Genitourinary Disorders

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1. After a retropubic prostatectomy, a client needs continuous bladder irrigation. The client has an I.V. of dextrose 5% in water infusing at 40 ml/hour, and a triple-lumen urinary catheter with normal saline solution infusing at 200 ml/hour. The nurse empties the urinary catheter drainage bag three times during an 8-hour period for a total of 2,780 ml. How many milliliters does the nurse calculate as urine? Record your answer using a whole number. Answer: ___milliliters

Explanation

The correct answer is 1180.

RATIONALE: During 8 hours, 1,600 ml of bladder irrigation has been infused (200 ml × 8 hour = 1,600 ml/8 hour). The nurse then subtracts this amount of infused bladder irrigation from the total volume in the drainage bag (2,780 ml − 1,600 ml = 1,180 ml) to determine urinary output.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Analysis

REFERENCE: Karch, A.M. Focus on Nursing Pharmacology,4th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 57.

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2. After undergoing renal arteriogram, in which the left groin was accessed, a client complains of left calf pain. Which intervention should the nurse perform first?

Explanation

RATIONALE: The nurse should begin by assessing peripheral pulses in the left leg to determine if blood flow was interrupted by the procedure. The client may also have thrombophlebitis. Cool compresses aren't used to relieve pain and inflammation in thrombophlebitis. The leg should remain straight after the procedure. Calf pain isn't a symptom ofanaphylaxis.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1509.

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3. A nurse preceptor is observing a new graduate during care of a client in contact isolation. Which action by the new graduate indicates a need for further teaching about handling infectious materials?

Explanation

RATIONALE: Using alcohol gel isn't acceptable after the nurse has been in contact with soiled material. The nurse should wash her hands with soap and water. The nurse demonstrates appropriate handling of infectious materials by wearing gloves with each client contact, washing her hands with soap and water when she enters and exits the room, and disposing contaminated articles in the room's biohazard container.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 524.

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4. A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?

Explanation

RATIONALE: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products.Impaired urinary elimination, Toileting self-care deficit,andActivity intolerancemay be pertinent but are secondary to the risk of infection.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1548.

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5. A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

Explanation

RATIONALE: Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 2507.

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6. A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?

Explanation

RATIONALE: If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1767.

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7. Because of difficulties with hemodialysis, peritoneal dialysisis initiated to treat a client's uremia. Which finding during this procedure signals a significant problem?

Explanation

RATIONALE: An increased WBC count indicates infection, probably resulting fromperitonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client.Hyperglycemia(evidenced by a blood glucose level of 200 mg/dl) occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1547.

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8. A client requires hemodialysis. Which type of drug should be withheld before this procedure?

Explanation

RATIONALE: Cardiac glycosides such as digoxin (Lanoxin) should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmiassecondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1552.

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9. A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that's most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes:

Explanation

RATIONALE: Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmiassuggest hyperkalemia, which is associated with renal failure. Hypotension,tachycardia, andtachypneasignal hemorrhage, another dialysis complication.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1540.

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10.
A nurse is explaining menstruation to a class. Place the steps of the menstrual cycle listed below in the correct order. Use all options.
1. The level of estrogen in the blood peaks.
2. Peak endometrial thickening occurs.
3. Estrogen and progesterone levels increase.
4. Top layer of the endometrium breaks down.
5. A follicle matures and ovulation occurs.
6. The endometrium begins thickening.

Explanation

The correct answer is 4,6,1,5,2,3.

RATIONALE: The menstrual cycle begins with the first day of menstruation, when the top layer of the endometrium breaks down and sloughs. The endometrium thickens and the level of estrogen in the blood peaks. Next, a follicle matures and ovulation occurs. Peak endometrial thickening occurs and the estrogen and progesterone levels increase, inhibiting luteinizing hormone.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1615.

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11. A client returns to an intensive care unit after coronary artery bypass graftsurgery, which was complicated by prolonged cardiopulmonary bypass and hypotension. After 3 hours in the unit, the client's condition stabilizes. However, the urine output has decreased despite adequate filling pressures. The nurse expects the physician to add which drug, at which flow rate, to the client's regimen?

Explanation

RATIONALE: This client is at high risk for acute prerenal failure secondary to decreased renal perfusion during surgery. To dilate the renal arteries and help prevent renal shutdown, the physician is likely to order dopamine at a low flow rate (2 to 5 mcg/kg/minute). Although this drug has mixed dopaminergic and beta activity when given at 5 to 10 mcg/kg/minute, the client is stabilized and thus doesn't need the beta effects from the higher flow rate — or the sympathomimetic effects of epinephrine. The dopaminergic effects of dopamine increase renal perfusion, contractility, and vasodilation. Dobutamine is used to increase cardiac output. Norepinephrine is a potent vasoconstrictor that shunts blood away from the kidneys to increase blood pressure.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 451.

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12. After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should the nurse do first?

Explanation

RATIONALE: Although postoperative pain is expected, the nurse should make sure that other factors, such as an obstructed irrigation catheter, aren't the cause of the pain. After assessing catheter patency, the nurse should administer an analgesic, such as morphine sulfate, as ordered. Increasing the I.V. flow rate may worsen the pain. Notifying the physician isn't necessary unless the pain is severe or unrelieved by the ordered medication.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1767.

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13. A nurse is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to:

Explanation

RATIONALE: When inserting a urinary catheter, the nurse can facilitate insertion by asking the client to breathe deeply. Breathing deeply will relax the urinary sphincter. Initiating a stream of urine isn't recommended during catheter insertion. Turning to the side or holding the labia or penis won't ease insertion, and doing so may contaminate the sterile field.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1531.

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14. A physician enters a computer order for a nurse to irrigate a client's nephrostomy tube every 4 hours to maintain patency. The nurse irrigates the tube using sterile technique. After irrigating the tube, the nurse decides that she can safely use the same irrigation set for her 8-hour shift if she covers the set with a paper, sterile drape. This action by the nurse is:

Explanation

RATIONALE: Irrigating a nephrostomy tube requires strict sterile technique; therefore, reusing the irrigation set (even if covered by a sterile drape) is inappropriate. Bacteria can proliferate inside the syringe and irrigation container. Although this procedure checks patency, it requires sterile technique to prevent the introduction of bacteria into the kidney. The material of which the sterile drape is made is irrelevant because a sterile drape doesn't deter bacterial growth in the irrigation equipment.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 720.

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15. A registered nurse and a nursing assistant are caring for a group of clients. Which client's care may safely be delegated to the nursing assistant?

Explanation

RATIONALE: The care of the client diagnosed with renal calculi may safely be delegated to the nursing assistant. The registered nurse should care for the client who had surgery 12 hours ago because the client requires close assessment. The client with uncontrolled diabetes mellitusalso requires careful assessment by the registered nurse. In addition, the registered nurse should care for the client who requires neurological assessment, which isn't within the scope of practice for the nursing assistant.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Analysis

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 323.

