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1- An elderly client tells the nurse “I have experienced leg pain for several weeks when I walk to the mailbox each afternoon, but it goes away once I stop walking.” What is

the priority assessment the nurse should perform?

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1.

Assess for dry, scaly skin on the lower legs

2.

Assess for presence or absence of hair growth on lower extremities

3.

Check for presence and quality of posterior tibial and dorsalis pedis pulses

4.

Obtain a dietary history

2- A client with coronary artery disease and stable angina is being discharged home on sublingual nitroglycerin (NTG). The nurse has completed discharge teaching related to

this medication. Which statement by the client indicates that the teaching has been

effective?

1.

“I can keep a few pills in a plastic bag in my pocket in case I need them while I’m out.”

2.

“I can still take this with my vardenafil prescription.”

3.

“I can take up to 3 pills in a 15-minute period if I am experiencing chest pain.”

4.

“I should stop taking the pills if I experience a headache.”

3- A client is being discharged after having a stent placed in the left anterior descending coronary artery. The client is prescribed clopidogrel. Which client data obtained by the

nurse would be concerning in relation to this new medication? Select all that apply.

1.

Blood pressure of 140/84 mm Hg

2.

Heart rate of 98/min

3.

Platelet count of 200,000/mm3 (200 x 109/L)

4.

Report of Ginkgo biloba use

5.

Report of peptic ulcer disease

4- An experienced nurse is mentoring a new registered nurse (RN) on the telemetry unit. The new RN is measuring orthostatic blood pressure (BP) for a client. Which

situation would warrant intervention by the experienced nurse?

1.

Nurse has client lie supine for 5-10 minutes prior to starting procedure

2.

Nurse interprets a decrease in systolic BP by 10 mm Hg as a normal finding

3.

Nurse starts by measuring BP and heart rate (HR) with the client standing

4.

Nurse takes BP and HR after standing at 1- and 3-minute intervals

5- The nurse is caring for a client on IV heparin infusion and oral warfarin. Current laboratory values indicate that the client’s aPTT is 5 times the control value and the

PT/INR is 2 times the control value. What action does the nurse anticipate?

1.

Clarify vegetable consumption with client

2.

Decrease the heparin rate

3.

Decrease the warfarin dose

4.

Obtain an order for vitamin K injection

6- The nurse is reviewing the medication administration record of a client with atrial

fibrillation. Which of the following should the nurse monitor before giving these

medications? Select all that apply. See medication administration record below.

1.

Digoxin level

2.

Glucose

3.

INR

4.

Platelet count

5.

Serum potassium

7- A client with chronic stable angina is reporting chest pain. The nurse notices that the transdermal nitroglycerin patch that was applied 1 hour ago has peeled off. The client’s

vital signs are stable. What is the nurse’s priority action?

1.

Administer PRN morphine

2.

Administer PRN sublingual nitroglycerin

3.

Apply a new transdermal nitroglycerin patch

4.

Obtain a 12-lead electrocardiogram

8- The nurse is reviewing laboratory data of a client who is receiving warfarin therapy for atrial fibrillation. Today’s INR is 5.0. What action should the nurse take?

1.

Administer the next scheduled dose of warfarin

2.

Anticipate infusing fresh, frozen plasma

3.

Call the pharmacy to see if protamine is available

4.

Request a prescription from the health care provider (HCP) for vitamin K

9- The nurse is caring for a client who experienced an anterior wall myocardial infarction 24 hours ago. The nurse recognizes the rhythm on the cardiac monitor as which rhythm?

1.

Premature ventricular contractions

2.

Sinus tachycardia

3.

Ventricular fibrillation

4.

Ventricular tachycardia

10- A client with suspected moderate to large pericardial effusion is admitted for

monitoring. The nurse performs a head-to-toe assessment. Which of these findings

indicate likely cardiac tamponade and require immediate intervention? Select all that

apply.

1.

Blood pressure of 90/70 mm Hg

2.

Bounding peripheral pulses

3.

Decreased breath sounds on left side

4.

Distant heart tones

5.

Jugular venous distension

11- The nurse working in the intensive care unit hears an alarm coming from a client’s room. On entering the room, the nurse sees the rhythm displayed in the exhibit on the

monitor. The nurse recognizes it as which rhythm?

1.

Asystole

2.

Atrial fibrillation

3.

Ventricular fibrillation (VF)

4.

Ventricular tachycardia

12- An 80-year-old client with hypertension and type 2 diabetes has recently started taking chlorthalidone. Which report by the client is most concerning to the office nurse?

1.

Dizziness on standing

2.

Fasting blood sugar of 160 mg/dL (8.9 mmol/L)

3.

Presence of muscle cramps

4.

Sunburn

13- A client is receiving a continuous heparin infusion and the most recent aPTT is 140 seconds. The nurse notices blood oozing at the surgical incision and IV insertion

sites. What interventions should the nurse implement? Select all that apply.

