Tissue Integrity & Elimination
A patient's severe and widespread psoriasis has prompted her care provider to prescribe potent topical corticosteroids. When teaching this patient about her new medication regimen, the nurse should recognize that topical corticosteroids that are applied to large skin surfaces create a risk of: A Adrenal suppression B Disseminated intravascular coagulation (DIC) C Hypothyroidism D Kaposi's sarcoma
A Adrenal suppression
A client with chronic kidney disease (CKD) is starting hemodialysis. Which diet will the dialysis nurse likely recommend? A Diet low in proteins but including eggs and lean meat B High-calorie diet primarily with carbohydrates C Low-protein diet with only 15% of protein intake being of high biologic value D High-protein diet with rich amino acid content
A Diet low in proteins but including eggs and lean meat
During hemodialysis, toxins and wastes in the blood are removed by which of the following? A Diffusion B Osmosis C Ultrafiltration D Filtration
A Diffusion Dialysate fluid has a lower concentration of particles than the kidneys current do, so the toxins/waste move to the dialysate and out of the kidneys
A nurse is caring for a client with end-stage renal failure who has symptoms of anemia. The nurse anticipates administering which intervention to increase red blood cell production? A Epoetin alfa B Whole blood C Oxygen D Iron
A Epoetin alfa Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa)
The most important principle of psoriasis treatment is which of the following? A Gentle removal of scales B Application of emollient creams C Establishment of regular skin care routine D Dressing changes
A Gentle removal of scales
A client has undergone abdominal surgery for the treatment of cancer and is recovering with a Hemovac drain in place. When caring for this device, which interventions should the nurse perform? Select all that apply. -Administer analgesia before changing the dressing around the drain, if needed. -Perform hand hygiene and put on goggles before emptying the drain. -Use a gauze pad to clean the drain outlet after emptying it. -Leave the drain open for 5 to 7 minutes to ensure full drainage. -Fasten the drain to the client's gown using a safety pin after emptying and recompressing it.
Administer analgesia before changing the dressing around the drain, if needed. Use a gauze pad to clean the drain outlet after emptying it. Fasten the drain to the client's gown using a safety pin after emptying and recompressing it.
The nurse is planning the care for a client with acute kidney injury (AKI). What should the nurse prioritize in the client's plan of care? Select all that apply. -Assessing fluid balance -Monitoring electrolyte levels -Promoting infection control -Optimizing pain control -Protecting from falls
Assessing fluid balance Monitoring electrolyte levels Promoting infection control
The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day? A 1,250 mL B 2,000 mL C 2,750 mL D 3,500 mL
B 2,000 mL
The nurse is performing palpation of the kidney during assessment of the client on the urology unit. The nurse plans to palpate in which area? A Upper abdomen, under the costal margins B Between the 12th thoracic and 3rd lumbar vertebrae C Lower abdomen in the suprapubic area D Right costal margin, anterior abdomen
B Between the 12th thoracic and 3rd lumbar vertebrae
Which primary lesions are associated with acne caused by sebum blockage in hair follicles? A Furuncles B Comedones C Carbuncles D Striae
B Comedones
The nurse working at a physician's office is providing teaching to the parent of a child diagnosed with Tinea capitis (ringworm of the head). How often should the nurse instruct the parent to shampoo the child's hair with ketoconazole or a selenium sulfide shampoo? A Once B Daily C Weekly D Twice weekly
B Daily
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? A Diuresis B Fever C Absence of pain D Weight loss
B Fever
A client with diabetes mellitus has impaired skin integrity due to an injury. Which skin disorder is the client likely to develop? A Psoriasis B Furuncle C Dermatitis D Dermatophytosis
B Furuncle
When caring for the client with proteinuria, the nurse recognizes that dysfunction in which structure of the kidney allows protein to leak into the urine? A Renal pelvis B Glomerulus C Calyx D Collecting tubule
B Glomerulus
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following? A Abnormalities in urine B Location of discomfort C Elevated calcium levels D Structural defects in the kidneys
B Location of discomfort
A client is admitted to the ICU after a motor vehicle accident. On the second day of the hospital admission, the client develops acute kidney injury. The client is hemodynamically unstable, and renal replacement therapy is needed to manage the client's hypervolemia and hyperkalemia. Which of the following therapies will the client's hemodynamic status best tolerate? A Hemodialysis B Peritoneal dialysis C Continuous venovenous hemodialysis (CVVHD) D Plasmapheresis
C CVHD CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are usually mild in comparison to hemodialysis, so CVVHD is best tolerated by an unstable client.
