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Performance
Exit

Final Score

100%
74 out of 93 questions answered correctly

Completed on Feb 9, 2023 12:39 pm

Incorrect (19)

Correct (74)

During an 8-hour shift a client drinks two 6-oz (180-mL) cups of tea and

vomits 125 mL of fluid. Intravenous fluids absorbed equaled the urinary

output. What is the client’s fluid balance during this 8-hour period?
Record your answer using a whole number. 235 mL

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Rationale
235 mL is the correct calculation. The client’s intake was 360 mL (12 oz × 30 mL = 360
mL), and the loss was 125 mL of fluid; 360 mL – 125 mL = 235 mL.

Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be
available for you to determine your response, which you will then type into the
provided space.

Which rationale supports the need for the nurse to contact the client’s
primary health care provider when a nurse observes vaginal packing
protruding from the client’s vaginal vault after radium implants for
cervical cancer were inserted?
The radioactive packing will injure healthy tissue.
Removal of the packing will prevent excessive blood loss.

Radium exposure to the environment diminishes the effectiveness.

Removal of the packing minimizes life-threatening contact with the radiation.

Rationale
During the procedure, vaginal packing maintains the radium implant in the correct
location; correct placement minimizes the effect on healthy tissue. There should not be
active bleeding with a radium implant; there is an expectation of cellular sloughing.
Although exposure to the radioactive packing damages healthy tissue, it is not life-
threatening.

Test-Taking Tip: Look for answers that focus on the client or are directed toward
feelings.

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Which information about benign prostatic hyperplasia (BPH) is

important for the nurse to consider when caring for a client with that
condition?
It is a congenital abnormality.
A malignancy usually results.

It predisposes to hydronephrosis.

Prostate-specific antigen decreases.

Rationale
Inability to empty the bladder as a result of pressure exerted by the enlarging prostate
on the urethra causes a backup of urine into the ureters and finally the kidneys (
hydronephrosis). BPH develops over the client’s life span; it is not congenital. It is
uncommon for BPH to become malignant. Prostate-specific antigen will increase.

Which explanation for the client’s behavior would be useful to consider

in planning care for a client who has been on hemodialysis for 2 years,
communicates in an angry, critical manner, and does not adhere to the
prescribed medications and diet?
An attempt to punish the nursing staff

A constructive method of accepting reality

A defense against underlying depression and fear
An effort to maintain life and to live it as fully as possible

Rationale
Both hostility and noncompliance are forms of anger that are associated with grieving.
The client’s behavior is not a conscious attempt to hurt others but a way to relieve and
reduce anxiety within the self. The client’s behavior is a self-destructive method of
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coping, which can result in death. The client’s behavior is an effort to maintain control
over a situation that is really controlling the client; it is an unconscious method of
coping, and noncompliance may be a form of denial.

Which information in the response of a client receiving peritoneal

dialysis indicates understanding of the purpose of the procedure?
Reestablishing normal kidney function

Cleaning the peritoneal membrane

Providing fluid for intracellular spaces
Removing toxins and metabolic wastes

Rationale
Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for
diffusion of toxins and wastes from the blood into the dialyzing solution. Peritoneal
dialysis acts as a substitute for kidney function; it does not reestablish kidney function.
The dialysate does not clean the peritoneal membrane; the semipermeable membrane
allows toxins and wastes to pass into the dialysate within the abdominal cavity. Fluid in
the abdominal cavity does not enter the intracellular compartment.

Which statement explains why metabolic acidosis develops with kidney

failure?
Inability of the renal tubules to secrete hydrogen ions and conserve
bicarbonate
Depressed respiratory rate due to metabolic wastes, causing carbon dioxide
retention

Inability of the renal tubules to reabsorb water to dilute the acid contents of
blood
Impaired glomerular filtration, causing retention of sodium and metabolic
waste products

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Rationale
Bicarbonate buffering is limited, hydrogen ions accumulate, and acidosis results. The
rate of respirations increases in metabolic acidosis to compensate for a low pH. The
fluid balance does not significantly alter the pH. The retention of sodium ions is
related to fluid retention and edema rather than to acidosis.

Which answer would a nurse give to a client receiving a hemodialysis

treatment who asks which substances are being removed?
Blood
Sodium

Glucose
Bacteria

Rationale
Sodium is an electrolyte that passes through the semipermeable membrane during
hemodialysis. Red blood cells do not pass through the semipermeable membrane
during hemodialysis. Glucose does not pass through the semipermeable membrane
during hemodialysis. Bacteria do not pass through the semipermeable membrane
during hemodialysis.

Which description would the nurse provide to a client scheduled for a

cystoscopy who asks about the procedure?
"It is a computerized scan that outlines the bladder and surrounding tissue."
"It is an x-ray film of the abdomen, kidneys, ureters, and bladder after
administration of dye."

"It is the visualization of the bladder lining with an instrument connected to a

source of light."
"It is the imaging of the urinary tract through ureteral catheterization using
radiopaque material."
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Rationale
The response, "It is the visualization of the bladder lining with an instrument
connected to a source of light," answers the client’s question and provides an accurate
description of a cystoscopy. A cystoscopy is not a computerized examination. A
cystoscopy does not involve x-ray films or dye. Radiopaque material is not used in a
cystoscopy, and the catheter is inserted into the bladder via the urethra, not the
ureters.

Which statement by a client who has chronic kidney failure treated with
continuous ambulatory peritoneal dialysis (CAPD) indicates
understanding of the therapy?
"It provides continuous contact of dialyzer and blood to clear toxins by
ultrafiltration."
"It exchanges and cleanses blood by correction of electrolytes and excretion of
creatinine."

"It decreases the need for immobility because it clears toxins in short and
intermittent periods."
"It uses the peritoneum as a semipermeable membrane to clear toxins by
osmosis and diffusion."

Rationale
Diffusion moves particles from an area of greater concentration to an area of lesser
concentration; osmosis moves fluid from an area of lesser to an area of greater
concentration of particles, thereby removing waste products into the dialysate, which is
then drained from the abdomen. The principle of ultrafiltration involves a pressure
gradient, which is associated with hemodialysis, not peritoneal dialysis. Peritoneal
dialysis uses the peritoneal membrane to indirectly cleanse the blood. Dialysate does
not clear toxins in a short time; exchanges may occur four or five times a day.

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Which indicators of a developing infection would the nurse teach to the

male client who has had a ureterolithotomy?
Urgency or frequency of urination

An increase of ketones in the urine

The inability to maintain an erection

Pain radiating to the external genitalia

Rationale
Urgency or frequency of urination occur with a urinary tract infection (UTI) because of
bladder irritability; burning on urination and fever are additional signs of a UTI.
Increase of ketones is associated with diabetes mellitus, starvation, or dehydration. The
inability to maintain an erection is not related to a UTI. Pain radiating to the external
genitalia is a symptom of a urinary calculus, not infection.