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16. A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation?

Explanation

RATIONALE: Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal and requires further investigation. Urine specific gravity normally ranges from 1.002 to 1.035, making this client's value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, with color ranging from pale yellow to deep amber.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 310.

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17. A nurse is collecting a health history on a client who's to undergo a renal angiography. Which statement by the client should be the priority for the nurse to address?

Explanation

RATIONALE: An allergy to iodine, shellfish, or other seafood should immediately be investigated because the contrast agent used in the procedure may contain iodine, which can cause a severe allergic reaction. Although contrast agents should be used cautiously in clients with diabetes mellitus, investigating this isn't the nurse's priority if the client also has a shellfish allergy. It's appropriate for the client to not eat after midnight before the procedure. The client's hypertension isn't a priority because this condition is the likely reason the renal angiography was ordered.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1508.

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18. A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged I.V. pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow?

Explanation

RATIONALE: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1767.

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19. A nurse is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 6.2 mEq/L. Correct administration and the effects of this enema should include having the client:

Explanation

RATIONALE: Kayexalate is a sodium-exchange resin. Thus, the client will gain sodium as potassium is lost in the bowel. For the exchange to occur, Kayexalate must be in contact with the bowel for at least 30 minutes. Sorbitol in the Kayexalate enema causes diarrhea, which increases potassium loss and decreases the potential for Kayexalate retention.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 1163.

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20. A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:

Explanation

RATIONALE: The client with CRF is at risk for fluid imbalance — dehydrationif the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys' inability to excrete phosphorus; such imbalances may lead tohyperphosphatemiawith reciprocal hypocalcemia. CRF may causemetabolic acidosis, notmetabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1529.

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21. A client on the genitourinary floor has refused all medications for 3 days. A nurse caring for this client asks why he isn't complying with his medication. The client states, "I don't want to take those pills anymore." The nurse informs the client that he must take all the medication the physician orders. With this statement, the nurse has violated the:

Explanation

RATIONALE: The nurse has violated the client's right to refuse medication by telling him that he must take all ordered medication. The nurse hasn't violated client privacy because she didn't share any information. An advance directivestates a client's wishes if he's in a terminal condition and can't express them, which doesn't apply at this time. The nurse hasn't violated the client's right to accurate medication administration.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 557.

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22. A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra–high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:

Explanation

RATIONALE: The nurse should instruct the client to report the presence of foul-smelling or cloudy urine to the physician. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal because of residual stone products. Hematuriais common after lithotripsy.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1594.

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23. When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

Explanation

RATIONALE: To maintain effective drainage, the client should keep the drainage bag below the bladder; doing so allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because the bag could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1588.

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24. A nurse is caring for a client diagnosed with ovarian cancer. Diagnostic testing reveals that the cancer has spread outside the pelvis. The client has previously undergone a right oophorectomyand receivedchemotherapy. The client now wants palliative care instead of aggressive therapy. The nurse determines that the care plan's priority nursing diagnosis should be:

Explanation

RATIONALE: Palliative care for the client with advanced cancer includes pain management, emotional support, and comfort measures. The client is in the hospital, so home maintenance doesn't apply at this time. The client has chosen palliative care, so she isn't noncompliant. The client isn't breast-feeding, so the diagnosis of Ineffective breast-feedingdoesn't apply.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 1329.

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25. A nurse is caring for an 8-year-old girl with multiple chronic urinary tract infections. The child's parents appear protective, never leaving their daughter's side. While the nurse helps the child's mother provide morning care, the child states, "My uncle doesn't clean me that way." Her mother becomes visibly upset and gives the girl a stern warning not to discuss the matter. She states, "Don't tell anyone about that again." The nurse has a legal responsibility to:

Explanation

RATIONALE: The nurse has a legal responsibility to report suspected abuseof a child or an elderly person. It's inappropriate to offer to clean the child in the same way as the suspected abuser. Leaving the room doesn't fulfill that responsibility. A chart entry about the parent's behavior reflects the nurse's opinion and isn't based on subjective assessment and objective data.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 1298.

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26. A client with a history of bladder retention hasn't voided for 8 hours. A nurse concerned that the client is retaining urine notifies the physician. He orders a bladder ultrasonic scan and placement of an indwelling catheter if the residual urine is greater than 350 ml. The nurse knows that using the bladder ultrasonic scan to measure residual urine instead of placing a straight catheter reduces the risk of:

Explanation

RATIONALE: Bladder ultrasonic scanning, a noninvasive way of calculating the amount of urine in the bladder, reduces the risk of transferring microorganisms into the bladder. Use of a straight catheter to measure residual urine increases the transfer of microorganisms into the bladder, and increases, rather than reduces, client discomfort. A bladder ultrasonic scan doesn't reduce the risk of prostate irritation or incorrect urine output values.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1507.

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27. A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys' ability to remove a substance from the plasma in:

Explanation

RATIONALE: The creatinine clearance test determines the kidneys' ability to remove a substance from the plasma in 1 minute. It doesn't measure the kidneys' ability to remove a substance over a longer period.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1507.

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28. After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?

Explanation

RATIONALE: Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1767.

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29. A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal?

Explanation

RATIONALE: TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; each requires an incision.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed., Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1761.

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30. A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan?

Explanation

RATIONALE: The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1539.

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31. 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?

Explanation

RATIONALE: The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1589.

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32. A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?

Explanation

RATIONALE: ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1523.

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33. A nurse is reviewing a client's fluid intake and output record. Fluid intake and urine output should relate in which way?

Explanation

RATIONALE: Normally, fluid intake is about equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isn't inversely proportional to the urine output.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Comprehension

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1679.

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34. A client with a urinary tract infectionis ordered co-trimoxazole (trimethoprim-sulfamethoxazole). The nurse should provide which medication instruction?

Explanation

RATIONALE: The nurse should instruct a client receiving a sulfonamide such as co-trimoxazole to drink at least eight 8-oz glasses of fluid daily to maintain a urine output of at least 1,500 ml/day. Otherwise, inadequate urine output may lead to crystalluria or tubular deposits. For maximum absorption, the client should take this drug at least 1 hour before or 2 hours after meals. No evidence indicates that antacids interfere with the effects of sulfonamides. To prevent a photosensitivity reaction, the client should avoid direct sunlight during co-trimoxazole therapy.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 366.

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35. A nurse is planning a group teaching session on the topic of urinary tract infection(UTI) prevention. Which point should the nurse include?

Explanation

RATIONALE: Urgency, burning, frequency, and difficulty urinating are all common symptoms of a UTI. The client should notify the physician so that a microscopic urinalysis can be done and appropriate treatment can be initiated. The client should be instructed to drink 2 to 3 L of fluid per day to dilute the urine and reduce irritation of the bladder mucosa. To prevent UTI recurrence, the full amount of antibiotics ordered must be taken despite the fact that the symptoms may have subsided. Women are told to avoid scented toilet tissue and bubble baths and to wear cotton underwear, not nylon, to reduce the chance of irritation.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1577.