The nurse is caring for a patient with severe pain related to ureteral colic. What medication can the nurse administer with a physician's order that will inhibit the synthesis of prostaglandin E, thereby reducing swelling and facilitating passage of the stone? A Morphine sulfate B Aspirin C Ketoralac (Toradol) D Meperidine (Demerol)
C Ketoralac (Toradol) Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac (Toradol) are effective in treating renal stone pain
A nurse is caring for a client diagnosed with acute renal failure. The nurse notes on the intake and output record that the total urine output for the previous 24 hours was 35 mL. Urine output that's less than 50 ml in 24 hours is known as: A oliguria. B polyuria. C anuria. D hematuria.
C anuria.
A client has developed blisters around the tape securing a dressing. What nursing action would be appropriate to prevent further damage to the tissues? A applying tape to the side of the blisters B using paper tape on the blisters C applying the dressing with a binder D applying skin barrier to protect the skin
C applying the dressing with a binder Bandages, binders, and stretch nets also can be used to hold gauze dressings in place and will prevent further damage to the tissues.
A nurse is caring for a client in a wound care clinic. The client has a wound on the left forearm from a roofing accident. During wound care, the nurse notes that the wound base is beefy red and bleeds easily during wound cleansing. Which stage of wound healing should the nurse recognize in this client's wound? A hemostasis B inflammatory phase C proliferation phase D maturation phase
C proliferation phase
The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse? A "Even though this is from a childhood disease, I am still contagious." B "Herpes zoster is caused by a viral infection." C "Herpes zoster is a reactivation of the varicella virus." D "Once I get the infection, I cannot get it again."
D "Once I get the infection, I cannot get it again."
The nurse is changing the dressing of a chronic wound. There is no sign of infection or heavy drainage. How long will the nurse leave the wound covered for? A 6 to 12 hours B 12 to 24 hours C 24 to 36 hours D 48 to 72 hours
D 48 to 72 hours
A nurse is planning the care of a client with herpes zoster. What medication, if given within the first 24 hours of the initial eruption, can arrest herpes zoster? A Prednisone B Azathioprine C Triamcinolone D Acyclovir
D Acyclovir
The nurse is conducting discharge teaching for a client who was admitted with a kidney stone. The nurse includes which instruction as a measure to prevent additional kidney stones? A Increase protein intake. B Adhere to a low-calcium diet. C Avoid drinking water before bedtime. D Avoid drinking tea.
D Avoid drinking tea
A nurse is assessing a teenage client with acne vulgaris. The client's mother states, "I keep telling him that this is what happens when you eat as many french fries as he does." What aspect of the pathophysiology of acne should inform the nurse's response? A A sudden change in client's diet may exacerbate, rather than alleviate, the client's symptoms. B French fries are one of the foods that are known to directly cause acne. C Elimination of fried foods from the client's diet will likely lead to resolution within several months. D Diet is thought to play a minimal role in the development of acne.
D Diet is thought to play a minimal role in the development of acne.
A client with decreased urine output refractory to fluid challenges is evaluated for renal failure. Which condition may cause the intrinsic (intrarenal) form of acute renal failure? A Poor perfusion to the kidneys B Damage to cells in the adrenal cortex C Obstruction of the urinary collecting system D Nephrotoxic injury secondary to use of contrast media
D Nephrotoxic injury secondary to use of contrast media Nephrotoxic injury is direct injury to the kidney
The nurse is caring for a client with a nursing diagnosis of "Impaired urinary elimination related to discomfort of urinary tract infection." Which medication will provide comfort to this client? A Fosfomycin B Sulfamethoxazole C Nitrofurantoin D Phenazopyridine
D Phenazopyridine
Which of the following would a nurse classify as a prerenal cause of acute renal failure? A Polycystic disease B Ureteral stricture C Prostatic hypertrophy D Septic shock
D Septic Shock
A client fell from a truck and required abdominal surgery to repair lacerations of the abdomen and bowel. The client now has constant drainage from a wound that will not heal on the surface of the abdomen. What does the nurse identify has occurred with the client's wound? A There is an infection present. B The client has wound dehiscence. C There is evidence of evisceration. D The client has fistula formation.
