Urinary Tract Health Problems NCLEX Questions with Rationale

NCLEX Urinary Tract Health Problems Questions

Urinary Tract Health Problems NCLEX Practice Questions

Question 1.    
A client has undergone a cystectomy and an ileal conduit diversion. What should the nurse include in the discharge instructions? Select all that apply.
(a) Drink at least 3,000 mL of fluid each day.
(b) Minimize daily activities.
(c) Keep urine alkaline to prevent urinary tract infections.
(d) Avoid odor-producing foods, such as onions, fish, eggs, and cheese.
(e) Wear snug clothing over the stoma to encourage urine flow into the drainage bag.
Answer:
(a) Drink at least 3,000 mL of fluid each day.
(d) Avoid odor-producing foods, such as onions, fish, eggs, and cheese.

Explanation:
(a), (d). An adequate fluid intake aids in the prevention of urinary calculi and infection. Odor- producing foods can produce offensive odors that may impact the client’s lifestyle and relationships. Lack of activity leads to urinary stasis, which promotes urinary calculi development and infection. Acidic urine helps prevent urinary tract infections. Tight clothing over the stoma obstructs blood circulation and urine flow.

Question 2.    
A nurse is instructing a client with an ileal conduit about skin care around the stoma. What should the nurse tell the client about stoma care? Select all that apply.
(a) “The stoma will shrink to a normal size in 4 to 6 weeks.”
(b) “You can take a shower or a bath with the appliance on or off.”
(c) “You should wash around the stoma with an antibacterial soap.”
(d) “You can use an electric razor to remove the hair around the stoma.”
(e) “You should remove the collection bag every day to inspect the stoma for infection”
Answer:
(a) “The stoma will shrink to a normal size in 4 to 6 weeks.”
(b) “You can take a shower or a bath with the appliance on or off.”
(d) “You can use an electric razor to remove the hair around the stoma.”

Explanation:
(a), (b), (d). The nurse should instruct the client with an ileal conduit that the stoma will shrink in about 4 to 6 weeks. The client can take a shower or a bath with the collection pouch on or off. The client can shave the hair around the stoma using an electric razor to make it easier for the collec-tion bag to adhere to the skin. The client should wash the skin around the stoma with water; it is not necessary to use an antibacterial soap, and soap may cause the skin to become dry and irritated. The collection bag can remain in place for up to 7 days.

Question 3.
A client is admitted to the recovery room after cystoscopy with biopsy. Before the nurse can discharge the client, what should the nurse assess?
The client has:
(a) had a bowel movement.
(b) no pain.
(c) emptied the bladder.
(d) no blood in the urine.
Answer:
(c) emptied the bladder.

Explanation:
The nurse should verify that the client has voided prior to discharge in order to evaluate bladder function. Bowel function is not expected to be affected by this procedure. There may not be a need for pain medication immediately after the procedure and before discharge, but the nurse should assess the client’s pain status and inform the client about the use and side effects of the medication. It is normal for the client to have hematuria because of the procedure.
 
Question 4.
The nurse should conduct a focused assessment for the client with suspected bladder cancer for which common sign of the disease?
(a) suprapubic pain
(b) painful voiding
(c) painless hematuria
(d) urine retention
Answer:
(d) urine retention

Explanation:
Painless hematuria is the most common clinical finding in bladder cancer. Other symptoms include urinary frequency, dysuria, and urinary urgency, but these are not as common as hematuria. Suprapubic pain and urine retention do not occur in bladder cancer.

Question 5. 
Which symptom indicates that a client has developed a complication after a cystoscopy?
(a) dizziness
(b) chills
(c) pink-tinged urine
(d) bladder spasms
Answer:
(b) chills

Explanation:
Chills could indicate the onset of acute infection that can progress to septic shock. Dizziness would not be an anticipated symptom after a cystoscopy. Pink-tinged urine and bladder spasms are common after cystoscopy.

Question 6.
If the client develops lower abdominal pain after a cystoscopy, what should the nurse instruct the client to do?
(a) Apply an ice pack to the pubic area.
(b) Massage the abdomen gently.
(c) Ambulate as much as possible.
(d) Sit in a tub of warm water.
Answer:
(d) Sit in a tub of warm water.

Explanation:
Lower abdominal pain after a cystoscopy is frequently caused by bladder spasms. Warm water can help relax muscles. Ice is not effective in relieving spasms. Massage and ambulation may increase bladder irritability.

Question 7.
A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Prior to surgery, what comment by the client indicates that the client understands the procedure?
(a) “This is a temporary procedure that can be reversed later.”
(b) “I will urinate through my rectum.”
(c) “My urine will come out through an opening on my abdomen.”
(d) “My urine will go from my bladder into a drainage bag.”
Answer:
(c) “My urine will come out through an opening on my abdomen.”

Explanation:
An ileal conduit is a permanent urinary diversion in which a portion of the ileum is surgically resected and one end of the segment is closed. The ureters are surgically attached to this segment of the ileum, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma. The client must wear a pouch to collect the urine that continually flows through the conduit. The bladder is removed during the surgical procedure, and the ileal conduit is not reversible. Diversion of urine to the sigmoid colon is called a ureteroileosigmoidostomy. An opening in the bladder that allows urine to drain externally is called a cystostomy.

Question 8.
After surgery for an ileal conduit, the nurse should closely assess the client for the occurrence of which complication specifically related to this pelvic surgery?
(a) peritonitis
(b) thrombophlebitis
(c) ascites
(d) inguinal hernia
Answer:
(b) thrombophlebitis

Explanation:
After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Ascites is most frequently an indication of liver disease. Inguinal hernia may be caused by an increase in intra-abdominal pressure or a congenital weakness of the abdominal wall; ventral hernia occurs at the site of a previous abdominal incision.

Question 9.
The nurse is assessing the urine of a client who has had an ileal conduit and notes that there is a moderate amount of mucus in the urine. What should the nurse do next?
(a) Change the appliance bag.
(b) Notify the health care provider (HCP).
(c) Obtain a urine specimen for culture.
(d) Encourage a high fluid intake.
Answer:
(d) Encourage a high fluid intake.

Explanation:
Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or to notify the HCP.  The mucus is not an indication of an infection, so a urine culture is not necessary.

Question 10.    
When teaching the client to care for an ileal conduit, the nurse instructs the client to empty the appliance frequently. Which outcome indicates that the client is following instructions?
(a) The skin around the stoma is red.
(b) The urine is a deep yellow.
(c) There is no odor present.
(d) The seal around the stoma is intact.
Answer:
(d) The seal around the stoma is intact.

Explanation:
If the appliance becomes too full, it is likely to pull away from the skin completely or to leak urine onto the skin; thus, if the seal is intact, the client is emptying the appliance regularly. The skin around the seal should not be red or irritated, which could indicate a leak. There will likely be an odor from the urine. Deep yellow urine indicates that the client should be increasing fluid intake.

Question 11.   
The nurse is instructing a client with an ileal conduit. What should the nurse instruct the client to do to prevent urine leakage when changing the appliance?
(a) Insert a gauze wick into the stoma.
(b) Close the opening temporarily with a cellophane seal.
(c) Suction the stoma before changing the appliance.
(d) Limit oral fluids for several hours before changing the appliance.
Answer:
(a) Insert a gauze wick into the stoma.

Explanation:
Inserting a gauze wick into the stoma helps prevent urine leakage when changing the appliance. The stoma should not be sealed or suctioned. Oral fluids do not need to be avoided.

Question 12. 
The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with which product?
(a) baking soda
(b) soap
(c) hydrogen peroxide 
(d) alcohol
Answer:
(b) soap

Explanation:
A reusable appliance should be routinely cleaned with soap and water. Other products are not necessary and may damage the appliance or be caustic to the client’s skin.

Question13. 
The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which statements indicate that the client has correctly understood the teaching? Select all that apply.
(a) “If I limit my fluid intake, I won’t have to empty my ostomy pouch as often.”
(b) “I can place an aspirin tablet in my pouch to decrease odor.”
(c) “I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
(d) “I must use a skin barrier to protect my skin from urine.”
(e) “I should empty my ostomy pouch of urine when it is full.”
Answer:
(c) “I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
(d) “I must use a skin barrier to protect my skin from urine.”

Explanation:
(c), (d). The client with an ileal conduit must learn self-care activities related to care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 mL/day and should not limit intake. Adequate fluid intake helps to flush mucus from the ileal conduit. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine. An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight of the urine from pulling the appliance away from the skin.

Question 14.    
A client has an ileal conduit. Which solutions will be useful to help control odor in the urine collecting bag after it has been cleaned?
(a) saltwater
(b) vinegar
(c) ammonia
(d) bleach
Answer:
(b) vinegar

Explanation:
A distilled vinegar solution acts as a good deodorizing agent after an appliance has been cleaned well with soap and water. If the client prefers, a commercial deodorizer may be used. Salt solution does not deodorize. Ammonia and bleaching agents may damage the appliance.

Question 15.    
A client who has a urinary diversion tells the nurse, “This urinary pouch is embarrassing. Everyone will know that I’m not normal. I don’t see how I can go out in public anymore.” What is an appropriate goal for the nurse to set with this client?
(a) Manage anxiety about not being normal.
(b) Learn how to care for the urinary diversion.
(c) Overcome feelings of worthlessness.
(d) Express fears about the urinary diversion.
Answer:
(d) Express fears about the urinary diversion.

Explanation:
It is normal for clients to express fears and concerns about the body changes associated with a urinary diversion. Allowing the client time to verbalize concerns in a supportive environment and suggesting that she discuss these concerns with people who have successfully adjusted to ostomy surgery can help her begin coping with these changes in a positive manner. Although the client may be anxious about this situation and may be feeling worthless, the underlying problem is a disturbance in body image. There are no data to indicate that the client does not know how to care for the urinary diversion.