1.

Continue heparin infusion and recheck aPTT in 6 hours

2.

Prepare to administer vitamin K

3.

Redraw blood for laboratory tests

4.

Review guidelines for administration of protamine

5.

Stop infusion of heparin and notify the health care provider (HCP)

14- The nurse is discharging a client who has been prescribed warfarin for chronic atrial fibrillation. The nurse should instruct the client to avoid excess or inconsistent intake of

which foods? Select all that apply.

1.

Bananas

2.

Broccoli

3.

Grapefruit juice

4.

Red meat

5.

Spinach

15- The nurse cares for a client who had an abdominal aortic aneurysm repair 6 hours ago. Which assessment would require immediate follow-up?

1.

Abdomen is soft, nondistended, and tender to touch

2.

Blood pressure is 96/66 mm Hg and apical pulse is 112/min

3.

Client rates pain as 4 on a scale of 0-10

4.

Green bile is draining from the nasogastric tube

16- The nurse is providing community health screening. Which of the following clients should be referred to a health care provider for further evaluation?

1.

30-year-old athlete with a heart rate of 50/min

2.

45-year-old client with a body mass index of 35 kg/m2 and fingerstick glucose of 150 mg/dL

(8.3 mmol/L)

3.

55-year-old client missing all the hair on the lower legs and failing the pinprick test

4.

80-year-old client with a blood pressure of 150/90 mm Hg

17- An 8-month-old infant is scheduled for a femorally inserted balloon angioplasty of a

congenital pulmonic stenosis in the cardiac catheterization laboratory. Which finding

should the nurse report to the health care provider that could possibly delay the

procedure?

1.

Auscultation of a loud heart murmur

2.

Infant has been NPO for 4 hours

3.

Infant has severe diaper rash

4.

Slight cyanosis of the nail beds

18- An experienced registered nurse (RN) is mentoring a new nurse in the telemetry unit. Which assessment technique by the new nurse requires intervention by the RN?

1.

Nurse carefully auscultates for heart murmurs at Erb’s point

2.

Nurse palpates bilateral carotid arteries simultaneously to assess for symmetry

3.

Nurse places client in semi-Fowler’s position to assess for jugular venous distension

4.

Nurse positions client supine to assess the point of maximal impulse

19- A client diagnosed with a ST-segment elevation myocardial infarction (STEMI) is receiving an intravenous thrombolytic infusion. In evaluating the client’s response to

treatment, which assessment finding by the nurse is the best indicator that reperfusion has

occurred?

1.

Increase in troponin level

2.

Nonsustained ventricular tachycardia

3.

Reduction of chest pain

4.

Return of ST segment to baseline

20- The nurse reinforces teaching a client on prescribed dabigatran for chronic atrial fibrillation. Which statement by the client indicates a need for further teaching?

1.

“I will call my health care provider if I notice red urine or blood in my stool.”

2.

“I will not stop taking dabigatran even if I get a stomachache.”

3.

“I will place capsules in my pill box so I will not forget to take a dose.”

4.

“I will swallow the capsule whole with a full glass of water.”

21- The nurse is admitting a client from the post-anesthesia care unit who just received a permanent atrioventricular pacemaker for a complete heart block. Which action should

the nurse implement first?

1.

Assess incision for bleeding or hematoma formation

2.

Auscultate bilateral anterior and posterior lung sounds

3.

Initiate continuous cardiac monitoring

4.

Reestablish IV fluids and postoperative antibiotics

22- The nurse is caring for a client who has been admitted to the hospital for an acute

exacerbation of heart failure. Blood pressure is 104/62 mm Hg, pulse is 96/min,

respirations are 22/min, and oxygen saturation is 91%. Which of these findings supports

the diagnosis of acute heart failure exacerbation?

1.

B-type natriuretic peptide (BNP) 1382 pg/mL [1382 pmol/L]

2.

Flat jugular veins when seated at a 45-degree angle

3.

Sodium 150 mEq/L [150 mmol/L]

4.

Urine output greater than 100 mL/hr

23- A client with mitral valve prolapse (MVP) has been experiencing occasional palpitations, lightheadedness, and dizziness. The health care provider prescribes a beta blocker. What

additional teaching should the nurse include for this client?

1.

Avoid aerobic exercise

2.

Ensure you receive antibiotics prior to dental work

3.

Stay well hydrated and avoid caffeine

4.

Wear a medical alert bracelet

24- The nurse is developing a teaching plan for a 65-year-old African American male client with a BMI of 30 kg/m2 and a strong family history of cardiovascular disease. Which

risk factor for coronary artery disease (CAD) should the nurse focus on during teaching?

1.

Client’s BMI of 30 kg/m2

2.

Client’s ethnicity

3.

Client’s gender

4.