D The client has fistula formation. A fistula is an abnormal tubelike passageway that forms from one organ to outside the body.
The nurse recognizes that which risk factor does NOT predispose a client to the development of kidney stones? A immobilization B gout C hyperparathyroidism D hypoparathyroidism
D hypoparathyroidism
When caring for the client with kidney failure, the nurse anticipates that which laboratory test abnormalities will be present? Select all that apply. -Elevated potassium -Decreased calcium -Increased creatinine -Decreased BUN -Decreased phosphate
Elevated potassium Decreased calcium Increased creatinine
The nurse is instructing a health class of high school seniors on the function of the kidney. The nurse is correct to highlight which information? Select all that apply. -Regulates estrogen and progesterone -Excretes waste products -Controls blood pressure -Regulate calcium and the synthesis of vitamin D -Activates growth hormone -Regulates red blood cell production
Excretes waste products Controls blood pressure Regulate calcium and the synthesis of vitamin D Activates growth hormone Regulates red blood cell production
A nurse is assessing a client with suspected urine retention. Which assessment findings will help to confirm this diagnosis? Select all that apply. -Severe pain of palpation of the bladder -Frequency -Straining when initiating urination -Feelings of incomplete bladder emptying -Increased white blood cell count (WBC)
Frequency Straining when initiating urination Feelings of incomplete bladder emptying
A client with chronic kidney disease reports having extreme fatigue, chest pressure when walking and trouble breathing when lying supine in bed. The client's current hemoglobin level is 8.3 g/dL (83 g/L). Which intervention(s) will likely be prescribed for this client during this visit? Select all that apply. -Increase in iron intake via food and supplementation -Dietary consult to focus on low phosphate foods and high fiber options -Injection of an erythropoietin-stimulating agent -Educational handout on foods to help increase the blood platelet count -Type and crossmatch for an immediate blood transfusion
Increase in iron intake via food and supplementation Injection of an erythropoietin-stimulating agent
The nurse is caring for a client with a sacral wound. Upon assessment, the wound is noted to have a shallow skin crater with serous drainage. How will the nurse categorize this pressure injury? stage I stage II stage III stage IV
stage III Stage I pressure injuries are characterized by intact but reddened skin that is unblanchable. Stage II involves blistering or a skin tear. Stage III involves a shallow skin crater that extends to the subcutaneous tissue; it may have serous or purulent drainage. Stage IV exposes muscle and bone.
The nurse is providing care to a team of clients. Which clients are at risk for injury to the skin? Select all that apply. -the client who has a body mass index (BMI) of 34 -the client who is emaciated from self-induced vomiting and food deprivation -the client who has a temperature of 104°F (40°C) and is perspiring -the ambulatory client who is recovering from an endoscopic procedure for abdominal pain -the client who is experiencing an allergic reaction and is scratching the skin
the client who has a body mass index (BMI) of 34 the client who is emaciated from self-induced vomiting and food deprivation the client who has a temperature of 104°F (40°C) and is perspiring the client who is experiencing an allergic reaction and is scratching the skin
A client with a recent diagnosis of renal failure requiring hemodialysis is being educated in the dietary management of the disease. Which statement by the client shows an accurate understanding of this component of treatment? Select all that apply. -"I'll increase the carbohydrates in my diet to provide sufficient energy." -"I've made a list of high-phosphate foods so that I can try to avoid them." -"I'm making a point of trying to eat lots of bananas and other food rich in potassium." -"I don't think I've been drinking enough, so I want to include 8 to 10 glasses of water each day." -"I'm going to try a high-protein, low-carbohydrate diet."