Which part of the female genitalia protects inner vulval structures and
enhances sexual arousal?
Clitoris

Mons pubis
Labia majora

Bartholin glands

Rationale
The labia majora are two vertical folds of adipose tissue that protects the inner vulval
structures and enhances sexual arousal. The clitoris is a small, cylindrical organ that
becomes larger and increases sexual sensation. The mons pubis is a fat pad that covers
and protects the symphysis pubis during coitus. The Bartholin glands are located near
the vaginal opening; they secrete lubricating fluid during sexual excitement.

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Test-Taking Tip: You have at least a 25% chance of selecting the correct response in
multiple-choice items. If you are uncertain about a question, eliminate the choices that
you believe are wrong and then call on your knowledge, skills, and abilities to choose
from the remaining responses.

Which process is a function of antidiuretic hormone? Select all that

apply. One, some, or all responses may be correct.
Controlling calcium balance
Increasing arteriole constriction

Increasing tubular permeability to water

Stimulating the bone marrow to make red blood cells

Promoting sodium reabsorption in the distal convoluted tubule (DCT)

Rationale
Antidiuretic hormone (ADH), also known as vasopressin, is a hormone released from
the posterior pituitary gland. ADH increases arteriole constriction and tubular
permeability to water. Calcium balance is controlled by blood levels of calcitonin and
the parathyroid hormone (PTH). Erythropoietin stimulates the bone marrow to make
red blood cells. Aldosterone promotes the reabsorption of sodium in the DCT.

Which information would the nurse include when teaching

postoperative care to a client with a large calculus in the calyces of the
right kidney who has surgery scheduled for removal of the stone?
The calculi are too large for transurethral removal.

During the surgery, removal of the right ureter occurs.

After surgery, a suprapubic catheter will be in place.

After surgery, there will be a small incision in the right flank area.

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Rationale
The client will have a small incision in the right flank area after surgery. If the calculus
was in the renal pelvis, the client could have a percutaneous pyelolithotomy
performed. Transurethral removal of a large ureteral calculus involves using a
ureteroscopic ultrasonic lithotripsy. Removal of the calculus may occur without
damage to the ureter. Placement of a suprapubic catheter usually is unnecessary
unless there is damage to the ureter during the procedure.

Which number would a nurse document as the client’s fluid balance

after an 8-hour shift where a client has a 6-oz (180-mL) cup of tea and
360 mL of water, vomits 100 mL, and the instilled intravenous (IV) fluids
equaled the urinary output?
240 mL
-340 mL

440 mL

540 mL

Rationale
440 mL is the correct calculation. The client’s intake was 180 mL of tea and 360 mL of
water for a total fluid intake of 540 mL; the client vomited 100 mL, which when
subtracted from 540 mL equals 440 mL. The IV fluid intake and the urinary output are
equal; therefore they do not influence the final fluid balance. The options 240 mL, -340
mL, and 540 mL are incorrect calculations.

Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be
available for you to determine your response, which you will then type in the provided
space.

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Which considerations would the nurse integrate into the postoperative

plan of care of a client scheduled for an internal arteriovenous fistula in
one arm and placement of an external arteriovenous shunt in the other
arm for hemodialysis?
The graft has a higher risk of hemorrhage, clotting, and infection than the
fistula does.
Staff will obtain blood pressure readings from the arm with the fistula, but not
the one with the shunt.

Administer intravenous (IV) fluids in the arm with the shunt, but not the one
with the fistula.

Cover the fistula with a light dressing, and cover the shunt thoroughly with a
heavy dressing.

Rationale
The external shunt may come apart with possible hemorrhage; clotting is a potential
hazard. Frequent handling increases risk of infection. The nurse should not obtain
blood pressure readings in the extremity with the shunt or the fistula because of the
pressure exerted on the circulatory system during the procedure. The nurse should not
use an IV in the extremity with the shunt or the fistula to avoid pressure from the
tourniquet and to lessen the chance of developing phlebitis. The nurse should leave
the ends of the shunt cannula exposed for rapid reconnection to the dialysis
equipment in the event of disruption.

Which term would the nurse use to document a client experiencing

urinary incontinence via involuntary loss of small amounts (25–35 mL)
of urine from an overdistended bladder?
Urge incontinence

Stress incontinence
Overflow incontinence

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Functional incontinence

Rationale
Overflow incontinence describes what is happening with this client; overflow
incontinence occurs when the pressure in the bladder overcomes sphincter control.
Urge incontinence describes a strong need to void that leads to involuntary urination
regardless of the amount in the bladder. Stress incontinence occurs when the client
expels a small amount of urine because of an increased intra-abdominal pressure that
occurs with coughing, lifting, or sneezing. Functional incontinence occurs from other
issues rather than the bladder, such as cognitive (dementia) or environmental (no
toileting facilities).

Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your
anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume
review of the question.

Which information would the nurse include in response to a client’s

questioning a protein-restricted dietary change required for acute
kidney injury?
"A high-protein intake ensures an adequate daily supply of amino acids to
compensate for losses."

"Essential and nonessential amino acids are necessary in the diet to supply
materials for tissue protein synthesis."

"This diet supplies only essential amino acids, reducing the amount of
metabolic waste products, thus decreasing stress on the kidneys."

"Currently, your body is unable to synthesize amino acids, so the nitrogen for
amino acid synthesis must come from the dietary protein."

Rationale

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The amount of protein permitted in the diet depends on the extent of kidney function;
excess protein causes an increase in urea concentration, excess metabolic waste, and
added stress on the kidneys. The restricted protein diet prevents overburdening the
client’s kidneys at this time. When experiencing acute kidney injury, the kidneys are
unable to eliminate the waste products of a high-protein diet. The body is able to
synthesize the nonessential amino acids. Urea is a waste product of protein
metabolism; the body is able to synthesize the nonessential amino acids.

Test-Taking Tip: Make educated guesses when necessary.

Which statement would the nurse use to respond to an older adult

client who states, "I walk 2 miles [3.2 km] a day for exercise, but now
that the weather is hot, I am worried about becoming dehydrated"?
"Drink fruit juices if you start to feel dehydrated."

"Thirst is a good guide to use to determine fluid intake."

"Fluids should be increased if the urine becomes darker."
"Water should be consumed when the skin becomes dry."

Rationale
In hot weather, dark-colored urine indicates dehydration. When urine is dark, there is a
decreased amount of fluid excreted and the body is attempting to conserve fluid. Avoid
fruit juices during rehydration because of their high sugar content. By the time people
become thirsty, they already are dehydrated, especially older adults. Dry skin in older
adults typically relates to aging rather than to dehydration and is not a good indicator
of dehydration in older adults.