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36. A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:

Explanation

RATIONALE: Wearing a condom during intercourse considerably reduces the risk of contracting STDs. Asking all potential sexual partners if they have an STD; considering intercourse safe if his partner has no visible discharge, lesions, or rashes; and expecting to limit the number of sexual partners won't reduce the risk of contracting an STD to the extent wearing a condom will. A monogamous relationship also reduces the risk of contracting STDs.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 2509.

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37. A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by:

Explanation

RATIONALE: Most catheters have a self-sealing port for obtaining a urine specimen. Antiseptic solution is used to reduce the risk of introducing microorganisms into the catheter. Tubing shouldn't be disconnected from the urinary catheter. Any break in the closed urine drainage system may allow the entry of microorganisms. Urine in urine drainage bags may not be fresh and may contain bacteria, giving false test results. When there's no urine in the tubing, the catheter may be clamped for no more than 30 minutes to allow urine to collect.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1495.

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38. Which statement describing urinary incontinence in an elderly client is true?

Explanation

RATIONALE: Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes. Certain medications, includingdiuretics, hypnotics, sedatives,anticholinergics, and antihypertensives, may trigger urinary incontinence. Most clients with urinary incontinence can be treated; some can be cured.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1578.

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39. After undergoing retropubic prostatectomy, a client returns to his room. The client is on nothing-by-mouth status and has an I.V. infusing in his right forearm at a rate of 100 ml/hour. The client also has an indwelling urinary catheter that's draining light pink urine. While assessing the client, the nurse notes that his urine output is red and has dropped to 15 ml and 10 ml for the last 2 consecutive hours. How can the nurse best explain this drop in urine output?

Explanation

RATIONALE: The drop in urine output to less than 30 ml/hour is abnormal and requires further assessment. The reduction in urine output may be caused by an obstruction in the urinary catheter tubing or deficient fluid volume from blood loss. The client's nothing-by-mouth status isn't the cause of the low urine output because the client is receiving I.V. fluid to compensate for the lack of oral intake. Ambulation promotes urination; however, the client should produce at least 30 ml of urine/hour.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1586.

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40. A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stomais red, weeping, and painful. What should the nurse conclude?

Explanation

RATIONALE: If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn't be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn't performed with an ileal conduit, although it may be done with a colostomy if ordered.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1605.

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41. A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:

Explanation

RATIONALE: After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1509.

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42. A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change?

Explanation

RATIONALE: The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1507.

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43. A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?

Explanation

RATIONALE: The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn't needed. Lithotripsy doesn't require an incision. Hematuriamay occur for a few hours after lithotripsy but should then disappear.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1594.

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44. A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?

Explanation

RATIONALE: Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 2507.

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45. A client is admitted for treatment of glomerulonephritis. On initial assessment, the nurse detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include:

Explanation

RATIONALE: Periorbital edema is a classic sign of acute glomerulonephritis of sudden onset. Other classic signs and symptoms of this disorder include hematuria(not green-tinged urine), proteinuria, fever, chills, weakness, pallor,anorexia, nausea, and vomiting. The client also may have moderate to severe hypertension (not hypotension),oliguriaor anuria (notpolyuria), headache, reduced visual acuity, and abdominal or flank pain.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1517.

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46. Which client is at highest risk for developing a hospital-acquired infection?

Explanation

RATIONALE: The invasive nature of an indwelling urinary catheter increases the client's risk of a hospital-acquired infection. The nurse must perform careful, frequent catheter care to minimize the client's risk. Although the client with a laceration, the client who's taking prednisone, and the client with Crohn's disease have a risk of infection, the one with an indwelling catheter is at the greatest risk.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1588.

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47. A nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?

Explanation

RATIONALE: Encouraging a daily fluid intake of at least 2 L helps fill the client's bladder, thereby promoting bladder retraining by stimulating the urge to void. The nurse shouldn't give the client soda before bedtime; soda acts as a diureticand may make the client incontinent. The nurse should take the client to the bathroom or offer the bedpan at least every 2 hours throughout the day; twice per day is insufficient. Consultation with a dietitian won't address the problem of urinary incontinence.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Comprehension

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1583.

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48. When performing a scrotal examination, a nurse finds a nodule. What should the nurse do next?

Explanation

RATIONALE: The nurse who discovers a nodule, swelling, or other abnormal finding during a scrotal examination should transilluminate the scrotum by darkening the room and shining a flashlight through the scrotum behind the mass. A scrotum filled with serous fluid transilluminates as a red glow; a more solid lesion, such as a hematoma or mass, doesn't transilluminate and may appear as a dark shadow. Although the nurse should notify the physician of the abnormal finding, performing transillumination first provides the physician with additional information. The nurse can't uncover more information about a scrotal mass by changing the client's position and repeating the examination or by performing a rectal examination.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Bickley, L.S. Bates' Guide to Physical Examination and History Taking,9th ed. Philadelphia: Lippincott Williams & Wilkins, 2005, p. 418.

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49. Which laboratory value supports a diagnosis of pyelonephritis?

Explanation

RATIONALE: Pyelonephritis is diagnosed by the presence of pyuria, leukocytosis,hematuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Myoglobinuria is seen with any disease process that destroys muscle. Ketonuria indicates a diabetic state. Because the client with pyelonephritis typically has signs ofinfection, the WBC count is more likely to be high rather than low.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Comprehension

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1577.

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50. A client with acute pyelonephritisreceives a prescription for co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the ordered regimen?

Explanation

RATIONALE: Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, absence of bacteria on urine culture indicates that the drug has achieved its desired effect. Although flank pain may decrease as theinfectionresolves, this finding isn't a reliable indicator of the drug's effectiveness. Co-trimoxazole doesn't affect urine output or the RBC count.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 366.

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51. A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:

Explanation

RATIONALE: Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuriais unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1541.

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52. A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

Explanation

RATIONALE: When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1767.

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53. A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:

Explanation

RATIONALE: RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness. Nausea and vomiting may occur in CRF but don't result from faulty RBC production. Dyspneaandcyanosisare associated with fluid excess, not CRF. Thrush, which signals fungalinfection, and circumoral pallor, which reflects decreased oxygenation, aren't signs of CRF.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1529.

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54. After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?

Explanation

RATIONALE: Kegel exercisesare noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1768.

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55. A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

Explanation

RATIONALE: Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1666.

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56. A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

Explanation

RATIONALE: An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 324.

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57. Which nursing diagnosis is appropriate for a client with renal calculi?

Explanation

RATIONALE: Infectioncan occur with renal calculi from urine stasis caused by obstruction.Ineffective tissue perfusion (renal)andDecreasedcardiac outputaren't appropriate for this client, and retention of urine, rather than incontinence, usually occurs.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1593.

