Documentgu

Congratulations - you have completed NCLEX Exam: Renal Disorders and

Management 1 (50 Items).

You scored 37 out of 50.

Your performance has been rated as Not bad!

Your answers are highlighted below.

Question 1

CORRECT

You expect a patient in the oliguric phase of renal failure to have a 24 hour urine

output less than:

200ml

400ml

800ml

1000ml

Question 1 Explanation:

Oliguria is defined as urine output of less than 400ml/24hours.

Question 2

CORRECT

Your patient with chronic renal failure reports pruritus. Which instruction should

you include in this patient’s teaching plan?

Rub the skin vigorously with a towel

Take frequent baths

Apply alcohol-based emollients to the skin

Keep fingernails short and clean


Calcium-phosphate deposits in the skin may cause pruritus. Scratching leads to

excoriation and breaks in the skin that increase the patient’s risk of infection.

Keeping fingernails short and clean helps reduce the risk of infection.

Question 3

CORRECT

You have a patient that might have a urinary tract infection (UTI). Which

statement by the patient suggests that a UTI is likely?

“I pee a lot.”

“It burns when I pee.”

“I go hours without the urge to pee.”

“My pee smells sweet.”


A common symptom of a UTI is dysuria. A patient with a UTI often reports

frequent voiding of small amounts and the urgency to void. Urine that smells

sweet is often associated with diabetic ketoacidosis.

Question 4

CORRECT

You’re planning your medication teaching for your patient with a UTI prescribed

phenazopyridine (Pyridium). What do you include?

“Your urine might turn bright orange.”

“You need to take this antibiotic for 7 days.”

“Take this drug between meals and at bedtime.”

“Don’t take this drug if you’re allergic to penicillin.”


The drug turns the urine orange. It may be prescribed for longer than 7 days and

is usually ordered three times a day after meals. Phenazopyridine is an azo

(nitrogenous) analgesic; not an antibiotic.

Question 5

CORRECT

You have a paraplegic patient with renal calculi. Which factor contributes to the

development of calculi?

Increased calcium loss from the bones

Decreased kidney function

Decreased calcium intake

High fluid intake


Bones lose calcium when a patient can no longer bear weight. The calcium lost

from bones form calculi, a concentration of mineral salts also known as a stone,

in the renal system.

Question 6

CORRECT

You suspect kidney transplant rejection when the patient shows which

symptoms?

Pain in the incision, general malaise, and hypotension

Pain in the incision, general malaise, and depression

Fever, weight gain, and diminished urine output

Diminished urine output and hypotension


Symptoms of rejection include fever, rapid weight gain, hypertension, pain over

the graft site, peripheral edema, and diminished urine output.

Question 7

CORRECT

Which sign indicated the second phase of acute renal failure?

Daily doubling of urine output (4 to 5 L/day)

Urine output less than 400 ml/day

Urine output less than 100 ml/day

Stabilization of renal function


Daily doubling of the urine output indicates that the nephrons are healing. This

means the patient is passing into the second phase (dieresis) of acute renal

failure.

Question 8

CORRECT

Your patient has complaints of severe right-sided flank pain, nausea, vomiting

and restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP

140/90 mmHg, Pulse 118 beats/min., respirations 33 breaths/minute, and

temperature, 98.0F. Which subjective data supports a diagnosis of renal calculi?

Pain radiating to the right upper quadrant

History of mild flu symptoms last week

Dark-colored coffee-ground emesis

Dark, scanty urine output


Patients with renal calculi commonly have blood in the urine caused by the

stone’s passage through the urinary tract. The urine appears dark, tests positive

for blood, and is typically scant.

Question 9

CORRECT

What change indicates recovery in a patient with nephrotic syndrome?

Disappearance of protein from the urine

Decrease in blood pressure to normal

Increase in serum lipid levels

Gain in body weight


With nephrotic syndrome, the glomerular basement membrane of the kidney

becomes more porous, leading to loss of protein in the urine. As the patient

recovers, less protein is found in the urine.

Question 10

CORRECT

A patient who received a kidney transplant returns for a follow-up visit to the

outpatient clinic and reports a lump in her breast. Transplant recipients are:

At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral)

Consumed with fear after the life-threatening experience of having a transplant

At increased risk for tumors because of the kidney transplant

At decreased risk for cancer, so the lump is most likely benign


Cyclosporine suppresses the immune response to prevent rejection of the

transplanted kidney. The use of cyclosporine places the patient at risk for

tumors.

Question 11

CORRECT

A patient returns from surgery with an indwelling urinary catheter in place and

empty. Six hours later, the volume is 120ml. The drainage system has no

obstructions. Which intervention has priority?

Give a 500 ml bolus of isotonic saline

Evaluate the patient’s circulation and vital signs

Flush the urinary catheter with sterile water or saline

Place the patient in the shock position, and notify the surgeon


A total UO of 120ml is too low. Assess the patient’s circulation and hemodynamic

stability for signs of hypovolemia. A fluid bolus may be required, but only after

further nursing assessment and a doctor’s order.

Question 12

CORRECT

Which of the following symptoms do you expect to see in a patient diagnosed

with acute pyelonephritis?

Jaundice and flank pain

Costovertebral angle tenderness and chills

Burning sensation on urination

Polyuria and nocturia


Costovertebral angle tenderness, flank pain, and chills are symptoms of acute

pyelonephritis. Jaundice indicates gallbladder or liver obstruction. A burning

sensation on urination is a sign of lower urinary tract infection.