Client’s strong family history of cardiovascular disease

25- A client has heart failure and has gained 5 lb (2.26 kg) over the last 3 days. Blood laboratory results from today are shown in the exhibit. What medication administration

does the nurse anticipate?

1.

0.2% intravenous normal saline

2.

Calcium gluconate

3.

Furosemide

4.

Sodium polystyrene

26- The nurse reviews the assigned clients’ laboratory results and medication administration records. Which finding is the highest priority for the nurse to follow-up with the health

care provider?

1.

Gram-negative infection and positive blood cultures in a client prescribed tobramycin

2.

Serum B-type natriuretic peptide (BNP) 650 pg/mL (650 ng/L) in a client prescribed

furosemide

3.

Serum potassium 5.7 mEq/L (5.7 mmol/L) in a client prescribed spironolactone

4.

Serum sodium 132 mEq/L (132 mmol/L) in a client prescribed IV normal saline solution at

175 mL/hr

27- The nurse has just completed discharge teaching for a client who had aortic valve replacement with a mechanical heart valve. Which statement by the client indicates that

teaching has been effective?

1.

“I’m glad that I can continue taking my Ginkgo biloba.”

2.

“I will increase my intake of leafy green vegetables.”

3.

“I will start applying vitamin E to my chest incision after showering.”

4.

“I will shave with an electric razor from now on.”

28- A client is admitted to the emergency department after a fall with dizziness and light- headedness. Blood pressure is 88/62 mm Hg, and the cardiac monitor displays the

rhythm in the exhibit. The nurse recognizes it as which rhythm?

1.

Complete heart block

2.

1st-degree heart block

3.

Sinus bradycardia

4.

Sinus rhythm

29- A client with myocardial infarction (MI) underwent successful revascularization with stent placement, is now chest pain free, and will be attending cardiac rehabilitation as an

outpatient. The client is embarrassed to talk to the health care provider (HCP) about

resuming sexual relations after an MI. What teaching should the nurse initiate with this

client?

1.

If the client is able to climb 2 flights of stairs without symptoms, the client may be ready for

sexual activity if approved by the HCP

2.

Inform the client that medications such as sildenafil or tadalafil are available as prescriptions

from the HCP

3.

It will be 6 months before the heart is healthy enough for sexual activity

4.

The client will be ready for sexual activity after completion of cardiac rehabilitation

30- The client is scheduled to have a cardiac catheterization. Which findings will cause the nurse to question the safety of the test proceeding? Select all that apply.

1.

Elevated C-reactive protein level

2.

History of previous reaction to IV contrast

3.

Prolonged PR interval on electrocardiogram

4.

Serum creatinine of 2.5 mg/dL (221 µmol/L)

5.

Took metformin today for type 2 diabetes

31- The nurse reviews laboratory data for a client admitted to the emergency department with chest pain. Which serum value requires the most immediate action by the nurse?

1.

Glucose 200 mg/dL (11.1 mmol/L)

2.

Hematocrit 38% (0.38)

3.

Potassium 3.4 mEq/L (3.4 mmol/L)

4.

Troponin 0.7 ng/mL (0.7 mcg/L)

32- A nurse receives an electrocardiogram of a client with type 2 diabetes, heart failure, and hypothyroidism. Based on the findings, which of the following medications should the

nurse suspect as the most likely cause?

1.

Captopril

2.

Carvedilol

3.

Glimepiride

4.

Levothyroxine

33- The nurse is preparing medications for a group of clients. Which prescription should the nurse clarify with the health care provider before administering?

1.

Client diagnosed with cirrhosis had 2 stools today; laxative lactulose prescribed daily

2.

Client is prescribed lisinopril PO daily; serum potassium level is 5.6 mEq/L (5.6 mmol/L)

3.

Client is receiving vancomycin IV; mild facial flushing noted after 30 minutes

4.

Client with diabetes has insulin glargine prescribed; current blood glucose is 100 mg/dL (5.6

mmol/L)

1- When a client diagnosed with acute urinary retention is emergently catheterized, the nurse should initially assess for which priority manifestation that may occur as a result of the catheterization?

1.

Dysuria

2.

Hypotension

3.

Infection

4.

Tachycardia

2- The nurse provides post-procedure teaching for a female client who had a

cystoscopy as an outpatient. Which client statement indicates the need for additional instruction?

1.

“I can expect pink-tinged urine for at least 24 hours.”

2.

“I can take a warm bath and acetaminophen if I have discomfort or bladder spasms.”

3.

“I should expect frequency and burning when I urinate.”

4.

“I should expect to see blood clots in my urine for up to 24 hours.”

3- A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia?

1.

Intravenous calcium gluconate

2.

Intravenous regular insulin with dextrose

3.

Oral sodium polystyrene sulfonate

4.

