nclex urinary/ bowel elimination

The nurse is caring for a patient with risk for kidney disease for whom a urinalysis has been ordered. What time would the nurse instruct the unlicensed assistive personnel is best to collect this sample? 1. With first morning void 2. Before any meal 3. At bedtime 4. Immediately

1. With first morning void Urinalysis is a part of any complete physical examination and is especially useful for patients with suspected kidney or urologic disorders. Ideally, the urine specimen is collected at the morning's first voiding. Specimens obtained at other times may be too dilute.

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. The nurse's BEST reply is: "Blood pressure changes are a common side effect of antibiotic therapy." "Blood pressure changes are a sign that the condition has become chronic." "Acute hypertension, or high blood pressure, must be anticipated and identified." "Hypotension, or low blood pressure, leading to sudden shock can develop at any time."

"Acute hypertension, or high blood pressure, must be anticipated and identified." Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations do not indicate chronic disease. Most children with glomerulonephritis fully recover. Vital signs, in particular blood pressure, provide information about the severity of the disease and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Hypertension is more likely with glomerulonephritis.

A patient diagnosed with acute kidney failure had a urine output of 1560 mL for the past 8 hours. The LPN/LVN who is caring for this patient under the RN's supervision asks how a patient with kidney failure can have such a large urine output. What is the RN's best response? 1. "The patient's kidney failure was caused by hypovolemia, and we have given him IV fluids to correct the problem." 2. "Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day." 3. "With that much urine output, there must have been a mistake in the patient's diagnosis." 4. "An increase in urine output like this is an indicator that the patient is entering the recovery phase of acute kidney failure."

"Acute kidney failure patients go through a diuretic phase when their kidneys begin to recover and may put out as much as 10 L of urine per day." Patients with acute kidney failure usually go through a diuretic phase 2 to 6 weeks after the onset of the oliguric phase. The diuresis can result in an output of up to 10 L/day of dilute urine. During this phase, it is important to monitor for electrolyte and fluid imbalances. This is followed by the recovery phase. A patient with acute kidney failure caused by hypovolemia would receive IV fluids to correct the problem; however, this would not necessarily lead to the onset of diuresis.

The RN is supervising a senior nursing student who is caring for a 78-year-old patient scheduled for an intravenous pyelography test. What information would the RN be sure to stress about this procedure to the nursing student? 1. "After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults." 2. "The purpose of this procedure is to measure kidney size." 3. "Because this procedure assesses kidney function, there is no need for a bowel prep." 4. "Keep the patient NPO after the procedure because during the procedure the patient will receive drugs that affect the gag reflex."

"After the procedure, monitor urine output because contrast dye increases the risk for kidney failure in older adults." The risk for contrast-induced kidney failure is greatest in patients who are older or dehydrated. If possible, arrange for the patient to have this procedure early in the day to prevent dehydration. The purpose of this procedure is to assess kidney function and identify anomalies. The administration of drugs that affect the gag reflex is not done during this procedure.

The nurse prepares a patient for discharge after a cystoscopy. It is most important for the nurse to provide additional information in response to which patient statement? "I should drink plenty of fluids to prevent complications." "If my urine is cloudy, I should contact my health care provider." "Bright red bleeding is normal for a few days after the procedure." "Sitz baths and acetaminophen will help to reduce my discomfort."

"Bright red bleeding is normal for a few days after the procedure." Rationale: Bright red bleeding after a cystoscopy is not normal and should be reported immediately. Other complications include urinary retention, bladder infection, and perforation of the bladder. Patients should drink plenty of fluids and expect burning on urination, pink-tinged urine, and urinary frequency. Warm sitz baths, heat, and mild analgesics may be used to relieve discomfort.

A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's best response is: "No additional treatments are usually necessary." "Chemotherapy may be necessary." "Chemotherapy with or without radiation therapy is indicated." "Kidney transplant is indicated eventually."

"Chemotherapy with or without radiation therapy is indicated." Additional therapy is indicated after the tumor is removed. Radiation therapy may be necessary. This determination will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiation therapy is usually indicated. Most children with Wilms' tumor do not require renal transplants.

A patient tells the nurse that they are having burning on urination, dysuria, and frequency. What is the best response by the nurse? "Drink less fluid so you don't have to void so often." "Take some acetaminophen to decrease the discomfort." "Come in so we can check a clean-catch urine specimen." "Avoid caffeine and spicy food to decrease inflammation."

"Come in so we can check a clean-catch urine specimen." Rationale: The patient's symptoms are typical of a urinary tract infection. To verify this, a clean-catch urine specimen must be obtained for a specimen of urine to culture. Drinking less fluid will not improve the symptoms. Acetaminophen would not decrease the discomfort; an antibiotic would be needed. Avoiding caffeine and spicy food may decrease bladder inflammation but will not affect these symptoms.

A patient with incontinence will be taking oxybutynin chloride 5 mg by mouth three times a day after discharge. Which information would a nurse be sure to teach this patient before discharge? 1. "Drink fluids or use hard candy when you experience a dry mouth." 2. "Be sure to notify your health care provider (HCP) if you experience a dry mouth." 3. "If necessary, your HCP can increase your dose up to 40 mg/day." 4. "You should take this medication with meals to avoid stomach ulcers.

"Drink fluids or use hard candy when you experience a dry mouth." Oxybutynin is an anticholinergic agent, and these drugs often cause an extremely dry mouth. The maximum dosage is 20 mg/day. Oxybutynin should be taken between meals because food interferes with absorption of the drug.

An unlicensed assistive personnel (UAP) reports to the RN that a patient with acute kidney failure had a urine output of 350 mL over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks the nurse how this can happen. What is the nurse's best response? 1. "During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics." 2. "There must be some sort of error. Someone must have failed to record the urine output." 3. "A patient with acute kidney failure retains sodium and water, which counteracts the action of the furosemide." 4. "The gradual accumulation of nitrogenous waste products results in the retention of water and sodium."

"During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics." During the oliguric phase of acute kidney failure, a patient's urine output is greatly reduced. Fluid boluses and diuretics do not work well. This phase usually lasts from 8 to 15 days. Although there are occasionally omissions in recording intake and output, this is probably not the cause of the patient's decreased urine output. Retention of sodium and water is the rationale for giving furosemide, not the reason that it is ineffective. Nitrogenous wastes build up as a result of the kidneys' inability to perform their elimination function.

A patient with suspected renal insufficiency is scheduled for a creatinine clearance diagnostic test. Which instructions would be appropriate for the nurse to provide to the patient? "Empty your bladder and discard the urine; then save all urine for 24 hours." "Your blood creatinine level will be tested after you eat a high-protein meal." "This test should not be performed if you have allergies to iodine or shellfish." "A sterile container must be used to store the urine during the collection period.

"Empty your bladder and discard the urine; then save all urine for 24 hours." Rationale: The patient should discard the first urination when this test is started. Urine should be saved from all subsequent urinations for 24 hours. Creatinine clearance testing does not involve the injection of contrast dye. A serum creatinine is determined during the 24-hour period and used in the calculation to determine creatinine clearance. Consumption of a high-protein meal is not indicated. Sterile containers would be indicated if cultures are performed to determine the presence of microorganisms.

When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? "I will be able to regulate when I have stools." "I will be able to wear a pouch until it leaks." "The drainage from my stoma can damage my skin." "Dried fruit and popcorn must be chewed very well."

"I will be able to regulate when I have stools." Rationale: An ileostomy is in the ileum and drains liquid stool frequently, unlike a colostomy, which has more formed stool the farther distal the ostomy is in the colon. The ileostomy pouch is usually worn for 4 to 7 days or until it leaks. It must be changed immediately if it leaks because the drainage is very irritating to the skin. To avoid obstruction, popcorn, dried fruit, coconut, mushrooms, olives, stringy vegetables, food with skin, and meats with casings must be chewed extremely well before swallowing because of the narrow diameter of the ileostomy lumen.

Which statement about continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? "Maintain a daily written record of blood pressure and weight." "It is essential that you maintain aseptic technique to prevent peritonitis." "You will be allowed a more liberal protein diet once you complete CAPD." "Continue regular medical and nursing follow-up visits while performing CAPD."

"It is essential that you maintain aseptic technique to prevent peritonitis." Rationale: Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of prevention. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality that peritonitis does.