Question 13

CORRECT

Which of the following causes the majority of UTI’s in hospitalized patients?

Lack of fluid intake

Inadequate perineal care

Invasive procedures

Immunosuppression


Invasive procedures such as catheterization can introduce bacteria into the

urinary tract. A lack of fluid intake could cause concentration of urine, but

wouldn’t necessarily cause infection.

Question 14

CORRECT

A patient is experiencing which type of incontinence if she experiences leaking

urine when she coughs, sneezes, or lifts heavy objects?

Overflow

Reflex

Stress

Urge


Stress incontinence is an involuntary loss of a small amount of urine due to

sudden increased intra-abdominal pressure, such as with coughing or sneezing.

Question 15

WRONG

What is the appropriate infusion time for the dialysate in your 38 y.o. patient with

chronic renal failure?

15 minutes

30 minutes

1 hour

2 to 3 hours


Dialysate should be infused quickly. The dialysate should be infused over 15

minutes or less when performing peritoneal dialysis. The fluid exchange takes

place over a period ranging from 30 minutes to several hours.

Question 16

CORRECT

Which intervention do you plan to include with a patient who has renal calculi?

Maintain bed rest

Increase dietary purines

Restrict fluids

Strain all urine


All urine should be strained through gauze or a urine strainer to catch stones that

are passed. The stones are then analyzed for composition. Ambulation may help

the movement of the stone down the urinary tract. Encourage fluid to help flush

the stones out.

Question 17

CORRECT

What is the most important nursing diagnosis for a patient in end-stage renal

disease?

Risk for injury

Fluid volume excess

Altered nutrition: less than body requirements

Activity intolerance


Kidneys are unable to rid the body of excess fluids which results in fluid volume

excess during ESRD.

Question 18

CORRECT

You’re preparing for urinary catheterization of a trauma patient and you observe

bleeding at the urethral meatus. Which action has priority?

Irrigate and clean the meatus before catheterization

Check the discharge for occult blood before catheterization

Heavily lubricate the catheter before insertion

Delay catheterization and notify the doctor


Bleeding at the urethral meatus is evidence that the urethra is injured. Because

catheterization can cause further harm, consult with the doctor.

Question 19

CORRECT

Clinical manifestations of acute glomerulonephritis include which of the

following?

Chills and flank pain

Oliguria and generalized edema

Hematuria and proteinuria

Dysuria and hypotension


Hematuria and proteinuria indicate acute glomerulonephritis. These finding result

from increased permeability of the glomerular membrane due to the antigen-

antibody reaction. Generalized edema is seen most often in nephrosis.

Question 20

WRONG

A 30 y.o. female patient is undergoing hemodialysis with an internal

arteriovenous fistula in place. What do you do to prevent complications

associated with this device?

Insert I.V. lines above the fistula.

Avoid taking blood pressures in the arm with the fistula

Palpate pulses above the fistula

Report a bruit or thrill over the fistula to the doctor


Don’t take blood pressure readings in the arm with the fistula because the

compression could damage the fistula. IV lines shouldn’t be inserted in the arm

used for hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill

should be reported to the doctor.

Question 21

CORRECT

Immunosuppression following Kidney transplantation is continued:

For life

24 hours after transplantation

A week after transplantation

Until the kidney is not anymore rejected


For life.

Question 22

CORRECT

What is the priority nursing diagnosis with your patient diagnosed with end-stage

renal disease?

Activity intolerance

Fluid volume excess

Knowledge deficit

Pain


Fluid volume excess because the kidneys aren’t removing fluid and wastes. The

other diagnoses may apply, but they don’t take priority.

Question 23

WRONG

Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which

information is important for providing care for the patient?

The patient shouldn’t feel pain during initiation of dialysis

The patient feels best immediately after the dialysis treatment

Using a stethoscope for auscultating the fistula is contraindicated

Taking a blood pressure reading on the affected arm can cause clotting of the fistula


Pressure on the fistula or the extremity can decrease blood flow and precipitate

clotting, so avoid taking blood pressure on the affected arm.

Question 24

WRONG

Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal

disease. The priority intervention is:

Call the doctor immediately

Give the patient IV lidocaine (Xylocaine)

Prepare to defibrillate the patient

Check the patient’s latest potassium level


The patient with ESRD may develop arrhythmias caused by hypokalemia. Call the

doctor after checking the patient’s potassium values. Lidocaine may be ordered if

the PVCs are frequent and the patient is symptomatic.

Question 25

CORRECT

Which patient is at greatest risk for developing a urinary tract infection (UTI)?

A 35 y.o. woman with a fractured wrist

A 20 y.o. woman with asthma

A 50 y.o. postmenopausal woman

A 28 y.o. with angina


Women are more prone to UTI’s after menopause due to reduced estrogen

levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli

bacteria, which protect against infection. Angina, asthma and fractures don’t

increase the risk of UTI.

Question 26

CORRECT

Your patient returns from the operating room after abdominal aortic aneurysm

repair. Which symptom is a sign of acute renal failure?

Anuria

Diarrhea

Oliguria

Vomiting


Urine output less than 50ml in 24 hours signifies oliguria, an early sign of renal

failure. Anuria is uncommon except in obstructive renal disorders.

Question 27

CORRECT

Which finding leads you to suspect acute glomerulonephritis in your 32 y.o.

patient?

