Med Surg Exam 4- Renal, Bladder and Immune Questions – Flashcards
Unlock all answers in this set
Unlock answersquestion
(Ch. 46) (Evolve) The nurse is admitting a patient with the diagnosis of advanced renal carcinoma. Based upon this diagnosis, the nurse will expect to find which of the following as the "classic triad" of presenting symptoms occurring in patients with renal cancer? A. Fever, chills, flank pain B. Hematuria, flank pain, palpable mass C. Hematuria, proteinuria, palpable mass D. Flank pain, palpable abdominal mass, and proteinuria
answer
B. Hematuria, flank pain, palpable mass (There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.)
question
(Ch. 46) (Evolve) Which of the following nursing interventions is appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? A. Help the patient cope with the rapid progression of the disease. B. Suggest genetic counseling resources for the children of the patient. C. Expect the patient to have polyuria and poor concentration ability of the kidneys. D. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.
answer
B. Suggest genetic counseling resources for the children of the patient. (PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.)
question
(Ch. 46) (Evolve) An elderly male patient visits his primary care provider because of burning on urination and production of urine that he describes as "foul smelling." The health care provider should assess the patient for which of the following factors that may dispose him to urinary tract infections (UTIs)? A. High-purine diet B. Sedentary lifestyle C. Benign prostatic hyperplasia (BPH) D. Recent use of broad-spectrum antibiotics
answer
C. Benign prostatic hyperplasia (BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotics use are unlikely to contribute to UTIs, whereas a diet high in purines is associated with renal calculi.)
question
(Ch. 46) (Evolve) The nurse is providing care for a patient who has been admitted to the hospital for the treatment of nephrotic syndrome. Which of the following is a priority nursing assessment in the care of this patient? A. Assessment of pain and level of consciousness. B. Assessment of serum calcium and phosphorus levels. C. Blood pressure and assessment for orthostatic hypotension. D. Daily weights and measurement of the patient's abdominal girth.
answer
D. Daily weight and measurement of the patient's abdominal girth. (Peripheral edema is characteristic of nephrotic syndrome and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the etiology of nephrotic syndrome.)
question
(Ch. 46) (Evolve) Which of the following nursing diagnoses is a priority in the care of a patient with renal calculi? A. Acute pain B. Deficient fluid volume C. Risk for constipation D. Risk for powerlessness
answer
A. Acute pain (Urinary stones are associated with severe abdominal or flank pain. Deficient fluid volume is unlikely to results from urinary stones, whereas constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.)
question
(Ch. 46) (Evolve) Eight months after the delivery of her first child, a 31-year-old woman has sought care because of occasional incontinence that she experiences when sneezing or laughing. Which of the following measures should the nurse first recommend in an attempt to resolve the woman's incontinence? A. Kegel exercises B. Use of adult incontinence pads C. Intermittent self-catheterization D. Dietary changes including fluid restriction.
answer
A. Kegel exercises (Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.)
question
(Ch. 47) (Evolve) The nurse is preparing to administer a dose of PhosLo to a patient with chronic kidney disease would interpret that this medication should have a beneficial effect on which of the following laboratory values of the patient? A. Sodium B. Potassium C. Magnesium D. Phosphorus
answer
D. Phosphorus (Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with chronic kidney disease)
question
(Ch. 47) (Evolve) When caring for a patient during the oliguric phase of acute kidney injury, which of the following would be an appropriate nursing intervention? A. Weigh the patient three times weekly. B. Increase dietary sodium and potassium. C. Provide a low-protein, high-carbohydrate diet. D. Restrict fluids according to previous daily loss.
answer
D. Restrict fluids according to previous daily loss. (Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention; hence, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 ml for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times a week.
question
(Ch. 47) (Evolve) Which of the following statements by the nurse regarding continuous ambulatory peritoneal dialysis (CAPD) would be of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis." B. "You will be allowed a more liberal protein diet once you complete CAPD." C. "It is important for you to maintain a daily written record of blood pressure and weight." D. "You will need to continue regular medical and nursing follow-up visits while performing CAPD."
answer
A. "It is essential that you maintain aseptic technique to prevent peritonitis." (Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of preventing this from occurring. Although the other teaching statements are accurate, they do not have the potential for mortality as does the peritonitis, thus making that nursing action of highest priority.)
question
(Ch. 47) (Evolve) A patient with a history of end-stage renal disease secondary to diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which of the following assessments should the nurse prioritize before, during, and after his treatment? A. Level of consciousness B. Blood pressure and fluid balance C. Temperature for signs and symptoms of infection D. Assessment for signs and symptoms of infection
answer
B. Blood pressure and fluid balance (Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the nature of procedure indicates a particular need to monitor patients blood pressure and fluid balance.)
question
(Ch. 47) (Evolve) A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours ago. Which of the following is an expected assessment finding for this patient during this early stage of recovery? A. Hypokalemia B. Hyponatremia C. Large urine output D. Leukocytosis with cloudy urine output
answer
C. Large urine output (Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intevention.)
question
(Ch. 47) (Evolve) Which of the following assessment findings is a consequence of the oliguric phase of acute kidney injury (AKI)? A. Hypovolemia B. Hyperkalemia C. Hypernatremia D. Thrombocytopenia
answer
B. Hyperkalemia (In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or dimished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.)
question
(Ch. 45) (Evolve) In preparing a patient for an intravenous pyelogram (IVP), the nurse would expect to: A. Administer a cathartic or enema B. Assess patient for allergies to penicillin C. Keep the patient NPO for 4 hours preprocedure D. Advise the patient that a metallic taste may occur during procedure
answer
A. Administer a cathartic or enema (Nursing responsibilities in caring for a patient undergoing an IVP include administration of a cathartic or enema to empty the colon of feces and gas. The nurse will also assess the patient for iodine sensitivity, keep the patient NPO for 8 hours preprocedure, and advise the patient that warmth, a flushed face, and a salty taste during injection of contrast material may occur.)
question
(Ch. 45) (Evolve) In addition to urine function, the nurse recognizes that the kidneys perform numerous other functions important to the maintenance of homeostasis. Which of the following physiologic processes are performed by the kidneys (select all that apply)? A. Production of renin B. Hemolysis of old red blood cells (RBCs) C. Activation of vitamin D D. Carbohydrate metabolism E. Erythropoietin production
answer
A. Production of renin C. Activation of vitamin D E. Erythropoietin production (In addition to urine formation, the kidneys activate vitamin D to maintain calcium levels, produce erythropoietin to stimulate RBC production, and release renin to maintain blood pressure. Carbohydrate metabolism and hemolysis of old RBCs are not physiologic functions that are performed by the kidneys.)
question
(Ch. 45) (Evolve) As a component of the head-to-toe assessment of a patient who has been recently transferred, the nurse is preparing to palpate the patient's kidneys. The nurse should position the patient A. Prone B. Supine C. Seated at the edge of the bed D. Standing, facing away from the nurse
answer
B. Supine (To palpate the right kidney, the patient is positioned supine and the nurse's left hand is placed behind and supports the patient's right side between the rib cage and the iliac crest. The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney.)
question
(Ch. 45) (Evolve) A 70-year-old male patient has sought care because of recent difficulties in establishing and maintaining a urine stream as well as pain that occasionally accompanies urination. The nurse would document which of the following abnormal assessment findings? A. Anuria B. Dysuria C. Oliguria D. Enuresis
answer
B. Dysuria (Painful and difficult urination is characterized as dysuria. Anuria is an absence of urine production, whereas oliguria is diminished urine production. Enuresis is involuntary nocturnal urination.)
question
(Ch. 45) (Evolve) A patient with a history of recurrent urinary tract infections has been scheduled for a cystoscopy. Which of the following teaching points should the nurse emphasize before the procedure? A. "You might have pink-tinged urine and burning after your cystoscopy." B. "You'll need to refrain from eating or drinking after midnight the day before the test." C. "You'll require a urinary catheter inserted before the cystoscopy and it will be in place for a few days." D. "The morning of the test, the nurse will ask you to drink some water that contains a contrast solution."