Transport to hemodialysis unit

4- A client with chronic kidney disease is admitted with pneumonia and pleurisy. The client’s laboratory results are shown in the exhibit. Which prescription will the nurse question?

1.

Acetaminophen 500 mg PO every 6 hours, as needed for fever

2.

Epoetin alfa 15,000 units subcutaneus injection, once weekly

3.

Ketorolac 15 mg IV every 6 hours, as needed for pain

4.

Levofloxacin 500 mg IV, once daily

5- A nurse is caring for a child with acute glomerulonephritis. Frequent monitoring of which of the following is a priority?

1.

Blood pressure

2.

Hematuria

3.

Intake and output

4.

Peripheral edema

6- A nurse is reviewing the laboratory values for a 3-year-old client with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome?

1.

Glomerular injury

2.

Hepatic impairment

3.

Inherited hypercholesterolemia

4.

Malnutrition

7- The nurse assesses a pediatric client who was diagnosed with diarrhea caused by Escherichia coli. The nurse is most concernedwith which finding?

1.

Blood-streaked stools

2.

Client drank fruit juice

3.

Dry mucous membranes

4.

Petechiae noted on the trunk

8- The nurse is providing discharge instructions to a client receiving oxybutynin for overactive bladder. Which client statement indicates that further teaching is required?

1.

“I am looking forward to our summer vacation at the beach.”

2.

“I plan to eat more fruits and vegetables to prevent constipation.”

3.

“I should not drive until I know how this drug affects me.”

4.

“I will drink at least 6-8 glasses of water daily.”

9- The nurse is caring for a 68-year-old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention?

1.

Conduct a bladder scan

2.

Help the client out of bed

3.

Insert an indwelling catheter using sterile technique

4.

Obtain a prescription for intermittent catheterization

10- A client underwent a transurethral resection of the prostate (TURP) today and has a 3-way Foley urinary catheter with continuous bladder irrigation (CBI). The client reports lower abdominal pain rated as an 8 on a scale of 0-10. What action should the nurse carry out first?

1.

Administer prescribed belladonna-opium suppositories prn

2.

Administer prescribed morphine intravenous push prn

3.

Check amount and characteristics of urine output

4.

Check when the client had the last flatus or bowel movement

11- The nurse reviews the serum laboratory results of assigned clients. Which results are most important to report to the health care provider? Select all that apply.

1.

Client with a malignancy prescribed filgrastim has neutropenia

2.

Client with acute osteomyelitis prescribed vancomycin has leukocytosis

3.

Client with acute pancreatitis prescribed hydromorphone has an elevated lipase level

4.

Client with hypertension prescribed candesartan has hyperkalemia

5.

Client with peritonitis prescribed tobramycin has an elevated creatinine level

12- The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following statements indicate that teaching has been effective? Select all that apply.

1.

“I am going to join a walking program to lose excess weight.”

2.

“I may have dry mouth as a side effect from the oxybutynin.”

3.

“I really need caffeine to get myself going in the morning.”

4.

“I should perform Kegel exercises several times daily.”

5.

“I will void every 2 hours until I am having fewer accidents.”

13- A nurse is preparing an educational presentation on herbal supplements for the local community center. Saw palmetto is one herbal medicine being discussed. Which audience participants would find this information beneficial?

1.

Clients diagnosed with heart failure

2.

Clients experiencing major depressive disorder

3.

Elderly clients with benign prostatic hyperplasia

4.

Perimenopausal clients experiencing hot flashes

14- The nurse is caring for a client with overflow urinary incontinence related to diabetic neuropathy. Which of the following interventions are appropriate? Select all that apply.

1.

Decrease fluid intake to 1 glass with each meal and at bedtime

2.

Encourage the client to bear down while attempting to void

3.

Inspect the perineal area for evidence of skin breakdown

4.

Measure postvoid residual volumes as prescribed

5.

Tell the client to wait 30 seconds after voiding and then attempt to void again

15- A nurse is caring for a client 2 days after surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the health care provider?

1.

2+ pitting edema of the extremity with the arteriovenous fistula

2.

Loud swooshing sound auscultated over the arteriovenous fistula

3.

Pale skin of the hand of the arm with the arteriovenous fistula

4.

Surgical site pain reported by the client as 3 on a scale of 0-10 during hand exercises

16- The nurse is caring for a 72-year-old client with a history of renal calculi and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2 F (38.4 C), and flank pain. Which of the following is the priority nursing intervention?

1.

Administer intravenous antibiotics

2.

Check baseline serum creatinine level

3.

Have the client strain all urine

4.

Obtain blood and urine cultures

17- The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What actions should the nurse perform initially? Select all that apply.

1.

Assess for abdominal distention and constipation

2.

Contact the client’s health care provider

3.

Examine the catheter for kinks and obstructions

4.

Flush the tubing with 100 mL of dialysate

5.