The nurse is preparing to administer famotidine to a patient after a laparotomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? "It will prevent air from accumulating in the stomach, causing gas pains." "It will reduce the amount of acid in the stomach while you are not eating." "It will prevent the heartburn that occurs as a side effect of general anesthesia." "The stress of surgery is likely to cause stomach bleeding if you do not receive it."

"It will reduce the amount of acid in the stomach while you are not eating." Rationale: Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.

A 28-year-old married female patient with cystitis requires instruction about how to prevent future urinary tract infections (UTIs). The supervising RN has assigned this teaching to a newly graduated nurse. Which statement by the new graduate requires that the supervising RN intervene? 1. "You should always drink 2 to 3 L of fluid every day." 2. "Empty your bladder regularly even if you do not feel the urge to urinate." 3. "Drinking cranberry juice daily will decrease the number of bacteria in your bladder." 4. "It's okay to soak in the tub with bubble bath because it will keep you clean."

"It's okay to soak in the tub with bubble bath because it will keep you clean." Women should avoid irritating substances such as bubble baths, nylon underwear, and scented toilet tissue to prevent UTIs. Adequate fluid intake, consumption of cranberry juice, and regular voiding are all good strategies for preventing UTIs.

A patient has urolithiasis and is passing the stones into the lower urinary tract. What is the priority nursing concern for the patient at this time? 1. Pain 2. Infection 3. Injury 4. Anxiety

1. Pain When patients with urolithiasis pass stones, they can be in excruciating pain for as much as 24 to 36 hours. All of the other nursing concerns for this patient are accurate; however, at this time, pain is the most urgent concern for the patient.

A patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient's health history and is most concerned if the patient makes which statement? "I am allergic to bee stings." "My tongue swells when I eat shrimp." "I have had epigastric pain for 2 months." "I have a pacemaker because my heart rate was slow."

"My tongue swells when I eat shrimp." Rationale: The percutaneous transhepatic cholangiography procedure will include the use of radiopaque contrast medium. Patients allergic to shellfish and iodine are also allergic to contrast medium.

The RN is supervising a nurse orientating to the acute care unit who is discharging a patient admitted with kidney stones and who underwent lithotripsy. Which statement by the orienting nurse to the patient requires that the supervising RN intervene? 1. "You should finish all of your antibiotics to make sure that you don't get a urinary tract infection (UTI)." 2. "Remember to drink at least 3 L of fluids every day to prevent another stone from forming." 3. "Report any signs of bruising to your health care provider (HCP) immediately because this indicates bleeding." 4. "You can return to work in 2 days to 6 weeks, depending on what your HCP prescribes."

"Report any signs of bruising to your health care provider (HCP) immediately because this indicates bleeding." Bruising is to be expected after lithotripsy. It may be quite extensive and take several weeks to resolve. All of the other statements are accurate for a patient after lithotripsy.

The RN is supervising a new graduate nurse who is orientating to the unit. The new nurse asks why the patient with uncomplicated cystitis is being discharged with a prescription for ciprofloxacin 250 mg twice a day for only 3 days. What is the RN's best response? 1. "We should check with the health care provider because the patient should take this drug for 10 to 14 days." 2. "A 3-day course of ciprofloxacin is not the appropriate treatment for a patient with uncomplicated cystitis." 3. "Research has shown that a 3-day course of ciprofloxacin is effective for uncomplicated cystitis and there is increased patient adherence to the plan of care." 4. "Longer courses of antibiotic therapy are required for hospitalized patients to prevent nosocomial infections."

"Research has shown that a 3-day course of ciprofloxacin is effective for uncomplicated cystitis and there is increased patient adherence to the plan of care." For uncomplicated cystitis, a 3-day course of antibiotics is an effective treatment, and research has shown that patients are more likely to adhere to shorter antibiotic courses. Seven-day courses of antibiotics are appropriate for complicated cystitis, and 10- to 14-day courses are prescribed for uncomplicated pyelonephritis. This patient is being discharged and should not be at risk for a nosocomial infection.

The home care nurse visits a patient receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? "Drain time is faster if I rub my abdomen." "The fluid draining from the catheter is cloudy." "The drainage is bloody when I have my period." "I wash around the catheter with soap and water."

"The fluid draining from the catheter is cloudy." Rationale: The primary manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.

The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked and help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement."

"The tube will help to drain the stomach contents and prevent further vomiting." The NG tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting. The NG tube will not push past the blocked area. Potential surgery is not currently indicated. The location of the obstruction will determine the type of fluid to use, not measure the amount of stomach contents.

After a vasectomy, what instruction should be included in discharge teaching? "Some secondary sexual characteristics may be lost after the surgery." "Use an alternative form of contraception until your semen is sperm free." "Erectile dysfunction may be present for several months after this surgery." "You will be uncomfortable, but you may safely have sexual intercourse today."

"Use an alternative form of contraception until your semen is sperm free." Rationale: Because vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.

A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. What teaching point should the nurse emphasize before the procedure? "You might have pink-tinged urine and burning after your cystoscopy." "You'll need to refrain from eating or drinking after midnight the day before the test." "The morning of the test, you will drink some water that contains a contrast solution." "You'll need a urinary catheter before the cystoscopy, and it will be in place for a few days."

"You might have pink-tinged urine and burning after your cystoscopy." Rationale: Pink-tinged urine, burning, and frequency are common after a cystoscopy. The patient does not need to be NPO before the test, and contrast media is not needed. A cystoscopy does not always necessitate catheterization before or after the procedure.

A patient was involved in a motor vehicle crash and reports an inability to have a bowel movement. What is the best response by the nurse? "Your parasympathetic nervous system is now working to slow the GI tract." "The circulation in the GI system has been increased, so less waste is removed." "Your sympathetic nervous system was activated, so there is slowing of the GI tract." "You may have bruised your intestines, so no stool will be produced for a few days."

"Your sympathetic nervous system was activated, so there is slowing of the GI tract." The constipation is most likely related to the sympathetic nervous system activation from the stress related to the accident. Sympathetic nervous system activation can decrease peristalsis. Even without oral intake for a short time, stool will be formed. The parasympathetic system stimulates peristalsis. The circulation to the gastrointestinal system is decreased with stress.

The nurse is providing care for a patient after a kidney biopsy. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Check vital signs every 4 hours for 24 hours. 2. Remind the patient about strict bed rest for 2 to 6 hours. 3. Reposition the patient by log-rolling with supporting backroll. 4. Measure and record urine output. 5. Assess the dressing site for bleeding and check complete blood count results. 6. Teach the patient to resume normal activities after 24 hours if there is no bleeding

1,2,3,4 Checking vital signs, repositioning patients, and recording intake and output are within the scope of practice for a UAP. Assessing and teaching are more within the scope of practice for professional nurses. If no bleeding occurs, the patient can resume general activities after 24 hours. However, instruct him or her to avoid lifting heavy objects, exercising, and performing other strenuous activities for 1 to 2 weeks after the biopsy procedure. Driving may also be restricted.

The nurse is providing nursing care for a patient with acute kidney failure for whom volume overload has been identified. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Measuring and recording vital sign values every 4 hours 2. Weighing the patient every morning using a standing scale 3. Administering furosemide 40 mg orally twice a day 4. Reminding the patient to save all urine for intake and output measurement 5. Assessing breath sounds every 4 hours 6. Ensuring that the patient's urinal is within reach

1,2,4,6 Administering oral medications is appropriate to the scope of practice for an LPN/LVN or RN. Assessing breath sounds requires additional education and skill development and is most appropriately within the scope of practice of an RN, but it may be part of the observations of an experienced and competent LPN/LVN. All other actions are within the educational preparation and scope of practice of an experienced UAP.

The RN supervising a senior nursing student is discussing methods for preventing acute kidney injury (AKI). Which points would the RN be sure to include in this discussion? Select all that apply. 1. Encourage patients to avoid dehydration by drinking adequate fluids. 2. Instruct patients to drink extra fluids during periods of strenuous exercise. 3. Immediately report a urine output of less than 2 mL/kg/hr. 4. Record intake and output and weigh patients daily. 5. Question any prescriptions for potentially nephrotoxic drugs. 6. Monitor laboratory values that reflect kidney function

1,2,4,6 Dehydration reduces perfusion and can lead to AKI. Patients should be encouraged to take in adequate fluids, and extra fluids should be taken in during strenuous exercise. Intake and output, as well as daily weights, should be documented. Lab values that indicate kidney function should be followed. The health care provider should be notified for a urine output of less than 0.5 mL/kg/hr that persists for more than 2 hours. Many drugs are potentially nephrotoxic but as still administered. Patients are encouraged to take in extra fluids, and nurses must monitor for any nephrotoxic effects when these drugs are prescribed.