Test-Taking Tip: Look for answers that focus on the client or directed toward the
client’s feelings.

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Which response would the nurse use as a reply to a client diagnosed

with sexual dysfunction who states, "Well, I guess my sex life is over"?
"I’m sorry to hear that."
"Oh, you have a lot of good years left."
"You are concerned about your sex life?"

"Have you asked your primary health care provider about that?"

Rationale
The response "You are concerned about your sex life?" explores the meaning of the
statement and allows further expression of concern. The response "I’m sorry to hear
that" does not allow an explanation of feelings and cuts off communication. The
response "Oh, you have a lot of good years left" lacks both empathy and
understanding; it also cuts off communication. The response "Have you asked your
primary health care provider about that?" shirks responsibility; the client may be
embarrassed to ask the primary health care provider and needs the nurse to act as
facilitator.

Which statement would the nurse use in response to the needs of a

client with renal colic who frequently uses the call light and has many
demands the night before scheduled extracorporeal shock-wave
lithotripsy?
"I know how you feel; I had this same procedure last year."
"We’ll take good care of you, so you have nothing to worry about."
"You are facing a new experience tomorrow; tell me what concerns you have."

"Your behavior tells me that you are scared of what you are facing tomorrow."

Rationale
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The response "You are facing a new experience tomorrow" acknowledges the client’s
situation and allows the client to discuss feelings and fears related to the surgery. The
response "I know how you feel" is inaccurate; each client’s experience is unique. The
response "We’ll take good care of you" minimizes the client’s feelings and provides
false reassurance. The phrase "Your behavior tells me" may not be an accurate
interpretation of the client’s behavior.

Which statement would the nurse use to instruct the female client about
obtaining a urine specimen?
'Start urinating in the cup and then finish urinating in the toilet.'

'If you can’t fill the cup, then leave it on the toilet and use it again when you
next void.'

'With the enclosed towelettes, wipe your labia from front to back before
collecting the specimen.'

'When you finish, leave the cup on the back of the toilet and the aide will get it
when making rounds.'

Rationale
The client must use the packaged towelettes and wipe the labia from front to back
before urinating. The client needs to void a small amount of urine in the toilet first and
then hold the cup under the perineal area and finish urinating in the cup. If the client
cannot void enough for a specimen, the nurse would discard the insufficient sample
and obtain another specimen when the client is able to void a sufficient amount. The
client should notify the nurse immediately after the specimen collection so sending
the specimen to the laboratory for analysis occurs in a timely manner.

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Which order would the nurse identify as a priority nursing action after
reviewing the prescriptions for the newly admitted emergency
department client with urolithiasis?

Strain the client’s urine.

Place the client in the high-Fowler position.
Administer the prescribed morphine.

Collect a urine specimen for culture and sensitivity.

Rationale

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Pain relief is the priority. Client’s report that ureteral colic is excruciatingly painful.
Once pain is under control and the client is comfortable, the nurse may implement the
other medical and nursing interventions. Although straining all urine is required, pain
relief is the priority. Once the client receives the medication for pain control, the nurse
will be able to strain the set-aside urine specimen. The high-Fowler position is not
necessary. The client can be assisted to assume a position of comfort. The emergency
department will have sent the urine to the laboratory for a culture and sensitivity.

Which observation supports the nurse’s suspicion that a client may have
myoglobinuria?
Red-colored urine
Brown-colored urine
Dark, amber-colored urine

Very pale, yellow-colored urine

Rationale
Red-colored urine in clients with kidney dysfunction indicates the presence of
myoglobin. Brown-colored urine indicates increased bilirubin levels. Dark, amber-
urine indicates concentrated urine. Very pale, yellow urine indicates dilute urine.

Test-Taking Tip: You have at least a 25% chance of selecting the correct response in
multiple-choice items. If you are uncertain about a question, eliminate the choices that
you believe are wrong and then call on your knowledge, skills, and abilities to choose
from the remaining responses.

Which action would the nurse implement in a male client who reports
an inability to void after undergoing a cystoscopy and biopsy of the
prostate gland due to dysuria, nocturia, and difficulty starting a urinary
stream?
Insert a urinary retention catheter.

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Palpate above the pubic symphysis.

Limit oral fluids until the client voids.

Assure the client that this is expected.

Rationale
A full bladder is palpable with urinary retention and distention, which are common
problems after a cystoscopy because of urethral edema. After determining if the
bladder is palpable, the nurse would implement conservative nursing methods, such
as running water or placing a warm cloth over the perineum, to precipitate voiding;
catheterization carries a risk of infection and used as the last resort. Fluids dilute the
urine, reduce the chance of infection after cystoscopy, and should not be limited.
Although urinary retention can occur, it is not expected; the nurse must assess the
extent of bladder distention and discomfort first.

Which function would the nurse include when teaching a group of

student nurses about the loop of Henle?
Secretion of ammonia in the descending limb
Secretion of hydrogen in the descending limb

Reabsorption of sodium in the ascending limb

Reabsorption of water in the ascending limb

Rationale
The reabsorption of sodium takes place in the ascending limb of the loop of Henle to
maintain normal blood serum levels of sodium in the body. Ammonia is secreted from
the distal tubule. The secretion of hydrogen occurs in the proximal and distal tubules
of the nephron. Reabsorption of water is carried out in the descending limb of the
loop of Henle.

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Which hormone elevation indicates Turner syndrome? Select all that

apply. One, some, or all responses may be correct.
Lutropin
Prolactin
Follitropin

Testosterone
Progesterone

Rationale
Elevation of lutropin and follitropin indicates Turner syndrome. Elevation of prolactin
indicates possible galactorrhea, pituitary tumor, disease of hypothalamus or pituitary
gland, and hypothyroidism. Elevated testosterone levels in women indicate adrenal
neoplasm, ovarian neoplasm, and polycystic ovary syndrome. Elevated progesterone
levels in men indicate possible testicular tumors and hyperthyroidism. Elevated
progesterone levels in women indicate possible ovarian luteal cysts.

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Which part of the figure is engorged in a female during the excitation

phase of sexual intercourse?

B
C
D

Rationale
Label B indicates the clitoris, which is engorged with blood during the excitation phase
of sexual intercourse. Label A indicates the mons pubis, which is a fatty layer covering
the pubic bone. Label C represents the Skene gland, which lubricates the urinary
meatus. Label D represents the hymen, which surrounds the vaginal introitus.

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Which blood test will be prescribed for a client who fears pregnancy
despite the use of oral contraceptives?
Prolactin test

Testosterone test
Progesterone test
Human chorionic gonadotropin (hCG) test

Rationale
A human chorionic gonadotropin (hCG) test is used to detect pregnancy; therefore the
primary health care provider orders an hCG test for the client. A prolactin test is used
to detect amenorrhea. A testosterone test is used to determine ovarian dysfunction. A
progesterone test is used to determine the occurrence of ovulation.