Question 16.    
The nurse teaches the client with a urinary diversion to attach the appliance to a standard urine collection bag at night. The intended outcome of the instruction is to prevent what occurrence?
(a) urine reflux into the stoma
(b) appliance separation
(c) urine leakage
(d) the need to restrict fluids
Answer:
(a) urine reflux into the stoma

Explanation:
The most important reason for attaching the appliance to a standard urine collection bag at night is to prevent urine reflux into the stoma and ureters, which can result in infection. Use of a standard collection bag also keeps the appliance from separating from the skin and helps prevent urine leakage from an overly full bag, but the primary purpose is to prevent reflux of urine. A client with a urinary diversion should drink 2,000 to 3,000 mL of fluid each day; it would be inappropriate to suggest decreasing fluid intake.

Question 17.    
The nurse is teaching the client with an ileal conduit how to prevent a urinary tract infection. Which measure would be most effective?
(a) Avoid people with respiratory tract infections.
(b) Maintain a daily fluid intake of 2,000 to 3,000 mL.
(c) Use sterile technique to change the appliance. 
(d) Irrigate the stoma daily.
Answer:
(b) Maintain a daily fluid intake of 2,000 to 3,000 mL.

Explanation:
Maintaining a fluid intake of 2,000 to 3,000 mL/day is likely to be most effective in preventing urinary tract infection. A high fluid intake results in high urine output, which prevents urinary stasis and bacterial growth. Avoiding people with respiratory tract infections will not prevent urinary tract infections. Clean, not sterile, technique is used to change the appliance. An ileal conduit stoma is not irrigated.

Question 18.    
The nurse evaluates the effectiveness of the client’s postoperative plan of care. Which outcome is expected for a client with an ileal conduit?
(a) The client verbalizes the understanding that physical activity must be curtailed.
(b) The client will place an aspirin in the drainage pouch to help control odor.
(c) The client demonstrates how to catheterize the stoma.
(d) The client will empty the drainage pouch frequently throughout the day.
Answer:
(d) The client will empty the drainage pouch frequently throughout the day.

Explanation:
It is important that the client empty the drainage pouch throughout the day to decrease the risk of leakage. The client does not normally need to curtail physical activity. Aspirin should never be placed in a pouch because aspirin can irritate or ulcerate the stoma. The client does not catheterize an ileal conduit stoma.

Question 19.    
A client is scheduled to undergo weekly intravesical chemotherapy for bladder cancer for 8 weeks. Which statement indicates that the client understands how to manage the urine as a biohazard?
(a) “I’ll void into a bedpan and then empty the urine into the toilet.”
(b) “I can disinfect the urine and toilet with bleach for 6 hours following a treatment.”
(c) “It’s important to clean the bathroom daily with disinfectant wipes.”
(d) “I should use a separate bathroom from the rest of the family for the next 8 weeks.”
Answer:
(b) “I can disinfect the urine and toilet with bleach for 6 hours following a treatment.”

Explanation:
After intravesical chemotherapy, the client must treat the urine as a biohazard; this involves disinfecting the urine and the toilet with household bleach for 6 hours following a treatment. It is not necessary to use a bedpan and then empty the urine in the toilet; the client can use the toilet, but must disinfect the urine with bleach. The bathroom does not need to be cleaned daily with disinfectant wipes. The client does not need to use a separate bathroom as long as the client’s urine is disinfected with bleach.

Question 20.    
A nurse is planning care for a client who underwent a percutaneous needle biopsy of the kidney. What should the nurse plan to do immediately after the biopsy? Select all that apply.
(a) Assess the biopsy site.
(b) Take vital signs every hour.
(c) Assess urine for hematuria.
(d) Place the client in a prone position.
(e) Assess the client for chest pain.
Answer:
(a) Assess the biopsy site.
(c) Assess urine for hematuria.
(d) Place the client in a prone position.

Explanation:
(a), (c), (d). The nurse should assess the biopsy site for bleeding and hematoma formation. The client should remain prone for 8 to 24 hours after the biopsy. A pressure dressing will aid in blood coagulation. Vital signs assessment should be taken every 5 to 15 minutes for the first hour and then less often if the client is stable. The urine does not need to be collected and kept on ice. The nurse should collect serial urine specimens to assess for hematuria. A renal biopsy does not put the client at increased risk for chest pain.

Question 21. 
A client had a percutaneous nephrolithotomy to remove a kidney stone. The client is being discharged with drainage tubes from the kidney. What should the nurse instruct the client to do after the procedure? Select all that apply.
(a) Avoid heavy lifting for 2 to 4 weeks.
(b) Return to work after one month.
(c) Report fever or chills to the health care provider (HCP).
(d) Go to the emergency department for bleeding from the drainage tubes.
(e) Strain all urine and report presence of stones.
Answer:
(a) Avoid heavy lifting for 2 to 4 weeks.
(b) Return to work after one month.
(e) Strain all urine and report presence of stones.

Explanation:
(a), (b), (e). Following percutaneous nephrolithotomy, the nurse should instruct the client to avoid lifting heavy objects for 2 to 4 weeks. The client should contact the HCP if having chills or fever. The client should go to the emergency department if there is bleeding from the drainage tubes. Usuallythe client can return to work in a week. It is not necessary to strain the urine. The client will likely have X-rays or ultrasound several weeks after the surgery to determine if there are other stones in the kidney.

Question 22.    
A client has renal colic due to renal lithiasis. What is the nurse’s first priority in managing care for this client?
(a) Do not allow the client to ingest fluids.
(b) Encourage the client to drink at least 500 mL of water each hour.
(c) Request the central supply department to send supplies for straining urine.
(d) Administer an opioid analgesic as prescribed. 
Answer:
(d) Administer an opioid analgesic as prescribed. 

Explanation:
If infection or blockage caused by calculi is present, a client can experience sudden severe pain in the flank area, known as renal colic. Pain from a kidney stone is considered an emergency situation and requires analgesic intervention. Withholding fluids will make urine more concentrated and stones more difficult to pass naturally. Forcing large quantities of fluid may cause hydronephrosis if urine is prevented from flowing past calculi. Straining urine for small stones is important but does not take priority over pain management.

Question 23.    
A client is admitted to the hospital with a diagnosis of renal calculi. The client is experiencing severe flank pain and nausea; the temperature is 100.6°F (38.1°C). Which outcome is a priority for this client?
(a) prevention of urinary tract complications
(b) alleviation of nausea
(c) alleviation of pain
(d) maintenance of fluid and electrolyte balance
Answer:
(c) alleviation of pain

Explanation:
The priority nursing goal for this client is to alleviate the pain, which can be excruciating. Prevention of urinary tract complications and alleviation of nausea are appropriate throughout the client’s hospitalization, but relief of the severe pain is a priority. The client is at little risk for fluid and electrolyte imbalance.

Question 24.    
The client is scheduled to have a kidney, ureter, and bladder (KUB) radiograph. What should the nurse explain to the client about this procedure?
(a) Fluid and food will be withheld the morning of the examination.
(b) A tranquilizer will be given before the examination.
(c) An enema will be given before the examination.
(d) No special preparation is required for the examination.
Answer:
(d) No special preparation is required for the examination.

Explanation:
A KUB radiographic examination ordinarily requires no preparation. It is usually done while the client lies supine and does not involve the use of radiopaque substances. It is not necessary for the client to withhold fluids; the client will not need to take a tranquilizer; an enema is not included in the preparation.

Question 25.
In addition to nausea and severe flank pain, a female client with renal calculi has pain in the groin and bladder. What additional sign should the nurse assess?
(a) nephritis
(b) referred pain
(c) urine retention
(d) additional stone formation
Answer:
(b) referred pain

Explanation:
The pain associated with renal colic due to calculi is commonly referred to the groin and bladder in female clients and to the testicles in male clients. Nausea, vomiting, abdominal cramping, and diarrhea may also be present. Nephritis or urine retention is an unlikely cause of the referred pain. The type of pain described in this situation is unlikely to be caused by additional stone formation.

Question 26. 
Which measure is likely to provide the most relief from the pain associated with renal colic?
(a) applying moist heat to the flank area
(b) administering morphine
(c) encouraging high fluid intake
(d) maintaining complete bed rest
Answer:
(b) administering morphine

Explanation:
During episodes of renal colic, the pain is excruciating. It is necessary to administer opioid analgesics such as morphine to control the pain. Application of heat, encouraging high fluid intake, and limitation of activity are important interventions, but they will not relieve the renal colic pain.

Question 27.
A client who has been diagnosed with renal calculi reports that the pain is intermittent and less colicky. Which nursing action is most important at this time?
(a) Report hematuria to the health care provider.
(b) Strain the urine carefully.
(c) Administer morphine every 3 hours.
(d) Apply warm compresses to the flank area.
Answer:
(b) Strain the urine carefully.

Explanation:
Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect passage of the stone. Hematuria is to be expected from the irritation of the stone. Analgesics should be administered when the client needs them, not routinely. Moist heat to the flank area is helpful when renal colic occurs, but it is less necessary as pain is lessened.

Question 28. 
The client is scheduled for an intravenous pyelogram (IVP) to determine the location of the renal calculi. Which action would be most important for the nurse to include in pretest preparation?
(a) Ensure adequate fluid intake on the day of the test.
(b) Prepare the client for the possibility of bladder spasms during the test.
(c) Check the client’s history for allergy to iodine.
(d) Determine when the client last had a bowel movement.
Answer:
(c) Check the client’s history for allergy to iodine.

Explanation:
A client scheduled for an IVP should be assessed for allergies to iodine and shellfish. Clients with such allergies may be allergic to the IVP dye and be at risk for an anaphylactic reaction. Adequate fluid intake is important after the examination. Bladder spasms are not common during an IVP. Bowel preparation is important before an IVP to allow visualization of the ureters and bladder, but checking for allergies is most important.