Place the client in a side-lying position

18- The health care provider prescribes phenazopyridine hydrochloride for a client with a urinary tract infection. What would the office nurse teach the client to expect while taking this medication?

1.

Constipation

2.

Difficulty sleeping

3.

Discoloration of urine

4.

Dry mouth

19- The nurse gathers a health history from a 58-year-old male client with acute urinary

retention. Which of the following questions should the nurse ask to aid in assessing for

benign prostatic hyperplasia? Select all that apply.

1.

“Do you feel the need to urinate again immediately after urinating?”

2.

“Do you have to strain to begin your stream of urine?”

3.

“How often do you engage in sexual intercourse?”

4.

“How often do you wake at night with the urge to urinate?”

5.

“Is your stream of urine weak or intermittent?”

20- The nurse cares for a client scheduled for a percutaneous left kidney biopsy as an outpatient. Which intervention should the nurse include in the client’s post- procedure care plan?

1.

Compare pre- and post-procedure BUN and creatinine levels

2.

Insert and maintain the patency of an indwelling urinary catheter

3.

Maintain prone position for at least 30 minutes

4.

Monitor vital signs every 15 minutes for the first hour

21- The health care provider is starting an elderly client on terazosin to treat benign prostatic hyperplasia (BPH). Which information should be included when teaching this client about the new medication?

1.

Change positions slowly when going from lying to standing

2.

Do not drink grapefruit juice when taking this drug

3.

Take this medication first thing in the morning, before breakfast

4.

Your stool may become darker and that’s normal

22- A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain?

1.

Blood pressure measurements

2.

Daily weight measurements

3.

Intake and output measurements

4.

Severity of pitting edema

23- The nurse is caring for a client who received extracorporeal shock wave lithotripsy with ureteral stent placement for treatment of a kidney stone. Which discharge instructions provided by the nurse are appropriate? Select all that apply.

1.

“Contact your health care provider if you develop a fever or chills.”

2.

“Except for using the bathroom, you should stay on bed rest for the next 48 hours.”

3.

“Increase your fluid intake to help flush out the kidney stone fragments.”

4.

“It is common to have some blood in the urine up to 24 hours after this procedure.”

5.

“You may develop some bruising on your back or on the side of your abdomen.”

24- A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective?

1.

Serum pH 7.32, HCO3- 26 mEq/L (26 mmol/L), potassium 4.9 mEq/L (4.9 mmol/L)

2.

Serum pH 7.34, HCO3- 21 mEq/L (21 mmol/L), potassium 5.1 mEq/L (5.1 mmol/L)

3.

Serum pH 7.39, HCO3- 24 mEq/L (24 mmol/L), potassium 3.8 mEq/L (3.8 mmol/L)

4.

Serum pH 7.41, HCO3- 18 mEq/L (18 mmol/L), potassium 4.3 mEq/L (4.3 mmol/L)

25- A client with chronic kidney disease has blood laboratory results as shown in the exhibit. What is the best afternoon snack to provide to this client?

1.

Apple slices with caramel dip

2.

Chips and avocado dip

3.

Nonfat yogurt with orange slices

4.

Vanilla pudding with strawberries

26- The charge nurse is making rounds and should immediately intervene when making which observation?

1.

A new nurse is using gentle pressure to flush a kidney pelvis catheter with 5 mL of fluid

2.

A nursing assistant is hanging a urinary drainage bag on the back of a wheelchair when

transporting a client

3.

Indwelling urinary catheter is taped to a male client’s inner thigh

4.

Total oral fluid intake in 24 hours for a client with a urinary diversion device is 2,800 mL

27- The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis?

1.

Constant; increased by pressure over the suprapubic area

2.

Dull and continuous; occasional spasms over the suprapubic area

3.

Dull flank pain; extending toward the umbilicus

4.

Excruciating; sharp flank pain radiating to the groin

28- A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention?

1.

Administer antihypertensives that were held prior to dialysis

2.

Administer PRN ondansetron to relieve nausea

3.

Contact the health care provider

4.

Place client in Trendelenburg position

29- The nurse is caring for a client with multiple renal calculi. Which nursing interventions should be included in the plan of care? Select all that apply.

1.

Administer analgesics at regularly scheduled intervals

2.

Encourage fluid intake of up to 3 L/day

3.

Instruct client to stay on bed rest

4.

Provide massage to the client’s flank

5.

Strain all urine for the presence of stones

30- After reviewing the urinalysis report data on a client, which question is most

appropriate for the nurse to ask?

1.

“Do you have a family history of diabetes?”

2.

“Do you have any burning or difficulty urinating?”

3.

“Have you suffered any recent kidney trauma?”

4.

“What has your fluid intake been for the last 24 hours?”

31- The nurse assesses a client with benign prostatic hyperplasia. Which client statement requires further assessment?

1.

