Lewis EAQ minus musculoskeletal

A client who has chronic kidney failure is to be treated with continuous ambulatory peritoneal dialysis (CAPD). Which statement by the client indicates understanding of the therapy?

Diffusion moves particles from an area of greater concentration to an area of lesser concentration; osmosis moves fluid from an area of lesser to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.

Which report by the client post transrectal prostate biopsy needs to be communicated to the health care provider as a possible sign of infection?

Discharge from the penis should be communicated to the health care provider for possible infection because discharge is an indication of infection. Soreness, rust-colored semen, and light rectal bleeding are expected after transrectal prostate biopsy.

Which virus is responsible for causing infectious mononucleosis in clients?

Epstein-Barr virus is responsible for mononucleosis and possibly Burkitt lymphoma. Parvovirus and rotavirus cause gastroenteritis. Coronavirus causes upper respiratory tract infections.

Which statement is accurate regarding erythropoietin?

Erythropoietin is produced by the kidneys; its deficiency occurs in renal failure. Erythropoietin is released by the kidneys, not the pancreas. Erythropoietin deficiency causes anemia. Erythropoietin is secreted in response to hypoxia, which results in decreased oxygenated blood flow to the tissues.

A client recovering from deep partial-thickness burns develops chills, fever, flank pain, and malaise. The primary health care provider makes a tentative diagnosis of urinary tract infection. Which diagnostic tests would the nurse expect the primary health care provider to prescribe to confirm this diagnosis?

Urine culture with urinalysis

Which electrolyte deficiency triggers the secretion of renin?

Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells. Deficiencies of calcium, chloride, and potassium do not stimulate the secretion of renin.

Which characteristic of urine changes in the presence of a urinary tract infection (UTI)?

Cloudy urine usually indicates drainage associated with infection. Viscosity is a characteristic that is not measurable in urine. Urinary glucose levels are not affected by UTIs. Specific gravity yields information related to fluid balance.

Which complication is the most serious for a client with kidney failure?

Decreased glomerular filtration leads to hyperkalemia, which may cause lethal dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious complication and should be treated in relation to the client's clinical manifestation; erythropoietin and iron supplements usually are used. Weight loss alone is not life threatening. Uremic frost, a layer of urea crystals on the skin, causes itching, but it is not the most serious complication.

Which type of immunoglobulin is present in tears, saliva, and breast milk?

IgA - IgA immunoglobulin is present in tears, saliva, and breast milk. IgE and IgG immunoglobulins are present in plasma and interstitial fluids. IgM immunoglobulin is present in plasma.

Which is the concentration of estradiol in the blood during the follicular phase of the menstrual cycle?

In the follicular phase of the menstrual cycle, 20 to 150 pg/mL of estradiol is released. Therefore 130 pg/mL of estradiol would be its concentration during the follicular phase of the menstrual cycle. Concentrations of 159, 165, and 171 pg/mL are greater than the reference range.

Which age-related effects on the immune system occur in the older client?

Increased autoantibodies - The effects of aging on the immune system include increased autoantibodies. Expression of IL-2 receptors, delayed hypersensitivity reaction, and primary and secondary antibody responses decrease in older adults because of the effects of aging on the immune system.

The nurse is teaching a client receiving peritoneal dialysis about the reason dialysis solution is warmed before it is instilled. Which information would the nurse share with the client?

A warm temperature encourages the removal of serum urea by preventing constriction of peritoneal blood vessels so that urea, a large-molecular substance, is shifted from the body into the dialyzing solution. Heat does not affect the shift of potassium into the cells. The removal of metabolic wastes is affected in kidney failure, not the metabolic processes. Heating dialysis solution does not affect cardiac dysrhythmias.

Which term refers to the Cowper gland?

Bulbourethral gland - Cowper glands are accessory glands of the male reproductive system; they are also referred to as the bulbourethral glands. Skene glands are a part of the female reproductive system. The prostate gland is also a gland of the male reproductive system. Bartholin glands are part of the female reproductive system.

Which structure is removed during circumcision?

Circumcision involves removal of the prepuce, which is a skin folding over the glans. The glans is the tip of the penis. The epididymis is the internal structure that helps in the transportation and maturation of sperm. The vas deferens carries sperm from the epididymis to the ejaculatory duct.

Which decreased hormone level may cause a client's anemia?

Erythropoietin stimulates the production of red blood cells (RBCs) in the bone marrow. Deficiency of erythropoietin causes a decrease in RBCs, thereby resulting in anemia. Bradykinin increases blood flow and vascular permeability. Prostaglandins regulate kidney perfusion. Activated vitamin D promotes the absorption of calcium in the gastrointestinal (GI) tract.

Which roles would norepinephrine's mechanism of action perform in managing anaphylaxis?

Norepinephrine functions as a peripheral vasoconstrictor - Norepinephrine is a vasopressor that elevates the blood pressure and cardiac output in clients suffering from anaphylactic reactions. Diphenhydramine HCl blocks the effects of histamine on various organs. Corticosteroids such as dexamethasone prevent the degranulation of mast cells. Epinephrine works by rapidly stimulating alpha- and beta-adrenergic receptors.

Which rational explains the purpose of administering diphenoxylate hydrochloride to clients with acquired immunodeficiency syndrome (AIDS)?

To manage diarrhea - Diphenoxylate hydrochloride is an antidiarrheal medication prescribed to clients with AIDS to manage frequent diarrhea experienced by a client with AIDS. Opioid analgesics such as tramadol are used to manage pain. Ketoconazole can be used to treat candidal esophagitis associated with AIDS. Behavioral problems are managed with psychotropic medications.

The nurse is educating new parents about circumcision. Which structure of the penis would the nurse tell the parents is removed during circumcision?

Circumcision is a procedure that involves removal of the prepuce, a skin fold over the glans. The glans is the tip of the penis. The epididymis is the internal structure that promotes transportation of the sperm. The vas deferens carries the sperm from the epididymis to the ejaculatory duct.

The day after receiving instructions regarding dressing changes and care of a recently inserted nephrostomy tube, the client states, "I hope I can handle all this at home; it's a lot to remember." Which response would the nurse use?

The response "You seem to be nervous about going home" is the best reply. Reflection conveys acceptance and encourages further communication. The response "I'm sure you can do it" is false reassurance that does not help reduce anxiety. The response "Oh, a family member can do it for you" provides false reassurance and removes the focus from the client's needs. The response "Perhaps you can stay in the hospital another day" is unrealistic, and it is too late to suggest this.

Which response would the nurse offer when a client undergoing brachytherapy for breast cancer asks what precautions need to be observed?

Visitors should be limited, particularly pregnant women and children, during brachytherapy, although the radiation risk is very low. The restriction includes limiting visitors. Body fluid is not radioactive from brachytherapy. Contact isolation is not required with brachytherapy.

Which stage of kidney tumor is indicated by spread to the renal vein and lymph nodes?

A stage III kidney tumor extends to the renal vein and lymph nodes. A stage I kidney tumor is situated within the capsule of the kidney. A stage II kidney tumor is located beyond the capsule but within Gerota fascia. A stage IV kidney tumor invades the adjacent organs beyond Gerota fascia or metastasizes to distant tissues.

Which term is used to indicate an absence of menstruation?

An absence of menstruation indicates amenorrhea. Gonorrhea is a sexually transmitted disease. Dysmenorrhea is with painful menstruation associated with abdominal cramps. The formation of a fetus outside the uterus, such as a fallopian tube, is ectopic pregnancy.

Before client examination, the registered nurse provides education for a student nurse regarding the gross anatomy and physiology of the kidneys. Which statement made by the student nurse indicates the need for additional teaching?

"The right kidney is a little longer and narrower than the left kidney." - Generally in a human body, the left-side kidney is slightly longer and narrower compared with the right-side kidney. The nurse should intervene to correct this misconception. All the other statements are correct. There could be three kidneys in a human body, and as long as the kidney function is normal, the client would be normal. A single horseshoe-shaped kidney could occasionally be found in certain clients, and this is normal if the kidney function is normal. The urinary bladder lies directly behind the pubic bone.

A client with chronic kidney disease selects treatment using continuous ambulatory peritoneal dialysis (CAPD). Which statement indicates the client understands the purpose of this therapy?

"The treatment uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion. - Diffusion moves particles from an area of greater concentration to an area of lesser concentration. Osmosis moves fluid from an area of lesser concentration to an area of greater concentration of particles, thereby removing waste products into the dialysate, which is then drained from the abdomen. The principle of ultrafiltration involves a pressure gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses the peritoneal membrane for indirect cleansing of the blood. Dialysate does not clear toxins in a short time; exchanges may occur four or five times a day.

The nurse is providing postoperative care 8 hours after a client had a total cystectomy and the formation of an ileal conduit. Which assessment finding would be reported to the health care provider immediately?

A dusky-colored stoma may denote a compromised blood supply to the stoma and impending necrosis. An edematous stoma and absence of bowel sounds are expected in the early postoperative period after this surgery. Pink-tinged urine may be present in the immediate postoperative period.

Which test helps identify reproductive tract fibroids, tumors, and fistulas?

A hysterosalpingogram is an x-ray used to evaluate tubal anatomy and patency and is further used to identify uterine problems such as fibroids, tumors, and fistulas. A mammography is an x-ray of the soft tissue of the breast. Ultrasonography is a technique used to assess fibroids, cysts, and masses. Computed tomography is used to detect and evaluate masses and identify lymphatic enlargement from metastasis.

Which interventions would the nurse plan for a client undergoing a renal scan? Select all that apply. One, some, or all responses may be correct.

A renal scan is performed to examine the structure, function, and perfusion of the kidneys using the intravenous administration of a radioisotope. During the procedure, furosemide should be administered after initial imaging to better visualize kidney function and blood flow. A peripheral intravenous catheter should be inserted to deliver the radioisotope. Fasting is not required before the procedure. Because the procedure uses only trace doses of radioisotopes, no precautions related to radioisotope exposure are required. The client should be encouraged to drink fluids after the procedure to help excrete the isotope.

Which interventions would the nurse implement for a client with a ureteral calculus? Select all that apply. One, some, or all responses may be correct.

A urinary calculus may obstruct urine flow, which will be reflected in a decreased output; obstruction may result in hydronephrosis. Urine is strained to determine whether any calculi or calcium gravel is passed. Reduction of pain is a priority. A calculus obstructing a ureter causes flank pain that extends toward the abdomen, scrotum and testes, or vulva; the pain begins suddenly and is severe (renal colic). Fluids should be encouraged to promote dilute urine and facilitate passage of the calculi. Recording the blood pressure is not critical.

A client with kidney failure has an increased rate and depth of breathing. Which laboratory parameter would the nurse suspect is associated with this client's condition?

An increased rate and depth of breathing is called Kussmaul respiration and occurs due to metabolic acidosis in clients with kidney disease. Serum bicarbonate level decreases in metabolic acidosis. The normal range of serum bicarbonate is 23 to 30 mEq/L. The bicarbonate value of 15 mEq/L is associated with Kussmaul respirations in the client. The normal serum potassium is 3.5 to 5 mEq/L. A potassium level of 8 mEq/L indicates hyperkalemia and is associated with changes in cardiac rate and rhythm. The normal range of hemoglobin is 12 to 16 g/dL in females and 14 to 18 g/dL in males. A hemoglobin of 10 g/dL indicates anemia; this is associated with fatigue, pallor, and shortness of breath. The normal range of serum phosphorous is 3 to 4.5 mg/dL. A phosphorous value of 7 mg/dL indicates hyperphosphatemia, which is associated with hypocalcemia and demineralization of bone.

How long will a client's ovum stay viable for fertilization after its release?

An ovum can be fertilized up to 72 hours after its release. The ovum disintegrates after 72 hours, and menstruation begins soon after. The ovum cannot be viable for 84, 96, or 112 hours, and fertilization will not occur.

After a nephrectomy, the client arrives in the postanesthesia care unit in the supine position. Which action would the nurse implement to assess the client for signs of hemorrhage?

Because of the anatomical position of the incision, drainage will flow by gravity and accumulate under the client lying in the supine position. Nail beds indicate peripheral perfusion, not early hemorrhage. Respiratory hemorrhage is not common after kidney surgery. The blood pressure decreases and the pulse rate increases with hemorrhage.

Which client statement indicates understanding of content taught about removing his or her three-way indwelling catheter and continuous bladder irrigation (CBI)?

Because of the trauma to the mucous membranes of the urinary tract, burning on urination is an expected response that should subside gradually. Deliberate dilution of the client's urine ceases after removal of the three-way indwelling catheter in which the continuous bladder irrigation is connected. However, the urine may have a slight pink tinge because of the trauma from the surgery and the presence of the catheter. An inability to urinate may happen if removal the indwelling catheter occurs too soon when there is still edema of the urethra or the client loses bladder tone. Production of dark red urine is a sign of hemorrhage, which should not occur.

Which immunomodulatory agent is beneficial for the treatment of clients with multiple sclerosis?