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58. A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:

Explanation

RATIONALE: Many clients who undergo surgery for creation of an ileal conduit experience anxiety associated with changes in body image. The mental health practitioner can help the client cope with these feelings of anxiety. Mental health practitioners don't evaluate whether the client is a surgical candidate. None of the evidence suggests that urinary diversion surgery, such as creation of an ileal conduit, places the client at risk for suicide. Although evaluating the need for mental health intervention is always important, this client displays no behavioral changes that suggest intervention is necessary at this time.

CLIENT NEEDS CATEGORY: Psychosocial integrity
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1602.

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59. A nurse is caring for a client in acute renal failure. The nurse should expect hypertonicglucose, insulin infusions, and sodium bicarbonate to be used to treat:

Explanation

RATIONALE: Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 324.

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60. A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:

Explanation

RATIONALE: Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1668.

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61. A female client reports to a nurse that she experiences a loss of urine when she jogs. The nurse's assessment reveals no nocturia, burning, discomfort when voiding, or urine leakage before reaching the bathroom. The nurse explains to the client that this type of problem is called:

Explanation

RATIONALE: Stress incontinence is a small loss of urine with activities that increase intra-abdominal pressure, such as running, laughing, sneezing, jumping, coughing, and bending. These symptoms occur only in the daytime. Functional incontinence is the inability of a usually continent client to reach the toilet in time to avoid unintentional loss of urine. Reflex incontinence is an involuntary loss of urine at predictable intervals when a specific bladder volume is reached. Total incontinence occurs when a client experiences a continuous and unpredictable loss of urine.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 215.

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62. A client admitted to the unit with a diagnosis of end-stage renal disease is scheduled to undergo hemodialysis. He voices anxiety over shunt placement and management of care at home. A nurse initiates a referral to which members of the interdisciplinary team?

Explanation

RATIONALE: Home care for a client with end-stage renal disease requires ongoing education and referral; team members include the home health nurse, the nutritionist, and social services in this process. The home health nurse assists with client teaching and support, completion of physical assessments, and evaluation of outcomes. The nutritionist explains dietary needs and necessary changes in the diet. The social worker assists with finding resources and provides counseling and support to the client and family members. Physical and occupational therapy and dialysis aren't components of home care. Family members aren't part of the interdisciplinary health care team.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 32.

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63. An elderly client with a diagnosis of chronic renal failure is being discharged to home with his wife. The home health nurse visits the hospital before discharge to discuss home safety with the client, who reports decreased mobility and a need for greater assistance with activities of daily living. The nurse focuses her home-safety teaching on:

Explanation

RATIONALE: The home health nurse should focus her safety teaching on factors that promote mobility, such as having adequate lighting, removing cluttered paths, and using nonskid bathroom surfaces. Child safety hazards, such as unsteady ladders, overloaded electrical outlets, and improperly stored plastic bags, guns, flammable liquids, and pesticides aren't applicable to this client. Although factors such as defective smoke detectors and steps with broken concrete or without handrails are important, they aren't the teaching priority at this time.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 677.

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64. A client with suspected renal dysfunction is scheduled for excretory urography. The nurse reviews his history for conditions that may warrant changes in client preparation. Normally, the client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding calls for the client to be well hydrated?

Explanation

RATIONALE: Fluid depletion before excretory urography is contraindicated in clients with multiple myeloma, severediabetes mellitus, and uric acid nephropathy — conditions that can seriously compromise renal function in fluid-depleted clients with reduced renal perfusion. If these clients must undergo excretory urography, they should be well hydrated before the test.Cystic fibrosis,gout, andmyasthenia gravisdon't necessitate changes in client preparation for excretory urography.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1508.

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65. A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has aninfectioncaused byCandida albicans?

Explanation

RATIONALE: The symptoms of C. albicansinclude itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign ofTrichomonas vaginalis.Gray-white discharge and a fishy odor are signs ofGardnerella vaginalis.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1626.

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66. A female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat the infection. Another medication is ordered to decrease the pain and frequency. Which is the most likely medication ordered for the pain?

Explanation

RATIONALE: Phenazopyridine may be ordered in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesicproperties. Although ibuprofen and acetaminophen with codeine are analgesics, they don't exert a direct effect on the urinary mucosa.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 1014.

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67. A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?

Explanation

RATIONALE: A small quantity of the fungus Candida albicanscommonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1662.

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68. A nurse correctly identifies a urine specimen with a pH of 4.3 as being which type of solution?

Explanation

RATIONALE: Normal urine pH is 4.5 to 8.0; a value of 4.3 reveals acidic urine pH. A pH above 7.0 is considered an alkaline or basic solution. A pH of 7.0 is considered neutral.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 310.

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69. A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?

Explanation

RATIONALE: The nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1669.

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70. A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?

Explanation

RATIONALE: The guidelines for initiating bladder retraining include assessing the client's present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client's fluid intake won't reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1588.

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71. A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?

Explanation

RATIONALE: Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute paintakes highest priority. Diagnoses ofRisk for infectionandImpaired urinary eliminationare appropriate when the client's pain is controlled. A diagnosis ofImbalanced nutrition: Less than body requirementsisn't pertinent at this time.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1594.

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72. A nurse receives her client care assignment. Following the report, she should give priority assessment to the client:

Explanation

RATIONALE: A sodium level of 110 mEq/L and a potassium level of 2.0 mEq/L in a client immediately following dialysis should be the priority assessment. Pinkish mucus discharge in the appliance bag is a normal finding for a client who's had an ileal conduit, as are a sodium level of 135 mEq/L and a potassium level of 3.7 mEq/L in a client who's had a kidney transplant. Although the nurse should further assess mild pain from urolithiasis, this is an expected finding and not a priority in relation to the client with abnormal sodium and potassium levels.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1540.

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73. A nurse is caring for a client who also works in the hospital, has recently received a diagnosis of genital herpes, and is being treated for a urinary tract infection(UTI). While on lunch break in the cafeteria, the nurse sees the client's coworkers, who voice concern over his condition. The nurse's best response would be:

Explanation

RATIONALE: Offering to tell the client that his coworkers are thinking of him is the only appropriate response. Discussing his diagnosis or condition violates his right to privacy.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 95.

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74. A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

Explanation

RATIONALE: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn't be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn't fluid-overloaded so his urine output won't increase with furosemide, which would actually worsen the client's condition. The client doesn't require dialysis because the oliguriaand elevated BUN and creatinine levels are caused bydehydration.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1525.

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75. 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:

Explanation

RATIONALE: Urine output less than 50 ml in 24 hours is called anuria. Urine output of less than 400 ml in 24 hours is calledoliguria.Polyuriais excessive urination.Hematuriais the presence of blood in the urine.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Comprehension

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1515.