“I have a burning sensation when I urinate.”

2.

“I have been having some dribbling after I finish urinating.”

3.

“I missed 3 days of finasteride while on a trip last week.”

4.

“I was awakened 3 times last night by the need to urinate.”

32- A client with a chronic kidney disease has blood laboratory values as shown in the exhibit. The nurse administers sodium polystyrene sulfonate by mouth per the health care provider’s prescription. The nurse evaluates that the therapy is effective when which value is noted on the follow-up results?

1.

Calcium 7.4 mg/dL (1.85 mmol/L)

2.

Creatinine 4.0 mg/dL (353 µmol/L)

3.

Phosphorus 3.9 mg/dL (1.26 mmol/L)

4.

Potassium 4.9 mEq/L (4.9 mmol/L)

33- The nurse has assessed 4 children. Which finding requires immediate follow-up with the health care provider?

1.

Child who had a surgical repair of hypospadias earlier today with no urinary output in the

past hour

2.

Child who is awaiting a neurological consult for suspected absence seizures and is sleeping

soundly

3.

Child who returned from a bronchoscopy an hour ago and coughed up blood-tinged sputum

4.

Child with gastroenteritis, serum sodium of 131 mEq/L (131 mmol/L), and temperature of

100 F (37.7 C)

34- A client with chronic kidney disease has received a continuous intravenous infusion of heparin for 5 days. The nurse reviews the coagulation studies and the medication administration record. Which prescription would the nurse question?

1.

Epoetin

2.

Sodium polystyrene sulfonate

3.

Vitamin K

4.

Warfarin

35- The nurse is admitting a 4-year-old diagnosed with Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority in the preoperative care plan?

1.

Assessment of the child’s emotional maturity level

2.

Auscultating for adventitious breath sounds

3.

Instructions not to palpate the abdomen

4.

Monitoring blood pressure closely

1- When a client diagnosed with acute urinary retention is emergently catheterized, the nurse should initially assess for which priority manifestation that may occur as a result of the catheterization?

1.

Dysuria

2.

Hypotension

3.

Infection

4.

Tachycardia

2- The nurse provides post-procedure teaching for a female client who had a

cystoscopy as an outpatient. Which client statement indicates the need for additional instruction?

1.

“I can expect pink-tinged urine for at least 24 hours.”

2.

“I can take a warm bath and acetaminophen if I have discomfort or bladder spasms.”

3.

“I should expect frequency and burning when I urinate.”

4.

“I should expect to see blood clots in my urine for up to 24 hours.”

3- A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia?

1.

Intravenous calcium gluconate

2.

Intravenous regular insulin with dextrose

3.

Oral sodium polystyrene sulfonate

4.

Transport to hemodialysis unit

4- A client with chronic kidney disease is admitted with pneumonia and pleurisy. The client’s laboratory results are shown in the exhibit. Which prescription will the nurse question?

1.

Acetaminophen 500 mg PO every 6 hours, as needed for fever

2.

Epoetin alfa 15,000 units subcutaneus injection, once weekly

3.

Ketorolac 15 mg IV every 6 hours, as needed for pain

4.

Levofloxacin 500 mg IV, once daily

5- A nurse is caring for a child with acute glomerulonephritis. Frequent monitoring of which of the following is a priority?

1.

Blood pressure

2.

Hematuria

3.

Intake and output

4.

Peripheral edema

6- A nurse is reviewing the laboratory values for a 3-year-old client with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome?

1.

Glomerular injury

2.

Hepatic impairment

3.

Inherited hypercholesterolemia

4.

Malnutrition

7- The nurse assesses a pediatric client who was diagnosed with diarrhea caused by Escherichia coli. The nurse is most concernedwith which finding?

1.

Blood-streaked stools

2.

Client drank fruit juice

3.

Dry mucous membranes

4.

Petechiae noted on the trunk

8- The nurse is providing discharge instructions to a client receiving oxybutynin for overactive bladder. Which client statement indicates that further teaching is required?

1.

“I am looking forward to our summer vacation at the beach.”

2.

“I plan to eat more fruits and vegetables to prevent constipation.”

3.

“I should not drive until I know how this drug affects me.”

4.

“I will drink at least 6-8 glasses of water daily.”

9- The nurse is caring for a 68-year-old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention?

1.

Conduct a bladder scan

2.

Help the client out of bed

3.

Insert an indwelling catheter using sterile technique

4.

Obtain a prescription for intermittent catheterization

10- A client underwent a transurethral resection of the prostate (TURP) today and has a 3-way Foley urinary catheter with continuous bladder irrigation (CBI). The client reports lower abdominal pain rated as an 8 on a scale of 0-10. What action should the nurse carry out first?

1.

Administer prescribed belladonna-opium suppositories prn

2.

Administer prescribed morphine intravenous push prn

3.

Check amount and characteristics of urine output

4.