answer
A. "You might have pink-tinged urine and burning after your cystoscopy." (Pink-tinged urine, burning, and frequency are common following a cystoscopy. The patient does not need to be NPO prior to the test and a contrast solution is unnecessary. A cystoscopy does not always necessitate catheterization before or after the procedure.)
question
(Ch. 45) (Evolve) Which of the following urinalysis would the nurse recognize as an abnormal finding? A. pH 6.0 B. White blood cells (WBCs) 9/hpf C. Amber yellow color D. Specific gravity 1.025
answer
B. White blood cells (WBCs) 9/hpf (Normal WBC levels in urine are below 5/hpf, with levels exceeding this indicative of inflammation or urinary tract infection. Amber yellow is normal coloration, whereas pH of 6.0 is average. Reference ranges for specific gravity are 1.003 to 1.030.)
question
(Ch. 16) (Evolve) The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which of the following abnormalities associated with this oncologic emergency? A. Hypokalemia B. Hypocalcemia C. Hypouricemia D. Hypophosphatemia
answer
B. Hypocalcemia (TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal failure. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia)
question
(Ch. 16) (Evolve) The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snaks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
answer
D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. (The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat.)
question
(Ch. 16) (Evolve) Which of the following items would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
answer
D. 1 tsp salt in 1 L water mouth rinse (A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy.)
question
(Ch. 16) (Evolve) Which of the following nursing diagnoses is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection
answer
D. Risk for infection (Myelosuppression is accompanied by a high risk of infection and sepsis. Hypotheramia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.)
question
(Ch. 16) (Evolve) Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which of the following dietary modifications should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods
answer
A. A bland, low-fiber diet (Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.)
question
(Ch. 16) (Evolve) A 33-year-old patient has recently been diagnosed with stage II cervical cancer. The nurse would understand that the patient's cancer: A. Is in situ B. Has metastasized C. Has spread locally D. Has spread extensively
answer
C. Has spread locally (Stage II cancer is associated with local spread. Stage 0 denotes cancer in situ; stage III denotes extensive regional spread, and stage V denotes metastasis.)
question
(Ch. 45) (Study Book) A patient with an obstruction of the renal artery causing renal ischemia exhibits hypertension. One factor that may contribute to the hypertension is: A. Increased renin release B. Increased antidiuretic hormone (ADH) secretion C. Decreased aldosterone secretion D. Increased synthesis and release of prostaglandins
answer
A. Increased renin release
question
(Ch. 45) (Study Book) A clinical situation in which the increased release of erythropoietin would be expected is: A. Hypoxemia B. Hypotension C. Hyperkalemia D. Fluid overload
answer
A. hypoxemia
question
(Ch. 45) (Study Book) One factor that contributes to an increased incidence of urinary tract infections in women is: A. The shorter length of the urethra. B. The larger capacity of the bladder. C. Relaxation of pelvic floor muscles. D. The right muscular support at the rhabdosphincter.
answer
A. The shorter length of the urethra.
question
(Ch. 45) (Study Book) An age-related change in the kidney that leads to nocturia in an older adult is: A. Decreased renal mass. B. Decreased detrusor muscle tone. C. Decreased ability to conserve sodium. D. Decreased ability to concentrate urine.
answer
D. Decreased ability to concentrate urine.
question
(Ch. 45) (Study Book) During physical assessment of the urinary system, the nurse: A. Auscultates the lower abdominal quadrants for fluid sounds. B. Palpates an empty bladder at the level of the symphysis pubis. C. Percusses the kidney with a firm blow at the posterior costovertebral angle. D. Positions the patient prone to palpate the kidneys with a posterior approach.
answer
C. Percusses the kidney with a firm blow at the posterior costovertebral angle.
question
(Ch. 45) (Study Book) A urinalysis of a urine specimen that is not processed within 1 hour may result in erroneous measurement of: A. Glucose B. Bacteria C. Specific gravity D. White blood cells
answer
B. Bacteria
question
(Ch. 45) (Study Book) Urinalysis results that most likely indicate a urinary tract infection (UTI) include: A. Yellow, protein: 6 mg/dL; pH 6.8; 10-2 bacteria B. Cloudy, yellow; WBC: >5/hpf; pH: 8.2; numerous casts C. Cloudy, brown; ammonia odor; specific gravity: 1.030; RBC: 3/hpf D. Clear; colorless; glucose: trace; ketones: trace; osmolality: 500 mOsm/kg (500 mmol/kg)
answer
B. Cloudy, yellow; WBC: >5/hpf; pH: 8.2; numerous casts
question
(Ch. 45) (Study Book) Which of the following urine specific gravity values would indicate to the nurse that the patient is receiving excessive IV fluid therapy? A. 1.002 B. 1.010 C. 1.025 D. 1.030
answer
A. 1.002
question
(Ch. 45) (Study Book) After a patient has a renal arteriogram, it is important that the nurse: A. Observe for gross bleeding in the urine. B. Place the patient in high Fowler's position. C. Monitor the patient for signs of allergy to the contrast medium. D. Assess peripheral pulses in the involved leg every 30 to 60 minutes.
answer
D. Assess peripheral pulses in the involved leg every 30 to 60 minutes.
question
(Ch. 45) (Study Book) A patient with an elevated blood urea nitrogen (BUN) A. Has decreased urea in the urine. B. May have nonrenal tissue destruction. C. Definitely has impaired renal function D. Will always have a rise in serum creatinine.
answer
B. May have nonrenal tissue destruction.
question
(Ch. 45) (Study Book) The test that is most specific for renal function is the A. Renal scan. B. Serum creatinine C. BUN D. Creatinine clearance
answer
D. Creatinine clearance
question
(Ch. 45) (Study Book) Following a renal biopsy, it is important that the nurse: A. Offer warm sitz baths to relieve discomfort. B. Test urine for microscopic bleeding with a dipstick. C. Expect the patient to experience burning on urination. D. Monitor the patient for symptoms of a urinary infection.
answer
B. Test urine for microscopic bleeding with a dipstick.
question
(Ch. 46) (Study Book) While caring for a 77-year-old woman who has a urinary catheter, the nurse monitors the patient for the development of a UTI. The clinical manifestations the patient is most likely to experience include: A. Cloudy urine and fever B. Urethral burning and bloody urine C. Vague abdominal pain and disorientation D. Suprapubic pain and slight decline in body temperature
answer
C. Vague abdominal pain and disorientation
question
(Ch. 46) (Study Book) A woman with no history of UTIs who is experiencing urgency, frequency, and dysuria comes to the clinic, where a dipstick and microscopic urinalysis indicate a bacteriuria. The nurse anticipates that the patient will: A. Need to have a blood specimen drawn for a complete blood count (CBC) and kidney function tests. B. Not be treated with medication unless she develops fever, chills, and flank pain. C. Be requested to obtain a clean-catch midstream urine specimen for culture and sensitivity. D. Be treated empirically with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days.
answer
D. Be treated empirically with trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) for 3 days.
question
(Ch. 46) (Study Book) A female patient with a UTI has a nursing diagnosis of risk for infection related to lack of knowledge regarding prevention of recurrence. The nurse includes in the teaching plan instructions to: A. Empty the bladder at least 4 times a day. B. Drink at least 2 quarts of water every day. C. Wait to urinate until the urge is very intense. D. Clean the urinary meatus with an antiinfective agent after voiding.
answer
B. Drink at least 2 quarts of water every day.
question
(Ch. 46) (Study Book) Acute pyelonephritis resulting from an ascending infection from the lower urinary tract occurs most often when: A. The kidney is scarred and fibrotic. B. The organism is resistant to antibiotics. C. There is a preexisting abnormality of the urinary tract. D. The patient does not take all of the antibiotics for treatment of a UTI.