Dysuria, frequency, and urgency

Back pain, nausea, and vomiting

Hypertension, oliguria, and fatigue

Fever, chills, and right upper quadrant pain radiating to the back


Mild to moderate HTN may result from sodium or water retention and

inappropriate renin release from the kidneys. Oliguria and fatigue also may be

seen. Other signs are proteinuria and azotemia.

Question 28

CORRECT

Which instructions do you include in the teaching care plan for a patient with

cystitis receiving phenazopyridine (Pyridium).

If the urine turns orange-red, call the doctor.

Take phenazopyridine just before urination to relieve pain.

Once painful urination is relieved, discontinue prescribed antibiotics.

After painful urination is relieved, stop taking phenazopyridine.


Pyridium is taken to relieve dysuria because is provides an analgesic and

anesthetic effect on the urinary tract mucosa. The patient can stop taking it after

the dysuria is relieved. The urine may temporarily turn red or orange due to the

dye in the drug. The drug isn’t taken before voiding, and is usually taken 3 times

a day for 2 days.

Question 29

CORRECT

A patient with diabetes has had many renal calculi over the past 20 years and

now has chronic renal failure. Which substance must be reduced in this patient’s

diet?

Carbohydrates

Fats

Protein

Vitamin C


Because of damage to the nephrons, the kidney can’t excrete all the metabolic

wastes of protein, so this patient’s protein intake must be restricted. A higher

intake of carbs, fats, and vitamin supplements is needed to ensure the growth

and maintenance of the patient’s tissues.

Question 30

WRONG

Your patient is complaining of muscle cramps while undergoing hemodialysis.

Which intervention is effective in relieving muscle cramps?

Increase the rate of dialysis

Infuse normal saline solution

Administer a 5% dextrose solution

Encourage active ROM exercises


Treatment includes administering normal saline or hypertonic normal saline

solution because muscle cramps can occur when the sodium and water are

removed to quickly during dialysis. Reducing the rate of dialysis, not increasing

it, may alleviate muscle cramps.

Question 31

CORRECT

A patient diagnosed with sepsis from a UTI is being discharged. What do you plan

to include in her discharge teaching?

Take cool baths

Avoid tampon use

Avoid sexual activity

Drink 8 to 10 eight-oz glasses of water daily


Drinking 2-3L of water daily inhibits bacterial growth in the bladder and helps

flush the bacteria from the bladder. The patient should be instructed to void after

sexual activity.

Question 32

WRONG

After the first hemodialysis treatment, your patient develops a headache,

hypertension, restlessness, mental confusion, nausea, and vomiting. Which

condition is indicated?

Disequilibrium syndrome

Respiratory distress

Hypervolemia

Peritonitis


Disequilibrium occurs when excess solutes are cleared from the blood more

rapidly than they can diffuse from the body’s cells into the vascular system.

Question 33

WRONG

A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis.

Which intervention do you include in his plan of care?

Apply pressure to the needle site upon discontinuing hemodialysis

Keep the head of the bed elevated 45 degrees

Place the left arm on an arm board for at least 30 minutes

Keep the left arm dry


Apply pressure when discontinuing hemodialysis and after removing the

venipuncture needle until all the bleeding has stopped. Bleeding may continue

for 10 minutes in some patients.

Question 34

CORRECT

A 22 y.o. patient with diabetic nephropathy says, “I have two kidneys and I’m still

young. If I stick to my insulin schedule, I don’t have to worry about kidney

damage, right?” Which of the following statements is the best response?

“You have little to worry about as long as your kidneys keep making urine.”

“You should talk to your doctor because statistics show that you’re being unrealistic.”

“You would be correct if your diabetes could be managed with insulin.”

“Even with insulin, kidney damage is still a concern.”


Kidney damage is still a concern. Microvascular changes occur in both of the

patient’s kidneys as a complication of the diabetes. Diabetic nephropathy is the

leading cause of end-stage renal disease. The kidneys continue to produce urine

until the end stage. Nephropathy occurs even with insulin management.

Question 35

WRONG

Which criterion is required before a patient can be considered for continuous

peritoneal dialysis?

The patient must be hemodynamically stable

The vascular access must have healed

The patient must be in a home setting

Hemodialysis must have failed


Hemodynamic stability must be established before continuous peritoneal dialysis

can be started.

Question 36

CORRECT

Which action is most important during bladder training in a patient with a

neurogenic bladder?

Encourage the use of an indwelling urinary catheter

Set up specific times to empty the bladder

Encourage Kegel exercises

Force fluids


Instruct the patient with neurogenic bladder to write down his voiding pattern

and empty the bladder at the same times each day.

Question 37

CORRECT

Which drug is indicated for pain related to acute renal calculi?

Narcotic analgesics

Nonsteroidal anti-inflammatory drugs (NSAIDS)

Muscle relaxants

Salicylates


Narcotic analgesics are usually needed to relieve the severe pain of renal calculi.

Muscle relaxants are typically used to treat skeletal muscle spasms. NSAIDS and

salicylates are used for their anti-inflammatory and antipyretic properties and to

treat less severe pain.

Question 38

CORRECT

You have a patient that is receiving peritoneal dialysis. What should you do when

you notice the return fluid is slowly draining?

Check for kinks in the outflow tubing

Raise the drainage bag above the level of the abdomen

Place the patient in a reverse Trendelenburg position

Ask the patient to cough


Tubing problems are a common cause of outflow difficulties, check the tubing for

kinks and ensure that all clamps are open. Other measures include having the

patient change positions (moving side to side or sitting up), applying gentle

pressure over the abdomen, or having a bowel movement.

