26. A client with mitral valve prolapse is advised to have elective mitral valve replacement. Because the client is a Jehovah’s Witness, she declares in her advance directive that no blood products are to be administered. As a result, the consulting cardiac surgeon refuses to care for the client. It would be most appropriate for nurse Christian who’s caring for the client to:
a. realize the surgeon has the right to refuse to care for the client
b. advise the surgeon to arrange for an alternate cardiac surgeon
c. tell the client that she can donate her own blood for the procedure
d. inform the client that her decision could shorten her life
27. A newly hired charge nurse assesses the staff nurses as competent individually but ineffective and nonproductive as a team. In addressing her concern, the charge nurse should understand that the usual reason for such a situation is:
a. unhappiness about the change in leadership
b. unexpressed feelings and emotions among the staff
c. fatigue from overwork and understaffing
d. failure to incorporate staff in decision making
28. Nurse Chrisopher is caring for an infant with congenital clubfoot. After the final cast has been removed, which member of the health care team will most likely help the infant with leg and ankle exercises and provide his parents with a home exercise regimen?
a. Occupational therapist
b. Physical therapist
c. Recreational therapist
d. Speech therapist
29. Which statement reflects appropriate documentation in the medical record of a hospitalized client?
a. Small pressure ulcer noted on left leg
b. Client seems to be mad at the physician
c. Client had a good day
d. Client’s skin is moist and cool
30. Critical pathways of care refer to:
a. a plan of care that provides outcome-based guidelines with a designated length of stay
b. a plan of care designed for physicians to prescribe medications
c. a design of treatment that includes approved therapies
d. a technique in therapy to care for the client holistically
Urinary/ Renal Function/ Electrolyte Imbalance
31. A client with urinary incontinence asks the nurse for suggestions about managing this condition. Which suggestion would be most appropriate?
a. “Make sure to eat enough fiber to prevent constipation.”
b. “Try drinking coffee throughout the day.”
c. “Use scented powders to disguise any odor.”
d. “Limit the number of times you urinate during the day.”
32. A client is frustrated and embarrassed by urinary incontinence. Which measure should the nurse include in a bladder retraining program?
a. Restricting fluid intake to reduce the need to void
b. Establishing a predetermined fluid intake pattern for the client
c. Encouraging the client to increase the time between voidings
d. Assessing present voiding patterns
33. A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client’s risk of:
a. a decreased serum phosphate level secondary to kidney failure.
b. an increased serum calcium level secondary to kidney failure.
c. water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
d. metabolic alkalosis secondary to retention of hydrogen ions.
34. Which is the correct term for the ability of the kidneys to clear solutes from the plasma?
a. Glomerular filtration rate (GFR)
b. Renal clearance
c. Specific gravity
d. Tubular secretion
35. A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
a. Start I.V. fluids with a normal saline solution bolus followed by a maintenance dose.
b. Administer furosemide (Lasix) 20 mg I.V.
c. Encourage oral fluids.
d. Start hemodialysis after a temporary access is obtained.
36. Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
a. Increased red blood cell count
b. Decreased serum potassium level
c. Increased serum calcium level
d. Increased serum creatinine level
37. A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
a. Serum sodium level of 135 mEq/L
b. Serum potassium level of 4.9 mEq/L
c. Temperature of 99.2° F (37.3° C)
d. Urine output of 20 ml/hour
>>See answer and rationale<<
38. A nurse is reviewing the history and physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?
a. Urinary retention
b. Painless hematuria
39. After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
a. “The effluent should be allowed to drain by gravity.”
b. “It is important to use strict aseptic technique.”
c. “The infusion clamp should be open during infusion.”
d. “It is appropriate to warm the dialysate in a microwave.”
40. Which of the following is a characteristic of a normal stoma?
b. No bleeding when cleansing stoma
c. Dry in appearance
d. Pink color
41. To assess circulating oxygen levels, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines recommends the use of which of the following diagnostic tests?
c. Arterial blood gases
d. Serum iron levels
42. A nurse is reviewing the history of a client who is suspected of having glomerulonephritis. Which of the following would the nurse consider significant?
a. History of hyperparathyroidism
b. History of osteoporosis
c. Recent history of streptococcal infection
d. Previous episode of acute pyelonephritis
43. Which type of incontinency refers to the involuntary loss of urine due to medications?
44. The nurse is to check residual urine amounts for a client experiencing urinary retention. Which of the following would be most important?
a. Catheterize the client immediately after the client voids.
b. Check for residual after the client reports the urge to void.
c. Set up a routine schedule of every 4 hours to check for residual urine.
d. Record the volume of urine obtained.
45. The client asks the nurse about the functions of the kidney. Which should the nurse include when responding to the client? Select all that apply.
a. Vitamin D synthesis
b. Secretion of prostaglandins
c. Vitamin B production
d. Secretion of insulin
e. Regulation of blood pressure
46. A client is scheduled for a creatinine clearance test. The nurse should explain that this test is done to assess the kidneys’ ability to remove a substance from the plasma in:
a. 1 hour.
b. 24 hours.
c. 1 minute.
d. 30 minutes.
47. A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
a. Impaired urinary elimination
b. Toileting self-care deficit
c. Risk for infection
d. Activity intolerance
48. When preparing a client for hemodialysis, which of the following would be most important for the nurse to do?
a. Check for thrill or bruit over the access site.
b. Warm the solution to body temperature.
c. Inspect the catheter insertion site for infection.
d. Add the prescribed drug to the dialysate.
49. A physician orders cystoscopy and random biopsies of the bladder for a client who reports painless hematuria. Test results reveal carcinoma in situ in several bladder regions. To treat bladder cancer, the client will have a series of intravesical instillations of bacillus Calmette-Guérin (BCG), administered 1 week apart. When teaching the client about BCG, the nurse should mention that this drug commonly causes:
a. delayed ejaculation.
d. renal calculi.
50. A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
a. “Be aware that your urine will be cherry-red for 5 to 7 days.”
b. “Increase your fluid intake to 2 to 3 L per day.”
c. “Apply an antibacterial dressing to the incision daily.”
d. “Take your temperature every 4 hours.”
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