answer
C. There is a preexisting abnormality of the urinary tract.
question
(Ch. 46) (Study Book) The patient with acute pyelonephritis is more likely than the patient with a lower UTI to have a nursing diagnosis of: A. Hyperthermia related to infection. B. Acute pain related to dysuria and bladder spasms. C. Impaired urinary elimination related to infection. D. Risk for infection related to lack of knowledge regarding prevention of recurrence.
answer
A. Hyperthermia related to infection.
question
(Ch. 46) (Study Book) A patient with suprapubic pain and symptoms or urinary frequency and urgency has two negative urine cultures. One assessment finding that would indicate interstitial cystitis is: A. Residual urine >200 mL. B. A large, atonic bladder on urodynamic testing. C. A voiding pattern that indicates psychogenic urinary retention. D. Pain with bladder filling that is transiently relieved by urination.
answer
D. Pain with bladder filling that is transiently relieved by urination.
question
(Ch. 46) (Study Book) When caring for the patient with interstitial cystitis, the nurse teaches the patient to: A. Avoid foods that make the urine more alkaline. B. Use high-potency vitamin therapy to decrease the autoimmune effects of the disorder. C. Always keep a voiding diary to document pain, voiding frequencies, and patterns of nocturia. D. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.
answer
D. Use the dietary supplement calcium glycerophosphate (Prelief) to decrease bladder irritation.
question
(Ch. 46) (Study Book) Glomerulonephritis is characterized by glomerular damage caused by: A. Growth of microorganisms in the glomeruli. B. Release of bacterial substances toxic to the glomeruli. C. Hemolysis of RBCs circulating through the glomeruli. D. Accumulation of immune complexes and complement in the glomeruli.
answer
D. Accumulation of immune complexes and complement in the glomeruli.
question
(Ch. 46) (Study Book) Restriction of dietary protein may be indicated in management of acute poststreptococcal glomerulonephritis (APSGN) when the patient has: A. Hematuria B. Proteinuria C. Hypertension D. Elevated blood urea nitrogen (BUN)
answer
D. Elevated blood urea nitrogen (BUN)
question
(Ch. 46) (Study Book) The nurse plans care for the patient with APSGN based on the knowledge that: A. Most patients with APSGN recover completely or rapidly improve with conservative management. B. Chronic glomerulonephritis leading to renal failure is a common sequela to acute glomerulonephritis. C. Pulmonary hemorrhage may occur as a result of antibodies also attacking the alveolar basement membrane. D. A large percentage of patients with APSGN develop rapidly progressive glomerulonephritis resulting in kidney failure.
answer
A. Most patients with APSGN recover completely or rapidly improve with conservative management.
question
(Ch. 46) (Study Book) The edema associated with nephrotic syndrome occurs as a result of: A. Hypercoagulability B. Hyperalbuminemia C. Decrease plasma oncotic pressure D. Decreased glomerular filtration rate
answer
C. Decreased plasma oncotic pressure
question
(Ch. 46) (Study Book) An appropriate nursing diagnosis for the patient with nephrotic syndrome is: A. Risk for injury related to decreased clotting function. B. Risk for impaired skin integrity related to immobility. C. Risk for infection related to altered immune responses. D. Imbalanced nutrition: more than body requirements related to high cholesterol intake.
answer
C. Risk for infection related to altered immune responses.
question
(Ch. 46) (Study Book) Patients at risk for renal lithiasis can prevent the stones in many cases by: A. Leading an active lifestyle. B. Limiting protein and acid foods in the diet. C. Drinking enough fluids to produce a urine output of 2 L/day. D. Taking prophylactic antibiotics to control UTI's.
answer
C. Drinking enough fluids to produce a urine output of 2 L/day.
question
(Ch. 46) (Study Book) On assessment of the patient with a renal calculus passing down the ureter, the nurse would expect the patient to report: A. dull, costovertebral flank pain. B. A history of chronic UTIs. C. Severe, colicky back pain radiating to the groin. D. A feeling of bladder fullness with urgency and frequency.
answer
C. Severe, colicky back pain radiating to the groin.
question
(Ch. 46) (Study Book) Prevention of calcium oxalate stones would include dietary restriction of: A. Milk and milk products. B. Dried beans and dried fruits. C. Liver, kidney, and sweetbreads. D. Spinach, cabbage, and tomatoes.
answer
D. Spinach, cabbage, and tomatoes
question
(Ch. 46) (Study Book) Following lithotripsy for treatment of renal calculi, the patient has a nursing diagnosis of risk for infection related to the introduction of bacteria following manipulation of the urinary tract. An appropriate nursing intervention for the patient is to: A. Monitor for hematuria. B. Encourage high fluid intake. C. Apply moist heat to the flank area. D. Strain all urine through gauze or a special strainer.
answer
B. Encourage high fluid intake.
question
(Ch. 46) (Study Book) In providing care for the patient with adult-onset polycystic kidney disease, the nurse: A. Helps the patient cope with the rapid progression of the disease. B. Suggests genetic counseling resources for the children of the patient. C. Expects the patient to have polyuria and poor concentration ability of the kidney's. D. Implements appropriate measures for the patient's deafness and blindness in addition to the renal problems.
answer
B. Suggests genetic counseling resources for the children of the patient.
question
(Ch. 46) (Study Book) When obtaining a nursing history from a patient with cancer of the urinary system, the nurse recognizes that a risk factor associate with cancer of both the kidney and the bladder is: A. Smoking B. A family history of cancer. C. Chronic use of phenacetin. D. Chronic, recurrent nephrolithiasis.
answer
A. Smoking
question
(Ch. 46) (Study Book) Thirty percent of patients with kidney cancer have metastasis at the time of diagnosis. This occurs because: A. The only treatment modalities for the disease are palliative. B. Diagnostic tests are not available to detect tumors before they metastasize. C. The classic symptoms of hematuria and palpable mass do not occur until the disease is advanced. D. Early metastasis to the brain impairs the patient's ability to recognize the seriousness of symptoms.
answer
C. The classic symptoms of hematuria and palpable mass do not occur until the disease is advanced.
question
(Ch. 46) (Study Book) A 60-year-old man with cancer of the bladder has laser photocoagulation for treatment of the tumor. Following the procedure, the nurse plans to: A. Assess the patient for symptoms of cystitis. B. Encourage the patient to use warm sitz baths. C. Monitor the patient for irritative bladder symptoms. D. Monitor urine output from the urinary catheter for hematuria.
answer
B. Encourage the patient to use warm sitz baths.
question
(Ch. 46) (Study Book) To assist the patient with stress incontinence, the nurse teaches the patient to: A. Void every 2 hours to prevent leakage. B. Use absorptive perineal pads to contain urine. C. Perform pelvic floor muscle exercises 40 to 50 times per day. D. Increase intraabdominal pressure during voiding to empty the bladder completely.
answer
C. Perform pelvic floor muscle exercises 40 to 50 times per day.
question
(Ch. 46) (Study Book) Nursing care that applies to the management of all urinary catheters in hospitalized patients includes: A. Measuring urine output every 1 to 2 hours to ensure patency. B. Turning the patient frequently from side to side to promote drainage. C. Using strict sterile technique during irrigation and obtaining culture specimens. D. Daily cleaning of the catheter insertion site with soap and water and application of an antimicrobial ointment.
answer
C. Using strict sterile technique dring irrigation and obtaining culture specimen.
question
(Ch. 46) (Study Book) A patient has a right ureteral catheter placed following a lithotripsy for a stone in the ureter. In caring for the patient after the procedure, the nurse: A. Milks or strips the catheter every 2 hours. B. Measures ureteral urinary drainage every 2 hours. C. Irrigates catheter with 30-mL sterile saline every 4 hours. D. Encourages ambulation to promote urinary peristaltic action.
answer
B. Measures ureteral urinary drainage every 2 hours.
question
(Ch. 46) (Study Book) During assessment of the patient who has a nephrectomy, the nurse would expect to find: A. Shallow, slow respirations. B. Clear breath sounds in all lung fields. C. Decreased breath sounds in the lower left lobe. D. Decreased breath sounds in the right and left lower lobes.