Question 39

WRONG

An 18 y.o. student is admitted with dark urine, fever, and flank pain and is

diagnosed with acute glomerulonephritis. Which would most likely be in this

student’s health history?

Renal calculi

Renal trauma

Recent sore throat

Family history of acute glomerulonephritis


The most common form of acute glomerulonephritis is caused by group A beta-

hemolytic streptococcal infection elsewhere in the body.

Question 40

CORRECT

What is the best way to check for patency of the arteriovenous fistula for

hemodialysis?

Pinch the fistula and note the speed of filling on release

Use a needle and syringe to aspirate blood from the fistula

Check for capillary refill of the nail beds on that extremity

Palpate the fistula throughout its length to assess for a thrill


The vibration or thrill felt during palpation ensures that the fistula has the desired

turbulent blood flow. Pinching the fistula could cause damage. Aspirating blood is

a needless invasive procedure.

Question 41

WRONG

You’re developing a care plan with the nursing diagnosis risk for infection for

your patient that received a kidney transplant. A goal for this patient is to:

Remain afebrile and have negative cultures

Resume normal fluid intake within 2 to 3 days

Resume the patient’s normal job within 2 to 3 weeks

Try to discontinue cyclosporine (Neoral) as quickly as possible


The immunosuppressive activity of cyclosporine places the patient at risk for

infection, and steroids can mask the signs of infection. The patient may not be

able to resume normal fluid intake or return to work for an extended period of

time and the patient may need cyclosporine therapy for life.

Question 42

CORRECT

A patient with diabetes mellitus and renal failure begins hemodialysis. Which diet

is best on days between dialysis treatments?

Low-protein diet with unlimited amounts of water

Low-protein diet with a prescribed amount of water

No protein in the diet and use of a salt substitute

No restrictions


The patient should follow a low-protein diet with a prescribed amount of water.

The patient requires some protein to meet metabolic needs. Salt substitutes

shouldn’t be used without a doctor’s order because it may contain potassium,

which could make the patient hyperkalemic. Fluid and protein restrictions are

needed.

Question 43

CORRECT

Your 60 y.o. patient with pyelonephritis and possible septicemia has had five UTIs

over the past two years. She is fatigued from lack of sleep, has lost weight, and

urinates frequently even in the night. Her labs show: sodium, 154 mEq/L;

osmolarity 340 mOsm/L; glucose, 127 mg/dl; and potassium, 3.9 mEq/L. Which

nursing diagnosis is priority?

Fluid volume deficit related to osmotic diuresis induced by hyponatremia

Fluid volume deficit related to inability to conserve water

Altered nutrition: Less than body requirements related to hypermetabolic state

Altered nutrition: Less than body requirements related to catabolic effects of insulin deficiency

Question 44

WRONG

Polystyrene sulfonate (Kayexalate) is used in renal failure to:

Correct acidosis

Reduce serum phosphate levels

Exchange potassium for sodium

Prevent constipation from sorbitol use


In renal failure, patients become hyperkalemic because they can’t excrete

potassium in the urine. Polystyrene sulfonate acts to excrete potassium by

pulling potassium into the bowels and exchanging it for sodium.

Question 45

CORRECT

Which statement correctly distinguishes renal failure from prerenal failure?

With prerenal failure, vasoactive substances such as dopamine (Intropin) increase blood pressure

With prerenal failure, there is less response to such diuretics as furosemide (Lasix)

With prerenal failure, an IV isotonic saline infusion increases urine output

With prerenal failure, hemodialysis reduces the BUN level


Prerenal failure is caused by such conditions as hypovolemia that impairs kidney

perfusion; giving isotonic fluids improves urine output. Vasoactive substances

can increase blood pressure in both conditions.

Question 46

WRONG

The most common early sign of kidney disease is:

Sodium retention

Elevated BUN level

Development of metabolic acidosis

Inability to dilute or concentrate urine


Increased BUN is usually an early indicator of decreased renal function.

Question 47

WRONG

The most indicative test for prostate cancer is:

A thorough digital rectal examination

Magnetic resonance imaging (MRI)

Excretory urography

Prostate-specific antigen


An elevated prostate-specific antigen level indicates prostate cancer, but it can

be falsely elevated if done after the prostate gland is manipulated. A digital

rectal examination should be done as part of the yearly screening, and then the

antigen test is done if the digital exam suggests cancer. MRI is used in staging

the cancer.

Question 48

CORRECT

Which cause of hypertension is the most common in acute renal failure?

Pulmonary edema

Hypervolemia

Hypovolemia

Anemia


Acute renal failure causes hypervolemia as a result of overexpansion of

extracellular fluid and plasma volume with the hypersecretion of renin.

Therefore, hypervolemia causes hypertension.

Question 49

CORRECT

Your patient becomes restless and tells you she has a headache and feels

nauseous during hemodialysis. Which complication do you suspect?

Infection

Disequilibrium syndrome

Air embolus

Acute hemolysis


Disequilibrium syndrome is caused by a rapid reduction in urea, sodium, and

other solutes from the blood. This can lead to cerebral edema and increased

intracranial pressure (ICP). Signs and symptoms include headache, nausea,

restlessness, vomiting, confusion, twitching, and seizures.

Question 50

CORRECT

Immediately post-op after a prostatectomy, which complications requires priority

assessment of your patient?