"I'll increase the carbohydrates in my diet to provide sufficient energy." "I've made a list of high-phosphate foods so that I can try to avoid them." Excessive fluids are not good for patients on hemodialysis
A caregiver is preparing to take over wound care for a client being discharged from the hospital. Which teaching will the nurse provide about wound healing for an older adult client? Select all that apply. -"It may take longer for an older adult to heal." -"Increased appetite will provide better nutrition to help with healing." -"Consider having a home health aide to assist with bathing and personal care." -"Older adults with lots of sun exposure may experience delayed healing." -"Depression after surgery is normal; this will not affect healing processes."
"It may take longer for an older adult to heal." "Consider having a home health aide to assist with bathing and personal care." "Older adults with lots of sun exposure may experience delayed healing."
Which education points would the nurse use to explain the development of pressure injuries to clients and how to prevent them? Select all that apply. -"Pressure injuries usually occur over bony prominences where body weight is distributed over a small area without much subcutaneous tissue." -"Most pressure injuries occur over the trochanter and calcaneus." -"Generally, a pressure injury will not appear within the first 2 days in a person who has not moved for an extended period of time." -"The major predisposing factor for a pressure injury is internal pressure over an area, resulting in occluded blood capillaries and poor circulation to the tissues." -"The skin can tolerate considerable pressure without cell death, but for short periods only." -"The duration of pressure, compared to the amount of pressure, plays a larger role in pressure injury formation."
"Pressure injuries usually occur over bony prominences where body weight is distributed over a small area without much subcutaneous tissue." "The skin can tolerate considerable pressure without cell death, but for short periods only." "The duration of pressure, compared to the amount of pressure, plays a larger role in pressure injury formation."
When a patient has been diagnosed with scabies, if the infection has spread, family members may complain of pruritus within which time frame? 1 month 2 weeks 3 weeks 6 weeks
1 month
A football player is thought to have sustained an injury to his kidneys from being tackled from behind. The ER nurse caring for the client reviews the initial orders and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason? A Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. B Intake and output calculations are essential and the laboratory will calculate the precise urine output produced by this client. C A creatinine clearance study may be ordered at a later time and the laboratory will hold all urine until it is determined if the test will be necessary. D There is great concern about electrolyte imbalances and the laboratory will monitor the urine for changes in potassium and sodium concentrations.
A Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential.
A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely? A Hydronephrosis B Urinary calculi C Papillary necrosis D Prostatic hyperplasia
A Hydronephrosis Hydronephrosis refers to urine-filled dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction of urine outflow.
A client with acute renal failure progresses through four phases. Which describes the onset phase? A It is accompanied by reduced blood flow to the nephrons. B Fluid volume excess develops, which leads to edema, hypertension, and cardiopulmonary complications. C The excretion of wastes and electrolytes continues to be impaired despite increased water content of the urine. D Normal glomerular filtration and tubular function are restored.
A It is accompanied by reduced blood flow to the nephrons. The onset phase is the initial injury to the kidney. In this case, that initial injury is the decreased blood flow to the nephrons.
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? A Kidney B Ureter C Bladder D Urethra
A Kidney
What is the best way for the nurse to ensure there is not any tension on the tubing when caring for a client with a Jackson-Pratt drain? A Secure the drain to the client's gown with a safety pin below the level of the wound. B Tape the drain to the dressing material securely below the level of the wound. C Allowed the Jackson-Pratt drain to hang freely to avoid any kinks in the tubing. D Apply an abdominal binder over the entire wound and drain to support the site.
A Secure the drain to the client's gown with a safety pin below the level of the wound.
A student nurse is preparing to perform a dressing change for a pressure injury on a client's sacrum area. The chart states that the pressure injury is staged as "unstageable." Which wound description should the student nurse expect to assess? A The wound is 3 × 5 cm, with yellow tissue covering the entire wound. B The wound is 3 × 5 cm, with 50 percent gray tissue and 50 percent red tissue, with subcutaneous tissue visible. C The wound is 3 × 5 cm, with 60 percent tan tissue and 40 percent granulation tissue, with a tendon showing. D The wound is a 3 × 5-cm blood-filled blister.
A The wound is 3 × 5 cm, with yellow tissue covering the entire wound.