The RN is teaching a patient how to perform intermittent self-catheterization for a long-term problem with incomplete bladder emptying. Which are important points for teaching this technique? Select all that apply. 1. Always use sterile techniques. 2. Proper hand washing and cleaning of the catheter reduce the risk for infection. 3. A small lumen and good lubrication of the catheter prevent urethral trauma. 4. A regular schedule for bladder emptying prevents distention and mucosal trauma. 5. The social work department can help you with the purchase of sterile supplies. 6. If you are uncomfortable with this procedure, a home health nurse can do it

2,3,4 Intermittent self-catheterization is often used to help patients with long-term problems of incomplete bladder emptying. It is not a sterile procedure and does not require sterile equipment. It is a clean procedure. Important teaching points include responses 2, 3, and 4 of this question.

The nurse is reviewing the lab values for a patient with risk for urinary problems. Which finding is of most concern to the nurse? 1. Blood urea nitrogen (BUN) of 10 mg/mL (3.6 mmol/L) 2. Presence of glucose and protein in urine 3. Serum creatinine of 0.6 mg/mL (53 mcmol/L) 4. Urinary pH of 8

2. Presence of glucose and protein in urine When blood glucose levels are greater than 220 mg/dL (12.2 mmol/L), some glucose stays in the filtrate and is present in the urine. Normally, almost all glucose and most proteins are reabsorbed and are not present in the urine. Report the presence of glucose or proteins in the urine of a patient undergoing a screening examination to the health care provider because this is an abnormal finding and requires further assessment.

The nurse identifies that which patient is at highest risk for developing colon cancer? A 28-yr-old man who has a body mass index of 27 kg/m2 A 32-yr-old woman with a 12-year history of ulcerative colitis A 52-yr-old man who has followed a vegetarian diet for 24 years A 58-yr-old woman taking prescribed estrogen replacement therapy

A 32-yr-old woman with a 12-year history of ulcerative colitis Rationale: Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity; family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, or hereditary nonpolyposis colorectal cancer syndrome; eating red meat; cigarette use; and drinking alcohol.

The charge nurse must rearrange room assignments to admit a new patient. Which two patients would be best suited to be roommates? 1. A 58-year-old patient with urothelial cancer receiving multiagent chemotherapy 2. A 63-year-old patient with kidney stones who has just undergone open ureterolithotomy 3. A 24-year-old patient with acute pyelonephritis and severe flank pain 4. A 76-year-old patient with urge incontinence and a urinary tract infection (UTI)

3,4 Both of these patients will need frequent assessments and medications. The patient receiving chemotherapy and the patient who has just undergone surgery should not be exposed to any patient with infection.

Which laboratory result is of most concern to the nurse for an adult patient with cystitis? 1. Serum white blood cell (WBC) count of 9000/mm3 (9 x 109/L) 2. Urinalysis results showing 1 or 2 WBCs present 3. Urine bacteria count of 100,000 colonies per milliliter 4. Serum hematocrit of 36%

3. Urine bacteria count of 100,000 colonies per milliliter The presence of 100,000 bacterial colonies per milliliter of urine or the presence of many white blood cells (WBCs) and red blood cells (RBCs) indicates a urinary tract infection. This WBC count is within normal limits, and the hematocrit is a little low, which may need follow-up. Neither of these results indicates infection.

The nurse is caring for a patient admitted with dehydration secondary to deficient antidiuretic hormone (ADH). Which specific gravity value supports this diagnosis? 1. 1.010 2. 1.035 3. 1.020 4. 1.002

4. 1.002 A patient with dehydration due to deficient ADH would have diluted urine with a decreased urine specific gravity. Normal urine specific gravity ranges from 1.003 to 1.030. A specific gravity of 1.035 would indicate urine that is concentrated.

Which patient has the most significant risk factors for CKD? A 50-yr-old white woman with hypertension A 61-yr-old Native American man with diabetes A 28-yr-old black woman with a urinary tract infection A 40-yr-old Hispanic woman with cardiovascular disease

61-yr-old Native American man with diabetes Rationale: The nurse identifies the 61-year-old Native American with diabetes as the most at risk. Diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD 6 times more frequently than other ethnic groups. Hypertension causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. Blacks have the highest rate of CKD because hypertension is significantly increased in blacks. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.

A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? 7:00 AM, 10:00 AM, and 1:00 PM 8:00 AM, 12:00 PM, and 4:00 PM 9:00 AM and 3:00 PM 9:00 AM, 12:00 PM, and 3:00 PM

8:00 AM, 12:00 PM, and 4:00 PM Rationale: A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.

The nurse is teaching clinic patients about risk factors for testicular cancer. Which person is at highest risk for developing testicular cancer? A 48-yr-old black man with erectile dysfunction A 30-yr-old white man with a history of cryptorchidism A 19-yr-old Asian man who had surgery for testicular torsion A 28-yr-old Hispanic man with infertility caused by a varicocele

A 30-yr-old white man with a history of cryptorchidism Rationale: The incidence of testicular cancer is four times higher in white men than in black men. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to exogenous estrogen, and testicular cancer in the contralateral testis.

The charge nurse would assign the nursing care of which patient to an LPN/LVN, working under the supervision of an RN? 1. A 48-year-old patient with cystitis who is taking oral antibiotics 2. A 64-year-old patient with kidney stones who has a new order for lithotripsy 3. A 72-year-old patient with urinary incontinence who needs bladder training 4. A 52-year-old patient with pyelonephritis who has severe acute flank pain

A 48-year-old patient with cystitis who is taking oral antibiotics The patient with cystitis who is taking oral antibiotics is in stable condition with predictable outcomes, and caring for this patient is therefore appropriate to the scope of practice of an LPN/LVN under the supervision of an RN. The patient with a new order for lithotripsy will need teaching about the procedure, which should be accomplished by the RN. The patient in need of bladder training will need the RN to plan this intervention. The patient with flank pain needs careful and skilled assessment by the RN.

For which patient is the nurse most concerned about the risk for developing kidney disease? 1. A 25-year-old patient who developed a urinary tract infection (UTI) during pregnancy 2. A 55-year-old patient with a history of kidney stones 3. A 63-year-old patient with type 2 diabetes 4. A 79-year-old patient with stress urinary incontinence

A 63-year-old patient with type 2 diabetes A history of chronic health problems, especially diabetes and hypertension, increases the risk for development of kidney disease.

Which patient will the charge nurse assign to an RN floated to the acute care unit from the surgical intensive care unit (SICU)? 1. A patient with kidney stones scheduled for lithotripsy this morning 2. A patient who has just undergone surgery for renal stent placement 3. A newly admitted patient with an acute urinary tract infection (UTI) 4. A patient with chronic kidney failure who needs teaching on peritoneal dialysis

A patient who has just undergone surgery for renal stent placement A nurse from the surgical ICU will be thoroughly familiar and comfortable with the care of patients who have just undergone surgery. The patient scheduled for lithotripsy may need education about the procedure. The newly admitted patient needs an in-depth admission assessment, and the patient with chronic kidney failure needs teaching about peritoneal dialysis. All of these interventions would best be accomplished by an experienced nurse with expertise in the care of patients with kidney problems.

A male patient reports fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? A very tender prostate gland Reports of chills and rectal pain Reports of urgency and frequency Escherichia coli bacteria in his urine

A very tender prostate gland Rationale: A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatitis.

The nurse is reviewing the home medication list for a patient admitted with suspected hepatic failure. Which medication could cause hepatotoxicity? Digoxin Nitroglycerin Ciprofloxacin Acetaminophen

Acetaminophen Many chemicals and drugs are potentially hepatotoxic and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal antiinflammatory drugs may be hepatotoxic.

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? Restraining child as necessary Discouraging parents from holding child Doing passive range-of-motion exercises once a day Adjusting activities to child's tolerance level

Adjusting activities to child's tolerance level Restraints should not be used. Parents should be encouraged to hold child. The child should be encouraged to move all extremities while in bed. The child will have a variable level of tolerance for activity. This will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child.