Beta interferon - Beta interferon is an immunomodulator administered in the treatment of multiple sclerosis. Interleukin 11 (IL-11) prevents development of thrombocytopenia after chemotherapy. IL-2 treats metastatic renal cell carcinoma and metastatic melanoma. Alpha interferon treats hairy cell leukemia, chronic myelogenous leukemia, and malignant melanoma.

Which urine characteristic is consistent with a urinary tract infection?

Cloudy - Cellular debris, white blood cells, bacteria, and pus can cause the urine to become cloudy. Dark, smoky urine usually suggests hematuria. Orange-amber color of urine may indicate concentrated urine; also, it can be caused by phenazopyridine or foods such as beets. Yellow-brown to dark color of urine indicates excessive bilirubin.

Which instruction would the nurse include in a health practices teaching plan for a female client with a history of recurrent urinary tract infections?

Cotton allows air to circulate and does not retain moisture the way synthetic fabrics do; microorganisms multiply in warm, moist environments. Voiding frequently helps flush ascending microorganisms from the bladder, thereby reducing the risk for urinary tract infections; holding urine for more than 6 hours can lead to urinary tract infections. Foods high in acid, not alkaline ash, help acidify urine; this urine is less likely to support bacterial growth. Alkaline urine promotes bacterial growth. Wiping the genitals from back to front after toileting may transfer bacteria from the perianal area toward the urinary meatus, which will increase the risk for urinary tract infection.

A client arrives at a health clinic reporting a recent onset of hematuria, frequency, urgency, and pain on urination. Which diagnosis will the nurse observe in the client's medical record?

Cystitis is an inflammation of the bladder that causes frequency and urgency of urination, pain on micturition, and hematuria. Chronic glomerulonephritis is a disease of the kidney that is associated with manifestations of systemic circulatory overload. Nephrotic syndrome is a condition of increased glomerular permeability characterized by severe proteinuria. Pyelonephritis is a diffuse, pyogenic infection of the pelvis and parenchyma of the kidney that causes flank pain, chills, fever, and weakness.

Which test provides information on bladder capacity, bladder pressure, and voiding reflexes?

Cystometrography (CMG) - CMG is a urodynamic study that provides information on bladder capacity, bladder pressure, and voiding reflexes. Radiography is a diagnostic test for clients with disorders of kidney and urinary system to screen for the presence of two kidneys, to measure kidney size, and to detect gross obstruction in kidneys or urinary tract. Renal arteriography is a diagnostic study used to determine renal blood vessel size and abnormalities. EMG is a urodynamic study used to test the strength of perineal muscles in voiding.

Which hormone elevations indicate Turner syndrome? Select all that apply. One, some, or all responses may be correct.

Elevation of lutropin and follitropin indicates Turner syndrome. Elevation of prolactin indicates possible galactorrhea, pituitary tumor, disease of hypothalamus or pituitary gland, and hypothyroidism. Elevated testosterone levels in women indicate adrenal neoplasm, ovarian neoplasm, and polycystic ovary syndrome. Elevated progesterone levels in men indicate possible testicular tumors and hyperthyroidism. Elevated progesterone levels in women indicate possible ovarian luteal cysts.

A client with ascites has a paracentesis, and 1500 mL of fluid is removed. Which clinical manifestation would indicate an immediate adverse response to the fluid removal?

Fluid shifts from the intravascular compartment into the abdominal cavity, causing hypovolemia. Tachycardia is a compensatory response to this shift. Decreased peristalsis is not likely to occur in the immediate period. After a paracentesis, intravascular fluid shifts into the abdominal cavity, not into the lungs. Body temperature usually is not affected immediately; if there were an infection, fever would develop later.

The clinic nurse instructs a client to discard the morning first-voided urine, then collect a fresh urine specimen and transport it to the laboratory within 1 hour of collection. Which diagnostic procedure requires this process?

For urine cytologic study, the morning's first-voided specimen is not used because epithelial cells may change in appearance in the urine held in the bladder overnight. Urine cytologic study requires this intervention with a fresh urine sample. Residual urine tests, concentration tests, and protein determination tests do not require this intervention. Catheterization or bladder ultrasound equipment are used in a client prescribed with a residual urine test after the client has voided. The concentration test requires the client to fast after a given time in the evening and then three urine specimens are collected in hourly intervals. A dipstick may be used to test the protein levels in the urine.

In which components of the nephron unit does furosemide decrease fluid reabsorption? Select all that apply. One, some, or all responses may be correct.

Furosemide, known as a "loop diuretic," inhibits sodium and chloride reabsorption from the ascending loop of Henle, proximal tubules, and distal tubules. The glomerulus is the site of glomerular filtration. The BC is the site of the collection of glomerular filtrate and contains the glomerulus.

Which findings would the nurse expect when assessing a client who has a ureteral calculus?

Hematuria and pain may result from damage to the ureteral lining as the calculus moves down the urinary tract; the urine may become cloudy or pink tinged. Although severe pain may be present, urgency is not associated with renal calculi; urgency may be associated with an enlarged prostate, cystitis, or other genitourinary problems. The odor of urine is not foul with this condition; the color of urine is not dark with this condition, although it may be cloudy, pink, or red from hematuria. Frequency may occur when the calculus reaches the bladder.

Which factor may contribute to a client developing urinary calculi?

Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles (4.8 km) daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.

Where is the blood pressure cuff placed on a client with a dialysis access fistula in the right arm?

If the fistula is located in the right arm, then the left arm should be used for blood pressure cuff placement. Blood pressure cuffs or any other restrictive devices should not be placed on the arm with a dialysis access fistula including above, below, or over the fistula site.

To prevent the development of ureteral colic from renal calculi in the future, which strategy would the nurse include in the client's plan of care?

Increasing fluid intake dilutes the urine, and crystals are less likely to coalesce and form calculi. An elevated serum creatinine has no relationship to the formation of renal calculi. Calcium restriction is necessary only if calculi have a calcium phosphate basis. Producing only 2000 mL of urine per 24 hours is inadequate.

Which clinical manifestation would the nurse expect a client with diabetes insipidus to exhibit?

Insufficient antidiuretic hormone (ADH) decreases water uptake by the kidney tubules, resulting in very dilute urine with low osmolarity. Diabetes insipidus does not affect glucose levels; diabetes mellitus affects glucose levels. Serum sodium levels increase because of hemoconcentration. Specific gravity decreases with dilute urine.

To help prevent a cycle of recurring urinary tract infections in a female client, which instruction would the nurse share?

Intercourse may cause urethral inflammation, increasing the risk of infection; voiding clears the urinary meatus and urethra of microorganisms. Most fruit juices, with the exception of cranberry juice, cause alkaline urine, which promotes bacterial growth. Douching is no longer recommended because it alters the vaginal flora. Bubble baths can promote urinary tract infections.

Which finding supports the diagnosis of condyloma acuminatum?

Moist, fleshy projections on the penis with single or multiple projections is a clinical manifestation of condyloma acuminatum. Plaques on the penis or scrotum are clinical manifestations of penile erythema. Chancroid is manifested by pus-filled ulcers on the penis. A swollen penis with tight foreskin is a clinical manifestation of paraphimosis.

A client weighed 210 pounds (95.2 kg) on admission to the hospital. After 2 days of diuretic therapy, the client weighs 205.5 pounds (93.2 kg). How many liters of fluid has the client excreted? Record your answer using a whole number. ____ L

One liter of fluid weighs approximately 2.2 pounds (1 kg); therefore a 4.5-pound (2 kg) weight loss equals approximately 2 liters.

Which physical assessment maneuver is the nurse performing when placing the nurse's left hand under on the client's right lower back between the rib cage and the iliac crest?

Palpation - The physical assessment involves inspection, palpation, percussion, and auscultation. During palpation of the right kidney, the nurse places the left hand behind and supports the client's right side between the ribcage and the iliac crest. During an inspection, the nurse assesses the client for changes in skin, abdomen, weight, face, and extremities. During percussion, the nurse strikes the fist of one hand against the dorsal surface of the other hand, which is placed flat along the post costovertebral angle (CVA) margin. While performing auscultation, the nurse uses the bell of the stethoscope over both CVAs and in the upper abdominal quadrants.

The nurse provides education related to self-management techniques for a client newly diagnosed with polycystic kidney disease. Which statement made by the client indicates the need for further teaching?

Polycystic kidney disease is characterized by a sudden weight gain due to enlarged kidneys. The client should weigh himself or herself every day at the same time of day, wearing the same amount of clothing. Bowel movements should be monitored to prevent constipation. The client should regularly record his or her blood pressure to prevent hypertension. The client should notify the health care provider if he or she has a fever.

The nurse providing postoperative care for a client who had kidney surgery reviews the client's urinalysis report. Which urinary finding indicates the need to notify the primary health care provider?

Presence of large proteins - The glomeruli are not permeable to large proteins such as albumin or red blood cells, and finding them in the urine is abnormal; the nurse would report their presence to the primary health care provider to modify the client's treatment plan. The urine can be acidic; normal pH is 4.0 to 8.0. Glucose and bacteria should be negative and are normal findings

A client admitted with urinary retention has an indwelling urinary catheter prescribed. Which action would the nurse implement to prevent the client from developing a urinary tract infection?

Promoting hydration maintains urine production that flushes the bladder, thereby preventing urinary stasis and possible infection. Although assessing urine specific gravity and collecting a weekly urine specimen for culture and sensitivity may help identify a urinary tract infection, these actions will not prevent it. The nurse should empty the collection bag once every shift unless the bag is full and needs emptying sooner

Which structure surrounding the male urethra would the nurse describe to a client scheduled for a dilation of the urethra?

Prostate Gland - The prostate gland is shaped like a ring, with the urethra passing through its center. The epididymis lies along the top and sides of the testes. The seminal vesicles are on the posterior surface of the bladder. The bulbourethral gland lies below the prostate.

The nurse shares the discharge instructions with a client who has prostate cancer. The client asks, "How much more blood will they need? Don't they have enough?" Which laboratory test would the nurse discuss the need to monitor throughout the course of the disease?

Prostate-specific antigen (PSA) - The PSA is an indication of the presence of prostate cancer; the higher the level, the greater the tumor burden. The health care provider will monitor the PSA levels throughout the course of the disease and periodically thereafter. Albumin is a protein and an indicator of nutritional and fluid status. Creatinine and BUN levels indicate renal function and may elevate when blockage of the urethra occurs from an enlarged prostate, but the reports do not indicate metastasis or prostate cancer.

In which parts of the kidney are glucose and amino acids reabsorbed?

Proximal tubule - Glucose, amino acids, electrolytes, and bicarbonate are reabsorbed in the proximal tubule. In distal tubules, water and bicarbonate are reabsorbed, but not glucose and amino acids. Sodium and chloride are reabsorbed in the ascending limb, and water in the descending loop, of the Loop of Henle. Water is reabsorbed in the presence of antidiuretic hormone in the collecting duct.

Which statement explains why women have a greater risk for recurrent urinary tract infections than men do?

Proximity of the urethra to the anus - Because a woman's urethra is closer to the anus than a man's is, the area has a greater risk for becoming contaminated. Urinary pH is within the same range in both men and women. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in men and women.

Which action would the nurse take for a client with invasive bladder carcinoma who is receiving radiation to the lower abdomen?

Radiation may damage the bowel mucosa, causing bleeding. Blood pressure changes are not expected during radiation therapy. Enemas are contraindicated with lower abdominal radiation because of the damaged intestinal mucosa. Diarrhea, not constipation, occurs with radiation that influences the intestine.

Which action is promoted by vasopressin?

Reabsorption of water - Vasopressin is also known as an antidiuretic hormone. It helps in the reabsorption of water into the capillaries. Aldosterone promotes sodium reabsorption. Natriuretic hormones promote tubular secretion of sodium. Erythropoietin stimulates bone marrow to make red blood cells.

Which intervention would the nurse implement first when providing care for an older adult male client who is immobile and incontinent of urine?

Regularly offering the urinal is the first step. Retraining the bladder includes a routine pattern of attempts to void, which may increase bladder muscle tone and produce a conditioned response. Restricting fluid intake can result in dehydration and a urinary tract infection in an older client. Applying incontinence pants does not address the cause of the incontinence, promotes skin breakdown, and may lower the client's self-esteem. Inserting an indwelling urinary catheter increases the risk of a urinary tract infection. Insertion of an indwelling urinary catheter requires a primary health care provider's prescription.

Which food would the nurse encourage the client requiring hemodialysis to include in his or her dietary intake?

Rice - Foods high or moderately high in carbohydrates and low in protein, sodium, and potassium are encouraged for clients on hemodialysis. Potatoes are high in potassium, which is restricted. Canned salmon is high in protein and sodium, which usually are restricted. Barbecued beef is high in protein, sodium, and potassium, which usually are restricted.

Which sexually transmitted infection is caused by a virus?

Strains of the human papillomavirus (HPV) cause the sexually transmitted infection of genital warts. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

A client had an annual tuberculin purified protein derivative (PPD) test, and the area of induration was 10 mm within 48 hours after planting. Which conclusion would the nurse make about the client's response to this diagnostic?