answer
B. Clear breath sounds in all lung fields.
question
A patient with bladder cancer undergoes cystectomy with formation of an ileal conduit. During the patient's first postoperative day, the nurse plans to: A. Measure and fit the stoma for a permanent appliance. B. Encourage high oral intake to flush mucus from the conduit. C. Teach the patient to self-catheterize the stoma every 4 to 6 hours. D. Empty the drainage bad every 2 to 3 hours and measure the urinary output.
answer
D. Empty the drainage bad every 2 to 3 hours and measure the urinary output.
question
(Ch. 46) (Study book) A teaching plan developed by the nurse for the patient with a new ileal conduit includes instructions to: A. Clean the skin around the stoma with alcohol every day. B. Use a wick to keep the skin dry during appliance changes. C. Use sterile supplies and technique during care of the stoma. D. Change the appliance every day and wash it with soap and warm water.
answer
B. Use a wick to keep the skin dry during appliance changes.
question
(Ch. 46) (Study Book) Delegation Decision: Indicate which of the listed nursing interventions may be delegated to nursing assistive personnel (NAP) (select all that apply). A. Asses for need for catheterization. B. Provide perineal care with soap and water around a urinary catheter. C. Teach patient pelvic floor (Kegel) muscle exercises. D. Insert indwelling catheter for uncomplicated patient. E. Use bladder scanner to estimate residual urine. F. Assist incontinent patient to commode at regular intervals. G. Determine the type of incontinence the patient is experiencing.
answer
B. Provide perineal care with soap and water around a urinary catheter. E. Use bladder scanner to estimate residual urine. F. Assist incontinent patient to commode at regular intervals.
question
(Ch. 47) (Study Book) The nurse determines that a patient with oliguria has prerenal oliguria when: A. Urine testing reveals a low specific gravity. B. The causative factor is malignant hypertension. C. Urine testing reveals a high sodium concentration. D. Reversal of the oliguria occurs with fluid replacement.
answer
D. Reversal of the oliguria occurs with fluid replacement.
question
(Ch. 47) (Study Book) Tubular damage is indicated in the patient with AKI by a urinalysis finding of: A. Hematuria B. Specific gravity fixed at 1.010. C. Urine sodium of 12 mEq/L (12mmol/L). D. Osmolality of 1000 mOsm/kg (1000 mmol/kg)
answer
B. Specific gravity fixed at 1.010.
question
(Ch. 47) (Study Book) Metabolic acidosis occurs in the oliguric phase of AKI as a result of impaired: A. Ammonia synthesis. B. Excretion of sodium. C. Excretion of bicarbonate. D. Conservation of potassium.
answer
A. Ammonia synthesis
question
(Ch. 47) (Study Book) The nurse determines that a patient with AKI is in the recovery phase when the patient experiences: A. A return to normal weight. B. A urine output of 3700 mL/day. C. Decreasing blood urea nitrogen (BUN) and creatinine levels. D. Decreasing sodium and potassium levels.
answer
C. Decreasing blood urea nitrogen (BUN) and creatinine levels.
question
(Ch. 47) (Study Book) While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems, notifying the health care provider when: A. Urine output is 300 mL/day. B. Edema occurs in the feet, legs, and sacral area. C. The cardiac monitor reveals a depressed T wave and a sagging ST segment. D. The patient experiences increasing muscle weakness and abdominal cramping.
answer
D. The patient experiences increasing muscle weakness and abdominal cramping.
question
(Ch. 47) (Study Book) Prevention of AKI is important because of the high mortality rate. Which of the patients below are at risk (select all that apply)? A. An 86-year-old female scheduled for a cardiac catheterization. B. A 48-year-old male with multiple injuries from a motor vehicle accident. C. A 64-year-old female with chronic heart failure admitted with bloody stools. D. A 32-year-old female following abruptio placentae and a C-section delivery. E. A 58-year-old male with prostate cancer undergoing preoperative workup for prostatectomy.
answer
A B C D E
question
(Ch. 47) (Study Book) Priority Decision: A patient on a medical unit has a potassium level of K+ 6.8 mEq/L. The priority action for the nurse would be: A. Check the patient's blood pressure (BP). B. Place the patient on a cardiac monitor. C. Instruct the patient to avoid high potassium foods. D. Call the lab and request a redraw of the lab to verify results.
answer
B. Place the patient on a cardiac monitor.
question
(Ch. 47) (Study Book) A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and the following arterial blood gas results: pH 7.28, PaCO2 30 mmHg, PaO2 86 mmHg, HCO3- 18 mEq/L (18 mmol/L). The nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in the: A. pH B. Potassium level C. Bicarbonate level D. Carbon dioxide level
answer
B. Potassium level
question
(Ch. 47) (Study Book) In replying to a patient's questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on the: A. Total daily urine output. B. Glomerular filtration rate. C. Serum creatinine and urea levels. D. Degree of altered mental status.
answer
B. Glomerular filtration rate.
question
(Ch. 47) (Study Book) The nurse identifies a nursing diagnosis of risk for injury: fracture related to alterations in calcium and phosphorus metabolism for a patient with CKD. The pathologic process directly related to the risk for fractures is: A. Loss of aluminum through the impaired kidneys. B. Deposition of calcium phosphate in soft tissues of the body. C. Impaired vitamin D activation resulting in decreased GI absorption of calcium. D. Increased release of parathyroid hormone in response to decreased calcium levels.
answer
C. Impaired vitamin D activation resulting in decreased GI absorption of calcium.
question
(Ch. 47) (Study Book) The most appropriate snack for the nurse to offer the patient with CKD is: A. Raisins B. Ice cream C. Dill pickles D. Hard candy
answer
D. Hard candy (A patient with CKD may have unlimited intake of sugars and starches (unless the patient is diabetic), and hard candy is an appropriate snack and may help relieve the metallic and urine taste common in the mouth. Raisins are a high-potassium food, picked foods have high sodium contents, and ice cream contains protein.)
question
(Ch. 47) (Study Book) During the nursing assessment of the patient with renal insufficiency, the nurse asks the patient specifically about a history of: A. Angina B. Asthma C. Hypertension D. Rheumatoid arthritis
answer
C. Hypertension
question
(Ch. 47) (Study Book) The patient with end-stage renal disease tells the nurse that she hates the thought of being tied to the machine but is glad to start dialysis because she will be able to eat and drink what she wants. Based on this information, the nurse identifies the nursing diagnosis of: A. Self-esteem disturbance related to dependence on dialysis. B. Anxiety related to perceived threat to health status and role functioning. C. Ineffective self-health management related to lack of knowledge of treatment plan. D. Risk for imbalanced nutrition: more than body requirements related to increased.
answer
C. Ineffective self-health management related to lack of knowledge of treatment plan.
question
(Ch. 47) (Study Book) The dialysate for PD contains: A. Electrolytes in an equal concentration to that of the blood. B. Calcium in a lower concentration than in the blood. C. Sodium in a higher concentration than in the blood. D. Dextrose in a higher concentration than in the blood.
answer
D. Dextrose in a higher concentration than in the blood.
question
(Ch. 47) (Study Book) To prevent the most common serious complication of PD, it is important for the nurse to: A. Infuse the dialysate slowly. B. Use strict aseptic technique in the dialysis procedures. C. Have the patient empty the bowel before the inflow phase. D. Reposition the patient frequently and promote deep breathing.
answer
B. Use strict aseptic technique in the dialysis procedures.
question
(Ch. 47) (Study Book) A patient on hemodialysis develops a thrombus of a subcutaneous AV graft requiring its removal. While waiting for a replacement graft or fistula, the patient is most likely to have: A. Peritoneal dialysis. B. A percutaneous jugular vein cannula. C. A percutaneous femoral vein cannula. D. A Silastic catheter tunneled subcutaneously to the jugular vein.