Which diagnostic test will a nurse anticipate being prescribed to a

female client suspected by the primary health care provider of having
pituitary gland dysfunction?
Estradiol test
Prolactin test
Postcoital test (PCT)

Papanicolaou (Pap) test

Rationale
A prolactin test is used to detect pituitary gland dysfunction that causes amenorrhea.
The primary health care provider would suggest that the client have a prolactin test to
determine if the client does or does not have any pituitary gland dysfunction. Estradiol
is tested to determine functioning of the ovaries. In men the estradiol test is used to
detect testicular tumors. The Postcoital test (PCT) is used to evaluate the hostility of the
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cervix for passage of sperm from the vagina into the uterus. The Pap test detects
malignancies, particularly cervical cancer.

Which instruction would the nurse provide a client prescribed oral

extended-release ciprofloxacin therapy for a urinary tract infection?
Chew the medication along with food.
Take a walk in morning sunlight.

Stop the drug after symptoms subside.

Refrain from taking the tablet immediately after an antacid.

Rationale
Ciprofloxacin is an antibiotic used in treating urinary tract infections. The nurse would
instruct the client to refrain from consuming ciprofloxacin within 2 hours of taking an
antacid. Most antacids contain aluminum or magnesium, which interfere with the
absorption of ciprofloxacin. The client should be instructed to swallow the tablet and
not chew it because chewing it negates the extended-release action of the drug.
Clients on ciprofloxacin therapy should avoid sunlight because the medication
increases sensitivity to sun and could result in sunburn. The prescribed medication
regimen should be followed even if symptoms subside. Premature cessation of
medication can lead to recurrence of infection or bacterial resistance.

Which intervention would the nurse implement for a client with a

ureteral calculus? Select all that apply. One, some, or all responses may
be correct.
Limiting fluid intake at night
Monitoring intake and output

Straining the urine at each voiding

Recording the client’s blood pressure
Administering the prescribed analgesic
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Rationale
A urinary calculus may obstruct urine flow, which will be reflected in a decreased
output; obstruction may result in hydronephrosis. Urine is strained to determine
whether any calculi or calcium gravel is passed. Reduction of pain is a priority. A
calculus obstructing a ureter causes flank pain that extends toward the abdomen,
scrotum and testes, or vulva; the pain begins suddenly and is severe (renal colic). Fluids
should be encouraged to promote dilute urine and facilitate passage of the calculi.
Recording the blood pressure is not critical.

Which test result would confirm the diagnosis of benign prostatic

hyperplasia (BPH)?
Digital rectal examination

Serum phosphatase level

Biopsy of prostatic tissue
Massage of prostatic fluid

Rationale
A definitive diagnosis of the cellular changes associated with BPH is made by biopsy,
with subsequent microscopic evaluation. Palpation of the prostate gland through rectal
examination is not a definitive diagnosis; this only reveals size and configuration of the
prostate. The serum phosphatase level will provide information for prostatic cancer; a
definitive diagnosis cannot be made with this test for BPH. A sample of prostatic fluid
helps diagnosis prostatitis.

Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able
to get a good night’s sleep the night before your exam. Cramming is not smart, and it
is hard work that increases stress while reducing learning. When you cram, your mind
is more likely to go blank during a test. When you cram, the information is in your
short-term memory, so you will need to relearn it before a comprehensive exam.

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Relearning takes more time. The stress caused by cramming may interfere with your
sleep. Your brain needs sleep to function at its best.

Which preventive wellness recommendation will the nurse make to a

male client who tests positive for the BRCA mutation after his mother
and two sisters are found to carry the gene? Select all that apply. One,
some, or all responses may be correct.
Get a baseline mammogram at 40 years.

Get prostate screenings starting at the age of 50.

Get breast self-examination (BSE) training at 35 years.

Get a clinical breast examination (CBE) every 6 months starting at 35 years.

Get a clinical breast examination every 6 months beginning at 40 years.

Rationale
A male client who tests positive for the BRCA mutation should get a baseline
mammogram at 40 years, be provided with BSE training at 35 years, and get a CBE
every 6 months starting at age 35. Prostate screening should be initiated at 40 years,
not 50.

Which medication strengthens the urinary sphincters?

Midodrine
Duloxetine

Oxybutynin

Mirabegron

Rationale

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Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that strengthens

urinary sphincters and has anticholinergic action. Midodrine is an alpha-adrenergic
agonist, which increases the contractile force of the urethral sphincter. Oxybutynin is
an antispasmodic that causes bladder muscle relaxation. Mirabegron is a beta-3
blocker that relaxes the detrusor smooth muscle, which increases bladder capacity and
urinary storage.

Which condition would the nurse suspect if the client reports passing
urine involuntarily while coughing?
Enuresis

Pneumaturia
Urinary retention

Stress incontinence

Rationale
Involuntary urination upon increased pressure is called stress incontinence. The
pressure on the urinary bladder increases while sneezing and coughing. Involuntary
urination at night is called enuresis. Urination with the presence of gas in it is called
pneumaturia. Urinary retention is the inability to urinate despite a full bladder.

Which natural physiological process helps prevent bacterial infections

within the client’s bladder?
The secretions of the urothelium
The relaxation of the detrusor muscle

The contraction of the external sphincter

The muscle tone of the internal sphincter

Rationale
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The urothelium is the innermost epithelial lining of the bladder. The cells of the
urothelium naturally produce antibacterial secretions that prevent bacterial growth
within the bladder where urine is stored. The combined effect of relaxation of the
detrusor muscle, contraction of external sphincter, and muscle tone of the internal
sphincter help maintain continence.

Arrange the steps for the collection of a urine sample from a client with
an indwelling catheter in correct order.

1. Clamp drainage tubing.

2. Attach a sterile syringe.

3. Aspirate the urine.

4. Remove the clamp.

Rationale
In a client with an indwelling catheter, urine sample is collected by first applying a
clamp, distal to the injection port, on to the drainage tubing. Then the injection port
cap of the catheter drainage tubing is cleaned with alcohol. The next step is to attach a
5-mL sterile syringe into the port and aspirate the urine sample required. Finally, the
clamp is removed so that the drainage is resumed.

Test-Taking Tip: In this question type, you are asked to prioritize (put in order) the
options presented. For example, you might be asked the steps of performing an action
or skill such as those involved in medication administration.

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Arrange in order the steps involved when the nurse is assisting the
primary health care provider during renal ultrasonography.