The nurse coordinates postoperative care for a 70-year-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/VN)? (Select all that apply.) Teach the patient how to perform Kegel exercises. Provide instructions to the patient on catheter care. Administer oxybutynin (Ditropan) for bladder spasms. Manually irrigate the urinary catheter to restore catheter flow. Monitor catheter drainage for clots and increase flow of irrigation as needed.

Administer oxybutynin (Ditropan) for bladder spasms. Manually irrigate the urinary catheter to restore catheter flow. Monitor catheter drainage for clots and increase flow of irrigation as needed. Rationale: The nurse may delegate the following to an LPN/VN: monitor catheter drainage for increased blood or clots, increase flow of irrigating solution to maintain light pink color in outflow, and administer antispasmodics and analgesics as needed. A registered nurse may not delegate teaching, assessments, or clinical judgments to the LPN/VN.

The patient problem of constipation related to compression of the intestinal tract has been identified in a patient with polycystic kidney disease. Which care action should the nurse assign to a newly-trained LPN/LVN? 1. Instructing the patient about foods that are high in fiber 2. Teaching the patient about foods that assist in promoting bowel regularity 3. Assessing the patient for previous bowel problems and bowel routine 4. Administering docusate sodium 100 mg by mouth twice a day

Administering docusate sodium 100 mg by mouth twice a day Administering oral medications appropriately is covered in the educational program for LPNs/LVNs and is within their scope of practice. Teaching and assessing the patient require additional education and skill and are appropriate to the scope of practice of RNs.

A frail 86-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? Aspirin Acetaminophen Diphenhydramine Aluminum hydroxide

Aluminum hydroxide Rationale: Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.

Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD)? (Select all that apply.) Anemia Dehydration Hypertension Hypercalcemia Increased fracture risk Elevated white blood cells

Anemia Hypertension Increased fracture risk Rationale: When the kidney fails, erythropoietin is not excreted, so anemia is expected. Dehydration and hypercalcemia are not expected in chronic renal disease. Fluid volume overload with hypertension and hypocalcemia are expected. Hypocalcemia from chronic renal disease stimulates the parathyroid to release parathyroid hormone, causing calcium liberation from bones increasing the risk of pathological fracture. Although impaired immune function should be expected, elevated white blood cells would indicate inflammation or infection not associated with chronic renal failure itself but a complication.

A with stage 3 CKD is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? Apple, green beans, and a roast beef sandwich Granola made with dried fruits, nuts, and seeds Watermelon and ice cream with chocolate sauce Bran cereal with ½ banana and milk and orange juice

Apple, green beans, and a roast beef sandwich Rationale: When the patient selects an apple, green beans, and a roast beef sandwich, the patient shows understanding of the low-potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have high levels of potassium, at or above 200 mg per 1/2 cup.

A patient with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? Assess the patient's hydration status. Insert a urinary catheter for the expected diuresis. Evaluate the patient's lower extremities for edema. Check the patient's urine for the presence of ketones.

Assess the patient's hydration status. Rationale: Preexisting kidney disease is the most important risk factor for the development of contrast-associated nephropathy and nephrotoxic injury. If contrast media must be administered to a high-risk patient, the patient needs to have optimal hydration. The nurse should assess the hydration status of the patient before the procedure is performed. Indwelling catheter use should be avoided whenever possible to decrease the risk of infection.

A hospitalized older patient reports his foreskin is retracted and will not return to normal. Which action is the priority? Start oral antibiotics. Apply ice to reduce swelling. Attempt to move the foreskin over the glans. Call the provider to prepare for circumcision.

Attempt to move the foreskin over the glans. Rationale: Paraphimosis can occur when the foreskin is pulled back during bathing, during catheter insertion, or after intercourse and not returned to the normal position. Attempting to return the foreskin over glans is the priority action. If the nurse is unsuccessful, then ice would be applied to decrease swelling. If the foreskin is not returned to the normal position manually by the health care provider, then circumcision would be indicated. Paraphimosis is considered a urologic emergency because arterial blood flow to the glans penis is impaired.

The nurse is performing an abdominal assessment for a patient. Which assessment technique by the nurse is mostaccurate? Palpate the abdomen before auscultation. Percuss the abdomen before auscultation. Auscultate the abdomen before palpation. Perform deep palpation before light palpation.

Auscultate the abdomen before palpation. During examination of the abdomen, auscultation is done before percussion and palpation because these latter procedures may alter the bowel sounds.

The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? Avoid straining during defecation. Restrict fluids to prevent incontinence. Sexual functioning will not be affected. Prostate examinations are not needed after surgery.

Avoid straining during defecation. Rationale: Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Teach the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.

The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? Hamburger with cheese, pudding, and coffee Grilled steak, French fries, and vanilla shake Baked chicken, peas, apple slices, and skim milk Grilled cheese sandwich, onion rings, and hot tea

Baked chicken, peas, apple slices, and skim milk Rationale: A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

During the health history interview, a 73-yr-old male patient states that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance about what condition? A tumor of the prostate Benign prostatic hyperplasia Bladder atony because of age Age-related altered innervation of the bladder

Benign prostatic hyperplasia Rationale: Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men older than age 50 years and 80% of men older than age 80 years. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.

A postoperative patient had a urinary catheter. Eight hours after catheter removal and drinking fluids, the patient has not been able to void. What is the nurse's first action to assess for urinary retention? Bladder scan Cystometrogram Residual urine test Kidneys, ureters, bladder (KUB) x-ray

Bladder scan Rationale: If the patient is unable to void, the bladder may be palpated for distention or percussed for dullness if it is full, or a bladder scan may be done to determine the approximate amount of urine in the bladder. A cystometrogram visualizes the bladder and evaluates vesicoureteral reflux. A KUB x-ray delineates size, shape, and positions of kidneys and possibly a full bladder. Neither of these would be useful in this situation. A residual urine test requires urination before catheterizing the patient to determine the amount of urine left in the bladder, so this assessment would not be helpful for this patient.

A patient with end-stage renal disease (ESRD) secondary to diabetes has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? Level of consciousness Blood pressure and fluid balance Temperature, heart rate, and blood pressure Assessment for signs and symptoms of infection

Blood pressure and fluid balance Rationale: Although all the assessments are relevant to the care of a patient receiving hemodialysis, fluid removal during the procedure will require monitoring blood pressure and fluid balance prior, during, and after.

Which clinical manifestations of inflammatory bowel disease are common to both patients with ulcerative colitis (UC) and Crohn's disease? (Select all that apply) Restricted to rectum Strictures are common Bloody, diarrhea stools Cramping abdominal pain Lesions penetrate intestine

Bloody, diarrhea stools Cramping abdominal pain Rationale: Manifestations of UC and Crohn's disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn's disease.

A patient with a 25-year history of type 1 diabetes is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood glucose levels. Which diagnostic study is most indicative of chronic kidney disease (CKD)? Serum creatinine Serum potassium Microalbuminuria Calculated glomerular filtration rate (GFR)

Calculated glomerular filtration rate (GFR) Rationale: The best study to determine kidney function or CKD that would be expected in the patient with diabetes is the calculated GFR that is obtained from the patient's age, gender, race, and serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

A patient on the medical-surgical unit with acute kidney failure is to begin continuous arteriovenous hemofiltration (CAVH) as soon as possible. What is the priority collaborative action at this time? 1. Call the charge nurse and arrange to transfer the patient to the intensive care unit. 2. Develop a teaching plan for the patient that focuses on CAVH. 3. Assist the patient with morning bath and mouth care before transfer. 4. Notify the health care provider (HCP) that the patient's mean arterial pressure is 68 mm Hg.

Call the charge nurse and arrange to transfer the patient to the intensive care unit. CAVH is a continuous renal replacement therapy that is prescribed for patients with kidney failure who are critically ill and do not tolerate the rapid shifts in fluids and electrolytes that are associated with hemodialysis. A teaching plan is not urgent at this time. A patient must have a mean arterial pressure (MAP) of at least 60 mm Hg or more for CAVH to be of use. The HCP should be notified about this patient's MAP; it is a priority but not the highest priority. When a patient urgently needs a procedure, morning care does not take priority and may be deferred until later in the day.

Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What does the nurse recognize is the most likely reason for this abnormal assessment finding? Herpesvirus Candida albicans Vitamin deficiency Irritation from ill-fitting dentures

Candida albicans White, curd-like lesions surrounded by erythematous mucosa are associated with oral candidiasis. Herpesvirus causes benign vesicular lesions in the mouth. Vitamin deficiencies may cause a reddened, ulcerated, swollen tongue. Irritation from ill-fitting dentures will cause friable, edematous, painful, bleeding gingivae.

The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? Write an incident report about this untoward event. Attempt to have the family convince the patient to take the ordered dose. Withhold the medication at this time and try to administer it later in the day. Chart the dose as not given on the medical record and explain in the nursing progress notes.

Chart the dose as not given on the medical record and explain in the nursing progress notes. Rationale: Whenever a patient refuses medication, the dose should be charted as not given with an explanation of the reason documented in the nursing progress notes. In this instance, the refusal indicates good judgment by the patient, and the patient should not be encouraged to take it today.

The nurse is caring for a patient with chronic kidney disease after hemodialysis. Which patient care action should the nurse delegate to the experienced unlicensed assistive personnel (UAP)? 1. Assess the patient's access site for a thrill and bruit. 2. Monitor for signs and symptoms of postdialysis bleeding. 3. Check the patient's postdialysis blood pressure and weight. 4. Instruct the patient to report signs of dialysis disequilibrium syndrome immediately.

Check the patient's postdialysis blood pressure and weight. Checking vital signs and weighing patients are within the scope of practice for the UAP. However, the nurse must be sure to caution the UAP to check BP in the arm opposite to the access site. Assessing, teaching, and monitoring require additional skills that fit within the scope of practice for the professional nurse.

A patient with abdominal pain is being prepared for surgery to make an incision into the common bile duct to remove stones. What procedure will the nurse prepare the patient for? Colectomy Cholecystectomy Choledocholithotomy Choledochojejunostomy

Choledocholithotomy Rationale: A choledocholithotomy is an opening into the common bile duct for the removal of stones. A colectomy is the removal of the colon. The cholecystectomy is the removal of the gallbladder. The choledochojejunostomy is an opening between the common bile duct and jejunum.

The nurse should recognize which laboratory value as being abnormal? pH: 4 Specific gravity: 1.020 Protein level: absent Glucose level: absent

pH: 4 The expected pH is 4.8 to 7.8. This is within the normal specific gravity range of 1.016 to 1.022. Protein should not be present in the urine. If present, it would indicate an abnormality in glomerular filtration. Glucose should not be present. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

A patient is 1 day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? Requires 2 tablets of Tylenol #3 during the night. Reports fatigue and claims to have minimal appetite. Continuous bladder irrigation infusing with decreased output. Expresses anxiety about his planned discharge home the next day.

Continuous bladder irrigation infusing with decreased output. Rationale: A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.

The provider has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? Hemodialysis (HD) three times per week Automated peritoneal dialysis (APD) Continuous venovenous hemofiltration (CVVH) Continuous ambulatory peritoneal dialysis (CAPD)

Continuous venovenous hemofiltration (CVVH) Rationale: CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD three times per week would not be used for this patient because fluid and solutes build up and then are rapidly removed. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not as rapidly remove large amounts of fluid as CVVH can do.

During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? Give hypertonic saline. Initiate a blood transfusion. Decrease the rate of fluid removal. Administer antiemetic medications.

Decrease the rate of fluid removal. Rationale: The patient is having hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

The nurse is caring for an older adult patient taking bumetanide. What age-related changes does the nurse inform the patient may be experienced? Benign enlargement of prostatic tissues Decreased sensation of bladder capacity Decreased function of the loop of Henle Less absorption in the Bowman's capsule

Decreased function of the loop of Henle Rationale: Bumetanide (Bumex) is a loop diuretic that acts in the loop of Henle to decrease reabsorption of sodium and chloride. Because the loop of Henle loses function with aging, the excretion of drugs becomes less and less efficient. Thus, the circulating levels of drugs are increased and their effects prolonged. The benign enlargement of prostatic tissue, decreased sensation of bladder capacity, and loss of concentrating ability do not directly affect the action of loop diuretics.

Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI)? (Select all that apply.) Dehydration Hypokalemia Hypernatremia BUN increases Urine output increases Serum creatinine increases

Dehydration Hypokalemia Urine output increases Rationale: The hallmark of entering the diuretic phase is the production of copious amounts of urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN and serum creatinine levels begin to decrease.

The nurse asks a patient scheduled for colectomy to sign the operative permit as directed in the provider's preoperative orders. The patient states that the provider has not explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? Ask family members whether they have discussed the surgical procedure with the provider. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. Have the patient sign the form and state the provider will visit to explain the procedure before surgery. Delay the patient's signature on the consent and notify the provider about the conversation with the patient.

Delay the patient's signature on the consent and notify the provider about the conversation with the patient. Rationale: The patient should not be asked to sign a consent form unless the procedure has been explained to the satisfaction of the patient. The nurse should notify the provider, who has the responsibility for obtaining consent.

The nurse should recognize that the liver performs which functions? (Select all that apply.) Bile storage Detoxification Protein metabolism Steroid metabolism Red blood cell (RBC) production

Detoxification Protein metabolism Steroid metabolism Rationale: The liver performs multiple major functions that aid in the maintenance of homeostasis. These include metabolism of proteins and steroids as well as detoxification of drugs and metabolic waste products. The Kupffer cells of the liver participate in the breakdown of old RBCs. The liver produces bile, but storage occurs in the gallbladder.

To monitor the progression of decreased urinary stream, the nurse should encourage which type of regular screening? Uroflowmetry Transrectal ultrasound Digital rectal examination (DRE) Prostate-specific antigen (PSA) monitoring

Digital rectal examination (DRE) Rationale: DRE is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia (BPH) in men older than 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.

Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? IV tobramycin Incompatible blood transfusion Poststreptococcal glomerulonephritis Dissecting abdominal aortic aneurysm

Dissecting abdominal aortic aneurysm Rationale: A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststreptococcal glomerulonephritis are intrarenal causes of AKI.

The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? Wear a mask to prevent transmission of infection. Have visitors use the alcohol-based hand sanitizer. Wipe down equipment with ammonia-based disinfectant. Don gloves and gown before entering the patient's room.

Don gloves and gown before entering the patient's room. Rationale: Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room, and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.

When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? White bread, cheese, and green beans Fresh tomatoes, pears, and corn flakes Oranges, baked potatoes, and raw carrots Dried beans, All Bran (100%) cereal, and raspberries

Dried beans, All Bran (100%) cereal, and raspberries Rationale: A high-fiber diet is recommended for diverticular disease. Dried beans, All Bran (100%) cereal, and raspberries all have higher amounts of fiber than white bread, cheese, green beans, fresh tomatoes, pears, corn flakes, oranges, baked potatoes, and raw carrots.

A patient with type 2 diabetes and chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which finding will the nurse monitor for? Fatigue Dysrhythmias Hypoglycemia Elevated triglycerides

Dysrhythmias Rationale: Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Fatal dysrhythmias can occur when the serum potassium level reaches 7 to 8 mEq/L. Fatigue and hypertriglyceridemia may be present but do not require urgent intervention. Hypoglycemia is a complication related to diabetes control, not hyperkalemia. However, administration of insulin and dextrose is an emergency treatment for hyperkalemia.

A patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. How should the nurse document this abnormal assessment finding? Anuria Dysuria Oliguria Enuresis

Dysuria Rationale: Painful and difficult urination is characterized as dysuria. Whereas anuria is an absence of urine production, oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.

A patient is scheduled for surgery with general anesthesia in 1 hour and is observed with a moist but empty water glass in his hand. Which assessment finding may indicate that the patient drank a glass of water? Easily heard, loud gurgling in abdomen High-pitched, hollow sounds in abdomen Flat abdomen without movement upon inspection Tenderness in left upper quadrant upon palpation

Easily heard, loud gurgling in abdomen If the patient drank water on an empty stomach, gurgling can be assessed without a stethoscope or assessed with auscultation. High-pitched, hollow sounds are tympanic and indicate an empty cavity. A flat abdomen and tenderness do not indicate that the patient drank a glass of water.

A patient in the intensive care unit is receiving gentamicin for treatment of pneumonia from Pseudomonas aeruginosa. What assessment results should the nurse report to the health care provider? Decreased weight Increased appetite Increased urinary output Elevated creatinine level

Elevated creatinine level Rationale: Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the provider because it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have side effects of anorexia.