answer
D. A Silastic catheter tunneled subcutaneously to the jugular vein.
question
(Ch. 47) (Study Book) A patient with end-stage renal failure is scheduled for hemodialysis following healing of an AV fistula. The nurse explains that during dialysis: A. He will be able to visit, read, sleep, or watch TV while reclining in a chair. B. He will be placed on a cardiac monitor to detect any adverse effects that might occur. C. The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the waste products. D. A large catheter with two lumens will be inserted into the fistula to send blood to and return it from the dialyzer.
answer
A. He will be able to visit, read, sleep, or watch TV while reclining in a chair.
question
(Ch. 47) (Study Book) The nurse evaluates the patency of an AV graft by: A. Palpating for pulses distal to the graft site. B. Auscultating for the presence of a bruit at the site. C. Evaluating the color and temperature of the extremity. D. Assessing for the presence of numbness and tingling distal to the site.
answer
B. Auscultating for the presence of a bruit at the site.
question
(Ch. 47) (Study Book) A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). The most common indication for use of CRRT is: A. Azotemia. B. Pericarditis. C. Hyperkalemia. D. Fluid overload.
answer
D. Fluid overload.
question
(Ch. 47) (Study Book) A patient rapidly progressing toward end-stage renal disease asks about the possibility of a kidney transplant. In responding to the patient, the nurse knows that contraindications to kidney transplantation include: A. Hepatitis C infection B. Coronary artery disease C. Refractory hypertension D. Extensive vascular disease
answer
D. Extensive vascular disease
question
(Ch. 47) (Study Book) During the immediate postoperative care of the recipient of a kidney transplants, the nurse expects to: A. Regulate fluid intake hourly based on urine output. B. Fluid urine-tinged drainage on the abdominal dressing. C. Medicate the patient frequently for incisional flank pain. D. Remove the urinary catheter to evaluate the ureteral implant.
answer
A. Regulate fluid intake hourly based on urine output.
question
(Ch. 16) (Study Book) The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse stresses that the most important preventive action for both women and men is: A. Smoking cessation. B. Routine colonoscopies. C. Protection from ultraviolet light. D. Regular examination of reproductive organs.
answer
A. Smoking cessation.
question
(Ch. 16) (Study Book) The defect in cellular proliferation that occurs in the development of cancer involves: A. A rate of cell proliferation that is more rapid than that of normal body cells. B. Shortened phases of cell life cycles with occasional skipping of G1 or S phases. C. Rearrangement of stem cell RNA that causes abnormal cellular protein synthesis. D. Indiscriminate and continuous proliferation of cells with loss of contact inhibition.
answer
D. Indiscriminate and continuous proliferation of cells with loss of contract inhibition.
question
(Ch. 16) (Study Book) The presence of carcinoembryonic antigens (CEAs) and a-fetoprotein (AFP) on cell membranes is an indication that cells have: A. Shifted to more immature metabolic pathways and functions. B. Spread from areas of original development to different body tissues. C. Become more differentiated as a result of repression of embryonic functions. D. Produced abnormal toxins or chemicals that indicate abnormal cellular function.
answer
A. Shifted to more immature metabolic pathways and functions.
question
(Ch. 16) (Study Book) The major difference between benign tumors and malignant tumors is that malignant tumors: A. Grow at a faster rate. B. Are often encapsulated. C. Invade and metastasize D. Cause death whereas benign tumors do not.
answer
C. Invade and metastasize
question
(Ch. 16) (Study Book) A small lesion is discovered in a patient's lung when an x-ray is performed for cervical spine pain. The definitive method of determining if the lesion is malignant is by: A. Lung scan. B. Tissue biopsy. C. CT or PET scan. D. Presence of oncofetal antigens in the blood.
answer
B. Tissue biopsy.
question
(Ch. 16) (Study Book) A patient is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. The nurse recognizes that this procedure is performed to (select all that apply) A. Prevent breast cancer. B. Diagnose breast cancer. C. Cure or control breast cancer. D. Provide palliative care for untreated breast cancer.
answer
A. Prevent breast cancer. C. Cure or control breast cancer. D. Provide palliative care for untreated breast cancer.
question
(Ch. 16) (Study Book) Chemotherapy for the treatment of cancer would be most effective in: A. A small tumor of the bone. B. A young tumor of the brain. C. A large tumor in a highly vascular area. D. Malignant changes in hemopoietic cells.
answer
D. Malignant changes in hemopoietic cells.
question
(Ch. 16) (Study Book) The nurse uses many precautions during IV administration of vesicant chemotherapeutic agents primarily to prevent: A. Septicemia B. Extravasation. C. Catheter occlusion. D. Anaphylactic shock.
answer
B. Extravasation
question
(Ch. 16) (Study Book) When teaching the patient with cancer about chemotherapy, the nurse should: A. Avoid telling the patient about possible side effects of the drugs to prevent anticipatory anxiety. B. Explain that antimetics, antidiarrheals, and analgesics will be provided as needed to control side effects. C. Assure the patient that the side effects from chemotherapy are merely uncomfortable, not life threatening. D. Inform the patient that chemotherapy-related alopecia is usually permanent but can be managed with lifelong use of wigs.
answer
B. Explain that antimetics, antidiarrheals, and analgesics will be provided as needed to control side effects.
question
(Ch. 16) (Study Book) Normal tissues that may manifest early, acute responses to radiation therapy include: A. Spleen and liver. B. Kidney and nervous tissue. C. Bone marrow and gastrointestinal mucosa. D. Hollow organs such as the stomach and bladder.
answer
C. Bone marrow and gastrointestinal mucosa.
question
(Ch. 16) (Study Book) The rationale for treatment of cancer with radiation includes the knowledge that: A. Radiation damages cellular DNA only in abnormal cells. B. Malignant cells respond to the effects of radiation because they more frequently go through mitosis. C. Damage to cells will occur only during M and G2 phases of the cell cycle, necessitating a series of treatment. D. Normal cells are able to repair radiation-induced damage to DNA and do not have permanent radiation damage.
answer
B. Malignant cells respond to the effects of radiation because they more frequently go through mitosis.
question
(Ch. 16) (Study Book) When a patient is undergoing brachytherapy, it is important for the nurse to recognize that: A. The patient will undergo simulation to identify and mark the field of treatment. B. The patient is a source of radiation and personnel must wear film badges during care. C. The goal of this treatment is only palliative and the patient should be aware of the expected outcome. D. Computerize dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue.
answer
B. The patient is a source of radiation and personnel must wear film badges during care.
question
(Ch. 16) (Study Book) To prevent the debilitating cycle of fatigue-depression fatigue in patients receiving radiation therapy, the nurse encourages the patient to: A. Implement a walking program. B. Ignore the fatigue as much as possible. C. Do the most stressful activities when fatigue is tolerable. D. Schedule rest periods throughout the day whether fatigue is present or not.
answer
A. Implement a walking program.
question
(Ch. 16) (Study Book) The late effects of chemotherapy and high-dose radiation may include: A. Third-space syndrome. B. Chronic nausea and vomiting. C. Persistent myelosuppression. D. Secondary resistant malignancies.
answer
D. Secondary resistant malignancies
question
(Ch. 16) (Study Book) The primary use of biologic therapy in cancer treatment is to: A. Prevent the fatigue associated with chemotherapy and high-dose radiation. B. Enhance or supplement the effects of the host's immune responses to tumor cells. C. Depress the immune system and circulating lymphocytes, as well as increasing a sense of well-being. D. Protect normal rapidly reproducing cells of the gastrointestinal system from damage during chemotherapy.
answer
B. Enhance or supplement the effects of the host's immune responses to tumor cells.
question
(Ch. 16) (Study Book) A side effect common to biologic therapies is: A. Flulike syndrome. B. Bone marrow suppression. C. Central nervous system deficits. D. Nausea, vomiting, anorexia, and diarrhea.
answer
A. Flulike syndrome.
question
(Ch. 16) (Study Book) While caring for a patient who is at the nadir of chemotherapy, the nurse establishes the highest priority for the nursing diagnosis of: A. Diarrhea B. Grieving C. Risk for infection. D. Imbalanced nutrition: less than body requirements.