Pneumonia

Hemorrhage

Urine retention

Deep vein thrombosis


Hemorrhage is a potential complication. Urine retention isn’t a problem soon

after surgery because a catheter is in place. Pneumonia may occur if the patient

doesn’t cough and deep breathe. Thrombosis may occur later if the patient

doesn’t ambulate.

Congratulations - you have completed NCLEX Exam: Genitourinary System

Disorders 1 (50 Items).

You scored 30 out of 50.

Your performance has been rated as Not bad!

Your answers are highlighted below.

Question 1

CORRECT

A 55-year old 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, Nurse Gerry

asks the surgeon which prostatectomy procedure will be done. What is the most

widely used procedure for prostate gland removal?

Transurethral resection of the prostate (TURP)

Suprapubic prostatectomy

Retropubic prostatectomy

Transurethral laser incision of the prostate


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; they all require an incision.

Question 2

WRONG

Dr. Grey prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily, for a client

with a urinary tract infection (UTI). The client asks the nurse how long to continue

taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin

therapy is:

3 to 5 days.

7 to 10 days.

12 to 14 days.

10 to 21 days.


For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Taking

the drug for less than 7 days wouldn’t eradicate such an infection. Taking it for

more than 10 days isn’t necessary. Only a client with a complicated UTI must

take norfloxacin for 10 to 21 days.

Question 3

WRONG

The nurse is aware that the following findings would be further evidence of a

urethral injury in a male client during rectal examination?

A low-riding prostate

The presence of a boggy mass

Absent sphincter tone

A positive Hemoccult


When the urethra is ruptured, a hematoma or collection of blood separates the

two sections of urethra. This 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 non-urethral injury. Absent sphincter

tone would refer to a spinal cord injury. The presence of blood would probably

correlate with GI bleeding or a colon injury.

Question 4

WRONG

A 24-year old female client has just been diagnosed with condylomata acuminata

(genital warts). What information is appropriate to tell this client?

This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.

The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.

The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex.


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.

Question 5

WRONG

The client underwent a transurethral resection of the prostate gland 24 hours

ago and is on continuous bladder irrigation. Nurse Yonny is aware that the

following nursing interventions is appropriate?

Tell the client to try to urinate around the catheter to remove blood clots

Restrict fluids to prevent the client’s bladder from becoming distended

Prepare to remove the catheter

Use aseptic technique when irrigating the catheter


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. 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 only removed with a physician’s order.

Question 6

CORRECT

The nurse is aware that the following laboratory values supports a diagnosis of

pyelonephritis?

Myoglobinuria

Ketonuria

Pyuria

Low white blood cell (WBC) count


Pyelonephritis is diagnosed by the presence of leukocytosis, hematuria, pyuria,

and bacteriuria. The client exhibits fever, chills, and flank pain. Because there is

often a septic picture, the WBC count is more likely to be high rather than low, as

indicated in option D. Ketonuria indicates a diabetic state.

Question 7

WRONG

A female client requires hemodialysis. Which of the following drugs should be

withheld before this procedure?

Phosphate binders

Insulin

Antibiotics

Cardiac glycosides


Cardiac glycosides such as digoxin should be withheld before hemodialysis.

Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a

hypokalemic client is at risk for arrhythmias secondary to digitalis 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.

Question 8

WRONG

Nurse Vic is monitoring the fluid intake and output of a female client recovering

from an exploratory laparotomy. Which nursing intervention would help the client

avoid a urinary tract infection (UTI)?

Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg

Limiting fluid intake to 1 L/day

Encouraging the client to use a feminine deodorant after bathing

Encouraging the client to douche once a day after removal of the indwelling urinary catheter


Maintaining a closed indwelling urinary catheter system helps prevent

introduction of bacteria; securing the catheter to the client’s leg also decreases

the risk of infection by helping to prevent urethral trauma. To flush bacteria from

the urinary tract, the nurse should encourage the client to drink at least 10

glasses of fluid daily, if possible. Douching and feminine deodorants may irritate

the urinary tract and should be discouraged.

Question 9

CORRECT

A male 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,

Nurse Billy suspects that the client is at risk for:

cardiac arrhythmia

paresthesia

dehydration

pruritus


As urine output decreases, the serum potassium level rises; if it rises sufficiently,

hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia

doesn’t cause paresthesia (sensations of numbness and tingling). Dehydration

doesn’t occur during this oliguric phase of ARF, although typically it does arise

during the diuretic phase. In a client with ARF, pruritus results from increased

phosphates and isn’t associated with hyperkalemia.

Question 10

WRONG

Nurse Lily is assessing a male client diagnosed with gonorrhea. Which symptom

most likely prompted the client to seek medical attention?

Rashes on the palms of the hands and soles of the feet

Cauliflower-like warts on the penis

Painful red papules on the shaft of the penis

Foul-smelling discharge from the penis


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.

Question 11

CORRECT

Nurse Pete is reviewing the report of a client’s routine urinalysis. Which value

should the nurse consider abnormal?

Specific gravity of 1.03

Urine pH of 3.0

Absence of protein

Absence of glucose


Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. 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, its color

ranging from pale yellow to deep amber.

Question 12

CORRECT

Nurse Pippy is reviewing a client’s fluid intake and output record. Fluid intake and

urine output should relate in which way?

Fluid intake should be double the urine output

Fluid intake should be approximately equal to the urine output

Fluid intake should be half the urine output

Fluid intake should be inversely proportional to the urine output


Normally, fluid intake is approximately 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.