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76. A client who has cervical cancer is scheduled to undergo internal radiation. In teaching the client about the procedure, the nurse should tell the client that:

Explanation

RATIONALE: The nurse should tell the client that she'll receive an enema before the procedure because bowel motility during cervical radiation implant therapy can disrupt or dislodge the implants. The client will be in a private room, but activities will be restricted to keep the implants in place. To keep the bladder empty, an indwelling catheter will be used. Positioning in bed shouldn't exceed a 20-degree elevation because sitting up can cause the implants to move from their intended locations. Semi-Fowler's positionis 45 degrees.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1684.

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77. A client with chronic renal failure (CRF) is admitted to the urology unit. Which diagnostic test results are consistent with CRF?

Explanation

RATIONALE: The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges from 0.7 to 1.5 mg/dl. A BUN level of 100 mg/dl and a serum creatinine of 6.5 mg/dl are abnormally elevated results, reflecting CRF and the kidneys' decreased ability to remove nonprotein nitrogen waste from the blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF also increases serum levels of potassium, magnesium, and phosphorous, and decreases serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls within the normal range of 60% to 75%.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1528.

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78. A client is scheduled for urinary diversion surgery to treat bladder cancer. Before surgery, the health care team — consisting of a nurse, dietitian, social worker, enterostomal therapist, surgeon, client educator, and mental health worker — meets with the client. After the meeting, the client states, "My life won't ever be the same. What am I going to do?" Which health care team member should the nurse consult to help with the client's concerns?

Explanation

RATIONALE: The nurse should consult the client educator to help the client with his fears and concerns. Providing the client with information can greatly allay the client's fears. The social worker can provide the client with services he may need after discharge. Although the surgeon tells the client about the surgery, he isn't the best person to help the client with fears and concerns. The dietitian can help with dietary concerns but can't provide help with direct concerns about the surgery.

CLIENT NEEDS CATEGORY: Psychosocial integrity
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Analysis

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 505.

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79. A client is scheduled for a renal arteriogram. When the nurse checks the chart for allergies to shellfish or iodine, she finds no allergies recorded. The client is unable to provide the information. During the procedure, the nurse should be alert for which finding that may indicate an allergic reaction to the dye used during the arteriogram?

Explanation

RATIONALE: The nurse should be alert for pruritusandurticaria, which may indicate a mild anaphylactic reaction to the arteriogram dye. Decreased (not increased) alertness may occur as well asdyspnea(not hypoventilation). Unusually smooth skin isn't a sign ofanaphylaxis.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1508.

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80. A physician orders a single dose of trimethoprim/sulfamethoxazole (Bactrim) by mouth for a client diagnosed with an uncomplicated urinary tract infection. The pharmacy sends three unit-dose tablets. The nurse verifies the physician's order. What should the nurse do next?

Explanation

RATIONALE: The nurse should call the hospital pharmacy and question the medication supplied. The hospital pharmacist should be able to tell the nurse whether three tablets are necessary for the single dose or whether a dispensing error occurred. It isn't clear whether the three tablets are the single dose because they were packaged as a unit-dose. The physician's order was clearly written, so clarifying the order with the physician isn't necessary. Administering the tablets without clarification might cause a medication error.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 781.

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81. A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about:

Explanation

RATIONALE: A skin or upper respiratory infectionof streptococcal origin may lead to acuteglomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, andcytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhoodasthmaand a family history ofpernicious anemiaaren't significant history findings for a client with renal dysfunction.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1501.

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82. A nurse is teaching a female client with a history of multiple urinary tract infections(UTIs). Which statement indicates the client understands the teaching about preventing UTIs?

Explanation

RATIONALE: The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow. The client should wipe from front to back to avoid introducing bacteria from the anal area into the urethra. The client should shower, not bathe, to minimize the amount of bacteria that can enter the urethra. The client should increase her fluid intake, and void every 2 to 3 hours and completely empty her bladder. Holding urine in the bladder can cause the bladder to become distended, which places the client at further risk for UTI.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1577.

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83. A client who has been treated for chronic renal failure (CRF) is ready for discharge. The nurse should reinforce which dietary instruction?

Explanation

RATIONALE: A client with CRF requires extra carbohydrates to prevent protein catabolism. In a client with CRF, unrestricted intake of sodium, protein, potassium, and fluid may lead to a dangerous accumulation of electrolytes and protein metabolic products, such as amino acids and ammonia. Therefore, the client must limit intake of sodium; meat, which is high in protein; bananas, which are high in potassium; and fluid, because the failing kidneys can't secrete adequate urine. Salt substitutes are high in potassium and should be avoided.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1530.

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84. Which steps should a nurse follow to insert a straight urinary catheter?

Explanation

RATIONALE: Preparing the client and equipment, creating a sterile field, putting on gloves, cleaning the urinary meatus, and inserting the catheter until urine flows are all the vital steps for inserting a straight catheter. The nurse must prepare the client and equipment before creating a sterile field. Putting on gloves before creating a sterile field and performing the other tasks is incorrect. Testing the catheter balloon describes the procedure for inserting a retention catheter, rather than a straight catheter.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1527.

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85. A client with a genitourinary problem is being examined in the emergency department. When palpating the client's kidneys, the nurse should keep in mind which anatomic fact?

Explanation

RATIONALE: The left kidney usually is slightly higher than the right one. An adrenal gland lies atop each kidney. The average kidney measures approximately 11 cm (4⅜″) long, 5 to 5.8 cm (2″ to 2¼″) wide, and 2.5 cm (1″) thick. The kidneys are located retroperitoneally, in the posterior aspect of the abdomen, on either side of the vertebral column. They lie between the 12th thoracic and 3rd lumbar vertebrae.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1493.

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86. A client with a history of chronic cystitis comes to an outpatient clinic with signs and symptoms of this disorder. To prevent cystitis from recurring, the nurse recommends maintaining an acid-ash diet to acidify the urine, thereby decreasing the rate of bacterial multiplication. On an acid-ash diet, the client must restrict which beverage?

Explanation

RATIONALE: A client on an acid-ash diet must avoid milk and milk products because these make the urine more alkaline, encouraging bacterial growth. Other foods to avoid on this diet include all vegetables except corn and lentils; all fruits except cranberries, plums, and prunes; and any food containing large amounts of potassium, sodium, calcium, or magnesium. Cranberry and prune juice are encouraged because they acidify the urine. Coffee and tea are considered neutral because they don't alter the urine pH.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Comprehension

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1577.

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87. For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important?

Explanation

RATIONALE: During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failureandpulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn't take precedence over fluid limitation. Controlling pain isn't important because ARF rarely causes pain.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1526.

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88. A nurse is caring for a client with acute pyelonephritis. Which nursing intervention is the most important?

Explanation

RATIONALE: Acute pyelonephritis is a sudden inflammation of the interstitial tissue and renal pelvis of one or both kidneys. Infecting bacteria are normal intestinal and fecal flora that grow readily in urine. Pyelonephritis may result from procedures that involve the use of instruments (such as catheterization, cystoscopy, and urologic surgery) or from hematogenic infection. The most important nursing intervention is to increase fluid intake to 3 L/day. Doing so helps empty the bladder of contaminated urine and prevents calculus formation. Administering a sitz bath would increase the likelihood of fecal contamination. Using an indwelling urinary catheter could cause further contamination. Encouraging the client to drink cranberry juice to acidify urine is helpful but isn't the most important intervention.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1578.