The client has been exposed to the tubercle bacillus. - Induration measuring 10 mm or more in diameter is interpreted as significant; it does not indicate that active tuberculosis is present. About 90% of individuals who have significant induration do not develop the disease. Exposure to the tubercle bacillus indicates exposure; infection can be past or present. Passive immunity occurs when the body plays no part in the preparation of the antibodies; a positive tuberculin purified protein derivative indicates the presence of antibodies, not how they were formed. Developing a resistance to the tubercle bacillus reaction indicates exposure, not resistance.

A client presents with a sore throat and a generalized rash. The client reports that a chancre that had been present healed approximately 3 months ago. Serological test findings indicate a diagnosis of syphilis. Which stage of syphilis is the client in at this time?

The client has secondary syphilis, which occurs 1 to 3 months after healing of the primary lesion and lasts for several weeks to as long as a year; it is the stage at which the individual is most infectious. Primary syphilis is the stage of initial infection and is characterized by the presence of a chancre, a painless lesion at the site of infection. Latent syphilis occurs after the secondary stage and before the late stage of syphilis; in latent syphilis the immune system is able to suppress the infection and there are no clinical signs and symptoms. Tertiary syphilis, also known as late syphilis, is the final stage of syphilis. At this stage, it is a slowly progressive inflammatory disease that can involve many organs; the skin, brain, and heart can be affected.

The nurse is assisting the primary health care provider during renal ultrasonography. Arrange the steps involved in the procedure in correct sequence. 1. Apply gel over skin. 2. Wipe gel with cotton pad. 3. Move transducer across skin. 4. Place client in prone position.

The client undergoing renal ultrasonography should first be placed in the prone position. Then the sonographic gel should be applied on the client's skin over the back and flank regions. Then the transducer is moved across the client's skin to measure the echoes. The images are visualized on the display screen. At the end of the procedure the gel is removed from the client's skin by wiping the gel off.

A client is diagnosed with a pathology in the medulla of the kidney. Which part of the nephron is the region affected by the pathology?

The descending loop of Henle (D) is located in the medulla of the kidney. The loop of Henle is most probably affected by the pathology. The Bowman capsule (A) is located in the cortex of the kidney, the glomerulus (B) is a part of the nephron that lies in the cortex of the kidney, and the distal convoluted tubule (C) of the nephron is also located in the cortex.

Which component of the client's nephron delivers blood from the glomerulus into the peritubular capillaries or the vasa recta?

The efferent arteriole is the vascular component of the nephron that delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta. The arcuate artery is a curved artery of the renal system that surrounds the renal pyramids. The afferent arteriole is the vascular component of the nephron that delivers arterial blood from the branches of the renal artery into the glomerulus. The interlobular artery feeds the lobes of the kidney.

A client with end-stage renal disease has an internal arteriovenous fistula in one arm and an external arteriovenous shunt in the other arm. Which difference between the two methods of access will the nurse consider in planning care?

The external shunt may come apart with possible hemorrhage; clotting is a potential hazard. Frequent handling increases the risk of infection. Blood pressure readings should not be obtained in the extremity that has a shunt or fistula because of the pressure exerted on the circulatory system during the procedure. IV fluids should not be infused in the extremity with the shunt or the fistula to avoid pressure from the tourniquet and to lessen the chance of phlebitis. The ends of the shunt cannula should be left exposed for rapid reconnection in the event of disruption.

Which instruction would the nurse include when teaching the client how to perform peritoneal dialysis and the importance of preventing peritonitis? Select all that apply. One, some, or all responses may be correct.

The location of the peritoneal dialysis catheter makes it a direct portal to the peritoneum, which increases the client's risk for peritonitis. The nurse would ensure that the client understands the importance of preventing peritonitis when providing instructions on performing peritoneal dialysis. The client would be instructed to wear a mask during the procedure, especially when changing connector sets. The nurse would show the client how to properly clean the area around the catheter exit site and instruct that this be done every day to remove secretions. The client must be aware that meticulous aseptic technique throughout all phases of the exchange is essential. Proper hand-washing technique would be demonstrated and the client instructed on the importance of hand washing before the exchange. Supplies would be stored in a clean and dry place.

Which structures are included in the external genitalia of the male anatomy? Select all that apply. One, some, or all responses may be correct.

The male reproductive system is divided into primary reproductive organs and secondary reproductive organs. Secondary reproductive organs include ducts, sex glands, and external genitalia. The external genitalia consists of the penis and the scrotum. Testes are the primary reproductive organs. The urethra is the duct, and the seminal vesicles are sex glands.

Upon review of four clients' urinalysis reports, which client's results support the nurse's suspicion that the client may be developing kidney disease?

The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL. The serum creatinine concentration of client C is 2.5 mg/dL, which is greater than the normal value, indicating renal impairment. The laboratory findings of client C support the nurse's suspicion. A serum creatinine concentration of 1.1 mg/dL in client A is a normal finding. The normal range of blood urea nitrogen (BUN) is 10 to 20 mg/dL; therefore the urinalysis reports for clients B and D are normal. Blood urea nitrogen levels are affected by fluid volume deficit or excess; therefore the finding alone does not indicate renal impairment. Finding the serum creatinine concentration is the best way to determine renal function, because the value is not affected by fluid volumes.

Which urine specific gravity level is abnormal?

The normal specific gravity of urine lies between 1.005 and 1.030. A specific gravity value of 1.041 is higher than the normal range; therefore it's abnormal. The specific gravity values of urine such as 1.006, 1.012, and 1.028 lie in the normal range.

The nurse is assisting a primary health care provider to perform an examination of the reproductive tract of a female client. Which nursing actions are beneficial for the client? Select all that apply. One, some, or all responses may be correct.

The nurse should provide nonjudgmental support and relaxation techniques to the client to increase her comfort during the examination. The client should empty her bladder before the examination to ensure appropriate test results. Assisting the client to a recumbent position on the examination table provides for client safety and facilitated the examination. The client should place her arms towards her sides to allow better relaxation of the abdominal muscles. The client should be draped adequately to provide modesty throughout the examination. Drapes will be removed and replaced after examining the specific area.

Which clinical manifestation would the nurse associate with successful fluid replacement therapy?

The nurse would consider a urinary output rate of 30 mL/h adequate for perfusion of the kidneys, heart, and brain. A central venous pressure reading of 1.5 mm Hg indicates hypovolemia. A baseline pulse rate of 120 beats/min decreasing to 110 beats/minute within a 15-minute period and a baseline blood pressure of 50/30 mm Hg increasing to 70/40 mm Hg within a 30-minute period indicates improved tissue perfusion, but not necessarily adequate tissue perfusion. Compensatory mechanisms such as the renin-angiotensin-aldosterone system may continue reabsorption of fluids. Clinical manifestations reflecting adequate tissue perfusion also means the client does not need the compensatory mechanisms any longer, and urinary output increases.

Which disorder would the nurse suspect when a client's urinary urea nitrogen level is 9 g/24 h?

The nurse would suspect kidney damage or liver disease when the urea nitrogen level is lower than normal. The normal level of urea nitrogen in urine ranges from 12 to 20 g/24 h (0.43-0.71 mmol/24 h). Normal kidneys are able to filter urea and other toxic byproducts of ammonia. An increased level of urea nitrogen is indicative of sepsis, dehydration, or a high-protein diet in the client.

Which term is used to describe a client passing air and bubbles during urination?

The occurrence of gas along with urination is called pneumaturia and could result from the formation of a fistula between the bowel and urinary bladder. Frequent urination during the night is called nocturia and is associated with conditions such as heart failure and diabetes mellitus. In medical conditions such as severe dehydration and shock, the urine output is reduced to 100 to 400 mL/day, and this is termed oliguria. Weak sphincter control, urinary retention, and estrogen deficiency are some causes for stress incontinence or involuntary urination during increased pressure situations.

A postmenopausal client with cancer of the breast decides to have a lumpectomy followed by chemotherapy. After receiving chemotherapy for several weeks, she is not feeling well. The nurse reviews the medical record data presented in the image. After analysis of the available history, laboratory tests, and clinical manifestations, which goal has the highest priority for this client?

The prevention of infection is the priority because an infection can be life threatening for an immunocompromised client. Chemotherapeutic medications depress the bone marrow, causing leukopenia. This client's white blood cell count is below the expected range of 4500 to 11,000/mm3 (4.5 to 11 × 109/L) for an older female adult. Although the elevation in the client's temperature, pulse, and respirations may relate to the direct effects of the chemotherapeutic agents, they also may reflect the client resisting a microbiologic stress. Although a balance between rest and activity is important, it is not the priority. Although chemotherapeutic medications depress the bone marrow and cause anemia, this client's red blood cell count is within the expected range of 4.0 to 5.0 million/mm3 (4.7 to 6.1 × 1012/L) for an older female adult. The client's hemoglobin level is within the expected range of 11.5 to 16.0 g/dL (115-160 mmol/L). Even though preventing injury is important, it is not the priority. Although chemotherapeutic medications depress the bone marrow, causing thrombocytopenia, this client's platelet count is within the expected range of 150,000 to 400,000/mm3 (150 × 109/L to 400 × 109/L) for an adult. Although maintaining fluid balance is important, it is not the priority. The client's hematocrit is within the expected range of 38% to 41% for an older female adult, indicating that the client is not dehydrated. A decreased blood pressure indicates dehydration or fluid volume deficit; however, the client's blood pressure is within acceptable limits. Although chemotherapeutic medications may cause nausea, vomiting, and diarrhea, the client did not indicate these clinical manifestations occurred.

When performing presurgical teaching for a client pending a transurethral resection of the prostate (TURP), which statement would the nurse include?

The primary health care provider will insert a three-way indwelling urethral catheter because surgical trauma can cause edema and urinary retention, leading to additional complications such as bleeding. Urinary control is not lost in most cases; loss of control usually is temporary if it does occur. Sexually ability usually is not affected; the client maintains sexual ability if the client was able to perform sexually before surgery. The procedure does not use a cystostomy tube if a client has a transurethral resection; however, the provider does use a cystostomy tube for a suprapubic resection.

Which part of the nephron secretes creatinine for elimination?

The proximal tubule of the nephron secretes creatinine and hydrogen ions. It also reabsorbs water and electrolytes. The glomerulus filters the blood selectively. The ascending loop of Henle reabsorbs sodium and chloride, whereas the descending loop of Henle concentrates the filtrate. The collecting duct reabsorbs water.

A client with cancer of the bladder and pending surgical intervention asks, "If they remove my bladder, how will I be able to urinate?" Which response would the nurse use?

The response, "I know you're upset, but there are alternatives to removing your bladder" offers the best combination of factual information and emotional support. The response, "You can still function normally without a bladder" disregards the client's feelings; the information is inaccurate because removal of the bladder will not leave a normally functioning urinary system. Although the response, "I am sure this is very upsetting to you, but it will be over soon" identifies the client's feelings, further communication is cut off by the second part of the response. The response, "The tests will help determine whether your bladder has to be removed" is factual, but does not answer the question or offer emotional support; the response may increase the client's anxiety.

Which manifestations are specifically associated with urinary system disorders? Select all that apply. One, some, or all responses may be correct.

The specific manifestations associated with urinary system disorders include facial edema and stress incontinence. The general manifestations associated with urinary system disorders include excessive thirst, nausea and vomiting, and elevated blood pressure.

What is the function of the structure labeled in the given figure?

The structure labeled in the figure represents the fallopian tubes, fingerlike projections that massage the ovaries to facilitate ovum extraction. The ovaries produce ova. The uterus accommodates the fetus. The cervix serves as an entry to the sperm and is also involved in expulsion of menses.

Which action would the nurse implement when providing care for a client with continuous bladder irrigations?

The total amount of irrigation solution instilled into the bladder is eliminated with urine and therefore must be subtracted from the total output to determine the volume of urine excreted. An accurate specific gravity cannot be obtained when irrigating solutions are instilled into the bladder. Hourly outputs are indicated only if there is concern about renal failure or oliguria. A 24-hour urine test is not accurate if the client is receiving continuous bladder irrigations.

A client has returned from surgery with a nephrostomy tube. Which actions would the nurse take? Select all that apply. One, some, or all responses may be correct.

The tube must be kept patent to prevent urine backup, hydronephrosis, and kidney damage. Keeping an accurate record of intake and output and observing the urine drainage color and consistency is important to identify possible complications. Milking the tube every 2 hours is unnecessary. Instill no more than 5 mL of normal saline only if prescribed.

The nurse prepares a male client with a history of recurrent urinary tract infections (UTIs) for discharge after a ureterolithotomy. Which clinical manifestations of a UTI would the nurse teach this client to recognize?

Urgency or frequency of urination occurs with a urinary tract infection because of bladder irritability; burning on urination and fever are additional signs of a UTI. Increased ketones indicate diabetes mellitus, starvation, or dehydration. A UTI does not affect the ability of a male to maintain an erection. Pain radiating to the external genitalia is a symptom of a urinary calculus, not an infection.

A client recovering from deep, partial-thickness burns develops chills, fever, flank pain, and malaise. Which prescribed diagnostic test would the nurse expect to confirm a tentative urinary tract diagnosis?