Question 29.
After an intravenous pyelogram (IVP), the nurse should include which measure in the client’s plan of care?
(a) Maintain bed rest.
(b) Encourage adequate fluid intake.
(c) Assess for hematuria.
(d) Administer a laxative.
Answer:
(b) Encourage adequate fluid intake.

Explanation:
After an IVP, the nurse should encourage fluids to decrease the risk of renal complications caused by the contrast agent. There is no need to place the client on bed rest or administer a laxative. An IVP would not cause hematuria.

Question 30. 
A client has a ureteral catheter in place after renal surgery. What should the nurse do to provide safe care of the ureteral catheter?
(a) Irrigate the catheter with 30 mL of normal saline every 8 hours.
(b) Ensure that the catheter is draining freely.
(c) Clamp the catheter every 2 hours for 30    minutes.
(d) Ensure that the catheter drains at least 15 mL/h.
Answer:
(b) Ensure that the catheter is draining freely.

Explanation:
The ureteral catheter should drain freely without bleeding at the site. The catheter is rarely irrigated, and any irrigation would be done by the health care provider (HCP) Q. The catheter is never clamped. The client’s total urine output (ureteral catheter plus voiding or indwelling urinary catheter output) should be at least 30 mL/h.

Question 31. 
Which would be the most appropriate measure for preventing the development of a paralytic ileus in a client who had renal surgery yesterday?
(a) Encourage the client to ambulate every 2 to 4 hours.
(b) Offer 3 to 4 oz (90 to 120 mL) of a carbonated beverage periodically.
(c) Administer a stool softener daily.
(d) Ensure 3,000 mL of IV fluids in 24 hours.
Answer:
(a) Encourage the client to ambulate every 2 to 4 hours.

Explanation:
Ambulation stimulates peristalsis. A client with paralytic ileus is kept on nothing-by-mouth status until peristalsis returns. Carbonated beverages will increase gas and distention but will not stimulate peristalsis. A stool softener will not stimulate peristalsis. IV fluid infusion is a routine postoperative prescription that does not have any effect on preventing paralytic ileus.

Question 32.    
The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. The nurse should report which finding to the health care provider (HCP)?
(a) temperature: 99.8°F (37.7°C)
(b) urine output: 20 mL/h
(c) absence of bowel sounds
(d) serosanguineous drainage on the dressing
Answer:
(b) urine output: 20 mL/h

Explanation:
The decrease in urine output may reflect inadequate renal perfusion and should be reported immediately. Urine output of 30 mL/h or greater is considered acceptable. A slight elevation in temperature is expected after surgery. Peristalsis returns gradually, usually the second or third day after surgery. Bowel sounds will be absent until then. A small amount of serosanguineous drainage is to be expected.

Question 33.    
A client with a history of renal calculi formation is being discharged after surgery to remove the calculus. What instruction should the nurse include in the client’s discharge teaching plan?
(a) Increase daily fluid intake to at least 2 to 3 L.
(b) Strain all urine for one week.
(c) Eliminate dairy products from the diet.
(d) Follow measures to alkalinize the urine.
Answer:
(a) Increase daily fluid intake to at least 2 to 3 L.

Explanation:
A high daily fluid intake is essential for all clients who are at risk for calculi formation because it prevents urinary stasis and concentration, which can cause crystallization. Depending on the composition of the stone, the client also may be instructed to institute specific dietary measures aimed at preventing stone formation. Clients may need to limit purine, calcium, or oxalate. Urine may need to be either alkaline or acid. There is no need to strain urine.

Question 34.    
Allopurinol is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which adverse effect of this medication?
(a) retinopathy
(b) maculopapular rash
(c) nasal congestion
(d) dizziness
Answer:
(b) maculopapular rash

Explanation:
Allopurinol is used to treat renal calculi composed of uric acid. Adverse effects of allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report rashes and unusual bleeding or bruising. Retinopathy, nasal congestion, and dizziness are not adverse effects of allopurinol.

Question 35. 
A client has been prescribed allopurinol for renal calculi that are caused by high uric acid levels. Which symptoms indicate the client is experiencing adverse effects of this drug? Select all that apply.
(a) nausea
(b) rash
(c) constipation
(d) flushed skin
(e) bone marrow depression
Answer:
(a) nausea
(b) rash
(e) bone marrow depression

Explanation:
(a), (b), (e). Common adverse effects of allopurinol include gastrointestinal distress, such as anorexia, nausea, vomiting, and diarrhea. A rash is another potential adverse effect. A potentially life-threatening adverse effect is bone marrow depression. Constipation and flushed skin are not associated with this drug.

Question 36. 
A client is to receive peritoneal dialysis. What should the nurse do to prepare the client for the procedure?
(a) Assess the dialysis access for a bruit and thrill.
(b) Insert an indwelling urinary catheter and drain all urine from the bladder.
(c) Ask the client to turn toward the left side.
(d) Warm the dialysis solution in the warmer.
Answer:
(d) Warm the dialysis solution in the warmer.

Explanation:
Solution for peritoneal dialysis should be warmed to body temperature in a warmer or with a heating pad; do not use the microwave. Cold dialy- sate increases discomfort. Assessment for a bruit and thrill is necessary with hemodialysis when the client has a fistula, graft, or shunt. An indwelling urinary catheter is not required for this procedure. The nurse should position the client in a supine or low Fowler’s position.

Question 37. 
A client has been admitted with acute renal failure. What should the nurse do while admitting the client? Select all that apply.
(a) Elevate the head of the bed 30 to 45 degrees.
(b) Take vital signs.
(c) Establish an IV access site.
(d) Call the admitting health care provider (HCP) for prescriptions.
(e) Contact the hemodialysis unit.
Answer:
(a) Elevate the head of the bed 30 to 45 degrees.
(b) Take vital signs.
(c) Establish an IV access site.
(d) Call the admitting health care provider (HCP) for prescriptions.

Explanation:
(a), (b), (c), (d). Elevation of the head of the bed will promote ease of breathing. Respiratory manifestations of acute renal failure include shortness of breath, orthopnea, crackles, and the potential for pulmonary edema. Therefore, priority is placed on facilitation of respiration. The nurse should assess the vital signs because the pulse and respirations will be elevated. Establishing a site for IV therapy will become important because fluids will be administered IV in addition to orally. The HCP will need to be contacted for further prescriptions; there is no need to contact the hemodialysis unit.

Question 38.    
A client developed cardiogenic shock after a severe myocardial infarction and has now developed acute renal failure. The client’s family asks the nurse why the client has developed acute renal failure. What should the nurse tell the family?
“Because of the cardiogenic shock, there is:
(a) a decrease in the blood flow through the kidneys.”
(b) an obstruction of urine flow from the kidneys.”
(c) a blood clot that formed in the kidneys.”
(d) structural damage to the kidney.”
Answer:
(a) a decrease in the blood flow through the kidneys.”

Explanation:
There are three categories of acute renal failure: prerenal, intrarenal, and postrenal. Causes of prerenal failure occur outside the kidney and include poor perfusion and decreased circulating volume resulting from such factors as trauma, septic shock, impaired cardiac function, and dehydration. In this case of severe myocardial infarction, there was a decrease in perfusion of the kidneys caused by impaired cardiac function.

An obstruction within the urinary tract, such as from kidney stones, tumors, or benign prostatic hypertrophy, is called postrenal failure. Structural damage to the kidney resulting from acute tubular necrosis is called intrarenal failure. It is caused by such conditions as hypersensitivity (allergic disorders), renal vessel obstruction, and nephrotoxic agents.

Question 39.    
A client with acute renal failure has a serum potassium level of 6.5 rnEq/L (6.5 mmol/L). The nurse should monitor the client for which potential complication?
(a) cardiac arrest
(b) pulmonary edema
(c) circulatory collapse
(d) hemorrhage
Answer:
(a) cardiac arrest

Explanation:
Normal potassium levels range from 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Hyperkalemia places the client at risk for serious cardiac arrhythmias and cardiac arrest. Therefore, the nurse should carefully monitor the client for cardiac arrhythmias and be prepared to treat cardiac arrest when caring for a client with hyperkalemia. Increased potassium levels do not result in pulmonary edema, circulatory collapse, or hemorrhage.

Question 40.    
A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. What should the nurse tell the client to expect when following this diet?
The diet will:
(a) act as a diuretic.
(b) reduce demands on the liver.
(c) help maintain urine acidity.
(d) prevent the development of ketosis.
Answer:
(d) prevent the development of ketosis.

Explanation:
High -carbohydrate foods meet the body’s caloric needs during acute renal failure. Protein is limited because its breakdown may result in accumulation of toxic waste products. The main goal of nutritional therapy in acute renal failure is to decrease protein catabolism. Protein catabolism causes increased levels of urea, phosphate, and potassium. Carbohydrates provide energy and decrease the need for protein breakdown. They do not have a diuretic effect. Some specific carbohydrates influence urine pH, but this is not the reason for encouraging a high-carbohydrate, low-protein diet. There is no need to reduce demands on the liver through dietary manipulation in acute renal failure.

Question 41.    
The client with acute renal failure asks the nurse for a snack. Because the client’s potassium level is elevated, which snack is most appropriate?
(a) a gelatin dessert
(b) yogurt
(c) an orange
(d) peanuts
Answer:
(a) a gelatin dessert

Explanation:
Gelatin desserts contain little or no potassium and can be served to a client on a potassium- restricted diet. Foods high in potassium include bran and whole grains; most dried, raw, and frozen fruits and vegetables; most milk and milk products; and chocolate, nuts, raisins, coconut, and strong brewed coffee.

Question 42.    
The client is in the oliguric phase of acute renal failure. For which risk should the nurse assess the client?
(a) pulmonary edema
(b) metabolic alkalosis
(c) hypotension
(d) hypokalemia 
Answer:
(a) pulmonary edema

Explanation:
Pulmonary edema can develop during the oliguric phase of acute renal failure because of decreased urine output and fluid retention. Metabolic acidosis develops because the kidneys cannot excrete hydrogen ions, and bicarbonate is used to buffer the hydrogen. Hypertension may develop as a result of fluid retention. Hyperkalemia develops as the kidneys lose the ability to excrete potassium.