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89. During a rectal examination, which finding is evidence of a urethral injury?

Explanation

RATIONALE: When the urethra is ruptured, a hematoma or collection of blood separates the two sections of the urethra. This condition may feel like a boggy mass on rectal examination. Because of the rupture and hematoma, the prostate becomes high riding. A palpable prostate gland usually indicates a nonurethral injury. Absent sphincter tone would refer to a spinal cord injury. The presence of blood (a positive Hemoccult) would probably correlate with GI bleeding or a colon injury.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1595.

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90. A nurse is providing inservice education for staff members about evidence collection after sexual assault. The educational session is successful when staff members focus their initial care on which step?

Explanation

RATIONALE: The teaching session is successful when staff members focus first on supporting the client's emotional status. Next, staff members should gain consent to perform the pelvic examination, perform the examination, and collect evidence, such as semen if present.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 2551.

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91. A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl. The most therapeutic pharmacologic intervention would be to administer:

Explanation

RATIONALE: Chronic renal failure diminishes the production of erythropoietin by the kidneys and leads to a subnormal Hb level. (Normal Hb level is 13 to 18 g/dl in men and 12 to 16 g/dl in women.) An effective pharmacologic treatment for this is epoetin alfa, a recombinant erythropoietin. Because the client's anemia is caused by a deficiency of erythropoietin and not a deficiency of iron, administering ferrous sulfate would be ineffective. Neither filgrastim, a drug used to stimulate neutrophils, nor enoxaparin (low-molecular-weight heparin) will raise the client's Hb level.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Analysis

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 501.

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92. A nurse is caring for a client who's ordered continuous ambulatory peritoneal dialysis (CAPD). Which finding should lead the nurse to question the client's suitability for CAPD?

Explanation

RATIONALE: A history of diverticulitiscontraindicates CAPD because CAPD has been associated with the rupture of diverticulum. A history of severe anemia while on hemodialysis or being on the transplant waiting list doesn't contraindicate CAPD. The client who's blind or partially blind can still learn to perform CAPD.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1549.

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93. A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond?

Explanation

RATIONALE: Treatment for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin (Zithromax) is also ordered. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 2507.

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94. During rounds, a client admitted with gross hematuriaasks the nurse about the physician's diagnosis. To facilitate effective communication, what should the nurse do?

Explanation

RATIONALE: Providing privacy for the conversation is a form of active listening, which focuses solely on the client's needs. Asking why the client is concerned, changing the subject, or giving advice tends to block therapeutic communication.

CLIENT NEEDS CATEGORY: Psychosocial integrity
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Application

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 486.

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95. After trying for a year to conceive, a couple consults an infertility specialist. When obtaining a history from the husband, the nurse asks about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility?

Explanation

RATIONALE: Mumps is the childhood infectious disease that most significantly affects male fertility. Chickenpox, measles, and scarlet fever don't affect male fertility.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge

REFERENCE: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing and Childrearing Family,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2006, p. 139.

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96. A client receiving total parenteral nutritionis ordered a 24-hour urine test. When initiating a 24-hour urine specimen, the collection time should:

Explanation

RATIONALE: When initiating a 24-hour urine specimen, have the client void, then start the timing. The collection should start on an empty bladder. The exact time the test starts isn't important but the test is commonly started in the morning.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Knowledge

REFERENCE: Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care,6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1496.

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97. A client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 ml, the nurse suspects that the client is at risk for:

Explanation

RATIONALE: As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't causeparesthesia(sensations of numbness and tingling).Dehydrationdoesn't occur during this oliguric phase of ARF, although typically it does arise during thediureticphase. In the client with ARF,pruritusresults from increased phosphates and isn't associated with hyperkalemia.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1526.

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98. A client with renal insufficiency is admitted to the hospital with pneumonia. He's being treated with gentamicin (Garamycin). Which laboratory value should be closely monitored?

Explanation

RATIONALE: BUN and creatinine levels should be closely monitored to detect elevations caused by nephrotoxicity. Sodium level should be routinely monitored in all hospitalized clients. Alkaline phosphatase helps evaluate liver function. The WBC count should be monitored to evaluate the effectiveness of the antibiotic; it doesn't help evaluate kidney function.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 636.

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99. Which clinical finding should a nurse look for in a client with chronic renal failure?

Explanation

RATIONALE: Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosisresults from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin. Hypertension (from fluid overload) may or may not be present in chronic renal failure. Hypotension,metabolic alkalosis, and polycythemia aren't present in renal failure.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1528.

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100. Two weeks after being diagnosed with a streptococcal infection, a client develops fatigue, a low-grade fever, and shortness of breath. The nurse auscultates bilateralcracklesand observes jugular vein distention. Urinalysis reveals red and white blood cells and protein. After the physician diagnoses poststreptococcalglomerulonephritis, the client is admitted to the medical-surgical unit. Which immediate action should the nurse take?

Explanation

RATIONALE: The nurse must provide a high-protein diet to supply energy and reduce catabolism of protein. The nurse must also closely monitor the client's fluid intake and output. It isn't necessary for the client to be on bed rest. Because of the risk of altered urinary elimination related to oliguria, this client may require hemodialysis or plasmapheresis for several weeks until renal function improves; however, a Tenckhoff catheter is used inperitoneal dialysis, not hemodialysis. Although providing comfort measures (such as placing the client on a sheepskin) are important, this action isn't a priority.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1518.

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101. A client scheduled for a vasectomy asks the nurse how soon after the procedure he can have sexual intercourse without using an alternative birth control method. How should the nurse respond?

Explanation

RATIONALE: After a vasectomy, sterilization isn't ensured until the client's sperm count measures zero. This usually requires 6 to 36 ejaculations. Having intercourse immediately after the procedure or as soon as discomfort disappears may lead to pregnancy.

CLIENT NEEDS CATEGORY: Health promotion and maintenance
CLIENT NEEDS SUBCATEGORY: None
COGNITIVE LEVEL: Comprehension

REFERENCE: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing and Childrearing Family,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 122.

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102. A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:

Explanation

RATIONALE: Renal calculi usually presents as a dull, constant ache at the costovertebral angle. The client may also present with nausea and vomiting, diaphoresis, and pallor. The client with an overdistended bladder and interstitial cystitis presents with dull, continuous pain at the suprapubic area that's intense with voiding. The client also complains of urinary urgency and straining to void. The client with acute prostatitis presents with a feeling of fullness in the perineum and vague back pain, along with frequency, urgency, and dysuria.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1502.