Question 13

CORRECT

A female client with chronic renal failure (CRF) is receiving a hemodialysis

treatment. After hemodialysis, nurse Sarah knows that the client is most likely to

experience:

hematuria

weight loss

increased urine output

increased blood pressure


Because CRF causes loss of renal function, the client with this disorder retains

fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is 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.

Question 14

CORRECT

Nurse Karen is caring for a client who had a cerebrovascular accident (CVA).

Which nursing intervention promotes urinary continence?

Encouraging intake of at least 2 L of fluid daily

Giving the client a glass of soda before bedtime

Taking the client to the bathroom twice per day

Consulting with a dietitian


By encouraging a daily fluid intake of at least 2 L, the nurse 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 diuretic

and 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.

Question 15

CORRECT

A female client with an indwelling urinary catheter is suspected of having a

urinary tract infection. Nurse Angel should collect a urine specimen for culture

and sensitivity by:

disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container

wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle

draining urine from the drainage bag into a sterile container

clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine


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 is no urine in the tubing, the catheter may be

clamped for no more than 30 minutes to allow urine to collect.

Question 16

CORRECT

A male client with bladder cancer has had the bladder removed and an ileal

conduit created for urine diversion. While changing this client’s pouch, the nurse

observes that the area around the stoma is red, weeping, and painful. What

should Nurse Kaye conclude?

The skin wasn’t lubricated before the pouch was applied

The pouch faceplate doesn’t fit the stoma

A skin barrier was applied properly

Stoma dilation wasn’t performed.


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.

Question 17

WRONG

Nurse Harry 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:

limit oral fluid intake for 1 to 2 weeks.

report the presence of fine, sand-like particles through the nephrostomy tube.

notify the physician about cloudy or foul-smelling urine.

report bright pink urine within 24 hours after the procedure.


The client should report the presence of foul-smelling or cloudy urine. Unless

contraindicated, the client should be instructed to drink large quantities of fluid

each day to flush the kidneys. Sand-like debris is normal due to residual stone

products. Hematuria is common after lithotripsy.

Question 18

CORRECT

A male client is admitted for treatment of glomerulonephritis. On initial

assessment, Nurse Miley detects one of the classic signs of acute

glomerulonephritis of sudden onset. Such signs include:

generalized edema, especially of the face and periorbital area.

green-tinged urine.

moderate to severe hypotension.

polyuria.


Generalized edema, especially of the face and periorbital area, 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), oliguria or anuria (not

polyuria), headache, reduced visual acuity, and abdominal or flank pain.

Question 19

CORRECT

Nurse Erica is planning to administer a sodium polystyrene sulfonate

(Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct

administration and the effects of this enema would include having the client:

retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea

retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea

retain the enema for 60 minutes to allow for sodium exchange; diarrhea isn’t necessary to reduce the potassium level

retain the enema for 60 minutes to allow for glucose exchange; diarrhea isn’t necessary to reduce the potassium level


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.

Question 20

CORRECT

A male client who has been treated for chronic renal failure (CRF) is ready for

discharge. Nurse Billy should reinforce which dietary instruction?

“Be sure to eat meat at every meal.”

“Monitor your fruit intake, and eat plenty of bananas.”

“Increase your carbohydrate intake.”

“Drink plenty of fluids, and use a salt substitute.”


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. Extra

carbohydrates are needed to prevent protein catabolism.

Question 21

WRONG

A male client is scheduled for a renal clearance test. Nurse Sheldon should

explain that this test is done to assess the kidneys’ ability to remove a substance

from the plasma in:

1 minute

30 minutes

1 hour

24 hours


The renal 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.

Question 22

CORRECT

After trying to conceive for a year, a couple consults an infertility specialist.

When obtaining a history from the husband, Nurse Jessica inquires about

childhood infectious diseases. Which childhood infectious disease most

significantly affects male fertility?

Chickenpox

Measles

Mumps

Scarlet fever


Mumps is the most significant childhood infectious disease affecting male

fertility. Chickenpox, measles, and scarlet fever don’t affect male fertility.

Question 23

CORRECT

A female client has just been diagnosed with condylomata acuminata (genital

warts). What information is appropriate to tell this client?

This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.

The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.

The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex.


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.

Question 24

CORRECT

A female client with a urinary tract infection is prescribed co-trimoxazole

(trimethoprim-sulfamethoxazole). Nurse Dolly should provide which medication

instruction?

“Take the medication with food.”

“Drink at least eight 8-oz glasses of fluid daily.”

“Avoid taking antacids during co-trimoxazole therapy.”

“Don’t be afraid to go out in the sun.”


When receiving a sulfonamide such as co-trimoxazole, the client should 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.

Question 25

CORRECT

Nurse Eve is caring for a client who had a cerebrovascular accident (CVA). Which

nursing intervention promotes urinary continence?

Encouraging intake of at least 2 L of fluid daily

Giving the client a glass of soda before bedtime

Taking the client to the bathroom twice per day

Consulting with a dietitian


By encouraging a daily fluid intake of at least 2 L, the nurse 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 diuretic

and 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.

Question 26

CORRECT

After having transurethral resection of the prostate (TURP), a Mr. Lim 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?

The urine in the drainage bag appears red to pink

The client reports bladder spasms and the urge to void

The normal saline irrigant is infusing at a rate of 50 drops/minute

About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned


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 retained 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.

Question 27

WRONG

For a male client in the oliguric phase of acute renal failure (ARF), which nursing

intervention is most important?