1. Place client in prone position.

2. Apply gel over skin.

3. Move transducer across skin.

4. Wipe gel with cotton pad.

Rationale
The client undergoing renal ultrasonography should first be placed in the prone
position. Then the sonographic gel should be applied on the client’s skin over the back
and flank regions. Then the transducer is moved across the client’s skin to measure the
echoes. The images are visualized on the display screen. At the end of the procedure
the gel is removed from the client’s skin by wiping the gel off.

Which statement would the nurse include when teaching about

pneumaturia to a coworker?
"It is passage of urine containing gas."

"It is stinging pain in the urethral area."

"It is the diminished amount of urine in a given time."

"It is involuntary urination with increased pressure."

Rationale
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Pneumaturia is characterized by the passage of urine containing gas that occurs with
fistula connections between the bowel and bladder. Burning sensation on urination
constitutes the stinging pain in the urethral area. Oliguria is the presence of a
diminished amount of urine during a given time. Stress incontinence is involuntary
urination with increased abdominal pressure, such as during sneezing or coughing.

Which component of the client’s nephron delivers blood from the

glomerulus into the peritubular capillaries or the vasa recta?
Arcuate artery

Efferent arteriole
Afferent arteriole

Interlobular artery

Rationale
The efferent arteriole is the vascular component of the nephron that delivers arterial
blood from the glomerulus into the peritubular capillaries or the vasa recta. The
arcuate artery is a curved artery of the renal system that surrounds the renal pyramids.
The afferent arteriole is the vascular component of the nephron that delivers arterial
blood from the branches of the renal artery into the glomerulus. The interlobular
artery feeds the lobes of the kidney.

Which action would the nurse take when a client who has been told she
needs a hysterectomy for cervical cancer reports being upset about
being unable to have a third child?
Evaluate her willingness to pursue adoption.

Encourage her to focus on her own recovery.

Emphasize that she does have two children already.

Ensure that other treatment options for her are explored.

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Rationale
Although a hysterectomy may be performed, conservative management may include
cervical conization and laser treatment that do not preclude future pregnancies; clients
have a right to be informed by their primary health care provider of all treatment
options. Willingness to pursue adoption currently is not the issue for this client.
Encouraging her to focus on her own recovery and emphasizing that she does have
two children already negate the client’s feelings.

During a 12-hour shift, a client has a 6-oz (180-mL) cup of tea and 360
mL of water. The client vomits 100 mL, and the instilled intravenous (IV)
fluids equaled the urinary output. Which fluid balance would the nurse
record for the 12-hour period?
240 mL

340 mL
440 mL

540 mL

Rationale
The correct calculation is 440 mL. The client’s intake was 180 mL of tea and 360 mL of
water for a total fluid intake of 540 mL; the client vomited 100 mL, which, when
subtracted from 540 mL, leaves 440 mL. The IV fluid intake and the urinary output are
equal; therefore they do not influence the final fluid balance. The options 240 mL, 340
mL, and 540 mL are incorrect calculations.

Which action would the nurse take when caring for a client transferred
to the postanesthesia care unit after a pyelolithotomy whose urinary
output is 50 mL/h?
Record the output as an expected finding.

Encourage the client to drink oral fluids.

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Milk the client’s nephrostomy tube.

Notify the primary health care provider.

Rationale
An output of 50 mL/h is adequate; when urine output drops below 20 to 30 mL/h, it
may indicate renal failure, and the primary health care provider should be notified.
Encouraging the client to drink oral fluids is contraindicated; the client probably still
will be under the influence of anesthesia, and the gag reflex may be depressed.
Milking the client’s nephrostomy tube is unnecessary because the output is adequate.

Which nursing intervention would be included in the plan of care of a

client with liver cancer and ascites who is scheduled for a paracentesis?
Cleansing the intestinal tract in preparation
Marking the anesthetic insertion site

Discussing the operating room setup

Having the client void before the procedure

Rationale
Because the trocar is inserted below the umbilicus, having the client void decreases the
danger of puncturing the bladder. Cleansing the intestinal tract is not necessary
because the gastrointestinal tract is not involved in a paracentesis. The primary health
care provider, not the nurse, uses a local anesthetic to block pain during the insertion
of the aspirating needle; marking the site usually is not done. A paracentesis usually is
performed in a treatment room or at the client’s bedside, not in the operating room.

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Which action would the nurse expect to take before initiating antibiotic
therapy prescribed by the primary health care provider of a client in a
nursing home who is diagnosed with urethritis?
Start a 24-hour urine collection.

Prepare for urinary catheterization.

Teach the client how to perform perineal care.

Obtain a specimen for culture and sensitivity.

Rationale
The causative organism should be isolated before starting antibiotic therapy; a culture
and sensitivity should be obtained before starting the antibiotic. A 24-hour urine test
will not determine the infective organism causing the problem. Catheterization is not a
routine intervention for urethritis. Although client teaching is important, it is not the
priority at this time.

STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best
getting up early and studying during daylight hours. Owls, night people, are more
alert after dark and can remain up late at night studying, catching up on needed sleep
during daylight hours. It is better to work with natural biorhythms than to try to
conform to an arbitrary schedule. You will absorb material more quickly and retain it
better if you use your most alert periods of each day for study. Of course, it is
necessary to work around class and clinical schedules. Owls should attempt to register
in afternoon or evening lectures and clinical sections; larks do better with morning
lectures and day clinical sections.

Which intervention would the nurse undertake before a scheduled

intravenous pyelogram (IVP) for a client with a renal disorder? Select all
that apply. One, some, or all responses may be correct.
Ensure that the consent form has been signed.

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Assess the client for iodine sensitivity.

Have the client remove all metal objects.

Administer an enema or cathartic to the client.

Instruct the client to lie still during the procedure.

Rationale
The presence, position, shape, and size of kidneys, ureters, and bladder can be
evaluated using an IVP. An IVP does need a consent form because the procedure is
invasive. The contrast medium used in the procedure may cause hypersensitivity
reactions. The nurse should assess the client for sensitivity to iodine before the
procedure. The nurse should use a cathartic or enema to empty the colon of feces and
gas. The nurse has the client remove all metal objects before performing a magnetic
resonance imaging (MRI) procedure. The nurse instructs the client to lie still during a
computed tomographic (CT) scan procedure; during an IVP, the client may be asked to
turn certain ways.

Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable
under ordinary circumstances and that the action can be carried out in the given
situation.

Which response would the nurse give to a menstruating female client

who asks how to avoid toxic shock syndrome with tampon use?
"Change the tampon every 8 hours."

"Force the tampon up as far as it will go."

"Wash your hands before inserting the tampon."

"Use the strongest absorbency tampon that you need."

Rationale

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Washing the hands before inserting the tampon is an intervention to reduce

introducing organisms to the vagina and causing toxic shock syndrome. Tampons
should be changed every 3 to 6 hours. Tampons should be inserted gently and with
care, and not forced into the vagina in order to avoid damaging the tissue. Super
absorbent tampons should be avoided.