A patient donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is having significant pain and refuses to get up to walk. How should the nurse respond? Allow the patient to rest and try again tomorrow. Encourage a short walk around the patient's room. Have the transplant psychologist convince her to walk. Tell the patient she is lucky she did not have an open nephrectomy.

Encourage a short walk around the patient's room. Rationale: Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker's role is to determine if the patient is emotionally stable enough to handle donating a kidney; postoperative care is the nurse's role. Telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery. Early ambulation should be encouraged, waiting until tomorrow is too long.

After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? Return the patient to NPO status. Place cool compresses on the abdomen. Encourage the patient to ambulate as ordered. Administer an as-needed dose of IV morphine sulfate.

Encourage the patient to ambulate as ordered. Rationale: Swallowed air and reduced peristalsis after surgery can result in abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain. Medications used to reduce gas pain include metoclopramide, which stimulates peristalsis. A heating pad can help to alleviate some of the pain and help make the patient more comfortable. There is no need for the patient to return to NPO status. Drinking ginger ale may be helpful.

The nurse is preparing a patient for a capsule endoscopy. What should the nurse ensure is included in the preparation? Ensure the patient understands the required bowel preparation. Have the patient return to the procedure room for removal of the capsule. Teach the patient to maintain a clear liquid diet throughout the procedure. Explain to the patient that conscious sedation will be used during capsule placement.

Ensure the patient understands the required bowel preparation. A capsule endoscopy study involves the patient performing a bowel prep to cleanse the bowel before swallowing the capsule. The patient will be on a clear liquid diet for 1 to 2 days before the procedure and will remain NPO for 4 to 6 hours after swallowing the capsule. The capsule is disposable and will pass naturally with the bowel movement, although the monitoring device will need to be removed.

A patient after a stroke who primarily uses a wheelchair for mobility has developed diarrhea with fecal incontinence. What is a priority assessment by the nurse? Fecal impaction Perineal hygiene Dietary fiber intake Antidiarrheal agent use

Fecal impaction Rationale: Patients with limited mobility are at risk for fecal impactions caused by constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.

A patient with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. After the procedure, which signs and symptoms should the nurse teach the patient to report immediately? Fever and abdominal pain Flatulence and liquid stool Loudly audible bowel sounds Sleepiness and abdominal cramps

Fever and abdominal pain The patient should be taught to observe for signs of rectal bleeding and peritonitis. Fever, malaise, and abdominal pain and distention could indicate a perforated bowel with peritonitis.

A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? Nausea and vomiting Hyperactive bowel sounds Firmly distended abdomen Abrasions on all extremities

Firmly distended abdomen Manifestations of abdominal trauma are guarding and splinting of the abdominal wall; a hard, distended abdomen (indicating possible intraabdominal bleeding); decreased or absent bowel sounds; contusions, abrasions, or bruising over the abdomen; abdominal pain; pain over the scapula; hematemesis or hematuria; and signs of hypovolemic shock (tachycardia and decreased blood pressure).

The nurse is admitting a 66-year-old male patient suspected of having a urinary tract infection (UTI). Which part of the patient's medical history supports this diagnosis? 1. Patient's wife had a UTI 1 month ago 2. Followed for prostate disease for 2 years 3. Intermittent catheterization 6 months ago 4. Kidney stone removal 1 year ago

Followed for prostate disease for 2 years Prostate disease increases the risk of UTIs in men because of urinary retention. The wife's UTI should not affect the patient. The times of the catheter usage and kidney stone removal are too distant to cause this UTI.

A patient had a gastric resection for stomach cancer. The nurse plans to teach the patient about decreased secretion of which hormone? Gastrin Secretin Cholecystokinin Gastric inhibitory peptide

Gastrin Gastrin is the hormone activated in the stomach (and duodenal mucosa) by stomach distention that stimulates gastric acid secretion and motility and maintains lower esophageal sphincter tone. Secretin, cholecystokinin, and gastric inhibitory peptide are all secreted from the duodenal mucosa.

The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? Low-pitched and rumbling above the area of obstruction High-pitched and hypoactive below the area of obstruction Low-pitched and hyperactive below the area of obstruction High-pitched and hyperactive above the area of obstruction

High-pitched and hyperactive above the area of obstruction Rationale: Early in intestinal obstruction, the patient's bowel sounds are hyperactive and high pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.

The nurse is assessing a patient admitted with a possible bowel obstruction. Which assessment finding would be expected in this patient? Tympany to abdominal percussion Aortic pulsation visible in epigastric region High-pitched sounds on abdominal auscultation Liver border palpable 1 cm below the right costal margin

High-pitched sounds on abdominal auscultation The bowel sounds are higher pitched (rushes and tinkling) when the intestines are under tension, as in intestinal obstruction. Bowel sounds may also be diminished or absent with an intestinal obstruction. Normal findings include aortic pulsations on inspection and tympany with percussion, and the liver may be palpable 1 to 2 cm along the right costal margin.

The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? Osteoarthritis History of colorectal polyps History of lactose intolerance Use of herbs as dietary supplements

History of colorectal polyps A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for an exploratory laparotomy? How to care for the wound How to deep breathe and cough The location and care of drains after surgery Which medications will be used during surgery

How to deep breathe and cough Rationale: Because anesthesia, an abdominal incision, and pain can impair the patient's respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively but will be done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.

Which laboratory finding, in conjunction with the presenting symptoms, indicates nephrosis? Hypoalbuminemia Low specific gravity Decreased hemoglobin Decreased hematocrit

Hypoalbuminemia Hypoalbuminemia is a result of the large amount of protein that leak through the glomerular membrane into urine. Specific gravity is increased because of the large amount of protein. These measures would be elevated secondary to the hypovolemia. These measures would be elevated secondary to the hypovolemia.

two days after a bowel resection for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Inflammation of the incision site

Impaired peristalsis Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? Increasing the pressure gradient Increasing osmolality of the dialysate Decreasing the glucose in the dialysate Decreasing the concentration of the dialysate

Increasing osmolality of the dialysate Rationale: Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis, the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? Hypokalemia Hyponatremia Large urine output Leukocytosis with cloudy urine output

Large urine output Rationale: Patients often have diuresis in the hours and days immediately after a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? Maintain a high intake of fluid and fiber in the diet. Discontinue intake of medications causing constipation. Eat several small meals per day to maintain bowel motility. Sit upright during meals to increase bowel motility by gravity.

Maintain a high intake of fluid and fiber in the diet. Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be discontinued. Eating several small meals per day and position do not facilitate bowel motility.

The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? Monitor the patient's cardiac status. Teach the patient about hand washing. Obtain a serum specimen for electrolytes. Increase direct observation of the patient.

Monitor the patient's cardiac status. Rationale: The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as ordered by the health care provider.

The nurse should administer an as-needed dose of magnesium citrate after noting what information when reviewing a patient's medical record? Abdominal pain and bloating No bowel movement for 3 days A decrease in appetite by 50% over 24 hours Muscle tremors and other signs of hypomagnesemia

No bowel movement for 3 days Rationale: Magnesium citrate is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. It would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.

The patient has a history of cardiovascular disease and has developed erectile dysfunction. He is frustrated because he is taking nitrates and cannot take erectogenic medications. What should the nurse do first? Give the patient choices for penile implant surgery. Recommend counseling for the patient and his partner. Obtain a thorough sexual, health, and psychosocial history. Assess levels of testosterone, prolactin, luteinizing hormone, and thyroid hormones.

Obtain a thorough sexual, health, and psychosocial history. Rationale: The nurse's first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.

The nurse is caring for a patient with risk for incomplete bladder emptying. Which noninvasive finding best supports this problem? 1. Patient is able to void additional 100 mL after nurse massages over the bladder. 2. Patient voids additional 350 mL with insertion of an intermittent catheter. 3. Patient has postvoid residual of 275 mL documented by bedside bladder scanner. 4. Patient has constant dribbling between voidings.

Patient has postvoid residual of 275 mL documented by bedside bladder scanner. The use of portable ultrasound scanners in the hospital and rehabilitation setting by nurses is a noninvasive method of estimating bladder volume. Bladder scanners are used to screen for postvoid residual volumes and to determine the need for intermittent catheterization based on the amount of urine in the bladder rather than the time between catheterizations. There is no discomfort with the scan, and no patient preparation beyond an explanation of what to expect is required. Use of bladder massage or presence of urinary dribbling is inexact, and intermittent catheterization is invasive.