Encouraging coughing and deep breathing

Promoting carbohydrate intake

Limiting fluid intake

Providing pain-relief measures


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 failure and pulmonary 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.

Question 28

CORRECT

A female client with acute renal failure is undergoing dialysis for the first time.

The nurse in charge monitors the client closely for dialysis equilibrium syndrome,

a complication that is most common during the first few dialysis sessions.

Typically, dialysis equilibrium syndrome causes:

confusion, headache, and seizures

acute bone pain and confusion

weakness, tingling, and cardiac arrhythmias

hypotension, tachycardia, and tachypnea


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 physiologic 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

arrhythmias suggest hyperkalemia, which is associated with renal failure.

Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis

complication.

Question 29

WRONG

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 nurse is aware that the functions of the three lumens include:

Continuous inflow and outflow of irrigation solution

Intermittent inflow and continuous outflow of irrigation solution

Continuous inflow and intermittent outflow of irrigation solution

Intermittent flow of irrigation solution and prevention of hemorrhage


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.

Question 30

WRONG

A male client comes to the emergency department complaining of sudden onset

of sharp, severe pain in the lumbar region, which radiates around the side and

toward the bladder. The client also reports nausea and vomiting and appears

pale, diaphoretic, and anxious. The physician tentatively diagnosed 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?

Kidney

Ureter

Bladder

Urethra


The most common site of renal calculi formation is the kidney. Calculi may travel

down the urinary tract with or without causing damage and may lodge anywhere

along the tract or may stay within the kidney. The ureter, bladder, and urethra

are less common sites of renal calculi formation.

Question 31

WRONG

Nurse Harry is aware that the following is an appropriate nursing diagnosis for a

client with renal calculi?

Ineffective tissue perfusion

Functional urinary incontinence

Risk for infection

Decreased cardiac output


Infection can occur with renal calculi from urine stasis caused by obstruction.

Options A and D aren’t appropriate for this diagnosis, and retention of urine

usually occurs, rather than incontinence.

Question 32

WRONG

A client comes to the outpatient department complaining of vaginal discharge,

dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD),

Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be

reported to the public health department?

Chlamydia

Gonorrhea

Genital herpes

Human papillomavirus infection


Gonorrhea must be reported to the public health department. Chlamydia, genital

herpes, and human papillomavirus infection aren’t reportable diseases.

Question 33

WRONG

When caring for a male client with acute renal failure (ARF), Nurse Fatrishia

expects to adjust the dosage or dosing schedule of certain drugs. Which of the

following drugs would not require such adjustment?

acetaminophen (Tylenol)

gentamicin sulfate (Garamycin)

cyclosporine (Sandimmune)

ticarcillin disodium (Ticar)


Because acetaminophen is metabolized in the liver, its dosage and dosing

schedule need not be adjusted for a client with ARF. In contrast, the dosages and

schedules for gentamicin and ticarcillin, which are metabolized and excreted by

the kidney, should be adjusted. Because cyclosporine may cause nephrotoxicity,

the nurse must monitor both the dosage and blood drug level in a client receiving

this drug.

Question 34

WRONG

A client reports experiencing vulvar pruritus. Which assessment factor may

indicate that the client has an infection caused by Candida albicans?

Cottage cheese–like discharge

Yellow-green discharge

Gray-white discharge

Discharge with a fishy odor


The symptoms of C. albicans include itching and a scant white discharge that has

the consistency of cottage cheese. Yellow-green discharge is a sign of

Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of

Gardnerella vaginalis.

Question 35

WRONG

A male client in the short-procedure unit is recovering from renal angiography in

which a femoral puncture site was useD. When providing postprocedure care, the

nurse should:

keep the client’s knee on the affected side bent for 6 hours.

apply pressure to the puncture site for 30 minutes.

check the client’s pedal pulses frequently.

remove the dressing on the puncture site after vital signs stabilize.


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 shouldn’t remove this dressing for several hours — and only if instructed to

do so.

Question 36

CORRECT

When a female client with an indwelling urinary (Foley) catheter insists on

walking to the hospital lobby to visit with family members, nurse Rose teaches

how to do this without compromising the catheter. Which client action indicates

an accurate understanding of this information?

The client sets the drainage bag on the floor while sitting down.

The client keeps the drainage bag below the bladder at all times

The client clamps the catheter drainage tubing while visiting with the family

The client loops the drainage tubing below its point of entry into the drainage bag


To maintain effective drainage, the client should keep the drainage bag below

the bladder; this 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 it

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.

Question 37

CORRECT

A female adult client admitted with a gunshot wound to the abdomen is

transferred to the intensive care unit after an exploratory laparotomy. Which

assessment finding suggests that the client is experiencing acute renal failure

(ARF)?

Blood urea nitrogen (BUN) level of 22 mg/dl

Serum creatinine level of 1.2 mg/dl

Serum creatinine level of 1.2 mg/dl

Urine output of 400 ml/24 hours


ARF, characterized by abrupt loss of kidney function, commonly causes oliguria,

which is demonstrated by a urine output of 400 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.

Question 38

CORRECT

When examining a female client’s genitourinary system, Nurse Sandy assesses

for tenderness at the costovertebral angle by placing the left hand over this area

and striking it with the right fist. Normally, this percussion technique produces

which sound?