Which assessment finding would be reported to the health care provider

immediately by a nurse providing postoperative care 8 hours after a
client had a total cystectomy and the formation of an ileal conduit?
Edematous stoma

Dusky-colored stoma
Absence of bowel sounds

Pink-tinged urinary drainage

Rationale
A dusky-colored stoma may denote a compromised blood supply to the stoma and
impending necrosis. An edematous stoma and absence of bowel sounds are expected
in the early postoperative period after this surgery. Pink-tinged urine may be present in
the immediate postoperative period.

Which information would the nurse provide about what the client can
expect after surgery for a transurethral resection of the prostate?
'Urinary control may be permanently lost to some degree.'
'An indwelling urinary catheter is required for at least a day.'

'Your ability to perform sexually will be impaired permanently.'

'Burning on urination will last while the cystostomy tube is in place.'

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Rationale
An indwelling urethral catheter is used, because surgical trauma can cause edema and
urinary retention, leading to additional complications, such as bleeding. Urinary
control is not lost in most cases; loss of control usually is temporary if it does occur.
Sexual ability usually is not affected; sexual ability is maintained if the client was able to
perform before surgery. A cystostomy tube is not used if a client has a transurethral
resection; however, it is used if a suprapubic resection is done.

Which information would the nurse share when teaching a client

receiving peritoneal dialysis about the reason dialysis solution is warmed
before it is instilled?
It forces potassium back into the cells, thereby decreasing serum levels.
It adds extra warmth to the body because metabolic processes are disturbed.

It helps prevent cardiac dysrhythmias by speeding up removal of excess

potassium.
It encourages removal of urea by preventing constriction of peritoneal blood
vessels.

Rationale
A warm temperature encourages the removal of serum urea by preventing constriction
of peritoneal blood vessels so that urea, a large-molecular substance, is shifted from
the body into the dialyzing solution. Heat does not affect the shift of potassium into
the cells. The removal of metabolic wastes is affected in kidney failure, not the
metabolic processes. Heating dialysis solution does not affect cardiac dysrhythmias.

Which statement made by a client supports the previous diagnosis of

late-stage (tertiary) syphilis?
'I noticed a wart on my penis.'

'I have sores all over my mouth.'

'I’ve been having a sore throat lately.'
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'I’m having trouble with my balance.'

Rationale
Neurotoxicity, as manifested by ataxia (balance problems), is evidence of tertiary
syphilis, which may involve the central nervous system or cardiovascular system. A wart
on the penis occurs in the secondary stage of syphilis. Sores all over the mouth occur
in the first and secondary stage of syphilis. Sore throat with flulike symptoms occurs in
the secondary stage of syphilis.

Which instruction would the nurse give to a client on peritoneal dialysis

when the nurse observes that drainage of the dialysate from the
peritoneal cavity has ceased before the required volume has returned?
Drink a glass of water.

Turn from side to side.

Deep breathe and cough.

Rotate the catheter periodically.

Rationale
Turning from side to side will change the position of the catheter, thereby freeing the
drainage holes of the tubing, which may be obstructed. Drinking a glass of water and
deep breathing and coughing do not influence drainage of dialysate from the
peritoneal cavity. The position of the catheter should be changed only by the primary
health care provider.

Which action would the nurse take for a client with invasive bladder
carcinoma who is receiving radiation to the lower abdomen?
Observe the feces for the presence of blood.

Monitor the blood pressure for hypertension.

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Administer enemas to remove sloughing tissue.

Provide a high-bulk diet to prevent constipation.

Rationale
Radiation may damage the bowel mucosa, causing bleeding. Blood pressure changes
are not expected during radiation therapy. Enemas are contraindicated with lower
abdominal radiation because of the damaged intestinal mucosa. Diarrhea, not
constipation, occurs with radiation that influences the intestine.

Which action would the nurse take when a client’s scrotum is

edematous and painful twenty-four hours after a penile implant?
Assist the client with a sitz bath.

Apply warm soaks to the scrotum.

Elevate the scrotum using a soft support.

Prepare for an incision and drainage procedure.

Rationale
Elevating the scrotum using a soft support increases lymphatic drainage, reducing
edema and pain. Assisting the client with a sitz bath and applying warm soaks to the
scrotum increase circulation to the area, intensifying edema and pain in this client.
Preparing for an incision and drainage procedure is not indicated; scrotal swelling is
caused by the trauma of surgery, not infection.

Which complication is the most serious for a client with kidney failure?
Anemia

Weight loss
Uremic frost

Hyperkalemia
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Rationale
Decreased glomerular filtration leads to hyperkalemia, which may cause lethal
dysrhythmias such as cardiac arrest. Anemia may occur but is not the most serious
complication and should be treated in relation to the client’s clinical manifestation;
erythropoietin and iron supplements usually are used. Weight loss alone is not life
threatening. Uremic frost, a layer of urea crystals on the skin, causes itching, but it is
not the most serious complication.

Which action would the nurse take before a client’s scheduled

hemodialysis treatment?
Obtain the client’s urine specimen to evaluate kidney function.
Weigh the client to establish a baseline for later comparison.

Administer medications that are scheduled to be given within the next hour.

Explain that the peritoneum serves as a semipermeable membrane to remove

wastes.

Rationale
A baseline weight must be obtained to be able to determine the net fluid loss from
dialysis. Obtaining a urine specimen to evaluate kidney function is not necessary;
clients with advanced kidney disease may not produce urine. Medications often are
delayed until after dialysis to prevent them from being filtered into the dialysate.
Explaining that the peritoneum serves as a semipermeable membrane to remove
wastes applies to peritoneal dialysis, not hemodialysis.

Which response would the nurse provide to a client who asks about
what to expect postoperatively before a transurethral resection of the
prostate (TURP)?
"Your urine will be pink and free of clots."
"You will have an abdominal incision and a dressing."
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"There will be an incision between your scrotum and rectum."

"There will be a urinary catheter and a continuous bladder irrigation."

Rationale
The presence of an indwelling urinary catheter and a continuous bladder irrigation are
routine postoperative expectations after a TURP; they provide for hemostasis and
urinary excretion. After a TURP, the client initially can expect hematuria and some
blood clots; the continuous bladder irrigation keeps the bladder free of clots and the
catheter patent. An abdominal incision and dressing are present with a suprapubic, not
transurethral, prostatectomy. An incision between the scrotum and rectum is
associated with a perineal prostatectomy, not a TURP.

Which technique would the nurse use to obtain a culture specimen of

discharge from the penis?
Instruct the client to provide a semen specimen.

Swab the discharge from the prepuce.

Instruct the client to obtain a clean-catch specimen of urine.

Swab the drainage directly from the urethra.