answer
C. Risk for infection
question
(Ch. 16) (Study Book) An allogenic hematopoietic stem cell transplant is considered as treatment for a patient with acute myelogenous leukemia. The nurse explains that during this procedure: A. There is no risk for graft-versus-host disease because the donated marrow is treated to remove cancer cells. B. Bone marrow is obtained from a donor who has an HLA match with the patient. C. The patient's bone marrow will be removed, treated, stored, and then reinfused after intensive chemotherapy. D. There is no need for posttransplant protective isolation because the stem cells are infused directly into the blood.
answer
B. Bone marrow is obtained from a donor who has an HLA match with the patient.
question
(Ch. 16) (Study Book) During initial chemotherapy a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be: A. Establishing ECG monitoring. B. Increasing urine output with hydration therapy. C. Administering a bisphosphonate such as pamidronate (Aredia). D. Restricting fluids and administering hypertonic sodium chloride solution.
answer
B. Increasing urine output with hydration therapy.
question
(Ch. 16) (Book) Trends in the incidence and death rates of cancer include the fact that: A. Lung cancer is the most common type of cancer in men. B. A higher percentage of women than men have lung cancer. C. Breast cancer is the leading cause of cancer deaths in women. D. African Americans have a higher death rate from cancer than whites.
answer
D. African Americans have a higher death rate from cancer than whites.
question
(Ch. 16) (Book) What cellular features of cancer cells distinguish them from normal cells (Select all that apply). A. Cells lack contact inhibition. B. Cells return to a previous undifferentiated state. C. Oncogenes maintain normal cellular expression. D. Proliferation occurs when there is a need for more cells. E. New proteins characteristic of embryonic stage emerge on cell membrane.
answer
A. Cells lack contact inhibition. B. Cells return to a previous undifferentiated state. E. New proteins characteristic of embryonic stage emerge on cell membrane.
question
(Ch. 16) (Book) A characteristic of the stage of progression in the development of cancer is: A. Oncogenic viral transformation of target cells. B. A reversible steady growth facilitated by carcinogens. C. A period of latency before clinical detection of cancer. D. Proliferation of cancer cells in spite of host control mechanisms.
answer
D. Proliferation of cancer cells in spite of host control mechanisms.
question
(Ch. 16) (Book) The primary protective role of the immune system related to malignant cells is: A. Surveillance for cells with tumor-associated antigens. B. Binding with free antigen released by malignant cells. C. Production of blocking factors that immobilize cancer cells. D. Responding to a new set of antigenic determinants on cancer cells.
answer
A. Surveillance for cells with tumor-associated antigens.
question
(Ch. 16) (Book) The primary difference between benign and malignant neoplasms is the: A. Rate of cell proliferation. B. Site of malignant tumor. C. Requirements for cellular nutrients. D. Characteristic of tissue invasiveness.
answer
D. Characteristic of tissue invasiveness.
question
(Ch. 16) (Book) The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to: A. Motivate change in unhealthy lifestyles. B. Educate her about the seven warning signs of cancer. C. Instruct her about healthy stress relief and coping practices. D. Allow her to communicate about the meaning of this experience.
answer
D. Allow her to communicate about the meaning of this experience.
question
(Ch. 16) (Book) The goals of cancer treatment are based on the principle that: A. Surgery is the single most effective treatment for cancer. B. Initial treatment is always directed toward cure of the cancer. C. A combination of treatment modalities is effective for controlling many cancers. D. Although cancer cure is rare, quality of life can be increased with treatment modalities.
answer
C. A combination of treatment modalities is effective for controlling many cancers.
question
(Ch. 16) (Book) The most effective method of administering a chemotherapeutic agent that is a vesicant is to: A. Give it orally. B. Give it intraarterially. C. Use an Ommaya reservoir. D. Use a central venous access device.
answer
D. Use a central venous access device.
question
(Ch. 16) (Book) The nurse explains to a patient undergoing brachytherapy of the cervix that she: A. Must undergo simulation to locate the treatment area. B. Requires the use of radioactive precautions during nursing care. C. May experience desquamation of the skin on the abdomen and upper legs. D. Requires shielding of the ovaries during treatment to prevent ovarian damage.
answer
B. Requires the use of radioactive precautions during nursing care.
question
(Ch. 16) (Book) A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9, hemoglobin of 10.8 and a platelet count of 99. Based on the CBC results, which of the following is the most serious clinical finding? A. Cough, rhinitis, and sore throat. B. Fatigue, nausea, and skin redness at site of radiation. C. Temperature of 101.9, fatigue, and shortness of breath. D. Skin redness at site of radiation, headache, and constipation.
answer
C. Temperature of 101.9, fatigue, and shortness of breath.
question
(Ch. 16) (Book) During the initial dose of rituximab (Rituxan), the patient starts to complain of feeling cold with the subsequent development of shivering. The first course of action the nurse should take is to: A. Administer one ampule of sodium bicarbonate. B. Cover the patient with a blanket and offer a warm beverage. C. Stop the infusion of rituximab and administer normal saline. D. Place emergency medication and equipment by the patient's infusion chair.
answer
C. Stop the infusion of rituximab and administer normal saline.
question
(Ch. 16) (Book) The nurse counsels the patient receiving radiation therapy or chemotherapy that: A. Effective birth control methods should be used for the rest of the patient's life. B. If nausea and vomiting occur during treatment, the treatment plan will be modified. C. Following successful treatment, a return to the person's previous functional level can be expected. D. The cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity.
answer
C. Following successful treatment, a return to the person's previous functional level can be expected.
question
(Ch. 16) (Book) A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing interventions would be a priority? A. Advise the patient to eat foods that are fatty, fried, or high in calories. B. Discuss with the physician the need for parenteral or enteral feedings. C. Advise the patient to drink a nutritional supplement beverage at least three times a day. D. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.
answer
D. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.
question
(Ch. 16) (Book) A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this most likely caused by: A. Hypercalcemia B. Tumor lysis syndrome C. Spinal cord compression D. Superior vena cava syndrome
answer
A. Hypercalcemia
question
(Ch. 16) (Book) A patient has recently been diagnosed with early stages of breast cancer. Which of the following is most appropriate for the nurse to focus on? A. Maintaining the patient's hope. B. Preparing a will and advance directives. C. Discussing replacement child care for the patient's children. D. Discussing the patient's past experiences with her grandmother's cancer.
answer
A. Maintaining the patient's hope.
question
(Ch. 46) (Book) In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidney's through: A. The bloodstream. B. The lymphatic system. C. A descending infection. D. An ascending infection.
answer
D. An ascending infection.
question
(Ch. 46) (Book) The nurse teaches the female patient who has frequent UTIs that she should: A. Take tub baths with bubble bath. B. Urinate before and after sexual intercourse. C. Take prophylactic sulfonamides for the rest of her life. D. Restrict fluid intake to prevent the need for frequent voiding.
answer
B. Urinate before and after sexual intercourse.
question
(Ch. 46) (Book) The immunologic mechanisms involved in glomerulonephritis include: A. Tubular blocking by precipitates of bacteria and antibody reactions. B. Deposition of immune complexes and complement along the GBM. C. Thickening of the GBM from autoimmune microangiopathic changes. D. Destruction of glomeruli by proteolytic enzymes contained in the GBM.
answer
B. Deposition of immune complexes and complement along the GBM.
question
(Ch. 46) (Book) One of the most important roles of the nurse in relation to acute poststreptococcal glomerulonephritis is to: A. Promote early diagnosis and treatment of sore throats and skin lesions. B. Encourage patients to request antibiotic therapy for all upper respiratory infections. C. Teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence. D. Monitor patients for respiratory symptoms that indicate that the disease is affecting the alveolar basement membrane.
answer
A. Promote early diagnosis and treatment of sore throats and skin lesions.
question
(Ch. 46) (Book) The edema that occurs in nephrotic syndrome is due to: A. Increased hydrostatic pressure caused by sodium retention. B. Decreased aldosterone secretion from adrenal insufficiency. C. Increased fluid retention caused by decreased glomerular filtration. D. Decreased colloidal osmotic pressure caused by loss of serum albumin.