Question 43.
The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client?
(a) Use the unaffected arm for blood pressure measurements.
(b) Draw blood from the cannula for routine laboratory work.
(c) Percuss the cannula for bruits each shift.
(d) Inject heparin into the cannula each shift.
Answer:
(a) Use the unaffected arm for blood pressure measurements.

Explanation:
The unaffected arm should be used for blood pressure measurement. The external cannula must be handled carefully and protected from damage and disruption. In addition, a tourniquet or clamps should be kept at the bedside because dislodgment of the cannula would cause arterial hemorrhage. The arm with the cannula is not used for blood pressure measurement, IV therapy, or venipuncture. Patency is assessed by auscultating for bruits every shift. Heparin is not injected into the cannula to maintain patency. Because it is part of the general circulation, the cannula cannot be heparinized.

Question 44.
During dialysis, the client has disequilibrium syndrome. What should the nurse do first?
(a) Administer oxygen per nasal cannula.
(b) Slow the rate of dialysis.
(c) Reassure the client that the symptoms are normal.
(d) Place the client in modified Trendelenburg’s position.
Answer:
(b) Slow the rate of dialysis.

Explanation:
If disequilibrium syndrome occurs during dialysis, the most appropriate intervention is to slow the rate of dialysis. The syndrome is believed to result from too-rapid removal of urea and excess electrolytes from the blood; this causes transient cerebral edema, which produces the symptoms. Administration of oxygen and position changes do not affect the symptoms. It would not be appropriate to reassure the client that the symptoms are normal.

Question ​​​​​​​45.
Which abnormal blood value would not be improved by dialysis treatment?
(a) elevated serum creatinine level
(b) hyperkalemia
(c) decreased hemoglobin concentration
(d) hypernatremia
Answer:
(c) decreased hemoglobin concentration

Explanation:
Dialysis has no effect on hemoglobin levels because some red blood cells are injured during the procedure; dialysis aggravates a low hemoglobin concentration and may contribute to anemia. Dialysis will clear metabolic waste products from the body and correct electrolyte imbalances, correct electrolyte imbalances such as creatinine, potassium and sodium levels.

Question ​​​​​​​46. 
The nurse is teaching the client how to recognize infection in the shunt. What sign should the nurse tell the client to assess each day?
(a) absence of a bruit
(b) sluggish capillary refill time
(c) coolness of the involved extremity
(d) swelling at the shunt site
Answer:
(d) swelling at the shunt site

Explanation:
Signs and symptoms of an external access shunt infection include redness, tenderness, swelling, and drainage from around the shunt site. The absence of a bruit indicates closing of the shunt. Sluggish capillary refill time and coolness of the extremity indicate decreased blood flow to the extremity.

Question ​​​​​​​47.
The client with acute renal failure asks the nurse, “Will my kidneys ever function normally again?” What should the nurse tell the client?
You will:
(a) continue to improve over a period of weeks.
(b) likely need dialysis.
(c) improve when you have a kidney transplant.
(d) have more kidney damage in several years.
Answer:
(a) continue to improve over a period of weeks.

Explanation:
The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. The client should be taught how to recognize the signs and symptoms of decreasing renal function and to notify the health care provider (HCP) if such problems occur. In a client who is recovering from acute renal failure, there is no need for renal transplantation or permanent hemodialysis. Chronic renal failure develops before end-stage renal failure.

Question ​​​​​​​48. 
The nurse is teaching an older adult with a urinary tract infection about the importance of increasing fluids in the diet. What puts this client at a risk for not obtaining sufficient fluids?
(a) diminished liver function
(b) increased production of antidiuretic hormone (ADH)
(c) decreased production of aldosterone
(d) decreased ability to detect thirst
Answer:
(d) decreased ability to detect thirst

Explanation:
The sensation of thirst diminishes in those >60 years of age; hence, fluid intake is decreased, and dissolved particles in the extracellular fluid compartment become more concentrated. There is no change in liver function in older adults, nor is there a reduction of ADH and aldosterone as a normal part of aging.
 
Question ​​​​​​​49.
A client with a urinary tract infection is to take nitrofurantoin four times each day. The client asks the nurse, “What should I do if I forget a dose?” What should the nurse tell the client?
(a) “You can wait and take the next dose when it’s due.”
(b) “Double the amount prescribed with your next dose.”
(c) “Take the prescribed dose as soon as you remember it, and if it’s very close to the time for the next dose, delay that next dose.”
(d) “Tell your health care provider (HCP), who can then adjust your prescribed dose.”
Answer:
(c) “Take the prescribed dose as soon as you remember it, and if it’s very close to the time for the next dose, delay that next dose.”

Explanation:
Antibiotics have the maximum effect when the level of the medication in the blood is maintained, and the client should take the medication as soon as possible after missing a dose. Because nitrofurantoin is readily absorbed from the gastrointestinal tract and is primarily excreted in urine, toxicity may develop by taking the dose too close to the time the next dose should be taken or doubling the dose. If possible, the client should not skip a dose, if one dose is missed. It is not necessary to contact the HCP as the dosage does not need to be adjusted. The nurse can coach the client to set a timer or use a pill container with timed doses so that the client does not forget to take the medication.

Question ​​​​​​​50. 
What should the nurse do to prevent catheter-associated urinary tract infection? Select all that apply.
(a) Change the catheter daily.
(b) Provide perineal care at least once a day.
(c) Maintain a closed drainage system.
(d) Encourage the client to drink 3,000 mL fluids daily.
(e) Recommend the health care provider prescribe antibiotics.
Answer:
(b) Provide perineal care at least once a day.
(c) Maintain a closed drainage system.
(d) Encourage the client to drink 3,000 mL fluids daily.

Explanation:
(b), (c), (d). Catheter-associated urinary tract infection is the most frequent type of health care- acquired infection (HAI) and represents as much as 80% of HAIs in hospitals. The nurse should provide meticulous perineal care at least once a day, maintain a closed drainage system, and encourage the client to obtain an adequate fluid intake. It is not necessary to change the catheter daily. It is recommended that long-term use of an indwelling urinary catheter be evaluated carefully and other methods considered if the catheter will be in place longer than 2 weeks. It is not necessary to request a prescription for antibiotics as the client does not currently have an infection.

Question ​​​​​​​51. 
A nurse is assessing a client with a urinary tract infection who takes an antihypertensive drug. The nurse reviews the client’s urinalysis results (see chart). What should the nurse do next?

Test	Result
pH	6.8
Red blood cells	3 per high power field
Color	Yellow
Specific gravity	1.030

(a) Encourage the client to increase fluid intake.
(b) Withhold the next dose of antihypertensive medication.
(c) Restrict the client’s sodium intake.
(d) Encourage the client to eat at least half of a banana per day.
Answer:
(a) Encourage the client to increase fluid intake.

Explanation:
The client’s urine specific gravity is elevated. Specific gravity is a reflection of the concentrating ability of the kidneys. This level indicates that the urine is concentrated. By increasing fluid intake, the urine will become more dilute. Antihypertensives do not make urine more concentrated unless there is a diuretic component within them. The nurse should not hold a dose of antihy-pertensive medication. Sodium tends to pull water with it; by restricting sodium, less water, not more, will be present. Bananas do not aid in the dilution of urine.

Question ​​​​​​​52. 
A client has nephropathy. The health care provider (HCP) prescribes a 24-hour urine collection for creatinine clearance. Which action is necessary to ensure proper collection of the specimen?
(a) Collect the urine in a preservative-free container and keep it on ice.
(b) Inform the client to discard the last voided specimen at the conclusion of urine collection.
(c) Obtain a self-report of the client’s weight before beginning the collection of urine.
(d) Request a prescription for insertion of an indwelling urinary catheter.
Answer:
(a) Collect the urine in a preservative-free container and keep it on ice.

Explanation:
All urine for creatinine clearance determination must be saved in a container with no preservatives and refrigerated or kept on ice. The first urine voided at the beginning of the collection is discarded, not the last. A self-report of weight may not be accurate. It is not necessary to have an indwelling urinary catheter inserted for urine collection.

Question ​​​​​​​53.    
A client who weighs 207 lb (94.1 kg) is to receive 1.5 mg/kg of gentamicin sulfate IV three times each day. How many milligrams of medication should the nurse administer for each dose? Round to the nearest whole number. .................... mg.
Answer:
141 mg
1.5 mg x 94.1 = 141.15 = 141mg

Question ​​​​​​​54.    
The client asks the nurse, “How did I get this urinary tract infection?” What should the nurse tell the client causes cystitis?
(a) congenital strictures in the urethra
(b) an infection elsewhere in the body
(c) urinary stasis in the urinary bladder
(d) an ascending infection from the urethra
Answer:
(d) an ascending infection from the urethra

Explanation:
Although various conditions may result in cystitis, the most common cause is an ascending infection from the urethra. Strictures and urine retention can lead to infections, but these are not the most common cause. Systemic infections are rarely causes of cystitis.

Question ​​​​​​​55.    
The client, who is a newlywed, is afraid to discuss her diagnosis of cystitis with her husband. Which approach would be best?
(a) Arrange a meeting with the client, her husband, the health care provider (HCP), and the nurse.
(b) Insist that the client talk with her husband because good communication is necessary for a successful marriage.
(c) Talk first with the husband alone and then with both of them together to share the husband’s reactions.
(d) Spend time with the client addressing her concerns and then, if the client requests, stay with her while she talks with her husband.
Answer:
(d) Spend time with the client addressing her concerns and then, if the client requests, stay with her while she talks with her husband.