Urinalysis and urine culture and sensitivity - The client's manifestations may indicate a urinary tract infection. A culture of the urine will identify the microorganism, and sensitivity will identify the most appropriate antibiotic. A cystoscopy is too invasive as a screening procedure; altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms. Creatinine clearance reflects renal function; A/G ratio reflects liver function. Although an increased urine specific gravity may indicate red blood cells, white blood cells, or casts in the urine, which are associated with urinary tract infection, it will not identify the causative organism.

Which intervention is the best approach to condom use for prevention of sexually transmitted infection?

Use of a condom with oral sex - Condoms should be used with all sexual encounters, including oral sex, to reduce sexually transmitted infection. There is no evidence that spermicides prevent sexually transmitted infection. Oil-based lubricants can break down latex condoms permitting the transfer of disease. Natural membranes condoms allow the transfer of some infections.

Which surgeries are associated with permanent contraception? Select all that apply. One, some, or all responses may be correct.

Vasectomy is the surgical removal of a portion of the vas deferens, which is considered to be a form of male permanent contraception or sterilization. In tubal sterilization, the fallopian tubes are ligated. Tubal sterilization is a form of permanent contraception. Cryosurgery is used to treat and kill abnormal cells with the aid of subfreezing temperature. The surgical removal of either one or both the breasts is called mastectomy and is included in the treatment of breast cancer. The surgery performed to repair the varicose veins of the scrotum is called varicocelectomy.

While reviewing the result of an intravenous pyelogram, the nurse discovers that the client has a shortened urethra. Which nursing intervention helps prevent complications associated with this condition?

Weakened urinary sphincters and shortened urethras are age-related physiological changes in older adults. Because a shortened urethra has an increased potential for bladder infections, the nurse should provide thorough perineal care after each voiding. Encouraging the client to use the toilet or bedpan every 2 hours will help avoid overflow urinary incontinence. Responding quickly to the client's indication of the need to void will help alleviate urinary stress incontinence episodes. Applying voiding stimulants to the perineum will help initiate voiding in the client.

A client fears pregnancy despite the use of oral contraceptives. The nurse anticipates that which blood test will be prescribed?

A client fears pregnancy despite the use of oral contraceptives. The nurse anticipates that which blood test will be prescribed?

Which intervention would be beneficial when preparing a client who has kidney dysfunction for a cystoscopy?

A client who is about to undergo cystoscopy should be NPO (nil per os) after midnight on the night before the procedure. The client should eat a light evening meal. The nurse should instruct the client to take oral fluids after the procedure to increase urine output. A bowel preparation with enemas should be performed the evening before the procedure.

In addition to being highly infectious, which additional fact would the nurse teach the client with gonorrhea?

Can produce sterility

Which sexually transmitted infection causes condylomata acuminate?

Condylomata acuminate are genital warts that are caused by HPV. Genital warts are not caused by chlamydia, gonorrhea, or herpes simplex.

Which part of the female reproductive system produces testosterone?

Testosterone is an androgen, and in females, androgens are produced by the ovaries and adrenal glands. The uterus holds the fetus during pregnancy. Fallopian tubes facilitate fertilization of oocyte and sperm. An ovarian follicle is a collection of oocytes in the ovary.

Which laboratory value would the nurse assess when preparing a client for a renal biopsy? Select all that apply. One, some, or all responses may be correct.

The nurse would assess the client's hematocrit and hemoglobin before and after the procedure to determine blood loss. The nurse would also check the client's platelets, PT/INR, and PTT to determine if the client is at risk for hemorrhage.

Which condition would the nurse expect to see in the laboratory reports of a client who has Cushing syndrome?

With glucocorticoid excess, aldosterone hypersecretion occurs and sodium is retained; therefore potassium is excreted, leading to hypokalemia. Hypervolemia occurs because of sodium and water retention precipitated by aldosterone. Hypocalcemia is not associated with aldosteronism. Aldosterone hypersecretion causes sodium retention and hypernatremia, not hyponatremia.

The nurse reviews the prescriptions for the newly admitted emergency department client with urolithiasis. Which order is the priority nursing action?

administer the prescribed morphine

A client, transferred to the postanesthesia care unit after a transurethral resection of the prostate (TURP), has an intravenous (IV) line and a urinary retention catheter. During the immediate postoperative period, for which potentially critical complication would the nurse monitor?

hemmorhage

A pathology report states a client's urinary calculus is composed of uric acid. Which food item would the nurse instruct the client to avoid?

liver - A low-purine diet controls the development of uric acid stones. Clients with uric acid stones should avoid foods high in purine, such as organ meats and extracts. The client should avoid milk if he or she had calcium stones, not uric acid stones. The client should avoid cheese or animal protein if he or she had cysteine stones, not uric acid stones. The client does not need to avoid vegetables when on a low-purine diet.

Which food selection indicates understanding of sources with high biologic value protein?

Cottage cheese contains more protein than the other choices. Apple juice is a source of vitamins A and C, not protein. Raw carrots are a carbohydrate source and contain beta-carotene. Whole wheat bread is a source of carbohydrates and fiber.

Which statement made by a client supports the previous diagnosis of late-stage (tertiary) syphilis?

Neurotoxicity, as manifested by ataxia (balance problems), is evidence of tertiary syphilis, which may involve the central nervous system or cardiovascular system. A wart on the penis occurs in the secondary stage of syphilis. Sores all over the mouth occur in the first and secondary stage of syphilis. Sore throat with flulike symptoms occurs in the secondary stage of syphilis.

Which action would the nurse take to assess for ascites?

Percussing over the client's abdomen will produce a dull sound if excess fluid is present. Respiratory distress may occur with ascites, but it is not evidence of ascites, and can be caused by many other conditions. Palpating the lower extremities assesses for dependent edema, not ascites. Bowel sounds may still be heard with developing ascites; when ascites is extensive, bowel sounds may diminish.

Which finding during peritoneal dialysis would the nurse act on as a sign of infection?

The cloudy return of dialysate indicates infection and should be cultured for confirmation. Pain with instillation can happen when the dialysate is not warmed. Constipation can slow the flow of dialysate. Leakage around the catheter can happen early in the new placement of the catheter and when the peritoneum contains too much fluid.

Which action would the nurse implement when performing peritoneal dialysis for a client?

The nurse would warm dialysate fluids to body temperature to decrease abdominal discomfort and promote dilation of peritoneal vessels. The side-lying position may restrict fluid inflow and prevent maximum urea clearance. The nurse would place the client in the semi-Fowler position to promote drainage of dwelling dialysate fluids and infusion of the new solutions. The infusion of dialysate solution should take approximately 10 to 20 minutes. Routine medications should not interfere with the infusion of dialysate solution.

Which urinary diagnostic test does not require any dietary or activity restrictions for the client before or after the test?

A renal scan does not require any dietary or activity restrictions. A renal biopsy requires bed rest for 24 hours after the procedure. A renal arteriogram requires the client to maintain bed rest with affected leg straight. A concentration test requires the client to fast after a given time in the evening.

Which diseases can be transmitted by air? Select all that apply. One, some, or all responses may be correct.

Measles, chicken pox, and tuberculosis are infectious diseases transmitted by air. Transmission of scabies and pediculosis is by direct contact.

Which organism is responsible for causing dermatitis related to a sexually transmitted infection (STI)?

Phthirus pubis - Phthirus pubis is responsible for dermatitis related to sexually transmitted infections. Candida albicans may lead to vulvovaginitis. Campylobacter jejuni may cause proctitis. Ureaplasma urealyticum may cause salpingitis, infertility, reproductive loss, and ectopic pregnancies.

Which action would the nurse plan for a client during the early postoperative period after a prostatectomy?

Straining applies pressure to the operative site, which can precipitate bleeding and should be avoided. A retention catheter is routinely put into place, so standing to void and not voiding by bedtime are not applicable. To prevent trauma, negative pressure should not be exerted on the bladder by using a bulb syringe to aspirate.

A male client reported dysuria, nocturia, and difficulty starting a urinary stream. The client has a cystoscopy and biopsy of the prostate gland scheduled. After the procedure, the client reports an inability to void. Which action would the nurse implement?

A full bladder is palpable with urinary retention and distention, which are common problems after a cystoscopy because of urethral edema. After determining if the bladder is palpable, the nurse would implement conservative nursing methods, such as running water or placing a warm cloth over the perineum, to precipitate voiding; catheterization carries a risk of infection and used as the last resort. Fluids dilute the urine, reduce the chance of infection after cystoscopy, and should not be limited. Although urinary retention can occur, it is not expected; the nurse must assess the extent of bladder distention and discomfort first.

Which procedure involves the examination of the ureters and the renal pelvises?

A pyelogram is a retrograde examination of the ureters and the pelvis of both kidneys. A cystogram is a retrograde examination of the bladder. An urethrogram is a retrograde examination of the urethra. A voiding cystourethrogram is used to determine whether urine is flowing backward into the urethra.

Which diagnostic tests are used to measure kidney size? Select all that apply. One, some, or all responses may be correct.

A radiography and CT scan are diagnostic tests used to measure kidney size in clients with kidney dysfunction. A cystoscopy is used to identify abnormalities of the bladder wall in clients with kidney dysfunction. A cystography and a cystourethrography are used to examine the structure of the urethra and to detect backward flow of urine.

During the first 24 hours after a client has had a permanent colostomy created, the nurse observes no drainage from the colostomy. Which circumstance explains this finding?

Absence of peristalsis is caused by manipulation of abdominal contents and the depressant effects of anesthetics and analgesics. Edema will not interfere with peristalsis; edema may cause peristalsis to be less effective, but some output will result. An absence of fiber has a greater effect on decreasing peristalsis than does decreasing fluids. A nasogastric tube decompresses the stomach; it does not cause cessation of peristalsis.

A client who is admitted to the hospital with liver cancer and ascites is scheduled for a paracentesis. Which nursing intervention would be included in the client's plan of care?

Because the trocar is inserted below the umbilicus, having the client void decreases the danger of puncturing the bladder. Cleansing the intestinal tract is not necessary because the gastrointestinal tract is not involved in a paracentesis. The primary health care provider, not the nurse, uses a local anesthetic to block pain during the insertion of the aspirating needle; marking the site usually is not done. A paracentesis usually is performed in a treatment room or at the client's bedside, not in the operating room.

A 55-year-old client reports cessation of menstrual periods for a year. Which term describes the client's condition?

Cessation of menstruation is called menopause; this is an aging process and occurs due to functional decline of the ovaries. The first episode of menstrual bleeding is called menarche. Dyspareunia refers to painful sexual intercourse. Menorrhagia is excessive vaginal bleeding.

For which client illness would airborne precautions be implemented?

Chickenpox - Chickenpox is known or suspected to be transmitted by air. Diseases that are known or suspected to be transmitted by droplet include influenza and pneumonia. A disease that is known or suspected to be transmitted by direct contact is respiratory syncytial virus.

Which would the nurse use to perform hand hygiene when caring for an immunocompromised client?

Chlorhexidine - Chlorhexidine will be used for hand hygiene when caring for immunocompromised clients because it decreases the risk of spreading infection. Cleansing hands with soap and alcohol-based hand sanitizers is not as effective at preventing the spread of infection. Betadine is not used for hand hygiene.

Which process would the IgD immunoglobulin found in human cord blood support?

Differentiation of B-lymphocytes - IgD is present on the lymphocyte surface and found in human cord blood; this immunoglobulin differentiates B-lymphocytes. IgE causes symptoms of allergic reactions by adhering to mast cells and basophils. IgE also helps defend the body against parasitic infections. IgA lines the mucous membranes and protects body surfaces. IgM provides the primary immune response.

Which type of hepatitis virus spreads through contaminated food and water?

Hepatitis A virus - Hepatitis A virus spreads through contaminated food and water. Hepatitis B, C, and D viruses spread through contaminated needles, syringes, and blood products.

Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia?

Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small, superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathological condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.

A chronically ill, older client lives with their daughter. The client reports the daughter, who has three small children, seems run-down, coughs a lot, and sleeps all the time. Which statement supports the need for the nurse to pursue the daughter's condition as a potential case finding?

Older adults with chronic illness are more susceptible to tuberculosis - The client's chronic illness and older age increase vulnerability; the daughter's condition should be explored in greater detail. Tuberculosis is only one of many potential causes of the daughter's clinical condition. Children who have not yet reached puberty and adolescence have the lowest incidence of tuberculosis. Morbidity and mortality resulting from tuberculosis are increasing, not decreasing.

Which term is used for the tip of a pyramid in the kidney?

Pyramids are components of renal medulla, and the tip of each pyramid is called a papilla. A calyx is a structure that collects the urine at the end of each pyramid. The renal calices join together to form the renal pelvis. A renal column is a cortical tissue that separates the pyramids.

Which intervention is most important in preventing hospital-acquired catheter-associated urinary tract infections (CAUTIs)?

Removing the catheter - Research demonstrates that decreasing the use of indwelling urinary catheters is the most important intervention to prevent CAUTIs. Keeping the drainage bag off the floor, washing hands before and after assessing the catheter, and cleansing the urinary meatus daily with soap and water will help reduce infections; however, these are not the most important interventions to prevent CAUTIs.