Check when the client had the last flatus or bowel movement

11- The nurse reviews the serum laboratory results of assigned clients. Which results are most important to report to the health care provider? Select all that apply.

1.

Client with a malignancy prescribed filgrastim has neutropenia

2.

Client with acute osteomyelitis prescribed vancomycin has leukocytosis

3.

Client with acute pancreatitis prescribed hydromorphone has an elevated lipase level

4.

Client with hypertension prescribed candesartan has hyperkalemia

5.

Client with peritonitis prescribed tobramycin has an elevated creatinine level

12- The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following statements indicate that teaching has been effective? Select all that apply.

1.

“I am going to join a walking program to lose excess weight.”

2.

“I may have dry mouth as a side effect from the oxybutynin.”

3.

“I really need caffeine to get myself going in the morning.”

4.

“I should perform Kegel exercises several times daily.”

5.

“I will void every 2 hours until I am having fewer accidents.”

13- A nurse is preparing an educational presentation on herbal supplements for the local community center. Saw palmetto is one herbal medicine being discussed. Which audience participants would find this information beneficial?

1.

Clients diagnosed with heart failure

2.

Clients experiencing major depressive disorder

3.

Elderly clients with benign prostatic hyperplasia

4.

Perimenopausal clients experiencing hot flashes

14- The nurse is caring for a client with overflow urinary incontinence related to diabetic neuropathy. Which of the following interventions are appropriate? Select all that apply.

1.

Decrease fluid intake to 1 glass with each meal and at bedtime

2.

Encourage the client to bear down while attempting to void

3.

Inspect the perineal area for evidence of skin breakdown

4.

Measure postvoid residual volumes as prescribed

5.

Tell the client to wait 30 seconds after voiding and then attempt to void again

15- A nurse is caring for a client 2 days after surgical creation of an arteriovenous fistula in the forearm. Which finding should the nurse report immediately to the health care provider?

1.

2+ pitting edema of the extremity with the arteriovenous fistula

2.

Loud swooshing sound auscultated over the arteriovenous fistula

3.

Pale skin of the hand of the arm with the arteriovenous fistula

4.

Surgical site pain reported by the client as 3 on a scale of 0-10 during hand exercises

16- The nurse is caring for a 72-year-old client with a history of renal calculi and diabetes mellitus who was admitted for acute pyelonephritis. The nurse assesses shaking chills, temperature of 101.2 F (38.4 C), and flank pain. Which of the following is the priority nursing intervention?

1.

Administer intravenous antibiotics

2.

Check baseline serum creatinine level

3.

Have the client strain all urine

4.

Obtain blood and urine cultures

17- The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What actions should the nurse perform initially? Select all that apply.

1.

Assess for abdominal distention and constipation

2.

Contact the client’s health care provider

3.

Examine the catheter for kinks and obstructions

4.

Flush the tubing with 100 mL of dialysate

5.

Place the client in a side-lying position

18- The health care provider prescribes phenazopyridine hydrochloride for a client with a urinary tract infection. What would the office nurse teach the client to expect while taking this medication?

1.

Constipation

2.

Difficulty sleeping

3.

Discoloration of urine

4.

Dry mouth

19- The nurse gathers a health history from a 58-year-old male client with acute urinary

retention. Which of the following questions should the nurse ask to aid in assessing for

benign prostatic hyperplasia? Select all that apply.

1.

“Do you feel the need to urinate again immediately after urinating?”

2.

“Do you have to strain to begin your stream of urine?”

3.

“How often do you engage in sexual intercourse?”

4.

“How often do you wake at night with the urge to urinate?”

5.

“Is your stream of urine weak or intermittent?”

20- The nurse cares for a client scheduled for a percutaneous left kidney biopsy as an outpatient. Which intervention should the nurse include in the client’s post- procedure care plan?

1.

Compare pre- and post-procedure BUN and creatinine levels

2.

Insert and maintain the patency of an indwelling urinary catheter

3.

Maintain prone position for at least 30 minutes

4.

Monitor vital signs every 15 minutes for the first hour

21- The health care provider is starting an elderly client on terazosin to treat benign prostatic hyperplasia (BPH). Which information should be included when teaching this client about the new medication?

1.

Change positions slowly when going from lying to standing

2.

Do not drink grapefruit juice when taking this drug

3.

Take this medication first thing in the morning, before breakfast

4.

Your stool may become darker and that’s normal

22- A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain?

1.

Blood pressure measurements

2.

Daily weight measurements

3.

Intake and output measurements

4.

Severity of pitting edema

23- The nurse is caring for a client who received extracorporeal shock wave lithotripsy with ureteral stent placement for treatment of a kidney stone. Which discharge instructions provided by the nurse are appropriate? Select all that apply.

1.

“Contact your health care provider if you develop a fever or chills.”

2.