Explanation:
As newlyweds, the client and her husband need to develop a strong communication base. The nurse can facilitate communication by preparing and supporting the client. Given the situation, an interdisciplinary conference is inappropriate and would not promote intimacy for the client and her husband. Insisting that the client talk with her husband is not addressing her fears. Being present allows the nurse to facilitate the discussion of a difficult topic. Having the nurse speak first with the husband alone shifts responsibility away from the couple.

Question ​​​​​​​56.    
The nurse teaches a female client who has cystitis methods to relieve her discomfort until the antibiotic takes effect. Which response by the client would indicate that she understands the nurse’s instructions?
(a) “I will place ice packs on my perineum.”
(b) “I will take warm tub baths.”
(c) “I will drink a cup of warm tea every hour.”
(d) “I will void every 5 to 6 hours.”
Answer:
(b) “I will take warm tub baths.”

Explanation:
Warm tub baths promote relaxation and help relieve urgency, discomfort, and spasm. Applying heat to the perineum is more helpful than cold because heat reduces inflammation. Although liberal fluid intake should be encouraged, caffein- ated beverages, such as tea, coffee, and cola, can be irritating to the bladder and should be avoided. Voiding at least every 2 to 3 hours should be encouraged because it reduces urinary stasis.

Question ​​​​​​​57.    
The client with first-time bacterial cystitis is being treated with an antibiotic to be taken for 7 days. What should the nurse instruct the client to do?
(a) Limit fluids to 1,000 mL/day.
(b) Notify the health care provider (HCP) when the urine is clear.
(c) Take the entire prescription as ordered.
(d) Use condoms if having sex.
Answer:
(c) Take the entire prescription as ordered.

Explanation:
The client should take the prescription as prescribed. The client should increase fluid intake to 3,000 mL/day to increase urination. Even though the urine may become clear in a short period, it is not necessary to notify the HCP. The client should continue to take the entire prescription of antibiotics. Cystitis is not sexually transmitted, so protection by using a condom is not necessary.

Question ​​​​​​​58.    
When teaching the client with a urinary tract infection about taking a prescribed antibiotic for 7 days, the nurse should tell the client to report which symptoms to the health care provider (HCP)? Select all that apply.
(a) cloudy urine for the first few days
(b) blood in the urine
(c) rash
(d) mild nausea
(e) fever above 100°F (37.8°C)
(f) urinating every 3 to 4 hours
Answer:
(b) blood in the urine
(c) rash
(d) mild nausea
(e) fever above 100°F (37.8°C)

Explanation:
(b), (c), (e). The nurse should instruct the client to report signs of adverse reaction to the antibiotic or indications that the urinary tract infection is not clearing. Blood in the urine is not an expected outcome, rash is an adverse response to the antibiotic, and an elevated temperature indicates a persistent infection. These signs should be reported to the HCP. Cloudy urine can be expected during the first few days of antibiotic treatment. Mild nausea is a side effect of antibiotic therapy, but it can be managed with eating small, frequent meals. Urinating every 3 to 4 hours or more is expected, particularly if the client is increasing the fluid intake as directed.

Question ​​​​​​​59. 
A client has been prescribed nitrofurantoin for treatment of a lower urinary tract infection. Which instructions should the nurse include when teaching the client about this medication? Select all that apply.
(a) “Take the medication on an empty stomach.”
(b) “Your urine may become brown in color,”
(c) “Increase your fluid intake.”
(d) “Take the medication until your symptoms subside.”
(e) “Take the medication with an antacid to decrease gastrointestinal distress.”
Answer:
(b) “Your urine may become brown in color,”
(c) “Increase your fluid intake.”

Explanation:
Clients who are taking nitrofurantoin should be instructed to take the medication with meals and to increase their fluid intake to minimize gastrointestinal distress. The urine may become brown in color. Although this change is harmless, clients need to be prepared for this color change. The client should be instructed to take the full prescription and not to stop taking the drug because symptoms have subsided. The medication should not be taken with antacids as this may interfere with the drug’s absorption. 

Question ​​​​​​​60. 
Nitrofurantoin, 75 mg four times per day, has been prescribed for a client with a lower urinary tract infection. The medication comes in an oral suspension of 25 mg/5 mL. How many milliliters should the nurse administer for each dose? Record your answer using a whole number. ...................... mL.
Answer:
15 mL
The following formula is used to calculate the correct dosage:
25 mg /5mL = 75 mg / X mL 
X = 15mL.

Question ​​​​​​​61.
Which statements by a female client would indicate that she is at high risk for a recurrence of cystitis?
(a) “I can go 8 to 10 hours without emptying my bladder.”
(b) “I take a tub bath every evening.”
(c) “I drink herbal tea with each meal.”
(d) “I work out by lifting weights three times a week.”
Answer:
(a) “I can go 8 to 10 hours without emptying my bladder.”

Explanation:
Stasis of urine in the bladder is one of the chief causes of bladder infection, and a client who voids infrequently is at greater risk for reinfection. A tub bath does not promote urinary tract infections as long as the client avoids harsh soaps and bubble baths. Scrupulous hygiene and liberal fluid intake (unless contraindicated) are excellent preventive measures, but the client also should be taught to void every 2 to 3 hours during the day. Drinking herbal tea or lifting weights are not risk factors for cystitis.

Question ​​​​​​​62. 
To prevent recurrence of cystitis, the nurse should plan to encourage the female client to include which measure in her daily routine?
(a) wearing cotton underpants
(b) increasing citrus juice intake
(c) douching regularly with 0.25% acetic acid
(d) using vaginal sprays
Answer:
(a) wearing cotton underpants

Explanation:
A woman can adopt several health promotion measures to prevent the recurrence of cystitis, including avoiding too-tight pants, noncotton underpants, and irritating substances, such as bubble baths and vaginal soaps and sprays. Increasing citrus juice intake can be a bladder irritant. Regular douching is not recommended; it can alter the pH of the vagina, increasing the risk of infection.

Question ​​​​​​​63.
The nurse explains to the client the importance of drinking large quantities of fluid to prevent cystitis. How much fluid should the nurse tell the client to drink?
(a) twice as much fluid as usual
(b) at least 1,000 mL more than usual
(c) as much water or juice, as possible
(d) at least 3,000 mL of fluids daily
Answer:
(d) at least 3,000 mL of fluids daily

Explanation:
Instructions should be as specific as possible, and the nurse should avoid general statements such as “a lot.” A specific goal is most useful. A mix of fluids will increase the likelihood of client compliance. It may not be sufficient to tell the client to drink twice as much as or 1 quart (950 mL) more than she usually drinks if her intake was inadequate to begin with.

Question ​​​​​​​64. 
A client is at risk for acute pyelonephritis. The nurse should instruct the client about which health promotion behaviors that will be most effective in preventing pyelonephritis?
(a) Wash the perineum with warm water and soap, cleaning from front to back.
(b) Treat fungal infections such as athlete’s foot immediately.
(c) Have a pneumonia immunization to prevent streptococcal infection.
(d) Treat skin lesions with antibiotics, and cover any open lesions.
Answer:
(a) Wash the perineum with warm water and soap, cleaning from front to back.

Explanation:
Acute pyelonephritis usually begins with a bacterial infection of the lower urinary tract via the ascending urethral route; most infections are due to gram-negative bacilli, such as Escherichia coli, normally found in the gastrointestinal tract. Thorough perineal care using soap and warm water, and cleansing from front to back, decreases the likelihood that organisms will be introduced into the urinary tract and ascend upward toward the kidneys. Although preventing and treating all infections are appropriate, fungal infections from the feet and bacterial infections in the throat or skin are less likely to be immediate sources of infection causing pyelonephritis.

Question ​​​​​​​65.
A client is diagnosed with acute pyelonephritis. What should the nurse instruct the client to do?
(a) Empty the bladder every 2 to 3 hours.
(b) Take bubble baths instead of showers.
(c) Take antibiotics for the rest of the client’s life.
(d) Decrease fluid intake to 1,000 mL per day.
Answer:
(a) Empty the bladder every 2 to 3 hours.

Explanation:
Pyelonephritis usually begins with colonization and infection of the lower urinary tract via the ascending urethral route, and the client should have an adequate intake of fluids to promote the flushing action of urination. Bubble baths and limiting fluid intake increase the risk of developing a urinary tract infection. Antibiotics should be used on a short-term basis because the risk of antibiotic resistance may lead to breakthrough infections with increasingly virulent pathogens.

Question ​​​​​​​66.
Which factor would put the client at increased risk for pyelonephritis?
(a) history of hypertension
(b) intake of large quantities of cranberry juice
(c) fluid intake of 2,000 mL/day
(d) history of diabetes mellitus
Answer:
(d) history of diabetes mellitus

Explanation:
A client with a history of diabetes mel- litus, urinary tract infections, or renal calculi is at increased risk for pyelonephritis. Others at high risk include pregnant women and people with structural alterations of the urinary tract. A history of hypertension may put the client at risk for kidney damage, but not kidney infection. Intake of large quantities of cranberry juice and a fluid intake of 2,000 mL/day are not risk factors for pyelonephritis.

Question ​​​​​​​67. 
The client with pyelonephritis asks the nurse, “How will I know whether the antibiotics are treating my infection?” What should the nurse tell the client?
(a) “After you take the antibiotics for 2 weeks, you won’t have any infection.”
(b) “Your health care provider can tell by the color and odor of your urine.”
(c) “Your health care provider will take a urine culture.”
(d) “When your symptoms disappear, you’ll know that your infection is gone.”
Answer:
(c) “Your health care provider will take a urine culture.”

Explanation:
Antibiotics are usually prescribed for a 2- to 4-week period. A urine culture is needed to evaluate the effectiveness of antibiotic therapy. Urine must be examined microscopically to adequately determine the presence of bacteria; looking at the color of the urine or checking the odor is not sufficient. Symptoms usually disappear 48 to 72 hours after antibiotic therapy is started, but antibiotics may need to continue for up to 4 weeks.