answer
D. Decreased colloidal osmotic pressure caused by loss of serum albumin.
question
(Ch. 46) (Book) A patient is admitted to the hospital with severe renal colic caused by renal lithiasis. The nurse's first priority in management of the patient is to: A. Administer opioids as prescribed. B. Obtain supplies for straining all urine. C. Encourage fluid intake of 3 to 4 L/day. D. Keep the patient NPO in preparation for surgery.
answer
A. Administer opioids as prescribed.
question
(Ch. 46) (Book) The nurse recommends genetic counseling for the children of a patient with: A. Nephrotic syndrome. B. Chronic pyelonephritis. C. Malignant nephrosclerosis. D. Adult-onset polycystic renal disease.
answer
D. Adult-onset polycystic renal disease
question
(Ch. 46) (Book) The nurse encourages strict diabetic control in the patient prone to diabetic nephropathy knowing that the renal tissue changes that may occur in this condition include: A. Uric acid calculi and nephrolithiasis. B. Renal sugar-crystal calculi and cysts. C. Lipid deposits in the glomeruli and nephrons. D. Thickening of the GBM and glomerulosclerosis.
answer
D. Thickening of the GBM and glomerulosclerosis.
question
(Ch. 46) (Book) The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of: A. Aspirin use. B. Tobacco use. C. Chronic alcohol abuse. D. Use of artificial sweeteners.
answer
B. Tobacco use.
question
(Ch. 46) (Book) In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes: A. Teaching the patient to use Kegel exercises. B. Clamping and releasing a catheter to increase bladder tone. C. Teaching the patient biofeedback mechanisms to suppress the urge to void. D. Counseling the patient concerning choice of incontinence containment device.
answer
A. Teaching the patient to use Kegel exercises.
question
(Ch. 46) (Book) A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes: A. Encouraging the patient to drink fruit juices and milk. B. Forcing fluids of at least 2 to 3 L per day after nausea has subsided. C. Irrigating the nephrostomy tube with 10 mL of normal saline solution as needed. D. Notifying the physician if nephrostomy tube drainage is more than 30 mL per hour.
answer
B. Forcing fluids of at least 2 to 3 L per day after nausea has subsided.
question
(Ch. 46) (Book) A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should: A. Notify the physician. B. Notify the charge nurse. C. Irrigate the drainage tube. D. Chart it as a normal observation.
answer
D. Chart it as a normal observation.
question
(Ch. 47) (Book) Which of the following characterize acute kidney injury (select all that apply)? A. Primary cause of death is infection. B. Almost always affects older people. C. Disease cause is diabetic nephropathy. D. Most common cause is diabetic nephropathy. E. Cardiovascular disease is most common cause of death.
answer
A. Primary cause of death is infection. C. Disease cause is diabetic nephropathy.
question
(Ch. 47) (Book) RIFLE defines three stages of AKI based on changes in: A. Blood pressure and urine osmolality. B. Fractional excretion of urinary sodium. C. Estimation of GFR with the MDRD equation. D. Serum creatinine or urine output from baseline.
answer
D. Serum creatinine or urine output from baseline.
question
(Ch. 47) (Book) During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply): A. Hypotension. B. ECG changes. C. Hypernatremia. D. Urine with high specific gravity.
answer
B. ECG changes.
question
(Ch. 47) (Book) If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia. B. Hyperkalemia and hypernatremia. C. Hypokalemia and hyponatremia. D. Hypokalemia and hypernatremia.
answer
C. Hypokalemia and hyponatremia.
question
(Ch. 47) (Book) A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by: A. Progressive irreversible destruction of the kidneys. B. A rapid decrease in urinary output with an elevated BUN. C. An increasing creatinine clearance with a decrease in urinary output. D. Prostration, somnolence, and confusion with coma and imminent death.
answer
A. Progressive irreversible destruction of the kidneys.
question
(Ch. 47) (Book) Nurses need to educate patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply): A. Older African Americans. B. Individuals more than 60 years old. C. Those with a history of pancreatitis. D. Those with a history of hypertension. E. Those with a history of type 2 diabetes.
answer
A. Older African Americans. B. Individuals more than 60 years old. D.Those with a history of hypertension. E. Those with a history of type 2 diabetes.
question
(Ch. 47) (Book) Patients with chronic kidney disease experience an increased incidence of cardiovascular disease related to (select all that apply) A. Hypertension. B. Vascular calcifications. C. A genetic predisposition. D. Hyperinsulinemia causing dyslipidemia. E. Increased high-density lipoprotein levels.
answer
A. Hypertension. B. Vascular calcifications. D. Hyperinsulinemia causing dyslipidemia.
question
(Ch. 47) (Book) Measures indicated in the conservative therapy of chronic kidney disease include: A. Decreased fluid intake, carbohydrate intake, and protein intake. B. Increased fluid intake, decreased carbohydrate intake and protein intake. C. Decreased fluid intake and protein intake, increased carbohydrate intake. D. Decreased fluid intake and carbohydrate intake, increased protein intake.
answer
C. Decreased fluid intake and protein intake, increased carbohydrate intake.
question
(Ch. 47) (Book) An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that: A. Successful transplantation usually provides better quality of life than that offered by dialysis. B. If rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. C. The immunosuppressive therapy that is required following transplantation causes fatal malignancies in many patients. D. Hemodialysis replaces the normal functions of the kidneys and patients do not have to live with the continual fear of rejection.
answer
A. Successful transplantation usually provides better quality of life than that offered by dialysis.
question
(Ch. 47) (Book) To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should: A. Irrigate the graft daily with low-dose heparin. B. Monitor for any increase in BP in the affected arm. C. Listen with a stethoscope over the graft for the presence of a bruit. D. Frequently monitor the pulses and neurovascular status distal to the graft.
answer
C. Listen with a stethoscope over the graft for the presence of a bruit.
question
(Ch. 47) (Book) One of the major advantages of peritoneal dialysis is that: A. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. B. The diet is less restricted and dialysis can be performed at home. C. The dialysate is biocompatible and causes no long-term consequences. D. High glucose concentrations of the dialysate cause a reduction in appetite promoting weight loss.
answer
B. The diet is less restricted and dialysis can be performed at home.
question
(Ch. 47) (Book) A kidney transplant recipient complains of having fever, chills, and dysuria over the course of the past 2 days. What is the first action that the nurse should take? A. Assess temperature and initiate workup to rule out infection. B. Provide warm cover for the patient and give 1 g acetaminophen orally. C. Reassure the patient that this is common after transplantation. D. Notify the nephrologist that the patient has developed symptoms of acute rejection.
answer
A. Assess temperature and initiate workup to rule out infection.
question
(Ch. 45) (Book) A renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with: A. The structural support of the kidney. B. Regulation of the concentration of urine. C. The entry and exit of blood vessels at the kidney. D. Collection and drainage of urine from the kidney.
answer
D. Collection and drainage of urine from the kidney.
question
(Ch. 45) (Book) A patient with renal disease has oliguria and a creatinine clearance of 40 mL/min. These findings most directly reflect abnormal function of: A. Tubular secretion. B. Glomerular filtration. C. Capillary permeability. D. Concentration of filtrate.
answer
B. Glomerular filtration.
question
(Ch. 45) (Book) The nurse identifies a risk for urinary calculi in a patient who relates a past health history that includes: A. Adrenal insufficiency. B. Serotonin deficiency. C. Hyprealdoesteronism. D. Hyperparathyroidism.
answer
D. Hyperparathyroidism.
question
(Ch. 45) (Book) Diminished ability to concentrate urine, associated with aging of the urinary system, is attributed to: A. A decrease in bladder sensory receptors. B. A decrease in the number of functioning nephrons. C. Decreased function of the loop of Henle and tubules. D. Thickening of the basement membrane of Bowman's capsule.