A client diagnosed with invasive cancer of the bladder has brachytherapy scheduled. Which successful therapy outcome would the nurse expect with this client?

Shrinkage of the tumor when scanned - Brachytherapy involves implanting isotope seeds in, or next to, the tumor. The isotope seeds interfere with cell multiplication, which should control the growth and metastasis of cancerous tumors. Radiation affects healthy as well as abnormal cells; urinary output will increase with successful therapy. With brachytherapy of the bladder, an increase in pulse strength is not a sign of success. The radioactive isotope seeds may affect the client's bone marrow sites, resulting in a reduction of WBCs.

Which collecting structure is located at the end of the renal papilla?

The calyx is a cuplike structure that collects urine and is located at the end of each papilla. The outer surface of the kidney consists of fibrous tissue and is called the capsule. The renal cortex is the outer tissue layer. The renal columns are the cortical tissue that dip down into the interior of the kidney and separate the pyramids.

Which statement reflects the nurse's suspicions regarding a client's cloudy urine noted on a urinalysis report?

The client has a urinary infection. - The urine becomes cloudy when an infection is present due to the presence of leukocytes. The nurse concludes the client has a urinary infection. In cases of biliary obstruction, the urine contains bilirubin. The presence of ketones in the urine indicates diabetic ketoacidosis or prolonged starvation.

Which statement by a client after a cervical biopsy indicates that the client understands the self-care instructions?

The client with cervical biopsy should keep the perineum clean and dry with an antiseptic solution to reduce the chance of infections. The client should report to the primary health care provider immediately in case of heavy bleeding and infection. The client should rest for 24 hours after the procedure to ensure healing of operative site and prevent postoperative bleeding. Douching, using tampons, and having vaginal intercourse are not recommended in the client because the client is more susceptible to infections, pain, and bleeding.

Which part of the kidney senses changes in blood pressure?

The macula densa, a part of the distal convoluted tubule, consists of cells that sense changes in the volume and pressure of blood. Calices are cuplike structures, present at the end of each papilla, that collect urine. The glomerulus is the initial part of the nephron, which filters blood to make urine. Juxtaglomerular cells secrete renin. Renin is produced when sensing cells in the macula densa sense changes in blood volume and pressure.

Which is the causative organism for syphilis?

Treponema pallidum - The causative organism for syphilis is Treponema pallidum. Campylobacter jejuni is the causative organism for proctitis. Trichomonas vaginalis is the causative organism for vulvovaginitis. Chlamydia trachomatis is the causative organism for salpingitis.

Which hypersensitivity reaction may occur in a newborn with hemolytic disease?

Type II - Hemolytic disease in a pregnant woman may result in erythroblastosis fetalis, a type II hypersensitivity reaction. Type I reactions involve immunoglobulin E (IgE)-mediated reactions such as anaphylaxis and wheal-and-flare reactions. Type III reactions are immune complex reactions such as rheumatoid arthritis or systemic lupus erythematosus. Type IV reactions are delayed hypersensitivity reactions such as contact dermatitis.

Which organ is protected by microglial cells?

Microglial cells are macrophages present in the brain. The lungs are protected by alveolar macrophages. The liver is protected by Kupffer cells. Mesangial cells are present in the kidneys.

Among which group of women are breast cancer death rates the lowest?

Among these groups of women, Asian American women have the lowest rates of death from breast cancer. Samoan, Hawaiian, Puerto Rican, and African American women have the highest breast cancer death rates.

A client expresses concern regarding the lack of annual flu vaccines because of a supply and demand problem. Which response by the nurse is best?

"There are other things you and your family can do to prevent the flu, such as hand washing." - The statement "There are other things you can do to prevent the flu, such as hand washing" is a teaching opportunity of which the nurse can take advantage and show the client the things that can be done to avoid infection. The response "It's unfortunate, but there was such a limited supply available" is empathic, but it does not address the client's concern of vulnerability. The response "There are many others who also were unable to get a flu vaccine" belittles the client for being concerned. The response "It doesn't matter because the vaccine is for just one particular strain" may be true, but it belittles the client's concern.

Which instruction would the nurse provide a client needing to collect a clean-catch urine specimen?

"Urinate a small amount, stop flow, and then fill one half of the specimen cup." - Instruct the client to always collect midstream urine to send as a test specimen. Instruct the client to cleanse the perineum with the wipe provided, urinate a small amount, and then stop the flow. The client should then position the specimen cup a few inches from the urethra and resume urination, filling at least one half of the cup with urine. Instruct the client to collect the first sample voided in the morning because the urine is highly concentrated in the morning. Keeping the urine sample in the refrigerator helps reduce bacterial growth due to the urine's alkaline environment. The cells in the urine sample begin to break down in alkalinity; therefore instruct the client to send the sample to the laboratory as soon as possible after the collection.

Which action would the nurse take before a client's scheduled hemodialysis treatment?

A baseline weight must be obtained to be able to determine the net fluid loss from dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary; clients with advanced kidney disease may not produce urine. Medications often are delayed until after dialysis to prevent them from being filtered into the dialysate. Explaining that the peritoneum serves as a semipermeable membrane to remove wastes applies to peritoneal dialysis, not hemodialysis.

The nurse is performing a male reproductive system assessment of an older adult client. The nurse expects which age-related finding?

A reduction in the size of the testes is a characteristic of aging. The testes are symmetrical in shape and length; any change in their symmetry denotes an abnormality. Pubic hair is normally present. For uncircumcised males, a foreskin will be present and should be easily retractable.

Which reaction is an example of a type I hypersensitivity reaction?

Anaphylaxis - An example of a type I hypersensitivity reaction is anaphylaxis. Serum sickness is a type III immune complex reaction. Contact dermatitis is a type IV delayed hypersensitivity reaction. A blood transfusion reaction is a type II cytotoxic reaction.

Which factor would the nurse explain as a reason why women are at a greater risk than men for contracting a urinary tract infection?

Because a woman's urethra is closer to the anus than a man's, it is at greater risk for becoming contaminated. Urinary pH is within the same range in both men and women. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in men and women.

The registered nurse (RN) is teaching a nursing student about the care given to a female client before a prostate antigen-specific test. Which statement of the nursing student indicates a need for further teaching?

Before a prostate antigen-specific test, no fluid or food restrictions are required; therefore asking the client to remain NPO indicates a need for further teaching. The nurse should observe breast changes and any thick discharge from the nipples. The nurse should also know about the client's menstrual cycle. The nurse should observe the venipuncture site for a hematoma or bleeding.

A client's respiratory tract infection, which started with a common cold, has progressed to whooping cough. The client reports "coughing fits" lasting for several minutes. Which organism is responsible for the client's condition?

Bordetella pertussis - Bordetella pertussis causes whooping cough . Pertussis is a respiratory tract infection beginning with the common cold and progresses to whooping cough. The client also develops coughing episodes lasting for several minutes. Inhalation anthrax is caused by Bacillus anthracis. Streptococcus pneumoniae may cause pneumonia. Mycobacterium tuberculosis infection leads to tuberculosis.

Which disorder is a primary glomerular disease?

Chronic glomerulonephritis - Chronic glomerulonephritis is a primary glomerular disease. Diabetic glomerulopathy, hemolytic-uremic syndrome, and systemic lupus erythematosus are secondary glomerular diseases.

Which instruction on infection prevention would the nurse include when providing discharge education to a client who received a cadaveric renal transplant? Select all that apply. One, some, or all responses may be correct.

Clients who receive an organ transplant need to take immunosuppressant medications for the rest of their lives to prevent organ rejection. These medications put the client at increased risk for infection. The nurse would provide infection prevention teaching to the client after renal transplant, which would include instructions to avoid eating from buffets, get an annual flu vaccine, practice regular hand hygiene, and avoid crowded areas. Clients would also be instructed to report a temperature greater than 100.5°F to their health care provider as it could indicate infection or organ rejection and requires treatment.

The nurse receives a urine culture and sensitivity report that reveals a client has vancomycin-resistant enterococcus (VRE). After notifying the primary health care provider, which action would the nurse take?

Clients with VRE should be moved to a private room to decrease transmission to others. VRE has been identified in the urine, not respiratory secretions. Contact isolation should be implemented. A Foley catheter should not be inserted because it will predispose the client to develop an additional infection. A HEPA respirator is not required when entering the room.

Which complication would the nurse suspect in a client with genital herpes disease?

Cold sores - Cold sores are the autoinoculation of the virus to extragenital sites, such as the fingers and lips. It is a complication of genital herpes disease. Infertility and reactive arthritis are the complications of chlamydial infection. Bartholin abscess is a complication of gonorrhea.

Which part of the kidney produces the hormone bradykinin?

Juxtaglomerular cells of the arterioles - The juxtaglomerular cells of the arterioles produce the hormone bradykinin, which increases blood flow and vascular permeability. The kidney tissues produce prostaglandins that regulate internal blood flow by vasodilation or vasoconstriction. The kidney parenchyma produces erythropoietin that stimulates the bone marrow to make red blood cells. The renin-producing granular cells produce the renin hormone that raises blood pressure as a result of angiotensin and aldosterone secretion.

Which complication is associated with Pott disease?

Destruction of intervertebral discs - Pott disease is tuberculosis (TB) of the spine, which can lead to destruction of intervertebral discs. Abdominal TB can cause peritonitis. Central nervous system TB can cause severe bacterial meningitis. Generalized lymphadenopathy can be caused by miliary tuberculosis.

Which conclusion would the nurse make about the assessment finding of a client's very pale-yellow-colored urine?

Dilute urine tends to appear very pale-yellow in color. Dark-red or brown color urine indicates hematuria, the presence of blood in the urine. Dark-amber color urine indicates concentrated urine. Red color urine may indicate the presence of myoglobinuria.

Which condition would the nurse document to describe a client presenting with the loss of the ability to taste after cancer treatment has affected the client's ability to eat food?

Dysgeusia - Dysgeusia is the loss of the ability to taste, which can occur after treatment for cancer. Mucositis is the inflammation and irritation of the mucosa in the mouth or throat. Dysphagia is difficulty in swallowing or an inability to swallow. Xerostomia is dry mouth. All four of these complaints are common side effects of chemotherapy or radiation treatment.

What would the presence of ketones in the urine of a client indicate?

Fat metabolism - The body of a client, who is ingesting fewer calories than are needed for maintenance, produces ketones from fat metabolism as an alternate source of fuel for muscles and organs. Increased red blood cells in the urine indicate cystitis. Increased specific gravity of the urine indicates heart failure. The presence of casts in the urine indicates urinary calculi.

Which hypersensitivity reaction may occur in a newborn with hemolytic disease

Hemolytic disease in a pregnant woman may result in erythroblastosis fetalis, a type II hypersensitivity reaction. Type I reactions involve immunoglobulin E (IgE)-mediated reactions such as anaphylaxis and wheal-and-flare reactions. Type III reactions are immune complex reactions such as rheumatoid arthritis or systemic lupus erythematosus. Type IV reactions are delayed hypersensitivity reactions such as contact dermatitis.

Which substance is released in response to low serum levels of calcium?

If serum calcium levels decline, the parathyroid gland releases parathyroid hormone to maintain calcium homeostasis. Renin is a hormone released in response to decreased renal perfusion; this hormone is responsible for regulating blood pressure. Erythropoietin is released by the kidneys in response to poor blood flow to the kidneys; it stimulates the production of red blood cells. Atrial natriuretic peptide is produced by the right atrium of the heart in response to increased blood volume. This hormone then acts on the kidneys to promote sodium excretion, which decreases the blood volume.

Which statement indicates the nurse has a correct understanding of kidney ultrasonography?

Kidney ultrasonography is a minimal-risk diagnostic procedure. Ultrasonography makes use of sound waves, which when reflected from internal organs of varying densities produce images of the kidneys, bladder, and associated structures on the display screen. Although a dye can be used in computed tomography (CT), it is not the primary method. Generally, when performing a kidney ultrasonography, the client's bladder is full. A CT scan gives three-dimensional information about the kidney and associated structures.

The nurse teaches a class about male anatomy. Identify the function of the structure pinpointed in the provided figure.

Label A in the figure indicates the scrotum, which holds the testes by forming a protective sac. Sperm production occurs by the seminiferous tubules within the testes. Cowper's glands, the prostate gland, and the seminal vesicles produce and secrete semen. The epididymis transports sperm during maturation.

Which structure indicated in the figure is the primary reproductive organ of the female?

Label A indicates the ovary, the primary reproductive organ of a female. Label B indicates the fallopian tubes, label C indicates the uterus, and label D indicates the symphysis pubis. The fallopian tubes, uterus, and vagina are the secondary reproductive organs of the female.

Which finding in a urinalysis indicates a urinary tract infection?

Leukoesterases are released by white blood cells in response to an infection or inflammation. The presence of this chemical in urine indicates a urinary tract infection. The presence of crystals in the urine indicates that the specimen had been allowed to stand. Presence of bilirubin in the urine indicates anorexia nervosa, diabetic ketoacidosis, and prolonged fasting. The presence of ketones indicates diabetic ketoacidosis.

Which hormone is crucial for ovulation and complete maturation of the ovarian follicles?