Question ​​​​​​​68. 
The nurse is to administer 1,200 mg of an antibiotic. The drug is prepared with 6 g of the drug in 2 mL of solution. The nurse should administer how many milliliters of the drug? Record your answer using one decimal point. ......................... mL.
Answer:
0.4 mL
First, convert grams to milligram: 6 g = 6,000 mg.
Next, set up a proportion:
6,000 mg / 2 mL= 1,200 mg/X 
X = (1,200 / 6,000) × 2 mL 
X = 0.4 mL. 

Question ​​​​​​​69. 
The client with acute pyelonephritis wants to know the possibility of developing chronic pyelonephritis. The nurse’s response is based on knowledge of which disorder that most commonly leads to chronic pyelonephritis?
(a) acute pyelonephritis
(b) recurrent urinary tract infections
(c) acute renal failure
(d) glomerulonephritis
Answer:
(b) recurrent urinary tract infections

Explanation:
Chronic pyelonephritis is most commonly the result of recurrent urinary tract infections. Chronic pyelonephritis can lead to chronic renal failure. Single cases of acute pyelonephritis rarely cause chronic pyelonephritis. Acute renal failure is not a cause of chronic pyelonephritis. Glomerulonephritis is an immunologic disorder, not an infectious disorder.

Question ​​​​​​​70.
A client is diagnosed with pyelonephritis. Which nursing action is a priority for care now?
(a) Monitor hemoglobin levels.
(b) Insert a urinary catheter.
(c) Stress importance of use of long-term antibiotics.
(d) Ensure sufficient hydration.
Answer:
(d) Ensure sufficient hydration.

Explanation:
The nurse should ensure the client has adequate hydration. A urinary catheter is discouraged because of the risk of urinary tract infection. Monitoring of the hemoglobin level is not necessary for clients with pyelonephritis. Although antibiotics may be prescribed for long-term management and for chronic pyelonephritis, at this time the nurse should focus on helping the client maintain hydration.

Question ​​​​​​​71. 
A client with end-stage renal failure has an internal arteriovenous fistula in the left arm for vascular access during hemodialysis. What should the nurse instruct the client to do? Select all that apply.
(a) Remind health care providers to draw blood from veins on the left side.
(b) Avoid sleeping on the left arm.
(c) Wear wristwatch on the right arm.
(d) Assess fingers on the left arm for warmth.
(e) Obtain blood pressure [BP) from the left arm.
Answer:
(b) Avoid sleeping on the left arm.
(c) Wear wristwatch on the right arm.
(d) Assess fingers on the left arm for warmth.

Explanation:
(b), (c), (d). The nurse instructs the client to protect the site of the fistula. The client should avoid pressure on the involved arm such as sleeping on it, wearing tight jewelry, or obtaining BP. The client is also advised to assess the area distal to the fistula for adequate circulation, such as warmth and color. When the client is hospitalized, the nurse posts a sign on the client’s bed not to draw blood or obtain BP on the left side; the client is also instructed to be sure that none of the health care team members do so.

Question ​​​​​​​72. 
A client with end-stage chronic renal failure is admitted to the hospital with a serum potassium level of 7 mEq/L (7 mmol/L). In what order of priority from first to last does the nurse perform the prescriptions? All options must be used.
(a) Administer insulin and glucose
(b) Start an IV access site.
(c) Obtain serum potassium level.
(d) Attach the client to a cardiac monitor.
Answer:
(b) Start an IV access site.
(d) Attach the client to a cardiac monitor.
(a) Administer insulin and glucose
(c) Obtain serum potassium level.

Explanation:
(b), (d), (a), (c). The nurse first assures an IV access site in case the client has respiratory or cardiac arrest. Next, the nurse monitors the client’s heart rate and rhythm: Cardiovascular signs of elevated serum potassium levels are irregular, slow heart rate; decreased blood pressure; narrow, peaked T waves; widened QRS complexes, prolonged PR intervals, and flattened D waves; frequent ectopy; ventricular fibrillation; and ventricular standstill. The nurse then administers intravenous insulin and D50W, which have an immediate action to antagonize the effect of hyperkalemia on cardiac muscle. Last, the nurse obtains a blood sample to evaluate the effectiveness of the medication.

Question ​​​​​​​73.
A client with chronic renal failure is receiving hemodialysis three times a week. What should the nurse do to protect the fistula?
(a) Take the blood pressure in the arm with the fistula.
(b) Report the loss of a thrill or bruit on the arm with the fistula.
(c) Maintain a pressure dressing on the shunt.
(d) Start a second IV in the arm with the fistula.
Answer:
(b) Report the loss of a thrill or bruit on the arm with the fistula.

Explanation:
The nurse must always auscultate for a bruit and palpate for a thrill in the arm with the fistula and promptly report the absence of either a thrill or bruit to the health care provider (HCP) as it indicates an occlusion. The client should not have a pressure dressing on the shunt and should avoid wearing tight clothing or carrying heavy items such as purse over the area of the shunt to avoid restricting blood flow in the shunt. No procedures such as IV access, blood pressure measurements, or blood draws are done on an arm with a fistula as they could damage the fistula.

Question ​​​​​​​74. 
A client with chronic renal failure who receives hemodialysis twice a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply.
(a) Drink fluids before eating solid foods.
(b) Have limited amounts of fluids only when thirsty.
(c) Limit activity.
(d) Keep all dialysis appointments.
(e) Eat smaller, more frequent meals. 
Answer:
(b) Have limited amounts of fluids only when thirsty.
(d) Keep all dialysis appointments.
(e) Eat smaller, more frequent meals. 

Explanation:
(b), (d), (e). To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty and eat food before drinking fluids to alleviate dry mouth, and encourage strict follow-up for blood work, dialysis, and health care provider (HCP) visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as pos-sible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

Question ​​​​​​​75.
The nurse warms the dialysis solution before use in peritoneal dialysis. What is the expected outcome of warming the solution?
(a) Encourage the removal of serum urea.
(b) Force potassium back into the cells.
(c) Add extra warmth to the body.
(d) Promote abdominal muscle relaxation.
Answer:
(a) Encourage the removal of serum urea.

Explanation:
The main reason for warming the peritoneal dialysis solution is that the warm solution helps dilate peritoneal vessels, which increases urea clearance. Warmed dialyzing solution also contributes to client comfort by preventing chilly sensations. but this is a secondary reason for warming the solution. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation.

Question ​​​​​​​76.    
A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client’s abdomen?
(a) Assess for urticaria.
(b) Observe respiratory status.
(c) Check capillary refill time.
(d) Monitor electrolyte status.
Answer:
(b) Observe respiratory status.

Explanation:
During dwell time, the dialysis solution is allowed to remain in the peritoneal cavity for the time prescribed by the health care provider (HCP) (usually 20 to 45 minutes). During this time, the nurse should monitor the client’s respiratory status because the pressure of the dialysis solution on the diaphragm can create respiratory distress. The dialysis solution would not cause urticaria or affect circulation to the fingers. The client’s laboratory values are obtained before beginning treatment and are monitored every 4 to 8 hours during the treatment, not just during the dwell time.

Question ​​​​​​​77.    
A client is having peritoneal dialysis. During the exchange, the nurse observes that the solution draining from the client’s abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. What clinical judgment should the nurse make about the blood-tinged drainage?
(a) It is expected with a permanent peritoneal catheter.
(b) It indicates abdominal blood vessel damage.
(c) It can indicate kidney damage.
(d) It is caused by too-rapid infusion of the dialysate.
Answer:
(b) It indicates abdominal blood vessel damage.

Explanation:
Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the health care provider (HCP) should be notified. The bleeding is originating in the peritoneal cavity, not the kidneys. Too-rapid infusion of the dialysate can cause pain, not blood-tinged drainage.

Question ​​​​​​​78.    
A client undergoing long-term peritoneal dialysis at home is currently experiencing a reduced outflow from the dialysis catheter. To determine if the catheter is obstructed, what should the nurse ask the client about experiencing recently?
(a) diarrhea
(b) vomiting
(c) flatulence
(d) constipation
Answer:
(d) constipation

Explanation:
Constipation may contribute to reduced urine outflow in part because peristalsis facilitates drainage outflow. For this reason, bisacodyl suppositories can be used prophylactically, even without a history of constipation. Diarrhea, vomiting, and flatulence typically do not cause decreased outflow in a peritoneal dialysis catheter.

Question ​​​​​​​79.    
Which should be included in the client’s plan of care during dialysis therapy?
(a) Limit the client’s visitors.
(b) Monitor the client’s blood pressure.
(c) Pad the side rails of the bed.
(d) Keep the client on nothing-by-mouth (NPO) status.
Answer:
(b) Monitor the client’s blood pressure.

Explanation:
Because hypotension is a complication associated with peritoneal dialysis, the nurse records intake and output, monitors vital signs, and observes the client’s behavior. The nurse also encourages visiting and other diversional activities. A client on peritoneal dialysis does not need to be placed in a bed with padded side rails or kept on NPO status.

Question ​​​​​​​80.    
The client performs self-peritoneal dialysis. What should the nurse teach the client about preventing peritonitis? Select all that apply.
(a) Broad-spectrum antibiotics may be administered to prevent infection.
(b) Antibiotics may be added to the dialysate to treat peritonitis.
(c) Clean technique is permissible for prevention of peritonitis.
(d) Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort.
(e) Peritonitis is the most common and serious complication of peritoneal dialysis.
Answer:
(a) Broad-spectrum antibiotics may be administered to prevent infection.
(b) Antibiotics may be added to the dialysate to treat peritonitis.
(d) Peritonitis is characterized by cloudy dialysate drainage and abdominal discomfort.
(e) Peritonitis is the most common and serious complication of peritoneal dialysis.