The nurse is creating a care plan for older adult patients with incontinence. For which patient will a bladder-training program be an appropriate intervention? 1. Patient with functional incontinence caused by mental status changes 2. Patient with stress incontinence due to weakened bladder neck support 3. Patient with urge incontinence and abnormal detrusor muscle contractions 4. Patient with transient incontinence related to loss of cognitive function

Patient with urge incontinence and abnormal detrusor muscle contractions A patient with urge incontinence can be taught to control the bladder as long as the patient is alert, aware, and able to resist the urge to urinate by starting a schedule for voiding, then increasing the intervals between voids. Patients with functional incontinence related to mental status changes or loss of cognitive function are not able to follow a bladder-training program. A better treatment for a patient with stress incontinence is exercises such as pelvic floor (Kegel) exercises to strengthen the pelvic floor muscles.

A patient reports severe pain when the nurse assesses for rebound tenderness. What may this assessment finding indicate? Hepatic cirrhosis Hypersplenomegaly Gallbladder distention Peritoneal inflammation

Peritoneal inflammation When palpating for rebound tenderness, the problem area of the abdomen will produce pain and severe muscle spasm when there is peritoneal inflammation. Hepatic cirrhosis, hypersplenomegaly, and gallbladder distention do not manifest with rebound tenderness.

The nurse preparing to give a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? Sodium Potassium Magnesium Phosphorus

Phosphorus Rationale: Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not have an effect on sodium, potassium, or magnesium levels.

The nurse is providing nursing care for a 24-year-old female patient admitted to the acute care unit with a diagnosis of cystitis. Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Teaching the patient how to secure a clean-catch urine sample 2. Assessing the patient's urine for color, odor, and sediment 3. Reviewing the nursing care plan and add nursing interventions 4. Providing the patient with a clean-catch urine sample container

Providing the patient with a clean-catch urine sample container Providing the equipment that the patient needs to collect the urine sample is within the scope of practice of a UAP. Teaching, planning, and assessing all require additional education and skill, which is appropriate to the scope of practice of professional nurses.

A child is receiving cyclosporine following a kidney transplant. The nurse should include which information in the teaching plan about this medication? (Select all that apply.) Select all that apply. Optimal time to take medication to decrease pain. Recommended foods to take with medication to enhance boosting of immunity. Purpose of medication is to suppress rejection. How to palpate pulses to check for improved circulation. Frequent hand washing.

Purpose of medication is to suppress rejection. Frequent hand washing. Cyclosporine is given to suppress rejection. Cyclosporine does not decrease pain, boost immunity, or improve circulation. When taking this medication, it is important to avoid others with contagious illnesses and to wash hands often, because it is an immunosuppressant medication.

The nurse is providing care for a patient with reflex urinary incontinence. Which action could be appropriately assigned to a new LPN/LVN? 1. Teaching the patient bladder emptying by the Credé method 2. Demonstrating how to perform intermittent self-catheterization 3. Discussing when to report the side effects of bethanechol chloride to the health care provider (HCP) 4. Reinforcing the importance of proper hand washing to prevent infection

Reinforcing the importance of proper hand washing to prevent infection Teaching about bladder emptying, self-catheterization, and when to notify the HCP about medication side effects requires additional knowledge and training and is appropriate to the scope of practice of the RN. The LPN/LVN can reinforce information that has already been taught to the patient.

In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to maintaining homeostasis. Which physiologic processes are performed by the kidneys? (Select all that apply.) Release of renin Activation of vitamin D Carbohydrate metabolism Erythropoietin production Hemolysis of old red blood cells (RBCs)

Release of renin Activation of vitamin D Erythropoietin production Rationale: In addition to urine formation, the kidneys release renin to maintain blood pressure, activate vitamin D to maintain calcium levels, and produce erythropoietin to stimulate RBC production. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.

Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? Reporting any bladder spasms Assessing the patient's incision Irrigating the patient's urinary catheter Evaluating the patient's pain and selecting analgesia

Reporting any bladder spasms Rationale: Cleaning around the catheter, recording intake and output, and reporting any pain or bladder spasms to the registered nurse are appropriate tasks for delegation to the UAP. Selecting analgesia, irrigating the patient's catheter, and assessing the incision are not appropriate skills or tasks for unlicensed personnel.

A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but reports of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? Notify the provider. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one.

Reposition the tube and check for placement. Rationale: The tube may be resting against the stomach wall. The first action by the nurse is to reposition the tube and check it again for placement. The provider does not need to be notified unless the nurse cannot restore the tube function. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.

When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? Weigh patient three times weekly. Increase dietary sodium and potassium. Provide a low-protein, high-carbohydrate diet. Restrict fluids according to previous daily loss.

Restrict fluids according to previous daily loss. Rationale: Patients in the oliguric phase of AKI will have fluid volume excess with potassium and sodium retention. Therefore, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week.

The nurse is caring for a patient who is in the oliguric phase of acute kidney disease. Which action would be appropriate to include in the plan of care? Provide foods high in potassium. Restrict fluids based on urine output. Monitor output from peritoneal dialysis. Offer high-protein snacks between meals.

Restrict fluids based on urine output. Rationale: Fluid intake is monitored during the oliguric phase. Fluid intake is determined by adding all losses for the previous 24 hours plus 600 mL. Potassium and protein intake may be limited in the oliguric phase to avoid hyperkalemia and elevated urea nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in acute kidney injury if dialysis is needed.

A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a photoselective vaporization of the prostate. What is the primary goal of this intervention? Resumption of normal urinary drainage Maintenance of normal sexual functioning Prevention of acute or chronic renal failure Prevention of fluid and electrolyte imbalances

Resumption of normal urinary drainage Rationale: The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser vaporization technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, impaired sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

The nurse is caring for a patient after a right kidney biopsy. Which position would be the most appropriate for this patient immediately after the procedure? Right lateral side-lying position Reverse Trendelenburg position Supine with lower extremities elevated High Fowler's position with arms supported

Right lateral side-lying position Rationale: After a renal biopsy, a pressure dressing should be applied. The patient should be kept on the affected side for 30 to 60 minutes to apply additional pressure from the patient's own body weight and then on bed rest for 24 hours. High Fowler's position with arms supported is a position for a patient in respiratory distress. Reverse Trendelenburg position is used to maintain circulation to the legs in peripheral artery insufficiency. Supine with legs elevated puts excessive pressure on the diaphragm and should generally be avoided.

The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen? Left lower quadrant Left upper quadrant Right lower quadrant Right upper quadrant

Right upper quadrant Although the left lobe of the liver is located in the left upper quadrant of the abdomen, the bulk of the liver is located in the right upper quadrant.

A patient with ulcerative colitis is scheduled for a colon resection with placement of an ostomy. The nurse should plan to include which prescribed measure in the preoperative preparation? Selecting the stoma site Where to purchase ostomy supplies Teaching about how to irrigate a colostomy Following a high-fiber diet the day before surgery

Selecting the stoma site Rationale: Care that is unique to ostomy surgery includes selecting the best site for the stoma. Instructions to irrigate the colostomy and where to purchase ostomy supplies will be done postoperatively. A clear liquid diet will be used the day before surgery with the bowel cleansing.

The patient has a low-grade cancer on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care? (Select all that apply.) Casts in his urine Presence of α-fetoprotein Serum PSA level 10 ng/mL Onset of erectile dysfunction Nodularity of the prostate gland Development of a urinary tract infection

Serum PSA level 10 ng/mL Nodularity of the prostate gland Rationale: The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues.

A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) admitted for pneumonia. What laboratory finding would be consistent with decreased kidney function? Serum uric acid of 5.2 mg/dL Serum creatinine 2.3 of mg/dL Urine specific gravity of 1.040 Blood urea nitrogen (BUN) of 10 mg/dL

Serum creatinine 2.3 of mg/dL Rationale: An expected assessment finding related to decreased kidney function in the aging process is an increased serum creatinine. Other expected assessments include an elevated BUN and inability to concentrate urine (with urine specific gravity fixed at 1.010). Uric acid is used as a screening test for disorders of purine metabolism or kidney disease; values depend on renal function, rate of purine metabolism, and dietary intake of food rich in purines. Normal reference intervals: serum creatinine, 0.6 to 1.3 mg/dL; BUN, 6 to 20 mg/dL; urine specific gravity, 1.003 to 1.030; and serum uric acid, 2.3 to 6.6 mg/dL (female) or 4.4 to 7.6 mg/dL (male).