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103. A charge nurse is making arrangements for an elderly client newly admitted from the emergency department for treatment of suspected pyelonephritis. The charge nurse notes that the client has been assigned to a semiprivate room with another client who has the same last name. What should the nurse do first?

Explanation

RATIONALE: To prevent errors, the charge nurse should ask the admissions department to assign the elderly client to another room. Making signs and verbally alerting staff members don't eliminate the risk of error. It isn't appropriate to ask the client if he'd be willing to answer to a different last name.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 678.

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104. A client with heart failureis admitted to an acute care facility and is found to have a cystocele. When planning care for this client, the nurse is most likely to formulate which nursing diagnosis?

Explanation

RATIONALE: Stress urinary incontinenceis a urinary problem associated with cystocele — herniation of the bladder into the birth canal. Other problems associated with this disorder include urinary frequency, urinary urgency,urinary tract infection, and difficulty emptying the bladder. Total incontinence, functional incontinence, and reflex incontinence usually result from neurovascular dysfunction, not cystocele.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1674.

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105. A nurse is teaching a client about peritoneal dialysis. The nurse should tell the client the dwell time is:

Explanation

RATIONALE: The average dwell time is about 20 minutes. The fluid infuses within 10 minutes, dwells for 20 minutes, and then drains in about 20 minutes. The diffusion on the small particles into the dialysate peaks in the first 10 minutes.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Comprehension

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1547.

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106. To treat a urinary tract infection, a client is ordered trimethoprim-sulfamethoxazole (Bactrim). The nurse should teach the client that trimethoprim-sulfamethoxazole is most likely to cause which adverse effect?

Explanation

RATIONALE: Trimethoprim-sulfamethoxazole is most likely to cause diarrhea. Nausea and vomiting are other common adverse effects. This drug rarely causes anxiety, headache, or dizziness.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Knowledge

REFERENCE: Springhouse Nurse's Drug Guide 2007.Philadelphia: Lippincott Williams & Wilkins, 2007, p. 365.

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107. A nurse is caring for an elderly male client who complains that he can't pass urine. A bladder scan reveals 600 ml of urine present in the bladder. The nurse attempts to place the indwelling catheter the physician ordered, but resistance prevents her from placing it. A serum prostate-specific antigen (PSA) test indicates a level of 29 g/L. The physician places an indwelling catheter and the urine specimen returns positive for nitrites, leukocytes, and bacteriuria. Which conditions should the nurse suspect? Select all that apply.

Explanation

RATIONALE: An elevated PSA level and lower urinary tract symptoms may indicate a prostate problem. A urine specimen positive for leukocytes, nitrites, and bacteriuria indicates UTI. The client's signs and symptoms don't indicate acute renal failure, liver failure, or a vitamin K deficiency.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1573.

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108. A client with depression and behavioral changes is transferred from a local assisted living center to the emergency department. The nurse notes that the client cries out when she approaches. When the nurse gains the client's confidence and performs an assessment, the nurse notes bruising of the labia and a lateral laceration in the perineal area. When the nurse asks the client about the injury, the client shakes her head and begins to cry "don't tell, don't tell." The nurse suspects sexual abuse. How should the nurse proceed?

Explanation

RATIONALE: The nurse should attend to the client's immediate physiological needs, including physical safety. Next, the nurse can notify the physician and the rape crisis team. The family should be notified if the client consents, but not until the rape investigation is complete.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 2551.

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109. Which statement best describes the therapeutic action of loop diuretics?

Explanation

RATIONALE: Loop diuretics block sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. They also dilate renal vessels. Although loop diuretics block potassium reabsorption, this isn't a therapeutic action. Thiazide diuretics, not loop diuretics, promote sodium secretion into the distal tubule.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Comprehension

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 953.

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110. A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomynurse. Which assessment finding indicates the need for further consultation?

Explanation

RATIONALE: Red, sensitive skin around the stoma site may indicate an ill-fitting appliance Beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Analysis

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical Surgical-Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1259.

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111. A charge nurse is completing day-shift client care assignments on the genitourinary floor. A new graduate is present for her first day on the unit. An agency nurse and an experienced nurse are also present on the unit. The charge nurse should assign the new graduate to the care of:

Explanation

RATIONALE: The charge nurse should assign the new nurse to the elderly client newly diagnosed with bladder cancer awaiting surgery, the elderly client who recently had a prostatectomy with bladder irrigation, and the elderly client with renal insufficiency. These clients have conditions common to the genitourinary floor. The charge nurse should assign the agency nurse to the client who had an ileo conduit, the older adult client with a UTI, and the adolescent with kidney stones. Their conditions have lesser acuity. The charge nurse should assign the experienced nurse to the most acute clients: the middle-age kidney-transplant recipient, the older adult client in acute renal failure, the older adult client with urinarysepsis, the older adult client just admitted for acutestroke, the young adult client with suspected kidney stones, and the middle-age client with suspectedpyelonephritis.

CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Management of care
COGNITIVE LEVEL: Application

REFERENCE: Craven, R.F., and Hirnle, C.J. Fundamentals of Nursing: Human Health and Function,5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007, p. 116.

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112. After undergoing a total cystectomy and urinary diversion, a client has a Kock pouch (continent internal reservoir) in place. Which statement by the client indicates a need for further teaching?

Explanation

RATIONALE: The client requires additional teaching if he states that he'll have to wear an external collection pouch for the rest of his life. An internal collection pouch, such as the Kock pouch, allows the client to perform self-catheterization for ileal drainage. This pouch is an internal reservoir, eliminating the need for an external collection pouch. A well-balanced diet is essential for healing; the client need not include or exclude particular foods. The client should drink at least eight glasses of fluid daily to prevent calculi formation and urinary tract infection. Intervals between pouch drainings should be increased gradually until the pouch is emptied two to four times daily.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Basic care and comfort
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1261.

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113. 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?

Explanation

RATIONALE: Intrinsic renal failure results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins. Poor perfusion to the kidneys may result in prerenal failure. Damage to the epithelial cells of the renal tubules results from nephrotoxic injury, not damage to the adrenal cortex. Obstruction of the urinary collecting system may cause postrenal failure.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1522.

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114. A nurse is caring for a client with chronic renal failure. The laboratory results indicate hypocalcemia and hyperphosphatemia. When assessing the client, the nurse should be alert for which signs and symptoms? Select all that apply.

Explanation

RATIONALE: Hypocalcemia is a calcium deficit that causes nerve fiber irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include Trousseau's sign, cardiacarrhythmias, diarrhea, increased clotting times, anxiety, and irritability. The calcium-phosphorus imbalance leads to brittle bones and pathologic fractures.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Reduction of risk potential
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 325.

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115. Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blockergiven to a client with benign prostatic hyperplasia (BPH)?

Explanation

RATIONALE: The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Pharmacological and parenteral therapies
COGNITIVE LEVEL: Application

REFERENCE: Smeltzer, S.C., et al. Brunner & Suddarth's Textbook of Medical-Surgical Nursing,11th ed. Philadelphia: Lippincott Williams & Wilkins, 2008, p. 1752.