A health care provider orders irrigation with normal saline for the treatment of a client's wound. What should the nurse do when performing this intervention? A Use clean technique instead of sterile technique if the wound is closed. B Apply petroleum jelly to the periwound skin to protect it from the irrigation solution. C Stop irrigating when the solution from the wound turns light pink. D If new bleeding is noted, continue irrigation cautiously and then notify the health care provider.
A Use clean technique instead of sterile technique if the wound is closed.
An infant has sebaceous retention cysts in the first few weeks of life. The nurse documents these cysts as: A milia. B prickly heat. C acne vulgaris. D lanugo.
A milia.
The nurse is providing care for a client with a wound that has purulent drainage. Which interventions will the nurse provide when caring for this client? Select all that apply. -Administer a prescribed analgesic 30 to 45 minutes before changing the dressing, if necessary. -Change the dressing midway between meals. -Apply a protective ointment or paste, if appropriate, to cleansed skin surrounding the draining wound. -Apply another layer of protective ointment or paste on top of the previous layer when changing dressings. -Apply an absorbent dressing material as the first layer of the dressing. -Apply a nonabsorbent material over the first layer of absorbent material.
Administer a prescribed analgesic 30 to 45 minutes before changing the dressing, if necessary. Change the dressing midway between meals. Apply a protective ointment or paste, if appropriate, to cleansed skin surrounding the draining wound.
A nurse assesses an area of pale white skin over a client's coccyx. After turning the client on her side, the skin becomes red and feels warm. What should the nurse do about these assessments? A Immediately report to the physician that the client has a pressure injury. B Reassess the coccyx area for fading of the redness in 60 to 90 minutes. C Document the presence of a pressure injury and develop a care plan. D Implement nursing interventions for altered skin integrity.
B Reassess the coccyx area for fading of the redness in 60 to 90 minutes. Blanching of skin over an area under pressure results from ischemia. When pressure is relieved, reactive hyperemia follows and the skin is red and feels warm. Reactive hyperemia is not a stage I pressure injury. To verify it is reactive hyperemia, the nurse reassesses the area in 60 to 90 minutes. The redness should fade within this time.
The nurse is caring for an older adult admitted for thromboembolism and on bed rest. Which assessments should the nurse use to help detect the potential for pressure injury? Select all that apply. -Stages of pressure injuries -Nutritional status -Mental status -Skin moisture -Sensory perception
Nutritional status Mental status Skin moisture Sensory perception
A client diagnosed with chronic kidney disease (CKD) with GFR < 5 mL/min/1.73 m2 should be monitored for which fluid and electrolyte imbalance? Select all that apply. -Polyuria -Hyperkalemia -Metabolic alkalosis -Hypocalcemia -Hyponatremia
Polyuria Hyperkalemia Hypocalcemia Hyponatremia
What are functions of the skin? Select all that apply. -Protection -Temperature regulation -Sensation -Vitamin C production -Immunologic
Protection Temperature regulation Sensation Immunologic
The nurse is teaching a group of nursing students about the formation of urine in the nephron. Which component does the nurse teach is a component of the nephron? Select all that apply. -Proximal convoluted tubule -Loop of Henle -Distal convoluted tubule -Collecting tubule -Renal pelvis
Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting tubule
What should the nurse assess for to determine if a patient using corticosteroids for a dermatologic condition is having local side effects? Select all that apply. -Skin atrophy -Striae -Telangiectasia -Comedones -Ecchymosis
Skin atrophy Striae Telangiectasia
The nurse will monitor which clients at risk for the development of chronic kidney disease (CKD)? Select all that apply. -Systemic lupus erythematosus -Polycystic kidney disease -Glomerulonephritis -Hyperlipidemia -Diabetes
Systemic lupus erythematosus Polycystic kidney disease Glomerulonephritis Diabetes
The nurse is triaging a client over the phone who states having a contact dermatitis rash. Which treatment option of over-the-counter preparations does the nurse suggest for the client? Select all that apply. -Topical antihistamines -Cosmetic lotions -Hydrocortisone cream -Moisturizing cream -Lanolin based ointment
Topical antihistamines Hydrocortisone cream Moisturizing cream Lanolin based ointment
The nursing student learns in her anatomy and physiology class that the bladder has how many main components? One Two Three Four
Two The body and the neck