The patient is receiving IV piggyback doses of gentamicin every 12 hours. Which would be the nurse's priority for monitoring during the period that the patient is receiving this drug? 1. Serum creatinine and blood urea nitrogen levels 2. Patient weight every morning 3. Intake and output every shift 4. Temperature

Serum creatinine and blood urea nitrogen levels Gentamicin can be a highly nephrotoxic substance. The nurse would monitor creatinine and blood urea nitrogen levels for elevations indicating possible nephrotoxicity. All of the other measures are important but are not specific to gentamicin therapy.

The nurse is performing an assessment for a patient and preparing to palpate the kidneys. How should the nurse position the patient for this assessment? Prone Supine Seated at the edge of the bed Standing, facing away from the nurse

Supine Rationale: To palpate the right kidney, the patient is positioned supine, and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney. The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it.

A patient is being admitted to rule out interstitial cystitis. What should the nurse's plan of care for this patient include specific to this diagnosis? 1. Take daily urine samples for urinalysis. 2. Maintain accurate intake and output records. 3. Obtain an admission urine sample to determine electrolyte levels. 4. Teach the patient about the cystoscopy procedure

Teach the patient about the cystoscopy procedure. A cystoscopy is needed to accurately diagnose interstitial cystitis. Urinalysis may show white blood cells and red blood cells but no bacteria. The patient will probably need a urinalysis upon admission, but daily samples do not need to be obtained. Intake and output may be assessed, but results will not contribute to the diagnosis. Cystitis does not usually affect urine electrolyte levels.

The nurse has delegated collection of a urinalysis specimen to an experienced unlicensed assistive personnel (UAP). For which action must the nurse intervene? 1. The UAP provides the patient with a specimen cup. 2. The UAP reminds the patient of the need for the specimen. 3. The UAP assists the patient to the bathroom. 4. The UAP allows the specimen to sit for more than 1 hour.

The UAP allows the specimen to sit for more than 1 hour. Urine specimens become more alkaline when left standing unrefrigerated for more than 1 hour, when bacteria are present, or when a specimen is left uncovered. Alkaline urine increases cell breakdown; thus, the presence of red blood cells may be missed on analysis. Ensure that urine specimens are covered and delivered to the laboratory promptly or refrigerated. Actions 1, 2, and 3 are appropriate for urinalysis specimen collection.

A patient with ulcerative colitis is scheduled for a total proctocolectomy with permanent ileostomy. The wound, ostomy, and continence nurse is selecting the site where the ostomy will be placed. What should be included in site consideration? Protruding areas make the best sites. The patient must be able to see the site. The site should be outside the rectus muscle area. The appliance will need to be placed at the waist line.

The patient must be able to see the site. In selection of the ostomy site, the WOC nurse will want a site visible to the patient so the patient can take care of it, within the rectus muscle to avoid hernias, and on a flat surface to more easily create a good seal with the drainage bag. Care should be taken to avoid skin creases, scars, and belt lines, which can interfere with the adherence of the appliance.

A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? Ultrasound Cremasteric reflex Doppler ultrasound Transillumination with a flashlight

Ultrasound Rationale: When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply.) Select all that apply. Vomiting Jaundice Swelling of the face Persistent diaper rash Failure to gain weight

Vomiting Persistent diaper rash Failure to gain weight Vomiting is a clinical manifestation observed in an infant with a urinary tract infection (UTI) and can be related to poor feeding. Persistent diaper rash is a clinical manifestation of UTI in an infant. Failure to gain weight is a clinical manifestation of UTI in an infant related to poor feeding and vomiting. Jaundice is not a clinical manifestation of UTI in an infant. Swelling of the face is not a clinical manifestation of UTI in an infant.

A toddler is hospitalized with acute renal failure secondary to severe dehydration. The nurse should assess the child for what possible complication? Hypotension Hypokalemia Hypernatremia Water intoxication

Water intoxication The child needs to be monitored for hypertension. Hyperkalemia is a concern in acute renal failure. Hyponatremia may develop in acute renal failure. The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes.

The nurse obtained a urine specimen from a patient. What result should the nurse recognize as an abnormal finding? pH of 6.0 Amber yellow color Specific gravity of 1.025 White blood cells (WBCs) 9/hpf

White blood cells (WBCs) 9/hpf Rationale: Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. A urine pH of 6.0 is average; amber yellow is normal coloration, and the reference range for specific gravity is 1.003 to 1.030.

An advantage of continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents that require dialysis is that: hospitalization is only required several nights per week. dietary restrictions are no longer necessary. adolescents can carry out procedures themselves. insertion of catheter does not require surgical placement.

adolescents can carry out procedures themselves. Procedure can be done at home. Dietary restrictions are still required but are less strict. This type of dialysis provides the most independence for adolescents with ESRD and their families. Adolescents can carry out the procedure themselves. The catheter is surgically implanted in the abdominal cavity.

The nurse is caring for a child with Wilms' tumor. The MOST important nursing intervention before surgery is to: avoid abdominal palpation. closely monitor arterial blood gases. prepare child/family for long-term dialysis. prepare child/family for renal transplantation.

avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. This is not indicated before this abdominal surgery. This is not indicated unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative radiation and/or chemotherapy are used to minimize the size of the tumor. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

A 6-year-old child with acute renal failure is being transferred out of the intensive care unit. Considering their diagnoses, which child would be the MOST appropriate roommate for this child? 6-year-old child with pneumonia 4-year-old child with gastroenteritis 5-year-old child who has a fractured femur 7-year-old child who had surgery for a ruptured appendix

c These children have potentially infectious disease processes. The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin.

An important nursing consideration when caring for a child with end-stage renal disease (ESRD) is that: children with ESRD usually adapt well to the minor inconveniences of treatment. children with ESRD require extensive support until they outgrow the condition. multiple stresses are placed on children with ESRD and their families until the illness is cured. multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means.

multiple stresses are placed on children with ESRD and their families because the children's lives are maintained by drugs and artificial means. ESRD is a complex disease process that requires substantial medical intervention. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed. This is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization.

A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? An UAP on the unit who has hospice experience An LPN that has worked on the unit for 10 years An RN with 6 months of experience on the surgical unit An RN who has floated to the surgical unit from pediatrics

n RN with 6 months of experience on the surgical unit Rationale: The patient needs ostomy care directions and reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a LPN/VN or UAP.

A 5-year-old female child has been sent to the school nurse for urinary incontinence 3 times in the past 2 days. The nurse should recommend to her parent that the FIRST action is to have the child evaluated for: school phobia. emotional causes. possible urinary tract infection. possible structural defects of the urinary tract.

possible urinary tract infection. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. A physical cause of the problem needs to be eliminated before a psychologic cause is considered. Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. Structural defects would be explored after a urinary tract infection is confirmed.

External defects of the genitourinary tract such as hypospadias are usually repaired as early as possible to: prevent urinary complications. prevent separation anxiety. promote acceptance of hospitalization. promote development of normal body image.

promote development of normal body image. Preventing urinary complications is important for defects that affect function, but all external defects should be repaired as soon as possible. Proper preprocedure preparation can facilitate coping with these issues. Proper preprocedure preparation can facilitate coping with these issues. This is extremely important. Surgery involving sexual organs can be very upsetting to children, especially preschoolers who fear mutilation and castration.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually is associated with: incontinence. urinary obstruction. recurrent kidney infections. infarction of renal vessels.

recurrent kidney infections. Incontinence may be associated with urinary tract infections. When reflux is associated with vesicoureteral reflux, it can cause renal scarring but not obstruction. Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Infarction of renal vessels does not occur.

In a non-potty-trained child with nephrotic syndrome, the best way to detect fluid retention is to: weigh the child daily. test the urine for hematuria. measure the abdominal girth weekly. count the number of wet diapers.

weigh the child daily. Measuring weight at the same time each day is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. Abdominal girth is reflective of edema, but weekly is too infrequent a measure. The number of wet diapers reflects how often they have been changed. The diapers should be weighed to reflect fluid balance.