has a bowel movement, the nurse should assess the stool for which characteristic that is expected with this disease?

Loose, watery stool

A client has just had a Foley catheter removed and is to be started on a bladder retraining program. Which intervention will provide the most useful information about the client's ability to empty the bladder?

Measuring postvoid residual using a bladder scan

A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which source of complete proteins to maximize the availability of essential amino acids?

Meats

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention is appropriate?

Monitor for fluid and electrolyte imbalance.

The nurse is admitting a client from the postanesthesia care unit who has had percutaneous nephrolithotomy for calculi in the renal pelvis. The nurse anticipates that the client's care will most likely involve monitoring which device?

Nephrostomy tube

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

Notify the PHCP before performing the catheterization.

A client with chronic kidney disease who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril. When should the nurse plan to administer this medication?

On return from dialysis

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which manifestation of duodenal ulcer?

Pain relieved by food intake

The nurse is assisting a primary health care provider (PHCP) with the insertion of a Miller-Abbott tube. The nurse understands that the procedure places the client at risk for aspiration and should therefore implement which action to decrease this risk?

Place the client in a semi-Fowler's to high-Fowler's position.

A client is being discharged to home while recovering from acute kidney injury (AKI). Reduced dietary intake of which substance indicates to the nurse that the client understands the dietary teaching?

Potassium

A client who has undergone creation of a colostomy has a concern about body image. What action by the client indicates the most significant progress toward identified goals?

Practicing proper cutting of the ostomy appliance

The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy?

Presence of asterixis

The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client?

Prevent loss of electrolytes.

The nurse is providing care for a client with a recent transverse colostomy. Which observation requires immediate notification of the primary health care provider?

Purple discoloration of the stoma

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the primary health care provider (PHCP)?

Rebound tenderness

The nurse is analyzing the posthemodialysis laboratory test results for a client with chronic kidney disease. The nurse interprets that the dialysis is having an expected but nontherapeutic effect if which value is decreased?

Red blood cell (RBC) count

A client experiencing end-stage kidney disease has an arteriovenous (AV) fistula placed surgically for hemodialysis. Which action is most appropriate for the nurse to document in the plan for care of the AV fistula?

Teach the client to avoid carrying heavy objects that would compress the AV fistula and cause thrombosis.

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

Tender, indurated prostate gland that is warm to the touch

A female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which problem?

The development of a vesicovaginal fistula

The nurse is caring for an older client. Which finding should the nurse expect to note in this client while evaluating renal function?

The glomerular filtration rate (GFR) diminishes

The nurse is caring for a client who has just returned from having a cystoscopy. The nurse should recognize which as an abnormal assessment finding for this client?

The nurse notes bright red urine output.

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

Trauma to the bladder or abdomen

The nurse plans care for a client postoperatively following creation of a colostomy. Which potential client problem should the nurse include in the plan of care?

Upset about appearance

A client tells the nurse about a pattern of a strong urge to void, followed by incontinence before the client can get to the bathroom. Based on the data provided, which condition should the nurse suspect?

Urge incontinence

The nurse is preparing to teach a client with a new colostomy about how to perform a colostomy irrigation. Which information should the nurse include in the teaching plan?

Use 500 to 1000 mL of warm tap water.

The nurse is caring for a client admitted to the hospital with suspected acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis?

WBC count of 18,000 mm3 (18 × 109/L)

The nurse is preparing to care for a client after a renal scan. Which intervention should the nurse include in the postprocedure plan of care?

Wear gloves if contact with the client's urine will occur.

A client with urolithiasis (struvite stones) has a history of chronic urinary tract infections. What should the nurse plan to teach the client to avoid?

Wearing synthetic underwear and pantyhose