Luteinizing hormone - Ovulation and complete maturation of ovarian follicles can only take place in the presence of luteinizing hormone. However, follicle-stimulating hormone initiates maturation of the follicles. Gonadotropin-releasing hormone stimulates the pituitary gland to release follicle-stimulating hormone and luteinizing hormone. Human chorionic gonadotropin hormone is released after implantation and is responsible for secretion of progesterone and estrogen during pregnancy.

A client has bright-red erythematosus macules and papules on the skin. The nurse would expect to teach the client about which condition?

Medication eruption

Which type of immunity is acquired through the transfer of colostrum from the mother to the child?

Natural passive immunity - Natural passive immunity is acquired through the transfer of colostrum from the mother to the child. Natural active immunity is acquired when there is a natural contact with an antigen through a clinical infection. Artificial active immunity is acquired through immunization with an antigen. Artificial passive immunity is acquired by injecting serum from an immune human.

A client with an acute kidney injury has peritoneal dialysis (PD) prescribed and asks why the procedure is necessary. Which response statement would the nurse use?

PD removes chemicals, wastes, and fluids usually removed from the body by the kidneys. The mention of heart problems is a threatening response and may cause increased fear or anxiety. Telling the patient that PD may 'restart' your kidneys so that they perform better than before is misleading. PD helps maintain fluid and electrolytes; in acute kidney injury, damage occurs in the nephrons, so the PD may or may not speed recovery.

Which medication turns urine reddish-orange in color?

Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts a characteristic orange or red color to urine. Amoxicillin is a penicillin form that could cause pseudomembranous colitis as a complication; it is not associated with reddish-orange colored urine. Ciprofloxacin is a quinolone antibiotic used for treating urinary tract infections (UTIs) and can cause serious cardiac dysrhythmias and sunburns. It is not, however, responsible for reddish-orange colored urine. Nitrofurantoin is an antimicrobial medication prescribed for UTIs. This medication may affect the kidneys but is not associated with reddish-orange colored urine.

Which hormone is crucial in maintaining the implanted ovum at its site?

Progesterone is necessary to maintain an implanted egg. Inhibin regulates the release of follicle-stimulating hormone and gonadotropin-releasing hormone. Estrogen plays a vital role in the development and maintenance of secondary sexual characteristics. Testosterone is important for bone strength and development of muscle mass.

The nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation?

Prolactin is the hormone that initiates and produces milk during lactation. Inhibin prevents the secretions of follicle-stimulating hormone and gonadotropin-releasing hormone. Estrogen and progesterone are the sex hormones produced by the ovaries.

Which process is a function of the kidney hormones?

Renin is a kidney hormone that raises blood pressure as a result of angiotensin and aldosterone secretion. Prostaglandin is a kidney hormone that regulates intrarenal blood flow via vasodilation or vasoconstriction. Bradykinin is a kidney hormone that increases blood flow and vascular permeability. Erythropoietin is a kidney hormone that stimulates the bone marrow to make red blood cells.

Which autoimmune disease can result in damage to the heart?

Rheumatic fever is an example of an autoimmune disease that can potentially result in permanent damage to the heart, including damage to valves and heart failure. Uveitis is an eye disorder that is an example of an autoimmune disease. Myasthenia gravis is a muscular disorder that is an example of an autoimmune disease. Graves disease is an endocrine disorder that is an example of an autoimmune disease. Other than rheumatic fever, these autoimmune diseases are not linked to cardiac damage.

Identify the type of hypersensitivity reaction associated with systemic lupus erythematosus (SLE).

SLE is an example of an immune complex-mediated, or type III, hypersensitive reaction. Anaphylaxis is an example of a type I, or immediate hypersensitive reaction. Cytotoxic, or type II, hypersensitive reactions can result in conditions such as myasthenia gravis and Goodpasture syndrome. Graft rejection and sarcoidosis are conditions caused by delayed, or type IV, hypersensitivity reactions.

Which symptoms are common during the fulminant stage of inhalation of anthrax? Select all that apply. One, some, or all responses may be correct.

The fulminant stage of inhalation of anthrax is manifested by dyspnea, diaphoresis, and a high body temperature. The prodromal stage of inhalation of anthrax is manifested by a dry cough and mild chest pain.

Which information would the nurse include when teaching about why women are more susceptible to urinary tract infections than men?

The length of the urethra is shorter in women than in men; therefore microorganisms have a shorter distance to travel to reach the bladder. The proximity of the meatus to the anus in women also increases the incidence of urinary tract infections. Fluid intake may or may not be adequate in both men and women and does not account for the difference. Hygienic practices can be inadequate in men or women. Mucous membranes are continuous in both men and women.

A client with end-stage renal disease has a mature arteriovenous (AV) fistula. Which interventions would the nurse include in the client's plan of care? Select all that apply. One, some, or all responses may be correct.

The presence of a bruit indicates patency of the AV fistula. The presence of a vibration or thrill indicates patency of the AV fistula. Avoid drawing blood from the extremity with the fistula to prevent damage to the AV fistula. An AV fistula is internal and is not irrigated. The AV fistula is under the skin and is not clamped.

The nurse teaches a group of student nurses about the function of the loop of Henle. Which function would the nurse include?

The reabsorption of sodium takes place in the ascending limb of the loop of Henle to maintain normal blood serum levels of sodium in the body. Ammonia is secreted from the distal tubule. The secretion of hydrogen occurs in the proximal and distal tubules of the nephron. Reabsorption of water is carried out in the descending limb of the loop of Henle.

A client scheduled for a cystoscopy asks the nurse to describe the procedure. Which description would the nurse provide?

The response, "It is the visualization of the bladder lining with an instrument connected to a source of light," answers the client's question and provides an accurate description of a cystoscopy. A cystoscopy is not a computerized examination. A cystoscopy does not involve x-ray films or dye. Radiopaque material is not used in a cystoscopy, and the catheter is inserted into the bladder via the urethra, not the ureters.

The nurse provides discharge teaching for a client who had a transurethral vaporization of the prostate. Which statement by the client indicates successful learning?

The surgical procedure affects the urethral mucosa in the area of the prostate, and strictures may form with healing. The client should notify his or her primary health care provider if his or her urinary stream decreases. The client should ambulate; sitting for several hours at a time is contraindicated because sitting promotes venous stasis and thrombus formation. The client should void as the need arises; straining to urinate can cause pressure in the operative area, precipitating hemorrhage. Although the client should avoid vigorous exercise immediately after surgery and during the healing process, 6 months is too long for this restriction.

Following a gastrectomy performed for peptic ulcer disease, the patient is ready for discharge. Which instructions would the nurse include in discharge teaching?

To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals. Fluids can be taken at least 30 to 45 minutes before or after meals. This helps prevent distention or a feeling of fullness. Concentrated sweets should be avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness. Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs.

Which medication is a leukotriene modifier used to manage and prevent allergic rhinitis?

Zileuton - Zileuton is a leukotriene modifier used to manage and prevent allergic rhinitis. Ephedrine is an ingredient in decongestants used to treat allergic rhinitis. Scopolamine is an anticholinergic used to reduce secretions. Cromolyn sodium is a mast cell stabilizing medication used to prevent mast cell membranes from opening when an allergen binds to immunoglobulin E (IgE).

Which glands help in lubricating the female urinary meatus?

Skene glands are located along the urinary meatus and help lubricate the urinary meatus. The prostate and Cowper gland are glands of the male reproductive system. Bartholin gland lies at the vaginal orifice and contributes in lubricating the vagina during sexual intercourse.

A client presents with abnormal uterine bleeding, pelvic pressure, pressure during urination, and painful intercourse. Which diagnosis would the nurse suspect when an enlarged uterus and nodular masses are palpated on examination?

Symptoms of abnormal uterine bleeding, pelvic pressure, pressure during urination, and painful intercourse indicate leiomyomas. Ovarian cysts can also cause constipation, anorexia, increased abdominal girth, and peripheral edema; a mass on an enlarged ovary would be felt during the pelvic exam. Endometriosis causes nodular bumps in the adnexa, but definitive diagnosis requires laparoscopy and biopsy. Pelvic inflammatory disease does not cause any urinary symptoms.

For which potential complications would the nurse monitor a client receiving continuous ambulatory peritoneal dialysis for end-stage kidney disease? Select all that apply. One, some, or all responses may be correct.

Tachycardia can be a symptom of peritonitis, a complication of peritoneal dialysis; the heart rate increases to meet the metabolic demands associated with infection. Cloudy or opaque dialysate outflow (effluent) is the earliest sign of peritonitis; the cloudiness is a result of the constituents associated with an infectious process. Abdominal pain is associated with peritonitis, a complication of peritoneal dialysis; pain results from peritoneal inflammation, abdominal distention, and involuntary muscle spasms. Severe itching (pruritus) results from the deposits of metabolic waste products in the skin; dialysis removes metabolic waste products, preventing this adaptation associated with kidney failure. The production of abnormally small amounts of urine (oliguria) is a sign of kidney failure, not a complication of peritoneal dialysis. Topics

After discussing a 23-year-old client's medical history, the nurse discovers the client has never had a Papanicolaou (Pap) test. Which intervention would the nurse suggest to the client?

The Papanicolaou (Pap) test is a cytological study performed annually after the age of 21 years. The nurse would advise a 23-year-old client to undergo a Pap test immediately to rule out precancerous and cancerous cells within the client's cervix. Undergoing a Pap test during menses may interfere with laboratory analysis and results. A human papillomavirus test is performed every 5 years. Pap tests and human papillomavirus tests are recommended in clients between the ages of 30 and 65 years.

Which mediator of injury is involved in the client with pruritic lesions from an immunoglobulin E (IgE)-mediated hypersensitivity reaction?

Histamine - Histamine is one of the mediators of injury involving IgE-mediated injury and potentially causes pruritus. Cytokines are the mediators of injury in delayed hypersensitivity reaction. Neutrophils are involved in immune complex-mediated hypersensitivity reactions. Macrophages in tissues are involved in cytotoxic reactions.

Which procedure involves severing a nerve for a patient with a peptic ulcer that is unresponsive to medical management?

A vagotomy is the severing of the vagus nerve either totally (truncal) or selectively (highly selective vagotomy). These procedures are done to decrease gastric acid secretion. Billroth I involves a partial gastrectomy with the removal of two thirds of the stomach and the anastomosis of the gastric stump to the duodenum. Billroth II is partial gastrectomy with the removal of two thirds of the stomach and the anastomosis of the gastric stump to the jejunum. Pyloroplasty consists of surgical enlargement of the pyloric sphincter to facilitate easy passage of contents from the stomach.

Which client's urinalysis report signifies the presence of excessive bilirubin?

Client 3's urinalysis report findings of the presence of yellow-brown to olive-green-colored urine which signifies excessive bilirubin. Client 1's urinalysis report findings of the presence of amber-yellow-colored urine signifies a normal finding. Client 2's urinalysis report findings of the presence of dark, smoky-colored urine signifies hematuria. Client 4's urinalysis report findings of orange-red or orange-brown-colored urine indicates the presence of phenazopyridine in the urine.

Which test result would the nurse anticipate in the laboratory reports of a client with a diagnosis of end-stage renal disease?

Clients with end-stage renal disease have impaired potassium excretion, so the nurse should anticipate a potassium level more than the expected range of 3.5 to 5 mEq/L (3.5-5 mmol/L). Clients with end-stage renal disease usually have a serum pH that is less than 7.35 because of metabolic acidosis. A pH of 7.5 that exceeds the expected range of 7.35 to 7.45 is not anticipated because this is alkalosis. Clients with end-stage renal disease have decreased erythropoietin, which leads to decreased red blood cell production and hematocrit; a hematocrit of 54% exceeds the expected range, which is 39% to 50% for males and 35% to 47% for females; therefore it is not anticipated. Clients with end-stage renal disease have a decreased ability to eliminate nitrogenous wastes, which leads to increased creatinine levels; a creatinine level of 1.2 mg/dL (106 mcmol/L) is within the expected range of 0.7 to 1.4 mg /dL (62-124 mcmol/L) and is not anticipated.

Which assessment is necessary for the nurse to complete in a client with chronic kidney disease receiving loop diuretics?

Diuretics are administered to increase urine output, so the measure of intake and output are very important to diuretic use. Hemoglobin levels are important to monitor in the use of erythropoietin in the chronic kidney disease client. Nausea and constipation are important to monitor with the administration of iron-containing vitamins and mineral supplements.

Before a client with syphilis can be treated, which issue must be addressed?

Existence of allergies - Although the treatment of choice is penicillin, clients who are allergic must be given other antimicrobial agents to avoid an anaphylactic reaction. The portal of entry does not influence treatment. The chancre is present only in the primary stage; it does not alter treatment. Although sexual contacts should be identified and notified, treatment should not be delayed.

Which value indicates a normal vaginal pH?

Normal vaginal pH ranges from 3.5 to 5. Clients with a higher vaginal pH (6.8, 7.5, and 9.3) are more prone to infections.

Which finding is expected in a client diagnosed with early glomerulonephritis?