answer
C. Decreased function of the loop of Henle and tubules.
question
(Ch. 45) (Book) During physical assessment of the urinary system, the nurse: A. Palpates an empty bladder as a small nodule. B. Auscultates over each CVA to detect impaired renal blood flow. C. Finds a dull percussion sound when 100 mL of urine is present in the bladder. D. Palpates above the symphysis pubis to determine the level of urine in the bladder.
answer
B. Auscultates over each CVA to detect impaired renal blood flow.
question
(Ch. 45) (Book) Normal findings expected by the nurse on physical assessment of the urinary system include (select all that apply): A. Nonpalpable left kidney. B. Auscultation of renal artery bruit. C. CVA tenderness elicited by a kidney punch. D. No CVA tenderness elicited by a kidney punch. E. Palpable bladder to the level of the pubic symphysis.
answer
A. Nonpalpable left kidney. D. No CVA tenderness elicited by a kidney punch.
question
(Ch. 45) (Book) A diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion is a(n): A. IVP B. VCUG C. Renal scan D. Loopogram
answer
C. Renal scan
question
(Ch. 45) (Book) On reading the urinalysis results of a dehydrated patient, the nurse would expect to find: A. a pH of 8.4 B. RBCs of 4/hpf C. color: yellow, cloudy D. Specific gravity of 1.035
answer
D. Specific gravity of 1.035
question
(Ch. 65) (ATI) One goal of renal dialysis for a client who has chronic renal failure is to: A. Restore kidney function. B. Replace hormonal function of the kidneys. C. Allow the client to have an unrestricted diet. D. Balance serum electrolytes.
answer
D. Balance serum electrolytes.
question
(Ch. 65) (ATI) Which of the following actions should the nurse take immediately prior to initiating hemodialysis? (select all that apply) A. Determine current medications being taken by the client. B. Assess AV fistula for bruit. C. Calculate total urine output for the previous shift. D. Assess dietary intake. E. Obtain weight. F. Check serum electrolytes. G. Obtain vital signs.
answer
A. Determine current medications being taken by the client. B. Assess AV fistula for bruit. E. Obtain weight. F. Check serum electrolytes G. Obtain vital signs.
question
(Ch. 65) (ATI) Which of the following actions should a nurse implement following a client's hemodialysis procedure? (select all that apply) A. Check BUN and serum creatinine. B. Assess for headache and/or confusion. C. Obtain weight. D. Administer IV antibiotic. E. Obtain serum electrolytes. F. Assess access site for indications of bleeding. G. Evaluate blood pressure on side of AV fistula.
answer
A. Check BUN and serum creatinine. B. Assess for headache and/or confusion. C. Obtain weight. E. Obtain serum electrolytes. F. Assess access site for indications of bleeding.
question
(Ch. 68) (ATI) Which of the following signs and symptoms should the nurse monitor for in a client with nephrotic syndrome? (select all that apply) A. Malnutrition B. Hematuria C. Infection D. Peritonitis E. Hyperkalemia F. Hypotension G. Fever
answer
A. Malnutrition B. Hematuria C. Infection D. Peritonitis E. Hyperkalemia G. Fever
question
(Ch. 68) (ATI) Which of the following assessments should be made while the client is in acute renal failure? (select all that apply) A. Cardiac enzymes B. Blood glucose C. Blood pressure D. Serum electrolytes E. Serum creatinine F. Arterial blood gases G. Urine output
answer
B. Blood glucose C. Blood pressure D. Serum electrolytes E. Serum creatinine F. Arterial blood gases G. Urine output
question
(Ch. 68) (ATI) Prioritize the following nursing interventions according to how they occur in a client diagnosed with renal failure. - Monitor serum potassium level -Turn the client every 2 hours -Offer emotional support to the family -Assess breath sounds
answer
1. Monitor serum potassium level 2. Assess breath sounds 3. Turn the client every 2 hours 4. Offer emotional support to the family
question
(Ch. 103) (ATI) A nurse is teaching a client about the risk for cancer. Which of the following client statements indicates the need for further teaching? A. "I see a dermatologist regularly for the mole on my thigh." B. "I take Milk of Magnesia for occasional constipation." C. "I tan using an indoor tanning lotion instead of laying out in the sun." D. "I used to smoke but switched to chewing tobacco 3 years ago."
answer
D. "I used to smoke but switched to chewing tobacco 3 years ago."
question
(Ch. 103) (ATI) A nurse is teaching a client about maintaining a diet that may prevent certain cancers. The nurse should inform the client that the intake of which of the following may be beneficial? (select all that apply) A. Low saturated fats B. Fruits C. Fiber D. Red meats E. Simple carbohydrates F. Vegetables G. Fish
answer
A. Low saturated fats B. Fruits C. Fiber F. Vegetables G. Fish
question
(Ch. 104) (ATI) A client who is undergoing chemotherapy is placed on neutropenic precautions. Which of the following actions is appropriate for the nurse to take? (select all that apply) A. Place the client on a high-fiber diet. B. Remove plants from the client's room. C. Have the client wear a mask during transport to radiology. D. Tell assistive personnel that the blood pressure machine cannot be removed from the room. E. Recommend a prescription for oprelvekin (Interleukin-11) F. Restrict the client from eating raw carrots.
answer
B. Remove plants from the client's room. C. Have the client wear a mask during transport to radiology. D. Tell assistive personnel that the blood pressure machine cannot be removed from the room. F. Restrict the client from eating raw carrots.
question
(Ch. 104) (ATI) A nurse is caring for a client who is undergoing a course of chemotherapy. The client is reporting severe nausea and has lost 7 lb since her last course of chemotherapy. Which of the following statements is appropriate for the nurse to make? A. "Your nausea will lessen with each course of chemotherapy." B. "Hot food is better tolerated because of the aroma it produces." C. "Try eating several small meals throughout the day." D. "Eat as much red meat as tolerated to keep your weight up."
answer
C. "Try eating several small meals throughout the day."
question
(Ch. 104) (ATI) A nurse is caring for a client who has a platelet count of 25,000/mm3. Which of the following medications is appropriate for the nurse to recommend? A. Oprelvekin (Interleukin-11) B. Epoetin alfa (Epogen) C. Filgrastim (Neupogen) D. Megestrol (Megace)
answer
A. Oprelvekin (Interleukin-11)
question
(Ch. 104) (ATI) A nurse is caring for a client being treated for cervical cancer with brachytherapy. When reviewing the client's restrictions, which of the following is appropriate to include? (select all that apply) A. Visitors can stay 30 min at a time. B. The client must stay on bed rest while the implant is in place. C. The client will have a catheter in place. D. The client will be placed on fiber laxatives. E. The client may not watch television with a radiation source in the room.
answer
A. Visitors can stay 30 min at a time. B. The client must stay on bed rest while the implant is in place. C. The client will have a catheter in place.
question
(Ch. 105) (ATI) A nurse should know that which of the following is the most reliable indicator of pain? A. Vital signs B. Facial expression C. Verbal expression of pain D. Location of pain
answer
C. Verbal expression of pain
question
(Ch. 105) (ATI) A client who has chronic cancer pain has a permanent epidural catheter that is used for administration of a fentanyl/bupivacaine solution. For which of the following findings should the nurse monitor? (select all that apply) A. Respiratory depression B. Hypotension C. Sedation D. Muscle spasticity E. Motor blockage
answer
A. Respiratory depression B. Hypotension C. Sedtion E. Motor blockage
question
(Ch. 105) (ATI) A nurse is caring for a client who is to undergo neurolytic ablation. The nurse should recognize that this treatment is used only when other measures have failed due to the risk of: A. Irreversible nerve damage B. Increased pain C. Myelosuppression D. Thrombocytopenia
answer
A. Irreversible nerve damage
question
(Ch. 105) (ATI) A nurse is caring for a client who has cancer. The goal of palliative pain management is to increase which of the following? (select all that apply) A. Mental acuity B. Physical mobility C. Time spent at home D. Quality of life E. Pain relief
answer
B. Physical mobility C. Time spent at home D. Quality of life E. Pain relief
