Rationale: Physicians have an ethical and legal right to refuse to care for any client in a non-emergency situation when standard medical care isn’t acceptable to the client. It isn’t the responsibility of the surgeon to find an alternate. Jehovah’s Witnesses don’t believe in any kind of transfusion, homologous or autologous. Informing the client that her decision can shorten her life is inappropriate in that the statement may be inaccurate and it ignores the client’s right of autonomy.
Rationale: The usual or most prevalent reason for lack of productivity in a group of competent nurses is inadequate communication or a situation where the nurses have unexpressed feelings and emotions. Although the other answers could be contributing to the problematic situation, they’re less likely to be the cause.
Rationale: After the final cast has been removed, foot and ankle exercises may be necessary to improve range of motion. A physical therapist should work with the child. A physical therapist is trained to help clients restore function and mobility, which will prevent further disability.
Rationale: Documentation should include data that the nurse obtains using only observations that are heard, seen, smelled, or felt. The nurse should record findings or observations precisely and accurately. Documentation of a leg ulcer should include its exact size and location. Documenting observed client behaviors or conversations is appropriate, but drawing conclusions about a client’s feelings is not. Stating that the client had a good day doesn’t provide precise enough information to be useful.
Rationale: Critical pathways are defined as a provision of care in a case management system. The pathways provide outcome-based guidelines for goal achievement within a designated length of stay. Critical pathways are to be used by the treatment team, not just by the physician. Pathways are designated lengths of stay, not therapies.
Rationale:?Suggestions to manage urinary incontinence include avoiding constipation such as eating adequate fiber and drinking adequate amounts of fluid. Scented powders, lotions, or sprays should be avoided because they can intensify the urine odor, irritate the skin, or cause a skin infection. Stimulants such as caffeine, alcohol, and aspartame should be avoided. The client should void regularly, approximately every 2 to 3 hours to ensure bladder emptying.
Rationale: The guidelines for initiating bladder retraining include assessing the client’s present intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the client’s fluid intake won’t reduce or prevent incontinence. The client should be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.
Rationale: The client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys’ inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions.
Rationale: Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. GFR is the volume of plasma filtered at the glomerulus into the kidney tubules each minute. Specific gravity reflects the weight of particles dissolved in the urine. Tubular secretion is the movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta.
Rationale: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize. The client wouldn’t be able to tolerate oral fluids because of the nausea, vomiting, and diarrhea. The client isn’t fluid-overloaded so his urine output won’t increase with furosemide, which would actually worsen the client’s condition. The client doesn’t require dialysis because the oliguria and elevated BUN and creatinine levels are caused by dehydration.
?Rationale: In renal failure, laboratory blood tests reveal elevations in BUN, creatinine, potassium, magnesium, and phosphorus. Calcium levels are low. The RBC count, hematocrit, and hemoglobin are decreased.
#37. ?Answer: D
Rationale: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client’s urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.
Rationale: The most common first symptom of a malignant tumor of the bladder is painless hematuria. Additional early symptoms include UTI with symptoms such as fever, dysuria, urgency, and frequency. Later symptoms are related to metastases and include pelvic pain, urinary retention (if the tumor blocks the bladder outlet), and urinary frequency from the tumor occupying bladder space.
?Rationale: The dialysate should be warmed in a commercial warmer and never in a microwave oven. Strict aseptic technique is essential. The infusion clamp is opened during the infusion and clamped after the infusion. When the dwell time is done, the drain clamp is opened and the fluid is allowed to drain by gravity into the drainage bag.
?Rationale: Characteristics of a normal stoma include a pink and moist appearance. It is insensitive to pain because it has no nerve endings. The area is vascular and may bleed when cleaned.
?Rationale: Although hematocrit has always been the blood test of choice to assess for anemia, the 2001 Kidney Disease Outcomes Quality Initiative: Management of Anemia Guidelines, recommend that anemia be quantified using hemoglobin rather than hematocrit measurements. Hemoglobin is recommended as it is more accurate in the assessment of circulating oxygen than hematocrit. Serum iron levels measure iron storage in the body. Arterial blood gases assess the adequacy of oxygenation, ventilation, and acid-base status.
?Rationale: Glomerulonephritis can occur as a result of infections from group A beta-hemolytic streptococcal infections, bacterial endocarditis, or viral infections such as hepatitis B or C or human immunodeficiency virus (HIV). A history of hyperparathyroidism or osteoporosis would place the client at risk for developing renal calculi. A history of pyelonephritis would increase the client’s risk for chronic pyelonephritis.
Rationale: Iatrogenic incontinence is the involuntary loss of urine due to medications. Reflex incontinence is the involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Overflow incontinence is the involuntary loss of urine associated with overdistention of the bladder.
Rationale: To obtain accurate residual volumes, it is important that clients void first and that catheterization occur immediately after the attempt. The nurse should record both the volume voided (even if it is zero) and the volume obtained by catheterization. Intermittent catheterizations are performed based on a schedule, usually 3 to 4 times per day. Residual urine refers to the amount remaining in the bladder after voiding. It is essential that the client voids.
#45.?Answers: A, B, E
?Rationale: Functions of the kidney include secretion of prostaglandins, regulation of blood pressure, and synthesis of aldosterone and vitamin D. The pancreas secretes insulin. The body does not produce Vitamin B.
?Rationale: The creatinine clearance test determines the kidneys’ ability to remove a substance from the plasma in 1 minute. It doesn’t measure the kidneys’ ability to remove a substance over a longer period.
?Rationale: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
#48. Answer: A
?Rationale: When preparing a client for hemodialysis, the nurse would need to check for a thrill or bruit over the vascular access site to ensure patency. Inspecting the catheter insertion site for infection, adding the prescribed drug to the dialysate, and warming the solution to body temperature would be necessary when preparing a client for peritoneal dialysis.
?Rationale: Intravesical instillation of BCG commonly causes hematuria. Other common adverse effects of BCG include urinary frequency and dysuria. Less commonly, BCG causes cystitis, urinary urgency, urinary incontinence, urinary tract infection, abdominal cramps or pain, decreased bladder capacity, tissue in urine, local infection, renal toxicity, and genital pain. BCG isn’t associated with renal calculi, delayed ejaculation, or impotence.
Rationale: The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system. Measuring temperature every 4 hours isn’t needed. Lithotripsy doesn’t require an incision. Hematuria may occur for a few hours after lithotripsy but should then disappear.