Protein in the urine (proteinuria) and hematuria (blood in the urine) are classic manifestations of the onset of glomerulonephritis because of the increased permeability of the vascular bed in the kidneys. Suppression of urine formation (anuria) is not an initial manifestation of glomerulonephritis; oliguria may be present. Pain or burning on urination (dysuria) is indicative of cystitis, not glomerulonephritis. Excessive urination (polyuria) does not occur as an initial change with glomerulonephritis; polyuria and nocturia may occur later with chronic glomerulonephritis, when the renal structures are destroyed.

Which goal would the nurse expect a client receiving treatment for bacterial cystitis to achieve before their discharge from the hospital?

Achieve relief of clinical symptoms and maintain kidney function - Relief of symptoms and continued urine output are measurable responses to therapy and are the desired outcomes. Four liters of water per day is too much fluid; 2 to 3 liters a day is recommended to flush the bladder and urethra. Dietary restrictions are not necessary with cystitis. Bleeding is not a complication associated with this treatment.

Which description of pain would the nurse expect a client with a ureteral calculus to report?

Pain with ureteral stones is caused by spasm (renal colic) and is excruciating and intermittent; it follows the path of the ureter to the bladder down to the groin. Pain is spasmodic and excruciating, not boring, dull, or constant. Pain intensifies as the calculus lodges in the ureter and spasms occur in an attempt to dislodge it. Pain at the costovertebral angle can indicate urinary tract infection. The pain is episodic and not located at the level of the kidneys.

A client with an upper respiratory infection asks the nurse why the health care provider did not prescribe an antibiotic. Which response from the nurse would be the best?

"Upper respiratory infections are generally caused by viruses and would not be treated with antibiotics." - Generally, upper respiratory infections are viral; therefore antibiotics would not be used. Overuse of antibiotics results in antibiotic-resistant strains of bacteria. Antibiotics are used to treat bacteria, not viruses.

Which dietary modifications help improve the nutritional status of a client with acquired immunodeficiency syndrome (AIDS)?

Refraining from consuming fatty foods - Many clients with AIDS become intolerant to fat due to the disease and the antiretroviral medications. The client should be instructed to refrain from consuming fatty foods. The client should be encouraged to eat small and frequent meals to improve nutritional status. High-calorie and high-protein foods are beneficial to clients with AIDS because they provide energy and build immunity.

Which hormone influences kidney function?

Released from the adrenal cortex, aldosterone influences kidney function. Renin, bradykinin, and erythropoietin are kidney hormones.

Which clinical manifestations are associated with a diagnosis of tuberculosis? Select all that apply. One, some, or all responses may be correct.

Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. Signs include a persistent cough, anorexia, hemoptysis, night sweats, shortness of breath, and a high body temperature. Diarrhea and weight gain are not associated with tuberculosis.

Which instruction would the nurse provide a client with leukopenia secondary to chemotherapy?

"You should avoid large crowds and people with infections." - Leukopenia consists of low levels of white blood cells. A leukopenic client should avoid large crowds and people with infection because the client may contract an infection as a result of compromised immunity. The suggestion of avoiding exposure to the sun and using a sunscreen would be beneficial for a client with chemotherapy-induced skin changes. The suggestion of eating high-fiber foods and increasing fluid intake would be beneficial for a client with constipation after chemotherapy. Consuming iron supplements and erythropoietin would be required for a client who developed anemia after chemotherapy.

Which client has an increased risk of developing IgE antibodies?

A client with pollen allergy - A client with a pollen allergy develops IgE antibodies that may result in an anaphylactic reaction. A client with poison ivy develops delayed hypersensitivity, which is mediated by T lymphocytes. A client with a bacterial infection develops IgG and IgM antibodies. A client undergoing blood transfusion may develop IgG and IgM type II hypersensitivity reactions.Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds; give your brain time to reflect, and recall may occur.

Which result would the nurse expect to find when reviewing the serum screening tests of a client with acquired immunodeficiency syndrome (AIDS)?

A decrease in CD4 T cells - The human immunodeficiency virus (HIV) infects helper T-cell lymphocytes; therefore 300 or fewer CD4 T cells per cubic millimeter of blood or CD4 cells accounting for less than 20% of lymphocytes is suggestive of AIDS. The thymic hormones necessary for T-cell growth are decreased. An increase in immunoglobulin E is associated with allergies and parasitic infections. A decrease in the serum level of glucose-6-phosphate dehydrogenase is associated with drug-induced hemolytic anemia and hemolytic disease of the newborn.Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question.

Which statement would the nurse include in the teaching plan of a client anticipating discharge with acquired immunodeficiency syndrome (AIDS)?

A person cannot contract human immunodeficiency virus (HIV) by eating from dishes previously used by an individual with AIDS; routine care is adequate. Washing used dishes in hot, soapy water is sufficient care for dishes used by the AIDS client. Dishes do not need to soak for 24 hours before being washed. The client's dishes do not need to be boiled for 30 minutes after use. Paper plates are fine to use but are not indicated to prevent the spread of AIDS.

According to the Centers for Disease Control and Prevention (CDC), which stage of the human immunodeficiency virus (HIV) disease is present in the client with a laboratory report revealing a CD4+ T-cell count of 520 cells/mm3?

According to the CDC, HIV disease is divided into four stages. A client with a CD4+ T-cell count of greater than 500 cells/mm3 is in the first stage of HIV disease. A client with a CD4+ T-cell count between 200 and 499 cells/mm3 is in the second stage of HIV disease. A client with a CD4+ T-cell count of less than 200 cells/mm3 is in the third stage of HIV disease. The fourth stage of HIV disease indicates a confirmed HIV infection with no information regarding the CD4+ T-cell counts

Which antimicrobial medication acts on susceptible pathogens by inhibiting nucleic acid synthesis?

Actinomycin is an antimicrobial medication that acts on susceptible pathogens by inhibiting nucleic acid synthesis. Penicillin acts on susceptible pathogens by inhibiting cell wall synthesis. Erythromycin acts on susceptible pathogens by inhibiting biosynthesis and reproduction. Cephalosporin acts on susceptible pathogens by inhibiting cell wall synthesis.

Identify the function of IgG antibodies in the body?

Activates the classic complement pathway - The classic complement pathway is activated by the IgG and IgM antibodies. IgE antibodies cause a degranulation of mast cells. IgA antibodies are found largely in mucous membrane secretions and play an important role in preventing upper and lower respiratory tract infections.

Which population would the nurse include in a community education session on sexually transmitted infections (STIs)? Select all that apply. One, some, or all responses may be correct.

Adolescents, homosexual men, transgender clients, and those with multiple sex partners are at high risk for STIs. Intravenous drug users are also high risk and in need of education on STIs, as they are at particular risk for transmitting or contracting human immunodeficiency virus (HIV) through needle sharing.

The nurse is educating a couple concerning the process of fertilization. Which hormone would the nurse explain as stimulating the release of estrogen and progesterone after fertilization?

After fertilization, human chorionic gonadotropin (hCG) stimulates the corpus luteum to produce estrogen and progesterone. Inhibin is a hormone produced by the ovarian follicles; it inhibits the secretion of FSH and gonadotropin-releasing hormone. Testosterone does not affect the release of estrogen and progesterone. Follicle-stimulating hormone (FSH) stimulates the growth and maturity of the ovarian follicle necessary for ovulation.

A client reporting a recent bee sting presents with localized redness, swelling, intense localized pain, and itching. Which action would the nurse implement?

Applying cold compresses to the affected area - A client with a bee sting may have localized redness, swelling, pain, and itching due to an allergic reaction. The nurse would apply cold compresses to the affected area to reduce the pain and edema at the sting site. A client with Candida albicans infection should keep his or her skin clean and dry to prevent further fungal infections. A client with a Borrelia burgdorferi infection may suffer from cardiac, arthritic, and neurological manifestations, which requires monitoring by the nurse. Direct contact may transmit a Sarcoptes scabiei infection; the nurse should make sure the client bleaches his or her clothes to prevent the transmission of the infection.

Which medications inhibit purine synthesis and suppress cell-mediated and humoral immune responses? Select all that apply. One, some, or all responses may be correct.

Azathioprine and mycophenolate mofetil are administered to inhibit purine synthesis and suppress cell-mediated and humoral immunity. Sirolimus binds to a mammalian target of rapamycin (mTOR), which suppresses T-cell activation and proliferation. Cyclophosphamide is administered to treat cancers, autoimmune disorders, and amyloidosis. Methylprednisolone is a corticosteroid that inhibits cytokine production.

A client receiving chemotherapy develops a temperature of 102.2°F (39°C). The temperature 6 hours ago was 99.2°F (37.3°C). Which nursing intervention is the priority in this case?

Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia then can be initiated. More vigorous intervention than obtaining the respirations, pulse, and blood pressure is rechecking the temperature in 1 hour. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system. Assessing the amount and color of urine and obtaining a specimen for a urinalysis is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also, the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs. Noting the consistency of respiratory secretions and obtaining a specimen for culture is not the priority, although important because respiratory tract infections are a common occurrence in clients with multiple myeloma.

Regarding the spread of malaria, which method would the nurse teach those clients traveling to Southeast Asia?

Bites from female Anopheles mosquitoes - Malaria is caused by the protozoan Plasmodium falciparum, which is carried by the female Anopheles mosquitoes. Avoiding untreated water, undercooked food, and overpopulated areas will not prevent protozoa from entering the bloodstream.

Which malnourished condition may predispose a client to secondary immunodeficiency?

Cachexia - Cachexia is a nutrition disorder that may occur because of wasting of muscle mass and weight, resulting in a secondary immunodeficiency disorder. Cirrhosis, diabetes mellitus, and Hodgkin lymphoma also lead to secondary immunodeficiency disorder, but these are not malnutrition disorders.

A client reports disturbed sleep due to allergic pruritus. Which medication would help the client sleep and treat the allergic symptoms?

Chlorpheniramine is an antihistamine that helps manage allergic symptoms by preventing vasodilation and decreasing allergic symptoms. Sedation is a side effect of chlorpheniramine; therefore this medication is prescribed to clients experiencing sleep issues due to allergic symptoms. Cetirizine effectively blocks histamine from binding to receptors and has less sedating potential. Fexofenadine and desloratadine are also less sedating antihistamine medications.

After teaching a post-radiation therapy client regarding proper skin care to the treatment area, which client statements indicate understanding? Select all that apply. One, some, or all responses may be correct.

Clients should avoid tight-fitting clothing such as brassieres and belts in the area of the treatment field. The client should avoid use of adhesive bandages unless permitted by the radiation therapist. Clients should not expose the radiation treatment area to cold temperatures. A client who underwent radiation therapy should regularly rinse the radiation treatment area with saline solution to prevent infection. Clients should also avoid use of lotions, ointments, perfumes, and makeup over the treatment area.

Which conditions may result from immunoglobulin IgE antibodies on mast cells reacting with antigens? Select all that apply. One, some, or all responses may be correct.

Clinical conditions such as asthma and hay fever are considered type I hypersensitive reactions mediated by a reaction between IgE antibodies with antigens. Type I hypersensitivities result in the release of mediators such as histamines. Type IV hypersensitivity reactions such as sarcoidosis are a result of reactions between sensitized T cells and antigens. Myasthenia gravis results from a type II hypersensitivity reaction due to an interaction between immunoglobulin IgG and the host cell membrane. Rheumatoid arthritis is a type III hypersensitivity reaction resulting in inflammation from the formation of immune complexes between antigens and antibodies.0

Which prescribed cytokine medication would the nurse administer to treat chemotherapy-induced neutropenia?

Filgrastim - Colony-stimulating factors such as filgrastim are administered to treat chemotherapy-induced neutropenia. Oprelvekin is used to prevent thrombocytopenia. Aldesleukin is used to treat metastatic renal cell carcinoma. Darbepoetin alfa is administered to treat anemia related to chronic cancer and kidney disease.

How would the nurse explain the purpose of standard precautions to the nursing assistant on a surgical unit?

Decrease the risk of transmitting unidentified pathogens - All staff members use standard precautions for all clients in all settings, regardless of their diagnosis or presumed infectiousness. Practices associated with standard precautions require health care providers, not a client, to use hand washing and personal protective equipment to protect themselves and others from body fluids. Transmission-based precautions, known as airborne, droplet, and contact precautions, are based on a client's diagnosed infection.

Which illnesses are caused by echoviruses? Select all that apply. One, some, or all responses may be correct.

Echoviruses cause gastroenteritis and aseptic meningitis. Parotitis is caused by mumps. Burkitt lymphoma and mononucleosis are caused by the Epstein-Barr virus.

Which phase of a woman's sexual response is characterized by elevation of the uterus?

Elevation of the uterus is a characteristic of the plateau phase of a woman's sexual response. The plateau phase occurs after the excitation phase, and excitation is maintained through the plateau phase, wherein the vagina expands and the uterus is elevated. The orgasmic phase is characterized by uterine and vaginal contractions. In the excitation phase the clitoris is congested and vaginal lubrication increases. The resolution phase is characterized by returning to the preexisting state.

Which safety precaution would the nurse employ when assisting with the removal of a client's vaginal radium seeds?