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After a retropubic prostatectomy, a client needs continuous bladder...
After undergoing renal arteriogram, in which the left groin was...
A nurse preceptor is observing a new graduate during care of a client...
A client with renal failure is undergoing continuous ambulatory...
A nurse is assessing a male client diagnosed with gonorrhea. Which...
A client underwent a transurethral resection of the prostate gland 24...
Because of difficulties with hemodialysis, peritoneal dialysisis...
A client requires hemodialysis. Which type of drug should be withheld...
A client with acute renal failure is undergoing dialysis for the first...
A nurse is explaining menstruation to a class. Place the steps of the...
A client returns to an intensive care unit after coronary artery...
After undergoing transurethral resection of the prostate to treat...
A nurse is inserting a urinary catheter into a client who is extremely...
A physician enters a computer order for a nurse to irrigate a...
A registered nurse and a nursing assistant are caring for a group of...
A nurse is reviewing a report of a client's routine urinalysis....
A nurse is collecting a health history on a client who's to...
A client is ordered continuous bladder irrigation at a rate of 60...
A nurse is planning to administer a sodium polystyrene sulfonate...
A client is admitted for treatment of chronic renal failure (CRF). The...
A client on the genitourinary floor has refused all medications for 3...
A nurse is providing postprocedure care for a client who underwent...
When a client with an indwelling urinary catheter wants to walk to the...
A nurse is caring for a client diagnosed with ovarian cancer....
A nurse is caring for an 8-year-old girl with multiple chronic urinary...
A client with a history of bladder retention hasn't voided for 8...
A client is scheduled for a creatinine clearance test. The nurse...
After having transurethral resection of the prostate (TURP), a client...
A client with benign prostatic hyperplasia doesn't respond to...
A client with a history of chronic renal failure receives hemodialysis...
A client comes to the emergency department complaining of sudden onset...
A client admitted with a gunshot wound to the abdomen is transferred...
A nurse is reviewing a client's fluid intake and output record....
A client with a urinary tract infectionis ordered co-trimoxazole...
A nurse is planning a group teaching session on the topic of urinary...
A nurse is caring for a male client with gonorrhea. The client asks...
A client with an indwelling urinary catheter is suspected of having a...
Which statement describing urinary incontinence in an elderly client...
After undergoing retropubic prostatectomy, a client returns to his...
A client with bladder cancer had his bladder removed and an ileal...
A client in a short-procedure unit is recovering from renal...
A client develops decreased renal function and requires a change in...
A client undergoes extracorporeal shock wave lithotripsy. Before...
A client comes to the outpatient department complaining of vaginal...
A client is admitted for treatment of glomerulonephritis. On initial...
Which client is at highest risk for developing a hospital-acquired...
A nurse is caring for a client who had a stroke. Which nursing...
When performing a scrotal examination, a nurse finds a nodule. What...
Which laboratory value supports a diagnosis of pyelonephritis?
A client with acute pyelonephritisreceives a prescription for...
A client with chronic renal failure (CRF) is receiving a hemodialysis...
A triple-lumen indwelling urinary catheter is inserted for continuous...
A client with chronic renal failure (CRF) has developed faulty red...
After a radical prostatectomy for prostate cancer, a client has an...
A female client has just been diagnosed with condylomata acuminata...
A client with chronic renal failure has a serum potassium level of 6.8...
Which nursing diagnosis is appropriate for a client with renal...
A client is scheduled to undergo surgical creation of an ileal...
A nurse is caring for a client in acute renal failure. The nurse...
A nurse is teaching a client with genital herpes. Education for this...
A female client reports to a nurse that she experiences a loss of...
A client admitted to the unit with a diagnosis of end-stage renal...
An elderly client with a diagnosis of chronic renal failure is being...
A client with suspected renal dysfunction is scheduled for excretory...
A client reports experiencing vulvar pruritus. Which assessment factor...
A female client seeks care for a possible infection. Her symptoms...
A nurse is reviewing a client's medical history. Which factor...
A nurse correctly identifies a urine specimen with a pH of 4.3 as...
A nurse is caring for a client diagnosed with a chlamydia infection....
A client is frustrated and embarrassed by urinary incontinence. Which...
A client comes to the emergency department complaining of severe pain...
A nurse receives her client care assignment. Following the report, she...
A nurse is caring for a client who also works in the hospital, has...
A client is admitted with nausea, vomiting, and diarrhea. His blood...
A nurse is caring for a client diagnosed with acute renal failure. The...
A client who has cervical cancer is scheduled to undergo internal...
A client with chronic renal failure (CRF) is admitted to the urology...
A client is scheduled for urinary diversion surgery to treat bladder...
A client is scheduled for a renal arteriogram. When the nurse checks...
A physician orders a single dose of trimethoprim/sulfamethoxazole...
A client with renal dysfunction of acute onset comes to the emergency...
A nurse is teaching a female client with a history of multiple urinary...
A client who has been treated for chronic renal failure (CRF) is ready...
Which steps should a nurse follow to insert a straight urinary...
A client with a genitourinary problem is being examined in the...
A client with a history of chronic cystitis comes to an outpatient...
For a client in the oliguric phase of acute renal failure (ARF), which...
A nurse is caring for a client with acute pyelonephritis. Which...
During a rectal examination, which finding is evidence of a urethral...
A nurse is providing inservice education for staff members about...
A client with chronic renal failure who receives hemodialysis three...
A nurse is caring for a client who's ordered continuous ambulatory...
A nurse is caring for a male client with gonorrhea who's receiving...
During rounds, a client admitted with gross hematuriaasks the nurse...
After trying for a year to conceive, a couple consults an infertility...
A client receiving total parenteral nutritionis ordered a 24-hour...
A client develops acute renal failure (ARF) after receiving I.V....
A client with renal insufficiency is admitted to the hospital with...
Which clinical finding should a nurse look for in a client with...
Two weeks after being diagnosed with a streptococcal infection, a...
A client scheduled for a vasectomy asks the nurse how soon after the...
A client presents to the emergency department complaining of a dull,...
A charge nurse is making arrangements for an elderly client newly...
A client with heart failureis admitted to an acute care facility and...
A nurse is teaching a client about peritoneal dialysis. The nurse...
To treat a urinary tract infection, a client is ordered...
A nurse is caring for an elderly male client who complains that he...
A client with depression and behavioral changes is transferred from a...
Which statement best describes the therapeutic action of loop...
A nurse is caring for a client who had an ileo conduit 3 days earlier....
A charge nurse is completing day-shift client care assignments on the...
After undergoing a total cystectomy and urinary diversion, a client...
A client with decreased urine output refractory to fluid challenges is...
A nurse is caring for a client with chronic renal failure. The...
Which factor should be checked when evaluating the effectiveness of an...
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