Rationale
Swabbing the drainage directly from the urethra obtains a specimen uncontaminated
by environmental organisms. Instructing the client to provide a semen specimen is not
as accurate as obtaining the purulent discharge from the site of origin. Swabbing the
discharge when it appears on the prepuce will contaminate the specimen with
organisms external to the body. Teaching the client how to obtain a clean-catch
specimen of urine will dilute and possibly contaminate the specimen.

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Which finding would the nurse assess for in a client who reports to a
health clinic because a sexual partner recently was diagnosed as having
gonorrhea and whose health history reveals that the client has engaged
in receptive anal intercourse?
Melena

Anal itching
Constipation

Ribbon-shaped stools

Rationale
Anal itching and irritation can occur from having anal intercourse with a person
infected with gonorrhea. Frank rectal bleeding, not upper gastrointestinal bleeding
(melena), occurs. Painful defecation, not constipation, occurs. The shape of formed
stool does not change; however, defection can be painful.

Which assessment finding in a hospitalized client with a history of

chronic kidney disease would alert the nurse to suspect kidney
insufficiency?
Facial flushing
Edema and pruritus

Dribbling after voiding

Diminished force of urination

Rationale
The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema
results from fluid overload caused by impaired urine production. Pallor, not flushing,
occurs with chronic kidney disease as a result of anemia. Dribbling after voiding is a
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urinary pattern that is not caused by chronic kidney disease; this may occur with
prostate problems. Diminished force and caliber of stream occur with an enlarged
prostate, not kidney disease.

Which factor would a nurse suspect as the likely cause in a client with
cancer of the prostate who requests the urinal frequently but either does
not void or voids in very small amounts?
Edema

Dysuria

Retention
Suppression

Rationale
An enlarged prostate constricts the urethra, interfering with urine flow and causing
retention. When the bladder fills and approaches capacity, small amounts can be
voided, but the bladder never empties completely. Edema does not cause the client to
void frequently in small amounts. Dysuria is painful or difficult urination, which is not
part of the client’s responses. The urge to void is caused by stimulation of the stretch
receptors as the bladder fills with urine; in suppression, little or no urine is produced.

Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of
an examination. Relaxation techniques such as deep breathing, imagery, head rolling,
shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with
feet flat on the floor can effectively reduce tension while causing little or no distraction
to those around you. It is recommended that you practice one or two of these
techniques intermittently to avoid becoming tense. The more anxious and tense you
become, the longer it will take you to relax.

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Which action would the nurse include in the plan of care for a client
after pelvic surgery?
Encouraging the client to ambulate in the hallway

Elevating the client’s legs by raising the bed’s knee support

Providing passive range of motion to the client’s legs

Maintaining the client on bed rest until the bandages are removed

Rationale
Muscle contraction during ambulation improves venous return, preventing venous
stasis and thrombus formation. Elevating the client’s legs by raising the bed’s knee
support places pressure on popliteal spaces, limiting venous return and increasing the
risk for thrombus formation. Passive range of motion will not prevent venous stasis,
active movement by the client is needed. Bed rest is associated with venous stasis,
which increases the risk for thrombus formation.

Which assessment finding is associated with rejection of a kidney

transplant? Select all that apply. One, some, or all responses may be
correct.
Fever

Oliguria

Jaundice
Polydipsia

Weight gain

Rationale
Fever is a characteristic of the systemic inflammatory response to the antigen
(transplanted kidney). Oliguria or anuria occurs when the transplanted kidney is
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rejected and fails to function. Weight gain can occur from fluid retention when the
transplanted kidney fails to function or as a result of steroid therapy; this response
must be assessed further. Jaundice is unrelated to rejection. Polydipsia is associated
with diabetes mellitus; it is not a clinical manifestation of rejection.

Which condition would the nurse suspect in a client with mumps who
reports pain, inflammation, and swelling of the testes?
Orchitis
Salpingitis

Ductal ectasia

Fibroadenoma

Rationale
Orchitis is characterized by painful inflammation and swelling of the testes. Clients
with mumps are at an increased risk of orchitis, which can lead to testicular atrophy
and sterility. Salpingitis is a uterine tube infection caused by chlamydia that can result
in female infertility. Ductal ectasia is a hard, irregular mass with nipple discharge,
enlarged axillary nodes, redness, and edema that is difficult to distinguish from cancer.
Fibroadenoma is the most common benign lesion of connective tissue that is
unattached to the surrounding breast tissue.

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Which organ will a nurse anticipate being affected when assessing a

client with mumps and orchitis?

B
C

Rationale
Mumps is a viral infection that may cause orchitis in males. Painful inflammation and
swelling of the testes (the organ indicated by choice D) indicates orchitis. Choice A

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indicates the seminal vesicles. Choice B indicates the prostate gland. Choice C
indicates the epididymis.

Which response would the nurse give to a client with an acute kidney
injury who has peritoneal dialysis (PD) prescribed and asks why the
procedure is necessary?
"PD prevents the development of serious heart problems by removing the
damaged tissues."
"PD helps perform some of the work usually performed by your kidneys."

"PD stabilizes the kidney damage and may ‘restart’ your kidneys to perform
better than before."
"PD speeds recovery because the kidneys are not responding to regulating
hormones."

Rationale
PD removes chemicals, wastes, and fluids usually removed from the body by the
kidneys. The mention of heart problems is a threatening response and may cause
increased fear or anxiety. Telling the patient that PD may ‘restart’ your kidneys so that
they perform better than before is misleading. PD helps maintain fluid and
electrolytes; in acute kidney injury, damage occurs in the nephrons, so the PD may or
may not speed recovery.

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A postmenopausal client with cancer of the breast decides to have a

lumpectomy followed by chemotherapy. After receiving chemotherapy
for several weeks, she is not feeling well. The nurse reviews the medical
record data presented in the image. After analysis of the available
history, laboratory tests, and clinical manifestations, which goal has the
highest priority for this client?

Promote rest

Prevent infection
Avoid bodily harm

Maintain fluid balance

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Rationale
The prevention of infection is the priority because an infection can be life-threatening
for an immunocompromised client. Chemotherapeutic medications depress the bone
marrow, causing leukopenia. This client’s white blood cell count is below the expected
range of 4500 to 11,000/mm 3 (4.5 to 11 × 10 9/L) for an older female adult. Although
the elevation in the client’s temperature, pulse, and respirations may relate to the
direct effects of the chemotherapeutic agents, they also may reflect the client resisting
a microbiologic stress. Although a balance between rest and activity is important, it is
not the priority. Even though preventing injury is important, it is not the priority.
Although maintaining fluid balance is important, it is not the priority. The client’s
hematocrit is within the expected range of 38% to 41% for an older female adult,
indicating that the client is not dehydrated. A decreased blood pressure indicates
dehydration or fluid volume deficit; however, the client’s blood pressure is within
acceptable limits. Although chemotherapeutic medications may cause nausea,
vomiting, and diarrhea, the client did not indicate these clinical manifestations
occurred.