Explanation:
(a), (b), (d), (e). Broad-spectrum antibiotics may be administered to prevent infection when a peritoneal catheter is inserted for peritoneal dialysis. If peritonitis is present, antibiotics may be added to the dialysate. Aseptic technique is imperative. Peritonitis, the most common and serious complication of peritoneal dialysis, is characterized by cloudy dialysate drainage, diffuse abdominal pain, and rebound tenderness.

Question ​​​​​​​81.
After completion of peritoneal dialysis, for which symptom should the nurse assess the client?
(a) hematuria
(b) weight loss
(c) hypertension
(d) increased urine output
Answer:
(b) weight loss
 
Explanation:
Weight loss is expected because of the removal of fluid. The client’s weight before and after dialysis is one measure of the effectiveness of treatment. Blood pressure usually decreases because of the removal of fluid. Hematuria would not occur after completion of peritoneal dialysis. Dialysis only minimally affects the damaged kidneys’ ability to manufacture urine.

Question ​​​​​​​82.    
Aluminum hydroxide gel is prescribed for the client with chronic renal failure to take at home. What is the expected outcome of this drug?
(a) relieving the pain of gastric hyperacidity
(b) preventing Curling’s stress ulcers
(c) binding phosphate in the intestine
(d) reversing metabolic acidosis
Answer:
(c) binding phosphate in the intestine

Explanation:
A client in renal failure develops hyper-phosphatemia that causes a corresponding excretion of the body’s calcium stores, leading to renal osteodystrophy. To decrease this loss, aluminum hydroxide gel is prescribed to bind phosphates in the intestine and facilitate their excretion. Gastric hyperacidity is not necessarily a problem associated with chronic renal failure. Antacids will not prevent Curling’s stress ulcers and do not affect metabolic acidosis.

Question ​​​​​​​83.    
The nurse teaches the client with chronic renal failure when to take aluminum hydroxide gel. Which statement indicates that the client understands the teaching?
(a) “I’ll take it every 4 hours around the clock.”
(b) “I’ll take it between meals and at bedtime.”
(c) “I’ll take it when I have an upset stomach.”
(d) “I’ll take it with meals and bedtime snacks.”
Answer:
(d) “I’ll take it with meals and bedtime snacks.”

Explanation:
Aluminum hydroxide gel is administered to bind the phosphates in ingested foods and must be given with or immediately after meals and snacks. There is no need for the client to take it on a 24-hour schedule. It is not administered to treat an upset stomach caused by hyperacidity in clients with chronic renal failure and therefore is not prescribed between meals.

Question ​​​​​​​84.    
Which teaching approach for the client with chronic renal failure who has difficulty concentrating due to high uremia levels would be most appropriate?
(a) Provide all needed teaching in one extended session.
(b) Validate the client’s understanding of the material frequently.
(c) Conduct a one-on-one session with the client.
(d) Use video clips to reinforce the material as needed.
Answer:
(b) Validate the client’s understanding of the material frequently.

Explanation:
Uremia can cause decreased alertness, so the nurse needs to validate the client’s comprehension frequently. Because the client’s ability to concentrate is limited, short lessons are most effective. If family members are present at the sessions, they can reinforce the material. Written materials that the client can review are superior to videos because the client may not be able to maintain alertness during the viewing of the videotape.

Question ​​​​​​​85.    
The nurse is instructing the client with chronic renal failure to maintain adequate nutritional intake. Which diet would be most appropriate?
(a) high-carbohydrate, high-protein
(b) high-calcium, high-potassium, high-protein
(c) low-protein, low-sodium, low-potassium
(d) low-protein, high-potassium
Answer:
(c) low-protein, low-sodium, low-potassium

Explanation:
Dietary management for clients with chronic renal failure is usually designed to restrict protein, sodium, and potassium intake. Protein intake is reduced because the kidney can no longer excrete the by-products of protein metabolism. The degree of dietary restriction depends on the degree of renal impairment. The client should also receive a high-carbohydrate diet along with appropriate vitamin and mineral supplements. Calcium requirements remain 1,000 to 2,000 mg/day.

Question ​​​​​​​86.    
The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which strategy would be most useful?
(a) Help the client to accept that sexual activity will be decreased.
(b) Suggest using alternative forms of sexual expression and intimacy.
(c) Tell the client to plan rest periods after sexual activity.
(d) Refer the client to a counselor.
Answer:
(b) Suggest using alternative forms of sexual expression and intimacy.

Explanation:
Altered sexual functioning commonly occurs in chronic renal failure and can stress marriages and relationships. Altered sexual functioning can be caused by decreased hormone levels, anemia, peripheral neuropathy, or medication. The client should not decrease or avoid sexual activity but instead should modify it. The client should rest before sexual activity. Unless the client provides additional information, it is not necessary to refer the client to counseling at this time.

Question ​​​​​​​87.    
A client who is 70 years of age and lives alone has stress incontinence. What should the nurse teach the client to do to prevent incontinence? Select all that apply.
(a) Ask someone else to lift heavy objects.
(b) Refrain from drinking coffee or alcohol.
(c) Perform perineal muscle exercises (i.e., Kegel exercises).
(d) Apply estrogen cream to the urinary meatus after voiding.
(e) Avoid jumping up and down.
Answer:
(b) Refrain from drinking coffee or alcohol.
(c) Perform perineal muscle exercises (i.e., Kegel exercises).
(e) Avoid jumping up and down.

Explanation:
(b), (C), (E). The nurse can teach the client that coffee and alcohol promote urination and should be eliminated from the diet. The client can perform perineal muscle exercises (Kegel exercises) to increase the tone of the urethral sphincters; the nurse teaches the client to perform the exercises in sets of at least 10 contractions, four to five times per day. The client also should avoid putting pressure on the bladder by jumping. Asking someone else to lift heavy loads may not always be practical. Applying estrogen cream to the urinary meatus after each intentional voiding can lead to UTIs. Drug therapy has a very limited role in the management of stress urinary incontinence.

Question ​​​​​​​88.    
A client has stress incontinence. Which data from the client’s history contribute to the client’s incontinence?
(a) the client’s intake of 2 to 3 L of fluid per day
(b) the client’s history of three full-term pregnancies
(c) the client’s age of 45 years
(d) the client’s history of competitive swimming
Answer:
(b) the client’s history of three full-term pregnancies

Explanation:
The history of three pregnancies is most likely the cause of the client’s current episodes of stress incontinence. The client’s fluid intake, age, or history of swimming would not create an increase in intra-abdominal pressure.

Question ​​​​​​​89.    
The nurse is planning care for a client with stress incontinence. What goal is realistic for the nurse to establish with the client?
(a) Help the client adjust to the frequent episodes of incontinence.
(b) Eliminate all episodes of incontinence.
(c) Prevent the development of urinary tract infections.
(d) Decrease the number of incontinence episodes.
Answer:
(d) Decrease the number of incontinence episodes.

Explanation:
The primary goal of nursing care is to decrease the number of incontinence episodes and the amount of urine expressed in an episode. Behavioral interventions (e.g., diet and exercise) and medications are the nonsurgical management methods used to treat stress incontinence. Without surgical intervention, it may not be possible to eliminate all episodes of incontinence. Helping the client adjust to the incontinence is not treating the problem. Clients with stress incontinence are not prone to the development of urinary tract infection.

Question ​​​​​​​90.    
A client has urge incontinence. When obtaining the health history, the nurse should ask the client about which factors that could precipitate incontinence?
(a) inability to empty the bladder
(b) loss of urine when coughing
(c) involuntary urination
(d) frequent dribbling of urine
Answer:
(c) involuntary urination

Explanation:
A characteristic of urge incontinence is involuntary urination with little or no warning. The inability to empty the bladder is urine retention. Loss of urine when coughing occurs with stress incontinence. Frequent dribbling of urine is common in male clients after some types of prostate surgery or may occur in women after the development of a vesicovaginal or urethrovaginal fistula.

Question ​​​​​​​91.
Which nursing action is most appropriate for a client who has urge incontinence?
(a) Have the client urinate on a timed schedule.
(b) Provide a bedside commode.
(c) Administer prophylactic antibiotics.
(d) Teach the client intermittent self-catheteriza tion technique.
Answer:
(a) Have the client urinate on a timed schedule.

Explanation:
Instructing the client to void at regularly scheduled intervals can help decrease the frequency of incontinence episodes. Providing a bedside commode does not decrease the number of incontinence episodes and does not help the client who leads an active lifestyle. Infections are not a common cause of urge incontinence, so antibiotics are not an appropriate treatment. Intermittent self-catheterization is appropriate for overflow or reflux incontinence but not urge incontinence because it does not treat the underlying cause.

Question ​​​​​​​92.
The nurse manager has employed three nurses from a culture that is different from that of most of the nurses who currently work on this unit. Which strategy would help the newly employed nurses socialize into the team and promote the cultural competence of all of the nurses?
(a) Create a staffing plan placing one of the newly employed nurses on each shift.
(b) Require newly employed nurses to speak English only when working.
(c) Hold a culture sharing session at monthly meetings.
(d) Encourage the staff to invite the new nurses to meet their families.
Answer:
(c) Hold a culture sharing session at monthly meetings.

Explanation:
Cultural competence is necessary for all nurses to provide culturally appropriate care and meet the needs of a diverse client population. Allowing staff time to share individual culturally specific information provides the opportunity to learn from each other and form relationships. This strategy also facilitates nurse identification with personal cultural attributes. It is important to provide support to the nurses from different cultures. Assigning one nurse to each shift may undermine the initial goal and result in attrition. Restricting language to only English could decrease client satisfaction for those who also speak a similar lan-guage. Asking staff to invite new staff to after-work activities is not appropriate because not all staff may have time to participate in these activities and could result in decreased staff morale.