“Except for using the bathroom, you should stay on bed rest for the next 48 hours.”

3.

“Increase your fluid intake to help flush out the kidney stone fragments.”

4.

“It is common to have some blood in the urine up to 24 hours after this procedure.”

5.

“You may develop some bruising on your back or on the side of your abdomen.”

24- A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective?

1.

Serum pH 7.32, HCO3- 26 mEq/L (26 mmol/L), potassium 4.9 mEq/L (4.9 mmol/L)

2.

Serum pH 7.34, HCO3- 21 mEq/L (21 mmol/L), potassium 5.1 mEq/L (5.1 mmol/L)

3.

Serum pH 7.39, HCO3- 24 mEq/L (24 mmol/L), potassium 3.8 mEq/L (3.8 mmol/L)

4.

Serum pH 7.41, HCO3- 18 mEq/L (18 mmol/L), potassium 4.3 mEq/L (4.3 mmol/L)

25- A client with chronic kidney disease has blood laboratory results as shown in the exhibit. What is the best afternoon snack to provide to this client?

1.

Apple slices with caramel dip

2.

Chips and avocado dip

3.

Nonfat yogurt with orange slices

4.

Vanilla pudding with strawberries

26- The charge nurse is making rounds and should immediately intervene when making which observation?

1.

A new nurse is using gentle pressure to flush a kidney pelvis catheter with 5 mL of fluid

2.

A nursing assistant is hanging a urinary drainage bag on the back of a wheelchair when

transporting a client

3.

Indwelling urinary catheter is taped to a male client’s inner thigh

4.

Total oral fluid intake in 24 hours for a client with a urinary diversion device is 2,800 mL

27- The nurse is conducting a pain assessment on a client with dysuria. Which pain description is most likely associated with pyelonephritis?

1.

Constant; increased by pressure over the suprapubic area

2.

Dull and continuous; occasional spasms over the suprapubic area

3.

Dull flank pain; extending toward the umbilicus

4.

Excruciating; sharp flank pain radiating to the groin

28- A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention?

1.

Administer antihypertensives that were held prior to dialysis

2.

Administer PRN ondansetron to relieve nausea

3.

Contact the health care provider

4.

Place client in Trendelenburg position

29- The nurse is caring for a client with multiple renal calculi. Which nursing interventions should be included in the plan of care? Select all that apply.

1.

Administer analgesics at regularly scheduled intervals

2.

Encourage fluid intake of up to 3 L/day

3.

Instruct client to stay on bed rest

4.

Provide massage to the client’s flank

5.

Strain all urine for the presence of stones

30- After reviewing the urinalysis report data on a client, which question is most

appropriate for the nurse to ask?

1.

“Do you have a family history of diabetes?”

2.

“Do you have any burning or difficulty urinating?”

3.

“Have you suffered any recent kidney trauma?”

4.

“What has your fluid intake been for the last 24 hours?”

31- The nurse assesses a client with benign prostatic hyperplasia. Which client statement requires further assessment?

1.

“I have a burning sensation when I urinate.”

2.

“I have been having some dribbling after I finish urinating.”

3.

“I missed 3 days of finasteride while on a trip last week.”

4.

“I was awakened 3 times last night by the need to urinate.”

32- A client with a chronic kidney disease has blood laboratory values as shown in the exhibit. The nurse administers sodium polystyrene sulfonate by mouth per the health care provider’s prescription. The nurse evaluates that the therapy is effective when which value is noted on the follow-up results?

1.

Calcium 7.4 mg/dL (1.85 mmol/L)

2.

Creatinine 4.0 mg/dL (353 µmol/L)

3.

Phosphorus 3.9 mg/dL (1.26 mmol/L)

4.

Potassium 4.9 mEq/L (4.9 mmol/L)

33- The nurse has assessed 4 children. Which finding requires immediate follow-up with the health care provider?

1.

Child who had a surgical repair of hypospadias earlier today with no urinary output in the

past hour

2.

Child who is awaiting a neurological consult for suspected absence seizures and is sleeping

soundly

3.

Child who returned from a bronchoscopy an hour ago and coughed up blood-tinged sputum

4.

Child with gastroenteritis, serum sodium of 131 mEq/L (131 mmol/L), and temperature of

100 F (37.7 C)

34- A client with chronic kidney disease has received a continuous intravenous infusion of heparin for 5 days. The nurse reviews the coagulation studies and the medication administration record. Which prescription would the nurse question?

1.

Epoetin

2.

Sodium polystyrene sulfonate

3.

Vitamin K

4.

Warfarin

35- The nurse is admitting a 4-year-old diagnosed with Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority in the preoperative care plan?

1.

Assessment of the child’s emotional maturity level

2.

Auscultating for adventitious breath sounds

3.

Instructions not to palpate the abdomen

4.

Monitoring blood pressure closely

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