Which response would the nurse give to a client with cancer of the
bladder and pending surgical intervention who asks, "If they remove my
bladder, how will I be able to urinate?"
"You can still function normally without a bladder."
"I am sure this is very upsetting to you, but it will be over soon."

"I know you’re upset, but there are alternatives to removing your bladder."
"The tests will help determine whether your bladder has to be removed."

Rationale
The response, "I know you’re upset, but there are alternatives to removing your
bladder" offers the best combination of factual information and emotional support.
The response, "You can still function normally without a bladder" disregards the client’s
feelings; the information is inaccurate because removal of the bladder will not leave a

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normally functioning urinary system. Although the response, "I am sure this is very
upsetting to you, but it will be over soon" identifies the client’s feelings, further
communication is cut off by the second part of the response. The response, "The tests
will help determine whether your bladder has to be removed" is factual, but does not
answer the question or offer emotional support; the response may increase the client’s
anxiety.

Which finding indicates that a client’s kidney transplant is successful?

Increased specific gravity
Correction of hypotension
Elevated serum potassium

Decreasing serum creatinine

Rationale
As the transplanted organ functions, nitrogenous wastes are eliminated, lowering the
serum creatinine. As more urine is produced by the transplanted kidney, the specific
gravity and concentration of the urine will decrease. With end-stage renal disease, fluid
retention causes hypertension; there should be a correction of hypertension, not
hypotension. After the transplant, the serum potassium should correct to within
expected limits for an adult.

Which statement would be made by the nurse when performing

presurgical teaching for a client pending a transurethral resection of the
prostate (TURP)?
"Urinary control may be permanently lost to some degree."

"An indwelling urinary catheter is required for at least 1 day."

"Your ability to perform sexually will be impaired permanently."
"Burning on urination will last while the cystostomy tube is in place."

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Rationale
The primary health care provider will insert a three-way indwelling urethral catheter
because surgical trauma can cause edema and urinary retention, leading to additional
complications such as bleeding. Urinary control is not lost in most cases; loss of
control usually is temporary if it does occur. Sexually ability usually is not affected; the
client maintains sexual ability if the client was able to perform sexually before surgery.
The procedure does not use a cystostomy tube if a client has a transurethral resection;
however, the provider does use a cystostomy tube for a suprapubic resection.

Which abnormal finding would the nurse monitor for during the
oliguric phase of acute kidney injury?
Hypothermia

Hyperkalemia
Hypocalcemia
Hypernatremia

Rationale
The kidneys retain potassium during the oliguric phase of acute kidney injury; an
elevated potassium level is one of the main indicators for placing a client on
hemodialysis when he or she is experiencing acute kidney injury. Hypothermia does
not occur with acute kidney injury. Serum levels of calcium decrease during the
oliguric phase of kidney failure. The retained fluids create a hemodilution effect and
hyponatremia occurs, not hypernatremia.

Which instruction would the nurse include regarding an ileal conduit

when providing a client’s discharge teaching?
"Maintain fluid intake of at least 2 L daily."
"Abstain from beer and other alcohol consumption."
"Avoid getting soap and water on the peristomal skin."

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"Notify the primary health care provider if the stoma size decreases."

Rationale
High fluid intake flushes the ileal conduit and prevents infection and obstruction
caused by mucus or uric acid crystals. Clients with an ileal conduit do not have an
alcohol restriction. Use of soap and water on the peristomal area helps prevent
irritation from waste products. Notifying the primary health care provider if the stoma
size decreases is not necessary because this is an expected response; as edema
decreases, the stoma will become smaller.

STUDY TIP: Try to decrease your workload and maximize your time by handling items
only once. Most of us spend a lot of time picking up things we put down rather than
putting them away when we have them in hand. Going straight to the closet with your
coat when you come in instead of throwing it on a chair saves you the time of hanging
it up later. Discarding junk mail immediately and filing the rest of your bills and mail
as they come in rather than creating an ever-growing stack saves time when you need
to find something quickly. Filing all items requiring further attention in some fashion
helps you remember to take care of things on time rather than being so engrossed in
your schoolwork that you forget about them. Many nursing students have had their
power or telephone service cut off because the bill simply was forgotten or buried in a
pile of old mail.

Which discharge instruction would the nurse teach a client who receives
a radium implant for uterine cervical cancer?
'Limit your daily fluid intake.'
'Return for follow-up care.'
'Change to a high-residue diet.'

'Double the daily mineral supplements.'

Rationale
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Before discharge, the nurse would instruct the client of the importance of returning
for follow-up care at specified intervals. The client does not need to reduce fluids
unless cardiac or renal pathology is present. With a uterine cervical radium implant,
the client should be placed on a low-residue diet to prevent pressure from a distended
colon. When the radium implant is removed, the client may return to a regular diet. If
the low-residue diet were inadequate, the client would include mineral supplements.

STUDY TIP: Record the information you find to be most difficult to remember on 3' ×
5' cards and carry them with you in your pocket or purse. When you are waiting in
traffic or for an appointment, just pull out the cards and review again. This 'found' time
might add points to your test scores that you have lost in the past.

Which rationale supports the nurse’s instruction that a client with

chronic kidney disease is to avoid all salt substitutes?
A person’s body tends to retain fluid when a salt substitute is included in the
diet.
Limiting salt substitutes in the diet prevents a buildup of waste products in
the blood.
Salt substitutes contain potassium, which must be limited to prevent
abnormal heartbeats.

The salt substitute substances interfere with capillary membrane transfer,

resulting in anasarca.

Rationale
Salt substitutes usually contain potassium, which can lead to hyperkalemia;
dysrhythmias are associated with hyperkalemia. Chronic kidney disease already places
the client at a higher risk for hyperkalemia because of poor elimination of fluids and
electrolytes. Sodium, not salt substitutes, in the diet causes retention of fluid. Salt
substitutes do not contain substances that influence blood urea nitrogen and
creatinine levels; these are the result of protein metabolism. There is not a substance
in the salt substitute that interferes with capillary membrane transfer. Anasarca is
extensive fluid in the tissues throughout the body and more extensive than typical
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edema.

STUDY TIP: When forming a study group, carefully select members for your group.
Choose students who have abilities and motivation similar to your own. Look for
students who have a different learning style than you. Exchange names, email
addresses, and phone numbers. Plan a schedule for when and how often you will
meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss
content for clarity or quiz one another on the material. You could also create your own
practice tests or make flash cards that review key vocabulary terms.

1 topics covered

Renal, Urinary, and Reproductive … Intermediate

RN Content Area / Medical-Surgical Nursing

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