Ensure long forceps are available for removing the radium. - Radium must be handled with long forceps because distance helps limit exposure. The nurse does not clean radium implants. Foil-lined rubber gloves do not provide adequate shielding from the gamma rays emitted by radium. The amount and duration of exposure are important in assessing the effect on the client; however, documentation will not affect safety during removal.

Which laboratory test will be elevated in a client with inflammatory arthritis?

Erythrocyte sedimentation rate (ESR) - The ESR measures the rate at which red blood cells fall through plasma. This rate is most significantly affected by an increased number of acute-phase reactants, which occur with inflammation. An elevated ESR (20 mm/hr) indicates inflammation or infection somewhere in the body. The ESR is chronically elevated with inflammatory arthritis. Leukocytes will be elevated when a bacterial infection is present. Hemoglobin and hematocrit are not used to determine the presence of inflammation. Blood urea nitrogen and creatinine levels are used to determine renal function.

Which type of cytokine is used to treat anemia secondary to chronic kidney disease?

Erythropoietin - Cytokines are signaling cells. Erythropoietin is used to treat anemia related to chronic kidney disease. The failing kidneys are not able to produce erythropoietin to signal the bone marrow to produce red blood cells, resulting in anemia. α-Interferon is used to treat hairy cell leukemia or malignant melanoma. Interleukin-2 is used to treat metastatic renal carcinoma. Interleukin-11 is used to prevent thrombocytopenia after chemotherapy.

Which bacteria colonies are commonly found in a client's large intestine?

Escherichia coli - Escherichia coli are bacteria that are part of the normal flora in the large intestine. Neisseria gonorrhoeae causes gonorrhea and pelvic inflammatory disease. Staphylococcus aureus secretes toxins that damage cells and causes skin infections, pneumonia, urinary tract infections, acute osteomyelitis, and toxic shock syndrome. Haemophilus influenzae causes nasopharyngitis, meningitis, and pneumonia.

Which tuberculosis client is at risk for developing optic neuritis?

Ethambutol is an antitubercular medication that causes optic neuritis. Client D is at risk for optic neuritis. Client A Isoniazid is at risk for vitamin B deficiency. Client B Rifampin is at risk for liver toxicity. Client C Pyrazinamide is at risk for sunburn.

Which actions transmit the human immunodeficiency virus (HIV)? Select all that apply. One, some, or all responses may be correct.

Fluids such as blood and semen are highly concentrated with HIV. HIV may be transmitted parenterally by sharing needles and postnatally through breast milk. HIV may also be transmitted through anal intercourse. HIV is not transmitted by mosquito bites, sharing of drinking glasses, or dry kissing. Deep kissing involving a large amount of salvia does transmit HIV.

Which type of continuing care would a client expect if discharged home with an infusion device to continue treatment for a leg wound?

Home care - Clients who are discharged with an infusion device to continue medication therapy at home should expect home care services to teach appropriate administration of medication therapy in the client's home. The client is being discharged to the home and not to a rehabilitation facility or to a skilled nursing facility. Outpatient therapy is not identified as a method for continuing antibiotic therapy with an infusion device.

Which infection would the nurse identify as requiring a client to be placed on droplet precautions?

Influenza - Clients with influenza will be placed on droplet precautions because the infection can be spread by talking or sneezing. HIV-positive clients will be instructed to use barrier protection with any kind of sexual contact to prevent spread of the virus. Clients with TB will be placed on airborne transmission precautions. Clients with MRSA would require contact precautions.

Identify the clinical manifestations associated with inhalation anthrax? Select all that apply. One, some, or all responses may be correct.

Inhalation anthrax is a bacterial infection caused by Bacillus anthracis. Clinical manifestations include fever, fatigue, mild chest pain, and a dry cough. Rhinitis and sore throat are manifestations of many common upper respiratory infections but are not associated with inhalation anthrax

Which mechanism of action applies to penicillin?

Inhibits cell wall synthesis of the pathogen - Penicillin is an antimicrobial medication that inhibits cell wall synthesis of the susceptible pathogen. Gentamicin is an antimicrobial medication that prevents the reproduction of the susceptible pathogen. Actinomycin is an antimicrobial medication that inhibits nucleic acid synthesis of the susceptible pathogen. Antifungal agents injure the cytoplasmic membrane of the susceptible pathogen.

Identify the mediators of injury in IgE-mediated hypersensitivity reactions? Select all that apply. One, some, or all responses may be correct.

Mast cells, histamines, and leukotrienes are the mediators of injury in IgE-mediated hypersensitivity reactions. Cytokines are the mediators of injury in the delayed type of hypersensitivity reaction (Type IV). Neutrophils are the mediators of injury in the immune-complex type of hypersensitivity reaction (Type III).

Identify the most important reason why medications used to treat acquired immunodeficiency syndrome (AIDS) become ineffective.

Missing doses of the prescribed medications - The most important reason for the development of medication resistance in the treatment of AIDS is missing doses of medications. When doses are missed, the blood medication concentrations become lower than what is needed to inhibit viral replication. The virus replicates and produces new particles that are resistant to the medications. Taking the medications 90% of the time prevents medications from becoming ineffective. Taking medications from different classes prevents the medications from becoming ineffective. IRIS occurs when T cells rebound with medication therapy and become aware of opportunistic infections.

In the management of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), which role does shark cartilage play?

Shark cartilage is a complementary therapy - Shark cartilage is considered as an alternative or complementary therapy to prescribed medications for clients with HIV and AIDS. Lymphocyte transfusions and bone marrow transplants are used to improve immunity in clients with HIV and AIDS. Lemon juice and lemongrass may provide relief from oral thrush in some clients with HIV and AIDS. A high-calorie, high-protein diet is advised to clients with HIV and AIDS to improve their nutritional status.

Which criteria would the nurse consider when determining if an infection is a health care-associated infection?

Occurred in conjunction with treatment for an illness - Health care-associated infections are classified as those that are contracted within a health care environment (e.g., hospital, long-term care facility) or result from a treatment (e.g., surgery, medications). Originating primarily from an exogenous source is not a criterion for identifying a health care-associated infection. The source of health care-associated infections may be endogenous (originate from within the client) or exogenous (originate from the health care environment or service personnel providing care); most health care-associated infections stem from endogenous sources and are caused by Escherichia coli and Staphylococcus aureus. Association with a medication-resistant microorganism is not a criterion for identifying a health care-associated infection. A health care-associated infection may or may not be caused by a medication-resistant microorganism. Still having the infection despite completing the prescribed therapy is not a criterion for identifying a health care-associated infection.

Which term would the nurse document in the client's medical record after observing reduced urinary output?

Oliguria - A reduced urinary output of less than 400 mL in a 24-hour interval is called oliguria. Anuria is the absence of urination. Painful or difficult urination is called dysuria. Frequent urination at night is called nocturia.

Which organism is a common opportunistic infection in a client infected with human immunodeficiency virus (HIV)?

Oropharyngeal candidiasis - Oropharyngeal candidiasis is the most common infection associated with HIV because the immune system can no longer control Candida fungal growth. Pneumocystis jiroveci pneumonia (PCP) is more common in a client infected with acquired immunodeficiency syndrome (AIDS). It causes tachypnea and persistent dry cough. Cryptosporidiosis, an intestinal infection caused by Cryptosporidium organisms, presents in clients with AIDS as does toxoplasmosis encephalitis, which is caused by Toxoplasma gondii and is acquired through contact with contaminated cat feces or by ingesting infected undercooked meat.

Which information would the nurse use to explain a positive diagnosis for human immunodeficiency virus (HIV) infection?

Positive enzyme-linked immunosorbent assay (ELISA) and Western blot tests - Positive ELISA and Western blot tests confirm the presence of HIV antibodies that occur in response to the presence of the HIV. Performance of high-risk sexual behaviors places someone at risk but would not constitute a positive diagnosis. Evidence of extreme weight loss and high fever do not confirm the presence of HIV; these adaptations are related to many disorders, not just HIV infection. The diagnosis of just an opportunistic infection is not sufficient to confirm the diagnosis of HIV. An opportunistic infection (included in the Centers for Disease Control and Prevention surveillance case definition for acquired immunodeficiency syndrome [AIDS]) in the presence of HIV antibodies indicates that the individual has AIDS.

Which conditions are examples of a type IV hypersensitivity reaction? Select all that apply. One, some, or all responses may be correct.

Sarcoidosis and poison ivy reactions are examples of type IV hypersensitivity reactions. In type IV hypersensitivity, the inflammation results from a reaction of sensitized T cells with the antigen and the resultant activation of macrophages because of the release of lymphokines. Myasthenia gravis is an example of a type II or cytotoxic hypersensitivity reaction. RA and SLE are examples of type III immune complex-mediated reactions.

A client diagnosed with acquired immunodeficiency syndrome (AIDS) states, "I'm not worried because they have a cure for AIDS." Which response would the nurse use?

Stating, "There is no cure for AIDS, but there are medications that can slow down the virus," is an honest response that corrects the client's misconception about the effectiveness of the current antiviral medications. Phlebotomy is not the treatment used to remove the virus from the client's body. Current pharmacological treatment does not eliminate the virus from the body, but the treatment can slow the progression of the virus. Treatment may even effect a remission (although, the medications are never discontinued), but there is no known cure. Stating, "Perhaps you should have worn condoms to prevent contracting the virus," is a nontherapeutic, judgmental response potentially alienating the client and precipitating feelings of guilt.

Which sexually transmitted infection (STI) is caused by Treponema pallidum?

Syphilis is an STI caused by Treponema pallidum. Neisseria gonorrhoeae causes gonorrhea. Haemophilus ducreyi and Klebsiella granulomatis cause genital warts. Herpes simplex virus, Trichomonas vaginalis, and Candida albicans may cause vulvovaginitis.

Upon review of morning laboratory reports, which client's report indicates acquired immunodeficiency syndrome (AIDS)?

The diagnosis of AIDS requires that the person should be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 (200 cells/(L) or less than 14% or an opportunistic infection. Client 3, with a CD4+ T-cell count of less than 200 cells/mm3 (200 cells/(L) and is HIV positive, is having AIDS-defining illness. A healthy client usually has at least 800 to 1000 CD4+ T-cells/mm3 of blood. The CD4+ T-cells are reduced in the client with HIV disease. Client 1, with a CD4+ T-cell count of 750 cells/mm3 and HIV positive, does not have AIDS. Client 2, with a CD4+ T-cell count of 550 cells/mm3 and HIV positive, does not have AIDS. Client 4, having a CD4+ T-cell count of 450 cells/mm3 and HIV positive does not have AIDS.

Which part of the female reproductive system secretes androgens?

The ovaries and adrenal glands produce androgens in women. The fetus develops in the uterus during pregnancy. The fallopian tubes facilitate fertilization of oocyte and sperm. The ovarian follicle is a collection of oocytes in the ovary.

Which clinical manifestations are associated with tuberculosis? Select all that apply. One, some, or all responses may be correct.

Tuberculosis is an infectious respiratory disease caused by Mycobacterium tuberculosis. The symptoms of tuberculosis are fatigue, nausea, low-grade fever, weight loss, and anorexia.

The nurse would teach clients that which diseases may occur due to rickettsial infections? Select all that apply. One, some, or all responses may be correct.

Typhoid fever and Rocky Mountain spotted fever are caused by rickettsial infections. Spirochetes and Mycobacterium leprae cause leprosy. Borrelia burgdorferi cause Lyme disease. The West Nile virus causes West Nile fever.

Which organism would the nurse teach immigrants is the cause of smallpox?

Variola virus - Smallpox is an infectious disease caused by the Variola virus. Yersinia pestis causes plague. Bacillus anthracis causes anthrax. Clostridium botulinum causes botulism.

Which viral infection will cause the nurse to observe for warts on the hands, feet, or genitals?

Warts are caused by papillomavirus and may be located on the hands, feet, or genitals. Poxviruses cause smallpox. Rhabdovirus causes rabies. Epstein-Barr causes mononucleosis and Burkitt lymphoma.

The school nurse presented a program for teachers about infection-control and hand-washing techniques. Which evaluation method is the most effective way for the nurse to evaluate the teachers' knowledge of hand-washing techniques?

Watch the teachers demonstrate infection-control techniques. - The best way to evaluate learning is by feedback demonstration of precautions related to infection control, such as hand-washing techniques. This method is observable and must meet objective criteria. Although observing a lecture, giving a written examination, or sharing what has been learned in a seminar are all evaluation techniques that may be used, none of these methods are as objective and definitive as observing an actual psychomotor demonstration of techniques.

A client's sputum smears for acid-fast bacilli (AFB) are positive and requires transmission-based airborne precautions. Which instruction would the nurse teach when orienting the client's visitors?

Wear a particulate respirator mask when in the room. - Tubercle bacilli are transmitted through air currents; therefore personal protective equipment, such as a particulate respirator that filters out organisms as small as 1 µm, is necessary. Gowns and gloves are not necessary. Tuberculosis is spread by airborne microorganisms; gloves are necessary only when touching articles contaminated with respiratory secretions. It is only necessary to avoid contact with objects in the client's room that are contaminated with respiratory secretions. Limiting contact with the client's nonexposed family members is unnecessary.