Question ​​​​​​​93.
Which hospitalized client is at highest risk for catheter-associated urinary tract infection (CAUTI)?
(a) client with diabetes mellitus
(b) client who had one course of antibiotic therapy
(c) client with a family history of UTIs
(d) client with a urinary calculus
Answer:
(a) client with diabetes mellitus

Explanation:
Clients who are immunosuppressed, have diabetes mellitus, or have undergone multiple courses of antibiotic therapy are prone to bacterial, fungal, and parasitic infections. Taking one course of antibiotic therapy or having a family history of UTIs does not make a client at high risk for development of a CAUTI. A predisposing factor for a UTI is ongoing problems of urinary calculi; one calculus would not place a client at high risk.

Question ​​​​​​​94.    
A client is scheduled for an intravenous pyelogram. Before the procedure, the nurse learns that the client has a sensitivity to shellfish. What should the nurse do next?
(a) Administer a cathartic to the client to empty the colon.
(b) Administer an antiflatulent to the client to relieve gas.
(c) Keep the client on nothing-by-mouth (NPO) status.
(d) Notify the health care provider.
Answer:
(d) Notify the health care provider.

Explanation:
Sensitivity to shellfish or iodine may cause an anaphylactic reaction to the contrast material, which contains iodine. Administering a cathartic or antiflatulent will not prevent an anaphylactic reaction to the contrast material. Keeping a client on NPO status for 8 hours before the procedure is part of the usual preparation for such a procedure to prevent aspiration of food or fluids if the client vomits when lying on the X-ray table.

Question ​​​​​​​95.    
The nurse finds a container with the client’s urine specimen sitting on a counter in the bathroom. The client states that the specimen has been sitting in the bathroom for at least 2 hours. What should the nurse do with the urine specimen?
(a) Discard the urine, and obtain a new specimen.
(b) Send the urine to the laboratory as quickly as possible.
(c) Add fresh urine to the collected specimen, and send the specimen to the laboratory.
(d) Refrigerate the specimen until it can be transported to the laboratory.
Answer:
(a) Discard the urine, and obtain a new specimen.

Explanation:
The appropriate action would be to discard the specimen and obtain a new one. Urine that is allowed to stand at room temperature will become alkaline, with multiplying bacteria. The specimen should be examined within 1 hour after urination.

Question ​​​​​​​96.    
A client with early acute renal failure has anemia, tachycardia, hypotension, and shortness of breath. The health care provider has prescribed 2 units of packed red blood cells (RBCs). What should the nurse determine prior to initiating the blood transfusion? Select all that apply.
(a) There is an IV access with the appropriate tubing and normal saline as the priming solution.
(b) There is a signed informed consent for transfusion therapy.
(c) Blood typing and cross-matching are documented in the medical record.
(d) The vital signs have been taken and documented in accordance with facility policy and procedure.
(e) There is the second unit of blood in the medication room.
(f) The client has an identification bracelet.
Answer:
(a) There is an IV access with the appropriate tubing and normal saline as the priming solution.
(b) There is a signed informed consent for transfusion therapy.
(c) Blood typing and cross-matching are documented in the medical record.
(d) The vital signs have been taken and documented in accordance with facility policy and procedure.
(f) The client has an identification bracelet.

Explanation:
(a), (b), (c), (d), (f). Before prescribing and administering packed RBCs, the nurse should assess the IV site to make sure it has an 18G to 20G infusion set. The nurse should also ensure that normal saline solution is used to prime the tubing to prevent RBCs from adhering to the tubing. The client must indicate informed consent El for the procedure by signing the consent form. The client’s blood must be typed to determine ABO blood typing and Rh factor and ensure that the client receives compatible blood. Cross-matching is done to detect the presence of recipient antibodies to the donor’s minor antigens. 

Vital signs provide a baseline reference for continuous monitoring throughout the transfusion. An identification bracelet and red blood band are essential for client identification per facility policy. Two nurses must double-check the client’s identification with the client listed on the unit of RBCs. The transfusion should be started within 30 minutes of the time that the RBC unit is checked out of the blood bank. Thus, no blood should be kept in the medication room before transfusion.

Question ​​​​​​​ 97.    
The nurse is instructing the unlicensed assistive personnel (UAP) about the correct technique for obtaining a clean-catch urine culture from a female client. Which statement indicates that the UAP has understood the instructions?
(a) “I will have the client completely empty her bladder into the specimen cup.”
(b) “I will need to catheterize the client to get the urine specimen.”
(c) “I will ask the client to clean her labia, void into the toilet, and then into the specimen cup.”
(d) “I will obtain the specimen in the afternoon after the client has had plenty of fluids.”
Answer:
(c) “I will ask the client to clean her labia, void into the toilet, and then into the specimen cup.”

Explanation:
The correct technique for a clean-catch urine culture specimen is to have the female client clean the labia from front to back, void into the toilet, and then void into the cup. The client does not need to fully empty her bladder into the cup. It is not necessary to catheterize the client to obtain the specimen. The first voided specimen of the day has the highest bacterial counts.

Question ​​​​​​​98.    
An older adult is admitted with new-onset confusion, headache, poor skin turgor, bounding pulse, and urinary incontinence and has been drinking copious amounts of water. Upon reviewing the lab results, the nurse discovers a sodium level of 122 mEq/L (122 mmol/L). A report to the health care provider (HCP) should include what recommendations? Select all that apply.
(a) fluid restriction
(b) vital signs every 2 hours
(c) bed alarm
(d) Foley catheter
(e) 2-g sodium diet
Answer:
(a) fluid restriction
(b) vital signs every 2 hours
(c) bed alarm
(d) Foley catheter

Explanation:
(a), (b), (c), (d). The client is hyponatremic. When the nurse contacts the HCP, the nurse can recommend that the client be placed on fluid restrictions and that the vital signs should be taken every 2 hours. The nurse can request a bed alarm for the client’s safety and a Foley catheter to prevent skin breakdown and facilitate accurate recording of intake and output. Restricting dietary sodium to 2 g may further exacerbate the hyponatremia. The nurse will also monitor for neurological changes and inform the HCP immediately of any change or if the client becomes unable to take food/fluids by mouth.

Question ​​​​​​​99.    
Which of the responsibilities related to the care of a client with a Foley catheter are appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? Select all that apply.
(a) Flush the catheter as needed to ensure patency.
(b) Empty drainage bag, and record output at specified times.
(c) Apply catheter-securing device to client’s leg.
(d) Perform bladder irrigation as prescribed.
(e) Provide Foley catheter and perineal care each shift.
(f) Ensure the urine drainage bag is below the level of the bladder at all times.
Answer:
(b) Empty drainage bag, and record output at specified times.
(c) Apply catheter-securing device to client’s leg.
(e) Provide Foley catheter and perineal care each shift.
(f) Ensure the urine drainage bag is below the level of the bladder at all times.

Explanation:
(b), (C),(E), (F). While the scope of practice for a UAP may vary by state, province, or territory, as well as by place of employment, general duties include recording input and output, including emptying and recording urine output from a Foley catheter. A UAP with proper training may apply a securing device to maintain safety, provide regular Foley catheter and perineal care, and ambulate a client with a catheter, continually monitoring that the collection bag remains below the level of the bladder to help prevent infection. Activities such as irrigating or flushing a catheter should not be assigned to a UAP as these activities involve nursing assessment skills.

Question ​​​​​​​100.    
The client is to receive antibiotic intravenous (IV) therapy in the home. The nurse should develop a teaching plan to ensure that the client and family can manage the IV fluid and infusion correctly and avoid complications. What should the nurse instruct the client to do? Select all that apply.
(a) Report signs of redness or inflammation at the site.
(b) Wear sterile gloves to change the fluids.
(c) Call the health care provider (HCP) for a temperature above 100°F (37.8°C).
(d) Cleanse the port with alcohol wipes.
(e) Place the IV bag on a table level with the client’s arm.
Answer:
(a) Report signs of redness or inflammation at the site.
(c) Call the health care provider (HCP) for a temperature above 100°F (37.8°C).
(d) Cleanse the port with alcohol wipes.

Explanation:
(a), (c), (d). When IV therapy must be administered in the home setting, teaching is essential. Written instructions as well as demonstration and return demonstration help reinforce key points. The client and/or caregiver is responsible for adhering to the established plan of care that includes the treatment plan, monitoring plan, potential for complications, expected outcome/outcomes, potential adverse effects, and plan for communicating with the HCP ED. 

Periodic laboratory testing may be necessary to assess the effects of IV therapy and the client’s progress. The client should report signs of redness or inflammation that could indicate infection, and also report an elevated temperature. Prior to changing the fluids, the caregiver should cleanse the port with alcohol wipes. It is not necessary to use sterile gloves; the IV bag should be elevated to promote gravity flow.

Question ​​​​​​​101.
Prior to discharging a client with end-stage cancer of the bladder from the hospital, what should the nurse do? Select all that apply.
(a) Determine if the client is likely to become suicidal.
(b) Give a list of the client’s medications to the client before discharge.
(c) Instruct the client to update information when medications are discontinued, doses are changed, or new medications are added.
(d) Explain the need to carry medication information with the client at all times.
(e) Instruct the client that the use of over-the-counter products need not be reported to the health care provider (HCP).
Answer:
(a) Determine if the client is likely to become suicidal.
(b) Give a list of the client’s medications to the client before discharge.
(c) Instruct the client to update information when medications are discontinued, doses are changed, or new medications are added.
(d) Explain the need to carry medication information with the client at all times.

Explanation:           
(a), (b), (c), (d). To ensure client safety, the nurse should assess clients that might be at risk for suicide, such as those with end-stage cancer. The nurse should also communicate accurate medication information by explaining the importance of managing medication information to the client when he/she is discharged from the hospital or at the end of an outpatient encounter. Examples include instructing the client to give a list of medications to his/her HCP to update the information when medications are discontinued, doses are changed, or new medications including over-the-counter products are added; and to carry medication information at all times in the event of emergency situations.