A flat sound

A dull sound

Hyperresonance

Tympany


Percussion over the costovertebral angle normally produces a dull, thudding

sound, which is soft to moderately loud with a moderate pitch and duration. This

sound occurs over less dense, mostly fluid-filled matter, such as the kidneys,

liver, and spleen. In contrast, a flat sound occurs over highly dense matter such

as muscle; hyperresonance occurs over the air-filled, overinflated lungs of a

client with pulmonary emphysema or the lungs of a child (because of a thin chest

wall); and tympany occurs over enclosed structures containing air, such as the

stomach and bowel.

Question 39

CORRECT

When performing a scrotal examination, Nurse Payne finds a nodule. What

should the nurse do next?

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

Change the client’s position and repeat the examination

Perform a rectal examination

Transilluminate the scrotum


A 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 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.

Question 40

CORRECT

After undergoing transurethral resection of the prostate to treat benign prostatic

hyperplasia, a male client returns to the room with continuous bladder irrigation.

On the first day after surgery, the client reports bladder pain. What should Nurse

Anthony do first?

Increase the I.V. flow rate

Notify the physician immediately

Assess the irrigation catheter for patency and drainage

Administer meperidine (Demerol), 50 mg I.M., as prescribed


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 meperidine, as prescribed. 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 prescribed medication.

Question 41

WRONG

A female client with suspected renal dysfunction is scheduled for excretory

urography. Nurse January reviews the history for conditions that may warrant

changes in client preparation. Normally, a client should be mildly hypovolemic

(fluid depleted) before excretory urography. Which history finding would call for

the client to be well hydrated instead?

Cystic fibrosis

Multiple myeloma

Gout

Myasthenia gravis


Fluid depletion before excretory urography is contraindicated in clients with

multiple myeloma, severe diabetes 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, and

myasthenia gravis don’t necessitate changes in client preparation for excretory

urography.

Question 42

WRONG

Nurse Grace is assessing a male client diagnosed with gonorrheA. Which

symptom most likely prompted the client to seek medical attention?

Rashes on the palms of the hands and soles of the feet

Cauliflower-like warts on the penis

Painful red papules on the shaft of the penis

Foul-smelling discharge from the penis


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.

Question 43

CORRECT

Nurse Mary 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:

initiate a stream of urine

breathe deeply

turn to the side

hold the labia or shaft of penis


When inserting a urinary catheter, facilitate insertion by asking the client to

breathe deeply. Doing this 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.

Question 44

CORRECT

Nurse Gil is aware that the following statements describing urinary incontinence

in the elderly is true?

Urinary incontinence is a normal part of aging

Urinary incontinence isn’t a disease

Urinary incontinence in the elderly can’t be treated

Urinary incontinence is a disease


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, including diuretics, hypnotics, sedatives,

anticholinergics, and antihypertensives, may trigger urinary incontinence. Most

clients with urinary incontinence can be treated; some can be cured.

Question 45

CORRECT

A 26-year-old 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 possible

infection. Another medication is prescribed to decrease the pain and frequency.

Which of the following is the most likely medication prescribed?

nitrofurantoin (Macrodantin)

ibuprofen (Motrin)

acetaminophen with codeine

phenazopyridine (Pyridium)


Phenazopyridine may be prescribed 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 analgesic properties. While

ibuprofen and acetaminophen with codeine are analgesics, they don’t exert a

direct effect on the urinary mucosa.

Question 46

WRONG

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a

female client’s uremia. Which finding signals a significant problem during this

procedure?

Potassium level of 3.5 mEq/L

Hematocrit (HCT) of 35%

Blood glucose level of 200 mg/dl

White blood cell (WBC) count of 20,000/mm3


An increased WBC count indicates infection, probably resulting from peritonitis,

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 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.

Question 47

CORRECT

A client is frustrated and embarrassed by urinary incontinence. Which of the

following measures should Nurse Ginny include in a bladder retraining program?

Establishing a predetermined fluid intake pattern for the client

Encouraging the client to increase the time between voidings

Restricting fluid intake to reduce the need to void

Assessing present elimination patterns


The guidelines for initiating bladder retraining include assessing the client’s

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 actually be encouraged to drink 1.5 to 2 L of water per day. A voiding

schedule should be established after assessment.

Question 48

CORRECT

A male client with acute pyelonephritis receives a prescription for co-trimoxazole

(Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the

client has followed the prescribed regimen?

Urine output increases to 2,000 ml/day.

Flank and abdominal discomfort decrease.

Bacteria are absent on urine culture.

The red blood cell (RBC) count is normal.


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 the infection

resolves, this isn’t a reliable indicator of the drug’s effectiveness. Co-trimoxazole

doesn’t affect urine output or the RBC count.

Question 49

CORRECT

A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L.

What should nurse Olivia assess first?

Blood pressure

Respirations

Temperature

Pulse


An elevated serum potassium level may lead to a life-threatening cardiac

arrhythmia, which the nurse can detect immediately by palpating the pulse. 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 can delay

assessing respirations and temperature because these aren’t affected by the

serum potassium level.

Question 50

CORRECT

A female client is admitted for treatment of chronic renal failure (CRF). Nurse

Julian knows that this disorder increases the client’s risk of:

water and sodium retention secondary to a severe decrease in the glomerular filtration rate.

a decreased serum phosphate level secondary to kidney failure.

an increased serum calcium level secondary to kidney failure.

metabolic alkalosis secondary to retention of hydrogen ions.


A client with CRF is at risk for fluid imbalance — dehydration if 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 to

hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic

acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete

hydrogen ions.

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